南京医科大学第一附属医院 /江苏省人民医院 耳鼻咽喉科江苏 南京
Department of Otorhinolaryngology,The First Affiliated Hospital,Nanjing Medical University
目的 探讨来我院就诊的耳鸣患者临床特征，为耳鸣的诊治提供参考依据。方法 收集2018年1月至2021年12月在南京医科大学第一附属医院（江苏省人民医院）耳鼻咽喉科门诊以耳鸣为第一主诉的854例患者的临床资料，统计分析临床特征，并将得到的患者性别、年龄、侧别、病程、持续性、患耳听力损失程度、耳鸣响度、耳鸣音调、焦虑自评量表评分、睡眠指数评分等因素为自变量，以耳鸣残疾量表评分为因变量，进行多因素线性回归和相关性分析。结果 854例耳鸣患者共有1290只耳鸣耳，患者的平均年龄为46.7 ± 14.65岁，在30～60岁年龄段的耳鸣患者占比最大（65.2%，557/854）；其中耳鸣多为持续性（84.0%，717/ 854），双侧耳鸣和单侧耳鸣各占一半，在双侧耳鸣患者中多为对称性耳鸣（97%，423/ 436）；55%（467/854）的耳鸣患者伴有不同程度的焦虑症状，58.8%（502/854）的耳鸣患者伴有不同程度的睡眠障碍，33%（426/1290）的耳鸣耳伴随不同程度的听力下降。耳鸣残疾量表分级以2～3级为主（18～56分，83.3%，711/854）；音调匹配以高频多见（4～8 kHz ，77.3%，997/1290）；耳鸣响度以中低响度多见（<60dB，82.3%，1062/1290）。耳鸣持续性（ β= -0.690，P=0.011）、听力损失程度（Spearman=0.140，P<0.001）、耳鸣响度（β=0.046，P=0.002；Spearman=0.135，P<0.001）、匹兹堡睡眠质量指数评分（β=0.049，P=0.001；Spearman =0.214，P< 0.001）、Zung氏焦虑自评量表（β=0.055，P< 0.001；Spearman=0.241，P< 0.001）与耳鸣残疾量表评分有关。结论 2018年以来在我院就诊的耳鸣患者其耳鸣严重程度多为轻中度，耳鸣音调多为高频，且大多数为中低响度的耳鸣声。耳鸣的发病人群逐渐年轻化，且多伴有焦虑、睡眠障碍、听力下降等症状。耳鸣的严重程度和耳鸣持续性、听力损失、耳鸣响度、睡眠障碍和焦虑相关，未来应该着重针对这部分人群制定个性化的耳鸣治疗方案。
Objective The objective of this study is to evaluate the clinical characteristics of tinnitus patients, and to provide profiles for the diagnosis and treatment of tinnitus. Methods This study included 854 tinnitus patients seeking treatment between January 2018 and December 2021 from Jiangsu Provincial People's Hospital (The First Affiliated Hospital of Nanjing Medical University). We collected clinical characteristics, and provided sex, age, tinnitus laterality, tinnitus time, tinnitus persistence, hearing loss, tinnitus loudness, tinnitus main tone matching, self-rating anxiety scale and Pittsburgh sleep quality index as independent variables, and the tinnitus handicap inventory was used as dependent variable to performed multivariate correlation analysis. Results 854 tinnitus patients with a total of 1290 tinnitus ears. The average age of the tinnitus patients was 46.7 ± 14.65 years old, and the largest proportion was in the age group of 30 to 60 years old (65.2%, 557/854). Most patients with tinnitus were persistent. Bilateral tinnitus and unilateral tinnitus each accounting for half, and symmetric tinnitus was more common in patients with bilateral tinnitus (97%，423/ 436). 55% (467/854) and 58.8% (502/854) of the tinnitus patients had different degrees of anxiety and sleep disorders, respectively. 33% (426/1290) of tinnitus ears accompanied varying degrees of hearing loss. Tinnitus Handicap Inventory was mainly graded from 2 to 3 (18～56 score, 83.3%, 711/854); The tone matching was more common in high frequencies (4～8 kHz, 77.3%, 997/1290); Tinnitus loudness was more common with low to medium loudness (< 60dB, 82.3%, 1062/1290). Tinnitus persistence ( β= -0.690, P=0.011), hearing loss (Spearman =0.140, P<0.001), tinnitus loudness (β=0.135, P=0.002; Spearman =0.140, P<0.001), Pittsburgh Sleep quality index score (β=0.049, P=0.001; Spearman =0.214, P<0.001), self-rating anxiety scale (β=0.055, P<0.001; Spearman =0.241, P<0.001) were related to tinnitus handicap inventory score. Conclusion Currently, the tinnitus patients are gradually younger, and most of them are accompanied by symptoms such as anxiety, sleep disturbance, and hearing loss. Most of tinnitus patients seeking treatment in our hospital had low to moderate tinnitus severity, the tinnitus tones were mostly high frequency, and most of them were low to medium loudness tinnitus. The severity of tinnitus was associated with tinnitus persistence, hearing loss, tinnitus loudness, sleep disturbance and anxiety. Therefore, we should focus on developing personalized tinnitus treatment plans for these tinnitus patients in the future.