调整生活方式对难治性耳鸣及睡眠障碍的疗效

目的:研究调整生活方式对难治性耳鸣及睡眠障碍的疗效。方法:回顾性分析在四川大学华西医院"耳鸣耳聋眩晕"专科门诊就诊的难治性耳鸣及睡眠障碍的临床资料。研究对象纳入标准:病程6个月以上,在外院接受过常规治疗无效,已停止治疗,且在随访期间未接受过任何其他治疗,有完整随访记录。干预方法为指导患者调整不良生活方式,具体包括合理饮食及睡眠、心理疏导消除压力等。睡眠和耳鸣的疗效评估方法分别用自行设计的包含有四项常用睡眠疗效指标的睡眠质量调查问卷(Sleep Quality Investigation Inventory,SQII)和耳鸣评价量表(Tinnitus Evaluation Questionnaire,TEQ)。结果:共纳入10例(男女各5例)患者,年龄22~71岁,平均(46.1±13.0)岁;就诊时睡眠障碍病程0.6~30年,平均(9.5±10.5)年;耳鸣病程0.6~20年,平均(7.0±7.4)年。仅靠调整生活方式,10例患者睡眠障碍和耳鸣均同时得以改善,起效时间为4~48 d,平均(17.8±13.1)天;在SQII的4项常用睡眠改善指标中,平均改善项目数达2;干预后的TEQ得分较干预前平均降低2.9分(P0.05)。结论:经常规治疗无效的10例难治性耳鸣及睡眠障碍患者,仅靠调整生活方式干预,便在短期内耳鸣和睡眠障碍得以改善,疗效较满意。是否严格遵医嘱调整生活方式,是影响疗效的重要因素。需要大样本、长时间随访及疗效评价方法的临床研究去进一步探索并发掘调整生活方式这一干预方法的临床价值。

Treatment of patients with previously untreatable tinnitus and sleep disorders with lifestyle modifications

Objective:Investigate the effectiveness of treating previously untreatable chronic tinnitus and sleep disor-ders with lifestyle modifications.Methods:Medical records for patients with previously untreatable severe chronic tinnitus and sleep disorders lasting over 6 months were analyzed retrospectively.Only patients with complete medical records who were seen within the previous 7 months at the Tinnitus-Hearing Loss-Vertigo Clinic at West China Hospital of Sichuan Uni-versity were candidates for the study.Following termination of unsuccessful treatment,these patients were treated entirely with lifestyle modifications,which included appropriate diet and sleep,as well as psychological counseling to alleviate stress.Outcomes were assessed with the Sleep Quality Investigation Inventory (SQII),which characterizes important sleep patterns,and the Tinnitus Evaluation Questionnaire (TEQ),which characterizes tinnitus severity.Results:A total of 1 0 patients (5 males,5 females)22 to 71 years of age met the inclusion criteria.The duration of sleep disorders ranged from 7 months to 30 years,and the duration of tinnitus ranges from 7 months to 20 years.Following treatment with lifestyle modifications,all patients experienced reduction in both sleep disorders and tinnitus simultaneously within 4 to 48 days (1 7.8 days on average).Meaningful average improvement in 2 of the 4 important sleep indexes in SQII.Scores on the TEQ improved significantly by over 2.9 units (P <0.05).Conclusion:All 1 0 patients with previously untreatable chro-nic tinnitus and sleep disorders experienced satisfying and meaningful improvements in both tinnitus symptoms and sleep disorders.The amount of improvement was related to the degree of compliance with the recommended lifestyle modifica-tions.Future research with larger samples,long-term follow-up,and additional outcome measures is needed to further e-valuate the effectiveness of lifestyle modifications and to determine additional symptoms for which its use is indicated.