[[alternative]]Effects of Yoga Panayama Meditation on Tinnitus Disturbance, Anxiety and Insomnia in Patients with Tinnitus: A Pilot Study

[[abstract]] 背景與目的：嚴重的耳鳴常導致患者身心相當煎熬，然而造成耳鳴的原因非常複雜且不易確定，常見耳鳴的困擾如失眠、憂慮、焦躁不安、抑鬱與無奈等感受，造成身心諸多壓力和負面情緒。目前正規的醫療治療耳鳴的方法是以藥物為主營養補充為輔，包括抗憂鬱劑、安神劑和維他命B 群等，而其他如聲音遮蔽療法或減敏療法目的都是讓病患逐步去適應耳鳴。瑜伽調息運用調整呼吸的技巧進而改善呼吸系統，增進睡眠品質，降低焦慮和預防躁鬱症及穩定神經系統與情緒等。本研究旨在探討瑜伽調息法介入對於改善患者因慢性耳鳴引起之耳鳴困擾、焦慮及失眠之成效。 材料與方法：本前驅試驗採單組前後測之設計，以南部某醫院之慢性耳鳴患者作為研究對象，共計收案12位耳鳴患者，為期16週的實驗分為二階段進行，第一階段為每週一次，每次60分鐘由老師帶領的瑜伽調息團體課程，連續進行12週；第二階段以CD音檔引導在家練習，連續進行4週，所有的研究對象於實驗介入前、團體課程結束及在家練習後三個時間進行資料收集。評估工具包含情境焦慮量表(STAI-S)、特質焦慮量表(STAI-T)、健康與耳鳴困擾問卷、匹茲堡睡眠量表 (Pittsburgh Sleep Quality Index) 與課程和練習感受訪談記錄。資料以利用弗理曼二因子等級變異數分析（Friedman test）進行檢定分析，模式中主要以「時間」為主效果來檢驗介入成效。 結果：共有11位耳鳴患者完成實驗，以 Friedman test 分析結果顯示，前測T1、期中測T2及後測T3時間點比較，耳鳴困擾部分在功能性、情感性、嚴重性及整體耳鳴困擾得分，均隨瑜伽調息練習時間增加而減少，達顯著差異。情境焦慮(STAI-S)部分在正向情緒、負向情緒及整體情境焦慮得分，均隨瑜伽調息練習時間增加而減少，達顯著差異。特質焦慮(STAI-T)只在正向特質部分呈顯著改善。情境及特質焦慮得分、耳鳴困擾得分均隨時間增加而減少，達顯著差異，顯示焦慮及耳鳴困擾獲得改善。在睡眠品質和耳鳴程度部分則未有明顯變化。各量表得分之相關性分析結果顯示，耳鳴困擾與情境焦慮呈顯著正相關(r=0.862, p=.001)，耳鳴困擾得分越高者情境焦慮愈嚴重。情境焦慮、耳鳴困擾與睡眠品質均呈顯著正相關(r=0.741, p=.009；r=0.823, p=.002)，情境焦慮與耳鳴困擾得分越高者睡眠品質愈差，在個案持續練習調息法改善耳鳴困擾後，情境焦慮亦隨之獲得舒緩，睡眠品質亦可獲得改善。本研究結果提供瑜伽調息作為改善耳鳴患者之耳鳴困擾及焦慮並改善生活品質進一步研究之參考。[[abstract]] Background and Purpose: The causes of tinnitus are complex and difficult to determine. Common ailments caused by tinnitus such as insomnia, anxiety, restlessness, depression and helplessness create many stress and negative emotions. The current method of medical treatment of tinnitus include anti-depressants, sedatives and vitamin B, etc., while others such as sound masking or desensitization therapy are designed to gradually adapt the patient to tinnitus. Yoga pranayama uses respiration breathing techniques to improve the respiratory system, improve sleep quality, reduce anxiety and prevent bipolar disorder and stabilize the nervous system and emotions. The purpose of this study was to investigate the effects of yoga pranayama on tinnitus, anxiety and insomnia caused by chronic tinnitus. Materials and Methods: A single group, pre-test and post-test study was conducted on patients with chronic tinnitus from a hospital in southern Taiwan. A total of 12 tinnitus patients participated in this study. The study spanned over a 16-week period, which was divided into two phases. The first phase included a 60-min yoga lesson given by an instructor once a week for 12 consecutive weeks; the second phase required the patients to practice yoga with a CD audio guide at home for 4 consecutive weeks. Data were collected before the participants began their yoga lessons, as well as after completing phase 1 and phase 2. Assessment tools included STAI-S, STAI-T, the Tinnitus Functional Index, the Pittsburgh Sleep Quality Index, and interviews with the participants. Data were analyzed using the Friedman test, in which the effect of intervention was mainly based on the time effect. Results: A total of 11 tinnitus patients completed the experiment. The results of the Friedman test showed that as the time period increased, the scores for functional index, emotional index, severity index, and overall tinnitus distress decreased at pre-test (T1), yoga exercise (T2), and CD audio yoga exercise (T3), in which significant differences were observed between the different phases. Results from the STAI-S survey showed significant differences in positive emotion, negative emotion, and overall anxiety as the time participants spent practicing yoga exercises increased, whereas significant differences in positive emotions were only observed in the STAI-T results. Results also showed that state anxiety, trait anxiety, and tinnitus distress scores decreased as the time practicing yoga increased. These findings indicated that yoga exercises reduced anxiety and tinnitus distress. However, yoga exercises did not significantly improve sleep quality and tinnitus severity. A positive correlation was found between tinnitus distress and anxiety (r = 0.862, P = 0.001). In addition, positive correlations were also observed between state anxiety, tinnitus distress, and sleep quality (r = 0.741, P = 0.009; r = 0.823, P =0.002). Results also showed that as a reduction in tinnitus distress occurred over time, both state anxiety and sleep quality also improved. This study demonstrated that yoga exercises can be used to reduce tinnitus distress and anxiety, as well as patients' overall living quality