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。

Characteristics of tinnitus in patients with idiopathic sudden sensorineural hearing loss

Objective To analyze the characteristics of tinnitus, correlation between tinnitus and hearing loss, effects of tinnitus, and mechanism of tinnitus in patients with sudden sensorineural hearing loss. Methods Clinical data of 231 tinnitus patients with idiopathic sudden sensorineural hearing loss were retrospectively reviewed. Results of Tinnitus Handicap Inventory (THI), visual analogue scale (VAS), pure tone audiometry, acoustic emission, tinnitus test and masking test were analyzed. Results ① Characteristics of hearing loss: Low-intermediate frequency hearing loss (rise type) was 8.7%, high-frequency hearing loss (fall type) was 26%, flat-type was 19%, total-deafness type was 34.2%, irregular type was 12.1%. ② Frequency of tinnitus: Low-frequency (<500 Hz) tinnitus was 21.2%, medium-frequency (51-2 000 Hz) tinnitus was 23.4%, high-frequency (>2 000 Hz) tinnitus was 52.8%, unmatched tinnitus was 2.6%. Of hearing loss with low-intermediate frequency, low, medium and high frequency tinnitus was 75%, 15% and 10% respectively. Of hearing loss with medium-high frequency, low, medium and high frequency tinnitus was 13.3%, 26.7% and 60.0% respectively. Of total deafness, low, medium and high frequency tinnitus was 17.1%, 19.0% and 63.3% respectively. There was an linear relationship between the frequency hearing loss and tinnitus frequency (r=0.590, P<0.01). ③ Tinnitus volume: Tinnitus volume was 0-30 dB HL(19.5%), 31-60 dB HL(26%), 60-90 dB HL(44.2%), >90 dB HL (27.8%), and unmatched (2.6%). Tinnitus volume was correlated with the degree of hearing loss (r=0.216, P<0.05). ④ Tinnitus disability level: According to THI scores, the tinnitus disability level was: grade 1 (11.7%), grade 2 (19%), grade 3 (28.6%), and grade 4 (40.7%). ⑤ The characteristics of THI and VAS scores: there was no correlation between THI scores and degree of hearing loss (r=0.087, P=0.287), no correlation between VAS score and degree of hearing loss (r=0.002, P=0.982), no correlation between THI and the logarithm of tinnitus frequency (r=-0.056, P=0.402), no correlation between VAS score and frequency of tinnitus (r=-0.003, P=0.970), no correlation between THI score and tinnitus volume, r=0.03, P=0.563), no correlation between VAS score and tinnitus volume (r=0.136, P=0.110). Conclusion ① High-frequency tinnitus with idiopathic sudden deafness is the most common among all types of hearing loss. ② There is a significant correlation between tinnitus frequency and type of hearing loss. ③ The frequency of the greatest hearing loss is consistent with the frequency of tinnitus. ④ Tinnitus disability level is grade 3-4 during the acute period of idiopathic sudden sensorineural hearing loss. ⑤ THI and VAS scores are not correlated with degree of hearing loss, tinnitus, tinnitus volume and frequency.