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研究生:邱淑雲
研究生(外文):Shu-yun Chiu
論文名稱:助聽器增益適切性指標
論文名稱(外文):The appropriateness of the proposed index for hearing aid gain
指導教授:陳小娟陳小娟引用關係
指導教授(外文):Hsiao-chuan Chen
學位類別:碩士
校院名稱:國立高雄師範大學
系所名稱:聽力學與語言治療研究所
學門:醫藥衛生學門
學類:復健醫學學類
論文種類:學術論文
論文出版年:2006
畢業學年度:94
語文別:中文
論文頁數:139
中文關鍵詞:助聽器增益實耳增益功能性增益噪音中的字詞聽辨NALDSL
外文關鍵詞:hearing aidgainreal ear gainfunctional gainword recognition in noiseNALDSL
相關次數:
  • 被引用被引用:1
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  • 收藏至我的研究室書目清單書目收藏:1
本研究主旨有三,一為發展助聽器適切性指標,並以驗證組聽力損失學生(N=19)驗證其合宜性,二為了解應用組聽損耳(N=165)適切指數之分佈,其三是了解應用組(N=112)在助聽器效益量表得分情形。
研究結果摘述如下:
一、 本研究建議以實耳測量或是功能性測量所得的增益值,計算其與NAL或DSL的差距,將各頻率得到的差距值代入下列公式,即可求得適切指數。(1*1 k Hz差距值+ 2*1.5 k Hz差距值+ 2*2 k Hz差距值+ 2*3 k Hz差距值+ 2*4 k Hz 差距值) / 9。以字詞聽辨得分預測此計算式,可獲得11.3%變異解釋量。
二、 以NAL系列處方法計算增益目標值,整體增益差距值平均介於4.24到11.71 dB,標準差大至11.15,排在前25%的增益差距值接近0,全體的適切指數平均為8.67(標準差7.67);以DSL系列處方法計算增益目標值,整體增益差距值平均大致介於7.48到32.92 dB,標準差最大為21.29,排序在 25%者只有2k Hz以下未超過10,全體的適切指數平均為19.62(標準差11.25)。
三、 實耳測量與功能性測量所得之助聽器增益適切指數平均值為正相關(p<.01)且無顯著差異,適切指數在實耳測量與功能性測量的寬鬆與嚴謹分界點分別為12.23、4.37和9.56、2.68,兩適切指數每增加1,噪音中的字詞聽辨分別增加1.55%、1.26%。
四、 應用組聽閾和整體滿意度與助聽器效益量表達顯著相關(p<.01),滿意度對全量表得分預測之標準化迴歸公式為:全量表得分=.482×滿意度;本研究與全量表相關最高的前10題之簡版量表二,其標準化迴歸公式:全量表得分=.921×本研究簡版量表二。
本研究最後依據研究結果,提出對臨床及未來研究方向之建議。
The main purpose of the study was to develop an index to determine the appropriateness of users’ hearing aid gain. The equation was derived based on 19 hearing impaired ears. The minor purpose was to know how the index values distributed for 165 hearing impaired ears, and to compare 112 hearing impaired students’ scores in hearing aid benefit inventory (HABI) with that of the elderly.
The results of the study were listed as follows.
1. The proposed index in determining the appropriateness of hearing aid gain was first to calculate the differences in each frequencies between the functional gain or the real ear gain and the target gain derived from NAL or DSL, and then to substitute the values in the following equation. (1*gain difference@1k Hz +2* gain difference@1.5k Hz + 2* gain difference@2k Hz + 2* gain difference@3k Hz + 2* gain difference@4k Hz) / 9. Scores of word recognition in noise test occupied 11.3% of variability in the index values.
2. If NAL series was used to calculate the target gain for 19 hearing- impaired ears, the mean of the difference between the target and measured gain was 4.24 to 11.71 dB (standard deviation was up to 11.15). The average index value was 8.67 (SD=7.67). If DSL series was used to calculate the target gain, the mean of the difference between the target and measured gain was 7.48 to 32.92 dB (standard deviation was up to 21.29). The average index value was 19.62 (SD=11.25).
3. The index values were significantly related between the real-ear measurement and the functional measurement. The difference between the two figures was not statistically significant. It was suggested that 12.23 and 4.37 to be used for the loose and strict boundary in teal ear measurement, whereas 9.56 and 2.68 to be used for functional measurement. Every increment in index value corresponded to 1.55 % and 1.26 % of word recognition in noise for real-ear measurement and functional measurement, respectively.
4. Hearing impaired students’ hearing thresholds and scores of HABI were significantly correlated (p <.01). Regression equations were derived as follows. (1) Total score of HABI = .482 * single-item satisfaction score. (2) Total score of HABI = .921 × abbreviated HABI.
Suggestions for the practical use and future researches were proposed.
目 次
第一章 緒論
第一節 研究背景與動機……………………………………………1
第二節 研究目的與待答問題………………………………………7
第三節 名詞解釋……………………………………………………9
第四節 研究限制……………………………………………………10
第二章 文獻探討
第一節 助聽器選配之處方法………………………………………11
第二節 助聽器客觀效益測量………………………………………17
第三節 助聽器主觀效益測量………………………………………24
第四節 助聽器選配適切性…………………………………………30
第三章 研究方法
第一節 研究流程……………………………………………………36
第二節 研究對象……………………………………………………42
第三節 研究工具……………………………………………………44
第四節 資料分析與統計方法………………………………………53
第四章 結果與討論
第一節 研究對象的基本描述………………………………………55
第二節 驗證組增益差距值.……..……………………………66
第三節 助聽器增益適切性指標…………………………………75
第四節 實耳測量與功能性測量適切指數之比較……….………82
第五節 應用組之功能性測量適切指數…………………………89
第六節 應用組助聽器效益量表之得分…..……………………99
第五章 結論與建議
第一節 結論 ………………………………………………………111
第二節 建議……………………………………..…………………114
參考書目
一、中文部分………………………………………………………116
二、英文部分………………………………………………………117
表 次
表2-1-1 使用NAL、DSL系列處方法之相關研究………………16
表3-3-1 甲生聽閾數值…………………………………………44
表3-3-2 NAL-R、NAL-RP對BTE和ITE助聽器之共同校正值…45
表3-3-3 NAL-RP對聽閾超過90dB HL之極重度聽損校正值…45
表3-3-4 使用NAL-R計算之甲生增益目標值…………………46
表3-3-5 乙生聽閾數值………………………………………46
表3-3-6 使用DSL所得之甲生實耳增益目標值…………………47
表3-3-7 使用WinCHAP計算所得之甲生實耳增益目標值……48
表3-3-8 「助聽器增益適切性指標」之各計算式加權比重…..…49
表3-3-9 國語語音閾測驗語詞 ……………………………………50
表4-1-1 驗證組助聽器款式與音量處理模式……………………..54
表4-1-2 驗證組未助聽純音聽閾(dB HL) (N=19)………………..56
表4-1-3 驗證組助聽器調整前與調整後聲場助聽聽閾(dB HL) (N=19)………………57
表4-1-4 驗證組調整前與調整後助聽測驗得分(N=19)…………..58
表4-1-5 應用組未助聽純音聽閾(dB HL)………………………..59
表4-1-6 應用組優耳或助聽器使用耳未助聽PTA(dB HL)….. ….60
表4-1-7 應用組聲場助聽聽閾(dB HL)…………………………..61
表4-1-8 應用組助聽器款式與音量處理模式……………………..62
表4-1-9 應用組每日使用助聽器時數之人數分佈表……………..63
表4-1-10 應用組對助聽器之整體滿意度分佈表…………………..63
表4-1-11 應用組每日使用助聽器時數與助聽器整體滿意度相關..64
表4-2-1 驗證組NAL小組與DSL小組之測試耳數………………66
表4-2-2 RECD平均值……………………………………………...67
表4-2-3 驗證組NAL小組之REAG增益目標值與測量值(N=10)……………………67
表4-2-4 驗證組NAL小組之REAG增益差距值(N=10)………68
表4-2-5 不同頻率在驗證組NAL增益差距值之重複量數單因子變異數分析結果摘要表…69
表4-2-6 驗證組DSL小組之REAG增益目標值與測量值(N=9)……………………69
表4-2-7 驗證組DSL小組之REAG增益差距值(N=9)………….70
表4-2-8 不同頻率在驗證組DSL增益差距值之重複量數單因子變異數分析結果摘要表…70
表4-2-9 NAL小組與DSL小組各頻率增益差距值之比較………71
表4-2-10 驗證組全組REAG增益目標值與測量值(N=19)………..72
表4-2-11 驗證組全組之REAG增益差距值(N=19)………………..72
表4-2-12 不同頻率在驗證組全組增益差距值之重複量數單因子變異數分析結果摘要表…73
表4-2-13 不同研究建議之處方法增益值誤差範圍………………73
表4-3-1 驗證組在8組計算式調整前後之適切指數(N=19)……..76
表4-3-2 不同頻率在8組計算式適切指數差距值之重複量數單因子變異數分析結果摘要表………………………………76
表4-3-3 驗證組各頻率助聽聽閾前後差距與8組計算式前後差距值之相關係數………77
表4-3-4 驗證組PTA、NWD、SRT、母音、子音聽辨差距值與8組計算式適切指數差距值之相關係數…………………78
表4-3-5 NWD 對8組計算式之迴歸分析……………………….79
表4-3-6 組合變項對8組計算式之迴歸分析……………………..79
表4-3-7 以計算式5為基礎發展之計算式(5-1到5-5)頻率加權…80
表4-3-8 NWD調整前後差距值對5組計算式適切指數差距值之迴歸分析…………81
表4-4-1 驗證組調整前與調整後實耳測量適切指數……………82
表4-4-2 dB HL 轉為dB SPL傳輸體校正值(ANSI 3.6, 1996)…83
表4-4-3 實耳未助聽增益值(REUG)………………...…………83
表4-4-5 驗證組功能性測量增益差距值(N=19)…….…..……….84
表4-4-6 驗證組調整前與調整後功能性測量適切指數…………84
表4-4-7 實耳測量與功能性測量適切指數之相關………………85
表4-4-8 實耳測量與功能性測量適切指數之t考驗………………85
表4-4-9 調整前後實耳測量、功能性測量適切指數差距與NWD得分差距之相關……88
表4-5-1 應用組助聽器類型與聲音處理模式…………………...89
表4-5-2 應用組NAL增益差距值…………………………………90
表4-5-3 應用組NAL增益差距值之四分位數…..………………..90
表4-5-4 應用組NAL功能性測量適切指數……………………...91
表4-5-5 應用組NAL功能性測量適切指數之四分位數…………91
表4-5-6 應用組NAL功能性測量適切指數分佈表.……………...92
表4-5-7 應用組DSL增益差距值….…………………………….93
表4-5-8 應用組DSL增益差距值之四分位數……………………94
表4-5-9 應用組DSL功能性測量適切指數…..…………………..94
表4-5-10 應用組DSL功能性測量適切指數之四分位數………….95
表4-5-11 應用組DSL功能性測量適切指數分佈表..……………95
表4-6-1 背景變項與助聽器效益量表得分之相關………………100
表4-6-2 配戴助聽器經驗與助聽器效益量表得分的t考驗……100
表4-6-3 整體滿意度與助聽器效益量表得分相關…………….100
表4-6-4 以相關變項預測全量表得分之逐步迴歸分析摘要表…101
表4-6-5 助聽器效益量表各題得分情形………………………103
表4-6-6 助聽器效益量表全量表得分與四個分量表之相關……105
表4-6-7 以分量表預測全量表得分之逐步迴歸分析摘要表……106
表4-6-8 助聽器效益量表之簡版量表(民91版)與全量表的相關………106
表4-6-9 助聽器效益量表之簡版量表(本研究版)與全量表的相關……107
表4-6-10 與「助聽器效益量表」相關最高前10題之情形……108
表4-6-11 以簡版量表預測全量表得分之強制迴歸分析摘要統整表……………………………………………………109
表4-6-12 應用組適切指數與全量表得分之相關…………………110

圖 次
圖 3-1-1 研究流程圖……………………………………………37
圖4-1-1 驗證組未助聽純音聽力圖………………………………56
圖4-1-2 驗證組聲場助聽聽力圖…………………………………57
圖4-1-3 應用組未助聽純音聽力圖………………………………60
圖4-1-4 應用組聲場助聽聽力圖…………………………………61
圖4-5-1 線性助聽器NAL適切指數偏態圖………………………92
圖4-5-2 非線性助聽器NAL適切指數偏態圖…………………92
圖4-5-3 全體助聽器NAL適切指數偏態圖……………………92
圖4-5-4 線性助DSL聽器適切指數偏態圖……………………96
圖4-5-5 非線性助聽器DSL適切指數偏態圖……………96
圖4-5-6 全體助聽器DSL適切指數偏態圖………………………96
附 錄
附錄一:DSL實耳增益值對照表……………………………………123
附錄二:子音、母音聽辨測驗………………………………………124
附錄三:「中國語音均衡字彙測驗」 - WSA2……………………132
附錄四:助聽器/人工電子耳效益量表………………………………133
附錄五:助聽器效益量表之簡版量表(民91版)……………………136
附錄六:助聽器效益量表之簡版量表(本研究版)…………………137
附錄七:助聽器增益適切指數計算表格……………………………138
一、 中文部分
余思儀(民91)。助聽器效益量表編製及運用之研究。國立高雄師範大學特殊教育學系碩士論文,未出版,高雄市。
陳小娟(民88)。三至八歲聽覺障礙兒童語音聽知覺接受力。台南師院特殊教育與復健學報,7,51-78。
陳小娟、利文鳳(民88)。學齡前兒童國語語音閾語詞之編製。特殊教育與復健學報,7,183-217。
陳小娟(民93)。助聽器與聲音擴大系統,國立高雄師範大學特殊教育系上課講義。
黃乾全、吳聰能、黃榮村(民84)。勞工聽力損失盛行率調查之先驅計畫聽力檢查及實驗室之標準化。衛生教育論文集刊,8,49-73
楊秀春(民90)。國語聲母聽辨測驗之編製研究。國立高雄師範大學特殊教育學系碩士論文,未出版,高雄市。
楊佳霖、陳小娟(民94)。老化型聽覺損傷者聽覺障礙程度推估之研究。特殊教育研究學刊,28,215-238
葉旭輝(民94)。華語各頻帶訊息對語音理解之重要度分析,國立陽明大學醫學工程研究所碩士論文,未出版,台北市。
羅意琪(民93)。助聽器滿意度量表編製及相關因素之研究。國立高雄師範大學溝通障礙教育研究所碩士論文,未出版,高雄市。
二、 英文部分
American Speech-Language- Hearing Association. (1996). Scope of practice in audiology. ASHA, 38(16), 12-15.
Amlani, A. M., Punch, J. L., & Ching, T.Y.C.(2002). Methods and Applications of the Audibility Index in Hearing Aid Selection and Fitting. Trends In Amplification, 6(3), 81-100
Arlinger, S. D. (1998). Clinical assessment of modern hearing aids. Scandinavian Audiology, 27 (4), 50-53.
Arlinger, S. D. (2001). How to assess outcome of hearing aid fitting in children. Scandinavian Audiology, 30(2), 68-72.
ASHA Ad Hoc Committee on Hearing Aid Selection and Fitting. (1998). Guidelines for hearing aid fitting for adults. American Journal of Audiology, 7(1), 5-13.
Bentler, R. A. & Pavlovic, C. V. (1989). Transfer functions and correction factors used in hearing aid evaluation and research. Ear and Hearing, 10(1), 58-63
Byrne, D. & Dillon. H. (1986). The National Acoustic Laboratories(NAL) new procedure for selecting the gain and frequency response of a hearing aid. Ear and Hearing, 7, 257-265
Ching, T. Y. C. (2002). Effect amplification for hraring-impaired children. The Hearing Journal, 55(4), 10-18.
Ching, T. Y. C., Dillon, H., & Byrne, D. (1998). Speech recognition of hearing-impaired listeners: Predictions from audibility and limited role of high-frequency amplification.The Journal of the Acoustic Society of American, 103(2), 1128-1140.
Ching, T. Y. C., Britton, L., Dillon, H., & Agung.( 2002). RECD, REAG, NAL-NL1: Accurate and practical methods for fitting non-linear hearing aids to infants and children. The Hearing Review, 9(8), 12 - 20, 52.
Ching, T.Y.C., Dillon, H., Katsch, R. & Byrne, D(2001). Maximising effective audibility in hearing aid fitting. Ear and Hearing, 22(3), 212-224.
Cornelisse, L. E., Seewald, R. C., & Jamieson, D. G. (1994). Wide-Dynamic-Range Compression Hearing Aids: The DSL[i/o] Approach. The Hearing Journal, 47(10), 23-29
Cornelisse, L. E., Seewald, R. C., & Jamieson, D. G. (1995). The input/output formula: A theoretical approach to the fitting of personal amplification devices. The Journal of the Acoustic Society of American, 97(3), 1854-1864
Cox, R. M. (1995). Using loudness data for hearing aid selection: the IHAFF approach. The Hearing Journal, 48(2), 39-44.
Cox, R. M.& Alexander, G. C. (1991). Hearing aid benefit in everyday environments. Ear and Hearing , 12, 127-139.
Cox, R. M.& Alexander, G. C. (1992). Maturation of hearing aid benefit: Objective and subjective measurements. Ear and Hearing , 13, 131-141
Cox, R. M.& Alexander, G. C. (1995). The abbreviated profile of hearing aid benefit. Ear and Hearing , 16(2), 176-186.
Cox, R.M. & Alexander, G..C. (2000). Expectations about hearing aids and their relationship to fitting outcome . Journal of the American Academy of Audiology, 11 (7), 368-382.
Cox, R. M. & Gilmore, C. (1990). Development of the profile of hearing aid performance (PHAP). Journal of Speech and Hearing Research, 33, 343-357.
Crowley, H. J. & Nabelek, I. V. (1996). Estimation of client-assessed hearing aid performance based upon unaided variables. Journal of Speech and Hearing Research. 39(1), 19-27.
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