听觉过敏的临床特征及评估方法

发布时间：2018-01-07 21:38

本文关键词：听觉过敏的临床特征及评估方法　出处：《郑州大学》2014年硕士论文　论文类型：学位论文

【摘要】：研究背景耳科门诊中耳鸣患者最多见，对耳鸣的临床研究发现有些耳鸣患者不仅受耳鸣困扰，而且对正常环境中常人未感不适的声音耐受度降低。Jastreboff曾报道耳鸣诊疗中心的60%耳鸣患者对日常生活中常人未感不适的声音表现出异常反应，如不适、烦躁、紧张、害怕、恐惧等消极反应。早在1938年Perlman第一次提出“听觉过敏（hyperacusis）”概念来描述声过敏症状。听觉过敏临床特征主要表现为对环境中正常的声音耐受度降低，并带有不良情绪反应，严重者表现出精神症状和神经症人格特征，给患者生活带来严重负面影响。流行病学的调查显示听觉过敏发病率逐年增加，听觉过敏的病因及发病机制尚无确切定论。目前临床中应用的听觉过敏评估方法，主要有问卷量表调查及听力学检测。由于不同国家之间文化及语言的差异，尚不存在国际统一通用的量表，国内学者尚未对听觉过敏临床评估量表进行深入研究。听觉过敏与耳鸣常伴随存在，临床医师常重点关注耳鸣而忽视听觉过敏症状，导致耳鸣习服治疗效果大大降低。听觉过敏对患者的直接影响并不亚于耳鸣或者其他听力疾病，但是由于临床医生对其症状表现及临床评估缺乏认识，在诊断治疗上往往陷入误区。因此正确认识听觉过敏对于其诊断、鉴别及有效治疗有重要意义。目的本研究的目的是探讨听觉过敏的临床特征，分析各种临床评估方法并确定有效评估方法，，为进行临床诊治提供帮助。方法收集耳科门诊中以听觉过敏伴或不伴耳鸣为主诉就诊患者的临床资料，共60例，其中其中男性21例，女性39例；年龄13~71岁，平均年龄38.82±14.15岁。选择20例无年龄和性别差异、无耳鸣及听觉过敏的听力正常志愿者作为正常对照组（C组），其中男10例，女10例；年龄13~70岁，平均年龄37.15±13.24岁。通过病史问卷表详细询问患者病史，以了解听觉过敏病史特征。所有研究对象均填写中文版听觉过敏调查问卷量表，对量表得分结果进行整理分析，同时进行听力学检查，分析比较各组纯音测听、响度不适阈、畸变产物耳声发射测试及对侧声刺激抑制试验结果。结果 60例听觉过敏患者中49例（81.67%）伴有耳鸣，14例（23.33%）伴有头痛。常见敏感声音有小孩哭声、尖叫声、突然短促高调声、电器噪声、汽笛声等。听觉过敏组和听觉过敏伴耳鸣组问卷总得分高于正常组(P0.05)，注意力、情绪子维度的得分受性别的影响，具有统计学差异性(P0.05)；听觉过敏组和听觉过敏伴耳鸣组响度不适阈值明显低于正常组(P0.05)，LDL阈值与听觉过敏问卷总得分、注意力、社会、情绪子维度得分的相关性得出两者无相关性（P＞0.05）；听觉过敏组和听觉过敏伴耳鸣组对侧声刺激后畸变产物耳声发射测试幅值与未抑制时比较无差异（P0.05）。结论听觉过敏是个体生理和心理共同作用的一种临床症状，临床评估主要包括听觉过敏主观症状问卷调查及听力学检查。中文版本听觉过敏调查问卷具有可靠性性和有效性，能够应用于临床量化评估听觉过敏对患者生活的影响。畸变产物耳声发射可评价听觉过敏耳蜗功能。
[Abstract]:Research background
In the most common otology clinic patients with tinnitus, clinical study of tinnitus found some tinnitus patients not only by tinnitus, and discomfort of ordinary people are not the normal environment of sound tolerance reduce.Jastreboff reported tinnitus treatment center 60% tinnitus patients of ordinary people in daily life are not sound discomfort showed abnormal responses such as discomfort, irritability, tension, fear, fear and other negative effects. As early as in 1938, Perlman first proposed the "hyperacusis (hyperacusis)" concept to describe the sound of allergic symptoms. Hyperacusis main clinical features of the environment in a normal voice tolerance decreased, and with negative emotional reactions, serious show mental symptoms and neurotic personality characteristics, bring serious negative impact on the life of patients.
Epidemiological surveys show that hyperacusis incidence increased year by year, the etiology and pathogenesis of allergic hearing is no definite conclusion. Hyperacusis evaluation method of clinical application at present, mainly include questionnaire survey and audiology. Due to cultural and language differences between different countries, there is no unified international general scale, domestic scholars yet for the hyperacusis clinical assessment of in-depth study.
Hyperacusis and tinnitus often accompanied by the existence of, clinicians often focus on tinnitus and ignore auditory allergy symptoms, cause tinnitus retraining therapy effect is greatly reduced. Hyperacusis is not less than tinnitus or other disease to directly affect the patient's hearing, but due to the lack of awareness of clinicians and clinical evaluation in diagnosis and treatment of their symptoms, often misunderstand. So a correct understanding of hyperacusis for its diagnosis, has important significance in differential and effective treatment.
objective
The purpose of this study is to explore the clinical features of auditory hypersensitivity, to analyze various clinical evaluation methods and to determine effective evaluation methods for clinical diagnosis and treatment.
Method
In order to collect hyperacusis with or without clinical data of patients with tinnitus in otology clinic, a total of 60 cases, including 21 males and 39 females; aged 13~71 years, mean age 38.82 + 14.15 years old. 20 cases of no age and gender differences, no tinnitus and hyperacusis as normal hearing volunteers the normal control group (C group), 10 cases were male, 10 were female; aged 13~70 years, mean age 37.15 + 13.24 years history. Through the questionnaire asked in detail about the patient's history to understand the characteristics of auditory allergy history. All of the subjects were in Chinese auditory sensitive version questionnaire, the score results by analyzing and audiological examination were analyzed and compared, pure tone audiometry, loudness discomfort threshold test and contralateral acoustic stimulation inhibition test results of distortion product otoacoustic emission.
Result
60 cases of hyperacusis patients in 49 cases (81.67%) accompanied by tinnitus, 14 cases (23.33%) accompanied by headache. Common sensitive voice of a child crying, screaming, suddenly high-profile short sound, electrical noise, whistle. Auditory allergy and hyperacusis and tinnitus questionnaire total score higher than the normal group (P0.05). Attention, emotional impact sub dimension scores by gender, with statistical difference (P0.05); auditory allergy and hyperacusis and tinnitus loudness discomfort threshold group was significantly lower than the normal group (P0.05, LDL) threshold and hyperacusis Questionnaire total score, attention, social, emotional dimension scores correlation between the two no correlation (P > 0.05); auditory allergy and hyperacusis and tinnitus group contralateral acoustic stimulation after DPOAE amplitude and no inhibition test showed no significant difference (P0.05).
conclusion
Hyperacusis is a common clinical symptom of individual physiological and psychological, clinical evaluation mainly includes the investigation and audiological examination hyperacusis subjective symptom questionnaire. Chinese version of hyperacusis questionnaire with reliability and validity, which can be applied to clinical quantitative evaluation of hyperacusis on patients life. The effects of distortion product otoacoustic emission auditory evaluation allergic cochlear function.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R764.45

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