主观性耳鸣的掩蔽及习服治疗效果分析

Analysis and comparison of the masking and TRT for patients with subjective tinnitus

目的:比较耳鸣掩蔽和习服治疗在主观性耳鸣治疗中的效果,分析掩蔽试验阳性组及阴性组耳鸣的习服治疗效果,为耳鸣的个性化治疗方案提供依据。方法:2006-01-2008-04就诊的主观性耳鸣患者217例,均行耳鸣检测(包括耳鸣音调、响度匹配、残余抑制试验等),其中掩蔽试验阳性患者143例,掩蔽试验阴性74例;随机将143例掩蔽试验阳性患者中75例纳入耳鸣掩蔽治疗组,其余68例加上74例掩蔽试验阴性共142例纳入耳鸣习服治疗组;随访中有10例失访,掩蔽治疗组6例,习服治疗组4例;最后疗效统计为207例,其中耳鸣掩蔽治疗组69例,耳鸣习服治疗组138例(包括掩蔽试验阳性66例及掩蔽试验阴性72例)。2组分别治疗6个月后对其疗效进行比较,疗效的评定采用国际公认的耳鸣残疾度量化表问卷及主观视觉耳鸣严重程度标尺进行评定。结果:耳鸣掩蔽治疗及耳鸣习服治疗均对耳鸣患者有效,2组治疗前后耳鸣严重程度得分及主观视觉耳鸣程度经检验均P<0.01;耳鸣习服治疗组与耳鸣掩蔽治疗组在前后耳鸣严重程度得分差方面差异有统计学意义,习服治疗较耳鸣掩蔽效果好;但其主观视觉耳鸣程度方面两者之间差异无统计学意义。耳鸣习服治疗对掩蔽试验阳性及阴性患者均有效,且两者之间差异无统计学意义。结论:耳鸣掩蔽治疗及耳鸣习服治疗均对耳鸣患者有效,是耳鸣治疗的首选手段,但习服治疗对掩蔽试验阳性及阴性患者均有效,而且在某些方面明显优于耳鸣掩蔽疗法,应用范围较广,是一个值得推广的治疗方法。

Objective：To compare the effect of tinnitus masking and tinnitus retraining therapy（TRT） in patients with subjective tinnitus,and to analyze the effect of TRT within the positive or negative group of tinnitus masking test.Method：The 217 patients from January,2006 to April,2008 in our hospital,were performed with the determination of tinnitus including pitch matching、intensity matching、Feldmann masking curve and residual inhibition test with TinniTestTM.Of which 143 cases were positive and 74 were negative in tinnitus masking.The follow-up was 6 months and 10 cases were lost.207 patients were divided into two groups for prospective study： 69 cases in tinnitus masking group and 138 cases in TRT group,The curative effect was evaluated according to tinnitus handicap inventory（THI） and Subjective Visual Tinnitus Scale（SVTS）.Result：Both masking treatment and TRT were effective for cases with tinnitus,there was significan difference of the score of THI and SVTS of tinnitus between pretherapy and posttherapy（P〈0.01）.TRT therapy was more effective than masking therapy,there was significant difference of the THI score between TRT and masking group,but there was no significant difference of of the SVTS between them.TRT therapy was suitable for the patients with both positive effect and negative effect of masking test,and there was no significant difference between them.Conclusion：Both TRT and masking therapy are the most important therapy for tinnitus patients,but TRT is much more effective than masking therapy in some aspects.