声学治疗噪声性听力损失的耳鸣

Acoustic Therapy for Tinnitus Treatment in Noise-Induced Hearing Loss

摘要: 目的：噪声性听力损失(NIHL)是一段时间过度暴露于噪声引起的感音神经性耳聋。耳鸣是NIHL最常见的症状之一，它会给患者造成痛苦，并对他们的生活质量产生不利影响。近年来，人们对声学疗法(AT)治疗耳鸣的兴趣有所增加。然而，结果却有很大的差异。结果上的差异可能是由于患者之间的异质性所致。本研究旨在探讨AT治疗NIHL相关性耳鸣的疗效。方法：本研究纳入204例患者：NIHL相关性耳鸣102例，慢性耳鸣102例。每个患者均接受纯音测听试验、耳鸣匹配试验和残余抑制试验(RIT)。测量了RIT治疗前后的耳鸣障碍量表(THI)和视觉模拟量表(VAS)。结果：NIHL组与慢性耳鸣组在2000 Hz、4000 Hz、8000 Hz时的纯音测听结果均有统计学差异(p < 0.05)。NIHL组的耳鸣响度高于慢性耳鸣组(p < 0.05)。在与NIHL相关的耳鸣患者中，RIT前后的THI和VAS评分有显著差异(p < 0.001)。NIHL相关耳鸣组与慢性耳鸣组的THI、VAS、RIT评分比较无差异(p > 0.05)。AT对轻度听力损失NIHL患者的疗效优于重度听力损失患者，但在年龄和耳鸣病程上无显著差异。结论：本研究是首次研究AT对NIHL相关耳鸣患者的有效性，本研究具有重大进展。我们的研究结果显示，AT对轻度听力损失患者的疗效更大。需要一项多中心、大样本的随机对照研究来证实这些初步发现。

Abstract: Background: Noise-induced hearing loss (NIHL) is sensorineural deafness caused by overexposure to noise for periods. The presence of tinnitus is one of the most common symptoms of NIHL, causing distress to patients and adversely affecting their quality of life. Recent years have seen an increase in interest in acoustic therapy (AT) as a treatment option for tinnitus. However, the results have varied considerably. The differences in results may be attributed to heterogeneity among patients. The present study aimed to investigate the effectiveness of AT in NIHL-associated tinnitus. Method: The present study enrolled 204 patients: 102 had NIHL-associated tinnitus, and 102 had chronic tinnitus. Each patient received the pure tone audiometry test, tinnitus matching test, and residual inhibition test (RIT). The tinnitus handicap inventory (THI) and visual analogue scale (VAS) for tin-nitus loudness were measured before and after the RIT. Results: Statistical differences in pure tone audiometry were found at 2000 Hz, 4000 Hz, and 8000 Hz between the NIHL group and the chronic tinnitus group (p < 0.05). The loudness of tinnitus was higher in the NIHL group than in the chronic tinnitus group (p < 0.05). In NIHL-associated tinnitus patients, significant differences were found in THI and VAS scores from before to after RIT (p < 0.001). No difference was found between the NIHL-associated tinnitus group and the chronic tinnitus group in the comparison of THI, VAS, and RIT scores (p > 0.05). AT showed better efficacy in NIHL patients with mild hearing loss than in pa-tients with severe hearing loss, but no significant difference was found in age or course of tinnitus. Conclusion: As the first study of its kind to examine the effectiveness of AT in patients with NIHL-related tinnitus, this study represents a major advance. Our results showed greater effective-ness of AT in patients with mild hearing loss. A multicentre, large-sample randomized controlled study is needed to confirm these initial findings.