DISABLING TINNITUS AND DEPRESSION IN THE ELDERLY

50岁以上的成年人患耳鸣的可能性是正常人的两倍， 比50岁以下的人致残的可能性高一倍。 虽然高- 频率感音神经性听力损失最好预测谁将有耳鸣， 出现抑郁症-不是耳鸣本身的属性-出现 以最好地预测谁会因此而残疾。这项研究将研究 抑郁症与耳鸣残疾关系研究 去甲替林的随机、安慰剂对照、双盲试验 残疾耳鸣患者组：符合DSM-III-R标准者 抑郁症和那些没有抑郁症的人 因此，有可能 确定三环类抗抑郁药治疗是否有效 在这些严格的条件下减少耳鸣残疾，如果 三环治疗的有效性是由于其对抑郁症的影响， 对耳鸣本身有更直接的影响（如镇痛作用 三环类药物治疗慢性疼痛综合征）。 治疗对 耳鸣的严重程度将在三个方面进行评估：生理严重程度 (by耳鸣的听力测量变化）。 功能严重度（按 耳鸣相关残疾变化的患者自我报告）和负担 疾病（通过配偶访谈和自我报告）。 这一详细分析 抑郁症和耳鸣之间的相互作用应该提供更多的 定义调解生产的心理社会参数 老年人因疾病而残疾。 通过提供更清晰的 了解症状与残疾的关系，我们可以 大大提高了我们对医疗/精神科共同疾病的一般认识， 老龄化背景下的发病率。

Adults over fifty years old are twice as likely to have tinnitus and four times as likely to be disabled by it than those under fifty. While high- frequency sensorineural hearing loss predicts best who will have tinnitus, the presence of depression--not properties of the tinnitus itself--appears to predict best who will become disabled by it. This study will examine the relationship between depression and tinnitus disability through a randomized, placebo-controlled, double-blind trial of nortriptyline in two groups of disabled tinnitus patients: those who meet DSM-III-R criteria for Major Depression and those who do not. It will thereby be possible to determine if tricyclic antidepressant treatment is effective for the reduction of tinnitus disability under these rigorous conditions and if the effectiveness of tricyclic treatment is due to its effects on depression or to a more direct effect on tinnitus itself (such as the analgesic effect of tricyclics in chronic pain syndromes). Impact of treatment upon tinnitus severity will be assessed in three areas: physiological severity (by changes in audiometric measures of tinnitus). Functional severity (by patient self-report of changes in tinnitus-related disability), and burden of illness (by spouse interview and self-report). This detailed analysis of the interaction between depression and tinnitus should provide greater definition of the psychosocial parameters that mediate the production of disability by medical illness in the elderly. By providing a clearer understanding of the relation of symptoms to disability, we can significantly advance our general understanding of medical/psychiatric co- morbidity in the context of aging.