脑源性神经营养因子及Val66Met基因多态性与慢性耳鸣的相关性研究

目的 探讨脑源性神经营养因子(BDNF)及Val66Met基因多态性与耳鸣的关系,评价耳鸣疗效及耳鸣程度与血浆BDNF的相关性。方法 测定30例耳鸣患者(实验组)和30例健康对照者(对照组)血清BDNF水平及其基因多态性(rs 6265Val66Met)。耳鸣严重程度使用耳鸣残疾评估量表(THI)评估。根据THI评分将耳鸣患者分为两组：轻度残疾(≤36分)和中重度残疾(≥38分)。所有患者使用经颅磁刺激治疗。以耳鸣残疾评估量表(THI)评分、血浆BDNF浓度治疗前后变化情况,探讨耳鸣程度及疗效与血浆BDNF浓度的关系。结果 耳鸣患者血清BDNF浓度低于健康对照组(P＜0.05)。耳鸣治疗有效患者治疗后血清BDNF浓度高于治疗前血清BDNF(P＜0.05);耳鸣治疗无效患者治疗前后血清BDNF浓度变化无统计学意义。在耳鸣患者和健康对照组中,BDNF(rs 6265Val66Met)基因多态性与血清BDNF浓度均无明显相关性。结论 BDNF的浓度与耳鸣的预后存在相关性,BDNF可能通过神经可塑性机制参与耳鸣疾病的发生;因此推测血清BDNF浓度可以作为耳鸣疗效的客观指标之一。     

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。     

听力正常高调耳鸣患者药物治疗前后畸变产物耳声发射变化分析

目的 通过对急性耳鸣、亚急性耳鸣和慢性耳鸣3组高调耳鸣患者药物治疗前后畸变产物耳声发射(DPOAE)反应幅值变化及3组不同发病时长高调耳鸣患者药物治疗前后DPOAE反应幅值差值结果的分析,了解药物治疗对高调耳鸣患者DPOAE反应幅值的影响及分析药物疗效与疾病发病时长的关系。方法 按发病时长将收治的68例(77耳)听力正常高调耳鸣患者分为3组,急性耳鸣组(病程≤3个月)25例(27耳),亚急性耳鸣组(3﹤病程≤12个月)23例(26耳),慢性耳鸣组(病程>12个月)20例(24耳),对3组患者检测其DPOAE反应幅值。通过药物治疗2周后,再次测量3组患者DPOAE反应幅值,初步评估药物治疗对耳鸣患者DPOAE反应幅值的影响和药物疗效与疾病发病时长的关系。结果 3组患者在药物治疗2周后,其在0.5~1 kHz频点DPOAE反应幅值的变化以及DPOAE反应幅值变化差值比较均无统计学意义,但在2～8 kHz频点,除第3组患者在6、8 kHz治疗前后DPOAE反应幅值的变化无统计学意义外,其余每组患者经药物治疗后,DPOAE反应幅值的改变均具有统计学意义(P<0.05),且3组患者治疗前后DPOAE反应幅值的差值比较具有统计学意义(P<0.05)。3组患者在治疗前后DPOAE引出率变化,在0.5~1.5 kHz频点无明显差异;在2～8 kHz频点有明显差异,但第3组患者在6、8 kHz频点除外。3组患者经药物治疗后,第1组患者有效率100%,第2组患者有效率65.38%,第3组患者有效率29.17%。3组间治疗有效率比较差异具有统计学意义(χ²=19.38,P<0.01)。结论 高调耳鸣患者给予改善内耳微循环等药物治疗是一种有效的治疗方法,发病时长越短,治疗后DPOAE反应幅值提高越大,且治疗后有效率越高,表明病程越短、疗效越佳,让其早发现、早干预,提高治愈率,以改善患者的生活质量。     

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。     

经皮迷走神经刺激术治疗慢性耳鸣的初步研究

目的探讨经皮外耳道迷走神经刺激术对慢性主观性耳鸣的治疗效果、安全性及可行性。方法选取THI评分≥38分,病史6≥个月的慢性主观性耳鸣患者,在常规治疗基础上以G6805-I型电针治疗仪实施经皮外耳道迷走神经刺激术(transcutaneous vagus nerve stimulation,T-VNS),对照组仅接受常规治疗。以耳鸣残障量表(tinnitus handicap inventory,THI),匹茨堡睡眠质量指数(Pittsburgh Sleep QualityIndex,PSQI),抑郁-焦虑-压力量表(Depression,Anxiety and Stress Scale-21,DASS-21)评价患者治疗前后的变化。结果第10天,T-VNS组主观症状改善率高于常规治疗组,差异显著;PSQI评分显示,T-VNS治疗期间睡眠质量获得明显改善,但3个月随访时,PSQI评分有轻度反弹;DASS-21评分显示,T-VNS治疗期间,T-VNS组焦虑评分较治疗前以及对照组均有下降;THI评分,治疗期间以及3个月随访时,组间对比无显著差异;T-VNS组治疗前后比较,治疗期间较治疗前THI评分降低,但差异不显著;3个月随访时,THI评分降低,差异显著。结论 T-VNS用于慢性主观性耳鸣的治疗对患者焦虑程度及睡眠质量有明显改善,仅少数患者治疗期间有短暂咳嗽或耳部刺痛感,安全性好。疗程及刺激参数的设置需要扩大样本进行进一步的探讨。     

声音疗法联合药物治疗慢性主观性耳鸣的临床随机对照研究

目的 探讨声音联合药物治疗与药物治疗对慢性主观性耳鸣患者的短期疗效及其差异。方法 纳入慢性耳鸣(>6个月)患者共64例,采用随机对照方法,分为声音联合药物组(联合组)和药物组各32例。在耳鸣咨询基础上,药物组予口服银杏叶提取物片,联合组在药物治疗基础上行个性化多元复合声治疗,比较两组治疗1个月前后耳鸣残疾量表(tinnitus handicap inventory, THI)、耳鸣严重程度视觉模拟量表(visual analogue scale, VAS)及焦虑自评量表(self-rating anxiety scale, SAS)评分变化,对比两组耳鸣治疗有效率,分析影响耳鸣治疗疗效的可能因素。结果 药物组及联合组治疗后的THI、VAS及SAS评分均较前下降(P=0.001);联合组较药物组治疗前后THI(P=0.003)、VAS(P=0.002)评分差值变化更大;短期治疗前后两组SAS评分差值无明显统计学差异;联合组治疗总有效率较药物组高(P=0.002);性别(P=0.366)、年龄(P=0.062)、耳鸣频率(P=0.142)、耳鸣侧别(P=0.891)、耳鸣音与听力下降...     

经皮耳迷走神经刺激治疗慢性耳鸣的疗效观察

目的:探讨经皮耳迷走神经刺激(taVNS)治疗慢性耳鸣的疗效.方法:采用taVNS治疗慢性失代偿耳鸣,10 d为一疗程.记录分析患者在治疗期间主观症状的改善情况,并于治疗结束时(治疗10 d)、治疗后3个月及6个月进行THI、PSQI、DASS-21评分,比较taVNS组和对照组的耳鸣改善情况,并对taVNS组THI评...     

综合护理干预在耳鸣音乐疗法中的应用

目的探讨综合护理干预在耳鸣音乐疗法中的临床应用效果。方法选取2019年3月至2020年6月我院耳鼻喉科收治的64例行音乐疗法的耳鸣患者。按照随机分组的原则分为对照组(常规护理组)和观察组(综合护理组),每组32例。入院时和治疗第10天分别采用耳鸣致残量表(THI)评价患者的治疗效果。结果入院时两组患者THI评分比较,差异无统计学意义(P>0.05)。治疗第10天两组患者THI评分均低于入院时,且观察组THI评分低于对照组,差异有统计学意义(P<0.05)。结论采用综合护理干预,有助于提高耳鸣音乐疗法的治疗效果。     

重复经颅磁刺激(rTMS)治疗慢性主观性耳鸣的短期疗效分析

目的采取1Hz低频重复经颅磁刺激(rTMS)治疗慢性主观性耳鸣并评价其治疗效果。方法对慢性主观性耳鸣患者46例行1Hz低频rTMS连续治疗2周,治疗前后分别行耳鸣残疾量表评分(THI)评分及主观疗效评估。结果rTMS对耳鸣治疗有明显效果,对主观耳鸣症状总体有效率为63.1%,其中失代偿性耳鸣(THI≥40)的有效率明显高于代偿性耳鸣(THI<40)(77%vs 45%;P<0.001),耳鸣患者治疗前后THI为(51.8±23.5 vs 37.0±18.8;t=5.94,p<0.001),VAS为(6.3±2.4 vs 4.9±1.8;t=5.27,p<0.01),治疗前后有统计学差异。失代偿组与代偿组耳鸣rTMS治疗后THI变化存在显著差异,两组差值为19.4±8.5(df=42,T=4.95,P<0.001)。结论rTMS治疗耳鸣有效,可明显降低THI得分,改善耳鸣症状,特别在失代偿性耳鸣效果更明显。     

慢性耳鸣的临床特点及严重程度影响因素分析

目的 分析慢性耳鸣的临床特点及严重程度的影响因素。方法 回顾性分析1 452例慢性耳鸣患者的临床资料,所有患者均进行详细的病史询问、纯音测听和耳鸣心理声学评估,填写耳鸣障碍量表(tinnitus handicap inventory, THI)、焦虑自评量表(self-rating anxiety scale, SAS)或广泛性焦虑障碍量表(generalized anxiety disorder-7,GAD-7),抑郁自评量表(self-rating depression scale, SDS)或抑郁筛查量表(patient health questionnaire-9,PHQ-9)、匹兹堡睡眠质量指数量表(pittsburgh sleep quality index, PSQI)和听觉过敏问卷等。分析耳鸣患者的临床特点,并以THI评分≥38分为中-重度耳鸣组,THI评分≤36分为轻度耳鸣组,以THI分组为应变量,上述各因素为自变量,采用Logistic回归分析探究各因素与耳鸣严重程度的相关性。结果 1 452例慢性耳鸣患者中,轻度耳鸣625例(43.04%),中-重度耳鸣827例(...     

The effect of transcutaneous electrical nerve stimulation (TENS) on chronic subjective tinnitus

ObjectivesChronic Subjective Tinnitus is a very highly prevalent disorder worldwide. There is no definitive treatment. The aim of this study is to investigate the efficacy of transcutaneous electrical nerve stimulation (TENS) applied to the auricula for treating tinnitus using the Depression Anxiety Stress Scales (DASS) and Tinnitus Handicap Inventory (THI).MethodsThe 60 patients were randomly divided into 3 groups of 20 patients. The first group (A) had one ear stimulated with TENS, and the second group (B) had both ears stimulated. Group C (placebo group) received no electrical or sound stimulation. All group patients received total of 10 sessions with a maximum of 4 days between the sessions.ResultsThe THI and DASS scores decreased significantly after the treatment (p < 0.05). A significant difference was also observed between the groups after treatment (p < 0.05). While there was no difference between group A and B, it was shown that group C's post-treatment score was significantly higher than those of both groups (p < 0.05.)ConclusionIt is important to note that TENS has a therapeutic effect on subjective chronic tinnitus as well as a placebo effect.     

Effects of tinnitus treatments on sleep disorders in patients with tinnitus

Objective: To assess the effects of tinnitus treatments on sleep disorders in patients with tinnitus. Design: Subjects completed the Pittsburg Sleep Quality Index (PSQI), Tinnitus Handicap Inventory (THI), Self-rating Depression Scale (SDS), and State Trait Anxiety Inventory (STAI). The questionnaire results and the patients’ sex, age, time since the onset of tinnitus, and mean hearing level were examined, and differences between a sleep disorder group and a normal sleep group were examined. Patients completed the questionnaires again after initiating tinnitus treatments (counselling and use of sound generators), and the change in questionnaire scores at follow-up was evaluated. Study sample: Patients (N?=?100) with tinnitus who visited Keio University Hospital and started treatment without medication between 2005 and 2008. Results: Sixty-six percent of the patients had sleep disorders. Compared with patients without sleep disorders, patients with sleep disorders had significantly higher SDS and STAI scores at the first visit. The mean PSQI scores showed significant improvement at follow-up. Conclusions: Sleep disorders in patients with tinnitus improved after tinnitus treatments. Complex interactions between depressive symptoms and anxiety may occur in these patients. The improvement in sleep disorders at follow-up was correlated with improvements in tinnitus severity and state anxiety.     

Effect of sound generator on tinnitus and hyperacusis

Objective: Sound generator (SG) plays a role as effective sound therapy of tinnitus retaining therapy (TRT) in patients with severe tinnitus (Category 1) or hyperacusis (Category 3). This study was performed to evaluate the therapeutic effect of SGs.

Methods: A total of 120 tinnitus patients who visited our tinnitus clinic and were treated with SG along with TRT from January 2008 to December 2016 were included. The patients were divided into two groups by tinnitus category; 78 patients of category 1 and 42 patients of category 3. Their medical records including questionnaires regarding tinnitus severity were retrospectively reviewed to evaluate the therapeutic effect of SGs on tinnitus and hyperacusis.

Results: Category 3 patients included more female patients, were younger than category 1 patients (p?=?.001), and were prescribed SG earlier due to their severe symptom of hyperacusis. (p?=?.004) All patients showed significant improvements on all categories of tinnitus visual analogue scale (VAS) scores and tinnitus handicap inventory (THI) scores after six months use of SG (p?Conclusion: SG with TRT seems to be an effective treatment modality for all tinnitus patients, especially those with comorbid hyperacusis.     

Tinnitus retraining therapy using portable music players

Objective

We aimed to perform acoustic analysis of environmental sounds used in sound therapy for tinnitus retraining therapy (TRT) and to evaluate the efficacy of TRT performed by using a portable music player (PMP) with recorded environmental sounds as the sound generator.

Methods

Acoustic analysis of environmental sounds was performed using a sound analyzer. The subjects were 23 patients with chronic tinnitus. Patients who had bilateral hearing loss and required hearing assistance were fitted with hearing aids (HAs). Patients with normal hearing or unilateral hearing loss were fitted with a tinnitus control instrument (TCI) or a PMP. The patients were divided into the PMP group, TCI group, and HA group. All subjects underwent audiometric evaluations prior to TRT and completed the tinnitus handicap inventory (THI). The THI scores were evaluated before treatment and 1 month, 3 months, 6 months, and 12 months after treatment.

Results

The sound spectrogram of the murmur of a stream showed a wide-frequency band with a constant strength, whereas that of a wave sound showed a wide-frequency band with variable strength. The THI score clearly decreased after 1 month, and this decrease tended to continue over 12 months. The TRT efficacy ratios in the PMP group, TCI group, and HA group at 12 months after treatment were 71%, 67%, and 70%, respectively.

Conclusions

TRT using a PMP had efficacy similar to those of TCI and HA. The murmur of a stream was one of the most effective sounds in TRT. TRT using a PMP as the sound generator can provide the most cost-effective treatment option for tinnitus patients.     

Association between tinnitus retraining therapy and a tinnitus control instrument

Objective

Tinnitus retraining therapy (TRT), which is an adaptation therapy for tinnitus based on the neurophysiological model proposed by Jastreboff in 1990,consists of directive counseling and acoustic therapy with a tinnitus control instrument (TCI) or other devices. For the past 5 years, our hospital has administered TRT characterized by the use of a TCI.

Method

In this study, we reviewed the clinical course of patients with tinnitus who presented to our outpatient clinic for tinnitus and hearing loss during the 3-year period from April 2004 to March 2007 and underwent TRT with a TCI. Among 188 patients with tinnitus (105 males and 83 females), 88 patients (51 males and 37 females, excluding dropouts) who purchased a TCI and continued therapy were included in the study.

Results

Significant improvement in Tinnitus Handicap Inventory (THI) and Visual Analogue Scale (VAS) scores was found as early as 1 month of treatment and later compared with those on initial examination, suggesting that TRT with a TCI may be an effective treatment for tinnitus. Among the noises generated by the TCI, the sound pressure output from the TCI was set at just below tinnitus loudness level both of the first adjustment and the second adjustment. Speech noise and white noise were frequently selected, whereas high-frequency noise and pink noise were infrequently selected. Speech noise was most frequently selected at the first adjustment, and the number of patients selecting white noise increased at the second adjustment. The results that we compared the two also revealed that the mean hearing level and tinnitus loudness levels were higher in the white noise group than in the speech noise group, which suggested that the inner ear disorder was more harder in the white noise group. Both the THI score and VAS grade improved after 1 month of treatment in the speech noise group, whereas improvement in these parameters was observed in the white noise group after 6 months of treatment. These results suggest that it took much longer the patients in the white noise group to improve.

Conclusion

: Significant improvement in THI and VAS scores was found as early as 1 month of treatment and later compared with those on initial examination, suggesting that TRT with a TCI may be an effective treatment for tinnitus. It resulted that many patients chose the speech noise or the white noise. And also it was indicated that noise generators set at just below mixing point with tinnitus are more effective. In this study, however, speech noise was often selected probably because of the reduced output at high frequencies and the level of comfort. As white noise produces greater sound volume, patients tended to switch from other therapeutic sound to white noise at the second adjustment. These findings may help administer acoustic therapy in the future.     

Tinnitus characteristics and associated variables on Tinnitus Handicap Inventory among a Hungarian population

BackgroundTinnitus is a sound precepted without an external sound stimulus. Its background can be categorised into primary and secondary cases. The secondary cases include pathologies of the external, middle and inner ear. Tinnitus can be objective or subjective; the latter can only identified by the sufferer. Previous research results have shown that tinnitus significantly affects the quality of life and daily functioning.ObjectivesTo analyse the impact of tinnitus on the daily functioning and the possible influence of demographical data and tinnitus duration on it.Methods630 patients (265 males and 365 females, 25–85 years of age) suffering from primary tinnitus were enrolled. In the Hungarian language, these patients completed the Tinnitus Handicap Inventory (THI) questionnaire and underwent a complete otorhinolaryngological examination. IBM SPSS V24 software was used for data processing; correlation tests, the Mann-Whitney U and Kruskal-Wallis non-parametric tests were used.ResultsAccording to the THI questionnaires outcomes, most patients (62.5%) were presented with a mild handicap. Based on statistical analysis, no significant correlation was observed between the total THI points and the age of the patients, along with the duration and localisation of the symptoms. However, the total THI scores of male and female patients significantly differed, indicating higher THI values in the female group (p = 0.000521).ConclusionsThe tinnitus severity was not affected by the duration, localisation of the symptoms and age but by gender, indicating higher values in the case of females.     

Impact of reduction of tinnitus intensity on patients’ quality of life

Objective: Assess the impact of a reduction of tinnitus intensity achieved through sound stimulation during sleep on the improvement in the patients’ quality of life. Design: Acoustic stimuli consisted of a highly customized sound that reproduced the spectral and intensity characteristics of the tinnitus in each patient. This stimulus was uploaded into a portable electronic device and delivered through customized ear buds during sleep, every night for three months. Study sample: Twelve patients with subjective idiopathic chronic tinnitus were studied. Results: Results were assessed through: (1) the measurement in dB SPL of tinnitus intensity reduction over time; (2) the results of three psychometric tests: Tinnitus handicap inventory (THI), Tinnitus reaction questionnaire (TRQ), Tinnitus functional index (TFI); and (3) a Visual analog scale (VAS) for tinnitus annoyance. After three months of treatment, we observed an average decrease in tinnitus intensity of 14.1 dB SPL (p?<?0.001), implying a 62% reduction of the perceived sound. This improvement was followed by a statistically significant decrease of TRQ (78%), THI (65%), and TFI (77%). Conclusions: These results suggested that the intensity reduction achieved through the protocol used in this study had a direct impact on the improvement in the patients’ quality of life.     

The effect of vitamin B12 on idiopathic tinnitus

IntroductionTinnitus is one of the most important challenges in the field of ear, nose and throat diseases. The aim of this study was to evaluate the effect of vitamin B12 on idiopathic tinnitus.Material and methodsIn this double-blind clinical trial study, 140 patients with idiopathic tinnitus were divided into two groups, the group receiving vitamin B12 and the group receiving placebo. The first group received vitamin B12 for a month and the other group received placebo. All patients filled a THI questionnaire before the participation, one month and three months after the participation. VAS evaluation questionnaires were also filled for the patients before the participation, one month and three months after the participation. The effect of vitamin B12 on tinnitus was also assessed according to hearing loss status. The two groups were also compared regarding the side effects.ResultsThere was no significant differences between two groups regarding age (p.value = 0.523), gender (females (p.value = 0.810) and males (p.value = 0.789), and hearing loss status (p value = 0.651). According to VAS score, there was no significant statistical differences in tinnitus severity in each group (B12 group, p.value = 0.851 and placebo group, p.value = 0.386). There was no significant statistical differences in tinnitus severity based on VAS score between two groups before the participation (p.value = 0.560), one month (p.value = 0.485) and three months (p.value = 0.254) after the participation. According to THI criterion, there was no significant statistical differences in tinnitus severity in each group (B12 group, p.value = 0.259 and placebo group, p.value = 0.521). There was no significant statistical differences in tinnitus severity based on THI score between two groups before the participation (p.value = 0.651), one month (p.value = 0.125) and three months (p.value = 0.089) after the participation. None of the patients of the two groups had any noticeable side effects. The mean of VAS and THI also had no statistically significant difference before and after the intervention in term of hearing loss status (p.value>0.05). These results were not significantly different between the two groups in term of hearing loss status (p value>0.05).ConclusionThe result of this study indicated that vitamin B12 has no distinctive effect on reducing tinnitus severity.