| 摘要: | 新生兒聽力篩檢於幼兒後天發展占重要地位，三歲內為幼兒語言學習黃金時期，聽損越早被診斷，就能盡早進行聽力相關手術、聽力及構音訓練，降低聽損對幼兒造成日後負面影響。國民健康署於2012年推動並補助新生兒聽力篩檢，採用自動聽性腦幹響應(Automated auditory brainstem responses, AABR)檢測。然而儀器昂貴、功能簡單、需電腦操作且空間受限、部分儀器介面也無顯示腦幹波形。
為降低成本與改善問題，本研究結合嵌入式系統與智慧型手機兩平台，搭配硬體與藍芽模組，開發無線AABR量測系統。使用者能以手機控制系統對人耳產生刺激音，再以電極片截取腦幹電位響應，並傳送至手機進行分析與顯示。本系統使用卡爾曼濾波器與指數權重平均演算法處理訊號，同時自動判斷第五波，並於手機即時顯示波形。
為了評估本系統偽陽性與再現性，本研究有6位年齡23至25歲男性個案(4位聽力正常；2位先天聽損)參與兩實驗。實驗一由本系統於聽力室對每位個案進行3次檢測，4位正常個案皆於系統辨識出第五波並顯示為”Pass”，2位聽損個案則為”Refer”，結果顯示此系統偽陽性為0，由於3次之檢測結果接近，因此具良好再現性。另外有2位個案於電磁波隔離室檢測，結果與聽力室無顯著差異；為了驗證本系統再現性，實驗二以市售儀器檢測並與本系統比較，發現兩者皆可比對出第五波，而市售儀器測得之反應時間較本系統長，但兩者於高音量刺激測得反應時間皆少於低音量。本研究開發之無線AABR量測系統能以手機無線操作，也可自動辨識第五波，於實驗檢測結果證實本系統可用性。
;Infants hearing screening is one of the most significant issues for the new born babies in their developments. It was the most important for the children to learn to speak before the age of 3 years old. Infants with congenital hearing-impaired should be diagnosed earlier. To reduce the negative influences for the developments of these children, it was suggested to carry out the hearing surgeries as earlier as possible. These children were also suggested to receive more trainings for hearing and articulation when they were growing. In 2012, Ministry of Health and Welfare (MHW) in Taiwan promoted the policy of the infants hearing screening with the technique of automated auditory brainstem responses (AABR). However, the instruments of AABR were expensive but with simple function, and designed to be operated with computers as the user interface, all these problems were caused to be inconvenient for each users. Furthermore, the function of displaying the patterns of the brainstem responses was not included with most instruments
To improve these disadvantages of these commercial instruments, a wireless-AABR measurement system was developed with the embedded system and the smart phone. Users could control this system to produce the stimuli with the smart phone. The evoked brainstem responses were measured from the scalp and transmitted to the smart phone through the Bluetooth module. The algorithms of Kalman filter and exponential weighted average (EWA) were used to process these signals in real-time. The wave V of the brainstem response would be identified automatically and displayed on the smart phone.
To evaluate the false positive and the reproducibility of our system, 6 male subjects (Age: 23-25; 4 subjects: Normal hearing, NH; 2 subjects: Congenital hearing-impaired, CHI) were tested in two experiments. In the first experiment, all subjects were tested with our system in the hearing exam room by 3 times. The wave V was identified with “Pass” from the results of the system on 4 normal subjects. In contract, the results showed “Refer” on another 2 subjects with hearing-impaired. The result of the false positive tested was 0, and the reproducibility was good for our system. There was no difference between the results measured in the hearing exam room and the electromagnetic pulses isolated room (EMP isolated room). To validate the accuracy of our system, we compared our system to the commercial system in the second experiment. The wave V of 5 subjects (4 NH, 1 CHI) were both identified from these two systems. However, the latencies measured from these two systems were both shorter in the higher volume of the stimuli. Although the relative latencies measured from the commercial system were longer than those of our system, our results showed that the wireless-AABR measurement system was plausible for hearing screening. |
