摘要
目的比较两种不同多个混合纯音频率声治疗方法在慢性主观性耳鸣的有效性,初步分析不同程度听力损失患者在两种声治疗方案的效果,并探讨其可能机制。方法 2018年1—5月就诊于北京协和医院耳鼻咽喉科门诊,诊断为主观性耳鸣的患者。采用双盲随机对照试验,共纳入56例患者,计算机进行随机抽样分为A、B两组,分别采用不同的声治疗方案,治疗前行纯音测听、声导抗、耳鸣匹配检查。治疗2周、1个月、2个月、3个月后随访患者,分别予耳鸣残障问卷(tinnitus handicap inventory,THI)及视觉模拟评分量表(visual analogue scale,VAS)评估耳鸣残障程度、响度及烦恼程度。运用重复测量方差分析进行统计学分析。结果治疗3个月后,两组THI评分均较治疗前显著减小(P=0.048,P=0.016),但两组间评分差异无统计学意义。根据听力损失程度将A、B两组再分为听力正常及轻度听力下降(26~40 dB HL)组(A1组,B1组),中度及以上听力下降(41 dB HL以上)组(A2组,B2组)。在听力正常及轻度听力下降患者,B1组THI(P=0.013)、VAS响度及烦恼程度评分(P<0.01)治疗后较治疗前显著降低,B1组声治疗方案有效。在中度及以上听力下降患者,A2组治疗后较治疗前THI、VAS响度及烦恼程度评分(P<0.01)均显著降低,A2组声治疗方案有效。结论本研究所采用的声治疗对部分患者有效,不同程度听力损失的患者所采用的声治疗方案不同,大多数患者的耳鸣无法完全消失,但可以使耳鸣程度减轻。临床医生应针对不同类型的耳鸣患者声学特征,采用个体化的声治疗方案。
Objective The effectiveness of two different sound therapies in chronic subjective tinnitus was compared. The effectiveness of different degrees of hearing loss patients on two different sound therapies were analyzed preliminarily and the possible mechanisms were discussed. Methods This clinical trial was conducted in the Peking Union Medical College Hospital, China from January 2018 to April 2018. Patients were received sound therapy when they were diagnosed as subjective tinnitus. This was a double-blinded randomized controlled trial. In our clinical trial, we included 56 participants who were randomly divided into Groups A and B with different sound therapies by using a computer allocation sequence. Pure tone audiometry, tympanometry and tinnitus matching were performed. The patients were followed up for 2 weeks, 1 month, 2 months and 3 months. Tinnitus handicap inventory (THI) and visual analog scales (VAS) measuring were used to evaluate the handicap, loudness and anxiety of tinnitus. An analysis of variance (ANOVA) of 2×5 repeated-measures was conducted. Results With the prolongation of the treatment time, both groups showed significantly lower scores after 3 months training compared with baseline which were measured by THI scores. While there was no effect between the two groups. According to the degree of hearing loss, Group A and B were divided into normal to mild hearing loss group (26-40 dB HL, Group A1, Group B1), moderate to profound hearing loss group (41 dB HL group and above, Group A2, Group B2). In the patients with normal hearing and mild hearing loss, the THI (P=0.013), VAS loudness and annoyance scores (P<0.01) after 3 months in Group B1 was significantly lower than those at baseline and the sound therapy in Group B1 was effective. In patients with moderate to profound hearing loss, the THI, VAS loudness and annoyance scores (P<0.01) after 3 months in Group A2 was significantly lower than those at baseline and the sound therapy in Group A2 was effective. Conclusions Sound therapy may be effective for some patients. Sound therapy for patients with different degrees of hearing loss are different. The tinnitus of most patients could not disappear completely, but reduce or eliminate. Doctors should use appropriate and individualized acoustic parameters for different characteristics of tinnitus. Doing so would provide effective and specific sound therapy for patients and reduce or eliminate tinnitus.
作者
李颖
冯国栋
吴海燕
高志强
Li Ying;Feng Guodong;Wu Haiyan;Gao Zhiqiang(Department of Otorhinolaryngology, Peking Union Medical College Hospital, Beijing 100730, China)
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2019年第5期355-361,共7页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
基金
国家自然科学基金(81870729).
关键词
耳鸣
声治疗
听力
随机对照试验
Tinnitus
Sound therapy
Hearing
Randomized controlled trial
