不同耳鸣频率患者的临床特征比较

目的：探讨不同耳呜频率患者的临床特征及其严重程度。方法：70例以主观性耳鸣为主诉的耳呜患者,按其耳呜频率的高低分为3组：高音调（4000～8000Hz）组42例,中音调（1000～3000Hz）组16例,低音调（125～750Hz）组12例。所有入选患者均行纯音听阈测定、耳鸣匹配检查,同时由患者填写耳鸣残疾评估量表（tinnitus handicap inventory,THI）及视觉模拟量表（visual—analogue scale,VAS）。结果：不同耳呜频率患者的耳鸣部位、耳鸣音调、响度及听力状况构成比较无显著差异;不同耳鸣频率患者其THI评分及VAS评分关系密切。结论：不同耳鸣频率患者耳呜匹配结果及其自我评分关系密切,临床上可以相互结合运用于临床耳呜严重程度的评价。     

延续护理在主观性耳鸣病人中的应用

[目的]探讨延续护理模式在出院主观性耳鸣病人中实施的效果。[方法]选择2015年3月—2015年12月出院的76例主观性耳鸣病人接收延续护理,于出院前3d、接收延续护理6个月后采用耳鸣残疾度量表(THI)、睡眠状况自评量表(SRSS)、满意度调查表对病人耳鸣严重程度、睡眠状况、护理满意度进行评估,对评估结果进行统计学分析。[结果]接受延续护理后病人THI得分、SRSS得分、护理满意度得分均优于实施延续护理前,差异有统计学意义(P0.05)。[结论]延续护理可有效改善出院主观性耳鸣病人的耳鸣程度、生活质量及睡眠状况,增强病人对耳鸣相关知识的认知度,提高病人对医护人员的满意度。     

Exploring outcomes associated with acupuncture

OBJECTIVE: The objective was to explore various methods of assessing clinically meaningful change associated with a course of acupuncture treatments. DESIGN: The design was a prospective cohort study. SETTING: The setting was an acupuncture clinic staffed by two physician acupuncturists in a university-affiliated family practice center. SUBJECTS: Subjects consisted of consecutive new patients to an acupuncture clinic. OUTCOME MEASURES: Outcomes were measured using the Medical Outcomes Study Short-Form 36 (SF-36) and Measure Your Own Medical Outcomes Profile (MYMOP). Outcomes measured were global clinical change and patient satisfaction. RESULTS: Out of 112 eligible patients, 110 consented to the study and contributed baseline data. Of these, 80 (71%) completed the 2-month follow-up questionnaire. Mean age of study subjects was 54.5 (standard deviation, SD 17.6) years; 85 (77%) were female, and 75 (68%) were married. Mean number of acupuncture treatments during the 2-month follow-up period was 5.8 (SD, 3.5, range, 1 to 16). Statistically significant improvement from baseline to follow-up was observed with the bodily pain subscale of the SF-36 and with the MYMOP. Among those who completed the study, 52 (67%) felt that the main symptom for which they sought acupuncture had improved over the course of the study and 72 (90%) were satisfied with their treatment in the acupuncture clinic. CONCLUSIONS: The MYMOP instrument appears to be the most useful of the four measures used to evaluate clinical outcomes associated with a course of acupuncture treatments (SF-36, MYMOP, global clinical change, and patient satisfaction). This easy-to-administer instrument appears to be sensitive to clinical change over a 2-month period among patients who sought acupuncture for a wide variety of clinical conditions.     

Spatial masking: Development and testing of a new tinnitus assistive technology

Masking is widely used in the management of tinnitus, however, masking at the perceived spatial location of tinnitus has not been investigated. This article examines the development of a method for the spatial masking of tinnitus. This report consists of three studies: Study I is a proof of concept study comparing customized spatial masking to conventional bilateral masking; Study II is a prototype evaluation in which the spatial masking paradigm was compared to a bilaterally equal masker using iPods connected to hearing aids in a 4-week cross-over trial; and Study III is a 4-month crossover pilot study-using prototype hearing aid-based maskers, and in which three-dimensional (3D) masking (2 months) was compared to a Tinnitus Retraining Therapy (2 months). There was a preference for the 3D masking stimulus across all three studies. Individual changes in the Tinnitus Handicap Inventory (THI) after 2 weeks of trial (Study II) and Tinnitus Functional Index (TFI) after 2 months of trial (Study III) were observed without large group differences. The spatial masking concept was piloted successfully. The qualitative and quantitative results obtained indicate directions for future clinical trials and therapy development. This study indicates that spatial masking of tinnitus is feasible, of benefit to many participants, and warrants further trials.     

Venous sinus stenting for the treatment of isolated pulsatile tinnitus: Results of a prospective trial

ObjectivesThis prospective study evaluates the effectiveness and safety of venous sinus stenting for patients with isolated pulsatile tinnitus and lateral sinus stenosis.MethodsPatients with isolated pulsatile tinnitus and lateral sinus stenosis with a minimum trans stenotic gradient of 4 mm Hg were treated with stenting. Pulsatile tinnitus before and after treatment was assessed with the Tinnitus Handicap Inventory (THI). Periprocedural adverse events, neurological complications, clinical and radiographic follow-up were also recorded.ResultsA total of 42 patients (41 females and 1 male) were included in the study (median age of 37.5 years). Thirty patients had post-stenotic fusiform and 12 had post-stenotic saccular venous sinus aneurysm. In addition to stenting, coils were used to treat the patients with saccular venous aneurysms. The median follow-up was 5 months (range 1 to 34 months). Most patients had complete (39/42) or near-complete (2/42) resolution of their pulsatile tinnitus post-procedure. There were no serious adverse events.ConclusionStenting of the lateral venous sinus is a safe and effective treatment for patients with isolated pulsatile tinnitus due to venous sinus stenosis.     

调整生活方式对难治性耳鸣及睡眠障碍的疗效

目的:研究调整生活方式对难治性耳鸣及睡眠障碍的疗效。方法:回顾性分析在四川大学华西医院"耳鸣耳聋眩晕"专科门诊就诊的难治性耳鸣及睡眠障碍的临床资料。研究对象纳入标准:病程6个月以上,在外院接受过常规治疗无效,已停止治疗,且在随访期间未接受过任何其他治疗,有完整随访记录。干预方法为指导患者调整不良生活方式,具体包括合理饮食及睡眠、心理疏导消除压力等。睡眠和耳鸣的疗效评估方法分别用自行设计的包含有四项常用睡眠疗效指标的睡眠质量调查问卷(Sleep Quality Investigation Inventory,SQII)和耳鸣评价量表(Tinnitus Evaluation Questionnaire,TEQ)。结果:共纳入10例(男女各5例)患者,年龄22~71岁,平均(46.1±13.0)岁;就诊时睡眠障碍病程0.6~30年,平均(9.5±10.5)年;耳鸣病程0.6~20年,平均(7.0±7.4)年。仅靠调整生活方式,10例患者睡眠障碍和耳鸣均同时得以改善,起效时间为4~48 d,平均(17.8±13.1)天;在SQII的4项常用睡眠改善指标中,平均改善项目数达2;干预后的TEQ得分较干预前平均降低2.9分(P0.05)。结论:经常规治疗无效的10例难治性耳鸣及睡眠障碍患者,仅靠调整生活方式干预,便在短期内耳鸣和睡眠障碍得以改善,疗效较满意。是否严格遵医嘱调整生活方式,是影响疗效的重要因素。需要大样本、长时间随访及疗效评价方法的临床研究去进一步探索并发掘调整生活方式这一干预方法的临床价值。     

A randomised, placebo-controlled trial of manual and electrical acupuncture for the treatment of tinnitus

The aim of this study was to examine the effects of manual/electrical acupuncture treatment on tinnitus in a randomised, single-blinded, placebo-controlled design. Fifty patients (46 males, 4 females) suffering from tinnitus were investigated. The patients were randomly assigned to three groups: a manual acupuncture group (MA), an electrical acupuncture group (EA), and a placebo group (PL). The frequency of tinnitus occurrence, tinnitus intensity, and reduction of life quality were recorded before treatment (Baseline), after 6 treatments (After-Treatment), and 1 month after the completion of treatment (1-Month-After). Standard audiometric tests were conducted on each patient at Baseline and After-Treatment. The patients also provided an overall subjective evaluation of treatment effectiveness at each stage. Eight to ten acupoints were selected at each treatment by an experienced acupuncturist. Six treatments were performed, each separated by an interval of 1 week. Analysis of variance and t-tests were used to statistically compare the data. The frequency of tinnitus occurrence and the tinnitus loudness were significantly decreased After-Treatment compared with Baseline in the EA group (P<0.009). Life quality was improved After-Treatment and at 1-Month-After compared with Baseline in both MA and EA groups (P<0.038). However, no significant differences were detected among the three groups (P>0.079). The audiogram did not show any significant changes after treatment in either group (P>0.091). The overall subjective evaluation indicated significant improvements After-Treatment compared with Baseline in both MA and EA groups (P<0.011). Furthermore, After-Treatment subjective evaluation was significantly better in the EA group compared with either the MA or PL group (P<0.011). These results indicate that there is no statistically significant differential effect of manual or electrical acupuncture on tinnitus treatment efficacy, however, electrical acupuncture does confer some relative advantages.     

Valproate-induced tinnitus misinterpreted as psychotic symptoms

Valproate sodium is an anticonvulsant medication, which has also been shown to be effective in the treatment of bipolar disorder. We report a case of valproate-induced tinnitus that was initially misinterpreted as increasing psychotic symptoms, which began approximately 2 days after initiation of valproate therapy. Tinnitus worsened during the next 6 days of treatment until it was recognized that this symptom was related to valproate. After discontinuance of the medication, the tinnitus gradually resolved over a period of 10 days with no residual effects. Although it is a rare adverse effect, valproate-induced tinnitus should be included in the differential diagnosis for tinnitus in patients receiving this medication. Tinnitus may be difficult to recognize in patients with active psychosis or mania.     

The Cavendish Centre for integrated cancer care: assessment of patients' needs and responses

The use of complementary therapies in combination with conventional medicine is increasing. In cancer care, as at the Cavendish Centre for Cancer Care in Sheffield, the range of therapies offered can include aromatherapy, massage, reflexology, shiatsu, acupuncture, homeopathy, counselling, visualization, hypnotherapy, relaxation, healing and art therapy. Before offering any therapy careful assessment of patients' needs is important as patients seeking complementary therapies may present with unrealistic hopes and expectations of benefit. There are wide variations in provision of services offering complementary cancer care throughout the United Kingdom but few offer a comprehensive assessment which is used as a baseline for both planning treatment and evaluating its outcome and which is conducted by a trained and objective practitioner who has no investment in any specific therapy. We describe the model of care developed at the Cavendish Centre with particular emphasis on the assessment process. Our model of assessment provides an opportunity for patients to tell their story, make sense of the illness experience, construct meaning from it and set realistic expectations for the chosen intervention. It also offers patients involvement and choice in decisions about their care. In addition we present evaluative data from a case series of 157 patients, 138 of whom (88%) reported improvement in their main concern on MYMOP (Measure Your Medical Outcome Profile).     

Comparison of two computer-automated procedures for tinnitus pitch matching.

Clinical assessment of the perceptual characteristics of tinnitus usually includes an attempt to match the pitch of tinnitus to a pure tone. A standardized clinical protocol for tinnitus pitch matching does not yet exist, and there is a history of unsuccessful attempts to obtain such measures reliably. The present study was designed to evaluate new protocols for identifying the perceived pitch of tinnitus, with the objectives of reducing testing time and improving test-retest reliability. Two protocols ("Octave" and "Binary") were developed, each of which was patterned after the testing procedure previously developed at the Oregon Tinnitus Clinic and used to assess thousands of tinnitus patients. Both protocols use computer-automation to conduct testing; the protocols differ according to their specific testing algorithms. Twenty subjects with nonfluctuating tinnitus were each tested over two sessions. Results of testing revealed that both protocols could obtain pitch matches within 20 to 25 min. Reliability of responses was good for some subjects but not others, and the Binary protocol generally provided more reliable results.     

Your Pillow May Not Guarantee a Good Night's Sleep or Symptom-Free Waking

Purpose: To describe the performance of the pillow that participants usually slept on with respect to retiring and waking cervico-thoracic symptoms, pillow comfort, and sleep quality.Methods: Participants (n=106) were systematically recruited for a field trial comparing their own pillow and five trial pillows. Participants provided daily retiring and waking symptom reports and sleep-quality and pillow-comfort ratings prospectively for 1 week on each pillow. Linear and logistic regression models were used to investigate the relationship between pillow use, age, gender, sleep quality, pillow comfort, and waking and temporal (overnight) symptom reports.Results: No waking symptoms were reported by 42.5% of participants on their own pillow. Regular waking symptoms, failure to relieve retiring symptoms, uncomfortable pillows, and/or poor-quality sleep were reported by over 50% of participants. All participants who reported poor sleep quality also reported poor pillow comfort. Pillow-comfort reports were not related to any waking symptom report; however, reports of poor sleep quality were significantly related to waking cervical stiffness (adjusted odds ratio [AOR]=4.3 [Confidence Interval (CI): 1.3-15.6]) and scapula pain (AOR=6.1 [CI: 1.1-31.6]). Feather pillow users provided consistently low reports of pillow comfort and sleep quality.Conclusion: Many participants appear to have made poor pillow choices, as poor sleep quality, low pillow comfort, and waking symptoms were common. Further research is required to understand why people choose particular pillows to sleep on, as well as to identify the best fit between person and pillow to optimize sleep quality and reduce waking symptoms.     

An audit of acupuncture in a single-handed general practice over one year

An audit was performed over one year on all patients undergoing acupuncture for a variety of conditions in a single-handed GP practice. The patients were observed for a further year to assess the effectiveness and duration of the treatment effect. Using the 'measure yourself medical outcome profile' (MYMOP) questionnaire, the effectiveness of acupuncture treatment was measured, and patients were categorised into no effect, improved or much improved. A total of 140 patients were audited over the one-year period. No effect was seen in 31% of patients, a further 31% were improved, and 38% were much improved. Those with a shorter duration of symptoms appeared to show the most benefit. During the one-year post-treatment observation period 50% of patients required further treatment. In conclusion, acupuncture appears to have been an effective treatment in the author's General Practice population. In this audit acupuncture seems to have had a short duration of effect. It is believed that this has lead to an increase in workload, not only as a result of patient demand, but also due to recurrence of symptoms following the initial success of treatment.     

'Ringing in the ears': narrative review of tinnitus and its impact

About 10% of the population experiences tinnitus, a common and distressing symptom characterized by the perception of sound in the absence of external stimuli. There is, however, marked heterogeneity in etiology, perception, and extent of distress among those who experience tinnitus. Reactions to tinnitus vary from simple awareness to severe irritation; some people have difficulty in hearing because of the loudness of the noise. Severe tinnitus causes many, often psychological, symptoms (e.g., tension, frustration, impaired concentration, disrupted sleep). For some, tinnitus is temporary, for others it is longstanding. Although many people adjust successfully, others are disabled by tinnitus; approximately 5% experience persistent and severe symptoms affecting their lifestyle and significantly reducing their quality of life. Because tinnitus is poorly understood and no single therapeutic approach is effective for all patients, many patients are told that 'nothing can be done' and they must 'learn to live with it.' In spite of these challenges, there is remarkably little relevant nursing literature on tinnitus. This literature review was conducted to explore current knowledge of tinnitus, including prevalence, causes and diagnosis, and assessment. Its psychosocial effects and impact on individuals are considered. Implications for practice are discussed-demonstrating that understanding the full impact of the condition and identifying patients' needs are essential to effective care.     

耳鸣掩蔽对耳鸣患者脑干听觉诱发电位波幅的影响

背景:研究发现耳鸣患者常伴有脑干听觉诱发电位波幅大Ⅲ小Ⅴ波的变化,耳鸣掩蔽是耳鸣治疗中的一种方法,在耳鸣掩蔽的治疗过程中耳鸣患者脑干听觉诱发电位将会如何变化?目的:观察耳鸣患者的脑干听觉诱发电位变化特点,以及耳鸣掩蔽后脑干听觉诱发电位变化规律。设计:病例-对照及自身前后对照。单位:吉林大学第一医院耳鼻咽喉--头颈外科。对象:持续性耳鸣组:63例(68耳),为1999-03/2001-10吉林大学第一医院门诊收治;对照组:听力正常的青年人(20～23岁)10例(20耳)。所有受试者自愿接受检测及治疗。方法:耳鸣患者首先进行脑干听觉诱发电位检查(采用额部乳突部引导方法记录),然后进行耳鸣检查及耳鸣掩蔽试验(掩蔽5min),随后立刻做脑干听觉诱发电位检查,并与对照组进行对比观察。主要观察指标:①耳鸣患者脑干听觉诱发电位的特点。②耳鸣掩蔽后对脑干听觉诱发电位波幅的影响,分为后效抑制试验阳性和阴性2组进行分析。结果:83例全部进入结果分析。①听力正常青年人的脑干听觉诱发电位波幅为小Ⅲ波大Ⅴ波,而63例(68耳)中有22耳(31.2%)脑干听觉诱发电位为大Ⅲ波小Ⅴ波,其中17耳后效抑制试验阳性,5耳阴性。②后效抑制试验阳性17耳经耳鸣掩蔽治疗后10耳由大Ⅲ波小Ⅴ波转为小Ⅲ波大Ⅴ波,3耳Ⅲ波幅度减小;阴性5耳经耳鸣掩蔽治疗后有2耳转为小Ⅲ波大Ⅴ波,其余3耳无改变。结论:耳鸣掩蔽能使耳鸣患者异常的脑干听觉诱发电位波幅恢复至正常,此结果有望作为后效抑制阳性判定的客观指标。     

Auricular acupuncture versus sham acupuncture in the treatment of women who have insomnia

BACKGROUND: Improvement in sleep parameters in relation to acupuncture treatment is often found and referred to as being a positive side-effect in the treatment of other illnesses. There is a lack of randomized studies, which primarily study the direct effect of acupuncture on sleep. OBJECTIVES: To investigate whether or not auricular acupuncture has an effect on sleep parameters among people with insomnia. DESIGN: A single-blind, randomized pilot study where the treatment group received auricular acupuncture treatment (AAT) on active points and the control group received AAT on sham points during a 6-week treatment period. SETTING: Participants were recruited from the psychiatric outpatient clinics in the geographical area connected to a local hospital in central Sweden. SUBJECTS: In all, 28 women were included in the study, with 14 in each group. Their mean and median age was 53 years. OUTCOME MEASURES: Sleep parameters were obtained by using the Karolinska Sleep Diary. RESULTS: No statistically significant differences were observed between the groups relating to parameters associated with the definition of insomnia. The treatment group experienced that it was easier to wake up in the morning compared with the control group (repeated-measures analysis of variance, p = 0.04). Both groups showed a statistically significant recovery in subjective sleep parameters during the study period (weeks 1-6) compared with baseline values (week 0). CONCLUSIONS: Only modest evidence was found supporting the hypothesis that AAT may have an effect on insomnia. Least improvements were found in total sleep time and number of awakenings, 2 parameters directly associated with the definition of insomnia. AAT may have a role in the treatment of insomnia, especially in combination with other treatments such as cognitive behavioral therapy. This study provides an example of how to perform studies using alternative therapies for sleep disorders.     

Development of a sleep diary for chronic pain patients

The present study examined the psychometric properties of the Daily Sleep Diary (DSD), an instrument developed for monitoring sleep among chronic pain patients. As part of a comprehensive evaluation, 46 chronic pain patients completed the DSD each morning. Items assessed the number of hours slept, length of sleep onset, frequency of awakenings during the night that resulted in trouble falling back to sleep, early morning awakening, quality of sleep, lack of restfulness, and the previous night's sleep compared to usual sleep. Reliability coefficients were significant. The sleep diary items significantly correlated with other retrospective measures of sleep. Duration of pain complaint was related to delayed sleep onset and lower quality of sleep. Pain severity was related to fewer hours slept and delayed sleep onset. The DSD items correlated with measures of both depression and anxiety. The results emphasize the importance of including sleep in both assessment and treatment of chronic pain patients.     

突发性感音神经性耳聋患者睡眠状况与其预后的相关性研究

目的探讨突发性感音神经性耳聋(简称突聋)患者睡眠状况与其预后包括听力学和主观症状改善程度的相关关系,为临床保健指导提供科学依据。方法对98例病程3~30 d的突聋患者通过匹兹堡睡眠质量指数(PSQI)量表和自行设计的一般情况调查表收集患者的睡眠状况和主观症状(耳鸣和耳闷堵感)改善情况,通过调查病历收集患者的听力学改善情况,从而综合评估患者的预后信息。结果突聋患者的睡眠状况与听力学改善程度存在趋势相关性(P=0.001),呈现正相关,不同睡眠程度与听力学改善程度存在直线关系趋势。突聋患者的睡眠状况与耳鸣改善程度不存在趋势相关性(P=0.441)。但PSQI4分的突聋患者耳鸣改善总有效率为87.5%,PSQI12分的突聋患者耳鸣改善总有效率为33.3%,突聋患者耳闷堵感治疗总有效率92.3%,突聋患者不同睡眠状况与治疗后耳闷堵感改善情况存在趋势相关性(P=0.000),出院时仅5例仍有耳闷堵感,其中4例集中在PSQI12分的患者中。结论突聋患者的睡眠状况对患者发病后4周内的治疗效果包括听力学和主观症状改善程度有影响,良好睡眠状况有助改善突聋预后。     

治脊疗法与TENS治疗躯体性耳鸣

目的:研究治脊疗法与经皮神经电刺激(TENS)治疗头颈肌紧张引起躯体性耳鸣的差异性。方法:耳鸣患者28例,随机分为2组各14例,治脊组采用治脊疗法,TENS组采用TENS治疗。测定2组治疗前后双侧咀嚼肌、胸锁乳突肌和上斜方肌静态下电位及耳鸣程度。结果:治疗2周后,2组耳鸣侧静态下电位值及耳鸣响度VAS均值均降低(P<0.01,0.05),治脊组较TENS组下降更显著(P<0.05),治脊组总有效率明显高于TENS组(P<0.01)。结论:治脊疗法和TENS对头颈肌紧张引起躯体性耳鸣具有治疗作用,且治脊疗法效果更佳。     

An audit of acupuncture in general practice

An audit was conducted to determine the effects of acupuncture treatment used in a dedicated clinic in primary care by a GP, starting shortly after first learning acupuncture. The outcome measure was MYMOP2 which was developed into the MYMOP pictorial during the course of the audit to improve patient compliance. Out of 62 patients enrolled in the audit, 55 completed both the initial and follow-up questionnaires: they had a mean age of 56 years, and included 43 women. The overall mean improvement in symptom 1 was 2.0 (standard deviation 1.6) scale points, and the improvement was significant in 30 patients (55%). Twenty-eight patients reported significant improvement in activity (58% of those reporting this section), and 23 patients (48% of those reporting) obtained a significant improvement in wellbeing. Adverse events were minor, though one patient fainted and fell to the floor. Although the conclusions of this audit are limited by its small size, nevertheless the results were generally encouraging, and the authors recommend that acupuncture should be considered for use in primary care for a wide range of complaints.     

Assessment of heart rate circadian rhythms in paroxysmal atrial fibrillation

Heart rate (HR) variations during night sleep and in the early predawn period in healthy subjects and patients with paroxisms of artrial fibrillation were used to assess HR circadian rhythms. Daily ECG monitoring was performed in 19 healthy subjects (mean age 36.0 +/- 7.05 years) and patients with paroxisms of atrial fibrillation (mean age 55.15 +/- 3.91 years). In healthy subjects, HR responsiveness during night sleep and in the early predawn hours was more prominent than in patients with paroxisms of atrial fibrillation. The number of HR spikes at night was 20.42 +/- 3.73 and 14.23 +/- 2.8 (p < 0.001) and one hour before waking 3.74 +/- 1.33 and 1.92 +/- 1.04 (p < 0.001) respectively; premorning activation coefficient was 0.19 +/- 0.007 and 0.13 +/- 0.007 (p < 0.05). It is concluded that HR responsiveness during the night sleep and the early predawn period in healthy subjects is higher than in patients with paroxisms of articular fibrillation. The number of HR spikes at night and one hour before waking as well as premorning activation coefficient can be used to assess RH circadian rhythms.