耳鸣严重程度评估方法的研究

目的探讨合理评估耳鸣严重程度的方法。方法对219例初诊耳鸣患者分别应用耳鸣程度评分法及THI（tinnitus handicap inventory,THI）评分法进行严重程度评估,对两种方法评估的总分及其子项目评分进行相关性分析。结果耳鸣程度评分法与THI评分法的相关系数为0.73（P〈0.001）,按耳鸣程度评分法进行的严重程度分级与THI评分呈正相关,耳鸣程度评分法中耳鸣对情绪的影响及耳鸣对工作和生活、睡眠的影响分别与THI评分中的情绪性评分及功能性评分具有较高的相关性（相关系数分别为0.674、0.703）。耳鸣程度评分法中耳鸣对情绪、工作和生活、睡眠的影响及严重性自我评分4个子项目与总分的相关性较大,耳鸣出现的环境及持续时间2个子项目与总分的相关性较小。结论耳鸣程度评分法与THI评分法的评估理念基本一致,结果相似,但前者更为简单实用,今后可进一步改良部分指标的权重。     

耳鸣认知压力对耳鸣严重程度的影响

目的 分析耳鸣患者对耳鸣的不正确认识与耳鸣对生活质量影响之间的相关性.方法 选择以耳鸣为第一主诉的192例患者为研究对象,年龄18~83岁,平均45±15.52岁;男99例,女93例,按年龄分为青年组(≤44岁)111例,中年组(45~59岁)42例,老年组(≥60岁)39例;男性患者耳鸣平均时间25.67±37.71月(0.20~216.00月),女性患者耳鸣平均时间27.12±45.42月(0.10~300.00月).所有对象均填写普通话版耳鸣问卷量表(Mandarin tinnitus questionnaire,MTQ)和普通话版耳鸣残疾评估量表(Chinese Mandarin tinnitus handicap inventory,THI-CM),分析MTQ中认知压力(cognitive distress,CD)与耳鸣严重程度之间的相关性.结果 192例患者MTQ平均得分为36.95±20.06分(6.00~88.00分),其中认知压力(问题17、18、23、41、42)平均得分为2.36±2.55分,问题17、18、23、41、42平均分分别为:2.81、2.63、2.59、2.40、2.41.THI-CM平均分为23.89±20.06分(2.00~90.00分),CD和THI-CM的相关系数为0.64(P<0.01),男性和女性CD和THI-CM的相关系数分别为0.63和0.66(P<0.01);青年组、中年组和老年组CD和THI-CM的相关系数分别为0.02、0.07、0.38(P>0.01).THI-CM评分为无残疾、轻度、中度和重度残疾组的CD和THI-CM的相关系数分别为0.30(P<0.01)、0.29(P>0.01)、-0.12(P>0.01)、0.23(P>0.01).结论 本组对象认知压力与耳鸣残疾严重程度之间有一定相关性,认知压力得分随着耳鸣严重程度的增加而增加;男性和女性均表现出相关性,但相关性不强;年龄和认知压力之间无相关性,但随着年龄增长,两者之间的相关系数增大,表明耳鸣患者的生活质量可能随着年龄增加,越容易受到对耳鸣不正确认知的影响.     

耳鸣严重程度与焦虑、抑郁及人格特征的相关性

目的 探讨主观性耳鸣患者的耳鸣严重程度和焦虑、抑郁情绪及人格特征的相关性.方法 采用耳鸣残疾量表(tinnitus handicap inventory,THI)、抑郁自评量表(self-Rating depression scale SDS)/焦虑自评量表(self-rating anxiety scale,SAS)...     

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。     

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。     

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。     

多元复合声治疗对突聋患者耳鸣的疗效分析

目的 探讨多元复合声治疗在突聋患者耳鸣的疗效,为突聋患者的耳鸣治疗提供参考。方法 回顾性分析2017年1月至2020年8月收治的112例单侧突聋伴耳鸣患者的临床资料,其中58例采用多元复合声联合药物治疗为观察组,54例采用单独药物治疗为对照组。详细收集患者病例资料,并行纯音听阈测定、耳鸣测试,以及耳鸣残疾评估量表、视觉模拟量表和焦虑自评量表评分。对比两组患者治疗前后听力水平、耳鸣严重程度及负性情绪评分。结果 治疗后两组患者听力总有效率显著提高,2周、1个月、3个月后听力总有效率观察组分别为55.2%、75.9%、77.6%,对照组为53.7%、77.8%、80.3%,组间差异无统计学意义(P>0.05)。治疗1个月、3个月后观察组耳鸣疗效(62.1%、81.1%)优于对照组(53.7%、59.3%),组间差异有统计学意义(P<0.05)。观察组耳鸣疗效在治疗3个月后(81.1%)优于治疗1个月后(62.1%),差异有统计学意义(P<0.05)。结论 多元复合声治疗对突聋患者的耳鸣疗效显著,延长治疗时间可提高耳鸣疗效。     

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。     

耳鸣患者的心理因素分析

目的 :研究耳鸣患者的心理健康状况及其影响因素。方法 :对 95例耳鸣患者采用症状自评量表(SCL 90 )进行问卷调查 ,并对与患者心理健康状况有关的某些因素作了调查并分析。结果 :躯体化、强迫症状、抑郁、焦虑 4个因子分与国内常模比较差别有统计学意义 (P <0 .0 5 ) ,耳鸣患者中情绪的稳定性和心理健康的关系较大 ,年龄与躯体症状关系较大 ,文化程度与各症状因子的关系居中 ,性别、婚姻、家庭经济状况与心理健康的关系较小。结论 :耳鸣患者具有较广泛的心理健康问题 ,影响其心理健康状态的主要因素为情绪的稳定性、年龄和文化程度。     

The relationship between tinnitus pitch and hearing sensitivity

Tinnitus is the phantom perception of sounds. No single theory explaining the cause of tinnitus enjoys universal acceptance, however, it is usually associated with hearing loss. The aim of this study was to investigate the relationship between tinnitus pitch and audiometry, minimum masking levels (MML), tinnitus loudness, and distortion product otoacoustic emissions (DPOAE). This was a retrospective analysis of participant’s records from the University of Auckland Hearing and Tinnitus Clinic database. The sample consisted of 192 participants with chronic tinnitus (more than 18 months) who had comprehensive tinnitus assessment from March 2008 to January 2011. There were 116 males (mean = 56.5 years, SD = 12.96) and 76 females (mean = 58.7 years, SD = 13.88). Seventy-six percent of participants had a tinnitus pitch ≥8 kHz. Tinnitus pitch was most often matched to frequencies at which hearing threshold was 40–60 (T50) dBHL. There was a weak but statistically significant positive correlation between tinnitus pitch and T50 (r = 0.15 at p < 0.05). No correlation was found between tinnitus pitch and DPOAEs, MML, audiometric edge and worst threshold. The strongest audiometric predictor for tinnitus pitch was the frequency at which threshold was approximately 50 dBHL. We postulate that this may be due to a change from primarily outer hair cell damage to lesions including inner hair cells at these levels of hearing loss.     

The relationship between tinnitus pitch and the audiogram

We studied the relationship between tinnitus pitch and the audiogram in 195 patients. Patients with tone-like tinnitus reported a higher pitch (mean = 5385 Hz) compared to those with a noise-like quality (mean = 3266 Hz). Those with a flat audiogram were more likely to report: a noise-like tinnitus, a unilateral tinnitus, and have a pitch < 2000 Hz. The average duration of bilateral tinnitus (12 years) was longer than that of unilateral tinnitus (5 years). Older subjects reported a less severe tinnitus handicap questionnaire score. Patients with a notched audiogram often reported a pitch ≤8000 Hz. Subjects with normal hearing up to 8000 Hz tended to have a pitch ≥8000 Hz. We failed to find a relationship between the pitch and the edge of a high frequency hearing loss. Some individuals did exhibit a pitch at the low frequency edge of a hearing loss, but we could find no similar characteristics among these subjects. It is possible that a relationship between pitch and audiogram is present only in certain subgroups.     

SSRI use by tinnitus patients: interactions between depression and tinnitus severity

Depression is often coincident with chronic tinnitus, and several studies have suggested that antidepressant medications may play a role in relieving tinnitus as well as depression. We conducted a retrospective study of the use of selective serotonin reuptake inhibitors (SSRIs) by patients at a large tinnitus clinic to assess the effects of these antidepressants on tinnitus severity. We focused on a subgroup of 30 patients with depression who had begun taking SSRI medication after the onset of their tinnitus; these patients had also been treated with psychotherapy by a mental health clinician. At a mean follow-up of 20.6 months, only 10 of the 30 patients reported that they were still experiencing major depression. Moreover, this group as a whole demonstrated a statistically significant improvement in tinnitus symptoms as reflected by a reduction in their Tinnitus Severity Index scores. We conclude that SSRIs represent one category of tools that can be used to help patients with severe tinnitus and depression. Like all antidepressant medications, SSRIs should be used in conjunction with psychotherapy to facilitate patient improvement.     

Re-examining the relationship between audiometric profile and tinnitus pitch

Abstract

Objective: We explored the relationship between audiogram shape and tinnitus pitch to answer questions arising from neurophysiological models of tinnitus: ‘Is the dominant tinnitus pitch associated with the edge of hearing loss?’ and ‘Is such a relationship more robust in people with narrow tinnitus bandwidth or steep sloping hearing loss?’ Design: A broken-stick fitting objectively quantified slope, degree and edge of hearing loss up to 16 kHz. Tinnitus pitch was characterized up to 12 kHz. We used correlation and multiple regression analyses for examining relationships with many potentially predictive audiometric variables. Study Sample: 67 people with chronic bilateral tinnitus (43 men and 24 women, aged from 22 to 81 years). Results: In this ample of 67 subjects correlation failed to reveal any relationship between the tinnitus pitch and the edge frequency. The tinnitus pitch generally fell within the area of hearing loss. The pitch of the tinnitus in a subset of subjects with a narrow tinnitus bandwidth (n = 23) was associated with the audiometric edge. Conclusions: Our findings concerning subjects with narrow tinnitus bandwidth suggest that this can be used as an a priori inclusion criterion. A large group of such subjects should be tested to confirm these results.

Sumario

Objetivo: Exploramos la relación entre la forma del audiograma y el tono del acufeno para responder a preguntas provenientes de modelos neurofisiológicos del acúfeno: ‘Es el tono dominante del acúfeno asociado con el borde de la hipoacusia?’y ‘Será tal relación más robusta en personas con un acúfeno de banda angosta o con una hipoacusia de caída abrupta?’ Diseño: Una pendiente tipo “palo roto” objetivamente cuantificada, con severidad y borde de la hipoacusia hasta 16 kHz. El tono del acúfeno fue caracterizado hasta 12 kHz. Utilizamos un análisis de correlación y regresión múltiple para examinar la relación con muchas de las variables potencialmente predictivas. Muestra del estudio: 67 personas con acúfeno bilateral crónico (43 hombres y 24 mujeres con edades entre 22 y 81 años). Resultados: En esta amplia muestra de 67 sujetos, la correlación no demostró ninguna relación entre el acúfeno y el borde de la frecuencia. El tono del acúfeno generalmente cayó dentro del área de la hipoacusia. En un subgrupo de sujetos, que tenían un acúfeno de banda angosta (n=23), si hubo asociación con el borde audiométrico. Conclusiones: Nuestros hallazgos que corresponden a los sujetos con un acúfeno de banda angosta, sugieren que esto puede ser utilizado a priori como un criterio de inclusión. Un grupo grande de sujetos debe ser examinado para confirmar estos resultados.     

Long-term reductions in tinnitus severity

Background  

This study was undertaken to assess long-term changes in tinnitus severity exhibited by patients who completed a comprehensive tinnitus management program; to identify factors that contributed to changes in tinnitus severity within this population; to contribute to the development and refinement of effective assessment and management procedures for tinnitus.     

Investigating the association between tinnitus severity and symptoms of depression and anxiety,while controlling for neuroticism,in a large middle-aged UK population

Objective: Clinical studies indicate increased risk for depression and anxiety among tinnitus patients. However population data are scarce, and no studies have controlled for neuroticism. We examined associations between tinnitus and symptoms of depression and anxiety in a large UK population, controlling for neuroticism, to explore whether neuroticism, as previously reported, fully explains the association between symptoms of depression and anxiety, and tinnitus. Design: We used the UK Biobank resource. Study sample: 171 728 participants answered hearing questions. Results: Using generalized linear modelling, we examined associations between tinnitus (mild to severe) and symptoms of depression and anxiety. Controlling for neuroticism, patients with severe tinnitus were at increased risk of depression (odds ratio (OR) = 1.27) and anxiety (OR = 1.11) symptoms, compared to those without tinnitus. Conclusions: Although it is not possible to determine whether tinnitus is a predisposing factor to depression, these results suggest an association. We suggest further exploration to determine the clinical significance of this association. Early psychosocial intervention aimed at reducing anxiety and depression in patients at increased risk might influence the extent to which tinnitus is experienced as troubling, and therefore psychological distress associated with it. Likewise, with tinnitus patients, assessment for anxiety/depression should be considered.     

The relationship between social behavior and severity of language impairment.

The Teacher Behavior Rating Scale (C. H. Hart and C. C. Robinson, 1996) was used to compare the withdrawn and sociable behaviors of 41 children with specific language impairment (SLI) and 41 typically developing peers. Three subtypes of withdrawal (reticence, solitary-active, solitary-passive) and 2 subtypes of sociable behavior (prosocial, impulse control/likeability) were examined. Teachers rated children with SLI as exhibiting higher levels of reticence and solitary-passive withdrawal than typical children. Teachers also rated the children with SLI as demonstrating lower levels of both types of sociable behavior than typical children. The group with SLI was then separated into subgroups of children having more severe and less severe language impairment. These groupings did not differ on comparisons involving withdrawn behavior, except that girls with more severe receptive problems demonstrated higher levels of solitary-passive withdrawal than did girls with less severe language problems. Children with less severe receptive language impairment demonstrated higher levels of proficiency on both types of sociable behavior than their peers with more severe impairment. Children with more severe expressive problems also demonstrated poorer prosocial behavior--but not poorer impulse control/likeability--than children with less severe expressive problems.     

Predictive factors for the severity of tinnitus

The majority of patients with tinnitus experience a lessening of their symptoms during an 18-month period after their first consultation. The exception to this rule is severe incapacitating tinnitus, the sometimes very troublesome symptoms of which show no sign of diminishing with time. The aim of the present study was to investigate risk factors for incapacitating tinnitus, as measured by absence from work related to tinnitus (AWT) of more than 1 month during an 18-month period after the first visit to the tinnitus clinic. Audiometric data and the scores from the Tinnitus Severity Questionnaire and the Nottingham Health Profile at the first visit to the clinic were correlated to AWT by a logistic regression model. By using this risk model, an individual risk score for AWT could be estimated. Depression and physical immobility were strong predictors of AWT, and hearing loss was moderate. Based on these results, we suggest that the aetiology of tinnitus severity could be described as depression-/anxiety-related, somatic, and auditory tinnitus.