Uppsatsen behandlar ämnet kyrkomusiker och deras exponering för ljud inom sin tjänst, främst med fokus på piporgel. Undersökningen har genomförts med kyrkomusiker och kyrkoherdar i Enköpings kontrakt för att få en uppfattning av kyrkomusikernas exponering till piporgelljud och om de kan ha fått en hörselskada utav detta. Huvudsakligen har studien baserats på individuella intervjuer med kyrkomusikerna och enkätsvar från kyrkoherdarna. I sex utvalda kyrkor har även ljudmätningar gjorts med en decibelmätare. Resultaten visar att hörselskaderisken är relativt låg vid piporgelspel, medan ljudexponering från körer anses vara ett större problem. Denna studie var begränsad geografiskt till ett kontrakt inom svenska kyrkan i Sverige och kan inte berätta om det är annorlunda någon annanstans.

Hörselnedsättning är ett vanligt problem. Dock, på grund av dess progressiva natur är det många som kan vara omedvetna om försämringen av deras hörsel. Forskning indikerar att skyddsbeteende relaterat till hörseln ofta är korrelerat med närvaron av symptom. Man har vidare identifierat  unga vuxna studenter som en speciellt utsatt grupp då studentliv ofta involverar högljudda miljöer som kan vara skadliga för hörseln. Dessutom att unga vuxna har höga risktendenser och tar få åtgärder för att skydda sin hörsel. Dock, här finns det viss meningsskiljaktigheter i fältet huruvida man hävdar att det är en majoritet eller minoritet av studenter som är i risk av att utveckla hörselnedsättning. Det finns därtill dessutom lite data om utbredning av hörselnedsättning bland studenter och den som finns har använt metoder som inte helt lämpar sig för att utvärdera hörselnedsättning. Denna studie ämnar att utreda utbredningen av hörselnedsättning bland studenter med ett mer lämpligt test och undersöka huruvida denna grupp riskerar att utveckla hörselnedsättning eller förvärra den samt undersöka om självskattning och symptom närvaro är förbundna med skyddsbeteende. Arbetsmiljöverket föreskrifter och rekommendationer gällande bullriga miljöer i kombination med tidigare gjorda studier användes för att identifiera skadliga ljudmiljöer i studenters vardag samt lämpliga skyddsbeteende i dessa. Detta användes som basis för en webbenkät som studenterna fyllde i efter vilket de genomgick ett webbaserat hörseltest. Endast en person av 77 kunde sägas ha hörselnedsättning. Även om majoriteten inte ofta var i skadliga ljudmiljöer, när de var det använde endast ett fåtal hörselskydd och det fanns en signifikant subgrupp vars beteende innebär hög risk för hörselnedsättning. Bristen på skyddsbeteende var korrelerat med självskattning och en negativ attityd gentemot hörselskydd. 75% upplevde övergående tinnitus och 88% hade upplevt övergående tinnitus eller temporär hörselnedsättning i skadliga ljudmiljöer. Denna studie bidrar till en ökande mängd evidens som pekar på att en majoritet av studenter är i risk av att utveckla hörselnedsättning senare i livet. För att förhindra att studenters hösel förvärras behövs det nya verktyg för att öka medvetenhet kring skadliga ljudmiljöer och hörselnedsättning, för att detektera tidiga stadier av hörselnedsättning samt nya hörselskydd som studenter kan ha en positivare attityd gentemot. / Hearing impairment is a common problem. However, due to its progressive nature many might be subjected to deteriorating hearing without knowing it. In addition, research indicates that protective behavior is often correlated with the presence of a symptom, which further stresses the importance of the individual's awareness. Studies suggest that young adult students are a particular vulnerable group, as student life involves being in loud environments, potentially harmful to hearing. Also, young adults have high risk tendencies, taking few precautions to protect their hearing. However, there is disparity within the field as to whether it is a majority or minority of students that are at risk. Furthermore, there is limited research on hearing impairment within this group, and the research that has been made used less than perfect methods. This study aims to ascertain the extent of hearing impairment within this group, by using a more appropriate test than previous studies and determine whether this group is at risk of developing hearing loss or worsening the condition and if self-estimation and presence of symptoms are significant factors of protective behavior. The Swedish work environment authorities regulations and recommendation about noisy environments in combination with previous studies were used to identify potentially damaging acoustical environments and appropriate protective action. This provided a basis for the questionnaire that the students filled in. In addition, a web-based hearing test was used to ascertain hearing loss. Only one person out of 77 was found to exhibit significant hearing loss. Although the majority were not often in loud environments, few used hearing protection and there was a significant subgroup whose behavior places them at high risk of hearing loss. The lack of protective behavior was correlated with self-estimation and a negative attitude towards ear protection devices. Furthermore, 75% experienced intermittent tinnitus and 88% had experienced temporary tinnitus or hearing loss within harmful sound-environments. This study therefore aligns itself with a growing literature that indicates that a majority of students are at risk of developing hearing impairment later in life even if it does not show at this stage. To prevent further deterioration of student’s hearing, new tools to raise awareness, detect early stages of hearing loss and hearing protections that elicit positive attitudes from students needs to be developed.

This thesis presents six studies concerned with the psychological status of people with audiological disorders, particularly tinnitus and hearing loss. Study One (Part I of the thesis) employed a structured interview and the General Health Questionnaire to investigate the emotional status of subjects with a variety of audiological symptoms. Psychological disorder was found to be more prevalent among subjects complaining of vertigo (64%) than among those complaining of tinnitus (45%); the prevalence of psychological disorder among subjects complaining of hearing loss was lower than among tinnitus subjects (27%). A higher prevalence of disturbance was found among subjects with multiple symptoms. A previous history of psychological distress correlated with current ratings of disturbance. Studies Two and Three (Part II) are concerned with the psychology of cochlear implantation. Methodological issues concerning psychological assessment in this context are discussed. Study Two uses Repertory Grid Technique to assess the psychological consequences of using an implant. Eight out of ten subjects reported important changes in psychological well-being related to their use of the device. Study Three identifies a group of subjects applying for an implant while having a non-organic hearing loss. The implications for the use of standardised assessment procedures are discussed. Studies Four, Five and Six (Part III) assess the cognitive functioning of subjects with tinnitus. Tinnitus subjects' performance on neuropsychological tests is compared with that of hearing impaired control subjects. Subjects were also assessed using the Cognitive Failures Questionnaire (CFQ). The emotional status of the subjects was assessed using the Speilberger State-Trait Anxiety Inventory. The Beck Depression Inventory was also used in Study Six. The groups were not distinguished by a number of neuropsychological tests, however it was found, in Studies Four and Five, that Tinnitus subjects' performance on verbal fluency tests was Significantly poorer than the Control subjects, after hearing loss was controlled for. In Study Six it was found that both Tinnitus and Control subjects performed less well than expected on the STROOP test; this was more apparent in the Tinnitus group. The Tinnitus group also obtained higher CFQ scores in Studies Four and Five. Trait anxiety was a feature of the Tinnitus groups. The implications for the cognitive functioning of both tinnitus and hearing impaired subjects are discussed in terms of Baddeley's model of working memory. The importance of these findings for complaint about tinnitus and hearing loss are considered.

碩士 / 國立成功大學 / 生理學研究所 / 95 / Tinnitus is the phantom sensation of sound in the absence of the corresponding external stimuli. Multiple over-doses of salicylate (SA) induced reversible tinnitus in humans and animals. Previous studies showed that SA-induced tinnitus was associated with an elevated hearing threshold (of about 15 dB) especially affecting high frequency regions (~10-16 kHz). On the other hand, SA was also reported in amplification of auditory evoked potentials. Whether SA produces same effects to different sound stimuli remained unclear. This knowledge is important for the understanding of pathophysiological mechanism of tinnitus. Brainstem auditory evoked potential (BAEP) reflect the electrophysiological activity of large numbers of neurons in the brainstem auditory pathway with acoustic stimulation. Here, we recorded BAEP from intra-cranial electrodes chronically implanted in freely moving rats before and after daily doses of SA (250 mg/kg/day, i.p.) over a period of 5 consecutive days. In order to assess the SA effect on the auditory brainstem including the inferior colliculus, which presumably is involved in the genesis of tinnitus, the active epi-dural recording electrode was placed about inferior colliculus (2mm from lamda on one side), and the reference electrode at the bregma. Average BAEP integrals in the post-stimulus 10 ms were taken as the response measure to clicks or tone bursts of systemically varied intensities. We found an elevation of threshold (about 10 dB) of BAEP to clicks after SA treatment and in addition signs of loudness recruitment. But, the BAEP to tone bursts of 16 kHz was sensitized (about 10 dB) after the same SA treatment and in addition signs of hyperacusis. Such enhanced sensitivity was not obvious in the low frequency region of 4 kHz. This is the first time that a differential effect of SA on BAEP from different sounds was observed in the same animal. We explain that such differential effect could be related, among other factors, to the different threshold of BAEP to clicks and to tones, and to the difference in the frequency composition of acoustic stimuli. The present results suggested that the mechanisms of tinnitus could involve turning on the automatic gain control of the descending auditory system at higher intensity levels after SA suppresses the cochlear inputs at low intensity levels.

碩士 / 國立成功大學 / 生理學研究所 / 92 / Tinnitus is a phantom sensation of sound in the absence of external stimulations and its pathogenesis is unclear. Overdose of salicylate (SA) is known to cause tinnitus in both human and animals. Local application of SA in the bulla suppresses evoked potential to sound suggesting a peripheral action of SA at the cochlea. Systemic application of SA also induces over-activities of central auditory neurons suggesting a central action. In this study, the effects of SA applied at two different routes were compared in order to elucidate the action sites. Fos-immunohistochemistry was used to reveal the hyper-activity in the brainstem nuclei. Adult rats were divided into two groups for aseptic surgery. The first group was intraperitoneally implanted with osmotic pumps that would sustain release SA for 7 days. The second group had a SA-presoaked gelfoam placed over the round window in the bullae for 6 days. Controls received similar procedures with vehicle-treatments. Brains were processed for Fos-immunohistochemistry on thick frozen sections according to the conventional ABC method. For comparison, a limited number of animals also received a 5-daily SA injection. For some animals, SA levels in the perilymph and cerebrospinal fluid were measured at different time points with mass spectrometry (ESI-MS/MS). 　　Both the osmotic pump and gelfoam applications that released SA slowly were effective in raising Fos-activity labeling both in the inferior colliculus and lateral superior olivary complex in a manner rather similar to the multiple-daily injection protocol, suggesting a possible occurrence of tinnitus. Following intra-bullar applications there was a rapid increase of SA in perilymph followed by a delayed increase in CSF to about the level, suggesting an effective fluid passage linking the two compartments likely through the cochlear aqueduct. Intra-peritoneal applications also led to a rapid rise in SA level in the perilymph at a level higher than the CSF, suggesting the presence of an active secretion mechanism in the cochlea. The fact that SA when applied locally to the cochlea, even on one side, was effective suggested that a peripheral site was likely involved but may also require the action at the central nervous system. The relatively high level of Fos-expression at the IC of control rats was discussed with respect to a physiological tinnitus, which might subside in Fos-expression after animals were adapted to a silent environment.

博士 / 國立臺灣大學 / 醫學工程學研究所 / 96 / Background/Purpose: Objective measurement by tone burst evoked auditory brainstem response provides relatively accurate estimates of the behavioral auditory thresholds at speech frequencies. The first part of this study reports the preliminary data of tone burst auditory brainstem response measurements in infants and very young children. As an excellent agreement and correlation between objective evoked-potential and subjective behavioral thresholds have been demonstrated by previous studies, the second part of this study investigates the effects of different age and degree of hearing loss on the above agreement and correlation. Comparison was made between objective tone burst auditory brainstem responses and subjective sound field audiometry. To further compare the differences between objective and subjective measures, the third part of this study applied another evoked potentials test to investigate if the subjective tinnitus demonstrates increased intensity dependence objectively at the selected frequencies. Methods: Of the part one study, 94 infants and very young children from 3 months to 3 years of age underwent tone burst auditory brainstem response measurements at selected four frequencies. Statistical methods were applied to study the relationship among recorded variables. In the part two, 1281 infants and very young children aged from 3 months to 3 years underwent diagnostic audiometry including sound field audiometry and tone burst auditory brainstem response measurements. Statistical analyses were applied to investigate the effects of age and hearing loss on the agreement and correlation between two measured thresholds. In the part three, we applied auditory cortical evoked potential test to investigate 9 tinnitus patients and 9 age- and sex-matched healthy subjects without tinnitus. Auditory cortical evoked potentials (N1-P2) were elicited from stimuli at four frequencies (4000, 2000, 1000 and 500 Hz) with five intensities (50, 56, 62, 68 and 74 dB nHL). Intensity dependences by latency of N1 and amplitude of N1-P2 were surveyed at midline electrodes. Results: The results of part one indicate that the averaged tone burst auditory brainstem response thresholds of the infants and young children with normal hearing in Taiwan are typically 10 to 20 dB nHL at 500, 1000, 2000, and 4000 Hz. There is no statistically difference for the thresholds regarding gender, laterality, and age distribution in this study. In part two, significant correlations (Ps＜0.001) were seen between two measured thresholds across groups of different ages and different degree of hearing loss more than 20 dB HL. However, the correlation strength deteriorated along with decreased degree of hearing loss. Correlations for hearing thresholds less than 20 dB HL were not significant at 1000, 2000 and 4000 Hz. In part three, significant differences existed in the intensity dependence of amplitude N1-P2 to the pooled frequencies at Fz and Cz position. These differences suggested that tinnitus patients tended to respond less to increased sound intensity and were inclined to weaker intensity dependence. Conclusion: Based on the published research and our study, we suggest setting the normal criterion levels for the infants and young children in Taiwan of the tone burst auditory brainstem response to air-conducted tones as 30 dB nHL for 500 and 1000 Hz, and 25 dB nHL for 2000 and 4000 Hz. From part two, properly obtained and interpreted with respect to the effects of age and degree of hearing loss, the evoked potentials test provide the very informative hearing threshold reference to perfect the behavioral audiometric evaluation for the infants and very young children with hearing loss. From part three, objectively increased intensity dependence of N1-P2 component at selected frequency can not be demonstrated in tinnitus patients with normal hearing. Restated, the edge frequency phenomenon fails to present in tinnitus patients with normal hearing, a different characteristic from tinnitus patients with hearing loss.

碩士 / 國立高雄師範大學 / 聽力學與語言治療研究所 / 103 / Background: Noise-induced tinnitus is continuous, nonpulsating, and persistent in nature. Tinnitus is a manifestation of the spontaneous depolarization of the auditory fibers, which creates noise without an external auditory stimulus. Zinc is present in the cochlea, especially the stria vascularis, in the form of Cu/Zn superoxide dismutase and trace elements, and zinc deficiency could cause tinnitus and hearing loss. We investigated the role of zinc supplementation in the treatment of tinnitus with noise-induced hearing loss (NIHL). Materials and methods: The study sample comprised 20 patients (mean age, 48.5 ± 11.3 years) with long-standing tinnitus and a typical NIHL audiogram. Another 20 patients without tinnitus made up the control group. A full medical history assessment was performed, and each underwent an otoscopic examination, a basic audiologic evaluation, distortion product otoacoustic emissions (DPOAE) testing, and tinnitus match testing. Zinc levels in serum were also measured. Tinnitus matching and subjective judgments regarding the severity of tinnitus were subsequently assessed using the Tinnitus Handicap Inventory (THI). After 2 months of treatment with zinc at 40 mg daily, all tests were repeated. Hearing thresholds, DPOAE results, tinnitus match test results, and serum zinc levels before and after each measure were analyzed and compared between the two groups. Pretreatment and post-treatment scores based on the THI were also analyzed. The paired t-test, Pearson’s correlation coefficient, and simple linear regression analysis were used for statistical analyses, and all data were analyzed using SPSS v.20 for descriptive statistics. Results: No significant differences were noted in pretreatment zinc levels between the two groups. However, a significant difference was found between pretreatment and post-treatment within the zinc group (73.6 ± 11.6 vs. 84.5 ± 12.5 µg/dL, respectively). The level increased to a lesser degree in older people after zinc supplementation. There were no statistically significant differences in hearing thresholds, speech reception thresholds, or DPOAE results before and after treatment. The pretreatment and post-treatment tinnitus pitch match rates were 5973.7 ± 1965.8 and 6052.6 ± 2026.2 Hz, respectively, without a statistically significant difference. A significant correlation was found between pretreatment and post-treatment tinnitus intensity (9.74 ± 10.2 vs. 5.6 ± 6.4 dB SL, p < .05), indicating a clinical improvement. The correlation between pretreatment and post-treatment THI-total scores was significant (38.3 ± 18.9 vs. 30.0 ± 18.6, p< .05). The most significant improvement was seen in the catastrophic category (p < .01). Conclusion: Subjective tinnitus loudness and THI scores significantly improved after oral zinc supplementation in patients with tinnitus-associated NIHL. However, no improvement in objective hearing parameters occurred. A larger sample is needed to confirm the results of this study.

碩士 / 國立交通大學 / 電信工程研究所 / 106

碩士 / 國立成功大學 / 生物學系碩博士班 / 92 / Tinnitus is a common symptom. People with serious tinnitus may be in the bad humor, attention-deficit, affecting life or insomnia. But the mechanisms of tinnitus is still unclear. Experiments had proved that take over dose of salicylate would cause tinnitus. It may affect the stability of the cochlear systems and central nervous systems. Taurine plays an important role in the auditory perception in the infants. It also can reduce the hydrops in the cochlea to protect hearing. Therefore, Taurine was used to investigate the tinnitus induced by the auditory dysfunctions. Abutilon indicum(L.) Sweet had been pointed out in many herbs medical books that it could cure tinnitus. So in this experiments with detecting the tinnitus animal model and the cochlear microphonics ,taurine and the cruded extracts of the Abutilon indicum(L.) Sweet were used to study to tinnitus induced by salicylate. The extracts of the Abutilon indicum(L.) Sweet was infused into stomach of guinea-pig with a gastric fistula, while taurine was injected intraperitoneally. We found that the retention period(the duration standing on the yellow zone ) and drinked water in the first testing day was not significant difference between the controlled and experimental groups (P>0.05, ANOVA). However, the retention period and the drinked water in the second testing day was shown a significant difference (P<0.01, ANOVA). The retention period of salicylate group and controlled saline groups was 83.9±13.9 min and 42.3±12.4 min, and the volume of drinked water was 11.7±4.4 and 30.0±5.3 ml, respectively. They were shown a very significant difference (P<0.01, t-test), and suggested that salicylate make guinea pig feel tinnitus. The retention period of taurine group and herb group was 33.5±12.5 and 44.9±11.6 min, and the level of drinked water was 29.4±14.9 and 22.5±5.1 ml, respectively. These two groups compared with those of salicylate groups were shown a significant difference (P<0.05). These results proved that both treatments could ameliorate the tinnitus behavior induced by salicylate. From the detection of cochlear microphonics(CM), we detected the CM of saline group and salicylate group was 132.5±54.0 and 224.0±58.0μV, respectively. It was showed that saliylate increased the CM(P=0.0089<0.01, t-test). The CM of the taurine group and the herb group was 156.7±62.8 and 139.2±62.3μV, respectively. It was shown a significant difference with that of salicylate group. It also showed that administrating taurine and the extracs of the Abutilon indicum(L.) Sweet in advance could decrease CM(P<0.05, test). These results suggest that taurine and the extracts of the Abutilon indicum(L.) Sweet can reduce tinnitus induced by salicylate, and can sustain the physiological functions of the outer hair cells. Therefore, both taurine and the extracts of the Abutilon indicum(L.) Sweet can decrease the perception of tinnitus by sustaining the functions of outer hair cells.

碩士 / 南華大學 / 自然醫學研究所 / 102 / Background: Tinnitus usually occurs in patients aged 40-70 years. The prevalence is about 30% for those over than 65 years old. Tinnitus patients often complain about different voices arising within the ears. Tinnitus can lead to sleep disorders, depression, frustration, irritability and cognitive interference; however, regular treatments usually dissatisfy physicians and patients. 　　Objective: This study aimed to investigate the effect of auricular acupressure and infrared-C (IR-C) hot compress on chronic tinnitus and develop an alternative treatment for tinnitus patients. 　　Methods: A randomized and single-blind design were carried out in this study to exclude the placebo effect. Four groups were classified including auricular acupressure (with semen vaccariae seeds) group, IR-C hot compress group, treatment combined auricular acupressure and IR-C hot compress, and the control group. There were 140 subjects recruited and 35 subjects in each group. The auricular acupressure points chosen in this study include shenmen(TF4), kidney(CO10) , sympathesis(AH6a), internal ear(LO6), infrared-C hot compress was placed on the head and neck regions. The intervention period was 28 days. 　　Results: The results indicated that auricular acupressure, IR-C hot compress, and treatment combined auricular acupressure and IR-C hot compress effectively decreased blood pressure, improve tinnitus distress (reduced tinnitus distress in the functional assessment, severe emotional scores and VAS scores), increased SDNN and improved the LF/HF ratio to the desired value. 　　Conclusion: Accordingly, auricular acupressure and IR-C hot compress can provide an alternative to patients with chronic tinnitus.