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助听器可减轻耳鸣,但患者是否根据听力损失程度接受放大治疗重要吗?一项荟萃分析。

Hearing Aids Mitigate Tinnitus, But Does It Matter if the Patient Receives Amplification in Accordance With Their Hearing Impairment or Not? A Meta-Analysis.

机构信息

Department of Logopedics, Phoniatrics and Audiology, Lund University, Sweden.

出版信息

Am J Audiol. 2022 Sep;31(3):789-818. doi: 10.1044/2022_AJA-22-00004. Epub 2022 Aug 16.

Abstract

PURPOSE

The purpose of the present meta-analysis is to explore the potential effects of objective verification of hearing aid amplification on tinnitus-related outcomes.

METHOD

Twenty-seven studies reporting tinnitus outcomes pre and post hearing aid fitting were identified through a systematic literature search. From these studies, data from 1,400 participants were included in the present meta-analysis. Studies were divided into subgroups based on whether they had reported performing objective verification of the participants' hearing aid amplification or not. Outcome measures were tinnitus distress and tinnitus loudness.

RESULTS

Meta-analyses of all included studies indicated verified amplification to result in significantly enhanced reduction of tinnitus loudness ( < .00001), while the enhanced reduction of tinnitus distress only approached statistical significance ( = .07). However, when excluding an outlier from the subgroup of studies using unverified amplification, individuals receiving verified amplification showed significantly greater reduction of tinnitus distress ( = .02). In addition, analyses of longitudinal effects revealed that the reductions of tinnitus distress decreased over time among individuals receiving unverified amplification but increased over time among individuals receiving verified amplification.

CONCLUSIONS

The present meta-analysis indicates verified hearing aid amplification to be superior to unverified amplification in terms of reduction of tinnitus loudness and distress. The longitudinal increase of mitigation of tinnitus distress with verified amplification only may reflect improved neural reorganization and/or better adherence to hearing aid use, with verified compared to unverified amplification. Due to the low cost of hearing aid verification compared to the high societal cost of tinnitus, objective verification of hearing aid amplification for tinnitus patients is recommended.

摘要

目的

本荟萃分析旨在探讨客观验证助听器放大效果对耳鸣相关结局的潜在影响。

方法

通过系统文献检索,确定了 27 项报告助听器适配前后耳鸣结局的研究。从这些研究中,共有 1400 名参与者的数据纳入本荟萃分析。根据是否报告对参与者助听器放大效果进行客观验证,将研究分为亚组。结局指标为耳鸣困扰和耳鸣响度。

结果

所有纳入研究的荟萃分析表明,经客观验证的放大效果可显著增强耳鸣响度的降低(<.00001),而耳鸣困扰的降低仅接近统计学意义(=.07)。然而,当从使用未经验证放大的亚组研究中排除一个异常值后,接受验证放大的个体表现出显著更大的耳鸣困扰降低(=.02)。此外,纵向效应分析表明,未经验证放大的个体的耳鸣困扰降低随时间推移而减少,而接受验证放大的个体的耳鸣困扰降低随时间推移而增加。

结论

本荟萃分析表明,在降低耳鸣响度和困扰方面,经客观验证的助听器放大效果优于未经验证的放大效果。与未经验证的放大相比,验证放大仅可能反映出更好的神经重组和/或对助听器使用的更好依从性,从而导致耳鸣困扰的纵向增加得到缓解。由于助听器验证的成本相对较低,而耳鸣的社会成本较高,因此建议对耳鸣患者进行助听器放大的客观验证。

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