217例主观性耳鸣的临床特征分析

目的研究分析耳呜患者的临床特征及听力学特点，比较不同类型耳呜的掩蔽试验效果，探索耳鸣的个性化治疗。方法对我科门诊及住院的主观性耳鸣患者217例，常规病史调查，同时行纯音测听、耳声发射、耳鸣检测及掩蔽，分析耳鸣患者的临床特征，评估各类耳鸣掩蔽试验的情况。结果耳鸣在人群高发年龄段为36—55岁，占24％。男女比例分别为48％及52％，耳鸣发生侧别以左侧最常见（42％），双侧耳鸣次之（30％），右侧耳鸣最少（28％）。城市人口及脑力劳动者居多，分别占77％和68％。病程中以慢性耳呜患者（病程〉1年）最多（占46％）。耳鸣高频及低频耳鸣患者掩蔽最为有效，有效率分别为71．6％及73．6％，而中频耳鸣掩蔽有效率仅有52．2％，夫特曼曲线类型与掩蔽试验阳性率明显相关，由I型掩蔽阳性率为89％降至V型掩蔽阳性率为11．7％。结论耳鸣患者各项特征与掩蔽试验、耳鸣频率等有较大相关性，可作为耳鸣治疗效果的预测指标。Feldman曲线类型在耳鸣诊断和治疗方面有很大应用价值及指导意义，是预测耳鸣掩蔽是否有效的一个重要指标，也是选择耳鸣个体化治疗的一个重要参考依据。

Clinical feature analysis on 217 patients with subjective tinnitus

Objective To analysis the clinical feature and audiology feature of patients with subjective tinnitus,compare masking,screening effectiveness of various kinds tinnitus,and search for the individual treatment ways for subjective tinnitus.Methods 217 patients in our hospistor were performed pure tone test,DPOAE,tinnitus determination,and tinnitus masking including pitch matching,intensity matching,Feldmann masking curve,and residual inhibition test with TinniTestTM.Results The prevalence rate is higher in female (52％).Tinnitts occur to the left side more common (42％),followed by bilateral ears (30％) and the right side (28％).The urban population ( 77％ ) and mental worker ( 68％ ) were primary in patients.The patients with chronic tinnitus (duration＞ 1 year) counts for most proportion (46％).The most effective treatment was masking treatment for cases with high frequency tinnitus and low frequency tinnitus; the effective power is 71.6％ and 73.6％.The lowest effective treatment was masking treatment for cases with middle frequency tinnitus; the effective power is only 52.2％.The positive ratio of masking test for cases with type Ⅰ to type Ⅴ (Feldman Curve Type) decreased from 90％ to 10％ gradually.Conclusions The feature of cases with tinnitus had much more dependence on masking test and tinnitus frequency; it could be predictive factor for curative effect of tinnitus.Feldman curve type has large utilization value and directed significance on diagnosis and treatment for tinnitus.It is much more valuable for the selection of masking therapy; and is an important predicted factor for the effectiveness of masking therapy;and it is an important evidence for the selection of personal treatment.