掩蔽治疗和习服治疗对慢性主观性耳鸣的临床疗效观察

Clinical treatment observation of chronic subjective tinnitus treated by masking therapy and tinnitus retraining therapy

目的 对比观察掩蔽治疗和习服治疗对慢性主观性耳鸣的临床疗效。方法 选取2014-2015就诊的主观性耳鸣患者116例（161耳）,均行耳鸣检测（包括耳鸣音调、响度匹配、残余抑制试验等）,其中掩蔽试验结果阳性和阴性分别为89例和27例。从89例阳性者中随机选取48例,采用掩蔽治疗（掩蔽治疗组）,其余41例患者和27例阴性患者采用习服疗法治疗（习服组）。分别于后6个月及12个月采用国际公认的耳鸣残疾度量表对其进行疗效评定,对比观察两组治疗6个月、12个月的耳鸣残疾度量化表（THI）评分和临床疗效。结果 与治疗前相比,两组治疗后6个月和12个月,THI评分均显著下降,且治疗12个月明显低于治疗6个月,差异均有统计学意义（P〈0.01）;习服组治疗后6个月和12个月THI评分（35.56±4.36分,27.01±4.21分）均明显低于掩蔽组（37.56±3.19分,33.41±4.34分）,差异有统计学意义（P〈0.01）。治疗后6个月和12个月,习服组总有效率（73.5%,80.8%）均明显高于掩蔽组（54.0%,60.4%）,差异有统计学意义（P〈0.05）。结论 掩蔽治疗和习服治疗对慢性主观性耳鸣患者均有效,习服治疗在改善THI评分和总有效率方面明显优于掩蔽治疗。

Objective To observe the clinical curative effect in treating chronic subjective tinnitus with masking therapy and tinnitus retraining therapy （TRT）. Methods Subjective tinnitus patients from 2014 to 2015, total 116 cases （ 161 ears） were selected, who were tested for tinnitus （ including matching tinnitus pitch, loudness, residual inhibition test, etc. ）, among which masking test results turned out 89 positive cases and 27 negative cases. 48 cases were randomly selected from 89 positive cases, using masking therapy （masking treatment group）, the remaining 41 patients and 27 negative cases received tinnitus retraining therapy （tinnitus retraining therapy group）. After 6 months and 12 months of treatment, curative effect evaluation of the two groups were performed with the internationally accepted tinnitus disability scale, the THI score and the clinical curative effect were compared. Results Compared with patients＇pre - treatment conditions, two groups after receiving 6 months and 12 months of treatment, had shown significantly decreased THI score, and the 12 months period score was considerably less than that of the 6 months treatment results, with significant difference （ P 〈 0.01 ）. Retraining group returned the following THI score （35.56 ± 4.36 points, 27.01 ± 4.21 points ） when 6 months and 12 months in the treatment. The scores were clearly lower than those of the masking group （ 57.56 ± 3.19 points, 33.41 ± 4.34 points） with significant difference （ P 〈 0.01 ）. After 6 months and 12 months of treatment, tinnitus retraining therapy groupg total effective rate （73.5%, 80.8% ） was significantly higher than that of the masking group （54.0%, 60.4% ）, and the difference was statistically significant （ P 〈 0.05 ）. Conclusion Masking therapy and tinnitus retraining therapy are both effective for chronic patients with subjective tinnitus, with tinnitus retraining therapy showing more positive results than masking treatment in terms of THI score and the total effective rate.