急、慢性耳鸣的临床和心理声学特征分析
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摘要
目的了解急、慢性耳鸣患者的临床特征,心理声学及伴发症状的情况。方法对343例耳鸣患者进行详细的病史采集,系统的耳部检查、听力学及耳鸣匹配检查,并完成耳鸣残疾量表(THI)及焦虑自评量表(SAS),抑郁自评量表(SDS)的填写。按耳鸣的病程将耳鸣分为急性耳鸣(耳鸣病程<6个月),慢性耳鸣:耳鸣病程≥6个月,最后统计分析急性与慢性耳鸣的临床特征、耳鸣心理声学的特征。结果急、慢性耳鸣患者的耳鸣匹配频率构成差异有统计学意义(P<0.05),急性耳鸣中,低中频所占比例较高,慢性耳鸣中高频所占比例较高;急、慢性耳鸣患者伴发焦虑、抑郁状态差异有统计学意义(P<0.05),急性耳鸣患者较慢性耳鸣患者更倾向伴发焦虑状态,而慢性耳鸣患者更倾向伴发抑郁症状。急、慢性耳鸣患者的性别、年龄分布,耳鸣匹配响度,是否有睡眠障碍、耳鸣严重程度差异无统计学意义(P>0.05)。结论急、慢性耳鸣患者的耳鸣频率和伴发焦虑、抑郁症状存在差异,对耳鸣患者的治疗有指导意义,值得进一步研究。
Objective To investigate the clinical and psychoacoustic characteristics in patients with acute and chronic tinnitus.Methods A total of 343 patients with tinnitus were enrolled in this study.Detailed medical history collection,systemic physical examination,audiologic testing,tinnitus evaluation,Tinnitus Handicap Inventory(THI) scale,Self-Rating Anxiety Scale(SAS),and Self-Rating Depression Scale(SDS) were performed.Tinnitus is divided into acute(tinnitus course<6 months) and chronic(tinnitus duration ≥ 6 months),according to the duration of tinnitus.Results The frequency of tinnitus in patients with acute and chronic tinnitus was significantly different(P<0.05).Most patients with acute tinnitus reported ear ringing of low or middle frequency pitch,while more patients with chronic tinnitus reported high pitch ear ringing.Patients with acute tinnitus were more likely to develop anxious state,while patients with chronic tinnitus were more likely to develop depressive symptoms.There was no significant difference in gender,age,tinnitus loudness,THI,sleeping disturbances between the acute and chronic tinnitus groups(P>0.05).Conclusions The frequency of tinnitus and the association with anxiety and depressive symptoms in patients with acute and chronic tinnitus are instructive in the treatment of tinnitus patients and deserve further investigation.
Objective To investigate the clinical and psychoacoustic characteristics in patients with acute and chronic tinnitus.Methods A total of 343 patients with tinnitus were enrolled in this study.Detailed medical history collection,systemic physical examination,audiologic testing,tinnitus evaluation,Tinnitus Handicap Inventory(THI) scale,Self-Rating Anxiety Scale(SAS),and Self-Rating Depression Scale(SDS) were performed.Tinnitus is divided into acute(tinnitus course<6 months) and chronic(tinnitus duration ≥ 6 months),according to the duration of tinnitus.Results The frequency of tinnitus in patients with acute and chronic tinnitus was significantly different(P<0.05).Most patients with acute tinnitus reported ear ringing of low or middle frequency pitch,while more patients with chronic tinnitus reported high pitch ear ringing.Patients with acute tinnitus were more likely to develop anxious state,while patients with chronic tinnitus were more likely to develop depressive symptoms.There was no significant difference in gender,age,tinnitus loudness,THI,sleeping disturbances between the acute and chronic tinnitus groups(P>0.05).Conclusions The frequency of tinnitus and the association with anxiety and depressive symptoms in patients with acute and chronic tinnitus are instructive in the treatment of tinnitus patients and deserve further investigation.
引文
1 Sindhusake D,Mitchell P,Newall P,et al.Prevalence and charac teristics of tinnitus in older adults:the Blue Mountains Hearin Study[J].Int J Audiol,2003,42(5):289-294.
2 Zirke N,Seydel C,Arsoy D,et a1.Analysis of mental disorders in tinnitus patients performed with composite international diagnos tic interview[J].Qual Life Res,2013,22(8):2095-2104.
3李明,张建宁.2014年美国《耳鸣临床应用指南》解读[J].听力学及言语疾病杂志,2015,23(2):112-115.Li M,Zhang JN.Interpretation of the AAO-HSN clinical practic guideline:Tinnitus in 2014[J].Journal of Audiology and Speech Pathology,2015,23(2):112-115.
4 Gul H,Nowak R,Buchner FA,et a1.Different treatment modatitie of tinnitus at the Euromed Clinic[J].Int Tinnitus j,2000,6(1)50-53.
5 Johansson MS,Arlinger SD.Prevalence of hearing impairment in population in Sweden[J].Int J Audiol,2003,42(1):18-28.
6 Mercier V,Luy D,Hohmann BW.The sound exposure of the audi ence at a music festival[J].Noise Health,2003,5(19):51-58.
7赖仁淙,马鑫.耳鸣观念的文艺复兴[J].中华耳科学杂志,201614(2):140-144.Lai RZ,Ma X.Renaissance of Tinnitus management[J].Chines Journal of Otology,2016,14(2):140-144.
8杨海弟,郑亿庆,区永康等.耳鸣患者静息态f MRI的局部区域一致性研究[J].中华耳科学杂志,2014,12(2):203-206.Yang HD,Zheng YQ,Ou YK.Resting-State f MRI regional homo geneity in tinnitus patients[J].Chinese Journal of Otology,201412(2):203-206.
9石勇兵,赵立东,王秋菊.耳鸣患者的检查与评估[J].中华耳科学杂志,2016,14(2):145-148.Shi YB,Zhao LD,Wang QJ.Evaluation of a tinnitus patient[J]Chinese Journal of Otology,2016,14(2):145-148.
10 Wallh?usser-Franke E,Schredl M,Delb W.Tinnitus and insom nia:is hyperarousal the common denominator[J]?Sleep Med Rev2013,17(1):65-74.
11 Xu Y,Yao J,Zhang Z,et al.Association between sleep qualit and psychiatric disorders in patients with subjective tinnitus in China[J].Eur Arch Otorhinolaryngol,2016,273(10):3063-3037.
12 Jastreboff PJ,Jastreboff MM.Tinnitus retraining therapy[J].Pro Brain Res,2007,166:415-423.
13 Ochi K,Ohashi T,Kenmochi M.Hearing impairment and tinnitu pitch in patients with unilateral tinnitus:comparison of sudden hearing loss and chronic tinnitus[J].Laryngoscope,2003,113(3)427-431.
14陈秀兰,秦兆冰.伴感音神经性聋的耳鸣患者临床表现及心理声学特点[J].中国耳鼻咽喉头颈外科,2011,18(2):77-79.Chen XL,Qin ZB.Clinical and psychocoustic characteristics o tinnitus patients with sensorineural hearing loss[J].CHIN ARCHOTOLARYNGOL HEAD NECK SURG,2011,18(2):77-79.
15邵茵,黄娟,李明.1240例耳鸣患者的临床表现分析[J].中华耳鼻咽喉头颈外科杂志,2009,44(8):641-644.Shao Y,Huang J,Li M.Clinical features analysis of 1240 tinnitu cases[J].Chin J Otorhinolaryngol Head Neck Surg,2009,44(8)641-644.
16 Andersson G.Tinnitus loudness matchings in relation to annoy ance and grading of severity[J].Auris Nasus Larynx,2003,30(2)129-33.
17杨静,周慧芳,杨东.耳鸣响度、听力下降与耳鸣严重程度的关系研究[J].临床耳鼻咽喉头颈外科杂志,2013,27(10):458-460.Yang J,Zhou HF,Yang D.To analyse the impact of tinnitus loud ness and hearing loss on the life of tinnitus patient[J].Clin Otorhi nolaryngol Head Neck Surg(China),2013,27(10):458-460.
18 Newman CW,Jacobson GP,Spitzer JB.Development of the Tinni tus Handicap Inventory[J].Arch Otolaryngol Head Neck Surg1996,122(2):143-148.
19刘博.加强耳鸣规范化综合治疗的研究和发展[J].中华耳科学杂志,2016,14(2):137-139.Liu B.Research and development of standardized comprehensiv treatment of tinnitus[J].Chinese Journal of Otology,2016,14(2)137-139.
20刘博.重视耳鸣临床特征与鉴别诊断关联的临床思维养成[J]临床耳鼻咽喉头颈外科杂志,2015,29(8):688-690.Liu B.The thinking of differential diagnosis of tinnitus based on clinical features[J].Clin Otorhinolaryngol Head Neck Surg,201529(8):688-690.
21 Tunkel DE.Bauer CA.Sun GH,et al.Clinical Practice Guideline Tinnitus[J].Otolaryngology head and neck surgery,2014,151(6)1995-2010.
22贾若,孙凤新,刘博.耳鸣和情绪认知的相关性研究[J].中华耳科学杂志,2016,14(2):158-162.Jia R,Sun FX,Liu B.Effects of cognition and emotion changes on tinnitus[J].Chinese Journal of Otology,2016,14(2):158-162.
23刁明芳,孙建军.耳鸣药物治疗现状与展望[J].中华耳科学杂志2014,12(3):507-511.Diao MF,Sun JJ.Current situation and prospect of tinnitus medi cation[J].Chinese Journal of Otology,2014,12(3):507-511.
24杨海弟,郑亿庆,区永康,等.重复经颅磁刺激(r TMS)治疗慢性主观性耳鸣的短期疗效分析[J].中华耳科学杂志,2015,13(2)278-281.Yang HD,Zheng YQ,Ou YK.The short-term effect analysis of re petitive transcranial magnetic stimulation(r TMS)in chronic tinni tus[J].Chinese Journal of Otology,2015,13(2):278-281.
25曾祥丽,招柏明,张姝琪,等.经皮迷走神经刺激术治疗慢性耳鸣的初步研究[J].中华耳科学杂志,2016,14(2):163-166.Zeng XL,Zhao BM,Zhang SQ,et al.Preliminary results of trans cutaneous vagus nerve stimulation for chronic subjective tinnitus A controlled clinical study[J].Chinese Journal of Otology,201614(2):163-166.
26王建洪,胡珍,高思敏,等.鼓室内注射利多卡因联合掩蔽及心理辅导治疗耳鸣疗效分析[J].中华耳科学杂志,2016,14(4)508-514.Wang JH,Hu Z,Gao SM,et al.Combined intratympanic lidocain with masking therapy and psychological intervention in treatin tinnitus[J].Chinese Journal of Otology,2016,14(4):508-514.
2 Zirke N,Seydel C,Arsoy D,et a1.Analysis of mental disorders in tinnitus patients performed with composite international diagnos tic interview[J].Qual Life Res,2013,22(8):2095-2104.
3李明,张建宁.2014年美国《耳鸣临床应用指南》解读[J].听力学及言语疾病杂志,2015,23(2):112-115.Li M,Zhang JN.Interpretation of the AAO-HSN clinical practic guideline:Tinnitus in 2014[J].Journal of Audiology and Speech Pathology,2015,23(2):112-115.
4 Gul H,Nowak R,Buchner FA,et a1.Different treatment modatitie of tinnitus at the Euromed Clinic[J].Int Tinnitus j,2000,6(1)50-53.
5 Johansson MS,Arlinger SD.Prevalence of hearing impairment in population in Sweden[J].Int J Audiol,2003,42(1):18-28.
6 Mercier V,Luy D,Hohmann BW.The sound exposure of the audi ence at a music festival[J].Noise Health,2003,5(19):51-58.
7赖仁淙,马鑫.耳鸣观念的文艺复兴[J].中华耳科学杂志,201614(2):140-144.Lai RZ,Ma X.Renaissance of Tinnitus management[J].Chines Journal of Otology,2016,14(2):140-144.
8杨海弟,郑亿庆,区永康等.耳鸣患者静息态f MRI的局部区域一致性研究[J].中华耳科学杂志,2014,12(2):203-206.Yang HD,Zheng YQ,Ou YK.Resting-State f MRI regional homo geneity in tinnitus patients[J].Chinese Journal of Otology,201412(2):203-206.
9石勇兵,赵立东,王秋菊.耳鸣患者的检查与评估[J].中华耳科学杂志,2016,14(2):145-148.Shi YB,Zhao LD,Wang QJ.Evaluation of a tinnitus patient[J]Chinese Journal of Otology,2016,14(2):145-148.
10 Wallh?usser-Franke E,Schredl M,Delb W.Tinnitus and insom nia:is hyperarousal the common denominator[J]?Sleep Med Rev2013,17(1):65-74.
11 Xu Y,Yao J,Zhang Z,et al.Association between sleep qualit and psychiatric disorders in patients with subjective tinnitus in China[J].Eur Arch Otorhinolaryngol,2016,273(10):3063-3037.
12 Jastreboff PJ,Jastreboff MM.Tinnitus retraining therapy[J].Pro Brain Res,2007,166:415-423.
13 Ochi K,Ohashi T,Kenmochi M.Hearing impairment and tinnitu pitch in patients with unilateral tinnitus:comparison of sudden hearing loss and chronic tinnitus[J].Laryngoscope,2003,113(3)427-431.
14陈秀兰,秦兆冰.伴感音神经性聋的耳鸣患者临床表现及心理声学特点[J].中国耳鼻咽喉头颈外科,2011,18(2):77-79.Chen XL,Qin ZB.Clinical and psychocoustic characteristics o tinnitus patients with sensorineural hearing loss[J].CHIN ARCHOTOLARYNGOL HEAD NECK SURG,2011,18(2):77-79.
15邵茵,黄娟,李明.1240例耳鸣患者的临床表现分析[J].中华耳鼻咽喉头颈外科杂志,2009,44(8):641-644.Shao Y,Huang J,Li M.Clinical features analysis of 1240 tinnitu cases[J].Chin J Otorhinolaryngol Head Neck Surg,2009,44(8)641-644.
16 Andersson G.Tinnitus loudness matchings in relation to annoy ance and grading of severity[J].Auris Nasus Larynx,2003,30(2)129-33.
17杨静,周慧芳,杨东.耳鸣响度、听力下降与耳鸣严重程度的关系研究[J].临床耳鼻咽喉头颈外科杂志,2013,27(10):458-460.Yang J,Zhou HF,Yang D.To analyse the impact of tinnitus loud ness and hearing loss on the life of tinnitus patient[J].Clin Otorhi nolaryngol Head Neck Surg(China),2013,27(10):458-460.
18 Newman CW,Jacobson GP,Spitzer JB.Development of the Tinni tus Handicap Inventory[J].Arch Otolaryngol Head Neck Surg1996,122(2):143-148.
19刘博.加强耳鸣规范化综合治疗的研究和发展[J].中华耳科学杂志,2016,14(2):137-139.Liu B.Research and development of standardized comprehensiv treatment of tinnitus[J].Chinese Journal of Otology,2016,14(2)137-139.
20刘博.重视耳鸣临床特征与鉴别诊断关联的临床思维养成[J]临床耳鼻咽喉头颈外科杂志,2015,29(8):688-690.Liu B.The thinking of differential diagnosis of tinnitus based on clinical features[J].Clin Otorhinolaryngol Head Neck Surg,201529(8):688-690.
21 Tunkel DE.Bauer CA.Sun GH,et al.Clinical Practice Guideline Tinnitus[J].Otolaryngology head and neck surgery,2014,151(6)1995-2010.
22贾若,孙凤新,刘博.耳鸣和情绪认知的相关性研究[J].中华耳科学杂志,2016,14(2):158-162.Jia R,Sun FX,Liu B.Effects of cognition and emotion changes on tinnitus[J].Chinese Journal of Otology,2016,14(2):158-162.
23刁明芳,孙建军.耳鸣药物治疗现状与展望[J].中华耳科学杂志2014,12(3):507-511.Diao MF,Sun JJ.Current situation and prospect of tinnitus medi cation[J].Chinese Journal of Otology,2014,12(3):507-511.
24杨海弟,郑亿庆,区永康,等.重复经颅磁刺激(r TMS)治疗慢性主观性耳鸣的短期疗效分析[J].中华耳科学杂志,2015,13(2)278-281.Yang HD,Zheng YQ,Ou YK.The short-term effect analysis of re petitive transcranial magnetic stimulation(r TMS)in chronic tinni tus[J].Chinese Journal of Otology,2015,13(2):278-281.
25曾祥丽,招柏明,张姝琪,等.经皮迷走神经刺激术治疗慢性耳鸣的初步研究[J].中华耳科学杂志,2016,14(2):163-166.Zeng XL,Zhao BM,Zhang SQ,et al.Preliminary results of trans cutaneous vagus nerve stimulation for chronic subjective tinnitus A controlled clinical study[J].Chinese Journal of Otology,201614(2):163-166.
26王建洪,胡珍,高思敏,等.鼓室内注射利多卡因联合掩蔽及心理辅导治疗耳鸣疗效分析[J].中华耳科学杂志,2016,14(4)508-514.Wang JH,Hu Z,Gao SM,et al.Combined intratympanic lidocain with masking therapy and psychological intervention in treatin tinnitus[J].Chinese Journal of Otology,2016,14(4):508-514.