Unidad de Otorrinolaringología, Hospital Universitario Fundación Alcorcón, C/Budapest, 1, 28922 Alcorcón, Madrid, Spain.
Eur Arch Otorhinolaryngol. 2010 Jul;267(7):1067-74. doi: 10.1007/s00405-009-1182-6. Epub 2010 Jan 1.
Acoustic deprivation, i.e. hearing loss, is responsible for a cascade of processes resulting in reorganisation of the cortex. Tinnitus mechanisms are explained by synchronization of the neural spontaneous activity and might be related to cortical re-mapping. Auditory discrimination training (ADT) has demonstrated in both animals and humans to induce tonotopical changes in the auditory pathways through neural plasticity. We hypothesize that ADT could have some effect on tinnitus perception. The objective of this study is to compare the effect on tinnitus following two paradigms of ADT. Only patients from 20 to 60 years of age were recruited. Inclusion criteria were pure tone tinnitus of mild or moderate handicap according to the Tinnitus Handicap Inventory score (<56). ADT patients were randomized in two groups: SAME (ADT in the same frequency of tinnitus pitch, 20 patients) and NONSAME (ADT in the frequency one-octave below tinnitus pitch, 21 patients). Groups of pair of tones (70% standard tones ST, 30% deviant tones ST + 0.1-0.5 kHz) were randomly mixed for 20 min/day during 1 month. Patient had to mark when the two sounds of the pair were similar or different. Control group included 26 patients from the waiting list (WLG). Patients were also divided according to the trained frequency and the deepest hearing-impaired frequency. Outcome parameters were set up according to the answer to the question "is your tinnitus better, same, or worse with the treatment?" (RESP), the tinnitus handicap inventory (THI) and the visual analogue scale from 1 to 10 on tinnitus intensity (VAS). Tinnitus improved in 42.2% of the patients (RESP). VAS and THI scores were reduced but only THI differences were statistically significant (P = 0.003). ADT patients improved significantly compared with WLG in RESP and THI scores (P < 0.01). Training frequencies one-octave below the tinnitus pitch (NONSAME) decreased significantly THI scores compared with patients trained frequencies similar to tinnitus pitch (SAME, P = 0.035). RESP and VAS scores decreased more in NONSAME group though differences were not significant. We did not find any differences when comparing the group training the deepest hearing-impaired frequency and the group who trained other frequencies. Auditory discrimination training significantly improved tinnitus handicap compared to a waiting list group. Those patients who trained frequencies one octave below the tinnitus pitch had better outcome than those who performed the ADT with frequencies similar to the tinnitus pitch (P = 0.035).
听觉剥夺，即听力损失，是导致皮层重新组织的一系列过程的原因。耳鸣机制通过神经自发性活动的同步解释，可能与皮质重映射有关。听觉辨别训练（ADT）在动物和人类中均已证明可通过神经可塑性诱导听觉通路的音调变化。我们假设 ADT 可能对耳鸣感知有一定影响。本研究的目的是比较两种 ADT 模式对耳鸣的影响。仅招募 20 至 60 岁的患者。纳入标准为根据耳鸣障碍量表（Tinnitus Handicap Inventory score）评分（<56）为轻度或中度听力障碍的纯音耳鸣。ADT 患者随机分为两组：相同频率（SAME，20 例）和不同频率（NONSAME，21 例）。每组均包括 70%标准音 ST 和 30%偏差音 ST+0.1-0.5 kHz 的成对音。患者需要标记出对声音是否相似或不同。对照组包括 26 名等候名单（WLG）的患者。患者还根据训练频率和最深听力受损频率进行分组。根据“治疗后您的耳鸣是更好、相同还是更差？”（RESP）、耳鸣障碍量表（THI）和耳鸣强度的 1 到 10 的视觉模拟量表（VAS）来设置疗效参数。42.2%的患者耳鸣改善（RESP）。VAS 和 THI 评分降低，但只有 THI 差异有统计学意义（P = 0.003）。ADT 患者与 WLG 相比，RESP 和 THI 评分均有显著改善（P < 0.01）。与训练与耳鸣音调相似的频率（SAME）的患者相比，训练频率比耳鸣音调低一个八度的 NONSAME 组的 THI 评分显著降低（P = 0.035）。尽管差异无统计学意义，但 NONSAME 组的 RESP 和 VAS 评分下降更多。当比较训练最深听力受损频率的组和训练其他频率的组时，我们没有发现任何差异。听觉辨别训练与等候名单组相比，显著改善了耳鸣障碍。与训练与耳鸣音调相似的频率相比，训练频率比耳鸣音调低一个八度的患者的结果更好（P = 0.035）。
