臺灣博碩士論文加值系統

研究目的：要如何評估小齡聽損兒植入電子耳的聽能技巧發展歷程，現有的客觀聽力檢查及主觀生活問卷觀察皆有其限制，故本研究欲探討現有的主觀評估問卷，並選擇有合適的年齡適用範圍與涵蓋聽能技巧四階段──察覺、分辨、辨識、理解的問卷，來探討植入人工電子耳兒童的聽能技巧發展歷程。

研究方法：本研究招募27名12歲（含）以下即將植入、或植入人工電子耳未滿3個月的聽損嬰幼兒及兒童，並請他們的家長及聽覺口語師於植入前、植入後3、6、9、12個月共5個時間點，填寫中文短版聽覺技巧檢核表，並將分數依據常童參照數據進行正規化，以去除生理年齡對於檢核表分數的影響。此外，亦探討影響人工電子耳成效之因素對於其聽能技巧發展的影響。包含以下因素（依資料來源分類）：（1）植入年齡早晚，自雅文基金會的資料庫蒐集；（2）配戴時長，家長自陳與聽覺口語師觀察蒐集；（3）聽能創（復）健的參與積極度/效能，由參與者的社工、聽力師、聽覺口語師分別進行評分。

研究結果：Pearson相關分析結果顯示：（1）各聽能技巧階段，家長與聽覺口語師評分達中至高度正相關；（2）無論由家長或聽覺口語師填寫聽能技巧檢核表，各聽能技巧階段分數及總分與植入時長皆達中度正相關。至於聽能技巧發展，以達常童參照數據的70%為標準，察覺能力於植入前至植入後3個月、分辨能力於植入後6個月、辨識能力於植入後6至9個月與常童相當、理解能力於植入後12個月尚未追上常童能力。若以達常童參照數據平均值減2個標準差為標準，察覺能力於植入前至植入後3個月、分辨能力於植入後6個月、辨識能力於植入前至植入後9個月、理解能力於植入後9個月與常童相當。此外，植入年齡、配戴時長、教學效能對於聽能技巧發展皆有顯著影響。

結論：隨著植入時長變久，其聽能技巧發展越佳。察覺能力於植入前至植入後3個月、分辨能力於植入後6個月、辨識能力於植入前至植入後9個月、理解能力於9個月與常童相當，然亦有可能於植入後12個月尚未追上常童能力未追上常童能力未追上常童能力。此結果有助於家長、聽力師、耳鼻喉科醫師、早療相關人員更了解人工電子耳兒童的成效，也有助於提供更好的聽能創（復）健課程計畫。

Purpose: The age at which children receive cochlear implants is progressively decreasing. However, evaluating the development of auditory skills in children after cochlear implantation presents challenges with both objective hearing assessments and subjective questionnaire observations. The objective of this study is to explore subjective questionnaires and select one that encompasses an appropriate age range and the four stages of auditory skills: detection, discrimination, identification, and comprehension. In addition, the study aims to explore the developmental trajectory of auditory skills in children after cochlear implantation.

Method: Twenty-seven children with hearing loss under 12 years of age were recruited. All children were either about to receive cochlear implants (CIs) or had been implanted for less than three months. The Mandarin Auditory Skill Checklist-Short Form was used to assess children’s auditory skills, completed independently by their caregivers and auditory-verbal (AV) specialists. Assessments were administered prior to implantation and at three-month intervals up to 12 months post-implantation. Each score was normalized using normative data to mitigate age-related influences on the checklist scores. In addition, factors impacting the efficacy of CIs were explored, including (categorized based on the data source): (1) Age at implantation, collected from the Children’s Hearing Foundation database; (2) Daily wear time of CIs, collected from caregiver reports and observations of the AV specialists; (3) Caregiver involvement and efficacy of hearing (re)habilitation, rated independently by the children’s social workers, audiologists, and AV specialists.

Results: Pearson correlation analyses indicated: (1) Moderate to high positive correlations between the scores provided by caregivers and by AV specialists across various stages of auditory skill development; (2) Moderate positive correlations between the duration of CI use and the scores for each stage of auditory skills and total scores, whether completed by caregivers or AV specialists. Regarding auditory skill development, with 70% of the scores from typically developing (TD) children as a benchmark, detection ability was comparable to TD children from pre-implantation to three months post-implantation; discrimination ability was comparable at six months post-implantation; identification ability at six to nine months post-implantation; and comprehension ability continued to develop at 12 months post-implantation. Using standard deviations below the mean score of TD children as a benchmark, detection ability was comparable to TD children from pre-implantation to three months post-implantation; discrimination ability was comparable at six months post-implantation; identification ability was comparable from pre-implantation to nine months post-implantation; and comprehension ability at nine months post-implantation. Moreover, age at implantation, daily wear time of CI, and caregivers’ efficacy had significant effects on auditory skill development.

Conclusions: With increased duration of CI use, children demonstrated improved auditory skill development. Detection ability was comparable to TD children from pre-implantation to three months post-implantation; discrimination ability was comparable at six months post-implantation; identification ability from pre-implantation to nine months post-implantation; and comprehension ability was comparable to at nine months post-implantation, or it may continue to develop up to 12 months post-implantation. These findings provide crucial insights into the developmental trajectory of auditory skills in children after cochlear implantation, thereby significantly enhancing the understanding of auditory skill development and informing the planning and improvement of auditory (re)habilitation programs among parents, audiologists, otolaryngologists, and early intervention professionals.

中文摘要 .............................................................................................................. i
英文摘要 ............................................................................................................ iii
表 索 引 ............................................................................................................ viii
圖 索 引 .............................................................................................................. ix
第一章 緒論 ........................................................................................................ 1
　　第一節 研究背景與動機 ............................................................................... 1
　　第二節 聽能技巧與聽能發展 ........................................................................ 3
　　第三節 研究目的 .......................................................................................... 3
第二章 文獻探討 ................................................................................................. 4
　　第一節 人工電子耳三大廠商出版之聽能技巧評估工具 ................................ 4
　　第二節 與聽能技巧發展相關之評量方式 ...................................................... 5
　　第三節 常見主觀問卷之適用年齡與觀察項目分析 ....................................... 7
　　第四節 聽能技巧檢核表（ASC）相關文獻與聽常兒童參照數據 ................ 11
　　第五節 影響人工電子耳成效之因素 ........................................................... 12
第三章 研究方法 ............................................................................................... 20
　　第一節 研究對象 ........................................................................................ 20
　　第二節 研究工具與材料 ............................................................................. 24
　　第三節 研究步驟 ........................................................................................ 25
　　第四節 資料分析 ........................................................................................ 25
第四章 研究結果 ............................................................................................... 27
　　第一節 家長和聽覺口語師評分聽能技巧檢核表分數的關係 ....................... 27
　　第二節 人工電子耳聽損兒聽能技巧發展情形 ............................................ 27
　　第三節 影響人工電子耳成效之因素與聽能技巧檢核表分數的關係 ............ 38
第五章 討論 ...................................................................................................... 46
　　第一節 家長和聽覺口語師評分聽能技巧檢核表分數的關係 ....................... 46
　　第二節 人工電子耳聽損兒聽能技巧發展情形 ............................................ 46
　　第三節 影響人工電子耳成效之因素與聽能技巧檢核表分數的關係 ............ 50
第六章 結論 ...................................................................................................... 52
參考文獻 ........................................................................................................... 53
附錄 .................................................................................................................. 60
　　附錄一 中文版短版聽覺技巧檢核表題目示例 ............................................. 60
　　附錄二 聽常兒童參照數據 ......................................................................... 62
　　附錄三 家長參與度與教學效能量表 ........................................................... 63
　　附錄四 植入年齡與ASC分數之混合效應模型分析詳細數據 ....................... 64
　　附錄五 配戴穩定度與ASC分數之混合效應模型分析詳細數據 ................... 66
　　附錄六 家長參與度與ASC分數之混合效應模型分析詳細數據 ................... 70
　　附錄七 家長效能與ASC分數之混合效應模型分析詳細數據 ....................... 78

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