Tinnitus refers to the subjective sensation of sound in the ear or head of the patient, but there is no corresponding sound source in the environment outside the body. Tinnitus occurs in 17% of the general population to varying degrees and in up to 33% of the elderly. The common diseases that cause tinnitus include external ear and middle ear diseases such as otitis externa, cerumen embolism, acute otitis media, chronic otitis media, eustachian tube obstruction, tympanic chamber effusion and otosclerosis; and inner ear diseases such as Meniere’s disease, auditory neuroma, noise deafness, drug-induced deafness and age-related deafness.
I. Etiological treatment
Finding the primary lesion and taking special treatment is more effective. If the etiology cannot be determined, but the cause is determined and difficult to treat, the etiological treatment is more difficult.
II. Drug treatment
So far, no drugs have been found to completely cure tinnitus, but certain drugs have short-term effects on tinnitus: 1.
1.Improve blood supply to the cochlea
The application of vasodilators such as β-histine, prostaglandin E2, calcium antagonists such as Cipro, nimodipine, etc., Kinnado (Ginkgo biloba extract injection), Selleck (butalbital hydrochloride tablets) are commonly used to improve microcirculation in the inner ear.
2.Improve energy metabolism of inner ear tissues
Nutrients such as adenosine triphosphate and coenzyme A help cellular energy metabolism and respiratory chain function and improve microcirculation, which can be used for tinnitus caused by early cochlear lesions.
3. Lidocaine and other anticonvulsants
Local anesthetics such as lidocaine have a blocking effect on the nerve axon junction to control the abnormal rhythmic overactivity in the auditory conduction pathway to treat peripheral or central tinnitus caused by cochlear or postcochlear lesions, which is generally considered to be 60% to 80% effective in the short term. It is more effective for low-frequency tinnitus than for high-frequency tinnitus.
Anticonvulsant drugs such as clonidine have been shown in clinical trials to be 73.8% effective, with varying degrees of improvement maintained after discontinuation of the drug. Aminoglutethimide (carbamazepine), however, has been reported to be more effective for lidocaine, but has greater side effects and requires attention to liver and kidney function. In addition, there are also deoxyphenibutol (paroxetine, side effects are smaller than carbamazepine), tocainate hydrochloride, etc.
4.Muscle relaxants
It is more suitable for tinnitus patients who have tension in the head and neck. Mconagh, 150mg/d orally for two weeks has obvious effect on tinnitus.
5.Anxiolytic and antidepressant drugs
Several studies at home and abroad have shown that tinnitus and psychological problems affect each other, and it is important to intervene in psychological problems during the treatment of tinnitus. Anti-anxiety and antidepressant drugs have different degrees of side effects, and some of them even aggravate tinnitus, so the drugs should be used with caution and should not be overdosed.
6.Chinese medicine and proprietary Chinese medicine treatment
Acupuncture treatment is effective for some patients. There are also many Chinese medicine prescriptions for tinnitus. The following Chinese medicines are commonly used: tonic Chinese medicine and spleen pill for tinnitus with spleen deficiency, Chen Xia Liu Jun Zi pill for tinnitus with phlegm dampness, and Qi Ye Shen An Tablet and Zhu Sha Shen An Wan for tinnitus with severe insomnia.
Masking therapy
Tinnitus masking therapy is actually a tinnitus suppression therapy. By giving a specific external sound (such as tinnitus masking device) that matches the tone and loudness of the patient’s tinnitus, and by giving pure tones and narrow band noise with a certain frequency and intensity of acoustic stimulation, the spontaneous excitation of the cochlea or cochlear nerve is suppressed and the abnormal spontaneous discharge activity is reduced, so as to reduce or eliminate tinnitus. This therapy requires long-term (more than three months) adherence to treatment, with efficacy up to 80% or more, and requires a high level of patient compliance.
In addition, both cochlear implant electrodes and hearing aids have been reported to be effective in the treatment of tinnitus, with the former being more effective than the latter. It has been reported that 86% to 92% of patients have reduced tinnitus after cochlear implantation, and only 10% of patients feel that their tinnitus has increased after cochlear implantation. For patients with certain hearing loss, hearing aids are also a good choice. There is now a tinnitus hearing aid that combines the functions of a tinnitus suppressor and a hearing aid, specifically for patients with tinnitus and hearing loss.
Biofeedback therapy
Tinnitus is a kind of disease related to the state of tension. Biofeedback therapy is to use different biofeedback signals to train patients to enter a relaxed state, so that patients can consciously control their body’s feeling of tinnitus and restore their internal balance.
V. Electrical stimulation therapy
It is a method to suppress tinnitus by directly stimulating the auditory system with electric current, and the treatment targets are mainly tinnitus patients with cochlear lesions.
Transcranial magnetic stimulation therapy
There is evidence that tinnitus is caused by overexcitation of the left superior temporal gyrus, and repetitive transcranial magnetic stimulation (rTMS) can suppress this abnormal activity. The efficacy and specific method of this new method is uncertain, and there are potential side effects that need to be treated with caution. Recent studies have shown that PET testing does not yet support the evidence that rTMS suppresses the auditory cortex.
VII. Tinnitus retraining therapy (TRT)
In recent years, a new approach has been developed to reduce the body’s response to tinnitus based on the plasticity of the central system, thus achieving the body’s habituation to tinnitus. It includes guided counseling and sound therapy. This therapy has been generally accepted internationally.
VIII. Surgical treatment
Certain causes of somatic sound can be treated surgically when there is an indication for surgery. For example, endolymphatic sac decompression or shunt, sympathectomy or vestibular nerve resection can be performed for tinnitus caused by Ménière’s disease according to different conditions.
Tinnitus brings untold pain to patients’ working life, and there are many techniques for tinnitus treatment, and the application of new techniques still has potential side effects. Therefore, in clinical work, we should strictly evaluate the cause and nature of tinnitus of patients, analyze the cases individually, and choose a suitable treatment plan comprehensively in order to relieve patients’ pain more effectively.