Tinnitus is a common and persistent disorder worldwide, described by the World Health Organization (WHO) as “a symptom of hearing impairment characterized by buzzing, ringing, clicking, pulsing, roaring or other noise sensations in the ear”, with an average incidence of 3% to 30%. Its etiology is complex and its mechanisms are unclear. Although there are many treatment options, there is no specific effective method so far. Currently, comprehensive treatment is mostly advocated. (1) Classification of tinnitus according to the site of hearing dysfunction ① Conductive tinnitus ② Sensorineural tinnitus ③ Central tinnitus (4) Pseudo-tinnitus. (3) According to the course of the disease, acute tinnitus (<3 months), subacute tinnitus (4-12 months), and chronic tinnitus (>12 months) are classified. (4) Classification according to whether tinnitus causes mental distress ① annoying tinnitus ② non-annoying tinnitus patients (5) Classification according to whether tinnitus can be detected by a doctor ① subjective tinnitus ② objective tinnitus Treatment of tinnitus Some scholars believe that acute tinnitus with a disease duration of less than 3 months is easier to treat, while chronic tinnitus is difficult. The actual situation in clinical work is often the same. 1. Etiological treatment Etiological treatment of tinnitus is the first and more ideal treatment method. However, sometimes the cause of tinnitus cannot be determined, or the cause of tinnitus cannot be treated even though it can be determined, or tinnitus may still exist even though it can be treated, so treatment of the cause is not as easy as expected. 2. Chinese medicine treatment Chinese medicine is one of the representatives of China’s excellent traditional culture. In recent years, there have been a lot of literature on the TCM treatment of tinnitus, including TCM dialectical prescriptions, empirical prescriptions with addition and subtraction, and acupuncture. Some domestic scholars believe that the comprehensive treatment of tinnitus by TCM has better efficacy, and its efficacy continues to work over time, which is a long-term benefit process. The advantage of Chinese medicine in the treatment of tinnitus is evidence-based treatment, but it needs to focus on the collation and research of relevant ancient texts and the application of modernization of Chinese medicine in the treatment of tinnitus. 3.Pharmacological treatment The following drugs are routinely used in the pharmacological treatment of tinnitus (1) vasodilator drugs: ginkgo biloba preparation, betahistine mesylate, ciprofloxacin, ④ hao salty tobacco rift take #2) neurotrophic drugs such as vitamin B12, nerve growth factor for injection, etc. (3) Drugs to reduce the effects of tinnitus: antidepressants; anti-anxiety drugs, etc. (4) Tinnitus suppressants: lidocaine; carbamazepine, etc. For tinnitus that has been onset for less than 6 months, active medication should be used, while for persistent tinnitus that has been onset for more than 12 months, routine application of the above drugs is not recommended. 4. Ganglion block therapy Research shows that repeated stellate ganglion block is a kind of resurrection exercise for plant nerves. It has been observed that stellate ganglion block can effectively improve the inner ear microcirculation of patients and improve the clinical treatment effect of subjective tinnitus. 5. Masking therapy Masking therapy is currently a more effective method in the treatment of tinnitus. The mechanism of masking therapy is based on the theory of outer hair cell compensation in tinnitus, that is, when the outer hair cells in a certain part of the cochlea are damaged, the adjacent normal hair cells will strengthen their electro-mechanical action in an attempt to compensate for it. Therefore, the clinical method of reducing tinnitus by masking the sound in the affected ear and suppressing the “compensatory” activity of the outer hair cells has been developed. The 2014 U.S. Guidelines for the Clinical Use of Tinnitus expert panel recommends that patients with persistently annoying tinnitus receive tinnitus sound therapy. There are various types of masking devices used as masking therapy: ambient sounds such as bells and running water; radio or mono-players that play music, rain, running water, etc.; hearing aids, which are mainly used in patients with low-pitched tinnitus; specialized masking devices; and combined types of masking devices. Masking therapy is a kind of physiological therapy, which is simple, safe and has no obvious side effects. At present, it is mostly advocated to combine with psychological therapy to better eliminate patients’ psychological barriers to tinnitus. 6.Psychological treatment Research suggests that there is a close relationship between anxiety, depression and tinnitus. Psychological treatment is mainly divided into cognitive therapy and biofeedback therapy. It has been reported that cognitive-behavioral interventions can significantly improve the anxiety scores and the overall effectiveness of tinnitus in tinnitus patients. 7. Habituation therapy Tinnitus habituation therapy was proposed by Jastreboff et al. in 1990. The main mechanism of habituation therapy is to reintegrate or recode the nervous system through long-term habituation training to reduce the central sensitivity to tinnitus, break the vicious circle between tinnitus and bad mood, and finally achieve adaptation to tinnitus. The goal of treatment with habituation therapy is not to eliminate sound production, but to block tinnitus-related sound signals transmitted from the auditory pathway to other systems in the brain , particularly the limbic and autonomic systems. If the treatment is effective, the patient will still be able to feel the tinnitus, but the tinnitus will not affect his or her life or emotions, and this process is called tinnitus habituation. Tinnitus therapy consists mainly of guided counseling and sound therapy. Patients should be trained over time and must use audible materials such as tinnitus maskers, music CDs, tapes, etc. to help achieve adaptation and habituation to tinnitus. The efficacy increases with the course of treatment and the overall tinnitus adaptation rate is greater than 80% after adherence to treatment. This method is adapted to all tinnitus for which the original treatment method is ineffective, is easy and has no side effects, but the treatment takes several months or even more than a year. Tinnitus habituation therapy can be seen as a combination of psychological treatment and masking therapy. In the author’s opinion, for patients with long-term persistent tinnitus, habit therapy is probably the most recommended method at present. 8.Transcranial magnetic stimulation therapy Transcranial magnetic stimulation is used to modulate the excitatory areas of the cerebral cortex associated with tinnitus by providing an electromagnetic field to the superficial cerebral cortex. 2014 U.S. Guidelines for the Clinical Use of Tinnitus expert panel recommends against the use of transcranial magnetic stimulation as a routine treatment for persistent and annoying tinnitus. 9. Electrical stimulation therapy Transcranial electrical stimulation therapy is rarely used in China, but has been more widely used abroad in recent years. It is very effective in treating severe tinnitus by applying electrical stimulation to the auditory organs according to the frequency of tinnitus. 10. Hyperbaric oxygen therapy Hyperbaric oxygen therapy for sensorineural tinnitus is a more widely used method in recent years. It has been observed that hyperbaric oxygen helps to improve the microcirculation in the inner ear of patients with neurological tinnitus. The mechanism of hyperbaric oxygen therapy for neurogenic tinnitus is that: hyperbaric oxygen can improve the hypoxic state of the auditory center and inner ear; improve the blood supply of the inner ear artery by improving the hypoxic edema of the vagus artery of the inner ear and increasing the blood supply of the vertebrobasilar artery; it can directly increase the blood supply of the ischemic area; improve aerobic metabolism and increase antioxidant enzyme activity, etc. The author has encountered several cases of neurological tinnitus patients who, after one session of hyperbaric oxygen therapy, complained that their tinnitus disappeared after leaving the chamber. It is the author’s experience that patients with persistent tinnitus of less than 6 months’ duration have better overall efficacy, and the shorter the duration of the disease, the better the efficacy. The treatment of long-term persistent tinnitus is still a worldwide challenge. There is still no specific method to eliminate tinnitus. Most advocate comprehensive treatment. There is a wide range of treatments with different efficacy, but there is a general lack of strong evidence. For cases with a duration of less than 6 months, tinnitus elimination can be sought by active interventions such as etiological treatment, pharmacological treatment, hyperbaric oxygen therapy, and psychological treatment; for patients with a duration of more than 12 months, treatment methods such as habit therapy can be tried along with the aforementioned treatments, with the aim of not eliminating tinnitus, but helping patients to recognize tinnitus, adapt to it, and eliminate anxiety and discomfort about it The aim is not to eliminate tinnitus, but to help patients understand it, adapt to it, and eliminate anxiety and discomfort about it.