Department of Otolaryngology, Yamato-Takada Municipal Hospital, Japan.
Department of Otolaryngology - Head and Neck Surgery, Nara Medical University Hospital, Japan.
Auris Nasus Larynx. 2020 Oct;47(5):763-768. doi: 10.1016/j.anl.2020.03.005. Epub 2020 May 4.
Acoustic therapies including hearing aids and tinnitus control instruments are widely used in Japan but without high levels of evidence. The outpatient hearing aid clinic at our institution fits patients with hearing aids and instructs patients on how to use them to control tinnitus if present. In this study, we examined the effects of this approach on tinnitus.
One hundred and eleven of 138 patients who visited our hearing aid clinic from April 2016 to September 2018 purchased hearing aids after fitting. Sixty-six of these patients (31 men, 35 women; mean age 78.0 ± 8.0 years) had both hearing loss and tinnitus and were enrolled. The tinnitus was bilateral in 41 patients and unilateral in 25 (poor hearing ear, n = 16, good hearing ear, n = 9). Hearing aids were worn bilaterally by 23 patients and unilaterally by 43 (89 devices). Seventeen of the 23 patients wearing bilateral hearing aids had bilateral tinnitus and 6 had unilateral tinnitus, i.e., in 40 ears, the tinnitus side matched the hearing aid side (40 devices) and in 6 ears did not (6 devices). Twenty-four of 43 patients wearing unilateral hearing aids had bilateral tinnitus, meaning that in 24 ears the tinnitus side matched the hearing aid side (24 devices). In six of the remaining 19 cases with unilateral tinnitus, the hearing aid and tinnitus were on the same side (6 devices) and in 13 were on opposite sides (13 devices). Changes in the Tinnitus Handicap Inventory (THI), visual analog scale (VAS, for tinnitus discomfort, severity, and persistence), and Hospital Anxiety and Depression Scale scores were measured immediately before using a hearing aid and 12 months later.
Significant effects of hearing aids on tinnitus were observed in all subjects (THI, p = 0.0000030), VAS (severity, p = 0.000000066; discomfort, p = 0.0000013). Significant effects were observed with bilateral hearing aids (THI, p = 0.0012; VAS for severity, p = 0.00069; VAS for discomfort, p = 0.00052) and with unilateral hearing aids (THI, p = 0.00055; VAS for severity, p = 0.000034; VAS for discomfort, p = 0.00007). Spearman's rank correlation coefficient showed a significant positive correlation between the THI and VAS scores (p = 0.0033). In cases of bilateral tinnitus, significant differences were observed with bilateral hearing aids (THI, p = 0.011; VAS for severity, p = 0.0019; VAS for discomfort; p = 0.020) and with unilateral hearing aids (THI, p = 0.00069; VAS for severity, p = 0.00071; VAS for discomfort, p = 0.000093).
Acoustic therapy using hearing aids was effective for tinnitus. Even when bilateral, a unilateral hearing aid is able to improve tinnitus. When unilateral, the ipsilateral hearing aid is able to improve tinnitus.
在日本，包括助听器和耳鸣控制仪器在内的声学疗法得到了广泛应用，但缺乏高水平的证据。我们机构的门诊助听器诊所为患者配备助听器，并指导他们如何使用助听器来控制耳鸣（如果存在的话）。在这项研究中，我们研究了这种方法对耳鸣的影响。
2016 年 4 月至 2018 年 9 月期间，有 138 名患者在我们的助听器诊所就诊，其中 111 名患者在配备助听器后购买了助听器。这些患者中有 66 名（31 名男性，35 名女性；平均年龄 78.0±8.0 岁）患有听力损失和耳鸣，并被纳入研究。41 名患者的耳鸣为双侧，25 名患者的耳鸣为单侧（听力较差耳，n=16，听力较好耳，n=9）。23 名患者双侧佩戴助听器，43 名患者单侧佩戴助听器（89 个设备）。23 名双侧佩戴助听器的患者中有 17 名患有双侧耳鸣，6 名患有单侧耳鸣，即 40 只耳朵的耳鸣侧与助听器侧匹配（40 个设备），6 只耳朵不匹配（6 个设备）。43 名单侧佩戴助听器的患者中有 24 名患有双侧耳鸣，这意味着在 24 只耳朵中，耳鸣侧与助听器侧匹配（24 个设备）。在其余 19 例单侧耳鸣患者中，6 例助听器和耳鸣位于同一侧（6 个设备），13 例位于对侧（13 个设备）。在使用助听器之前和 12 个月后，测量了耳鸣残疾量表（THI）、视觉模拟量表（VAS，用于耳鸣不适、严重程度和持续时间）和医院焦虑和抑郁量表的评分变化。
所有患者的助听器对耳鸣均有显著影响（THI，p=0.0000030），VAS（严重程度，p=0.000000066；不适，p=0.0000013）。双侧助听器（THI，p=0.0012；VAS 严重程度，p=0.00069；VAS 不适，p=0.00052）和单侧助听器（THI，p=0.00055；VAS 严重程度，p=0.000034；VAS 不适，p=0.00007）均有显著效果。Spearman 秩相关系数显示 THI 和 VAS 评分之间存在显著正相关（p=0.0033）。对于双侧耳鸣，双侧助听器（THI，p=0.011；VAS 严重程度，p=0.0019；VAS 不适，p=0.020）和单侧助听器（THI，p=0.00069；VAS 严重程度，p=0.00071；VAS 不适，p=0.000093）均有显著差异。
使用助听器的声学疗法对耳鸣有效。即使是双侧，单侧助听器也能改善耳鸣。当单侧佩戴时，同侧助听器能够改善耳鸣。
