| Objective: Tinnitus is one of the most common otology diseases,its etiology is complex and the exact pathogenesis has not been fully elucidated.Although many studies have confirmed that tinnitus is closely related to hearing loss,and that hearing loss is a triggering factor for tinnitus,a considerable proportion of patients with tinnitus have a normal hearing when detected by regular pure tone audiometry.Due to the large measurement interval and the determination of the loudness interval of the normal audiology of tinnitus,there is a certain error rate in the auditory evaluation of tinnitus patients.Therefore,a new method for the precise detection of tinnitus has been gradually applied in clinical practice in the past two years.This study is to clarify whether there is hidden hearing loss in tinnitus patients with normal regular pure tone audiometry hearing while detected by the precise detection of tinnitus,to analyze and compare the difference between the precise detection and the regular audiological detection of tinnitus,and to explore whether the precise detection of tinnitus can provide more accurate information for auditory assessment and intervention of tinnitus patients with normal regular pure tone audiometry hearing.Methods: From August 2018 to February 2019,57 tinnitus patients(72 ears)with normal hearing in the Department of Otorhinolaryngology Hearing and Dizziness in Tianjin Medical University General Hospital were selected as the tinnitus group.At the same time,25 non-tinnitus patients(50 ears)with normal hearing were selected as the control group.The tinnitus group was subjected to regular pure tone audiometry,regular audiological detection of tinnitus,precise detection of tinnitus and distortion product otoacoustic emission(DPOAE)test.For the control group,regular pure tone audiometry,1/24 octave precise pure tone audiometry and distortion product otoacoustic emission(DPOAE)test were sequentially performed.The obtained detection result data were summarized and statistical analysis was performed using SPSS 22.0 software.Results: 1.In the tinnitus group,35 ears(48.6%)were detected the presence of the V-shaped notch hearing threshold curve by the 1/24 octave precise pure tone audiometry,2 ears were located in the low frequency range band(≤1 k Hz),7 ears were located in the medium frequency band(1 k Hz--4 k Hz)and the other 26 ears were located in the high frequency band(>4 k Hz).In the control group,5 ears(10.0%)were detected the presence of the V-shaped notch hearing threshold curve by the 1/24 octave precise pure tone audiometry,1 ear was located in the low frequency range band(≤1 k Hz),1 ear was located in the medium frequency band(1 k Hz--4 k Hz)and the other 3 ears were located in the high frequency band(>4 k Hz).The chi-square test showed a statistically significant difference between the two groups(P<0.01).2.Most of the tinnitus main tone frequencies were high frequency tinnitus no matter matched by the regular audiological detection or matched by the precise detection of tinnitus.The results of regular audiological detection of tinnitus showed that the main frequency of tinnitus was 73.61% in the high frequency band(>4 k Hz),19.44% in the medium frequency band(1 k Hz--4 k Hz),and 6.95% in the low frequency band(≤1 k Hz).The results of the precise detection of tinnitus showed that the main frequency of tinnitus was 75.00% in the high frequency band(>4 k Hz),16.67% in the medium frequency band(1 k Hz--4 k Hz),and 8.33% in the low frequency band(≤1 k Hz),of which 11.11% of the tinnitus main frequency is above 8 k Hz.3.The residual inhibition test was performed according to the regular audiological detection of tinnitus matching results.The results showed that the residual inhibition test was positive for 28 ears(38.89%)and the residual inhibition test was negative for 44 ears(61.11%).The residual inhibition test was performed according to the precise detection of tinnitus matching results.The results showed that the residual inhibition test was positive for 42 ears(58.33%)and the residual inhibition test was negative for 30 ears(41.67%).The chi-square test showed that the difference between the two was statistically significant(P<0.01).4.32 ears(91.42%)of tinnitus main tone frequency were located in the V-shaped notch hearing threshold curve,and the other 3 ears(8.58%)of tinnitus main tone frequency were located outside the V-shaped notch hearing threshold curve.5.In the control group,43 ears(86.00%)had their DPOAE completely elicited,and another 7 ears(14.00%)could not completely elicit the DPOAE at certain frequencies.In the tinnitus group,32 ears(44.44%)had their DPOAE completely elicited,and another 40 ears(55.56%)could not completely elicit the DPOAE at certain frequencies.The DPOAE amplitude of the tinnitus group was significantly lower than that of the control group at 750 Hz,5 k Hz,6 k Hz,7 k Hz and 8 k Hz.And the difference was statistically significant by independent sample t test(P<0.05).The DPOAE amplitude of the tinnitus group was lower than that of the control group at 1 k Hz,1.5 k Hz,2 k Hz,3 k Hz and 4 k Hz,but the difference was not statistically significant(P>0.05).6.Among the 40 ears of tinnitus group had their DPOAE completely elicited,37 ears(92.50%)of DPOAE unextracted frequency point was consistent with the tinnitus main tone frequency,and 3 ears(7.50%)of DPOAE unextracted frequency point was inconsistent with the tinnitus main tone frequency.7.Most of the DPOAE unextracted frequency points were located in the frequency range of the V-shaped notch.Among the 35 ears with V-shaped notch in the tinnitus group,33 ears(94.28%)of DPOAE unextracted frequency points were located in the frequency range of the V-shaped notch,and 2 ears(5.72%)of DPOAE unextracted frequencies points were located outside the frequency range of the V-shaped notch.Among the 5 ears with V-shaped notch in the control group,the 5 ears(100.00%)of DPOAE unextracted frequency points were all within the frequency range of the V-shaped notch.Conclusion: Tinnitus patients with normal hearing may have hidden hearing loss,and their hidden hearing loss is mostly in the high frequency range of 4 k Hz-8 k Hz.In addition,tinnitus patients with normal hearing are more likely to have potential damage of the cochlea than non-tinnitus patients with normal hearing.Precise tinnitus detection can not only significantly improve the positive rate of residual inhibition test in tinnitus patients,but also has obvious advantages for the discovery of hidden hearing loss in tinnitus patients with normal hearing.Therefore,the precise detection of tinnitus can provide more comprehensive and accurate information for the diagnosis and treatment of tinnitus patients with normal hearing. |
PDF Full Text Request