Tinnitus is a symptom of self-conscious ringing in the ear, while deafness is a symptom of hearing loss in both or one ear, or a serious hearing impairment on objective examination. Tinnitus and deafness often occur sequentially or simultaneously. It can be caused by deficiency of yin and blood, deficiency of kidney essence, deficiency of middle qi, upward disturbance of wind and phlegm fire, wind evil attack, drug poisoning, etc. It can be seen in a variety of diseases of the external auditory canal, middle ear, inner ear, and also in a variety of systemic and especially chronic diseases.
Tinnitus is generally not diagnosed as a disease alone, while deafness can be diagnosed as an independent disease. If the disease type of tinnitus and deafness is not yet determined, tinnitus and deafness can be used as a preliminary diagnosis and treated with evidence.
I. Mechanistic analysis
1. Blockage of the ear orifice by objects: If there is a foreign body or cerumen blockage in the ear, tinnitus and deafness can be produced due to the blockage of the outer ear orifice and obstruction of sound transmission.
2. Damage to the eardrum: If the ear is hit by palm strike or fall, or if the eardrum is damaged by thunder or shell shock, or if the ear orifice is blocked by shock, the veins and collaterals are paralyzed and the qi and blood are not smooth, tinnitus and deafness can occur.
3.Evil congestion in the ear orifice: If the six evil spirits or epidemics attack the ear orifice, the skin and hair are attacked by the evil spirits, and the lungs are internally surrendered to the evil spirits.
4. Dysregulation of internal organs: Insufficient endowment, old age and weakness, loss of nourishment after prolonged illness, warm disease, poor diet, long-term noise, etc., lead to dysregulation of internal organs. The tinnitus and deafness are caused by the loss of nourishment of the orifices and loss of function.
Diagnosis
1. Symptomatic manifestations: Self-perceived ringing in the ears, or no sound in both ears or one ear, or objective examination shows severe hearing impairment. It can be manifested as.
(1) Self-perceived ringing in one or both ears, the sound may be large or small, and the attacks may be continuous or intermittent, or sometimes light and sometimes heavy, sometimes not.
(2) Tinnitus can be heard by others, and it is a cackling or pounding sound, mostly unilateral.
(3) Self-perceived hearing loss of varying degrees, either on one side or both sides, or sometimes light and sometimes heavy, or gradually aggravated.
2. Classification and gradation of tinnitus and deafness: Tinnitus can be divided into subjective tinnitus and objective tinnitus.
(1) Subjective (spontaneous) tinnitus: also known as non-vibratory tinnitus or intrinsic tinnitus. The patient’s subjective tinnitus symptoms are not audible to bystanders. The majority of tinnitus in clinical practice falls into this category.
(2) Objective (other-perceived) tinnitus: Also known as vibratory tinnitus or extrinsic tinnitus. Both the patient and the examiner can hear the ringing sound of tinnitus. It is less common clinically.
(3) Transonic deafness: It is characterized by normal bone conduction hearing and decreased air conduction hearing; on electrical audiometry, there is a gap between air and bone conduction on the audiogram. It is mainly seen clinically in external and middle ear diseases, such as cerumen embolism, cholesteatoma of the external ear canal, acute and chronic otitis media, middle ear adhesions, interrupted auditory chain, otosclerosis, and middle ear tumors.
(4) Sensorineural deafness: It is characterized by a simultaneous decrease in bone conduction hearing and air conduction hearing; there is no gap between the air and bone conduction on the audiogram by electrical audiometry. It is common in violent deafness (sudden deafness), drug-induced deafness, febrile deafness, noise deafness, and senile deafness.
(5) Mixed deafness: i.e., coexistence of transduction deafness and sensorineural deafness. It is characterized by a decrease in both bone and air conduction hearing, but the decrease in air conduction is more severe; there is a certain gap between air and bone conduction on the audiogram by electrical audiometry.
(6) Classification of deafness: The hearing sensitivity is generally measured clinically by the hearing threshold of speech frequency, i.e., the average hearing threshold of 500 Hz, 1000 Hz, and 2000 Hz is used as the classification standard of deafness. It is customary to classify deafness into 4 degrees: the average hearing threshold of speech frequency ≤30dB for mild deafness; ≤60dB for moderate deafness; ≤90dB for severe deafness; >90dB for total deafness.
3.Concomitant symptoms: It may be accompanied by ear pain, ear discharge, headache, vertigo, etc.
4.Consultation: We should pay attention to the cause or etiology of tinnitus and deafness, including the history of ear disease and systemic acute and chronic diseases, the state of occurrence of tinnitus and deafness (sudden, gradual, intermittent, persistent, sometimes light and sometimes heavy or day light and night heavy, etc.), the length of the disease, the change of severity, the coarse and macro (low) or sharp (high) sound, and any concomitant symptoms, etc.
5. Examination.
(1) Otologic examination, pay attention to the presence of foreign bodies or cerumen embolism in the external ear canal, the presence of eardrum invagination, congestion, swelling, perforation, the presence of tympanic chamber effusion sign, blue tympanic membrane sign, and in most cases, further nasal and nasopharyngeal examination and general examination of Eustachian tube function should be performed to clarify the diagnosis of ear disease.
(2) Audiological examination, such as tuning fork examination, pure tone hearing threshold, acoustic impedance, electrical response audiometry (brainstem evoked potentials, cochlear electrogram), to determine the nature and degree of deafness.
(3) If possible, tinnitus frequency and loudness matching test should be performed for tinnitus patients.
III. Identifying ideas
1. If the patient has tinnitus and can be heard by others, it is other-perceived tinnitus. This type of tinnitus has a real source of sound. It is commonly found in the following diseases.
(1) Patients with a weak constitution, swelling and coaxing in the ear when exhaling, enhanced self-sound, and symptoms aggravated after exertion, the tympanic membrane can be seen fluttering with breathing when pinching the nose and breathing deeply, and the breathing sound of deep inspiration (tinnitus) can be heard from the patient’s ear canal with an auscultation tube, which mostly belongs to abnormal opening of the eustachian tube.
(2) Tinnitus in the ear, mostly in the form of cackling or pulsating sound, with paroxysmal episodes, can also be heard by other people, and may be the sound produced by clonus of the tympanic membrane tensor muscle, stapedius muscle, spasm of the palatal sail muscle, eustachian tube muscle, and external pterygoid muscle.
(3) Tinnitus is heard in one or both ears when the temporomandibular joint moves, and disappears when the temporomandibular joint stops moving.
(4) Other-perceived tinnitus, often aggravated after exertion, accompanied by white face, pale tongue and low hematocrit, is mostly caused by blood strain.
(5) The ringing in one side of the ear is consistent with the pulse, and the ringing decreases or disappears after compressing the jugular vein on the affected side, and the ringing resurfaces after releasing it.
2. Tinnitus and deafness caused by external ear or middle ear disease, mostly with corresponding history of external ear or middle ear disease and corresponding signs of lesions, most of the hearing examinations show transonic deafness, and the degree is mostly mild or moderate. Common disorders such as.
(1) Tinnitus and deafness with gradual or sudden onset, and cerumen embolism or foreign body obstruction in the external ear canal is seen on examination, and the symptoms disappear immediately after removal, as cerumen or foreign body in the ear.
(2) If the tinnitus or deafness is caused by injury, there is a history of ear or head injury; if the injury is to the eardrum, the examination reveals perforation of the eardrum.
(3) Coarse tinnitus, deafness as closed, self-acoustic enhancement, recent history of exophthalmia, examination shows eardrum or congestion, entrapment, tympanic chamber effusion sign, hearing is transonic deafness, mostly ear swelling.
(4) If the tinnitus or deafness has been prolonged or has a history of recurrent attacks, and the examination shows changes such as eardrum invagination, turbidity, calcium spots, adhesions, etc., and the hearing is transonic deafness or mixed deafness, it is mostly ear closure.
(5) Those with chronic tinnitus, deafness, perforation of the eardrum, pus flowing out of the ear, and transonic deafness or mixed deafness are mostly chronic pus ear.
3. Tinnitus and deafness caused by inner ear and auditory nerve conduction pathway lesions, whose tinnitus and deafness can be sudden or gradual, mild or severe, or appear after a major illness or febrile disease, and hearing examination mostly shows sensorineural deafness. Commonly, such as.
(1) Sudden onset of tinnitus and deafness on one or both sides, with rotational vertigo, nausea and vomiting, especially with open eyes.
(2) Sudden onset of tinnitus and deafness on one or both sides, with rotational vertigo, nausea and vomiting, and hearing loss reaching the limit within minutes to hours, or with mild extrapyramidal syndrome, and negative glycerol test, mostly belong to tinnitus and deafness.
(3) Sudden hearing loss, or tinnitus with unknown cause, or a history of vertigo, and with the increase of vertigo attacks, tinnitus and deafness symptoms become more and more severe, hearing test is sensorineural deafness, the course of the disease is more than 3 months, most of them are long deafness.
(4) Slowly declining hearing, sensorineural deafness, both ears at the same time or successively, age over 50 years old, most of them are deaf in old age.
(5) Sensorineural deafness and tinnitus with a history of ototoxic drugs, such as streptomycin, gentamicin, kanamycin, neomycin, tachykinin, diuretics, salicylates, sulfonamides, etc., and a history of exposure to heavy metal salts, carbon monoxide poisoning, alcohol poisoning, etc., mostly belong to pharmacological deafness.
(6) Sensorineural deafness and tinnitus, and those who have a history of long-term high noise exposure, mostly belong to noise deafness.
(7) Sensori-neural deafness and tinnitus occurring in the middle or late stages of external febrile diseases (e.g. summer temperature, spring temperature, measles, rotten throat, cholera, whooping cough, mumps, seasonal cold, rubella, chicken pox, herpes zoster of the ear, pulmonary fever, wet temperature, etc.), mostly belong to febrile deafness.
(8) Pus ear vertigo: If one side of the ear is moderately or severely deaf, but not completely deaf, with a history of limited vaginitis or acute pus ear or mastoid surgery, with rotational vertigo, and vestibular function of the affected ear is reduced to different degrees, it is mostly pus ear vertigo; if the history is the same as before, one side of the ear is completely deaf, vertigo, nausea and vomiting is severe, and vestibular function of the affected ear is lost, it is mostly pus ear vertigo.
4. Tinnitus and deafness caused by systemic chronic diseases, whose tinnitus and deafness can be sudden or gradual, with a new or long duration of disease and sensorineural deafness on hearing examination, accompanied by a history of systemic chronic diseases and corresponding symptoms and signs, and sometimes accompanied by cerebral tinnitus. The common ones are.
(1) Those with long-standing tinnitus and deafness, sometimes mild and sometimes severe, with physical weakness and decreasing function of several internal organs, mostly belong to deficiency labor.
(2) Those with prolonged tinnitus and deafness, sometimes light and sometimes heavy, accompanied by vertigo and low blood pressure, mostly belong to deficiency vertigo.
(3) Those who have been suffering from tinnitus and deafness for a long period of time, sometimes light and sometimes heavy, with physical weakness and anemia in blood test, mostly belong to blood strain.
(4) Long-term illnesses with tinnitus and deafness, sometimes mild and sometimes severe, accompanied by physical weakness, and hematopoietic dysfunction on bone marrow examination are mostly caused by marrow strain.
(5) Middle-aged and young people who are overworked, and whose tinnitus and deafness are aggravated by labor, accompanied by insomnia, dreaminess and brain fatigue, are mostly suffering from mental labor.
(6) Sudden onset of tinnitus and deafness or sudden onset and offset, sometimes light and sometimes heavy, accompanied by dizziness and dizziness, and high blood pressure on examination, mostly belong to wind dizziness.
(7) Moderate or severe deafness and tinnitus, if accompanied by night sweats and headache, and if the examination reveals consumption and abnormal changes in cerebrospinal fluid, most of them belong to cerebral consumption.
5. Sudden or gradual onset of tinnitus and deafness on one side, with sensorineural deafness, if accompanied by walking and swaying, and enlarged photos of the inner ear canal on the same side, mostly belong to brain tumor (auditory neuroma).
6.Sudden onset of tinnitus and deafness, mostly bilateral, occurring after the injury caused by emotion, or with melancholy, anxiety, irritability, sighing, etc., mostly belong to qi [yu] syncope (neurosis).
7.Sudden onset of headache like splitting, two ears like thunder, accompanied by vicious cold and strong heat, nausea and vomiting, for thunder head wind.
8. Those who are unresponsive to sound after birth and are severely deaf bilaterally and have a mouth that cannot speak are deaf and dumb.
IV. Treatment according to disease
1.Foreign body and cerumen in the external ear canal.
(1) Remove foreign body and cerumen.
(2) If the ear canal is red, swollen and painful, treat according to the ear sore.
2.Ear swelling.
(1) Take oral antibiotics and dexamethasone.
(2) Tympanic membrane massage method, eustachian tube blowing method, can be combined with the application of ear infrared or ultrashort wave treatment once a day.
(3) If there is fluid accumulation in the tympanic chamber, perform tympanic membrane puncture and aspiration, which can be repeated regularly if necessary, or perform tympanotomy placement for drainage.
3. Ear closure.
(1) Tympanic membrane massage method, pharyngeal tube blowing and tensioning method.
(2) If the tympanic chamber is thick with fluid, tympanocentesis is feasible and 50% urea, alpha chymotrypsin, hyaluronidase, etc. are injected into the tympanic chamber to dilute the fluid and facilitate discharge from the eustachian tube.
(3) If the fluid in the tympanic chamber is as thick as glue, a large tympanic incision can be made and the fluid can be sucked out with a strong aspirator and a tube can be placed to keep the drainage open.
4.Acute pus ear.
5.Chronic pus ear.
6.Abnormal opening of the eustachian tube.
(1) Blowing method: 1:4 salicylic acid powder and boric acid powder combination is blown into the eustachian tube on the sick side through the catheter, which can cause congestion and swelling at the pharyngeal opening of the eustachian tube to reduce symptoms. Or blow into the guati san (guati, adzuki bean, clove each appropriate amount, powder), such as Yi Jinhuang San. 3 days blow once, 5 times for a course of treatment.
(2) cauterization method: 30% guanhua tincture or 10-20% silver nitrate, 2-10% trichloroacetic acid, coated pharyngeal canal pharyngeal mouth, so that the scar, reduce the canal mouth, once a week, 3 weeks after no improvement can be repeated once again.
(3) Local injection method: Injecting the homemade serum or 50% glucose, or polytetrachloroethylene paste or silicone rubber with a long injection needle through the anterior nostril under the nasal speculum to narrow the opening of the eustachian tube, and repeating once after 1 to 2 weeks if necessary.
(4) Palatine sail displacement: Those who have failed with conservative treatment.
7. Long-term deafness (sensorineural deafness).
(2) Chinese patent medicine: use Tonic Chinese Yi Qi Pill, Ten Perfect Great Tonic Pill, Liu Wei Di Huang Pill, Er Zhi Wan, Qi Ju Di Huang Pill, Tian Ma Shou Wu Tablet, Wu Shu Black Hair Pill, Gui Shen Wan, etc. as appropriate.
8. Tyrannical deafness (sudden deafness).
(1) Single experimental formula: Tong Qi San: 30g each of Chai Hu and Xiang Shen, 15g of Chuan Xiong, finely ground together, 15g each in the morning and evening. Blood Mansions and Blood Stasis Soup Plus: 20g of Red Peony, 10g each of Angelica sinensis, Tao Ren, Safflower, Chai Hu, Chuan Xiong, Radix Platycodon, Acorus calamus, 15g each of Citrus aurantium, Radix Achyranthes bidentata, 5g of Licorice, decoction in water, 1 dose daily. A pair of old sow’s ears, soap-horn prick (one according to the patient’s age one year) pricked on the pig’s ears, cooked over moderate heat, remove the prick and drink the soup to treat senile deafness. Magnet 60g, Pueraria lobata 45g, Boneset 50g, Yam 30g, Paeonia lactiflora, Chuanxiong 15g each, Rhubarb in wine 5g, Glycyrrhiza glabra 12g, decoction in water, 1 dose daily.
(2) Western medicine treatment
9, Explosive deafness.
50g of Radix Aromaticus, 50g of Radix Bupleurum, 25g of Rhizoma Chuanxiong, grinded, 9g per serving, 3 times daily.
10.Deafness by drug poisoning.
(1) Single experimental formula: Detoxification and sound smelling soup: Comfrey 10g, Black bean 15g, Boneset 10g, Chrysanthemum 10g, Lily 12g, Magnet 20g, Lotus leaf 6g, Acorus calamus 10g, Lutong 10g, Yellow goat’s horn crumb 10g, decoction in water, 1 dose daily. Xianhe Ge Gen Tang: 80g of Xianhe Cao, 50g of Ge Gen, 15g of Zelenia, 12g of Wuwei Zi, 30g of Bonesetter, decoction in water, 1 dose daily.
(2) Western medicine treatment: nerve nutrition. Improve microcirculation, vasodilator.
11, Noise deafness.
(1) Exposure to noise should be avoided, and neurotrophic drugs with vasodilators should be given for treatment.
(2) If there is hypertension or compensatory incomplete cardiovascular disease, or abnormal vestibular function, or progressive intractable hearing loss, consider changing the type of work to avoid noise exposure.
12. Deafness in old age.
Invigorate blood circulation. Revitalizing Blood and returning to congestion: 10g of Boneset, 20g of Magnet, 15g of Radix Rehmanniae, 15g of Lily, 10g of Chrysanthemum, 10g of Lotus, 10g of Rhizoma Polygonati, 10g of Radix et Rhizoma Polygonati, 6g of Safflower, 10g of Lutong, 6g of Acorus calamus, decoction in water, 1 dose daily.
IV. Symptomatic treatment
1. Commonly used herbal medicines for ear conduction and tinnitus control: such as magnet, cicada molasses, calamus, farinaceous, rattlesnake, etc. can be used as appropriate. For lung and spleen qi deficiency, magnets should not be used.
2.Sensory nerve deafness: use Chuanxiongzine, brain quarryzine, dibazol, nicotinic acid, 654–2, compound salvia tablets and other vasodilators of 2 to 3 kinds, orally. And with vitamin B1 orally.
3. Eardrum perforation: If there is still pus in the tympanic chamber or if it is moist and not dry, treat it according to the ear pus. If the tympanic chamber is already dry, the function of the eustachian tube is normal, and the hearing bone chain is normal, tympanic membrane patching treatment is feasible; if the hearing bone chain is damaged, hearing reconstruction surgery can be performed as appropriate.
4, transonic deafness, with nasal congestion, nasal drops with 1% ephedrine saline.
5.Acupuncture therapy.
(1) Body acupuncture therapy: take the ear area and Shaoyang meridian points as the main points. Main acupuncture points: Ear Gate, Hearing Palace, Cataract, Pulse, Cataract; supporting acupuncture points: Zhongzhu, Waiguan, Quchi, Yanglingquan, Sanyinjiao, and Feosanli. Each time to take 2-3 main points, 2 supporting points, flat tonic and flat diarrhea, once a day, 10 times for a course of treatment.
(2) Ear acupuncture therapy: external ear, inner ear, kidney, liver, Shen Men, endocrine, buried needles or acupuncture with needles, 2 points at a time, medium to strong stimulation, stay for 15-20 minutes, 10-15 times for a course of treatment.
(3) acupoint injection therapy: select the hearing palace, cataract, complete bone and other points, commonly used vitamin B1 injection, 0.2ml per point, once a day.
6.Hearing aid: Any deaf patients with hearing impairment and stable condition can wear hearing aid. In general, hearing aids should be worn if the hearing loss is above 40dB. 2-4 years old children are the key period of speech formation, even if they have mild hearing loss of 35dB, they should wear hearing aids as early as possible so that they can receive sound stimulation frequently to facilitate language training. Hearing loss of more than 90dB is less effective with hearing aids, and it is difficult to hear the speech but only the sound.
7.Cochlear implantation: Cochlear implantation is feasible for those who have the conditions.