Van de Heyning Paul, Gilles Annick, Rabau Sarah, Van Rompaey Vincent
aUniversity Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital (UZA), Edegem bFaculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
Curr Opin Otolaryngol Head Neck Surg. 2015 Oct;23(5):369-75. doi: 10.1097/MOO.0000000000000183.
Subjective tinnitus can be triggered by a variety of causes, and therefore tinnitus patients constitute a very heterogeneous population difficult to manage. In this article, we reviewed the current literature to present our conceptual model of the conscious auditory percept and tinnitus - based on experimental research - in order to explain the clinical approach to the individual tinnitus patient.
Fundamental research has provided evidence to support the neurophysiological model of tinnitus developed by Jastreboff. By manipulating the limbic, autonomic and auditory systems, tinnitus retraining therapy (TRT) aims to reduce the response to the abnormal stimulus. Evidence has confirmed the effectiveness of TRT and cognitive behavioral therapy in reducing the negative impact of subjective tinnitus on the patients' quality of life.
Every patient with subjective tinnitus has its unique 'tinnitus profile' which provides a guide to the necessary combination of therapeutic actions. Evidence suggests the multidisciplinary approach combining etiological therapy as well as TRT, and cognitive behavioral therapy in specialized clinics is not only effective in reducing the patient's quality of life but also cost-effective from a healthcare and societal point of view.
主观性耳鸣可由多种原因引发，因此耳鸣患者构成了一个非常难以管理的异质性群体。在本文中，我们回顾了当前的文献，以基于实验研究提出我们关于有意识听觉感知和耳鸣的概念模型，从而解释针对个体耳鸣患者的临床治疗方法。
基础研究为支持贾斯特雷博夫提出的耳鸣神经生理学模型提供了证据。耳鸣再训练疗法（TRT）旨在通过操纵边缘系统、自主神经系统和听觉系统来减少对异常刺激的反应。有证据证实了TRT和认知行为疗法在减轻主观性耳鸣对患者生活质量的负面影响方面的有效性。
每位主观性耳鸣患者都有其独特的“耳鸣特征”，这为必要的治疗行动组合提供了指导。有证据表明，在专业诊所将病因治疗与TRT以及认知行为疗法相结合的多学科方法，不仅能有效降低患者的生活质量，从医疗保健和社会角度来看也是具有成本效益的。
