纯音测听在耳鸣耳聋中医辨证中的作用

[目的]探讨纯音测听在耳鸣耳聋中医辨证中的作用。[方法]选择具有典型中医证候表现的耳鸣耳聋患者120例(165耳),经传统方法辨证为风热侵袭、肝火上扰、痰火郁结、脾胃虚弱、肾精亏损5个证型,分别进行纯音听阈测试、阈上功能测试、耳鸣频率及响度匹配,数据经SPSS软件进行统计学处理。[结果]耳鸣频率、自觉耳鸣程度、听力图类型及部分阈上功能测试指标在各证型间具有显著性差异(P<0.05),这些指标在不同的证型中表现出不同的特点:风热侵袭型的耳鸣频率较低,全频听阈升高,听力图多为平坦型,短增量敏感指数(SISI)得分在1 kHz较高,而4 kHz音衰(TD)值较低;肝火上扰型的耳鸣频率较高,听力损失以高频为主,听力图多为陡降型,4 kHz SISI得分及TD值均较高;痰火郁结型的自觉耳鸣响度较大,听力图以陡降型或缓降型为主,4 kHz SISI得分及TD值均较低;肾精亏损型的耳鸣频率较高,而自觉耳鸣响度较低,听力图以显降型或山型为主,4 kHz SISI得分及TD值均较高;脾胃虚弱型的平均听力损失较小,听力图无一定规律性,但以陡降型或切迹型为主,4 kHz SISI得分较低。[结论]综合分析纯音测听各项指标可能对耳鸣耳聋中医辨证有一定的参考价值。

Application of Pure-tone Test in the Syndrome Differentiation of Tinnitus and Hearing Loss

[Objective] To evaluate the application of pure-tone test in the syndrome differentiation of tinnitus and hearing loss. [Methods] One hundred and twenty cases (165 ears) of tinnitus and/or hearing loss were differentiated into five syndrome patterns according to the theory of traditional Chinese medicine: invasion of wind-heat, liver-fire up-stirring, stagnation of phlegm-fire, kidney-essence deficiency and weakness of spleen-stomach. Hearing threshold of pure-tone, function test above hearing threshold and matching of tinnitus frequency and loudness were carried out in all cases and the data were analyzed by SPSS statistical software. [ Results ] The tinnitus frequency, severity of subjective tinnitus, audiogram types and some items of function test above hearing threshold were significantly different in the five groups ( P < 0.05). Specific features of pure-tone test were found in the five groups: tinnitus frequency was low, whole-frequency hearing threshold high, audiogram even, short increment sensitivity index (SISI) at 1 kHz high and tone decline (TD) at 4 kHz low in the syndrome of invasion of wind-heat; tinnitus frequency was high, high-frequency hearing loss common, audiogram abruptly descending, SISI and TD at 4 kHz high in the syndrome of liver-fire up-stirring; subjective tinnitus was loud, audiogram abruptly descending or gradually descending, SISI and TD at 4 kHz low in the syndrome of stagnation of phlegm-fire; tinnitus frequency was high, subjective tinnitus low, audiogram markedly descending or hill-like, SISI and TD at 4 kHz high in the syndrome of kidney-essence deficiency; average hearing loss was less, audiogram irregular but abruptly descending or notched in most cases, SISI at 4 kHz low in the syndrome of weakness of spleen-stomach. [Conclusion] Pure-tone test can supply evidence for the syndrome differentiation of tinnitus and hearing loss.