Analysis Of The Incidence Of Delayed Hearing Loss In 15448 Preschool Children's Hearing Screening

Research Background:Hearing screening is one of the main contents of newborn screening.A complete hearing screening program for newborns includes: 1 primary screening,rescreening 2 diagnosis,intervention 3 rehabilitation,follow-up,and the project has been widely developed in China.In most areas,the coverage rate has reached or exceeded 90%,which greatly promotes the “early detection,early diagnosis and early intervention” of hearing impairment.However,we also have to see that children may experience hearing loss at various stages of growth and development.According to data released by the Centers for Disease Control and Prevention(CDC)in 2011,the incidence of hearing loss in children is much higher than that of newborns,reaching 14.9%.Therefore,hearing screening should not only be carried out in the neonatal period,but also in all ages of child growth and development.Preschool(3-6 years old)is an important period for children's language learning and cognitive development.Hearing loss occurs at this stage,which will seriously affect children's language development,learning ability and social and psychological development.Delayed hearing loss is defined as permanent hearing loss after hearing screening in newborns.Among them,light,moderate hearing loss,especially the unilateral morbidity is not easy to be found by parents.Hearing screening for school-age children can make early diagnosis and early intervention in this part of the child.Therefore,it is necessary to conduct hearing screening for preschool children,mainly children with “hearing normal” in kindergartens.Children's hearing screening and newborn hearing screening complement each other.Especially,it plays anirreplaceable role in children's hearing loss1.Research objective:This study conducted a statistical and retrospective analysis of the results of hearing screening of 15448 preschool children aged 3-6 years in Nanjing(April 2017-June 2017,a total of 66 kindergardens),and summarized the clinical features of their delayed hearing loss,and emphasized the feasibility,effectiveness,and necessity of hearing screening for preschool children.2.Research methods:(1)Screening was performed using an otoacoustic emitter(Natus BiologicAUDX580).Screened DPOAE(first occurrence of non-standard English writing)was most commonly used in newborn hearing screening.It was particularlysuitable for large-sample population screening because of its objectivity,sensitivity,rapid,non-invasive and easy-to-operate characteristics.The checkwas performed with an otoacoustic transmitter and test in a quiet room with anoise floor of ? 45 d B(A).The standard: the 10 th percentile(P10)ofhalf-frequency rms in four frequency bands(0.5 k Hz,1 k Hz,2 k Hz,4 k Hz)wasthe standard value,and the half-frequency root mean square of the subject's 3 ormore bands must be higher than the standard value.The screening results wereautomatically analyzed by the instrument.If “Pass” was displayed,the hearingscreening was passed.If the ears had not passed or the single ear has not passed,rescreening within one month;(2)Rescreening was still screened by ear acoustic emission meter.The screeningmethod was the same as that of the primary screening.If the rescreening stillfailed,it would be referred to Nanjing Maternal and Child Health Hospital.;(3)After the child was referred to the Department of Otorhinolaryngology,NanjingMaternal and Child Health Hospital,a comprehensive otological examinationand audiological assessment were performed,including otoscopy,acoustic impedance,auditory brainstem response,imaging examination,etc.Then the final diagnosis was made and intervention and follow-up were followed.3.Research results 3.1 Preschool children were screened twice for hearing loss detection rateOf the 15448 screening subjects,1704(11.03%,1704/15448)children did not pass the primary screening,1202(7.78%,1202/15448)failed screening failed,and were referred to our hospital.Among the 1202 cases,560 people failed to pass,and 642 single ears did not pass(left ear 318,right ear 324),a total of 1762 ears were calculated.See Figure 1-2 for details.3.2 Diagnostic results of children who have failed to pass the screening:In 1762 ears,after further audiological examination and diagnosis,55 ears were diagnosed as normal hearing,1612 ears were temporary hearing loss.The reasons include secretory otitis media / eustachian tube function abnormality(44.9%),ceruminal impaction(41.5%),tympanitis(3.5%)and otitis externa(1.6%),accounting for 96.1%.Another 95 ears were delayed hearing loss,the reasons include the cause is unknown(4.6%),large vestibular aqueduct syndrome(0.5%),inner ear malformation(0.2%),and ototoxic drug use(0.1%),accounting for a total of 5.4%.3.3 Positive rate and false positive rate of preschool children screeningIn this study,30896 ears(15448 cases)were used as the screening object,and 1762 ears failed the secondary screening,and the positive rate of screening was 5.7%(1762/30896).After audiometric examination,55 ears were diagnosed as normal hearing,1,612 as temporary hearing loss,and 95 as delayed hearing loss.The false positive rate for screening was 0.2%(55/30896).3.4 Distribution of causes of delayed hearing lossIn this study,95 ears with delayed hearing loss were found,including 81 ears with unknown causes,9 ears with LVAS,3 ears with Mondini malformation of cochlea and 2 ears with ototoxic drugs.3.5 High resolution CT scanning results of inner earThe results of plain CT scanning of the inner ear showed that all 9 ears met the CT diagnostic criteria of LVAS,and all of them were simple,enlarged VA of different degrees,with diverse shapes.Among the 9 cases,3were bilateral and 3 was unilateral.3.6 Results of play audionelry in 9 LVASThree cases of bilateral LVAS with average hearing threshold are moderate hearing loss(30-60 d B HL).The prevalence of hearing loss and ear disease in preschool children is high,and the large-scale development of hearing screening work is of great practical significance.Through screening,early childhood ear problems and hearing loss can be detected early and intervened early to effectively promote the development of language and learning for preschool children.It is feasible to conduct pre-school children's hearing screening in kindergartens,but it still needs a lot of relevant research to accumulate the experience of hearing screening.Preschool children undergo audiological examination according to the ratio of detection rate from high to low: secretory otitis media / eustachian tube function abnormality(44.9%),ceruminal impaction(41.5%),tympanitis(3.5%)and otitis externa(1.6%),mainly concentrated in external auditory canal disorders(ceruminal impaction,external auditory canal,etc.)and tympanic negative pressure.The prevalence of late hearing loss in preschool children was from high to low: unknown cause(4.6%),large vestibular aqueduct syndrome(0.5%),inner ear malformation(0.2%)and ototoxic drugs(0.1%).4.Conclusions:In this study,a total of 95 ears of delayed hearing loss were found in 15 448 preschool children(30896 ears).The subjects of this study have excluded children with congenital hearing impairment.The incidence rate can still reach 0.3%.The causes are unknown,large vestibular aqueduct syndrome,Mondini malformation of cochlea,use of toxic drugs?So regular hearing screening for children is necessary after universal newborn hearing screening.