Amanda Bonaconsa, Manuela Mazzoli, Antonia Magnano, Claudio Milanesi, Gregorio Babighian
Dept. Azienda Ospedaliera of Padua, Padua, Italy.
Int Tinnitus J. 2010;16(1):44-50.
Somatic modulation in tinnitus has been demonstrated by several studies although few investigations have been published on the efficacy of physical treatments in tinnitus subjects. In the present study the prevalence of somatic components to tinnitus were evaluated and the efficacy of two different physical treatments were compared: InterX® transcutaneous dynamic electrical stimulation and manual osteopathic therapy. Furthermore, posturographic measurements were analysed to verify the postural control in tinnitus subjects. 40 consecutive tinnitus patients, aged 18-65, were randomly selected for treatment (once a week for 2 months): 20 tinnitus subjects were treated with osteopathic manipulations, 20 with InterX®. They were evaluated pre and post therapy with audiogram up to 16 kHz, tinnitus pitch and loudness match, MML, THI questionnaire, posturography, structured interview with special attention on postural and movement influence on tinnitus, physical evaluation and osteopathic evaluation. 40 controls with no tinnitus, underwent audiological tests, postural and osteopathic evaluation for comparison. In our population, tinnitus sufferers presented more frequently musculoscheletal strains assessed with osteopathic visit and postural problems assessed with posturography measures in comparison with controls. Posturographic test, showed an average oscillating areas significantly greater in tinnitus participants (p ≤ 0.05), compared with control subjects. On the average in the treated groups, the enveloped areas were not significantly affected by either of the treatments. Tinnitus improved subjectively in most patients: loudness decreased, % time of awareness, % time of annoyance and quality of life was overall perceived as improved. This was mostly evident in subjects with muscular strain and tensions. This study indicates the benefit of physical, manipulation therapy for those patients with somatic modulation of their tinnitus, further studies are needed to establish the diagnostic or prognostic role of posturographic measurements.
多项研究已证实耳鸣存在躯体调制现象，不过关于物理治疗对耳鸣患者疗效的研究发表较少。在本研究中，评估了耳鸣的躯体成分患病率，并比较了两种不同物理治疗方法的疗效：InterX®经皮动态电刺激和手动整骨疗法。此外，还分析了姿势描记测量结果，以验证耳鸣患者的姿势控制情况。连续选取40例年龄在18 - 65岁的耳鸣患者进行治疗（每周一次，共2个月）：20例耳鸣患者接受整骨手法治疗，20例接受InterX®治疗。在治疗前后，对他们进行了高达16kHz的听力图、耳鸣音高和响度匹配、最小掩蔽级（MML）、耳鸣残疾评定量表（THI）问卷、姿势描记、特别关注姿势和运动对耳鸣影响的结构化访谈、体格检查和整骨评估。选取40例无耳鸣的对照者进行听力测试、姿势和整骨评估以作比较。在我们的研究人群中，与对照组相比，耳鸣患者通过整骨检查评估出的肌肉骨骼劳损和通过姿势描记测量评估出的姿势问题更为常见。姿势描记测试显示，与对照组相比，耳鸣参与者的平均摆动面积显著更大（p≤0.05）。在治疗组中，平均而言，两种治疗方法对包络面积均无显著影响。大多数患者的耳鸣主观上有所改善：响度降低，自觉耳鸣时间百分比、烦恼时间百分比和生活质量总体上被认为有所改善。这在有肌肉劳损和紧张的患者中最为明显。本研究表明，对于耳鸣存在躯体调制的患者，物理手法治疗有益，还需要进一步研究以确定姿势描记测量在诊断或预后方面的作用。
