近年來許多研究發現電子耳配合助聽器使用可以促進電子耳使用者的音調知覺，有助改善電子耳使用者的聽能表現，特別是噪音環境下的表現。對華語這類聲調語言，音調訊息影響語意的傳遞，因此電子耳結合對側助聽器所提供的低頻訊息，對音調的覺知可能帶來更多的助益。本研究之目的在於探討配戴對側助聽器對華語電子耳兒童聲調及句子辨識的影響。
19位合併使用電子耳與助聽器兒童參與本研究。以受測者間均衡施測順序分別在聆聽條件為只有使用電子耳、合併使用電子耳與助聽器進行安靜環境下單字詞聲調（4選1）、雙字詞聲調（2選1）及安靜或噪音環境下開放式句子辨識作業。結果顯示，在聲調辨識方面，合併使用電子耳與助聽器的正確率稍微高於只使用電子耳的正確率（單字詞聲調辨識提升3.2%的正確率，但未達顯著水準；雙字詞聲調辨識提升3.7%的正確率且達顯著差異）；在句子辨識方面，不論安靜或噪音環境時，合併使用電子耳與助聽器的句子辨識率均高於只使用電子耳的辨識率（分別提升為5.2%及7.6%的正確率），但這些差異均未達顯著水準。
本研究結果發現增加配戴助聽器所提供的低頻訊息，整體而言，有助於提升電子耳兒童聲調及句子辨識表現，但兩種聆聽條件下表現的差異並不大。受測兒童在各作業中都呈現相當大的個人變異，有些兒童在電子耳配合助聽器使用時表現較好，但有些兒童則是在只使用電子耳時表現較好。

Recent studies have shown that the use of a unilateral cochlear implant and a contralateral hearing aid would help implanted users to perceive better pitch information and significantly enhance their speech perception, especially in noise. Few studies have been conducted in Mandarin speakers. Since Mandarin is a tonal language in which semantic information is conveyed by pitch, it is therefore the hypothesize that combined electric and acoustic stimulation（EAS） would bring extra benefit for users of Mandarin. The present study aimed to investigate the benefit of combined a cochlear implant and a contralateral hearing aid on lexical tone and sentence recognition in Mandarin-speaking children.
Nineteen children with cochlear implants were recruited. The test conditions included EAS（combined a cochlear implant and a contralateral hearing aid）and CI（cochlear implant alone）. The order of test conditions was counterbalanced across subjects. The lexical tone recognition was conducted by using monosyllabic words（four-alternative forced-choice） and disyllabic words（two-alternative forced-choice） in quiet. The open-set sentence recognition was conducted both in quiet and in noise. The results shown that the EAS average scores were better than CI average scores in lexical tone and sentence recognition. These implanted children had slight higher tone recognition scores in the EAS condition than in the CI condition（performance on monosyllabic words and disyllabic words improved 3.1% and 3.7%, respectively; the former was not significantly different but the latter was significantly better） and had considerable higher sentence recognition scores in the EAS condition than in the CI condition both in quiet and noise （increased 5.2% and 7.6%, respectively; these differences, however, were not significant）.
The results revealed that the low-frequency information provided by hearing aid on the unimplanted ear generally improve the performance on lexical tone and sentence recognition, but the benefit was limited. The EAS benefits varied greatly among individuals. While some implant users had better performance in the EAS condition, others had better performance in the CI condition.

謝辭 i
摘要 vi
Abstract vi
目次 iv
表次 vi
圖次 vii
附錄 ix
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的與待答問題 5
第三節 名詞釋義 6
第二章 文獻探討 8
第一節 聽覺障礙與人工電子耳 8
第二節 電子耳使用者的聽知覺表現 18
第三節 電聲學刺激使用者的聽知覺特徵 31
第三章 研究方法 47
第一節 研究架構 47
第二節 研究對象 49
第三節 研究材料 49
第四節 研究流程 52
第五節 統計分析 57
第四章 結果與討論 58
第一節 研究對象之背景資料 58
第二節 聲調辨識表現之差異 63
第三節 句子辨識表現之差異 75
第四節 受測兒童的個別差異 81
第五節 綜合討論 87
第五章 研究結論與建議 94
第一節 結論與應用價值 94
第二節 研究限制及建議 95
參考文獻 97
附錄 108

參考文獻
中文部分：
九十八年第九週內政統計通報（2009）。97年底列冊身心障礙者人數統計。上檢索日期：2009年4月22日。網址：http://www.moi.gov.tw/info_detail.aspx?sn=37
台北市政府社會局（2009）。人工電子耳補助計畫。上檢索日期：2009年4月14日。網址：http://www.dosw.taipei.gov.tw/i/i0300.asp?l1_code=05&l2_code=14&fix_code=0514002&group_type=1
王南梅、郭于靚、黃國祐、劉樹玉、劉俊榮（2009）。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。台灣聽力語言學會雜誌，22，55-85。
行政院勞委會（1998）。防護具選用技術手冊－防音防護具。台北市：勞工安全衛生研究所。
官英華、廖憲正（2009）。自動化華語聲調錯誤偵測系統之初探，中原華語文學報，4，117-137。
林寶貴、韓福榮（1997）。台灣地區聽覺障礙者接收人工電子耳植入術現況及溝通能力之研究。特殊教育研究學刊，15，131-149。
林永松、彭淑貞、張顯達（2002）。人工耳蝸植入兒童之國語輔音發音與聽辨。中耳醫誌，37，250-259。

韋志曄、楊惠美、吳俊良（2004）。先天性聽障孩童人工耳蝸植入後的語音聽知覺發展。臺灣耳鼻喉頭頸外科雜誌，39（1），12-17。
許雅玲（2005）。先天性重度聽力損失高中學生之國語聲調聽知覺清晰度及聲學特性分析：初步研究。國立台北護理學院聽語障礙科學研究所碩士論文，未出版，台北市。
曾凡鋼、魏朝剛、曹克利、王宣中（1999）。多頻道人工電子耳使用者刺激速率辨別與聲調識別的關係。聽覺輔具發展及復健研討會研習手冊。
董書豪（2007）。人工電子耳進階結合編碼策略的華語語音辨識成效模擬—結合助聽器之分析。國立中央大學電機工程研究所碩士論文，未出版，桃園縣。
趙元任（1980）。中國話的文法（丁邦新譯）。台北：台灣學生。
鄭惟仁（2006）。結合人工電子耳與助聽器對華語語音辨識率的影響。國立中央大學電機工程研究所碩士論文，未出版，桃園縣。
蕭雅文（2008）。聽力學導論。台北：五南。

英文部分：
Barry, J. G., Blamey, P. J., Martin, L. F. A., Lee, K. Y.-S., Tang, T., Ming, Y. Y., & Hasselt, C. A. （2002）. Tone discrimination in Cantonese-speaking children using a cochlear implant. Clinical Linguistics and Phonetics, 16, 79-99.
Beijen, J.-W., Mylanus, A. M., Leeuw, A. R. & Snik, F. M.（2008）. Should a hearing aid in the contralateral ear be recommended for children with a unilateral cochlear implant? Annals of Otology, Rhinology & Laryngology, 117（6）, 397-403.
Blamey, P. J., Sarant, J. Z., Paatsch, L. E., Barry, J. G., Bow, C. P., Wales, R. J., Wright, M., Psarros, C., Rattigan, K., & Tooher, R. （2001）. Relationships among speech perception, production, language, hearing loss, and age in children with impaired hearing. Journal of Speech, Language, and Hearing Research, 44, 264–285.
Campisi, P., Low, A., Papsin, B., Mount, R., Cohen-Kerem, R., & Harrison, R.（2005）. Acoustic analysis of the voice in pediatric cochlear implant recipients: A longitudinal study. The Laryngoscope, 115, 1046-1050.
Ching, T. Y. C. （2001）. Do cochlear implants work with hearing aids? Yes, they do! Cochlear Implant Club International, Inc.
Ching, T. Y. C. （2006）. An overview of binaural advantages for children and adults who use binaural/bimodal hearing devices. Audiol Neurotol, 11, 6-11.
Ching, T. Y., Incerti, P., & Hill, M. （2004）. Binaural benefits for adults who use hearing aids and cochlear implants in opposite ears. Ear Hear, 25, 9–21.
Ching, T. Y. C., Psarros, C., Hill, M., Dillon, H., & Incerti, P. （2001）. Should children who use cochlear implants wear hearing aids in the opposite ear? Ear and Hearing, 22, 365-380.
Ching, T. Y. C., Wanrooy, E., & Dillon, H. （2007）. Binaural-Bimodal fitting or bilateral implantation for managing severe to profound deafness: A review. Trends in Amplification, 11, 161-192.
Ciocca, V., Francis, A. L., Aisha, R., & Wong, L. （2002）. The perception of Cantonese lexical tones by early-deafened cochlear implantees. The Journal of the Acoustical Society of Amesica, 111, 2250-2256.
Dorman, M. F., Spahr, A. J., Loizou, P. C., Dana, C. J., & Schmidt, J. S.（2005）. Acoustic simulations of combined electric and acoustic hearing （EAS）. Ear and Hearing, 26, 371-380.
Dunn, C. C., Tyler, R. S., & Witt, S. A. （2005）. Benefit of wearing aid on the unimplanted ear in adult users of a cochlear implant. Journal of Speech, Language, and Hearing Research, 48, 668-680.
Fitzpartick, E., McCrae, R., & Schramm, D. （2006）. A retrospective study of cochlear implant outcomes in children with residual hearing. BMC Ear, Nose and Throat Disorders, 6, 7
Friesen, L. M., Shannon, R. V., Baskent, D., & Wang, X. （2001）. Speech recognition in noise as a function of the number of spectral channels: Comparison of acoustic hearing and cochlear implants. The Journal of the Acoustical Society of Amesica, 110, 1150-1163.
Fu, Q. J., Zeng, F. G., Shannon, R. V., & Soli, S. D. （1998）. Importance of tonal envelope cues in Chinese speech recognition. The Journal of the Acoustical Society of Amesica, 104, 505-510.
Fu, Q. J., & Zeng, F. G. （2000）. Identification of temporal envelope cues in Chinese tone recognition. Asia Pacific Journal of Speech, Language, and Hearing Research, 5, 45-57.
Gantz, B. J., Turner, C., Gfeller, K. E., & Lowder, M. W. （2005）. Preservation of hearing in cochlear implant surgery: Advantages of combined electrical and acoustical speech processing. Laryngoscope, 115, 796-802.
Garnham, C., O’Driscoll, M., Ramsden, R., & Saeed, S. （2002）. Speech understanding in noise with a Med-EICOMBI 40+ cochlear implant using reduced channel sets. Ear and Hearing, 23, 540-552.
Geers, A., Brenner, C., & Davidson, L. （2003）. Factors associated with development of speech perception skills in children implanted by age five. Ear and Hearing, 24, 24-35.
Gifford, R. H., Dorman M. F., McKarns, S. A., & Spahr, A. J. （2007）. Combined electric and contralateral acoustic hearing: Word and sentence recognition with bimodal hearing. Journal of Speech, Language, and Hearing Research, 50, 835-843.
Godar, S. P., Litovsky, R. Y., Johnstone, P. M. & Agrawal, S. S. （2004）. Cochlear implant plus hearing aid: measuring binaural benefit in children. International Congress Series, 1273, 219-222.
Green, T., Faulkner, A., & Rosen, S. （2004）. Enhancing temporal cues to voice pitch in continuous interleaved sampling cochlear implants. The Journal of the Acoustical Society of Amesica, 116, 2298-2310.
Holt, R. F., Kirk, K. I., Eisenberg, L. S., Martinez, A. S., & Campbell, W. （2005）. Spoken word recognition development in children with residual hearing using cochlear implants and hearing aids in opposite ears. Ear and Hearing, 26（4）, 82S-91S.
Hua, Z., & Dodd, B. （2000）. The phonological acquisition of Putonghua. Journal of Child Language, 27,3-42.
James, C. J., Fraysse, B., Deguine, O., Lenarz, T., Mawman, D., Ramsden, R., & Sterkers, O. （2006）. Combined electroacoustic stimulation in conventional candidates for cochlear implantation. Audiology Neurotology, 11, 57-62.
Kiefer, J., Pok, M., Adunka, O., Sturzebecher, E., Baumgartner, W., Schmidt, M., Tillein, J., Ye, Q., & Gstoettner, W. （2005）. Combined electric and acoustic stimulation of the auditory system: Results of a clinical study. Audiology Neurotology, 10, 134-144.
Kong, Y.-Y., Stickney, G., & Zeng, F.-G. （2005）. Speech and melody recognition in binaurally combined acoustic and electric hearing, The Journal of the Acoustical Society of Amesica, 117, 1351–1361.
Kuo, Y.-C. （2006）. Cochlear implant in a tone language–Mandarin Chinese. Unpublished doctoral dissertation, University College London, London, England.
Kuo, Y.-C., Rosen, S., & Faulkner, A.（2004）. Perception of lexical tone and its effect on sentence recognition in children using cochlear implants. ARO MidWinter Meeting.
Kuo, Y.-C., Rosen, S., & Faulkner, A. （2008）. Acoustic cues to tonal contrasts in Mandarin: Implications for cochlear implants. The Journal of the Acoustical Society of Amesic, 123（5）, 2815-2824.
Lan, N., Nie, K.-B., Gao, S.-K., & Zeng, F.-G. （2004）. A novel speech-processing strategy incorporating tonal information for cochlear implants. IEEE Transactions on Biomedical Engineering, 51, 752-760.
Lee, S.-H., Lee, K.-Y., Huh, M.-J., & Jang, H.-S. （2008）. Effect of bimodal hearing in Korean children with profound hearing loss. Acta Oto-Laryngologica, 128, 1227-1232.
Lee, Y. S., Hasselt, C. A., Chiu, S. N., & Cheung, M. C.（2002）. Cantones tone perception ability of CI children in comparison with normal-hearing children. International Journal of Pediatric Otorhinolaryngology, 63, 137-147.
Li, N. & Loizou, P. C. （2008）. A glimpsing account for the benefit of simulated combined acoustic and electric hearing. The Journal of the Acoustical Society of Amesic, 123, 2287-2294.
Lin, H. C., Shu, M. T., Chang, K. C., & Bruna, S. M. （2000）. Screening of infant hearing. Journal of Taiwan Otolaryngological Society, 35, 376-382.
Lin, Y.-S., Lee, F.-P., Huang, I. S. & Peng, S. C. （2007）. Continuous improvement in Mandarin lexical tone perception as the number of channels increased: a simulation study of cochlear implant. Acta Oto-Laryngologica, 127, 505-514.
Loizou, P. C. （1998）. Mimicking the human ear. IEEE Signal Processing Magazine. 15（5）, 101-130.
Loizou, P. C. （1999）. Introduction to cochlear implant. IEEE Engineering in Medicine and Biology, Mag. 18（1）, 32-42.
Loizou, P. C. （2006）. Speech processing in vocoder-centric cochlear implants. Adv Otorhinolaryngol, 64, 109-143.
Looi, V., McDermott, H., McKay, C., & Hickson, L.（2008）. Music perception of cochlear implant users compared with that of hearing aid users. Ear and Hearing, 29, 421-434.
Luntz, M., Shpak T., & Weiss, H.（2005）. Binaural-biomodal hearing: Concomitant use of a unilateral cochlear implant and a contralateral hearing aid. Acta Oto-Laryngologica, 125, 863-869.
Luntz, M., Yehudai, N., & Shpak T. （2007）. Hearing progress and fluctuations in biomodal-binaural hearing users. Acta Oto-Laryngologica, 127, 1045-1050.
Luo, X., & Fu, Q.-J.（2004）. Enhancing Chinese tone recognition by manipulating amplitude envelope: Implications for cochlears. The Journal of the Acoustical Society of Amesic, 116, 3659-3667.
Luo, X., & Fu, Q.-J.（2006）. Contribution of low-frequency acoustic information to Chinese speech recognition in cochlear implant simulations. The Journal of the Acoustical Society of Amesic, 120（4）, 2260-2266.
Luo, X., Fu, Q.-J., & Wang, R.-H.（2005）. Enhancing Chinese speech recognition for cochlear implant users by using hearing aid in the contralateral ear. Beijing Biomedical Engineering, 24（4）, 250-254.
Mildner, V., Sindija, B., & Zrinski, K. V.（2006）. Speech perception of children with cochlear implants and children with traditional hearing aids. Clinical Linguistics and Phonetics, 20（2-3）, 219-229.
Mok, M.,Grayden, D., Dowell, R. C. & Lawrence, D.（2006）. Speech perception for adults who use hearing aids in conjunction with cochlear implants in opposite ears. Journal of Speech, Language, and Hearing Research, 49, 338-351.
Moore, C. J. （2003）. Coding of sounds in the auditory system and its relevance to signal processing and coding in cochlear implants. Otology and Neurotology, 24, 243-254.
Moore, C. J. （2008）. The role of temporal fine structure processing in pitch perception, masking, and speech perception for normal-hearing and hearing-impaired people. Journal of the Association for Research in Otolaryngology, 9, 399-406.
Morera, C., Manrique, M., Ramos, A., Garcia-Ibanez, L., Cavalle, L., Huarte, A., Castillo, C., & Estrada, E. （2005）. Advantages of binaural hearing provided through bimodal stimulation via a cochlear implant and a conventional hearing aid: A 6-month comparative study. Acta Oto-Laryngologica, 125, 596-606.
NIDCD（2006）. Cochlear implant. Retrieved from National Institute on Deafness and Other Communication Disorder: http://www.nidcd.nih.gov/health/hearing/coch.asp2006
Nikolopoulos, T. P., Archbold, S. M., & O’Donoghue, G. M.（1999）. The development of auditory perception in children following cochler implantion. International Journal of Pediatric Otorhinolaryngology, 49, 189-191.
Noble, W., Tyler, R., Dunn, C., & Bhullar N.（2008）. Unilateral and bilateral cochlear implants and the implant-plus-hearing-aid profile: Comparing self-assessed and measured abilities. International Journal of Audiology, 47, 505-514.
O’Donoghue, G. M., Nikolopoulos, T. P., Archbold, S. M., & Tait, M. （1998）. Speech perception in children after cochlear implantation. The American Journal of Otology, 19, 762-767.
Peng, S.-C., Tomblin, J. B., Cheung, H., Lin, Y.-S., & Wang L.-S.（2004）. Perception and production of mandarin tones in prelingually deaf children with cochlear implants. Ear and Hearing, 25, 251-264.
Peng, S.-C., Tomblin, J. B., Spencer, L. J. & Hurtig, R. （2007）. Imitative production of rising speech intonation in pediatric cochlear implant recipients. Journal of Speech, Language, and Hearing Research, 50（5）, 1210-1227.
Peng, S.-C., Tomblin, J. B., Spencer, L. J. & Turner, C. W. （2008）. Production and perception of speech intonation in pediatric cochlear implant recipients and individuals with normal hearing. Ear and Hearing. 29, 336-351.
Peng, S.-C., Spencer, L. J., & Tomblin, J. B. （2004）. Speech intelligibility of pediatrie cochlear implant recipients with seven years of device experience. Journal of Speech, Language, and Hearing Research, 47, 1227-1236.
Qian, Y.-H., Guo, M.-H., & Xu, R.-H. （2004）. Effect of contralateral hearing aid for on performance of cochlear implant user. Journal of Audiology and Speech Pathology, 12（1）, 19-21.
Qin, M. K., & Oxenham, A. J. （2006）. Effects of introducing unprocessed low-frequency information on the reception of envelope-vocoder processed speech. The Journal of the Acoustical Society of Amesic, 119, 2417-2426.
Rubinstein, J. T. （2002）. Paediatric cochlear implantation: prosthetic hearing and language development. The Lancet, 360, 483-485.
Schafer, E. C., & Thibodeau, L. M.（2006）. Speech recognition in noise in children with cochlear implants while listening in bilateral, bimodal, and fm-system arrangements. American Journal of Audiology, 15, 114-126.
Skubisz, K. C. （2006）. Responses Short-Term auditory stimulation through contralateral hearing aid use in pediatric cochlear implant users. Unpublished doctoral dissertation. James Madison University Harrisonburg, Virginia:
Thompson, D. C., McPhilips, H., Davis, R. L., Lieu, T. A., Homer, C. J., & Helfand, M. （2001）. Universal newborn hearing screening. Journal of the American Medical Association, 286, 2000-2010.
Tye-Murray, N.（2009）. Foundations of Aural Rehabilitation: Children, Adults, and Their Family Members （3rd ed）. New York: Delmar.
Turner, C. W. （2006）. Hearing loss and the limits of amplification. Audiol Neurotol., 11, 2-5.
Turner, C. W., Gantz, B. J., Vidal, C., Behrens, A., & Henry, B. A.（2004）. Speech recognition in noise for cochlear implant listeners: Benefits of residual acoustic hearing. The Journal of the Acoustical Society of Amesic, 115（4）, 1729-1735.
Turner, C. W., Gantz, B. J. & Reiss, L. A.J. （2008）. Integration of acoustic and electrical hearing. Journal of Rehabilitation Research and Development, 45 （5）, 769-778.
Turner, C. W., Reiss, L. A. J., & Gantz, B. J. （2008）. Combined acoustic and electric hearing: Preserving residual acoustic hearing. Hearing Research., 242, 164-171.
Tyler, R. （2005）. Two cochlear implant-what have we learned, The 5th Asia Pacific Symposium on Cochlear Implant and Related Sciences, Hong Kong.
Tyler, R. S. （1993）. Cochlear implants : Audiological foundations. San Diego, Calif. : Singular Pub. Group.
Tyler, R. S., Parkinson, A. J., Wilson, B. S., Witt, S., Preece, J. P., & Noble, W. （2002）. Patients utilizating a hearing aid and cochlear implant: Speech perception and localization. Ear and Hearing. 23（2）, 98-105.
Ullauri, A., Crofts, H., Wilson, K., & Titley, S.（2007）. Bimodal benefits of cochlear implant and hearing aid（on the non-implanted ear）: a pilot study to develop a protocol and a test battery. Cochlear Implants International, 8（1）, 29-37.
Waltzman, S. B., & Cohen, N. L. （1998）. Cochlear implantation in children younger than 2 years old. The American Journal of Otology, 19, 158-162.
Waltzman, S. B., Cohen, N. L., Gomolin, R. H., Green, J. E., Shapiro, W. H., Hoffman, R. A., & Roland, J. T. （1997）. Open-set speech perception in congenitally deaf children using cochlear implants. The American Journal of Otology, 18, 342-349.
Waltzman, S. B., Cohen, N. L., Green, J., & Roland, J. T.（2002）. Long-term effects of cochlear implants in children. Otolaryngol head neck Surgery, 126, 505-511.
Waltzman, S. B. & Roland Jr., J. T.（2006）. Cochlear Implants（2nd ed）. New York: Thieme Medical Publishers.
Wang, N.-M., Huang, T.-S., Wu, C.-M., Shen, S.-Z., Lo, C., & Lin, C.-K. （2004）. Long-term outcome of school-aged children with cochlear implants. 4th Congress of Asia Pacific Symposium on Cochlear Implant, 5, 109-111.
Wei , C. G., Cao, K., & Zeng, F. G.（2004）. Mandarin tone recognition in cochlear-implant subjects. Hearing Research, 197, 87–95.
Wong, A. O. C., & Wong, L. L. N.（2004）. Tone perception of Cantonese-speaking prelingually hearing-impaired children with cochlear implants. Otolaryngology-Head and Neck Surgery. 130（6）, 751-758.
Wu, J.-L., Yuang,H.-M. （2003）. Speech perception of Mandarin Chinese speaking young children after cochlear implant use: effect of age at implantation. International Journal of Pediatric Otorhinolaryngology, 67, 247-253.
Xu, L., Ld, Y., Hao, J., Chen, X., Xue, S. A., & Han, D.（2004）. Tone production in Mandarin-speaking children with cochlear implants: A preliminary study. Acta Oto-Laryngologica, 124, 363-367.
Yost, W. A. （2006）. Fundamentals of Hearing: An Introduction （5th）. Emerald Group Pub Ltd.
Yoshinaga-Itano, C., Sedey, A. L., Coulter, D. K., & Mehl, A. L. （1998）. Language of early and later-identified children with hearing loss. Pediatrics, 102, 1161-1171.
Yuen, K.-C.,Cao, K.-L., Wei, C.-G., Luan, L., Li, H., & Zhang, Z.-Y. （2009）. Lexical tone and word recognition in noise of Mandarin-speaking children who use cochlear implants and hearing aids in opposite ears. Cochlear Implants Int, 10, 120-129.
Zeng, F.-G. （2004）. Trends in cochlear implants. Trends in Amplification, 8, 1-34.