A Clinical Research Of Psychoacoustic And Clinical Characteristics Of Decompensated Tinnitus And The Effect Of Composite Acoustic Therapy In Patients Of Sudden Deafness With Tinnitus

Background and objectivesTinnitus, deafness and vertigo are three challenges in the study of otology, and tinnitus is known as the most difficult one. Because of the rapid development of our country’s social business,the incidence of tinnitus is increasing gradually along with the aggravated social pressure and noise pollution. A conservative estimate of the incidence of tinnitus in our country was about 10% as many as 130 million people according to epidemiological investigation,and about 20%～25%of them are pursuing treatments continually. An obstinate tinnitus can also cause insomnia, depression, anxiety and fear, and these may lead to a series of family and social problems that will greatly affect the quality of life. The pathogenesis of tinnitus is complex and not clear.The existing research confirmed that abnormal electrical activity in nerve fibers of the auditory pathway, disorders of limbic system and autonomic nervous system participate in and form the tinnitus and its related symptoms.The diagnosis and treatment of tinnitus is different according to its different properties. Decompensated tinnitus is more serious and can cause distraction of patient’s attention and mental symptoms such as sleep disorders, anxiety, depression and fear. And these patients need to receive individualized intervention and comprehensive treatment. It is difficult to diagnosis and treat tinnitus for there is no uniform method and standard to measure the degree of tinnitus complaint in clinic. Guidelines at home and abroad have given some evaluation scales for assessment of the extent of decompensated tinnitus, but there are lack of recognized grading standard and unified consensus. There are few clinical researches for this kind of tinnitus in foreign literatures, and no related reports were retrieved in domestic literatures, So it makes sense to make further discussion and research to provide a reference basis for clinical diagnosis and treatment of decompensated tinnitus.Sound therapy is often used in the treatment of chronic tinnitus with unknown etiology and treatment. But it is less used in acute tinnitus that can be cured by drug. A multi-center clinical research of 1024 cases of sudden deafness, which is an otology common disease, showed that 864 (84.38%) cases had tinnitus,18 (1.76%) cases had cranial tinnitus. A delayed or non-standard treatment will induce a higher incidence of disability caused by deafness and tinnitus. In this study, the difference of the curative effect between composite acoustic therapy and non-composite acoustic therapy will be observed, meanwhile the clinical effect of composite acoustic therapy and the plan and course design of treatment will be discussed. These dates would provide evidence of choices of composite acoustic therapy for acute tinnitus.1 Subjects and methods1.1 A Clinical Research of Psychoacoustic and Clinical Characteristics of Decompensated Tinnitus1.1.1 Object of study The clinical data of 628 patients(single ear 433 cases; bilateral ear 195 cases)with an diagnosis of tinnitus from October 2013 to July 2014 in the outpatient department of otolaryngology head and neck surgery of nanfang hospital were analysed retrospectively.1.1.2 Test items All cases were examined by pure tone audiometry, tinnitus matching and residual inhibition test. A positive result of residual inhibition test means the tinnitus symptom of the patient was relieved more than 20%, and a negative result means the symptom was relieved 20% or less.1.1.3 Questionnaire The tinnitus interrogation scale contains the clinic experience of patients, the nature of the tinnitus, the loudness VAS scale, and systemic diseases along with the type of the diseases that patients suffered from. The severity of innitus from light to heavy was divided into I-V levels in the "scale of the self-evaluation of tinnitus". The patients whose answers to the "scale of the self-evaluation of tinnitus" showed the sleep, work or emotion was affected would be identified as decompensated tinnitus patients.1.1.4 Statistical analysis The Spss13.0 software was used for statistical analysis, and the data were analysed through t test, chi-square test and pearson correlation test according to its type. Statistical significance was achieved if P was less than 0.05.1.2 Effect of Composite Acoustic Therapy in Patients with Sudden Deafness with Tinnitus1.2.1 Object of study The clinical data of 96 patients with an initial diagnosis of sudden deafness with tinnitus from September 2013 to April 2014 in the outpatient department of otolaryngology head and neck surgery of nanfang hospital were analysed. Sudden deafness diagnosis in accordance with the diagnostic criteria of Guideline of diagnosis and treatment of sudden deafness (2005, Jinan). Patients were randomized divided into experimental group and control group equally according to the time of seeking medical advice.1.2.2 Study Procedures Patients in the experimental group were treated with drugs and composite acoustic, and the others were treated with drugs only.1.2.3 Test items All cases were examined by pure tone audiometry, tinnitus inquiry, composite acoustic matching and residual inhibition test. Patients chose the most approximate one Of the sound sources such as pure tone, pulse pure tone, white noise, narrow road noise and speech noise as masking sound, and the intensity of the sound was lOdB HL higher than minimum masking level. At the same time, music that patients like were added in. The best composite sound was gotten then according to the test results.1.2.4 Treatment courses of composite sound The masking sound was given to the single ear and the loudness should not higher than 90 dB HL. If the hearing of the sick ear lost more than 90 dB HL, composite sound was given to the healthy one. The sound of music was given to both ears and the loudness should be contronled from 40 to 70 dB HL. The frequency of administration was 2 times a day,30 minutes every time. After a treatment for 30 days, patients continue to accept treatment at home by listening to light music in the computer through high-fidelity headset for 60 days,2 times a day and 60 minutes every time.1.2.5 Evaluation index Scores of the "Visual Analogue Scale VAS", "Tinnitus Handicap Inventory THI" and "Self-rating Anxiety Scale SAS" were recorded on admission, after 30 days’ and 60 days’ treatment.1.2.6 Statistical analysis The Spss13.0 software was used for statistical analysis, and the data were analysed through t test, chi-square test and pearson correlation test according to its type. Statistical significance was achieved if P was less than 0.05.2 Results2.1 A Clinical Research of Psychoacoustic and Clinical Characteristics of Decompensated Tinnitus2.1.1 The constituent ratios of patients of different age groups between compensated and decompensated groups were different (χ2=16.535,V=3,P=0.001). The proportion of patients younger than 30 years was highest in decompensated group, while the proportion of patients older than 60 years was highest in compensated group (χ2=13.786,V=3,P=0.003).2.1.2 Of the 453 cases in the decompensated group,434 cases have persistent tinnitus (95.8%). Of the 175 cases in the compensated group,110 cases have persistent tinnitus(62.9%). The difference of the constituent ratio between two groups had statistical significance (χ2=118.275, V=1,P=0.000).2.1.3 The t test for the average of loudness VAS score showed a significant difference between the compensated group and decompensated group (4.85±2.46 vs 6.61±2.40; P=0.000).2.1.4 Clinic classification:1.236 patients had the experience to see a doctor for 1-3times because of the tinnitus(52.2%).2.107 acute tinnitus patients went to see a doctor for the first time(23.6%).3.60 cases went to see a doctor repeatedly because of the tinnitus(13.2%).4.50 cases had tinnitus for a long time but went to see a doctor for the first time(11%).2.1.5 The ratio of patients who described the pitch of the tinnitus as cicadas sound or drone was 62%. Tinnitus most commonly present at the left side, followed by the right side and double side orderly. The constituent ratio of left, right and double sides between monotonous tinnitus and bitonality tinnitus showed statistical difference (x2=49.012, V=2, P=0.000). The constituent ratio of left, right and double sides between tinnitus and cranial tinnitus showed statistical difference (χ2=7.426, V=2, P=0.024). The constituent ratio of left, right and double sides between normal people and hearing loss patients showed statistical difference (χ2=1.781,V=1, P=0.41).2.1.6 The most common pitch of decompensated tinnitus were 8000 Hz,6000 Hz and 500 Hz, and for the "residual inhibition test "positive ones are 500 Hz,6000 Hz and 8000 Hz. What’s more, the positive rate of "residual inhibition test" was highest in low-frequency and high frequency, and it was relatively low in the intermediate frequency. In short, the positive rate of "residual inhibition test" in Meniere disease was higher than sudden deafness, and the rate of sudden deafness is higher than other sensorineural tinnitus.2.1.7 There were 153 cases who were diagnosed with sensorineural deafness with descending audiometric curve. The tinnitus tones of the 112 cases were at 8000 Hz, and the tones of the other 41 cases were not at 8000 Hz. By a threshold of 50 dBHL,8000 Hz auditory threshold> 50 dBHL and 8000 Hz tones of auditory threshold 50 dBHL in the two groups of tinnitus or less than 8000 Hz 8000 Hz and tone number distribution was statistically difference (χ1= 5.108V=1,P=0.023)2.1.8 Of the 453 tinnitus patients,267 cases had clear incentives(59%). The symptom of 195 cases were suspected to be associated with other disease(44%).96 cases had clear incentives and suffered from other diseases at the same time(21.2%).2.1.9 There was no statistical difference in the number distribution of the classification of tinnitus severity between the patients with or without other diseases (χ2=8.792,V=4,P=0.067)2.2 Effect of Composite Acoustic Therapy in Patients of Sudden Deafness with Tinnitus2.2.1 After 30 days treatment, the VAS score and hearing recovery rate between the two groups have no statistical difference(P=0.214), and the THI score and SAS score between the two groups have statistical difference(P=0.000). After 90 days treatment, the VAS score, THI score and SAS score between the two groups have statistical difference(P=0.041, P=0.000, P=0.001), but the hearing recovery rate between the two groups still have no statistical difference.2.2.2 The VAS score of tinnitus loudness between the two groups have statistical difference at the first 30 days but not the latter 60 days treatment. However, the hearing recovery rate of the two groups have no statistical difference at both the first 30 days and the latter 60 days.2.2.3 The VAS score of tinnitus at the first 30 days and the latter 60 days treatment of the control group have no statistical difference. However, the hearing recovery rate of the control group during the first 30 days was much higher than that during the latter 60 days(P=0.000). The VAS score of tinnitus and the hearing recovery rate at the first 30 days and the latter 60 days treatment of the experiment group had statistical difference, and the curative effect during the first 30 days was much better than that during the latter 60 days.2.2.4 After treated for 30 days, there was no correlation between the VAS and THI scores of the tinnitus volume, and there was no correlation between the THI score and hearing recovery rate either (P>0.05). There was only THI score have no correlation with the rate of the hearing recovery after 90 days treatment (P>0.05).The rest of the indexes showed linear correlation.3 Conclusions3.1 A Clinical Research of Psychoacoustic and Clinical Characteristics of Decompensated Tinnitus3.1.1 The sleep, work and emotion of 453 (72.2%) decompensated tinnitus patients(single ear 313cases; bilateral ear 140 cases) were affected.3.1.2 The patients of decompensated group had a highest proportion of age< 30 years old. That may be cause by the younger have more stress at work and their edge nervous system are more sensitive. The patients of decompensated group had a highest proportion of age≥60 years old. And that may be cause by the tolerance ability of the older were stronger.3.1.3 The VAS score of the tinnitus loudness and the proportion of persistent tinnitus patients of the decompensated groups were much higher than that of compensated groups.3.1.4 52.2% of those decompensated tinnitus patients can tolerate the symptom, and just 13.2% can not bear. The worries or fear about tinnitus of many patients can be removed through the way of education and consultation.3.1.5 Most patients described the voice as cicadas sound or drone. The tinnitus and cranial tinnitus on the left side were more than the right side. The multiple-tune tinnitus in bitonality tinnitus was much more than in monotonous tinnitus, that may be associated with bilateral asymmetry hearing loss.3.1.6 The frequency of the auditory threshold from 50 to 60 dBHL may have relationship with the pitch of tinnitus in the sensorineural deafness with steep fall or slow down audiogram.3.1.7 The positive rate of residual inhibition test of patients with acute tinnitus was higher than patients with chronic tinnitus, and giving sound therapy in acute stage may be better.3.1.8 Tinnitus is closely related to the inducement and systemic diseases, so people should try to avoid the inducement and strengthen the control of systemic diseases in daily life.3.1.9 No obvious influence was found beween systemic diseases and the severity of the tinnitus in the research3.2 Effect of Composite Acoustic Therapy in Patients of Sudden Deafness with Tinnitus3.2.1 The compliance of the tinnitus patients that were treated with complex sound was better than that were treated with simple masking or acclimatization therapy.3.2.2 The tinnitus volume and anxiety of the patients that were treated with complex sound were gradually reduced as the treatment was progressed. The curative effect was significant3.2.3 Patients that have sudden deafness along with tinnitus should be treated with sound as soon as possible3.2.4 Compared to the control group, the curative effect of the first 30 days is better than the latter 60 days in the experiment group. This may have something to do with the use of sound treatment in the experiment group but not in the control group,or because of the difference between complex sound and music.3.2.5 There was no correlation between the VAS and THI scores of the tinnitus volume, and between the THI score and hearing recovery rate after treated for 30 days. There was only THI score have no correlation with the rate of the hearing recovery after 90 days treatment, that may because of the THI scale contains functions, mood and catastrophic, was not associated with single evaluation index, and may also because of the patients who had tinnitus in one week misunderstood the THI scale, so the overall correlation evaluation was affected.