A Study Of The Relationship Between Hyperacusis And Tinnitus

ObjectiveHypercusis(Also reported as auditory hypersensitivity,reduced,decreased sound tolerance,etc.)is a health condition characterized a collapsed tolerance to usual environmental sound,while tinnitus is the perception of sound within the ears or cranial when no external sound source is present.These two phenomena are very common in clinical practice.However,at present,only a few reports on the hyperacusis literature at home and abroad,and the hyperacusis has not yet been fully understood.Clinical experience shows that many patients with hyperacusis have a complaint of tinnitus,a number of patients and clinicians misunderstand the hyperacusis is tinnitus.So,the relationship between hyperacusis and tinnitus is worth of research value.However,there are few reports on this subject at home and abroad,the view from Traditional Chinese Medicine(TCM)remains blank.The diagnosis and treatment to hyperacusis and tinnitus is difficult.In this study,by collecting a certain amount of sample data of patients with hyperacusis and tinnitus,the relationship between the hyperacusis and tinnitus in the clinical features and pathogenesis of TCM was studied to provide ideas for seeking effective prevention and treatment programs.MethodsCorrelation analysis for the relation of two variables.During 2017.2 to 2018.1,in the Otorhinolaryngology Outpatient Department of the First Affiliated Hospital of Guangzhou University of Chinese Medicine.we investigated those who with a chief complaint of hyperacusis or/and tinnitus,over 15 years old,willing to cooperate with the examination,uncapable to understand and communicate by speech communication.The patient's basic information(including gender,age,etc.)was collected,and the patient was instructed to complete the Tinnitus Questionnaire(including TEQ),Acoustic Sense Inventory(including VAS score),Self-Rating Depression Scale SDS(SAS),Spleen and Stomach Function Scores,Living Habits Questionnaire(including sleep habits,eating habits,mood stress,etc.),and clinical examination including pure tone audiometry and loudness discomfort levels,etc.We established a database,statistical analysis was performed by Excel(2016)and SPSS 22.0.Statistical analysis of counting data in univariate analysis using chi-square test,measurement data statistics using T test or rank sum test,two-variable correlation analysis.Statistical analysis to univariate analysis by Chi-square test for enumeration data and T test or rank sum test for measurement data.Next,we analyzed the differences of clinical characteristic between hyperacusis and tinnitus.Including the clinical symptoms and the severity of condition,anxiety and depression,the etiology and pathogenesis,etc.Results1.General Information:A total of 272 eligible cases were collected in this study.There were 143 males(52.57%)and 129 females(47.43%)with a ratio of 1.1: 1,with an average age of 41.30 ± 12.92 years.There were 87 cases(31.99%)with hyperacusis,185 cases(68.01%)with tinnitus.There is no significant difference in gender and age in these two groups.2.Incidence rate: Of the 87 patients with hyperacusis,79(90.80%)combined with tinnitus,and 8(9.20%)had no tinnitus.Of 264 patients with tinnitus,79(29.92%)were hyperacusis and 185(70.08%)were negative.In 79 patients with hyperacusis and tinnitus,33 cases(41.77%)were tinnitus first onset,7 cases(8.86%)were hyperacusis.And concurrenced in the other 38 cases(48.10%).1 case(1.27)the patient can not remember which occurred first.3.Cinical features:Among the 87 patients with clinical sensitivity,57.47% were not able to produce any sound and 42.53% were dissatisfied with specific sounds.Of the 37 patients who were sensitive to specific sounds,13(35.14%)were sensitive to one voice only,and 24(64.86%)were sensitive to two or more than two specific sounds.Of the 87 patients with sonic sensitivity,16.09% appeared to be 1 discomfort,51.72% showed 2 discomfort,32.18% showed 3 or more discomfort.Of these,68.97% of the cases with ear related discomfort were the same as those with tinnitus and ears,accounting for 75%.After discontinuing contact with the outside voice,79.31% of discomfort disappeared immediately,and a few patients(20.69%)disappeared before and after 5 minutes.In 264 cases of tinnitus,the location of the ringing of the tinnitus included ears,left ear,right ear,intracranial,cranial surface and body.83.33% of the patients only heard 1 kinds of voice,15.15% patients could hear 2 or more than 2 kinds of tinnitus,1.52% patients could not speak clearly.4.Audiology test:(1)The incidence of hearing loss: the standard of hearing loss with the mean of speech frequency(500HZ-4KHZ)or more than 25 d BHL,53.75% of patients were accompanied by hearing loss;the threshold of hearing loss at any frequency of 250HZ-8KHZ was greater than that of 25 d BHL as a standard of hearing loss,70.75% of the patients were accompanied by hearing loss,and the incidence of hearing loss under the two standards was in the presence of a hearing loss.There was no significant difference between the two groups in acoustic sensitivity and noiseless sensitivity(P>0.05).(2)The mean value of hearing threshold was 30.36 + 17.05 d B and 28.67 + 13.63 d B in the right ear of the sound sensitive group and the non sound sensitive group respectively.The mean tone threshold of the left ear was 28.16 + 15.26 d B and 27.80 + 13.48 d B respectively,and there was no statistical difference between the left and right ear threshold values(P>0.05).(3)DR mean value: the mean DR mean of the right ear in the sound sensitive group and the silent group was 72.64 + 20.11 d B and 68.87 + 14.67 d B respectively.The DR mean of the left ear was 77.201 + 29.39 and 75.96 + 23.49 respectively,and there was no statistical difference between the DR mean of the left and right ears(P>0.05).5.Investigation of anxiety and depression:(1)The incidence of depression in the sound sensitive group(28.74%),the incidence of anxiety(27.59%)was greater than that in the non sound sensitive group(17.84%,13.51%),the mean value of SDS(45.68 + 11.44)in the sound sensitive group and the mean value of SAS(43.39 + 9.44)were greater than those in the non sound sensitive group(41.82 + 11.32,39.87 + 9.57).(2)The correlation coefficient of sound sensitive VAS score and SDS score and SAS score were 0.336 and 0.275 respectively.There was positive correlation(medium and weak);the correlation coefficient of tinnitus TEQ score and SDS score and SAS score were 0.272 and 0.312 respectively,and there was a positive correlation(weak,middle).6.The investigation of living habits:Of all the patients,86.76% had insufficient sleep,93.75% were fat,81.25% were cold,88.60% had bad mood,97.79% had psychological pressure,and there was no statistical difference between the sound sensitive group and the silent sensitive group(P>0.05).7.The Investigation of the function of spleen and stomach:(1)The mean value of spleen and stomach function score of all patients(39.8 + 9.9)was far higher than that of healthy people(9.9 + 2.7),suggesting that the patients were generally poor in spleen and stomach function,and that 38.97% of the patients with spleen and stomach diseases were identified.There was no statistical difference between the spleen and stomach function score and the incidence of spleen and stomach diseases between the sound sensitive group and the non acoustic sensitivity group(P>0.05).(2)The correlation coefficient of spleen and stomach function score and sound sensitive VAS score and tinnitus TEQ score were 0.255 and 0.312 respectively,suggesting that there was a positive correlation(weak and middle),and the more serious the tinnitus,the higher the score of the spleen and stomach function(P < 0.05).Conclusion:1.Hyperacusis is closely related to the tinnitus and they often appear together.Hyperacusis rarely appears alone,most of them appeared in patients who suffers tinnitus.So,we should pay close attention to the diagnosis and treatment of tinnitus in clinical practice.2.The clinical features of hyperacusis and tinnitus are obviously different: the former is the real existence of the external voice to produce the discomfort symptoms of the body.Most of the symptoms disappear immediately after the external sound is stopped,and the patient likes a quiet environment;Tinnitus is heard of a sound,which is unsound and difficult to describe,and this sound will not produce directly body discomfort symptoms,but may cause psychological confusion,fear and so on.Patients like the sound environment.3.Hyperacusis and tinnitus perhaps have similar causes:insufficient sleep,bad mood(high social pressure),improper diet,etc.They also share similar pathogenesis: spleen and stomach dysfunction,also often accompanied by anxiety and depression.It suggesting that the general treatment direction should be centered on the spleen and stomach and psychological counseling treatment is indeed recommmended for those who suffers hyperacusis or/and tinnitus.