急性声损伤与耳鸣、听觉过敏关系的研究进展

急性声损伤,又称爆震性聋,是由短暂而强烈的爆炸所引起的听力损伤,可以导致显性/隐性听力损失,常伴发耳鸣和/或听觉过敏等听觉感知障碍,进而引发焦虑,严重影响患者生活质量。听觉感知障碍发病机制复杂,可能与听力损伤、炎症、遗传等多方面因素有关。临床上常以掩蔽法或噪声脱敏法治疗,但患者很少痊愈。现就急性声损伤致耳鸣、听觉过敏的发病机制做简要综述,以期为临床治疗提供思路。     

听觉耐受下降与耳鸣

听觉耐受下降(decreased sound tolerance)是指对声音的容忍度降低,或指对声音的敏感性增强,包括听觉过敏,厌声症,恐声症〔1〕。耳鸣是指在周围环境中无相应声源或电刺激存在的情况下,患者自觉耳内或颅内有声音的一种主观感觉;常伴或     

听觉过敏

听觉过敏(hyperacusis)是对正常环境声音的异常耐受或者是对正常人感觉没有危害或不适的声音做出持续夸大或不正当的反应.听觉过敏分为两类[1]:①对高强度/能量的声音或噪声敏感;②对特殊的声音或噪声敏感,与声音的强度/能量无关.后者有时被称为恐声症(phonophobia).     

面瘫患者听觉过敏的听力学探讨

面瘫患者听觉过敏的听力学探讨任重，任登霄，松本康听觉过敏（Ｈｙｐｅｒａｃｕｓｉｓ）是指耳对强声的耐受力降低。常见于颞骨内面神经麻痹患者（简称面瘫），发生原因尚无定论。为此，该文从听力学方面探讨听觉过敏的原因。１资料与方法发病３周内经流泪试验、镫骨肌声...     

854例耳鸣患者的临床特征分析

目的 探讨收诊的耳鸣患者临床特征,为耳鸣的诊治提供参考依据。方法 收集2018年1月—2021年12月在门诊以耳鸣为第一主诉的854例患者的临床资料,统计分析临床特征,并将患者性别、年龄、侧别、病程、持续性、患耳听力损失程度、耳鸣响度、耳鸣音调、焦虑自评量表评分、睡眠指数评分等因素为自变量,以耳鸣残疾量表评分为因变量,进行多因素线性回归和相关性分析。结果 854例耳鸣患者共有1290耳伴耳鸣,患者的平均年龄为(46.7±14.65)岁,在30～60岁年龄段的耳鸣患者占比最大(65.2%,557/854);其中耳鸣多为持续性(84.0%,717/854),双侧耳鸣和单侧耳鸣约各占一半,在双侧耳鸣患者中多为对称性耳鸣(97.0%,423/436);54.7%(467/854)的耳鸣患者伴有不同程度的焦虑症状,58.8%(502/854)的耳鸣患者伴有不同程度的睡眠障碍,33.0%(426/1290)的耳鸣伴有不同程度的听力下降。耳鸣残疾量表分级以2～3级为主(18～56分,83.3%,711/854);音调匹配以高频多见(4～8kHz,77.3%,997/1290);耳鸣响度以中低响度多见(<60dB,82.3%,1062/1290)。耳鸣持续性(β=-0.690,P=0.011)、听力损失程度(Spearman=0.140,P<0.001)、耳鸣响度(β=0.046,P=0.002;Spearman=0.135,P<0.001)、匹兹堡睡眠质量指数评分(β=0.049,P=0.001;Spearman=0.214,P<0.001)、Zung氏焦虑自评量表(β=0.055,P<0.001;Spearman=0.241,P<0.001)与耳鸣残疾量表评分有关。结论 2018年以来就诊的耳鸣患者其耳鸣严重程度多为轻中度,耳鸣音调多为高频,且大多数为中低响度的耳鸣声。耳鸣的发病人群逐渐年轻化,且多伴有焦虑、睡眠障碍、听力下降等症状。耳鸣的严重程度和耳鸣持续性、听力损失、耳鸣响度、睡眠障碍和焦虑相关,未来应该着重针对这部分人群制定个性化的耳鸣治疗方案。     

耳鸣患者听觉传出神经系统功能分析

目的　利用耳声发射技术探讨耳鸣患者听觉传出系统功能。方法　对 2 4名 (2 4耳 )单侧耳鸣患者(其中耳鸣无听力下降者 8例 ,耳鸣伴高频听力下降者 10例 ,耳鸣伴低频听力下降者 6例 ) ,使用ILO - 92耳声发射测试系统 ,观察对侧声刺激对耳声发射的影响。结果　①健康耳自发性耳声发射 (SOAE)检出率为 4 1.7% ,耳鸣侧三组SOAE检出率分别为 37.5 %、2 0 %、33.3% ;②SOAE受对侧刺激声影响主要表现为幅值改变 ,健康侧瞬态诱发耳声发射 (TEOAE)抑制幅度为 2 .1± 0 .8dBSPL ;2 4耳耳鸣耳中 ,16耳TEOAE抑制幅度为 1.9± 0 .8dBSPL ,8耳TEOAE不被抑制 ,听力和耳鸣匹配情况各异。③ 8例听力正常耳鸣耳中 ,3耳畸变产物耳声发射 (DPOAE)对侧声抑制效应明显 ,另 5耳DPOAE反应正常 ,其中 2耳对侧声抑制效应下降。 10例高频听力下降耳鸣耳中 ,8耳受对侧声抑制 ,另 2耳抑制幅度减低同时声衰减试验阳性。 6例低频听力下降的耳鸣耳中仅有 2耳出现对侧声抑制效应。结论　健康耳的对侧声抑制效应与正常人耳一致 ,但耳鸣耳的结果不同 ,提示耳鸣发病机制的多样性     

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。     

《认知行为疗法减轻耳鸣、听觉过敏及恐声症所致痛苦的现状》摘 译

1 耳鸣的定义和心理学影响 耳鸣是没有外部声音刺激的情况下对声音的感知.耳鸣常见描述有:嗡嗡声、高音调噪声、口哨声、瀑布声、砂轮声、铃声、静电噪声等,大约20％ 的患者无法描述他们的耳鸣声.大多数耳鸣患者伴有某种程度的听力损失,但并非所有的听力损失患者都有耳鸣.英国最近一项针对在耳鸣和听觉过敏诊所就诊的445例患者的研...     

耳鸣残疾量表在耳鸣应用中的现状和分析

耳鸣残疾量表（tinnitus handicap inventory,THI）及其翻译量表是临床诊断耳鸣常用而有效的工具,目前被广泛应用于耳鸣的评估。本文将THI及其翻译量表在耳鸣中的应用进行综述和分析,以便为临床医师和研究者提供有效、实用的参考。     

DPOAE in estimation of the function of the cochlea in tinnitus patients with normal hearing

Objective

The most probable place generating tinnitus in the auditory pathway is the outer hair cells (OHCs) inside the cochlea. Otoacoustic emissions are used to assess their activity. The objective of the investigation was to measure the features of distortion product otoacoustic emissions (DPOAE) in a group of tinnitus patients without hearing loss, estimate the diagnostic value of the parameters for the analysis of cochlear function in the patients, emphasizing those most useful in localizing tinnitus generators, and determine the hypothetical influence of hyperacusis and misophony on DPOAE parameters in tinnitus patients.

Patients and methods

The material consisted of 44 patients with tinnitus and without hearing loss. In the control group were 33 patients without tinnitus with the same state of hearing. The tinnitus patients were divided into three subgroups: those with hyperacusis, those with misophonia, and those with neither. After collecting medical history and performing clinical examination of all the patients, tonal and impedance audiometry, ABR, and discomfort level were evaluated. Then DPOAE were measured using three procedures. First the amplitudes of two points per octave were assessed, second the “fine structure” method with 16–20 points per octave (f2/f1 = 1.22, L1 = L2 = 70 dB), and the third procedure included recording the growth function in three series for input tones of f2 = 2002, 4004, and 6006 Hz (f2/f1 = 1.22) and L1 = L2 levels increasing by increments of 5 dB in each series.

Results and conclusions

Hyperacusis was found in 63% and misophonia in 10% of the tinnitus patients with no hearing loss. DPOAE amplitudes in recordings with two points per octave and the fine structure method are very valuable parameters for estimating cochlear function in tinnitus patients with normal hearing. Function growth rate cannot be the only parameter in measuring DPOAE in tinnitus patients, including subjects with hyperacusis and misophonia. The markedly higher DPOAE amplitudes in the group of tinnitus patients without hearing loss suggest that tinnitus may be caused by increased motility of the OHCs induced by decreasing efferent fiber activity, and not by OHC failure. Hyperacusis significantly increases the amplitude of DPOAE in tinnitus patients with no hearing loss.     

Factors related to uncomfortable loudness levels for patients seen in a tinnitus and hyperacusis clinic

Objectives: The aims were as follows: (1) to explore patterns of uncomfortable loudness levels (ULLs) across frequency and their associated factors for patients with tinnitus and hyperacusis, and (2) to re-evaluate the criteria for diagnosing hyperacusis based on ULLs and scores for the Hyperacusis Questionnaire (HQ). Design: This was a retrospective cross-sectional study. Study sample: 573 consecutive patients for whom ULLs had been measured were included. Results: A good correspondence between the diagnosis of hyperacusis based on the across-frequency average ULL for the ear with the lowest ULLs (ULLmin) and hyperacusis handicap based on HQ scores was obtained with cut-off values of ULLmin ≤77?dB HL and HQ score ≥?22. A regression model showed significant relationships between ULLmin and the score on the HQ and age. The mean HQ score for patients with a large interaural asymmetry in ULLs was significantly higher than for the remainder. Hyperacusis handicap was associated with strong across-frequency variations in ULLs. Conclusions: Appropriate cut-off values for diagnosing hyperacusis are ULLmin ≤77?dB HL and HQ score ≥22. Large interaural asymmetry and large across-frequency variations in ULLs are associated with higher HQ scores.     

Factors related to tinnitus and hyperacusis handicap in older people

Objective: The aim was to assess factors related to tinnitus and hyperacusis handicap in older people. Design: Retrospective cross-sectional. Study sample: Data were gathered for 184 patients with an average age of 69 years. Results: Tinnitus handicap as measured via the Tinnitus Handicap Inventory (THI) was significantly predicted by tinnitus annoyance as measured via the visual analogue scale (VAS) (regression coefficient, b?=?2.9, p?b?=?3.9, p?b?=?0.8, p?b?=?0.07, p?=?0.048). Insomnia scores as measured via the Insomnia Severity Index (ISI) were significantly predicted by scores on the depression subscale of the HADS (b?=?0.46, p?=?0.007). Conclusions: Since tinnitus annoyance significantly predicts tinnitus handicap, it is important to explore factors associated with annoyance that may be useful in designing appropriate rehabilitative interventions aimed at reducing tinnitus handicap in older people. Future studies should explore whether hyperacusis and insomnia in older people with tinnitus need to be managed in conjunction with treatment for depression.     

Assessment of hyperacusis with a newly produced Japanese version of the Khalfa hyperacusis questionnaire

Objectives: The purpose of this study was to determine the validity and reliability of a Japanese version of the Khalfa hyperacusis questionnaire (KHQ) and proposed a threshold KHQ score for classifying hyperacusis.

Methods: In total, 112 patients with hyperacusis (group A) and 103 patients without hyperacusis (group B). The patients in group A were further classified into the following subgroups: subjects with hyperacusis as their chief complaint (n?=?26, group A1) and subjects with hyperacusis accompanied by chief complaints of tinnitus and/or hearing loss (n?=?86, group A2).

Results: The average total questionnaire score for patients in group A was 11.8?±?9.7, which was statistically significantly higher than that of patients in group B, 5.7?±?4.8. Cronbach’s coefficients for internal consistency were high for the total score (0.92). The average total scores for groups A1 and A2 were 18.1?±?11.1 and 9.9?±?8.4, respectively, and the difference between the groups was statistically significant.

Conclusions: We developed a Japanese version of the KHQ. It showed high reliability and validity; suggesting its usefulness in clinical practice. We propose that a total KHQ score of 16 is an appropriate cutoff for classifying hyperacusis     

Acoustic trauma-induced auditory cortex enhancement and tinnitus

There is growing evidence suggests that noise-induced cochlear damage may lead to hyperexcitability in the central auditory system (CAS) which may give rise to tinnitus. However, the correlation between the onset of the neurophysiological changes in the CAS and the onset of tinnitus has not been well studied. To investigate this relationship, chronic electrodes were implanted into the auditory cortex (AC) and sound evoked activities were measured from awake rats before and after noise exposure. The auditory brainstem response (ABR) was used to assess the degree of noise-induced hearing loss. Tinnitus was evaluated by measuring gap-induced prepulse inhibition (gap-PPI). Rats were exposed monaurally to a high-intensity narrowband noise centered at 12 kHz at a level of 120 dB SPL for 1 h. After the noise exposure, all the rats developed either permanent (>2 weeks) or temporary (<3 days) hearing loss in the exposed ear(s). The AC amplitudes increased significantly 4 h after the noise exposure. Most of the exposed rats also showed decreased gap-PPI. The post-exposure AC enhancement showed a positive correlation with the amount of hearing loss. The onset of tinnitus-like behavior was happened after the onset of AC enhancement.     

Self-reported and behavioral sound avoidance in tinnitus and hyperacusis subjects,and association with anxiety ratings

Abstract

Objective: The purpose of the study was to analyse the role of sound avoidance and anxiety in tinnitus subjects with hyperacusis, defined as hypersensitivity to low to moderate intensity sounds. Design: A group of tinnitus subjects with hyperacusis was compared to tinnitus subjects without hyperacusis, and healthy controls. For assessing noise avoidance, a questionnaire was developed (noise avoidance questionnaire, NAQ) and the duration of self-exposure to a pure tone was assessed as a behavioral index. Different self-rating instruments concerning tinnitus (STI, TF-12), hyperacusis (GÜF), and anxiety (BAI, STAI-T) were used, as well as a psychoacoustic indicator of hyperacusis (ULL). Study sample: Fifty-six tinnitus subjects with/without hyperacusis and 30 controls without tinnitus and hyperacusis participated in the experiment. Results: The findings indicate that subjects with hyperacusis reported significantly more noise-related avoidance in daily life and show significantly shorter exposure to a pure tone than non-hyperacusic subjects, while discomfort was at the same level for each individual. Self-reported avoidance behavior correlated significantly with distress attributed to hyperacusis (r =0.81), and with anxiety ratings. Conclusions: These results suggest that hyperacusis is associated with noise-related avoidance behavior and anxiety. Systematic exposure to sound could play a significant role in the treatment of hyperacusis.     

Tinnitus characteristics in patients with hyperacusis and vertigo (including Ménière's disease) vs. hyperacusis alone

Introduction and objectivesTo compare clinical and psychoacoustic tinnitus characteristics in patients with the comorbidity of hyperacusis, hyperacusis and vertigo, and with Ménière's disease (MD).Materials and methodsThree hundred and twenty-nine tinnitus patients underwent audiological and otoneurological evaluation. Records of 94 individuals younger than 65 years, 40 women and 54 men (mean age 41.8, range 24–64 years), who complained of tinnitus and hyperacusis, were analyzed. One hundred and thirty-one ears with tinnitus were identified: 67 in the group of patients with tinnitus and hyperacusis (group 1; 41 patients); 28 in the group fulfilling criteria of MD diagnosis (group 2; 28); and 36 in the group with tinnitus, hyperacusis and typical symptoms of vertigo (group 3; 25).Results and conclusionsMean value of interaural difference in canal paresis in group 1 was 6.3%; in group 2: 23.7%; and in group 3: 25.9%; p < .001. Mean tinnitus pitch value was significantly lower in group 3 (1679 Hz; SD = 1139) and group 2 (2250 Hz; SD = 1162) compared to group 1 (4538 Hz; SD = 3123; p = .012). Values of tinnitus intensity and other characteristics did not significantly differ between the groups. Tinnitus and hyperacusis were most frequently preceded by acoustic trauma. Tinnitus coinciding with hyperacusis and vertigo was observed in patients after head trauma.Mean tinnitus pitch was lower in the groups of patients with hyperacusis and peripheral labyrinthine lesion than in tinnitus sufferers with hyperacusis alone. Tinnitus sufferers with low tinnitus pitch should undergo vestibular system evaluation. Hyperacusis and vertigo are likely comorbidities in tinnitus patients after head trauma. Hyperacusis may coincide in tinnitus patients after head trauma.     

Therapy of hyperacusis in patients with tinnitus

BACKGROUND: Patients with tinnitus very often suffer from hyperacusis also. METHODS AND PATIENTS: In the present study a possible treatment for patients with bilateral hyperacusis is introduced and the therapeutical results of 41 patients suffering from bilateral hyperacusis combined with a uni- or bilateral tinnitus are discussed. Twenty-one of them also had a cochlear hearing loss. By means of white noise generators or hearing aids and a specific acoustic training the auditory input to the central nervous system was increased. All patients were taught a method to reduce stress (Progressive muscle relaxation according to Jacobson). Uncomfortable loudness levels were analysed before as well as 3 weeks and 6 months after beginning of the treatment. RESULTS: By the time of 3 weeks the discomfort from ordinary sounds was distinctly reduced and the reduction progressed further after 6 months of treatment. In more than 50% of the participants the uncomfortable loudness levels could be raised to a normal range. Interestingly the improvement of hyperacusis was independent of an existing hearing loss. CONCLUSIONS: The described method of treatment seems to be helpful for patients with hyperacusis and will be compared to other therapeutical regimes.     

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.