摘要
目的评估音乐联合认知行为疗法治疗主观性耳鸣的疗效及治疗前后静息态脑电中α波表现。方法对2017.5-2018.5于中山大学孙逸仙纪念医院就诊的主观性耳鸣,20例患者进行音乐治疗联合认知行为疗法,标记为治疗组;随机选取平均年龄、性别、侧别等相匹配的已进行音乐治疗的20例患者作为对照组。在治疗组中随机抽取8例采集治疗前后静息态闭眼EEG数据,并选取8例平均年龄、性别相匹配的健康人作为脑电对照组,采集静息态闭眼EEG数据。治疗过程定时填写耳鸣致残量表(Tinnitus Handicap Inventory,THI)、焦虑量表(Self-Rating Anxiety Scale,SAS)、耳鸣主观严重程度视觉模拟标尺(Visual Analogue Scale,VAS)进行随访。分别对治疗组治疗前后和正常人EEG进行α波源定位分析。结果经过音乐联合认知行为疗法治疗后耳鸣患者的THI、SAS和VAS评分均比治疗前低,经SPSS非参数秩和检验方法分析,THI治疗前后变化具有统计学意义(P<0.05)、VAS治疗前后变化具有统计学意义(P<0.05)、SAS治疗前后变化具有统计学意义(P<0.05);音乐联合认知行为疗法治疗前后患者的评分差值均比单纯进行音乐治疗的患者差值大,治疗组治疗前后THI差值为18.533±15.108,对照组治疗前后THI差值为5.636±12.120,两者经SPSS分析得出差值具有统计学意义(P<0.05);治疗组治疗前后VAS差值为1.866±1.505,对照组治疗前后VAS差值为0.181±1.789,两者经SPSS分析得出差值具有统计学意义(P<0.05);脑电检查,源定位分析后发现,经过音乐治疗联合认知行为疗法治疗耳鸣后耳鸣患者的α波活动的区域远离了边缘系统。结论音乐联合认知行为疗法治疗主观性耳鸣的疗效比单纯音乐治疗组明显有效,客观检查EEG特征波提取后源定位分析发现治疗后α波远离了边缘系统,这与主观检查THI、VAS、SAS的分值减少及患者自觉耳鸣改善情况相符,可证明音乐联合认知行为疗�
Objective To evaluate the efficacy of music combined with cognitive behavioral therapy in treating subjective tinnitus and presentation of alpha waves on resting EEG before and after treatment.Method Patients with subjective tinnitus(n=20)seen at Sun Yat-sen Memorial Hospital,Sun Yat-Sen University,from May 2017 to May 2018,underwent music therapy combined with cognitive behavioral therapy(the treatment group),with 20 randomly selected and age,gender and side-matched patients who had completed music therapy serving as the control.Eight patients in the treatment group were randomly enrolled to provide closed-eye EEG data before and after treatment,with 8 age and gender-matched healthy individuals providing EEG control.The THI,SAS and VAS were completed on a regular basis during treatment and follow-up.Alpha wave source localization analysis was performed before and after treatment in the treatment group.Results Following treatment,THI,SAS and VAS scores were lower than those before treatment(P<0.05).The changes in patients receiving music combined cognitive-behavioral therapy were greater than in patients treated with music only:18.533±15.108 vs 5.636±12.120 for THI and 1.866±1.505 vs 0.181±1.789 for VAS,respectively,(P<0.05);EEG examination and source localization analysis revealed that area of alpha wave activities moved away from the limbic system after treatment with music combined with cognitive behavioral therapy.Conclusion Music combined with cognitive-behavioral therapy was significantly more effective than music alone for subjective tinnitus.Source localization analysis after extraction of characteristic EEG waves demonstrated a shift away from the limbic system after treatment,which was consistent with reduction of THI,VAS and SAS scores and improvement of patients'tinnitus perception,supporting efficacy of music in combination with cognitive behavioral therapy for subjective tinnitus and its value in clinical application.
作者
陈泓钰
张心苑
郑亿庆
杨海弟
CHEN Hongyu;ZHANG Xinyuan;ZHEN yiqing;YANG Haidi(Southern Medical University Shunde Hospital(First People’s Hospital of Shunde);Department of Otolaryngology,Sun Yat-Sen Memorial Hospital,Sun Yat-Sen University;Department of Hearing and Speech Science,Xinhua College of Sun Yat-Sen University)
出处
《中华耳科学杂志》
CSCD
北大核心
2020年第6期1045-1049,共5页
Chinese Journal of Otology
基金
广东省自然科学基金(2017A030313585)
中山大学2018年度高校基本科研业务费青年教师培育项目(18ykpy20)支持。
关键词
主观性耳鸣
认知行为疗法
脑电图
Subjective Tinnitus
Cognitive Behavioral Therapy
Electroencephalography
