摘要
研究目的：據報導傳統中醫（TCM）可成功緩解耳鳴，但尚未進行良好對照研究。在這項研究中，我們嘗試使用試驗耳鳴方（EMF01）其含有地黃、山茱萸、丹參、葛根、五味子、茯苓和桔梗的中藥複方，來治療含有水楊酸鹽引起的耳鳴。材料和方法：初步研究檢測了8.75g/kg和17.5g/kg 耳鳴方（EMF01）（通過口服強飼法遞送20天）的效果，並且顯示8.75g/kg組中抑制率（SR）略微降低。為了確認EMF01對8.75g/kg耳鳴的可能影響，進行了進一步的研究，樣本量更大。結果：雖然治療組之間存在統計學上的顯著差異，但事後檢驗顯示耳鳴方（EMF01）對水楊酸鹽誘導的耳鳴沒有任何顯著影響。結論：雖然本研究不支持耳鳴方（EMF01）治療水楊酸鹽誘導的耳鳴的療效，但應進一步研究以確定它是否能減輕與聽覺損傷相關的耳鳴。
內文
耳鳴被描述為在沒有外部聽覺刺激的情況下在一隻或兩隻耳朵或頭部內部產生的聲音的感知[1]。耳鳴是耳朵常見的疾病之一，可導致多種精神和身體損傷，並可能損害生活質量[2]。這種現象的患病率估計為3-30％[3]。這種疾病在25％的病例中強烈影響患者的生命[4]; 8-10％的耳鳴患者聽力正常，其中無耳鳴[5]。儘管現代醫學取得了重大進展，但耳鳴的確切病理生理學仍然未知[2]。各種藥物包括抗組胺藥、巴比妥類藥物、麻醉藥、鈣通道阻滯劑、血管擴張劑、肌肉鬆弛劑、抗驚厥藥以及各種心理治療方法和耳鳴掩蔽劑，已用於降低耳鳴嚴重程度; 然而它們幾乎沒有效果，它們的結果與安慰劑沒有差別[4]。以前對未知原因耳鳴的研究表明，氧化應激事件是提出的耳鳴機制之一[6]，其方式是抗氧化劑被認為是降低耳鳴嚴重程度的有效措施之一[7]。氧化應激過程通常發生在抗氧化酶構建中使用的稀有元素濃度不平衡的情況下[8]。產生耳鳴領域的重要機制之一是谷氨酸作為興奮性神經遞質的增加，谷氨酸的增加與神經毒性的影響有關，這種增加通過刺激產生自由基導致炎症和傳入耳蝸器官科爾蒂細胞的樹突壞死[9，10]。
表1中已經證明了不同類型的耳鳴原因。
藥用植物和耳鳴
儘管最近在現代醫學方面取得了進展，但仍然沒有明確的聽力損失治療方法。這些疾病推動了研究，以發現新的治療方法和藥物。在這方面，人們對醫學領域的傳統醫學和植物療法的方法產生了新的興趣。藥用植物和它們的衍生物進行了研究，通過的科學方法的應用，在體外，動物，並最終在臨床試驗中，以便更有效的治療方法和藥物可以被發現[16-26]。除藥物治療外，其他方法也用於耳鳴治療，如植物療法（表2））。似乎單獨或與其他治療組合的任何治療對耳鳴都不是很有效，這就是為什麼FDA沒有批准任何治療耳鳴的原因[27]。中所使用的藥用植物，銀杏（銀杏）的是，在治療耳鳴頻繁使用和在各種研究[已研究了草藥之一28，29 ]。銀杏屬於銀杏科。銀杏葉有一系列的植物化學物質，包括烷烴、脂類、甾醇、類胡蘿蔔素、苯丙、碳水化合物、類黃酮和類萜[30，31]。研究表明，銀杏葉這是一種單胺氧化酶抑製劑（MAOI）可以有效改善因楊梅素和槲皮素黃酮類化合物引起的耳鳴引起的耳鳴，以及銀杏內酯和白果萜類化合物[32]。銀杏葉具有抗血小板和血管調節作用。換句話說，它可以改善血液流動並適當調節血管張力。因為血管問題是耳蝸神經皮層區域的耳鳴的原因之一，心血管問題可能導致迷路動脈血液供應出現問題，會導致耳蝸外毛細胞缺氧並導致主觀耳鳴。為銀耳提供足夠的血液供應，這可以通過銀杏來證明，可以阻止這個過程。對大腦，聽覺皮層和皮層下神經細胞的抗氧化和保護作用也可以證明銀杏葉的抗耳鳴作用[33]。銀杏報導以清除主（O2-,OH）（ROO）和次級自由基[34，35 ]。這些有益特性似乎部分來自銀杏葉成分如黃酮和萜烯的活性。銀杏可以說是一種草藥，其活性藥理基團是具有抗氧化和血管舒張作用的黃酮類化合物和萜內酯，作為抗血小板藥物[36]。
結果
在20-50％的患者中，同時使用弱雷射暴露於耳蝸和給予銀杏葉提取物4周是有用的。弱雷射作用機制尚不清楚，但已證明光導致生化過程的無熱刺激。實際上，銀杏與弱雷射聯合治療慢性耳鳴非常有效。銀杏提供了更好的氧氣和雷射直接操作黃素蛋白，以激活修復機制[46]。此外，Plath和Olivier證實，銀杏與弱雷射在某些情況下可以減輕耳鳴的嚴重程度，並得出結論，softlaser和Ginkgo的組合可用於一些嚴重耳鳴患者[47]。此外，銀杏葉臨床上用於治療內耳疾病，如聽力喪失，頭暈和耳鳴。這種草藥廣泛用於治療歐洲國家和其他地區的耳鳴。然而，在一些研究和臨床試驗中與安慰劑相比，這種草藥在治療耳鳴方面沒有有益效果。關於銀杏葉治療耳鳴患者的影響的研究很多，這些研究的大多數發現是相互對比的; 一方面，一些研究報導銀杏葉有效治療耳鳴有效[48-53]和上提到了它作為無效草藥[另一方面其他研究28，54-57]。系統評價的結果表明，銀杏葉在治療耳鳴方面的效果很差/較差。該研究報告指出，選擇這些治療方法對患者有益，不僅可以降低患者的費用，還可以防止患者選擇和尋找其他無效的治療方法[58]（表3）。
結論
根據之前的研究和本研究，銀杏葉可以被認為是一種有希望的改善耳鳴的選擇以及進一步的研究。由於耳鳴是多因素的，建議根據耳鳴的原因，治療方案和不同劑量的銀杏葉單獨評估患者在未來的研究中更廣泛的水平。根據其共病情況（如精神障礙，老年性耳聾，聽覺損傷（噪音）和醫學基礎條件）對耳鳴進行分類，並研究藥物在這些亞組中的作用可被視為評估藥物治療範圍的更準確的解決方案或非藥物方法。此外，似乎尋找未來控制耳鳴的新方法將需要神經生理學和神經科學研究; 促進有效的藥物治療肯定取決於了解神經遞質及其受體的變化。因此，除非不能很好地理解耳鳴的機制，否則設計詳細的治療將會失敗。
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Authors: Mohammad Reza Mahmoudian-Sani, Morteza Hashemzadeh-Chaleshtori, Majid Asadi-Samani, Qian Yang.
From：Journal of Ethnopharmacology，Volume 128, Issue 2, 24 March 2010, Pages 545-54824 March 2010, Pages 545-548
https://doi.org/10.1016/j.jep.2010.01.053
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