[[alternative]]Comparison of Prescriptive Targets for Sensorineural Hearing Impaired Adults Who Use Digital Hearing Aids

[[abstract]]本研究旨在探討感音神經性聽力損失人配戴數位助聽器時，NAL-NL1選配法和DSL v5.0成人版選配法目標值之差異、選配法建議的聆聽級和助聽器配戴者偏好的聆聽級之差異，及在日常生活中配戴這二個選配法後的評比及原因分析，以期作為在成人助聽器選配時運用DSLv5.0之參考。本研究募集16名目前配戴NAL-NL1選配法驗證的助聽器使用者，以其本身使用的助聽器進行研究。個別取得其配戴以NAL-NL1和DSL v5.0選配法驗證之真耳戴助聽器反應目標值，並以paired t-test檢驗其NAL-NL1 和DSL v5.0選配法，3個刺激音 (55, 70 dB SPL語音、85 dB SPL純音) 在各頻率目標值差異的顯著性。再分別以70 dB SPL語音為刺激音進行個人偏好聆聽級之量測，並以線性迴歸和paired t-test分析二種選配法的建議聆聽級和個人偏好聆聽級之關係。受試者在使用DSL v5.0選配法驗證助聽器二星期後，施以選配法評量表問卷，探討選配法主觀的偏好。研究結果：本研究計16位受試者共26耳進行目標值分析，55 dB SPL刺激音時，在1000至3000 Hz處，NAL-NL1建議的目標值皆大於DSL v5.0建議的目標值且有顯著差異；70 dB SPL刺激音時，NAL-NL1在低頻和高頻的目標值皆小於DSL v5.0目標值，在中頻處，NAL-NL1建議的目標值大於DSL v5.0建議的目標值。除了4 kHz外，其他頻率NAL-NL1的飽和聲壓目標值皆小於DSL v5.0的目標值。NAL-NL1選配法建議的聆聽級和主觀偏好聆聽級的差異有顯著性，而DSL v5.0選配法建議的聆聽級和主觀偏好聆聽級之間的差異則無顯著性，故DSL選配法的目標值較接近助聽器配戴者偏好的聆聽級。16名受試者中，有10名喜歡DSL v5.0驗證法的表現，3名不喜歡，3名覺得二者表現是一樣的。因應聽力損失兒童擴音需求的DSL 4.0用於成人助聽器配戴時常出現過高的目標值，因此臨床上採用NAL-NL1選配法作為成人助聽器驗證已行之有年。但根據本研究結果的呈現，DSL v5.0成人版目標值和NAL- NL1選配法目標值的差異型態與過去DSL 4.0和NAL- NL1選配法目標值差異的型態已有所不同；受試者主觀的偏好聆聽級也較接近DSL v5.0的建議聆聽級；受試者主觀評比較多的受試者覺得DSLv5.0表現比NAL-NL1好。建議DSL v5.0 選配法可運用在成人助聽器選配和驗證流程。[[abstract]]Prescribed target is regarded as the starting point of hearing aid fitting. NAL and DSL are two generic fitting methods which have been used in hearing aid fitting and verification worldwide. The purpose of this study was to determine the relationship of prescribed targets, wearers’ preferred listening level and acceptance between NAL-NL1 and DSL v 5.0 adult version.Sixteen current hearing aid wearers with mild to severe sensorineural hearing loss were recruited. Ten of them are binaural wearers and six are monaural wearers. Their own hearing aids were used for the study. All hearing aids have been verified by NAL-NL1 before the study. Real Ear Mesurement (REM) was conducted to collect Real Ear Aided Response (REAR). Three different stimuli (55, 70 dB SPL speech and 85 dB SPL pure tone) were used for the REM. 70 dB SPL recorded speech stimuli was used for the Preferred Listening Level test. Then the hearing aids were programmed and verified with DSL v5.0. REAR of targets and of PLL for both NAL-NL1 and DSL v5.0 were recorded. Finally a Fitting Methold Preferrence questionnaire was used to determine wearer’s acceptance of DSL v5.0. Paired t-test was used for the target comparison. Linear regression and Paired t-test were used for the comparison of recommended listening level and preferred listening level. For 55 dB SPL speech stimulus, NAL-NL1 REAR targets at 1000 to 3000 Hz were greater than those of DSL v50. For 70 dB SPL speeh stimulus, NAL-NL1 REAR targets at low and high frequencies were less than those of DSL v5.0, but NAL-NL1 REAR targets were more than DSL v5.0 REAR at mid frequencies. For RESR, all frequencies except for 4000 Hz，NAL-NL1 prescribed less RESR. Linear regression of the recommended listening level (RLL) and preferred listening level (PLL) suggested subjects’ PLLs were less than the recommended. The paired t-test result suggested there was significant difference (*p