Tinnitus is often a headache for doctors and patients alike. Patients do not describe it clearly, and doctors can hardly hear it or experience it well. As a result, tinnitus has long been regarded as sensorineural and treated in a thousand ways, so the effect is not very obvious. In fact, tinnitus is caused by abnormalities in the cochlear sensorineural function in different parts of the ear and different etiologies, or abnormalities in the perception, analysis and memory of tinnitus signals by the cortical auditory center. From the point of view of auditory signal generation, sound is transmitted from the auricle, the external auditory canal, through the tympanic membrane, the auditory chain, the inner ear sensor and the auditory nerve, and finally uploaded to the cortex. Problems with each of these links can produce tinnitus of different tones. For example, one patient complained of tinnitus, which was a roaring sound like the sound of a computer working, but her hearing was normal and her acoustic conductance was normal. He had normal hearing and normal acoustic conductance, but he was not getting better with medication. When I received this patient, I examined him carefully with an otoscope and found that there was a thin hair on the tympanic membrane. After gently removing it, the tinnitus stopped immediately. The tinnitus stopped immediately. The reason I mentioned this little thing is to show you that even a small abnormality in the eardrum can cause tinnitus. Further on, the problem of the auditory chain. If there is an abnormal activity of the auditory chain, such as inflammation, hardening of the tissue, trauma (including violence and pneumatic injury), etc., it can affect the “processing” of the sound (note that I emphasize this point here – the process of sound transmission through the auditory chain is actually the processing of the sound, not just the amplification of the sound!) . This can lead to abnormal amplification of certain frequencies of sound reaching the basilar membrane of the inner ear, causing tinnitus, or further causing damage to the basilar membrane sensor in the corresponding area, resulting in permanent tinnitus! Now, let’s talk about the most common cause and location of tinnitus – the inner ear. Tinnitus can be caused when you are suddenly shocked by a loud sound, slapped in the face, working as a telephone operator, spending a lot of time in a noisy environment, or when you are on fire as the people say, or when you have been working at a desk for a long time. But the tone of the sound may be various, and when we do tinnitus matching, we often capture the corresponding tone very well, which provides a good basis for diagnosis. For example: low frequency booming tinnitus is often a problem in the cochlear roof area, so we have to consider whether it is a cochlear roof vagus edema; tinnitus near 4kHz is often related to noise damage; while tinnitus near 8kHZ is mostly related to cervical spine or long-term low sound intensity noise. Therefore, the causes of tinnitus are different, so there should be a difference in the means of medication and treatment. So, how do we go about finding clues to the above? Clinicians often see the hearing test are normal ah? Let me tell you that there is a test that can help us find the cause of tinnitus when the hearing is normal, and that is the “otoacoustic emission” test. This test is widely used for hearing screening of infants and children, but many doctors overlook the fact that this test is actually an “objective, accurate, sensitive, non-invasive and rapid method of microscopic, early detection of cochlear function”. I have been studying the clinical application of otoacoustic emissions since 1998 and have accumulated a great deal of clinical experience. You know, otoacoustic data can change less than one decibel a year for a person without ear disease, right? You are welcome to discuss and share with me!