How many tinnitus patients are there in China? There is no way to know the exact number, but it can be estimated from the percentage of tinnitus among online users’ inquiries that tinnitus is almost the most common complaint of otologic discomfort in China. However, most doctors do not have the patience to explain to patients about tinnitus. It is also unrealistic for all patients to go to big hospitals in big cities to see big name specialists. Therefore, I believe that tinnitus patients should rely on themselves to learn more about tinnitus, which will create conditions for consultation and treatment. I am willing to make my humble efforts. The following content is taken from the book “130 Questions on Tinnitus Prevention and Treatment” edited by Tan Zulin, which is easy to understand and is a good textbook for popularization. Tinnitus basics I think are very important to help patients understand the doctor’s treatment plan and actively cooperate with the treatment. It is important to remember that an experienced tinnitus doctor will ask questions very carefully and examine the patient carefully without being blind and targeted. Therefore, he or she will give individualized treatment to different tinnitus patients, and will never respond to all changes with the same medicine, nor will he or she give the same advice to all patients. In the near future, I will introduce the cutting-edge knowledge of tinnitus treatment for the benefit of our readers, hoping to give help to the majority of tinnitus patients.
1. What is tinnitus? What is cranial tinnitus?
The common saying “screaming in the ears” seems to have defined tinnitus, but this only describes the phenomenon of tinnitus and does not reflect the essence of tinnitus. I often hear people say, “When I get angry, my ears squeak, but sometimes I take some medicine to clear the fire, and sometimes I don’t take any medicine, and it goes away by itself. These are all phenomena of tinnitus. As for the definition of tinnitus, it is usually considered to be a subjective feeling of ringing in the ear without an external corresponding sound source or external stimulation. This definition includes two meanings: one is the absence of an external source of sound or stimulation, and the other is a subjective sensation. Tinnitus cannot be heard by others, but can only be felt by the patient.
Because tinnitus is a subjective sensation in humans, it is safe to say that tinnitus has been around since the beginning of mankind, which means that the history of tinnitus is as long as the history of mankind. However, it is only since the advent of language that tinnitus has been a subjective complaint; and it is only since the advent of writing that tinnitus has been recorded. It was recorded by Hippocrates in the 4th-5th centuries B.C., and the earliest written records are found in the 16th century B.C. in ancient Egyptian scribblings on sedge paper.
Tinnitus is a noisy sensation in the ear, a spontaneous intrinsic noise. The patient may feel a variety of sounds in the ear such as hissing, ringing, whistling, waves, steam whistles, motor roar, cricket chirping, cicada chirping, wind blowing, etc., but there is no corresponding sound source in his surroundings. There are various manifestations of tinnitus, some eggs are screaming, some both ears are famous; some ringing in the ears, some can’t point to the direction, as if the whole brain is chirping, so it is called cranial tinnitus; some tinnitus is intermittent, some screaming day and night. Light tinnitus is felt only when one is quiet and attentive; heavy tinnitus is felt to be noisy and disturbing no matter at rest or at work.
Some tinnitus is caused by ear diseases, while others are the concomitant symptoms of systemic diseases. Because tinnitus is a subjective sensation of the patient and cannot be objectively evaluated, it is not well understood by clinicians and is usually difficult for doctors to make an exact diagnosis and treatment.
Cranial tinnitus is essentially tinnitus as well. People with cranial tinnitus often complain of tinnitus in the brain, but in fact it is a manifestation of the stereo-auditory effect of bilateral tinnitus. In some tinnitus patients, the position of the tinnitus from the midline of the skull can be changed during the tinnitus masking test. This phenomenon confirms the above point from one side. Therefore, cranial tinnitus is often treated as tinnitus in clinical practice.
2. How to describe tinnitus?
To describe a patient’s tinnitus, it is necessary to describe the parameters associated with the tinnitus. These parameters include the location, nature, duration, characteristics, pitch and loudness of the tinnitus, as well as the degree to which the tinnitus affects the patient’s mood.
(1) Location: In the ear – unilateral or bilateral, left-sided or right-sided; intracranial – definite or undetermined location.
(2) Nature: A single sound, a combination of two or more sounds, tinnitus can be “buzzing”, “booming”, “squeaking”, “clanking”, or “tinkling”. “, “clanking sound”, “whistle sound”, etc.
(3) Temporal characteristics: It can be continuous, intermittent, steady state or fluctuating, and also the duration of tinnitus disease.
(4) Tone: low frequency sound, medium frequency sound or high frequency sound. Tinnitus tone is generally tested by matching method, and its purpose is to find out the dominant frequency of tinnitus and provide a basis for choosing suitable masking noise for tinnitus masking treatment.
(5) Loudness: The determination of tinnitus loudness helps doctors and tinnitus patients to understand and evaluate the change of tinnitus. Testing of tinnitus loudness can be performed by the matching method or measured by the patient’s self-assessment. In clinical practice, it has been found that self-assessment of tinnitus loudness correlates well with loudness measured by the audiometer matching method if the patient is cooperative. Self-assessment of tinnitus loudness can provide a rapid diagnostic basis for the diagnosis of tinnitus patients in the clinical setting.
(6) The degree of emotional impact of tinnitus: The severity of tinnitus is related to the psychological quality and personality characteristics of the patient. If the tinnitus symptoms are mild and the patient has a strong personality, there is often no significant change in his or her mood; on the contrary, the patient’s mood may be affected and he or she may become disturbed and restless. On the contrary, patients’ emotions may be affected and they may become upset and restless.
3.What are the clinical manifestations of tinnitus?
There are various clinical manifestations of tinnitus, such as whistling like wind, rumbling like machines, chirping like cicadas, or insects, birds, running water, or whistling bells. Some tinnitus occurs in one ear, which is called monaural tinnitus; some occur in both ears, which is called binaural tinnitus. Some tinnitus is intermittent, called intermittent tinnitus; some tinnitus is continuous day and night, called persistent tinnitus. In some cases, it is called persistent tinnitus. In mild cases, it can be heard when the ear is quiet, while in severe cases, it can be heard when studying or working.
Some people believe that tinnitus caused by lesions in the sound-transmitting apparatus of the ear (such as the external auditory canal, tympanic membrane, middle ear bones, and eustachian tube) is mostly low-pitched, such as booming, whirring, and passing sounds: tinnitus caused by lesions in the sound-sensing apparatus of the ear (such as the inner ear vagus, cochlear nerve, and auditory nerve conduction pathway, especially the cochlear part of the inner ear vagus) is mostly high-pitched, such as cicada whistling.
Tinnitus is often accompanied by hearing loss and vertigo. Tinnitus can occur before or after hearing loss, or it can occur simultaneously. However, some tinnitus has no other symptoms.
4. How is tinnitus classified?
Feldman classifies tinnitus patients into the following five types according to the relationship between the pure-tone hearing curve and the masking threshold curve of tinnitus.
Type I: It is often high-tone tinnitus with high-frequency hearing loss, and the hearing curve and the masking threshold curve gradually converge from low to high frequency, so it is also called convergence type. This type of tinnitus is mostly industrial noise deafness, accounting for about 22% of the patients examined.
Type II: It is less common, and the two curves are gradually separated from low to high frequencies, so it is also called the separation type. This type accounts for about 2% of the examined patients.
Type III: The hearing curve and masking curve are adjacent to each other and nearly overlap, so it is also called the overlap type. This type can be seen in patients with Meniere’s disease and otosclerosis, accounting for 53% of those examined.
Type IV: When the frequency points of the hearing curve and the masking curve are 10 dB or more apart, there is a certain distance between the two curves, which means that a louder sound is needed to mask the tinnitus, so it is also called the spacing type. This type is uncommon and accounts for about 17% of the people examined
Type V: Tinnitus that cannot be masked by any intensity of pure sound or noise is this type, so it is also called damped or unmaskable. This type can be seen in patients with severe sensorineural deafness. Because of the severe hearing loss, even if a strong masking noise is used, it is only near the patient’s hearing threshold, or even not heard at all, so it is difficult to produce the masking effect on tinnitus. Not only that, but some patients still have the same tinnitus even though the masking noise is very loud. In patients with bilateral tinnitus, the masking sound should be applied to both ears simultaneously to determine if this is the case. This type of tinnitus accounts for about 6% of the patients examined.
5. Why is tinnitus a common symptom?
Tinnitus is a common symptom and many people experience it. Some tinnitus symptoms are mild or transient and often go unnoticed; some tinnitus is often disturbing, affecting rest and work efficiency and becoming a medical condition. If you listen carefully in a quiet environment, almost everyone has tinnitus. For example, when you are walking alone in a quiet mountain forest, you often get a chilling feeling because of the sound of tinnitus.
The epidemiological survey data of tinnitus shows that it is a common symptom. Since there is a lack of statistical information on this subject in China, we can only quote the relevant survey reports from abroad. Large-scale epidemiological surveys have been conducted in the United Kingdom and the United States. According to studies conducted by the Auditory Research Group of the Medical Research Council of the United Kingdom, the Census Office of the United Kingdom and the National Institutes of Health of the United States, the prevalence of tinnitus is much higher than we might think. The prevalence in the UK and the US is 15-20% of the population. The British Medical Council’s Audiology Research Unit sent 6804 letters to random groups of people in four cities, asking the recipients to answer each of the questions posed in the letters. The prevalence of tinnitus in the total population of these four cities was 15.5-18.6% (excluding those with tinnitus lasting less than 5 minutes or those with instantaneous tinnitus induced by strong external sounds); those with tinnitus causing severe distress accounted for 0.4-2.8% of the total population in the survey sample; and those with severe interference with normal work or life ability accounted for 0.4-0.5%. Moreover, the prevalence of tinnitus increases significantly with age and exposure to noise. If the diagnostic criteria for tinnitus were relaxed to include brief tinnitus and transient tinnitus after noise exposure, the prevalence of tinnitus would rise to 22-32%.
If the prevalence of tinnitus were to be conservatively reduced by some percentage based on foreign survey data, the estimated number of tinnitus patients in China would be 130-140 million at 10%, and at least 10-15 million people would have severe tinnitus and need medical help.
In clinical work, it is common to encounter people who present with tinnitus as a chief complaint symptom or as a concomitant symptom of certain diseases. In recent years, a lot of work has been done at home and abroad in the clinical and basic research of tinnitus, and it is believed that a major breakthrough can be made in the prevention and treatment of tinnitus, and human beings will be able to cure and control this clinical stubborn disease.
6.What is the clinical significance of the characteristics of the course of tinnitus?
There are various characteristics of the course of tinnitus, some of which are rapid in onset, some of which are persistent, and some of which are brief in onset; some of which are long lasting, reaching several years, a decade, or even decades, while some of which disappear after a few days or weeks after onset. These characteristics of the course of tinnitus are of great importance to the diagnosis and treatment of tinnitus.
If tinnitus is sudden and persistent, the etiology of tinnitus is usually due to obstruction of the eustachian tube or fluid accumulation after a cold or flu, while the sensorineural system is often affected by loud sound due to blast ear injury, drug poisoning or ear trauma. However, sudden onset of tinnitus with intermittent or fluctuating intensity is often seen in Meniere’s disease. If the onset of tinnitus is slow, it can be caused by systemic diseases, neurasthenia, mental anxiety, etc.
The duration of tinnitus is also of great importance. If the duration of tinnitus is long or progressive, the cause of tinnitus is mostly related to the sensorineural system, which often indicates serious irreversible damage; while if the duration of tinnitus is short, the cause of tinnitus is mostly a disorder of the sensorineural system, and the lesion is mild and reversible.
Mastering the characteristics of the course of tinnitus can help in the diagnosis of the cause of tinnitus, the efficacy^ of treatment and the prognosis. In clinical practice, the characteristics of the course of tinnitus should be carefully observed and understood.
7. What are the differences in tinnitus in terms of gender?
For a long time, many experts at home and abroad have conducted a series of studies on tinnitus. According to the epidemiological survey of tinnitus and the analysis of a large number of clinical cases, it is found that there is a slight difference in the prevalence of tinnitus in terms of gender. The percentage of women among tinnitus patients is slightly higher than that of men, 55.3% and 44.7% respectively; among the investigated population of the same gender, the prevalence of tinnitus in the female group is 17.6%, while that in the male group is 16.9%.
The factors influencing the prevalence of tinnitus in women more than men are not well understood. At present, it is mostly believed that: firstly, women have poorer psychological tolerance than men; secondly, female workers are more closely exposed to noise, for example, female workers in textile factories are exposed to noise up to 90-100 decibels; in addition, changes in endocrine level during menstruation can cause or aggravate tinnitus symptoms in some female patients.
8.What is the relationship between the onset of tinnitus and age?
It is not an exaggeration to say that tinnitus can occur from newborn to over 80 years old. According to foreign literature, a 26-year-old female patient said that she had tinnitus for as long as she could remember and that she thought everyone had tinnitus until she was a teenager when she gradually realized that people around her did not have tinnitus. Another middle-aged man found that his daughter had been aware of tinnitus for as long as she could remember. Therefore, it can be assumed that tinnitus can begin at a very young age. Since tinnitus is generally a subjective symptom and there is no objective test to confirm it, according to the patient’s statement, tinnitus started when she remembered, so it is likely that she had tinnitus from the time she was born to the time she remembered, but there is no way to confirm this and it is only an inference.
Statistics show that the prevalence of tinnitus increases significantly with age. According to the survey, the minimum age of onset is 3 years old, the maximum age of onset is 88 years old, and the average age of onset is slightly less than 45 years old. After the age of 40, the prevalence of tinnitus rose sharply, with 49.6% of all investigators aged 40-59.
The age of onset of tinnitus in middle age may be related to the combined effect of the following factors.
(1) Medication factors: as age increases, the chance or number of medications increases. Certain drugs can damage the auditory organs, and long-term or intermittent application of these drugs can produce a cumulative toxic effect on the iner. After middle age, various kinds of pain have gradually increased, such as headache, bone pain, back and leg pain is very common, need to take all kinds of oral painkillers to relieve these pains, and common painkillers such as aspirin can cause tinnitus in some patients.
(2) Noise factors: It has been confirmed that various kinds of noise, especially strong noise, are risk factors for tinnitus. Although these risk factors only cause momentary tinnitus at the initial stage, tinnitus may gradually develop into persistent with increased noise exposure. In addition, noise and medications have an additive effect on damage to the inner ear, which further increases the chances of tinnitus occurring.
(3) Age factor: As we age, many changes occur in the inner ear structure. There is sufficient evidence that the basilar membrane thickens and becomes less flexible with age, that the hair cells that transform sound signals into electrical signals undergo degenerative changes, and that other cells (such as spiral ganglion cells) that rely on the blood supply and fluid environment of the inner ear to maintain normal function can also undergo degenerative changes. These are the basic pathological basis for the development of age-related deafness and can be understood as the basic pathological changes in the inner ear that produce tinnitus in middle-aged and elderly people. Deafness is more common in the elderly, while tinnitus is more common in the elderly, and the two often coexist.
(4) Systemic disease factors: As people reach middle age, systemic diseases also increase. Cardiovascular diseases, such as hypertension, coronary heart disease, cerebral arteriosclerosis, and metabolic diseases, such as diabetes, hyperlipidemia, etc., can all impair the microcirculation of the auditory system, thus affecting the blood supply to the auditory system and eventually leading to tinnitus.
9. Can tinnitus be hereditary?
As we all know, in most cases, tinnitus is only a common symptom but not an independent disease. The causes of tinnitus are complex and varied, and the clinical manifestations are also diverse. Therefore, the question of whether tinnitus is hereditary should not be considered in a nutshell, but should depend on the specific cause of tinnitus. In terms of the cause of tinnitus, if it is caused by cerumen or foreign body blockage in the external ear canal or middle ear inflammation, it obviously has nothing to do with heredity. As for noise damaging tinnitus or drug toxic tinnitus, they may also show sensitivity to damage due to the presence of a family genetic predisposition.
Otosclerosis is a disease in which the dense lamellar bone of the osseous vagus is focally replaced by new spongy bone rich in cells and blood vessels, and when the lesion involves the stapes or the cochlea, it produces transonic or sensorineural deafness, accompanied by tinnitus. According to research, otosclerosis is associated with autosomal dominant inheritance, is mostly seen in Caucasians, has significant regional differences in prevalence, and can be seen in all ages, with the majority of young and middle-aged people developing the disease, and about 2.5 times more women than men. In addition, common diseases that cause tinnitus, such as hypertension and diabetes, may also have a genetic predisposition. Therefore, to clarify whether tinnitus is hereditary, it is actually a matter of finding out whether each specific disease that can cause tinnitus is hereditary.
10.What is the difference between tinnitus and phantom hearing?
Tinnitus and phantom hearing are both auditory hallucinations, but there is a difference between the two. Some patients tell their doctors that they sometimes hear the sound of crying, laughing, singing, and talking, but no one else can hear them, when in fact there are no such sounds in the outside world at that time. This is phantom hearing, which indicates that the patient’s central nervous system function is disrupted. In addition, some musicians, composers, and music lovers can often hear complete music due to normal thinking, but after actual listening, there are no such sounds, and this phenomenon also belongs to phantom hearing.
The essential difference between tinnitus and phantom hearing is that tinnitus is a disorganized, in-ear or in-ear sound with no specific content, while phantom hearing is a meaningful, or contented, auditory hallucination. Phantom auditory hallucinations can be seen in patients with status epilepticus (especially temporal lobe epilepsy) or temporal lobe tumors, and can only be classified as a psychiatric disorder after detailed examination to rule out neurological counterfactuals.
11.What is the danger of tinnitus?
Tinnitus is often not taken seriously when the symptoms are mild or transient; when it is severe, it can cause certain harm to the patient. This harm is mainly manifested in the following two aspects.
(1) Affecting one’s hearing: Severe tinnitus often interferes with the patient’s rest, causing a feeling of extreme boredom to the point of lack of concentration and reduced auditory sensitivity. In addition, tinnitus that is too loud can disrupt the auditory content of a person’s hearing, thus inevitably affecting the person’s hearing.
(2) Affecting people’s mental life: Once you suffer from tinnitus, especially severe tinnitus, it often makes you restless and affects your sleep, thus making you feel pessimistic and bored. In turn, this boredom aggravates the tinnitus symptoms. The result of this vicious cycle is that the tinnitus patients’ mental burden is increased and they often show signs of worry, fear and mental overstimulation.
12.What are the common psychological reactions of tinnitus patients?
The common psychological reactions of tinnitus patients are as follows.
(1) Excessive apprehension: Survey shows that at least 2/3 of tinnitus patients are worried about their symptoms. Their concerns and their percentages of the total number of people surveyed are: they think there is no treatment for tinnitus, accounting for 13%; tinnitus makes them depressed and depressed, accounting for 12.9%; tinnitus will worsen, accounting for 10.4%; tinnitus is a lifelong affliction, accounting for 10.3%; tinnitus will damage their hearing, accounting for 8.9%; tinnitus hinders their normal social activities, accounting for 8.5%; tinnitus affects Tinnitus interferes with rest and sleep (5.7%) and can lead to deafness (5%). These overly worried psychological states are harmful to patients and can cause them to look sad and depressed all day long. As the saying goes, “A smile makes a decade less; a sorrow makes a head white.” This saying is not without truth. A reputable tinnitus specialist, Dr. Dorek, once said, “I have treated many tinnitus patients who, from the outside, look at least 10 years older than their actual age!”
(2) Irritability and mood swings: Tinnitus patients are often disturbed and disturbed by the constant ringing in their ears or skull, and are in great pain. For introverted patients, this psychological disorder does not necessarily show itself, while for extroverted patients, this psychological disorder often manifests itself as irritability and mood swings. The essence of the psychological disorder is the same for both extroverted and introverted patients, that is, the central nervous system is in a state of constant tension due to the continuous stimulation of abnormal sensations, which causes neuroendocrine dysregulation, especially the change of monoamine neurotransmitters, which weakens the downstream inhibition of the central nervous system, manifesting as weakened self-control, reduced self-regulation, irritability and mood swings. Whether this causes such psychological disorders often depends on the severity of the tinnitus. Mild tinnitus is rare; patients with loud tinnitus and irritable tones are more likely to develop this type of psychological disorder. In clinical work, it has been found that the degree of psychological disorders in patients with similar tinnitus loudness varies, depending on the psychological quality of the patient and the degree of adaptability. For those who have good psychological quality and strong adaptability, the degree of this kind of psychological disorder will be lighter; on the contrary, it will be heavier and even reach an unbearable degree.
(3) Sleep disorder: Insomnia is a common symptom of neurosis, and tinnitus can cause a certain degree of sleep disorder. It is generally believed that once tinnitus patients have fallen asleep, they will rarely be woken up by the sound of tinnitus because in the sleep state, the higher central nervous system is in a highly inhibited state and there is no consciousness, so patients are not aware of or cannot feel tinnitus during sleep and will not be woken up by it. However, once awakened, tinnitus will immediately return, and its nature and degree will be similar to that before sleep. However, there are different views on this issue. For example, Hazel reported in 1979 that 23.2% of the patients surveyed responded that they had been awakened by tinnitus during sleep, and about 1/3 of them said they were awakened by tinnitus every night during sleep. It is not difficult to understand that since you can be woken up by external noise during sleep, you may also be woken up by internal environmental noise. There are inconsistent findings as to whether tinnitus causes difficulty in falling asleep, but in general, the more severe the tinnitus, the more likely it is to cause difficulty in falling asleep. Moreover, there are gender differences in the occurrence of sleep disturbances among patients with severe tinnitus, generally more in women than in men.
(4) Personality changes: Tinnitus, as a symptom, can cause further psychological conflicts and contradictions, and even form an obsessive-compulsive concept, changing the original personality, manifesting as a preference for solitude, avoidance of social interaction, and silence, which is different from that before the disease. The emergence and severity of personality changes are not only related to the severity of tinnitus symptoms, but also depend on the patient’s original psychological quality and resilience.
(5) Depressive state: The most serious psychological disorder caused by tinnitus is depressive state. Once a patient is found to be in a depressed state, a psychiatrist or psychologist should be consulted and appropriate medication should be administered. The formation of depression is mainly due to the fact that the aforementioned psychological disorders caused by tinnitus have not been eliminated in time, and the patient suffers from long-term tinnitus torment, coupled with psychological disorders such as anxiety and irritability, insomnia, and personality changes. Insomnia is often more serious, often sleepless at night. Those who usually smoke and drink alcohol may show excessive smoking or alcohol abuse. In fact, patients feel that they can no longer tolerate tinnitus and psychological torture, and can no longer feel the joy of life, thus creating a psychological tendency of misanthropy. At this point, if left untreated, a tragic end is inevitable.
Tinnitus can cause a series of psychological disorders, and it goes without saying that psychological counseling and psychotherapy are a very important part of tinnitus therapeutics. In recent years, psychological counseling has been widely carried out in large and medium-sized cities in China. Tinnitus patients may want to get out of their misconceptions and actively participate in psychological counseling clinics and psychotherapy. As a counseling physician, he or she should explain the knowledge about tinnitus to the patient patiently and concisely, so that the patient can have a correct understanding of the symptom of tinnitus, eliminate unnecessary worries and fears, stabilize emotions, enhance confidence, and finally get rid of the heavy psychological burden and actively cooperate with clinical treatment, thus achieving a better treatment effect.