Madeira G, Montmirail Ch, Decat M, Gersdorff M
Veranneman, Auxiliaire Acoustique, Galerie Ravenstein 35-37, 1000 Bruxelles, Belgique.
Rev Laryngol Otol Rhinol (Bord). 2007;128(3):145-8.
Tinnitus Retraining Therapy (TRT) (which aims to induce changes in the mechanisms responsible for transferring signals from the auditory system to the limbic and autonomic systems) is a method for treating Tinnitus and decreased sound tolerance. An individualised explanation of Jastreboff's neurophysiological model allows greater insight and motivation on the part of the patient. Previous studies have demonstrated that daytime TRT is effective. As sleep forms a significant component of the distress associated with Tinnitus however, we hypothesised that night-time TRT could represent a useful tool in the treatment of this disabling condition.
46 patients were studied (30 male, 16 female). Patients were selected from an ENT outpatient clinic. Patients with significant psychological disability were excluded. Patients were reviewed twice by their doctor and 5 times by a therapist over 12 months. Treatment consisted of 8 hours nighttime white noise stimulation, at progressively increasing intensity. Although several objective assessments of response were undertaken, patients' subjective testimonies were considered a more accurate signal of success.
In total, 80% of patients had a satisfactory response after 1 year of treatment. 20% had no response. Patients were subcategorised according to Jastreboff's categories as follows: 1. Tinnitus (n = 6), 100% improved; 2. Tinnitus with hearing loss (n = 16); 62% improved; 3. Hyperacusis (with or without Tinnitus) (n = 16), 88.5% improved; 4. Hyperacusis (with or without Tinnitus, exacerbated by noise) (n = 8), 75% improved.
Tinnitus is a symptom rather than an illness, and TRT gives patients greater control, allowing re-integration of normal perception. Night-time TRT is an effective treatment for Tinnitus and decreased sound tolerance. It has the potential advantage over day-time TRT of rapidly improving sleep and decreasing use of sedative hypnotics, a secondary effect noted in the personal testimonies of our cohort of patients. Further studies are needed to confirm this advantage, in view of the significant risks associated with long-term use of benzodiazepines. When investigating therapies for Tinnitus, it is necessary to measure success in terms of quality of life, as it is to this that the patient attaches the most importance.
耳鸣再训练疗法（TRT）（旨在促使负责将信号从听觉系统传递至边缘系统和自主神经系统的机制发生改变）是一种治疗耳鸣和声音耐受性下降的方法。对贾斯特雷博夫神经生理学模型进行个性化解释，能让患者有更深入的理解并增强其积极性。此前的研究表明日间TRT是有效的。然而，由于睡眠是与耳鸣相关的痛苦的一个重要组成部分，我们推测夜间TRT可能是治疗这种致残病症的一种有用工具。
对46例患者进行了研究（男性30例，女性16例）。患者从耳鼻喉科门诊选取。排除有严重心理障碍的患者。在12个月内，患者由医生复查两次，由治疗师复查5次。治疗包括8小时的夜间白噪声刺激，强度逐渐增加。尽管进行了多项反应的客观评估，但患者的主观陈述被认为是成功的更准确信号。
总体而言，80%的患者在治疗1年后有满意的反应。20%的患者无反应。根据贾斯特雷博夫的分类，患者被分为以下几类：1. 耳鸣（n = 6），100%改善；2. 伴有听力损失的耳鸣（n = 16）；62%改善；3. 听觉过敏（伴有或不伴有耳鸣）（n = 16），88.5%改善；4. 听觉过敏（伴有或不伴有耳鸣，因噪声加重）（n = 8），75%改善。
耳鸣是一种症状而非疾病，TRT能让患者更好地控制病情，使正常感知得以重新整合。夜间TRT是治疗耳鸣和声音耐受性下降的有效方法。与日间TRT相比，它具有快速改善睡眠和减少镇静催眠药使用的潜在优势，这是我们患者群体个人陈述中提到的一个次要效果。鉴于长期使用苯二氮䓬类药物存在重大风险，需要进一步研究来证实这一优势。在研究耳鸣治疗方法时，有必要根据生活质量来衡量成功与否，因为患者最为看重的正是这一点。
