Folmer Robert L, Theodoroff Sarah M, Martin William Hal, Shi Yongbing
National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Portland, OR; Department of Otolaryngology, Oregon Health and Science University, Portland, OR.
Department of Otolaryngology, Oregon Health and Science University, Portland, OR.
J Am Acad Audiol. 2014 Jan;25(1):106-25. doi: 10.3766/jaaa.25.1.7.
Because chronic tinnitus is a condition that negatively impacts the quality of life of millions of people worldwide, a safe and effective treatment for tinnitus has been sought for millennia. However, effective treatments for tinnitus are greatly outnumbered by ineffective strategies, medications, devices, and surgeries that continue to be developed and promoted for the condition.
This article describes and critiques experimental, controversial, and potential treatments for chronic tinnitus. The purpose of this review is to provide information that should help patients and clinicians to select tinnitus treatment and management strategies most likely to be effective for each set of symptoms and circumstances.
PubMed and MEDLINE databases (National Center for Biotechnology Information, U.S. National Library of Medicine) were searched for the term tinnitus in articles published from 1940 to 2012. Other historical documents and publications were also reviewed as needed for particular topics.
Studies included in this review were selected to represent a sampling of treatment methodologies that have been used for tinnitus.
Due to the heterogeneity of the studies reviewed, it was not appropriate to perform a meta-analysis. A selective review of the literature was conducted to summarize and critique published research results.
Most invasive treatments for tinnitus should be avoided because (1) at best, there is scant evidence that any of these treatments is effective, and (2) the risk to patients for most invasive procedures is much greater than the risk posed by the tinnitus perception. Effective and noninvasive treatments for tinnitus include acoustic therapy (which includes hearing aids and other types of environmental sound enrichment); cognitive-behavioral therapy; psychological counseling; hypnosis; biofeedback; and relaxation training. Over-the-counter or prescription medications may be used as needed to facilitate sleep and to reduce anxiety, depression, or obsessive-compulsiveness.
Patients and clinicians should be especially cautious when considering invasive (and potentially harmful) treatments for tinnitus, which is a non-life-threatening symptom. Unless well-designed clinical trials verify that a tinnitus therapy demonstrates effectiveness above and beyond the placebo effect, consumers should be wary of medications, devices, or procedures promoted as a "cure." Although a true cure for tinnitus has not yet been found, effective and noninvasive tinnitus management strategies are available now. If progress is made to medically (or genetically) treat sensorineural hearing loss in humans, this breakthrough should also help to simultaneously reduce the perception of tinnitus for many patients.
由于慢性耳鸣是一种对全球数百万人的生活质量产生负面影响的病症，数千年来人们一直在寻找一种安全有效的耳鸣治疗方法。然而，针对耳鸣的有效治疗方法在数量上远远少于那些仍在不断开发和推广的无效策略、药物、设备及手术。
本文描述并评论了针对慢性耳鸣的实验性、有争议的及潜在的治疗方法。本综述的目的是提供有助于患者和临床医生选择最有可能对每种症状和情况有效的耳鸣治疗及管理策略的信息。
在PubMed和MEDLINE数据库（美国国立医学图书馆国家生物技术信息中心）中检索1940年至2012年发表的文章中包含“耳鸣”一词的文献。还根据特定主题的需要查阅了其他历史文献和出版物。
本综述纳入的研究旨在代表已用于耳鸣治疗的各种方法。
由于所综述研究的异质性，进行荟萃分析并不合适。对文献进行了选择性综述，以总结和评论已发表的研究结果。
应避免大多数针对耳鸣的侵入性治疗，原因如下：（1）充其量，几乎没有证据表明这些治疗方法中的任何一种是有效的；（2）大多数侵入性手术给患者带来的风险远大于耳鸣感知带来的风险。有效的非侵入性耳鸣治疗方法包括声学疗法（包括助听器和其他类型的环境声音增强）；认知行为疗法；心理咨询；催眠；生物反馈；以及放松训练。可根据需要使用非处方或处方药物来促进睡眠并减轻焦虑、抑郁或强迫症状。
在考虑针对耳鸣这种非危及生命症状的侵入性（且可能有害）治疗时，患者和临床医生应格外谨慎。除非精心设计的临床试验证实某种耳鸣治疗方法的有效性超过安慰剂效应，否则消费者应警惕被宣传为“治愈方法”的药物、设备或手术。尽管尚未找到真正治愈耳鸣的方法，但现在已有有效的非侵入性耳鸣管理策略。如果在医学（或基因）治疗人类感音神经性听力损失方面取得进展，这一突破也应有助于同时减轻许多患者的耳鸣感知。
