音乐联合认知行为疗法治疗耳鸣的疗效及多因素回归分析  

Effect and multivariate regression analysisof music combined with cognitive behavior therapy on tinnitus

作　　者：杨海弟[1] 张心苑 熊浩[1] 冯天赐 黄夏茵[1] 陈泓钰 郑亿庆[1] YANG Haidi;ZHANG Xinyuan;XIONG Hao;FENG Tianci;HUANG Xiayin;CHEN Hongyu;ZHENG Yiqing(Department of Otolaryngology,Sun Yat-sun Memorial Hospital,Sun Yat-sun University,Guangzhou,Guangdong,510120,China)

机构地区：[1]中山大学孙逸仙纪念医院耳鼻咽喉科,广东广州510120

出　　处：《中国耳鼻咽喉头颈外科》2018年第10期533-537,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：广东省自然科学基金资助项目(2015A030313084和2017A030313585)

摘　　要：目的评估音乐联合认知行为疗法对慢性主观性耳鸣的治疗效果及影响因素。方法对2017年8月～2017年12月就诊于中山大学孙逸仙纪念医院耳鼻咽喉科43例慢性主观性耳鸣患者随机分成对照组和联合治疗组共两个组,分别进行音乐治疗和音乐联合认知行为疗法治疗,分别评估两组治疗方法的主观疗效及有效率,同时在治疗前及治疗后3个月分别采用耳鸣残疾评估量表(tinnitus handicap inventory,THI)、视觉模拟量表(visual analogue scale,VAS)和焦虑自评量表(self-rating anxiety scale,SAS),对患者耳鸣严重程度及负性情绪进行评估,对患者基本信息(包括性别、侧别、耳鸣频率、响度)等做单因素回归分析,评估两种方法对主观性耳鸣患者的治疗效果更佳。结果耳鸣个人主观恢复为疗效的评定标准,联合治疗组明显改善12例,改善6例,不改善2例,总有效率90.00%;对照组明显改善8例,改善8例,不改善7例,总有效率69.57%。两组比较差异有统计学意义。音乐治疗及认知行为治疗均对耳鸣患者显效,两组治疗前后的THI、VAS和SAS得分差值比较,差异有统计学意义。经单因素回归分析表明,性别、年龄、病程、耳鸣频率、耳鸣响度、耳鸣侧别、是否伴体力下降与耳鸣疗效均无统计学意义(P>0.05),对耳鸣疗效无明显影响。结论认知行为治疗相比于音乐治疗,对慢性主观性耳鸣患者有更明显疗效,可有效改善主观性耳鸣患者的耳鸣主观感受及伴随的焦虑抑郁症状,值得临床推广。OBJECTIVE To evaluate the effect of music therapy combined with cognitive behavioral therapy on subjective tinnitus and its influencing factors. METHODS 43 patients suffering from subjective tinnitus in Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University were randomly divided into two groups from August 2017 to December 2017, and received music therapy or music combined with cognitive behavioral therapy, respectively. The subjective efficacy and effectiveness of the 2 groups were evaluated separately. At the same time, the tinnitus disability assessment scale（THI）, visual analog scale（VAS） and anxiety self-assessment scale（SAS） were used to estimate the severity and negative emotions of tinnitus before and after treatment. The logistic regression analysis was performed on the patient’s basic information（including gender, sideline, tinnitus frequency, loudness, etc）, to evaluate the effect of the 2 methods for subjective tinnitus patients. RESULTS The individual subjective recovery of tinnitus was the evaluation criteriony of efficacy. The combined treatment group improved significantly in 12 cases, improved in 6 cases, did not improve in 2 cases, and had a total effective rate of 90%. In the control group, 8 cases improved significantly, 8 improved, and 7 did not improve, and the total effective rate is 69.57%. There were statistical differences between the 2 groups. Both music therapy and cognitive behavioral therapy were effective in tinnitus patients. The differences in THI, VAS and SAS scores before and after treatment in both groups were statistically significant（P〈0.05）. Single factor regression analysis, showed that there was no statistically significant difference in gender, age, duration, frequency of tinnitus, tinnitus loudness, side effects of children, and whether there was a decrease in physical strength or tinnitus（P〉0.05）. Therefore, there was no significant effect on the efficacy of tinnitus. CONCLUSION Compared with music therapy, cognitive behavioral therapy has

关 键 词：耳鸣 问卷调查 回归分析 认知行为疗法 音乐治疗 

分 类 号：R764.45[医药卫生—耳鼻咽喉科]