声敏感的临床特征及与耳鸣的关系

Clinical features of acoustic hypersensitivity and its relationship with tinnitus

目的提出声敏感的命名,并探讨其临床特征及与耳鸣的关系。方法 2014年1月—2016年1月对214例以声敏感或耳鸣为第一主诉的患者进行临床调查,收集其具体临床表现、伴随症状及相关病史,指导患者填写听觉过敏量表、焦虑自评量表,对耳鸣患者应用耳鸣评价量表进行耳鸣程度评估。结果声敏感患者中耳鸣的发生率为93.3%,耳鸣患者中声敏感的发生率为47.3%,声敏感发生率随着耳鸣程度的加重而升高;55.1%的声敏感与耳鸣同时发生,34.7%的声敏感发生在耳鸣之后,10.2%的声敏感发生于耳鸣之前。声敏感患者中,大多数对高于普通音量的任何性质的声音感到不适,主要的不适为心烦,其次还有耳内或颅内回响、耳内胀闷或刺痛等,68.6%的患者在外界声音停止后不适感即消失;声敏感患者常伴有听力下降、耳堵塞感、眩晕及焦虑等;28.6%的声敏感患者有噪声接触史。结论声敏感大多与耳鸣合并存在,二者的关系十分密切,但临床特征明显不同,对声敏感统一命名、规范概念、加强诊断与临床评估的研究十分必要。

Objective To propose and relationship with tinnitus. Methods the terminology of acoustic hypersensitivity, and investigate its clinical features A total of 214 patients with acoustic hypersensitivity or tinnitus as their first chief complaint were recruited and studied between January 2014 to January 2016. Detailed information of clinical manifestations, accompanying symptoms and related medical history were collected in the patients with acoustic hypersensitivity. Patients were instructed to complete the Hyperacusis Questionnaire and the Self-rating Anxiety Scale. The Tinnitus Evaluation Questionnaire was used to evaluate tinnitus severity in patients with tinnitus. Results Among the patients with acoustic hypersensitivity as their first chief complaint, 93.3% had tinnitus; 47.3% of the patients with tinnitus as their first chief complaint had acoustic hypersensitivity and the prevalence of acoustic hypersensitivity increased as the tinnitus severity increased. In terms of onset of the two symptoms, simultaneous acoustic hypersensitivity and tinnitus occurred in 55.1% of the patients, acoustic hypersensitivity occurred after tinnitus in 34,7% of the patients, and acoustic hypersensitivity occurred before tinnitus in 10.2% of the patients. Most patients with acoustic hypersensitivity as the first chief complaint felt uncomfortable to any sounds that are louder than usual. The main manifestations included feeling disturbed, echoing in the ear or head, ear fullness or pain. Discomfort in 68.6% of the patients disappeared when there was no environmental sound. It was found that hearing loss, ear fullness, vertigo, and anxiety were usually present in patients with acoustic hypersensitivity, and 28.6% of the patients with acoustic hypersensitivity had a history of noise exposure. Conclusions Acoustic hypersensitivity occurs together with tinnitus for the majority of time, which shows a close relationship between these two symptoms. However, acoustic hypersensitivity shows different clinical manifestations from tinnitus. It is important to unify the terminology and standardize the concept of acoustic hypersensitivity among clinicians. It is also critical to conduct more clinical research in terms of diagnosing and evaluating acoustic hypersensitivity.