听觉过敏与耳鸣之间的关联：患病率及对日常功能影响的分析

文献信息

中文摘要

背景： 听觉过敏是慢性主观性耳鸣患者中常见但常被低估的共病。声音耐受性降低与更重的耳鸣相关负担、沟通受损、社会参与减少以及日常功能较差有关。然而，已发表关于其患病率和临床影响的数据仍然有限且不一致。
目的： 确定慢性主观性耳鸣患者中听觉过敏的患病率，并评估其与耳鸣相关障碍、不适响度水平、听力损失程度及日常功能的关联。
方法： 这项横断面研究纳入194例年龄21-85岁的慢性主观性耳鸣患者。听觉过敏通过结构化临床访谈进行评估，访谈包括关于声音耐受性降低和声音诱发耳痛的问题，并测量不适响度水平（ULLs）。患者被分为两组：伴听觉过敏的耳鸣（T + H；n = 32）和不伴听觉过敏的耳鸣（T；n = 162）。耳鸣对日常功能的影响使用标准化且经临床验证的问卷——耳鸣障碍量表（THI）进行评估。数据采用适当的参数和非参数统计检验进行分析。
结果： 194例慢性耳鸣患者中有32例（16.5%）被识别出听觉过敏。伴听觉过敏的耳鸣患者（T + H）THI评分显著高于单纯耳鸣患者，表明耳鸣相关障碍更重（76.3 vs. 41.9；p < 0.001）。伴听觉过敏的患者ULL值也显著低于不伴听觉过敏的患者（p < 0.001）。
结论： 尽管文献中报道的耳鸣患者听觉过敏患病率存在差异，但我们的研究结果表明，听觉过敏是一种常见共病，与显著更重的耳鸣相关障碍有关。应将听觉过敏的常规评估，包括ULL测量，纳入耳鸣患者的临床评估，以促进全面诊断并优化管理。这些发现强调了在常规听力学实践中对耳鸣患者进行听觉过敏系统评估的重要性。

英文摘要

Background: Hyperacusis is a common, but often underrecognized comorbidity in patients with chronic subjective tinnitus. Reduced sound tolerance is associated with a greater tinnitus-related burden, impaired communication, reduced social participation, and poorer daily functioning. However, published data regarding its prevalence and clinical impact remain limited and inconsistent. Objectives: To determine the prevalence of hyperacusis in patients with chronic subjective tinnitus and to assess its association with tinnitus-related handicap, uncomfortable loudness levels, and degree of hearing loss and daily functioning. Methods: This cross-sectional study included 194 patients aged 21-85 years with chronic subjective tinnitus. Hyperacusis was assessed using a structured clinical interview that included questions on decreased sound tolerance and sound-induced ear pain and uncomfortable loudness level measurements (ULLs). Patients were categorized into two groups: tinnitus with hyperacusis (T + H; n = 32) and tinnitus without hyperacusis (T; n = 162). The impact of tinnitus on daily functioning was evaluated using a standardized and clinically validated questionnaire-the Tinnitus Handicap Inventory (THI). Data were analyzed using appropriate parametric and nonparametric statistical tests. Results: Hyperacusis was identified in 32 of 194 patients with chronic tinnitus (16.5%). Patients with tinnitus and hyperacusis (T + H) had significantly higher THI scores than those with isolated tinnitus, indicating greater tinnitus-related handicap (76.3 vs. 41.9; p < 0.001). Patients with hyperacusis also demonstrated significantly lower ULL values than those without hyperacusis (p < 0.001). Conclusions: Although the reported prevalence of hyperacusis among patients with tinnitus varies across the literature, our findings indicate that hyperacusis is a common comorbidity associated with significantly greater tinnitus-related handicap. Routine assessment of hyperacusis, including ULL measurements, should be incorporated into the clinical evaluation of patients with tinnitus to facilitate comprehensive diagnosis and optimize management. These findings highlight the importance of systematic assessment of hyperacusis in patients with tinnitus in routine audiological practice.