精细化声治疗耳鸣的疗效分析

Factors Affecting the Efficacy of Precision Sound Therapy in Tinnitus Treatment

徐飘;杨静雅;林琼萍;李达飞;赵海燕;储洪娟;田广永;

1:南方医科大学第三附属医院耳鼻咽喉头颈外科

摘要
目的探讨精细化声治疗对耳鸣患者的疗效。方法对病程大于3个月的耳鸣患者156例(216耳)进行常规纯音测听和耳鸣精细化测试,按照纯音测听结果将受试者分为听力正常耳鸣组59例(89耳)、听力下降耳鸣组97例(127耳),对所有患者进行精细化的耳鸣位点匹配,根据耳鸣匹配结果给予个性化声治疗3个月,分别于治疗前、治疗1周、1个月及3个月后应用耳鸣残疾量表(tinnitus handicap inventory, THI)进行疗效评估。结果 (1)156例耳鸣患者中1周声治疗总有效率为12.82%(20/156),其中76例耳鸣患者完成3个月治疗,有效者43例,总有效率为56.58%(43/76);(2)听力正常组与听力下降组精细化声治疗1周、1个月及3个月后疗效差异均无统计学意义(P值分别为0.239,0.767,0.798);(3)听力正常和听力下降两组中耳鸣频率位于高频者精细化声治疗疗效最好,超高频率次之,低中频率最差;(4)听力正常组声治疗3个月后,匹配组疗效要优于未匹配组(χ2=4.857,P=0.028)。结论精细化声治疗对听力下降或正常的耳鸣患者都有一定疗效,其中高频耳鸣疗效最佳,且耳鸣位点匹配者疗效优于未匹配者。
关键词
耳鸣;精细化声治疗;疗效
基金项目(Foundation):
广东省科技计划(2017B090912006)
作者
徐飘;杨静雅;林琼萍;李达飞;赵海燕;储洪娟;田广永;
参考文献

1 赖仁淙,马鑫.耳鸣观念的文艺复兴[J].中华耳科学杂志,2016,14(02):140-144.

2 Yang S,Bao S.Homeostatic mechanisms and treatment of tinnitus[J].Restor Neurol Neurosci.2013,31(2):99-108.

3 罗彬,熊彬彬,孙伟,等.个性化多元复合声对慢性主观性耳鸣临床疗效的初步分析[J].临床耳鼻咽喉头颈外科杂志,2018,32(11):819-822,826.

4 Plein CT,Harounian J,Floyd E,et al.A systematic review of eligibility and outcomes in tinnitus trials:reassessment of tinnitus guideline [J].Otolaryngology-Head and Neck Surgery,2016,154(1):24-32.

5 Zeman F,Koller M,Figueiredo R,et al.Tinnitus handicap inventory for evaluating treatment effects:which changes are clinically relevant[J]?Otolaryngology-Head and Neck Surgery,2011,145(2):282-287.

6 Henry JA."Measurement" of tinnitus [J].Otology & Neurotology,2016,37(1):E276-E285.

7 陈平,周津徽.影响突发性聋患者耳鸣疗效的相关因素分析 [J].听力学及言语疾病杂志,2013,21(1):37-40.

8 Lee K,Makino K,Yamahara K.Evaluation of tinnitus retraining therapy for patients with normal audiograms versus patients with hearing loss [J].Auris,Nasus,Larynx,2018,45(2):215-221.

9 Guest H,Munro KJ,Prendergast G,et al.Tinnitus with a normal audiogram:relation to noise exposure but no evidence for cochlear synaptopathy [J].Hearing Research,2017,344:265-274.

10 Zeitler DM,Sladen DP,DeJong MD,et al.Cochlear implantation for single-sided deafness in children and adolescents [J].International Journal of Pediatric Oorhinolaryngology,2019,118:128-133.

11 Searchfield GD,Kobayashi K,Hodgson SA,et al.Spatial masking:development and testing of a new tinnitus assistive technology [J].Assistive Technology,2016,28(2):115-125.

12 Krick CM,Argstatter H,Grapp M,et al.Heidelberg neuro-Music therapy enhances task-negative activity in tinnitus patients[J].Front Neurosci,2017,11:384.

13 Langguth B.Treatment of tinnitus[J].Curr Opin Otolaryngol Head Neck Surg,2015,23(5):361-368.

14 Li Y,Feng G,Wu H,et al.Clinical trial on tinnitus patients with normal to mild hearing loss:broad band noise and mixed pure tones sound therapy[J].Acta Otolaryngol,2019,13(3):284-293.

15 Maccà I,Scapellato ML,Carrieri M,et al.High-frequency hearing thresholds:effects of age,occupational ultrasound and noise exposure[J].Hearing Reseaserch,2006,222(1):108-114.

16 Vanneste S,De Ridder D.Deafferentation-based pathophysiological differences in phantom sound:Tinnitus with and without hearing loss[J].Neuroimage,2016,129:80-94.

17 Norena A,Micheyl C,Chéry-Croze S,et al.Psychoacoustic Characterization of the tinnitus spectrum:Implications for the Underlying mechanisms of tinnitus[J].Audiology & Neuro-otology,2002,7(6):358-369.

18 Hebert S,Fournier P,Norena A.The auditory sensitivity is increased in tinnitus ears[J].J Neurosci,2013,33(6):2356-2364.

19 Formby C,Sherlock LP,Hawley ML,et al.A sound therapy-based intervention to expand the auditory dynamic range for loudness among persons with sensorineural hearing losses:case evidence showcasing treatment efficacy[J].Semin Hear,2017,38(1):130-150.

20 Durai M,Kobayashi K,Searchfield GD.A feasibility study of predictable and unpredictable surf-like sounds for tinnitus therapy using personal music players [J].International Journal of Audiology,2018,57(9):707-713.

21 Wallhausser-Franke E,Cuautle-Heck B,Wenz G,et al.Scopolamine attenuates tinnitus-related plasticity in the auditory cortex [J].Neuroreport,2006,17(14):1487-1491.

22 Husain FT.Neural networks of tinnitus in humans:elucidating severity and habituation [J].Hearing Research,2016,334:37-48.

23 Carterette EC.Release from masking as a means of studying hair cell function [J].Journal of Speech And hearing Research,1969,12(3):497-509.

24 Jackson R,Vijendren A,Phillips J.Objective measures of tinnitus:a systematic review [J].Otology & Neurotology,2019,40(2):154-163.