耳鸣训练疗法治疗耳鸣

文中记载了1997年9月至11月间收治的9例耳鸣患者,采用耳鸣训练疗法(tinnitusretrainng therapy,TRT)进行治疗,包括(1)正确的咨询指导;(2)对合并有听力损失者选配助听器;(3)用一个低强度的噪声来掩蔽;(4)松驰练习.结果有7例患者取得了较好的效果,为耳鸣的治疗开拓了另一条途径.     

认知行为疗法对耳鸣疗效的Meta分析

目的 系统评价并比较认知行为疗法（cognitive behavioral therapy,CBT）与其他常规疗法或等候队列对耳鸣的疗效。方法 检索中国知网（CNKI）、万方数据库（Wanfang Data）、维普数据库（VIP）、中国生物医学文献数据库（CBM）、PubMed、Cochrane Library、Web of Science、Embase等中英文数据库自建库至2022年公开发表的耳鸣治疗的相关文献,筛选出符合纳入和排除标准的CBT相关的随机对照研究或队列研究,采用ReMan5.4软件进行Meta分析。结果 共纳入文献11篇,其中一篇双中心研究,共12项数据,总计1 158例,治疗组(CBT治疗)586例,对照组（其他疗法或等候队列）572例。其中纳入的4篇文献的有效率Meta分析显示认知行为疗法疗效显著(P<0.05),在主要结局指标的Meta分析中,除了耳鸣问卷(TQ),耳鸣致残量表评分(THI)、耳鸣反应问卷(TRQ)、耳鸣功能指数(TFI)均表现为治疗组优于对照组,差异有统计学意义（P<0.05）。次要结局指标失眠严重指数(ISI)、医院焦虑抑郁量表-...     

耳鸣掩蔽疗法

耳鸣掩蔽疗法是通过对耳鸣性质的系统测试后，选择与耳鸣音调响度相匹配的特定外界声作为掩蔽声，在医生的指导下聆听掩蔽声以达到抑制耳鸣或缓解耳鸣症状的方法。     

耳鸣习服疗法

耳鸣严重影响着人们的身心健康,不仅伴随耳部的不适症状,还有失眠、焦虑、抑郁等心理问题,给患者带来极大困扰。耳鸣的发病机制不明,其治疗方法也在不断探索。耳鸣习服疗法是近年来出现的众多治疗方法中最为国际认可的手段,本文就耳鸣习服疗法的治疗、神经机制及发展前景等进行综述。     

声音疗法联合药物治疗慢性主观性耳鸣的临床随机对照研究

目的 探讨声音联合药物治疗与药物治疗对慢性主观性耳鸣患者的短期疗效及其差异。方法 纳入慢性耳鸣(>6个月)患者共64例,采用随机对照方法,分为声音联合药物组(联合组)和药物组各32例。在耳鸣咨询基础上,药物组予口服银杏叶提取物片,联合组在药物治疗基础上行个性化多元复合声治疗,比较两组治疗1个月前后耳鸣残疾量表(tinnitus handicap inventory, THI)、耳鸣严重程度视觉模拟量表(visual analogue scale, VAS)及焦虑自评量表(self-rating anxiety scale, SAS)评分变化,对比两组耳鸣治疗有效率,分析影响耳鸣治疗疗效的可能因素。结果 药物组及联合组治疗后的THI、VAS及SAS评分均较前下降(P=0.001);联合组较药物组治疗前后THI(P=0.003)、VAS(P=0.002)评分差值变化更大;短期治疗前后两组SAS评分差值无明显统计学差异;联合组治疗总有效率较药物组高(P=0.002);性别(P=0.366)、年龄(P=0.062)、耳鸣频率(P=0.142)、耳鸣侧别(P=0.891)、耳鸣音与听力下降...     

掩蔽疗法在老年耳鸣患者中的应用

掩蔽疗法在老年耳鸣患者中的应用宋海涛，郝炼，周金梅，朱树椿老年耳鸣患者临床多见，但对其治疗缺乏满意效果。我们选用掩蔽疗法对耳鸣患者治疗旨在为临床提供一个简便、易行的治疗方法。１资料与方法１．１资料７２例中，男３０例，女４２例；年龄在６０～７０岁之间。...     

感音神经性耳鸣的足反射疗法疗效分析

目的 探讨足反射疗法对感音神经性耳鸣的疗效。方法 应用足反射疗法治疗１２３例１４８耳感音神经性耳鸣患者，治疗前筛查症状自评量表（ＳＣＬ－９０）、纯音听阈、ＡＢＲ、耳鸣匹配等，治疗后复测耳鸣匹配。结果 治疗后耳鸣消失者１９耳，占１２．８４％，有效６５耳，占４３．９２％，总有效率５６．７６％，耳鸣响度平均下降７．７５分贝，对伴有焦虑、抑郁症状者有效率可达８７％。未出现明显不良反应。结论 足反射疗法是一     

声治疗与药物治疗慢性耳鸣疗效的Meta分析

目的 比较单纯声治疗与药物治疗慢性耳鸣的疗效.方法 通过计算机检索中国期刊全文数据库(CNKI)、万方数据库、维普数据库(VIP)、中国生物医学文献数据库(CBM)、Pubmed、Embase、OVID、SciVerse ScienceDirect和Cochrane library从建库到2017年5月与耳鸣治疗相关文献,按照纳入和排出标准进行筛选,并对其进行严格质量评价和资料提取,采用Revman 5.2软件对纳入文献的总有效率、耳鸣障碍量表(tinnitus handicap inventory,THI)分值和视觉模拟量表(visual analogue scale,VAS)分值进行Meta分析.结果 共纳入符合要求的文献16篇,其中,中文文献14篇,英文文献2篇,共计1 594例患者;声治疗组总有效率分别为86.42％(按例数)和80.50％(按耳数),药物治疗组总有效率分别为60.62％(按例数)、48.10％(按耳数),差异均有统计学意义[P＜0.01(按例数);P＜0.01(按耳数)].治疗后声治疗的THI值比治疗前明显下降,且较药物治疗降低更明显(P＜0.01),治疗后声治疗的VAS值较治疗前明显下降,且较药物治疗降低更明显(P＜0.05).结论 与药物治疗相比,声治疗能明显提高耳鸣疗效,减轻耳鸣患者症状.     

晚期下咽癌手术综合疗法与非手术综合疗法两种治疗策略疗效比较的Meta分析北大核心CSCD

目的使用Meta分析的方法,比较手术综合疗法[surgery plus radio(chemo)therapy,SRT]与非手术综合疗法(non-surgery chemoradiotherapy,CRT)在治疗晚期下咽癌患者中的远期疗效及喉功能保存率。方法检索PubMed、the Cochrane Library、万方数据库、中国期刊全文数据库、中文科技期刊数据库中公开发表的关于手术综合疗法与非手术综合疗法治疗晚期下咽癌病例对照研究的文献。检索语言限定为中文和英文,时间段为1990年至2018年,通过制定的纳入与排除标准对文献进行严格筛选,提取本研究所需要的数据,采用RevMan 5.3软件进行Meta分析。结果共纳入13篇文献,整体文献质量相对较高,未提示明显发表偏倚。共1994例受试者,其中SRT组720例,CRT组1274例。SRT组与CRT组的平均3年总生存率分别为42.9%与44.8%,差异无统计学意义(OR=1.14,95%CI:0.62~2.06,P=0.68)。SRT组的平均5年总生存率(OR=1.42,95%CI:1.10~1.84,P<0.01)、5年局部无复发生存率(OR=1.68,95%CI:1.11~2.55,P=0.01)及5年局部控制率(OR=2.17,95%CI:1.52~3.12,P<0.01)分别为46.4%、47.4%及71.2%均高于CRT组(分别为37.9%、32.0%及52.2%),平均喉功能保存率为19.8%低于CRT组的80.6%,差异有统计学意义(OR=0.03,95%CI:0.01~0.07,P<0.01)。结论本研究发现SRT远期疗效更好,CRT的喉功能保存效果更佳。     

耳鸣习服疗法

耳鸣是临床上的一种常见症状。一直以来,耳鸣的病因及发病机制尚未明确,治疗方法各式各样。耳鸣习服疗法（tinnitus retraining therapy,TRT）是近年来最受欢迎的一种疗法之一,其理论基础为耳鸣神经生理模型。根据神经生理模型,TRT主要包括两部分：指导性咨询和声治疗。本文主要就耳鸣习服疗法的理论基础、组成成分、与心理疗法的关系、评价方法、随诊时间展开讨论与总结。     

Tinnitus retraining therapy using portable music players

Objective

We aimed to perform acoustic analysis of environmental sounds used in sound therapy for tinnitus retraining therapy (TRT) and to evaluate the efficacy of TRT performed by using a portable music player (PMP) with recorded environmental sounds as the sound generator.

Methods

Acoustic analysis of environmental sounds was performed using a sound analyzer. The subjects were 23 patients with chronic tinnitus. Patients who had bilateral hearing loss and required hearing assistance were fitted with hearing aids (HAs). Patients with normal hearing or unilateral hearing loss were fitted with a tinnitus control instrument (TCI) or a PMP. The patients were divided into the PMP group, TCI group, and HA group. All subjects underwent audiometric evaluations prior to TRT and completed the tinnitus handicap inventory (THI). The THI scores were evaluated before treatment and 1 month, 3 months, 6 months, and 12 months after treatment.

Results

The sound spectrogram of the murmur of a stream showed a wide-frequency band with a constant strength, whereas that of a wave sound showed a wide-frequency band with variable strength. The THI score clearly decreased after 1 month, and this decrease tended to continue over 12 months. The TRT efficacy ratios in the PMP group, TCI group, and HA group at 12 months after treatment were 71%, 67%, and 70%, respectively.

Conclusions

TRT using a PMP had efficacy similar to those of TCI and HA. The murmur of a stream was one of the most effective sounds in TRT. TRT using a PMP as the sound generator can provide the most cost-effective treatment option for tinnitus patients.     

Small-Group Counseling in a Modified Tinnitus Retraining Therapy for Chronic Tinnitus

Objectives

The authors have treated chronic tinnitus patients using a combination of a simplified tinnitus retraining therapy (TRT) and medications, which we called modified TRT. In this clinical setting, we have attempted small-group counseling to find a time-effective equivalent of individual counseling. The aim of the present study was to evaluate the effectiveness of small-group counseling by comparing the treatment outcomes between individual and small-group counseling.

Methods

The patients who had distressing chronic tinnitus with normal hearing or mild hearing loss were included. The subjects were placed into the small-group (group 1:4) or the individual (group 1:1) counseling group, and underwent a modified TRT composed of a single session of directive counseling and ambient sound stimulation. In addition, alprazolam (0.25 mg) and ginkgo biloba extract (80 mg) were administered orally to the subjects for 3 months. The 3- and 6- month outcomes were assessed using the follow-up rates and tinnitus severity scores: awareness, tinnitus handicap inventory (THI), loudness, annoyance, and effect on life. The treatment responses were classified as improvement, no changes, and worsening.

Results

Of the total 149 patients (77 in group 1:1; 72 in group 1:4), 104 patients completed the protocol at 3 months, and 55 patients at 6 months. The follow-up rates were similar in both groups. Over the period of 6 months, all scores declined significantly except the loudness score at 3 months in both groups. Treatment responses showed no between-group differences. The success rate based on THI was 70% in group 1:1, and 64% in group 1:4 at 6 months.

Conclusion

The small-group counseling of our modified TRT was comparable to the individual counseling for tinnitus relief. We suggest that this protocol can be implemented effectively in any crowded otolaryngology clinics.     

Tinnitus in elderly patients

Tinnitus is the perceived sensation of sound in the absence of acoustic stimulation. Spontaneous idiopathic tinnitus is a significant interdisciplinary therapeutic problem. In elderly patients it most frequently coexists with sensorineural hearing loss. The chief idea of tinnitus retraining therapy (TRT) in treatment of chronic tinnitus consists of following strategies: low level and broad band noise surroundings, diversion of the attention to other things and psychological counseling and therapy. The purpose of this study was to verify the benefits and ramifications of tinnitus retraining therapy in elderly patients suffering from chronic tinnitus with sensorineural hearing loss. Methods 30 subjects aged 65-90 years suffering from chronic tinnitus and sensorineural hearing loss were questioned about features of the tinnitus using a set of standardised questions. All of them were fitted with modern digital hearing aids and questioned about subjective hearing results after a month of follow-up. Main result 24 of the patients declared to have had considerable improvement in tolerance of the tinnitus. Main conclusion Fitting with hearing aids is an effective way of treatment in the majority of elderly patients with chronic tinnitus. The effectiveness of supplying elderly patients with hearing aids for tinnitus management depended in our group of patients on whether the patient had good speech understanding prior to fitting with hearing aids (speech discrimination score below and above 80%).     

分泌性中耳炎与耳鸣

目的 探讨分泌性中耳炎(Secretory Otitis Media,SOM)患者的耳鸣特点。方法:选择以耳鸣为第一主诉的SOM患者23例,采用耳鸣分类调查表和耳鸣问卷进行耳鸣的分类统计,积极对因治疗后仍遗留长期耳鸣者采用耳鸣习服疗法治疗。结果:客观耳鸣2例2耳,主观耳鸣21例29耳,以单调、连续耳鸣居多,耳鸣匹配以低频为主。对病因治愈后仍遗留长期耳鸣者采用习服疗法,患者均能较快地适应和习惯耳鸣。结论:SOM既可引起客观性耳鸣,也可引起主观性耳鸣,而且耳鸣可以成为第一主诉。文中对耳鸣病因、耳鸣成为第一主诉的原因以及治疗方法进行了讨论。     

Patient-based outcomes in patients with primary tinnitus undergoing tinnitus retraining therapy

OBJECTIVE: To determine whether the Tinnitus Handicap Inventory (THI), a validated patient-based outcomes measure, may improve our ability to quantify impact and assess therapy for patients with tinnitus. DESIGN: Nonrandomized, prospective analysis of 32 patients undergoing tinnitus retraining therapy (TRT). Assessment tools included comprehensive audiology, a subjective self-assessment survey of tinnitus characteristics, and the THI. Tinnitus Handicap Inventory scores were assessed at baseline and 6 months following TRT. RESULTS: Baseline analysis revealed significant correlation between the subjective presence of hyperacusis and higher total, emotional, and catastrophic THI scores. Tinnitus Handicap Inventory scores correlated with subjective perception of overall tinnitus effect (P<.001). Mean pure-tone threshold average was 17.4 dB, and mean speech discrimination was 97.0%. There were no consistent correlations between baseline audiologic parameters and THI scores. Following 6 months of TRT, the total, emotional, functional, and catastrophic THI scores significantly improved (P<.001). Loudness discomfort levels also significantly improved (P< or =.02). CONCLUSIONS: There is significant improvement in self-perceived disability following TRT as measured by the THI. The results confirm the utility of the THI as a patient-based outcomes measure for quantifying treatment status in patients with primary tinnitus.     

52例慢性耳鸣习服治疗疗效观察

目的探讨慢性耳鸣患者习服治疗(tinnitus retraining therapy,TRT)的临床疗效。方法对52例慢性耳鸣患者在医师指导下让患者长期坚持耳鸣不完全掩蔽、松弛训练、转移注意力和心理咨询等习服训练,并且使用有声材料如耳鸣掩蔽器、助听器、音乐光盘、收音机、磁带等以协助达到对耳鸣适应和习惯的目的。在治疗开始后第2、6和12个月时进行3次疗效评定。疗效分为完全适应、基本适应、部分适应、未适应。结果TRT治疗后总有效率2个月为4 4.2%,6个月为7 3.1%,1 2个月为8 8.5%。结论耳鸣习服治疗是临床治疗慢性耳鸣的理想方法之一。     

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.     

Outcomes of clinical trial: tinnitus masking versus tinnitus retraining therapy

A controlled clinical study was conducted to evaluate prospectively the clinical efficacy of tinnitus masking (TM) and tinnitus retraining therapy (TRT) in military veterans having clinically significant tinnitus. Qualifying patients were placed into the two groups in an alternating manner (to avoid selection bias), and treatment was administered at 0, 3, 6, 12, and 18 months. Outcomes of treatment were evaluated using three self-administered tinnitus questionnaires (Tinnitus Handicap Inventory, Tinnitus Handicap Questionnaire, Tinnitus Severity Index) and the verbally administered TRT interview forms. Findings are presented from the three written questionnaires, and from two of the interview questions (percentage time aware of, and annoyed by, tinnitus). Outcomes were analyzed on an intent-to-treat basis, using a multilevel modeling approach. Of the 123 patients enrolled, 118 were included in the analysis. Both groups showed significant declines (improvements) on these measures, with the TRT decline being significantly greater than for TM. The greater declines in TRT compared to TM occurred most strongly in patients who began treatment with a "very big" tinnitus problem. When patients began treatment with a "moderate" tinnitus problem, the benefits of TRT compared to TM were more modest.     

耳鸣患者耳鸣的心理声学特征变化

目的探讨随时间推移主观性耳鸣患者的临床特征及其变化,研究长期耳鸣对患者听力的影响。方法分析比较随访3年以上的30例主观性耳鸣患者初诊时和3年后复诊时的临床表现、耳鸣心理声学特征等的变化。结果 30例患者中,初复诊时均以左侧耳鸣最多见,为12例(40%),三年后复诊时有1例由右侧耳鸣转变为双侧耳鸣。初诊时耳鸣主调多为高频,复诊时耳鸣主调发生变化的有8例,占26.67%,其中,主调频率降低1例,升高6例,1例由初诊时的200Hz纯音复诊时变得无法匹配。复诊时患者500～4 000Hz的平均听阈与初诊时比较无明显变化(P>0.05),耳鸣主调所在频率的平均听阈复诊时较初诊时提高,差异有统计学意义(P<0.05),初、复诊时耳鸣主调相邻的正、负1倍频程频率平均听阈无明显变化(P>0.05)。复诊时30例总体耳鸣响度较初诊时降低(P<0.05),其中,响度不变者2例,变大者3例,变小者25例;复诊时总体的烦躁级别较初诊时减轻(P<0.05),其中,烦燥级别不变8例,减轻18例,加重4例;THI分级不变12例,降低12例,升高6例,总体THI分级无变化。初、复诊时Feldman曲线均主要以汇聚型为主,间距型和重叠型次之,后效抑制阳性率也以汇聚型曲线最高。结论随着耳鸣病程的延长,患者耳鸣的响度较前变小,烦躁级别较前减轻,耳鸣可成为代偿性耳鸣,对患者的心理影响减轻;耳鸣主调频率的听力损失可加重,耳鸣主调频率会出现漂移现象。