急、慢性耳鸣的临床和心理声学特征分析

发布时间：2018-02-11 01:28

  本文关键词： 耳鸣 临床特征 心理声学　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：耳鸣(tinnitus)是一种在没有外源性声、电刺激情况下,耳内或颅内产生的异常听觉感知,并且持续5分钟以上。耳鸣的发病率很高,美国和欧洲在2003年的调查显示,耳鼻咽喉科门诊的10%~20%的患者是以耳鸣为主诉就诊,其中经常因为耳鸣就诊的患者达5%~10%,因为耳鸣严重影响到患者的生活、注意力集中、工作、社交活动以及睡眠的占2%~5%,由于严重的耳鸣导致残疾的患者约有0.5%~1%。耳鸣带给患者的痛苦除了恼人、单一的声音外,其伴随的精神情绪症状,如睡眠障碍,焦虑,抑郁,注意力不集中等也值得我们重视。按照耳鸣的性质,可分为主观性耳鸣与客观性耳鸣;根据耳鸣对患者的影响,可分为恼人的耳鸣和不恼人的耳鸣。2014年美国《耳鸣指南》中指出,根据耳鸣的病程将耳鸣分为:1.新近发生的耳鸣:耳鸣持续时间短于6个月(急性耳鸣);2.持续性耳鸣:耳鸣持续6个月以上(慢性耳鸣)。由于耳鸣的病因,发病机制复杂,所以耳鸣的治疗效果也不尽如人意。有研究显示,急性耳鸣的预后较慢性耳鸣预后好。急性耳鸣多有因可循,常给予药物治疗,而慢性耳鸣多为原发性耳鸣,不易完全消除耳鸣声,临床上多采用声治疗的方法治疗慢性耳鸣。不同病程的耳鸣,其病因及发病机制不同,临床及心理声学特征也不尽相同。为了探讨不同病程耳鸣的特点,本文通过对不同病程耳鸣患者的分析,探讨急、慢性耳鸣患者在病因,临床特征,耳鸣的伴发症状及耳鸣的心理声学特征的不同,以期对耳鸣的临床治疗提供依据,提高耳鸣患者的疗效。对象与方法研究对象选自2015年9月至2016年6月期间就诊于郑州大学第一附属医院耳科的耳鸣患者343例。采集耳鸣患者病史,记录患者一般情况:患者的性别、年龄、耳鸣侧别、起病情况、是否为持续性、持续时间、伴随疾病,睡眠质量情况:有无入睡困难、多梦、早醒等。并由同一位具有资质的专业人员,给予纯音测听、声导抗测试,耳鸣匹配检查。运用“耳鸣残疾量表”评估患者的耳鸣严重程度,使用“焦虑自评量表”,“抑郁自评量表”评估耳鸣患者的有无焦虑及抑郁状态。根据结果进行统计学分析。结果1.急、慢性耳鸣的病因构成比较结果:急性耳鸣组,突发性耳聋94例(51.93%),原发性耳鸣67例(37.01%)。慢性耳鸣组,原发性耳鸣122例(75.31%)。2.急、慢性耳鸣患者的一般临床特征比较结果:急性耳鸣组:男性97例(53.59%);45~60岁患者70例(38.67%);左耳鸣89例(49.17%),右耳鸣73例(40.33%);持续性耳鸣137例(75.69%)。慢性耳鸣中:男性75例(46.29%),45~60岁患者58例(35.80%);左耳鸣66例(40.74%),右耳鸣68例(41.98%);持续性耳鸣耳鸣108例(66.67%)。两组相比患者在性别、年龄、耳鸣侧别及持续性的分布上构成差异无统计学意义(P0.05)。3.急、慢性耳鸣患者的伴随症状比较结果:急性耳鸣伴睡眠障碍82例(45.30%),伴焦虑症状38例(20.99%),伴抑郁症状22例(12.15%);慢性耳鸣患者伴睡眠障碍57例(35.19%),伴焦虑症状17例(10.49%),伴抑郁症状39例(24.07%)。两组相比患者伴睡眠障碍的情况差异无统计学意义(P0.05)。伴焦虑、抑郁情况有统计学差异(P0.05)。4.急、慢性耳鸣的心理声学特征比较:急性耳鸣组,听力下降以低中频为主68例(37.57%);耳鸣匹配频率为低中频96例(53.04%),耳鸣匹配响度≤5dBSL90例(49.72)。慢性组,听力下降为低中频的患者26例(16.05%),耳鸣频率匹配为高频患者109例(67.28%),耳鸣匹配响度≤5dBSL的患者87例(53.70%)。两组相比患者听力下降频率及耳鸣匹配频率的分布,差异有统计学意义(P0.05)。两组在耳鸣匹配响度的分布上差异无统计学意义(P0.05)。5.急、慢性耳鸣的严重程度比较结果:急性组,THI分级为3级61例(33.70%);慢性组,THI分级为3级52例(32.10%)。两组相比患者的耳鸣严重程度分级上差异无统计学意义。结论1.急、慢性耳鸣患者在耳鸣病因的构成上不同。急性耳鸣病因以突发性耳聋为主,其次为原发性耳鸣,慢性耳鸣以原发性耳鸣为主。2.急、慢性耳鸣患者伴发睡眠障碍比例较高,但两组间差异无统计学意义。3.急、慢性患者伴发焦虑、抑郁情况差异有统计学意义,急性耳鸣患者较慢性者更易伴发焦虑状态;慢性耳鸣患者较急性耳鸣者更易伴发抑郁状态。4.急、慢性耳鸣患者的耳鸣匹配频率有差异,急性耳鸣患者以低中频为主;慢性耳鸣患者以高频为主。
[Abstract]:Tinnitus (tinnitus) is a kind of sound in the absence of exogenous stimulation, under the condition of abnormal auditory perception in the ear or intracranial generated, and lasts over 5 minutes. The tinnitus incidence rate is very high, the United States and Europe in the 2003 survey, the 10%~20% Department of otolaryngology clinic patients with complaints of tinnitus the treatment, often because of tinnitus patients up to 5%~10%, because tinnitus seriously affect the patient's life, focus, work, social activities and sleep accounted for 2%~5%, due to severe tinnitus disability patients about 0.5%~1%. of tinnitus and bring the pain of the patient in addition to annoying, single voice, the concomitant mental emotional symptoms such as, sleep disorders, anxiety, depression, attention is also worthy of our attention. According to the nature of tinnitus, can be divided into subjective tinnitus and objective tinnitus; according to the influence of tinnitus on patients, can be divided into. It points out that the tinnitus and tinnitus annoying.2014 American "in the" guidelines for tinnitus, tinnitus and tinnitus according to course will be divided into: 1. recent onset tinnitus: ringing duration is shorter than 6 months (acute tinnitus); 2. persistent tinnitus: ringing for 6 months or more (chronic tinnitus) due to tinnitus. The etiology, pathogenesis is complex, so the tinnitus treatment effect is not satisfactory. Studies have shown that the prognosis of acute tinnitus with good prognosis of chronic tinnitus acute tinnitus. Many are due to follow, often given drug therapy, and chronic tinnitus is idiopathic tinnitus, not easy to completely eliminate tinnitus, clinical use method the sound of the treatment of chronic tinnitus. The different course of tinnitus, its etiology and pathogenesis, clinical and psychological acoustic features are not the same. In order to explore the characteristics of different duration of tinnitus, based on the analysis of different duration of tinnitus patients, discuss the urgent And the clinical characteristics of patients with chronic tinnitus in the etiology of tinnitus, and psychological symptoms of tinnitus and acoustic characteristics of different, provide the basis for clinical treatment to improve the curative effect of tinnitus, tinnitus patients. Subjects and methods during the study from September 2015 to June 2016 clinic in the First Affiliated Hospital of Zhengzhou University Department of tinnitus patients in 343 cases. Acquisition the history of tinnitus patients, record the general condition of the patients: the patient's sex, age of onset, tinnitus laterality, whether persistent, duration, comorbidity, sleep quality, sleep without difficulty, dreams, waking up early. And with a qualified professional personnel, for pure tone audiometry, tympanometry, tinnitus, check. Use "patients with tinnitus severity of tinnitus disability scale assessment, using the self rating Anxiety Scale", "self rating depression scale assessment of tinnitus patients with and without 鐒﹁檻鍙婃姂閮佺姸鎬，

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