Caffier Philipp P, Haupt Heidemarie, Scherer Hans, Mazurek Birgit
Department of Otorhinolaryngology, Charité-University Medicine Berlin, Joint Facility of Free University and Humboldt-University, Campus Charité Mitte, Berlin, Germany.
Ear Hear. 2006 Dec;27(6):619-27. doi: 10.1097/01.aud.0000240504.77861.1a.
Increasing tinnitus compliance and coping are desirable aims of successful treatment in chronic tinnitus. However, application of established procedures such as tinnitus retraining therapy (TRT) is often relatively short. In addition, the value of tinnitus control instruments (TCI) is questionable, especially for minor severity levels of tinnitus, and the comparability of treatment results is low. To evaluate long-term changes of tinnitus-related distress, defined psychometric data were collected in patients with compensated tinnitus (cT) or decompensated tinnitus (dT) during a standardized 2-yr outpatient tinnitus-coping therapy (TCT).
In a prospective clinical investigation, the data of 70 tinnitus patients were recorded at the beginning and at 6-mo intervals, with a final investigation after 24 mo. The first group consisted of 40 patients with cT and dT who were randomly assigned to a treatment group and a waiting-list control group. After a period of 12 mo without treatment, the control group was treated similarly. The tinnitus questionnaire (TQ) of Goebel and Hiller, visual analog scales (VAS), and a severity questionnaire for tinnitus-associated complaints were used as psychodiagnostic instruments. Therapy components consisted of counseling, fitting patients with TCIs (TCI provision), auditory and relaxation training, and psychosomatic care if necessary. A second group of 30 patients with cT receiving TCT without TCI devices was investigated to evaluate the additive efficacy of TCI in cT.
The initial TQ score did not differ between the treatment group and the waiting-list control group. After 12 mo, the control group did not show any significant changes, but the treatment group had improved significantly. During TCT, the combined data of both groups showed a statistically significant decrease of the TQ score in dT (59.1 to 34.8) and cT (32.8 to 24.0). These changes were especially reflected by the subscales of cognitive and emotional distress and also by the VAS and the severity questionnaire. dT patients benefitted without dependence on age or duration of pre-existing tinnitus; for cT patients, this was true mainly of the younger and older subjects and for tinnitus lasting for less than 1 yr. TCI provision improved the efficacy of TCT in patients with cT.
The psychometric changes demonstrate a clear decrease of tinnitus-related distress in all severity levels of sufficiently treated chronic tinnitus. Long-term TCT induces improvement even up to the time of 24 mo. With TCIs established particularly in patients with dT, our results suggest that a supporting adjustment of TCI devices is helpful in cT to foster quicker rehabilitation. The outpatient interdisciplinary TCT, consisting of cognitive tinnitus desensitization, TCI provision, and psychosomatic support if required, represents a successful treatment strategy for both dT and cT patients.
提高耳鸣的依从性和应对能力是慢性耳鸣成功治疗的理想目标。然而，耳鸣再训练疗法（TRT）等既定程序的应用时间通常相对较短。此外，耳鸣控制仪器（TCI）的价值存在疑问，尤其是对于轻度耳鸣患者，而且治疗结果的可比性较低。为了评估耳鸣相关痛苦的长期变化，在一项标准化的为期2年的门诊耳鸣应对疗法（TCT）中，收集了代偿性耳鸣（cT）或失代偿性耳鸣（dT）患者的特定心理测量数据。
在一项前瞻性临床研究中，对70名耳鸣患者的数据在开始时以及每隔6个月进行记录，24个月后进行最终调查。第一组由40名cT和dT患者组成，他们被随机分配到治疗组和等待名单对照组。在未经治疗的12个月期间后，对照组接受类似治疗。使用戈贝尔和希勒的耳鸣问卷（TQ）、视觉模拟量表（VAS）以及耳鸣相关症状严重程度问卷作为心理诊断工具。治疗组成部分包括咨询、为患者配备TCI（提供TCI）、听觉和放松训练，以及必要时的身心护理。第二组30名接受TCT但未使用TCI设备的cT患者接受调查，以评估TCI在cT中的附加疗效。
治疗组和等待名单对照组的初始TQ评分没有差异。12个月后，对照组没有显示出任何显著变化，但治疗组有显著改善。在TCT期间，两组的综合数据显示dT（从59.1降至34.8）和cT（从32.8降至24.0）的TQ评分有统计学显著下降。这些变化尤其体现在认知和情绪痛苦的子量表上，也体现在VAS和严重程度问卷上。dT患者受益，且不依赖于年龄或耳鸣的既往持续时间；对于cT患者，主要是年轻和年长的受试者以及持续时间少于1年的耳鸣患者受益。提供TCI提高了TCT对cT患者的疗效。
心理测量变化表明，在充分治疗的慢性耳鸣的所有严重程度水平上，耳鸣相关痛苦明显减轻。长期TCT甚至在24个月时仍能带来改善。特别是在dT患者中使用TCI，我们的结果表明，对TCI设备进行支持性调整有助于cT患者更快康复。由认知性耳鸣脱敏、提供TCI以及必要时的身心支持组成的门诊多学科TCT，是dT和cT患者的一种成功治疗策略。
