耳鸣患者焦虑情绪的再认识

耳鸣患者的焦虑情绪逐渐受到研究者们的关注,但目前的主流观点主要集中在焦虑的“危害性”上。为了更好的开展耳鸣的心理治疗,必须提倡对焦虑的全面认识。本文简要介绍了焦虑在个体生活中的重要意义,分析了耳鸣患者焦虑情绪的产生及增强原因,并对耳鸣的心理治疗提出了见解,最后对耳鸣的焦虑研究提出了一些建议。     

耳鸣诊治基本原则与耳鸣习服疗法

耳鸣是临床常见症状,发生率很高,估计中国有1.3亿耳鸣患者。虽然人数众多,但并不是所有的耳鸣患者均就医治疗,只有那些以耳鸣为第一主诉并且影响休息、学习和工作,甚至使患者感到非常苦恼时才来耳鸣门诊求医。如果患者同时有眩晕、耳聋、耳鸣、头痛等症状时,以眩晕为首要症状者     

耳鸣的诊治及干预策略

耳鸣是许多全身性疾病及局部疾病表现的一种症状,其激发和影响因素极多,与患者的心理状态有密切关联。由于耳鸣所致患者的烦恼常为主观表现,其病因和发病机理目前尚不清楚,尤其是缺乏行之有效的客观评定方法,诊断极为困难。尽管如此,但在临床上对耳鸣诊断的目的仍应达到:①病变     

中西医结合诊治耳鸣的进展

耳鸣系指患者主观感到耳内或颅内有鸣声,周围环境中并无相应的声源,常是指耳或头部的一种闹音感觉。表现纷繁不一,或如蝉鸣蚊噪,或似风雨潮汐,又如金属音响,或似电话铃叮,有时聋鸣共存,有时有鸣无聋。其诊治常是耳科同仁的棘手难题,国际耳鸣研讨会也已举行了三届,现将有关的认识及诊治进展状况略述如下:     

搏动性耳鸣中医诊治研究进展

耳鸣是临床常见症状,是最具特色和优势的中医治疗病种之一。搏动性耳鸣是耳科的少见症状,隶属于耳鸣范畴,就目前现有的相关性文献,本文从病因病机、诊断及治疗方面做一总结。     

对中西医诊治耳鸣的浅识

中华民族繁衍生息数千年,在和疾病的抗争中积累了丰富的经验,这些经验被总结成中医或其他民族医学的形式传承下来,其中包括了对耳鸣的认识和诊治。近来,笔者就耳鸣的发病机制、特点、诊断和治疗等方面复习了国内中西医方面的文献,受益非浅,很受鼓舞,因此整理出来,供从事西医的同道参考,也请中医同道给予指正,以便一起推动我国的耳鸣研究。     

耳鸣及其美国的诊治指导方案

Tinnitus这个词最早在古罗马时便开始使用．而这个词所描述的疾病折磨着成千上万的患者．如果说现在广泛使用的一种治疗方法是由古希腊思想家亚里士多德最早提出的．而Google只用了不到一秒钟便搜索出了180多万条与此相关的词．在这期的听力学小词典将介绍tinnitus这个词。根据即将出版的斯坦克《听力学词典》，     

耳鸣再训练疗法的国内外应用

耳鸣是一种临床常见的听觉系统症状,不仅在耳部疾患中出现,全身其他一些疾病时也可能发生。人群中约17％的个体有过耳鸣的感觉,4％～5％的人因耳鸣就诊。耳鸣的临床表现可从轻微的烦恼到完全不能忍受,极大多数耳呜为主观自觉症状,故有关耳鸣的机理研究难以深入,也限制了对耳鸣的客观诊断和治疗。耳鸣的治疗方法有很多,从临床实践来看:药物治疗方法简单但效果不理想;手术治疗较少采用,原因之一是手术本身可引起耳鸣;其他如心理疗法、电磁治疗及掩盖等都被试用于耳鸣的治疗,但其作用机理有待探讨、治疗规律有待摸索、疗效有待提高。     

喉白斑32例临床诊治分析及再认识

正喉白斑是常见的喉部炎性增生性疾病,表现为喉黏膜表面的白色斑块状或白色改变,可有局部的突起[1]。我们回顾分析了32例发生于声带的喉白斑的临床资料,总结如下。1资料与方法1.1一般资料收集2016年8月至2018年6月收治的32例喉白斑的临床资料,其中男23例(71.88%),女9例(28. 12%); 38~70岁,中位年龄54岁;长期     

12例颈静脉源性耳鸣诊治分析

目的:探讨颈静脉源性耳鸣的诊断及治疗。方法:回顾性分析12例诊断为颈静脉源性耳鸣患者的临床表现、诊断依据及治疗方案,对接受颈内静脉结扎术后患者的近期和远期临床效果进行评价,并对相关文献作一综述。结果:术后1周内,7例诉耳鸣明显减轻或消失,5例无明显改善。远期随访到5例近期明显减轻的患者,其中3例耳鸣无改善,2例耳鸣明显减轻(2/7);远期随访到2例近期耳鸣无明显改善者,其中1例耳鸣无改善,另1例加重,发展为啸鸣音。远期随访时间为术后1～5年。随访到的7例均无明显并发症。结论:颈静脉源性脉动性耳鸣为一排除性诊断,并无金标准,单纯依据脉动性耳鸣病史,按压颈内静脉耳鸣明显减轻或消失,以及耳部CT和颅脑MRI排除相关占位性病变并不足以诊断,联合CT动脉及静脉检查有助于排除硬脑膜动静脉瘘、乙状窦憩室等病变。通过颈内静脉结扎术治疗颈静脉源性耳鸣仍存争议。     

血管源性耳鸣诊断及治疗

目的探讨血管源性耳鸣(vascular tinnitus,VT)客观检测的临床应用和治疗效果。方法采用血管源性耳鸣与心电图同步监测技术(VT-ECG),对VT组46例,对照组60例(主观性耳鸣30例,正常人30名)进行了检测及分析。部分VT患者予以中药治疗,并对46例VT相关病因进行分类。结果VT-ECG同步监测技术与听诊器听诊和声阻抗声顺异常的检查阳性率分别为95.4%,25.6%和4.7%;VT病因主要为三类(动、静脉性、心输出量增加性、不明原因);部分患者服用中药治疗有效率为63.7%。结论血管源性耳鸣与心电图同步监测可对VT的诊断和疗效评估提供帮助;中药治疗对VT有效。     

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.     

Principles of tinnitology: tinnitus diagnosis and treatment a tinnitus-targeted therapy

OBJECTIVE: To provide to the tinnitus professional a rationale for establishing accuracy in tinnitus diagnosis and the selection of modalities of therapy (i.e., medication, instrumentation, and surgery) for attempting tinnitus relief for patients with tinnitus diagnosed by completion of a medical-audiological tinnitus protocol (MATPP) and clinical course and found to be subjective idiopathic tinnitus of the severe disabling type (SIT). BACKGROUND: The completion of a MATPP has been recommended since 1977 for each tinnitus patient in an attempt to establish an accurate diagnosis. A tinnitus-targeted therapy (TTT), a combined treatment of medication and instrumentation focusing on pharmacotherapy, has evolved from our ongoing clinical experience since 1977 (now in excess of 10,000 SIT patients) [1-4]. Principles for SIT treatment have evolved from the TTT experience that provides a rationale for attempting tinnitus relief. In this report, the term tinnitus refers to SIT. METHOD: The strategies of TTT are based on the clinical translation for SIT diagnosis and treatment of (1) fundamentals of neuro-otological diagnosis; (2) fundamentals of sensory physiology; (3) extrapolation for treatment of known underlying neurochemistries from nuclear medicine imaging results e.g. single-photon emission computed tomography and positron emission tomography; (4) hypothesis of mechanism of tinnitus production , Tinnitus Dysynchrony Synchrony Theory (TDST) [5] , and hypothesis of the transformation-transition of the sensation of an aberrant auditory sensation-tinnitus (i.e., sensory component)-to one of affect (i.e., the emotional-behavioral component), Final Common Pathway of Tinnitus (FCP)[8]; and (5) innovative application of drug therapies designed for indications other than tinnitus [2,3]. ResuLTS AND CONCLUSION: The ongoing clinical application of a rationale based on principles of diagnosis and treatment for SIT, which has evolved from our TTT clinical experience in SIT patients, continues to result in long-term tinnitus relief: in excess of 1 year in approximately 75% to 85% with medication and in 10% to 15% with instrumentation. SIT patients resistant to therapy persist at 10% to 15%.     

The use of intravenous lignocaine in the diagnosis and treatment of tinnitus

The effect of intravenous lignocaine upon the symptom of tinnitus has been assessed in seventy-eight patients and the results correlated with associated hearing loss. Lignocaine appears to be highly effective in suppressing tinnitus in patients with presumed damage or degeneration of the Organ of Corti and is less effective in other groups. It is postulated that tinnitus in patients with Organ of Corti damage is the result of abnormal hyperactivity in the auditory pathway following deafferentation.     

Clinical practice guidelines for diagnosis and treatment of chronic tinnitus in Japan

Clinical practice guidelines in Japan for tinnitus were published in May 2019. Effective treatment of tinnitus contributes to quality of life and may improve depression, anxiety, and cognitive function. The highest priority of treatment recommended by this guideline involves educational counseling, including an explanation of the mechanisms of tinnitus. Understanding tinnitus pathology has also been reported to be a therapeutically effective educational counseling strategy. Further, explaining how sound therapy such as tinnitus retraining therapy (TRT) works is effective. Psychological and cognitive behavioral therapies may be an option. Here, the hearing aid is coupled with a sound generator in order to administer sound therapy for patients with more-severe symptoms. In Japan, it can be difficult to perform psychotherapy alongside otorhinolaryngology, and exemplary sound therapy is more likely to be carried out. In any case, the purpose of treatment is not to eliminate tinnitus, but rather reduce distress that manifests in response to tinnitus by promoting sensory adaptation. Clinically, the most important subject is not the loudness of tinnitus, but the severity of tinnitus distress.TRT consists of educational counseling and sound therapy. The tinnitus handicap inventory (THI) is used to measure the distress level for tinnitus and to determine treatment priorities. Rehabilitation of tinnitus is important because anxiety and depression are often observed in patients with severe tinnitus.Additionally, drug administration should be avoided. As a surgical treatment, a cochlear implant can affect tinnitus symptoms. It is essential to establish a treatment policy according to the disease condition and degree of distress.     

耳鸣的诊断与治疗

根据掩蔽治疗与利多卡因试验的结果，对１１９例耳鸣患者采用了不同的方法进行治疗。冼选掩蔽治疗，掩蔽无效者进行利多卡因试验，阳性者给予抗癫痫药物治疗，阴性者给予中枢抑制药物治疗，对耳鸣的产生机制进行了讨论。     

Objective audiometry in diagnosis of tinnitus

During last 3 years there have been 900 tinnitus patients treated at ENT Rehabilitation Center in Poznan. Everyone underwent a thorough laryngological and audiological examination. Diagnostic procedure comprised also neurological and endocrinological consultations with accessory blood tests. Wide group of audiological tests used for diagnosis was divided into objective (BERA, OAE, tympanometry, stapedius reflex) and subjective (pure tone audiometry, speech audiometry, suprathreshold audiometry) methods. Otological diagnostic in tinnitus patients is difficult due to its subjective character. That is why it is so important to have objective methods for its evaluation. In this paper authors present results of BERA tests and impedance conducted on group of 900 patients. Performed objective tests enabled to diagnose otosclerosis, chronic otitis media and pathology in cerebello-pontine angle in patients without any abnormalities on physical examination.