| Objectives: Tinnitus is common and frequent disease which puzzles human survival quality;it is also the puzzled medical problem in the world. There are still no conclusive methods on Clinic to treat tinnitus, and there are also no uniform and recognized criteria for assess curative effect. So it is becomes a kind of important research problem which is intentioned and needed to solve urgently in Otorhinolaryngology. The treatment of TCM has superiority in treating tinnitus. Therapy methods based on syndrome differentiation is the essence methods of TCM. Syndrome differentiation is precondition of therapy, if syndrome differentiation is correct, there is good curative effect. In traditional methods of syndrome differentiation the information is collected by four diagnostic methods. However, many patients suffer only tinnitus and have no other symptoms, which have brought big difficulties in differentiating syndromes by traditional means. Recently some scholars begin to look for the objective index in syndrome differentiation of tinnitus, and find audiological tests may contain the relational information of TCM syndrome type. Through clinical research, Liu Peng etc. had observed and studied from simple index to more indexes, and combined the statistical method of multivariate discriminant analysis. They studied common symptoms of the Invasion of Wind-heat, the Liver-fire Up-stirring, the Stagnation of phlegm-fire, the Weakness of Spleen-stomach and the kidney-essence deficiency of tinnitus, and summarize discriminant function based on auditory index, and compare them with personal syndromes. In the upper research, the cases of tinnitus accompanied by typical Syndrome of TCM were verified on the foreseeability by standard contrast, and the cases of tinnitus that had notypical Syndrome of TCM were verified on the foreseeability by diagnostic remedy. The study aimed to verify the 5 syndrome-functions from the two different aspects through enlarging the sample amount. And according to this improve the veracity and maneuverability of TCM syndrome differentiation.Methods: All patients selected according to criterion of tinnitus come from the first hospital of Guangzhou TCM university from 2004, Jan. to 2006, Jan. And the research was divided into two projects. The first group included the cases of tinnitus accompanied by typical Syndrome of TCM. And syndrome differentiation was made by two doctors whose professional title were associate professor at least according to traditional 4 diagnostic methods. The syndrome is regarded as gold criterion. Pure tone test, acoustic immittance measurement and auditory brainstem response about 17 audiology indexes were detected for each patient. All data were added into multielement discriminant function, and computed to an objective type of syndrome. Sensitivity, specificity and accuracy of each syndrome were calculated. The second group was the cases of tinnitus that had no typical Syndrome of TCM. And they were divided into two groups including experiment and comparison group by random. The 17 audiology indexes were detected for each patient by the specially physician. Hold the test outcome into functions in order to differentiating syndromes. And the senior professors take charge of differentiation of syndromes by the account result and give corresponding prescription and drugs. The senior professors give the stringing the kidney herbal to the comparison group patients taking orally too. And compare the similarities and differences of the validity rate between two groups.Result: The study was verified on the foreseeability from two different aspects based on whether accompanied by typical Syndrome of TCM.The first aspect included 95 cases with typical Syndrome of TCM, 58 male and 37 female, the age from 14 to 73 years old, the mean age was 40.0 years old. There were 24 of the Invasion of Wind-heat, 14 of the Liver-fire Up-stirring, 14 of the Stagnation of phlegm-fire, 22 of the Weakness of Spleen-stomach and 21 of the kidney-essence deficiency. The foreseeability was verified that the discriminating mean accurate rate in the five discriminant functions attained 81. 7%, which was very close to the test itself. The discriminant functions of the Invasion of Wind-heat had lower sensitivity and accuracy than the test itself, but the specificity approached the testitself. Although its sensitivity was lower than the test itself, it has a lowest rate of missed diagnosis in the five discriminant functions, and its rate of wrong diagnosis wasn't high. So it approached the test itself and indicated the higher repeatability. The discriminant functions of the Liver-fire Up-stirring had a littler lower sensitivity than the test itself, but the specificity and accuracy were higher than the test itself, which indicated the relatively higher repeatability. The discriminant functions of the Stagnation of phlegm-fire had lower sensitivity than the test itself obviously, but the specificity and accuracy were higher than the test itself, which indicates a higher rate of missed diagnosis and the lower rate of wrong diagnosis if you used the function to distinguish the cases of tinnitus with the Stagnation of phlegm-fire. The discriminant functions of the Weakness of Spleen-stomach had lower sensitivity than the test itself obviously, but the specificity was higher than the test itself, and the accuracy approached the test itself which was highest in the five discriminant functions. It indicates a higher rate of missed diagnosis and the lower rate of wrong diagnosis, which had the similar tendency to the Stagnation of phlegm-fire. The discriminant functions of the kidney-essence deficiency had the highest specificity and the lowest sensitivity in the five discriminant functions, the accuracy rate attained 78. 9%, thus if you used the function to distinguish the tinnitus with the kidney-essence deficiency, there were a large number of missed cases, and if you had distinguished the cases of the kidney-essence deficiency, it is almost true.The second aspect included 101 cases of tinnitus that had no typical Syndrome of TCM. It includes 64 cases of experimental group and 37 cases of control group. The experimental group had 42 male and 22 female, the age from 18 to 78 years old, the mean age was 38.97 years old, and the course of disease between 0. 3 months and 240 months, the mean course of disease was 22. 12 months. According to the objective Syndrome Differentiation, there were 4 cases of the Invasion of Wind-heat, 27 cases of the Liver-fire Up-stirring, 10 cases of the Stagnation of phlegm-fire, 10 cases of the Weakness of Spleen-stomach and 13 cases of the kidney-essence deficiency. The control group included 18 male and 19 female, the age from 20 to 71 years old, the mean age was 43.70 years old, and the course of disease between 0.1 months and 120 months, the mean course of disease was 28.40 months. The sex, age, course and degree oftinnitus in two groups have no significant difference (P>0. 05). The result indicated that the score of tinnitus degree in two groups dropped after treatment, paired-samples T test showed the significant difference (P<0.01), which indicated the effectively in two groups. The reduced score of the experimental group (1.14) was bigger than that of the control group (0.76), but statistics showed the difference was not significant (P>0. 05). Effective rate of experimental group was 71.9%, and the control group was 48.6%, the statistics showed the significant difference (P<0. 05), which indicated the effective rate of experimental group was higher than the control group, and the discriminant functions have high clinical value. Except the validity rate of Syndrome of the Stagnation of phlegm-fire is lower (20%), the others are higher than 70% after treatment.Conclusions: The foreseeability verified that based on the indexes of audiometry, the accurate rate of the multivariate discriminant function of the five Syndromes, such as the Invasion of Wind-heat, the Liver-fire Up-stirring, the Stagnation of phlegm-fire, the Weakness of Spleen-stomach and the kidney-essence deficiency, is 81.7%, which very approach the test itself. These functions have some application value to the cases of tinnitus that have no typical Syndrome of TCM so as hard to differentiate. The Syndrome differentiation of the Invasion of Wind-heat and the Liver-fire Up-stirring are relatively true, and the Invasion of Wind-heat is preferential, but there are still some probabilities of wrong distinguish. If the Syndrome of the Weakness of Spleen-stomach or the kidney-essence deficiency were differentiated, its confidence is relatively high. But if the Syndrome of the Stagnation of phlegm-fire were differentiated, you must carefully consider some probabilities of wrong distinguish. If result of distinguish don't fit any Syndrome of the five, you may consider the Syndrome of the kidney-essence deficiency and think the treatment of invigorating the kidney because of the higher rate of missed diagnosis in the function of the kidney-essence deficiency.Because the samples in the research were less comparatively, so the result should be further study in the future. If we can continue enlarge the sample amount, extend observing time, select representatively items from the most indexes of audiometry and establish the optimum discrimination function, may improve its accurate rate of Syndrome Differentiation, offer basis on clinic,and avoid the blindness of therapy.
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