低频重复经颅磁刺激治疗耳鸣的疗效分析

目的 探讨低频重复经颅磁刺激治疗耳鸣的有效性和安全性.方法 选取听力正常的主观性耳鸣患者102例,其中颅鸣患者34例(26~65岁,平均53±12.59岁),耳鸣患者68例(31~69岁,平均51±12.29岁);采用1 Hz低频脉冲刺激患者左侧颞顶部,每次一次性连续给予1 000次脉冲刺激,脉冲间隔时间为10 s,5次/周,连续2周.所有患者治疗前后采用视觉模拟量表(visual-analogue scale,VAS)评估耳鸣的严重程度.结果 治疗后,34例颅鸣患者中,24例颅鸣减轻或消失,总有效率为70.59%(24/34),其中2例患者自觉颅鸣完全消失(5.88%,2/34),22例自觉颅鸣响度减轻(64.71%,22/34), 治疗前VAS平均分为5.09±1.01分,治疗后降为3.06±1.77分;68例耳鸣患者总有效率为64.71%(44/68),44例耳鸣减轻或消失(64.71%,44/68),其中1例耳鸣完全消失(1.47%,1/68),43例自觉耳鸣减轻(63.24%,43/68);治疗前VAS评分为5.68±1.51分,治疗后降为3.75±2.11分.两组患者治疗前后纯音听阈无显著变化,且无一例出现头痛、头晕、头皮灼伤、癫痫发作、耳鸣加重等不良反应.结论 低频重复经颅磁刺激治疗耳鸣安全有效,其中颅鸣患者效果更佳.     

重复经颅磁刺激治疗主观性耳鸣的研究进展

主观性耳鸣是指在没有任何内部或外部声刺激的情况下产生的一种耳内或颅内的听错觉[1]。流行病学资料显示,耳鸣的发病率约占总人口的10%~15%,其中1%~2%的患者深受耳鸣影响[2]。由于耳鸣机制的复杂性及确定病因的困难,目前临床上没有统一有效的药物或手段治疗耳鸣。传统的治疗耳鸣的方法包括习服疗法和认知行为治疗等,但这些方法并非是从神经学机制上治疗耳鸣,而是在于增强个体对耳鸣的适应性,以减轻其对生活的影响;     

重复经颅磁刺激对耳鸣患者听觉处理功能的影响

目的 探讨不同刺激频率的重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)对主观性耳鸣患者听觉处理功能的影响.方法 10例主观性耳鸣患者随机分为低频组和高频组进行rTMS治疗,每组5例,低频组采用1 Hz刺激频率,高频组采用10 Hz刺激频率,每天1次,...     

通过联合其他康复技术改进重复经颅磁刺激和经颅直流电刺激在慢性耳鸣治疗中的作用

慢性耳鸣的形成和维持是皮层重组的结果,重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)和经颅直流电刺激(transcrani-al direct current stimulation,tDCS)是能够调节皮层兴奋性的非侵入性脑刺激技术(NIBS),但...     

重复经颅磁刺激治疗慢性前庭综合征疗效评价

目的 探讨重复经颅磁刺激(rTMS)治疗慢性前庭综合征(CVS)的疗效.方法 慢性前庭综合征(CVS)患者60例,随机数字法分为对照组和治疗组各30例,两组均进行垂直方向和水平方向的平稳跟踪眼动练习,治疗组另加以rTMS治疗4周.以治疗前后两组患者的头晕评价量表(DHI)评分、冷热试验单/双侧半规管反应减退(UW)值为...     

重复经颅磁刺激治疗耳鸣的新进展

耳鸣可以分为主观性耳鸣和客观性耳鸣[1],主观性耳鸣是在没有任何耳内部或外部声刺激存在时,在内耳或者中枢神经系统中出现的异常生物电活动所致[2]。有研究表明,耳鸣在人群中的发生率约为10%~15%,其中1%~2%的患者深受其影响[2]。持续耳鸣还可引起耳闷、耳痛、恶心、头晕头痛、听力减退和颞下颌关节紊乱等,严重者可出现入睡困难、焦虑、抑郁等症状[3]。目前临床上尚无统一有效的耳鸣治疗方法,传统的方法包括习服疗法和认知行为治疗等,这些治疗旨在增强个体对于耳鸣的适应性,而非从神经学机制上治疗耳鸣。     

慢性主观性耳鸣的声治疗研究进展

慢性主观性耳鸣发病率较高,严重影响患者的情绪、睡眠和生活质量。近年来,皮层功能检测技术的发展促进了对慢性主观性耳鸣的机制研究。声治疗作为一种有效的治疗手段,其疗效和适用性尚存在一定争议。论文从系统层面概述当前慢性主观性耳鸣的理论模型,并总结国内外慢性主观性耳鸣声治疗的研究进展,为进一步研究和声治疗的临床应用提供参考。     

主观性耳鸣的掩蔽及习服治疗效果分析

目的:比较耳鸣掩蔽和习服治疗在主观性耳鸣治疗中的效果,分析掩蔽试验阳性组及阴性组耳鸣的习服治疗效果,为耳鸣的个性化治疗方案提供依据。方法:2006-01-2008-04就诊的主观性耳鸣患者217例,均行耳鸣检测(包括耳鸣音调、响度匹配、残余抑制试验等),其中掩蔽试验阳性患者143例,掩蔽试验阴性74例;随机将143例掩蔽试验阳性患者中75例纳入耳鸣掩蔽治疗组,其余68例加上74例掩蔽试验阴性共142例纳入耳鸣习服治疗组;随访中有10例失访,掩蔽治疗组6例,习服治疗组4例;最后疗效统计为207例,其中耳鸣掩蔽治疗组69例,耳鸣习服治疗组138例(包括掩蔽试验阳性66例及掩蔽试验阴性72例)。2组分别治疗6个月后对其疗效进行比较,疗效的评定采用国际公认的耳鸣残疾度量化表问卷及主观视觉耳鸣严重程度标尺进行评定。结果:耳鸣掩蔽治疗及耳鸣习服治疗均对耳鸣患者有效,2组治疗前后耳鸣严重程度得分及主观视觉耳鸣程度经检验均P<0.01;耳鸣习服治疗组与耳鸣掩蔽治疗组在前后耳鸣严重程度得分差方面差异有统计学意义,习服治疗较耳鸣掩蔽效果好;但其主观视觉耳鸣程度方面两者之间差异无统计学意义。耳鸣习服治疗对掩蔽试验阳性及阴性患者均有...     

声刺激联合认知行为治疗慢性耳鸣的初步探讨

目的 探讨声刺激联合认知行为治疗(CBT)对慢性耳鸣的临床疗效。方法 本研究将49例慢性耳鸣患者按照随机数字表法分为干预组(25例)和对照组(24例),所有患者均行声音刺激1个月。干预组患者同时接受持续1个月的个体化的CBT,对照组患者不接受个体化CBT。所有患者在治疗前和治疗后30 d均需填写问卷,包括耳鸣残疾评估量表(THI)、焦虑自评量表(SAS)及匹兹堡睡眠质量指数(PSQI)。结果 两组患者均完成临床试验。治疗1个月后观察,对照组患者THI、SAS、PSQI的平均值分别下降15.58、15.46、4.96,干预组患者THI、SAS、PSQI的平均值分别下降40.52、41.76、7.72, 差异具有统计学意义(P＜0.05);且干预组患者THI、SAS、PSQI的得分均明显低于对照组。结论 声音刺激和CBT可以预测治疗效果,声音刺激联合CBT的治疗效果优于单独的声音刺激。性别、年龄和听力障碍是耳鸣最相关的危险因素。     

助听器治疗慢性主观性耳鸣的长期疗效

目的　观察助听器治疗双侧伴听力下降的慢性主观性耳鸣患者的长期疗效。方法　回顾性分析2013～2017年我科采用配戴助听器作为听力补偿手段治疗双侧伴听力下降的慢性主观性耳鸣患者105例，记录患者耳鸣情况（耳鸣病程、耳鸣音调、单侧耳鸣或双侧耳鸣）、配戴助听器前的听力下降情况（耳聋病变类型、听力 损失程度）、助听器配戴情况（每日配戴时长、配戴总时长、单侧配戴或双侧配戴），采用卡方检验分析配戴助听器后以上因素对于慢性主观性耳鸣患者的疗效。结果  ①配戴助听器治疗双侧慢性主观性耳鸣的总有效率为72.38%；②双侧配戴助听器治疗双侧慢性主观性耳鸣的疗效显著性高于单侧配戴助听器（χ2=4.435，P＜0.05）；③每日配戴助听器时间越长、配戴助听器总时间越长，治疗双侧慢性主观性耳鸣的疗效越高；④双侧慢性主观性耳鸣患者听力损失程度越高，配戴助听器的疗效越低（χ2=8.373，P＜0.05）。⑤配戴助听器对于双侧慢性主观性耳鸣患者的疗效与听力损失类型比较、与不同耳鸣音调比较，差异无统计学意义（P＞0.05）。结论　配戴助听器治疗双侧伴听力下降的慢性主观性耳鸣患者可行性高，长期疗效显著。配戴助听器对于双侧伴听力下降的慢性主观性耳鸣患者而言，不仅是一种听力补偿的措施，更对耳鸣治疗起了一定的作用。     

Short Term Effects of Repetitive Transcranial Magnetic Stimulation in Patients with Catastrophic Intractable Tinnitus: Preliminary Report

Objectives

The short-term effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) in the patients with catastrophic and intractable tinnitus were investigated.

Methods

Fifteen participants were recruited among patients with catastrophic intractable tinnitus to receive 1 Hz rTMS treatment. Tinnitus severity was assessed before rTMS and directly after sham or real rTMS using the tinnitus handicap inventory (THI) and visual analog scale (VAS).

Results

There was no statistical difference in the THI score before and after sham stimulation. However, after 5 replications of real rTMS there was statistically significant reduction in THI score. Eight patients showed a decrease of more than 10 in THI score. Patients who showed a vast change in THI score after rTMS also showed a large decrease in their VAS score (r=0.879, P<0.001). Duration of tinnitus and change of THI score showed statistically significant moderate negative correlation (r=-0.637, P=0.011). But in case of VAS, there was no significant difference between VAS and duration of tinnitus.

Conclusion

Among total 15 patients with catastrophic intractable chronic tinnitus, eight patients showed some improvement in symptoms after 1 Hz rTMS. rTMS can be considered management modality for intractable tinnitus even with distress as severe as catastrophic stage.     

Transcutaneous Electric Nerve Stimulation in Chronic Subjective Tinnitus

ObjectiveIt is aimed to determine the therapeutic role of transcutaneous electrical nerve stimulation (TENS) on chronic subjective tinnitus with a randomized and comparative analysis.Method46 individuals with normal hearing, chronic subjective tinnitus, aged 20–65; randomly divided into the study (TENS therapy) and tje control groups. The control group (n = 23) was informed only about tinnitus, while the study group (n = 23) received TENS therapy (20 sessions in 4 weeks). Before TENS therapy, tinnitus-related evaluations of all participants [tinnitus frequency, loudness, minimum masking level (MMS), residual inhibition (RI)] were made and Tinnitus Handicap Inventory (THI), Visual Analogue Scale (VAS), Short Form 36 (SF-36), and The Quality of Life Scale were applied to the participants. These evaluations and questionnaires were repeated after 4 weeks of the therapy.ResultsThere was a significant decrease in the tinnitus severity after TENS therapy in the study group (p = 0.003). Moreover, it was found that VAS (loudness and annoyance), THI (functional, emotional and total score), SF-36 (physical function, physical role, pain, general health, vitality, emotional role and social function) values improved compared to before TENS therapy and the difference was significant (p < 0.05). There was no significant difference between the first and last evaluations of the control group (p > 0.05).ConclusionTENS is an effective, practical and reliable therapy method in reducing severity, loudness, and annoyance of tinnitus, and increasing the quality of life in individuals with chronic subjective tinnitus.     

Repetitive transcranial magnetic stimulation (rTMS) for treatment of chronic tinnitus

Objective

There is compelling evidence that tinnitus is associated with functional alterations in the central nervous system. Repetitive transcranial magnetic stimulation (rTMS) is a potent tool for modifying neural activity at the stimulated area and at a distance along the functional anatomical connections. Depending on the stimulation parameters, cortical networks can be functionally disturbed or modulated in their activities. Low-frequency rTMS has been shown to result in a decrease in cortical excitability. The technique can alleviate tinnitus by modulating the excitability of neurons in the auditory cortex. We aimed to investigate the effects of low-frequency rTMS in patients and determine the factors that predict a beneficial outcome with rTMS treatment.

Methods

Sixteen patients (male 10, female 6) with chronic tinnitus underwent low-frequency (1 Hz) rTMS (intensity: 110% motor threshold; number of stimuli: 1200) to the left auditory cortex. The treatment outcome was assessed with a visual analog scale (VAS) of loudness, annoyance and duration, loudness balance test, and tinnitus handicap inventory (THI). Therapeutic success was studied according to the patients’ clinical characteristics.

Results

A significant reduction in the VAS (loudness and annoyance) occurred immediately after rTMS, with a gradual return to pretreatment levels after 7 days. The tinnitus patients with sudden deafness were significant resistant to rTMS treatment compared with those diagnosed with age-related hearing loss.

Conclusion

These results support the potential of rTMS as a new therapeutic tool for the treatment of chronic tinnitus. Because this study was performed with a small sample size and showed high interindividual variability in treatment effects, further development of the technique is needed before it can be recommended for clinical applications.     

Cortical Representation of the Orbicularis Oculi Muscle as Assessed by Transcranial Magnetic Stimulation (TMS)

Objectives To analyze characteristic features and details on motor‐evoked potentials (MEPs) of the orbicularis oculi muscle resulting from cortical transcranial magnetic stimulation (TMS) in normal subjects as a basis for further investigations on motorcortical representation in patients presenting with facial nerve diseases. Study Design MEPs of the orbicularis oculi muscle resulting from focal cortical TMS with a figure‐8‐shaped coil were investigated in 17 healthy subjects with special regard to amplitude and onset latency as a function of the coil position on the head surface along the interaural line and in the anterior–posterior direction. The results were then compared with our data on lower‐lip mimetic muscles and on the frontalis muscle obtained in previous studies. Results Bilateral reproducible responses could be observed at coil positions varying from 1 to 13 cm lateral to the vertex. During moderate muscle activation, maximum responses (mean amplitude 0.75 ± 0.44 mV contralateral, 0.74 ± 0.36 mV ipsilateral) were obtained at a mean stimulus position of 8.6 ± 1.6 cm lateral and 2.0 ± 2.2 cm anterior to the vertex for contralateral responses, and of 8.6 ± 2.0 cm lateral and 2.8 ± 2.4 cm anterior to the vertex for ipsilateral responses, respectively. Voluntary muscle activation by forced eye‐closure was associated with a further increase in mean amplitudes. At rest, bilateral responses could be elicited in 15 subjects (88.2%). During moderate muscle activation, the shortest mean onset latencies were obtained at the optimum stimulus position on the interaural line, both for contralateral (10.2 ± 1.3 ms) and ipsilateral (10.6 ± 1.5 ms) MEPs. Comparing our data on the orbicularis oculi muscle with those obtained on lower‐lip muscles and on the frontalis muscle, there was a considerable overlap of coil positions from which reproducible MEPs could be elicited in all three groups of mimetic muscles, but with the orbicularis oculi area being placed between forehead and lower‐lip motorcortical areas. Conclusions A statistically significant separation of the cortical representation areas of forehead, orbicularis oris, and lower‐lip mimetic muscles is possible by focal cortical TMS reflecting a kind of somatotopic organization of the face‐associated motorcortex. Compared with the results on lower‐lip and forehead muscles, orbicularis oculi muscle responses show characteristics of both.     

习服疗法与掩蔽疗法对慢性耳鸣疗效的Meta分析

目的 系统评价并比较习服疗法和掩蔽疗法对慢性耳鸣的疗效.方法 从万方数据库、中国期刊全文数据库(CNKI)、维普数据库(VIP)、中国生物医学文献数据库(CBM)、PubMed、Web of science和Cochrane li-brary等中英文数据库中检索自建库到2020年2月与慢性耳鸣治疗相关的文献,全面收集采...     

Magnetic Resonance Angiography in Pulsatile Tinnitus: The Role of Anatomical Variations

Pulsatile tinnitus (PT) is a perception of a rhythmical sound that is synchronous with the heartbeats. Despite being seen rarely in daily practice, frequently it is associated with identifiable causes, thus warranting special attention in regard to the etiological diagnosis. PT results from blood flow turbulence, which in turn results from changes in flow velocity or in the vessel lumen. One of the most important causes of PT is the paraganglioma, a vascular tumor that appears as a reddish retrotympanic mass. However, a normal tympanic membrane mandates differentiating among other diagnoses, such as arteriovenous malformations or fistulas, intracranial or extracranial aneurysms, a high or dehiscent jugular bulb, and persistent stapedial artery. Owing to the progress of radiological evaluation, magnetic resonance angiography (MRA) has proven to be excellent for evaluating vascular diseases. From January 1995 to June 1997, the authors prospectively studied 16 patients with PT and normal otoscopic examination. The study comprised 1 male and 15 female patients (ages 25-71 years; mean age, 42.5 years). All were subjected to MRA evaluation, which revealed the etiological diagnosis in 13 cases (81.25%), including 2 aneurysms and 1 case of intracranial hypertension. Of the 13 patients 9(69.23%) presented with at least one variation of vascular anatomy of the skull, showing a close correlation, in most cases, with the side on which PT occurred. Our results confirm that MRA is an excellent primary screening modality for patients with PT and normal otoscopic findings. The authors point out the importance of making etiological diagnoses in such cases, suggesting that variations of the vascular anatomy of the skull are a possible etiology.     

Systematic Screening of the Serotonin Receptor 1A (5-HT1A) Gene in Chronic Tinnitus

Objective Chronic tinnitus is a highly prevalent condition and has been hypothesized to result from an innate disturbance in central nervous serotonergic transmission. Given the frequent comorbidity with major depression and anxiety, we argue that candidate genes for these disorders are likely to overlap. The present study addresses the gene encoding for the 5-HT1A receptor as a putative risk factor for tinnitus. Methods In 88 subjects with a diagnosis of chronic subjective tinnitus who underwent a detailed neurootological examination, the entire 5-HT1A gene was amplified using overlapping PCR products. Amplicons were custom sequenced bidirectionally and were screened for variants in multiple alignments against the human genome reference. Results We identified a synonymous C > T exchange at residue 184 (Pro) in 7/88 subjects, but detected no missense variants in the population under study. Specifically, the following residues were fully conserved: 16 (Pro), 22(Gly), 28(Ile), 98 (Val), 220(Arg), 267 (Val), 273 (Gly), and 418 (Asn). Discussion The present data count against the causation of chronic tinnitus by a change in the 5-HT1A receptor's amino acid sequence. However, the allele frequency for the 184Pro minor allele (0.04) reached twice the frequency reported in control cohorts from the same ethnicity. Additional investigations are invited to clarify the role of the 5-HT1A polymorphism in larger samples, and to control for comorbid affective disorders.