本文關鍵詞： 耳鳴 臨床特征 心理聲學　出處：《鄭州大學》2017年碩士論文　論文類型：學位論文

【摘要】：耳鳴(tinnitus)是一種在沒有外源性聲、電刺激情況下,耳內(nèi)或顱內(nèi)產(chǎn)生的異常聽覺感知,并且持續(xù)5分鐘以上。耳鳴的發(fā)病率很高,美國和歐洲在2003年的調(diào)查顯示,耳鼻咽喉科門診的10%~20%的患者是以耳鳴為主訴就診,其中經(jīng)常因為耳鳴就診的患者達5%~10%,因為耳鳴嚴重影響到患者的生活、注意力集中、工作、社交活動以及睡眠的占2%~5%,由于嚴重的耳鳴導致殘疾的患者約有0.5%~1%。耳鳴帶給患者的痛苦除了惱人、單一的聲音外,其伴隨的精神情緒癥狀,如睡眠障礙,焦慮,抑郁,注意力不集中等也值得我們重視。按照耳鳴的性質(zhì),可分為主觀性耳鳴與客觀性耳鳴;根據(jù)耳鳴對患者的影響,可分為惱人的耳鳴和不惱人的耳鳴。2014年美國《耳鳴指南》中指出,根據(jù)耳鳴的病程將耳鳴分為:1.新近發(fā)生的耳鳴:耳鳴持續(xù)時間短于6個月(急性耳鳴);2.持續(xù)性耳鳴:耳鳴持續(xù)6個月以上(慢性耳鳴)。由于耳鳴的病因,發(fā)病機制復雜,所以耳鳴的治療效果也不盡如人意。有研究顯示,急性耳鳴的預后較慢性耳鳴預后好。急性耳鳴多有因可循,常給予藥物治療,而慢性耳鳴多為原發(fā)性耳鳴,不易完全消除耳鳴聲,臨床上多采用聲治療的方法治療慢性耳鳴。不同病程的耳鳴,其病因及發(fā)病機制不同,臨床及心理聲學特征也不盡相同。為了探討不同病程耳鳴的特點,本文通過對不同病程耳鳴患者的分析,探討急、慢性耳鳴患者在病因,臨床特征,耳鳴的伴發(fā)癥狀及耳鳴的心理聲學特征的不同,以期對耳鳴的臨床治療提供依據(jù),提高耳鳴患者的療效。對象與方法研究對象選自2015年9月至2016年6月期間就診于鄭州大學第一附屬醫(yī)院耳科的耳鳴患者343例。采集耳鳴患者病史,記錄患者一般情況:患者的性別、年齡、耳鳴側(cè)別、起病情況、是否為持續(xù)性、持續(xù)時間、伴隨疾病,睡眠質(zhì)量情況:有無入睡困難、多夢、早醒等。并由同一位具有資質(zhì)的專業(yè)人員,給予純音測聽、聲導抗測試,耳鳴匹配檢查。運用“耳鳴殘疾量表”評估患者的耳鳴嚴重程度,使用“焦慮自評量表”,“抑郁自評量表”評估耳鳴患者的有無焦慮及抑郁狀態(tài)。根據(jù)結果進行統(tǒng)計學分析。結果1.急、慢性耳鳴的病因構成比較結果:急性耳鳴組,突發(fā)性耳聾94例(51.93%),原發(fā)性耳鳴67例(37.01%)。慢性耳鳴組,原發(fā)性耳鳴122例(75.31%)。2.急、慢性耳鳴患者的一般臨床特征比較結果:急性耳鳴組:男性97例(53.59%);45~60歲患者70例(38.67%);左耳鳴89例(49.17%),右耳鳴73例(40.33%);持續(xù)性耳鳴137例(75.69%)。慢性耳鳴中:男性75例(46.29%),45~60歲患者58例(35.80%);左耳鳴66例(40.74%),右耳鳴68例(41.98%);持續(xù)性耳鳴耳鳴108例(66.67%)。兩組相比患者在性別、年齡、耳鳴側(cè)別及持續(xù)性的分布上構成差異無統(tǒng)計學意義(P0.05)。3.急、慢性耳鳴患者的伴隨癥狀比較結果:急性耳鳴伴睡眠障礙82例(45.30%),伴焦慮癥狀38例(20.99%),伴抑郁癥狀22例(12.15%);慢性耳鳴患者伴睡眠障礙57例(35.19%),伴焦慮癥狀17例(10.49%),伴抑郁癥狀39例(24.07%)。兩組相比患者伴睡眠障礙的情況差異無統(tǒng)計學意義(P0.05)。伴焦慮、抑郁情況有統(tǒng)計學差異(P0.05)。4.急、慢性耳鳴的心理聲學特征比較:急性耳鳴組,聽力下降以低中頻為主68例(37.57%);耳鳴匹配頻率為低中頻96例(53.04%),耳鳴匹配響度≤5dBSL90例(49.72)。慢性組,聽力下降為低中頻的患者26例(16.05%),耳鳴頻率匹配為高頻患者109例(67.28%),耳鳴匹配響度≤5dBSL的患者87例(53.70%)。兩組相比患者聽力下降頻率及耳鳴匹配頻率的分布,差異有統(tǒng)計學意義(P0.05)。兩組在耳鳴匹配響度的分布上差異無統(tǒng)計學意義(P0.05)。5.急、慢性耳鳴的嚴重程度比較結果:急性組,THI分級為3級61例(33.70%);慢性組,THI分級為3級52例(32.10%)。兩組相比患者的耳鳴嚴重程度分級上差異無統(tǒng)計學意義。結論1.急、慢性耳鳴患者在耳鳴病因的構成上不同。急性耳鳴病因以突發(fā)性耳聾為主,其次為原發(fā)性耳鳴,慢性耳鳴以原發(fā)性耳鳴為主。2.急、慢性耳鳴患者伴發(fā)睡眠障礙比例較高,但兩組間差異無統(tǒng)計學意義。3.急、慢性患者伴發(fā)焦慮、抑郁情況差異有統(tǒng)計學意義,急性耳鳴患者較慢性者更易伴發(fā)焦慮狀態(tài);慢性耳鳴患者較急性耳鳴者更易伴發(fā)抑郁狀態(tài)。4.急、慢性耳鳴患者的耳鳴匹配頻率有差異,急性耳鳴患者以低中頻為主;慢性耳鳴患者以高頻為主。
[Abstract]:Tinnitus (tinnitus) is a kind of sound in the absence of exogenous stimulation, under the condition of abnormal auditory perception in the ear or intracranial generated, and lasts over 5 minutes. The tinnitus incidence rate is very high, the United States and Europe in the 2003 survey, the 10%~20% Department of otolaryngology clinic patients with complaints of tinnitus the treatment, often because of tinnitus patients up to 5%~10%, because tinnitus seriously affect the patient's life, focus, work, social activities and sleep accounted for 2%~5%, due to severe tinnitus disability patients about 0.5%~1%. of tinnitus and bring the pain of the patient in addition to annoying, single voice, the concomitant mental emotional symptoms such as, sleep disorders, anxiety, depression, attention is also worthy of our attention. According to the nature of tinnitus, can be divided into subjective tinnitus and objective tinnitus; according to the influence of tinnitus on patients, can be divided into. It points out that the tinnitus and tinnitus annoying.2014 American "in the" guidelines for tinnitus, tinnitus and tinnitus according to course will be divided into: 1. recent onset tinnitus: ringing duration is shorter than 6 months (acute tinnitus); 2. persistent tinnitus: ringing for 6 months or more (chronic tinnitus) due to tinnitus. The etiology, pathogenesis is complex, so the tinnitus treatment effect is not satisfactory. Studies have shown that the prognosis of acute tinnitus with good prognosis of chronic tinnitus acute tinnitus. Many are due to follow, often given drug therapy, and chronic tinnitus is idiopathic tinnitus, not easy to completely eliminate tinnitus, clinical use method the sound of the treatment of chronic tinnitus. The different course of tinnitus, its etiology and pathogenesis, clinical and psychological acoustic features are not the same. In order to explore the characteristics of different duration of tinnitus, based on the analysis of different duration of tinnitus patients, discuss the urgent And the clinical characteristics of patients with chronic tinnitus in the etiology of tinnitus, and psychological symptoms of tinnitus and acoustic characteristics of different, provide the basis for clinical treatment to improve the curative effect of tinnitus, tinnitus patients. Subjects and methods during the study from September 2015 to June 2016 clinic in the First Affiliated Hospital of Zhengzhou University Department of tinnitus patients in 343 cases. Acquisition the history of tinnitus patients, record the general condition of the patients: the patient's sex, age of onset, tinnitus laterality, whether persistent, duration, comorbidity, sleep quality, sleep without difficulty, dreams, waking up early. And with a qualified professional personnel, for pure tone audiometry, tympanometry, tinnitus, check. Use "patients with tinnitus severity of tinnitus disability scale assessment, using the self rating Anxiety Scale", "self rating depression scale assessment of tinnitus patients with and without 鐒﹁檻鍙婃姂閮佺姸鎬，

本文編號：1501906