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研究生:許惇彥
研究生(外文):Tun-Yen Hsu
論文名稱:決定噪音性聽力障礙患者純音聽力圖上呈現雙側notches的因素
論文名稱(外文):The Determinants of the Bilateral Audiometric Notches in Noise-Induced Hearing Loss
指導教授:王照元
指導教授(外文):Jaw-Yuan Wang
學位類別:碩士
校院名稱:高雄醫學大學
系所名稱:臨床醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2012
畢業學年度:101
語文別:中文
論文頁數:59
中文關鍵詞:噪音性聽力障礙純音聽力圖
外文關鍵詞:Noise induced hearing lossaudiometric notch
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研究目標:
探索決定噪音性聽力障礙患者純音聽力圖上呈現雙側notches的可能因素。
研究設計:
前瞻性收錄的橫斷性研究。
研究方法:
412名在工作時暴露於連續性噪音(噪音暴露量標準化到工作天一天8小時超過75dBA)的男性工人被收錄在本研究當中。純音聽力圖上呈現雙側notches與年齡、噪音暴露時間、噪音暴露強度以及與不同頻率的實際聽力閾值與預測聽力閾值相較的偏差值之間的關係,以迴歸分析(regression model analysis)、接收者操作特徵分析(receiver operating characteristic analysis)以及曲線下面積分析(area under the curve analysis)等方法分析。
結果:
純音聽力圖上呈現雙側notches與1k、2k、3k、4k以及6kHz頻率的實際聽力閾值與預測聽力閾值相較的偏差值是密切相關的。實際聽力閾值與預測聽力閾值相較的偏差值在有配戴聽力保護裝置與沒有配戴聽力保護裝置的情況下是有一些差異。相較於年齡、噪音暴露時間、噪音暴露強度,實際聽力閾值與預測聽力閾值相較的偏差值與純音聽力圖上呈現雙側notches有較強的關聯性。
結論:
在噪音性聽力障礙患者純音聽力圖上呈現雙側notches並不是由年齡、性別、噪音暴露強度以及噪音暴露時間所決定的。其他與純音聽力圖上呈現雙側notches有關的因素的重要性是可以被理解的。釐清與純音聽力圖上呈現雙側notches有關聯的因素可以幫助我們發展一更全面的保護方針來預防噪音性聽力障礙的發生。

Objectives/Hypothesis: To explore the possible determinants of bilateral audiometric notches in noise-induced hearing
loss (NIHL).
Study Design: Prospectively enrolled cohort with cross-sectional analysis.
Methods: Male workers (n =412) with exposure to continuous loud noise (noise exposure level normalized to a nominal 8-hour working day >75 dBA) during work were included in this cohort study. The relationship between the presence of bilateral audiometric notches and age, noise exposure duration, noise exposure level, and shift from the predicted thresholds over different frequencies were determined by regression model analysis, receiver operating characteristic analysis, and area under the curve analysis.
Results: The presence of bilateral audiometric notches was closely associated with the shifts from the predicted thresholds over 1, 2, 3, 4, and 6 kHz. The shift pattern was somewhat different between those who used hearing protection devices and those who did not. The shifts from the predicted thresholds demonstrated a stronger association with bilateral audiometric notches than did age, gender, noise exposure level, or noise exposure duration.
Conclusions: The bilateral audiometric notches in NIHL could not be determined only on the basis of age, gender, noise exposure level, or noise exposure duration. The importance of other factors associated with bilateral audiometric notches should be recognized. Elucidation of the factors of formation of bilateral audiometric notches would help us to develop a more comprehensive protection strategy to prevent further NIHL.

目 錄
中文摘要………………………………………………………1
英文摘要………………………………………………………2
誌 謝…………………………………………………………3
第一章 前言與文獻回顧 …………………………………4
第二章 材料與方法
第一節 受試者招募與臨床評估………………………6
第二節 噪音暴露的定量………………………………8
第三節 純音聽力圖的特色……………………………9
第四節 資料分析……………………………………11
第三章 結果………………………………………………12
第四章 討論………………………………………………16
第五章 結論………………………………………………19
參考文獻……………………………………………………20
附表…………………………………………………………25
附圖…………………………………………………………31
附錄…………………………………………………………33

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