Patient: tinnitus for 2 months, started mildly, checked hearing in the middle, normal, but at the end of December tinnitus worsened, then felt hearing right ear slightly worse, electric audiometry 1k down to 35. immediately after treatment, vincristine, mellopin treatment for 6 days, followed by aspergillus, urine muscle enzyme, jen peptide for 7 days, in the middle take prednisone 30mg for 5 days, tretinoin 1 shot to the ear, now tinnitus worsened, every moment, cold, occasional cough and nasal congestion. I have a cough and nasal congestion occasionally, and my electric audiometry has dropped from 1k to 55. I am not dizzy for now. What exactly is my disease, is it sudden deafness, what treatment should be given and is there a possibility of cure? Xiaowei Wang, Department of Otolaryngology, Peking Union Medical College Hospital: Please add whether the tinnitus is a high-pitched cicada sound or a machine booming sound or a pulsating sound in line with the pulse, and whether there are precipitating factors before the appearance of symptoms and before the worsening of symptoms. It is necessary to add an acoustic conductance test (most likely already done at the initial visit, please review it again to compare the results), brainstem evoked potentials (ABR), and preferably a thin:layer CT scan of the temporal bone to rule out other disorders. It should be noted that, from the description, it is still more likely that the primary neurological inner ear dysfunction is neurological tinnitus and deafness. The medications you applied previously were all treatments for this condition. The supplemental tests described above may only further confirm the diagnosis and rule out other problems, and may not suggest other treatments based on the results of the supplemental tests. Patient: I am currently taking bitter discs and Bechsin injections. There are various sounds of tinnitus, including high frequency sounds, and in severe cases the loudness is in line with the sound we make when we hit a porcelain bowl with chopsticks, or a little higher than that. There are also sounds that are consistent with the frequency of the pulse. The tinnitus had been for two months before the symptoms appeared, but it was not serious at that time and did not affect the hearing, but it started to worsen on December 29 and the treatment started on the 30th. It has been going on until now. When the symptoms worsened after the treatment, I caught a cold, and I don’t know if it had anything to do with that. Now it is 2k down to 40db, looking forward to your reply. I don’t know if I can use it now or not, but the doctor who gave me the treatment here doesn’t recommend it. In addition, I have been diagnosed with sudden deafness. The acoustic conductance test was also done and there is no big problem. Do you see that these tests you suggested to me for brainstem evoked potentials (ABR) and preferably a thin layer CT scan of the temporal bone to rule out other diseases are still needed? I started treatment the day after I found it and I have also used hormones. It is now 19 days of treatment. A teacher in my unit recommended hyperbaric oxygen to me. Do you think I can still use hyperbaric oxygen and hormone treatment in my current situation? Wang Xiaowei, Department of Otolaryngology, Peking Union Medical College Hospital: The diagnosis of neurological tinnitus is valid, both in terms of incidence and in your current situation. As for sudden deafness, the full name is primary sudden sensorineural deafness. The nature of your case is clear and there is no need to dwell on whether it is sudden or not. It must be said that there is a lack of clear and effective means for the treatment of neurological tinnitus and deafness, and all families use drugs that nourish the peripheral nerves and improve microcirculation in the head. In addition, they can be combined with hormones and Chinese herbal medicines. The treatment of neurological tinnitus and deafness has a clear time-sensitive nature, therefore, the treatment machine at the early stage of the onset is crucial, including hyperbaric oxygen, but it is not certain to be well with the use of drugs. It has a lot to do with the physical quality of each person. In your case, you are still optimistic due to your youth, but it has been several months since the onset of the disease, so the next step of treatment should be at the discretion of your supervising physician. At present, you can learn about some drugs for tinnitus and deafness through various media, the vast majority of which are not clinically proven, so do not spend unnecessary money or even damage your own body. As for the recommendation that you have an ABR and CT, it is to rule out microscopic tumors in the inner ear. Since the incidence is extremely low, you can decide for yourself whether or not to suggest that your doctor perform these tests for you. Patient: My supervising doctor said that since I had already used hormones, I didn’t need them. At that time I was on prednisone 30mg for 5 days and at that time my doctor said that the dose given was conservative because I weighed 50kg and my hearing dropped to 2k40db at the time of the injection in the hospital. i was going to suggest my doctor to do the tests you mentioned. Would you say that in my current situation, 1. can hormones be used 2. can hyperbaric oxygen still be done? Wang Xiaowei, Department of Otolaryngology, Peking Union Medical College Hospital: I don’t think hormones are very useful anymore because glucocorticoids have some side effects after using them for a long time, so it is not recommended that you use them. As for hyperbaric oxygen, the effect will not be very obvious at present. But because of the small side effects, you can try it for a week. For now, I suggest you relax and avoid emotional stress, overwork and other factors that may aggravate your condition. This will keep the ear problem from getting worse. Then, the current condition should no longer affect your life after a month. Patient: My doctor here says I can’t use hyperbaric oxygen, and she thinks the reason is that if I don’t use it well, it will make the small blood vessels spasm. When you say, “Well, the current condition should no longer affect your life after a month.” Does that mean that I will adapt to this life? Or does it mean something that I don’t quite understand. My current condition is that 2000k is normal, but at 1k it is still 45db, I just don’t understand, I was treated in time, how can I not be able to get up to this point? Wang Xiaowei, Department of Otolaryngology, Peking Union Medical College Hospital, Beijing, China: What I mean by that is adaptation. Of course, it is possible to recover, but even if the hearing at 1000Hz (1k) still cannot be improved, as long as it does not develop further, it will not bring you more inconvenience in your future life. The reason why hearing at a certain frequency still cannot be improved after such treatment is that the acute disorder of blood supply to the inner ear causes degeneration of the auditory receptor cells (hair cells) in the inner ear, and after treatment, part of the degenerated cells regain their normal function, while another part of the degenerated cells cannot be restored and therefore lose their normal function. Traditional theory holds that nerve cells are non-renewable, and therefore, despite regular treatment, neurological tinnitus and deafness may still not be completely resolved. Of course, it is now believed that even nerve cells can be regenerated, so it is not necessarily true that further recovery is not possible. However, further recovery may not be drug-related. Unrelated to drugs, then, the most important thing is emotional regulation. You now have trouble sleeping, then the first thing to do is to relax your emotions. Must not be pessimistic, people in the 35 years of experience, it is likely to encounter some disease too, tinnitus deafness is difficult to treat, but the harm is not yet so great, so, sincerely please put down the burden of thought. Patient: I can’t sleep well now, does it have something to do with the injections I’ve had as well? Because I’ve been getting hang-up injections for 20 days, most of them are vasodilators. My doctor here says it’s a problem with the eustachian tube, so I have to use Fumar nasal drops and take oral anti-inflammatory medicine, do you think it’s right? After the injection, do I need to take some oral medication, because I don’t know if I need to consolidate this disease. Wang Xiaowei, Department of Otolaryngology, Peking Union Medical College Hospital: The sensation of stuffy ears often occurs during the course of sudden deafness. It may just be a subjective feeling and there is no drop in middle ear pressure. The ear stuffiness caused by cold is mostly due to the middle ear pressure drop caused by the swelling and blockage of the eustachian tube, which can be judged by the acoustic conductance test. It should not be a side effect of infusion therapy. In this regard, it is better to listen to your own doctor. As for the present, you can apply some oral medications, such as oral miconazole, for nerve nutrition. In the future, you can also use some inexpensive vitamins, mainly B vitamins, for a long time.