854例耳鸣患者的临床特征分析

Clinical characteristics of tinnitus:an analysis of 854 patients

目的探讨收诊的耳鸣患者临床特征,为耳鸣的诊治提供参考依据。方法收集2018年1月—2021年12月在门诊以耳鸣为第一主诉的854例患者的临床资料,统计分析临床特征,并将患者性别、年龄、侧别、病程、持续性、患耳听力损失程度、耳鸣响度、耳鸣音调、焦虑自评量表评分、睡眠指数评分等因素为自变量,以耳鸣残疾量表评分为因变量,进行多因素线性回归和相关性分析。结果854例耳鸣患者共有1290耳伴耳鸣,患者的平均年龄为(46.7±14.65)岁,在30~60岁年龄段的耳鸣患者占比最大(65.2%,557/854);其中耳鸣多为持续性(84.0%,717/854),双侧耳鸣和单侧耳鸣约各占一半,在双侧耳鸣患者中多为对称性耳鸣(97.0%,423/436);54.7%(467/854)的耳鸣患者伴有不同程度的焦虑症状,58.8%(502/854)的耳鸣患者伴有不同程度的睡眠障碍,33.0%(426/1290)的耳鸣伴有不同程度的听力下降。耳鸣残疾量表分级以2~3级为主(18~56分,83.3%,711/854);音调匹配以高频多见(4~8 kHz,77.3%,997/1290);耳鸣响度以中低响度多见(<60 dB,82.3%,1062/1290)。耳鸣持续性(β=-0.690,P=0.011)、听力损失程度(Spearman=0.140,P<0.001)、耳鸣响度(β=0.046,P=0.002;Spearman=0.135,P<0.001)、匹兹堡睡眠质量指数评分(β=0.049,P=0.001;Spearman=0.214,P<0.001)、Zung氏焦虑自评量表(β=0.055,P<0.001;Spearman=0.241,P<0.001)与耳鸣残疾量表评分有关。结论2018年以来就诊的耳鸣患者其耳鸣严重程度多为轻中度,耳鸣音调多为高频,且大多数为中低响度的耳鸣声。耳鸣的发病人群逐渐年轻化,且多伴有焦虑、睡眠障碍、听力下降等症状。耳鸣的严重程度和耳鸣持续性、听力损失、耳鸣响度、睡眠障碍和焦虑相关,未来应该着重针对这部分人群制定个性化的耳鸣治疗方案。

Objective To evaluate the clinical characteristics of tinnitus patients,and to provide profiles for the diagnosis and treatment of tinnitus.Methods A total of 854 patients with tinnitus seeking treatment in out-patient department of our hospital between Jan 2018 and Dec 2021 were included.Their clinical characteristics were collected.Multivariate correlation analyses were performed,selecting the provided sex,age,tinnitus laterality,course of disease,tinnitus persistence,hearing loss,tinnitus loudness,tinnitus main tone matching,self-rating anxiety scale and Pittsburgh sleep quality index as independent variables,and the tinnitus handicap inventory(THI)score as dependent variable.Results All the 854 tinnitus patients had a total of 1290 tinnitus ears.The average age was 46.7±14.65 years old,and the largest proportion was in the age group of 30 to 60 years old(65.2%,557/854).Tinnitus was persistent in most patients.Bilateral and unilateral tinnitus each accounting for half,and symmetric tinnitus was more common in patients with bilateral tinnitus(97.0%,423/436).The percentages of the patients with different degrees of anxiety and sleep disorders were 54.7%(467/854)and 58.8%(502/854),respectively.Thirty-three percent(426/1290)of the tinnitus ears accompanied varying degrees of hearing loss.THI score was mainly graded from 2 to 3(18~56 score,83.3%,711/854).Most tinnitus(77.3%,997/1290)matched to high frequencies(4~8 kHz).The predominant intensity of tinnitus was low to medium loudness(<60 dB,82.3%,1062/1290).Tinnitus persistence(β=-0.690,P=0.011),hearing loss(Spearman=0.140,P<0.001),tinnitus loudness(β=0.135,P=0.002;Spearman=0.140,P<0.001),Pittsburgh sleep quality index score(β=0.049,P=0.001;Spearman=0.214,P<0.001),self-rating anxiety scale(β=0.055,P<0.001;Spearman=0.241,P<0.001)were related to THI score.Conclusion Currently,the tinnitus patients are gradually younger,and most of them are accompanied by symptoms such as anxiety,sleep disturbance,and hearing loss.Most of the tinnitus patients seeking treatment in our hospital have tinnitus of low to moderate severity,high frequency tone,and low to medium loudness.The severity of tinnitus is associated with tinnitus persistence,hearing loss,tinnitus loudness,sleep disturbance and anxiety.Therefore,we should focus on developing personalized tinnitus treatment plans for these tinnitus patients in the future.