臺灣博碩士論文加值系統

為了探討鼻咽癌治療所造成的聽覺器官損害是否會影響鼻咽癌患者治療後助聽器介入的成效，本研究採便利取樣方式，選取有鼻咽癌病史之助聽器使用者與非鼻咽癌助聽器使用者，分別針對純音骨導聽閾、安靜及噪音下雙字詞辨識、個案導向的助聽器使用之溝通成效量表、成人聽覺表現量表-簡易版、或年長者聽覺表現量表-簡易版等四個聽覺復健成效評估向度進行分析。
本研究共分析16位助聽器使用者（鼻咽癌組與非鼻咽癌組各有8人），22隻耳朵，平均年齡為57.8歲，平均骨導聽閾值為48.7 dB HL，平均助聽器使用經驗為21.7個月，大多數患者（81%）使用全方位麥克風。結果發現：(1)鼻咽癌組之骨導聽閾年變化量（M0.5k-2kHz/low band＝-0.2 dB；M4kHz/high band＝2.5 dB）與非鼻咽癌組之骨導聽閾年變化量（M0.5k-2kHz/low band＝-0.7 dB；M4kHz/high band＝-3.4 dB），並無顯著差異。(2)不論是比較未助聽時、助聽時、或助聽前後的差異，鼻咽癌組之可接受最小訊噪比（Munaided＝4.4 dB；Maided＝10.0 dB；Mdiff.＝5.6 dB）與非鼻咽癌組之可接受最小訊噪比（Munaided＝7.5 dB；Maided＝6.9 dB；Mdiff.＝-0.6 dB），都無顯著差異。(3)於安靜中與1-2人對話、噪音中與1-2人對話、安靜中與群體對話、噪音中與群體對話等四種主要溝通情境，兩組之助聽器助益程度、助聽後表現、以及助聽器整體助益，都沒有顯著差異。(4)兩組之自評聽覺障礙總分，並無顯著差異。
儘管兩組在個別成效評估測驗上的表現無顯著差異，但研究暗示：(1)鼻咽癌組之周邊聽力衰退程度有高於非鼻咽癌組之周邊聽力衰退程度的傾向，(2)助聽器提供一般聽損者在噪音下的語音知覺表現改善效果有優於鼻咽癌患者的傾向。因此，建議除了加強鼻咽癌患者治療前的聽力諮詢、定期追蹤聽力外，更該考慮為鼻咽癌患者選配具有較佳噪音消減功能、方向性麥克風的助聽器，或使用調頻系統，並且訓練個體對噪音容忍度的提升、噪音下語音知覺的促進技巧。

To investigate whether the damage of auditory organs resulting from radiation therapy would affect outcome of hearing aid user, the present study sampled 8 ( 12 ears ) irradiated nasopharyngeal carcinoma patients（NPC group）and 8 ( 10 ears ) hearing impairment patients without radiation history（control group）. The mean age was 57.8 years old and the mean bone-conducted threshold before hearing aid fitting was 48.7 dB HL. The mean experience of using hearing aid was 21.7 months. Participants’ performances in pure tone threshold test, words discrimination test, Client Oriented Scale of Improvement, and Hearing Handicap Inventory for Adults-short form or Hearing Handicap Inventory for the Elderly-short form, were analyzed.
Most participants（81%）chose hearing aid of omni-directional microphone. The followings were the results. (1) There was no significant difference in hearing deterioration between NPC group and control group. (2) There was no significant difference in minimal signal-to-noise ratio between NPC group and control group in any aided condition. (3) Neither in case of conversation with one or two persons in quiet or noise environment nor in case of conversation with group in quiet or noise environment showed significant difference in hearing aid benefit or aided performance between NPC group and control group. (4) There was no significant difference in handicap score between NPC group and control group.
Although no significant difference between two groups in any outcome measures was found, the present findings still implied that (1) hearing deterioration rate of NPC patients may be higher than general population. (2) NPC patients may face more difficulties in adaptation with noise environment than general population. In addition to regular hearing threshold counseling and speech training in noise environment, the choice of hearing aid with stronger noise- reduction management, directional hearing aid or FM system are recommend for irradiated NPC patients with hearing impairment.

第一章 緒論
第一節 研究背景與研究目的 .......................... 1
第二節 研究設計與研究限制 .......................... 4
第三節 研究假設與研究問題 .......................... 8
第二章 文獻探討
第一節 鼻咽癌的流行病學與臨床病理學 ................ 11
第二節 鼻咽癌治療所帶來的耳毒性副作用 .............. 16
第三節 鼻咽癌患者治療後的聽覺復健與成效評估 .. 27
第三章 研究方法
第一節 研究流程與架構 ........................ 37
第二節研究對象 .............................. 40
第三節聽覺復健成效評估 ...................... 41
第四節資料分析 .............................. 48
第四章結果與討論
第一節研究結果............................. 49
第二節討論................................. 61
第五章結論與建議 .............................. 67
參考文獻 ........................................ 69
附錄........................................... 83

表次
表2-1 放射線治療造成的耳毒性作用--動物實驗 .......... 21
表2-2 放射線治療造成的耳毒性作用--人體實驗 .......... 22
表2-3 治療鼻咽癌常用的化學藥物與副作用/影響 ......... 26
表4-1 受試者選配前背景資料 ..................... 50
表4-2 比較不同研究之助聽器棄用原因排序 ............. 61
表4-3 比較不同研究之骨導聽閾年變化量 ........... 62
表4-4 比較不同研究之五年聽損發生率 ............. 63
表4-5 比較不同研究之雙耳選配優勢 ............... 65
表4-6 聽覺復健成效的組間比較 ................... 66

圖次
圖3-1 研究流程 ................................. 39
圖4-1 受試者選配前各頻率骨導聽閾 ............... 51
圖4-2 受試者各頻率骨導聽閾年變化量 ............. 53
圖4-3 受試者裸耳最舒適位階、
裸耳最大可忍受噪音位階 ............ 54
圖4-4 受試者助聽後最舒適位階、
助聽後最大可忍受噪音位階 ........... 56
圖4-5 受試者助聽前後可接受之最小訊噪比 ......... 57
圖4-6 受試者於四種主要溝通情境下的
         助聽器助益分數 .... 58
圖4-7 受試者於四種主要溝通情境下的
         助聽表現 ......... 60

附錄
附錄一 個案背景資料調查表 ....................... 83
附錄二 個案聽力追蹤表 ........................... 84
附錄三 受試者同意書 ............................. 85
附錄四 個案導向的助聽器使用之溝通成效量表 ......... 87
附錄五 成人聽覺表現簡易量表 ........................88
附錄六 年長者聽覺表現簡易量表 .......................89
附錄七 雙字詞辨識測驗詞彙表 ..................... 90

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