突发性聋伴耳鸣患者耳鸣特征

目的 分析研究突发性聋伴耳鸣患者的耳鸣特点、耳鸣与听力损失的关系、耳鸣对患者的影响程度, 探讨突聋患者耳鸣的产生机制。 方法 突发性聋伴有耳鸣患者231例常规采集病史, 填写耳鸣致残量表(THI)及视觉模拟得分表(VAS), 同时进行纯音听阈测试、耳声发射、耳鸣检测及掩蔽试验等检查。分析患者的耳鸣特点、耳鸣与听力的关系、耳鸣的THI及VAS得分以及它们特点。 结果 ①听力损失特点：低中频下降型20例(占8.7%), 中高频下降型60例(占26.0%), 平坦型44例(占19.0%), 全聋型79例(占34.2%), 不规则型28例(占12.1%);②耳鸣频率:低频耳鸣(≤500 Hz)49例(占21.2%), 中频耳鸣(51～2 000 Hz)54例(23.4%), 高频耳鸣(>2 000 Hz)122例(52.8%), 未匹配6例(占2.6%)。其中听力损失类型为低中频下降型的患者中, 低频、中频、高频耳鸣的比例分别为75%、15%、10%;中高频下降型患者中, 低频、中频、高频耳鸣的比例分别为13.3%、26.7%、60.0%;全聋型患者中, 低频、中频、高频耳鸣的比例分别为17.1%、19.0%、63.3%。听力下降最明显的频率对数与耳鸣频率对数呈线性关系, r=0.592, P<0.01;③耳鸣响度:0～30 dB HL 45例(占19.5%), 31～60 dB HL 60例(占26.0%), 60～90 dB HL 102例(占44.2%), 大于90 dB HL 18例(占27.8%), 未匹配6例(占2.6%)。耳鸣响度与听力损失程度(250～4 000 Hz平均听阈)有相关性, 相关系数r=0.216, P=0.001<0.05。④耳鸣致残级别:按照Newman等依据THI得分将耳鸣残疾分级, 其中1级27例(占11.7%), 2级耳鸣44例(占19.0%), 3级66例(占28.6%), 4级94例(占40.7%)。⑤THI及VAS得分特点:THI得分与听力损失程度无相关性r=0.087, P=0.287>0.05。VAS得分与听力损失程度无相关性r=0.002, P=0.982>0.05。THI得分与耳鸣频率对数无相关性, 相关系数r=-0.056, P=0.402>0.05。VAS得分与耳鸣频率对数无相关性, 相关系数r=-0.003, P=0.970>0.05。THI得分与耳鸣响度无相关性, 相关系数r=0.039, P=0.563>0.05。VAS得分与耳鸣响度无相关性, 相关系数r=0.136, P=0.110>0.05。结论 ①突发性聋伴耳鸣患者中高频耳鸣最常见;②耳鸣频率与听力损失类型显著相关, 低中频下降型以低频耳鸣多见, 而中高频下降型及全聋型以高频耳鸣多见;③听力损失最大的频率与耳鸣的频率有较高的一致性;④突发性聋伴耳鸣患者急性期的耳鸣致残程度以3～4级为多;⑤THI及VAS得分与听力损失的程度、耳鸣的频率、耳鸣的响度均无相关性。     

耳鸣心理声学特征与一般环境声掩蔽耳鸣效果的关系

目的：分析一般环境声（强度约60 dB A ）对特发性耳鸣患者掩蔽治疗的效果,为应用一般环境声治疗耳鸣提供依据。方法对2012年3～7月诊治的154例特发性耳鸣患者进行纯音听阈、声导抗、耳鸣心理声学特征检查,记录患者在一般环境声中对耳鸣的感受,分析其性别、年龄、耳鸣侧别、病程、有无听力损失、耳鸣主调频率、耳鸣响度、Feldmann曲线类型、残余抑制试验对一般环境声中患者对耳鸣感受的影响。结果154例耳鸣患者中,耳鸣主调频率为高频者占62．99％（97／154）;耳鸣响度≤5 dB SL者占50．00％（77／154）;Feldman曲线为间距型者占67．53％（104／154）;残余抑制试验阴性者占86．36％（133／154）。154例患者中,各频率听力正常19例,有任一频率听力损失者135例,纯音听阈最高频率与耳鸣主调频率相关且有较高的一致性（χ2＝16．865,P＜0．001）;耳鸣主调频率、耳鸣响度及残余抑制试验结果对一般环境声掩蔽耳鸣的效果无影响（P＞0．05）;不同Feldman曲线类型的耳鸣患者一般环境声中耳鸣感受不完全相同（ P＝0．001）;耳鸣主调频率听阈升高者较正常者在一般环境声更易掩蔽其耳鸣（ P＜0．001）;耳鸣主调频率听阈≥41 dB H L患者的耳鸣更易被一般环境声掩蔽。结论特发性耳鸣患者在一般环境声中有无耳鸣感受与患者性别、年龄、病程、耳鸣侧别、有无听力损失、耳鸣主调频率、耳鸣主调响度、Feldman曲线及残余抑制试验无关,与耳鸣主调频率听阈相关,耳鸣主调频率听阈≥41 dB HL患者的耳鸣更易被一般环境声掩蔽或部分掩蔽。     

梅尼埃病的耳鸣特征与影响因素分析

目的分析与探讨梅尼埃病患者耳鸣的临床特征与影响因素。方法 90例梅尼埃病患者,收集纯音听阈、耳鸣匹配结果,记录耳鸣侧别、时间、睡眠质量,使用耳鸣残障量表(Tinnitus Handicap Inventory,THI)进行评价。结果 1患者平均年龄48.08±10.28岁,男女比例为1.09:1;耳鸣主调频率匹配为低频和言语频率耳鸣者65例(72.2%);响度匹配为响度<10d B SL者(51例,56.7%),≥10d BSL者(39例,43.3%),其中以5-9d B SL最多,为30例(33.3%);≥15d B SL者最少,为15例(16.7%);持续性耳鸣患者77例(85.6%);单侧耳鸣患者68例(75.6%);有睡眠障碍者28例(31.1%)。2耳鸣响度较大(F=3.203,P=0.027)、睡眠质量较差(t=2.813,P=0.006)和持续性耳鸣(t=3.018,P=0.003)的患者其THI评分高于耳鸣响度较小、睡眠质量较好和间断性耳鸣的患者。双侧耳鸣患者THI评分高于单侧耳鸣患者,但差异无统计学意义(t=1.892,P=0.062)。不同性别、听力损失水平和耳鸣频率的患者THI评分间无明显差异(P>0.05)。3耳鸣影响因素有序多分类Logistic回归分析:耳鸣严重程度与耳鸣响度[P=0.011,95%可信区间(confidence interval,CI)1.019~1.151,优势比(odds ratio,OR)=1.083]、睡眠质量(P=0.011,95%CI1.288~6.931,OR=2.986)和耳鸣持续时间(P=0.007,95%CI1.559~16.265,OR=5.033)有关。结论梅尼埃病患者的耳鸣常常为低频、持续性的。耳鸣的严重程度与耳鸣的响度、睡眠质量和耳鸣的持续有关。     

急性噪声损伤后耳鸣患者的临床特征分析

目的探讨急性噪声损伤后耳鸣患者的耳鸣特点及预后。方法对61例(75耳)参加打靶训练后2周仍有持续性耳鸣的空军军医大学学员进行耳鸣残疾量表(THI)、耳鸣评价量表(TEQ)调查及耳鸣心理声学检测,并给予耳鸣咨询及金纳多治疗一个月,随访6个月分析结果。结果 61例(75耳)耳鸣者中,左耳45例,右耳2例,双耳14例;耳鸣主调频率主要在4 000~8 000 Hz 65耳(86.67%),平均为5 708±1 568 Hz;耳鸣响度≤10 dB SL 74耳(98.67%),平均为2.714±2.46 dB SL;Feldman掩蔽曲线主要为汇聚型(54耳, 72%)和重叠型(13耳,17.33%);残余抑制试验阳性61耳(81.33%);耳鸣的严重程度多为轻中度(Ⅰ~Ⅲ级);伴耳鸣相应频率听阈下降者61耳(81.33%),听阈正常14耳(18.67%)。随访6个月后耳鸣消失35例(57.38%),减轻24例(39.34%),无变化2例(3.28%),其中耳鸣未消失者打靶后两周的纯音听阈均值(44±18.85 dB HL)及耳鸣频率(6 204.45±1 364.51 Hz)显著高于耳鸣消失者(分别为28.15±14.48 dB HL,5 446.18±1 520.17 Hz)(P<0.05)。结论打靶后2周持续性耳鸣者耳鸣的主调声频率为高频,掩蔽曲线以汇聚型为主,残余抑制试验多为阳性,打靶后6个月仍有持续耳鸣者打靶后2周患耳的纯音听阈及耳鸣频率均高于耳鸣消失者。     

69例梅尼埃病伴耳鸣的发病特点及影响因素

目的 分析梅尼埃病患者的耳鸣特点和相关影响因素。 方法 2012年8月~2016年8月诊治的69例梅尼埃病患者,收集每位患者的纯音听阈、耳鸣患侧、持续时间、睡眠质量,采用耳鸣残障量表(THI)、眩晕残障程度评定量表(DHI)(中文版)评分。 结果 (1) 耳鸣主调频率为低频者31例,中频15例,高频23例。耳鸣响度<10 dB(SL)、10~14 dB(SL)、≥15 dB(SL)分别为41例、18例、10例;持续性耳鸣患者60例,间歇性耳鸣9例;一侧耳鸣患者58例,双侧耳鸣患者11例;(2) 伴有持续性耳鸣(t=3.099,P=0.008),睡眠质量较差(t=2.987, P=0.012),耳鸣响度较大(F=3.356,P=0.013)的患者其THI评分高于间断性耳鸣、睡眠质量较好、耳鸣响度较小的患者;(3) 多元线性回归分析结果显示,耳鸣发作频率、病程、平均听阈与DHI评分呈正相关。 结论 梅尼埃病患者伴随的耳鸣特点主要为持续低频性耳鸣。耳鸣的严重程度与耳鸣的响度、持续时间、睡眠质量有关。梅尼埃病患者性别、年龄、耳侧、双温试验对DHI评分无影响,但发作频率、持续时间、平均听阈均为影响评分的主要因素,发作频率越高的患者,其眩晕感觉越重。     

伴耳鸣听神经病患者的随访研究

目的分析伴耳鸣听神经病患者(auditory neuropathy, AN)的耳鸣及听力学特征,总结伴耳鸣AN患者的临床听力学转归情况并分析其耳鸣特征。方法对2001年9月至2015年11月间确诊为AN并伴有耳鸣的19例(37耳)患者,随访期1-14年。对比首诊及复诊的听力学特征,并分析患者的耳鸣特征。检测项目包括:声导抗测试、纯音测听、言语识别率测试(SDS)、听性脑干反应测试(ABR)、畸变产物耳声发射测试(DPOAE)、耳鸣问卷、耳鸣评估。结果伴耳鸣AN患者耳鸣及听力学特点:①纯音测听平均听阈复诊与首诊相比0.5-4kHz平均听阈未见明显变化(P>0.05),首诊为40.45±16.21dB HL,复诊为42.43±17.52 dB HL。低频0.25-1kHz平均听阈复诊较首诊未见明显变化(P>0.05),首诊为44.58±16.35dB HL,复诊为46.88±16.59 dB HL。4、8kHz此2个频率纯音阈值复诊较首诊升高(P<0.05);②镫骨肌反射引出率首诊与复诊均为5.4%;③言语识别率复诊与首诊相比未见明显变化(P>0.05),首诊为39.00±23.76%,复诊为37.20±21.67%。言语识别率与平均听阈之间无显著相关性(P>0.05),与250Hz、500Hz、1000Hz频率处的听阈呈显著相关(P<0.05),与余频率无显著相关性;④首诊患者的ABR有1耳引出反应,阈值异常升高。复诊所有患者均未引出反应;⑤首诊患者的DPOAE均正常或大部分正常引出,复诊全频引出率降低;⑥听力损失程度与耳鸣严重程度无明显相关性;⑦患者耳鸣程度多集中在轻中度,耳鸣频率以中低频为主。结论随着病情发展:①伴耳鸣AN患者4、8kHz频率处纯音阈值升高,DPOAE引出率降低,ABR引出率降低。患者应定期复诊了解听力变化,以便及时采取干预措施;②单侧AN患者可能发展成为双侧AN,单侧AN患者应关注健耳听力发展情况;③患者耳鸣程度多集中在轻中度,对生活影响较小,但感冒、疲劳、环境噪音等会使其耳鸣加重。     

76例耳鸣患者的心理因素初步分析

目的:了解耳鸣患者的心理状态,并分析心理障碍在耳鸣患者中的分布,为临床上诊疗耳鸣提供参考。方法:所有患者均进行耳鸣的频率和响度测试,并使用90项症状清单(SCL-90)、生活满意度量表、匹兹堡睡眠质量指数量表(PSQI)、耳鸣残疾量化表(THI)对患者进行相关的评估。将所取得的数据采用SPSS11.0统计分析软件进行分析。结果:①耳鸣的频率、响度和患者的SCL-90、生活满意度评定量表(LSR)、生活满意度指数A(LSIA)、LSIB、PSQI、THI得分均无直线相关。②耳鸣患者的SCL-90多项因子分高于国内常模,生活满意度低于国内常模(P<0.05),睡眠障碍患病率高于普通人群(P<0.05)。③THI 4级、THI 5级患者的生活满意度降低,SCL-90中多项因子分均高于国内常模;THI 5级患者睡眠障碍患病率高于普通人群。结论:耳鸣的频率、响度和患者的SCL-90、LSR、LSIA、LSIB、PSQI、THI得分均无直线相关。THI 4级、THI 5级患者的心理障碍明显,应给予重点关注。     

耳鸣患者耳鸣的心理声学特征分析

目的分析耳鸣患者耳鸣的心理声学特征,为开展耳鸣心理声学治疗提供依据。方法对159例以耳鸣为第一主诉的患者用耳鸣综合诊断治疗仪TTS-1000A进行耳鸣心理声学测试,对相关结果进行分析。结果 159例患者的耳鸣主调大多为纯音(103例,64.78%),且主调频率以8 000Hz最多(58例,36.48%);耳鸣响度分布<5dB SL者最多(80例,50.31%);耳鸣最小掩蔽级测试佛德曼曲线中以汇聚型最多(63例,39.62%);残余抑制时间1～60秒者最多(75例47.17%),90例(56.60%)残余抑制试验部分阳性;117例(73.58%)伴听力下降,听力下降组患者的抑制试验阳性和部分阳性病例所占比例显著高于听力正常组(P<0.05)。在掩蔽曲线为汇聚型的听力下降组中,残余抑制试验阳性和部分阳性者(73.33%)明显高于其它组(P<0.05)。结论耳鸣患者中,耳鸣掩蔽曲线为汇聚型且伴听力下降的患者,其耳鸣更易被掩蔽。     

不同年龄耳鸣患者耳鸣的心理声学特性及听力状况分析

目的了解不同年龄段耳鸣患者的耳鸣心理声学特性、严重程度及听力特点。方法 81名患者分为≤30岁组（16例）、30～岁组（32例）、45～岁组（16例）和〉60岁组（17例）,各组均进行纯音听阈、声导抗、ABR、DPOAE检测,并询问耳鸣对其情绪、睡眠、工作的影响以及环境声对耳鸣的影响情况,由患者自我评价耳鸣响度和烦躁度,并进行耳鸣匹配和耳鸣掩蔽后效抑制试验。结果不同年龄组耳鸣患者的听力状况构成差异有统计学意义（P〈0.05）,随年龄增加听力损失程度逐渐加重;不同年龄段患者在工作、睡眠和情绪受耳鸣影响、环境声对耳鸣的影响等方面差异无统计学意义（P〉0.05）,各组患者自评耳鸣响度和烦躁度差异无统计学意义（P〉0.05）;≤30岁组的耳鸣响度大于31～岁组和45～60岁组;31～岁组和45～岁组的耳鸣掩蔽后效抑制时间均较≤30岁组长。结论不同年龄耳鸣患者的耳鸣响度和耳鸣掩蔽后效抑制效果存在差异,值得进一步研究。     

300例大学生主观性耳鸣患者临床表现分析

目的:探讨大学生主观性耳鸣患者的临床表现及心理声学特点。方法:以问卷调查的方法,收集300例大学生主观性耳鸣患者的基本信息,并进行纯音测听及耳鸣匹配检查,分析耳鸣的基本特征及其与各相关因素之间的关系。结果:耳鸣伴听力下降163例(54.3%),耳鸣匹配频率与听力下降频率有密切关系(P<0.01),耳鸣响度与严重度无明显相关性(P>0.05)。耳鸣对86.0%的患者的心理及学习生活产生较明显影响。结论:耳鸣与听力损失最大的音频近似;耳鸣响度与严重程度无相关性。耳鸣对患者心理及学习生活产生了较大的影响,在临床工作中应特别注重心理和社会因素对其的影响。     

扩展高频气导听阈和耳鸣的关系

目的 :探讨纯音听阈正常的耳鸣患者扩展高频气导听阈的变化。方法 :对 4 8例纯音听阈正常的耳鸣患者作扩展高频气导听阈测试 ,并根据年龄≤ 2 5岁 (14例 ) ,2 6～ 35岁 (18例 ) ,36～ 4 5岁 (16例 )分成 3个年龄组。同时以 30例正常听力、无耳鸣的青年作为正常对照组 ,分析 4组扩展高频气导听阈与耳鸣的关系。结果 :3个年龄组患侧各频率扩展高频听阈均数与自身健侧比较 ,且与正常对照组相比差异均有统计学意义 (P <0 .0 1) ;各年龄组患侧扩展高频听阈与 3个年龄组健侧相同频率听阈比较 ,差异有统计学意义 (P <0 .0 1) ,除≤2 5岁组与 2 6～ 35岁组相比差异无统计学意义 (P >0 .0 5 )外 ,≤ 2 5岁组与正常组在 10 .0kHz,12 .0kHz和 14 .0kHz差异亦无无统计学意义 (P >0 .0 5 )。结论 :纯音听阈正常的耳鸣患者的扩展高频气导听阈并不一定正常 ,耳鸣可能是内耳早期病变的症状之一 ,但是 ,对于年龄在 30岁左右及更年长者 ,扩展高频听阈改变还可能与年龄有关。扩展高频听阈测试应作为一种常规听力检查     

突发性聋患者耳鸣程度及耳鸣疗效的相关因素分析

目的 研究影响突发性聋伴耳鸣患者耳鸣严重程度及远期疗效的相关因素.方法 回顾性分析2017年3月～2019年5月荆州市中心医院收治的106例单侧突发性聋伴耳鸣患者随访半年临床资料.观察耳鸣严重程度及耳鸣疗效与性别、年龄、侧别、初始听力损失程度、听力曲线类型、初诊时间、耳聋疗效的关系.结果 耳鸣严重程度与不同性别、年龄、...     

Characteristics of tinnitus with or without hearing loss: Clinical observations in Sicilian tinnitus patients

Objective

To analyze the clinical characteristics of tinnitus both in normal hearing subjects and in patients with hearing loss.

Methods

The study considered 312 tinnitus sufferers, 176 males and 136 females, ranging from 21 to 83 years of age, who were referred to the Audiology Section of the Department of Bio-technology of Palermo University. The following parameters were considered: age, sex, hearing threshold, tinnitus laterality, tinnitus duration, tinnitus measurements and subjective disturbance caused by tinnitus. The sample was divided into two groups: Group 1 (G1) subjects with normal hearing; Group 2 (G2) subjects with hearing loss.

Results

Among the patients considered, 115 have normal hearing while 197 have a hearing deficit. There is a slight predominance of males respect to females that is more evidenced in G2 (61.42% of males vs. 38.58% of females). The highest percentage of tinnitus results in the decades 41–50 for G1 and >70 for G2 with a statistically significant difference between the two groups (P < 0.0001).The hearing impairment results in most cases of sensorineural type (74.62%) and limited to the high frequencies (58.50%), moreover the 72.10% of the patients with SNHL had a high-pitched tinnitus while the 88.37% of the patients high-frequency sensorineural hearing loss had a high-pitched tinnitus (P < 0.0001). As for the subjective discomfort, the catastrophic category resulted most representative among subjects with normal hearing with a statistically significant difference between the two groups but no significant correlation was found between the level of tinnitus intensity and the tinnitus annoyance confirming the possibility that tinnitus discomfort is elicited by a certain degree of psychological distress as anxiety, depression, irritability and phobias that do not allow the phenomenon of the ‘habituation’.

Conclusion

This work, according to literature data, suggests that the hearing status and the elderly represent the principal tinnitus related factors; moreover tinnitus characteristics differ in the two groups for tinnitus pitch. There is, in fact, a statistically significant association between high-pitched tinnitus and high-frequency SNHL suggesting that the auditory pathway reorganization induced by hearing loss could be one of the main source of the tinnitus sensation.     

2171例耳鸣患者的临床特征分析

目的 探讨耳鸣患者的临床特征,为耳鸣诊治提供参考.方法 收集2014年1月至2015年12月就诊于中山大学孙逸仙纪念医院耳鼻喉科门诊以耳鸣为第一主诉的2 171例(2 736耳)耳鸣患者的临床资料,以耳鸣残疾量表(tinnitus handicap inventory,THI)及视觉模拟评分(visual analogue scale,VAS)评估耳鸣的严重程度,并分析耳鸣的发病年龄、耳鸣侧别、听力状况及可能病因等基本特征.结果 2 171例耳鸣患者平均年龄为44.08±15.37岁,其中41~50岁为分布最集中的年龄段(491例,22.60%),其次为31~40岁(445例,20.50%)1~60岁(438例,20.20%);主观性耳鸣2 120例(97.65%),客观性耳鸣51例(2.35%);单侧耳鸣(1 606例,73.98%)多于双侧耳鸣(539例,24.83%), 颅鸣最少(26例,1.19%);2 736侧耳鸣耳8 000 Hz的平均听阈为69.26±27.70 dB HL,高于1 606侧非耳鸣耳(54.16±30.98 dB HL);THI分级以2、3级为主(55.78%,1 211/2 171),VAS分级以轻、中度耳鸣为主(83.83%,1 820/2 171);音调匹配以高频多见(4~8 kHz,1 199例,55.23%);位于前三位的可能病因为不明原因591例(27.22%)、突发性聋549例(25.29%)及中耳疾病270例(12.44%).结论 本组耳鸣患者中以主观性耳鸣为主,中青年者居多,单侧耳鸣多于双侧耳鸣,耳鸣与听力关系密切;引起耳鸣的病因多而复杂,部分患者不明原因或与耳疾有关,习服治疗是值得推广的治疗方法.     

Otoacoustic emissions, ear fullness and tinnitus in the recovery course of sudden deafness

OBJECTIVE: This study aimed to investigate how the symptoms of ear fullness, tinnitus and otoacoustic emissions (OAE) change in relation to the recovery course of pure tone audiometry thresholds (PTA) in sudden deafness (SD). METHODS: This study analyzed follow-up data on ear fullness, tinnitus and otoacoustic emissions of eight SD patients with good hearing improvement (Group A) and eight SD patients with poor hearing improvement (Group B) in an attempt to elucidate the behavior of these symptoms in their recovery course. This study was done until there was no change in the PTA for more than 1 week and hearing recovery was no longer expected. RESULTS: All patients from both groups had ear fullness and tinnitus in association with the onset of SD. However, these symptoms improved only in Group A. showing a significant relationship between PTA recovery and the improvement of ear fullness annoyance (P<0.05), presence of tinnitus (P<0.01), improvement in tinnitus loudness (P<0.01) and in tinnitus annoyance (P<0.01). No patients (Group A or B) had OAE responses at their first examination. In Group A, OAE responses appeared simultaneously with improvement of hearing levels in five patients (63%) and it appeared later than hearing levels improvement in the other three patients (37%) from Group A. No patient from Group B showed OAE response on follow-up. CONCLUSION: SD patients with good hearing improvement (Group A) tended to have OAE responses and the sensations of the ear fullness and tinnitus improved almost simultaneously with hearing level improvement. Their PTA improvement occurred primarily in the low to mid frequencies, with high frequencies showing less recovery. When hearing recovery was not full, OAEs did not reappear for these frequencies. Patients with poor hearing improvement tended to have absent OAEs and persistent ear fullness and tinnitus.     

Direct current stimulation of the ear in tinnitus treatment: a double-blind placebo-controlled study

The objectives of the study are assessment of the influence of direct current electrical stimulations of the ear in tinnitus treatment, comparison of the results with placebo group and evaluation of hearing after electrical stimulations. The study comprised 120 tinnitus and sensorineural hearing loss patients (n = 184 tinnitus ears). In group one (n = 119 tinnitus ears) the authors applied a non-invasive hydrotransmissive electrical stimulation (15) of the ear, in group two (n = 65 tinnitus ears)—placebo electrical stimulation. Direct rectangular, positive polarization current was used. The frequency of stimulation was adjusted according to tinnitus frequency. In group two, the authors used similar procedure, but no current was delivered through the active electrode. Evaluation of tinnitus and hearing was conducted. In groups one and two, directly after the treatment, the number of ears with permanent tinnitus decreased considerably. In group one in 40 ears (33.6 %) tinnitus disappeared; in group two, tinnitus disappeared in four ears (6.1 %). After 30 days, statistically significant changes were observed in group one (p < 0.05), which were comparable with results returned 90 days later (p > 0.05). Changes in group two (after 30 and 90 days) were not significant (p > 0.05). The authors recognized audiometric improvement of hearing (in pure tone audiometry). The application of direct current electrical stimulation of the hearing organ, with current frequencies similar to tinnitus frequencies (selective electrical stimulation), was an efficient method in severe tinnitus treatment. We did not observe a harmful effect of direct current on hearing organ.     

Evaluation of tinnitus patients with normal hearing sensitivity using TEOAEs and TEN test

Objectives

This study was designed to investigate the possibility of underlying cochlear damage whether outer hair cells (OHCs) or inner hair cells (IHCs) in tinnitus suffering patients with normal hearing sensitivity, using transient evoked otoacoustic emission (TEOAEs) and threshold equalizing noise (TEN) test, if any.

Methods

Twenty patients suffering from unilateral tinnitus with normal hearing sensitivity participated in this study. Their other ear acted as control ears. They were subjected to full history taking, otoscopy, basic audiologic evaluation, TEOAEs and TEN test.

Results

TEOAEs were abnormal in 85% of the tinnitus ears compared to 20% in control ears; this difference was statistically significant. The abnormal TEOAEs frequency bands in the tinnitus ears were statistically significant above 2000 Hz when compared to the control ears and were more common for the 4000 and 5000 Hz. This suggests that OHCs dysfunction may be important in the generation of tinnitus. TEN test demonstrated dead regions in the cochlea in 15% of the tinnitus ears only. This might be attributed to increased resistance of IHCs to damage compared to OHCs vulnerability. The affected frequency location was at 500 Hz in 5%, 3000 and 4000 Hz in 10% of tinnitus ears.

Conclusion

This work has shown a higher prevalence of OAE abnormalities in tinnitus patients with normal hearing in contrast to TEN test denoting the more vulnerability of OHCs to damage.     

Distortion products of otoacoustic emissions (DPOAE) in acute tinnitus aurium

BACKGROUND: The origin of subjective tinnitus is not really known yet. It is possible to investigate the function of outer hair cells by means of the distortion products of otoacoustic emissions (DPOAE). METHODS: DPOAE of 56 patients were analysed in a prospective study (tinnitus without any loss of hearing n = 34; hearing loss with a maximum of 35 dB and tinnitus n = 22). There was always a normal tympanogram and in no case a conductive hearing loss. The relation of the primary tones f2/f1 was 1.22, the levels of the primary tones were 70 dB. RESULTS: DPOAE-amplitudes were reduced distinctly in both groups of patients. But there was no general difference and no difference at the frequency of tinnitus between the ear with tinnitus and the contralateral ear (no hearing loss) or there was a small reduction related to the normal ear (distinct hearing loss). DPOAE-amplitudes did not change in patients without hearing loss after a treatment with Pentoxifylline i.v., also not at the frequency of tinnitus, although there was a subjective reduction of tinnitus. In patients with hearing loss DPOAE-amplitudes enhanced like the improvement of hearing threshold at the frequency of tinnitus. CONCLUSIONS: The low DPOAE-amplitudes are a sign of damaged outer hair cells of the patients. But there is a symmetry of the DPOAE-amplitudes and there is no change of DPOAE after a therapy with Pentoxifylline i.v. in patients without hearing loss.     

不同时机鼓室内注射糖皮质激素治疗重度以上突发性聋的疗效分析

目的 观察全身联合不同时机鼓室内注射糖皮质激素治疗重度以上突发性聋的疗效,探讨鼓室内注射时机,分析影响重度以上突发性聋预后的因素。方法 回顾性分析108例重度以上突发性聋患者的临床资料及治疗效果,其中全身联合初始鼓室组64例,全身联合延后鼓室组44例;对两组患者出院时与随访时疗效分别进行比较,并分析治疗有效组和无效组临床特征。结果 出院时和随访时两种治疗方案平均听阈、平均听阈改善值、总有效率比较差异均无统计学意义（P均>0.05）,两种治疗方案痊愈率比较差异具有统计学意义（P<0.05）。两种治疗方案治疗前与出院时、治疗前与随访时分别比较差异均具有统计学意义（P均<0.001）。108例患者中,有效83例（76.9%）,伴眩晕者治疗有效率低（P<0.05）,治疗有效率与患者初始听阈损失程度（P<0.05）及听力曲线类型（P<0.05）相关,与年龄、性别、侧别、是否伴发耳鸣均无明显相关性（P均>0.05）。结论 对于重度以上突发性聋,听力损失程度、曲线类型、是否伴发眩晕与预后相关,治疗上建议尽早全身联合局部应用糖皮质激素。