基于神经重塑的声学参量与耳鸣特征的相关性研究

Tinnitus is the perception of sound without an external source. More than 40 million people in China have reported experiencing tinnitus, resulting in an estimated prevalence of 10% to 15% in adults. The economic burden to our country due to tinnitus and its management is likely quite large. Despite the high prevalence of tinnitus ，its potential significant effect on quality of life and the economic burden there are no effective therapy to assist clinicians with management.Clinicians should not recommend medical therapy , acupuncture and transcranial magnetic stimulation for the routinea treatment of patients with tinnitus.While clinicians may recommend sound therapy to patients. Sound therapy has been accepted by most doctors worldwide, while it has the disadvantages of cost, inconvenience, and dissatisfaction.Numerous methods of sound therapy have been used, including tinnitus masking therapy,music therapy and so on.The effect of different characteristics of tinnitus patients is very different.It is difficult to define the indications of the various forms of sound therapy.. Therefore, patients seeking sound therapy must be provided realistic expectations regarding potential outcomes,including form,effect,time of sound therapy.It is the difficult problem that the clinicians need to solve. Different tinnitus patients have different tinnitus characteristics, including the characteristics of tinnitus frequency, loudness and severity, and the degree of hearing loss.In the face of so many of the characteristics of tinnitus, the purpose of our study is to summarize effective acoustic parametric information according to the different characteristics of tinnitus.It will provide effective sound therapy for the patients and a feasible treatment scheme for clinicians.

耳鸣在成人发病率约为10%-15%，我国至少有4千万耳鸣患者，严重影响其生活质量，产生较重的经济负担。目前尚无有效治疗耳鸣的方法，药物、针灸、经颅磁刺激等均证明无效，而声治疗是已被证实的一个合理的治疗选择。虽然声治疗已得到全球大多数医生的认可，但其有成本高、治疗方法单一、疗效不满意等诸多问题；也有耳鸣掩蔽、音乐治疗等多种声治疗方案，但不同耳鸣特征患者疗效千差万别，很难明确不同声治疗方案的适应症。.因此，给声治疗患者明确的治疗方案、效果及治疗时间，正是我们亟待解决的难题。不同耳鸣患者具有不同的耳鸣特征，包括耳鸣性质、频率、响度及严重程度评估，听力损失程度等。面对如此众多的耳鸣特征，如何根据不同患者的耳鸣特点提取出具有代表性耳鸣特征，并归纳为有效的声学参量信息，从而根据该耳鸣特征予患者特异、有效的声治疗方案，是本课题研究宗旨。从而为患者提供有效的声治疗，为临床医生提供切实可行的耳鸣声治疗方案。

耳鸣是指没有外界声源时被感知到的声音。耳鸣的患病率为11.9%-30.3%，其中1%-5%的患者正经历着耳鸣产生的严重的不良影响，如焦虑、抑郁、恐惧、睡眠障碍、社交回避等，严重者会出现自杀行为。耳鸣已成为不能被忽视的全球性的生命健康问题。耳鸣缺乏特效的治疗方案，声刺激可以抑制或减弱耳鸣。2014年美国《耳鸣临床应用指南》中提到“临床医生可以建议持续性、恼人型耳鸣患者进行声音治疗”。自20世纪70年代医生首次使用宽带噪声治疗耳鸣以来，声治疗发展至今出现了多种多样的治疗方案，不同方案使用的声信号差别较大，治疗时间及次数也不固定，疗效不确切，缺乏大样本量研究的理论支持。为此，基于耳鸣发病机制，我们优化了耳鸣声治疗的方案。本课题一方面探讨了慢性耳鸣的特征及影响耳鸣严重性的主要因素；另一方面，研究了该声治疗方案对慢性耳鸣的治疗效果，分析了影响疗效的主要因素，以便筛选适合该声治疗的耳鸣特征人群；此外，通过与传统声治疗方案、安慰剂对比，证实该声治疗方案的优势。本课题研究成果可后续应用于临床，有利于缓解慢性耳鸣对部分患者的生活、工作、学习产生的不利影响，提高慢性耳鸣患者的生活质量，减少其反复就医诊治产生的医疗负担。