啟智學校學生聽力損失出現率初探

A Preliminary Study on the Occurrence of Hearing Loss among Students with Intellectual Disability

智障者聽力損失發生率高於一般人，聽力檢測可有效偵測聽力問題，防止後續可能的溝通、學習與適應困難。本研究的目的是以證據本位立場，探討智障學生的聽力問題，了解他們在各測驗通過與不通過的比率、不同分類方式下的聽力損失發生率、以及分類方式與發生率的關係。受試者是高雄市某啟智學校60位智障生（男45人，女15人，平均16.37歲，標準差2.32，範圍七至20歲），實施的聽力相關檢測含耳視鏡、中耳鼓室圖、變頻耳聲傳射（DPOAE）與純音聽閾，任一項測驗無法施測者有九人（15％）。各測驗正常的定義：耳垢未堵塞外耳道、耳膜無異常現象、鼓室圖A型、聽力在正常範圍（500與2kHz平均聽閾≦25分貝）。可施測的51人中，26人（51％）各測驗都正常，22.7％者聽力正常但至少一項異常。聽力損失發生率是21.6％，男女生分別是26.3％與7.7％，中至輕度與重至極重度者是12.0％與30.0％，唐氏症與非唐氏症者是100％與16.6％，自閉症與非自閉症者是25.0％與20.9％，多重與非多重障礙者是41.7％與15.4％；卡方檢定顯示聽力損失發生率與是否為唐氏症有關，也與是否為多重障礙有關（p＜.001），而與性別及是否為自閉症無關。檢測前只知一人有聽力損失，檢測後多10人（90.9％）。本研究結果顯示此弱勢族群的聽力問題容易被個案的異常掩蓋，且發生率相當高，因此必須提高教師與主要照顧者對聽覺照護與聽力問題的察覺，而教育當局與學校也需要了解聽力損失帶給溝通與學習的困難，儘速為這些有迫切聽力服務需求的學生設置教育聽力師職務並提供常態的聽力服務。

Persons with intellectual-disability have higher prevalence of hearing impairments. Appropriate hearing examination can effectively identify these problems and prevent the possible harmful consequences in communication, learning, and adaption. The purpose of the study was to investigate hearing status of students with intellectual disability, their pass-rates in different hearing related examinations, the prevalence of hearing loss and the correlation between the prevalence and the various categories of classifications. Subjects were 60 intellectual-disabled students, 45 male and 15 female, who attended a special school in Kaohsiung. Their averaged age was 16.37 (SD = 2.32, range = 7 to 20). Otoscopic examination, tympanogram, and distortion product otoacousitc emissions (DPOAE) were administered. If an abnormal test result was found in any of these examinations, a play or behavioral observation pure-tone audiometry followed. Fifty-one subjects successfully completed these examinations and 9 subjects, 15%, could not be tested for at least one test. 'All normal' was defined as no occlusion in the external canal, type A tympanogram, and hearing within normal limits. Normal hearing was considered as either passing the DPOAE or the averaged hearing threshold at 500 and 2kHz was at 25dB or below. Among the 51 subjects, 26 subjects, 51%, were considered all normal, whereas 22.7% had normal hearing but failed at lest one hearing examination. Eleven subjects, 21.6%, were hearing impaired, 26.3% of the males and 7.7% of the females. When different classification was used, 12.0% of all students tested had mild to moderate hearing loss and 30.0% had severe to profound hearing loss. The prevalence of hearing loss was 100% among students with Down syndrome and 16.6% among students without Down syndrome, 25.0% among students with autism and 20.9% among students without autism, 41.7% among students with multiple handicap and 15.4% among students without multiple handicap. The chi-square showed that the prevalence of hearing loss was related to Down syndrome and the presence intellectual-disabled It was not related to gender or autism. Only one student was known to have hearing loss prior to the test. Ten more students were found to have hearing loss after the test. The above results revealed that the prevalence of hearing loss was high among students with intellectual disabilities and their hearing loss was often masked by the presence of other disabilities. It is hoped that special education schools and government agencies would be aware of the need and the ramifications of hearing loss on communication and learning. Care takers and teachers' awareness about haring loss is important. In addition, establishing educational audiologist positions and regular hearing service programs to these students are urgently needed.