本文關(guān)鍵詞：聽(tīng)覺(jué)過(guò)敏的臨床特征及評(píng)估方法　出處：《鄭州大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

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【摘要】：研究背景 耳科門(mén)診中耳鳴患者最多見(jiàn)，對(duì)耳鳴的臨床研究發(fā)現(xiàn)有些耳鳴患者不僅受耳鳴困擾，而且對(duì)正常環(huán)境中常人未感不適的聲音耐受度降低。Jastreboff曾報(bào)道耳鳴診療中心的60%耳鳴患者對(duì)日常生活中常人未感不適的聲音表現(xiàn)出異常反應(yīng)，如不適、煩躁、緊張、害怕、恐懼等消極反應(yīng)。早在1938年P(guān)erlman第一次提出“聽(tīng)覺(jué)過(guò)敏（hyperacusis）”概念來(lái)描述聲過(guò)敏癥狀。聽(tīng)覺(jué)過(guò)敏臨床特征主要表現(xiàn)為對(duì)環(huán)境中正常的聲音耐受度降低，并帶有不良情緒反應(yīng)，嚴(yán)重者表現(xiàn)出精神癥狀和神經(jīng)癥人格特征，給患者生活帶來(lái)嚴(yán)重負(fù)面影響。 流行病學(xué)的調(diào)查顯示聽(tīng)覺(jué)過(guò)敏發(fā)病率逐年增加，聽(tīng)覺(jué)過(guò)敏的病因及發(fā)病機(jī)制尚無(wú)確切定論。目前臨床中應(yīng)用的聽(tīng)覺(jué)過(guò)敏評(píng)估方法，主要有問(wèn)卷量表調(diào)查及聽(tīng)力學(xué)檢測(cè)。由于不同國(guó)家之間文化及語(yǔ)言的差異，尚不存在國(guó)際統(tǒng)一通用的量表，國(guó)內(nèi)學(xué)者尚未對(duì)聽(tīng)覺(jué)過(guò)敏臨床評(píng)估量表進(jìn)行深入研究。 聽(tīng)覺(jué)過(guò)敏與耳鳴常伴隨存在，臨床醫(yī)師常重點(diǎn)關(guān)注耳鳴而忽視聽(tīng)覺(jué)過(guò)敏癥狀，導(dǎo)致耳鳴習(xí)服治療效果大大降低。聽(tīng)覺(jué)過(guò)敏對(duì)患者的直接影響并不亞于耳鳴或者其他聽(tīng)力疾病，但是由于臨床醫(yī)生對(duì)其癥狀表現(xiàn)及臨床評(píng)估缺乏認(rèn)識(shí)，在診斷治療上往往陷入誤區(qū)。因此正確認(rèn)識(shí)聽(tīng)覺(jué)過(guò)敏對(duì)于其診斷、鑒別及有效治療有重要意義。 目的 本研究的目的是探討聽(tīng)覺(jué)過(guò)敏的臨床特征，分析各種臨床評(píng)估方法并確定有效評(píng)估方法，，為進(jìn)行臨床診治提供幫助。 方法 收集耳科門(mén)診中以聽(tīng)覺(jué)過(guò)敏伴或不伴耳鳴為主訴就診患者的臨床資料，共60例，其中其中男性21例，女性39例；年齡13~71歲，平均年齡38.82±14.15歲。選擇20例無(wú)年齡和性別差異、無(wú)耳鳴及聽(tīng)覺(jué)過(guò)敏的聽(tīng)力正常志愿者作為正常對(duì)照組（C組），其中男10例，女10例；年齡13~70歲，平均年齡37.15±13.24歲。通過(guò)病史問(wèn)卷表詳細(xì)詢問(wèn)患者病史，以了解聽(tīng)覺(jué)過(guò)敏病史特征。所有研究對(duì)象均填寫(xiě)中文版聽(tīng)覺(jué)過(guò)敏調(diào)查問(wèn)卷量表，對(duì)量表得分結(jié)果進(jìn)行整理分析，同時(shí)進(jìn)行聽(tīng)力學(xué)檢查，分析比較各組純音測(cè)聽(tīng)、響度不適閾、畸變產(chǎn)物耳聲發(fā)射測(cè)試及對(duì)側(cè)聲刺激抑制試驗(yàn)結(jié)果。 結(jié)果 60例聽(tīng)覺(jué)過(guò)敏患者中49例（81.67%）伴有耳鳴，14例（23.33%）伴有頭痛。常見(jiàn)敏感聲音有小孩哭聲、尖叫聲、突然短促高調(diào)聲、電器噪聲、汽笛聲等。聽(tīng)覺(jué)過(guò)敏組和聽(tīng)覺(jué)過(guò)敏伴耳鳴組問(wèn)卷總得分高于正常組(P0.05)，注意力、情緒子維度的得分受性別的影響，具有統(tǒng)計(jì)學(xué)差異性(P0.05)；聽(tīng)覺(jué)過(guò)敏組和聽(tīng)覺(jué)過(guò)敏伴耳鳴組響度不適閾值明顯低于正常組(P0.05)，LDL閾值與聽(tīng)覺(jué)過(guò)敏問(wèn)卷總得分、注意力、社會(huì)、情緒子維度得分的相關(guān)性得出兩者無(wú)相關(guān)性（P＞0.05）；聽(tīng)覺(jué)過(guò)敏組和聽(tīng)覺(jué)過(guò)敏伴耳鳴組對(duì)側(cè)聲刺激后畸變產(chǎn)物耳聲發(fā)射測(cè)試幅值與未抑制時(shí)比較無(wú)差異（P0.05）。 結(jié)論 聽(tīng)覺(jué)過(guò)敏是個(gè)體生理和心理共同作用的一種臨床癥狀，臨床評(píng)估主要包括聽(tīng)覺(jué)過(guò)敏主觀癥狀問(wèn)卷調(diào)查及聽(tīng)力學(xué)檢查。中文版本聽(tīng)覺(jué)過(guò)敏調(diào)查問(wèn)卷具有可靠性性和有效性，能夠應(yīng)用于臨床量化評(píng)估聽(tīng)覺(jué)過(guò)敏對(duì)患者生活的影響。畸變產(chǎn)物耳聲發(fā)射可評(píng)價(jià)聽(tīng)覺(jué)過(guò)敏耳蝸功能。
[Abstract]:Research background
In the most common otology clinic patients with tinnitus, clinical study of tinnitus found some tinnitus patients not only by tinnitus, and discomfort of ordinary people are not the normal environment of sound tolerance reduce.Jastreboff reported tinnitus treatment center 60% tinnitus patients of ordinary people in daily life are not sound discomfort showed abnormal responses such as discomfort, irritability, tension, fear, fear and other negative effects. As early as in 1938, Perlman first proposed the "hyperacusis (hyperacusis)" concept to describe the sound of allergic symptoms. Hyperacusis main clinical features of the environment in a normal voice tolerance decreased, and with negative emotional reactions, serious show mental symptoms and neurotic personality characteristics, bring serious negative impact on the life of patients.
Epidemiological surveys show that hyperacusis incidence increased year by year, the etiology and pathogenesis of allergic hearing is no definite conclusion. Hyperacusis evaluation method of clinical application at present, mainly include questionnaire survey and audiology. Due to cultural and language differences between different countries, there is no unified international general scale, domestic scholars yet for the hyperacusis clinical assessment of in-depth study.
Hyperacusis and tinnitus often accompanied by the existence of, clinicians often focus on tinnitus and ignore auditory allergy symptoms, cause tinnitus retraining therapy effect is greatly reduced. Hyperacusis is not less than tinnitus or other disease to directly affect the patient's hearing, but due to the lack of awareness of clinicians and clinical evaluation in diagnosis and treatment of their symptoms, often misunderstand. So a correct understanding of hyperacusis for its diagnosis, has important significance in differential and effective treatment.
objective
The purpose of this study is to explore the clinical features of auditory hypersensitivity, to analyze various clinical evaluation methods and to determine effective evaluation methods for clinical diagnosis and treatment.
Method
In order to collect hyperacusis with or without clinical data of patients with tinnitus in otology clinic, a total of 60 cases, including 21 males and 39 females; aged 13~71 years, mean age 38.82 + 14.15 years old. 20 cases of no age and gender differences, no tinnitus and hyperacusis as normal hearing volunteers the normal control group (C group), 10 cases were male, 10 were female; aged 13~70 years, mean age 37.15 + 13.24 years history. Through the questionnaire asked in detail about the patient's history to understand the characteristics of auditory allergy history. All of the subjects were in Chinese auditory sensitive version questionnaire, the score results by analyzing and audiological examination were analyzed and compared, pure tone audiometry, loudness discomfort threshold test and contralateral acoustic stimulation inhibition test results of distortion product otoacoustic emission.
Result
60 cases of hyperacusis patients in 49 cases (81.67%) accompanied by tinnitus, 14 cases (23.33%) accompanied by headache. Common sensitive voice of a child crying, screaming, suddenly high-profile short sound, electrical noise, whistle. Auditory allergy and hyperacusis and tinnitus questionnaire total score higher than the normal group (P0.05). Attention, emotional impact sub dimension scores by gender, with statistical difference (P0.05); auditory allergy and hyperacusis and tinnitus loudness discomfort threshold group was significantly lower than the normal group (P0.05, LDL) threshold and hyperacusis Questionnaire total score, attention, social, emotional dimension scores correlation between the two no correlation (P > 0.05); auditory allergy and hyperacusis and tinnitus group contralateral acoustic stimulation after DPOAE amplitude and no inhibition test showed no significant difference (P0.05).
conclusion
Hyperacusis is a common clinical symptom of individual physiological and psychological, clinical evaluation mainly includes the investigation and audiological examination hyperacusis subjective symptom questionnaire. Chinese version of hyperacusis questionnaire with reliability and validity, which can be applied to clinical quantitative evaluation of hyperacusis on patients life. The effects of distortion product otoacoustic emission auditory evaluation allergic cochlear function.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R764.45

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本文編號(hào)：1394329