臺灣博碩士論文加值系統

本研究旨在探討感音神經性聽力損失人配戴數位助聽器時，NAL-NL1選配法和DSL v5.0成人版選配法目標值之差異、選配法建議的聆聽級和助聽器配戴者偏好的聆聽級之差異，及在日常生活中配戴這二個選配法後的評比及原因分析，以期作為在成人助聽器選配時運用DSLv5.0之參考。
本研究募集16名目前配戴NAL-NL1選配法驗證的助聽器使用者，以其本身使用的助聽器進行研究。個別取得其配戴以NAL-NL1和DSL v5.0選配法驗證之真耳戴助聽器反應目標值，並以paired t-test檢驗其NAL-NL1 和DSL v5.0選配法，3個刺激音 (55, 70 dB SPL語音、85 dB SPL純音) 在各頻率目標值差異的顯著性。再分別以70 dB SPL語音為刺激音進行個人偏好聆聽級之量測，並以線性迴歸和paired t-test分析二種選配法的建議聆聽級和個人偏好聆聽級之關係。受試者在使用DSL v5.0選配法驗證助聽器二星期後，施以選配法評量表問卷，探討選配法主觀的偏好。
研究結果：本研究計16位受試者共26耳進行目標值分析，55 dB SPL刺激音時，在1000至3000 Hz處，NAL-NL1建議的目標值皆大於DSL v5.0建議的目標值且有顯著差異；70 dB SPL刺激音時，NAL-NL1在低頻和高頻的目標值皆小於DSL v5.0目標值，在中頻處，NAL-NL1建議的目標值大於DSL v5.0建議的目標值。除了4 kHz外，其他頻率NAL-NL1的飽和聲壓目標值皆小於DSL v5.0的目標值。NAL-NL1選配法建議的聆聽級和主觀偏好聆聽級的差異有顯著性，而DSL v5.0選配法建議的聆聽級和主觀偏好聆聽級之間的差異則無顯著性，故DSL選配法的目標值較接近助聽器配戴者偏好的聆聽級。16名受試者中，有10名喜歡DSL v5.0驗證法的表現，3名不喜歡，3名覺得二者表現是一樣的。
因應聽力損失兒童擴音需求的DSL 4.0用於成人助聽器配戴時常出現過高的目標值，因此臨床上採用NAL-NL1選配法作為成人助聽器驗證已行之有年。但根據本研究結果的呈現，DSL v5.0成人版目標值和NAL- NL1選配法目標值的差異型態與過去DSL 4.0和NAL- NL1選配法目標值差異的型態已有所不同；受試者主觀的偏好聆聽級也較接近DSL v5.0的建議聆聽級；受試者主觀評比較多的受試者覺得DSLv5.0表現比NAL-NL1好。建議DSL v5.0 選配法可運用在成人助聽器選配和驗證流程。

Prescribed target is regarded as the starting point of hearing aid fitting. NAL and DSL are two generic fitting methods which have been used in hearing aid fitting and verification worldwide. The purpose of this study was to determine the relationship of prescribed targets, wearers’ preferred listening level and acceptance between NAL-NL1 and DSL v 5.0 adult version.
Sixteen current hearing aid wearers with mild to severe sensorineural hearing loss were recruited. Ten of them are binaural wearers and six are monaural wearers. Their own hearing aids were used for the study. All hearing aids have been verified by NAL-NL1 before the study. Real Ear Mesurement (REM) was conducted to collect Real Ear Aided Response (REAR). Three different stimuli (55, 70 dB SPL speech and 85 dB SPL pure tone) were used for the REM. 70 dB SPL recorded speech stimuli was used for the Preferred Listening Level test. Then the hearing aids were programmed and verified with DSL v5.0. REAR of targets and of PLL for both NAL-NL1 and DSL v5.0 were recorded. Finally a Fitting Methold Preferrence questionnaire was used to determine wearer’s acceptance of DSL v5.0. Paired t-test was used for the target comparison. Linear regression and Paired t-test were used for the comparison of recommended listening level and preferred listening level.
For 55 dB SPL speech stimulus, NAL-NL1 REAR targets at 1000 to 3000 Hz were greater than those of DSL v50. For 70 dB SPL speeh stimulus, NAL-NL1 REAR targets at low and high frequencies were less than those of DSL v5.0, but NAL-NL1 REAR targets were more than DSL v5.0 REAR at mid frequencies. For RESR, all frequencies except for 4000 Hz，NAL-NL1 prescribed less RESR. Linear regression of the recommended listening level (RLL) and preferred listening level (PLL) suggested subjects’ PLLs were less than the recommended. The paired t-test result suggested there was significant difference (*p<0.0001) between NAL-NL1 RLL and subjects’ PLL, but no significant difference (p=0.0515) between DSL v5.0 RLL and subjects’ PLL. The differences were -4.308 and -1.381 dB respectively. Ten out of sixteen preferred DSL v5.0 in daily use. Main reason for the preference of DSL v5.0 was that DSL v5.0 provided better clarity, more awareance of soft sounds and better understanding in noisy environment.
Based on this study, subjects’ preferred listening level was more close to the recommended listening level of DSL v5.0. More subjects preferred DSL v5.0 than NAL-NL1 in daily use. It is suggested that DSL v5.0 fitting method can be used in adults’ hearing aid fitting and verification procedure.

目錄
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究重要性 3
第三節 研究目的 4
第四節 名詞釋義 5
第二章 文獻探討 7
第一節 DSL和NAL選配法 7
第二節 偏好聆聽級相關研究 16
第三節 助聽器驗證相關研究 18
第四節 助聽器適應性 22
第三章 研究方法 24
第一節 研究架構 24
第二節 研究對象 27
第三節 研究工具 29
第四節 研究流程與量測方法 33
第五節 資料處理與分析 44
第四章 研究結果 45
第一節 研究對象的基本描述 45
第二節 目標值比較 51
第三節 建議聆聽級與偏好聆聽級比較 65
第四節 使用者喜好比較 68
第五章 討論 70
第一節 目標值比較 70
第二節 建議聆聽級與偏好聆聽級比較 73
第三節 使用者喜好比較 74
第六章 結論與建議 74
第一節 結論 75
第二節 研究限制 76
第三節 建議 77
參考文獻 80
附錄一 偏好聆聽級指導語 85
附錄二 選配法評量表 86
附錄三 受試者基本資料一覽表 87
附錄四 受試者聽力資料一覽表 88
附錄五 受試者助聽器資料一覽表 89
附錄六 NAL-NL1目標值與驗證值差異一覽表 (70 dB SPL) 90
附錄七 DSL v5.0目標值與驗證值差異一覽表 (70 dB SPL) 91

一、中文部份
鄭秀蓮、李宗伊、黃啟原（2009）。國語版可接受噪音值之初步臨床測試結果。台灣聽力語言學會第九十七年度大會論文發表，高雄市。
郭姿吟（2008）。助聽器音效問題解決策略對音效抱怨與滿意度之效應。國立高雄師範大學聽力學與語言治療研究所碩士論文，未出版，高雄市。

二、英文部份
Aarts, N. L., & Caffee, C. S. (2005). The accuracy and clinical usefulness of manufacturer-predicted REAR values in adult hearing aid fitting. International Journal of Audiology, 44, 293-301.
ANSI (1997). American National StandardMethods for the Calculation of the Speech Intelligibility Index, ANSI S3.5-1997 (Vol. 1997a). New York: American National Standard Institute.
ASHA (2005). Type, degree and configuration of hearing loss. In A. S.-L.-H. Association (Ed.).
Audioscan (2008). AudioScan Verifit hearing instrument fitting system user's guide Version 3.2
Bagatto, M. P., Moodie, S., Scollie, S., & Seewald, R. (2005). Clinical protocol for hearing instrument fitting in the Desired Sensation Level method. Trends in Amplification, 9(4), 199-226.
Beck, D. L., Moodie, S., & Speidel, D. (2007). Pediatric hearing aid fittings and DSL v5.0. The Hearing Journal, 60(6), 54-58.
BSA, & BAA (2007). Guidance of the use of real ear measurement to verify the fitting of digital signal processing hearing aids: British Society of Audiology & British Academy of Audiology.
Byrne, D., & Dillon, H. (1986). The national acoustics laboratories' (NAL) new procedure for selection gain and frequency response of a hearing aid. Ear & Hearing, 7(4), 257-265.
Byrne, D., Dillon, H., Ching, T., Katsch, R., & Keidser, B. (2001). NAL-NL1 procedure for fitting nonlinear hearing aids: Characteristics and comparisons with other procedures. Journal of American Academy of Audiology, 12, 37-51.
Byrne, D., Parkinson, A., & Newall, P. (1990). Hearing aid gain and frequency respnse requrements for the severely/profound hearing impaired. Ear & Hearing, 11, 51-59.
Byrne, D., & Tonnison., W. (1976). Selecting the gain in hearing aid for persons with sensorineural hearing impairements. Scandinavian Audiology, 5, 51-59.
Ching, T., Newall, P., & Wigney, D. (1997). Comparison of severely and profoundly hearing-impaired children's amplification preferences with the NAL-RP and the DSL 3.0 Prescriptions. Scandinavian Audiology, 26(4), 219-222.
Ching, T. Y. C., Dillion, H., Katsch, R., & Byrne, D. (2001). Maximizing effective audibility in hearing aid fitting. Ear & Hearing, 22, 212-224.
Cornelisse, L. E., Seewald, R., & Jamieson, D. G. (1995). The input/output formula: A theoretical approach to the fitting of personal amplification devices. Journal of the Acoustical Society of America, 97, 2108-2120.
Cox, R. M. (1984). Relationship between aided preferred listening level and long-term listening range. Ear & Hearing, 5(2), 72-76.
Cox, R. M. (1995). Using loudness data for hearing aid selection: The IHAFF approach. The Hearing Journal, 48(2), 10, 39-44.
Cox, R. M., & Alexander, G. C. (1991). Preferred hearing aid gain in everyday environment. Ear & Hearing, 12(2), 123-126.
Cox, R. M., & Bisset, J. D. (1982). Prediction of aided preferred listening levels for hearing aid gain prescription. Ear & Hearing, 3(2), 66-71.
Cox, R. M., & Moore, J. (1988). Composite speech spectrum for hearing aid gain prescription. Journal of Speech and Hearing Research, 31, 102-107.
Dean, M. R., & McDermott, H. J. (2000). Preferred listening levels:the effect of background noise for moderate-to-profoundly hearing impaired aid users. Scandinavian Audiology, 29, 139-149.
Dillon, H. (1999). NAL-NL1: A new procedure for fitting non-linear hearing aids. The Hearing Journal, 52(4), 10-16.
Dillon, H. (2001). Prescribing hearing aid performance. In H. Dillion (Ed.), Hearing aid (pp. 234-262). Sydney: Boomerage Press.
Dillon, H., Bryne, D., Brewer, S., Katsch, R., Ching, T., & Keidser, G. (1998). The NAL-NL1 prescription procedure for non-linear hearing aids. Sydney: National Acoustic Laboratories.
Fabry, D. Real Ear Measurements and digital hearing aids: realities, myths, and measurement techniques. Focus, 32.
Fabry, D. A. (2003). Nonlinear hearing aids and verification of fitting targets. Trends in Amplification, 7(3), 99-115.
Gatehouse, A. (1992). The time course and magnitude of perceptual acclimatization to frequency responses: evidence from monaural fitting of hearing aids. Journal of Acoustic Society of America, 92(3), 1258-1268.
Gatehouse, A., Davis, A. C., & Bamford, J. M. (2001). Good practice guidance for adult hearing aid fitting services. BAAS newsletter, 36.
Hawkins, D., Alvarez, E., & Houlihan, J. (1991). Reliability of three types of probe tube microphone measurements. Hearing Instruments 4(3), 14-16.
Hornsby, B. W. Y., & Ricketts, T. A. (2003). The effect of hearing loss on the contribution of high-and low-frequency speech information to speech understanding.
Jenstad, L. M., Bagatto, M. P., Seewald, R. C., Scollie, S. D., Cornelisse, L., & Scicluna, R. (2007). Evaluation of the desiared sensation level [Input/Output] algorithm for adults with hearing loss: The acceptable range for amplified conversational speech. Ear & Hearing, 28(6), 793-811.
Keidser, G., Brew, C., & Peck, A. (2003a). How proprietary fitting algorithms compare to each other and some generic algorithms. The Hearing Journal, 28-38.
Keidser, G., Brew, C., & Peck, A. (2003b). How propriety fitting alogrithms compare to each other and some generic algorithms. The Hearing Journal, 28-38.
Keidser, G., & Grant, F. (2001). Comparing loudness normalization(IHAFF) with speech intelligibility maximization (NAL-NL1) when implmented in a two-channel device. Ear & Hearing, 22, 501-515.
Keidser, G., & Grant, F. (2003). Loudness Normalization or Speech Intelligibility Maximization? Differences in Clinical Goals, Issues, and Preferences. The Hearing Review, Januarary, 14-22.
Killion, M. C., & Fikret-Pasa, S. (1993). The 3 types of sensorineural hearing loss: Loudness and intelligibility considerations. The Hearing Journal, 46(11), 31-36.
Kuk, F., Keenan, D., Lau, C.-c., & Ludvigseb, C. (2004). The reliability of aided sound-field thresholds in nonlinear hearing aids. The Hearing Review. Retrieved from http://www.hearingreview.com/issues/articles/2004-12_02.asp
Marriage, J., Moore, B., & Alcantara, J. (2004). Comparison of three procedures for initial fitting of compression hearing aids. III. Inexperienced versus experienced users. International Journal of Audiology, 43(4), 198-210.
Moodie, S., Scollie, S., Bagatoo, M., & Seewald, R. (2006). Waht's new in prescriptive fittings up north for adults and children? Paper presented at the Phonak Hearing Proceeding 2006, Chicago.
Moodie, S., Scollie, S., Seewald, R., Bagatto, M., & Beaulac, S. (2007). The DSL method for pediatric and adult hearing instrument fitting: Version 5. Focus 37.
Muller, H. G. (2005). Fitting hearing aids to adults using prescriptive methods: an evidence-based Review of effectivement. Journal of American Academy of Audiology, 16(7), 448-460.
Muller, H. G. (2005). Probe-mic measures:Hearing aid fittings' most neglected element. The Hearing Journal, 58(10), 21-30.
Muller, H. G. (2006). Hearing aid verification: Old concepts and new consideration Phonak 2006 Proceedings (pp. 155-165): Phonak.
Nilsson, M., Soli, S. D., & Sullivan, J. A. (1994). Development of the Hearing In Noise Test for the measurement of speech reception thresholds in quiet and in noise. Journal of The Acoustical Society of America, 95,(2), 1085-1099.
Nozza, R. J. (1998). Threshold are not enough: Understanding how infants process speech has a role in how we manage hearing loss. Paper presented at the 1st International Conference: A Sound Foundation Through Early Amplification, Chicago, USA.
Pavlovic, C. V. (1984). Use of the articulation index for assessing residual auditory function in listeners with sensorineural hearing impairment. Journal of the Acoustic Society of America, 75(4), 1253-1258.
Pumford, J., & Sinclair, S. (2001). Real-Ear measurement: Basic terminology and procedures. American Academy of Audiology, 12(3), 150-154.
Scollie, S. (2006). The DSL method: Improved with age. The Hearing Journal, 59(9), 10-16.
Scollie, S. (2007). DSL version v5.0: Description and early result in children, from http://www.audiologyonline.com/articles/pf_article_detail.asp?article_id=1753
Scollie, S., Seewald, R., Cornelisse, L., Moodie, S., Bagatto, M., Laurnagaray, D., et al. (2005). The Desired Sensation Level multistage Input/Output Algorithm. Trends in Amplification, 9(4), 159-197.
Scollie, S., Seewald, R., Cornellisse, L., Moodie, S., Bagatto, M., Laurnagaray, D., et al. (2005). The desired sensation level multistage input/output algorithm. Thrends in Amplification, 9(4), 159-197.
Scollie, S., Seewald, R. C., Moodie, K. S., & Dekok, K. (2000). Preferred listening levels of children who use hearing aids: Comparison to prescriptive targets Journal of American Academy of Audiology, 11, 230-238.
Seewald, R., & Bagatto, M. (2006). DSL v5.0: The new DSL method for hearing instrument fitting. National Center for Hearing, University of Western Ontario.
Seewald, R., Corcoran, J., Scollie, S., Ching, T., & Dillion, H. (2005). Amplification preferences of children in different listening environment, Presentation 2. European Pediatric Conference 2005. Amsterdam: Phonak.
Seewald, R., Mills, J., Bagatto, M., Scollie, S., & Moodie, S. (2008). A comparison of manufacturer-specific prescriptive procedures for infants. The Hearing Journal, 61(11), 26-34.
Seewald, R., Moodie, S., Scollie, S., & Bagatto, M. (2005). The DSL method for pediatric hearing instrument fitting: Historical perspective and current issues. Trends in Amplification, 9(4), 145-157.
Seewald, R., Ross, M., & Spiro, M. K. (1985). Selecting amplification characteristics for yourng hearing-impaired children Ear & Hearing, 6, 48-53.
Seewald, R., Zelisko, D., & Ramji, K. (1991). DSL 3.0: A computer-assisted implementation of the Desired Sensation Level Method for electroacoustic seklection and fitting in children. London, ON: University of Western Ontario.
Smeds, K. (2004a). Is normal or less than normal overall loudness preferred by first-time hearing aid users? Ear & Hearing, 25(2), 159-172.
Smeds, K. (2004b). Less or more? Loudness aspects of prescriptive methods for nonlinear hearing aids Veteskap Och Konst, Stockholm.
Snik, A. F., & Hombergen, G. C. (1993). Hearing aid fitting of preschool and primary school children. An evaluation using the insertion gain measurement. Scandinavian Audiology, 22(4), 245-250.
Stelmachowicz, Kopun, Mace, & Lewis (1996). Measures of hearing aid gain for real speech. Ear & Hearing, 17, 520-527.
Stelmachowicz, P. G., Hoover, B., Lewis, D. E., & Brennan, M. (2002). Is functional gain really functional? The Hearing Journal, 55(11), 38-42.
Strom, K. E. (2005). Reasons for Optimism: A look at the 2004-2005 hearing aid market. The Hearing Review.
Taylor, B. (2007). Changes in hearing aid benefit over time: an evidence-based review. Audiologyonline, 1853.
Venema, T. H. (2001). The NAL-NL1 fitting method. Retrieved from www.audiologyonline.com/articles/pf_article_detail.asp?article_id=253