| ObjectiveTinnitus is the perception of sound in the ear or head without an external source which is one of otology refractory disease with high morbidity.The western medicine thinks that tinnitus has numerous etiology and unclear pathogenesis which leading to the lack of a well-established treatment so far.Although there are a large number of reports of Traditional Chinese Medicine(TCM)treatments of tinnitus,but high quality literature are rare,so the treatment effect has not been generally accepted.Past studies have shown that disharmony of spleen and stomach is the basic pathogenesis of tinnitus which is caused by improper diet,living impermanence or disordered emotion.These factors all depend on adjusting lifestyle by themselves.Health formula was released by the World Health Organization(WHO)shows that lifestyle in the health effects of 60%.To prevent and control chronic diseases by lifestyle adjustment has gradually drawn attention of people in recent years.This is the first population study about treating tinnitus with lifestyle adjustment.And we choose a more reliable tinnitus severity and curative effect evaluation standard for evaluation of therapeutic efficiency which is recommended by the current domestic profession of Chinese and western in this study.After analyzing the degree of lifestyle and other relevant factors for the effect of tinnitus,we may reveal the value of the lifestyle adjustment based on the guidance of the philosophy of TCM on the curative effect of tinnitus.medicine.MethodsMake a survey among out-patients and inpatients with tinnitus that is in accordance with diagnostic criteria and treated in ENT Department of the First Affiliated Hospital of Guangzhou University of TCM from March 2015 to September 2016.All of the patients must be more than 18 years old and cooperate with the investigation,then ruled out some patients who were received other treatment that may interfere with the treatment results.The therapy that has hag been used for tinnitus patients is to mainly adjust the lifestyle and supplement by Chinese herbs,auriculotherapy and massage.We have collected the basic information of the patients,detailed tinnitus information,hearing and systemic diseases at the first visit,then gathered information of tinnitus severity and lifestyle information at the subsequent visit and follow-up visit.Indicators of Tinnitus Severity(ITS)were used to get score of tinnitus severity of patient visits that was recommended by the current domestic profession of Chinese and western medicine.The higher the ITS score,the more serious of the tinnitus.We used the habits of the self-designed questionnaire to collect lifestyle information during patient visits and obtain following lifestyle and tinnitus severity information of patients after their last visit by telephone.According to the tinnitus curative effect evaluation standard to evaluate the curative effect of treatment,there are two indicators consists of cure rate and effective rate as indicators of curative effect analysis.That quantitative lifestyle criteria developed by ourselves under the guidance of principle of TCM keeping in good health were used to quantitative score of lifestyle information consists of sleep,diet,mood and sports when collected before and after treatment respectively.The higher of lifestyle score,the more healthy of lifestyle.Put all the raw data collected finished data into the computer and set up the database,then use the office software Excel(2010)and SPSS 22.0 statistical software for data statistical analysis.There are statistically significant differences in P<0.05.Analysis of the content mainly includes the curative effect of statistics and the influence of lifestyle adjustment and other factors on the curative effect.Results1.General information:There are 239 cases included in the standard of tinnitus patients in this study.Among them,the male are of 138 cases(57.74%),female are of 101 cases(42.26%).Their age ranges from 18 to 79,and the average is 42.80 ± 14.OOyears old.The education background of all eligible constitution of 12 cases with primary school degrees,55 cases with junior high school degrees,45 cases with senior high school degrees,21 cases with technical secondary school degrees,31 cases with junior college degrees,57 cases with university degrees,12 cases with graduate degrees and more than,6 cases without degree information.197 cases(82.43%)sufferer from other basic diseases of the body and 42 cases(17.57%)had no systemic disease.57 cases(23.85%)had normal hearing,while 159 cases(66.53%)with hearing loss and 23 cases(9.62%)without hearing information.There are 81 cases with sound sensitivity(33.89%)and 158 cases without sound sensitivity(66.11%).The tinnitus parts of all eligible constitution of 75 cases(31.38%)in the left ear,41 cases(17.15%)in the right ear,97 cases(40.59%)in two ears,15 cases(6.28%)with intracranial ringing,7 cases(2.93%)with extracranial ringing,2 cases(0.84%)outside body,2 cases(0.84%)hard to describe.The duration of tinnitus ranges from 0.25 months to 480 months(39.72 months on average).The score of ITS ranges from 6 to 21 points at the first visit(12.42 points on average).2.Curative effect:After an average of 6.74 months of treatment with lifestyle adjustment we found that 27 cases were cured(11.30%),115 cases were markedly improved(48.12%),46 cases were effective(19.25%),51 cases were invalid(21.34%),the total effective rate of treatment was 78.66%and cure recovery rate was 11.30%.3.The curative effect of lifestyle adjustment:(1)the food,sleep,mood,sports scores and lifestyle score of 239 cases was respectively 15.20±2.88?20.96±3.55?22.52±3.42?8.88±1.61?67.56±6.98 points on average before treatment,after treatment lifestyle scored an average of 22.36±4.55?25.48±3.40?26.83±3.58?9.51± 1.16?84.19 ±10.02 points respectively,the lifestyle score after treatment is significantly higher than before treatment(P<0.05),That prompting the lifestyle of patients after treatment in general is relatively healthy before treatment.The lifestyle score of after treatment between four groups consists of healing,excellen,valid and void was statistically difference(P<0.05),the higher the lifestyle score after treatment,the better the curative effect of tinnitus.(2)When the overall degree of lifestyle adjustment after treatment was different,their curative effect was also different.The cure rate of fewer lifestyle adjustment group,more lifestyle adjustment group,best lifestyle adjustment group were 0.00%,1.85%and 0.00%respectively;The effective rate of the three groups were 26.83%,80.56%and 100.00%respectively,Both the cure rate and the effective rate of the three groups difference had statistically significant differences(P<0.05).The cure rate and effective rate of tinnitus were significantly increased with the degree of compliance with the recommended lifestyle adjustment.(3)The amount of improvement was related to the degree of compliance with the recommended lifestyle adjustment that included sleep,diet,mood,exercise after treatment individually.The cure rate and effective rate of strict lifestyle adjustment group were much higher than the group that was not following the recommended lifestyle adjustment strictly(P<0.05).(4)Based on the results of multiple regression analysis between the four factors of lifestyle and the curative effect,we found that the effect of diet adjustment was the biggest,followed by mood adjustment and sleep adjustment,and exercise habits of weaker influence on curative effect.4.The ITS variation score has all of the positive correlations with the overall variation score of lifestyle before and after the treatment,the overall score of lifestyle after treatment,the variation scores of diet,sleep,mood and exercise before and after the treatment,their correlation coefficients are 0.805?0.705?0.697?0.632?0.611?0.100 respectively.This means that ITS variation score has strong correlation with the overall variation score of lifestyle before and after the treatment,lifestyle score after treatment and variation score of diet before and after the treatment;ITS variation score has moderate correlation with the variation scores of sleep and mood before and after treatment;ITS variation score has weak correlation with the variation score of exercise before and after the treatment.5.Other factors affect curative effect:(1)Course Period of treatment:the cure rate and effective rate of tinnitus increase with the increase of course of treatment.The course of treatment is divided to sections as one month,1~3 months,3~6 months and over 6 months,their cure rates were 3.77%,7.95%,9.21%,7.95%respectively,their effective rates were 10.04%,30.54%,42.26%,78.66%respectively,the differences were statistically significant(P<0.05).(2)Tinnitus severity:tinnitus cure rate decreased with the increase of severity(P<0.05),but the effective rate was higher(P<0.05);Multi-factors analysis showed that the tinnitus severity of the first visit only has weak influence on the curative effect of tinnitus represented by the ITS variation score.(3)Hearing:single factor and multiple factors analysis all showed that the cure rate decreased with hearing loss;But the effective rate of tinnitus has no relation with the presence of hearing loss.6.Irrelevant factors with the curative effect:(1)the duration of use of traditional Chinese medicine(TCM):tinnitus cure or not has nothing to do with taking Chinese traditional medicine time over the percentage of the course of treatment(P>0.05);but the time of taking Chinese traditional medicine over the percentage of the course of treatment for the valid group is shorter than that of the invalid group(P<0.05).It means that increasing the time of taking Chinese traditional medicine couldn' t improve the curative effect.(2)the course of the disease:single factor analysis showed that the curative rate(18.52%)of tinnitus for the course of disease within six months duration was higher than the course of more than half a year(7.59%),the difference was statistically significant(P<0.05),but effective rate has no statistical difference between two groups(P>0.05);Multiple factors analysis showed that the course of disease didn't affect the curative rate and effective rate of tinnitus.(3)the factors such as gender,age,whether or not associated with systemic disease,whether or not associate with sound sensitive and tinnitus psychological acoustic features had no obvious influence on the curative rate and effective rate of tinnitus(P>0.05).Conclusion1.For the first time,this article carried out the long term follow-up visit of the curative effect by using the lifestyle adjustment scheme under the guidance of keeping in good health view of traditional Chinese medicine to cure tinnitus on the basis of conventional treatment of traditional Chinese medicine.The follow-up results of 239 cases showed that the cure rate of tinnitus was 11.30%,total effective rate was 78.66%,the curative effect is satisfied.In the process of clinical tinnitus treatment,need to pay attention to the lifestyle adjustment.2.For the first time,this article carried out the quantitative evaluation of lifestyle based on the principle of Chinese medicine keeping in good health way of life,as a basis for the evaluation of lifestyle is healthy or not.Single factor and multiple factors analysis results show that the decisive factors affecting the curative effect of tinnitus are medically indicated in patients with enforcement of lifestyle adjustment,namely the closer to health standard by lifestyle adjustment,the better curative effect.Among four factors of lifestyle such as diet,sleep,mood and exercise,with the effect of diet on the biggest,followed by the adjustment of the mood and sleep habits,the effect of exercise habits adjust to the weakest.3.Under the premise of following the doctor' s advice to adjust lifestyle,the longer course of treatment,the better curative effect.Tinnitus severity has certain influence on the curative effect,namely the more serious tinnitus,the lower cure rate of tinnitus,but effective rate might be slightly higher.For those with hearing loss,the cure rate of tinnitus as lower than those with normal hearing,but has no influence on the effective rate.4.The curative effect of treatment of tinnitus by lifestyle adjustment has no relation with the course of tinnitus,taking time percentage accounted for the entire course of Chinese traditional medicine,and the patient's gender,age,whether associated with systemic disease or not,whether with sound sensitive or not,tinnitus psychological acoustic features and other factors. |
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