台灣電子耳兒童現況調查研究－電子耳使用、聽覺能力、口語溝通能力表現

Cochlear Implanted Children in Taiwan Ⅰ: Device Use, Auditory Performance, and Communication Skills

10.6143/JSLHAT.2009.01.03

王南梅(Nan-Mai Wang)；郭于靚(Yu-Ching Kuo)；黃國祐(Kuo-You Huang)；劉樹玉(Shu-Yu Liu)；劉俊榮(Chun-Jung Liu)

台灣電子耳兒童 ； 電子耳使用現況 ； 輔具補助 ； 聽覺表現 ； 口語溝通能力 ； Cochlear implanted children ； Device use ； Device reimbursement ； Auditory performance ； Oral communication skills

台灣聽力語言學會雜誌

22期（2009 / 01 / 01）

55 - 85

繁體中文

國內人工電子耳植入術發展二十餘年，雖然電子耳術的醫療團隊技術水準、聽能復健團隊資源已經漸趨完整，但缺乏跨電子耳醫療中心之群體研究，尤其兒童電子耳使用現況，表現於口語溝通、聽覺能力、就學、學習、生活品質等項目，作為廣泛性之電子耳聽覺輔具使用成效，並進一步提供政府單位對聽覺輔具補助、聽障者福利政策的擬定與參考。本研究目的包括：一、提供現階段國內電子耳兒童使用者基本資料；二、提供電子耳使用現況；三、提供電子耳兒童之聽覺能力表現；四、提供電子耳兒童的口語溝通能力表現。研究方法：本研究方法以家長填答式問卷調查進行，受訪對象為國內七家電子耳中心醫學中心之18歲以下佩戴電子耳兒童，以描述統計方式進行資料分析。結果顯示229位電子耳兒童平均年齡9.75歲（2.3歲至18.8歲），電子耳植入時間以3.5歲分兩組（＜3.5歲、≧3.5歲），電子耳佩戴時間分三組（＜4年、4-6年、≧6年），總計六個組別。六組的男女比例接近、86.5%電子耳兒童僅具聽障，94.3%兒童領有重度以上聽障殘障手冊、79%聽損年齡在二歲以前、95.6%雙親聽力正常、76.9%兒童在學、64.6%佩戴電子耳後仍有不同程度之聽覺困難；而30.5%兒童有不同程度操作電子耳困難度，89.5%家長認為電子耳是正確決定。81.7%的電子耳獲得補助，平均補助金額35萬元，個案之間補助差異頗大。電子耳維修頻率每年約2次、維修金額每年約1萬2仟元。94.2%電子耳兒童曾接受聽能訓練，而其中由語言治療師執行者占74.7%，聽能訓練時間為3.05年。電子耳機型以澳洲Cochlear公司的機型最多占78.2%、63.4%電子耳語音處理器為口袋型；97%兒童經常且持續使用電子耳、每天使用時間80.6%在8-16小時之間。九類聽覺層級的聽能表現顯示，5.6%無法聽懂任何語音、76.3%使用者可以聽懂熟人以上的話語、58%使用者可以使用電話。77.3%使用者安靜環境下可以聽懂大部分對話、吵雜環境下只有38.9%可以聽懂大部分對話。60.8%兒童可以聽懂陌生人話語或使用電話交談；僅有40.2%使用者的口語清晰度可以讓大部分人聽懂。本調查提供國內現階段電子耳兒童對聽覺輔具使用現況，依其個案特色、輔具操作、補助、維修現況、到聽覺改善、口語溝通表現，雖然九成的家長都認為電子耳佩戴是相當正確的決定，然而使用者資料與各項能力表現，仍有改善空間。而未來政府單位需要規劃國家型聽覺研究中心，建立全國性電子耳使用者資料庫，提供衛生醫療、復健、教育、輔具、福利等政策參考，並進一步提供國內研究者進行跨專業領域與跨中心之全國性研究，以落實造福國內的聽障人口。

Objectives: The objectives of this study were to examine: (1) demographic data of cochlear implanted children in Taiwan; (2) background information of implant use; (3) auditory performance of implanted children; and (4) communication skills of those children. Study Design: In a cross-sectional study, the parents of a representative sample of cochlear implanted children were invited to complete questionnaires regarding to children's background information, device use related information, auditory performance, and spoken communication skills. A parental questionnaire investigation was conducted on cochlear implanted children under age 18 from the cochlear implant centers of 7 major hospitals. A descriptive statistics was conducted to analyze data in SPSS v.12. Results: The results demonstrated that 229 respondents served as a valid sample with a mean age of 9.75 years (2.3-18.8y), six groups of children were classified based on their implantation age at 3.5 years, and three lengths of implant use. 86.5% of children had hearing disorders only, the age onset of hearing loss was before age 2 among 79% of children, 95.6% of children’s parents with normal hearing, and 76% of them studied at school. 64.6% of them had listening difficulties and 30% of them had difficulties operating their devices, and 59.4% of them used other hearing devices to supplement their implants. Totally 89.5% of respondents agreed that cochlear implantation was a right decision. 81.7% of implants were reimbursed, an average fee was NT $350,000. Yearly, the devices needed repair twice, the mean cost was NT $12,000. 94.2% of children had received auditory training, 74.7% of training was conducted by speech therapists, duration of training was 3.05 years. 78.2% of implant devices were Australian Nucleus products and 63.4% of speech processor were pocket type. 97% of children used the devices frequently and 80.6% of them used the devices within 8-16 hours daily. Auditory performance with CAPR indicated that 5.6% of children reached under level 3, 76.3% of them reached over level 6, and 58% of them could use telephone. Speech understanding showed 77.3% vs. 38.9% of children understood the majority of conversation in quiet or in noisy environment. Speech perception demonstrated 61% of children could understand strangers and 40.2% of children could be understood by a majority of listeners. Conclusion: This study has provided current status of device use, auditory performance, and communication skills among 229 cochlear implanted children in Taiwan. To establish a nationwide hearing research institute is a must to support policy making decisions for the Government also to upgrade social welfare for the hearing-impaired, also to conduct national research on hearing and hearing disorders.

1. 劉秀丹（2004）。啟聰學校學生文法手語、自然手語及書面與故事理解能力之研究。Unpublished manuscript，台灣彰化。
2. 九十七年第三十四週內政統計通報。（檢自：http://www.moi.gov.tw/news_detail.aspx?type_code=01&sn=1324）
3. Incidence and Prevalence of Hearing Loss and Hearing Aid Use in the United States (2008). from http://www.asha.org/NR/rdonlyres/1785DC45-7DA4-4FDD-921E-0C2A32F4C9C2
4. Allen, M. C.,Nikolopoulos, T. P.,O''Donoghue, G. M.(1998).Speech intelligibility in children after cochlear implantation.Am J Otol,19(6),742-746.
5. Archbold, S. M.,Nikolopoulos, T. P.,Lloyd-Richmond, H.(2008).Long-term use of cochlear implant systems in paediatric recipients and factors contributing to non-use.Cochlear Implants Int.,10(1),25-40.
6. Archbold, S. M.,Nikolopoulos, T. P.,Lutman, M. E.,O''Donoghue, G. M.(2002).The educational settings of profoundly deaf children with cochlear implants compared with age-matched peers with hearing aids: Implications for management.Int J Audiol,41(3),157-161.
7. Archbold, S.,Harris, M.,O''Donoghue, G.,Nikolopoulos, T.,White, A.,Richmond, H. L.(2008).Reading abilities after cochlear implantation: The effect of age at implantation on outcomes at 5 and 7 years after implantation.Int J Pediatr Otorhinolaryngol,72(10),1471-1478.
8. Archbold, S.,Robinson, K.(1997).A European perspective on pediatric cochlear implantation, rehabilitation services, and their educational implications.Am J Otol,18(6 Suppl.),S75-78.
9. Barton, G. R.,Fortnum, H. M.,Stacey, P. C.,Summerfield, A. Q.(2006).Hearing-impaired children in the United Kingdom, III: Cochlear implantation and the economic costs incurred by families.Ear & Hearing,27(5),563-574.
10. Barton, G. R.,Stacey, P. C.,Fortnum, H. M.,Summerfield, A. Q.(2006).Hearing-impaired children in the United Kingdom, II: Cochlear implantation and the cost of compulsory education.Ear & Hearing,27(2),187-207.
11. Beadle, E. A.,McKinley, D. J.,Nikolopoulos, T. P.,Brough, J.,O''Donoghue, G. M.,Archbold, S. M.(2005).Long-term functional outcomes and academic-occupational status in implanted children after 10 to 14 years of cochlear implant use.Otol Neurotol,26(6),1152-1160.
12. Blanchfield, B. B.,Feldman, J. J.,Dunbar, J. L.,Gardner, E. N.(2001).The severely to profoundly hearing-impaired population in the United States: Prevalence estimates and demographics.J Am Acad Audiol,12(4),183-189.
13. Chia, E.-M.,Wang, J. J.,Rochtchina, E.,Cumming, R. R.,Newall, P.,Mitchell, P.(2007).Hearing impairment and health-related quality of life: The blue mountains hearing study.Ear & Hearing,28(2),187-195.
14. Connor, C. M.,Craig, H. K.,Raudenbush, S. W.,Heavner, K.,Zwolan, T. A.(2006).The age at which young deaf children receive cochlear implants and their vocabulary and speech-production growth: Is there an added value for early implantation?.Ear & Hearing,27(6),628-644.
15. Damen, G. W.,Krabbe, P. F.,Archbold, S. M.,Mylanus, E. A.(2007).Evaluation of the parental perspective instrument for pediatric cochlear implantation to arrive at a short version.Int J Pediatr Otorhinolaryngol,71(3),425-433.
16. Damen, G. W.,van den Oever-Goltstein, M. H.,Langereis, M. C.,Chute, P. M.,Mylanus, E. A.(2006).Classroom performance of children with cochlear implants in mainstream education.Ann Otol Rhinol Laryngol,115(7),542-552.
17. Fagan, M. K.,Pisoni, D. B.,Horn, D. L.,Dillon, C. M.(2007).Neuropsychological correlates of vocabulary, reading, and working memory in deaf children with cochlear implants.J Deaf Stud Deaf Educ,12(4),461-471.
18. Fortnum, H. M.,Stacey, P. C.,Summerfield, A. Q.(2006).An exploration of demographic bias in a questionnaire survey of hearing-impaired children: Implications for comparisons of children with and without cochlear implants.Int J Pediatr Otorhinolaryngol,70(12),2043-2054.
19. Geers, A. E.(2003).Predictors of reading skill development in children with early cochlear implantation.Ear & Hearing,24(1 Suppl.),S59-68.
20. Geers, A. E.(2004).Speech, language, and reading skills after early cochlear implantation.Arch Otolaryngol Head Neck Surg,130(5),634-638.
21. Geers, A. E.,Nicholas, J. G.,Sedey, A. L.(2003).Language skills of children with early cochlear implantation.Ear & Hearing,24(1 Suppl.),S46-58.
22. Geers, A.,Brenner, C.(2003).Background and educational characteristics of prelingually deaf children implanted by five years of age.Ear & Hearing,24(1 Suppl.),S2-14.
23. Geers, A.,Brenner, C.,Davidson, L.(2003).Factors associated with development of speech perception skills in children implanted by age five.Ear & Hearing,24(1 Suppl.),S24-35.
24. Govaerts, P. J.,De Beukelaer, C.,Daemers, K.,De Ceulaer, G.,Yperman, M.,Somers, T.(2002).Outcome of cochlear implantation at different ages from 0 to 6 years.Otol Neurotol,23(6),885-890.
25. Huang, C. Y.,Yang, H. M.,Sher, Y. J.,Lin, Y. H.,Wu, J. L.(2005).Speech intelligibility of Mandarin-speaking deaf children with cochlear implants.Int J Pediatr Otorhinolaryngol,69(4),505-511.
26. Huber, M.(2005).Health-related quality of life of Austrian children and adolescents with cochlear implants.Int J Pediatr Otorhinolaryngol,69(8),1089-1101.
27. Huber, M.,Wolfgang, H.,Klaus, A.(2008).Education and training of young people who grew up with cochlear implants.Int J Pediatr Otorhinolaryngol,72(9),1393-1403.
28. Izzo, A.(2002).Phonemic awareness and reading ability: An investigation with young readers who are deaf.Am Ann Deaf,147(4),18-28.
29. Kyle, F. E.,Harris, M.(2006).Concurrent correlates and predictors of reading and spelling achievement in deaf and hearing school children.J Deaf Stud Deaf Educ,11(3),273-288.
30. Laszig, R.,Aschendorff, A.,Stecker, M.,Muller-Deile, J.,Maune, S.,Dillier, N.(2004).Benefits of bilateral electrical stimulation with the nucleus cochlear implant in adults: 6-month postoperative results.Otol Neurotol,25(6),958-968.
31. Marschark, M.,Rhoten, C.,Fabich, M.(2007).Effects of cochlear implants on children's reading and academic achievement.J Deaf Stud Deaf Educ,12(3),269-282.
32. Nikolopoulos, T. P.,Archbold, S. M.,Gregory, S.(2005).Young deaf children with hearing aids or cochlear implants: Early assessment package for monitoring progress.Int J Pediatr Otorhinolaryngol,69(2),175-186.
33. Nikolopoulos, T. P.,Lloyd, H.,Archbold, S.,O''Donoghue, G. M.(2001).Pediatric cochlear implantation: The parents' perspective.Arch Otolaryngol Head Neck Surg,127(4),363-367.
34. Nunes, T.,Pretzlik, U.,Ilicak, S.(2005).Validation of a parent outcome questionnaire from pediatric cochlear implantation.J Deaf Stud Deaf Educ,10(4),330-356.
35. O''Donoghue, G. M.,Nikolopoulos, T. P.,Archbold, S. M.,Tait, M.(1999).Cochlear implants in young children: The relationship between speech perception and speech intelligibility.Ear Hear,20(5),419-425.
36. O''Neill, C.,Lutman, M. E.,Archbold, S. M.,Gregory, S.,Nikolopoulos, T. P.(2004).Parents and their cochlear implanted child: Questionnaire development to assess parental views and experiences.Int J Pediatr Otorhinolaryngol,68(2),149-160.
37. O''Neill, C.,O''Donoghue, G. M.,Archbold, S. M.,Normand, C.(2000).A cost-utility analysis of pediatric cochlear implantation.Laryngoscope,110(1),156-160.
38. Orabi, A. A.,Mawman, D.,Al-Zoubi, F.,Saeed, S. R.,Ramsden, R. T.(2006).Cochlear implant outcomes and quality of life in the elderly: Manchester experience over 13 years.Clin Otolaryngol,31(2),116-122.
39. Peng, S. C.,Weiss, A. L.,Cheung, H.,Lin, Y. S.(2004).Consonant production and language skills in Mandarin-speaking children with cochlear implants.Arch Otolaryngol Head Neck Surg,130(5),592-597.
40. Ramsden, R.,Greenham, P.,O''Driscoll, M.,Mawman, D.,Proops, D.,Craddock, L.(2005).Evaluation of bilaterally implanted adult subjects with the nucleus 24 cochlear implant system.Otol Neurotol,26(5),988-998.
41. Richter, B.,Eissele, S.,Laszig, R.,Lohle, E.(2002).Receptive and expressive language skills of 106 children with a minimum of 2 years' experience in hearing with a cochlear implant.Int J Pediatr Otorhinolaryngol,64(2),111-125.
42. Sach, T. H.,Whynes, D. K.,Archbold, S. M.,O''Donoghue, G. M.(2005).Estimating time and out-of-pocket costs incurred by families attending a pediatric cochlear implant programme.Int J Pediatr Otorhinolaryngol,69(7),929-936.
43. Schulze-Gattermann, H.,Illg, A.,Schoenermark, M.,Lenarz, T.,Lesinski-Schiedat, A.(2002).Cost-benefit analysis of pediatric cochlear implantation: German experience.Otol Neurotol,23(5),674-681.
44. Spencer, L. J.,Barker, B. A.,Tomblin, J. B.(2003).Exploring the language and literacy outcomes of pediatric cochlear implant users.Ear & Hearing,24(3),236-247.
45. Stacey, P. C.,Fortnum, H. M.,Barton, G. R.,Summerfield, A. Q.(2006).Hearing-impaired children in the United Kingdom, I: Auditory performance, communication skills, educational achievements, quality of life, and cochlear implantation.Ear & Hearing,27(2),161-186.
46. Steffens, T.,Lesinski-Schiedat, A.,Strutz, J.,Aschendorff, A.,Klenzner, T.,Ruhl, S.(2008).The benefits of sequential bilateral cochlear implantation for hearing-impaired children.Acta Otolaryngol,128(2),164-176.
47. Tait, M.,Nikolopoulos, T. P.,Archbold, S.,O''Donoghue, G. M.(2001).Use of the telephone in prelingually deaf children with a multichannel cochlear implant.Otol Neurotol,22(1),47-52.
48. Thoutenhoofd, E.(2006).Cochlear implanted pupils in Scottish schools: 4-year school attainment data (2000-2004).J Deaf Stud Deaf Educ,11(2),171-188.
49. Tyler, R. S.,Dunn, C. C.,Witt, S. A.,Preece, J. P.(2003).Update on bilateral cochlear implantation.Curr Opin Otolaryngol Head Neck Surg,11(5),388-393.
50. Valimaa, T. T.,Sorri, M. J.,Lopponen, H. J.(2001).Speech perception and functional benefit after multichannel cochlear implantation.Scand Audiol Suppl,52,45-47.
51. Vermeire, K.,Brokx, J. P.,Wuyts, F. L.,Cochet, E.,Hofkens, A.,Van de Heyning, P. H.(2005).Quality-of-life benefit from cochlear implantation in the elderly.Otol Neurotol,26(2),188-195.
52. Wang, N. M.,Huang, T. S.,Wu, C. M.,Kirk, K. I.(2007).Pediatric cochlear implantation in Taiwan: Long-term communication outcomes.Int J Pediatr Otorhinolaryngol,71(11),1775-1782.
53. Watson, L. M.,Archbold, S. M.,Nikolopoulos, T. P.(2006).Children's communication mode five years after cochlear implantation: Changes over time according to age at implant.Cochlear Implants Int,7(2),77-91.
54. Watson, L. M.,Hardie, T.,Archbold, S. M.,Wheeler, A.(2008).Parents' views on changing communication after cochlear implantation.J Deaf Stud Deaf Educ,13(1),104-116.
55. Wheeler, A.,Archbold, S.,Gregory, S.,Skipp, A.(2007).Cochlear implants: The young people's perspective.J Deaf Stud Deaf Educ,12(3),303-316.
56. Wu, J. L.,Lin, C. Y.,Yang, H. M.,Lin, Y. H.(2006).Effect of age at cochlear implantation on open-set word recognition in Mandarin speaking deaf children.Int J Pediatr Otorhinolaryngol,70(2),207-211.
57. Wu, J. L.,Yang, H. M.(2003).Speech perception of Mandarin Chinese speaking young children after cochlear implant use: Effect of age at implantation.Int J Pediatr Otorhinolaryngol,67(3),247-253.
58. Zeitler, D. M.,Kessler, M. A.,Terushkin, V.,Roland, T. J., Jr.,Svirsky, M. A.,Lalwani, A. K.(2008).Speech perception benefits of sequential bilateral cochlear implantation in children and adults: A retrospective analysis.Otol Neurotol,29(3),314-325.
59. 林寶貴、黃玉枝(1997)。聽障學生國語文能力及錯誤類型之分析。特殊教育研究學刊，15，109-129。
60. 錡寶香(2000)。聽覺障礙學生閱讀能力之分析。特殊教育學報，14，155-158。

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