- 期刊
新型無線跨傳式助聽器改善單側耳聾患者之效益評估
The Efficacy of New Wireless Contralateral Routing of Signal Hearing Aids in Subjects with Single-sided Deafness
摘要
背景：單側耳聾患者在團體對話、空間辨識方面遭遇聆聽困難，尤其在噪音環境中更是為吃力，而單耳聽覺的不便可歸究於頭影效應（Head shadow effect）。目前跨傳式助聽器（contralateral routing of signals, CROS）為改善單側耳聾聆聽品質的首要考量，然而過去的研究大多採取舊式有類比訊號的機型。本研究為一前瞻性研究，主要探討新型無線跨傳式助聽器應用於單側耳聾之聽能表現。方法：透過主觀測試—Speech, Spatial and Qualities Questionnaires（SSQ）問卷、操作適應及聆聽困難改善指標，客觀測試—安靜環境下佩戴前後的語音接收閾測試（speech recognition threshold, SRT）、噪音環境下未佩戴、佩戴後兩週及佩戴後3個月以上等三階段的語音接收閾（speech recognition threshold in noise, SRTN），並計算訊噪比（signal-to-noise ratio, S/N）。結果：患者共有6名年齡介於14－28歲（平均23歲），其中包括2名男性，佩戴時間為6－14個月（平均10.67個月）。操作適應方面，絕大部分受試者對音量調整、助聽器操作以及助聽器音質均有不錯的滿意度；8項聆聽困難改善指標之滿意度平均獲得1分以上之提升。SSQ問卷中，言語方面以“團體隨機發言理解度”此項目之改善達到顯著差異（p=0.02），空間方面雖均有提升但不具統計意義，品質方面以“必須專注聽”及“乘車時能輕鬆聆聽”等指標獲得明顯改善（p=0.03, p=0.009）。語言辨識度方面，在安靜環境下之SRT，佩戴前後之平均聽閾分別為20 dB SPL及19 dB SPL（p=0.46），未達顯著差異；在噪音干擾下之SRTN，若語音及噪音皆在患側時，平均訊噪比第一階段為-2dB，第二階段及第三階段均為-4.67dB（p=0.03），顯示佩戴後訊噪比較佳；若語音位於患側而噪音來自於對側時，平均訊噪比第一階段為-1dB，第二階段為-1.33dB，第三階段為-1.67dB （p=0.67），佩戴後訊噪比雖有改善但未達顯著差異。結論：本研究發現，佩戴新型無線跨傳式助聽器能克服頭影效應並提升單側耳聾患者的聆聽品質，尤其在聲源為單一音質、及聆聽專注度方面達到顯著差異；在噪音環境下聆聽時，能降低訊噪比而提升語音辨識度，惟當訊噪異側時其效益較不彰顯。
並列摘要
BACKGROUND: Individuals with single-sided deafness (SSD) encounter difficulties in communication with respect to both group and spatial hearing, especially in noisy environments. The head shadow effect contributes to the disadvantages of monaural hearing. As the first choice of treatment for SSD, contralateral routing of signal (CROS) hearing aids offer benefits that improve monaural hearing. This prospective trial investigated the efficacy of the CROS hearing aid for subjects with SSD using a new wireless digital technology. METHODS: Subjects with SSD (pure tone average [PTA] ＞ 90dB HL) and normal hearing in the opposite ear (PTA ＜ 25dB HL) were fitted with contralateral routing of signal devices for at least 3 months. The outcome measures included 1) subjective benefits, as measured using the Speech, Spatial and Qualities Questionnaire (SSQ), operating adaptation, and improvement in listening quality; 2) objective tests, such as the speech recognition threshold (SRT) in a quiet environment and the speech recognition threshold in a noisy environment (SRTN) were used to test subjects unaided (stage 1), aided for 2 weeks (stage 2), and aided for a minimum of 3 months (stage 3). A lower signal-to-noise ratio (S/N) indicated better hearing. RESULTS: Six adults with SSD with an average age of 23 years (range 14-28years), including 2 males, were fitted with CROS hearing aids for 10.67 months on average (range 6-14months). There was consistent satisfaction in regard to operating adaptation, improvement in quality of listening, and in SSQ scores. ＂Conversation switching from one to another in a group＂ in the speech domain, and ＂Little effort required for listening＂ and ＂Listening while riding in a vehicle＂ in the qualities domain attained statistical significance with regard to improvement. In a quiet space, there was no difference in regard to SRT (unaided: 20dB SPL, aided: 19dB SPL, p=0.46). The results of the SRTN indicated notable benefits when using the CROS device, and the S/N decreased when both signal and noise were localized on the diseased side (stage 1S/N=-2dB, stage 2S/N=-4.67dB, stage 3S/ N=-4.67dB, p=0.03); when the signal was on the side with the diseased ear, and noise impacted the better side, the S/N improvement did not reach statistical significance. CONCLUSIONS: The new wireless CROS device overcomes the head shadow effect and improves the quality of listening in a population with SSD, most significantly in regard to conversation in groups, and it allows better speech perception in situations where there is background noise.