慢性耳鸣急性加重或再次失代偿的社会心理因素分析

Social psychological factors causes of acute exacerbation or re-decompensation of clinically significant chronic tinnitus

目的:分析负性生活事件及社会支持度对慢性耳鸣预后的影响,为及时有效地发现、干预负性生活事件的影响,改善慢性耳鸣的预后提供理论依据。方法:对136例慢性耳鸣急性加重或再发失代偿的患者进行系统的听力学检查、耳鸣严重程度评估,对未查及新出现听力损失者进一步行生活状况调查及社会支持评定量表评估,并对病因明确者进行相应干预。结果:1新出现听力改变89例,患者均能诉说耳鸣加重的准确时间,5例同时感觉听力损失加重;2遭遇负性生活事件42例,耳鸣病情加重出现在数周到3个月之内,患者多不能提供耳鸣加重或再次失代偿的准确发生时间,未查及耳鸣加重原因5例;3未查及新出现听力损失47例患者社会支持度得分显著低于健康成年人。结论:导致慢性耳鸣急性加重的重要原因需首先检查是否新出现听力损失,及时发现并给予有效治疗可挽回新出现的听力损失,治愈或减轻耳鸣;负性生活事件及较低的社会支持度是慢性耳鸣加重或再次失代偿的另一重要原因,提示耳鸣的诊疗需要深入关注听觉以外的病因或诱因。

Objective：To analyze social-psychological causes of acute exacerbation or re-decompensation of chronic tinnitus and provide theoretical basis for controlling and preventing tinnitus exacerbation and re-decompensation.Method：Systemic audiological tests and tinnitus handicap inventory were performed on 136 chronic tinnitus patients with acuteexacerbation or re-decompensation.For the patients with new hearing loss,a further investigation of living conditions and assessment of social support rating scale were utilized.The patients with relatively definite causes were treated accordingly.Result：1 There were 89 patients complained of new changes of hearing,all of whom could tell the definite time point of tinnitus exacerbation,and 5of them felt the exacerbation of hearing loss meanwhile.2 Forty-two patients encountered adverse events on life or working,and tinnitus exacerbation occurred within several weeks to 3months afterwards.Most of these patients could not tell the definite time point of tinnitus exacerbation or re-decompensation.Five cases of tinnitus exacerbation didn＇t tell any adverse events on life or working,but showed mood disorders,and the anti-anxiety treatment was effective to them.3Forty-seven cases without new hearing loss scored significantly lower in SSRS than healthy adults.Conclusion：Emerging hearing loss is the main cause of acute exacerbation of chronic tinnitus.To find it in time and give effective treatment can save newly presented hearing loss,cure or relieve tinnitus.Adverse events in life（or working）and short of social support is another important cause of acute exacerbation of chronic tinnitus or decompensation recurrence,which suggests that social-psychological factors besides of hearing loss should be concerned in diagnosis and treatment of tinnitus.