DISABLING TINNITUS AND DEPRESSION IN THE ELDERLY

50岁以上的成年人患耳鸣的可能性是前者的两倍，后者是后者的四倍。 因此而致残的可能性是50岁以下人群的两倍。虽然很高- 频率感音神经性听力损失最能预测谁会有耳鸣， 抑郁的存在--而不是耳鸣本身的特征--出现 最好地预测谁会因此而致残。这项研究将检查 抑郁症与耳鸣功能障碍的关系 去甲替林的随机、安慰剂对照、双盲试验 残疾耳鸣患者群体：符合DSM-III-R标准的患者 对于严重萧条和那些没有这样做的人。因此，将有可能 确定三环类抗抑郁药治疗对 在这些严酷的条件下减少耳鸣残疾，如果 三环类药物的疗效取决于它对抑郁症或 对耳鸣本身有更直接的影响(如止痛作用 三环类药物在慢性疼痛综合征中的应用)。治疗对以下方面的影响 耳鸣的严重程度将在三个方面进行评估：生理严重程度 (通过耳鸣听力测量的变化)。功能严重程度(按 患者自我报告耳鸣相关残疾的变化)和负担 (通过配偶面谈和自我报告)。这一详细的分析 抑郁症和耳鸣之间的相互作用应该提供更大的 对调解产生的心理社会参数的定义 老年人因疾病致残。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学/精神病学合作的总体理解 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.