山东大学耳鼻喉眼学报 ›› 2019, Vol. 33 ›› Issue (4): 43-46.doi: 10.6040/j.issn.1673-3770.0.2018.393

• 论著 • 上一篇    下一篇

突发性聋伴耳鸣的治疗与转归

钟晓声1,杨海弟2,郑亿庆2,*()   

  1. 1. 广州市增城区人民医院/中山大学孙逸仙纪念医院增城院区耳鼻喉科,广东 增城 511300
    2. 中山大学孙逸仙纪念医院耳鼻喉科,广东 广州 510120
  • 收稿日期:2018-08-29 出版日期:2019-07-16 发布日期:2019-07-22
  • 通讯作者: 郑亿庆 E-mail:zhengyiq@mail.sysu.edu.cn

Treatment and outcome of tinnitus in sudden deafness

Xiaosheng ZHONG1,Haidi YANG2,Yiqing ZHENG2,*()   

  1. 1. Department of Otolaryngology, Zengcheng People′s Hospital, Guangzhou 511300, Guangdong, China
    2. Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Zhongshan University, Guangzhou 511300, Guangdong, China
  • Received:2018-08-29 Online:2019-07-16 Published:2019-07-22
  • Contact: Yiqing ZHENG E-mail:zhengyiq@mail.sysu.edu.cn

摘要: 目的

研究分析突发性聋伴耳鸣患者的治疗与转归情况。

方法

选取突发性聋伴耳鸣患者76例,入院后常规按《突发性聋的诊断和治疗指南(2015)》治疗, 2周后分析耳鸣致残量表(THI)及视觉模拟得分表(VAS)评分变化。出院时对所有患者进行心理辅导,对未能适应耳鸣者个体化行短期药物治疗、掩蔽治疗、习服治疗、助听器治疗。随访1年,因耳鸣再次就诊者予掩蔽治疗或习服治疗,观察耳鸣的转归。

结果

76例患者治疗前后THI得分分别为(49.71±2.69)、(41.04±2.84)分,差异有统计学意义(t=3.935,P<0.001);治疗前后VAS得分分别为(5.17±0.20)、(4.22±0.25)分,差异有统计学意义(t=5.010, P<0.001)。听力有效53例,无效23例,听力有效及无效者常规治疗前后THI差值分别为(13.57±2.27)、(-2.60±4.28)分,差异有统计学意义(t=3.339,P=0.002);听力有效及无效者常规治疗前后VAS差值分别为(1.35±0.17)、(0±0.43)分,差异有统计学意义(t=2.953, P=0.006)。经心理辅导后,电话随访1年,其中有53例患者自然适应耳鸣(未因耳鸣困扰再次就诊),占69.7%,23例患者因耳鸣返院就诊,占30.3%,THI得分18~92分,平均56.6,多为3~4级严重耳鸣患者。2周时及1年后VAS得分分别为(4.22±0.25)、(3.39±0.18)分,两个时间段VAS得分比较,差异有统计学意义(t=6.362, P<0.001)。治疗2周后耳鸣消失4例,明显减轻7例,减轻11例,不变49例,加重5例,2周后耳鸣总减轻比例28.9%;治疗1年后耳鸣消失6例,明显减轻10例,减轻14例,不变42例,加重4例,耳鸣总减轻比例39.5%,治疗2周后与1年后耳鸣减轻率比较,差异有统计学意义(χ2=43.978, P<0.001)。1年后,完全适应31例,基本适应40例,总适应率92.1%,难以适应6例。

结论

常规治疗、心理辅导、掩蔽治疗和习服治疗对突发性聋伴耳鸣患者均有较好效果,经个体化治疗后耳鸣转归良好。

关键词: 突发性聋, 耳鸣, 治疗结局, 转归

Abstract: Objective

To study and analyze the treatment and outcome of tinnitus in sudden deafness with tinnitus.

Methods

Seventy-six cases of sudden deafness with tinnitus were selected and treated according to the Guidelines for Diagnosis and Treatment of Sudden Deafness (2015). After 2 weeks, the tinnitus disability scale (THI) and visual analog scale (VAS) scores were analyzed. All patients were provided psychological counseling at discharge. Individualized short-term medication, masking therapy, acclimatization therapy, and hearing aid therapy were provided to those who could not adapt to tinnitus. At the 1-year follow-up, patients who still experienced tinnitus were treated with masking therapy or acclimatization.

Result

Before and after 2 weeks of routine treatment, the THI scores of the 76 patients were 49.71±2.69 and 41.04±2.84, respectively (t=3.935, P < 0.001); VAS scores were 5.17±0.20 and 4.22±0.25, respectively (t=5.010, P < 0.001). Hearing was good in 53 cases and poor in 23 cases. The difference in THI before and after routine treatment in the good and poor hearing groups was 13.57±2.27 and -2.60±4.28, respectively (t=3.339, P=0.002); the VAS difference before and after routine treatment in the good and poor hearing groups was 1.35±0.17 and 0±0.43, respectively (t=2.953, P=0.006). After psychological counseling, patients were followed up for 1 year by telephone. Of these, 53 patients had adapted to tinnitus, accounting for 69.7% of patients. Twenty-three patients returned to hospital due to tinnitus, accounting for 30.3% of patients. The THI scores ranged between 18 and 92 with an average of 56.6, a mean mostly driven by scores in 3-4 patients with severe tinnitus. The VAS scores at 2 weeks and 1 year were 4.22±0.25 and 3.39±0.18, respectively. There was a significant difference in VAS scores between the two time periods (t=6.362, P < 0.001). After treatment for 2 weeks, tinnitus resolved in four patients and was significantly alleviated in seven patients, alleviated in 11 patients, unchanged in 49 patients, and aggravated in five patients. Tinnitus was reduced by 28.9%. After one year of treatment, tinnitus resolved in six patients and was significantly alleviated in 10 patients, alleviated in 14 patients, unchanged in 42 patients, and aggravated in four patients. In total, for 39.5% of patients, tinnitus was alleviated. After treatment for 2 weeks and 1 year later, there was a significant difference in the rate of tinnitus relief, (χ2=43.978, P < 0.001). After 1 year, 31 patients were completely adapted to tinnitus, and 40 patients were largely adapted; the total adaptation rate was 92.1%. Six patients found it difficult to adapt.

Conclusion

Routine treatment, psychological counseling, masking therapy, and acclimatization therapy for sudden deafness have positive effects on tinnitus. Patients with tinnitus recovered well after individualized treatment.

Key words: Sudden deafness, Tinnitus, Treatment, Outcome

中图分类号: 

  • R764.437
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