Search

目的探讨星状神经节阻滞（SGB）用于慢性主观性耳鸣困扰的辅助干预效果，及相应的预测指标，为SGB应用于耳鸣的临床干预累积经验。方法回顾因其他干预方案效果不理想而在中山大学附属第三医院耳鼻咽喉-头颈外科接受SGB干预的慢性主观性耳鸣患者资料。SGB干预前进行耳鸣残疾量表（THI）评估、纯音听阈测试、耳鸣响度评估，部分患者接受了睡眠质量（PSQI）评估。SGB干预后复测THI，以评价SGB的干预效果。随后，通过相关分析及线性回归方程探寻预测SGB干预效果的潜在指标。数据的统计分析采用SPSS 24.0进行，P < 0.05表示存在统计学意义。结果至2023年04月，共有107名慢性主观性耳鸣患者接受了SGB干预，其中男性患者67名，女性患者40名，平均（45.32±11.40）周岁，耳鸣持续（20.32±24.64）月［16（12~20）］。有7名患者因个人原因中途退组，退组率6.54%，干预依从性良好。所有患者均未出现穿刺部位感染、血肿、神经损伤、局麻药中毒等不良反应，安全性良好。SGB干预后，有77名患者的THI得分下降至36分及以下，剩余的患者中有12名的THI得分下降幅度达到10分及以上，有效率为89%；配对样本t检验显示，SGB干预前后的THI得分有显著的统计学差异（t = 15.575，P < 0.001），干预效果良好。皮尔逊相关分析显示，干预前的THI得分和耳鸣主观响度与THI的改善水平呈显著的正相关关系（P < 0.05）；进一步的逐步线性回归分析发现，“干预前THI得分”具有显著的统计学意义（P < 0.001），回归系数为0.308，预测了THI改善水平的17.4％。结论SGB干预慢性主观性耳鸣困扰的短期效果良好、安全性高，可用于常规干预方案不理想时（尤其是THI得分较高患者）的补充方案，但后续研究需要明确长期疗效及内在机制，为SGB应用于主观性耳鸣的干预奠定更为扎实的理论基础。

Objective To analyze the changes in tinnitus after stapedotomy combined with artificial stapes implantation, and further explore the factors influencing the efficacy of postoperative tinnitus in patients with otosclerosis. Methods A total of 54 patients (65 ears) with otosclerosis complicated with tinnitus symptoms who underwent stapedotomy combined with artificial stapes implantation were enrolled. The hearing test results of all patients before surgery, 1 and 6 months after surgery were recorded. The scores of Tinnitus Handicap Inventory (THI) and Clinical Global Impression Scale (CGI-S) before surgery, 1 and 6 months after surgery were compared. Results Before surgery, low-frequency (<1 kHz) tinnitus was observed in 31 ears (47.7%), medium-frequency (1-4 kHz) tinnitus in 14 ears (21.5%), and high-frequency (≥ 4 kHz) tinnitus in 20 ears (30.8%). At 1 month after surgery, tinnitus symptom was alleviated in 48 ears (73.8%)(complete healing and mitigation of tinnitus), no changes in 16 ears (24.6%), and tinnitus symptom was aggravated in 1 ear (1.5%). At 6 months after surgery, tinnitus symptom was eased in 50 ears (76.9%), no changes in 13 ears (20.0%), and tinnitus symptom was aggravated in 1 ear (1.5%). Patients with low- and medium-frequency tinnitus obtained more significant improvement in tinnitus compared with their counterparts with high-frequency tinnitus (P < 0.001 and P = 0.013). At postoperative 1 month, the changes in subjective tinnitus, such as the average air conduction and bone conduction thresholds significantly differed from those before surgery (all P < 0.001), whereas there was no statistical significance in air-bone gap (P > 0.05). Conclusions Stapedotomy combined with artificial stapes implantation can not only restore the hearing of patients with otosclerosis, but also mitigate the tinnitus symptoms in most patients. Patients with low- and medium-frequency tinnitus before surgery can obtain more significant improvements in tinnitus after surgery than those with high-frequency tinnitus. [ABSTRACT FROM AUTHOR]

Copyright of China Pulp & Paper is the property of China Pulp & Paper Magazines Publisher and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)