耳鸣程度分级与疗效评定标准的探讨

目的探讨耳鸣的疗效评定标准.方法根据耳鸣出现的环境、自觉耳鸣的响度、是否影响睡眠和工作以及是否出现精神症状等四个方面,将耳鸣的严重程度分为7个等级,以此为依据制定耳鸣的疗效评定标准.结果根据耳鸣程度分级标准,定出相应的痊愈、显效、有效、无效4个等级的疗效评定标准.结论对耳鸣疗效的判定不能脱离患者的主观感受,研究制定出统一的疗效评定标准,将有利于寻找有效的耳鸣治疗方法.     

耳鸣测定法评价耳鸣疗效

诱发耳鸣与影响耳鸣的因素十分复杂〔1,2〕。本文对 85例 (1 2 6耳 )以耳鸣为主 ,部分伴有感音神经性聋、眩晕患者 ,进行了临床动态跟踪观察 ,试图为临床医生选择治疗方案 ,观察治疗效果 ,提供检测手段和参考指标。1　资料与方法1 .1 　 临床资料本组 85例 (1 2 6耳 )均为 1 998年 3月～ 1 999年 1 0月我院耳科门诊患者 ,男 5 1例 ,女 3 4例 ,男女比例为 1 .5∶ 1 ;年龄 1 5～ 74岁 ,平均 5 2 .6岁。以耳鸣为主诉 2 8例 ,以耳鸣及耳聋为主诉 3 4例 ,以耳鸣、耳聋、眩晕为主诉 2 3例。双耳鸣 41例 ,左耳鸣 2 1例 ,右耳鸣 2 3例。病程 <1年 45…     

用耳鸣匹配法评价耳鸣治疗中的疗效

目的：为耳鸣疗效提供评价依据。方法：治疗前后分别以耳鸣匹配试验进行测试，分析测试结果与疗效相关性。结果：不同等级疗效的患者，其耳鸣匹配试验结果存在明显差异。结论：耳鸣匹配是评价耳鸣疗效的重要指标之一。     

耳鸣评价量表的临床应用价值研究

目的 探讨耳鸣评价量表(tinnitus evaluation questionnaire, TEQ)的临床应用价值.方法 以耳鸣为第一主诉初诊的187例患者(13~80岁,平均42.5±13.5岁)为研究对象,由专业医务人员进行TEQ评估,以患者自填的耳鸣残疾量表(tinnitus handicap inventory, THI)作为对照,研究TEQ的汇聚效度;从中抽取96例患者由两名专业医务人员在半天内对同一患者进行2次TEQ评估,评估耳鸣严重程度,以比较不同测试者间的重测信度;抽取57例患者给予治疗一个月,根据治疗前后患者主观感觉耳鸣有无变化,应用效应量(effect size, ES)计算公式评估TEQ反应度(responsiveness);记录TEQ评估每位患者的测试用时及患者自填THI的时间,以比较测试时效.结果 187例患者TEQ、THI总分分别为10.69±2.88和43.12±19.40,相关系数r=0.79(P<0.01),TEQ与THI汇聚效度好;接受两名测试者评估的96例患者不同测试者间TEQ重测信度为0.94(P<0.01),TEQ的重测信度良好;57例患者治疗一个月后自觉耳鸣症状改善组(36例)治疗前TEQ得分10.69±2.74分,治疗后为7.83±2.74分,效应量为1.04,为较大效应量;说明TEQ能敏感反映患者症状变化,反应度良好.TEQ评估时间(3.27±1.01分钟)显著短于THI评估时间(11.17±3.11分钟)(P<0.01).结论 TEQ的准确性、可靠性、敏感性及可操作性均较理想,且费时少,具有良好的临床实用价值,适用于对耳鸣严重程度和疗效的评估.     

内置灵韵技术助听器对耳鸣的疗效分析

目的：评价内置灵韵技术助听器治疗耳鸣的效果。方法选择30例（46耳）伴不同程度听力损失的耳鸣患者,均配戴内置灵韵技术的助听器,比较其佩戴助听器前、佩戴后6周其耳鸣残疾评估量表（tinnitus handi-cap inventory ,THI）得分,评估灵韵技术助听器治疗耳鸣的效果。结果30例耳鸣患者佩戴灵韵技术助听器前THI平均得分为56．80±16．95分,佩戴6周后THI平均得分为29．93±15．05分,佩戴前后THI平均得分差值为26．53±15．81分;共有21例患者 THI得分较佩戴前减少≥20分,治疗有效率达70．0％,其中6例患者佩戴后THI得分降至≤16分,即治愈率为20．0％。结论配戴内置灵韵技术助听器能帮助伴听力损失的耳鸣患者有效缓解耳鸣症状。     

中文版耳鸣致残量表和耳鸣功能指数的检验以及临床应用

目的验证耳鸣致残量表(THI)和耳鸣功能指数(TFI)中文版本的信度和效度,为其在中国的临床推广应用提供依据。方法对100例耳鸣患者进行THI及TFI的调查分析并分别进行信度及效度检验。同时让患者填写流行病研究中心抑郁量表(CES-D)、贝克焦虑量表(BAI)和生活满意度量表(SWLS),将THI和TFI得分分别与这些量表的关系进行相关性分析。结果 100份中文版THI量表的Cronbach’sα=0.939,TFI量表的Cronbach’sα=0.966。THI的探索性因素分析显示了3个因子,其累计方差贡献率为54.637%。TFI的因子分析显示各子量表的信度在0.351到0.859之间。其中84份量表与各心理量表进行相关性分析,结果表明除SWLS量表外,其余量表之间均呈正相关关系。结论中文版本THI和TFI的信度检验显示了很高的内部一致性,具有较高的信度和效度,可用于中国的临床评估耳鸣对患者生活造成的影响,是可靠的耳鸣严重程度的评估工具。     

耳鸣掩蔽结合心理咨询治疗耳鸣的疗效评价

目的 评价耳鸣掩蔽结合心理咨询治疗耳鸣的疗效.方法 对35例(48耳)耳鸣患者进行耳鸣掩蔽结合心理咨询治疗,分别于治疗前、治疗结束后以及半年后填写耳鸣残疾评估量表(tinnitus handicap inventory, THI),根据THI量表得分变化分析疗效.治疗后THI得分比治疗前减少≥20分认为治疗有效.结果 所有耳鸣患者均完成一个疗程的治疗,20例完成半年随访.耳鸣掩蔽结合心理咨询前后THI评分减少≥20分者15例,有效率为43%(15/35),半年后有效率为45%.男女之间耳鸣严重程度有统计学差异.40～49岁和50～80岁组治疗效果最好,20～29岁和10～19岁组治疗效果最差,但各年龄段疗效无统计学差异.治疗前后及半年后THI、E项(感情评价)、F项(功能性评价)、C项(严重性评价)差异有统计学意义,治疗有效.不同耳鸣持续时间的治疗效果差异没有统计学意义(P=0.551).结论 耳鸣掩蔽结合心理咨询治疗耳鸣能够取得一定疗效,并且效果稳定.有高频听力损失患者治疗效果好.     

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。     

耳鸣中医综合治疗的远期疗效随访

目的：调查中医综合治疗耳鸣的远期疗效,并探讨影响远期疗效的相关因素。方法使用电话联系的方式对2008年至2011年就诊于广州中医药大学第一附属医院耳鸣专科门诊的124例耳鸣患者进行远期随访,采用国内较为公认的耳鸣评价量表进行疗效评价,所得数据用SPSS 16.0统计学软件进行数据统计分析。结果近期耳鸣消失者5例（4.0%）,显效13例（10.5%）,有效43例（34.7%）,无效63例（50.8%）,总有效率为49.2%;平均停止治疗达32.3个月后,远期耳鸣消失者22例（17.7%）,显效23例（18.6%）,有效57例（46.0%）,无效22例（17.7%）,总有效率为82.3%。经统计学分析,耳鸣消失与否两组间数据差异有统计学意义的因素主要有耳鸣声频率、是否伴听力损失、病程、疗程及停诊时耳鸣评分（P﹤0.05）,而性别、年龄、耳鸣主调声听阈、耳鸣主调声响度、佛德曼曲线类型、残余抑制试验、中医证型、初诊时耳鸣评分和随访时间差异均无统计学意义（P﹥0.05）。主成分分析结果显示第一主成分主要包含疗程、病程、是否伴听力损失的信息,贡献率28.749%。耳鸣获效与否两组间数据差异有统计学意义的因素只有初诊时耳鸣评分（P﹤0.05）,余各因素差异均无统计学意义（P﹥0.05）。结论中医综合治疗耳鸣具有较好的疗效,其疗效随时间推移而持续发挥作用,是一个长期受益过程。病程、疗程、是否伴听力损失等因素对耳鸣远期疗效有一定的影响,初诊及停诊时的耳鸣程度对于远期疗效也可能有一定的影响。     

Systematic Screening of the Serotonin Receptor 1A (5-HT1A) Gene in Chronic Tinnitus

Objective Chronic tinnitus is a highly prevalent condition and has been hypothesized to result from an innate disturbance in central nervous serotonergic transmission. Given the frequent comorbidity with major depression and anxiety, we argue that candidate genes for these disorders are likely to overlap. The present study addresses the gene encoding for the 5-HT1A receptor as a putative risk factor for tinnitus. Methods In 88 subjects with a diagnosis of chronic subjective tinnitus who underwent a detailed neurootological examination, the entire 5-HT1A gene was amplified using overlapping PCR products. Amplicons were custom sequenced bidirectionally and were screened for variants in multiple alignments against the human genome reference. Results We identified a synonymous C > T exchange at residue 184 (Pro) in 7/88 subjects, but detected no missense variants in the population under study. Specifically, the following residues were fully conserved: 16 (Pro), 22(Gly), 28(Ile), 98 (Val), 220(Arg), 267 (Val), 273 (Gly), and 418 (Asn). Discussion The present data count against the causation of chronic tinnitus by a change in the 5-HT1A receptor's amino acid sequence. However, the allele frequency for the 184Pro minor allele (0.04) reached twice the frequency reported in control cohorts from the same ethnicity. Additional investigations are invited to clarify the role of the 5-HT1A polymorphism in larger samples, and to control for comorbid affective disorders.     

Production of Infant Scale Evaluation (PRISE) in Italian normal hearing children: A validation study

Objectives

Parental questionnaires are important tools in the evaluation of auditory and language skills of very young children affected by sensorineural hearing loss. One of these instruments is the Production on Infant Scale Evaluation (PRISE). The purposes of this study were to adapt and validate the PRISE on Italian children with normal hearing; and to obtain normative data.

Methods

A back translation technique was used to adapt the Italian version of PRISE. The PRISE was submitted to parents of 234 normal children aged between 3 and 18 months of life. All of them passed local universal newborn hearing screenings and they presented no audiological risk factors.

Results

The PRISE internal reliability (Cronbach's alpha) was 0.87. Split-half reliability indexes were λ₄ = 0.89 and λ₆ = 0.89. Corrected item-total correlation coefficients were significant for all items. The correlation of PRISE with a modified Infant Toddler Meaningful Auditory Integration Scale (IT-MAIS), collected for convergent validity measurement purposes, was good (r = 0.743). A positive correlation of PRISE scores with age was found, reflecting on the age-dependence of pre-verbal skills.

Conclusion

These findings demonstrate high reliability and convergent validity of the Italian PRISE version. This questionnaire constitutes a robust tool for assessing early language development in infants and toddlers with normal hearing. It seems particularly sensitive to the normal language development in the first years of life, which can be very useful for early rehabilitation of hearing loss.     

Smell Changes and Efficacy of Nasal Theophylline (SCENT) irrigation: A randomized controlled trial for treatment of post-viral olfactory dysfunction

ObjectiveTo evaluate the efficacy and safety of intranasal theophylline saline irrigation on olfactory recovery in patients with post-viral olfactory dysfunction (PVOD).MethodsBetween May 2019 and April 2020, we conducted a double-blinded, placebo-controlled randomized clinical trial of adults with 6–36 months of PVOD. Patients were randomized to nasal theophylline saline irrigation or placebo saline irrigation twice a day for 6 weeks. The primary outcome was the Global Rating of Smell Change. Secondary outcomes were changes in the University of Pennsylvania Smell Identification Test (UPSIT) and Questionnaire of Olfactory Disorders-Negative Statements (QOD-NS).ResultsTwenty-two patients (n = 12, theophylline; n = 10, placebo) completed the study. Slightly more patients in the theophylline group (33%) reported improved smell compared to the placebo group (30%, difference 3.3%, 95% CI -35.6% to 42.3%). The median differences in pre- and post-treatment UPSIT and QOD-NS change between the two groups were 1 (95% CI -3 to 5) and -10 (95% CI -15 to -4), respectively in favor of theophylline. Three patients receiving theophylline and 2 receiving placebo had clinically meaningful improvements on the UPSIT (difference 5%, 95% CI -30% to 40%). There were no adverse events, and serum theophylline levels were undetectable in 10/10 patients.ConclusionsWhile safe, there were no clinically meaningful differences in olfactory change between the two groups except for olfaction-related quality of life, which was better with theophylline. The imprecise estimates suggest future trials will need substantially larger sample sizes or treatment modifications, such as increasing the theophylline dose, to observe larger treatment effects.     

听尼特~(TM)耳鸣综合诊断治疗仪的临床应用

目的探讨应用听尼特TM耳鸣综合诊断治疗仪对主观性耳鸣患者进行全面问诊和康复治疗效果评估的意义。方法用听尼特TM耳鸣综合诊断治疗仪,对30例耳鸣患者进行全面问诊评估、诊断测试,在测试评估的基础上,制定并实施个体化耳鸣治疗方案,进行耳鸣康复治疗。结果30例患者在耳鸣残疾度量化测试和耳鸣烦躁级别评估中,残疾度级别1级(轻微的)～5级(灾难性的)治疗前后的病例数分别为6、7、6、7、4和12、13、4、1、0例,将耳鸣残疾度量化2级及以下的患者定为轻度,3级及以上患者定为重度,康复治疗前后轻度的患者分别为13例(43%)和25例(83%),重度患者治疗前后分别为17例(57%)和5例(17%),差异有统计学意义(χ2=10.33,P<0.05)。烦躁级0(无烦躁)～6级(最烦躁)治疗前后病例数分别为2、6、4、6、5、4、3和5、9、6、6、3、1、0例。将耳鸣烦躁级量化表2级及以下的患者定为轻度,3级及以上患者定为重度,康复治疗前后轻度患者分别为8例(27%)和14例(47%),重度患者治疗前后分别为22例(73%)和16例(53%),差异有统计学意义(χ2=4.28,P<0.05)。完成第一疗程治疗后,痊愈2例,占7%;有效27例,占90%;无效1例,占3%,总有效率为97%,均没有出现严重副作用。结论听尼特TM耳鸣综合诊断治疗仪能为耳鸣患者提供准确测试和客观评估,实施因人而异的个体治疗方法;在治疗中辅以心理咨询,可帮助患者更好的理解耳鸣,树立信心,增加患者依从性,提高疗效。     

自适应动态范围优化技术临床应用效果探讨

目的比较宽动态范围压缩线路(wide dynamic range compression,WDRC)助听器和自适应动态范围优化线路(adaptive dynamic range opti mization,ADRO)助听器的助听性能。方法选择具有2年以上WDRC线路助听器配戴史的中重度感音神经性听力损失青年人9名(13耳),分别配戴WDRC线路助听器和ADRO线路助听器,经8周适应期后,通过问卷调查和言语识别率测试对不同压缩线路助听器的助听效果进行评估。结果问卷调查结果显示,受试者配戴WDRC线路助听器在适宜交谈的安静环境(EC)、具有背景噪声的环境(BN)、存在回响和混响的环境(RV)、令人厌恶的或突然的声音(AV)的聆听困难度(不适度)的得分分别为20.2%、33.5%、45.6%、38.9%;配戴ADRO线路助听器在EC、BN、RV、AV的聆听困难度(不适度)的得分分别为17.9%、35.4%、53.6%、46.9%。言语识别率测试结果则显示,无论是处于安静环境或噪声环境,针对不同强度的声音信号,受试者配戴ADRO线路助听器所记录的言语识别率较配戴WDRC线路助听器所记录的言语识别率平均可提高8%~10%(P值均<0.05)。结论自适应动态范围优化线路助听器的助听性能优于宽动态范围压缩线路助听器。     

A New Electrode (HIM-5) for CM Measurement in Extratympanic Electrocochleography

A new electrode (HN-5) for measuring cochlear microphonics (CMs) in extratympanic (ET) electrocochleography (ECochG) has been developed. The HN-5 electrode consists of a silver wire 2 mm in diameter and 5.0 cm in length connected to a low noise cable. The HN-5 electrode showed low impedance and excellent frequency characteristics. Using the dummy ear, artefact contamination tests, such as electromagnetic induction and mechanical vibration, were performed with the HN-5 electrode and various other electrodes. In the HN-5 electrode, artefact contaminations were kept within acceptable noise levels, whereas in the smaller electrodes, the measurable artefact contaminations were larger. The CMs were measured from subjects with normal hearing. CM findings obtained using the HN-5 electrode did not differ from those obtained by transtympanic (TT) ECochG, apart from their amplitude. HN-5 overcame the major disadvantage of the ET ECochG and provided a very favourable signal-to-noise ratio, resulting in repeatable response signals averaged from the same relatively small number of samples as those of TT ECochG. This resulted in successful CM measurements of ET ECochG.     

Sensitivity of a New Grading System for Studying Nasal Polyps with the Potential to Detect Early Changes in Polyp Size after Treatment with a Topical Corticosteroid (Budesonide)

We have previously compared different scoring systems for endoscopic staging of nasal polyps. Of the five methods evaluated, we found that two were better than the others with regard to reproducibility and agreement between physicians. One method was lateral imaging, developed by the authors, and the other was a scoring system developed by Lildholdt et al. The main objective of the present study was to compare the sensitivity of these two methods. Another aim was to study the effect on nasal polyposis of topical nasal corticosteroids over a 2-week period. Patients with bilateral nasal polyposis ( n = 100) were randomized to a 2-week treatment with a topical corticosteroid (budesonide aqueous nasal spray; 128 &#119 g b.i.d.) or placebo in a double-blind manner. Nasal symptoms were scored before treatment and after 3, 7 and 14 days of treatment, and the patients underwent nasal endoscopy at clinical visits. Patients treated with active substance had an improvement in their symptoms, an effect already detectable after 3 days of treatment, compared with those who received placebo. In addition, a statistically significant decrease in polyp size could be registered after 14 days using lateral imaging but not with the other scoring system. In conclusion, lateral imaging was more sensitive and could detect effects earlier than the other scoring system and can be recommended for the endoscopic staging of nasal polyps in clinical studies.     

The effect of hearing impairment in older people on the spouse: Development and psychometric testing of The Significant Other Scale for Hearing Disability (SOS-HEAR)

The effects of hearing impairment on the person with the impairment and on their significant others are pervasive and affect the quality of life for all involved. The effect of hearing impairment on significant others is known as a third-party disability. This study aimed to develop and psychometrically test a scale to measure the third-party disability experienced by spouses of older people with hearing impairment. The Significant Other Scale for Hearing Disability (SOS-HEAR) was based on results of a previous qualitative study investigating the effect of hearing impairment on a spouse's everyday life. Psychometric testing with 100 spouses was conducted using item analysis, Cronbach's alpha, factor analysis, and test-retest reliability. Principal components analysis identified six key underlying factors. A combined set of 27 items was found to be reliable (alpha = 0.94), with weighted kappa for items ranging from fair to very good. The SOS-HEAR is a brief, easy to administer instrument that has evidence of reliability and validity. The SOS-HEAR could serve as a means of identifying spouses of older people with hearing impairment in need of intervention, directed towards either the couple or the spouse alone.     

A preliminary investigation into the use of an auditory brainstem response (ABR) simulator for training audiology students in waveform analysis

Abstract

Objective: To determine if a computer simulation can be used to improve the ability of audiology students to analyse ABR waveforms. Design: A pretest-posttest, quasi-experimental design was used. All participants completed a pretraining examination of their ability to analyse ABR waveforms, eight hours of ABR analysis training over eight weeks using one of three training modes—manual, simulator or combined manual and simulator training, and a posttraining examination of their ability to analyse ABR waveforms. Study sample: Fourteen third-year audiology students (13 female, one male, aged 21 to 22 years) participated in this study. Results: Participants who completed the manual or the combined manual and simulator training achieved significantly higher normalized gain scores on their ABR waveform analysis examinations compared to those who completed the simulator training (p < 0.05). Conclusions: Our findings suggest that the improvements seen in the ability of these audiology students to analyse ABR waveforms were driven primarily by the manual training. The minimal improvements seen in the students who received the simulator training suggest that face-to-face instruction could be required to enhance the ability of audiology students to analyse ABR waveforms.