[[alternative]]The Effect of Tinnitus Retraining Therapy on the ANL of the Tinnitus Patients

[[abstract]]本研究欲探索耳鳴患者對於內在噪音（耳鳴）的接受度，可否同等反映在對於外在環境噪音的接受度。研究中分析耳鳴減敏治療（TRT）是否改變耳鳴患者之可接受噪音值（ANL），並探討治療前後，患者耳鳴障礙量表（THI）分數變化與ANL變化，兩者之相關。 完成研究計劃六個月TRT療程之受試者共19名，為了瞭解同意接受TRT之患者於治療前之ANL數值，與未受TRT治療的耳鳴患者之間，其ANL數值是否具顯著差異，因此另收集20名耳鳴患者為對照組。檢定顯示兩組ANL無顯著差異。 THI得分數為量化患者耳鳴障礙程度之工具，研究結果顯示受試者在接受TRT後，耳鳴障礙程度可見顯著改善，但ANL則無顯著變化。在不同變項於TRT前後變化量的部分，THI分數變化量與ANL變化量在治療前後之相關雖未達顯著水準，但具有正相關趨勢（r=0.434, p=0.063）。進一步分析THI及三項子量表（功能、情緒及災厄子量表）分數，以及ANL、最舒適音量（MCL）與背景噪音量上限（BNL）等變項治療前後變化量，結果指出THI分數變化量與BNL變化量有顯著負相關（p<0.05），而THI功能子量表分數改變量分別與ANL改變量呈正相關（p<0.05），與BNL變化量呈現負相關關係（p<0.01）。 臨床上常以量表或問卷評估患者對於耳鳴的感受，然而根據本研究結果，顯示個體對於耳鳴的接受及適應力似乎亦可藉由客觀的BNL測試結果來表現。而ANL測試雖然在六個月TRT療程前後無顯著變化，但可藉由THI功能子量表的分數變化觀察到趨勢，換言之，隨著耳鳴在生活功能障礙的改善越多，患者越有在較大背景噪音下聽取語音之傾向。建議在後續的研究方面，可增加受試者人數以及以更長的治療追蹤時間，以進一步探究聽能訓練的方式及時長對於ANL的影響力。[[abstract]]The purpose of this study aimed to explore whether tinnitus patients’ acceptance of internal noise (tinnitus) could response to their acceptance of external background noise. This study explored whether the acceptable noise level (ANL) of patients with tinnitus could be affected by tinnitus retraining therapy (TRT), and to explore the correlation between change of tinnitus handicap inventory (THI) scores and that of ANL before and after 6-months TRT. There were 19 tinnitus subjects who would receive TRT (experimental group) and 20 tinnitus subjects without TRT (control group) in this study. ANLs of those patients with and without TRT were compared. No significant difference in the ANL result between the two groups was found. THI scores could reflect the degree of patients’ tinnitus distress. Results of this study revealed that the TRT may improve the tinnitus distress, but no significant change in ANL. The correlation between the change of THI scores and that of ANL before and after treatment was positive but not significant (r=0.434, p=0.063). We further analyzed the variation of three THI subscales (functional, emotional and catastrophic subscales), ANL, MCL and BNL, The results showed a significant negative correlation between variation of THI score and that of BNL. Furthermore, THI-functional subscale was positively correlated to variation of ANL (p<0.05), and negatively correlated to variation of BNL (p