Title (srp)

Аудиолошки етиолошко фактори хроничног субјективног тинитуса

Author

Trifunović, Miroljub,

Contributor

Stojanović, Jasmina, 1969-
Jakovljević, Vladimir, 1971-
Baletić, Nenad, 1968-
Ignjatović Ristić, Dragana, 1963-

Description (eng)

Introduction: According to epidemiological studies, about 10-16% of adult population sufferfrom chronic ringing or buzzing in ears. The suffering caused by this feeling is most similar tochronic neuropathic pain. The etiology and mechanism for generation of this disease are stillnot completely known. It can affect the entire life of an individual, prevent their intellectualwork and disturb their quality of life. In some cases, tinnitus can cause suicide. There is noefficient drug to cure this health problem.Aim: To examine possible audiological-etiological factors for generation of tinnitus and theirrelationships with hearing impairment.Material and Methods: The study was designed as a cohort correlational prospectiveanalytical study. In the first part of the study, the audiological profile of patients involved in theresearch was determined; it was compared with the audiological profile of persons from thecontrol 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 malepatients and 56 female patients, i.e. the total of 117 patients (М = 60, SD = 13), whereas thecontrol 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 totalcholesterol and triglycerides was measured and the degree of angiopathy in the eye fundus wasestablished. The parameters were compared with those in the control group. In the examinedgroup itself, those with comorbidities and those without them were compared with respect tothe audiogram and the intensity of sound experienced by the patient. There were 80 tinnituspatients – 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 temperamentin 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 48females, and 71 patients without tinnitus, aged M = 59.31, SD = 14.2, out of whom 39 malesand 42 females.Research instruments: Health conditions and sociodemographic questionnaire,otorhinolaryngological examination, audiological and vestibular testing, questionnaire оncardiovascular comorbidities, ophthalmological examination of the fundus, Keith-WagenerBarker (KWB) classification system, ТЕМPS-А temperament scaleResults: The audiogram has a steeply sloping trend in persons with tinnitus – the differencebetween hearing thresholds for neighbouring frequencies is highly statistically significant(р<0.00). The examined group has a statistically higher hearing threshold at all measuredfrequencies than the control group, if the persons without hearing loss (р<0.05) are excludedfrom the examined group. The intensity of tinnitus measured by means of the visual-analoguescale (VAS) in the left ear is 5.24, and in the right one 4.83. It is statistically more significantin the left ear in the group with hearing impairment (р=0.00), and it is higher in the right ear ifcompared to the left one in the group without hearing impairment (р= 0.24). Tinnitus moreoften occurs in the left ear in persons with hearing impairment (р=0.19), while occurring moreoften in the right ear in persons without hearing impairment (р=0.36). The correlationcoefficient obtained by comparing the average hearing impairment in persons with tinnitus whohad hearing impairment and the intensity of tinnitus is 0.46 for the right ear and 0.32 for the leftone, 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. Thefrequency of comorbidities in the examined group is 57%. Hypertension was found in 51% ofpatients (р=0.93 relative to the control group), diabetes in 16% (р=1.00 relative to the controlgroup) 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 andthose without them is (р=0.03) for the left ear and (р= 0.00) for the right ear. The mean valueof the total cholesterol in the examined group is 6.02 and it is statistically significant relative tothe normal values (р=0.02), but it does not differ from the one in the control group. The degreeof correlation obtained by comparing the degree of angiopathy and hearing loss at the measuredfrequencies in the control group is high at all frequencies for both ears (р<0.05), and in theexamined group it is lower for the left ear, while for the right one it practically does not existand its values are around zero. The values are considerably higher in the examined group inpersons without comorbidities (р<0.05). The temperament scores do not show any differencerelative to the control group, regardless of gender. The dominant temperaments in the examinedgroup are anxious-cognitive (AnxC) with the mean score of 2.03 and hyperthymic (Hyper) withthe mean score of 2.12. The hyperthymic temperament is dominant in males and its score isconsiderably higher than in the control group (р=0.005), and in females the dominant anxioustemperament is considerably higher than in the control group (р=0.02). In the group withouthearing impairment, the dominant temperament is hyperthymic (in males 3.16, and in females1.85); in males, the values of hyperthymic temperament mildly decrease with the increase inhearing and it is replaced with the anxious one, which is, in both genders, practically aroundzero in the group without hearing impairment, and it is dominant in females in all groups withhearing impairment (about 3) and in males with more severe hearing impairment. In the groupaged less than 45, the dominant temperament is Hyper (3.13 in males, and 1.43 in females). Thescore for АnxC in the group below 45 is 1.55 in males and 2.32 in females. The presence of thistemperament increases with age in both genders.Conclusion: The environmental factors and endogenic factors which lead to hearingimpairment play an important role in the mechanism for generation of tinnitus. In order tounderstand 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.

Description (srp)

Uvod: Epidemiološke studije govore da oko 10%–16% odrasle populacije pati odhroničnog zujanja u ušima. Patnja koju izaziva ovaj osećaj najviše podseća na hroničnineuropatski bol. Još uvek se ne zna sve o etiologiji i mehanizmu nastanka ove bolesti.Može uticati na celokupan život pojedinca, sprečava intelektualni rad i narušavakvalitet života. U nekim slučajevima tinitus može izazvati samoubistvo. Ne postojiefikasan lek za lečenje ove tegobe.Cilj: Ispitati moguće audiološko-etiološke faktore rizika za nastanak tinitusa injihovu vezu sa oštećenjem sluha.Materijal i metode: Studija je zamišljena kao kohortna korelaciona, prospektivnaanalitička studija. U prvom delu studije pacijentima uključenim u istraživanjeodređen je audiološki profil; on je poređen sa audiološkim profilom osoba izkontrolne grupe; merene su jačina doživljenog tinitusa i dužina njegovog trajanja;tražen je odnos između tih parametara. Ispitivana grupa imala je 61 pacijenta muškogi 56 pacijenata ženskog pola, ukupno 117 pacijenata (M = 60, SD = 13), dok su ukontrolnu grupu uključena 42 pacijenta muškog i 46 pacijenata ženskog pola, ukupno88 pacijenata (M = 59, SD = 13,9). U drugom delu studije, pacijentima sa tinitusomodređena je učestalost kardiovaskularnog komorbiditeta – hipertenzije, aritmije idijabetesa. Meren je nivo ukupnog holesterola i triglicerida i ustanovljen stepenangiopatije na očnom dnu. Parametri su poređeni sa onima u kontrolnoj grupi. U samojispitivanoj grupi poredili smo one sa komorbiditetom i bez njega u pogleduaudiograma i jačine zvuka koju pacijent doživljava. Uključeno je 80 pacijenata satinitusom – 41 pacijent muškog i 39 ženskog pola (M = 61, SD = 39; u kontrolnoj grupiM = 59,5, SD = 13,9). Treći deo studije se sastojao iz traženja dominantnog afektivnogtemperamenta kod pacijenata sa hroničnim subjektivnim tinitusom u zavisnosti odpola, 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 beztinitusa, starosti M = 59,31, SD = 14,2, od toga 39 muškog i 42 ženskog pola.Instrumenti istraživanja: Upitnik o zdravstvenom stanju pacijenta isociodemografskim karakteristikama, otorinolaringološki pregled, audiološkovestibuloško ispitivanje, upitnik o kardiovaskularnom komorbiditetu, oftamološkoispitivanje očnog dna, korišćen je Keith-Wagener-Barker (KWB) sistem klasifikacije,TEMS-A skala temperamentaRezultati: Audiogram ima strmi nishodni tok kod osoba sa tinitusom – razlika izmeđupragova sluha susednih frekvenciji je visoko statistički značajna (r < 0,00).Ispitivana grupa ima statistički viši prag sluha na svim merenim frekvencijama odkontrolne 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 jestatistički značajna u korist levog uva u grupi sa oštećenjem sluha (r = 0,00) a veća jena desnom uvu u odnosu na levo u grupi bez oštećenja sluha (r = 0,24). Tinitus se prejavlja na levom uvu kod osoba sa oštećenjem sluha (r = 0,19), dok se kod osoba bezoštećenja sluha pre javlja na desnom uvu (r = 0,36). Koeficijent korelacije dobijenpoređenjem prosečnog oštećenja sluha kod osoba sa tinitusom koje imaju oštećenjesluha i jačine tinitusa je 0,46 za desno i 0,32 za levo uvo a poređenjem dužine tinitusai 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 nakontrolnu grupu) i aritmiju je imalo 19% (r = 0,77 u odnosu na kontrolnu grupu). Uispitivanoj grupi razlika u prosečnom pragu sluha između osoba sa komorbiditetom ibez njega za levo uvo je r = 0,03, a za desno uvo r = 0,00. Srednja vrednost ukupnogholesterola u ispitivanoj grupi iznosi 6,02 i statistički je značajna u odnosu nanormalne vrednosti (r = 0,02) ali se ne razlikuje od one u kontrolnoj grupi. Stepenkorelacije dobijen poređenjem stepena angiopatije i gubitka sluha na merenimfrekvencijama 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 suoko 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 bezobzira na to o kom polu je reč. Dominantni temperamenti u ispitivanoj grupi suanksiozni sa kognitivnom komponentom prosečnog skora 2,03 i hipertimični saprosečnim skorom 2,12. Kod muškog pola dominira hipertimični i njegov skor jeznačajno veći od onoga u kontrolnoj grupi (r = 0,005), a kod ženskog je dominantananksiozni značajno viši od onog kontrolne grupe (r = 0,02). U grupi bez oštećenja sluhadominira Hypertimic (kod muškaraca 3,16, a kod ženskog pola 1,85); kod muškaracavrednosti hipertimičnog temperamenta blago padaju sa porastom sluha zamenjujući gaanksioznim, koji je kod oba pola praktično oko nule u grupi bez oštećenja sluha adominira kod žena u svim grupama sa oštećenjem sluha (oko 3) i kod muškaraca sa većimoštećenjem sluha. U grupi mlađoj od 45 godina dominira Hyper (kod muškaraca 3,13 akod žena 1,43). Skor za AnxC u grupi ispod 45 godina iznosi kod muškaraca 1,55 a kodžena 2,32. Prisustvo ovog temperamenta raste sa godinama kod oba pola.Zaključak: Faktori sredine i endogeni činioci koji dovode do oštećenja sluha igrajubitnu ulogu u mehanizmu nastanka tinitusa. U razumevanju ovog oboljenja, poredoštećenja sluha i kardiovaskularnog komorbiditeta, treba uključiti i psihološkiprofil, tj. afektivni temperament koji je kod ovih osoba hipertimični i anksiozni sakognitivnom komponentom.

Description (srp)

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Object languages

Serbian

Date

2022

Rights

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