双位点重复经颅磁刺激对慢性耳鸣的临床疗效

Clinical Observation of Double-site Repetitive Transcranial Magnetic Stimulation for Chronic Tinnitus

目的观察不同刺激方案的重复经颅磁刺激(rTMS)对慢性耳鸣的影响。方法选取2019年10月至2021年10月河南省人民医院耳鼻喉科和康复科住院及门诊共60例慢性耳鸣患者,按照随机数字表法分为双位点(AC+L-DLPFC)组、AC组和对照组,每组20例,均用1-Hz-rTMS进行治疗,双位点组先刺激L-DLPFC 1000次,再刺激听觉皮层(AC)1000次,连续2周,每周5次,共10次。AC组选择与双位点组的方案但仅刺激AC,连续2000次脉冲。对照组接受与双位点组相同方案的假刺激。采用耳鸣障碍量表(THI)和视觉模拟量表(VAS)对患者进行评估。结果治疗后发现双位点组和AC组的THI和VAS评分优于治疗前,差异有统计学意义(P<0.05),双位点组的THI和VAS评分优于AC组,差异有统计学意义(P<0.05);双位点组和AC组THI和VAS评分优于对照组,差异有统计学意义(P<0.05)。结论AC和双位点rTMS均可改善患者慢性耳鸣,但是双位点rTMS治疗效果更明显。

Objective To observe the effects of different stimulation protocols of repetitive transcranial magnetic stimulation(rTMS)on chronic tinnitus.Methods A total of 60 inpatients and outpatients with chronic tinnitus in the Department of Otolaryngology and Rehabilitation of Henan Provincial People’s Hospital from October 2019 to October 2021 were selected and divided into double-site(AC+L-DLPFC)group,AC group and control group according to random number method,with 20 cases in each group.All patients were treated with 1-Hz-rTMS.In the double-site group,L-DLPFC was first stimulated 1000 times,then auditory cortex(AC)was stimulated 1000 times,5 times a week for a total of 10 times for 2 consecutive weeks.The AC group chose the same protocol as the double-site group but only stimulated the AC for 2000 consecutive pulses.The control group received the same sham stimulus as the double-site group.Tinnitus disorder scale(THI)and visual analog scale(VAS)were used to evaluate the therapeutic effect of patients in all three groups before and after treatment.Results After treatment,THI and VAS scores in the two-site group and AC group were better than those before treatment,with statistical significance(P<0.05).THI and VAS scores in the two-site group were better than those in the AC group,with statistical significance(P<0.05).THI and VAS scores in the two-site group and the AC group were better than those in the control group,with statistical significant(P<0.05).Conclusion Both AC and dual-site rTMS can improve chronic tinnitus,but the effect of dual-site rTMS is more obvious.