认知行为—习服疗法治疗耳鸣的临床研究

发布时间：2018-05-17 00:22

本文选题：耳鸣 + 认知-行为疗法　；参考：《皖南医学院》2015年硕士论文

【摘要】：目的:探讨认知行为-习服疗法治疗耳鸣患者的临床疗效。方法:1.收集2013年9月-2015年3月在皖南医学院第一附属弋矶山医院耳鼻喉科门诊以耳鸣为第一主诉或次于听力下降为第二主诉的患者为研究对象,并通过相关的听力学检测及必要的全身检查,排除因器质性疾病引起的耳鸣。2.让患者填写耳鸣调查问卷(耳鸣残疾评估量表(THI)、烦躁级量表),采集患者的基本信息并根据结果评估出患者的病情。3.在专科医师的讲解下,让患者对耳鸣有理性的认识,同时帮助患者纠正对耳鸣的错误认知,告知应对耳鸣的技巧和解决问题的方法,如让患者长期坚持耳鸣不全掩蔽(声治疗)、注意力转移等方式,最终使患者达到对耳鸣的适应和习惯。4.治疗6月后,通过电话方式随访,让患者再次填写耳鸣残疾评估量表(THI)和烦躁级量化表(TRI),根据两次量表得分进行疗效评估,疗效分为痊愈、显效、有效、无效。同时依据THI量表分析患者性别、年龄、是否单双耳及听力损失程度等各影响因素与耳鸣严重程度的关系。结果:1.治疗6月后THI评分(25.50±16.90)与治疗前评分(43.31±19.90)差异有统计学意义(P0.05)。2.将THI得分2级及以下的患者合计为轻度,治疗前为54例(51.92%,54/104),治疗6月后为84例(80.77%,84/104);3级及以上患者合计为重度,治疗前为50例(48.08%,50/104),治疗6月后为20例(19.23%,20/104),治疗前和治疗6月后轻、重度患者的构成比差异具有统计学意义(χ2=19.38,P0.05)。将耳鸣烦躁级量化表得分二级及以下合计为轻度,治疗前为43例(41.35%,43/104),治疗6月后为88例(84.62%,88/104),三、四级合计为中度,治疗前为56例(53.85%,56/104),治疗6月后为14例(13.46%,14/104),五、六级合计为重度,治疗前为5例(4.81%,5/104),治疗6月后为2例(1.92%,2/104)。治疗前和治疗6月后轻、中、重度患者的构成比差异具有统计学意义(χ2=41.94,P0.05)。3.将耳鸣患者的性别、年龄、是否单双耳及听力损失程度等各影响因素与THI得分行相关分析,结果显示各因素与耳鸣严重度均无相关性。结论:认知行为-习服训练疗法有望成为临床上治疗耳鸣的一种综合性干预方法。
[Abstract]:Objective: to investigate the clinical effect of cognitive behavior-acclimation therapy on tinnitus patients. Method 1: 1. From September 2013 to March 2015, patients with tinnitus as the first main complaint or secondary hearing loss as the second main complaint were collected in the otolaryngology clinic of the first affiliated Yogishan Hospital of Southern Anhui Medical College. The tinnitus caused by organic diseases was excluded from tinnitus by relevant audiological examination and necessary systemic examination. Ask the patient to fill out the tinnitus questionnaire (tinnitus disability assessment scale THIN, irritability scale), collect the basic information of the patient and evaluate the patient's condition based on the results. 3. Under the specialist's explanation, let the patient have a rational understanding of tinnitus, at the same time help the patient correct the wrong cognition of tinnitus, and inform him of the skills to deal with tinnitus and the solution to the problem. If the patient persists in the long term tinnitus masking (voice therapy, attention shift, etc.), the patient will eventually achieve the adaptation and habit of tinnitus. 4. After 6 months of treatment, the patients were followed up by telephone. The patients were asked to fill in the tinnitus Disability Assessment scale (THII) and the Quantification scale of fidgety scale (TRI) again. According to the scores of the two scales, the curative effect was evaluated, the curative effect was divided into recovery, remarkable effect, effective and ineffective. At the same time, according to the THI scale, the relationship between sex, age, mono-ear and hearing loss was analyzed between the patients and the severity of tinnitus. The result is 1: 1. The THI score (25.50 卤16.90) was significantly higher than that before treatment (43.31 卤19.90). The THI scores of grade 2 and below were mild, 54 cases were 51.92% 54 / 104% before treatment, 84 cases were severe after 6 months of treatment, 50 cases were 48.08% 50 / 10 4 before treatment, 20 cases were 19.23% 20 / 104% after 6 months of treatment, and were mild before and after 6 months of treatment. There was significant difference in the composition ratio of severe patients (蠂 2, 19.38, P 0.05). The second grade and below of the quantification table for tinnitus were mild, 43 cases were 41.35 / 104g before treatment, 88 cases were 84.62% / 104% after treatment six months later, three and four levels were moderate, 56 cases were 53.85% 56 / 104 before treatment, and 14 cases were 13.461414104r-1 / 104m after treatment after 6 months of treatment, and the fifth and sixth grades were severe. Before treatment, there were 5 cases with 4.81 / 10 4 and 2 cases 6 months after treatment with 1.92 2 / 10 4%. There was significant difference in composition ratio between mild, moderate and severe patients before treatment and 6 months after treatment (蠂 ~ 2 = 41.94) (P < 0.05). The influence factors of sex, age, single ear and hearing loss of tinnitus patients were analyzed. The results showed that there was no correlation between each factor and the severity of tinnitus. Conclusion: cognitive behavior-acclimatization training therapy is expected to be a comprehensive intervention in the treatment of tinnitus.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R764.45

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