- 學位論文
雙耳複頻聽性穩定狀態誘發反應預估職業噪音暴露與非噪音暴露聽力損失之聽力閾值
Prediction of Audiometric Thresholds Using Dichotic Multiple-Frequency Auditory Steady-State Responses in Noise-Exposure and Non-Exposure Hearing Impaired Subjects
摘要
目的：應用雙耳複頻聽性穩定狀態誘發反應（Mf-ASSR）預估噪音暴露工人之噪音性聽障及聽力閾值。另用統計方法比較Mf-ASSR預測聽力閾值的準確度於噪音性聽力損失勞工與一般非噪音暴露聽力損失的族群有無不同，以及Mf-ASSR各頻率的表現有無差異，並建立Mf-ASSR預測聽力閾值的模型。 方法：同時給予兩耳四個頻率刺激音(0.5,1,2,and 4kHz)，記錄34位噪音引起聽力損失工人及36位非噪音暴露聽力損失者的Mf-ASSR聽力閾值，評估Mf-ASSR與行為聽力閾值的相關及兩組間預估聽力閾值的準確度，並建立預測模型。 結果：Mf-ASSRs的預估聽力圖形與行為聽力圖形一致，兩者高度相關(r=0.85~0.95)，多因子預測模型預測準確度達0.9。兩者平均差值，在噪音性聽力損失勞工組介於11∼20dB，在一般非噪音暴露聽力損失族群介於6∼13dB，ANOVA統計分析顯示兩者差值平均在噪音性聽力損失勞工與一般非噪音暴露聽力損失族群間及在500Hz與其他頻率之間，有顯著差異。 結論：Mf-ASSR評估聽力閾值是可靠的，重複量數混和模型可以準確預估聽力閾值，是否噪音暴露引起的聽力損失和頻率會影響ASSR反應。
並列摘要
Objective: This study evaluated the usefulness of dichotic multiple-frequency auditory steady-state response (Mf-ASSR) to predict hearing threshold and audiogram of noise-induced hearing impaired in noise exposure workers. To evaluate the accuracy, using statistical methods, of the prediction of Mf-ASSRs in a large sample of sensorineural hearing impairment subjects with and without noise exposure. Design: The Mf-ASSR was recorded in a sample of 34 noise-induced hearing impairment workers (NIHL) and 36 non-noise-exposure hearing impaired subjects. Simultaneous carrier frequencies (0.5, 1, 2, and 4kHz) were presented binaurally. The correlation of Mf ASSR and behavioral thresholds were evaluated across all subjects. The accuracy of ASSR thresholds was compared across groups. A predicting equation with multivariate was calculated. Results: The results showed that, on average, ASSR threshold curves corresponded well with behavioral audiometric contour averaged across subjects. Multiple-ASSR threshold were 20±8, 16±9, 12±9 and 11±12dB above behavioral thresholds for 0.5, 1, 2, and 4 kHz, respectively. Behavioral and multiple-ASSR thresholds were significantly correlated (r=0.77-0.89). We confirmed the ASSR to be used in predicting hearing threshold in the noise-induced hearing-impaired subjects. ASSR and behavioral thresholds were strongly correlated across all subjects, with r-value between 0.85~0.95. And the r-square of the predicting regression equation was 0.9. In three-way repeated measures analysis of variance, the difference thresholds between ASSR and behavioral thresholds were significant higher in the NIHL subjects than in non-noise-exposure hearing-impaired subjects and for the 500Hz frequency compared with the higher frequencies. Conclusions: Noise exposure or not and carrier frequency have a significant effect on steady state response. Mf -ASSR was proved to be a valid technique for estimating hearing thresholds, and a mixed model of regression equation can accurately predict the thresholds with all the effect factors.