Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City, Guangdong Province, China.
Institute of Hearing and Speech-Language Science, Sun Yat-sen University, Guangzhou City, Guangdong Province, China.
Ear Hear. 2023;44(4):670-681. doi: 10.1097/AUD.0000000000001318. Epub 2022 Dec 8.
Chronic subjective tinnitus can have a serious effect on daily life, even causing serious psychological disorders. Currently there are no specific effective solutions or cures. Tailor-made notched music training (TMNMT) is a recently proposed sound therapy that has simpler processes and a higher compliance rate than tinnitus retraining therapy (TRT), a widely used treatment for chronic subjective tinnitus. This study explores the therapeutic effect of TMNMT in comparison to TRT to highlight its clinical value.
The study was a randomized controlled, single-blinded clinical trial. One hundred twenty eligible participants were randomly assigned to receive TMNMT (n = 60) or TRT (n = 60) for 3 mo with concurrent follow-up. It should be noted that the duration of sound treatment in TRT was modified to 2 hr per day for better feasibility in practice. The primary outcome was mean change in tinnitus handicap inventory (THI) measured at baseline ( T0 ), 1 mo ( T1 ) and 3 mo ( T2 ) after intervention. Change in visual analog scale (VAS) was measured as a secondary outcome. A comparison of therapeutic effectiveness between TMNMT and TRT was evaluated by repeated measure analysis of variance.
One hundred and twelve (93%) of participants took part in the study, of which 64 were men and 48 women. Mean (SD) age was 42.80 (12.91) years. Fifty-eight were allocated to receive TMNMT and 54 to receive TRT. The between-group difference in primary outcome was -6.90 points (95% confidence interval [CI], -13.53 to -0.27) at T1 and -6.17 points (95% CI, -13.04 to 0.71) at T2 . These results closely reached to clinical significance of tinnitus-related effective relief. For the secondary outcome, the mean value in the TMNMT group was 0.83 points (95% CI, 0.12 to 1.54), significantly lower than the mean value of the TRT group. The differences in THI and VAS between the two groups were statistically significant after intervention. Further analysis showed that age and baseline THI and VAS scores were associated with change in THI and VAS scores after interventions.
Both TMNMT and TRT were able to alleviate chronic subjective tinnitus effectively after a 3 month intervention. When the two forms of therapy were compared TMNMT appeared to be more effective and consequently potentially superior to TRT for reducing tinnitus loudness and functional and emotional disturbance associated with chronic subjective tinnitus.
慢性主观性耳鸣会严重影响日常生活，甚至导致严重的心理障碍。目前尚无特定的有效解决方案或治疗方法。定制凹口音乐训练（TMNMT）是一种最近提出的声音疗法，与广泛应用于慢性主观性耳鸣治疗的耳鸣再训练疗法（TRT）相比，其过程更简单，依从性更高。本研究旨在比较 TMNMT 与 TRT 的治疗效果，以突出其临床价值。
本研究为随机对照、单盲临床试验。120 名符合条件的参与者被随机分为 TMNMT 组（n=60）或 TRT 组（n=60），接受 3 个月的治疗，并进行随访。值得注意的是，TRT 的声音治疗持续时间修改为每天 2 小时，以提高其实践可行性。主要结局是在干预前（T0）、1 个月（T1）和 3 个月（T2）时用耳鸣残疾量表（THI）测量的平均变化。以视觉模拟量表（VAS）的变化作为次要结局。通过重复测量方差分析评估 TMNMT 和 TRT 之间的治疗效果比较。
112 名（93%）参与者完成了研究，其中 64 名男性，48 名女性。平均（SD）年龄为 42.80（12.91）岁。58 名参与者被分配接受 TMNMT，54 名接受 TRT。TMNMT 组和 TRT 组在主要结局方面的组间差异在 T1 时为-6.90 分（95%置信区间，-13.53 至-0.27），在 T2 时为-6.17 分（95%置信区间，-13.04 至 0.71）。这些结果非常接近耳鸣相关有效缓解的临床意义。次要结局方面，TMNMT 组的平均数值为 0.83 分（95%置信区间，0.12 至 1.54），显著低于 TRT 组。干预后两组间 THI 和 VAS 差异有统计学意义。进一步分析显示，年龄以及干预前的 THI 和 VAS 评分与干预后 THI 和 VAS 评分的变化有关。
TMNMT 和 TRT 均能有效缓解慢性主观性耳鸣，3 个月干预后均有效。与 TRT 相比，TMNMT 似乎更有效，因此可能优于 TRT，能够降低耳鸣响度和与慢性主观性耳鸣相关的功能和情绪障碍。
