What is tinnitus?
Tinnitus is the subjective sensation of sound in the ear or head when there is no external sound source. Tinnitus can be manifested in a variety of ways, such as buzzing, hissing, electric currents, cicadas, and telephone ringing. It can be unilateral tinnitus, bilateral tinnitus or cranial tinnitus. Tinnitus can be persistent, intermittent or pulsatile. It can be classified as subjective tinnitus and objective tinnitus according to the presence or absence of a sound source. Objective refers to real sounds of internal biological origin that are conducted through the body’s own tissues into the ear. Sources include: blood vessel pulsations, pulse sounds, middle ear muscle spasms, pharyngeal tube or soft palate movement sounds. The examiner can sometimes hear tinnitus by placing a stethoscope to the ear, also known as other-perceived tinnitus. On the contrary, subjective tinnitus is a kind of auditory perception hallucination where objective sounds cannot be recognized and only the patient can hear the tinnitus, which is the most common type of tinnitus. The tinnitus mentioned in this article refers mainly to subjective tinnitus.
What are the common causes of tinnitus?
(1) External ear pathology: cerumen embolism, foreign bodies, boils and tumors in the external ear canal are common;
②Middle ear pathology: Eustachian tube pathology, acute and chronic otitis media, tumors, etc. It can also be associated with sclerosis of the tympanic chamber and vascular disease within the tympanic chamber;
Inner ear lesions: Meniere’s disease, sudden deafness, otosclerosis, ototoxic drugs, noise, infection-induced inner ear damage, etc;
④Postcochlear auditory system lesions: such as auditory neuroma, pontocerebellar horn lesions, etc;
⑤ Other systemic pathologies: e.g. hypothyroidism, diabetes mellitus and inner ear concussion due to head trauma, etc;
Most tinnitus patients are unable to find a clear cause for their tinnitus. Triggering factors related to tinnitus, such as mental tension, poor sleep, poor living habits, noise stimulation, diet, etc., may all be related to tinnitus.
What is neurological tinnitus?
The term “neurological tinnitus” is a non-existent concept of tinnitus, which is stolen from the concept of “neurological deafness”. The term “neurological tinnitus” can cause patients to have the illusion that it is incurable, and it can easily aggravate patients’ prejudice and misunderstanding about tinnitus, causing psychological burden. When you search the Internet and type in “neurological tinnitus”, many explanations will appear, all of which are wrong, and there is no such name as “neurological tinnitus”. According to the Chinese Medical Association’s Society of Otolaryngology, Head and Neck Surgery, tinnitus with no clear cause is called “idiopathic tinnitus”.
Is it really true that tinnitus will lead to deafness after a long time?
Is it true that if you suffer from tinnitus, you will definitely go deaf in the future? When tinnitus occurs, the first thing to do is to have a hearing examination to rule out otolaryngological diseases such as cerumen embolism in the external ear canal, secretory otitis media, sudden deafness, Meniere’s disease, auditory neuroma, noise deafness, etc. The first symptom may be tinnitus. However, the statement that “tinnitus leads to deafness” is not scientific. There are many causes of tinnitus, including ear diseases and systemic diseases such as cardiovascular diseases, hypertension, diabetes, and traumatic brain injury, and the tinnitus caused by these diseases is mostly due to problems with human body functions, not necessarily with the ear organ.
What are the principles of tinnitus treatment?
The treatment of tinnitus is divided into etiological treatment and symptomatic treatment. Etiological treatment refers to the treatment of the primary disease that causes tinnitus (such as sudden deafness, Meniere’s disease, auditory neuroma, nasopharyngeal carcinoma, etc.). If the tinnitus persists after treatment of the primary disease and the cause cannot be found, symptomatic treatment is required. The goal of idiopathic tinnitus treatment is not to eliminate the presence of the tinnitus sound. There is no specific drug for tinnitus treatment, because the causes of tinnitus are different and it is not possible to treat all tinnitus of different causes with one drug.
Treatment options are individualized and the preferred option is chosen according to the specific circumstances of the patient, such as the severity of the tinnitus.
For tinnitus caused by external ear disease (e.g. cerumen embolism, foreign body in the external ear canal, external ear canal cholesteatoma, etc.), middle ear disease (secretory otitis media, middle ear cholesteatoma, adhesive otitis media, otitis media, etc.), inner ear disease (e.g. Meniere’s disease, auditory neuropathy, sudden deafness, ototoxic drugs, etc.) and postcochlear disease (auditory neuroma, pontocerebellar horn tumor, etc.), active treatment of the primary cause is chosen.
②For tinnitus caused by diseases other than the auditory system (such as hypertension, thyroid abnormalities, anemia, nasopharyngeal carcinoma, etc.), the principle of controlling the original disease should be taken into consideration.
③For those patients whose tinnitus has seriously disturbed their normal work, life and sleep, and who cannot tolerate it and have a series of psychoneurological symptoms, we should first treat the neurasthenia or anxiety symptoms of this type of patients, and also teach them to learn the correct psychological perception of tinnitus. Most of the tinnitus is characterized by increased tinnitus in quiet conditions, especially at night. During the day, it is mainly the environmental noise that plays a masking role. Therefore, tinnitus patients should avoid quiet environments as much as possible, and make appropriate background noise such as soft music or the sound of water flowing in a goldfish bowl. Medication can be chosen from glutamate, vitamin B complex, Guaifeng Ningxin tablets, clonidine, etc.
Most tinnitus patients have mild symptoms and short duration, so they are often ignored and do not feel the disturbance or pain of tinnitus. Some tinnitus patients have a long history of tinnitus and feel that the tinnitus is heavy at first, but over time the tinnitus does not increase or decreases and does not affect work, life or sleep. For these patients, after examination, if no organic lesion is found, i.e. not dangerous tinnitus, tinnitus counseling can be given to tell the patient that tinnitus is a kind reminder of the organism, a sound that does not need to be eliminated, so that the patient can understand tinnitus correctly. It is also known as cognitive behavioral therapy and does not require special treatment.
What are the precautions for tinnitus patients in their daily life?
Tinnitus is affected by many factors, and tinnitus patients should pay attention to the following issues.
① Have an optimistic and open-minded attitude towards life: Once you suffer from tinnitus, you should first pay attention to it and go to the hospital for examination. Clarify whether it is dangerous tinnitus or non-dangerous tinnitus. If it is not dangerous tinnitus, tinnitus patients should reduce their concern about tinnitus, cultivate hobbies, adjust the rhythm of life, pay attention to regular sleep and healthy diet;
② Avoid noise stimulation, disable ototoxic drugs, smoke and drink less;
③To have a correct understanding of tinnitus, tinnitus is a kind reminder of the organism and it is not necessary to eliminate the sound of tinnitus, eliminate the patient’s fearful thoughts about tinnitus, and establish a correct understanding of tinnitus.