中枢神经系统活动异常在耳鸣发生中的作用与机制

doi:10.6040/j.issn.1673-3770.0.2023.142

摘要/Abstract

摘要： 耳鸣指患者在缺乏外部声源的情况下,耳内或颅内产生嗡嗡声、嘶鸣等异常声幻觉的现象。伴随着临床研究对耳鸣发病机制的不断深入,越来越多的研究分析显示,中枢神经系统活动在耳鸣患者发病机制中存在密切的关联。然而,影响中枢神经系统活动的因素复杂多样。因此,通过中枢神经系统的作用机制对耳鸣症状进行探究,对于缓解患者临床症状、减轻耳鸣对日常工作和生活造成的影响具有重要的研究意义。本研究结论显示,主观性耳鸣的发病机制与中枢神经系统存在密切关联;微量元素的异常以及边缘系统功能的异常同样可能对耳鸣的发生发展发挥推动作用,通过阻断上述影响机制的作用通路,可对耳鸣患者症状的缓解发挥一定的作用,从而为耳鸣患者的治疗提供新的思路。

关键词: 中枢神经系统活动, 耳鸣发病机制, 边缘系统, 精神症状, 微量元素

Abstract: Tinnitus refers to the perception of noise without an external sound source, ear or intracranial buzzing, hoarseness, and other abnormal sound illusion phenomena. With the development of clinical research on the pathogenesis of tinnitus, additional studies and analyses show that central nervous system activity is closely related to the pathogenesis of tinnitus. However, the factors affecting central nervous system activity are complex and diverse. Therefore, it is critical to investigate tinnitus symptoms through the mechanism of the central nervous system to relieve the clinical symptoms and the effects of tinnitus on daily work and life. Thus, this study observed that the pathogenesis of subjective tinnitus is closely related to the central nervous system. Limbic system function may also contribute to the development of tinnitus by blocking the pathways of these mechanisms; it may also contribute to the relief of tinnitus symptoms, thus providing a new approach to treating tinnitus patients.

Key words: Central nervous system activity, Tinnitus pathogenesis, Limbic system, Psychiatric symptoms, Trace elements

中图分类号:

R764.45

张红,李欣. 中枢神经系统活动异常在耳鸣发生中的作用与机制[J]. 山东大学耳鼻喉眼学报, 2023, 37(4): 24-29.

ZHANG Hong, LI Xin. The role and mechanism of abnormal central nervous system activity in the occurrence of tinnitus[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(4): 24-29.

参考文献

[1] 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
[2] 孙慧颖, 冯国栋, 高志强. 影响慢性主观性耳鸣严重程度的关键因素分析: 基于复杂网络分析的研究[J]. 临床耳鼻咽喉头颈外科杂志, 2021, 35(7): 586-592. doi:10.13201/j.issn.2096-7993.2021.07.003 SUN Huiying, FENG Guodong, GAO Zhiqiang. Key factors of the severity of chronic subjective tinnitus: a complex network analysis[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2021, 35(7): 586-592. doi:10.13201/j.issn.2096-7993.2021.07.003
[3] 马晓波, 李薇, 张利荣, 等. 单侧特发性耳鸣临床特点和情绪、认知特征的对比分析及相关性研究[J]. 中国耳鼻咽喉头颈外科, 2022, 29(6): 382-385. doi:10.16066/j.1672-7002.2022.06.010 MA Xiaobo, LI Wei, ZHANG Lirong, et al. The clinical features and emotional, cognitive differences and the correlation in unilateral idiopathic tinnitus patients[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2022, 29(6): 382-385. doi:10.16066/j.1672-7002.2022.06.010
[4] 张秩荻, 熊姗, 马芙蓉. 结构磁共振成像和磁共振弥散张量成像应用于主观性耳鸣的研究进展[J]. 中华耳科学杂志, 2022, 20(1): 141-145. doi:10.3969/j.issn.1672-2922.2022.01.028 ZHANG Zhidi, XIONG Shan, MA Furong. Research progress on application of structural magnetic resonance imaging and diffu-sion tensor imaging in subjective tinnitus evaluation[J]. Chinese Journal of Otology, 2022, 20(1): 141-145. doi:10.3969/j.issn.1672-2922.2022.01.028
[5] 周爽, 廖华, 王文静, 等. 水杨酸钠致耳鸣大鼠下丘GDNF的表达[J]. 听力学及言语疾病杂志, 2020, 28(2): 177-180. doi:10.3969/j.issn.1006-7299.2020.02.015 ZHOU Shuang, LIAO Hua, WANG Wenjing, et al. Expression of GDNF in the inferior Colliculus of tinnitus rats induced by sodium salicylate[J]. Journal of Audiology and Speech Pathology, 2020, 28(2): 177-180. doi:10.3969/j.issn.1006-7299.2020.02.015
[6] 杨松柏, 彭利艳, 梅志刚, 等. 耳穴电刺激配合声音掩蔽对耳鸣大鼠听觉皮层的CREB蛋白、BDNF及其受体TrkB表达的影响[J]. 中国针灸, 2019, 39(6): 637-642. doi:10.13703/j.0255-2930.2019.06.018 YANG Songbai, PENG Liyan, MEI Zhigang, et al. Effect of electrical stimulation at auricular points combined with sound masking on the expression of CREB, BDNF and TrkB in the auditory cortex of tinnitus rats[J]. Chinese Acupuncture & Moxibustion, 2019, 39(6): 637-642. doi:10.13703/j.0255-2930.2019.06.018
[7] 胡伟倪, 刘俊秀, 毛兰群, 等. 水杨酸钠作用后大鼠伏隔核内多巴胺水平变化[J]. 中国耳鼻咽喉头颈外科, 2017, 24(3): 153-155. doi:10.16066/j.1672-7002.2017.03.011 HU Weini, LIU Junxiu, MAO Lanqun, et al. Effects of salicylate on dopamine levels in rat nucleus accumbens[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2017, 24(3): 153-155. doi:10.16066/j.1672-7002.2017.03.011
[8] Potashner SJ, Suneja SK, Benson CG. Regulation of D-aspartate release and uptake in adult brain stem auditory nuclei after unilateral middle ear ossicle removal and cochlear ablation[J]. Exp Neurol, 1997, 148(1): 222-235. doi:10.1006/exnr.1997.6641
[9] Voytenko SV, Galazyuk AV. mGluRs modulate neuronal firing in the auditory midbrain[J]. Neurosci Lett, 2011, 492(3): 145-149. doi:10.1016/j.neulet.2011.01.075
[10] Martin WH, Schwegler JW, Scheibelhoffer J, et al. Salicylate-induced changes in cat auditory nerve activity[J]. Laryngoscope, 1993, 103(6): 600-604. doi:10.1288/00005537-199306000-00004
[11] 曹雅晨, 张瑾, 张文, 等. 耳鸣与咽喉反流相关性研究进展[J]. 听力学及言语疾病杂志, 2021, 29(2): 226-228. doi:10.3969/j.issn.1006-7299.2021.02.025
[12] 陈黎明, 胡龙. 阿尔茨海默病患者血清微量元素同型半胱氨酸水平与认知功能的相关性研究[J]. 中国基层医药, 2019, 26(18): 2209-2214. doi:10.3760/cma.j.issn.1008-6706.2019.18.008
[13] 冯爱成, 陈婷丽, 谢艺, 等. 耳鸣患者血清锌和铜水平分析[J]. 检验医学与临床, 2014, 11(18): 2563-2564. doi:10.3969/j.issn.1672-9455.2014.18.028
[14] Ding YJ, Song Y, Liu JX, et al. Effect of neuronal excitability in hippocampal CA1 area on auditory pathway in a rat model of tinnitus[J]. Chin Med J, 2018, 131(16): 1969-1974. doi:10.4103/0366-6999.238148
[15] 邬信芳, 高伟, 李钦. 中枢系统在耳鸣中作用机制的研究进展[J]. 世界最新医学信息文摘(连续型电子期刊), 2021, 21(17): 123, 125. doi:10.3969/j.issn.1671-3141.2021.17.049
[16] 冯芹, 冯茜. Calpain 1在水杨酸钠诱导耳鸣大鼠的下丘脑神经元中的表达及对听力的影响[J]. 基因组学与应用生物学, 2020, 39(3): 1337-1343. doi:10.13417/j.gab.039.001337 FENG Qin, FENG Qian. Expression of calpain 1 in hypothalamus neurons of tinnitus rats induced by sodium salicylate and its influence on hearingrevoke[J]. Genomics and Applied Biology, 2020, 39(3): 1337-1343. doi:10.13417/j.gab.039.001337
[17] Zhang I, Wu C, Martel DT, et al. Remodeling of cholinergic input to the hippcampus after noise exposure and tinnitus induction in Guinea pigs [J]. Hippocampus, 2019, 29(8):669-682. doi: 10.1002/hipo.23058
[18] 韦芮, 陈善文, 唐开新, 等. 人工耳蜗植入前后耳鸣与焦虑、抑郁相关性分析[J]. 听力学及言语疾病杂志, 2022, 30(4): 432-435. doi:10.3969/j.issn.1006-7299.2022.04.021
[19] 宋勇莉, 齐柳, 陈阳, 等. 慢性耳鸣患者合并焦虑和抑郁影响因素的分析[J]. 听力学及言语疾病杂志, 2021, 29(4): 398-402. doi:10.3969/j.issn.1006-7299.2021.04.009
[20] 陈茹, 陈橹冰, 时晨, 等. 听力正常耳鸣患者焦虑敏感性的研究[J]. 听力学及言语疾病杂志, 2022, 30(5): 515-518. doi:10.3969/j.issn.1006-7299.2022.05.014 CHEN Ru, CHEN Lubing, SHI Chen, et al. Study on anxiety sensitivity of tinnitus patients with normal hearing[J]. Journal of Audiology and Speech Pathology, 2022, 30(5): 515-518. doi:10.3969/j.issn.1006-7299.2022.05.014
[21] 张婉容, 姚小芹, 蔡伟伟, 等. 基于“中枢可塑性”理论针磁联合治疗神经性耳鸣的疗效及对中枢神经递质的影响[J]. 中国中医基础医学杂志, 2020, 26(9): 1333-1336.doi: 10.3969/j.issn.1006-3250.2020.09.032 ZHANG Wanrong, YAO Xiaoqin, CAI Weiwei, et al. Clinical effect of acupuncture combined with transcranial magnetic stimulation in treating for neurogenic tinnitus based on the theory of “central plasticity” and its effect on central neurotransmitters[J]. Journal of Basic Chinese Medicine, 2020, 26(9): 1333-1336.doi: 10.3969/j.issn.1006-3250.2020.09.032
[22] 朱晓月, 罗征, 孙越甲, 等. 主观性耳鸣患者心理人格特征研究[J]. 中国耳鼻咽喉头颈外科, 2022, 29(5): 301-303, 316. doi:10.16066/j.1672-7002.2022.05.007 ZHU Xiaoyue, LUO Zheng, SUN Yuejia, et al. Study on the psychologic status and personality traits of patients with tinnitus[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2022, 29(5): 301-303, 316. doi:10.16066/j.1672-7002.2022.05.007
[23] 刘颖, 丁然然, 郑剑龙, 等. 耳鸣患者的焦虑抑郁状况及其影响因素研究[J]. 中国听力语言康复科学杂志, 2020, 18(2): 106-110. doi:10.3969/j.issn.1672-4933.2020.02.008 LIU Ying, DING Ranran, ZHENG Jianlong, et al. The status and influencing factors of anxiety and depression in patients with tinnitus[J]. Chinese Scientific Journal of Hearing and Speech Rehabilitation, 2020, 18(2): 106-110. doi:10.3969/j.issn.1672-4933.2020.02.008
[24] 杨春梅, 张婷, 任庆萍, 等. 针刺加常规疗法联合重复经颅磁刺激治疗神经性耳鸣的临床观察[J]. 广州中医药大学学报, 2022, 39(1): 106-110. doi:10.13359/j.cnki.gzxbtcm.2022.01.019 YANG Chunmei, ZHANG Ting, REN Qingping, et al. Clinical observation of acupuncture plus conventional therapy combined with repeated transcranial magnetic stimulation in the treatment of neurogenic tinnitus[J]. Journal of Guangzhou University of Traditional Chinese Medicine, 2022, 39(1): 106-110. doi:10.13359/j.cnki.gzxbtcm.2022.01.019
[25] 张军华, 田浩, 谢飞, 等. 经皮神经电刺激联合颈肌牵伸治疗躯体性耳鸣临床分析[J]. 中国实用神经疾病杂志, 2016, 19(10): 61-63.doi: 10.3969/j.issn.1673-5110.2016.10.036
[26] 夏红艳, 赵立东. 电刺激治疗耳鸣研究进展[J]. 中华耳科学杂志, 2019, 17(5): 783-787. doi:10.3969/j.issn.1672-2922.2019.05.032
[27] 钟零珠, 林智, 孙丽霞. 人工耳蜗植入患者耳鸣临床特征和相关因素调查研究[J]. 中华耳科学杂志, 2020, 18(6): 1072-1076. doi:10.3969/j.issn.1672-2922.2020.06.014 ZHONG Lingzhu, LIN Zhi, SUN Lixia. Clinical characteristics and related factors of tinnitus in patients with cochlear implant[J]. Chinese Journal of Otology, 2020, 18(6): 1072-1076. doi:10.3969/j.issn.1672-2922.2020.06.014
[28] 王洪田, 郗昕, 韩东一, 等. 人工耳蜗植入对耳鸣的影响[J]. 中华耳科学杂志, 2005, 3(2): 116-117. doi:10.3969/j.issn.1672-2922.2005.02.011 WANG Hongtian, XI Xin, HAN Dongyi, et al. Most tinnitus suppression benefit from cochlear implantation[J]. Chinese Journal of Otology, 2005, 3(2): 116-117. doi:10.3969/j.issn.1672-2922.2005.02.011
[29] 陈泓钰, 张心苑, 郑亿庆, 等. 音乐联合认知行为治疗主观性耳鸣疗效及静息态脑电的源定位分析[J]. 中华耳科学杂志, 2020, 18(6): 1045-1049. doi:10.3969/j.issn.1672-2922.2020.06.009 CHEN Hongyu, ZHANG Xinyuan, ZHENG Yiqing, et al. Efficacy of music combined with cognitive behavioral therapy in subjective tinnitus and source localization on resting EEG[J]. Chinese Journal of Otology, 2020, 18(6): 1045-1049. doi:10.3969/j.issn.1672-2922.2020.06.009
[30] 丁毅, 郭裕. 音乐疗法浅析及其在耳鸣治疗中的应用[J]. 中国中西医结合耳鼻咽喉科杂志, 2016, 24(2): 157-159. doi:10.16542/j.cnki.issn.1007-4856.2016.02.031
[31] 于恩光, 许月萍, 邱娟娟, 等. 循经艾灸联合五行音乐疗法辅助治疗神经性耳鸣60例疗效观察[J]. 浙江中医杂志, 2019, 54(6): 438-439. doi:10.13633/j.cnki.zjtcm.2019.06.038 YU Enguang, XU Yueping, QIU Juanjuan, et al. Observation on the effect of five elements music therapy combined with moxibustion on improving neurological tinnitus in 60 cases[J]. Zhejiang Journal of Traditional Chinese Medicine, 2019, 54(6): 438-439. doi:10.13633/j.cnki.zjtcm.2019.06.038
[32] 杨仕明, 王倩. 人工耳蜗植入抑制耳鸣与听觉中枢神经调控[J]. 听力学及言语疾病杂志, 2022, 30(4): 347-349. doi:10.3969/j.issn.1006-7299.2022.04.001
[33] 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, 17. 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, 17. doi:10.6040/j.issn.1673-3770.0.2021.404
[34] 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

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