听阈基本正常主观特发性耳鸣严重程度影响因素分析  

Factors Affecting Severity of Subjective Idiopathic Tinnitus in Individuals with Basically Normal Pure Tone Thresholds

作　　者：李刚 张剑宁[1] 李明[1] LI Gang;ZHANG Jianning;LI Ming(Department of Otorhinolaryngology Tinnitus and Hyperacusis Center,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200437)

机构地区：[1]上海中医药大学附属岳阳中西医结合医院耳鼻咽喉科耳鸣和听觉过敏中心,上海200437

出　　处：《中华耳科学杂志》2021年第3期473-479,共7页Chinese Journal of Otology

基　　金：上海市市属博士学科点建设基金。

摘　　要：目的分析影响纯音测听阈值基本正常主观特发性耳鸣严重程度的客观因素,为耳鸣的临床研究提供参考依据。方法对453例以耳鸣为第一主诉的纯音测听阈值基本正常主观特发性耳鸣患者进行系统的耳鼻咽喉科专科检查、纯音听阈测试、声导抗、耳鸣心理声学检测和耳鸣残疾评估量表(tinnitus handicap inventory,THI)评分,分析患者的性别、年龄、病程、耳鸣侧别和耳鸣心理声学检测结果与THI评分的关系。结果经χ2检验,各耳鸣响度阶段与THI评分等级有相关性,通过Pearson检验,耳鸣响度与THI、C、E、F评分呈正相关,相关系数分别为r=0.164(0.000)、r=0.104(0.027)、r=0.152(0.001)、r=0.173(0.000),随着耳鸣响度的增加,THI、C、E、F评分就越高,单因素方差分析结果示耳鸣响度≥16 dB SL的耳鸣患者THI、C、E、F评分明显高于响度≤5 dB SL的患者(分别为:P=0.018,P=0.033,P=0.042,P=0.015)。通过pearson检验,年龄与THI、C、E、F评分呈负相关,相关系数分别为r=-0.125(0.008),r=-0.104(0.027),r=-0.131(0.005),r=-0.108(0.022);通过Pearson检验,病程与THI、E、F评分无相关性,但与C评分成正相关,相关系数为r=0.109(0.021),慢性耳鸣患者的C评分相对较高,但单因素方差分析各病程阶段无统计学意义;有序多元Logistic回归分析也显示THI评分等级相关与年龄成负相关,与耳鸣响度成正相关关系(分别为:P=0.016,P=0.002)。结论本研究中年龄和耳鸣响度是影响纯音测听阈值基本正常主观特发性耳鸣患者严重程度的重要因素,而且此类患者对耳鸣的控制和耐受能力随着病程的延长而下降。Objective To identify factors affecting severity of subjective idiopathic tinnitus in individuals with basically normal pure tone thresholds audiometry for further clinical study of tinnitus.Methods A total of 453 patients with subjective idiopathic tinnitus were systematically examined by otorhinolaryngologic evaluation,pure tone audiometry,acoustic immittance,psychoacoustics tinnitus tests and the Tinnitus Handicap Inventory(THI).The relations between THI scores and sex,age,disease course,affected side and psychoacoustics tinnitus parameters were analyzed.Resultsχ2 test showed correlation between tinnitus loudness and THI scores,while Pearson test indicated positive correlation between tinnitus loudness and total THI(r=0.164,P=0.000),THI-C(r=0.104,P=0.027),THI-E(r=0.152,P=0.001)and THI-F(r=0.173,P=0.000)scores.One-way ANOVA showed that these scores were significantly higher in patients with tinnitus loudness matched at≥16 dB SL than in those with tinnitus loudness matched at≤5 dB SL(P<0.05).These scores were also negatively correlated with age(r=0.125,P=0.008;r=0.104,P=0.027;r=0.131,P=0.005;and r=0.108,P=0.022;respectively),but not with disease course except for a positive correlation with the THI-C score(r=0.109,P=0.021)by Pearson test.The THI-C score was relatively high in patients with chronic tinnitus,although with no statistically significant difference by one-way ANOVA.Ordered multiple logistic regression analysis also showed that the THI score was negatively correlated with age and positively correlated with matched tinnitus loudness(P<0.05).Conclusion Age and matched tinnitus loudness are the main factors affecting severity of subjective idiopathic tinnitus in patients with basically normal pure tone thresholds and their ability to control and tolerate tinnitus decreases with prolongation of the disease.

关 键 词：主观特发性耳鸣 纯音测听阈值基本正常 耳鸣残疾评估量表 相关因素 

分 类 号：R764[医药卫生—耳鼻咽喉科]