Tinnitus is one of the most common complaints seen in ENT departments. After years of clinical practice in tinnitus diagnosis and treatment, it is confirmed that from the perspective of tinnitus management and rehabilitation treatment, classifying and disposing of tinnitus is a very meaningful clinical and scientific work, not only because of the high market demand due to the higher incidence of tinnitus than deafness and vertigo! Tinnitus certainly did not fall from the sky ……
For receiving patients with tinnitus, we need to reflect on.
Tinnitus is an objective sound signal, unlike occasional phantom hearing! Through the concept of “aberration product”, the existence of tinnitus sound signals can be understood graphically! Many people think that tinnitus is a symptom or a warning signal or that tinnitus causes deafness …… etc. This description of tinnitus characteristics is not the whole picture of tinnitus, but at the management level: tinnitus is an important object of study in otology!
When it comes to the classification of tinnitus, there are objective, subjective, conductive, neurological …… and so on, which are basically based on observational studies or literature disseminated arguments, as well as highly generalized, with a sense of blackmail. By classifying tinnitus in such a general way, doctors who see tinnitus patients on a daily basis are at a loss and confuse their thinking instead!!!
When it comes to tinnitus treatment, many doctors must know about “masking” and “habituation”, and it seems to be very simple to say, or even dismissive. Literally, it is very intuitive, but how do you apply it in your daily tinnitus practice? How does it work? In fact, from the time a tinnitus patient is seen to the time when acoustic treatment is finally needed and what results are achieved, it is a rigorous treatment process that may require surgery to resolve! In fact, some tinnitus is not suitable for masking, and there are some line masking after the tinnitus loudness increased condition appears. A growing number of experts believe that the use of narrowband sound is preferable to broadband sound in tinnitus sound treatment.
As early as 2002 the American Academy of Audiology issued its Tinnitus Guidelines and listed tinnitus as a job for audiologists. In fact, a number of otologists, neurologists, and audiologists have been working on tinnitus with remarkable success. One of the most familiar is TRT, founded by Jastter boff, known in this country as the “Study Service”. It is not a question of money, but from this point of view we can understand that TRT is not what is often referred to as a “practice service”. If the two words “learning to serve” cost $3,000, it would be higher than what Warren Buffett received!
Because otolaryngologists tend to focus on surgical work with clear foci, they do not devote enough research to the clinical classification and treatment of tinnitus. There is a general consensus that it is more difficult to receive tinnitus or there are errors in interpretation and poor patient compliance …… The reasons for this are manifold. Without the support of a complete audiology center and otology, it is difficult to record complete and accurate information about tinnitus, and without the thought patterns of neuro-otology, it leads to difficulties in analyzing and interpreting tinnitus, compared to The lesion is not visualized enough …… etc. It is not difficult to understand, as the current very lively artificial hearing, vertigo center, deafness genetic diagnosis, otolaryngology …… are some of the doctors stepping out, not only to solve the patient suffering, but also to create a platform for the development of clinical otologists, which is significant!
Regarding misinformation, in the earlier period of literature, some clinicians used patients’ subjective descriptions to record tinnitus, others used audiometers for tinnitus pitch matching, some doctors placed special emphasis on psychotherapy …… and so on. In fact, hearing is ultimately a behavioral response to sound. From the physiological basis of hearing, we can find that the auditory afferent structures and functions of the human ear are very fine, and receive control and innervation from auditory efferent nerves and other neural networks. Uncritical and unrefined recordings can lead to errors in analysis and interpretation, and even to misdiagnosis, omission, and misdirection of research. Some physicians claim to be “misinformed”.
In most cases, tinnitus is the work of otology or audiology, but there are many patients who complain of tinnitus that is actually an artifact or a disease that requires surgery or medication, and whose tinnitus is only a subjective description. For example, there is a lot of high frequency tinnitus, mostly above 3800 Hz, in which case, through refined tinnitus testing, we will find results different from those reported in the literature, while such refined results find their basis in the auditory science base. In fact, the patient’s description of the tinnitus is a “tone”, which belongs to the category of psychoacoustics. The stimulus sound given by an audiometer is a pure tone of a fixed frequency. Tone is related to and differs from frequency, and tone is also influenced by loudness. Especially in the 4200 Hz – 8000 Hz interval, tinnitus tone is usually an acoustic signal consisting of two frequencies.
”Autonomic sound sensation in the absence of external acoustic or electrical stimulation” is the definition of tinnitus that is now generally accepted internationally. In clinical practice, no cases have been found that require a change in the definition!
”More than 80% of tinnitus is associated with lesions or abnormalities of the patient’s auditory system”, which is an important reason to consider tinnitus as a research component of otology.
Two important elements of tinnitus research are the tinnitus itself; and the adverse psychological state caused by the tinnitus. We can analyze and explain tinnitus from these two aspects, as well as conduct tinnitus risk assessment and tinnitus management. In other words, it means that both physical and psychological characteristics of tinnitus must be taken into account in tinnitus treatment. For example, tinnitus caused by anxiety must be treated differently than tinnitus caused by anxiety.
The “mechanism of tinnitus” is something that doctors like, but the mechanism of rhinitis is something that doctors who like rhinologic surgery do not pay much attention to. “Seeing the lesion and performing surgery” is a habit of mind that most doctors are proud of. In fact, the same is true for tinnitus, and many tinnitus complaints require surgery, except that otology is microsurgery, which requires an “in-depth” study of otologic disease in order to create a “surgical space model” and to take into account the patient’s hearing and balance function. It’s not easy to learn, and it’s faster to get through the nose! The volume of surgery is quite rich in the in-depth study of deafness, tinnitus, vertigo and other complaints, and the surgical skills and results are more rewarding. To put it differently, practicing audiology and balancing medicine does not require a change in the surgical habits of the ear surgeon, but rather a perfect enhancement and a need for progress in the development of modern otology —— to study, analyze and interpret diseases in depth and detail, this process of refinement is a “taste for life”.
The diagnosis of tinnitus patients actually lies in experience, which is nothing but detection, diagnosis, treatment and rehabilitation, only that no “tinnitus diagnosis and treatment model” has been formed, and there is a lack of analysis, interpretation and risk assessment methods!
To analyze and explain tinnitus, one must have basic knowledge of auditory science and complete audiological test results and medical history taking data, etc. In fact, the disposition of otologic diseases cannot be separated from the auditory basis, as we can see: even among otologic surgeons, there is a significant difference between the high and low levels in treatment techniques, surgical thinking, surgical skills, surgical results, etc. This difference is never a matter of surgical proficiency!
Tinnitus risk assessment and management is both an important part of otolaryngology work and a means and method to obtain good results!
Otolaryngologists are the most accomplished, especially in otology! The volume of patients is high, the types of conditions are numerous, the number of specialty excitements one can engage in is high, and one can also delve into immune damage to the inner ear as well as functional testing of the nucleus accumbens, etc. Audiologists were ranked as the 4th best profession in 2013.
Minor points
1.Tinnitus classification: Traditional classification methods tend to confuse and mess up thinking.
2.Clinical symptoms: hearing loss, migraine, vertigo, sleep disorders, anxiety, mental illness, etc.
3.Disease types: auditory system, peripheral diseases. Nasopharyngeal cancer, otosclerosis, eustachian tube abnormalities, auditory neuropathy, Meniere, hypertension ……
4.A lot of clinical practice proves that sound is a special medicine for tinnitus! It is also an effective means to verify the diagnosis result of tinnitus.
5.Sound therapy means: tinnitus rehabilitation therapy device, tinnitus rehabilitation therapy matching platform, hearing compensation (different from the concept of hearing aid fitting), etc.
6.Strategy of tinnitus sound therapy: sound + drugs
Efficacy: tinnitus disappears, tinnitus sound diminishes, tinnitus adverse effects disappear, tinnitus adverse effects diminish.