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研究生： 郭俊麟
Kuo, Chun-Lin
論文名稱： 以風險管理和台灣臨床資料庫為基礎的耳鳴篩檢工具初步研究
A Pilot Study of a Tinnitus Screener Based on Risk Management and Taiwan Clinical Database
指導教授： 杜翌群
Du, Yi-Chun
學位類別： 碩士
Master
系所名稱： 工學院 - 生物醫學工程學系
Department of BioMedical Engineering
論文出版年： 2024
畢業學年度： 112
語文別： 英文
論文頁數： 66
中文關鍵詞： 耳鳴 、規範模式模型 、耳鳴風險評估
外文關鍵詞： tinnitus, rule-based analysis, tinnitus risk assessment
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    • 耳鳴是一種在無外部刺激下產生的主觀聽覺現象，全球盛行率約15%，且隨年齡增長而增加，超過四分之一老年族群曾經歷耳鳴。耳鳴的成因和相關因素複雜多樣，並因種族、地域等特徵有所差異，包括聽力損失、壓力、精神疾病、結構異常及腫瘤等。耳鳴的影響範圍差異顯著，從偶爾出現的短暫音段到嚴重干擾日常生活，甚至可能導致精神健康問題。研究顯示，全球嚴重影響生活的耳鳴患者約佔3%，且其所帶來的精神失能及醫療負擔在歐洲及美國平均每人每年超過5,500美元。然而，目前尚無有效的客觀方法來評估耳鳴嚴重程度及風險，此大幅限制耳鳴篩檢、治療及療效評估之研究，而囿縮可延伸應用的空間。本研究利用台灣臨床病歷數據，分析本土耳鳴患者特徵並探尋潛在風險因素。基於文獻和臨床研究結果並結合規範模式模型，本研究開發了一種專為台灣人群設計的耳鳴風險篩檢工具。分析結果將耳鳴患者按風險程度進行分層，並與臨床評估結果進行比較。初步研究顯示，此篩檢工具在識別高風險耳鳴患者方面的準確度達到88.2%。該篩檢工具不僅能為台灣耳鳴族群及其失能照護者提供客觀參考依據，幫助潛在風險者及時就醫，避免錯失黃金治療期。此外，亦可減輕耳鳴患者對耳鳴情形及就醫的焦慮，進而減輕耳鳴帶來的精神、經濟、醫療及社會負擔。

    Tinnitus, characterized by the perception of sound without an external source, is a widespread condition affecting approximately 15% of the global population, with a notably higher prevalence reaching up to 25% among older adults. The etiology of tinnitus is complex and multifactorial, encompassing factors such as hearing loss, stress, psychiatric disorders, structural abnormalities, and even tumors. The impact of tinnitus can range from mild, transient episodes to severe disruptions in daily life, potentially leading to psychiatric comorbidities. Studies suggest that severely debilitating tinnitus affects about 3% of individuals, with associated disability costs exceeding 5,500 USD annually per person. The absence of objective methods for assessing tinnitus risk complicates research and clinical practice. This study utilized clinical data from Taiwan to characterize tinnitus features and identify potential risk factors within the local population. Building on existing literature and clinical experience, a normative model-based tinnitus screening tool was developed specifically for Taiwanese individuals. The analysis stratified tinnitus patients according to risk levels and compared these results with clinical assessments. Preliminary findings demonstrate an accuracy of 88.2% in identifying high-risk tinnitus cases. This screening tool shows promise as an objective reference for Taiwanese individuals, their caregivers, and healthcare providers to evaluate tinnitus status and facilitate timely intervention for those at elevated risk. Additionally, it has the potential to mitigate anxiety related to tinnitus status and healthcare decisions, thereby reducing the psychological, economic, medical, and societal burdens associated with the condition.

    摘要 I ABSTRACT II 致謝 III TABLE OF CONTENTS IV LIST OF TABLES VI LIST OF FIGURES VII LIST OF ABBREVIATIONS VIII CHAPTER 1: INTRODUCTION 1 1.1 Global Prevalence of Tinnitus 1 1.2 The Burden of Tinnitus: A Global Perspective 3 1.3 Etiologies and Mechanisms of Tinnitus 4 1.3.1 Mechanisms of Hearing Loss and Noise Exposure in Tinnitus 5 1.3.2 Stress and Mental Health in Tinnitus: Mechanisms and Pathways 5 1.4 Treatment and Evaluation of Tinnitus 7 1.4.1 Behavior Therapy 8 1.4.2 Sound Therapy 9 1.4.3 Medication Therapy 9 1.5 Unmet Needs 10 1.5.1 Lacking of Risk Awareness Against Tinnitus 10 1.5.2 Lacking of Objective Assessment 11 1.5.3 Research Purpose 12 CHAPTER 2: LITERATURE REVIEW 14 2.1 Characteristics of Tinnitus Perception 14 2.2 Categorization of Tinnitus 15 2.2.1 Pulsatile and Non-pulsatile Tinnitus 16 2.2.2 Unilateral and Bilateral Tinnitus 16 2.3 Comorbidities and Tinnitus 17 2.3.1 Hearing Loss and Noise Exposure 17 2.3.2 Cardiovascular Related Disorders 17 2.3.3 Psychogenic Disorders 18 2.4 Severity Assessment 19 2.5 Previous Research in Taiwan Population 19 CHAPTER 3: MATERIAL AND METHOD 21 3.1 Electronic Medical Records 21 3.2 Data Source 21 3.2.1 Dataset Inclusion 21 3.2.2 Data Grouping 22 3.3 Methodology 24 3.3.1 Data Sampling 24 3.3.2 Risk Factors Identification 24 3.4 Statistical Analysis 25 3.4.1 Multiple Logistic Regression 26 3.4.2 Odds Ratio 26 3.5 Rule-based Analysis and Scoring System Setting 27 3.5.1 Rule-based Analysis 27 3.5.2 Tinnitus Risk Score System 29 3.6 Risk Stratification and Validation 29 3.6.1 Risk Stratification 29 3.6.2 Validation of Risk Stratification Accuracy 30 CHAPTER 4: EXPERIMENTAL DESIGN AND RESULT 31 4.1 Demographic Analysis 32 4.2 Medical Visits Annual Distribution 35 4.3 Risk Analysis of Tinnitus 36 4.4 Tinnitus Risk Score Development 39 CHAPTER 5: DISCUSSION 43 5.1 Implications of Diagnostic Tinnitus Definition 43 5.2 Development of a Taiwanese Tinnitus Risk Screening Framework 44 5.2.1 Scope of Variables Examination 44 5.2.2 Potential Sources of Bias 45 5.3 Accuracy of Tinnitus Risk Assessment Model 46 CHAPTER 6: CONCLUSION AND FUTURE WORKS 48 6.1 Conclusion 48 6.2 Future Works 49 6.2.1 Validation of the Tinnitus Risk Assessment 49 6.2.2 Comprehensive Tinnitus Screener Construction 50 6.2.3 Integration of EEG-Based Assessment in Tinnitus Risk Analysis 51 REFERENCES 52

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