Analysis of comorbid psychiatric disorders in patients with chronic otitis media associated tinnitus
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摘要: 目的 探讨慢性中耳炎相关性耳鸣患者情绪障碍的分布特点。方法 回顾性分析62例慢性中耳炎相关性耳鸣患者的临床资料。所有患者均完成耳鸣问卷(TQ)、耳鸣残疾量表(THI)、耳鸣严重程度评价量表(TEQ)、焦虑自评量表(SAS)、抑郁自评量表(SDS)及匹兹堡睡眠质量指数(PSQI)量表填写，并行纯音测听及声导抗检查，SAS、SDS评分均≥50分判定为伴有情绪障碍，PSQI>6判定为伴有睡眠障碍，并对上述判定结果进行分析。结果 62例患者中，慢性化脓性中耳炎43例，中耳胆脂瘤19例; 慢性中耳炎病程为(14.38±14.06)年，耳鸣病程为(8.39±11.69)年; 轻度耳鸣(Ⅰ~Ⅱ级)32例(51.61%)，中-重度耳鸣(Ⅲ~Ⅴ级)30例(48.39%); 术前听力正常者4例(6.45%)、传导性聋38例(61.29%)、混合性聋20例(32.36%)。不同听力下降程度及类型之间的耳鸣严重程度差异无统计学意义(P>0.05)。SAS评分为45.10±11.61，SDS评分为43.48±14.67，均高于正常人模量(30分)。伴情绪障碍者共27例(44.00%); 伴情绪障碍患者THI评分(57.85±21.1)显著高于不伴情绪障碍患者(29.2±17.39)(P < 0.05);伴情绪障碍者PSQI评分(8.86±3.47)显著高于不伴情绪障碍者(6.24±2.54)(P < 0.05)。术后53例患者随访0.5~1.8年，术后耳鸣减轻或消失43例(81.13%)，耳鸣缓解组与未缓解组的年龄、性别、病程、病变类型、是否伴有情绪障碍和(或)睡眠障碍及术后听力等因素差异无显著性。结论 情绪障碍是慢性中耳炎相关性耳鸣患者常见的合并症状，伴情绪障碍的患者耳鸣严重程度显著高于不伴情绪障碍的患者。针对慢性中耳炎相关性耳鸣的治疗，除手术外，还需对患者的情绪、睡眠等相关因素进行综合评估，术后进一步给予相应的治疗。Abstract: Objective To analyze the distribution of comorbid psychiatric disorders in patients with chronic otitis media associated tinnitus.Method The data of patients with chronic otitis media associated tinnitus who accepted surgical treatments from July 2017 to September 2018 were retrospectively analyzed. All patients accepted pure tone audiometry and acoustic conductance examination and were requested to fill the tinnitus history questionnaire, THI, TEQ, SAS, SDS and PSQI scales before operation. When the SAS or/and SDS score ≥50 the patient was judged as having comorbid psychiatric disorders. When the PSQI score>6 the patient was judged as having comorbid sleep disorder, and then all the results were analyzed.Result Sixty-two patients were included in the study, 43 cases were diagnosed as chronic suppurative otitis media, and 19 cases were diagnosed as middle ear cholesteatoma. The average course of chronic otitis media or middle ear cholesteatoma was(14.38±14.06) years, while the average course of tinnitus was(8.39±11.69) years. There were 32 cases with mild to moderate tinnitus(gradeⅠ-Ⅱ)(51.61%) and 30 cases with moderate to severe tinnitus(grade Ⅲ-Ⅴ)(48.39%). Before operation, there were 4 cases(6.45%) with normal hearing, 38 cases(61.29%) with conductive hearing loss, and 20 cases(32.36%) with mixed hearing loss. There was no significant difference in tinnitus severity between different hearing loss degrees and types(P>0.05). The average SAS score was 45.10±11.61, and the average SDS score was 43.48±14.67, both higher than the normal modulus(30 points), among which 27 cases(44.00%) comorbid psychiatric disorders. The THI score in patients with comorbid psychiatric disorders(57.85±21.1) was significantly higher than that in patients without comorbid psychiatric disorders(29.2±17.39)(P < 0.05). The PSQI score in patients with comorbid psychiatric disorders(8.86±3.47) was significantly higher than that of those without comorbid psychiatric disorders(6.24±2.54)(P < 0.05). Fifty-three patients were followed up for 0.5 to 1.8 years after operation, and in 43 cases the tinnitus was reduced or disappeared after operation(the effective rate was 81.13%). There were no significant difference between patients in tinnitus relief group and those in tinnitus without relief group in age, sex, course of the disease, type of the disease, with or without comorbid psychiatric disorders and/or sleep disorder, postoperative hearing improvement.Conclusion Comorbid psychiatric disorders are common in patients with chronic otitis media associated tinnitus and the tinnitus in patients with comorbid psychiatric disorders is significantly more serious than that those without. For the treatment of chronic otitis media associated tinnitus, besides surgery, the complications such as psychiatric and sleep disorders and so on should be evaluated and treated accordingly.
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Key words:
- chronic otitis media /
- tympanoplasty /
- tinnitus /
- psychiatric disorders /
- sleep disorders
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表 1 耳鸣严重程度分布
耳鸣评分 例数 Ⅰ级 Ⅱ级 Ⅲ级 Ⅳ级 Ⅴ级 THI 62 12(19.35) 20(32.26) 18(29.03) 11(17.75) 1(1.61) TEQ 62 7(11.29) 28(45.16) 17(27.42) 10(16.13) 0(0) 
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表 2 术前与术后听力改变情况(n=53)
dB HL 手术时间 气导听阈 骨导听阈 气骨导差 术前 56.94±19.09 23.10±12.69 33.83±12.46 术后 38.88±16.58 26.41±13.84 12.47±12.71 t值 7.55 -1.81 8.38 P值 0.00 0.08 0.00
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表 3 慢性中耳炎患者术后影响耳鸣缓解的因素分析
项目 耳鸣缓解组
(n=43)耳鸣未缓解组
(n=10)t/χ2值 P值 性别 0.83 0.36 男 11 4 女 32 6 年龄/岁 43.74±14.73 35.8±11.75 1.90 0.07 病程/年 10.34±13.07 4.91±5.85 1.59 0.09 病变侧别 3.32 0.07 右 18 8 左 25 2 病变类型 1.59 0.24 慢性中耳炎 34 6 中耳胆脂瘤 9 4 情绪障碍 0.18 0.99 无 21 2 有 22 8 睡眠障碍 1.70 0.16 无 21 2 有 22 8 气导听阈/dB HL 18.24±14.05 17.29±10.77 0.15 0.88 骨导听阈/dB HL -3.10±14.05 -4.20±11.69 0.23 0.82 气骨导差/dB HL 21.34±13.63 21.46±17.84 0.02 0.99
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