本文關(guān)鍵詞： 耳鳴 臨床特征 誘發(fā)因素 復(fù)合聲 突發(fā)性聾 評價　出處：《南方醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：背景與目的耳鳴,被譽為耳科學(xué)三大難題(耳鳴、耳聾、眩暈)之首。隨著我國社會事業(yè)的高速發(fā)展,耳鳴發(fā)病率也隨著人群所承受的社會壓力及噪聲污染的加重而逐步提高。根據(jù)流行病學(xué)調(diào)查保守估計,我國耳鳴發(fā)生率約為10%,患者人群多達1.3億人,其中約有20%-25%的耳鳴患者在不斷地求醫(yī)。久治不愈的耳鳴可導(dǎo)致失眠、焦慮、恐懼、抑郁,并帶來家庭、生活和工作等種種社會問題,嚴重影響人們的生活質(zhì)量。但耳鳴的發(fā)病機制復(fù)雜,至今研究仍不十分清楚。但現(xiàn)有相關(guān)研究證實,聽覺傳導(dǎo)途徑中的神經(jīng)纖維異常電活動、邊緣系統(tǒng)與自主神經(jīng)系統(tǒng)的紊亂等機制共同參與并形成了耳鳴及其相關(guān)癥狀。不同性質(zhì)的耳鳴決定了診療方式的不同�！笆Т鷥斝远Q”表現(xiàn)為耳鳴較為嚴重,可分散患者注意力,并可引起睡眠障礙、焦慮、抑郁、恐懼等精神癥狀,這類耳鳴患者需要接受個體化的干預(yù)和綜合治療。但如何量化患者的失代償程度,目前在臨床上尚沒有統(tǒng)一的方法和標準。國內(nèi)外的耳鳴指南,給出了一些耳鳴評價量表,用以評估患者的失代償程度,但尚缺乏耳鳴專家的共識和統(tǒng)一的評分標準。針對這一類耳鳴人群的臨床研究,國外文獻報道甚少,檢索國內(nèi)文獻,尚沒有相關(guān)報道。所以針對這類人群的臨床特征有必要做進一步的探討和研究,為臨床診療提供參考依據(jù)。聲治療常用于病因不明且治療方法不多的慢性耳鳴,較少應(yīng)用于藥物治療常有效的急性耳鳴。突發(fā)性耳聾是耳科常見疾病,全國多中心突聾臨床研究結(jié)果顯示,在1024例單側(cè)突聾患者中,864例(84.38%)伴有耳鳴,18例(1.76%)伴有顱鳴。突發(fā)性聾治療不及時或不規(guī)范有較高的耳聾和耳鳴致殘率。為更好的治療突發(fā)性聾伴有的耳鳴癥狀,減輕耳聾、耳鳴致殘率,本文觀察了應(yīng)用與不應(yīng)用復(fù)合聲治療突發(fā)性聾伴耳鳴患者的療效差異,探討了療程設(shè)計和治療方式,總結(jié)了復(fù)合聲治療耳鳴的臨床經(jīng)驗,為更好地應(yīng)用復(fù)合聲治療急性耳鳴提供參考依據(jù)。1觀察對象及方法1.1失代償性耳鳴的心理聲學(xué)及臨床特征分析1.1.1受試對象收集于2013年10月至2014年7月,就診于南方醫(yī)科大學(xué)南方醫(yī)院耳鼻咽喉頭頸外科門診的耳鳴患者,其臨床資料628例,823耳(單耳433例,雙耳195例)。1.1.2檢測項目 純音測聽、耳鳴匹配、殘余抑制試驗：耳鳴減輕大于20%記為殘余抑制陽性,無改變或減輕小于20%記為陰性。1.1.3量表填寫 《耳鳴問診量表》包含患者的就診經(jīng)歷、耳鳴性質(zhì),患者是否伴有全身性疾病和疾病類型、響度VAS標尺等。《耳鳴嚴重程度自評表》根據(jù)6項指標的總評分將耳鳴的嚴重程度由輕到重分為Ⅰ-Ⅴ級。失代償型耳鳴患者入組標準：在《耳鳴嚴重程度自評表》中,耳鳴對(睡眠、工作、情緒)的影響的選項(不影響、有時影響、經(jīng)常影響、非常影響),3個問題沒有勾選(不影響)的患者。1.1.4統(tǒng)計學(xué)分析用SPSS13.0軟件完成統(tǒng)計學(xué)處理,按資料類型和檢驗?zāi)康?分別進行t檢驗、卡方檢驗、Pearson相關(guān)性檢驗,顯著性水準為0.05。1.2復(fù)合聲治療突發(fā)性聾患者耳鳴的臨床對照研究1.2.1受試對象收集于2013年9月至2014年4月,就診于南方醫(yī)科大學(xué)南方醫(yī)院耳鼻咽喉科門診及收治住院的突發(fā)性聾伴耳鳴患者96例。突發(fā)性聾的診斷標準采用《突發(fā)性聾的診斷和治療指南》(2005年,濟南)。按就診時間順序持隨機序列號分入試驗組和對照組,每組48例。1.2.2試驗過程試驗組采用突發(fā)性聾常規(guī)藥物治療+復(fù)合聲治療,對照組僅用藥物治療。1.2.3試驗組檢測項目 純音測聽、耳鳴問診、復(fù)合聲匹配、殘余抑制試驗。復(fù)合聲匹配步驟：類比法在純音、脈沖純音、白噪聲、窄道噪聲、言語噪聲等聲源中選擇最近似的聲音作為掩蔽聲,強度為最小掩蔽響度+10dBHL,同時加入患者喜歡的音樂,根據(jù)檢測結(jié)果得出最佳復(fù)合聲。1.2.4復(fù)合聲治療方法療程掩蔽聲單耳給聲,響度不得高于90dBHL,若患耳對應(yīng)頻率聽力損失超過90dBHL,則采用健側(cè)耳給聲；音樂聲雙耳給聲,響度控制在40-70 dBHL間,以健側(cè)耳舒適為標準。2次/日,30分鐘/次,治療30天,30天后患者在家中用電腦通過高保真耳機雙耳播放輕音樂治療,治療60天,2次/日,60分鐘/次。1.2.5評價指標記錄患者就診或入院時、治療第30天及第90天的耳鳴視覺量表響度評分(Visual Analogue Scale, VAS)、耳鳴致殘量表評分(Tinnitus Handicap Inventory, THI)中文版、焦慮自評量表評分(Self-rating Anxiety Scale, SAS)及純音聽閾閾值。1.2.6統(tǒng)計學(xué)分析用SPSS13.0軟件完成統(tǒng)計學(xué)處理,按資料類型和檢驗?zāi)康?分別進行t檢驗、卡方檢驗、Pearson相關(guān)性檢驗,顯著性水準為0.05。2結(jié)果2.1失代償性耳鳴的心理聲學(xué)及臨床特征分析2.1.1代償性和失代償性各年齡段人數(shù)構(gòu)成比有差異(χ2=16.535,V=3,P=0.001)。30歲組失代償性人數(shù)比例最高,≥60組歲男性代償性人數(shù)比例最高(χ2=13.786,V=3,P=0.003)。2.1.2失代償性453例中,持續(xù)性耳鳴434例(95.8%),代償性175例中,持續(xù)性耳鳴110例(62.9%),兩者間構(gòu)成比有統(tǒng)計學(xué)差異(χ2=118.275,V=1,P=0.000)。2.1.3 175例代償性耳鳴與453例失代償性耳鳴響度VAS評分均數(shù)的t檢驗：4.85±2.46 vs 6.61±2.40,兩者有顯著性差異(P=0.000)。2.1.4就診分類①既往有1-3次耳鳴就診經(jīng)歷的236例(52.2%)；②急性耳鳴患者首次就診107例(23.6%)；③因耳鳴反復(fù)求醫(yī)60例(13.2%)；④長期患有耳鳴,但首次就診50例(11%)。2.1.5耳鳴音調(diào)描述呈蟬鳴音、嗡嗡聲的占62%,左側(cè)耳鳴最多,右耳其次,雙耳最少；單調(diào)、復(fù)調(diào)性耳鳴的左、右、雙側(cè)別構(gòu)成比有顯著性差異(χ2=49.012,V=2,P=0.000)；耳、顱鳴的左、右、雙側(cè)構(gòu)成比有顯著性差異(χ2=7.426,V=2,P=0.024)：正常、受損聽力的左、右、雙側(cè)構(gòu)成比無顯著性差異(χ2=1.781,V=1,P=0.41)。2.1.6失代償性耳鳴音調(diào)最多的是8000、6000和500 Hz,殘余抑制陽性率最高的是500、6000和8000 Hz；呈現(xiàn)低頻和高頻殘余抑制陽性率高,中頻相對較低。殘余抑制陽性率：梅尼埃病突發(fā)性耳聾其他類型耳鳴。2.1.7 153例聽力曲線呈下降型的感音神經(jīng)性聾患者中有112例耳鳴音調(diào)在8000Hz,41例音調(diào)非8000Hz；以聽閾50dBHL為界,8000Hz聽閾50dBHL和8000Hz聽閾_50dBHL兩組的耳鳴音調(diào)8000 Hz和音調(diào)非8000Hz人數(shù)分布有統(tǒng)計學(xué)差異(χ2=5.108,V=1,P=0.023)。2.1.8 267/453例(59%)表示有明確誘因?qū)е露Q的發(fā)生；195/453例(44%)懷疑耳鳴與自身伴隨疾病的轉(zhuǎn)歸有關(guān)；既有誘因又有伴隨疾病的患者為96/453例(21.2%)。2.1.9伴有疾病和不伴有疾病的患者耳鳴嚴重程度分級人數(shù)分布無顯著性差異(χ2=8.792,V=4,P=0.067)2.2復(fù)合聲治療突發(fā)性聾患者耳鳴的臨床對照研究2.2.1治療30天后兩組患者數(shù)據(jù)比較：VAS評分(P=0.214)和聽力恢復(fù)率無統(tǒng)計學(xué)差異,THI評分(P=0.004)和SAS(P=0.000)評分有統(tǒng)計學(xué)差異。治療90天后數(shù)據(jù)比較：VAS評分(0.041)、THI評分(0.000)和SAS評分(0.001)有統(tǒng)計學(xué)差異,聽力恢復(fù)率仍無統(tǒng)計學(xué)差異。2.2.2試驗組與對照組耳鳴響度VAS評分有統(tǒng)計學(xué)差異的變化,出現(xiàn)在治療前30天(P=0.041),而非31-90天；兩組聽力恢復(fù)率在前30天和31-90天變化值的比較,均無統(tǒng)計學(xué)差異。2.2.3對照組內(nèi)部(前30天與31-90天)耳鳴VAS評分無統(tǒng)計學(xué)差異,聽力恢復(fù)率前30天明顯好于31-90天(P=0.000)；試驗組內(nèi)部耳鳴VAS評分和聽力恢復(fù)率前30天明顯好于31-90天(P=0.000)。2.2.4治療30天的患者僅耳鳴響度VAS評分與THI評分、THI評分與聽力恢復(fù)率不存在相關(guān)性(P≥0.05),治療90天僅THI評分與聽力恢復(fù)率不存在相關(guān)性(P≥0.05),其余指標均存在兩兩線性相關(guān)(P0.05)。3結(jié)論3.1失代償性耳鳴的心理聲學(xué)及臨床特征分析3.1.1睡眠、工作、情緒均有受影響的失代償性耳鳴453例(單耳313例,雙耳140例)占72.2%。3.1.2調(diào)查人群中30歲組年齡段失代償性人數(shù)比例高,這可能與年輕人聽覺和邊緣神經(jīng)系統(tǒng)較為敏感,且與工作壓力大有關(guān)。而≥60歲男性組代償性人數(shù)比例高,可能與患者耳鳴時間較長、老年人耐受能力增強有關(guān)。3.1.3失代償性耳鳴響度VAS評分均數(shù)及持續(xù)性耳鳴的人數(shù)比例,顯著高于代償性耳鳴,這兩項指標可能是導(dǎo)致失代償?shù)闹匾蛩亍?.1.4失代償性耳鳴中52.2%的患者可以耐受,無法耐受的僅占13.2%；大部分的患者僅需通過宣教和咨詢,可解除其對耳鳴的擔(dān)憂或恐懼。3.1.5耳鳴呈蟬鳴音和嗡嗡聲的最多；左側(cè)耳鳴、顱鳴均多于右側(cè)；復(fù)調(diào)性耳鳴在雙側(cè)耳鳴患者中出現(xiàn)的比例,顯著高于單側(cè)耳鳴患者,可能與雙側(cè)不對稱性聽力下降有關(guān)。3.1.6在陡降或緩降型感音神經(jīng)性聽力曲線中,聽閾處在50～60dBHL的頻率對耳鳴主頻有一定影響。3.1.7在伴有感音神經(jīng)性聽力損失的耳鳴中,急性期患者的殘余抑制陽性率高于慢性期,在急性期時給予聲治療可能效果更佳。3.1.8耳鳴與誘發(fā)因素和全身伴隨疾病有密切的聯(lián)系,生活中盡量避免其誘發(fā)因素的同時,應(yīng)加強對全身伴隨疾病的控制。3.1.9本研究暫未發(fā)現(xiàn)全身伴隨疾病和耳鳴嚴重程度之間的關(guān)系。3.2復(fù)合聲治療突發(fā)性聾患者耳鳴的臨床對照研究3.2.1復(fù)合聲治療耳鳴的過程中,所有患者依從性均較好,相對較單純的掩蔽和習(xí)服治療患者更易接受。3.2.2隨著治療的進行,試驗組患者耳鳴響度和焦慮情緒逐漸減輕,復(fù)合聲治療效果顯現(xiàn)。3.2.3突發(fā)性聾伴耳鳴發(fā)病后應(yīng)盡快對耳鳴進行聲治療。3.2.4通過對比可以看出,實驗組前30天耳鳴的治療效果要好于第31-90天,對照組無差異,這可能與試驗組應(yīng)用了聲治療,而對照組沒有采用,但也可能與復(fù)合聲和音樂聲治療效果有差異有關(guān)。3.2.5治療30天耳鳴響度VAS評分與THI評分、THI評分與聽力恢復(fù)率不存在相關(guān)性,治療90天僅THI評分與聽力恢復(fù)率不存在相關(guān)性,這可能與THI量表包含更豐富的評價功能有關(guān),也可能與發(fā)病僅1周的患者THI量表認知理解存在誤差,影響了總體相關(guān)性評價有關(guān)。
[Abstract]:Background and objective tinnitus, known as the three major problems of otology (tinnitus, deafness, vertigo) first. With the rapid development of social undertakings in China, the incidence of tinnitus with increased population social stress and noise pollution gradually increased. According to the epidemiological investigation of a conservative estimate, China's incidence of tinnitus about 10% people, as many as 130 million people, of which about 20%-25% in the treatment of patients with tinnitus constantly. Persistent tinnitus can cause insomnia, anxiety, fear, depression, and family, social problems in life and work, seriously affecting people's quality of life. But the pathogenesis of tinnitus is complex, since the study but that is still not very clear. The existing research, the nerve fibers of abnormal electrical activity in the auditory pathway, limbic system and autonomic nervous system disorders such as joint participation and the formation mechanism of tinnitus and related disorders Like. The different nature of the different ways of diagnosis and treatment of tinnitus decided. "Decompensated tinnitus tinnitus" is more serious, can disperse the patients' attention, and can cause sleep disorders, anxiety, depression, fear and other psychiatric symptoms, the tinnitus patients need to accept individualized intervention and comprehensive treatment. But how to quantify patients in the current clinical decompensation degree, there is no unified method and standard. Tinnitus guide at home and abroad, gives some tinnitus assessment scale to assess patients with decompensated degree, but there is still a lack of standard for evaluation of tinnitus expert consensus and unity. According to the clinical study of this type of tinnitus groups, foreign reports the literature about the domestic literature retrieval, there is no relevant reports. So the clinical features for this kind of people it is necessary to do further study and research, to provide reference for clinical diagnosis and treatment. The sound is usually used to treat disease For unknown and few treatment options for chronic tinnitus acute tinnitus is rarely applied in drug therapy is often effective. Sudden deafness is a common disease in otology, multicenter clinical study showed that sudden deafness, in 1024 cases of patients with unilateral sudden deafness in 864 cases (84.38%) accompanied by tinnitus, 18 cases (1.76%) with cranial Ming. The treatment of sudden deafness is not timely or not standardized high deafness and tinnitus disability. For better treatment of sudden deafness accompanied by tinnitus symptoms, reduce the morbidity of deafness, tinnitus, the curative effect difference between application and application of composite sound is not the treatment of sudden deafness and tinnitus patients, discusses the course design and the treatment methods, summarized the clinical experience in the treatment of tinnitus sound composite, for better application of composite sound to provide reference for.1 observation and clinical features of psychological acoustic object and method of 1.1 decompensated tinnitus by analysis of 1.1.1 treatment of acute tinnitus Samples collected from October 2013 to July 2014, admitted to Nanfang Hospital of Southern Medical University Department of Otolaryngology Head and neck surgery outpatient tinnitus patients, the clinical data of 628 cases, 823 ears (single ear in 433 cases, 195 cases of binaural).1.1.2 detection program, pure tone audiometry, tinnitus, tinnitus, residual inhibition test: reduce more than 20% recorded as residual inhibition positive, no change or reduce less than 20% can fill in "inquiry scale > tinnitus patients contain experience tinnitus properties table was negative for.1.1.3, whether patients with systemic disease and disease types, etc.. VAS scale loudness of tinnitus severity questionnaire > tinnitus severity from light to heavy according to 1 V - according to the total score of 6 indicators. The decompensated type tinnitus patients enrolled in < tinnitus severity questionnaire >, tinnitus (to sleep, work, emotional) influence the options (not, sometimes, often Effect of impact, 3) is not checked (not) with.1.1.4 statistical analysis software SPSS13.0 statistical processing, according to data type and testing purposes, respectively, t test, chi square test, Pearson correlation test, the level of significance for clinical 0.05.1.2 composite sound treatment of tinnitus patients with sudden deafness control study of 1.2.1 subjects were collected from September 2013 to April 2014, admitted to Nanfang Hospital of Southern Medical University Department of Otorhinolaryngology clinic and admitted to hospital sudden deafness and tinnitus in 96 patients. The diagnostic criteria of sudden deafness by "the diagnosis and treatment of sudden deafness Guide > (2005, Ji'nan). According to the visiting sequence with random sequence number is divided into experiment group and control group, 48 cases in each.1.2.2 experiment process group with sudden deafness routine therapy + composite sound treatment, the control group only treated with medicine.1.2.3 group Test pure tone audiometry, tinnitus interrogation, composite acoustic matching, residual inhibition test. Step matching composite sound: analogy in tone, tone pulse, white noise, channel noise, speech noise sound source in recent voice as the masker intensity, minimum masking loudness +10dBHL, while adding patients love music according to the test results, the optimum composite sound.1.2.4 composite sound treatment course of masker sound to monaural loudness, not more than 90dBHL, if the ear corresponding to the frequency of hearing loss is more than 90dBHL, the normal ear to sound; music for binaural sound, loudness control in 40-70 dBHL, with normal ear comfort as the standard.2 / day, 30 minutes / time, for 30 days, 30 days with computer play light music therapy by high fidelity headset ears at home, for 60 days, 2 times / day, 60 minutes / time.1.2.5 evaluation index records of patients or into The hospital, for thirtieth days and 90 days of the visual scale score of tinnitus loudness (Visual Analogue Scale, VAS), tinnitus handicap scale (Tinnitus Handicap Inventory, THI Chinese version), self rating Anxiety Scale score (Self-rating Anxiety, Scale, SAS) threshold threshold.1.2.6 SPSS13.0 statistical analysis software to statistical treatment and pure tone, according to data type and testing purposes, respectively, t test, chi square test, Pearson correlation test, significant level and clinical characteristics of the psychological acoustic 0.05.2 results of 2.1 decompensated tinnitus 2.1.1 compensated and decompensated age number analysis the proportion difference (x 2=16.535, V=3, P=0.001) the.30 age group decompensated the highest proportion, more than 60 year old male compensatory group the highest proportion (x 2=13.786, V=3, P=0.003).2.1.2 decompensated 453 cases, persistent tinnitus in 434 cases (95.8%), 175 cases of compensatory, holding Continued tinnitus in 110 cases (62.9%), there was significant difference between the constituent ratio (x 2=118.275, V=1, P=0.000) t test.2.1.3 175 cases of decompensated tinnitus and 453 cases of decompensated tinnitus loudness mean VAS scores: 4.85 + 2.46 vs 6.61 + 2.40, there was significant difference between them (P=0.000) from.2.1.4 the classification of 236 cases of 1-3 patients with tinnitus treatment experience of the times (52.2%); the acute tinnitus patients was 107 cases (23.6%); the doctor repeated due to tinnitus in 60 cases (13.2%); the long suffering from tinnitus, but for the first time in 50 cases (11%) were described.2.1.5 tinnitus pitch humming sound of cicadas, accounted for 62%, the left ear tinnitus most, secondly, ears at least; monotonous, polyphonic tinnitus left, right, both don't have significant differences in the constituent ratio (x 2=49.012, V=2, P=0.000); the left ear, right cranial tinnitus, which showed significant difference in bilateral (x 2=7.426, V=2, P=0.024). Normal, impaired hearing left, Right, there was no significant difference between the proportion of bilateral (x 2=1.781, V=1, P=0.41).2.1.6 decompensated tinnitus pitch is up to 80006000 and 500 Hz, the residual inhibition of the highest positive rate is 5006000 and 8000 Hz; showing the residual low frequency and high frequency suppression positive rate and high frequency is relatively low. The positive rate of residual inhibition.2.1.7 of Meniere's disease with sudden deafness tinnitus 153 cases of other types of audiometric curve decreasing type patients with sensorineural hearing loss in 112 cases of tinnitus pitch in 8000Hz, 41 cases of non 8000Hz to 50dBHL tones; hearing threshold for the community, the tinnitus pitch of two groups of 8000Hz 50dBHL and 8000Hz _50dBHL threshold threshold of 8000 Hz and non 8000Hz tone number distribution there were significant differences (2=5.108, V=1, P=0.023).2.1.8 267/453 (59% cases) indicate a clear cause of the occurrence of tinnitus; 195/453 cases (44%) with its suspected tinnitus and prognosis; both cause and with The disease in patients with 96/453 (21.2% cases) of patients with tinnitus severity classification number distribution of.2.1.9 had no significant difference with the disease and without disease (x 2=8.792, V=4, P=0.067) were compared between the two groups data of 2.2 composite sound treatment of tinnitus patients with sudden deafness clinical study of 2.2.1 treatment for 30 days: VAS score (P=0.214) and hearing recovery rate showed no significant difference, THI score (P=0.004) and SAS (P=0.000) score had significant difference. After 90 days of treatment data: (0.041) the VAS score, THI score and SAS score (0) (0.001) had statistical difference, hearing recovery rate is still no significant difference between the test group.2.2.2 score change statistically significant difference between the control group and tinnitus loudness VAS, appeared on the 30 day before treatment (P=0.041), rather than 31-90 days; comparison in the first 30 days and 31-90 days changes in the value of the two groups of hearing recovery rate, there was no statistically significant difference in.2.2.3 group internal (before 3 0 days and 31-90 days) tinnitus VAS was no significant difference between the 30 days before the hearing recovery rate was significantly better than that of 31-90 day (P=0.000); experimental group internal tinnitus VAS score and hearing recovery rate of 30 days before the day was significantly better than that of 31-90 (P=0.000).2.2.4 treatment only VAS tinnitus loudness score and THI scores in patients with 30 days, the THI score and the hearing recovery rate there is no correlation (P = 0.05), only 90 days of treatment with the THI score of hearing recovery rate there is no correlation (P = 0.05), the other indexes are 22 linear correlation (P0.05).3 conclusion the clinical features and psychological acoustics 3.1 decompensated tinnitus analysis 3.1.1 sleep, work, mood have affected decompensated tinnitus in 453 cases (single ear in 313 cases, 140 cases of ears) accounted for 72.2%.3.1.2 population 30 years old age groups in decompensated high proportion, which may be hearing with young people and the edge of the nervous system is more sensitive, and work pressure. But more than 60 years old male group compensatory proportion is high, and the longer time of patients with tinnitus, tolerance of the elderly increase.3.1.3 decompensated tinnitus loudness VAS scores and the number of the number of persistent tinnitus ratio was significantly higher than that of decompensated tinnitus, these two indicators may be caused by the loss of important factors of decompensated.3.1.4 52.2% patients with compensatory tinnitus can be tolerated, intolerance accounted for only 13.2%; most of the patients only through education and counseling, most can relieve the worry or fear of tinnitus, tinnitus is.3.1.5 sound and hum of cicadas; the left cranial tinnitus, Ming were more than right; polyphonic tinnitus in bilateral tinnitus patients the proportion was significantly higher than that in patients with unilateral tinnitus, may be related to.3.1.6 in the steep drop or slow down the sensorineural hearing curve decreased and bilateral asymmetry in the hearing threshold, 50 ~ 60dBHL frequency The frequency of tinnitus tinnitus.3.1.7 sensorineural hearing loss in patients with certain effects in patients with positive rate of residual inhibition was higher than that in chronic phase, given the sound treatment may be better.3.1.8 tinnitus and predisposing factors and systemic diseases are closely linked with in the acute phase, to avoid the predisposing factors and life that should strengthen the body with control of.3.1.9 disease in this study has not yet found the body accompanied by.3.2 composite sound between disease and severity of tinnitus treatment of tinnitus patients with sudden deafness clinical study of 3.2.1 composite sound treatment of tinnitus in the process, all the patients compliance were better than the pure relative masking and acclimatization treatment patients are more likely to accept.3.2.2 as the treatment, experimental group patients with tinnitus loudness and anxiety is reduced gradually, the treatment effect of complex sound show.3.2.3 sudden deafness tinnitus After the onset of.3.2.4 treatment should be performed as soon as possible sound of tinnitus can be seen by comparing the experimental group 30 days before the treatment of tinnitus is better than the first 31-90 days, control group had no difference, which could be applied with the acoustic treatment and the experimental group, while the control group did not use, but also may have therapeutic difference about.3.2.5 30 days tinnitus loudness VAS and the THI score and the composite sound and music therapy, THI score and hearing recovery rate there is no correlation, only 90 days of treatment with the THI score of hearing recovery rate there is no correlation, which may contain more abundant assessment function and THI scale, also may be associated with the onset of only 1 weeks in patients with THI scale cognitive

【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R764.4

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