臺灣博碩士論文加值系統

研究目的：聽覺下行神經的對側抑制功能可以透過測量誘發性耳聲傳射（evoked otoacoustic emissions, EOAEs）振幅及噪音中語音辨識表現來評估。一般而言，在給予對側噪音情況下，受測耳誘發性耳聲傳射振幅會下降，而噪音中語音辨識表現會變好。對於聽力正常無耳鳴者，有些研究發現誘發性耳聲傳射振幅的對側抑制量與噪音中語音辨識表現的提升量有顯著正相關，有些研究則無發現有顯著關聯。本研究欲探討無耳鳴者及有耳鳴者在給予對側噪音情況下，受測耳變頻耳聲傳射（distortion product OAE, DPOAE）振幅對側抑制量與噪音中語音辨識表現提升量兩者間的關係。
研究方法：本研究招募有高頻聽損合耳鳴者（實驗組）19名及聽力正常無耳鳴者（控制組）20名。控制組年齡介於25至53歲（平均35歲，標準差9.2歲），實驗組年齡介於21至55歲（平均44.3歲，標準差11.5歲）。納案的實驗組必須是實驗進行時雙側耳朵至少有持續三個月以上的主觀性耳鳴，且0.25到8 k Hz每一八度音程音階的純音聽力閾值小於40 dB HL。在給予對側噪音的前、後，分別紀錄研究參與者受測耳的變頻耳聲傳射振幅及噪音中語音辨識表現。
研究結果：實驗組及控制組，在給予對側噪音的情況下，受測耳在測試頻率f2為1312 Hz及2343 Hz的變頻耳聲傳射振幅皆變小，且噪音中的語音辨識表現皆顯著提升。此外，無耳鳴的控制組的變頻耳聲傳射振幅，當測試頻率f2為2343 Hz時，對側抑制量與噪音中語音辨識表現提升量呈顯著正相關；然而對於有耳鳴的實驗組，並沒有發現變頻耳聲傳射振幅的對側抑制量與噪音中語音辨識表現提升量間有顯著關聯。
結論：不論是高頻聽損併有耳鳴者或正常聽力無耳鳴者，於非受測耳播放噪音都會降低受測耳變頻耳聲傳射的振幅，並且提升受測耳噪音中語音辨識的表現。雖然進一步可觀察到聽力正常無耳鳴者的變頻耳聲傳射振幅對側抑制量與噪音中語音辨識表現提升量呈顯著正相關，但於高頻聽損併有耳鳴者卻無相同的觀察發現。本研究受限於人數的限制，未來應招募更多的受試者以進行更適當的分析比較。

Purpose: Function of auditory efferent pathway on olivocochlear system can be evaluated by measuring contralateral suppression of evoked otoacoustic emissions (EOAEs) and speech-in-noise perception (SINP). For normal hearing subjects, previous studies found that when sufficient noise was delivered to the contralateral ear, there will be a positive correlation between the amount of suppression on the EOAEs amplitude and the amount of change in signal-to-noise ratio (SNR) of improvement on speech-in-noise perception. However, there is still controversy about conclusive evidence shown by the other studies. The purpose of the present study is to examine the differential effects of contralateral noise on the distortion-products OAE (DPOAE) and speech-in-noise perception for both high-frequency hearing loss subjects with tinnitus and normal hearing subjects without tinnitus.
Methods: The study comprised 39 participants, performed on 20 normal hearing subjects as the control group, 6 men and 14 women, 25 to 53 years old (mean = 35 years, SD = 9.2 ), and on 19 patients with tinnitus and high-frequency sensorineural hearing loss as the experimental group, 2 men and 17 women, 21 to 55 years old (mean = 44.3 years, SD = 11.5 ). Recruited subjects in the experimental group their hearing loss should be less than 40 dB HL at each of the measured octave intervals from 0.25 to 8 kHz. The DPOAE and speech-in-noise perception were measured in the test ear with and without the presence of contralateral noise.
Results: Contralateral noise stimulation decreased DPOAE amplitudes in each group. Meanwhile, the improvement of speech-in-noise perception in the test ear was observed in each group but the significant difference only present on two frequencies in which f2 was 1312 Hz and 2343 Hz. In the control group, a positive correlation can be seen between the suppression amounts of the DPOAE amplitude and the improved change of SNR at the frequency of 2343 Hz. Whereas such a correlation was not observed in the experimental group.
Conclusion: The presence of contralateral noise can reduce the DPOAE amplitude and improve the speech-in-noise perception for normal listeners and high-frequency hearing-impaired listeners with tinnitus. However, in our current study with limited participants, only listeners with normal hearing present a correlation between SINP changes and the amount of DPOAE contralateral suppression. Further studies by increasing the sample size are required to allow optimal analysis.

中文摘要 i
英文摘要 iii
表　　次 vii
圖　　次 viii
第一章 緒論 1
第二章 文獻探討 2
第一節 有交叉內側橄欖耳蝸神經束 2
第二節 耳鳴患者聽覺下行神經的對側抑制表現 8
第三章 研究動機與目的 12
第四章 研究方法 13
第一節 研究參與者 13
第二節 語音噪音與寬頻噪音的製作 15
第三節 系統性失真 16
第四節 研究程序 16
第五章 研究結果 21
第一節 對側噪音對於變頻耳聲傳射之影響 21
第二節 對側噪音對於噪音中語音辨識表現之影響 25
第三節 變頻耳聲傳射對側抑制量與噪音中語音辨識表現提升量之關係 29
第六章 討論 31
第一節 對側噪音下變頻耳聲傳射之表現 31
第二節 對側噪音下語音辨識之表現 33
第三節 對側噪音下語音辨識表現與變頻耳聲傳射表現間之關係 34
第四節 研究限制與建議 35
第七章 結論 36
參考文獻 37


 

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