| Tinnitus is a subjective symptom of sound in the ear or skull when there is no corresponding sound source or electrical stimulation in the surrounding environment.Tinnitus can be divided into subjective tinnitus and objective tinnitus.Clinically,most patients with tinnitus present as subjective tinnitus,which is mainly caused by abnormal activity of brain nerves and may be related to different lesions such as ear,auditory nerve and systemic diseases.In this study,tinnitus assessment methods were studied for patients with normal pure tone threshold through a small sample Characteristics of tinnitus were analyzed for patients with different diseases with tinnitus through a large sample retrospective study,aiming to establish a standardized tinnitus assessment process by fine classification and subjective and objective assessment of tinnitus.At the same time,by combing the research progress of tinnitus genetics and analyzing the preliminary research results,it provides a reference for the future tinnitus genetics research.This study mainly includes the following parts:Part 1.Study on assessment methods of tinnitus without hearing loss in pure tone audimetryObjective:To explore the effective objective examination of the development,diagnosis and treatment of the subjective tinnitus.Method:26 ears with tinnitus and normal hearing were selected as the group of tinnitus,and 18 ears with normal hearing without tinnitus were selected as the control group.Audiological examinations were performed on the tinnitus group and the normal control group,including pure tone audimetry,tympanometry,high frequency extended audiometry,distortion produce otoacoustic emissions and auditory brainstem response.Tinnitus examination and Electroencephalogram test were performed on the tinnitus group.Results:There was no significant difference in the auditory threshold rate between the tinnitus group and the control group(P>0.05).However,at the same frequency of 12.5kHz,the average hearing threshold of the tinnitus group and the control group was statistically significant(P<0.05).The detection rate of otoacoustic emissions in the tinnitus group was 57.7%at 0.75Hz and 94.4%in the control group at the same frequency.The difference in otoacoustic emissions was statistically significant(P<0.05),and the other frequencies were not statistically significant(P>0.05).No significant difference in the latency,interphase period,amplitude of,?,? waves and ?/? amplitude ratio between tinnitus group and the control group(P>0.05).In tinnitus group,ratio of the wave ? amplitude was larger than that of the wave V amplitude was 53.9%(14/26),the control group was 0%.The difference between the two groups was statistically significant(P<0.05).In electroencephalogram examination,the loudness of tinnitus decreased in 85%of the patients after acoustic stimulation compared with that before acoustic stimulation.There was 5 patients' electroencephalogram outcomes had changes compared with that before acoustic stimulation.Conclusion:The objective examination of subjective tinnitus patients with normal hearing can help to find the early recessive function change,and provide reference for diagnosis and treatment of tinnitus.Electroencephalogram may be useful in evaluating the effect of acoustic stimulation.Part 2.Analysis of Tinnitus characteristics in patients with hearing loss In this part,a retrospective study was conducted on 1153 hospitalized patients in the department of otorhinology.According to different classification methods,tinnitus was classified and graded to explore the characteristics of tinnitus in different diseases.Meniere's disease,auditory neuropathy,noise-induced deafness,sensorineural deafness and sudden deafness are all characterized by moderate to severe tinnitus.In tinnitus tone matching,meniere's disease and auditory neuropathy were dominated by low frequency tones,while noise deafness,sensorineural deafness and nasopharyngeal carcinoma were dominated by high frequency tones.In tinnitus loudness matching,tinnitus loudness of patients with noise-induced deafness was lower,while that of patients with auditory neuropathy was higher.Patients with sensorineural hearing loss are often accompanied by different degrees of sleep disorders,anxiety and hyperacusis.Attentions should be paid to the psychological state of patients for appropriate intervention.Part 3.A preliminary study on related genetics of tinnitus Recent etiological studies emphasized the important role of genetic factors in tinnitus,but lack of reproducibility.This study retrospectively analyzed the gene research related to tinnitus in recent years.Found that gene studies related to tinnitus mainly involve growth associated proteins,immediate early genes,activity regulated cytoskeleton genes,receptor gene,potassium circulation pathway genes and neurotrophic factors.The studies of gene in patients with tinnitus are still in its infancy.Careful and accurate selection of subjects based on phenotype is required.This will help identify tinnitus genes or genes associated with tinnitus complications.In this study,we conducted comprehensive audiological assessment and gene testing on 37 patients with auditory neuropathy.The characteristics of tinnitus in different types of auditory neuropathy were analyzed,with the purpose of finding out the rare variation of monophyletic tinnitus.Our study shows that patients with different types of genetic mutations had different characteristics of tinnitus.Patients with OTOF gene mutation did not have tinnitus,while all patients with AIFM1 gene mutation had tinnitus symptoms of varying degrees.The characteristics of tinnitus in different types of patients have reference value for our understanding of various diseases and the differential diagnosis of diseases.The classification of diseases according to phenotypes combined with the further study of big data and the new generation of sequencing technology will play a key role on genetic research of tinnitus in the future. |
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