梅尼埃病的耳鸣特征与影响因素分析

目的分析与探讨梅尼埃病患者耳鸣的临床特征与影响因素。方法 90例梅尼埃病患者,收集纯音听阈、耳鸣匹配结果,记录耳鸣侧别、时间、睡眠质量,使用耳鸣残障量表(Tinnitus Handicap Inventory,THI)进行评价。结果 1患者平均年龄48.08±10.28岁,男女比例为1.09:1;耳鸣主调频率匹配为低频和言语频率耳鸣者65例(72.2%);响度匹配为响度<10d B SL者(51例,56.7%),≥10d BSL者(39例,43.3%),其中以5-9d B SL最多,为30例(33.3%);≥15d B SL者最少,为15例(16.7%);持续性耳鸣患者77例(85.6%);单侧耳鸣患者68例(75.6%);有睡眠障碍者28例(31.1%)。2耳鸣响度较大(F=3.203,P=0.027)、睡眠质量较差(t=2.813,P=0.006)和持续性耳鸣(t=3.018,P=0.003)的患者其THI评分高于耳鸣响度较小、睡眠质量较好和间断性耳鸣的患者。双侧耳鸣患者THI评分高于单侧耳鸣患者,但差异无统计学意义(t=1.892,P=0.062)。不同性别、听力损失水平和耳鸣频率的患者THI评分间无明显差异(P>0.05)。3耳鸣影响因素有序多分类Logistic回归分析:耳鸣严重程度与耳鸣响度[P=0.011,95%可信区间(confidence interval,CI)1.019~1.151,优势比(odds ratio,OR)=1.083]、睡眠质量(P=0.011,95%CI1.288~6.931,OR=2.986)和耳鸣持续时间(P=0.007,95%CI1.559~16.265,OR=5.033)有关。结论梅尼埃病患者的耳鸣常常为低频、持续性的。耳鸣的严重程度与耳鸣的响度、睡眠质量和耳鸣的持续有关。     

突发性聋伴耳鸣患者治疗前耳鸣性状分析

目的 分析突发性聋伴耳鸣患者的耳鸣性状及其与听力损失之间的关系,探讨耳鸣对患者影响的评估方法.方法 对56例(56耳)突发性聋伴耳鸣患者行听力检测和耳鸣主观分级(评估)及耳鸣匹配检查.结果 ①耳鸣匹配的频率集中于听力损失的频率范围,耳鸣匹配的类型主要为窄带噪声,匹配响度分布较为广泛;②耳鸣主观分级与匹配类型,响度、听力...     

耳鸣患者耳鸣的心理声学特征变化

目的探讨随时间推移主观性耳鸣患者的临床特征及其变化,研究长期耳鸣对患者听力的影响。方法分析比较随访3年以上的30例主观性耳鸣患者初诊时和3年后复诊时的临床表现、耳鸣心理声学特征等的变化。结果 30例患者中,初复诊时均以左侧耳鸣最多见,为12例(40%),三年后复诊时有1例由右侧耳鸣转变为双侧耳鸣。初诊时耳鸣主调多为高频,复诊时耳鸣主调发生变化的有8例,占26.67%,其中,主调频率降低1例,升高6例,1例由初诊时的200Hz纯音复诊时变得无法匹配。复诊时患者500～4 000Hz的平均听阈与初诊时比较无明显变化(P>0.05),耳鸣主调所在频率的平均听阈复诊时较初诊时提高,差异有统计学意义(P<0.05),初、复诊时耳鸣主调相邻的正、负1倍频程频率平均听阈无明显变化(P>0.05)。复诊时30例总体耳鸣响度较初诊时降低(P<0.05),其中,响度不变者2例,变大者3例,变小者25例;复诊时总体的烦躁级别较初诊时减轻(P<0.05),其中,烦燥级别不变8例,减轻18例,加重4例;THI分级不变12例,降低12例,升高6例,总体THI分级无变化。初、复诊时Feldman曲线均主要以汇聚型为主,间距型和重叠型次之,后效抑制阳性率也以汇聚型曲线最高。结论随着耳鸣病程的延长,患者耳鸣的响度较前变小,烦躁级别较前减轻,耳鸣可成为代偿性耳鸣,对患者的心理影响减轻;耳鸣主调频率的听力损失可加重,耳鸣主调频率会出现漂移现象。     

性别、年龄、听力损失程度与耳鸣严重程度的关系探讨

目的用耳鸣残疾量化表得分评估耳鸣患者耳鸣的严重程度,分析患者的性别、年龄、听力损失程度是否影响耳鸣严重度。方法对97例以耳鸣为第一主诉的主观性耳鸣患者进行系统的耳鼻咽喉科检查、听力学检查和耳鸣残疾评估量表(tinnitus handicap inventory,THI)评分,分析患者的性别、年龄及听力损失程度与THI得分的关系。结果 97例中,男36例,年龄18～78岁(平均47±12.5岁);女61例,年龄15～71岁(平均55±17.6岁),经Wilcoxon秩和检验分析,不同性别间患者的THI得分差异无统计学意义(P>0.05),Spearman相关性分析显示,耳鸣患者的年龄、听力损失程度与THI得分之间无明显的相关性(均为P>0.05)。结论耳鸣残疾评估量表得分分析可知耳鸣患者的性别、年龄、听力损失程度对耳鸣严重程度无明显的影响。     

人工耳蜗植入对耳鸣影响的问卷调查研究

目的通过问卷调查研究人工耳蜗植入对耳鸣的影响。方法随机调查人工耳蜗植入成年患者人工耳蜗植入术前是否伴有耳鸣以及术后耳鸣改变情况,通过联合应用"视觉模拟评分法(visual analog scale,VAS)"和"耳鸣致残量表(tinnitus handicap inventory,THI)中文版"对耳鸣进行评估。VAS用于评估耳鸣响度,双耳分别打分;THI用于量化耳鸣对日常生活的影响。要求受试者对术前和术后的耳鸣情况分别打分。结果随机调查人工耳蜗植入成人52例,术前伴有耳鸣30例(57.7%)。单侧人工耳蜗植入术后,自觉耳鸣减轻或消失者25例(83.3%),其中,植入耳同侧耳鸣消失5例,这5例患者中2例患者对侧的耳鸣也消失了,即双侧耳鸣均消失;自觉耳鸣较术前无明显变化3例(10.0%);自觉耳鸣加重2例(6.7%)。VAS耳鸣响度得分:耳蜗植入侧术前得分6.5±2.4,术后得分2.8±2.3(t=6.287,P<0.01);术前对侧得分6.2±1.8,术后对侧得分3.3±2.2(t=4.763,P<0.05)。THI得分:术前得分51.9±27.7,术后得分25.3±25.8(t=4.759,P<0.01)。结论耳鸣在人工耳蜗植入候选人群中具有较高的发生率。人工耳蜗植入术后能够显著缓解耳鸣响度,减少耳鸣对患者日常生活的影响。     

慢性耳鸣急性加重时的听阈改变及其对耳鸣预后的影响

目的 探讨慢性耳鸣急性加重时患者的听阈改变及其对耳鸣预后的影响.方法 对32例在习服治疗过程中出现耳鸣急性加重的患者进行纯音听阈、声导抗、耳声发射、听性脑干反应、耳蜗电图及甘油试验等听力学检测,对新出现听阈提高者在习服治疗的同时,按照突发性聋方案治疗.对照组75例仅接受习服治疗.分析慢性耳鸣急性加重时的听阈改变,以及耳鸣加重组与对照组在习服治疗的第3、6、9、12个月时的耳鸣代偿情况.结果 慢性耳鸣急性加重时,出现3种类型的局部频率听阈提高:①既往为4～8 kHz高频下降型听力曲线,耳鸣加重时,相邻的中频区1～2个频率(含半倍频)听阈提高;②既往中频区单个频率听力损失,耳鸣加重时,紧邻的中频区新增单个频率听阈提高,听力曲线由锯齿型转变为凹槽型;③低频听力波动型,慢性耳鸣急性加重时,125～1000 Hz平均听阈较既往提高10～30 dB,而高频区听阈无改变.按照突发性聋方案治疗后,随着新出现听力损伤的恢复,25例随之实现耳鸣代偿.耳鸣加重组与对照组在习服治疗的第3、6、9个月,代偿率差异无统计学意义(X2值分别为0.005、0.005、2.587,P值均>0.05),12个月时,耳鸣加重组代偿率明显高于对照组,差异有统计学意义(X2=0.108,P<0.05).结论 慢性耳鸣急性加重时,出现了不同形式的局部频率听力损失,对新出现听力损失及时有效的治疗,在挽救听力的同时,加速了耳鸣的代偿.     

伴围绝经期综合征的主观性耳鸣患者临床特征分析

目的　观察与分析围绝经期女性的耳鸣特征。方法　对就诊我科248例患主观性急性耳鸣伴围绝经期综合征女性进行纯音听阈测试、耳鸣频率和响度匹配测试、耳鸣问卷调查、睡眠质量评价和血清促卵泡刺激素（follicle-stimulating hormone, FSH）测定。结果　单耳鸣多于双耳鸣，差异有统计学意义（χ2=97.58，P＜0.05），左、右耳耳鸣发生率基本相当，差异无统计学意义；高频耳鸣占总数的62.73%、中频占2.80%、低频占34.47%；耳鸣频率与听力下降频率无明显相关性，与严重程度亦无明显相关性；耳鸣残疾评估量表（tinnitus handicap inventory,THI）响度评级主要为2、3级，占72.18%，其次为1、4级，占24.60%，5级极少，仅占3.22%；FSH水平与耳鸣严重程度有相关性，与耳鸣响度无明显相关性；睡眠障碍发生率58.06%，随耳鸣程度增加，睡眠障碍发生率增加，耳鸣程度与睡眠质量呈正相关。结论　围绝经期女性耳鸣特征、病因与发病机制与听觉系统病变的耳鸣有所不同，主要与FSH水平有关。耳科医师应注意鉴别诊断，综合分析和治疗。     

2171例耳鸣患者的临床特征分析

目的 探讨耳鸣患者的临床特征,为耳鸣诊治提供参考.方法 收集2014年1月至2015年12月就诊于中山大学孙逸仙纪念医院耳鼻喉科门诊以耳鸣为第一主诉的2 171例(2 736耳)耳鸣患者的临床资料,以耳鸣残疾量表(tinnitus handicap inventory,THI)及视觉模拟评分(visual analogue scale,VAS)评估耳鸣的严重程度,并分析耳鸣的发病年龄、耳鸣侧别、听力状况及可能病因等基本特征.结果 2 171例耳鸣患者平均年龄为44.08±15.37岁,其中41~50岁为分布最集中的年龄段(491例,22.60%),其次为31~40岁(445例,20.50%)1~60岁(438例,20.20%);主观性耳鸣2 120例(97.65%),客观性耳鸣51例(2.35%);单侧耳鸣(1 606例,73.98%)多于双侧耳鸣(539例,24.83%), 颅鸣最少(26例,1.19%);2 736侧耳鸣耳8 000 Hz的平均听阈为69.26±27.70 dB HL,高于1 606侧非耳鸣耳(54.16±30.98 dB HL);THI分级以2、3级为主(55.78%,1 211/2 171),VAS分级以轻、中度耳鸣为主(83.83%,1 820/2 171);音调匹配以高频多见(4~8 kHz,1 199例,55.23%);位于前三位的可能病因为不明原因591例(27.22%)、突发性聋549例(25.29%)及中耳疾病270例(12.44%).结论 本组耳鸣患者中以主观性耳鸣为主,中青年者居多,单侧耳鸣多于双侧耳鸣,耳鸣与听力关系密切;引起耳鸣的病因多而复杂,部分患者不明原因或与耳疾有关,习服治疗是值得推广的治疗方法.     

伴乙肝的耳鸣患者心理声学特征初探

目的：初步探讨伴乙肝的耳鸣患者的心理声学特征,为此类人群制订更为个性化的耳鸣治疗方案提供临床依据。方法使用听尼特TM1000A耳鸣综合诊断治疗仪对35例伴乙肝的耳鸣患者进行纯音测听和耳鸣心理声学测试,对结果进行统计分析。结果35例患者中,听力正常组12例,听力损失组23例;耳鸣音调匹配失败5耳;耳鸣音调匹配类型以纯音为主（占68.6%）;耳鸣频率以高频居多（占70.0%）;耳鸣响度不大,以10 dB SL以内为主（占80.0%）;耳鸣佛德曼曲线在听力正常组与听力损失组均以汇聚型最多;残余抑制试验阳性率听力损失组（占70.0%）高于听力正常组（占50.0%）。结论伴乙肝的耳鸣患者,听力损失人数居多;汇聚型佛德曼曲线且伴听力下降的患者残余抑制试验阳性率最高,耳鸣更易被掩蔽。     

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。     

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。     

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.     

Evaluation of tinnitus retraining therapy for patients with normal audiograms versus patients with hearing loss

Objective

A few chronic tinnitus patients show normal hearing thresholds in the pure tone audiometry from 125 Hz to 8000 Hz (≤20 dB). We report the characteristics of the course of those patients underwent tinnitus retraining therapy (TRT) compared with other patients suffering from chronic and severe tinnitus.

An investigation of the audiologic handicap associated with unilateral sudden sensorineural hearing loss

OBJECTIVE: To determine the incidence of tinnitus and associated handicap after unilateral sudden sensorineural hearing loss (SSNHL); in addition, to determine the hearing handicap experienced as a consequence of such a loss. STUDY DESIGN: Identification of patients and determination of demographic and audiologic data by retrospective case review; determination of handicap and distress by postal questionnaire. SETTING: Teaching hospital department of otolaryngology. PATIENTS: Thirty-eight patients were identified as having been treated for a unilateral sudden sensorineural hearing loss in the period 1988 through 1997. Of those, 21 (55.3%) replied to the questionnaire. MAIN OUTCOME MEASURES: Audiometric data at admission and at 4-week follow-up, Tinnitus Handicap Inventory (THI), visual analogue scales of tinnitus loudness and distress, Hearing Handicap Inventory in Adults (HHIA). RESULTS: The questionnaire responder group did not significantly differ from the questionnaire nonresponder group on demographic nor audiometric variables, and hence were considered to be a representative sample. Tinnitus was present in 14 patients (67%). Hearing handicap was found in 86% of patients (of the 21 questionnaire responders) and tinnitus handicap in 57% (of the 14 with tinnitus). Correlations were found between tinnitus loudness, distress, and handicap. There was no correlation between time elapsed since SSNHL and tinnitus or hearing handicap, nor was there a correlation between the extent of audiometric loss and hearing or tinnitus handicap. A strong negative correlation was, however, found between recovery in audiometry in the first 4 weeks after onset and tinnitus and hearing handicap. The audiometric status of the contralateral ear correlated with hearing handicap. CONCLUSIONS: A majority of patients after unilateral SSNHL have a perceived handicap associated with tinnitus and hearing. Although this condition is an otologic emergency, careful thought should be given to the audiologic rehabilitation of this patient group.     

Cochlear implant in patients with sudden unilateral sensorineural hearing loss and associated tinnitus

Introduction and objectivesTo assess the efficacy of cochlear implantation in patients with unilateral sudden sensorineural hearing loss and associated disabling tinnitus.MethodsTen patients suffering from severe-to-profound sudden hearing loss and tinnitus in the affected ear received implants. The sample was comprised of 4 men and 6 women, with a mean age of 42.7 years (range 34-62) at implantation. The severity of the tinnitus was evaluated with the Spanish validated version of the Tinnitus Handicap Inventory (THI) and a visual analogue scale. These assessments were obtained before and after implantation.ResultsTinnitus suppression was observed in 2 patients. In 7 cases, we observed an improvement in the THI, in different degrees, and 1 patient remained without changes. Tinnitus worsening was not found in the series studied.ConclusionsTinnitus reduction following cochlear implantation can be explained by several mechanisms, such as habituation, acoustic masking, direct stimulation of the cochlear nerve and reorganisation of cortical areas. Even though further research is required, cochlear implantation is an effective method for the treatment of disabling tinnitus in patients with severe-to-profound unilateral sudden sensorineural hearing loss.     

69例梅尼埃病伴耳鸣的发病特点及影响因素

目的 分析梅尼埃病患者的耳鸣特点和相关影响因素。 方法 2012年8月~2016年8月诊治的69例梅尼埃病患者,收集每位患者的纯音听阈、耳鸣患侧、持续时间、睡眠质量,采用耳鸣残障量表(THI)、眩晕残障程度评定量表(DHI)(中文版)评分。 结果 (1) 耳鸣主调频率为低频者31例,中频15例,高频23例。耳鸣响度<10 dB(SL)、10~14 dB(SL)、≥15 dB(SL)分别为41例、18例、10例;持续性耳鸣患者60例,间歇性耳鸣9例;一侧耳鸣患者58例,双侧耳鸣患者11例;(2) 伴有持续性耳鸣(t=3.099,P=0.008),睡眠质量较差(t=2.987, P=0.012),耳鸣响度较大(F=3.356,P=0.013)的患者其THI评分高于间断性耳鸣、睡眠质量较好、耳鸣响度较小的患者;(3) 多元线性回归分析结果显示,耳鸣发作频率、病程、平均听阈与DHI评分呈正相关。 结论 梅尼埃病患者伴随的耳鸣特点主要为持续低频性耳鸣。耳鸣的严重程度与耳鸣的响度、持续时间、睡眠质量有关。梅尼埃病患者性别、年龄、耳侧、双温试验对DHI评分无影响,但发作频率、持续时间、平均听阈均为影响评分的主要因素,发作频率越高的患者,其眩晕感觉越重。     

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。     

Clinical effect of an active transcutaneous bone-conduction implant on tinnitus in patients with ipsilateral sensorineural hearing loss

ObjectivesThis study investigated the effect of an active transcutaneous bone conduction implant (BoneBridge^?) in the management of tinnitus in patients with unilateral sensorineural hearing loss.MethodsFrom October 2016 to July 2018, 15 patients with unilateral tinnitus accompanied by ipsilateral sensorineural hearing loss received BoneBridge^? implants. Pure-tone average, tinnitus handicap inventory (THI), and a visual analogue scale (VAS) for awareness, loudness, and annoyance were measured before and 6 months after surgery. We defined improvement as a reduction of more than 20% between preoperative and postoperative VAS and THI scores, and changes in the THI of over 7 points were also assessed.ResultsMean THI scores before surgery (72.8 ± 16.1) had significantly improved by 6 months postoperatively (50.9 ± 18.9) (p = 0.003). VAS scores for loudness and annoyance also statistically significantly improved (p = 0.011 and 0.002). The amount of functional hearing gain correlated with changes in VAS scores for annoyance. This correlation was stronger with the improvement of high frequency hearing.ConclusionBoneBridge^? is beneficial in patients with tinnitus accompanied by sensorineural hearing loss. This finding can help select patients who will benefit most from bone conduction implants.