Gudex Claire, Skellgaard Preben H, West Torben, Sørensen Jan
CAST - Centre for Applied Health Services Research and Technology Assessment, University of Southern Denmark, Odense, Denmark.
BMC Ear Nose Throat Disord. 2009 Jun 26;9:6. doi: 10.1186/1472-6815-9-6.
Tinnitus impairs the possibility of leading a normal life in 0.5-1% of the population. While neither medical nor surgical treatment appears effective, counselling may offer some relief. An intervention combining counselling and hearing devices is offered to clients referred to the Centre for Help Aids and Communication (CHC) in southern Denmark. The aims of this exploratory study were to examine i) the characteristics of CHC's clients and their tinnitus, ii) the effectiveness of the treatment, and iii) whether particular client groups benefit more than others.
One hundred new clients presenting with tinnitus completed the Tinnitus Handicap Inventory (THI) three times - before their first consultation, after one month and after 1-2 years. The scores were tested for significant differences over time using tests for paired data. Logistic regression was used to examine factors associated with a clinically important difference (i.e. THI score improvement of at least 20 points).
At final follow-up, total THI score was significantly lower than baseline, i.e. 29.8 (CI 25.5-34.2) vs. 37.2 (CI 33.1-37.2), p < 0.01. The programme achieved a clinically important difference for 27% and 24% of the clients one month and 1-2 years after the first consultation, respectively. It appeared that greater improvement in THI score was related to higher baseline THI score and possibly also to treatment by a particular CHC therapist. The absolute reduction in mean THI score after 1-2 years for clients with moderate and severe handicap was 14 and 20 points, respectively, i.e. similar to that previously reported for TRT (14-28 points). The cost of the current programme was approximately 200 EUR per client.
The tinnitus management programme appeared to provide significant benefit to many clients at a relatively low cost. It would be useful to conduct a randomised controlled study comparing the current programme with alternative forms of combination counselling/sound therapy approaches.
耳鸣使0.5% - 1%的人口无法正常生活。虽然药物和手术治疗似乎都无效，但咨询可能会有所帮助。丹麦南部的帮助与交流中心（CHC）为前来咨询的客户提供了一种将咨询与听力设备相结合的干预措施。这项探索性研究的目的是：i）研究CHC客户及其耳鸣的特征；ii）治疗的有效性；iii）特定客户群体是否比其他群体受益更多。
100名新的耳鸣患者在首次咨询前、一个月后以及1 - 2年后三次完成耳鸣障碍量表（THI）。使用配对数据检验来测试分数随时间的显著差异。采用逻辑回归分析与临床重要差异相关的因素（即THI分数至少提高20分）。
在最终随访时，THI总分显著低于基线，即29.8（95%置信区间25.5 - （此处原文括号有误，应为34.2））对比37.2（95%置信区间33.1 - 37.2），p < 0.01。该项目在首次咨询后一个月和1 - 2年时，分别使27%和24%的客户达到了临床重要差异。似乎THI分数的更大改善与更高的基线THI分数有关，也可能与CHC的特定治疗师的治疗有关。中重度障碍患者在1 - 2年后THI平均分的绝对降低分别为（此处原文有误，应为14）和20分，即与之前报道的耳鸣再训练疗法（TRT）（14 - 28分）相似。当前项目的成本约为每位客户200欧元。
耳鸣管理项目似乎以相对较低的成本为许多客户带来了显著益处。进行一项随机对照研究来比较当前项目与其他形式的联合咨询/声音疗法将是有益的。
