Vielsmeier Veronika, Kreuzer Peter M, Haubner Frank, Steffens Thomas, Semmler Philipp R O, Kleinjung Tobias, Schlee Winfried, Langguth Berthold, Schecklmann Martin
Department of Otorhinolaryngology, University of RegensburgRegensburg, Germany; Interdisciplinary Tinnitus Center of the University of RegensburgRegensburg, Germany.
Interdisciplinary Tinnitus Center of the University of RegensburgRegensburg, Germany; Department of Psychiatry and Psychotherapy, University of RegensburgRegensburg, Germany.
Front Aging Neurosci. 2016 Dec 15;8:293. doi: 10.3389/fnagi.2016.00293. eCollection 2016.
Many tinnitus patients complain about difficulties regarding speech comprehension. In spite of the high clinical relevance little is known about underlying mechanisms and predisposing factors. Here, we performed an exploratory investigation in a large sample of tinnitus patients to (1) estimate the prevalence of speech comprehension difficulties among tinnitus patients, to (2) compare subjective reports of speech comprehension difficulties with behavioral measurements in a standardized speech comprehension test and to (3) explore underlying mechanisms by analyzing the relationship between speech comprehension difficulties and peripheral hearing function (pure tone audiogram), as well as with co-morbid hyperacusis as a central auditory processing disorder. Speech comprehension was assessed in 361 tinnitus patients presenting between 07/2012 and 08/2014 at the Interdisciplinary Tinnitus Clinic at the University of Regensburg. The assessment included standard audiological assessments (pure tone audiometry, tinnitus pitch, and loudness matching), the Goettingen sentence test (in quiet) for speech audiometric evaluation, two questions about hyperacusis, and two questions about speech comprehension in quiet and noisy environments ("How would you rate your ability to understand speech?"; "How would you rate your ability to follow a conversation when multiple people are speaking simultaneously?"). Subjectively-reported speech comprehension deficits are frequent among tinnitus patients, especially in noisy environments (cocktail party situation). 74.2% of all investigated patients showed disturbed speech comprehension (indicated by values above 21.5 dB SPL in the Goettingen sentence test). Subjective speech comprehension complaints (both for general and in noisy environment) were correlated with hearing level and with audiologically-assessed speech comprehension ability. In contrast, co-morbid hyperacusis was only correlated with speech comprehension difficulties in noisy environments, but not with speech comprehension difficulties in general. Speech comprehension deficits are frequent among tinnitus patients. Whereas speech comprehension deficits in quiet environments are primarily due to peripheral hearing loss, speech comprehension deficits in noisy environments are related to both peripheral hearing loss and dysfunctional central auditory processing. Disturbed speech comprehension in noisy environments might be modulated by a central inhibitory deficit. In addition, attentional and cognitive aspects may play a role.
许多耳鸣患者抱怨在言语理解方面存在困难。尽管这一问题在临床上具有高度相关性，但对于其潜在机制和诱发因素却知之甚少。在此，我们对大量耳鸣患者进行了一项探索性研究，以（1）估计耳鸣患者中言语理解困难的患病率，（2）将言语理解困难的主观报告与标准化言语理解测试中的行为测量结果进行比较，以及（3）通过分析言语理解困难与外周听力功能（纯音听力图）之间的关系，以及与作为中枢听觉处理障碍的共病性听觉过敏之间的关系来探索潜在机制。对2012年7月至2014年8月期间在雷根斯堡大学跨学科耳鸣诊所就诊的361名耳鸣患者进行了言语理解评估。评估内容包括标准听力学评估（纯音听力测定、耳鸣音调及响度匹配）、用于言语听力评估的哥廷根句子测试（安静环境下）、两个关于听觉过敏的问题，以及两个关于安静和嘈杂环境中言语理解的问题（“你如何评价自己理解言语的能力？”；“当多人同时讲话时，你如何评价自己跟上对话的能力？”）。耳鸣患者中主观报告的言语理解缺陷很常见，尤其是在嘈杂环境（鸡尾酒会情境）中。所有被调查患者中有74.2%表现出言语理解障碍（哥廷根句子测试中数值高于21.5 dB SPL表明）。主观言语理解抱怨（包括一般情况和嘈杂环境中的情况）与听力水平以及听力学评估的言语理解能力相关。相比之下，共病性听觉过敏仅与嘈杂环境中的言语理解困难相关，而与一般的言语理解困难无关。耳鸣患者中言语理解缺陷很常见。安静环境中的言语理解缺陷主要归因于外周听力损失，而嘈杂环境中的言语理解缺陷与外周听力损失和中枢听觉处理功能障碍均有关。嘈杂环境中言语理解障碍可能受中枢抑制缺陷调节。此外，注意力和认知方面可能也起作用。
