| Part 1:Apply Logistic regression analysis to fit the predictive model of repeated transcranial magnetic stimulation for chronic tinnitusObjective:To apply Logistic regression to analyze the related factors that affect the therapeutic effect of repeated transcranial magnetic stimulation(rTMS),and to fit the prediction model.Methods:From December 2014 to June 2019,363 patients with subjective tinnitus diagnosed by the Department of Otolaryngology Head and Neck Surgery of the Sixth People’s Hospital Affiliated to Shanghai Jiaotong University were selected as research subjects.All patients underwent rTMS treatment.The magnetic field intensity was 1.1 times the threshold value,and the patient’s left temporal apex was stimulated with a low frequency pulse of 1 Hz,a total of 1000 pulse stimulations(one-time continuous administration),with a pulse interval of 1s,once a day for 10 consecutive days.Using visual analog scale scoring method,the score was reduced as an effective standard,and tinnitus patients were divided into effective group and ineffective group.The clinical characteristics such as age,gender,duration of disease,health status,accompanying symptoms,type of tinnitus,night sleep status,tinnitus test,and history of hearing loss were used as influencing factors to compare the differences in treatment effectiveness.Multivariate Logistics regression analysis was used to analyze the relevant factors affecting the efficacy and construct a predictive model.ROC curve was used to evaluate the predictive performance of this model on the efficacy of rTMS.Results:After rTMS treatment,various factors were included in univariate Logistic regression to evaluate the relationship between each predictor and the efficacy of rTMS.The results showed that age,gender,duration of disease,type of tinnitus,type of tinnitus,hearing status,and nighttime sleep quality were all related to the efficacy of rTMS(all P<0.05).The relevant factors obtained from the above single factor analysis were included in the multivariate Logistic regression analysis,which showed that disease duration(OR 2.577,P=0.001),hearing status(OR 2.302,P=0.002),night sleep quality(OR 1.766,P=0.020)as independent related factors of rTMS efficacy.The prediction model constructed from this had a good predictive performance for the efficacy of rTMS(AUC 0.728,95%CI:0.676-0.780,P<0.001),showing the usefulness of the Nomo diagram to clinically quickly evaluate the effect of different influencing factors on the efficacy of rTMS treatment in patients.Conclusion:rTMS had a certain effect on tinnitus patients.The duration of the disease,hearing status,and sleep quality was good predictive factor for the therapeutic effect of rTMS,and could provide a reference for the best indications for clinical selection of rTMS treatment.Part Ⅱ:Analysis of the short-term efficacy of repeated transcranial magnetic stimulation for tinnitus craniiObjective:To compare and analyze the difference in clinical efficacy of rTMS in the treatment of chronic tinnitus and tinnitus cranii,and to explore new methods for tinnitus cranii treatment.Methods:From December 2014 to June 2019,363 cases of subjective tinnitus diagnosed by the Department of Otolaryngology Head and Neck Surgery of the Sixth People’s Hospital Affiliated to Shanghai Jiaotong University were selected and divided into tinnitus group according to the complaints of patients.The tinitus group included316 patients and the tinnitus cranii group included 47 patients.Both groups of patients were treated with standardized rTMS and scored using a visual analog scale.The non-parametric test was used to compare the decline in the scores of patients with tinnitus and tinnitus cranii after receiving rTMS treatment.Results:There was no significant difference in age and gender between the two groups(P>0.05).After rTMS treatment,the VAS score of 316 patients with tinnitus decreased from 5.78±1.71 points before treatment to 4.60±2.27 points,and the VAS score of 47 patients with tinnitus cranii decreased from 5.19±1.10 points before treatment to 2.96±1.90 points.In the tinnitus group,the proportion of the VAS score decreased by 42.72%,and in the tinnitus cranii group,the proportion of the VAS score decreased by 70.21%.The difference between the two groups was statistically significant(X~2=12.438,P<0.001).Compared with the tinnitus group,the tinnitus cranii group had significant differences in duration,type of tinnitus,and hearing status.The difference was statistically significant(P<0.05).In terms of health status,accompanying symptoms,and night sleep,there was no significant difference between the two groups.Conclusion:Compared with the tinnitus group,the tinnitus cranii group patients after rTMS treatment obtained better tinnitus suppression,which provided new ideas and methods for clinical treatment of tinnitus cranii. |
PDF Full Text Request