臺灣博碩士論文加值系統

本研究目的旨在了解國內聽損兒童的聽損察覺、聽損確診、配戴助聽器與語言創/復健介入等年齡，並從中探討不同聽損程度、聽損高危險群、母親教育程度及全面性新生兒聽力篩檢推廣等對聽損兒的此等「聽損有關年齡」及「聽損有關年齡之間隔」之影響。
本研究對象為曾在雅文兒童聽語文教基金會台北或高雄中心接受聽力檢查與上課之聽損兒童，出生年份分布自1981至2003年共359名，研究資料取自雅文兒童聽語文教基金會之聽力病歷資料表、學生報名表與聽力檢查報告。
研究結果摘要如下：
一、聽損兒不分聽損程度，聽損有關年齡之平均如下：聽損察覺20.75個月；聽損確診26.22個月；配戴助聽器30.89個月；語言創/復健介入37.00個月。
二、各種聽損有關年齡和聽損程度的關係：平均聽損察覺年齡最早為極重度聽損者的14.40個月、最晚為輕度聽損者的34.33個月；平均聽損確診年齡最早為極重度聽損者的18.81個月、最晚為中重度聽損者的36.76個月；配戴助聽器的平均年齡最早為極重度聽損者的24.43個月、最晚為中度聽損者的41.29個月；語言創/復健介入的平均年齡最早為極重度聽損者的33.56個月、最晚為中度聽損者的44.18個月。而聽損確診年齡中，極重度聽損者與中度、中重度、重度，重度聽損者與中重度有顯著差異(p< .05)；配戴助聽器年齡中，極重度聽損者與中度、中重度聽損者，重度聽損者與中重度聽損者有顯著差異(p< .05)，其餘無顯著差異 (p> .05)。
三、一般聽損與聽損高危險群個案之「聽損有關年齡」及「聽損有關年齡之間隔」比較，結果顯示均無統計上之顯著差異(p> .05)。
四、母親教育程度和聽損兒之聽損有關年齡的關係：雖然母親教育程度高中以上的聽損兒在聽損確診、配戴助聽器、與語言創/復健介入年齡等均比高中以下的聽損兒早，且其散佈情形皆較集中，相關性皆較高；但兩組間無顯著差異(p> .05)。確診～創介與配助～創介的時間，在高中以上組皆較短，且兩組間有顯著差異(p< .05)，即母親(主要照顧者)教育程度高中以下者在其聽損兒聽損確診後，至配戴助聽器與語言創/復健介入階段所花費的時間較長且較不一致，因此教育程度較低者在確診～創介期間極可能會花費更多時間來進行。
五、以1998年國內開始推動全面性新生兒聽力篩檢為界，1998年前出生之聽損兒其聽損確診年齡與配戴助聽器年齡為高度正相關(係數 .867)，其餘為中度正相關；1998年後出生之聽損兒其全部聽損有關年齡間皆呈高度正相關。 1998年前、後出生之聽損兒其「聽損有關年齡及其間隔」皆有顯著差異(p< .05)。1998年後接受篩檢之聽損兒，其聽損有關年齡皆與未接受篩檢者有顯著差異(p< .05)，但年齡間隔無顯著差異(p> .05)。

結論：聽損程度愈重者其聽損察覺年齡與聽損確診年齡愈早。非新生兒聽力篩檢之聽損兒不論是一般聽損中之不同聽損程度或是聽損高危險群者，其聽損確診至語言創/復健介入年齡間隔略同並無太大差異，且其聽損確診至語言創/復健介入年齡間隔平均為10個多月，距離美國JCIH(2000) 3個月大前聽損確診、 6個月大前接受早期療育計畫的目標尚有一大差距；因此欲達早期診斷早期療育的目標，提早聽損察覺年齡是一可能性，而全面性新生兒聽力篩檢即是達到此目標的有利工具，1998年後接受聽力篩檢的聽損兒之「聽損有關年齡」皆較非聽力篩檢的聽損兒早，且兩組間有顯著差異，證明推行全面性新生兒聽力篩檢確實有助於聽損的早期診斷；但「聽損有關年齡之間隔」在篩檢組與非篩檢組間並無顯著差異，篩檢組的間隔甚至反而較非篩檢組長，則顯示目前在早期療育或語言創/復健介入的成效仍不佳，有待聽語專業、公衛專業以及媒體等方面的加強合作。此外，本研究結果亦顯示母親(主要照顧者) 教育程度較低者在確診～創介期間花費更多時間來進行，故建議應將「加強教育程度較低家長的衛教」列為推廣早期診斷早期療育之重點，以期能縮短確診～創介間隔。

The purpose of this study is to survey the ages of suspicion of hearing loss, identification of hearing loss, hearing aid fitting, and intervention of habilitation/rehabilitation in hearing impaired children in Taiwan. We also investigate the influence of severity of hearing loss, high risk factors of hearing loss, education levels of mother (main care-giver) and newborn hearing screening on various ages related with hearing loss and their intervals.
The subjects are those who once undertook the hearing tests and habilitation/rehabilitation in Ya-Wen Children’s Hearing Foundation, either in Taipei or Kaohsiung. The subjects were born from 1981 to 2003 and the total numbers of studied subjects are 359. The analysis data were obtained from records of history of hearing loss and demographics, and reports of hearing tests of all subjects from Ya-Wen Children’s Hearing Foundation.
Summary of Results:
1. Despite of severity of hearing loss, the average age of suspicion is 20.75 months, the average age of identification is 26.22 months, the average age of hearing aid fitting is 30.89 months and the age of intervention of habilitation/rehabilitation is 37.00 months.
2. Association between the severity of hearing loss and various ages related with hearing loss: The earliest average age of suspicion is 14.40 months in children with profound hearing loss and the latest one is 34.33 months in those with mild hearing loss. The earliest average age of identification is 18.81 months in children with profound hearing loss and the latest one is 36.76 months in those with moderate-severe hearing loss. The earliest average age of hearing aid fitting is 24.43 months in children with profound hearing loss and the latest one is 41.29 months in those with moderate hearing loss. The earliest age of intervention of rehabilitation/ rehabilitation is 33.56 months in children with profound hearing loss and the latest one is 44.18 months in those with moderate hearing loss. Furthermore, there is significant difference in the average age of identification between profound hearing loss group and groups of moderate, moderate-severe and severe hearing loss (p< .05), and between severe hearing loss group and moderate-severe hearing loss group (p< .05). Significant difference in the average age of hearing aid fitting is also shown between profound hearing loss group and groups of moderate and moderate-severe hearing loss (p< .05), and between severe hearing loss group and moderate-severe hearing loss group (p< .05).
3. There is no significant difference in various ages related with hearing loss and their intervals between groups with and without high risk hearing loss (p> .05).
4. Association of education levels of mother and ages related with hearing loss of hearing impaired children: In higher education level group (above high school), the average ages of identification, hearing aids fitting and intervention of habilitation/rehabilitation are earlier, distribution tendency is more concentrated and highly related than in the lower one (below high school). However, there is no significant difference in these average ages between two groups (p> .05). In addition, the age interval between identification and intervention of habilitation/rehabilitation, as well as that between hearing aids fitting and intervention of habilitation/rehabilitation, is significantly shorter in higher education level group. Intervals between identification, hearing aids fitting and intervention of habilitation/ rehabilitation are longer and more inconsistent in lower education level group. In other words, mothers of lower education level very likely need more time to process intervention of habilitation/rehabilitation after identification of hearing loss.
5. In Taiwan, the newborn hearing screening started in 1998. For children born before 1998, the ages of identification and hearing aids fitting are highly related (Pearson Correlation Coefficient .867) and the rest combinations are moderately related (Pearson Correlation Coefficient .552 and .438). For children born after 1998, all ages related with hearing loss are highly related. Significant differences in all ages related with hearing loss, as well as their intervals, are shown between those born before and after 1998 (p< .05). For children born after 1998, significant differences in all ages related with hearing loss are shown between those with and without hearing screening (p< .05), but not in their intervals (p> .05).

Conclusions: The severer the hearing loss is, the earlier the ages of suspicion and identification of hearing loss are. For children without newborn hearing screening, the average interval between ages of identification and intervention of habilitation/rehabilitation is about 10 months, no matter who are with or without the high-risk hearing loss, and no matter how the hearing loss severity is in those without the high-risk. It is still a big gap from JCIH(2000) target, identification of hearing loss at 3 months old and intervention of habilitation/ rehabilitation before 6 months old. Therefore early suspicion of hearing loss is a way to match the target of early identification and early intervention, and newborn hearing screening would be a good tool for it. The ages related with hearing loss are all significantly earlier in children with hearing screening born after 1998 than those without hearing screening, indicating that newborn hearing screening can benefit early identification of hearing loss. However, no significant differences in the intervals of various ages related with hearing loss are shown between children with and without hearing screening. The intervals are even longer in children with hearing screening than those without hearing screening, indicating the effect of early intervention is not good enough at present. It needs more professional effort and cooperation including speech and hearing specialty, public health and public media to achieve the aim of early intervention. Furthermore, this research result also shows that interval between identification and intervention of habilitation/rehabilitation is longer for mothers (main care-givers) of lower education level. Therefore, more effort on public education for parents of lower education level is recommended to be the important part of early diagnostic and early intervention plan to shorten the interval between identification and intervention of habilitation/rehabilitation.

目錄 (頁數)


誌謝 I
中文摘要 III
英文摘要 VI
目錄 XI
表目次 XIV
圖目次 XV

第一章 緒論
第一節 前言 1
第二節 研究目的 3

第二章 文獻探討
第一節 聽力發展與聽損之相關文獻探討 4
第二節 早療之相關文獻探討 10
第三節 嬰幼兒之聽損有關年齡之文獻探討 14

第三章 研究方法
第一節 研究對象 17
第二節 研究材料與工具 21
第三節 資料處理與統計分析 25
第四節 名詞簡寫註解 28

第四章 研究結果
第一節 聽損程度與聽損察覺、聽損確診、配助聽器及語言創/復健介入等年齡及其間隔的相關性 29
第二節 主要照顧者的教育程度與聽損兒的「聽損有關年齡及其間隔」的相關性 39
第三節 全面性新生兒聽力篩檢推廣對聽損兒的「聽損有關年齡及其間隔」的影響 45

第五章 討論
第一節 聽損兒的聽損程度與「聽損有關年齡及其間隔」的相關性 53
第二節 母親教育程度與聽損兒的「聽損有關年齡及其間隔」的相關性 57
第三節 全面性新生兒聽力篩檢推廣對聽損兒的「聽損有關年齡及其間隔」的影響 59

第六章 結論
第一節 結論與建議 61
第二節 研究限制與建議 64

參考文獻
中文部份 65

英文部分 66
附錄
附錄一 聽力病歷資料表
附錄二 學生報名表
附錄三 聽力檢查報告

表目次
表2-1聽損程度分類 7
表3-1個案之基本與相關聽損資料 24
表4-1不同聽損程度之一般聽損個案之「聽損有關年齡」 29
表4-2不同聽損程度之一般聽損個案之「聽損有關年齡之間隔」 30
表4-3「聽損有關年齡及其間隔」之不同聽損程度單因子分析顯著差異結果p值 33
表4-4 一般聽損個案與高危險群聽損個案之「聽損有關年齡及其間隔」之比較 37
表4-5不同教育程度母親之聽損兒聽損程度分佈百分比 39
表4-6不同教育程度母親之聽損兒「聽損有關年齡及其間隔」之比較 41
表4-7 全面性新生兒聽力篩檢推廣對聽損兒之「聽損有關年齡及其間隔」的影響比較 48
表4-8 1998年後聽力篩檢聽損兒與未聽力篩檢聽損兒之「聽損有關年齡及其間隔」之比較 51

圖目次
圖3-1 全部個案之出生年分布 18
圖3-2 全部個案之聯絡縣市分布 19
圖4-1 不同聽損程度聽損兒之「聽損有關年齡及其間隔」 31
圖4-2 聽閾值與「聽損有關年齡及其間隔」的相關、散佈圖與迴歸曲線 35
圖4-3 一般聽損兒與高危險群聽損兒之「聽損有關年齡及其間隔」 38
圖4-4 不同教育程度母親之聽損兒「聽損有關年齡及其間隔」 42
圖4-5 不同教育程度母親之聽損兒「聽損有關年齡」間的相關、散佈圖與迴歸曲線 44
圖4-6 1998年前後聽損兒之「聽損有關年齡」間的相關、散佈圖與迴歸曲線 46
圖4-7 1998年前後聽損兒之「聽損有關年齡及其間隔」 49
圖4-8 1998年後聽力篩檢聽損兒與未聽力篩檢聽損兒之「聽損有關年齡及其間隔」 52

中文部份

-呂文琬(2005)。台灣地區新生兒聽力篩檢現況研究。碩士論文。國立高雄師範大學溝通障礙教育學系。
-林政佑、黃啟原、吳俊良、林愛惜 (2002)。都會區的新生兒聽力篩檢。中華民國耳鼻喉科醫學會雜誌，37(5)，321-329。
-林鴻清、徐銘燦、張克昌、Bruna S.M. (2000)。嬰幼兒聽力篩檢。中華民國耳鼻喉科醫學會雜誌，35(6)，376-381。
-孟珍怡、張斌 (1992)。臺灣聽障兒童的評估。中華民國耳鼻喉科醫學會雜誌，27(3)，202-206。

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