Baguley David M, Humphriss Rachel L, Axon Patrick R, Moffat David A
Department of Audiology, Addenbrooke's Hospital, Cambridge, United Kingdom.
Skull Base. 2006 May;16(2):49-58. doi: 10.1055/s-2005-926216.
To review the symptoms, signs, and clinical findings in a large series of patients diagnosed with unilateral sporadic vestibular schwannoma (VS) to describe the clinical characteristics of tinnitus in this population. Further, to ascertain which of the proposed mechanisms of tinnitus generation in VS was supported.
Retrospective case note and database review.
Tertiary university teaching hospital departments of audiology and neuro-otology.
Nine hundred forty-one patients with unilateral sporadic VS, diagnosed during the period 1986 to 2002. Twenty-three additional patients were excluded due to missing clinical data.
The presence or absence of tinnitus, and its rated subjective severity were analyzed in conjunction with data regarding patient demographics, symptoms, signs, and diagnostic audiovestibular test findings.
No statistical association at the 5% level was found between tinnitus presence/absence and patient age, gender, 2- to 4-kHz audiometric thresholds, ipsilateral auditory brainstem response abnormality, length of history, tumor side, nor caloric test abnormality. Statistically significant associations were found between tinnitus presence/absence and tumor size (p = 0.012) and type of hearing loss (progressive, sudden, fluctuant, nil) with a tendency for patients without hearing loss to be less likely to experience tinnitus. Statistically significant associations were identified between classification of tinnitus severity and age at diagnosis (p < 0.001) (greater age being associated with greater tinnitus severity), abnormal findings on caloric testing (p = 0.01) (abnormal calorics being associated with greater tinnitus severity), and tinnitus as a principal presenting symptom (p < 0.001) (this being associated with greater tinnitus severity).
The analysis does not identify any single one of the proposed mechanisms for tinnitus as being the obvious culprit. In fact, even in a homogeneous group of patients such as this, there is evidence of multiple mechanisms that are not mutually exclusive. The association between increased tinnitus severity in older patients, patients with canal pareses on caloric testing, and with tinnitus as a principal presenting symptom should be borne in mind by the clinician.
回顾大量被诊断为单侧散发性前庭神经鞘瘤（VS）患者的症状、体征及临床检查结果，以描述该人群中耳鸣的临床特征。此外，确定VS中所提出的耳鸣产生机制中哪些得到了支持。
回顾性病例记录及数据库审查。
三级大学教学医院的听力学和神经耳科学科室。
1986年至2002年期间诊断出的941例单侧散发性VS患者。另外23例患者因临床数据缺失被排除。
结合患者人口统计学、症状、体征及诊断性听前庭测试结果的数据，分析耳鸣的有无及其主观严重程度评级。
在耳鸣的有无与患者年龄、性别、2至4千赫兹听力阈值、同侧听觉脑干反应异常、病史长短、肿瘤侧别以及冷热试验异常之间，未发现5%水平的统计学关联。在耳鸣的有无与肿瘤大小（p = 0.012）以及听力损失类型（进行性、突发性、波动性、无）之间发现了统计学显著关联，听力正常的患者出现耳鸣的可能性较小。在耳鸣严重程度分级与诊断时的年龄（p < 0.001）（年龄越大，耳鸣严重程度越高）、冷热试验异常结果（p = 0.01）（冷热试验异常与耳鸣严重程度越高相关）以及耳鸣作为主要首发症状（p < 0.001）（这与耳鸣严重程度越高相关）之间确定了统计学显著关联。
该分析未确定所提出的耳鸣机制中有任何单一机制是明显的罪魁祸首。事实上，即使在这样一组同质患者中，也有证据表明存在多种并非相互排斥的机制。临床医生应牢记老年患者、冷热试验出现半规管轻瘫的患者以及以耳鸣为主要首发症状的患者中耳鸣严重程度增加之间的关联。
