耳鳴에 관한 임상적 연구 (A Clinical Study of Tinnitus)
- 최인화
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- 한방안이비인후피부과학회지
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- 제14권2호
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- pp.134-145
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- 2001
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Introduction: Noises in the ear, whether real or imagined, are called tinnitus. Subjective causes of tinnitus(which is heard only by the patient) are extremely common and the majority of them are treated conservatively. For certain individuals their tinnitus is a major handicap; for others a trivial concern. The most common from of subjective tinnitus is a rushing, hissing or buzzing noise; it is frequently associated with sensorineural heanng loss. The patient may be unaware of the hearing loss, especially if it is a high frequency deficit of moderate severity. The character of the tinnitus may give a clue to the etiology. But the patient often has difficulty in explaining his/her tinnitus in absolute terms, as they have no other tinnitus with which to compare it but their own Tinnitus, like pain, is a subjective state and trying to objectively assess the severity is problematic. Audiological techniques to match subjective loudness to machine-produced noise may offer some help, in that sound intensity matches can bear little correspondence to subjective complaint. In spite of many studies, most patients presently seen complaining of tinnitus are told by their doctors that there is no treatment and that they will have to learn to live with this symptom. Objectives: To perform a clinical analysis of tinnitus and estimate the efficacy of Oriental Medical treatment according to the Byeonjeung(辨證). Subject: We studied 34 patients with complaints of tinnitus who had visited Pundang Cha Oriental Medicine Hospital Department of Otorhinolaryngology from March 1998 to February 2000. All of them had been treated 2 or 3 times a week with acupuncture treatment and had taken herbs according to the Byeonjeung(辨證) method. It was therefore possible for me to know whether their symptoms improved or not. Parameters Observed and Method: We treated them with acupuncture & herb-medication. Sometimes we gave them moxibustion or negative therapy with bloodletting at the acupuncture points(耳門, 聽宮, 聽會). Parameters Observed 1) Distribution of age & sex 2) Chief complaints 3) The sites of tinnitus 4) The quality of tinnitu 5) The duration of disease 6) The problem induced tinnitus 7) Factors increasing disease severity 8) The classification of the Byeonjeung(辨證) 9) The efficacy of treatments Results: 1. Age and sex distribution: The most common occurrence was found in males in their twenties: 6 males(
$17.7\%$ ), and in females in their thirties and over sixty: 8 females($23.5\%$ ). Total patient numbers for men and women were 20 men($58.8\%$ ), 14 women ($41.2\%$ ). 2. The most frequent major complaints were hearing disturbances related to tinnitus; and dizziness with tinnitus; each comprising 10 cases($29.4\%$ ). There were also 7 patients($20.6\%$ ) with only tinnitus. 3. Tinnitus sites: 13($38.2\%$ ) said that they felt tinnitus in both ears, equally. In the right ear, 9($26.5\%$ ), in the left, 6($17.7\%$ ). 4. The most frequent descriptive symptoms of tinnitus were: humming, hissing, buzzing etc. 5. The duration of disease. 14cases($41.2\%$ ) had a duration of less than 1 year. 6. 15cases($44.1\%$ ) complained that it was hard to watch TV or make a phone call because of tinnitus. 10 cases($29.4\%$ ) complained about depression. 7. Factors increasing severity of tinnitus: ⅰ) fatigue: 18cases($52.9\%$ ) ⅱ) stress/ tension: 10 cases($29.4\%$ ) ⅲ) alcohol and tobacco: 5cases($l4.7\%$ ) 8. Classification through Byeonjeung : ⅰ) 19 cases($55.9\%$ ) were classified as showing Deficiency syndrome. ⅱ) 15 cases($44.l\%$ ) were classified as showing Excess syndrome. The deficiency of Qi was 7($20.6\%$ ), deficiency of Xue, 8($23.5\%$ ) and insufficiency of the Kidney Yin & Yang, 4($11.8\%$ ). The flare of Liver fire was 8($23.5\%$ ) and phlegm-fire, 7($20.6\%$ ), 9. The efficacy of treatments showed: an improvement in 17cases($50.0\%$ ); no real improvement or changes in 13 cases($38.2\%$ ); and some worsening in 4 cases($11.8\%$ ). In the group with deficiency in Qi, 4($57.1\%$ ) improved, 1($14.3\%$ ) showed no change and 2($28.6\%$ ) were aggravated. In the cases of deficiency in Xue, 6($75.0\%$ ) improved, 2($25.0\%$ ) showed no change. In the cases of insufficiency of Kidney Yin & Yang, 3($75.0\%$ ) showed no change and 1($25.0\%$ ) were aggravated. In the group of flare of Liver fire, 4($50.0\%$ ) improved, 3($37.5\%$ ) no change and 1($12.5\%$ ) were aggravated. In the cases of phlegm-fire, 3($42.9\%$ ) improved, 4($57.1\%$ ) showed no change. Conclusion: We would recommend that any further studies of tinnitus utilize trial treatments of longer than 2 months duration, as any positive effects observed in our study showed that improvement occurred fairly slowly. And we suggest that this study could be utilized as a reference for clinical Oriental Medical treatment of tinnitus. If we try to apply music or sound therapy treatment properly combined with ours, we expect it to provide psycological stability in addition to inducing masking effects, even though it may not directly decrease or completely remove tinnitus.