定制音乐用于慢性特发性耳鸣精准声治疗的前瞻性研究

发布时间：2018-03-02 15:32

本文选题：耳鸣　切入点：声治疗　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：耳鸣(tinnitus)是指患者在无外界声源存在的情况下,感受到耳部或头部的一种声音意识感觉。其主要分为客观性耳鸣和主观性耳鸣。主观性耳鸣中绝大部分是不明原因的,故也被称为特发性耳鸣(idiopathic tinnitus)。它既可以一种孤立的特发性症状存在,也可伴有不同程度的感音神经性聋。虽经多年研究与探索,对本病的医学干预仍面临诸多挑战:1、发病机制不明;2、评估手段有限;3、治疗方法虽然多元,临床效果却不肯定。慢性特发性耳鸣因其响度、持续性、烦扰程度的难以自行缓解成为其临床特点。由于耳鸣症状的主观特性,临床诊断主要基于患者对病情的描述。对耳鸣的感知常因患者的个人体验、心理素质、职业和所处社会、家庭环境的差异而有所不同,故缺少客观证据成为耳鸣研究的主要障碍之一。近年来,基于耳鸣机制中的听觉皮层不良重组理论(maladaptive auditory cortex reorganization),2010年Pantev首先提出应用经过特殊处理的定制音乐(tailor-made notched music,TMNM)对耳鸣进行个体化声治疗并对开展了相关的临床试验。迄今此类研究为数不多,且多为单中心和小样本,对其临床效果和应用价值的评价尚无定论,相关的循证医学证据还有待拓展与充实。本文采用前瞻设计和随机对照,与现有耳鸣声治疗方法进行比较,初步分析定制音乐对于慢性特发性耳鸣的近期效果,并探讨其可能机制。目的应用定制音乐疗法对慢性特发性耳鸣患者进行个体化干预,并与现有耳鸣声治疗常用方法进行比较,分析定制音乐疗法对慢性特发性耳鸣的治疗效果并探讨其可能作用机理。方法对象为2015年6月—2016年10月就诊于我院耳鼻咽喉科门诊的不明原因、伴有或不伴有感音神经性聋,病程≥6个月的耳鸣患者。患者经过严格的入选及排除标准纳入试验中后采用前瞻性设计。将其随机分为个体化组(A组=20人),类掩蔽组(B组=20人)和类习服组(C组=20人)进行为期3个月的声治疗。治疗前及治疗中的每个月分别对其进行耳鸣量表、耳鸣响度及听力学评估。结果经过1个月规律治疗,三组间有效率分别为38.9%、41.2%和41.2%,差异尚不明显(x2=0.026,P=0.9870.05)。治疗2个月时A组有效率异(44.4%)高于B组(29.4%),但低于C组(52.9%),同样三组间有效率也未见明显差异(x2=1.979,P=0.3720.05)。经过3个月的规律治疗后,A组有效率明显优于其他两组(77.8%vs 23.8%vs 52.9%,x2=10.317,P=0.0060.05);且随治疗时间的推移,A组有效率呈明显上升趋势(Χ2=6.406,P=0.0410.05),B组有效率下降但无明显意义(Χ2=1.275,P=0.5290.05);C组治疗一个月也呈现出一定疗效,C组有效率短期内上升后两个月保持不变(Χ2=0.628,P=0.713)。分析各组耳鸣残疾量表(tinnitus handicap inventory,THI)(F=5.603,P=0.0020.05)、响度视觉模拟量表(visual analogue scale,VAS)(F=13.780,P0.001)和耳鸣匹配响度数据(F=3.738,P=0.0270.05),显示A组疗效表现出明显的优势。结论本研究提示,经特殊声学处理的音乐可用于慢性特发性耳鸣的治疗。长时程、规范化聆听经个体化处理的定制音乐,可以显著减轻患者的耳鸣响度,不同程度地改善耳鸣对患者生活质量造成的影响。作者对该方法的效果与可能的机制进行了分析。
[Abstract]:Tinnitus (tinnitus) refers to the patients without the external sound source condition, feel a sound sense of head or ear feeling. It is mainly divided into objective tinnitus and tinnitus. Most subjective tinnitus in the cause is unknown, it is also known as idiopathic tinnitus (idiopathic tinnitus). Can a solitary idiopathic symptoms may also exist, with varying degrees of sensorineural hearing loss. Although the research and exploration of medical intervention for many years, the disease is still facing many challenges: 1, unknown pathogenesis; 2, evaluation means limited; 3, although the multi treatment clinical effect, but not sure. Chronic idiopathic tinnitus because of its loudness, persistent annoyance degree are difficult to alleviate as its clinical features. Because of the subjective characteristics of tinnitus symptoms, clinical diagnosis is mainly based on the description of the disease. Patients of tinnitus perception due to patients. People experience, psychological quality, occupation and social differences, family environment is different, so the lack of objective evidence has become one of the main obstacles of tinnitus research. In recent years, the mechanism of tinnitus in auditory cortex (maladaptive auditory based on the theory of adverse recombinant cortex reorganization), 2010 Pantev first proposed the application after special treatment of custom music (tailor-made notched music, TMNM) for individual sound treatment of tinnitus and relevant clinical trials carried out. So far this kind of research are few, and mostly and small single center, to evaluate the clinical effect and application value have been inconclusive, evidence has yet to expand and enrich the related in this paper. A prospective and randomized design, comparing with the existing tinnitus treatment method, a preliminary analysis of the recent effect of custom music for chronic idiopathic tinnitus, and explore the The possible mechanism to custom application of music therapy on chronic idiopathic tinnitus patients with individualized intervention, and with the existing tinnitus therapeutic methods of comparison, analysis of customized music therapy on chronic idiopathic tinnitus treatment effect and to explore the possible mechanism. Methods of unknown reason as June 2015 to October 2016 in our hospital department of Otorhinolaryngology clinic, with or without sensorineural hearing loss, course more than 6 months. The patients with tinnitus patients after the inclusion and exclusion criteria included in the test after the prospective design strictly. It will be randomly divided into individual group (A group =20), group B (class of masking group =20) and acclimatization group (C group =20) sound therapy for 3 months. A month before and after treatment respectively on the scale of tinnitus, tinnitus loudness and audiological assessment. Results after 1 months of treatment, between the three groups The efficiency were 38.9%, 41.2% and 41.2%, the difference is not obvious (x2=0.026, P=0.9870.05). 2 months A treatment group effective rate of (44.4%) is higher than that of B group (29.4%), but lower than that of group C (52.9%), the same between the three groups showed no significant difference between the efficiency (x2=1.979, P=0.3720.05). After the law 3 months after treatment, A group was significantly better than the other two groups (77.8%vs 23.8%vs 52.9%, x2=10.317, P=0.0060.05); and with the treatment time, the effective rate of group A was significantly increased (x 2=6.406, P=0.0410.05), B group, but no significant decline in the efficiency of meaning (x 2=1.275. P=0.5290.05); group C one month of treatment also showed a certain effect, the efficiency of the C group in the short term after rising two months remained unchanged (x 2=0.628, P=0.713) were analyzed. The tinnitus disability scale (tinnitus handicap inventory THI (F=5.603), P= 0.0020.05), loudness, visual analogue scale (visual analogue scale (F=13.780, VAS), P0.001) and tinnitus loudness matching data (F=3.738, P=0.0270.05), show the efficacy of the A group showed obvious advantages. Conclusion this study suggests that, after the special acoustic processing of music can be used for the treatment of chronic idiopathic tinnitus. Long term, standardized listening to the individualized treatment of customized music, can significantly reduce patients tinnitus loudness, improve the effect on quality of life in patients with tinnitus caused by the author. The effect of the method and the possible mechanism is analyzed.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R764.45

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