山东大学耳鼻喉眼学报 ›› 2023, Vol. 37 ›› Issue (4): 46-52.doi: 10.6040/j.issn.1673-3770.0.2022.551

• • 上一篇    

焦虑抑郁状态与特发性耳鸣预后的相关性研究

吴波1,黄天德1,闫斌1,陈伊1,汤勇2   

  1. 1. 四川天府新区人民医院 耳鼻咽喉头颈外科, 四川 成都 610213;
    2. 长春中医药大学 临床医学院, 吉林 长春 130000
  • 发布日期:2023-07-27
  • 通讯作者: 汤勇. E-mail:15943012058@163.com
  • 作者简介:吴波、黄天德为本文共同第一作者

Correlation between the anxiety-depression state and idiopathic tinnitus prognosis

WU Bo1, HUANG Tiande1, YAN Bin1, CHEN Yi1, TANG Yong2   

  1. 1. Department of Otorhinolaryngology & Head and Neck Surgery, Sichuan Tianfu New Area People's Hospital, Chengdu 610213, Sichuan, China2. School of Clinical Medicine, Changchun University of Chinese Medicine, Changchun 130000, Jilin, China
  • Published:2023-07-27

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摘要： 目的 探讨特发性耳鸣患者的焦虑抑郁状态,同时研究可能影响耳鸣预后的因素。 方法 回顾性分析100例特发性耳鸣患者的临床资料,采用统一的耳鸣治疗方案,治疗12周后进行随访来评价疗效并分析可能影响耳鸣预后的因素。 结果 各量表治疗后效应良好,且差异均有统计学意义(P<0.05)。中重度组耳鸣患者广泛性焦虑障碍量表得分(Z=-6.482, P<0.001)、抑郁筛查量表得分(Z=-6.070, P<0.001)较轻度组更高。性别(P=0.216)、年龄(P=0.972)、耳鸣侧别(P=0.703)、响度(P=0.264)、频率(P=0.446)、病程(P=0.728)及听力损失程度(P=0.234),各组之间与耳鸣预后无明显相关性;治疗前耳鸣残疾评估量表(tinnitus handicap inventory, THI)得分(OR=1.028,P=0.003)、治疗后焦虑改善(OR=5.637, P<0.001)、抑郁改善(OR=4.200, P=0.001)、睡眠改善(OR=4.744, P=0.008)及耳鸣临床治愈(OR=7.306, P<0.001),各组之间耳鸣的预后差异均有统计学意义。多元线性回归分析示,治疗前THI得分、耳鸣临床治愈及治疗后焦虑改善均是耳鸣预后的相关因素(P均<0.05)。 结论 耳鸣的预后与性别、年龄、耳鸣侧别、响度、频率、病程及听力损失程度无关,与治疗前THI得分有关,且治疗后焦虑改善、抑郁改善、睡眠改善及耳鸣临床治愈是耳鸣预后良好的正性因素。中重度组耳鸣患者的焦虑抑郁状态较轻度组更重,故临床上应重视中重度耳鸣患者的精神心理状态。

关键词: 特发性耳鸣, 焦虑, 抑郁, 睡眠障碍, 量表, 预后

Abstract: Objective To study the anxiety and depression status of patients with idiopathic tinnitus and analyze the factors that may affect the prognosis of tinnitus. Methods The clinical data of 100 patients with idiopathic tinnitus were retrospectively analyzed. A uniform tinnitus treatment protocol was used. Patients were followed -up after 12 weeks of treatment to evaluate the efficacy and analyze the factors that may affect the prognosis of tinnitus. Results The effect of each scale after treatment was more than 0.50, and the difference was statistically significant(P<0.05). The GAD-7 score(Z=-6.482, P<0.001)and PHQ-9 score(Z=-6.070, P<0.001)were higher in the moderate-severe than in the mild tinnitus group. There were no statistically significant differences in the prognosis of tinnitus between the groups in terms of sex, age, side of tinnitus, loudness of tinnitus, frequency of tinnitus, degree of hearing loss, and duration of tinnitus disease(P>0.05). The pre-treatment THI score(OR=1.028, P=0.003), post-treatment improvement in anxiety(OR=5.637, P<0.001), post-treatment improvement in depression(OR=4.200, P=0.001), sleep improvement after treatment(OR=4.744, P=0.008)and clinical cure of tinnitus(OR=7.306, P<0.001)were independently associated with tinnitus prognosis. The multiple linear regression analysis results suggested that the pre-treatment THI score, clinical cure of tinnitus, and anxiety improvement after treatment positively correlated with tinnitus prognosis(all P<0.05). Conclusion Gender, age, side of tinnitus, loudness of tinnitus, frequency of tinnitus, degree of hearing loss, and tinnitus duration were not significantly associated with the prognosis. Conversely, the pre-treatment THI score, anxiety improvement after treatment, depression improvement after treatment, sleep improvement after treatment, and clinical cure of tinnitus were independently associated with tinnitus prognosis. The overall severity of tinnitus was positively associated with the anxiety-depression status. The anxiety-depression status of patients in the moderate-severe tinnitus group was more severe than that in the mild tinnitus group. Hence, clinical attention should be paid to the psychosocial status of patients with moderate-severe tinnitus.

Key words: Idiopathic Tinnitus, Anxiety, Depression, Somnipathy, Scale, Prognosis

中图分类号: 

  • 765.21
[1] Koops EA, Renken RJ, Lanting CP, et al. Cortical tonotopic map changes in humans are larger in hearing loss than in additional tinnitus[J] Neurosci, 2020, 40(16): 3178-3185. doi: 10.1523/JNEUROSCI.2083-19.2020
[2] 段新艳, 宋忠义, 王宁, 等. DPOAE与高刺激率ABR在听力正常耳鸣患者中的应用价值[J]. 山东大学耳鼻喉眼学报, 2022, 36(5): 6-10. doi: 10.6040/j.issn.1673-3770.0.2021.404 DUAN Xinyan, SONG Zhongyi, WANG Ning, et al. Application value of distortion product otoacoustic emission and high stimulation rate auditory brainstem response in patients with normal hearing tinnitus[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(5): 6-10. doi: 10.6040/j.issn.1673-3770.0.2021.404
[3] Tunkel DE, Bauer CA, Sun GH, et al. Clinical practice guideline: tinnitus[J]. Otolaryngol Head Neck Surg, 2014, 151(2 Suppl):S1-S40. doi: 10.1177/0194599814545325
[4] Zhang D, Xu Q, Caimino C, et al. The prevalence of tinnitus in China: a systematic review of the literature[J]. J Laryngol Otol, 2021, 135(1): 3-9. doi:10.1017/S002221512000256X
[5] McCormack A, Edmondson-Jones M, Somerset S, et al. A systematic review of the reporting of tinnitus prevalence and severity[J]. Hear Res, 2016, 337: 70-79. doi:10.1016/j.heares.2016.05.009
[6] 蒋涛, 龚树生, 王杰, 等. 《耳鸣临床应用指南》:实践和理论的一次重大探索[J]. 听力学及言语疾病杂志, 2015, 23(2): 116-139.doi: 10.3969/j.issn.1006-7299.2015.02.002 JIANG Tao, GONG Shusheng, WANG Jie, et al. Clinical application guide of tinnitus: an important exploration in practice and theory[J]. Journal of Audiology and Speech Pathology, 2015, 23(2): 116-139.doi: 10.3969/j.issn.1006-7299.2015.02.002
[7] 曾汝嫣, 庄惠文, 孙启阳, 等. 中文版耳鸣致残量表和耳鸣功能指数的检验以及临床应用[J].中华耳科学杂志, 2019, 17(6): 880-884 ZENG Ruyan, ZHUANG Huiwen, SUN Qiyang, et al.Validation and application of Chinese version Tinnitus Functional Index[J]. Chinese Journal of Otology, 2019, 17(6): 880-884
[8] 姜蕾, 朱素君, 彭中华, 等. PHQ-9、GAD-7用于孕妇心理健康调查结果分析[J].中国妇幼健康研究, 2021, 32(8): 1172-1177 JIANG Lei, ZHU Sujun,PENG Zhonghua, et al. Analysis of results of mental health survey in pregnant women in Shenzhen with PHO-9 and GAD-7[J]. Chinese Maternal and Child Health Research, 2021, 32(8): 1172-1177
[9] 田如如, 张海琴, 丁吉女, 等. 不同性别和年龄慢性耳鸣患者THI量表评估分析[J]. 听力学及言语疾病杂志, 2021, 29(6): 679-681 TIAN Ruru, ZHANG Haiqin, DING Jinv, et al. Analysis of THI scale assessment in patients with chronic tinnitus of different sexes and ages[J]. Journal of Audiology and Speech Pathology, 2021, 29(6): 679-681.
[10] Kim SH, Byun JY, Yeo SG, et al. Tinnitus retraining therapy in unilateral tinnitus patients with single side deafness[J]. J Int Adv Otol, 2016, 12(1): 72-76. doi:10.5152/iao.2016.1949
[11] Cohen J. A power primer. Psychol Bull[J]. 1992, 112(1): 155-159. doi: 10.1037//0033-2909.112.1.155
[12] McCombe A, Baguley D, Coles R, et al. Guidelines for the grading of tinnitus severity: the results of a working group commissioned by the British Association of Otolaryngologists, Head and Neck Surgeons, 1999[J]. Clin Otolaryngol Allied Sci, 2001, 26(5): 388-393. doi:10.1046/j.1365-2273.2001.00490
[13] 余力生,杨仕明,王秋菊, 等.耳鸣的诊断与治疗[J].临床耳鼻咽喉头颈外科杂志, 2022, 36(5): 325-334. doi:10.13201/j.issn.2096-7993.2022.05.001 YU Lisheng, YANG Shiming, WANG Qiuju, et al. Diagnosis and treatment of tinnitus [J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2022, 36(5): 325-334. doi:10.13201/j.issn.2096-7993.2022.05.001
[14] 王江, 陈智斌, 陈若希, 等. 854例耳鸣患者的临床特征分析[J]. 中国耳鼻咽喉颅底外科杂志, 2022, 28(6): 33-38. doi: 10.11798/j.issn.1007-1520.202222304 WANG Jiang, CHEN Zhibin, CHEN Ruoxi, et al. Clinical characteristics of tinnitus: an analysis of 854 patients[J]. Chinese Journal of Otorhinolaryngology-skull Base Surgery, 2022, 28(6): 33-38. doi: 10.11798/j.issn.1007-1520.202222304
[15] Fuller T, Cima R, Langguth B, et al. Cognitive behavioural therapy for tinnitus[J]. Cochrane Database Syst Rev, 2020, 1(1): CD012614. doi:10.1002/14651858.CD012614.pub2
[16] 王欣怡, 杨文杰, 余文兴, 等. 家庭化个体多元复合声治疗对耳鸣伴听力损失患者的疗效及影响因素分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(6): 70-76. doi:10.6040/j.issn.1673-3770.0.2022.327 WANG Xinyi, YANG Wenjie, YU Wenxing, et al. Effects and influencing factors of family-oriented customized sound therapy on patients with tinnitus and hearing loss[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(6): 70-76. doi:10.6040/j.issn.1673-3770.0.2022.327
[17] Jastreboff PJ. Phantom auditory perception(tinnitus): mechanisms of generation and perception[J]. Neurosci Res, 1990, 8(4): 221-254. doi: 10.1016/0168-0102(90)90031-9
[18] Cederroth CR, Gallus S, Hall DA, et al. Editorial: towards an understanding of tinnitus heterogeneity[J]. Front Aging Neurosci, 2019, 11: 53. doi:10.3389/fnagi.2019.00053
[19] 陈秀兰, 宋凡, 秦兆冰, 等. 耳鸣严重程度与焦虑、抑郁及人格特征的相关性[J]. 听力学及言语疾病杂志, 2021, 29(4): 444-446.doi: 10.3969/j.issn.1006-7299.2021.04.020 CHEN Xiulan, SONG Fan, QIN Zhaobing, et al. Correlation between the severity of tinnitus and anxiety, depression and personality characteristics[J]. Journal of Audiology and Speech Pathology, 2021, 29(4): 444-446. doi: 10.3969/j.issn.1006-7299.2021.04.020
[20] 张域开, 宋勇莉, 齐柳, 等. 慢性耳鸣的临床特点及严重程度影响因素分析[J]. 听力学及言语疾病杂志, 2022, 30(6): 627-631. doi: 10.3969/j.issn.1006-7299.2022.06.013 ZHANG Yukai, SONG Yongli, QI Liu, et al. Analysis of clinical characteristics and influencing factors of severity of chronic tinnitus[J]. Journal of Audiology and Speech Pathology, 2022, 30(6): 627-631. doi: 10.3969/j.issn.1006-7299.2022.06.013
[21] 周腊梅, 蒋雯, 刘稳, 等. 持续性特发性耳鸣严重程度的相关因素分析[J]. 山东大学耳鼻喉眼学报, 2021, 35(6): 70-76. doi: 10.6040/j.issn.1673-3770.0.2021.009 ZHOU Lamei, JIANG Wen, Liu Wen, et al. Analysis of factors related to the severity of persistent idiopathic tinnitus[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(6): 70-76. doi: 10.6040/j.issn.1673-3770.0.2021.009
[22] Bhatt JM, Bhattacharyya N, Lin HW. Relationships between tinnitus and the prevalence of anxiety and depression[J]. Laryngoscope, 2017, 127(2): 466-469. doi:10.1002/lary.26107
[23] Cho CG, Chi JH, Song JJ, et al. Evaluation of anxiety and depressive levels in tinnitus patients[J]. Korean J Audiol, 2013, 17(2): 83. doi:10.7874/kja.2013.17.2.83
[24] 陈丹萍, 王晓茜, 黄宏明, 等. 轻度及中重度非急性主观性耳鸣严重程度与焦虑和抑郁的相关性研究[J]. 临床耳鼻咽喉头颈外科杂志, 2015(22): 1995-1998 CHEN Danping, WANG Xiaoqian, HUANG Hongming, et al. The correlations between varying tinnitus severity and anxiety and depression in non-acute tinnitus patients[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2015(22): 1995-1998
[25] 中华医学会精神科分会. CCMD-3中国精神障碍分类与诊断标准[M]. 3版. 济南: 山东科学技术出版社, 2001: 118-122.
[26] Koo M, Hwang JH. Risk of tinnitus in patients with sleep apnea: a nationwide, population-based, case-control study[J]. Laryngoscope, 2017, 127(9): 2171-2175. doi:10.1002/lary.26323
[27] 李尧, 王铭歆, 周婧, 等. 特发性耳鸣患者的焦虑和抑郁状态研究及相关因素分析[J]. 临床耳鼻咽喉头颈外科杂志, 2019, 33(5): 416-421. doi:10.13201/j.issn.1001-1781.2019.05.008 LI Yao, WANG Mingxin, ZHOU Jing, et al. Study on anxiety and depression of patients with idiopathic tinnitus and analysis of related factors[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2019, 33(5): 416-421. doi:10.13201/j.issn.1001-1781.2019.05.008
[28] 王琳, 刘菊, 余力生, 等. OSAHS患者耳鸣发生率及相关因素的研究[J]. 中华耳科学杂志, 2020, 18(4): 744-748.doi: 10.3969/j.issn.1672-2922.2020.04.025 WANG Lin, LIU Ju, YU Lisheng, et al. The clinical study on the incidence and related factors of tinnitus in obstructive sleep apnea hypopnea syndrome[J]. Chinese Journal of Otology, 2020, 18(4): 744-748.doi: 10.3969/j.issn.1672-2922.2020.04.025
[29] 卢兢哲. 基于中医养生理念指导的生活方式调整对耳鸣疗效的影响[D]. 广州:广州中医药大学, 2017
[30] 卢兢哲, 刘蓬, 钟萍, 等. 原发性耳鸣预后影响因素分析[J]. 中国听力语言康复科学杂志, 2018, 16(6): 416-420. doi: 10.3969/j.issn.1672-4933.2018.06.004 LU Jingzhe, LIU Peng, ZHONG Ping, et al. Analysis of prognostic factors of primary tinnitus[J]. Chinese Scientific Journal of Hearing and Speech Rehabilitation, 2018, 16(6): 416-420. doi: 10.3969/j.issn.1672-4933.2018.06.004
[31] 刘蓬.浅谈耳鸣的中西医结合诊疗思路[J]. 中国中西医结合耳鼻咽喉科杂志, 2020, 28(5): 324-328. doi:10.16542/j.cnki.issn.1007-4856.2020.05.003 LIU Peng, Talking about the integrative diagnosis and treatment of tinnitus[J]. Chinese Journal of Otorhinolaryngology In Integrative Medicine, 2020, 28(5): 324-328. doi:10.16542/j.cnki.issn.1007-4856.2020.05.003
[32] 曹祖威, 岳凤娟, 卢兢哲, 等. 以调理脾胃为中心治疗耳鸣的疗效观察[J]. 广州中医药大学学报, 2016, 33(1): 22-27.doi: 10.13359/j.cnki.gzxbtcm.2016.01.007 CAO Zuwei, YUE Fengjuan, LU Jingzhe, et al. Therapeutic effect of comprehensive traditional Chinese medical therapy for regulating spleen and stomach in treating tinnitus[J]. Journal of Guangzhou University of Traditional Chinese Medicine, 2016, 33(1): 22-27.doi: 10.13359/j.cnki.gzxbtcm.2016.01.007
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