[[alternative]]The Effects of Hearing Aid Fitting on Tinnitus in Patients with Hearing Loss: Outcome and Relating Factors

[[abstract]]目的：本研究的目的是探討聽力損失病患同時有耳鳴困擾時，佩戴助聽器對耳鳴症狀的影響。耳鳴神經生理起源的理論與近期相關研究，揭露出利用擴音系統逆轉中樞聽覺神經系統可塑性的變化，從而減輕耳鳴症狀的可能性。本研究探討了可能會影響結果的相關因素並找出預測變項。材料與方法：本研究分別使用耳鳴量表(VAS)與耳鳴問卷(THI)以評估聽力損失病患在選配助聽器前後，耳鳴症狀改善的程度。共有83人參與VAS量表訪問，其中25人另外參與了THI的問卷評估。使用t檢定助聽器選配前後耳鳴分數改善幅度是否達到顯著，再將兩種量表所得到的耳鳴症狀改善程度與受試者的年齡、性別、優耳平均聽閾級、聽力圖型態、耳鳴困擾時間、未選配助聽器前的耳鳴嚴重程度、助聽器的種類、單雙耳選配、平均每天使用助聽器的時間等變項分別進行相關研究。並利用多元迴歸分析找出耳鳴改善效果的預測變項。結果：VAS量表與THI問卷的耳鳴分數在助聽器選配前與選配後的分數均達到顯著的改善。VAS量表的平均改善分數為22.7分，THI問卷的平均改善分數為17.4分。VAS量表中有81%的受試者分數得到改善，THI問卷中有88%的受試者分數得到改善。與VAS量表改善程度達到顯著相關的變項為每天平均使用助聽器的時間，與THI問卷改善程度達到顯著相關的變項為未選配助聽器前的THI問卷分數。多元迴歸逐步分析結果，VAS量表改善幅度的預測變項為每天平均使用助聽器時間大於8小時，其次為緩降型聽損型態。THI問卷改善幅度的預測變項為平坦型聽損型態。結論：在本次研究聽力損失合併耳鳴困擾的病患選配數位助聽器，約達8成的病患可以達到部份舒緩耳鳴症狀的效果。舒緩耳鳴症狀的效果與每天使用助聽器的時間有關，也與尚未選配助聽器前的耳鳴嚴重程度有關。每天平均使用助聽器的時間是否大於8小時，可以做為選配助聽器幫助舒緩耳鳴症狀的有效預測指標。[[abstract]]Objective: The aims of this study were to assess the effects of hearing aid fitting on tinnitus in patients with hearing loss. Recent studies in animal models of neural plasticity revealed the possibility of using amplification to reverse the central auditory plasticity changes and to decrease the symptoms of tinnitus. This study also probed into relating factors and predicting variables of these effects.Methods: VAS and THI tinnitus questionnaires were employed to evaluate tinnitus severity before and after hearing aid fitting. VAS questionnaires were administered to 83 patients, which contains 25 patients received both VAS and THI questionnaires. T-test was used to test the differences of pre- and post- fitting VAS and THI scores. Correlation analysis was also performed for factors including age, gender, PTA of better ear, types of audiogram, tinnitus duration, pre-fitting tinnitus severity, types of hearing aids, uni- or bi- lateral fitting and average wearing time per day. Multiple regression analysis was used to find out the predictive variables of tinnitus improvement.Result: There was a significant improvement between pre- and post hearing aids fitting on both VAS and THI tinnitus scores. The average improvement of VAS scores was 22.7. The average improvement of THI scores was 17.4. 81% VAS patients reported that hearing aids helped their tinnitus. 88% THI patients reported that hearing aids helped their tinnitus. VAS correlation factor was “average wearing time per day”. THI correlation factor was “pre-fitting tinnitus severity of THI scores”. The first predictive variable of VAS improvement was “<8 hours average wearing time per day”, the second was “gradually sloping audiogram”. The predictive variable of THI improvement was “flat audiogram”.Conclusion: There is a positive effect of digital hearing aids fitting on relief of tinnitus in patients with hearing loss. About 80% patients with hearing loss got some relief of their tinnitus. The effect of tinnitus relief was related to average wearing time per day and pre-fitting tinnitus severity. The predictive variable of tinnitus relief was