本文選題：耳鳴　切入點(diǎn)：聲治療　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：耳鳴(tinnitus)是指患者在無外界聲源存在的情況下,感受到耳部或頭部的一種聲音意識感覺。其主要分為客觀性耳鳴和主觀性耳鳴。主觀性耳鳴中絕大部分是不明原因的,故也被稱為特發(fā)性耳鳴(idiopathic tinnitus)。它既可以一種孤立的特發(fā)性癥狀存在,也可伴有不同程度的感音神經(jīng)性聾。雖經(jīng)多年研究與探索,對本病的醫(yī)學(xué)干預(yù)仍面臨諸多挑戰(zhàn):1、發(fā)病機(jī)制不明;2、評估手段有限;3、治療方法雖然多元,臨床效果卻不肯定。慢性特發(fā)性耳鳴因其響度、持續(xù)性、煩擾程度的難以自行緩解成為其臨床特點(diǎn)。由于耳鳴癥狀的主觀特性,臨床診斷主要基于患者對病情的描述。對耳鳴的感知常因患者的個人體驗(yàn)、心理素質(zhì)、職業(yè)和所處社會、家庭環(huán)境的差異而有所不同,故缺少客觀證據(jù)成為耳鳴研究的主要障礙之一。近年來,基于耳鳴機(jī)制中的聽覺皮層不良重組理論(maladaptive auditory cortex reorganization),2010年P(guān)antev首先提出應(yīng)用經(jīng)過特殊處理的定制音樂(tailor-made notched music,TMNM)對耳鳴進(jìn)行個體化聲治療并對開展了相關(guān)的臨床試驗(yàn)。迄今此類研究為數(shù)不多,且多為單中心和小樣本,對其臨床效果和應(yīng)用價值的評價尚無定論,相關(guān)的循證醫(yī)學(xué)證據(jù)還有待拓展與充實(shí)。本文采用前瞻設(shè)計(jì)和隨機(jī)對照,與現(xiàn)有耳鳴聲治療方法進(jìn)行比較,初步分析定制音樂對于慢性特發(fā)性耳鳴的近期效果,并探討其可能機(jī)制。目的應(yīng)用定制音樂療法對慢性特發(fā)性耳鳴患者進(jìn)行個體化干預(yù),并與現(xiàn)有耳鳴聲治療常用方法進(jìn)行比較,分析定制音樂療法對慢性特發(fā)性耳鳴的治療效果并探討其可能作用機(jī)理。方法對象為2015年6月—2016年10月就診于我院耳鼻咽喉科門診的不明原因、伴有或不伴有感音神經(jīng)性聾,病程≥6個月的耳鳴患者�；颊呓�(jīng)過嚴(yán)格的入選及排除標(biāo)準(zhǔn)納入試驗(yàn)中后采用前瞻性設(shè)計(jì)。將其隨機(jī)分為個體化組(A組=20人),類掩蔽組(B組=20人)和類習(xí)服組(C組=20人)進(jìn)行為期3個月的聲治療。治療前及治療中的每個月分別對其進(jìn)行耳鳴量表、耳鳴響度及聽力學(xué)評估。結(jié)果經(jīng)過1個月規(guī)律治療,三組間有效率分別為38.9%、41.2%和41.2%,差異尚不明顯(x2=0.026,P=0.9870.05)。治療2個月時A組有效率異(44.4%)高于B組(29.4%),但低于C組(52.9%),同樣三組間有效率也未見明顯差異(x2=1.979,P=0.3720.05)。經(jīng)過3個月的規(guī)律治療后,A組有效率明顯優(yōu)于其他兩組(77.8%vs 23.8%vs 52.9%,x2=10.317,P=0.0060.05);且隨治療時間的推移,A組有效率呈明顯上升趨勢(Χ2=6.406,P=0.0410.05),B組有效率下降但無明顯意義(Χ2=1.275,P=0.5290.05);C組治療一個月也呈現(xiàn)出一定療效,C組有效率短期內(nèi)上升后兩個月保持不變(Χ2=0.628,P=0.713)。分析各組耳鳴殘疾量表(tinnitus handicap inventory,THI)(F=5.603,P=0.0020.05)、響度視覺模擬量表(visual analogue scale,VAS)(F=13.780,P0.001)和耳鳴匹配響度數(shù)據(jù)(F=3.738,P=0.0270.05),顯示A組療效表現(xiàn)出明顯的優(yōu)勢。結(jié)論本研究提示,經(jīng)特殊聲學(xué)處理的音樂可用于慢性特發(fā)性耳鳴的治療。長時程、規(guī)范化聆聽經(jīng)個體化處理的定制音樂,可以顯著減輕患者的耳鳴響度,不同程度地改善耳鳴對患者生活質(zhì)量造成的影響。作者對該方法的效果與可能的機(jī)制進(jìn)行了分析。
[Abstract]:Tinnitus (tinnitus) refers to the patients without the external sound source condition, feel a sound sense of head or ear feeling. It is mainly divided into objective tinnitus and tinnitus. Most subjective tinnitus in the cause is unknown, it is also known as idiopathic tinnitus (idiopathic tinnitus). Can a solitary idiopathic symptoms may also exist, with varying degrees of sensorineural hearing loss. Although the research and exploration of medical intervention for many years, the disease is still facing many challenges: 1, unknown pathogenesis; 2, evaluation means limited; 3, although the multi treatment clinical effect, but not sure. Chronic idiopathic tinnitus because of its loudness, persistent annoyance degree are difficult to alleviate as its clinical features. Because of the subjective characteristics of tinnitus symptoms, clinical diagnosis is mainly based on the description of the disease. Patients of tinnitus perception due to patients. People experience, psychological quality, occupation and social differences, family environment is different, so the lack of objective evidence has become one of the main obstacles of tinnitus research. In recent years, the mechanism of tinnitus in auditory cortex (maladaptive auditory based on the theory of adverse recombinant cortex reorganization), 2010 Pantev first proposed the application after special treatment of custom music (tailor-made notched music, TMNM) for individual sound treatment of tinnitus and relevant clinical trials carried out. So far this kind of research are few, and mostly and small single center, to evaluate the clinical effect and application value have been inconclusive, evidence has yet to expand and enrich the related in this paper. A prospective and randomized design, comparing with the existing tinnitus treatment method, a preliminary analysis of the recent effect of custom music for chronic idiopathic tinnitus, and explore the The possible mechanism to custom application of music therapy on chronic idiopathic tinnitus patients with individualized intervention, and with the existing tinnitus therapeutic methods of comparison, analysis of customized music therapy on chronic idiopathic tinnitus treatment effect and to explore the possible mechanism. Methods of unknown reason as June 2015 to October 2016 in our hospital department of Otorhinolaryngology clinic, with or without sensorineural hearing loss, course more than 6 months. The patients with tinnitus patients after the inclusion and exclusion criteria included in the test after the prospective design strictly. It will be randomly divided into individual group (A group =20), group B (class of masking group =20) and acclimatization group (C group =20) sound therapy for 3 months. A month before and after treatment respectively on the scale of tinnitus, tinnitus loudness and audiological assessment. Results after 1 months of treatment, between the three groups The efficiency were 38.9%, 41.2% and 41.2%, the difference is not obvious (x2=0.026, P=0.9870.05). 2 months A treatment group effective rate of (44.4%) is higher than that of B group (29.4%), but lower than that of group C (52.9%), the same between the three groups showed no significant difference between the efficiency (x2=1.979, P=0.3720.05). After the law 3 months after treatment, A group was significantly better than the other two groups (77.8%vs 23.8%vs 52.9%, x2=10.317, P=0.0060.05); and with the treatment time, the effective rate of group A was significantly increased (x 2=6.406, P=0.0410.05), B group, but no significant decline in the efficiency of meaning (x 2=1.275. P=0.5290.05); group C one month of treatment also showed a certain effect, the efficiency of the C group in the short term after rising two months remained unchanged (x 2=0.628, P=0.713) were analyzed. The tinnitus disability scale (tinnitus handicap inventory THI (F=5.603), P= 0.0020.05), loudness, visual analogue scale (visual analogue scale (F=13.780, VAS), P0.001) and tinnitus loudness matching data (F=3.738, P=0.0270.05), show the efficacy of the A group showed obvious advantages. Conclusion this study suggests that, after the special acoustic processing of music can be used for the treatment of chronic idiopathic tinnitus. Long term, standardized listening to the individualized treatment of customized music, can significantly reduce patients tinnitus loudness, improve the effect on quality of life in patients with tinnitus caused by the author. The effect of the method and the possible mechanism is analyzed.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R764.45

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