耳鸣客观检测指标与中医证型相关性的临床研究

目的：观察耳呜客观检测指标与中医辨证分型的内在联系。方法：选择具有典型中医证候表现的6个证型的180例（215耳）耳鸣患者，分别进行纯音测听、声导抗、耳声发射、听性脑干反应、经颅多普勒等检查，数据经SPSS软件进行统计学处理。结果：不同证型的听力损失程度、听力图类型表现出不同的特点；风邪袭闭型耳呜频率最低，与其他型相比有显著性差异（P〈0．05）；而耳呜响度各组间无显著性差异（P〉0．05）。风邪袭闭型耳鸣TEOAE、DPOAE检出率最高，与其他型相比有显著性差异（P〈0．05）；而其他型之间相比无显著性差异（P〉0．05）。风邪袭闭型TCD检测异常者为31．8％，低于总的TCD检测异常率；气滞血瘀型TCD检测异常者为77．8％，高于总的TCD检测异常率；其余各型与总的TCD检测异常率接近。各证型间鼓室导抗图、声顺值、同侧和对侧镫骨肌声反射、ABR的Ⅰ、Ⅲ、Ⅴ波潜伏期及Ⅰ-Ⅲ、Ⅲ-Ⅴ、Ⅰ—Ⅴ波间期均无显著性差异（P〉0．05）。结论：对耳鸣患者进行客观检测有助于中医辨证分型。

Clinical Research of Relation between Objective Indexes and Syndrome Differentiation of Tinnitus

Objective：To observe the internal relation of objective indexes and syndrome differentiation of tinnitus. Methods ： 180 cases （215 ears） of tinnitus with 6 types accompanied by typical syndrome of TCM were selected. Pure tone test, acoustic immittance, otoacoustic emissions, auditory brainstem response, transcranial doppler examination were de- tected for each patient, and the data was analyzed statistically by SPSS software. Results ： The degree of hearing loss, au- diogram types of different type showed different characteristics ; the group of invasion of wind - evil had minimum frequen- cy of tinnitus, the difference was significant compared with the other groups （ P 〈 0.05 ） ; and the loudness of tinnitus had no significant difference in all groups （P 〉 0.05 ）. The group of invasion of wind - evil had the highest detection rate of TEOAE DPOAE, and the difference was significant compared with the other groups （P 〈 0.05 ） ; while compared with the other groups, the difference was not significant （ P 〉 0.05 ）. The abnormal rate of TCD detection in the group of inva- sion of wind - evil was 31.8%, lower than the total abnormal rate of TCD detection. The abnormal rate of TCD detection in the group of Qi stagnation and blood stasis was 77.8% , higher than the total abnormal rate of TCD detection. The ab- normal rate of TCD detection in the rest of groups was close to the total abnormal rate. Tympanogram, compliance value, ipsilateral and contralateral acoustic stapedial reflex, the latency of ABR I, III, V wave and the time of ABR I -III, III - V, I - V wave had no significant difference in all groups （ P 〉 O. 05 ）. Conclusion ： The objective detection of tinnitus patients contribute to the syndrome differentiation of TCM.