學齡前兒童之聽力篩檢

Preschool Hearing Screening

兒童的聽障不易被發現，並且會影響到兒童語音及各方面的學習與發展。聽力篩檢為偵測兒童聽障的有效方法。過去的研究顯示扭曲產物耳聲傳射檢查（DPOAE）及鼓室圖為簡單、快速、可信度高且具經濟效益的篩檢工具。本研究即使用此二種檢查針對幼稚園中班兒童做中耳及內耳功能之篩檢。其目的為發現中耳疾病所引起之傳音性聽障以及較輕微，而被忽略的感音性聽障。與過去不同的是，本研究以家長或學校老師帶幼童至醫院就檢的模式，以期改善過去測試環境不佳，機器易故障以及篩檢人員訓練不足等缺點。本研究共篩檢幼童3462人（6924耳），共有男童1849名，女童1613名，初檢結果台北縣異常者佔22%，嘉義縣14.5%，共佔19.5%，其中鼓室圖不正常者為9.9%，鼓室圖正常而耳聲傳射不正常者佔6.4%。鼓室圖不正常之683耳中358耳複檢，複檢結果正常的有37%，故照此推算中耳炎之盛行率約在6.3%左右。DPOAE不正常之學童中有194耳做純音聽檢，以純音聽力之結果對照計算，DPOAE之敏感度為81.5%，特異度為58.6%。由結果可知，中耳疾患及輕度感音性聽障的確常為父母或老師所忽略。應及早以DPOAE及鼓室圖將這些幼童偵測出來以期及早治療或復健。所以幼童聽力篩檢應加以推廣，本研究所採之模式為大規模全面篩檢所可採行之模式。

Normal auditory function is essential for language development in children. Failure to identify hearing loss early may result in retardation of language achievement and subsequent communication handicap. Hearing screening is an effective way to detect hearing loss in children. Previous research has shown that tympanogram and distortion production otoacoustic emissions(DPOAE)are the best tools to screen middle and inner ear function in children. In this project, these two tests were employed to screen 3462 preschool children. The purpose was to detect hearing loss caused by middle ear or inner ear diseases, so that intervention could begin without delay. In all, 3462 preschool children (1849 boys and 1613 girls) participated in this project. Primary screening revealed that 1350 (19.5%) of the ears were abnormal, while 683 (9.9%) had abnormal tympanograms. Abnormal DPOAE was found in 396 (6.4%) of the tested cars. Among the 683 ears that showed abnormal tympanograms, 358 ears were re-evaluated later. Thirty-seven percent of originally abnormal ears became normal. Therefore, the prevalence of middle ear disease among preschool children was estimated to be around 6.3%. Of the 396 ears with abnormal DPOAE, 194 received pure tone audiometry for control. The sensitivity and the specificity of DPOAE calculated were 81.5% and 58.6%, tespectively on the basis of the data from these control subjects.