Hesse G, Andres R, Schaaf H, Laubert A
Ohr- und Hör-Institut Hessen, Grosse Allee 3, 34454 Bad Arolsen.
HNO. 2008 Jul;56(7):694-700. doi: 10.1007/s00106-008-1730-1.
According to our audiological data, 90% of tinnitus patients have deficits in inner ear function as a generator of tinnitus, mainly in the outer hair cells (OHC). This can be verified by registration of distortion products of otoacoustic emissions (DPOAE). Thus, the main origin of tinnitus is peripheral, and most patients suffer from accompanying hearing loss, even though it is sometimes mild or subjectively not even felt. Whether or not the tinnitus is disturbing, however, is determined through further auditory processing of the "signal" tinnitus and its psychological validation. With almost 50% of our tinnitus and hyperacusis patients, we find hyperfunctioning of the OHC, possibly originating from reduced or ineffective efferent control in the auditory pathway. Efferent activity can be measured by acoustic stimulation of the contralateral ear, which normally reduces the DPOAE amplitudes via efferent inhibition.
DPOAE were recorded with 67 tinnitus patients (127 ears) with and without contralateral acoustic stimulation. Twenty-one persons (41 ears) served as controls.
With 64% of the tinnitus patients, DPOAE amplitudes were not reduced significantly, compared with 34% of the controls. The medium amplitude reduction for controls was 1.76 dB, whereas for the tinnitus patients it was significantly less (0.91 dB).
For a considerable number of tinnitus patients, efferent control of OHC activity is restricted, but this seems to be confined to a certain type of tinnitus only.
根据我们的听力学数据,90%的耳鸣患者存在内耳功能缺陷,这是耳鸣的产生原因,主要是外毛细胞(OHC)受损。这可以通过耳声发射畸变产物(DPOAE)的记录来证实。因此,耳鸣的主要起源是外周性的,大多数患者伴有听力损失,尽管有时听力损失较轻或患者主观上甚至没有感觉到。然而,耳鸣是否令人困扰,是通过对耳鸣“信号”的进一步听觉处理及其心理确认来确定的。在我们近50%的耳鸣和听觉过敏患者中,我们发现外毛细胞功能亢进,这可能源于听觉通路中传出控制减弱或无效。传出活动可以通过对侧耳的声刺激来测量,正常情况下,通过传出抑制可降低DPOAE幅度。
对67例耳鸣患者(127只耳)在有或没有对侧声刺激的情况下记录DPOAE。21人(41只耳)作为对照。
64%的耳鸣患者DPOAE幅度没有显著降低,而对照组这一比例为34%。对照组的平均幅度降低为1.76dB,而耳鸣患者的平均幅度降低明显较少(0.91dB)。
对于相当一部分耳鸣患者,外毛细胞活动的传出控制受到限制,但这似乎仅局限于某一类型的耳鸣。