Subjektif tinnitus tedavisinde Ege Üniversitesi yaklaşımı
Yükleniyor...
Dosyalar
Tarih
2016
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç Çalışmamızda toplumda oldukça sık görülen ve hayat kalitesinde anlamlı negatif etkilere neden olan subjektif tinnituslu hastalarında danışmanlık, maskeleme, ses zengileştirmesi ve alıştırma tedavisini içeren bir tinnitus tedavisi algoritmasının oluşturulması ve bunun etkinliğinin belirlenmesi amaçlanmıştır. Yöntem Çalışmaya Kasım 2014 ✹ Kasım 2015 tarihleri arasında Ege Üniversitesi Kulak Burun Boğaz Hastalıkları Kliniği'ne kronik subjektif tinnitus şikayetiyle başvuran ve daha önceki tedavilerden fayda görmemiş 60 hasta alındı. Hastalar toplam 5 grupta incelendi. Dört grupta (Grup 1, 2, 3, 4) farklı maskeleme cihazlarıyla total maskeleme, bir gruba ise habituasyon (Grup 5) tedavisi uygulandı. Maskeleme cihazından fayda görmeyen hastalara ise habituasyon tedavisi başlandı. Hastalar çalışmanın başında, 2.ayda ve 4.ayda tinnitus handikap anketi (THQ) ve görsel analog skala (VAS) sonuçlarıyla değerlendirildi. Maskeleme cihazından fayda gören hastalar grup A (18 hasta, %36), fayda görmeyip habituasyona geçilen hastalar grup B (32 hasta, %64), habituasyona devam eden hastalar ise grup C (10 hasta) olarak tekrar değerlendirildi. Bulgular Hastaların ortalama yaşı 51.62 yıl (29-76) olarak bulundu. Grup 1, 2 ve 4'te THQ skorları 2.ayda anlamlı olarak azaldı (p<0.05). VAS'ta tinnitus şiddeti (VASŞiddet) grup 1, 2 ve 3'te (p<0.05), tinnitusa bağlı rahatsızlık (VASRahatsızlık) grup 4'te ve tinnitusun yaşama olan etkisi (VASEtki) grup 2'de (p<0.05) anlamlı olarak azaldı. Grup A'nın 0.ay-2.ay ve 0.ay-4.ay THQ skorlarınında anlamlı azalma saptandı (p<0.05). Grup B'nin 0.ay-2.ay ve 0.ay-4.ay THQ skorlarınında anlamlı azalma saptandı (p<0.05). Grup C'nin 2.ay-4.ay ve 0.ay-4.ay THQ skorlarından anlamlı azalma saptandı (p<0.05). Sonuç Maskeleme cihazı ile total maskeleme uygulanması uygun hasta seçimi ve iyi hasta takibi ile etkili bir tedavi seçeneği olabilir ancak bu hasta grubu küçük bir popülasyonu oluşturmakta ve bu veriler uzun süreli takiple desteklenmelidir. İlk iki ayda maskeleme cihazı tedavisinden fayda görmeyen hastalarda habituasyon tedavisinin ve sadece habituasyon uygulanan hastalarda habituasyon tedavisinin etkinliğinin değerlendirilmesi için daha uzun süreli takip süreleri olan çalışmalara ihtiyaç vardır.
Aim The aim of this study was to define a management algorithm and to asses the effectiveness of masking therapy and habituation theraphy which is a combination of counseling and acoustic enrichment. Methods This study was carried out at the Ege University Otolaryngology Department between November 2014 and Nobemver 2015. Sixty chronic subjective tinnitus patients were included. Patients were evaluated in five groups. Total masking was implemented in four groups (group 1, 2, 3, 4) and habituation therapy in one group (group 5). Patients that did not benefit from masking therapy were offered habituation therapy. Patients were evaluated with tinnitus hanicap questionnaire (THQ) and visual analogue scale (VAS) in the beginning of the study and on the 2nd and 4th months. Patients were evaluated on the 2nd month and regrouped: patients that benefited from masking therapy were regrouped as group A (18 patients, 36%), patient that did not benefit from masking therapy and continued with habituation therapy were group B (32 patients, 64%) and patients that were only treated with habituation formed group C. Results THQ scores were found significantly lower at the end of the 2nd month in groups 1,2 and 4 (p<0.05). Tinnitus severity according to the VAS (VASSeverity) was significantly improved in groups 1, 2 and 3 (p<0.05). Tinnitus annoyance according to the VAS (VASAnnoyance) was significantly improved in group 4 and the effect of tinnitus on life (VASLife) was significantly lowered in group 2 (p<0.05). THQ scores of group A was significantly lower on the 2nd and 4th month compared to the beginning of the study (p<0.05). THQ scores of group B was significantly lower on the 2nd and 4th month compared to the beginning of the study (p<0.05). THQ scores of group C was significantly lower on the 4th month compared to the 2nd month and beginning of the study (p<0.05). Conclusion Total masking with the tinnitus masking device may be an efficient treatment option with proper patient selection and a good follow-up, however these patients constitute a small percentage of the tinnitus patients and this data has to be supported with the data yielded from studies with a longer follow-up duration. Studies with longer follow-up durations are warranted in order to assess the effectiveness of the habitaution treatment.
Aim The aim of this study was to define a management algorithm and to asses the effectiveness of masking therapy and habituation theraphy which is a combination of counseling and acoustic enrichment. Methods This study was carried out at the Ege University Otolaryngology Department between November 2014 and Nobemver 2015. Sixty chronic subjective tinnitus patients were included. Patients were evaluated in five groups. Total masking was implemented in four groups (group 1, 2, 3, 4) and habituation therapy in one group (group 5). Patients that did not benefit from masking therapy were offered habituation therapy. Patients were evaluated with tinnitus hanicap questionnaire (THQ) and visual analogue scale (VAS) in the beginning of the study and on the 2nd and 4th months. Patients were evaluated on the 2nd month and regrouped: patients that benefited from masking therapy were regrouped as group A (18 patients, 36%), patient that did not benefit from masking therapy and continued with habituation therapy were group B (32 patients, 64%) and patients that were only treated with habituation formed group C. Results THQ scores were found significantly lower at the end of the 2nd month in groups 1,2 and 4 (p<0.05). Tinnitus severity according to the VAS (VASSeverity) was significantly improved in groups 1, 2 and 3 (p<0.05). Tinnitus annoyance according to the VAS (VASAnnoyance) was significantly improved in group 4 and the effect of tinnitus on life (VASLife) was significantly lowered in group 2 (p<0.05). THQ scores of group A was significantly lower on the 2nd and 4th month compared to the beginning of the study (p<0.05). THQ scores of group B was significantly lower on the 2nd and 4th month compared to the beginning of the study (p<0.05). THQ scores of group C was significantly lower on the 4th month compared to the 2nd month and beginning of the study (p<0.05). Conclusion Total masking with the tinnitus masking device may be an efficient treatment option with proper patient selection and a good follow-up, however these patients constitute a small percentage of the tinnitus patients and this data has to be supported with the data yielded from studies with a longer follow-up duration. Studies with longer follow-up durations are warranted in order to assess the effectiveness of the habitaution treatment.
Açıklama
Anahtar Kelimeler
Tinnitus, Maskeleme Tedavisi, Habituasyon, Tinnitus, Masking Theapy, Habituation
