Objective: To investigate the auditory and speech abilities of children with congenital auditory neuropathy (AN) after cochlear implant (CI), and to analyze the role of genetic testing in predicting the postoperative outcomes of CI in AN patients. Methods: Fourteen children diagnosed with AN by audiological battery test and underwent CI surgery in Xijing Hospital of the Air Force Medical University from 2002 to 2021 were included in this study (9 males and 5 females), with an implantation age of (3.1±1.7) years (mean±standard deviation, the same as follows). The preoperative audiological results and deafness gene results were analyzed. Another 52 children with ordinary sensorineural hearing loss (SNHL) were selected as the control group (30 males and 22 females), with an implantation age of (2.2±0.9) years. The demographic factors such as age and gender were matched with those of the AN group. The modified Category Auditory Performance (CAP-Ⅱ) and Speech Intelligence Rate (SIR) were used to evaluate the development of postoperative auditory and speech abilities in two groups. The Mandarin Speech Test System was used to test the speech recognition rate of monosyllabic and disyllabic words and sentences. Matlab 2022 software was used to analyze the data. Results: The results of gene in 14 children with AN showed that 6 cases had OTOF gene mutations, 2 cases (siblings) were confirmed to have TNN gene mutations through whole exome sequencing, and the remaining 6 cases were not find any clear pathogenic gene mutations. All subjects underwent CI surgery with electrodes implanted into the cochlea smoothly, and there were no postoperative complications. After surgery, all AN children had improved auditory and speech abilities, but only 64% (9/14) of AN children with CI had auditory ability scores comparable to the control group of SNHL children (including 2 children with TNN gene mutations), and 36% (5/14) of AN children had lower scores than the control group of SNHL children.The average speech recognition rate of two children with TNN gene mutations was 86.5%, and of two children with OTOF gene mutations was 83.2%. Conclusions: AN children achieved varying degrees of auditory and speech abilities after CI, but the postoperative effects varied greatly. Some children achieved similar results as ordinary SNHL children, but there were still some children whose effects were worse than those of ordinary SNHL children. The postoperative efficacy of CI in two children with AN caused by TNN pathogenic genes were comparable to that of ordinary SNHL in children. Genetic testing had certain reference value for predicting the postoperative effect of CI in AN children.

Objective To study the clinical genetic phenotype of a hereditary deafness family, and provide genetic counseling and prenatal diagnosis for this family. Methods The genetic causes of patients were detected by the next-generation sequencing targeted panel to detect the pathogenic genes. The detected pathogenic mutations were confirmed by Sanger sequencing, and the prenatal molecular diagnosis of the family was performed by STR detection technology. Results Both generations of a family hare hereditary deafness with different causes. The proband was caused by the homozygous mutation of SLC26A4 gene c.919-2A＞G. The deafness of two fraternal twin daughters were caused by the compound heterozygous mutations c.5062＿ 5063 delCT/c.7396-1G＞A in MYO15A gene. Prenatal diagnosis results of the proband’s fetus during pregnancy showed that the risk of deafness was low, and successfully passed the newborn hearing screening after birth. Conclusion This study identified the genotype of this non-syndromic deafness family. In this study, it was first confirmed that the mutation of MYO15A gene c.5062＿5063delCT was pathogenic variation, which expanded the spectrum of pathogenic mutation of MYO15A gene.

Objective To study the influence of age and cognitive ability on benefits of hearing aids（HA） in the elderly, and to improve intervention and evaluation of HA benefits in the elderly with hearing loss. Methods Patients with hearing loss and wearing air conduction HA（n= 88） were divided into an elderly group（over 60 years, average age = 72.14 ± 8.52 years, n= 45） and a young and middle-aged group（20-60 years, average age = 39.96 ± 12.18 years, n= 43）. Pure tone hearing thresholds, maximum word recognition scores（WRS）, aided thresholds and speech recognition score in in the sound field at 65 dB SPL were obtained. The Chinese version of the international outcome inventory for hearing aids（IOI-HA） was used to assess effects of HA in actual listening environment; The Montreal Cognitive Assessment（MoCA） was used to evaluate cognitive function. Unpaired t-test was used to analyze the influence of age and cognitive ability on HA benefits. Results Average hearing threshold and aided threshold were not significantly different between the elderly group and the young and middle-aged group（P＞0.05）, although WRS was significantly lower in the former than in the latter（P＜0.05）. Total IOI-HA score was not significantly different between the two groups（P=0.538）.While average hearing threshold and aided threshold were not significantly different between the subjects with normal MoCA scores and those with abnormal scores in the elderly group（P＞0.05）, WRS and IOI-HA scores in the former were significantly higher than in the latter（P＜0.05）. Conclusion With comparable hearing loss, speech recognition ability with HA is significantly lower in the elderly than in the young and middle-aged, despite similar self-reported benefits of daily HA use. With equal degree of hearing loss, cognitive ability has a great impact on speech recognition ability with HA as well as overall benefits of HA in the elderly, suggesting the effects of age and cognitive function on the usefulness of HA and therefore the importance of early detection, early diagnosis and early intervention.

Objective:To investigate the safety and efficacy of regional parotid gland resection with small incision under microscope.Methods:The data of patients who underwent parotid tumor resection with small incision under microscope from January 2017 to November 2022 were retrospectively collected. The patients′ basic information, preoperative imaging data, intraoperative relevant information, and follow-up data were evaluated, and the occurrence of complications was analyzed.Results:A total of 78 patients were enrolled, including 36 males and 42 females, with a median age of 37 (28, 48) years. The operation time was (88.5±24.6) minutes. The amount of bleeding was (16.2±7.2) ml. The maximum diameter of tumors was less than 3.5 cm, and all the tumor was located in the superficial lobe of the parotid gland. The pathological results were all benign. The follow-up time was 3-60 months. There was no tumor recurrence and permanent facial nerve injury, and no other complications such as salivary leakage and infection occurred.Conclusions:Regional parotid resection with small incision under microscope is feasible, and its safety and efficacy need more cases and long-term follow-up studies.

当前医疗形势下,耳鼻喉专业的临床教学开展仍面临严峻的挑战,如教学内容枯燥抽象,理论教学与实践技能不匹配,新的专家共识及诊疗指南与临床教学不协调,无法有效激发学生学习、思考的积极性等,因此探索新的教学理念和方法,提升一线医生专业理论与实践相结合解决临床问题的能力,是耳鼻喉专业带教亟须思考的问题.本研究在耳鼻喉专业理论和实践带教工作中,运用基于问题的教学方法(PBL)联合案例式立体教学法(CTTM),把学科常见病、多发病及相关新的专家共识、诊疗指南和新进展等元素植入专业理论和实践教学中,促使一线医生将学科理论与临床技能融会贯通,既培养了临床思维能力,还有助于理论知识与实践技能的融合,丰富临床带教的方法和内容,提高临床带教的质量和水平.

目的 分析听性脑干反应(ABR)测试时强声刺激在4 ms左右出现的特殊正向波对诊断蜗神经发育不良(cochlear nerve deficiency,CND)的临床意义.方法 将磁共振成像(MRI)显示为蜗神经发育不良的患者56例(CND组103耳)作为研究对象,另选取50例(100耳)M RI提示蜗神经未见明显异常的极重度感音神经性聋患者作为对照组;两组均分别行ABR检测,分析ABR波形,判断强声刺激下4 ms左右是否记录到特殊正向波,并对此波形的特征进行分析.结果 ABR特殊正向波仅在高强度刺激声下引出,在100 dB nHL刺激声下二组对象中共32耳引出该特殊正向波,平均潜伏期为4.22±0.24 ms,平均反应阈为94.68±5.98 dB nHL;CND组103耳中28耳记录到特殊正向波,占27.18％,对照组100耳中4耳记录到此特殊正向波,占4.00％,此特殊正向波诊断CND的敏感性为27.18％,特异性为96.00％.结论 ABR测试在4 ms左右记录到的特殊正向波对诊断蜗神经发育不良的敏感性较低,但特异性极高,即出现此正向波可高度怀疑是CND,对CND的辅助诊断有重要作用.

目的 探究人工耳蜗植入后听障儿童听觉言语及社会适应能力的提升效果.方法 以我院2019年1月～2021年2月114例人工耳蜗植入听障儿童为研究对象,采用随机数字表法分为对照组及观察组,57例/组,对照组给予特殊儿童一对一康复教育,观察组在对照组基础上实施融合教育.比较两组干预前后有意义听觉整合量表(meaningful auditory integration scale,MAIS)、简易版普通话早期言语感知测试(lowverbal version of mandarin early speech perception test,LV-MESP)、普通话汉语沟通发展量表(chinese communication development index,CCDI)、儿童生存质量测定量表(pediatric quality of life,PedsQL)及社会情绪、适应能力评分变化情况.结果 观察组干预后MAIS、CCDI、LV-MESP评分及社会情绪、适应能力、PedsQL评分均高于对照组(P＜0.05).结论 将融合教育应用于人工耳蜗植入儿童干预中,可提高其听觉言语功能及沟通能力,并改善其社会适应能力及生存质量.

目的 慢性耳鸣病因复杂,研究旨在分析可能影响慢性耳鸣严重程度的因素.方法 对361例慢性耳鸣患者资料进行回顾性分析,所有患者进行纯音测听,声导抗,耳鸣心理声学及响度不适阈检测,所有患者均填写耳鸣病史调查表,THI、SAS,SDS,PSQI量表,听觉过敏评估量表,以THI评分≥38分判定为中-重度耳鸣组,THI评分≤36分判定为轻度耳鸣组.以THI分组作为应变量,上述各因素作为自变量,采用二元Logistical回归分析各因素与慢性耳鸣严重程度的相关性.结果 361例慢性主观性耳鸣患者中轻度耳鸣(THI≤36)组149例,中-重度耳鸣(THI≥38)组212例.二分类Logistic回归分析发现听觉过敏(OR=3.11)、抑郁障碍(OR=2.34)、头痛(OR=1.98)及睡眠障碍(OR=1.71)与耳鸣严重程度相关(P<0.05).结论 听觉过敏、抑郁障碍、头痛及睡眠障碍与慢性耳鸣严重程度相关,因此在治疗慢性耳鸣患者时应予关注.

目的 了解慢性主观性耳鸣患者的睡眠情况以及耳鸣合并睡眠障碍的影响因素.方法 回顾分析371例慢性主观性耳鸣患者(病程≥6个月)的临床资料.所有患者均接受纯音测听、声导抗、耳鸣心理声学(主频率匹配、响度匹配、掩蔽曲线、残余抑制)及响度不适阈(听觉过敏患者)检测,并填写耳鸣病史调查表、耳鸣残疾评估量表(THI)、焦虑自评量表(SAS)、抑郁自评量表(SDS)、匹兹堡睡眠质量指数(PSQI)量表、听觉过敏评估量表,以PSQI评分>5分判断为合并睡眠障碍,以SAS/SDS评分≥50分判定为合并焦虑/抑郁.分析慢性主观性耳鸣合并睡眠障碍的情况,并以PSQI评分作为因变量,以焦虑/抑郁、文化程度、听觉过敏、THI评分作为自变量,采用二项logistic回归分析各因素与慢性耳鸣合并睡眠障碍的相关性.结果 371例慢性主观性耳鸣患者中合并睡眠障碍225例(60.65％),PSQI评分与THI评分呈正相关(F=17.03,P<0.05).二项logistic回归分析结果发现,听觉过敏(OR=2.26)、文化程度(大学及以上,OR=0.36)、THI评分(OR=1.02)和焦虑(OR=1.08)与睡眠障碍有关.结论 慢性耳鸣患者常合并睡眠障碍,睡眠障碍的严重程度与耳鸣严重程度呈正相关.焦虑、听觉过敏、THI评分可能是慢性主观性耳鸣患者合并睡眠障碍的危险因素,受过高等教育有利于降低慢性耳鸣患者发生睡眠障碍的风险,在治疗慢性耳鸣患者时应关注这些因素.

噪声性聋(Noise induced hearing loss ,NIHL )又称噪声性听力损伤,是由于暴露于噪声环境中,导致耳蜗毛细胞损伤为典型性病理改变的一种进行性感音神经性聋.成年哺乳动物耳蜗毛细胞损伤后不能再生,是导致永久性听力损伤的主要原因.世界上约5％ 的人口遭受噪声导致的听力损伤,噪声性聋是世界工业化国家的一个主要职业风险,影响工人的交流,严重者会造成神经、内分泌和消化系统等功能受损,导致社会生产力下降[1].

该文分析1例中耳胆脂瘤合并胆固醇肉芽肿的临床特点,探讨机制和发病原因,总结经验教训.患者经检查确诊为中耳胆脂瘤合并胆固醇肉芽肿.手术选择完壁式鼓室成形术,同期鼓膜置入T型管.术后5个月未复发,右耳仍有混合性聋,气骨导差43 dB.分析原因胆脂瘤与胆固醇肉芽肿均与中耳负压有关,胆固醇肉芽肿可能是胆脂瘤破坏过程中导致出血所致.中耳胆脂瘤合并胆固醇肉芽肿罕见,但两者可以并存,该例原因考虑胆脂瘤上皮残留,阻塞鼓峡第二阀门,破坏颅底骨质导致出血从而形成胆固醇肉芽肿并局限乳突、上鼓室、鼓窦.治疗首先以清理病变为主,听力改善需二期手术处理.

目的 探讨语前聋患儿双模式(一侧人工耳蜗植入,对侧配戴助听器)干预与双侧人工耳蜗植入(co-chlear implantation,CI)后早期听觉言语康复效果以及生活质量,为语前聋患儿双侧干预模式的选择提供参考.方法 回顾性分析2016～2019年行双侧CI 28例(双侧CI组)和双模式干预28例(双模式组)语前聋患儿的临床资料,双侧CI组的平均植入年龄和术前助听器使用时长低于双模式组.所有患儿均于开机时、开机1、3、6和12个月时完成听觉行为分级标准(CAP)、婴幼儿有意义听觉整合量表(IT-MAIS)、言语可懂度分级标准(SIR)、有意义使用言语量表(MUSS)问卷填写,并于术后2±0.76年完成中文版CI儿童家长观点调查问卷(MPP),比较两组结果.结果 双模式组IT-MAIS得分在开机时(F=16.52,P<0.001)、开机1个月(F=12.02,P=0.001)、开机3个月(F=4.27,P=0.043)高于双侧CI组,之后两组间IT-MAIS得分无统计学差异(P>0.05).双模式组CAP分级在开机时(F=9.50,P=0.003)、开机1个月(F=8.70,P=0.005)高于双侧CI组,随后两组间CAP分级无统计学差异(P>0.05).双模式组术后MUSS得分高于双侧CI组(F=5.46,P=0.023).在开机时、开机1个月两组间SIR分级无统计学差异(P>0.05),在开机3个月(F=4.50,P=0.039)、6个月(F=10.89,P=0.002)和12个月时(F=5.46,P=0.023)双模式组SIR分级高于双侧CI组.MPP问卷的幸福感(F=9.15,P=0.004)、社会关系(F=5.03,P=0.029)和教育(F=7.97,P=0.007)维度得分双模式组高于双侧CI组,在交流、基本功能、自立能力、CI的效果和影响以及对患儿的支持维度两组间得分无统计学差异(P>0.05).结论 双侧CI与双模式干预患儿术后听觉言语能力均能取得较大进步;尽管术后早期双模式干预患儿的听觉言语能力进步更明显,但考虑到植入年龄、术前助听器使用时间等因素的影响,尚不能认为双模式干预的效果优于双侧CI.

目的 探讨重度阻塞性睡眠呼吸暂停综合征(OSAS)患者脉氧下降率与血压的相关性.方法 将2018年1月～2020年12月空军军医大学第一附属医院收治的重度OSAS患者80例和轻中度OSAS患者80例分别设为观察组和对照组,均行多导睡眠监测(PSG),比较2组患者的匹兹堡睡眠质量指数(PSQI)、夜间呼吸通气指标、脉氧下降率、血压,分析这些指标与病情严重程度的相关性.根据重度OSAS患者是否合并高血压,将观察组患者分为高血压组和血压正常组,比较2个亚组患者的PSQI、夜间呼吸通气指标、脉氧下降率,分析这些指标与患者血压的相关性.结果 观察组的PSQI评分、低通气指数(HI)、呼吸暂停指数(AI)、呼吸暂停低通气指数(AHI)、脉氧下降率、收缩压、舒张压均显著高于对照组(P值均<0.05),观察组的夜间平均血氧饱和度(SaO2)显著低于对照组(P<0.05).PSQI评分、HI、AI、AHI、脉氧下降率、收缩压、舒张压与OSAS患者病情严重程度呈正相关,夜间SaO2与OSAS患者病情严重程度之间呈负相关.高血压组的PSQI评分、HI、AI、AHI、脉氧下降率均显著高于血压正常组(P值均<0.05),而高血压组的夜间SaO2显著低于血压正常组(P<0.05).经相关性分析,PSQI评分、HI、AI、AHI、脉氧下降率与重度OSAS患者的血压均呈正相关,夜间SaO2与重度OSAS患者的血压呈负相关.结论 重度OSAS患者的夜间睡眠障碍、夜间呼吸通气受限均随着病情的加重而加重,而且夜间脉氧下降率越高,患者血压水平受到的影响越明显.

慢性失代偿性耳鸣是临床治疗的难题，明显影响患者生活质量。近年来，对慢性耳鸣的研究显示听力下降、失眠、焦虑和抑郁障碍、听觉过敏、头痛、慢性疼痛等因素可能是影响耳鸣代偿的常见因素，然而对于慢性耳鸣的代偿机制仍不清楚。了解急性耳鸣向慢性耳鸣的转变过程的病理机制可为深入研究耳鸣代偿机制及影响因素提供可靠依据。目前，对于急性耳鸣慢性化的研究较少，本文旨在介绍急性耳鸣慢性化的机制和影响因素研究进展，为研究急性耳鸣向慢性耳鸣的纵向转变过程提供理论依据。

目的 探讨儿童慢性化脓性中耳炎行鼓室成形术的疗效.方法 回顾性分析51例(51耳)行鼓室成形术的慢性化脓性中耳炎儿童年龄、手术方法、鼓膜愈合率、术后听力疗效.结果 51例患儿年龄7～17岁,平均12.98±3岁,51耳的鼓膜愈合率为90.2％(46/51);将患者分为≤13岁(26例)及>13岁(25例)两组,鼓膜愈合率分别为88.46％(23/26)、92.0％(23/25),差异无统计学意义(P>0.05);完成Ⅰ型鼓室成形术者35耳(68.63％),Ⅱ型鼓室成形术者16耳(31.37％),Ⅰ型和Ⅱ型鼓室成形术者术后术耳气骨导差较术前均有显著缩小(P<0.05);听力改善总有效率为78.43％(40/51),Ⅰ型和Ⅱ型鼓室成形术者听力改善的有效率分别为80％(28/35),75％(12/16).结论 7岁以上慢性化脓性中耳炎儿童的年龄可能不是影响鼓室成形术成功率的关键因素,但手术仍需谨慎.

目的 探究Waardenburg综合征患儿人工耳蜗植入后听觉言语康复效果以及生活质量情况,分析听觉言语康复效果影响因素,为Waardenburg综合征人工耳蜗植入患儿的术后效果评价提供参考.方法 回顾2011-2019年在我科行人工耳蜗植入的Waardenburg综合征(WS)患儿以及对照组患儿临床资料.随访汇总两组患儿的听觉行为分级标准(CAP)得分、言语可懂度分级标准(SIR)得分和中文版CI儿童家长观点调查问卷(MPP)得分,评估WS患儿人工耳蜗植入术后听觉言语康复效果和个人生活质量情况,并分析术后听力言语康复效果的影响因素.结果 WS组术后CAP分级和SIR分级无统计学差异.两组患儿术后生活质量得分,对照组患儿在交流(F=10.60,P=0.002)、幸福感(F=7.06,P=0.010)和社会关系(F=6.99,P=0.011)维度得分高于WS组.植入年龄(Z=-2.123,P=0.034)、监护人文化水平(Z=-2.106,P=0.035)、使用耳蜗时间(Z=-3.184,P=0.001)是WS患儿人工耳蜗术后CAP分级的影响因素.植入年龄(Z=-2.273,P=0.023)、监护人文化水平(Z=-2.026,P=0.039)、使用耳蜗时间(Z=-2.922,P=0.003)是WS患儿人工耳蜗术后SIR分级的影响因素.结论 WS患儿人工耳蜗术后听觉言语康复效果良好,植入年龄、监护人文化水平、使用耳蜗时间与听觉言语康复水平相关.尽管生活质量与非综合征性感音神经性聋患儿有差异,但具体原因还需要进一步排除混杂因素研究和探索.

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目的 分析慢性耳鸣的临床特点及严重程度的影响因素.方法 回顾性分析1 452例慢性耳鸣患者的临床资料,所有患者均进行详细的病史询问、纯音测听和耳鸣心理声学评估,填写耳鸣障碍量表(tinnitus handi-cap inventory,THI)、焦虑自评量表(self-rating anxiety scale,SAS)或广泛性焦虑障碍量表(generalized anxiety disorder-7,GAD-7),抑郁 自评量表(self-rating depression scale,SDS)或抑郁筛查量表(patient health questionnaire-9,PHQ-9)、匹兹堡睡眠质量指数量表(pittsburgh sleep quality index,PSQI)和听觉过敏问卷等.分析耳鸣患者的临床特点,并以THI评分≥38分为中-重度耳鸣组,THI评分≤36分为轻度耳鸣组,以THI分组为应变量,上述各因素为自变量,采用Logistic回归分析探究各因素与耳鸣严重程度的相关性.结果 1 452例慢性耳鸣患者中,轻度耳鸣625例(43.04％),中-重度耳鸣827例(56.96％),平均年龄43.59±12.64岁;耳鸣平均病程4.08±5.03年;双侧耳鸣880例(60.61％);持续性耳鸣944例(65％);Logistic回归分析示:焦虑(OR=3.01)、听觉过敏(OR=2.95)、睡眠障碍(OR=2.05)、抑郁(OR=1.58)、耳闷(OR=1.57)和耳鸣持续特点(OR=1.43)与耳鸣的严重程度相关.结论 焦虑、听觉过敏、睡眠障碍、抑郁、耳闷和持续性耳鸣可能是慢性耳鸣严重程度的影响因素.

Objective: To analyze the clinical features and surgical outcomes of petrous bone cholesteatomas (PBCs). Methods: Data from 39 PBCs patients treated in the Department of Otorhinolaryngology, Xijing Hospital from September 2011 to December 2017 were reviewed retrospectively, including 23 males, 16 femals, aged 12-71 years old, with the median age of 37. Clinical classifications, surgical methods, facial and hearing function, and intraoperative and postoperative complications were made summary analysis. Results: In this study, five patients were congenital PBCs and 34 patients were acquired PBCs. The common clinical symptoms were hearing loss (100%, 39/39), ear discharge/pus (89.7%, 35/39) and facial paralysis (46.2%, 18/39). According to Sanna's classification, 14 cases were supralabyrinthine, including three cases underwent transcochlear (TC) approach, six cases underwent transotic (TO) approach and five underwent translabyrinthine (TL) approach. 10 cases were infralabyrinthine, including eight cases underwent subtotal petrosectomy, one case underwent TO approach and one underwent TL approach.10 cases were massive, including seven cases underwent TC approach, three cases underwent TO approach. Five cases were infralabyrinthine-apical, including two cases underwent TC approach, two cases underwent TO approach, and one case underwent endoscope assisted infratemporal fossa type B. The degree of facial nerve (FN) dysfunction from high to low was massive (6/10), supralabyrinthine (8/14), infralabyrinthine-apical (2/5) and infralabyrinthine (2/10). 19 cases involved in facial nerve operation, three cases underwent FN decompression, four cases underwent FN rerouting, four cases underwent nerve grafting, and one case underwent facial-hypoglossal anastomosis. Preoperative FN involvement in 18 cases, and the FN function was improved in 14 cases after surgery. The improved rate of postoperative FN function was 77.8%. The bone conducted hearing retained 50.0% (14/28) postoperatively. Five cases with cerebrospinal fluid leak were managed by inserting free muscle plugs and cavity obliteration. Two cases with the cholesteatomas matrix involved the sigmoid sinus and the jugular bulb, and occlusion of the sigmoid sinus was performed. Postoperatively, two patients presented with synkinesis. The patients were followed up for 40 to 115 months, and there was no recurrence. Conclusions: There are no specific clinical manifestations for PBCs, thus, it is difficult in early diagnosis and treatment. According to Sanna's classification, preoperative FN and hearing function, the best surgical approach should be selected with minimal recurrences and perioperative morbidity.

目的 分析主观性耳鸣患者合并头痛的特点及其影响因素.方法 回顾性分析2019年12月至2020年5月就诊于西京医院耳鼻喉科门诊的361例主观性耳鸣患者的资料,记录所有患者详细的病史和耳鸣评估,包括:性别、年龄、耳鸣起病情况、耳鸣声性质、耳鸣侧别、病程、听力下降、是否伴头痛,其它伴发疾病或症状等,同时填写耳鸣残疾量表(timnitus handicap inventory,THI)、广泛性焦虑障碍量表(generalized anxiety disorder,GAD-7)、抑郁筛查量表(patient health questionnaire,PHQ-9)及匹兹堡睡眠质量指数量表(Pittsburgh sleep scale,PSQI)等量表,所有患者均接受纯音测听及耳鸣心理声学测试;根据是否合并头痛将患者分为头痛组(140例)、无头痛组(221例),并对两组患者间各相关因素进行统计学分析.结果 361例主观性耳鸣患者中140例(38.80％,140/361)合并头痛,女性患者合并头痛的比例(61.43％,86/156)显著高于男性(38.57％,54/205)(P<0.01),其中偏头痛62例(44.29％,62/140),紧张性头痛34例(24.29％,34/140),无法分类的头痛44例(31.42％,44/140).头痛组患者T H I评分(48.85±24.68分)显著高于无头痛组(37.55±24.30分),且中度以上耳鸣患者中合并头痛的比例(48.42％)显著高于轻度耳鸣患者(28.07％),头痛组听觉过敏、耳闷、头晕/眩晕、焦虑、抑郁及睡眠障碍发生率高于无头痛组(P<0.05).结论 主观性耳鸣患者常合并头痛,其中以偏头痛和紧张性头痛较为常见,合并头痛的患者耳鸣严重程度更高,更易合并听觉过敏、头晕/眩晕、焦虑、抑郁及睡眠障碍等.