臺灣博碩士論文加值系統

過去研究顯示，對側耳施予連續寬帶噪音可以激發內側橄欖-耳蝸束(medial olivocochlear bundle; MOCB)與耳蝸外毛細胞的突觸連結，此下行徑路會抑制變頻耳聲傳射之振幅。本研究的目的在探討：當上行聽覺神經傳導時間延宕時，是否會影響MOCB的抑制功能？本文中將無噪音時測得之變頻耳聲傳射(distortion products otoacoustic emissions; DPOAE)振幅減去噪音(連續白噪音50dBHL)下之DPOAE振幅，定義為對側抑制值(contralateral suppression)。
實驗組為腦幹聽性誘發電位(brainstem auditory evoked potential; BAEP)單側波間潛時延長的語言發展遲緩兒童八名，比較異常耳與正常耳間之DPOAE振幅及其對側抑制是否有差異? 研究結果發現：BAEP波間潛時異常耳與正常耳之DPOAE振幅兩耳間無顯著差異。而DPOAE在2000Hz 和4000Hz之對側抑制值有顯著差異(2kHz/p=0.036; 4kHz/p=0.017; 顯著水準為0.05)。在控制組方面則發現，正常兒童與成人之DPOAE及其對側抑制兩耳間皆無顯著差異。
本論文為首度報告：單側BAEP波間潛時延長可能影響該側MOCB抑制的功能，並提出生理解剖徑路可能的解釋。研究結果支持MOCB對耳蝸外毛細胞之回饋迴路(feedback loop)可能在腦幹上行與下行聽覺徑路的交互影響中扮演重要的角色。
同時，本研究發現，為數不少的語言發展遲緩兒童(31.66%)出現BAEP波間潛延長，有些為單側延長，有些則為雙側延長。聽力師對於這些兒童進行聽覺評估時，有必要檢視其BAEP的傳導時間，以瞭解他們腦幹聽覺徑路的成熟度。

The suppression of distortion products of otoacoustic emissions
(DPOAEs) by contralateral auditory stimulation can assess the activity of the efferent pathway from the superior olivary complex to outer hair cells of cochlea via the medial olivo-cochlear bundle(MOCB). The purpose of this study is to investigate if the suppressive effect of MOCB is abnormal in language developmental delayed children with unilateral prolonged interpeak latencies(IPL) of brainstem auditory evoked potentials. Contralateral suppression (CS) was defined in the present study as the amplitude change of DPOAEs with and without contralateral white noise of 50dBHL. CS of DPOAEs at 1k, 1.5k, 2k, 3k and 4kHz in one ear with unilateral prolonged IPL of BAEP were compared to those of the other healthy ear. In addition, CS between two ears in two control groups , fourteen normal children and twenty five adults, were compared.
The results showed that the contralateral suppression of DPOAEs at 2000 and 4000Hz were significantly different between the ears with prolonged IPLs of BAEP and the normal ears . This finding indicated that the efferent pathway of uncrossed MOCB as well as afferent pathway in brainstem was abnormal in children with prolonged IPLs of BAEP. Furthermore, contralateral suppression of DPOAEs measurement can be
clinically valuable in understanding the interaction between afferent and efferent auditory pathway, and dysfunction of efferent pathway as well as poor neural synchrony of afferent pathway may be implicated in language developmental delayed children.

目 次
頁數
誌 謝 ………………………………………………………………………. I
中文摘要 ……………………………………………………………………… II
英文摘要 ………………………………………………………………………… III
目 錄 ……………………………………………………………………… IV
圖表目次 ………………………………………………………………….…… V
第一章 緒 論
第一節 前言 ………………………………………………… 1
第二節 研究目的 ………………………………………………… 2
第二章 文獻探討
第一節 特殊兒童的腦幹聽性誘發電位 …………………………… 4
第二節 腦幹聽覺傳導系統 ……..………………………………… 6
第三節 腦幹聽性誘發電位 ………………………………………… 7
第四節 耳蝸外毛細胞與耳聲傳射 ………………………………… 8
第五節 變頻耳聲傳射之對側抑制 ………………………………… 10
第三章 研究方法 …………………………………………………… 16
第四章 結 果
第一節 實驗組之腦幹聽性誘發電位潛時反應 …………………… 23
第二節 變頻耳聲傳射振幅 ………………………………………… 25
第三節 變頻耳聲傳射之對側抑制 ………………………………… 28
第四節 實驗組兒童之醫療診斷及發展評估結果 ………………… 31
第五章 討 論 …………………………………………………… 32
第六章 結 論 …………………………………………………… 38
參考文獻 ……………………………………………………………… 39
附 錄
附錄一 正常成人控制組之變頻耳聲傳射振幅 ………… 47
附錄二 正常兒童控制組之變頻耳聲傳射振幅 ………… 51
附錄三 實驗組兒童之變頻耳聲傳射振幅 ……………………… 55
附錄四 正常成人控制組在對側噪音下之變頻耳聲傳射振幅 … 57
附錄五 正常兒童控制組在對側噪音下之變頻耳聲傳射振幅 …… 61
附錄六 實驗組兒童在對側噪音下之變頻耳聲傳射振幅 ………… 65
附錄七 正常成人控制組之變頻耳聲傳射對側抑制值 …………… 67
附錄八 正常兒童控制組之變頻耳聲傳射對側抑制值 …………… 68
附錄九 實驗組兒童之變頻耳聲傳射對側抑制值 ………………… 69

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