耳鸣客观检查及主观信息与中医证型的关系初探
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摘要
目的：初步探讨以耳鸣声学特征作为中医证型的量化指标的可能性,观察声阻抗检查与中医证型的相关性,观察听性脑干反应(ABR)与耳鸣中医证型的相关性,观察耳鸣患者临床主观信息与中医证型的关系,为耳鸣患者的中医辨证提供更多的辨证信息。
方法：选取2010年4月至2011年3月江苏省中医院耳鼻喉科门诊以耳鸣为第一主诉的患者共166例(228耳)进行包括纯音听阈测定、耳鸣检查、声阻抗检查、听性脑干反应测定及4项耳鸣主观信息调查的调查,并将资料进行临床统计分析。
结论：本文通过对166例(228耳)耳鸣患者进行包括纯音听阈测定、耳鸣检查、声阻抗检查、听性脑干反应测定及4项耳鸣主观信息调查,得出以下结论：
1.风热侵袭证的耳鸣患者,其发病年龄较轻,纯音听阈全频升高明显,耳鸣频率较低,耳鸣响度较低,同侧声反射阈各频均较高,患者自觉耳鸣程度得分亦较低,多在2-3分之间,且其发病病程较短。其纯音听阈测定全频升高明显、较低的耳鸣频率及其多不影响工作学习、但会有心烦等情绪欠佳之表现的这几项指标,对于其证型的确定有更为显著的意义。
2.肝火上扰证的耳鸣患者,其纯音听阈测定高频升高明显,耳鸣频率较高,响度较高,自觉响度得分在3-4分之间,自觉程度得分在4分左右,病程除较风热侵袭证稍长与其他证型相较均较短。且纯音听阈测定高频明显升高,较高的耳鸣频率,自觉耳鸣会引起心烦等情绪欠佳并常会影响工作学习以及病程不长等因素对其证型的确定有更为显著的意义。
3.气滞血瘀证的耳鸣患者,自觉耳鸣程度较重,得分约在4分左右,其耳鸣会引起心烦,并较多会影响到工作学习。
4.肾精亏虚证的耳鸣患者,具有年龄大、纯音听阈测定高频升高明显、耳鸣频率高、响度高、病程长等特点。且其纯音听阈测定高频明显升高、较高的耳鸣频率及较长的耳鸣病程对其证型的确定有着更为显著的意义。
5.气血亏虚证的耳鸣患者,具有年龄偏大、耳鸣响度较高、同侧声反射阈较低及病程较长的特点。其中较高的耳鸣响度、同侧声反射阈在2kHz及4kHz处较低及较长的病程对于其证型的确定有着更为显著的意义。
6.对于肾精亏虚证与气血亏虚证,二者的各项相关指标有着高度的相似性。但要更进一步的区分此两种证型,则需要更进一步细致而广泛的研究。
Objectives:Preliminary discusse the possibility that acoustic characteristics of tinnitus would become quantitative indicators as syndromes of TCM. To observe the correlation between TCM syndrome and acoustic immittance measurement. To observe the correlation between the TCM syndrome and auditory brainstem response audiometry (ABR). To observe the correlation between the TCM syndrome and clinical subjective information of tinnitus. The more information would be provided to TCM syndrome.
Methods:Select the 166 patients (228 ears) in Otorhinolaryngology clinic service of Jiangsu Province Chinese Medicine Hospital which the first uncomfortable is tinnitus. The examinations were included the tinnitus'exame, acoustic immittance measurement and auditory brainstem response audiometry (ABR) and we surveyed the clinical subjective information of tinnitus. The data was analysed by statistical of clinical.
Result:Based on the 166 patients (228 ears) tinnitus patients include the tinnitus'exame, acoustic immittance measurement, auditory brainstem response audiometry (ABR) and four tinnitus subjective informations, the conclusions are following:
1.The tinnitus patients of wind-heat invasion syndrome have the characteristics include younger, lower frequency ringing in the ears, lower tinnitus loudness scores, lower level of perceived tinnitus which have 2-3 scores in the most and the incidence of short duration. The lower frequency and the indicator which does not affect the work and study but will be affect emotion have more significant to the syndrome.
2.The tinnitus patients of Flaring-up of Liver Fire syndrome have higher frequency and higher loudness. The score of perceived loudness was during 3 to 4. The score of perceived level was about 4.The distance of tinnitus was the shortest except wind-heat invasion syndrome. The factors that higher frequency ringing in the ears, upset caused by tinnitus, consciously moody, affected work and learning and not long course have more significant to this syndrome.
3.Tinnitus patients of qi stagnation induced blood stasis syndrome have these characteristics:the higher levels of perceived tinnitus which scoring about 4 points or so, the tinnitus can cause upset, and more will affect the work and study.
4.Kidney essence deficiency syndrome in tinnitus patients has features of older age, higher frequency, higher impact, longer course. It is more significant to syndrome that higher frequency and longer duration of tinnitus.
5.Qi and blood deficiency syndrome of tinnitus patients has features of older age, higher tinnitus loudness and longer course of tinnitus. The higher of tinnitus loudness and longer duration were the determination of the syndrome.
6.The relevant indicators between the kidney essence deficiency syndrome and Qi and blood deficiency syndrome have a high degree of similarity. But how to distinguish these two syndromes would need more detailed and extensive research.
方法：选取2010年4月至2011年3月江苏省中医院耳鼻喉科门诊以耳鸣为第一主诉的患者共166例(228耳)进行包括纯音听阈测定、耳鸣检查、声阻抗检查、听性脑干反应测定及4项耳鸣主观信息调查的调查,并将资料进行临床统计分析。
结论：本文通过对166例(228耳)耳鸣患者进行包括纯音听阈测定、耳鸣检查、声阻抗检查、听性脑干反应测定及4项耳鸣主观信息调查,得出以下结论：
1.风热侵袭证的耳鸣患者,其发病年龄较轻,纯音听阈全频升高明显,耳鸣频率较低,耳鸣响度较低,同侧声反射阈各频均较高,患者自觉耳鸣程度得分亦较低,多在2-3分之间,且其发病病程较短。其纯音听阈测定全频升高明显、较低的耳鸣频率及其多不影响工作学习、但会有心烦等情绪欠佳之表现的这几项指标,对于其证型的确定有更为显著的意义。
2.肝火上扰证的耳鸣患者,其纯音听阈测定高频升高明显,耳鸣频率较高,响度较高,自觉响度得分在3-4分之间,自觉程度得分在4分左右,病程除较风热侵袭证稍长与其他证型相较均较短。且纯音听阈测定高频明显升高,较高的耳鸣频率,自觉耳鸣会引起心烦等情绪欠佳并常会影响工作学习以及病程不长等因素对其证型的确定有更为显著的意义。
3.气滞血瘀证的耳鸣患者,自觉耳鸣程度较重,得分约在4分左右,其耳鸣会引起心烦,并较多会影响到工作学习。
4.肾精亏虚证的耳鸣患者,具有年龄大、纯音听阈测定高频升高明显、耳鸣频率高、响度高、病程长等特点。且其纯音听阈测定高频明显升高、较高的耳鸣频率及较长的耳鸣病程对其证型的确定有着更为显著的意义。
5.气血亏虚证的耳鸣患者,具有年龄偏大、耳鸣响度较高、同侧声反射阈较低及病程较长的特点。其中较高的耳鸣响度、同侧声反射阈在2kHz及4kHz处较低及较长的病程对于其证型的确定有着更为显著的意义。
6.对于肾精亏虚证与气血亏虚证,二者的各项相关指标有着高度的相似性。但要更进一步的区分此两种证型,则需要更进一步细致而广泛的研究。
Objectives:Preliminary discusse the possibility that acoustic characteristics of tinnitus would become quantitative indicators as syndromes of TCM. To observe the correlation between TCM syndrome and acoustic immittance measurement. To observe the correlation between the TCM syndrome and auditory brainstem response audiometry (ABR). To observe the correlation between the TCM syndrome and clinical subjective information of tinnitus. The more information would be provided to TCM syndrome.
Methods:Select the 166 patients (228 ears) in Otorhinolaryngology clinic service of Jiangsu Province Chinese Medicine Hospital which the first uncomfortable is tinnitus. The examinations were included the tinnitus'exame, acoustic immittance measurement and auditory brainstem response audiometry (ABR) and we surveyed the clinical subjective information of tinnitus. The data was analysed by statistical of clinical.
Result:Based on the 166 patients (228 ears) tinnitus patients include the tinnitus'exame, acoustic immittance measurement, auditory brainstem response audiometry (ABR) and four tinnitus subjective informations, the conclusions are following:
1.The tinnitus patients of wind-heat invasion syndrome have the characteristics include younger, lower frequency ringing in the ears, lower tinnitus loudness scores, lower level of perceived tinnitus which have 2-3 scores in the most and the incidence of short duration. The lower frequency and the indicator which does not affect the work and study but will be affect emotion have more significant to the syndrome.
2.The tinnitus patients of Flaring-up of Liver Fire syndrome have higher frequency and higher loudness. The score of perceived loudness was during 3 to 4. The score of perceived level was about 4.The distance of tinnitus was the shortest except wind-heat invasion syndrome. The factors that higher frequency ringing in the ears, upset caused by tinnitus, consciously moody, affected work and learning and not long course have more significant to this syndrome.
3.Tinnitus patients of qi stagnation induced blood stasis syndrome have these characteristics:the higher levels of perceived tinnitus which scoring about 4 points or so, the tinnitus can cause upset, and more will affect the work and study.
4.Kidney essence deficiency syndrome in tinnitus patients has features of older age, higher frequency, higher impact, longer course. It is more significant to syndrome that higher frequency and longer duration of tinnitus.
5.Qi and blood deficiency syndrome of tinnitus patients has features of older age, higher tinnitus loudness and longer course of tinnitus. The higher of tinnitus loudness and longer duration were the determination of the syndrome.
6.The relevant indicators between the kidney essence deficiency syndrome and Qi and blood deficiency syndrome have a high degree of similarity. But how to distinguish these two syndromes would need more detailed and extensive research.
引文
[1]Jiang D耳鸣及其美国的诊治指导方案[J].中国听力语言康复科学杂志,2005,1：58.
[2]王洪田,主编.耳鸣诊治新进展[M].北京：人民卫生出版社,2004.8.
[3]王洪田.耳鸣的诊断治疗新进展[J].实用医学志,2005,02：114.
[4]刘蓬,李明,王洪田,黄治物,胡岢.原发性耳鸣刍议(摘要)
[5]Brenan J. Calcium homeostasis and tinnitus[J]. Tinnitus Today,1997,22:10.
[6]Martin R. Tinnitus:epidemiology, etiology and classification[M]. In:Reich G, Venon J. Eds. Preceedings of the fifth international tinnitus senimar, Protland. OR:American Tinnitus Association,1995.25-30.
[7]Soussi T, Otto SR. Effects of eletrical brainstem stimulation on tinnitus[J]. Acta Otolaryngol (Stockh), 1994,114:135.
[8]Jastreboff PJ, Brennen JF, Sasaki CT. An animal model for tinnitus[J]. Laryngoscope,1988,98:280.
[9]Moller AR, Moller MB, Jannetta PJ, et al. Compound action potentials recorded from the exposed eighth nerve in patients with intratabletinnitus[J]. Laryngoscope,1992,102:187.
[10]Moller AR,Moller MB,Yokota M. Some forms of tinnitus may involved the extralemniscal auditory pathway [J]. Laryngoscope,1992,102:1165.
[11]Muhlnickel W, Elbert T, Taub E,et al. Reorganization of au2ditory cortex in tinnitus [J]. Proc Nat] Acad Sci USA,1998,95:10 340.
[12]Jastreboff P J, Gray W C, Gold S L. Neurophysiological approach to tinnitus patients[J]. Am J Otol,1996,17 (2):2362240.
[13]Weissman J L,Hirsch B E. Imaging of tinnitus:a review [J]. Radiology,2000,216 (2):3422349.
[14]石伟,汪惠书.脑干听觉诱发电位对主观性耳鸣的诊断价值[J].临床神经电生理学杂志,2004,13(1) ：43
[15]LemaireMC et al.Audiology,1995; 34:287-300
[16]吴立新、尚小领、范淑敏等.听力正常耳鸣患者治疗前后诱发性耳声发射的临床研究[J].河北北方学院学报,2006,23(3)：30-31
[17]Melcher JR, Sigalovsky IS, Guinan JJ Jr,et al. Lateralized tinnitus studied with functional magnetic resonance imaging: abnormal inferior colliculus activation. J Neurophysiol,2000,83 (2):1058-1072
[18]Cacace AT. Image tinntius with fMRI. Assoc Res Otolaryngol,1998,20:7.
[19]Cacace AT, Tasciyan T, Cousins JP. Principles of functional magnetic resonance imaging: application to auditory neuroscience. J Am Acad Audiol,2000,11 (5):239-272.
[20]Arnold W. Bartenstein P, Oestreicher E. et al. Focal metabolic activation in the predominant left auditory cortex in patients suffering from tinnitus:a PET study with [18F] deoxyglucose. ORL J Otorhinolaryngol Relat Spec,1996,58(4):195-199.
[21]Mirz F, Pedersen B, Ishizu K, et al. Positron emission tomography of cortical centers of tinnitus. Hear Res,1999,134(1-2):133-144,
[22]Lockwood AH, Salvi RJ, Coad ML, et al. The functional neuroanatomy of tinnitus:evidence for limbic system links and neural plasticity. Neurology,1998,50 (1):114-120.
[23]Shulman A, Strashun, AM, Afriyie M, et al. SPECT imaging of brain and tinnitus nurotologic/neurologic implications. Int Tinnitus J,1995,1 (1):13-29.
[24]严庆波,迟放鲁.耳鸣的掩蔽治疗.国外医学耳鼻咽喉科分册,2004,28：367
[25]任明中,周慧芳.翎3型窄带噪声掩蔽器治疗耳鸣的疗效观察[J].临床耳鼻咽喉科,1991,5：40
[26]NaglerSM.Tinnitus retraining therapy and the neurophysiological model of tinnitus.TinnitusToday, 1998,23:13
[27]余力生,徐永良,于德林.耳鸣的诊断与治疗[J].临床耳鼻咽喉科,1998,12：147
[28]杜宝东,姬虹,刘淑芳,等.利多卡因对耳鸣患者ARB波幅的影响[J].临床耳鼻咽喉科,1997,11：310
[29]马有光,王建华,王广智.利多卡因穴位注射治疗耳鸣的疗效观察[J].中国中西医结合耳鼻咽喉科,2000,8：180
[30]松岛纯一,肖洪万,伶丽娟.耳鸣的电刺激疗法[J].日本医学介绍,1994,15：371
[31]沈静.难治性耳鸣的鼓室呷电刺激疗法[J].日本医学介绍,1993,14：284
[32]程康明.耳鸣治风[J].江苏中医,1997,22：10.
[33]李巧英.耳鸣耳聋从心论治四法[J].陕西中医函授,1995,5：1.
[34]刘让,孙晓红,陈太平,等.“益肾开窍”法治疗神经性耳聋耳鸣临床分析[J].中国中西医结合鼻咽喉科杂志,1997,5：192.
[35]谭凌翔.益气活血法治疗神经性耳鸣238例[J].现代中西医结合杂志,2001,10：2272.
[36]周芳城.加味通气汤治疗耳鸣[J].山东中医杂志,1994,13：560.
[37]王东方.主观性耳鸣客观测量与中医临床证型关系探讨[J].辽宁中医杂志,1995,22：296
[38]王永华,甘雨,丁水耿.耳鸣的虚实辨证及声学特征分析[J].中国中西医结合耳鼻咽喉科杂志,1996,4：129.
[39]丛品,郑沙盟.不同证型耳鸣特点探讨[J].中国中西医结合耳鼻咽喉科杂志,2000,8：73
[40]史军.纯音匹配151例主观性耳鸣的临床与辨证分析[J].辽宁中医杂志,2007,34(4)：393-394
[41]刘蓬.中医药治疗耳鸣的研究[J].听力学及言语疾病杂志,2007,巧(5)：343-345.
[42]刘蓬.耳鸣的中医辨证研究[J].中国中西医结合耳鼻咽喉科杂志,2003,H(2)：102-104.
[43]刘蓬,刘春松等.耳鸣耳聋主客观测听与中医证型的关系初探[J].中医药学刊,2004,22(10)：1832-1833.
[44]刘莲,刘春松等.纯音测听在耳鸣耳聋中医辨证中的作用[J].广州中医药大学学报,2004,21(4)：253-256.
[45]刘蓬.刘春松等.声导抗测试在耳鸣中医辨证中运用的临床研究[J].新中医,2005,37(11)：21-23.
[46]郑日新.耳鸣声学特征与中医证型关系的初步研究[J].安徽中医学院学报,2005,24(5)：6-7
[47]张虹.“五脏相音”理论及其在耳鸣诊断中的应用[J].北京中医药,2009,28(5)：350-352
[48]黄选兆.汪吉宝主编.实用耳鼻咽喉科学.人民卫生出版社,2005,(10)：1219、1227.
[49]王洪田,姜泅长,杨伟炎,韩东一.一种耳鸣分类调查表的介绍[J].听力学及言语疾病,2001,9(1)：48
[50]王沛英,顾瑞,翟所强,等.舒耳丹治疗耳聋耳鸣的临床观察[J].中国中西医结合耳鼻咽喉科,1996,4：127.
[51]沈兆科,陈焕汉.升麻二黄汤为主治疗中老年神经性耳鸣45例观察[J].中国中西医结合,1995,15：437.
[52]张青,郑荣华.主观性耳鸣的中医治疗[J].上海中医药,1992,(12)：：18.
[53]韩斌,于少林.辨证分型治疗神经性耳鸣60例[J].陕西中医,2005,26(6)：535-536
[54]戈言平.耳鸣不独治肾论[J].浙江中医,2003,38(9)：392-393.
[55]周争道.耳鸣从痰热论治[J].江西中医药,2002,33(2)：62-62.
[56]孙文丽.补中益气汤加味治疗耳鸣[J].现代中西医结合,2004,13(n)：1509-1509.
[2]王洪田,主编.耳鸣诊治新进展[M].北京：人民卫生出版社,2004.8.
[3]王洪田.耳鸣的诊断治疗新进展[J].实用医学志,2005,02：114.
[4]刘蓬,李明,王洪田,黄治物,胡岢.原发性耳鸣刍议(摘要)
[5]Brenan J. Calcium homeostasis and tinnitus[J]. Tinnitus Today,1997,22:10.
[6]Martin R. Tinnitus:epidemiology, etiology and classification[M]. In:Reich G, Venon J. Eds. Preceedings of the fifth international tinnitus senimar, Protland. OR:American Tinnitus Association,1995.25-30.
[7]Soussi T, Otto SR. Effects of eletrical brainstem stimulation on tinnitus[J]. Acta Otolaryngol (Stockh), 1994,114:135.
[8]Jastreboff PJ, Brennen JF, Sasaki CT. An animal model for tinnitus[J]. Laryngoscope,1988,98:280.
[9]Moller AR, Moller MB, Jannetta PJ, et al. Compound action potentials recorded from the exposed eighth nerve in patients with intratabletinnitus[J]. Laryngoscope,1992,102:187.
[10]Moller AR,Moller MB,Yokota M. Some forms of tinnitus may involved the extralemniscal auditory pathway [J]. Laryngoscope,1992,102:1165.
[11]Muhlnickel W, Elbert T, Taub E,et al. Reorganization of au2ditory cortex in tinnitus [J]. Proc Nat] Acad Sci USA,1998,95:10 340.
[12]Jastreboff P J, Gray W C, Gold S L. Neurophysiological approach to tinnitus patients[J]. Am J Otol,1996,17 (2):2362240.
[13]Weissman J L,Hirsch B E. Imaging of tinnitus:a review [J]. Radiology,2000,216 (2):3422349.
[14]石伟,汪惠书.脑干听觉诱发电位对主观性耳鸣的诊断价值[J].临床神经电生理学杂志,2004,13(1) ：43
[15]LemaireMC et al.Audiology,1995; 34:287-300
[16]吴立新、尚小领、范淑敏等.听力正常耳鸣患者治疗前后诱发性耳声发射的临床研究[J].河北北方学院学报,2006,23(3)：30-31
[17]Melcher JR, Sigalovsky IS, Guinan JJ Jr,et al. Lateralized tinnitus studied with functional magnetic resonance imaging: abnormal inferior colliculus activation. J Neurophysiol,2000,83 (2):1058-1072
[18]Cacace AT. Image tinntius with fMRI. Assoc Res Otolaryngol,1998,20:7.
[19]Cacace AT, Tasciyan T, Cousins JP. Principles of functional magnetic resonance imaging: application to auditory neuroscience. J Am Acad Audiol,2000,11 (5):239-272.
[20]Arnold W. Bartenstein P, Oestreicher E. et al. Focal metabolic activation in the predominant left auditory cortex in patients suffering from tinnitus:a PET study with [18F] deoxyglucose. ORL J Otorhinolaryngol Relat Spec,1996,58(4):195-199.
[21]Mirz F, Pedersen B, Ishizu K, et al. Positron emission tomography of cortical centers of tinnitus. Hear Res,1999,134(1-2):133-144,
[22]Lockwood AH, Salvi RJ, Coad ML, et al. The functional neuroanatomy of tinnitus:evidence for limbic system links and neural plasticity. Neurology,1998,50 (1):114-120.
[23]Shulman A, Strashun, AM, Afriyie M, et al. SPECT imaging of brain and tinnitus nurotologic/neurologic implications. Int Tinnitus J,1995,1 (1):13-29.
[24]严庆波,迟放鲁.耳鸣的掩蔽治疗.国外医学耳鼻咽喉科分册,2004,28：367
[25]任明中,周慧芳.翎3型窄带噪声掩蔽器治疗耳鸣的疗效观察[J].临床耳鼻咽喉科,1991,5：40
[26]NaglerSM.Tinnitus retraining therapy and the neurophysiological model of tinnitus.TinnitusToday, 1998,23:13
[27]余力生,徐永良,于德林.耳鸣的诊断与治疗[J].临床耳鼻咽喉科,1998,12：147
[28]杜宝东,姬虹,刘淑芳,等.利多卡因对耳鸣患者ARB波幅的影响[J].临床耳鼻咽喉科,1997,11：310
[29]马有光,王建华,王广智.利多卡因穴位注射治疗耳鸣的疗效观察[J].中国中西医结合耳鼻咽喉科,2000,8：180
[30]松岛纯一,肖洪万,伶丽娟.耳鸣的电刺激疗法[J].日本医学介绍,1994,15：371
[31]沈静.难治性耳鸣的鼓室呷电刺激疗法[J].日本医学介绍,1993,14：284
[32]程康明.耳鸣治风[J].江苏中医,1997,22：10.
[33]李巧英.耳鸣耳聋从心论治四法[J].陕西中医函授,1995,5：1.
[34]刘让,孙晓红,陈太平,等.“益肾开窍”法治疗神经性耳聋耳鸣临床分析[J].中国中西医结合鼻咽喉科杂志,1997,5：192.
[35]谭凌翔.益气活血法治疗神经性耳鸣238例[J].现代中西医结合杂志,2001,10：2272.
[36]周芳城.加味通气汤治疗耳鸣[J].山东中医杂志,1994,13：560.
[37]王东方.主观性耳鸣客观测量与中医临床证型关系探讨[J].辽宁中医杂志,1995,22：296
[38]王永华,甘雨,丁水耿.耳鸣的虚实辨证及声学特征分析[J].中国中西医结合耳鼻咽喉科杂志,1996,4：129.
[39]丛品,郑沙盟.不同证型耳鸣特点探讨[J].中国中西医结合耳鼻咽喉科杂志,2000,8：73
[40]史军.纯音匹配151例主观性耳鸣的临床与辨证分析[J].辽宁中医杂志,2007,34(4)：393-394
[41]刘蓬.中医药治疗耳鸣的研究[J].听力学及言语疾病杂志,2007,巧(5)：343-345.
[42]刘蓬.耳鸣的中医辨证研究[J].中国中西医结合耳鼻咽喉科杂志,2003,H(2)：102-104.
[43]刘蓬,刘春松等.耳鸣耳聋主客观测听与中医证型的关系初探[J].中医药学刊,2004,22(10)：1832-1833.
[44]刘莲,刘春松等.纯音测听在耳鸣耳聋中医辨证中的作用[J].广州中医药大学学报,2004,21(4)：253-256.
[45]刘蓬.刘春松等.声导抗测试在耳鸣中医辨证中运用的临床研究[J].新中医,2005,37(11)：21-23.
[46]郑日新.耳鸣声学特征与中医证型关系的初步研究[J].安徽中医学院学报,2005,24(5)：6-7
[47]张虹.“五脏相音”理论及其在耳鸣诊断中的应用[J].北京中医药,2009,28(5)：350-352
[48]黄选兆.汪吉宝主编.实用耳鼻咽喉科学.人民卫生出版社,2005,(10)：1219、1227.
[49]王洪田,姜泅长,杨伟炎,韩东一.一种耳鸣分类调查表的介绍[J].听力学及言语疾病,2001,9(1)：48
[50]王沛英,顾瑞,翟所强,等.舒耳丹治疗耳聋耳鸣的临床观察[J].中国中西医结合耳鼻咽喉科,1996,4：127.
[51]沈兆科,陈焕汉.升麻二黄汤为主治疗中老年神经性耳鸣45例观察[J].中国中西医结合,1995,15：437.
[52]张青,郑荣华.主观性耳鸣的中医治疗[J].上海中医药,1992,(12)：：18.
[53]韩斌,于少林.辨证分型治疗神经性耳鸣60例[J].陕西中医,2005,26(6)：535-536
[54]戈言平.耳鸣不独治肾论[J].浙江中医,2003,38(9)：392-393.
[55]周争道.耳鸣从痰热论治[J].江西中医药,2002,33(2)：62-62.
[56]孙文丽.补中益气汤加味治疗耳鸣[J].现代中西医结合,2004,13(n)：1509-1509.