Mazurek Birgit, Fischer Franziska, Haupt Heidemarie, Georgiewa Petra, Reisshauer Anette, Klapp Burghard F
Tinnitus Centre, Department of Otorhinolaryngology, Charité--University Medicine Berlin, Berlin, Germany.
Audiol Neurootol. 2006;11(5):276-86. doi: 10.1159/000093526. Epub 2006 May 23.
Tinnitus retraining therapy (TRT) in Germany includes not only directive counseling and sound therapy but also stress management and facultative psychotherapeutic treatment. The aim of the present study was to investigate the impact of this modified version of TRT on certain tinnitus-related aspects of distress and variables that may predict treatment outcome. Clinical data from 92 patients undergoing outpatient TRT in the Charité Tinnitus Centre were evaluated retrospectively over 1 year. Treatment outcome was defined by changes in specific areas of tinnitus-related distress and assessed by the Tinnitus Questionnaire. Changes in audiometric frequency and loudness of tinnitus were examined by regular audiometric testing. The overall Tinnitus Questionnaire score was significantly reduced after 1 year. Severely affected tinnitus sufferers (decompensated tinnitus) profited more than less affected patients (compensated tinnitus). In cases of indicated psychotherapy, improvement was significant for the patients who took advantage of psychotherapeutic treatment during TRT but was not significant for those who interrupted or dismissed an indicated psychotherapy. Changes in tinnitus-specific areas of distress were most pronounced in the scales for emotional and cognitive distress and intrusiveness. Significant changes in sleep disturbances, auditory perceptual difficulties and somatic complaints were observed in patients with decompensated tinnitus. In patients with chronic tinnitus, modified TRT may lead to significant subjective improvement in certain tinnitus-related symptoms like emotional and cognitive distress and intrusiveness. Particularly patients suffering from severe tinnitus distress take advantage of therapy. Careful psychotherapeutic diagnostics and therapies and, if necessary, motivation to make use of psychotherapy seem to be essential preconditions for therapeutic success in patients with severe psychosomatic comorbidity.
在德国，耳鸣再训练疗法（TRT）不仅包括指导性咨询和声音疗法，还包括压力管理和选择性心理治疗。本研究的目的是调查这种改良版TRT对耳鸣相关痛苦的某些方面以及可能预测治疗结果的变量的影响。对在夏里特耳鸣中心接受门诊TRT治疗的92例患者的临床数据进行了为期1年的回顾性评估。治疗结果通过耳鸣相关痛苦特定领域的变化来定义，并通过耳鸣问卷进行评估。通过定期听力测试检查耳鸣的听力频率和响度变化。1年后，耳鸣问卷的总体得分显著降低。受影响严重的耳鸣患者（失代偿性耳鸣）比受影响较小的患者（代偿性耳鸣）获益更多。在进行了心理治疗的病例中，在TRT期间接受心理治疗的患者改善显著，但对于中断或放弃指定心理治疗的患者则不显著。耳鸣特定痛苦领域的变化在情绪和认知痛苦以及侵扰量表中最为明显。在失代偿性耳鸣患者中观察到睡眠障碍、听觉感知困难和躯体不适有显著变化。对于慢性耳鸣患者，改良版TRT可能会使某些耳鸣相关症状如情绪和认知痛苦以及侵扰等方面有显著的主观改善。特别是患有严重耳鸣痛苦的患者能从治疗中获益。仔细的心理治疗诊断和治疗，以及必要时利用心理治疗的动机似乎是患有严重身心合并症患者治疗成功的基本前提。
