主观性耳鸣的分期治疗探讨及预后影响因素分析

Treatment for Subjective Tinnitus According to Stages and Analysis of Prognostic Factors

目的了解主观性耳鸣分期的必要性并分析影响预后的因素。方法将119例(127耳)主观性耳鸣患者随机分为治疗组和对照组,治疗组60例(65耳),根据病程分为急性期24例(25耳)、亚急性期16例(18耳)和慢性期20例(22耳);根据耳鸣匹配检查分为低中频25例(29耳)和高频35例(36耳),低中频耳鸣者采用改善微循环+激素治疗,高频耳鸣者采用离子通道阻滞剂+激素治疗。对照组59例(62耳),其中,急性期21例(23耳)、亚急性期18例(18耳)和慢性期20例(21耳);低中频25例(26耳)和高频34例(36耳);对照组均采用口服盐酸氟桂利嗪治疗。结果治疗组中急性、亚急性及慢性期患者有效率分别为92.0%、61.11%、18.18%;低中频、高频患者的有效率分别为68.96%、50.0%。对照组中急性、亚急性及慢性期患者的有效率分别为56.52%、27.78%、0;低中频、高频患者的有效率分别为42.31%、19.44%。单因素Logistic回归分析表明,性别、年龄、患耳侧别、单双耳患病、耳鸣程度、是否伴高血压、是否伴听力下降耳鸣患者的预后差异无统计学意义,而耳鸣的组别、治疗方法、频率及分期的预后差异有统计学意义。多因素Logistic回归分析表明,耳鸣的频率和分期是影响预后的主要因素。结论低中频耳鸣患者采用改善微循环和激素治疗,高频耳鸣患者采用离子通道阻滞剂和激素治疗,效果明显好于不按耳鸣频率均口服盐酸氟桂利嗪治疗耳鸣的疗效;低中频耳鸣者的预后好于高频耳鸣者;急性期及亚急性期预后较好,慢性期预后较差。有必要对主观性耳鸣患者进行分期并按不同耳鸣频率采用不同治疗方法。

Objective To explore the necessity of subjective tinnitus stage and to analysis the factors of prognosis. Methods One hundred and nineteen patients（one hundred and twenty seven ears） diagnosed as subjective tinnitus were studied from November 2010 to May 2011.All cases were randomly divided into experimental group and control group.In experimental group and control group,patients with subjective tinnitus were divided into acute,subacute and chronic stage on the basis of onset of tinnitus,and were classified as low frequency and high frequency according to tinnitus pitih matching.The experimental group of low frequency tinnitus was treated with microcirculation and steroid therapy,and high frequency tinnitus was treated with ion channel blockers and steroid therapy.The control group was treated with flunarizine hydrochloride. Results In the experimental group the effective percentage in acute,subacute and chronic stage were 92.0%,61.11% and 18.18%,respectively;the effective percentage in low frequency and high frequency were 68.96% and 50.0%,respectively.In the control group the effective percentage in acute,subacute and chronic stage were 56.52%,27.78% and 0%,respectively;the effective percentage in low frequency and high frequency were 42.31% and 19.44%,respectively.Univariate logistic regression analysis