Mihail R C, Crowley J M, Walden B E, Fishburne J, Reinwall J E, Zajtchuk J T
Department of Otolaryngology-Head and Neck Surgery, Walter Reed Army Medical Center, Washington, DC.
Ann Otol Rhinol Laryngol. 1988 Mar-Apr;97(2 Pt 1):120-3. doi: 10.1177/000348948809700204.
We examined 26 consecutive patients with subjective tinnitus. All subjects were treated with the tricyclic antidepressant trimipramine in a double-blind study, each subject acting as his own control. All subjects were evaluated with pure tone audiometry, site of lesion testing, and auditory brain stem evoked response. The tinnitus assessment consisted of frequency and intensity matching, the determination of masking levels, and a subjective evaluation of severity. Plasma levels of trimipramine were monitored at regular intervals, and the Zung and Millon inventories were administered at the beginning and end of each study period. Nineteen subjects completed the study. Within the trimipramine group, one reported complete disappearance of his tinnitus, eight reported improvement, three no change, and seven that tinnitus was worse. Within the placebo group, eight reported improvement, seven no change, and four that tinnitus was worse. The natural history of tinnitus is such that what has been observed may reflect the evolution of the disease itself, rather than the effect of treatment. We feel that while tricyclics may not have been shown to be effective, the placebo effect played a significant role in the results obtained.
我们对26例连续性主观耳鸣患者进行了研究。在一项双盲研究中，所有受试者均接受三环类抗抑郁药曲米帕明治疗，每个受试者均作为自身对照。所有受试者均接受了纯音听力测定、病变部位测试和听性脑干诱发电位评估。耳鸣评估包括频率和强度匹配、掩蔽水平的测定以及严重程度的主观评估。定期监测曲米帕明的血浆水平，并在每个研究期开始和结束时进行zung和millon量表评估。19名受试者完成了研究。在曲米帕明组中，1人报告耳鸣完全消失，8人报告有所改善，3人无变化，7人报告耳鸣加重。在安慰剂组中，8人报告有所改善，7人无变化，4人报告耳鸣加重。耳鸣的自然病程使得所观察到的情况可能反映了疾病本身的进展，而非治疗效果。我们认为，虽然三环类药物可能未被证明有效，但安慰剂效应在所得结果中发挥了重要作用。
