Van der Wal Annemarie, Luyten Tine, Cardon Emilie, Jacquemin Laure, Vanderveken Olivier M, Topsakal Vedat, Van de Heyning Paul, De Hertogh Willem, Van Looveren Nancy, Van Rompaey Vincent, Michiels Sarah, Gilles Annick
Department of Otorhinolaryngology - Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.
Department of Rehabilitation Sciences and Physiotherapy, Antwerp University, Antwerp, Belgium.
Front Neurosci. 2020 May 12;14:422. doi: 10.3389/fnins.2020.00422. eCollection 2020.
INTRODUCTION: Tinnitus is a complex symptom requiring a thorough multidisciplinary assessment to construct an individual's tinnitus profile. The Antwerp University Hospital hosts a tertiary tinnitus clinic providing intensive, multidisciplinary tinnitus care in the form of combinational psychological treatment with either Tinnitus Retraining Therapy (TRT)/Cognitive Behavioral Therapy (CBT) or TRT/eye movement desensitization and reprocessing therapy (EMDR), high-definition transcranial direct current stimulation (HD-tDCS), and physical therapy treatment (in cases of somatic influence of the neck or the temporomandibular area). Several factors may contribute to therapy effect of which the role of gender has recently gained more interest. As such, the current manuscript explores gender differences in the outcome of different tinnitus treatments. METHODS: Data on treatment outcome of four distinct tinnitus treatments (1. HD-tDCS; 2. orofacial physical therapy; 3. combination TRT + CBT; and 4. combination TRT + EMDR) were pooled and compared. Treatment outcome was assessed via the Tinnitus Functional Index (TFI). Participants completed the TFI at baseline, immediately after treatment and after 9 weeks (±3 weeks) follow-up. To explore the effect of gender on different treatment outcomes, a linear mixed model was designed including , , and as fixed factors as well as all interactions between these factors. RESULTS: TFI scores improved significantly over time regardless of therapy group ( < 0.0001). A mean TFI decrease of at least 13 points was obtained by all participants except by those in the HD-tDCS. Significant interactions between Gender and Time point were identified in all groups except for the TRT +EMDR group. Female subjects improved more extensively than males in the HD-tDCS ( = 0.0009) and orofacial therapy group ( = 0.0299). Contrarily, in the TRT +CBT group, male participants showed a significant improvement whereas the mean TFI scores of female subjects remained on baseline levels ( = 0.0138). CONCLUSION: Our data suggest that male and female tinnitus patients seem to react differently to different therapy options. We strongly encourage further prospective studies to discern the relevance of gender in therapy outcome.
引言:耳鸣是一种复杂的症状,需要进行全面的多学科评估以构建个体的耳鸣特征。安特卫普大学医院设有一家三级耳鸣诊所,以耳鸣再训练疗法(TRT)/认知行为疗法(CBT)或TRT/眼动脱敏再处理疗法(EMDR)联合心理治疗、高清经颅直流电刺激(HD-tDCS)以及物理治疗(针对颈部或颞下颌区域的躯体影响情况)的形式,提供强化的多学科耳鸣护理。有几个因素可能会对治疗效果产生影响,其中性别角色最近受到了更多关注。因此,本手稿探讨了不同耳鸣治疗结果中的性别差异。 方法:汇总并比较了四种不同耳鸣治疗(1. HD-tDCS;2. 口面部物理治疗;3. TRT+CBT联合治疗;4. TRT+EMDR联合治疗)的治疗结果数据。通过耳鸣功能指数(TFI)评估治疗结果。参与者在基线、治疗结束后即刻以及9周(±3周)随访后完成TFI评估。为了探究性别对不同治疗结果的影响,设计了一个线性混合模型,将性别、治疗组和时间点作为固定因素以及这些因素之间的所有交互作用纳入其中。 结果:无论治疗组如何,TFI评分随时间均有显著改善(P<0.000 1)。除HD-tDCS组外,所有参与者的TFI平均下降至少13分。除TRT+EMDR组外,所有组均发现性别与时间点之间存在显著交互作用。在HD-tDCS组(P=0.0009)和口面部治疗组(P=0.0299)中,女性受试者的改善程度比男性更大。相反,在TRT+CBT组中,男性参与者有显著改善,而女性受试者的TFI平均评分仍维持在基线水平(P=0.0138)。 结论:我们的数据表明,男性和女性耳鸣患者对不同治疗方案的反应似乎不同。我们强烈鼓励进一步开展前瞻性研究,以明确性别在治疗结果中的相关性。
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