以純音比對方式量測病患耳嗚頻率及強度的再現性

The Reliability of Frequency and Intensity Matching with Pure Tones in Patients with Tinnitus

李仲毅(Chung-Yi Lee) ； 許權振(Chuan-Jen Hsu)

《台灣耳鼻喉頭頸外科雜誌》 39卷5期 (2004/11) Pp. 171-176

https://doi.org/10.6286/2004.39.5.171

摘要

背景：本部耳鳴特別門診運用比對的方法來量測病患耳鳴的頻率及强度，以此做爲後續治療效果的參考指標。同一病患其耳鳴在不同時間經比對所測得頻率及强度是否一致值得注意，本研究即在探討臨床上比對病患耳鳴的作法是否恰當，比對所得的耳鳴頻率及强度是否穩定地代表臨床上病患主訴的耳鳴特質。
方法：自2002年9月至2003年2月，於本部耳鳴特別門診篩選其主訴耳鳴聲音特質（包括頻率及強度）未變的病患。在耳鳴聲音特質未變的情況下，經問診再確認病患主訴的耳鳴特質與之前無異後，以純音比對的方法量測病患耳鳴的頻率及強度。將間隔4週的兩次比對結果以配對t檢定比較前後測量所得病患耳鳴的頻率及强度是否一致。
結果：主訴耳鳴純音特質未變的23名病患，男11名，女12名，年齡分佈自13至64歲，平均435歲，有耳鳴困擾皆超過6個月。在l個月內接受兩次比對的方法來量測病患耳鳴的頻率及強度。以配對t檢定比較前後測量所得同一病患臨床上未變的耳鳴的頻率及强度有統計上明顯的差異，p值分別為0.029及0.039。
結論：運用純音比對的方法來量測病患耳鳴頻率及强度在本研究有限樣本數中呈現較低的再現性，本研究結果建議除參考該指標外，應再納入臨床上其他方式的評估，以求有效表現病患耳鳴的程度。這樣的結果較符合耳鳴之神經生理模型的基本主張。因爲病患對耳鳴的感受取决於整體聲音訊號處理過程的總加成，其耳鳴訊號的特質事實上是各個感受系統交互作用結果的呈現，而不單純爲純音之機械特質的表現。如何客觀地描述病患的耳鳴，量測的比對音源應更加多樣化以及量測的主體應該更逼近腦部處理聲音訊號的相關部位才合理。

關鍵字

耳嗚 ； 比對 ； 頻率 ； 強度

並列摘要

BACKGROUND: Tinnitus is a common problem of the auditory system affecting about 17% of the general population in USA and up to 33% of the elderly. About a quarter of these people (approx. 1 million patients in Taiwan) ale significantly affected by their tinnitus and have sought professional help. Since tinnitus perception is subjective by its nature, there are no objective measurements that can be related to it. For years clinicians have applied frequency and intensity matching as a means of tinnitus evaluation. Thus, it would be interesting to know if the test-retest reliability of this method is adequate as a clinical indicator of tinnitus severity.
METHODS: Between September 2002 and February 2003, patients were recruited who claimed that they suffered from tinnitus that was unchanged in pitch and loudness. Measurements were carried out on these patients to quantify the pitch and loudness of the tinnitus by pure-tone matching of frequency and intensity. Two measurements were performed at an interval of four weeks. A paired t test was adopted to analyze the test-retest reliability of the two measurements and to determine if there is any statistically significant difference between the two results.
RESULTS: 23 subjects aged from 13 to 64 (average 43.5) years were recruited in this study. All had suffered from tinnitus for more than 6 months. Two measurements were performed based on the premise that the patient's tinnitus was unchanged in pitch and loudness. The results were compared by paired t test for the matching of frequency and intensity and the p values were 0.029 and 0.039, respectively. Thus, there is a statistically significant difference between the two measurements for subjectively unchanged tinnitus.
CONCLUSIONS: The test-retest reliability of tinnitus matching with pure tone on frequency and intensity was quite limited in this study. Matching tinnitus with a pure tone is shown to be an ineffective indicator and other clinical evaluations should be included for a comprehensive evaluation of tinnitus severity. According to the neurophysio logical model of tinnitus, the limited reproducibility of the matching results is attributable to involvement in tinnitus perception of multiple systems. For better evaluation of a patient's tinnitus, the sound to be matched should be diversified and the targets of measurement should include the related central auditory systems and relevant systems of perception.

並列關鍵字

tinnitus ； matching ； frequency ； intensity