The Initial Investigation Of Tinnitus Patients' Psychologic Factors

Background:Tinnitus is commonly described as a perception of sound that is not related to an external acoustic source or electrical stimulation. It is an extremely common condition. Epidemiology indicated that there were about six to seventeen percent of common people had experience at least five minutes tinnitus, but only 0.5-2.5% men who thought tinnitus were significantly disturbed to them.Now it is generally thought patient who experience tinnitus, because they are trouble with tinnitus and they cann't realize this correctly, would suffer symptoms such as depress,anxious,sleep disord et.c, severily their social function would damaged, even they would kill themselves. Jastreboff introduced neurophysiologic model of tinnitus. It points out that tinnitus, through conditional reflex, results in continue exciting of limbic system and automatic nervous system, then leads to clinically psychologic obstacle related to tinnitus, such as depression. Based on this, Jastreboff introduced tinnitus re-education therapy, in order that patients could establish a new view of tinnitus, then above-mentioned psychologic obstacle no longer appeared when they were experiencing tinnitus.Objection:It is to know psychological conditon of tinnitus patients, to know whether they have psychologic obstacle such as depress,anxious,et.c, meanwhile to evaluate quality of their lives and sleep, through detailed detections related to tinnitus and psychologic evaluations. Then it is to analyze the distribution of these psychologic obstacle in tinnitus patients, in order to provide formation for diagnosing and treating tinnitus clinically.Materials and methods:All case of tinnitus patient came from otolaryngology-head & neck surgery outpatients of Xiangya hospital of Central South University. All patient were detected their frequency and loundess of tinnitus. Then they were evaluated by symptom checklist 90, Life Satisfaction Scale, Pittsburgh Sleep Quality Index, tinnitus handicap inventory.Symtom checklist 90 is made up of 90 items, can sum up to nine factors, include somatization, compulsive, person relationship, depression, anxiety, hostile, phobia, paranoia, psychosis. Scale co-operation group has analyzed the SCL-90 data of 1388 adult normal coming from 13 regions of our country, the major result was list as follow. Statistics indexMean±SDFactor scoreMean±SD Con-score129.96±38.76somatization1.37±0.48 Con-share1.44±0.43compulsive1.62±0.58 Number of24.92±18.41person1.65±0.51 positive itemsrelationship Number of65.08±18.33depression1.50±0.59 negative items Positive items2.60±0.59anxiety1.39±0.43 share hostile1.48±0.56 phobia1.23±0.41 paranoia1.43±0.57 physchosis1.29±0.42The life satisfaction scale is made up of three independent scale, one is judged by other people, life satisfaction rating scale, LSR. The other two scales are judged by oneself, life satisfaction index A(LSIA) and life satisfaction index B(LSIB). Literature indicated that the score of internal norm were LSR=17.8±4.6, LSIA=12.4±4.4, LSIB=15.5±4.7.Pittsburgh Sleep Quality Index(PSQI) is adapted to evaluate sleep quality of person who are sleeping disorder, psychonosema or common person. It is a evaluating tool to research the correlation between sleep quality and spirit and body healthy. Dr. Buysee indicated that if the cut score is five, its sensitivity is 89.6%, specificity is 86.5%. In our country, the test made by Xianchen Liu indicated that if the cut score is seven, ts sensitivity is 98.3%, specificity is 90.2%. Our study use the internal standard.Tinnitus handicap inventory (THI) is made up of tweety-five items, every one has three answers such as no, sometime, yes, the score of them is zero, two, four. Sum up all score of tweenty-five items, then classify. Grade one:without disability,0-16. Grade two:slight disability,18-36. Grade three:moderate disability,38-56. Grade four:severe disability, 58-76. Grade five:severely and profoundly handicapped,78-100. The higher score and grade are, the severer the perception of tinnitus is.All data were made in database, then analyzed with statistical analysis software of SPSS 11.0.Result:There was no straight line correlation beween frequency, loundness of tinnitus and the patient's scores from SCL-90,LSR,LSIA,LSIB,PSQ,THI.To 76 tinnitus patients,their con-score (X=165.72±53.68, t=5.808, P=0.000), con-share (X=1.84±0.59, t=5.866, P=0.000),number of positive items (X=40.86±21.8, t=6.354, p=0.000), positive items share (X=2.72±0.47, t=2.275, P=0.026)are higher than internal nom. Among them, besides interpersonal relationship factor (X=1.73±0.69, t=1.031, P=.306), other factors such as somatization (X=1.74±0.56, t=5.790, P=0.000), compulsive (X=2.10±0.73, t=5.745, P=0.000), depression(X=1.94±0.73, t=5.299, P=0.000), anxiety (X=1.91±0.72, t=6.230, P=0.000,hostile (X=1.87±0.84, t=4.092, P=0.000),phobia (X=1.55±0.59, t=4.776, P=0.000),paranoia (X=1.59±0.70, t=2.059, P=.043),psychosis (X=1.74±0.71, t=5.495, P=0.000) are higher than internal nom. In the investigation of 76 tinnitus patients,67 patients haveaccomplished LSR,64 patients have accomplished LSIA,66 patients have accomplished LSIB. Compareing with internal nom, the score of LSR, LSIA,and LSIB are all lower than it.60 patients have accomplished PSQI,45 of them get score what are higher than seven. It approved that 62 percent tinnitus patients have sleep disorder, the ratio is higher than internal nom.Grouping these patients, based on the score of THI, the somatization factor score of THI three grade group are higher than internal nom. To THI four grade group, their satisfaction of lives are lower, the score of factors such as somatization, compulsive, depression, anxiety, hostile, phobia, psychosis are higher. To THI five grade group, their satisfaction of lives are lower, the ratio of suffering sleep disorder is higher, and the score of factors such as somatization, compulsive, interpersonal relationship, depression, anxiety, hostile, stick, phobia, paranoia, psychosis are higher.Conclusion:there is no sraight line correlation beween frequency, loundness of tinnitus and the patient's scores from SCL-90,LSR,LSIA,LSIB,PSQI,THI.Grouping based on the score of THI, the groups of THI four grade and THI five grade are approved that they have psychologic obstacle obviously, they should be paied close attention.