Henry James A
VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System and Science University, Portland, Oregon.
Otol Neurotol. 2016 Sep;37(8):e276-85. doi: 10.1097/MAO.0000000000001070.
Chronic tinnitus is the persistent sensation of hearing a sound that exists only inside the head. The prevalence of tinnitus in adults in the United States is estimated at 10 to 15%. For about 20% of these individuals the tinnitus is significantly bothersome. Although myriad therapies for tinnitus are offered (often at significant cost), most are not evidence based. Difficulty in the assessment and further development of interventions for tinnitus stems from the limitations of techniques used to evaluate these interventions. Questionnaires are widely available to "measure" (tinnitus can only be indirectly measured) functional effects of tinnitus, such as difficulty sleeping and concentrating, and negative emotions such as anxiety, depression, and annoyance. Questionnaires have recently been documented for sensitivity to change in response to intervention (i.e., "responsiveness"). All of these questionnaires function well to assess the overall impact of tinnitus. The limitations mentioned pertain primarily to measures of tinnitus perception, which typically include the psychoacoustic measures of tinnitus loudness and pitch matches, tinnitus spectral content, minimum masking levels, and residual inhibition. These measures, which are obtained routinely in many clinics and as part of research studies, have not been validated for being diagnostic, prognostic, discriminative, or responsive. In order for these measures to become clinically meaningful, normative standards are needed, both for baseline measures and for repeated measures of tinnitus perception. Evidence-based intervention for tinnitus requires accurately measuring both the perception of, and reactions to, tinnitus.
慢性耳鸣是一种持续的感觉，即听到一种仅存在于头部内部的声音。据估计，美国成年人中耳鸣的患病率为10%至15%。在这些人中，约20%的人耳鸣严重困扰。尽管提供了无数治疗耳鸣的方法（通常成本高昂），但大多数都缺乏循证依据。耳鸣评估和干预措施进一步发展的困难源于用于评估这些干预措施的技术的局限性。问卷广泛用于“测量”（耳鸣只能间接测量）耳鸣的功能影响，如睡眠和注意力集中困难，以及焦虑、抑郁和烦恼等负面情绪。最近有文献证明问卷对干预反应变化的敏感性（即“反应性”）。所有这些问卷在评估耳鸣的总体影响方面都发挥得很好。上述局限性主要涉及耳鸣感知的测量，这通常包括耳鸣响度和音高匹配、耳鸣频谱内容、最小掩蔽水平和残余抑制等心理声学测量。这些测量在许多诊所常规获得，并作为研究的一部分，但尚未经过验证以用于诊断、预后、鉴别或反应评估。为了使这些测量具有临床意义，需要基线测量和耳鸣感知重复测量的规范标准。基于循证的耳鸣干预需要准确测量耳鸣的感知和对耳鸣的反应。
