音乐联合认知行为疗法治疗主观性耳鸣及脑电图变化

Effectiveness of music combined cognitive behavior therapy on subjective tinnitus and observation of changes of resting-state EEG

目的探讨音乐联合认知行为疗法对主观性耳鸣患者的治疗效果以及在闭眼状态下治疗前后的静息态脑电图(electroencephalogram,EEG)中的频谱特征变化。方法对8例主观性耳鸣患者为实验组,其中男4例,女4例,年龄18～40岁,平均(33.57±8.52)岁,病程(6.00±3.63)个月,右利手。进行音乐联合认知行为治疗,共6次会谈治疗。初次会谈治疗包括:与患者建立基本信任,了解患者性格、耳鸣症状、病史等基本情况;根据患者耳鸣频率、强度匹配频率和强度近似、经特殊处理的轻音乐,作为联合认知行为治疗的音频;收集主观性耳鸣患者7分钟EEG、耳鸣致残量表(tinnitus handicap inventory,THI)、耳鸣主观严重程度视觉模拟标尺(visual analogue scale,VAS)和焦虑自评量表(self-rating anxiety scale,SAS)。后5次会谈是训练和辅导患者一种放松疗法,主要是依每次会谈治疗的反馈,量身制定放松疗法。音乐联合认知行为治疗3个月后随访,复查8例患者7分钟EEG,以及THI、VAS和SAS量表。比较治疗前后7分钟EEG,以及THI、VAS和SAS量表结果。另招收8位无耳鸣,且听力正常受试者为对照组,其中男4例,女4例,年龄20～45岁,平均(21.26±7.56)岁。均右利手。对照组均行7分钟EEG检查。结果治疗前两组EEG比较,差异有统计学意义(t=4.404,P<0.05)。8例主观性耳鸣患者治疗前后EEG全频段(0.5～44 Hz)能量比较,差异有统计学意义(t=3.705,P<0.05),且治疗后实验组和对照组EEG平均功率更为相似。比较治疗前后患者THI量表(t=3.664,P<0.05)、VAS量表(t=3.265,P<0.05),差异有统计学意义;SAS量表比较,差异无统计学意义。结论音乐联合认知行为治疗对主观性耳鸣患者具有显著疗效,EEG能客观显示患者康复状况,具有一定康复指导意义。

OBJECTIVE To investigate the therapeutic effects of music combined cognitive behavioral therapy on subjective tinnitus and the changes in spectral characteristics of resting electroencephalogram(EEG) before and after treatment under eyes closed condition. METHODS 8 patients with subjective tinnitus were enrol.led as experimental group including 4 males and 4 females,with a mean age of 33.57±8.52 years from 18 to 40 years,6.00±3.63 months of illness and right-handedness. Music combined cognitive behavioral therapy included a total of 6 sessions of treatment.The initial session of the treatment aimed to establish basic trust with the patient and understand the patient's personality,tinnitus symptoms, medical history,and other basic conditions.The light music which was specially processed by mactching the frequency and intensity to the patient's tinnitus were selected as combined audio of cognitive behavioral therapy.7 minutes of closed-eye resting state EEG,THI scale,VAS scale, and SAS scale of the patients with subjective tinnitus were collected.The last 5 sessions was a tailored relaxation therapy including training and counseling patients to understand the treatment feedback after each meeting.After 3 months of the therapy,7 minutes of EEG,THI,VAS and SAS scales of the 8 patients were asessed.The results of 7min-EEG,THI,VAS,and SAS scales were compared in patients with tinnitus before and after treatment.In addition, 8 patients with normal hearing and without tinnitus were enrolled as control group including 4 males and 4 females,with a mean age of 21.26±7.56 years from 20 to 45 years and right-handedness.The control group underwent 7 minutes of EEG examination.RESULTS The difference between the two groups before treatment was statistically significant(t=4.404,P<0.05).The full-band(0.5-44 Hz) energy of EEG before and after treatment in 8 patients with subjective tinnitus was statistically significant(t=3.705, P<0.05),and the average power of EEG after treatment in the experimental group and the control group was similar. The THI scale(t=3.664,P<0.05)and VAS scale(t=3.265,P<0.05)were compared before and after treatment and the difference was statistically significant.The difference of SAS scales between the two groups was not statistically significant(P>0.05).CONCLUSION Music combined with cognitive behavioral therapy has a significant effect on subjective tinnitusand the closed-eye resting state of brain power can show the recovery of subjective ,tinnitus of patients objectively which has significance for rehabilitation.