以華語可接受噪音量預測聽力損失成人之助聽器使用率

Predicting the Frequency of Hearing-Aid Use by Using Unaided Mandarin Acceptable Noise Level Values

國外研究發現選配前量測個人的「可接受噪音量」（acceptable noise level, ANL），可預測未來助聽器配戴後的使用狀態。本研究目的是建構華語可接受噪音量（Mandarin ANL, M-ANL）與助聽器使用率之對應關係及其預測效力。研究工具為華語版ANL測驗及「助聽器使用現況調查問卷」，以個案有助聽需求時的使用率作為助聽器使用頻繁度的判斷標準。126位助聽器使用者參與本研究，依現有助聽器有無開啟噪音處理技術分成兩組（無功能組50人，有功能組76人）。研究結果如下：一、全體平均未助聽華語ANL值5.84dB（SD＝4.42dB，範圍-3～18dB）；二、未助聽華語ANL值和助聽器使用率有顯著的負相關（p＜.001），即華語ANL值愈小，助聽器使用率就愈高；三、助聽器高頻繁使用者平均未助聽華語ANL值在無功能組為4.33dB（SD＝3.41），有功能組是4.85dB（SD＝4.01）；四、未助聽華語ANL值≦5dB，有85％以上機率成為助聽器高頻繁使用者，未助聽華語ANL值＞13dB（無功能組）或未助聽華語ANL值＞17dB（有功能組），易成為助聽器低頻繁使用者，無功能組整體預測正確率是86.0％，有功能組為80.3％。本研究最重要的成果是建構國內助聽器使用者之未助聽華語ANL值相關數據，也佐證助聽器內建訊號處理技術會改變華語ANL值。臨床應用建議選配前量測華語ANL測驗，適時提供聽覺輔具進階技術與諮商，提升助聽輔具購買後的配戴使用率。另須留意未助聽的華語ANL值僅能解釋聽損者未來助聽器使用率的少部分，仍有多數未知的影響因素需要進一步探討。 Purpose: Studies have revealed that acceptable noise level can be used to predict the use of hearing aids even before the fitting of the aids. The aim of this study was to develop a corresponding relationship between Mandarin acceptable noise level (M-ANL) and the frequency of hearing-aid use as well as the predictive effectiveness of M-ANL test. The M-ANL test provides clinical professionals a tool to assess how often a particular hearing aid might be used in the future. The frequency of hearing-aid use is defined as the percentage of the hearing-aid use whenever it is required.Methods: The M-ANL test and a questionnaire pertaining to hearing-aid use were the tools used in this study. A total of 126 hearing-aid users participated in the experiment. The participants were categorized into two groups on the basis of whether the noise reduction features (NRFs) of their hearing aids were turned on or off. The group in which the NRFs were off (NRFoff group) comprised 50 participants, and the group in which the NRFs were on (NRF-on group) comprised 76 participants. Results/Findings: (1) The average of unaided M-ANL values for all participants was 5.84 dB (SD = 4.42, range = -3 to +18 dB). (2) There was a significant negative correlation between unaided M-ANL values and the frequency of hearing-aid use (p < .001). Specifically, the lower the unaided M-ANL values were, the higher the frequency of hearing-aid use became, and vice versa. (3) In the NRF-off group and NRF-on group, the average unaided M-ANL values of hearing-aid users who used the hearing aids frequently were 4.33 dB (SD = 3.41) and 4.85 dB (SD = 4.01), respectively. (4) Logistic regression curves revealed that if unaided M-ANL values were lower than 5 dB, then the probability of a hearing-aid user becoming a frequent user was more than 85%. Moreover, if unaided M-ANL values were greater than 13 dB in the NRF-off group and greater than 17 dB in the NRF-on group, then participants would become less frequent hearing-aid users (the odds of becoming a frequent user were less than 20%). Furthermore, unaided M-ANL values could accurately predict 86.0% (NRFoff group) and 80.3% (NRF-on group) of hearing-aid usage patterns.Conclusions/Implications: One of the most crucial achievements of this study is the determination of ANL values in Mandarin-speaking hearing-aid users. This study also verified that fitting a high-order hearing aid with more signal processing technologies would alter M-ANL values and increase the use of hearing aids. Thus, it is recommended to conduct the M-ANL test before hearing aids are fitted. The results of this study provide insights in informational counseling regarding advanced hearing-aid technologies. This can in turn improve the frequency of hearing-aid use. In clinical application, the unaided M-ANL value is one of the factors for predicting hearing-aid use; there are many unknown factors that should be investigated.