[Correlation between risk factors of hearing lose and results of initial hearing screening in 1021 neonates].

OBJECTIVE: To explore the risk factors of the newborns who failed initial hearing screening by analysing the distortion production otoacoustic emission (DPOAE) results of 1021 newborns with potential risk factors of hearing loss. METHOD: All newborns, who were born in obstetrical department and admitted in the neonatal department of the Nanfang Hospital during June 2009 to January 2012 and underwent initial hearing screening, were included in this study. Their clinical data and DPOAE results were analyzed retrospectively in order to identify the risk factors for failure of initial hearing screening in infants; cases who failed the DPOAE test were followed up by telephone interviews. RESULT: (1) One hundred and thirty-seven cases (13.42%) of the 1021 newborns did not pass the hearing screening. 51 cases (5.00%) did not pass the test in both ears. Meanwhile, left ear in 47 cases (4.60%) and right ear in another 39 cases (3.82%) failed the test respectively. (2) Univariate analysis showed that 14 factors had significant influence on the hearing screening results, such as birth weight, small for gestational age, multiple pregnancy, gestational age, delivery mode, oligohydramnion, oxytocin, blood sugar level of newborn, Apgar scores at 1 min, exposed prenatally to glucocorticoid, maxillofacial deformity, hypoxic-ischemic encephalopathy, neonatal respiratory distress syndrome and neonatal asphyxia (P < 0.01). (3) Multivariate Logistic regression analysis suggested that birthweight less than 1500 g, multiple pregnancy, Apgar scores of 0-4 at 1 min, exposed prenatally to glucocorticoid and maxillofacial deformity were risk factors for failure of initial hearing screening (OR were 3.132, 1.808, 2.615, 1.827 and 12.174 respectively; 95% CI were 1.466-6.691, 1.120-2.917, 1.317-5.336, 1.130-2.953 and 1.986-74.632 respectively). (4) Results of telephone interviews revealed that Apgar scores of 0-4 at 1 min would be a risk factor of language development. CONCLUSION: Birthweight less than 1500 g, multiple pregnancy, Apgar scores of 0-4 at 1 min, exposed prenatally to glucocorticoid and maxillofacial deformity are risk factors of failure of initial hearing screening among newborns with potential hearing loss. Monitoring of the hearing condition of the infants at risk should be strengthened.

[Effects of hyperbilirubinemia on distortion product otoacoustic emission, auditory brainstem response and mismatch negativity in guinea pigs].

OBJECTIVE: To explore the characteristics of distortion product otoacoustic emission (DPOAE), auditory brainstem response (ABR) and mismatch negativity (MMN) in guinea pigs with hyperbilirubinemia and assess the impact of hyperbilirubinemia on their hearing functions. METHOD: Normal neonatal guinea pigs were randomly divided into normal control, low- and high-dose bilirubin groups. DPOAE, ABR and MMN were tested and compared between the 3 groups of guinea pigs. RESULTS: The DPOAE was comparable between the 3 groups (P>0.05). The guinea pigs with peritoneal injection of low-dose bilirubin exhibited significantly prolonged wave III and V latencies and I-III interwave intervals during the ABR test in comparison with the control group (P<0.05). All the ABR parameters were significantly different between the high-dose bilirubin group and the control group (P<0.05). The detection rates of MMN were significantly different between the 3 groups (Chi(2)=7.438, P=0.024), and the average MMN latency was significantly shorter in the control group than in the high-dose group (P<0.05), but the amplitudes of MMN remained similar between the 3 groups (P>0.05). CONCLUSIONS: Hyperbilirubinemia results impairment primarily of retrocochlear auditory pathway with relative mild damage of the cochlear. Apart from sensorineural auditory impairment, hyperbilirubinemia may also cause central auditory processing abnormalities.

Successful auricle replantation via microvascular anastomosis 10 h after complete avulsion.

OBJECTIVE: To report a case of successful total auricle replantation 10 h after complete amputation. MATERIAL AND METHODS: Replantation was achieved by means of microvascular anastomosis and other therapies, and assisted by careful nursing. The patient's auricle was completely cut off with a sharp blade by an assailant, who retained it for 5 h. Having been retrieved, it was then preserved in ice for 5 h. Using microscopy, an artery and vein were found at the confluences of the upper and middle and lower and middle parts of the amputated auricle and head wound, respectively An end-to-end anastomosis was performed on these vessels. After operation, the following treatments were used: drainage; reopening of the drainage channels with a needle: flushing or soaking with heparin sodium solution; controlling infection and coagulation; increasing blood volume: dilating vessels; and special nursing. RESULTS: The replanted auricle survived with a normal contour and a very favorable esthetic appearance. CONCLUSIONS: The neat, uncontaminated wound margins and the fact that the amputated auricle was preserved in ice, even though it had been amputated 10 h before the operation, were prerequisites for successful auricle replantation. The microvascular anastomosis technique played a very important role in the survival of the amputated auricle. The postoperative treatment, observation and nursing were difficult but vital aspects of the procedure. The establishment of an effective venous return was a sign of the survival of the amputated auricle.