42例耳鸣伴听觉过敏患者特征分析

doi:10.6040/j.issn.1673-3770.0.2018.199

摘要/Abstract

摘要： 目的探讨耳鸣伴听觉过敏患者的临床、听力及心理声学特征以及对患者的影响。方法对2015年3月至2017年3月在广州医科大学附属第二医院耳鼻咽喉科门诊就诊的42例耳鸣合并听觉过敏患者进行纯音测听、耳鸣心理声学特征、响度不适阈(LDL)检测,并对耳鸣及听觉过敏严重程度进行评估。结果 42例中,24例以耳鸣为第一主诉(A组),18例以听觉过敏为第一主诉(B组)。耳鸣主调以纯音为主,频率以高频为主,响度多数≤5 dB SL。患者听觉过敏表现为对正常环境声过分关注或刻意回避,伴烦躁、心悸、惊慌、恐惧,戴耳塞、不敢出门。分别检测0.125~8 kHz频率的LDL,两组在同一频率的LDL差异无统计学意义(P>0.05)。结论不能以响度不适阈判断听觉过敏的严重程度;临床上耳鸣与听觉过敏常相伴随,要重视其对患者工作、生活、睡眠与情绪的影响,应制定和使用适合中国国情的评估量表。

关键词: 耳鸣, 听觉过敏, 影响因素, 耳鸣评估量表

Abstract: Objective To explore the clinical, auditory and psychoacoustic characteristics of patients with tinnitus accompanied by auditory hypersensitivity and to explore its effects on patients. Methods Forty-two patients with tinnitus and hyperacusis who were admitted to the Department of Otorhinolaryngology, Second Affiliated Hospital of Guangzhou Medical University from March 2015 to March 2017, were detected the pure tone audiometry, tinnitus psychoacoustic characteristics, loudness discomfort level(LDL). Results There were 24 cases of tinnitus as the first chief complaint group(group A)and 18 cases of hyperacusis as the first main complaint group(group B). Tinnitus tone was given priority to with pure tone, frequency was given priority to with high frequency, and the loudness is mostly ≤5dB SL. Patients with hyperacusis is characterized by excessive attention or deliberate avoidance of normal environmental sounds, accompanied by irritability, palpitations, panic, fear, wearing earplugs, and dare not going out. LDL at frequencies between 0.125 and 8kHz were detected, and there was no significant difference in LDL between the two groups at the same frequency(P>0.05). Conclusion The severity of auditory hyperacusis cannot be judged by the loudness discomfort threshold; clinical tinnitus and auditory allergy are often accompanied, and attention should be paid to its influence on the work, life, sleep and mood of patients. The evaluation scale suitable for China's national conditions should be formulated and used.

Key words: Hyperacusis, Correlated factors, Evaluation scale, Tinnitus

中图分类号:

R764.65

廖礼兵,刘绮明,宗凌,翟锦明,张建国. 42例耳鸣伴听觉过敏患者特征分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 31-36.

LIAO Libing, LIU Qiming, ZONG Ling, ZHAI Jinming, ZHANG Jianguo. Characteristics of 42 patients with tinnitus and hyperacusis[J]. J Otolaryngol Ophthalmol Shandong Univ, 2018, 32(5): 31-36.

参考文献 25

[1]	Sanchez L. The epidemiology of tinnitus[J]. Audiol Med, 2004, 2(1):8.
[2]	邵茵,黄娟,李明. 1240例耳鸣患者的临床表现分析[J]. 中华耳鼻咽喉头颈外科杂志,2009,44(8):641-644. SHAO Yin, HUANG Juan, LI Ming. Clinical features analysis of 1240 tinnitus cases[J]. Chin J Otorhinolaryngol Head Neck Surg, 2009, 44(8):641-644.
[3]	Andersson G, Lindwall N, Hursti T, et al. Hypersensitity to sound(hyperacusis)[J]. A prevalence study conducted via the internet and post[J]. Int J Audiol, 2002, 41(8):545-554.
[4]	Sood SK, Coles RRA. Hyperacusis and phonophobia in tinnitus patients[J]. Br J Audiol, 1998, 22(2):228.
[5]	Anari M, Axelsson A, Eliasson A, et al. Hypersensitivity to sound. Questionnaire data, audiometry and classification[J]. Scand Audiol, 1999, 28(4):219-230.
[6]	中华耳鼻咽喉头颈外科杂志编辑委员会耳科专业组. 2012耳鸣专家共识及解读[J]. 中华耳鼻咽喉头颈外科杂志,2012,47(9):709-712. Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery. Interpretation of Chinese 2012 tinnitus experts consensus[J]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi, 2012, 47(9):709-712.
[7]	Dauman RF, Bouscaus F. Assessment and amelioration of hyperacusis in tinnitus patients[J]. Acta Otolaryngol, 2005, 125(5):503-509.
[8]	Feldmann H. Tinnitus[M]. New York: Georg Thieme Verlag Stuttgart, 1998: 76-83.
[9]	Andersson G, Vretblad P, Larsen HC, et al. Longitudinal follow up of tinnitus complaints[J]. Arch Otolaryngol Head Neck Surg, 2001, 127(2):175-179.
[10]	Katzeneell U, Segal S. Hyperacusis: review and clinical guidelines[J]. Otol Neurotol, 2001, 22(3):321-326.
[11]	Muhlnickel W, Elbert T, Taub E, et al. Reorganization of auditory cortex in tinnitus[J]. Proc Natl Acad Sci U S A, 1998, 95(17):10340-10343.
[12]	Mulders WH, Robertson D. Hyperactivity in the auditory midbrain after acoustic trauma: dependence on cochlear activity[J]. Neuroscience, 2009, 164(20:733-746.
[13]	Rauschecker JP, Leaver AM, Mühlau M. Tuning out the noise: limbic-auditory interactions in tinnitus[J]. Neuronscience, 2010, 66(6):819-826.
[14]	Chen GD, Manohar S, Salvi R. Amygdala hyperactivity and tonotopic shift after salicylate exposure[J]. Brain Res, 2012, 1485(1):63-76.
[15]	Niu Y, Kumaraguru A, Wang R, et al. Hyperexcitability of inferior colliculus neurons caused by acute noise exposure[J]. J Neurosci Res, 2013, 91(2):292-299.
[16]	Dauman R, Bouscau-Faure F. Assessment and amelioration of hyperacusis in tinnitus patients[J]. Acta Otolaryngol, 2005, 125(5):503-509.
[17]	Tunkel DE, Bauer CA, Sun GH, et al. Clinical practice guideline: tinnitus[J]. Otolaryngol Head Neck Surg, 2014, 151(2 suppl):S1-S40.
[18]	李楚凌,王杰,梁韵怡,等. 耳鸣心理声学特征检测[J]. 听力学及言语疾病杂志,2009,17(4):387-388.
[19]	叶放蕾,王乐,陈蓓,等. 耳鸣患者耳鸣的心理声学特征分析[J]. 听力学及言语疾病杂志,2012,20(4):339-341. YE Fanglei, WANG Le, CHEN Bei, et al. The characteristics of tinnitus psychoacoustic in 159 patient[J]. J Audiol Speech Pathol, 2012, 20(4):339-341.
[20]	Lehnhardt E. Parxis deaudiometrie[M]. New York: Gerog Thieme Verlag Stuttgart, 1987: 116-117.
[21]	Moffat G, Adjout K, Gallego S, et al. Effects of hearing aid fitting on the perceptual characteristics of tinnitus[J]. Hear Res, 2009, 254(1-2):82-91.
[22]	蔡跃新,孙映凤,杨海弟,等. 个性化切迹音乐治疗主观性耳鸣的初步观察[J]. 中华耳科杂志,2017,15(4):465-470. CAI Yuexin, SUN Yingfeng, YANG Haidi, et al. Preliminary results of retraining using tailor made notch music in patients with subjective tinnitus[J]. Chin J Otol, 2017, 15(4):465-470.
[24]	Goldstein B, Shulman A. Tinnitus-hyperacusis and the loudness discomfort level test-a preliminary report[J]. Int Tinnitus J, 1996, 2(1):83-89.
	Meeus OM. Correlation between hyperacusis measurements in daily ENT practice[J]. Int J Audiol, 2010, 49(1):7-13.
[25]	Anari M, Axelsson A, Eliasson A, et al. Hypersensitivity to sound questionnnaire dsta,audiometry and classification[J]. Scand Audiol, 1999, 28(4):219-230.

相关文章 15

[1]	王坛,武珂,李连庆,宫丽丽. 皮下免疫治疗注射后出现全身不良反应的伴发因素及处理[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 71-74.
[2]	侯小兵,任同力,张毅博. 69例梅尼埃病伴耳鸣的发病特点及影响因素[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 37-40.
[3]	黄娟,庞宇峰,龚静蓉,董玥辉. 耳鸣声学特征与扩展高频听阈的关系[J]. 山东大学耳鼻喉眼学报, 2018, 32(4): 7-10.
[4]	张玉波,岳丽艳,尹晓妍,吕哲,单春光. 耳鸣治疗仪联合银杏叶提取物注射液治疗突聋伴耳鸣的疗效分析[J]. 山东大学耳鼻喉眼学报, 2017, 31(5): 50-53.
[5]	张晓莉,于泓,韩冬梅,杨瑞民,戚伟. 泪道激光联合引流管植入治疗泪道阻塞的临床观察[J]. 山东大学耳鼻喉眼学报, 2017, 31(4): 84-86.
[6]	伦杰,张亚楠. 慢性鼻-鼻窦炎伴鼻息肉复发的相关影响因素分析[J]. 山东大学耳鼻喉眼学报, 2017, 31(3): 80-83.
[7]	朱江彬,南兵卫,陈涛, 郝宗生. 低中频下降型突发性聋听阈恢复后残留耳鸣治疗体会[J]. 山东大学耳鼻喉眼学报, 2016, 30(6): 5-7.
[8]	苏怡,谢景华,潘晓李,曾国庆. 慢性鼻-鼻窦炎伴或不伴鼻息肉患者鼻内镜手术的疗效及影响因素分析[J]. 山东大学耳鼻喉眼学报, 2016, 30(4): 86-89.
[9]	谢朝峰,林宏浩. 慢性鼻-鼻窦炎手术预后的临床影响因素分析[J]. 山东大学耳鼻喉眼学报, 2016, 30(4): 90-93.
[10]	狄国华, 刘俊茹, 赵延祥, 高英恺. 利多卡因联合天麻素耳后注射治疗特发性耳鸣[J]. 山东大学耳鼻喉眼学报, 2015, 29(6): 5-7.
[11]	钟晓声, 杨海弟, 郑亿庆. 突发性聋伴耳鸣患者耳鸣特征[J]. 山东大学耳鼻喉眼学报, 2015, 29(4): 15-18.
[12]	王坛, 安丰伟, 陈剑秋, 林家峰, 侯晓智, 解翠丽, 王英, 林娟. 腭肌电图引导下治疗腭肌阵挛性耳鸣[J]. 山东大学耳鼻喉眼学报, 2015, 29(1): 12-14.
[13]	朱亚骄, 薛飞, 王秋萍. 90例耳鸣患者心理声学特征研究[J]. 山东大学耳鼻喉眼学报, 2014, 28(5): 14-17.
[14]	何迎雪, 丛琳, 杜怡峰. 阿尔茨海默病患者睡眠障碍的研究新进展[J]. 山东大学耳鼻喉眼学报, 2014, 28(4): 1-5.
[15]	张令1,孙传义1,许安廷2. 以耳聋就诊的岩尖胆脂瘤1例[J]. 山东大学耳鼻喉眼学报, 2013, 27(2): 93-94.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed