个性化多元复合声对慢性主观性耳鸣临床疗效的初步分析

Preliminary analysis of the effects of individualized sound therapy on chronic subjective tinnitus

目的:探讨个性化定制的多元复合声对慢性主观性耳鸣的治疗效果,以及耳鸣频率、听力损伤"切迹"与治疗效果的关系。方法:研究对象为就诊于我院眩晕耳鸣门诊的慢性主观性耳鸣患者78例,其纯音测听阈值正常,均接受了3个月的个性化定制复合声治疗。治疗前对其进行精细化听力学检测(包括精细化纯音测听、耳鸣匹配、残余抑制),并于治疗前、治疗第30天和第90天进行耳鸣残疾量表评估(THI)。结果:(1)78例患者,治疗前THI评分为24.62±15.65,治疗第30天为15.82±13.02,第90天为13.62±10.98,治疗第30天、第90天的THI评分较治疗前均显著性下降(P<0.01),但第30天和第90天的THI评分差异无统计学意义(P>0.05)。(2)耳鸣患者的性别、年龄及耳鸣侧别对耳鸣的个性化复合声治疗的疗效无影响(P>0.05)。(3)78例患者的精细化纯音听阈测试,有损伤"切迹"的31例,无"切迹"的47例,2组之间的THI评分在治疗第30天和第90天差异均无统计学意义(P>0.05),提示纯音测听损伤"切迹"对耳鸣的个性化复合声治疗的疗效无影响。(4)31例有切迹的患者,22例耳鸣频率位于"切迹"频率范围内,9例位于"切迹"频率范围之外,治疗第30天2组之间的疗效差异有统计学意义(P<0.05)。治疗第30天,有4例"切迹"在耳鸣频率之外的患者耳鸣频率发生改变,漂移至切迹频率范围之内,其频率漂移在治疗第90天有显著性差异(P<0.05)。结论:个性化定制的复合声治疗能够降低慢性主观性耳鸣患者的THI评分,改善由于耳鸣症状产生的影响和困扰,且耳鸣频率分布在听力损伤频率范围的患者声治疗效果较好。

Objective：To explore the effect of individualized multi-compound sound therapy on chronic subjective tinnitus and the relationship between tinnitus frequency, ＂ notch＂ hearing loss and the treatment effect of sound therapy.Method：Seventy-eight cases of chronic subjective tinnitus with the pure tone test threshold（PTA）in normal range（≤25 dB HL）were enrolled in this study.Their hearing threshold were re-evaluated using the precise pure-tone audiogram（P-PTA）.Tinnitus was evaluated on pitch and loudness matching,and the effectiveness of tinnitus was measured using Tinnitus Handicap Inventory（THI）before they received the individualized customized multi-compound sound therapy for 3 months.THI were re-evaluated on the 30 th day and 90 th day after treatment.Result：（1）The averaged THI score of these patients before the sound treatment was 24.62±15.65（n=78）.The score dropped significantly to 15.82±13.02 and 13.62 ±10.98 on the 30 th day and 90 th day after treatment,respectively（P〈0.01）.（2）Patient＇s gender,age,and the side of tinnitus has no effect on the sound treatment of tinnitus.（3）Of these 78 tinnitus patients,31 patients who showed ＂ notch＂ hearing loss and 47 patients without ＂ notch＂ hearing loss in the P-PTA.The averaged THI score between the patients with and without ＂notch＂ showed no statistical difference after the treatment（P〉0.05）.These data suggested that ＂ notch＂ hearing loss in P-PTA has no effect on the sound therapy.（4）Of 31 tinnitus patients with ＂ notch＂ hearing loss,the tinnitus frequency of 22 cases was at the ＂ notch＂ hearing loss and that of 9 cases was not at the ＂ notch＂ hearing loss.Sound treatment showed significant between the former and the latter（P〈0.05）.After 30 days of treatment,tinnitus frequency of four patients whose tinnitus was not at the notch hearing loss drifted to the ＂ notch＂ hearing loss frequency.Conclusion：Customized multi-compound sound therapy can reduce the THI score of chronic subjective tinnitus patients.The treatment reduced patient＇s anxiety and improved their quality of life.Sound treatment showed a better improvement in the patients whose tinnitus frequency was located at their notch hearing loss.