低频重复经颅磁刺激治疗耳鸣的疗效分析

The Effects of Low-Frequency Repetitive Transcranial Magnetic Stimulation on Tinnitus

目的探讨低频重复经颅磁刺激治疗耳鸣的有效性和安全性。方法选取听力正常的主观性耳鸣患者102例,其中颅鸣患者34例(26~65岁,平均53±12.59岁),耳鸣患者68例(31~69岁,平均51±12.29岁);采用1Hz低频脉冲刺激患者左侧颞顶部,每次一次性连续给予1 000次脉冲刺激,脉冲间隔时间为10s,5次/周,连续2周。所有患者治疗前后采用视觉模拟量表(visual-analogue scale,VAS)评估耳鸣的严重程度。结果治疗后,34例颅鸣患者中,24例颅鸣减轻或消失,总有效率为70.59%(24/34),其中2例患者自觉颅鸣完全消失(5.88%,2/34),22例自觉颅鸣响度减轻(64.71%,22/34),治疗前VAS平均分为5.09±1.01分,治疗后降为3.06±1.77分;68例耳鸣患者总有效率为64.71%(44/68),44例耳鸣减轻或消失(64.71%,44/68),其中1例耳鸣完全消失(1.47%,1/68),43例自觉耳鸣减轻(63.24%,43/68);治疗前VAS评分为5.68±1.51分,治疗后降为3.75±2.11分。两组患者治疗前后纯音听阈无显著变化,且无一例出现头痛、头晕、头皮灼伤、癫痫发作、耳鸣加重等不良反应。结论低频重复经颅磁刺激治疗耳鸣安全有效,其中颅鸣患者效果更佳。

Objective To explore the effects and safety of low-frequency repetitive transcranial magnetic stimulation（rTMS）on treating tinnitus.Methods A total of 102 normal hearing patients with tinnitus underwent active rTMS in the left temporoparietal region.Repetitive TMS consisted of 1 000 stimulations at 1 Hz daily and110% of the motor cortex threshold for 5consecutive days per week（Monday to Friday）for 2weeks.A visual analog scale（VAS）was used to assess tinnitus loudness.All participants were interviewed regarding age,gender,tinnitus duration,laterality and pitch etc.Results Low-frequency rTMS significantly decreased tinnitus in the head after the active stimulation.After rTMS treatments,34 cases of tinnitus in the head showed an effective rate of70.6%,in which 2patients reported complete tinnitus disappearance（5.9%）,22 cases had significantly reduced effect.Sixty-eight patients in the control group showed an effective rate of 64.7%,in which 1case＇s tinnitus disappeared（1.5%）and 43 cases significantly reduced.According to the results of PTA,the hearing thresholds of the two groups had no significant difference between before and after the treatment.There were no headaches,dizziness,nausea,drowsiness,burns,seizures in all the patients after treatment.Conclusion Active low-frequency rTMS resulted in a significant reduction in the loudness of tinnitus in the head.