伴发感音神经性聋的主观性耳鸣的检测分析与掩蔽治疗  

Evaluation test and masking therapy of subjective tinnitus

作　　者：张海林[1] 冯永[1] 梅凌云[1] 文雅[1] 

机构地区：[1]中南大学湘雅医院耳鼻咽喉科教研室,长沙410008

出　　处：《中华耳鼻咽喉头颈外科杂志》2009年第8期636-640,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家863计划（2007AA027A45）;国家自然科学基金（30470954、30671150）;“十一五”国家攻关计划（2007BA118813）;高等学校博士学科点专项基金（20060533043）

摘　　要：目的通过对伴发于感音神经性聋的主观性耳鸣患者进行检测分析及掩蔽治疗，为诊断此类耳鸣和为掩蔽治疗选择合适的病例提供参考。方法66例有感音神经性聋耳鸣患者，按照听力曲线类型分为3个研究组：陡降型组28例，缓降型组20例，平坦型组18例。所有病例均接受耳鸣的检测（即强度、频率、最小掩蔽曲线、后效抑制测试）和掩蔽治疗。结果陡降型听力曲线组耳呜表现为低强度[平均耳呜强度（感觉级，x±S，下同）为（5．7±2．9）dB]，高主频（频率中位数4750Hz），以重叠型和汇聚型掩蔽曲线为主，后效抑制多为阳性结果，掩蔽疗效较好（25例有效，有效率89．3％）。缓降型听力曲线组表现为耳呜低强度[平均耳呜强度（6．2±4．8）dB]，高主频（频率中位数4050Hz），掩蔽曲线及后效抑制分布无明显特征，掩蔽疗效低于陡降型组而高于平坦型组（11例有效，有效率55．0％）。平坦型听力曲线组耳鸣强度[平均耳鸣强度（9．2±5．0）dB]高于前述两组，频率无明显特征性分布，掩蔽曲线多阻尼型和分离型曲线，后效抑制多为阴性结果，掩蔽疗效不佳（2例有效，有效率11．1％）。3组之问比较差异有统计学意义（χ^2=9．127，P〈0．05）。结论对陡降型听力曲线的耳鸣患者，推荐进行掩蔽治疗；缓降型听力曲线患者可进行掩蔽治疗；平坦型听力曲线患者掩蔽治疗的疗效有限。Objective To undergo tinnitus evaluation test and masking therapy of subject tinntus associated with sensor/neural hearing loss as a reference for diagnosis and guiding masking therapy. Methods The 66 patients with subject tinnitus were diagnosed as sensorineural hearing loss. Sixty-six patients divide into three groups according to the results of pure tone audiometry, including steep drop type in 28 patients, slow drop type in 20 patients, and flat type in 18 patients. All the patients underwent tinnitus evaluation tests （pitch matching, intensity matching, tinnitus masking curves, residual inhibition） and masking theranv. Results Tinnitus with steen drop tvne manifest was as low intensitv [average intensity （5.7 ±2. 9） dB（x±s） ] and high frequency（median with 4750 Hz）. Residual inhibition was almost positive, but was usually consistent with convergence and congruence tinnitus masking curves. Masking therapy had better effect in the treatment of this type of tinnitus（ effective rate 89.3% ）. Tinnitus with slow drop type manifest was as low intensity [ average intensity ： （ 6.2 ± 4.8 ） dB ] and high frequency （ median ： 4050 Hz ）. The distribution of residual inhibition and tinnitus masking curves had no obviously characteristics. The effective rate of masking therapy of this type of tinnitus （55.0%）was higher than tinnitus with flat type but low than that of tinnitus with steep drop type. The intensity of tinnitus with flat type [ average intensity： （9.2± 5.0）dB ] was higher than that of the previous groups. The distribution of frequency of this type had no obviously characteristics. The residual inhibition was almost negative, and was usually consistent with divergence and persistence tinnitus masking curves. Masking therapy had unsatisfactory curative effect in the treatment of this type of tinnitus （ effective rate 11.1% ）. The effective rate of masking therapy was significant differences among the three groups （ Χ^2 = 9. 127, P 〈 0.05 ）. Conclusions Fo

关 键 词：耳鸣 听觉丧失 感音神经性 知觉掩蔽 测听法 纯音 

分 类 号：R686[医药卫生—骨科学]