耳鸣疗效评判探讨及中医综合治疗临床研究
摘要
一、研究目的
1.通过对219例耳鸣病人进行详细的耳鸣信息调查和四诊信息的采集,研究耳鸣的特点,在此基础上探讨一种较为科学的耳鸣评判标准。
2.通过科学科研设计下中医治疗过程的研究观察,得出相对可信、科学的数据,了解中医治疗耳鸣的疗效,进一步研究耳鸣治疗过程中变化、发展等方面特点,为今后研究耳鸣的治疗,发掘中医治疗耳鸣的优势奠定基础。
二、研究内容与方法
1.研究一:采集2007年6月到2008年12月间广州中医药大学第一附属医院耳鼻喉科门诊以耳鸣为主诉的219例患者的耳鸣详细信息及相关专科检查结果,对此进行筛查统计分析,以发现耳鸣的临床特点。对所有病例采用耳鸣评分法及THI评分法进行评估,探讨较为合理的耳鸣评价方法。
2.研究二:对69例耳鸣病例在详细信息调查及全面专科检查的基础上进行中医综合治疗,同时以34例西医综合治疗为对照组,疗程以1月为单位,研究中医治疗耳鸣的现状、优势及治疗过程中的改善因素,为今后进一步发掘中医治疗耳鸣的优势奠定基础。
三、研究结果
1.耳鸣的临床特征:患者就诊年龄在21-60岁为多174人(79.45%),高音调耳鸣居多共153人(69.9%),耳鸣响度自我评分与响度匹配之间无相关性(P>0.05)。耳鸣声音调匹配值能较好地反映患者主观感知耳鸣音调高低(P<0.05)。但耳鸣响度匹配值却不能反映患者所感知的耳鸣响度大小(P>0.05),大部分耳鸣139人(63.5%)都是有明确诱因的,其中最大为精神压力31人(14.6%)。耳鸣严重程度与患者因耳鸣声干扰而在情绪变化、睡眠障碍方面的影响及患者自觉鸣声大小(耳鸣声自主评分)依次相关(P<0.05)。与年龄、病程、性别、耳鸣音调匹配、响度匹配不相关(P>0.05)。耳鸣的中医证侯分布以脾胃虚弱证为主102人(47%),其次是痰湿困扰证44人(20%)、肝气郁结证40人(18%),肾精亏损证27人(12%),风热外袭证6人(3%),各型在年龄、耳鸣响度、匹配音调方面无统计学差异(P>0.05),但在实证组和虚证组耳鸣音调的对比上,虚证组的音调较实证组高(P<0.05)。
2.本研究中50.7%的患者耳鸣与听力损失可能有相关性,其中29.2%的人明确有相关性,21.5%的人可能相关; 49.3%的患者耳鸣与听损无明显相关,其中31.5%的患者有正常的听力,17.8%的患者存在不同程度的听力损失,但听力损失发生的部位和时间与耳鸣无明确的相关性。
3.耳鸣评分法与THI评分法两种耳鸣评估方法的相关性较高,相关系数为0.73(P<0.001)。按耳鸣评分法进行程度分级后,各级的耳鸣评分、THI评分及其功能性评分、情绪性评分、严重性评分都随着耳鸣程度分级的增加而升高,经方差分析及两两比较,耳鸣评分每两级之间均有统计学差异(PO.05),其余各级之间具有统计学差异(PO.05)。6.中医组中,治疗前后耳鸣评分中六个子项目分值均有减少,PObjectives of research
1. Through the detailed investigations to 219 tinnitus patients and the data collection of their Chinese four diagnosis results, the researcher studies the feature of tinnitus, and find out a reasonable criterion of judging tinnitus.
2. To study and observe the effects and treatments of Chinese medicine to tinnitus, which is under the scientific design, and establishes the basis for studying the treatment of tinnitus and the author digs out the advantages of Chinese medicine for treating tinnitus.
Content of the research and Methodology
In the first research, the author collected the detailed data and examined results of 219 tinnitus patients which have the chief complaint of ear ring in the first applicant Hospital of Guangzhou TCM University, and analyzed those statistics to find out the clinic features of tinnitus. By using the tinnitus scoring method and THI scoring system to evaluate the disease, and study a reasonable assessment to tinnitus.
In the second research, on the basis of detailed investigating and wholly examining to 69 patients, the researcher did the Chinese medicine integrated treatment, and studied the current situation, the advantages and some must-be improved elements of tinnitus in China are obvious by comparing with another group with 34 patients which is under the western medicine integrated treatment in one treatment period of 30 days.
Results
1. Clinical features of tinnitus: there are 174 patients, whose ages arebetween 21 and 60, accounting for 79. 45%. Tinnitus with high-pitched tone is in large proportion with153 people occupying 69. 9%, and there is no correlation between tinnitus loudness self-evaluation and loudness matching (P>0. 05). The value of tinnitus loudness matching has an effective reflection on patients' subjective perception of pitch (P<0.05). However, the value of tinnitus loudness matching doesn' t have a reflection on loudness of patients' subjective perception. The majority of 139 cases (63.5%) is with obvious inducement, among which there are 31 (14. 6%) suffering from mental strain. The degree of tinnitus seriousness is correlated with emotional changed and dyssomnia interrupted by tinnitus and self-perception of loudness (the scores from self-perception of tinnitus) (P<0. 05). There is no correlation among age, lasting of disease, gender, tone matching of tinnitus and loudness matching (P>0.05). The symptom of tinnitus in TCM aspect is mostly reflected as the following perspectives: the week spleen and stomach with 102 cases (47%), phlegm with 44 cases (20%), depression of hepatic qi with 40 cases (18%), damage of kidney-essence with 27 cases (12%), affection of exogenous wind-heat with 6 cases (3%). These types are with no statistical difference with age, tinnitus loudness and pitch matching (P>0. 05). By comparing tinnitus pitch between the group of stencil syndrome and asthenia syndrome, the group of asthenia syndrome is higher (P<0. 05).
2. In this research, 50. 7% of patients with tinnitus and hearing loss may have correlation. Among the 50. 7% correlated, 29. 2% have significant correlation and 21. 5% may have correlation. Among the 49. 3% uncorrelated, 31. 5% are with normal hearing; 17.8% with hearing loss and tinnitus are not significantly correlated.
3. The correlated coefficient between the tinnitus assessment methods and THI is 0.73(P<0.001). The degree of tinnitus gravity measured by the tinnitus assessment methods is positively correlated with THI scores. After the tinnitus assessment methods scaling, tinnitus assessment scores of every scale, THI scores, functional scores, emotional scores and scores of seriousness are increased with the increasing scaling of tinnitus degree. According to ANOVA, there is statistical difference between scores of tinnitus assessment and every two scales (P<0.001). In THI and its three subitems, there is no statistical difference between , LevelⅠ、Ⅱand LevelⅣ、Ⅴ(P>0. 05). There is statistical difference between the rest scales (P<0. 001). The correlation between scores of tinnitus assessment and the six indexes is as follows: tinnitus influenced by moods (0.766), the self-perception scores on tinnitus seriousness (0.743), the influence of tinnitus to work and life (0.739), the influence of tinnitus to sleeping (0. 622), the environment of tinnitus (0. 376) and the lasting of tinnitus (0.284).
4. There is great difference between the group of western-style medicine and TCM. The rate of cure of the latter group is 4. 35%, with obvious effect 10.14%, with effect 43.48%. With a global effectiveness of 57.97% is higher than the control group of 26. 47%, (P<0. 05).
5. The group of TCM made a statistical analysis for three groups with different treating time and they got three different rates of effectiveness: one period of treatment with 57.97%, two periods of treatment with 80% and more than two periods of treatment with 76.92%. The effectiveness of two periods is much higher than one period of treatment and the statistics have statistical difference (P<0. 05). The effectiveness of more than two periods of treatment is higher than the one period of treatment, but the statistics have no statistical difference (P>0.05)
6. The group of TCM, the scores of the six subitems after the treatment are lower than those before treatment, P<0.05 The improved value of the six items can be done with multiple regression, among which, the effect of treatment can be defined as Y, the improved emotional index, improved sleeping index, improved time index and improved environment group can be defined as X_1, X_2, X_3, X_4, and X_5 respectively. A regression equation can be like this;Y=3.879-0. 298X_1-0. 281X_2-0. 27X_3-0.184X_4-0.194X_5
Conclusion
1 Through this research, the researcher discovers that tinnitus has its specific clinic features such as age, loudness, influenced causes, traditional medicine feature, hearing damage, during its appearance, development, and changing processes. All those deserve our further study.
2 Both the tinnitus scoring method and THI scoring system have the same theoretical basis, and both of them have the good result correlation. But the tinnitus scoring method is simpler and concise, and easier to use and grasp, it is a practical and scientific assessment method.
3 Tinnitus treatments which are under TCM have more advantages. Compared to the Western medicine integrated treatment, the Chinese medicine integrated treatment has better effects. In one treatment period, the efficiency rate is 57.97%, and it deserves our research to find our benefits of the TCM treatment.
4. In the TCM treatment group, the effectiveness of two periods is much higher than one period of treatment. It is likely to be related with periods of treatment, which can be helpful for further research. The effectiveness of more than two periods of treatment (76. 92%) is higher than the one period of treatment (57.97%), but the statistics have no statistical difference. Maybe it is related with the sample of the group of more than two periods (13 cases). More samples should be considered in future study. The effectiveness of the group of two periods of treatment (80%) is close but higher than the effectiveness of the group of more than two periods of treatment (76.92). It is likely to be related with the sample (13 cases). Further study scheme can be designed in future research.
5. The influence of sleeping and emotion plays a key role in both the tinnitus seriousness degree and the period of treatment, which implies the function of the psychological guidance and adjustment of sleeping in treatment of tinnitus.
1.通过对219例耳鸣病人进行详细的耳鸣信息调查和四诊信息的采集,研究耳鸣的特点,在此基础上探讨一种较为科学的耳鸣评判标准。
2.通过科学科研设计下中医治疗过程的研究观察,得出相对可信、科学的数据,了解中医治疗耳鸣的疗效,进一步研究耳鸣治疗过程中变化、发展等方面特点,为今后研究耳鸣的治疗,发掘中医治疗耳鸣的优势奠定基础。
二、研究内容与方法
1.研究一:采集2007年6月到2008年12月间广州中医药大学第一附属医院耳鼻喉科门诊以耳鸣为主诉的219例患者的耳鸣详细信息及相关专科检查结果,对此进行筛查统计分析,以发现耳鸣的临床特点。对所有病例采用耳鸣评分法及THI评分法进行评估,探讨较为合理的耳鸣评价方法。
2.研究二:对69例耳鸣病例在详细信息调查及全面专科检查的基础上进行中医综合治疗,同时以34例西医综合治疗为对照组,疗程以1月为单位,研究中医治疗耳鸣的现状、优势及治疗过程中的改善因素,为今后进一步发掘中医治疗耳鸣的优势奠定基础。
三、研究结果
1.耳鸣的临床特征:患者就诊年龄在21-60岁为多174人(79.45%),高音调耳鸣居多共153人(69.9%),耳鸣响度自我评分与响度匹配之间无相关性(P>0.05)。耳鸣声音调匹配值能较好地反映患者主观感知耳鸣音调高低(P<0.05)。但耳鸣响度匹配值却不能反映患者所感知的耳鸣响度大小(P>0.05),大部分耳鸣139人(63.5%)都是有明确诱因的,其中最大为精神压力31人(14.6%)。耳鸣严重程度与患者因耳鸣声干扰而在情绪变化、睡眠障碍方面的影响及患者自觉鸣声大小(耳鸣声自主评分)依次相关(P<0.05)。与年龄、病程、性别、耳鸣音调匹配、响度匹配不相关(P>0.05)。耳鸣的中医证侯分布以脾胃虚弱证为主102人(47%),其次是痰湿困扰证44人(20%)、肝气郁结证40人(18%),肾精亏损证27人(12%),风热外袭证6人(3%),各型在年龄、耳鸣响度、匹配音调方面无统计学差异(P>0.05),但在实证组和虚证组耳鸣音调的对比上,虚证组的音调较实证组高(P<0.05)。
2.本研究中50.7%的患者耳鸣与听力损失可能有相关性,其中29.2%的人明确有相关性,21.5%的人可能相关; 49.3%的患者耳鸣与听损无明显相关,其中31.5%的患者有正常的听力,17.8%的患者存在不同程度的听力损失,但听力损失发生的部位和时间与耳鸣无明确的相关性。
3.耳鸣评分法与THI评分法两种耳鸣评估方法的相关性较高,相关系数为0.73(P<0.001)。按耳鸣评分法进行程度分级后,各级的耳鸣评分、THI评分及其功能性评分、情绪性评分、严重性评分都随着耳鸣程度分级的增加而升高,经方差分析及两两比较,耳鸣评分每两级之间均有统计学差异(P
1. Through the detailed investigations to 219 tinnitus patients and the data collection of their Chinese four diagnosis results, the researcher studies the feature of tinnitus, and find out a reasonable criterion of judging tinnitus.
2. To study and observe the effects and treatments of Chinese medicine to tinnitus, which is under the scientific design, and establishes the basis for studying the treatment of tinnitus and the author digs out the advantages of Chinese medicine for treating tinnitus.
Content of the research and Methodology
In the first research, the author collected the detailed data and examined results of 219 tinnitus patients which have the chief complaint of ear ring in the first applicant Hospital of Guangzhou TCM University, and analyzed those statistics to find out the clinic features of tinnitus. By using the tinnitus scoring method and THI scoring system to evaluate the disease, and study a reasonable assessment to tinnitus.
In the second research, on the basis of detailed investigating and wholly examining to 69 patients, the researcher did the Chinese medicine integrated treatment, and studied the current situation, the advantages and some must-be improved elements of tinnitus in China are obvious by comparing with another group with 34 patients which is under the western medicine integrated treatment in one treatment period of 30 days.
Results
1. Clinical features of tinnitus: there are 174 patients, whose ages arebetween 21 and 60, accounting for 79. 45%. Tinnitus with high-pitched tone is in large proportion with153 people occupying 69. 9%, and there is no correlation between tinnitus loudness self-evaluation and loudness matching (P>0. 05). The value of tinnitus loudness matching has an effective reflection on patients' subjective perception of pitch (P<0.05). However, the value of tinnitus loudness matching doesn' t have a reflection on loudness of patients' subjective perception. The majority of 139 cases (63.5%) is with obvious inducement, among which there are 31 (14. 6%) suffering from mental strain. The degree of tinnitus seriousness is correlated with emotional changed and dyssomnia interrupted by tinnitus and self-perception of loudness (the scores from self-perception of tinnitus) (P<0. 05). There is no correlation among age, lasting of disease, gender, tone matching of tinnitus and loudness matching (P>0.05). The symptom of tinnitus in TCM aspect is mostly reflected as the following perspectives: the week spleen and stomach with 102 cases (47%), phlegm with 44 cases (20%), depression of hepatic qi with 40 cases (18%), damage of kidney-essence with 27 cases (12%), affection of exogenous wind-heat with 6 cases (3%). These types are with no statistical difference with age, tinnitus loudness and pitch matching (P>0. 05). By comparing tinnitus pitch between the group of stencil syndrome and asthenia syndrome, the group of asthenia syndrome is higher (P<0. 05).
2. In this research, 50. 7% of patients with tinnitus and hearing loss may have correlation. Among the 50. 7% correlated, 29. 2% have significant correlation and 21. 5% may have correlation. Among the 49. 3% uncorrelated, 31. 5% are with normal hearing; 17.8% with hearing loss and tinnitus are not significantly correlated.
3. The correlated coefficient between the tinnitus assessment methods and THI is 0.73(P<0.001). The degree of tinnitus gravity measured by the tinnitus assessment methods is positively correlated with THI scores. After the tinnitus assessment methods scaling, tinnitus assessment scores of every scale, THI scores, functional scores, emotional scores and scores of seriousness are increased with the increasing scaling of tinnitus degree. According to ANOVA, there is statistical difference between scores of tinnitus assessment and every two scales (P<0.001). In THI and its three subitems, there is no statistical difference between , LevelⅠ、Ⅱand LevelⅣ、Ⅴ(P>0. 05). There is statistical difference between the rest scales (P<0. 001). The correlation between scores of tinnitus assessment and the six indexes is as follows: tinnitus influenced by moods (0.766), the self-perception scores on tinnitus seriousness (0.743), the influence of tinnitus to work and life (0.739), the influence of tinnitus to sleeping (0. 622), the environment of tinnitus (0. 376) and the lasting of tinnitus (0.284).
4. There is great difference between the group of western-style medicine and TCM. The rate of cure of the latter group is 4. 35%, with obvious effect 10.14%, with effect 43.48%. With a global effectiveness of 57.97% is higher than the control group of 26. 47%, (P<0. 05).
5. The group of TCM made a statistical analysis for three groups with different treating time and they got three different rates of effectiveness: one period of treatment with 57.97%, two periods of treatment with 80% and more than two periods of treatment with 76.92%. The effectiveness of two periods is much higher than one period of treatment and the statistics have statistical difference (P<0. 05). The effectiveness of more than two periods of treatment is higher than the one period of treatment, but the statistics have no statistical difference (P>0.05)
6. The group of TCM, the scores of the six subitems after the treatment are lower than those before treatment, P<0.05 The improved value of the six items can be done with multiple regression, among which, the effect of treatment can be defined as Y, the improved emotional index, improved sleeping index, improved time index and improved environment group can be defined as X_1, X_2, X_3, X_4, and X_5 respectively. A regression equation can be like this;Y=3.879-0. 298X_1-0. 281X_2-0. 27X_3-0.184X_4-0.194X_5
Conclusion
1 Through this research, the researcher discovers that tinnitus has its specific clinic features such as age, loudness, influenced causes, traditional medicine feature, hearing damage, during its appearance, development, and changing processes. All those deserve our further study.
2 Both the tinnitus scoring method and THI scoring system have the same theoretical basis, and both of them have the good result correlation. But the tinnitus scoring method is simpler and concise, and easier to use and grasp, it is a practical and scientific assessment method.
3 Tinnitus treatments which are under TCM have more advantages. Compared to the Western medicine integrated treatment, the Chinese medicine integrated treatment has better effects. In one treatment period, the efficiency rate is 57.97%, and it deserves our research to find our benefits of the TCM treatment.
4. In the TCM treatment group, the effectiveness of two periods is much higher than one period of treatment. It is likely to be related with periods of treatment, which can be helpful for further research. The effectiveness of more than two periods of treatment (76. 92%) is higher than the one period of treatment (57.97%), but the statistics have no statistical difference. Maybe it is related with the sample of the group of more than two periods (13 cases). More samples should be considered in future study. The effectiveness of the group of two periods of treatment (80%) is close but higher than the effectiveness of the group of more than two periods of treatment (76.92). It is likely to be related with the sample (13 cases). Further study scheme can be designed in future research.
5. The influence of sleeping and emotion plays a key role in both the tinnitus seriousness degree and the period of treatment, which implies the function of the psychological guidance and adjustment of sleeping in treatment of tinnitus.
引文
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