It is evident that tinnitus seriously endangers people’s quality of life, and although it is not a life-threatening disease, it is a source of great annoyance to patients, and some severe patients even feel worse than death. However, since there are many causes of tinnitus, it is difficult for some patients to be diagnosed, not to mention treated. Many patients are disappointed by the answers they get from their doctors, because many doctors, including some experts, tell patients that tinnitus is incurable and that they should stop wasting their time. Many patients can produce good results through psychological guidance, but it requires enough patience from the doctor. However, now the big hospitals are busy, many experts like a gyroscope around, which has time to listen to the patient nagging. Therefore, I think patients may want to learn more about the types and causes of tinnitus, so that they can have a preliminary diagnosis of their tinnitus and describe it more clearly and accurately to the doctor during the consultation. The following is an excerpt of the types of tinnitus: (divided by etiology) I. Physiological tinnitus: A person with normal hearing can hear the following sounds in a very quiet environment: 1. the humming sound of blood circulation or muscle tremors; 2. the sound produced by the movement of air on the tympanic membrane or liquid in the cochlea; 3. the pulsating tinnitus during strenuous exercise or emotional excitement; 4. The pulsating tinnitus may occur when the artery in the temporal region or the ear area is partially blocked by pressure; 5. Pathophysiological tinnitus 1. Spontaneous tinnitus: many people have whistle-like tinnitus for a few seconds, and about 15% of people have had tinnitus for more than 5 minutes; 2. Noise-related tinnitus: tinnitus caused by exposure to noise stimulation; 3. The incidence of this type of tinnitus is unclear. The clinical difficulty in diagnosis lies in the fact that it is not possible to determine whether the tinnitus is actually caused by long-term use of a certain drug. Based on my clinical experience, I roughly estimate that the actual incidence of this type of tinnitus may not be high. (2) Drugs with hearing loss: anticancer drugs (cisplatin, nitrogen mustard, etc.) aminoglycosides, cyclic peptides, macrolide antibiotics, chloroquine, quinine, diuretics, antipyretics and analgesics, salicylates, ibuprofen, oral contraceptives, anti-thyroxine drugs, etc. This kind of tinnitus also has the same difficulty of confirming the diagnosis, but unless it is taken for a long time it is also generally transient in the majority. 4. Toxicemic tinnitus: It is caused by toxemia and can be transient or persistent. C. Tinnitus associated with certain diseases (a) Body sound: 1. Myogenic: The most common one is palatal myoclonus, and the tinnitus is a clicking sound synchronized with myoclonus. It often disappears spontaneously. Tinnitus due to middle ear muscle clonus can occur when blinking, or when the stapedius muscle contracts due to acoustic stimulation or auricular skin irritation. The tinnitus can also occur when the eustachian tube is open or closed, or when the temporomandibular joint is abnormal and the mouth is opened or closed. 2. Respiratory: When the eustachian tube is abnormally open, there is often a blowing sound in the ear that is synchronized with breathing, and there may be a self-sounding over-intensity. It often occurs in excessively lethargic people, and can also be seen in diving, playing musical instruments and other occupations. 3. Vascular: It is pulsating tinnitus, and it is difficult to determine whether it is physiological or pathological. It often occurs intermittently and can be the only tinnitus or an additional tinnitus; or it can be a pulsating change of a high-pitched sensorineural tinnitus superimposed. However, sometimes it is a symptom of some disorder, so care should be taken to determine if the tinnitus is synchronized with the heartbeat. The most common cause of tinnitus is atherosclerosis or arterial vortex phenomenon caused by the coexistence of hypertension. Less common causes include arteriovenous aneurysms, arteriovenous fistulas, and jugular vein bulbs, with malformations of the mastoid guiding veins and high jugular vein bulbs being common. Arteriovenous fistula can be diagnosed when tinnitus is reduced by turning the head to the opposite side of the tinnitus and compressing the jugular vein on the affected side. (B) Conductive tinnitus: Tinnitus can be caused by diseases that cause obstruction of the external ear canal, tinnitus can be caused when cerumen touches the tympanic membrane, perforation of the tympanic membrane, acute or chronic otitis media, fluid in the auditory chain, and tumors in the tympanic chamber. (iii) Sensorineural tinnitus: Most of them come from intracochlear disorders. Sensorineural tinnitus can be divided into sensorineural, peripheral neural and central neural tinnitus. However, it is difficult to separate them clearly, and they are often mixed with each other. 1. Sensorineural tinnitus: It is the most frequent type of tinnitus, and is commonly associated with senile deafness, ototoxic drug-related hearing loss, noise-related hearing loss, Meniere’s disease, delayed membranous vagal effusion, exolymphatic fistula, otosclerosis, and cochlear vascular defects. There is a clear relationship between the severity and incidence of tinnitus and hearing loss. However, tinnitus can also occur in people with normal hearing. About 1/3 of people with moderate or severe hearing loss do not have tinnitus. 2. Peripheral neurogenic tinnitus: About 10 percent of people with auditory neuroma tinnitus as the first symptom, especially those with unilateral tinnitus and normal hearing, must be excluded. 3.Central nervous tinnitus: It often occurs in the ear with pre-existing or potential peripheral hearing dysfunction, such as tinnitus after vagus or auditory nerve surgery. Tinnitus can occur in tumors, vascular anomalies, local inflammation, multiple sclerosis, etc. that invade the hearing conduction pathway. If tinnitus occurs at the same time as cerebrovascular disease without hearing impairment, it is mostly central nervous tinnitus. As you can see, there are a variety of causes of tinnitus, and it is important to make a detailed consultation and necessary tests to determine what kind of tinnitus you have. There are many cases of tinnitus that can be relieved or even eliminated by medication, but there are also many cases of tinnitus that are stubborn and difficult to treat. This kind of tinnitus is more likely to be solved by treatments other than medication, so the doctor needs to have a more comprehensive knowledge structure and prescribe the right medicine according to the patient’s personality characteristics in order to receive satisfactory results for both the doctor and the patient. Because tinnitus is largely a subjective symptom of the patient, the best criterion for evaluating the effectiveness of treatment is the patient’s self-perceived reduction.