声敏感的临床特征及中医病因病机研究

发布时间：2017-12-31 11:36

  本文关键词：声敏感的临床特征及中医病因病机研究　出处：《广州中医药大学》2016年硕士论文　论文类型：学位论文

  更多相关文章： 声敏感 听觉过敏 耳鸣 临床特征 中医病因病机

【摘要】：研究目的声敏感指对正常声音出现不适反应,是临床上十分常见的病症,与耳鸣的关系较为密切,近年来开始为医学界所关注。目前国内外对声敏感这一现象无统一命名,亦缺乏流行病学研究资料,其病因、发病机制不清楚,临床诊断及评估、治疗均缺乏统一的认识。有关声敏感的中医病因病机及治疗的文献研究极为罕见。本研究通过临床流行病学调查,探讨声敏感的临床特征、中医病因病机,从而为声敏感的临床诊断及评估、中医药治疗及疗效评价提供临床资料。研究方法对2014年1月至2016年1月期间在广州中医药大学第一附属医院耳鼻喉科门诊及住院部以声敏感或耳鸣为主诉的患者进行临床调查,在全面收集患者的基本资料(包括性别、年龄、职业、学历、婚姻、民族等)的基础上,主要从两个方面进行调查研究：第一是研究声敏感的临床特征,通过记录患者声敏感的具体临床表现、伴随症状、与耳鸣的关系,指导患者填写“焦虑自评量表(SAS)”、“耳鸣情况调查表(包括TEQ)”、“声敏感情况调查表(包括HQ)”,等,并随机进行听力学检查,试图初步了解声敏感的临床特征；第二是研究声敏感的中医病因病机,通过指导患者填写“生活习惯调查表”、“全身健康状况调查表”以了解患者的生活习惯及全身健康状况,并从中医辨证角度记录患者的相关症状及舌象、脉象等信息,初步分析声敏感的中医病因病机。所有记录的信息录入Excel表格,用SPSS22.0软件对所收集的相关数据进行分析,计数资料运用卡方检验,计量资料采用t检验或方差分析。结果1.一般资料共收集符合纳入标准的病例214例,男119例(55.61%),女95例(44.39%),平均年龄42.89+13.37岁。其中单纯声敏感者7例,声敏感伴耳鸣98例,单纯耳鸣而无声敏感者109例,因单纯声敏感病例样本量较少,故将前二者合并为一组称为“声敏感组”,共105例,男52例(49.52%),女53例(50.47%),平均年龄41.01±12.58岁。单纯耳鸣组称为“无声敏感组”,共109例,男67例(61.47%),女42例(38.53%),平均年龄44.71±13.91岁。两组性别无统计学差异(P0.05),年龄有统计学差异(P0.05)。2.临床特征①声敏感与耳鸣的关系：声敏感组105例中,有耳鸣者98例,占93.3%,无耳鸣者7例,占6.7%。耳鸣207例中,有声敏感者98例,占47.3%,无声敏感者109例,占52.7%。依据TEQ评分来分级统计声敏感的发生率,发现声敏感发生率随着耳鸣程度的加重而升高。在既有声敏感又有耳鸣的98例患者中,耳鸣先于声敏感发生者占34.7%,声敏感先于耳鸣发生者占10.2%,同时发生者占55.1%。声敏感的有无在耳鸣患者的发生与耳鸣主调声频率、残余抑制试验结果、佛德曼曲线类型、主调声类型等耳鸣心理声学特征及纯音测听结果、耳声发射检查结果、SAS评分等差异无统计学意义(P0.05)。②常见的伴随症状：声敏感伴有听力下降者占67.6%,伴有耳堵塞感者占58.1%,伴有眩晕反复发作史者占37.1%。③声敏感的具体临床表现：在105例声敏感患者中对普通音量的声音感到不适者占20%,对高于普通音量的声音感到不适者占80%；61.9%对任何声音均感到不适,38.1%对1种或多种特定声音感到不适,常见的声音有金属敲击声、小孩哭闹声、女生讲话声、清嗓声、汽车喇叭声、碗碟碰撞声等；常见的不适感有心烦、耳内回响、耳内刺痛、耳周麻木感、耳内胀闷感、头晕等；68.5%的患者外界声音停止,不适感即消失,31.4%的患者外界声音停止,不适感持续一段时间后消失；声敏感组平均HQ评分为12.60±7.89,略高于健康人(P0.05)。3.中医病因病机分析：声敏感组中60%患有脾胃系疾病,92.4%压力大,93.3%嗜食肥甘厚味,55.2%嗜食生冷寒凉食物,92.4%有睡眠障碍,与健康人进行比较,P0.05,差异有统计学意义。声敏感组患者脾胃功能平均积分为35.2±17.1,比健康人、无声敏感组患者均升高。结论1.在耳鸣的患者中伴有声敏感者占47.3%,在声敏感的患者中伴有耳鸣者占93.3%,声敏感很少单独存在,多见于耳鸣患者中,且耳鸣越严重发生声敏感的机率越高,在耳鸣的诊治中应充分关注是否合并声敏感这一特殊现象。2.声敏感的特征主要表现为对正常人可以接受的外界声音感到心烦或产生耳内回响、耳内刺痛、耳周麻木感、耳内胀闷感、头晕等不适,约三分之二的患者在外界声音停止后不适感可自动消失,约三分之一的患者在外界声音停止后不适感仍会持续一段时间才消失,常伴有耳鸣、听力下降、耳堵塞感等症状,部分患者可伴有眩晕反复发作。如何合理评估声敏感的严重程度,尚需进一步研究。3.声敏感与耳鸣具有相似的病因病机,睡眠障碍、压力大、不良的饮食习惯等导致脾胃功能失调,可能是声敏感及耳鸣发生的主要病因病机。
[Abstract]:The purpose of the study refers to the sound sensitive normal voice discomfort reaction, is the most common clinical symptoms are closely related to tinnitus, pay more attention to the medical profession at home and abroad in recent years. This phenomenon is not sensitive to the sound of uniform naming, also lack of epidemiological research material, its etiology and pathogenesis is unclear. The clinical diagnosis and treatment, assessment, lack of unified understanding. Literature research on etiology and pathogenesis of traditional Chinese medicine and the treatment of the sound sensitive is extremely rare. This study through the epidemiological investigation, clinical features of sound sensitive, TCM disease due to illness, thus for clinical diagnosis and evaluation of acoustic sensitivity, and provide clinical data evaluation of traditional Chinese medicine drug treatment and efficacy. Research methods from January 2014 to January 2016 in the First Affiliated Hospital of Guangzhou University of Chinese Medicine Department of ENT outpatient and inpatient department to sound sensitive or tinnitus patients into complaints Clinical investigation in patients with a comprehensive collection of basic information (including gender, age, occupation, education, marriage, nationality) on the basis of investigation and research, mainly from two aspects: the first is the study of the clinical features of sound sensitive, by recording the specific clinical manifestation, patients with acoustic sensitive symptoms and tinnitus the relationship, guide the patients to fill out the "self rating Anxiety Scale (SAS)", "tinnitus questionnaire (including TEQ)", "sound sensitive questionnaire (including HQ), etc., and random audiological examination, attempts to explore the clinical characteristics of acoustic sensitivity; second is to study the etiology and pathogenesis of acoustic sensitivity and through the guidance of patients to fill out the" lifestyle questionnaire "," general health questionnaire "to understand the living habits and general health status of the patients, and from the TCM perspective related symptoms were recorded and tongue, pulse and other information, 鍒濇�ュ垎鏋愬０鏁忔劅鐨勪腑鍖荤梾鍥犵梾鏈�.鎵，

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