彭顺林对神经性耳鸣耳聋的治疗经验

耳鸣是指患者自觉耳内鸣响,外界环境并无相应声源的一种自觉症状。耳聋是指不同程度的听力下降。二者可单独出现,亦可伴随同发。笔者在跟师学习过程中发现本病的发病不再是中老年人的专利,低龄化趋势日益明显。彭顺林教授应用中医药为主、中成药为辅对神经性耳鸣耳聋的治疗取得了较好的成效。本文旨在记录彭老治疗本病的经验,以供临床参考。     

针灸配合推拿治疗耳聋耳鸣的疗效

目的 分析针灸配合推拿治疗耳聋耳鸣的疗效.方法 纳入2015年4月～2020年4月期间,我科收治的耳聋耳鸣患者共60例当作本次研究的观察对象,通过收治的先后奇偶顺序将其划分为常规组以及研究组,每组的样本容量均为30例.常规组执行常规西药治疗模式,研究组执行针灸+推拿联合治疗模式.对比并分析两组患者治疗有效值.结果 研究...     

耳聋左慈丸联合松龄血脉康治疗耳鸣的临床观察

目的采用随机、对照的临床研究方法观察耳聋左慈丸联合松龄血脉康治疗耳鸣的疗效。方法60例40岁以上以耳鸣为主诉的门诊患者,排除客观性耳鸣、外耳及中耳疾病。随机分为2组,对照组给予耳聋左慈丸治疗,实验组给予耳聋左慈丸治疗的同时,加用松龄血脉康胶囊,用药时间为1月,停药后随访1月,评定疗效。结果实验组痊愈4例、显效13例、有效8例、无效4例、失访1例,总有效率83.3%;对照组痊愈1例、显效10例、有效7例、无效12例,总有效率60.0%。2组总有效率比较P〈0.05。实验组有效率显著高于对照组。2组均未出现药物不良反应。结论耳聋左慈丸联合松龄血脉康临床上治疗主观性耳鸣较单用耳聋左慈丸有明显的优势,但还需大样本、多中心、随机对照的长期观察研究进一步验证确切疗效。     

癔病性耳鸣耳聋的治疗

目的 提高对癔病性耳鸣耳聋的认识和治疗水平,探讨其治疗模式.方法 回顾分析4例癔病性耳鸣耳聋患者的诊治过程及预后.结果 4例以耳鸣为第一主诉的患者,经过主观和客观听力学检查以及其他检查均排除了器质性病变,确诊为癔病性耳鸣耳聋,经过耳鼻咽喉科和心理医生的共同治疗,患者均康复,随访8月～4年无复发.结论 癔病性耳鸣耳聋的治疗比诊断困难,一旦确诊,不必按突聋进行治疗,需要请心理医生针对心因治疗.     

综合护理模式对耳鸣耳聋患者睡眠质量和心理压力的影响观察

目的研究综合护理模式对耳鸣耳聋患者睡眠质量和心理压力的影响。方法选取2018年8月~2019年12月我院收治的120例耳鸣耳聋患者作为主要研究对象,按随机数字表法分对照组与观察组,每组60例,分别对两组患者的护理前后的睡眠质量(PSQI)、焦虑程度(SAS)以及抑郁程度(SDS)进行比较。结果护理后,两组患者的PSQI、SAS、SDS评分明显低于对照组,且观察组明显低于对照组(P<0.05)。结论对耳鸣耳聋的患者开展综合护理干预,能够在缓解患者心理压力的同时,改善其睡眠质量,值得在临床推广应用。     

分析护理干预对于缓解突发性耳聋伴耳鸣患者焦虑的影响

目的评价护理干预对于缓解突发性耳聋伴耳鸣患者焦虑的影响。方法选择2019年4月~2020年7月来我院就诊的74例突发性耳聋伴耳鸣患者为研究目标展开调查,随机数分为观察组和对照组,对比两组患者的焦虑情绪和听力损伤程度。结果护理前的焦虑情绪评分差异无意义,护理后观察组的焦虑评分显著低于对照组,统计结果P<0.05;观察组护理后的听力损伤恢复情况明显优于对照组,组间差异P<0.05。结论在突发性耳聋半耳鸣患者护理中应用综合护理干预能有效缓解患者的不良情绪,减轻听力受损程度,值得临床借鉴应用。     

聪耳止鸣丸治疗肾虚型耳鸣耳聋的临床观察

目的观察聪耳止鸣丸治疗肾虚型耳鸣、耳聋的临床疗效。方法将138例肾虚型耳鸣、耳聋的患者随机分为治疗组100例(109耳)和对照组38例(38耳),治疗组在对照组常规治疗基础上加服聪耳止鸣丸,连续治疗30天,比较耳鸣、耳聋改善情况。结果总有效率:治疗组耳鸣为79.8%,对照组为31.6%;治疗组耳聋为66.9%,对照组为34.2%。经统计学处理,治疗组疗效明显优于对照组,差异具有统计学意义(P<0.01)。结论在常规西医治疗基础上加服聪耳止鸣丸,可以明显改善患者的临床症状。     

优质护理对突发性耳聋伴耳鸣患者焦虑的缓解作用

目的分析探究优质护理对突发性耳聋伴耳鸣患者焦虑的缓解作用。方法此次将我院在2019年10月—2020年10月收治的80例突发性耳聋伴耳鸣患者作为研究的对象,按随机数字表发分成两个不同的组别,每组平均为40例;其中,对照组患者采取常规护理方法,观察组患者采取优质护理方法,进一步对两组护理效果进行对比评价。结果护理后,观察组SAS评分、SDS评分均低于对照组,两组数据差异显著(P<0.05)。护理后,观察组的PSQI评分、气导平均阈值均显著要比对照组更低,两组之间的数据存在明显统计学差异(P<0.05)。结论优质护理应用于突发性耳聋伴耳鸣患者护理中,可有效改善其焦虑情绪、睡眠质量及听力状态,值得推广应用。     

中药内治联合针刺治疗突发性耳聋的临床研究

目的研究突发性耳聋采取中药内治配合针刺治疗的临床效果。方法以2019.12～2020.05为研究区段,以此区段本院收诊的30例突发性聋患者为探究对象,采取分别抽样法进行组别的划分,可将其划分为对照组(n=15)和治疗组(n=15),接受常规治疗者归为对照组,采取中药内治协同针刺治疗者归为治疗组,进行两组效果的比较。结果治疗组有效率相对于对照组具明显提升优势P<0.05。结论突发性耳聋采取中药内治配合针刺治疗效果可观,并可改善疾病相关性症状,应用可行性强,具良好推广前景。     

翳风穴穴位注射联合针刺治疗特发性耳鸣的疗效观察

目的 评价翳风穴穴位注射联合针刺治疗特发性耳鸣的临床疗效。方法 本研究包含符合纳入标准的特发性耳鸣患者80例,随机分为两组。治疗组40例,行翳风穴穴位注射联合针刺治疗;对照组40例,仅行单一针刺治疗。疗程均为4周,每周治疗3次,每次20分钟。分别于治疗前及治疗开始后第8天、第15天、第29天以及治疗结束后1个月观察评估所有患者耳鸣严重程度变化情况,比较分析两组患者耳鸣评分。结果治疗组总有效率72.5%,对照组总有效率52.5%,治疗组有效率明显高于对照组（P<0.05）。治疗组的耳鸣严重程度积分改善也优于对照组（P<0.05）,4个时间点的耳鸣环境、持续时间、睡眠质量、情绪等疗效比较,治疗组显著优于对照组（P<0.05）。结论 翳风穴穴位注射联合针刺治疗特发性耳鸣疗效确切,能更好地改善患者相关临床症状。     

Characteristics of tinnitus with or without hearing loss: Clinical observations in Sicilian tinnitus patients

Objective

To analyze the clinical characteristics of tinnitus both in normal hearing subjects and in patients with hearing loss.

Methods

The study considered 312 tinnitus sufferers, 176 males and 136 females, ranging from 21 to 83 years of age, who were referred to the Audiology Section of the Department of Bio-technology of Palermo University. The following parameters were considered: age, sex, hearing threshold, tinnitus laterality, tinnitus duration, tinnitus measurements and subjective disturbance caused by tinnitus. The sample was divided into two groups: Group 1 (G1) subjects with normal hearing; Group 2 (G2) subjects with hearing loss.

Results

Among the patients considered, 115 have normal hearing while 197 have a hearing deficit. There is a slight predominance of males respect to females that is more evidenced in G2 (61.42% of males vs. 38.58% of females). The highest percentage of tinnitus results in the decades 41–50 for G1 and >70 for G2 with a statistically significant difference between the two groups (P < 0.0001).The hearing impairment results in most cases of sensorineural type (74.62%) and limited to the high frequencies (58.50%), moreover the 72.10% of the patients with SNHL had a high-pitched tinnitus while the 88.37% of the patients high-frequency sensorineural hearing loss had a high-pitched tinnitus (P < 0.0001). As for the subjective discomfort, the catastrophic category resulted most representative among subjects with normal hearing with a statistically significant difference between the two groups but no significant correlation was found between the level of tinnitus intensity and the tinnitus annoyance confirming the possibility that tinnitus discomfort is elicited by a certain degree of psychological distress as anxiety, depression, irritability and phobias that do not allow the phenomenon of the ‘habituation’.

Conclusion

This work, according to literature data, suggests that the hearing status and the elderly represent the principal tinnitus related factors; moreover tinnitus characteristics differ in the two groups for tinnitus pitch. There is, in fact, a statistically significant association between high-pitched tinnitus and high-frequency SNHL suggesting that the auditory pathway reorganization induced by hearing loss could be one of the main source of the tinnitus sensation.     

针刺治疗感音神经性耳聋耳鸣的临床研究

目的观察针刺对感音神经性耳聋、耳鸣的疗效.方法严格筛选感音神经性耳聋(sensorineuralhearing loss,SNHL)患者154例188耳,随机分为治疗组及对照组.治疗组按中医辨证论治取穴,进行针刺治疗;对照组给予西药静脉滴注.结果治疗组总有效率达52.1%,与对照组比较,差异有显著性意义(P＜0.005).尤其对于轻度耳聋患者的疗效显著,有效率达88.9%;对中、重度聋患者疗效相似,有效率分别为47.5%和48.9%.结论根据中医辨证论治取穴,针刺对于SNHL患者有显著的临床效果.     

The effect of tinnitus specific intracochlear stimulation on speech perception in patients with unilateral or asymmetric hearing loss accompanied with tinnitus and the effect of formal auditory training

Objectives: Previous studies show that intracochlear electrical stimulation independent of environmental sounds appears to suppress tinnitus, even long-term. In order to assess the viability of this potential treatment option it is essential to study the effects of this tinnitus specific electrical stimulation on speech perception. Design: A randomised, prospective crossover design. Study sample: Ten patients with unilateral or asymmetric hearing loss and severe tinnitus complaints. Results: The audiological effects of standard clinical CI, formal auditory training and tinnitus specific electrical stimulation were investigated. Results show that standard clinical CI in unilateral or asymmetric hearing loss is shown to be beneficial for speech perception in quiet, speech perception in noise and subjective hearing ability. Formal auditory training does not appear to improve speech perception performance. However, CI-related discomfort reduces significantly more rapidly during CI rehabilitation in subjects receiving formal auditory training. Furthermore, tinnitus specific electrical stimulation has neither positive nor negative effects on speech perception. Conclusions: In combination with the findings from previous studies on tinnitus suppression using intracochlear electrical stimulation independent of environmental sounds, the results of this study contribute to the viability of cochlear implantation based on tinnitus complaints.     

200例主观性耳鸣患者听力损失临床分析

目的:对耳鸣患者的听力损失进行分析,为进一步探讨耳鸣的发病原因、检查方法提供临床依据。方法:对以主观性耳鸣为主诉的200例患者进行耳科专科检查、声导抗检测、常频纯音听阈测听和高频扩展听阈测听检查。结果:200例耳鸣患者中,单侧耳鸣123例(61.5%),双侧耳鸣77例(38.5%);46例(23.0%)听力正常。单侧耳鸣中,患侧与对侧听阈比较0.125～8kHz差异有统计学意义(P<0.05),10kHz及其以上频率差异无统计学意义(P>0.05)。常频听力正常组与听力异常组比较各频率阈值差异均具有统计学意义(均P<0.05),听力异常组扩展高频检出率低于听力正常组。结论:耳鸣可以存在听力正常的人群中,扩展高频测听能否为耳鸣患者提供早期听力损失的依据,尚需对更多的临床资料进一步研究。     

Hearing impairment and tinnitus pitch in patients with unilateral tinnitus: comparison of sudden hearing loss and chronic tinnitus

OBJECTIVES: The objectives were to analyze the results of pitch-matching and loudness-balance testing in patients with unilateral tinnitus and to evaluate the relationship between audiological findings based on the tinnitus-affected and tinnitus-unaffected threshold differences and tinnitus pitch by using linear interpolation methods. In addition, the effects of the duration of the tinnitus on this relationship were investigated. Sudden sensorineural hearing loss with tinnitus was selected for the "acute tinnitus" group, and unilateral tinnitus with unknown disease and a duration of more than 3 months was selected for the "chronic tinnitus" group. STUDY DESIGN: Retrospective study of the clinical records of patients. METHODS: One hundred thirty-two patients with unilateral tinnitus (comprising 68 female [51.5%] and 64 male [48.5%] patients) were investigated as subjects. Their mean age was 50.4 years (SD = 15.8 y). All patients underwent otoneurological testing, including the pure-tone audiogram and pitch-matching and loudness-balance tests. RESULTS: The mean difference in the hearing threshold between the tinnitus-affected ear and the tinnitus-unaffected ear was largest near the tinnitus pitch in both the acute and the chronic tinnitus groups. However, the relationship between hearing impairments and tinnitus pitch was somewhat different in the two groups: It exhibited a single smooth peak in the acute tinnitus group but a bimodal peak in the chronic tinnitus group. CONCLUSION: The results suggest that tinnitus is related to hearing impairment in the same frequency region in patients with sudden sensorineural hearing loss with tinnitus or in patients with chronic tinnitus, whereas some instances of chronic tinnitus are caused by reorganization in cortical cells.     

伴感音神经性聋的耳鸣患者临床表现及心理声学特点

目的 通过对157例伴感音神经性聋的主观性耳鸣患者分析,了解耳鸣的临床表现和心理声学特点,为耳鸣诊治提供科学依据.方法 采集157例伴感音神经性聋的主观性耳鸣患者的基本信息、既往史、临床表现、听力学及耳鸣检测结果资料,分析耳鸣的临床特点及各因素与耳鸣之间的关系.结果 157例患者男女比为1.6:1,听力下降以高频为主(...     

伴感音神经性聋耳鸣的心理声学和听力学特征

目的:研究伴感音神经性聋耳鸣的心理声学特征测试及听力学的特征。方法:选取感音神经性聋耳鸣患者61例(79耳)作为实验组,选取25例(50耳)听力正常且无耳鸣的志愿者作对照组,分别检测2组对象的纯音测听、声导抗测试、耳鸣检测、畸变产物耳声发射(DPOAE),并进行统计学分析。结果:实验组平均后效抑制阳性率为51.3%,其中耳鸣掩蔽曲线为汇聚型者掩蔽效果较好;实验组与对照组DPOAE的通过率差异有统计学意义,实验组(15.2%)低于对照组(96.0%);在500～8 000Hz各个频率点实验组DPOAE幅值低于对照组有统计学意义。结论:耳鸣心理声学测试能够更全面了解耳鸣详细的心理声学特征资料,对耳鸣康复指导提供更加详尽量化指标依据,DPOAE测试可以辅助对耳鸣患者耳蜗病变的诊断。     

家庭化个体多元复合声治疗对耳鸣伴听力损失患者的疗效及影响因素分析

目的 探究家庭化个体多元复合声治疗对耳鸣伴听力损失患者的有效性,并分析耳鸣伴听力损失患者疗效的影响因素。方法 利用四川省4家三甲医院的既往电子病历记录,回顾性分析2019年3月至2022年3月期间接受家庭化个体多元复合声治疗的212例耳鸣患者临床资料,收集耳鸣患者的人口学特征、听力损失相关和治疗前后的耳鸣障碍量表评分等资料。采用多因素二元逻辑回归分析疗效相关影响因素。结果 家庭化个体多元复合声治疗对耳鸣伴听力损失患者的总有效率为43.87%,治疗周期长于12个月的耳鸣患者的有效改善率(57.43%)显著高于治疗周期短于12个月的耳鸣患者(31.53%),单因素逻辑回归分析比值比(OR)值为2.93 (95%CI:1.67～5.14)。多因素逻辑回归分析提示治疗周期为影响家庭化个体多元复合声治疗效果的独立风险因素,OR值为2.23 (95%CI:1.09～5.00),患者年龄与声治疗疗效的OR值为1.03 (95%CI:1.01～1.05)。结论 研究表明家庭化个体多元复合声治疗可有效改善部分耳鸣患者的临床症状及恼人程度。其中,治疗周期是影响家庭化个体多元复合声治疗疗效的独立危险因素。临...