Audiološki etiološko faktori hroničnog subjektivnog tinitusa

Abstract

Uvod: Epidemiološke studije govore da oko 10%–16% odrasle populacije pati od hroničnog zujanja u ušima. Patnja koju izaziva ovaj osećaj najviše podseća na hronični neuropatski bol. Još uvek se ne zna sve o etiologiji i mehanizmu nastanka ove bolesti. Može uticati na celokupan život pojedinca, sprečava intelektualni rad i narušava kvalitet života. U nekim slučajevima tinitus može izazvati samoubistvo. Ne postoji efikasan lek za lečenje ove tegobe. Cilj: Ispitati moguće audiološko-etiološke faktore rizika za nastanak tinitusa i njihovu vezu sa oštećenjem sluha. Materijal i metode: Studija je zamišljena kao kohortna korelaciona, prospektivna analitička studija. U prvom delu studije pacijentima uključenim u istraživanje određen je audiološki profil; on je poređen sa audiološkim profilom osoba iz kontrolne grupe; merene su jačina doživljenog tinitusa i dužina njegovog trajanja; tražen je odnos između tih parametara. Ispitivana grupa imala je 61 pacijenta muškog i 56 pacijenata ženskog pola, ukupno 117 pacijenata (M = 60, SD = 13), dok su u kontrolnu grupu uključena 42 pacijenta muškog i 46 pacijenata ženskog pola, ukupno 88 pacijenata (M = 59, SD = 13,9). U drugom delu studije, pacijentima sa tinitusom određena je učestalost kardiovaskularnog komorbiditeta – hipertenzije, aritmije i dijabetesa. Meren je nivo ukupnog holesterola i triglicerida i ustanovljen stepen angiopatije na očnom dnu. Parametri su poređeni sa onima u kontrolnoj grupi. U samoj ispitivanoj grupi poredili smo one sa komorbiditetom i bez njega u pogledu audiograma i jačine zvuka koju pacijent doživljava. Uključeno je 80 pacijenata sa tinitusom – 41 pacijent muškog i 39 ženskog pola (M = 61, SD = 39; u kontrolnoj grupi M = 59,5, SD = 13,9). Treći deo studije se sastojao iz traženja dominantnog afektivnog temperamenta kod pacijenata sa hroničnim subjektivnim tinitusom u zavisnosti od pola, oštećenja sluha i godina starosti. Uključena su bila 92 ispitanika sa tinitusom, starosti M = 59,6, SD = 13,11, od toga 44 muškog i 48 ženskog pola i 71 ispitanik bez tinitusa, starosti M = 59,31, SD = 14,2, od toga 39 muškog i 42 ženskog pola. Instrumenti istraživanja: Upitnik o zdravstvenom stanju pacijenta i sociodemografskim karakteristikama, otorinolaringološki pregled, audiološkovestibuloško ispitivanje, upitnik o kardiovaskularnom komorbiditetu, oftamološko ispitivanje očnog dna, korišćen je Keith-Wagener-Barker (KWB) sistem klasifikacije, TEMS-A skala temperamenta Rezultati: Audiogram ima strmi nishodni tok kod osoba sa tinitusom – razlika između pragova sluha susednih frekvenciji je visoko statistički značajna (r < 0,00). Ispitivana grupa ima statistički viši prag sluha na svim merenim frekvencijama od kontrolne grupe, ako iz ispitivane grupe isključimo osobe bez gubitka sluha (r < 0,05). Jačina tinitusa merenog VAS-om na levom uvu je 5,24 a na desnom 4,83. Ona je statistički značajna u korist levog uva u grupi sa oštećenjem sluha (r = 0,00) a veća je na desnom uvu u odnosu na levo u grupi bez oštećenja sluha (r = 0,24). Tinitus se pre javlja na levom uvu kod osoba sa oštećenjem sluha (r = 0,19), dok se kod osoba bez oštećenja sluha pre javlja na desnom uvu (r = 0,36). Koeficijent korelacije dobijen poređenjem prosečnog oštećenja sluha kod osoba sa tinitusom koje imaju oštećenje sluha i jačine tinitusa je 0,46 za desno i 0,32 za levo uvo a poređenjem dužine tinitusa i prosečnog gubitka sluha kod osoba sa tinitusom iznosi 0,28 za levo i 0,25 za desno uvo. Učestalost komorbiditeta u ispitivanoj grupi je 57%. Hipertenziju je imao 51% ispitanika (r = 0,93 u odnosu na kontrolnu grupu), dijabet 16% (r = 1,00 u odnosu na kontrolnu grupu) i aritmiju je imalo 19% (r = 0,77 u odnosu na kontrolnu grupu). U ispitivanoj grupi razlika u prosečnom pragu sluha između osoba sa komorbiditetom i bez njega za levo uvo je r = 0,03, a za desno uvo r = 0,00. Srednja vrednost ukupnog holesterola u ispitivanoj grupi iznosi 6,02 i statistički je značajna u odnosu na normalne vrednosti (r = 0,02) ali se ne razlikuje od one u kontrolnoj grupi. Stepen korelacije dobijen poređenjem stepena angiopatije i gubitka sluha na merenim frekvencijama u kontrolnoj grupi je visok na svim frekvencijama za oba uva (r < 0,05) a u ispitivanoj grupi je nizak za levo, dok za desno praktično ne postoji i vrednosti su oko nule. Vrednosti su značajno više u ispitivanoj grupi kod osoba bez komorbiditeta (r < 0,05). Skorovi tempermenata ne pokazuju razliku u odnosu na kontrolnu grupu bez obzira na to o kom polu je reč. Dominantni temperamenti u ispitivanoj grupi su anksiozni sa kognitivnom komponentom prosečnog skora 2,03 i hipertimični sa prosečnim skorom 2,12. Kod muškog pola dominira hipertimični i njegov skor je značajno veći od onoga u kontrolnoj grupi (r = 0,005), a kod ženskog je dominantan anksiozni značajno viši od onog kontrolne grupe (r = 0,02). U grupi bez oštećenja sluha dominira Hypertimic (kod muškaraca 3,16, a kod ženskog pola 1,85); kod muškaraca vrednosti hipertimičnog temperamenta blago padaju sa porastom sluha zamenjujući ga anksioznim, koji je kod oba pola praktično oko nule u grupi bez oštećenja sluha a dominira kod žena u svim grupama sa oštećenjem sluha (oko 3) i kod muškaraca sa većim oštećenjem sluha. U grupi mlađoj od 45 godina dominira Hyper (kod muškaraca 3,13 a kod žena 1,43). Skor za AnxC u grupi ispod 45 godina iznosi kod muškaraca 1,55 a kod žena 2,32. Prisustvo ovog temperamenta raste sa godinama kod oba pola. Zaključak: Faktori sredine i endogeni činioci koji dovode do oštećenja sluha igraju bitnu ulogu u mehanizmu nastanka tinitusa. U razumevanju ovog oboljenja, pored oštećenja sluha i kardiovaskularnog komorbiditeta, treba uključiti i psihološki profil, tj. afektivni temperament koji je kod ovih osoba hipertimični i anksiozni sa kognitivnom komponentom.

Introduction: According to epidemiological studies, about 10-16% of adult population suffer from chronic ringing or buzzing in ears. The suffering caused by this feeling is most similar to chronic neuropathic pain. The etiology and mechanism for generation of this disease are still not completely known. It can affect the entire life of an individual, prevent their intellectual work and disturb their quality of life. In some cases, tinnitus can cause suicide. There is no efficient drug to cure this health problem. Aim: To examine possible audiological-etiological factors for generation of tinnitus and their relationships with hearing impairment. Material and Methods: The study was designed as a cohort correlational prospective analytical study. In the first part of the study, the audiological profile of patients involved in the research was determined; it was compared with the audiological profile of persons from the control group; the intensity of experienced tinnitus and the length of its duration were measured; the relationship between these parameters was searched for. The examined group had 61 male patients and 56 female patients, i.e. the total of 117 patients (М = 60, SD = 13), whereas the control group had 42 male patients and 46 female patients, i.e. the total of 88 patients (M = 59, SD = 13.9). In the second part of the study, the frequency of cardiovascular comorbidities – hypertension, arrhythmia and diabetes were determined for tinnitus patients. The level of total cholesterol and triglycerides was measured and the degree of angiopathy in the eye fundus was established. The parameters were compared with those in the control group. In the examined group itself, those with comorbidities and those without them were compared with respect to the audiogram and the intensity of sound experienced by the patient. There were 80 tinnitus patients – 41 males and 39 females (М = 61, SD = 39; in the control group M = 59.5, SD = 13.9). The third part of the study consisted of searching for the dominant affective temperament in patients with chronic subjective tinnitus depending on their sex, hearing impairment and age. There were 92 tinnitus patients, aged М = 59.6, SD = 13.11, out of whom 44 males and 48 females, and 71 patients without tinnitus, aged M = 59.31, SD = 14.2, out of whom 39 males and 42 females. Research instruments: Health conditions and sociodemographic questionnaire, otorhinolaryngological examination, audiological and vestibular testing, questionnaire оn cardiovascular comorbidities, ophthalmological examination of the fundus, Keith-WagenerBarker (KWB) classification system, ТЕМPS-А temperament scale Results: The audiogram has a steeply sloping trend in persons with tinnitus – the difference between hearing thresholds for neighbouring frequencies is highly statistically significant (р<0.00). The examined group has a statistically higher hearing threshold at all measured frequencies than the control group, if the persons without hearing loss (р<0.05) are excluded from the examined group. The intensity of tinnitus measured by means of the visual-analogue scale (VAS) in the left ear is 5.24, and in the right one 4.83. It is statistically more significant in the left ear in the group with hearing impairment (р=0.00), and it is higher in the right ear if compared to the left one in the group without hearing impairment (р= 0.24). Tinnitus more often occurs in the left ear in persons with hearing impairment (р=0.19), while occurring more often in the right ear in persons without hearing impairment (р=0.36). The correlation coefficient obtained by comparing the average hearing impairment in persons with tinnitus who had hearing impairment and the intensity of tinnitus is 0.46 for the right ear and 0.32 for the left one, and the coefficient obtained by comparing the length of duration of tinnitus and the average hearing loss in persons with tinnitus is 0.28 for the left ear and 0.25 for the right one. The frequency of comorbidities in the examined group is 57%. Hypertension was found in 51% of patients (р=0.93 relative to the control group), diabetes in 16% (р=1.00 relative to the control group) and arrhythmia in 19% (р=0.77 relative to the control group). In the examined group, the difference in the average hearing threshold between the persons with comorbidities and those without them is (р=0.03) for the left ear and (р= 0.00) for the right ear. The mean value of the total cholesterol in the examined group is 6.02 and it is statistically significant relative to the normal values (р=0.02), but it does not differ from the one in the control group. The degree of correlation obtained by comparing the degree of angiopathy and hearing loss at the measured frequencies in the control group is high at all frequencies for both ears (р<0.05), and in the examined group it is lower for the left ear, while for the right one it practically does not exist and its values are around zero. The values are considerably higher in the examined group in persons without comorbidities (р<0.05). The temperament scores do not show any difference relative to the control group, regardless of gender. The dominant temperaments in the examined group are anxious-cognitive (AnxC) with the mean score of 2.03 and hyperthymic (Hyper) with the mean score of 2.12. The hyperthymic temperament is dominant in males and its score is considerably higher than in the control group (р=0.005), and in females the dominant anxious temperament is considerably higher than in the control group (р=0.02). In the group without hearing impairment, the dominant temperament is hyperthymic (in males 3.16, and in females 1.85); in males, the values of hyperthymic temperament mildly decrease with the increase in hearing and it is replaced with the anxious one, which is, in both genders, practically around zero in the group without hearing impairment, and it is dominant in females in all groups with hearing impairment (about 3) and in males with more severe hearing impairment. In the group aged less than 45, the dominant temperament is Hyper (3.13 in males, and 1.43 in females). The score for АnxC in the group below 45 is 1.55 in males and 2.32 in females. The presence of this temperament increases with age in both genders. Conclusion: The environmental factors and endogenic factors which lead to hearing impairment play an important role in the mechanism for generation of tinnitus. In order to understand this disease, in addition to hearing impairment and cardiovascular comorbidities, the psychological profile, i.e. affective temperament, which is hyperthymic and anxiouscognitive in these persons, should also be included.