耳鸣掩蔽结合心理咨询治疗耳鸣的疗效评价

目的 评价耳鸣掩蔽结合心理咨询治疗耳鸣的疗效.方法 对35例(48耳)耳鸣患者进行耳鸣掩蔽结合心理咨询治疗,分别于治疗前、治疗结束后以及半年后填写耳鸣残疾评估量表(tinnitus handicap inventory, THI),根据THI量表得分变化分析疗效.治疗后THI得分比治疗前减少≥20分认为治疗有效.结果 所有耳鸣患者均完成一个疗程的治疗,20例完成半年随访.耳鸣掩蔽结合心理咨询前后THI评分减少≥20分者15例,有效率为43%(15/35),半年后有效率为45%.男女之间耳鸣严重程度有统计学差异.40～49岁和50～80岁组治疗效果最好,20～29岁和10～19岁组治疗效果最差,但各年龄段疗效无统计学差异.治疗前后及半年后THI、E项(感情评价)、F项(功能性评价)、C项(严重性评价)差异有统计学意义,治疗有效.不同耳鸣持续时间的治疗效果差异没有统计学意义(P=0.551).结论 耳鸣掩蔽结合心理咨询治疗耳鸣能够取得一定疗效,并且效果稳定.有高频听力损失患者治疗效果好.     

认知行为疗法联合声治疗对慢性特发性耳鸣的疗效及影响因素分析

目的 评价认知行为疗法联合声治疗对慢性特发性耳鸣患者的治疗效果，分析影响疗效的因素。方法 选取2018年6月到2020年6月在乐山市人民医院耳鼻咽喉头颈外科诊断为慢性特发性耳鸣并接受认知行为疗法联合声治疗的患者48例，分析患者治疗前后的耳鸣残疾评估量表(tinnitus handicap inventory, THI)和耳鸣严重程度评估量表(tinnitus evaluation questionnaire, TEQ)评分的差异，评估治疗效果，同时分析患者的年龄、性别、文化程度、耳鸣响度、耳鸣频率及听力损失程度是否为影响疗效的独立因素。结果 治疗后48例患者中痊愈5例(10.42%),显效13例(27.08%),有效13例(27.08%),无效17例(35.42%),总有效率64.58%(31/48)。治疗前THI评分为46.96±9.05分，TEQ评分为13.77±2.36分，治疗后THI评分为30.38±14.82分，TEQ评分为9.69±4.20分，治疗前后的THI评分差异和TEQ评分差异均有统计学意义(均为P<0.05)。患者的年龄、性别、耳鸣响度、耳鸣频率及听力损失程度...     

耳鸣评价量表的临床应用价值研究

目的 探讨耳鸣评价量表(tinnitus evaluation questionnaire, TEQ)的临床应用价值.方法 以耳鸣为第一主诉初诊的187例患者(13~80岁,平均42.5±13.5岁)为研究对象,由专业医务人员进行TEQ评估,以患者自填的耳鸣残疾量表(tinnitus handicap inventory, THI)作为对照,研究TEQ的汇聚效度;从中抽取96例患者由两名专业医务人员在半天内对同一患者进行2次TEQ评估,评估耳鸣严重程度,以比较不同测试者间的重测信度;抽取57例患者给予治疗一个月,根据治疗前后患者主观感觉耳鸣有无变化,应用效应量(effect size, ES)计算公式评估TEQ反应度(responsiveness);记录TEQ评估每位患者的测试用时及患者自填THI的时间,以比较测试时效.结果 187例患者TEQ、THI总分分别为10.69±2.88和43.12±19.40,相关系数r=0.79(P<0.01),TEQ与THI汇聚效度好;接受两名测试者评估的96例患者不同测试者间TEQ重测信度为0.94(P<0.01),TEQ的重测信度良好;57例患者治疗一个月后自觉耳鸣症状改善组(36例)治疗前TEQ得分10.69±2.74分,治疗后为7.83±2.74分,效应量为1.04,为较大效应量;说明TEQ能敏感反映患者症状变化,反应度良好.TEQ评估时间(3.27±1.01分钟)显著短于THI评估时间(11.17±3.11分钟)(P<0.01).结论 TEQ的准确性、可靠性、敏感性及可操作性均较理想,且费时少,具有良好的临床实用价值,适用于对耳鸣严重程度和疗效的评估.     

重复经颅磁刺激(rTMS)治疗慢性主观性耳鸣的短期疗效分析

目的采取1Hz低频重复经颅磁刺激(rTMS)治疗慢性主观性耳鸣并评价其治疗效果。方法对慢性主观性耳鸣患者46例行1Hz低频rTMS连续治疗2周,治疗前后分别行耳鸣残疾量表评分(THI)评分及主观疗效评估。结果rTMS对耳鸣治疗有明显效果,对主观耳鸣症状总体有效率为63.1%,其中失代偿性耳鸣(THI≥40)的有效率明显高于代偿性耳鸣(THI<40)(77%vs 45%;P<0.001),耳鸣患者治疗前后THI为(51.8±23.5 vs 37.0±18.8;t=5.94,p<0.001),VAS为(6.3±2.4 vs 4.9±1.8;t=5.27,p<0.01),治疗前后有统计学差异。失代偿组与代偿组耳鸣rTMS治疗后THI变化存在显著差异,两组差值为19.4±8.5(df=42,T=4.95,P<0.001)。结论rTMS治疗耳鸣有效,可明显降低THI得分,改善耳鸣症状,特别在失代偿性耳鸣效果更明显。     

耳鸣严重程度与焦虑的相关性研究

目的:研究耳鸣严重程度与焦虑的相关性,探讨其在耳鸣康复中的作用。方法:对以耳鸣为第一主诉就诊的119例患者,用耳鸣一般情况问卷表、耳鸣残疾量表(THI)和焦虑自评量表(SAS)进行横断面调查,分析其相关性。结果:THI得分和SAS得分正相关(r=0.573,P<0.01),THI得分分级和SAS得分正相关(r=0.551,P<0.01)。耳鸣严重程度越高,焦虑得分越高。结论:耳鸣严重程度与焦虑呈中度正相关性,对以耳鸣为第一主诉且其THI得分分级≥中度(即≥38分)的耳鸣患者,应注意了解其焦虑程度,进行必要的心理干预,有助于耳鸣患者的康复。     

内置灵韵技术助听器对耳鸣的疗效分析

目的：评价内置灵韵技术助听器治疗耳鸣的效果。方法选择30例（46耳）伴不同程度听力损失的耳鸣患者,均配戴内置灵韵技术的助听器,比较其佩戴助听器前、佩戴后6周其耳鸣残疾评估量表（tinnitus handi-cap inventory ,THI）得分,评估灵韵技术助听器治疗耳鸣的效果。结果30例耳鸣患者佩戴灵韵技术助听器前THI平均得分为56．80±16．95分,佩戴6周后THI平均得分为29．93±15．05分,佩戴前后THI平均得分差值为26．53±15．81分;共有21例患者 THI得分较佩戴前减少≥20分,治疗有效率达70．0％,其中6例患者佩戴后THI得分降至≤16分,即治愈率为20．0％。结论配戴内置灵韵技术助听器能帮助伴听力损失的耳鸣患者有效缓解耳鸣症状。     

TSG助听器用于耳鸣患者的临床结果

目的 评估TSG助听器(GN Resound Live 9 TS)改善患者耳鸣的效果,从而检验该技术用于治疗单纯性耳鸣和耳鸣伴有听力障碍患者的可行性和疗效.方法 采用耳鸣残疾评估量表(TinnitusHandicap Inventory,THI)作为评估素材,分别对9名受试者在TSG助听器配戴前后的耳鸣残疾程度进行评估.结果 ①全部受试者配戴GN Resound Live 9 TS助听器前后THI总分和各条目得分均有显著性差异(P<0.0001) ; ②GN Resound Live 9 TS助听器配戴前后受试者THI的功能性、情感性及严重性得分均得到显著性改善(P<0.0001).结论 GN Resound Live 9 TS助听器对单纯耳鸣受试者或耳鸣伴有轻中度感音神经性听力损失者均显示出明显的改善作用.     

伴发于突发性聋的耳鸣临床特征及声治疗短时疗效分析北大核心CSCD

目的探讨伴发于突发性聋的耳鸣患者临床听力学特征,并分析耳鸣及声治疗短期疗效影响因素。方法回顾性分析伴发于突发性聋的耳鸣患者人口学特征及心理声学特征,按照THI评分等级进行分组,使用卡方检验、单因素方差分析、Spearman相关分析、Logistic回归等分别分析各个因素对耳鸣严重程度的影响及其声治疗效果。结果1.纳入的患者共108名,其中轻度耳鸣组49名(45.5%),中度耳鸣组34名(31.5%),重度耳鸣组25名(23.1%)。2.经卡方检验,3组患者在SAS得分存在统计学差异(χ^(2)=25.239,P<0.05),SAS分数随着耳鸣分级增加有升高的趋势。3.轻度耳鸣组和中度耳鸣组与重度耳鸣组的PQSI结果存在统计学差异(χ^(2)=14.437,P<0.05)。重度耳鸣组睡眠障碍人数多于其他两组,轻度耳鸣组和中度耳鸣组之间则无统计学差异。4.经Spearman相关分析,PQSI、SAS等级与THI得分及各因子之间有显著的正相关(r>0,P<0.005)。5.经多元有序Logistic回归分析,结果显示影响THI等级与SAS等级、睡眠质量问题成正相关(P<0.005)。6.经二元多因素logistic回归结果显示,伴发于突发性聋的耳鸣患者声治疗短时疗效影响因素是残余抑制试验结果(P=0.020)。结论耳鸣发生的严重程度与焦虑症状有显著的关联;重度耳鸣患者更容易合并睡眠障碍;伴发于突发性聋耳鸣患者的声治疗效果与残余抑制试验结果有关,残余抑制试验结果可以为临床声治疗耳鸣提供指导。     

突发性聋伴耳鸣患者耳鸣特征

目的 分析研究突发性聋伴耳鸣患者的耳鸣特点、耳鸣与听力损失的关系、耳鸣对患者的影响程度, 探讨突聋患者耳鸣的产生机制。 方法 突发性聋伴有耳鸣患者231例常规采集病史, 填写耳鸣致残量表(THI)及视觉模拟得分表(VAS), 同时进行纯音听阈测试、耳声发射、耳鸣检测及掩蔽试验等检查。分析患者的耳鸣特点、耳鸣与听力的关系、耳鸣的THI及VAS得分以及它们特点。 结果 ①听力损失特点：低中频下降型20例(占8.7%), 中高频下降型60例(占26.0%), 平坦型44例(占19.0%), 全聋型79例(占34.2%), 不规则型28例(占12.1%);②耳鸣频率:低频耳鸣(≤500 Hz)49例(占21.2%), 中频耳鸣(51～2 000 Hz)54例(23.4%), 高频耳鸣(>2 000 Hz)122例(52.8%), 未匹配6例(占2.6%)。其中听力损失类型为低中频下降型的患者中, 低频、中频、高频耳鸣的比例分别为75%、15%、10%;中高频下降型患者中, 低频、中频、高频耳鸣的比例分别为13.3%、26.7%、60.0%;全聋型患者中, 低频、中频、高频耳鸣的比例分别为17.1%、19.0%、63.3%。听力下降最明显的频率对数与耳鸣频率对数呈线性关系, r=0.592, P<0.01;③耳鸣响度:0～30 dB HL 45例(占19.5%), 31～60 dB HL 60例(占26.0%), 60～90 dB HL 102例(占44.2%), 大于90 dB HL 18例(占27.8%), 未匹配6例(占2.6%)。耳鸣响度与听力损失程度(250～4 000 Hz平均听阈)有相关性, 相关系数r=0.216, P=0.001<0.05。④耳鸣致残级别:按照Newman等依据THI得分将耳鸣残疾分级, 其中1级27例(占11.7%), 2级耳鸣44例(占19.0%), 3级66例(占28.6%), 4级94例(占40.7%)。⑤THI及VAS得分特点:THI得分与听力损失程度无相关性r=0.087, P=0.287>0.05。VAS得分与听力损失程度无相关性r=0.002, P=0.982>0.05。THI得分与耳鸣频率对数无相关性, 相关系数r=-0.056, P=0.402>0.05。VAS得分与耳鸣频率对数无相关性, 相关系数r=-0.003, P=0.970>0.05。THI得分与耳鸣响度无相关性, 相关系数r=0.039, P=0.563>0.05。VAS得分与耳鸣响度无相关性, 相关系数r=0.136, P=0.110>0.05。结论 ①突发性聋伴耳鸣患者中高频耳鸣最常见;②耳鸣频率与听力损失类型显著相关, 低中频下降型以低频耳鸣多见, 而中高频下降型及全聋型以高频耳鸣多见;③听力损失最大的频率与耳鸣的频率有较高的一致性;④突发性聋伴耳鸣患者急性期的耳鸣致残程度以3～4级为多;⑤THI及VAS得分与听力损失的程度、耳鸣的频率、耳鸣的响度均无相关性。     

耳鸣对患者心理影响分析

目的调查耳鸣对患者造成的心理负担以及影响因素,为临床耳鸣患者咨询提供依据。方法选取四川大学华西医院听力中心收治的针对耳鸣为第一主诉的初诊患者,使用耳鸣评价量表(tinnitus evaluation questionnaire,TEQ)中的两个开放性问题调查耳鸣对患者最大的影响及患者对耳鸣最担心的情况。采用耳鸣残疾量表(tinnitus handicap inventory,THI)和TEQ评估耳鸣严重程度。结果共调查214例耳鸣患者,其中男性90例(42.06%),女性124例(57.94%)。患者中55.14%(118例)认为耳鸣主要影响情绪,26.17%(56例)认为耳鸣主要影响睡眠。对耳鸣,患者最担心的前3项依次是听力下降或耳聋(33.64%)、耳鸣治不好(32.24%)以及因耳鸣而担心其它健康问题(16.36%)。两组患者对耳鸣有或没有担心在基础疾病以及耳鸣严重程度得分方面具有显著差异(P<0.05)。结论耳鸣容易影响患者情绪,尤其是有基础疾病且耳鸣较严重的患者更易对耳鸣产生担心。患者最担心听力下降、耳鸣预后以及可能的潜在健康问题。针对患者的担忧予以疏解指导有利于促进耳鸣者康复。     

Effect of Melatonin on Tinnitus

Objective: Evaluate melatonin as a treatment for subjective tinnitus. Study Design: Randomized, prospective, double-blind, placebo-controlled crossover trial. Patients were given 3.0 mg melatonin, which was taken nightly for 30 days followed or preceded by a placebo nightly for 30 days, with a 7-day washout period between medications. Setting: Outpatient, private, neurotology practice. Patients: Thirty patients with subjective tinnitus. Main Outcome Measures: Tinnitus matching, Tinnitus Handicap Inventory (THI), patient questionnaire and interview. Results: The average pretreatment THI score was 33.91 as compared with 26.43 after the placebo and 26.09 after melatonin. The difference in the THI scores between melatonin and placebo treatment were not statistically significant. The average pretreatment THI score for patients who reported overall improvement with melatonin was statistically higher (P = 0.02) than the average pretreatment THI score for patients who reported no improvement with melatonin. Among subjects reporting difficulty sleeping attributable to their tinnitus, 46.7% reported an overall improvement after melatonin compared with 20.0% for placebo (P = 0.04). There was also a statistically significant difference in improvement with melatonin for those patients with bilateral tinnitus compared with those with unilateral tinnitus (P = 0.02). Conclusion: Melatonin has been shown to be useful in the treatment of subjective tinnitus. Patients with high THI scores and/or difficulty sleeping are most likely to benefit from treatment with melatonin. In light of its minimal side effects, melatonin should be a part of the physician's armamentarium in the treatment of tinnitus.     

Tinnitus Retraining Therapy (TRT): outcomes after one-year treatment

The aim of the study is to present our results regarding the efficacy of TRT for tinnitus relief in patients with clinically significant tinnitus compared to a group treated with vasoactive agents. In a nonrandomized prospective study, 63 patients with disabling tinnitus were recruited. Greek translation of the Tinnitus Handicap Inventory (THI) and visual analogue scale (VAS) for annoyance caused by tinnitus when conducting four major activities of everyday life (work, sleep, relaxation and concentration) were examined in a 12-month period. The THI score was significantly improved in the TRT group, as well as mean VAS scores, in all measures. Comparison of the mean improvement of THI and VAS scores after treatment showed significant differences between the two groups, favoring TRT treatment. Our data suggest that TRT is an effective treatment. It reduces the level of annoyance induced by tinnitus and improves the ability of patients to work, sleep, relax or be concentrated.     

Short Term Effects of Repetitive Transcranial Magnetic Stimulation in Patients with Catastrophic Intractable Tinnitus: Preliminary Report

Objectives

The short-term effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) in the patients with catastrophic and intractable tinnitus were investigated.

Methods

Fifteen participants were recruited among patients with catastrophic intractable tinnitus to receive 1 Hz rTMS treatment. Tinnitus severity was assessed before rTMS and directly after sham or real rTMS using the tinnitus handicap inventory (THI) and visual analog scale (VAS).

Results

There was no statistical difference in the THI score before and after sham stimulation. However, after 5 replications of real rTMS there was statistically significant reduction in THI score. Eight patients showed a decrease of more than 10 in THI score. Patients who showed a vast change in THI score after rTMS also showed a large decrease in their VAS score (r=0.879, P<0.001). Duration of tinnitus and change of THI score showed statistically significant moderate negative correlation (r=-0.637, P=0.011). But in case of VAS, there was no significant difference between VAS and duration of tinnitus.

Conclusion

Among total 15 patients with catastrophic intractable chronic tinnitus, eight patients showed some improvement in symptoms after 1 Hz rTMS. rTMS can be considered management modality for intractable tinnitus even with distress as severe as catastrophic stage.     

配戴助听器治疗伴有感音神经性听力减退的耳鸣患者的临床初探

目的探讨配戴助听器治疗伴有感音神经性听力减退的耳鸣患者的临床疗效。方法根据入组时的听力图类型将56名伴有感音神经性听力减退的耳鸣患者分为平坦型、上升型、下降型和切迹型4组,采用耳鸣残疾评估量表评估其配戴助听器前后耳鸣的变化程度,了解配戴助听器治疗伴有感音神经性听力减退的耳鸣患者的疗效。结果配戴助听器半年后,耳鸣情况得到改善,无论从THI总体得分,还是分别从功能性、情感性、严重性三个方面的评分来看,配戴助听器后均有明显改善（P〈0．01）,平坦型、上升型、下降型、切迹型4组之间没有差异（P〉0．05）。结论配戴助听器对部分伴有感音神经性听力减退的耳鸣患者有效。     

Tinnitus modifications after cochlear implantation

Tinnitus can be defined as a phantom sensation in the absence of an external sound. In our study, we evaluated the effect of cochlear implant on tinnitus evolution. Among adult, postlingually deaf patients who underwent cochlear implantation at our clinic, we selected 20 subjects with pre-implantation tinnitus (group A) and 10 subjects without pre-implantation tinnitus (group B). Pre- and post-surgery tinnitus was assessed through two questionnaires: the first one dealing with tinnitus characteristics and psychosocial impact, and the second one represented by THI, an internationally validated score of evaluation of the effects of tinnitus on patient’s emotions and activities of daily living. None of the patients belonging to group B developed tinnitus after surgery. As for group A, 40% of patients declared suppression of tinnitus, 30% attenuation of tinnitus after surgery, 25% reported tinnitus was unchanged and 5% reported worsening of tinnitus. In the nine patients with bilateral tinnitus (45%), after implantation tinnitus disappeared from both sides in four patients and attenuated bilaterally in four patients. A comparison between pre- and post-implantation THI scores showed decreased score in 65% of cases, unchanged score in 30% and increased score in 5%. The beneficial effect of cochlear implant on tinnitus, reported by a majority of patients, could be due to acoustic masking, to direct electrical stimulation of the acoustic nerve, and above all to a possible cochlear implantation dependent reorganization of the central auditory pathways and associative cerebral areas. In the light of these results, the authors propose (1) to include tinnitus in the selection criteria of which ear to implant; (2) to consider implantation eligibility for patients with bilateral severe hearing loss associated with severe tinnitus; and (3) to inform patients about the small risk of post-operative tinnitus worsening.     

Tinnitus retraining therapy: prognosis factors

INTRODUCTION: Tinnitus retraining therapy (TRT) is, nowadays, one of the most extended treatments for tinnitus control. The goal is the habituation to a nonsignificative signal, that is, tinnitus, first, eliminating its reaction and, second, minimizing its perception. PURPOSE: The objective of this study is to identify the factors that could improve or reduce the efficacy of TRT. MATERIALS AND METHODS: A prospective nonrandomized clinical assay (n = 137) was conducted. Three parameters were considered for tinnitus evaluation at 1-year follow-up: patient self-evaluation, visual analogue scale for intensity, and Tinnitus Handicap Inventory. RESULTS: Tinnitus retraining therapy group improved at 1-year follow-up, considering the 3 parameters. The most important factor of failure to TRT efficacy has been the refuse to instrumentation when it was required, according to TRT recommendations. Tinnitus Handicap Inventory score in this group did not show any improvement (P = .009). Highest scores of tinnitus intensity (visual analogue scale) and handicap (Tinnitus Handicap Inventory) before treatment as well as the most disabled diagnosis (sudden deafness and Meniere's disease) had better response to TRT. Jastreboff's treatment categories, longer presence of tinnitus, existence of hyperacusis or hearing loss, type of prosthesis used, duration of the treatment, and index of assistance to our follow-up program were not related to the effectiveness of TRT. CONCLUSIONS: Tinnitus retraining therapy has demonstrated to be an effective treatment of tinnitus. More severe tinnitus are susceptible to get better response with this approach. Instrumentation, when recommended, is mandatory to obtain a higher relief of this symptom (EMB rating: B-2).