| Tinnitus is a meaningless sound that a patient can hear at any time,or only at certain times or scenes.The incidence of tinnitus is high,and there are differences in the prevalence of tinnitus reported in different studies,but it is consistently believed that the prevalence of tinnitus increases with age until it reaches equilibrium,and decreases after a certain age.Epidemiological studies have shown that tinnitus patients account for about 10%-20% of the population,and about 1%-2% of tinnitus patients think that tinnitus seriously affects the quality of life.Subjective tinnitus is usually described by the patient as one or more sounds.However,in general,subjective tinnitus does not have any detectable related signs,and there are currently no objective methods or means to detect the tinnitus described by the patients.There is also no examination to distinguish between different forms of subjective tinnitus.Similarly,sound stimulation does not induce the same feeling.Severe tinnitus is often accompanied by mood abnormalities such as anxiety,depression,and other psychiatric disorders(sleep disorders),which in turn make the tinnitus worse and stubborn.The effect of tinnitus on the patient is the result of the negative psychological reaction caused by tinnitus itself and the emotions such as depression and anxiety caused by tinnitus,and the psychological problems caused by tinnitus to the patient are more serious than the pathological damage of the body itself.Subjective tinnitus has different forms and may be a group of diseases rather than a single disease.This has become a major obstacle to understanding its pathological processes and developing effective treatments.The assumptions about the pathology and mechanism of tinnitus continue to emerge and are constantly being abandoned.It is generally accepted that the pathology of tinnitus may begin to be related to the ear,and the vast majority of the pathological lesions that continue to be annoying subjective tinnitus are in the central nervous system.At present,there are various methods for clinical treatment of tinnitus,including drug therapy,surgical treatment,masking therapy,tinnitus habituation therapy,acoustic therapy,cognitive behavioral therapy,biofeedback therapy,transcranial magnetic stimulation therapy,Chinese medicine treatment,and acupuncture treatment.Hyperbaric oxygen therapy.The effective treatment plan for the etiology of tinnitus patients does not exist yet.The clinical research on tinnitus is paying more and more attention to its influence on the psychological/mental state of patients.The treatment of tinnitus patients is more and more emphasized while trying to reduce tinnitus.Pay attention to correcting the patient's adverse psychological reactions and other accompanying symptoms,reducing the burden of the disease,thereby improving the quality of life of patients with tinnitus.Sound stimulation is one of the most commonly used treatments.Studies have shown that cochlear injury can reduce the inhibitory neurotransmitters in the auditory center,leading to changes in spontaneous activity(SA)in the cochlear nerve after cochlear injury,which can induce tinnitus.A decrease in afferent input caused by peripheral lesions may trigger dramatic central changes that may eventually lead to abnormal neural activity,which may induce tinnitus.The basic principle of acoustic stimulation is based on this,which is intended to reverse the central changes induced by the decrease in the incoming input.The sound of the auditory stimuli given may be ambient sounds such as waves,creeks,waterfalls,rain,forest birds,etc.,or custom sounds,such as matched narrow-band noise consistent with the main frequency of the tinnitus.The patient underwent complete or incomplete masking.The results of the audiological examination usually do not reflect the difference in tinnitus,so there is no need to repeat the test on a regular basis.Brain remodeling takes a while to establish,so the duration of treatment required may vary from patient to patient.Ideal for tinnitus relief,it may take 6-8 months of sonic therapy.Section one The correlation between severity of tinnitus and anxiety and depression in patients with subjective tinnitusPurposes:By analyzing the correlation between anxiety and depression of tinnitus patients and the severity of tinnitus through questionnaires,the psychological state of tinnitus is discussed,which is conducive to the early detection and diagnosis of relevant psychological problems in clinical work.Methods:Inclusion and exclusion criteria were developed to screen out 384 patients with subjective non-acute tinnitus from July 2017 to June 2018 at the Department of Otorhinolaryngology,Second Affiliated Hospital of Nanchang University,with tinnitus as the first complaint.The patients were studied,and the medical history,physical examination,otolaryngology examination,audiological examination and tinnitus psychoacoustic examination results of each patient were recorded in detail.The Tinnitus Handicap Inventory(THI),Self-Rating Depression scale(SDS)and Self-Rating Anxiety scale(SAS)were used to evaluate the severity of tinnitus and the psychological state of tinnitus.All data were statistically analyzed with SPSS 24.0.The difference was statistically significant at P<0.05.Results:1.166 males and 218 females;aged 18-78 years,mean 45.62±14.53 years;duration 3 months-50 years,mean 4.10±6.61 years;2.tinnitus side: 123 cases on the left,107 cases on the right,130 cases on both sides,24 cases in the brain;the types of sounds matched by tinnitus: 276 cases of pure tone,76 cases of narrow band noise,9 cases of white noise,5 cases of arpeggio,18 cases of other;tinnitus frequency: low intermediate frequency(< 4000Hz)260 cases,high frequency(?4000Hz)168 cases;tinnitus loudness: 221 cases less than 5dBSL,99 cases of 6-10 dBSL,50 cases of 11-15 dBSL,14 cases of more than 15dBSL;There were 255 cases of tinnitus with hearing loss,including 177 cases with mild hearing loss,71 cases with moderate hearing loss,4 cases with severe hearing loss,3 cases with severe hearing loss,and 129 cases with normal hearing loss.3.THI scores of patients with tinnitus were: 72 cases of grade 1,116 cases of grade 2(188 cases with mild tinnitus),134 cases of grade 3,55 cases of grade 4,and 7 cases of grade 5(196 cases with moderate and moderate and severe tinnitus).The SAS score was 212 in less than 50 points,172 cases in greater than or equal to 50.The results of SDS score were: 205 cases less than 53 points,179 cases of equal or more than 53 points.4.According to gender grouping,there was no significant difference in THI,SAS and SDS scores between male and female patients.The correlation between age,gender,tinnitus loudness,tinnitus frequency,hearing condition,SAS and SDS score and tinnitus severity THI score was analyzed.The results showed that except that the hearing condition,SAS and SDS score were correlated with tinnitus severity,other factors were not significantly correlated with tinnitus severity.Conclusion:1.Tinnitus patients are often accompanied by hearing impairment.2.The severity of tinnitus mainly focuses on mild and moderate levels,and there is a significant correlation between the psychological state of patients and the severity of tinnitus.Section two Analysis of the effect and influencing factors of voice therapy in patients with subjective tinnitusPurposes:By observing the changes in the severity of tinnitus in patients with non-acute subjective tinnitus before and after treatment,as well as the degree of adaptation to tinnitus,a comprehensive analysis of the two sound treatment efficacy,at the same time,analyze the difference of the therapeutic effect of tinnitus in different psychological states and the correlation between the psychological state of tinnitus patients and the severity of tinnitus in different treatment stages,explore the influence of different psychological states on the therapeutic effect of tinnitus,and provide research basis for personalized treatment of tinnitus.Methods:384 patients with non-acute subjective tinnitus were subjected to psychoacoustic test and psychological evaluation of tinnitus.Among them,290 were negative in residual inhibition test,88 were positive and 6 were rebound.105 of the 290 patients with negative residual inhibition test were randomly included in the mask-based group(193 cases),and the remaining 185 cases and 6 cases were included in the class-like group(191 cases).All patients underwent Tinnitus Handicap Inventory(THI)and anxiety and depression self-rating scale(SAS and SDS)before treatment and 1 month,3 months,and 6 months after treatment.The tinnitus severity and mental state of tinnitus patients were compared at different time points.And compare the difference in efficacy between the two sonic treatments.Results:1.Rank-sum test of THI difference before and after treatment in the masking group and in the acculturation therapy group showed no statistically significant difference(Z=-1.305,P=0.192).2.With negative residual inhibition test,the mean THI score difference before and after treatment for 6 months was-15.18±7.35 in the masking group while-13.24±9.91 in the acculturation therapy group,and there was no statistically significant(F=3.058,P=0.081).3.At 1 month after treatment,the total effective rate was 65.28% in the masking group,and the total effective rate was 39.79% in the acculturation therapy group.The former is more efficient than the latter and the difference was significant(?2=25.026,P =0.000);At 3 months of treatment,the total effective rate was 74.09% in the masking group and 62.30% in the acculturation therapy group.There was a significant difference between the two groups(?2=6.155,P=0.013).At 6 months of treatment,the total effective rate was 80.31% in the masking group and 85.86% in the acculturation therapy group.There was no significant difference between the two groups(?2=2.105,P=0.147).4.SAS score: Compared between 1 month after treatment and before the treatment in the masking group(?2=3.569,p=.059)and there was no significant difference between treatment for 3 months and treatment for 6 months(?2= 0.795,p=.373).There was no significant difference between 1 month after treatment and before treatment in the group of acculturation therapy(?2=0.518,p=.472).The remaining pairwise comparisons were statistically significant at different times in the treatment group.SDS score: There was no significant difference between treatment for 3 months and the treatment for 6 months in the masking group(?2=2.080,p=.149).The rest have significant differences.There were significant differences between different times before and after treatment in the acculturation therapy group.Conclusions:1.Sound therapy can reduce the THI score of tinnitus.The short-term curative effect of masking treatment is better than that of acculturation therapy,Long term effect reversed.However,when the treatment time was long enough to reach 6 months,the efficacy of the two groups was not significantly different2.Tinnitus patients are mostly accompanied by anxiety and depression,and most of them are mild to moderate.The SAS and SDS scores of tinnitus patients were decreased by both kinds of sounds. |
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