针对患者的耳鸣咨询材料

耳鸣是一种临床症状,多数耳鸣的病因无法确认,目前也没有一种治愈耳鸣的方法。耳鸣对患者的影响涉及心理、情绪等诸多方面,因此耳鸣咨询（tinnitus counseling）作为耳鸣治疗的重要方面在国外已广泛开展。国内由于就诊患者数量大,这一工作在门诊很难开展。本来提供的资料编译来自美国爱荷华大学耳鼻咽喉头颈外科与语言病理及听力学中心,旨在提供给耳鸣患者咨询的一些基本信息,希望患者建立对耳鸣的正确认识。     

耳鸣临床应用指南

目的耳鸣是没有外界声源时所感知的声音,美国有超过5 000万人经历过耳鸣,由此可估计成人耳鸣发生率约为10%到15%。尽管耳鸣发生率非常高,对患者生活质量的潜在影响非常严重,目前尚无基于循证医学和多学科的临床应用指南帮助临床医生治疗耳鸣,本"指南"重点讨论恼人且持续(6个月或以上)的耳鸣,这种耳鸣常常会给患者的生活质量造成负面影响。本"指南"主要读者是治疗耳鸣患者的临床医生,也包括从事非医学的专业人士,涉及的患者群体是患有持续恼人的原发性耳鸣的成人(18岁及以上)。宗旨为治疗耳鸣患者的临床医生提供基于循证医学证据的建议,本"指南"给临床医生提供了一个合理的框架,以便改善患者诊疗质量,减轻持续恼人耳鸣给个人及社会带来的不利影响;将讨论对耳鸣患者的评估,包括诊断试验的选择和时机,以及专科转诊以确诊可治疗的潜在病因,进而专门讨论对于持续性原发性耳鸣患者的评估和治疗,提供检测和评估耳鸣影响的指导建议和改善耳鸣相关症状及提高生活质量的最适宜干预措施。临床决策建议"指南"专家组强烈建议临床医生须区分恼人耳鸣和非恼人耳鸣患者,强烈不推荐为耳鸣患者提供头颈部影像检查,特别是在评价无耳侧倾向的耳鸣、非搏动性耳鸣、不伴有局部神经病学异常和非对称性听力下降的情况下。专家组建议考虑如下选择:临床医生应该1在首次检测疑为原发性耳鸣患者时,进行有针对性的病史采集和身体检查,确诊那些可通过及时诊治减缓耳鸣影响的相关病症;2立即对单侧耳鸣或持续性耳鸣(≥6个月)或有听力损失的耳鸣患者进行全面听力学检查;3区分新发恼人耳鸣和持续性(≥6个月)耳鸣患者,决定干预的优先顺序,鼓励对患者病史及后续治疗的讨论;4为持续恼人耳鸣患者提供治疗方法的咨询;5向已确认有听力损失且有持续性恼人耳鸣患者推荐助听器验配;6向持续恼人耳鸣患者推荐认知行为疗法。"指南"专家组建议不推荐:1将抗抑郁药、抗惊厥药、抗焦虑药或鼓室内给药作为治疗持续恼人耳鸣的常规疗法;2将银杏提取物、褪黑素、锌制剂或其他膳食补充剂用于治疗持续恼人耳鸣;3将经颅磁刺激用于治疗持续恼人耳鸣的常规疗法。"指南"专家组建议可考虑以下各项选择:临床医生可以:1对耳鸣患者进行初始的全面听力检查(无论耳鸣的侧别、持续时间或听力状况);2建议持续恼人耳鸣患者接受耳鸣声治疗。"指南"专家组对持续恼人耳鸣患者接受针灸治疗未提供任何评价。     

不同年龄段耳鸣患者药物治疗进展

耳鸣（tinnitus）是耳鼻咽喉科一种常见症状，但其潜在机制尚未完全阐明，所以目前临床上用于治疗耳鸣的药物疗效并不确切。年龄已经被确定为耳鸣的一个重要相关因素，但是不同年龄的耳鸣患者发病机制不尽相同，所以针对耳鸣患者年龄制定个性化的治疗方案是耳鸣治疗以后的重要研究方向，故本文就不同年龄段耳鸣患者的药物治疗研究进展做一综述。     

耳鸣的神经生理学机制与针刺治疗耳鸣的思考

正耳鸣不仅是耳鼻咽喉科的一种常见症状,临床上有些学科的疾病,例如内科、妇科疾病等也常伴有耳鸣,并常常给患者带来很大痛苦。据保守估计,我国分别有10%的人体验过耳鸣,5%的耳鸣患者寻求医药治疗,2%的患者反映耳鸣严重影响生活、     

耳鸣咨询联合多元复合声治疗在慢性原发性耳鸣患者中的疗效评价

目的评价耳鸣咨询联合多元复合声治疗在慢性原发性耳鸣患者中的临床效果。方法40例慢性原发性耳鸣患者采用耳鸣咨询+多元复合声治疗的联合疗法,在治疗前、治疗1个月后分别进行耳鸣咨询,在治疗前、治疗1个月及治疗半年后,采用耳鸣致残量表法（THI）及主观视觉耳鸣严重程度标尺评分法（VAS）进行治疗效果的评价。结果经THI和VAS评分统计显示,治疗1个月与治疗前、治疗6个月与治疗前以及治疗1个月与治疗6个月比较,差异均具有统计学意义（P均<0.05）。以THI评分降低20分以上为有效,耳鸣咨询联合多元复合声治疗1个月后,总有效率为27.5%,耳鸣咨询联合多元复合声治疗6个月后有效率为67.5%。费德曼曲线分型中,以重叠型和汇聚型居多,重叠型的治疗效果最佳。统计分析显示在治疗前与治疗6个月后,VAS评分和THI评分具有相关性（P<0.05）。结论耳鸣咨询联合多元复合声治疗在慢性耳鸣中具有广泛应用价值,未来能够作为治疗慢性主观性耳鸣的首选方法;治疗效果可以采用THI和VAS评分系统进行评价分析。     

家庭化个体多元复合声治疗对耳鸣伴听力损失患者的疗效及影响因素分析

目的 探究家庭化个体多元复合声治疗对耳鸣伴听力损失患者的有效性,并分析耳鸣伴听力损失患者疗效的影响因素。方法 利用四川省4家三甲医院的既往电子病历记录,回顾性分析2019年3月至2022年3月期间接受家庭化个体多元复合声治疗的212例耳鸣患者临床资料,收集耳鸣患者的人口学特征、听力损失相关和治疗前后的耳鸣障碍量表评分等资料。采用多因素二元逻辑回归分析疗效相关影响因素。结果 家庭化个体多元复合声治疗对耳鸣伴听力损失患者的总有效率为43.87%,治疗周期长于12个月的耳鸣患者的有效改善率(57.43%)显著高于治疗周期短于12个月的耳鸣患者(31.53%),单因素逻辑回归分析比值比(OR)值为2.93 (95%CI:1.67～5.14)。多因素逻辑回归分析提示治疗周期为影响家庭化个体多元复合声治疗效果的独立风险因素,OR值为2.23 (95%CI:1.09～5.00),患者年龄与声治疗疗效的OR值为1.03 (95%CI:1.01～1.05)。结论 研究表明家庭化个体多元复合声治疗可有效改善部分耳鸣患者的临床症状及恼人程度。其中,治疗周期是影响家庭化个体多元复合声治疗疗效的独立危险因素。临...     

声信息治疗神经性耳鸣

耳鸣是耳科临床上的一种常见症状。据英国耳鸣协会统计此病发生率约10％,目前尚无特殊有效的治疗,我科对76例（106耳）神经性耳鸣患者选择不同治疗方案,对比观察治疗效果。     

耳鸣咨询联合认知行为疗法治疗慢性原发性耳鸣

目的：观察耳鸣咨询联合认知行为疗法对慢性原发性耳鸣患者主观耳鸣程度及情绪改善的疗效。方法对2014年1～2014年5月就诊的45例慢性原发性耳鸣患者给予耳鸣咨询联合认知行为疗法，耳鸣咨询主要以个体化咨询方式为主，对耳鸣相关医学问题进行解释咨询；认知行为疗法主要内容为矫正患者对原发性耳鸣的不合理认识，通过放松训练改善患者对耳鸣的不良体验，同时转移患者对耳鸣的注意；两种治疗同时进行，每二周治疗一次，共治疗二次。在治疗前及治疗后1个月采用耳鸣残疾评估量表（tinintus handicap inventory ，T HI）、焦虑量表、抑郁量表对患者耳鸣严重程度及负性情绪进行评估，对评估结果进行统计学分析。结果在耳鸣咨询联合认知行为疗法治疗前45例慢性原发性耳鸣患者T H I得分为31．71±10．54分，治疗后为22．36±8．04分，差异有统计学意义（ P＜0．05）；治疗前焦虑量表得分为5．18±2．39分，治疗后为3．09±1．43分，差异有统计学意义（ P＜0．05）；治疗前抑郁量表得分为5．22±2．73分，治疗后为3．16±1．76分，差异有统计学意义（ P＜0．05）。经耳鸣咨询配合认知行为疗法后，患者的耳鸣程度分级均有不同程度的改善，治疗前耳鸣残疾1级7例，2级20例，3级18例，4级0例，治疗后耳鸣残疾1级15例，2级26例，3级4例，4级0例，差异有统计学意义（ P＜0．05）。结论耳鸣咨询联合认知行为疗法治疗可有效改善慢性原发性耳鸣患者耳鸣主观感受及伴随的焦虑和抑郁症状。     

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。     

耳鸣的心理学问题

目的：分析耳鸣的心理原因和结果，以期引起临床医生的重视和研究。方法：对225例以耳鸣为第一主诉的主观耳鸣患者，采用唔谈，耳鸣分类调查表，耳鸣问卷，Zuang抑郁量表等进行心理问题评定，结果：全部患者均存在明显的心理问题，心理因素引起的耳鸣占21.0%，耳鸣引起的心理反应占67.7%，分不清先后（混合性）占11.3%。结论：耳鸣与心理因素密切相关，耳鸣问卷和耳鸣习服疗法能较好地测量和治疗患者的心理问题。     

Current concepts in the clinical management of patients with tinnitus

The current management in tinnitus of sensorineural origin is reviewed. Epidemiological data demonstrates that 90% of patients with hearing loss experience some tinnitus. Approximately 1% of the population suffer from a chronic tinnitus that causes severe distress and requires some type of management intervention. Present non-surgical therapies include masking techniques, psychological counseling, and biofeedback. There are also a number of drugs that have been applied, the most common being antidepressants. These have had the most success in managing patients with tinnitus, although it is currently felt that antidepressants treat underlying psychological problems rather than directly affect the tinnitus. The other large class of drugs include benzodiazopans, in addition to a new synthetic analog of a natural prostaglandin E1, misoprostol. Despite the many drugs now available,none has been approved by the United States Food and Drug Administration for the treatment of tinnitus. Many surgical therapies have been advocated but are directed towards the treatment of concurrent vertigo or for tumors of the cerebellopontine angle, with tinnitus sometimes being relieved by the operation. Specific surgical procedures such as cochlear resection and microvascular decompressions lack clear-cut efficacy. Despite author bias and a myriad of treatment modalities at present, there is still no specific therapy that definitively relieves tinnitus clinically.     

Establishing a tinnitus clinic in your practice

PURPOSE: While tinnitus is very common among the hearing impaired population, specific treatment for tinnitus is not provided in most clinics. This article provides a plan for establishing a tinnitus treatment program that can be implemented in stages at most audiology clinics. METHOD: Preparation for establishing a tinnitus clinic includes having an overall plan regarding the type and degree of tinnitus management. Assessment involves a measurement of tinnitus and of the reaction a patient has to the tinnitus, including the use of handicap questionnaires. Management typically involves some form of counseling and sound therapy. Four problematic areas in tinnitus management are thoughts and emotions, hearing and communication, sleep, and concentration. CONCLUSIONS: Licensed audiologists generally have the essential training necessary to provide counseling and sound therapy to treat tinnitus patients. We introduce 3 levels of treatment implementation, depending on whether the patient is curious, concerned, or distressed. Follow-up and referrals might be necessary in more severe cases. Finally, the development of a tinnitus clinic centers around establishing a need for individual treatment, creating a treatment plan, estimating the need for additional staff and resources, reimbursement options, and assessing the effectiveness of the program.     

Intratympanic perfusion for the treatment of tinnitus

Intratympanic treatment of tinnitus with corticosteroids or gentamicin should be considered as an option of treatment in selected tinnitus patients, alone or in combination with standard modalities of management such as tinnitus retraining therapy, masking, and hearing aid amplification. Review of the literature and the authors' experience suggest the following points regarding intratympanic treatment for tinnitus: 1. Lidocaine, although effective in decreasing tinnitus, has been largely abandoned because of its severe side-effect profile and need for inpatient administration. 2. Corticosteroids have been associated with few if any side effects. 3. The good results reported in the literature with intratympanic steroids for treating tinnitus of various causes should be viewed with caution,because most are retrospective and uncontrolled studies. 4. Some Meniere's disease patients with tinnitus may experience tinnitus improvement following intratympanic steroids. This treatment may be considered in such patients, especially for those with good hearing. 5. Gentamicin is effective in eliminating or reducing tinnitus in a significant number of patients with Meniere's disease and may be considered especially for those with nonserviceable hearing. 6. Further prospective, randomized, and controlled studies to evaluate the effect of intratympanic perfusion for the treatment of tinnitus are warranted.     

Medical evaluation of tinnitus

It has been estimated that 15% of the population in the United States has tinnitus which lasts greater than 5 minutes. It has also been estimated that 155 million patients have previously sought care for this symptom. It is clear that the incidence of tinnitus increases with age and by 70 years of age at least 25 to 30% of patients experience tinnitus constantly. In addition, noise exposure and noise induced sensorineural hearing loss are most often seen in tinnitus patients. Furthermore, of interest to the physician, 94% of patients who have sought medical care have not been offered treatment for their tinnitus, rather they have been informed that nothing could be done for them, and they should "live with it".     

Assessment and treatment of tinnitus patients using a "masking approach."

Audiology clinics are increasingly being asked to provide tinnitus treatment services to patients who are severely distressed by tinnitus. It is unclear what levels of tinnitus care are available at different audiology clinics across the nation. Some clinics have staff who are experienced with the tinnitus masking technique or with tinnitus retraining therapy (TRT), whereas other clinics may limit their care to the provision of hearing aids. This article is an attempt to provide some basic information for those clinicians who would like to provide at least a minimum level of care for their tinnitus patients using the tinnitus masking approach. The most important requirement is a commitment by the clinician to assemble some basic resources and to structure the clinical schedule so that adequate time is available for historical review, evaluation, trial and selection of devices, and tinnitus counseling. A minimum set of measurements is recommended for inclusion in the tinnitus evaluation process. This informal review summarizes a variety of clinical observations culled from years of direct patient care experience. A tinnitus questionnaire is provided to help clinicians review potentially relevant issues.     

Childhood tinnitus: Clinical characteristics and treatment

Purpose

Troublesome tinnitus in children can have an impact on their lives leading to behavioral or psychological problems. The present study was designed to identify the clinical features of childhood tinnitus, to establish the treatment strategy for each tinnitus category and severity, and to assess the treatment outcomes.

Materials and methods

Clinical data were retrospectively collected on 108 tinnitus patients in childhood and adolescence. The authors have classified tinnitus according to the acoustic source: otic (idiopathic subjective), myoclonic, and vascular tinnitus based on the tinnitus quality and appropriate diagnostic approaches. Treatment selection depended on the tinnitus category and severity. Treatment modalities included counseling, a simplified tinnitus retraining therapy, counseling with medications, and surgery.

Results

Of all 108 subjects, otic tinnitus was the most common form of childhood tinnitus (n = 80) followed by myoclonic (n = 21) and vascular tinnitus (n = 6). The prevalence of otic tinnitus increased with age. The mean age of myoclonic tinnitus patients was younger than that of the others. The majority of otic tinnitus showed normal hearing. The origin of 81% of myoclonic tinnitus was middle ear muscles. Of all subjects, 67.6% had mild tinnitus responsive to counseling alone. Distressing tinnitus was most common in myoclonic tinnitus. Almost all patients (97%) who were followed up at 3 months (64%) showed improvements.

Conclusions

We suggest that understanding the clinical characteristics of childhood tinnitus, establishing a diagnosis based on the acoustic source, and implementing appropriate therapy customized to the individual tinnitus category and severity would help clinicians to relieve tinnitus children of their troublesome tinnitus effectively.     

耳鸣掩蔽结合心理咨询治疗耳鸣的长期康复效果研究

目的:探讨耳鸣掩蔽结合心理咨询治疗耳鸣的长期康复效果。方法:对耳鸣掩蔽结合心理咨询的患者在治疗前、治疗后半年、1年、2年、3年进行随访,填写耳鸣残疾评估量表。结果:共纳入86例患者。半年后应随访82例,失访9例。1年后应随访79例,失访16例。2年后应随访60例,失访26例。3年后应随访44例,失访16例。治疗后半年、1年、2年、3年耳鸣残疾评估量表得分大于等于20分的例数占应随访人数的66%、56%、40%、48%。结论:耳鸣掩蔽结合心理咨询治疗耳鸣随访1年的有效率为66%,但1年以上长期疗效由于失访率高,需进一步研究。     

Management of tinnitus in children: Review of literature and effect of counseling

Objective

Tinnitus in children has not been studied sufficiently to date. And, there is no consensus regarding the management of tinnitus in children. Tinnitus counseling can be considered as the most basic tool among therapeutic options of tinnitus in children. In this article, the importance of management in children with tinnitus is highlighted through the review of the literature. Also, we present survey results regarding usefulness and necessity of tinnitus counseling provided from parents of children with tinnitus.

A clinical study of tinnitus maskers

This report describes a three-centre study of the effectiveness of tinnitus maskers, combination instruments (masker plus hearing aid), and hearing aids in the management of tinnitus. Some 472 patients entered the study with 382 reaching the first evaluation session after a minimum period of 6 months from fitting, and 206 reaching the second evaluation not less than 6 months after the first. The study included two control groups, by which to assess the comparative benefit to be derived solely from the investigation and counselling of such patients. The principal results were as follows: thorough investigation and careful counselling do much to help the patient; much further benefit is given by tinnitus masking instruments of various kinds; maskers are more often effective than hearing aids, although the latter are frequently the most appropriate first treatment of those patients who have substantial (but not yet treated or insufficiently treated) hearing difficulties as well; there is no evidence of masking having any harmful effect on hearing. None of the audiometric or tinnitus tests currently employed can be regarded as predictive, either of tinnitus severity, or of the eventual outcome of masking therapy, however certain measurements may help as a guide to patient management.