臺灣博碩士論文加值系統

本研究之目的於比較聽力損失成人無線聽性腦幹反應與行為閾值之一致性。使用click以及500與2000 Hz tone bursts為刺激音，測得感音神經性聽力損失成人無線聽性腦幹反應及其純音閾值之差異。
參與研究之個案共有35位，年齡範圍是23至85歲，雙耳純音聽閾於500, 1000, 2000及4000 Hz為30 dB HL至85 dB HL之間聽損程度，中耳鼓室圖為Type A。
本研究結果顯示，以click誘發無線聽性腦幹反應與純音頻率2000與4000 Hz，以及1000, 2000與4000 Hz之平均行為閾值差異值皆在± 5 dB之內，相關係數分別為0.93與0.76。500與2000 Hz tone bursts無線聽性腦幹反應與純音頻率500與2000 Hz平均閾值之差異100 %在10 dB之內，相關係數分別為0.74與0.90。
整體而言，本研究顯示以click為刺激音時，測得之無線聽性腦幹反應及純音頻率1000, 2000與4000 Hz平均行為閾值之間具有良好一致性。以500與2000 Hz tone bursts為刺激音時，測得之無線聽性腦幹反應及其行為閾值之間具有良好一致性。以tone bursts為刺激音，測得之聽性腦幹反應能可靠預估聽力損失成人之純音聽閾。

The purpose of this study is to compare wireless auditory brainstem responses and behavioral thresholds in adults with hearing loss. The auditory brainstem responses (ABR) of sensorineural hearing loss adults were obtained with click as well as 500 and 2000 Hz tone bursts stimuli. The ABR thresholds for each stimulus were determined and then were compared with pure tone average thresholds, respectively.
Thirty-five participants aged from 23 to 85 years old exhibited bilateral pure tone thresholds ranged between 30 to 85 dB HL at 500, 1000, 2000 and 4000 Hz, as well as type A tympanograms.
The results indicated that the mean differences between wireless auditory brainstem responses and pure tone average thresholds of 2000, 4000 Hz and 1000, 2000, 4000 Hz were less than 15 dB, correlation coefficients were 0.93 and 0.76, respectively, when using the stimuli was click. The differences between tone bursts evoked wireless ABR and pure tone thresholds of 500 and 2000 Hz were less than 10 dB, and the correlation coefficients were 0.74 and 0.90, respectively.
In summary, the present study suggests that by using wireless ABR, comparable results were found between ABR with click stimuli and pure tone average of 1000, 2000 and 4000 Hz. A reasonable estimate to the pure tone thresholds in adults with hearing loss is feasible by using wireless ABR with tone bursts stimuli.

中文摘要………………………………………………………………………………Ⅰ
英文摘要………………………………………………………………………………Ⅲ
目錄……………………………………………………………………………………V
表目次…………………………………………………………………………………V
附錄目次………………………………………………………………………………V
第一章 前言………………………………………………………………………… 1
第二章 文獻探討…………………………………………………………………… 2
第一節 聽性腦幹反應………………………………………………………… 2
第二節 頻率特定性聽性腦幹反應…………………………………………… 5
第三節 行為閾值與聽性腦幹反應…………………………………………… 8
第四節 無線聽性腦幹反應……………………………………………………12
第三章 研究方法……………………………………………………………………13
第一節 研究目的………………………………………………………………13
第二節 研究對象………………………………………………………………14
第三節 研究工具………………………………………………………………15
第四節 儀器校準………………………………………………………………16
第五節 研究步驟………………………………………………………………17
第六節 統計與分析方法………………………………………………………19
第四章 研究結果……………………………………………………………………20
第五章 討論…………………………………………………………………………26
第六章 結論…………………………………………………………………………29
參考文獻………………………………………………………………………………30

表目次
表1-1 無線聽性腦幹反應之記錄參數…………………………………………….18
表2-1 純音頻率500與2000 Hz之平均行為閾值與標準差…………………….20
表2-2 純音頻率2000與4000 Hz，以及1000, 2000與4000 Hz之平均行為
閾值與標準差…….…………………….…………………….……………..21
表2-3 click誘發無線聽性腦幹反應之平均閾值與標準差……………………….21
表2-4 click誘發之無線聽性腦幹反應與純音頻率2000與4000 Hz，以及
1000, 2000與4000 Hz之平均行為閾值之差異…………………………..22
表2-5 click以及500與2000 Hz tone bursts無線聽性腦幹反應之平均閾值與
標準差……………………………………………………………………….23
表2-6 tone bursts 500與2000 Hz之無線聽性腦幹反應閾值與其行為閾值之
平均差異………………………………………………………………….....24

附錄目次
附錄A 無線聽性腦幹反應之相關技術…………………………………………….33
附錄B 無線聽性腦幹反應輸出音強(dB pSPL)之參考值(0 dB nHL)…………….35
附錄C 個案(001)無線聽性腦幹反應記錄之波形…………………………………36
附錄D 個案(018)無線聽性腦幹反應記錄之波形…………………………………39

林慧珍(2009)。正常聽覺者聽性腦幹反應及無線聽性腦幹反應閾值與純音聽力閾值的比較。未出版之碩士論文，國立臺北護理學院聽語障礙科學研究所。臺北。

邱秀婷(2010)。正常聽力嬰幼兒無線聽性腦幹反應閾值與行為聽力閾值之比較。未出版之碩士論文，國立臺北護理學院聽語障礙科學研究所。臺北。

Bellman, S., Bernard, S., & Beagley, H. A. (1984). A nine year review of 841 children tested by transtympanic electrocochleography. The Journal of Laryngology and Otology, 98, 1-9.

Coats, A. C., & Martin, J. L. (1977). Human Auditory nerve action potentials and brainstem evoked response: effect of audiogram shape and lesion location. Archives of Otolaryngology, 103, 605-622.

Galambos, R., & Hecox, K. E. (1978). Clinical application of the auditory brain stem response. Otolaryngologic Clinics of North America, 11, 709-722.

Galambos, R., Hicks, G. E., & Wilson, M. J. (1984). The auditory brain stem response reliably predicts gearing loss in graduates of the tertiary intensive care nursery, Ear and Hearing, 5, 254-260.

Gravel, J. S. (1992). Audiologic assessment of infants and toddlers. American Speech Language Hearing Association Monographs-Report , 21, 55-62.

Gorga, M. P., Worthington, D. W., Reiland, J. K., Beauchaine, K. A., & Goldgar, D. E. (1985). Some comparisons between auditory brainstem response thresholds, latencies, and the pure-tone audiogram. Ear and Hearing, 6, 105-112.

Gorga, M. P., Kaminski, J. R., Beauchaine, K. L., & Bergman, B. M. (1993). A comparison of auditory brain stem response thresholds and latencies elicited by
air- and bone-conducted stimuli. Ear and Hearing, 14, 85-94.

Hall, J. M. III. (2006). New handbook of auditory evoked responses. Boston: Allyn and Bacon.

Jerger, J., & Mauldin, L. (1978). Prediction of sensorineural hearing loss from the brain stem evoked response. Archives of Otolaryngology, 104, 456-461.

Joint Committee on Infant Hearing. (2000). Position Statement. Journal of the American Academy of Audiology, 9, 9-29.

Katz, J. (2009). Handbook of clinical audiology (6th ed.). Baltimore: Lippincott Williams & Wilkins.

Kileny, P. R., & Magathan, M. G. (1987). Predictive value of ABR in infants and children with moderate to profound hearing impairment. Ear and Hearing, 8,
217-221.

Picton, T. W., Ouellette, J., Hamel, G., & Smith, A, D. (1979). Brainstem evoked potentials to tone pip in notched noise. The Journal of Otolaryngology, 8, 289-314.

Purdy, S. C., & Abbas, P. J. (2002). ABR thresholds to tone bursts gated with Blackman and linear windows in Adults with high-frequency sensorineural hearing loss. Ear and Hearing, 23, 385-368.

Sokolov, Y., Kurtz, I., Sokolov, O., Steinman, A., Tedesco, P., Broome, R. (2007). Freedom from sedation: a new Technology for ABRs. The Hearing Review, 4,
60-64.

Stapells, D. R., Gravel, J. S., & Martin, B. A. (1995). Thresholds for auditory brain stem responses to tones in notched noise from infants and young children with normal
hearing or sensorineural hearing loss. Ear and Hearing, 16(4), 361-371.

Stapells, D. R., Picton, T. W., Durieux-Smith, A., Edwards, C. G., & Moran, L. M. (1990). Thresholds for short-latency auditory-evoked potential to tones in notched noise in normal-hearing and hearing impaired subjects. Audiology,
29(5), 262-274.

Stapells, D. R. (2000). Thresholds estimation by the tone-evoked auditory brainstem response: a literature meta-analysis. Journal of Speech-Language Pathology and Audiology, 24, 74-83.


van der Drift, J. F. C., Brocaar, M. P., & van Zanten, G. A. (1987). The relation between the pure-tone audiogram and the click auditory brainstem response threshold in cochlear hearing loss. Audiology, 26, 1-10.

Yoshinaga-Itano, C., Sedey, A. L.,Coulter, D. K., & Mehl, A. L. (1998). Language of early-and later-identified children with hearing loss. Pediatrics, 102, 1161-1171.