慢性耳鸣患者心理声学特性与心理应激、预后不良的关系研究-东南大学学报医学版

慢性耳鸣患者心理声学特性与心理应激、预后不良的关系研究

单位：郑州大学第一附属医院耳科, 河南郑州 450000

分类号：R764.4;R764.45

出版年·卷·期（页码）：2025·44·第五期（747-757）

摘要：

目的:探讨慢性耳鸣患者心理声学特性与心理应激、预后不良的关系。方法:选取2022年6月至2024年6月本院收治的265例慢性耳鸣患者为研究对象,均进行耳鸣心理声学特性检查,并采用焦虑自评量表(SAS)、抑郁自评量表(SDS)、心理应激反应问卷(SRQ)对患者心理应激状态进行评估。采用Pearson相关性分析法分析慢性耳鸣患者心理声学特性与心理应激的关系。此外,给予患者常规药物治疗、健康宣教与指导等,根据预后情况将患者分为预后良好组与预后不良组。对比两组患者耳鸣心理声学特性、心理应激变化,采用多因素Logistic回归分析其与预后不良的关系;使用Amos 24.0软件建立结构方程模型,通过Bootstrap法分析心理应激在慢性耳鸣患者耳鸣心理声学特性与预后的中介效应。结果:265例慢性耳鸣患者中有190例伴听力损失(71.70%),耳鸣主调频率以高频为主(177例,66.79%),耳鸣响度以≤5 dB SL患者占比最高(143例,53.96%),Feldman曲线分类以间距型占比最高(152例,57.36%),残余抑制试验阳性患者最多(165例,62.26%),入院时SAS评分为(48.15±8.83)分,SDS评分为(49.35±9.38)分,SRQ问卷评分为(71.88±11.75)分,听力损失、耳鸣主调频率高频、耳鸣响度≥11 dB SL以及残余抑制试验阳性患者入院时SAS、SDS、SRQ问卷评分均高于听力正常、耳鸣主调频率低中频、耳鸣响度≤5 dB SL或6~10 dB SL、残余抑制试验阴性患者(P＜0.05);经Pearson相关性分析,慢性耳鸣患者纯音听阈、耳鸣主调频率、耳鸣响度、残余抑制试验阳性与心理应激(入院时SAS、SDS、SRQ问卷评分)呈正相关(P＜0.05)。265例慢性耳鸣患者预后不良率为22.26%(59/265);预后不良组中听力损失、耳鸣主调频率高频、耳鸣响度≥11 dB SL患者占比高于预后良好组(P＜0.05),预后不良组治疗前后的SAS、SDS、SRQ问卷评分均高于预后良好组(P＜0.05),预后良好组治疗后SAS、SDS、SRQ问卷评分均低于组内治疗前(P＜0.05);多因素Logistic回归分析显示,听力损失、耳鸣主调频率高频、耳鸣响度≥11 dB SL均是慢性耳鸣患者预后不良的危险因素(P＜0.05)。根据结构方程模型,耳鸣心理声学特性对预后不良的直接效应为0.62,通过SAS量表、SDS量表、SRQ问卷的间接效应分别为0.25、0.24、0.30,中介效应占总效应的28.74%、27.91%、32.61%。结论:慢性耳鸣患者心理声学特性与患者心理应激存在相关性,且听力损失、耳鸣主调频率高频、耳鸣响度≥11 dB SL是影响慢性耳鸣患者预后不良的重要因素,心理应激在慢性耳鸣患者耳鸣心理声学特性与预后间发挥部分中介效应。

Objective: To explore the relationship between psychoacoustic characteristics and psychological stress, poor prognosis in patients with chronic tinnitus. Methods: 265 patients with chronic tinnitus admitted to our hospital from June 2022 to June 2024 were selected as the research subjects. The tinnitus psychoacoustic characteristics of them were examined, and the psychological stress status of the patients was evaluated using the Self-Rating Anxiety Scale(SAS), Self-Rating Depression Scale(SDS) and Stress Response Questionnaire(SRQ). The relationship between psychoacoustic acoustic characteristics and psychological stress in patients with chronic tinnitus was analyzed using Pearson correlation analysis. In addition, patients were given routine medication treatment, health education and guidance, and they were divided into a good prognosis group and a poor prognosis group based on prognosis. The psychoacoustic characteristics of tinnitus and psychological stress changes between two groups of patients were compared, and its relationship with poor prognosis was analyzed using multiple Logistic regression analysis. A structural equation model was established using Amos 24.0 software, and the mediating effect of psychological stress on the tinnitus psychoacoustic acoustic characteristics and prognosis in patients with chronic tinnitus was analyzed using Bootstrap method. Results: Among 265 patients with chronic tinnitus, 190 cases had hearing loss(71.70%), and the main frequency of tinnitus was high frequency(177 cases,66.79%), and the patients with tinnitus loudness ≤5 dB SL accounted for the highest proportion(143 cases,53.96%), and the Feldman curve classification showed the highest proportion of interval type(152cases,57.36%), and the residual inhibition test positive patients were the most common(165 cases,62.26%), and SAS score at admission was(48.15±8.83) points, and SDS score at admission was(49.35±9.38) points, and SRQ questionnaire score at admission was(71.88±11.75) points. The SAS, SDS and SRQ questionnaire scores of patients with hearing loss at admission, high frequency of tinnitus tone, tinnitus loudness≥11 dB SL and positive residual inhibition test were higher than those of patients with normal hearing, low mid frequency tinnitus tone, tinnitus loudness ≤5 dB SL or 6-10 dB SL and negative residual inhibition test(P<0.05). According to Pearson correlation analysis, the pure tone hearing threshold, tinnitus main tone frequency, tinnitus loudness, positive residual inhibition test were positively correlated with psychological stress(SAS, SDS, SRQ questionnaire scores at admission) in patients with chronic tinnitus(P<0.05). The poor prognosis rate of 265 patients with chronic tinnitus was 22.26%(59/265). The proportions of patients with hearing loss, high frequency of tinnitus main tone and tinnitus loudness ≥11 dB SL in the poor prognosis group were higher than those in the good prognosis group(P<0.05), and the SAS, SDS and SRQ questionnaire scores of the poor prognosis group before and after treatment were all higher than those of the good prognosis group(P<0.05). The SAS, SDS and SRQ questionnaire scores of the good prognosis group after treatment were all lower than those before treatment within the group(P<0.05). Multivariate Logistic regression analysis showed that hearing loss, high frequency of tinnitus main tone and tinnitus loudness ≥11 dB SL were all risk factors for poor prognosis in patients with chronic tinnitus(P<0.05). According to the structural equation model, the direct effect of tinnitus psychoacoustic acoustic characteristics on poor prognosis was 0.62, and the indirect effects through SAS scale, SDS scale and SRQ questionnaire were 0.25, 0.24 and 0.30 respectively, and the mediating effects accounted for 28.74%, 27.91% and 32.61% of the total effect. Conclusion: There is a correlation between the psychoacoustic characteristics of chronic tinnitus patients and their psychological stress, and hearing loss, high frequency of tinnitus main tone and tinnitus loudness ≥11 dB SL are important factors for affecting the poor prognosis of chronic tinnitus patients, and psychological stress plays a partial mediating effect between the tinnitus psychoacoustic acoustic characteristics and prognosis in patients with chronic tinnitus.

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