耳鸣习服疗法治疗耳鸣患者117例临床分析

Tinnitus retraining therapy: a clinical control study of 117 patients

目的 探讨耳鸣习服疗法 (TRT)的临床效果。方法 将 2 2 5例以耳鸣为第一主诉的长期严重主观耳鸣患者分为 2组 ,TRT组 1 1 7例 ,对照组 1 0 8例。TRT组采用习服疗法 ,即在医生指导下让患者长期坚持耳鸣不全掩蔽、松弛训练、转移注意力和心理咨询等习服训练 ,并且必须使用有声材料如耳鸣掩蔽器、助听器、音乐光盘、收音机、磁带等以协助达到对耳鸣适应和习惯的目的。对照组不用习服疗法 ,按照自愿原则可用可不用有声材料 ,不给予任何习服训练的指导 ,观察能否达到习服的目的。两组均在治疗开始后 2、6和 1 2个月时进行 3次疗效评定。疗效分为完全适应、基本适应、部分适应、未适应。结果 TRT组总适应率 2个月时为 1 7.0 9% ,6个月为 82 .0 5 % ,1 2个月 88 0 3 %。对照组总适应率 2个月时 2 .78% ,6个月为 2 6 .85 % ,1 2个月为 41 .67%。 2组分别在 2、6和 1 2个月时比较 (χ2 检验 ) ,差异均有非常显著性意义 (均P <0 .0 1 )。结论 耳鸣习服疗法是临床治疗耳鸣的理想方法。

Objective To investigate the clinical effects of tinnitus retraining therapy (TRT) on tinnitus. Methods 225 tinnitus patients were divided into two groups. 117 patients in the TRT group were treated with TRT and drugs, and 108 patients in the control group were treated with only tinnitus masking and drugs. The TRT is consisted of four strategies: (1) tinnitus masking with low level and broad band noise; (2) deep relaxation of the whole body; (3) diversion of the attention to other things; and (4) psychological counseling and therapy. Drugs, such as vasodilator, neurotrophic drug, and sedative of the similar dose and duration of pharmacotherapy were administered to the 2 groups. Effect evaluation was conducted thrice 2, 6, and 12 months after the beginning of therapy to see if the tinnitus was attenuated or disappeared and if the patients′ emotion, sleep, and work were disturbed by tinnitus. Results The relief rate was 17.09%, 82.05%, and 88.03% in the TRT group 2, 6, and 12 months after respectively; and 2.78%, 26.85%, and 41.6% in the control group 2, 6, and 12 months after respectively (χ 2=12.54, 69.30, and 63.64, all P <0.01). Conclusion TRT is effective in treatment of tinnitus.