- 期刊
耳鳴臨床診療的新觀念與分類
The New Concept and Classification of Clinical Tinnitus Management
摘要
對耳鳴最早期的認識，認為耳鳴是從耳朵而來，故與聽力退化劃上等號，推演出試圖活化內耳毛細胞以及聲音遮蔽的療法，但效果有限。第二代於1990左右，神經生理學模式(Neurophysiological model)出現，耳鳴之不適反應會透過大腦的睡眠系統、情緒邊緣系統以及自律神經系統的交互影響，產生臨床上的症狀，併發惡性循環。耳鳴減敏療法(Tinnitus retrainingtherapy-TRT)此時應運而生，採用直接諮詢與聲音治療，到了90年代以後，有些精神科醫師和心理師發現單純的心理諮詢—認知行為療法(Cognitive behavior therapy-CBT)－成效也不錯，由此出現對耳鳴的第三代概念—耳鳴的腦內革命：對於病人以正面的，良善的解釋來去除恐懼，並且抑制中樞對於耳鳴的過度代償！但多年的經驗卻發現很多慢性耳鳴患者存有許多未被察覺的生理性障礙，比如耳咽管功能異常，潛在性的鼻竇炎，胃食道逆流，更年期症候群，睡眠呼吸中止症候群，藥物成癮，憂鬱症等等，造成耳鳴管控失調。因此新的耳鳴治療思維中，除正確解釋外，更在於尋找潛藏的病因，矯治可以改變的因素，以期恢復耳鳴的管控並容許管控得宜的耳鳴存在，這就是第四代耳鳴治療的新觀念與新分類。
並列摘要
The origin of tinnitus was first though to come from the ear itself, i.e. cochlea or inner ear. This notion (the 1^(st) generation) made tinnitus equivalent to hearing loss, which consequently developed the treatments focused on hair cell reactivation and tinnitus-masking with external sound. But these clinical results were unsatisfactory. In 1990s, through the hypothesis neurophysiological model, tinnitus was postulated (the 2^(nd) generation) to come from the central nervous system, i.e. the brain and a variety of clinical symptoms, or even a vicious cycle, could be ignited while the tinnitus aversive reaction arousing the limbic and autonomic systems. During this period, Tinnitus Retraining Therapy (TRT) was introduced to treat tinnitus with direct counseling and sound therapy. Later, more psychologists and psychotherapist were devoted to tinnitus treatment with Cognitive behavior therapy (CBT), which clinically merited as good and effective results as TRT. This experience summarized into a new notion (the 3^(rd) generation) of tinnitus treatment in 2000s - through a positive, encouraging and informative explanation to eliminate patients’ dread for tinnitus and to inhibit the over-compensation in the brain. However, after accumulating more than 20 years in clinical experience, we found chronic tinnitus concomitant with a variety of un-detected patho-physiological disturbances such as Eustachian tube dysfunction, silent paranasal sinusitis, gastro-esophageal reflux, menopause associated syndromes, obstructive sleep apnea syndromes, drug addiction, insomnia and depression. Recently, a new hypothesis about a tinnitus control system - frontostriatal gating - was developed to explain the co-existence of chronic tinnitus and other pathologic disturbances. By rebalancing the tinnitus control system and eliminating the undetected disorders, tinnitus might be well-controlled even it is still perceived or existed (the 4th generation).