多整合方法用于耳鸣表型引导的耳鼻咽喉科、牙科和物理治疗照护

文献信息

中文摘要

背景： 耳鸣是一种异质性感知，当其伴有临床意义显著的痛苦或功能损害时即成为一种障碍。听力损失是主要促成因素，而颞下颌、颈椎、睡眠、心理及情境因素可塑造症状表现。这种异质性支持协调评估，但其本身并不能证明整合照护路径可改善结局。目的：对与表型引导耳鸣照护相关的证据进行叙述性综合，并提出一个临床-组织框架，以协调耳鼻咽喉科与听力学照护、牙科与颞下颌管理、物理治疗康复以及补充性行为与睡眠干预。方法：参照SANRA制定了一项结构化叙述性综述。检索了PubMed/MEDLINE、Cochrane图书馆、主要指南数据库及针对性引文检索，纳入2014年1月至2026年8月12日的英文证据，并保留早期奠基性文献。优先纳入指南、系统综述、随机试验及具有临床信息价值的观察性研究。由于异质性显著，研究结果按主题综合而非合并。结果：证据分为三个层次。指南支持或相对较强的证据支持诊断评估、教育、认知行为治疗以及有指征时的听力康复。颞下颌与颈椎干预的证据较为有限，且为来自小型异质性研究的表型特异性证据。尚无比较性研究将所提出的整合框架作为完整治疗方案进行验证。因此，我们将协调、表型门控转诊、共享结局以及明确的适应或停止规则作为一个产生假设的组织模型提出。结论：所提出的框架应被视为一个产生假设的组织模型，而非经过验证的治疗方案。其各组成部分保留各自的证据水平，前瞻性研究应使用临床与卫生经济学结局，将协调框架与常规或标准照护进行比较。

英文摘要

Background: Tinnitus is a heterogeneous percept that becomes a disorder when it is accompanied by clinically meaningful distress or functional impairment. Hearing loss is a major contributor, while temporomandibular, cervical, sleep, psychological, and contextual factors can shape symptom expression. This heterogeneity supports coordinated assessment, but it does not by itself prove that an integrated care pathway improves outcomes. Objective: To narratively synthesize evidence relevant to phenotype-guided tinnitus care and to propose a clinical-organizational framework for coordinating otolaryngological and audiological care, dental and temporomandibular management, physiotherapeutic rehabilitation, and complementary behavioral and sleep interventions. Methods: A structured narrative review was developed with reference to SANRA. PubMed/MEDLINE, the Cochrane Library, major guideline repositories, and targeted citation searches were examined for English-language evidence from January 2014 to 12 August 2026, with seminal earlier publications retained. Guidelines, systematic reviews, randomized trials, and clinically informative observational studies were prioritized. Owing to substantial heterogeneity, findings were synthesized thematically rather than pooled. Results: The evidence separates into three levels. Guideline-supported or relatively strong evidence underpins diagnostic assessment, education, cognitive behavioral therapy, and hearing rehabilitation when indicated. Temporomandibular and cervical interventions have more limited, phenotype-specific evidence from small and heterogeneous studies. No comparative study has validated the proposed integrated framework as a complete treatment package. We therefore present coordination, phenotype-gated referral, shared outcomes, and explicit adaptation or stop rules as a hypothesis-generating organizational model. Conclusions: The proposed framework should be regarded as a hypothesis-generating organizational model rather than a validated treatment package. Its individual components retain their own levels of evidence, and prospective studies should compare the coordinated framework with usual or standard care using both clinical and health-economic outcomes.