耳鸣评价量表的临床应用价值研究

摘要

目的 探讨耳鸣评价量表(tinnitus evaluation questionnaire, TEQ)的临床应用价值.方法 以耳鸣为第一主诉初诊的187例患者(13~80岁,平均42.5±13.5岁)为研究对象,由专业医务人员进行TEQ评估,以患者自填的耳鸣残疾量表(tinnitus handicap inventory, THI)作为对照,研究TEQ的汇聚效度;从中抽取96例患者由两名专业医务人员在半天内对同一患者进行2次TEQ评估,评估耳鸣严重程度,以比较不同测试者间的重测信度;抽取57例患者给予治疗一个月,根据治疗前后患者主观感觉耳鸣有无变化,应用效应量(effect size, ES)计算公式评估TEQ反应度(responsiveness);记录TEQ评估每位患者的测试用时及患者自填THI的时间,以比较测试时效.结果 187例患者TEQ、THI总分分别为10.69±2.88和43.12±19.40,相关系数r=0.79(P<0.01),TEQ与THI汇聚效度好;接受两名测试者评估的96例患者不同测试者间TEQ重测信度为0.94(P<0.01),TEQ的重测信度良好;57例患者治疗一个月后自觉耳鸣症状改善组(36例)治疗前TEQ得分10.69±2.74分,治疗后为7.83±2.74分,效应量为1.04,为较大效应量;说明TEQ能敏感反映患者症状变化,反应度良好.TEQ评估时间(3.27±1.01分钟)显著短于THI评估时间(11.17±3.11分钟)(P<0.01).结论 TEQ的准确性、可靠性、敏感性及可操作性均较理想,且费时少,具有良好的临床实用价值,适用于对耳鸣严重程度和疗效的评估.%Objective To investigate the clinical value of tinnitus evaluation questionnaire (TEQ).Methods A total of 187 subjects whose first complaint is tinnitus, from the "Tinnitus, Hearing Loss, & Vertigo" clinic of the Hearing Center at the West China Hospital, were included in this study.All participants were tested with TEQ by two different testers in half a day to assess their tinnitus severity in order to examine the inter-rater test-retest reliability.The convergent validity was obtained by comparing the scores tested with TEQ and the tinnitus handicap inventory (THI).According to the patient's subjective impression of symptom change before and after treatment, the effect size (ES) was calculated to evaluate the responsiveness of TEQ.Testing time was recorded to compare the time-effectiveness between TEQ and THI.Results The inter-rater test-retest reliability of TEQ was 0.94 (P<0.01).The correlation coefficient between the total scores of TEQ and THI was 0.79 (P<0.01).Among all patients who were followed-up once after treatment, the ES of the self-reported relief group was 1.04, which proved a good responsiveness of TEQ.The average test time of TEQ was 3.27±1.01 mins, which was significantly shorter than that of THI(P<0.01).Conclusion The psychometric characteristics of TEQ, including its reliability, validity and sensitivity, as well as practicability, are preferable for clinical tinnitus severity and treatment outcome assessment.