伴发感音神经性聋的主观性耳鸣的检测分析与掩蔽治疗

结论 对陡降型听力曲线的耳鸣患者,推荐进行掩蔽治疗;缓降型听力曲线患者可进行掩蔽治疗;平坦型听力曲线患者掩蔽治疗的疗效有限.     

特发性耳鸣诊疗思路

耳鸣属于常见疾病,约有60％的人曾经有过耳鸣症状,美国统计有14．5％的人受到耳鸣困扰。耳鸣仍然是目前困扰耳科医生的一大难题。相对于耳科的其他顽症一耳聋和眩晕,耳鸣的研究明显滞后。其难以治疗的主要原因有：①病因数以百计。病因众多使得预防困难,也很难用一种或几种简单的方法治疗所有的耳鸣。     

Effects of tinnitus retraining therapy (TRT) for patients with tinnitus and subjective hearing loss versus tinnitus only

The patients with tinnitus and/or hyperacusis undergoing an 18-24 month period of TRT are divided into five categories of treatment. Different types of counselling and sound therapy are used in each category. Selection of patients into a specific category depends on such factors as: hyperacusis, subjective hearing loss and long-lasting effect of noise on tinnitus. The 108 cases were evaluated After 1 year of treatment. The results of therapy of 40 patients with tinnitus and subjective hearing loss (category II) were compared with the results of therapy of patients with tinnitus only (categories 0 and I). A special questionnaire, answered before and during the treatment, was used to assess the results. Our data indicate significant improvement in about 70% of patients with tinnitus only and in about 90% of patients with tinnitus and subjective hearing loss after one year of therapy.     

Clinical efficacy of cognitive behavioral therapy for chronic subjective tinnitus

Background

Although cognitive behavioral therapy (CBT) has been known with a theoretical basis for tinnitus patients, there still were lack of clinical evidence.

Thermal biofeedback and the treatment of tinnitus

Thermal biofeedback and general relaxation procedures were employed to treat 32 patients with subjective tinnitus. Each patient received eight 1-hour biofeedback sessions over an eight-week period, while listening to standard Jacobsonian type relaxation tapes. Sixty-five percent of the patients experienced a reduction of their symptoms. While none reported worsening of their symptoms, only two reported total symptom abatement. Findings suggest relaxation and peripheral vascular circulation are inversely related to the intensity of tinnitus symptoms. The probability that an individual will benefit from biofeedback appears related to his/her ego strength (Es). No differences were noted between the performance of male and female patients. Although not fail-safe, biofeedback and relaxation treatment are excellent management tools in the treatment of tinnitus.     

Predictors of tinnitus discomfort, adaptation and subjective loudness

In a nation-wide investigation, covering all the hearing centres in Sweden, a study was made of adaptation processes, subjective discomfort from tinnitus, subjective loudness of tinnitus and psychological complaints in 3372 subjects by means of a questionnaire. The most important predictors of discomfort from and adaptation to tinnitus were found to be the controllability and the degree of maskability by external sounds, i.e. the subject's coping abilities or internal-external locus of control. Increased control and masking effects from the environment imply a decrease in discomfort and better adaptation. The most important predictor of worsened subjective loudness of tinnitus was the duration of the tinnitus. That is, subjects who had had tinnitus for a longer time perceived the loudness as more intense. The psychosomatic factors which most strongly predicted increased discomfort from and decreased tolerance to tinnitus were depression and insomnia. These findings have theoretical and practical implications for the management and treatment of tinnitus.     

听宫穴针刺及注射利多卡因治疗神经性耳鸣

目的探讨针刺听宫穴注射利多卡因治疗神经性耳鸣的效果。方法对神经性耳鸣80例采用针刺听宫穴得气后注射2%利多卡因1ml。结果80例中治愈58例、66耳,显效10例、12耳,有效6例、6耳,无效6例、8耳。结论突聋伴耳鸣及噪声性耳鸣且病程短者疗效好,外伤性耳鸣及原因不明耳鸣者疗效较差,此法简便易行、安全,无毒副作用。     

实时反馈技术在言语矫治中的应用

本文在回顾传统的言语矫治方法的基础上，指出计算机实时反馈技术的使用将是言语矫治发展过程中最有代表性的一步。     

Comparison of tinnitus masking and tinnitus retraining therapy

Two methods for treating tinnitus are compared. Tinnitus masking has been used for over 25 years, and although this method is used in clinics around the world, there are many misconceptions regarding the proper protocol for its clinical application. Tinnitus retraining therapy has been used clinically for over 12 years and has received considerable international attention. Although these methods are distinctive in their basic approach to tinnitus management, certain aspects of treatment appear similar. These aspects of treatment have created considerableconfusion and controversy, especially regarding the use of "sound therapy" as a basic component of treatment. It is the objective of this article to clarify the major differences that exist between these two forms of treatment.     

Pharmacotherapy for severe, disabling, subjective, idiopathic tinnitus: 2005-2006

We present a tinnitus-targeted therapy (TTT), a combined treatment of medication and instrumentation focusing on pharmacotherapy. It embodies ongoing clinical experience (since 1977) in an excess of 8,500 patients with subjective idiopathic tinnitus of the severe disabling type (SIT). All have visited the Tinnitus Clinic of the Downstate Medical Center at the State University of New York (DMC/SUNY) and the Martha Entenmann Tinnitus Research Center, Inc. Since 1989, as a result of our evolving experience with single-photon emission computed tomography (SPECT) of brain, we have defined tinnitus as a sensory disorder of auditory perception exhibiting an aberrant auditory signal produced by interference in the excitatory-inhibitory process or processes involved in neurotransmission. This definition is considered to be dynamic: It embodies the integration of clinical observations and advances reported from neuroscience and nuclear medicine. These investigations have sought to identify an underlying mechanism of tinnitus production and have assisted in the establishment of the medical significance of tinnitus. In general, the goal of tinnitus therapy in 2005-2006 is to attempt to provide tinnitus relief for all clinical types of subjective idiopathic tinnitus (SIT). Although no cure for SIT exists currently, available protocols for diagnosis and treatment increase the efficacy of therapeutic modalities for attempting tinnitus relief. The strategies of TTT are based on the clinical translation of fundamentals of sensory physiology, extrapolation of underlying neurochemistry from nuclear medicine imaging results with SPECT in SIT patients, hypotheses of mechanisms of tinnitus production, and the innovative application of drug therapies designed for indications other than tinnitus. Such strategies have contributed to the development of a new discipline, tinnitology, an integrated multidiscipline of basic science, neuroscience, and clinical medicine attempting to understand an aberrant auditory phenomenon, unrelated to an external source of sound, and how it becomes transformed into one of affect. The goal of increasing accuracy of the SIT diagnosis is the impetus for increased efficacy of therapeutic modalities recommended for tinnitus relief.     

Intratympanic drug therapy with steroids for tinnitus control: a preliminary report

Intratympanic drug therapy (ITDT) is a surgical technique of instilling medication into the middle ear to perfuse the inner ear in treating hearing loss, tinnitus, vertigo, and ear blockage, alone or in combination, in patients with a predominantly inner-ear site of lesion. This preliminary report of ITDT focuses on attempts at tinnitus control (TC). Between November 1997 and February 1999, 10 patients with severe tinnitus were treated with steroid medication and were last seen in February 2000. TC was established in 7 of these 10 patients (70%). The clinical diagnosis of a predominantly cochlear-type tinnitus was established in each patient by a correlation of the clinical history with a medical-audiological tinnitus patient protocol that included cochleovestibular testing. An additional single patient with sudden hearing loss experienced no hearing improvement on ITDT steroid therapy. Vertigo as an associated complaint was reported by 6 of 10 patients with subjective idiopathic tinnitus. Significant control of the associated vertigo complaint was reported by 5 of 10 patients. Duration of tinnitus relief in 7 of 10 patients was hours in 1 of the 7; days in another of the 7; and 1 year or more in 5 of the 7. One of the seven patients reported TC 3 months after the procedure. Complications included tympanic membrane perforation that persisted for more than 6 months in two patients and an increase in the complaint of ear blockage and tinnitus intensity in one patient. In our preliminary study, ITDT with steroid has resulted in both short- and long-term tinnitus relief in 7 of 10 patients (70%) identified to have a predominantly cochlear-type tinnitus.     

The comparison of acoustic and psychic parameters of subjective tinnitus

We aim to assess the correlation between audiometric data, and psychotic and acoustic measures associated with subjective tinnitus (ST) and to clarify the importance of the psychological process in determining the degree of subjective annoyance and disability due to tinnitus. Fifty-four patients experiencing unilateral ST were allocated for the study. Acoustic assessment of patients including LDL (loudness discomfort levels), MML (minimum masking level) and RI (residual inhibition) was performed. Tinnitus Handicap Inventory (THI), Beck Depression Inventory (BDI) and Visual Analog Scale (VAS) tests were performed for the psychological aspects of subjective annoyance. RI was positive in 23 patients with 13 frequency-matched stimuli at 8,000 Hz. Masking treatment response was successful in 16 RI-positive patients. Mean and standard deviation (SD) of THI scores were 38.77 ± 23.63. Ten patients (%18.51) with tinnitus had ≥17 points score, which was significant for BDI. Mean and SD were 5.01 ± 2.31 for VAS-1 scores (severity of tinnitus), 7.98 ± 2.79 for VAS-2 (frequency and duration of tinnitus), 5.77 ± 2.72 for VAS-3 (discomfort level), 3.56 ± 3.30 for VAS-4 (attention deficit) and 3.31 ± 3.31 for VAS-5 (sleep disorders). A significant correlation was found between the tinnitus duration time, age, gender and THI scores (P < 0.05). There were statistically significant correlations between VAS 1, 2, 3 scores and LDL, MML and RI (P > 0.05). RI might be largely frequency dependent and was found as an indicator for the masking treatment response. We did not notice statistically significant correlations between audiometric data and THI and BDI. There were correlations between with VAS and LDL and with MML and RI. VAS was simpler and easier for the assessment of ST. We should consider the psychological aspects of ST and assess it as a symptom separately with acoustic and psychotic tests.     

Multivariate analyses by quantitative method II of subjective pitch and tonality of tinnitus]

Factors affecting subjective tinnitus pitch and tinnitus tonality were analyzed with the use of the quantitative method II. Ninety-one patients with unilateral tinnitus of a single kind were studied. Major factors affecting subjective tinnitus pitch were pitch matched frequency, age, puerility and impurity of tinnitus tonality, and loudness of tinnitus. In addition, major factors affecting puerility and impurity of tinnitus tonality were pitch matched frequency, loudness of tinnitus, and nature of the test tone. Furthermore, subjective puerility of tinnitus was associated with middle-pitched frequency and high-pitched frequency, and a loudness level of tinnitus between 25 and 49 dB HL. Whereas impurity of tinnitus was related to low-pitched frequency and noise of the test tone. These results may contribute to the clinical evaluation of tinnitus.     

主观性耳鸣的诊疗流程

在医学上治疗分为三级:一级治疗是预防.二级治疗是病因治疗,三级治疗是对症处理,即用止痛片治疗疼痛,用解热药物降温.从分级治疗的角度来看,显然三级治疗即对症处理的疗效最差.虽然医生有宣教的责任,来预防耳鸣的发生,但是在临床上面对的基本上是已经出现耳鸣症状的患者.     

Clinical trial to compare tinnitus masking and tinnitus retraining therapy

CONCLUSION: Both tinnitus masking (TM) and tinnitus retraining therapy (TRT) can be effective therapies for amelioration of tinnitus. TM may be more effective for patients in the short term, but with continued treatment TRT may produce the greatest effects. OBJECTIVES: Although TM and TRT have been used for many years, research has not documented definitively the efficacy of these methods. The present study was a controlled clinical trial to prospectively evaluate the clinical efficacy of these two methods for US military veterans with severe tinnitus. SUBJECTS AND METHODS: Over 800 veterans were screened to ensure that enrolled patients had tinnitus of sufficient severity to justify 18 months of individualized treatment. Qualifying patients (n=123) were placed quasi-randomly (alternating placement) into treatment with either TM or TRT. Treatment was administered at 0, 3, 6, 12, and 18 months. Outcomes of treatment were evaluated primarily using three self-administered tinnitus questionnaires (Tinnitus Handicap Inventory, Tinnitus Handicap Questionnaire, Tinnitus Severity Index). RESULTS: Findings are presented from the three written questionnaires with respect to three categories of patients: describing tinnitus as a 'moderate,' 'big,' and 'very big' problem at baseline. Based on effect sizes, both groups showed considerable improvement overall. In general, TM effects remained fairly constant over time while TRT effects improved incrementally. For the patients with a 'moderate' and 'big' problem, TM provided the greatest benefit at 3 and 6 months; benefit to these TRT patients was slightly greater at 12 months, and much greater at 18 months. For patients with a 'very big' problem, TM provided the greatest benefit at 3 months. For these latter patients, results were about the same between groups at 6 months, and improvement for TRT was much greater at 12 months, with further gains at 18 months.     

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.