Tinnitus, where does it come from? External sound, through the human external ear canal, middle ear, inner ear, to the sound processing plant – the cochlea, and here into a nerve signal, and then continue through the auditory nerve, to the brain, the person by is to hear the sound . “Under normal circumstances, this system is well-equipped and does not produce ‘murmur’. When any one of the components is injured, it may issue a ‘murmur’, resulting in tinnitus.” There are many causes of tinnitus, some of which are more dangerous. In about 5 percent of tinnitus, the cause is an auditory neuroma. Other causes are mostly simple and safe. In the case of cerumen in the external ear canal (i.e., earwax) and fluid from otitis media, these two conditions are easy to deal with, as the cerumen is pulled out and the fluid drained, and the tinnitus disappears. There are other causes of tinnitus that are not in the ear. About 10% of patients with high blood pressure will have tinnitus. This is due to chronic high blood pressure, which causes the blood vessels in the ear to spasm or even occlude. Tinnitus caused by hypertension or other vascular factors such as vascular malformations or aneurysms usually coincides with the rhythm of the pulse, which is known as “pulsatile tinnitus” and may be accompanied by headaches and dizziness. If the tinnitus is caused by high blood pressure, the tinnitus will be relieved if the blood pressure is well controlled. If the tinnitus is caused by a vascular malformation or aneurysm, a vascular ligation or tumor removal is required. Of course, with the advancement of medicine, the less damaging “super-selective vascular embolization” is now available for some patients to treat tinnitus. High blood pressure and diabetes, which can cause systemic vascular disease, may also cause tinnitus. Therefore, Prof. Zheng Yiqing has repeatedly emphasized that the first task to treat tinnitus is to find the cause. Some of them are easy to cure, so we should find them and cure them; some of them may be very dangerous, like time bombs, so we should find them and dismantle them. How can we cure tinnitus if we cannot find the cause? However, there are a considerable number of patients who will not find the specific cause of tinnitus. They have undergone many tests, but the doctor can only tell them that there is nothing wrong here or there, but cannot tell them exactly which part of the ear is wrong. However, even so, doctors can still treat it. And with regular and comprehensive treatment, most tinnitus can be cured. Here, I would like to explain how to cure tinnitus. The first thing that comes to mind is that the tinnitus has disappeared and the world has become quiet. This is certainly a cure for tinnitus, and it is the best case scenario. But unfortunately, even after regular and comprehensive treatment, less than half of the patients are the lucky ones. In these patients, after treatment, the cerebral cortex has become accustomed to the “murmur” that causes tinnitus, and only treats it as a “background sound” and relaxes its vigilance, so they “hear but do not hear” it. “The tinnitus gradually disappears. Another part of patients, after treatment, can “treat tinnitus as their own breathing, heartbeat, or snoring sound when their partner is sleeping, so that the effect of tinnitus will be minimized or even disappear.” Xiong Guanxia (deputy chief physician of the Department of Otolaryngology at the First Hospital of Sun Yat-sen University) points out that in otology tinnitus treatment also counts it as tinnitus cured. This method of curing tinnitus even if the cause cannot be found is the most popular tinnitus practice therapy. ”The reason why tinnitus causes so much pain to patients is because of the limbic system in the brain, which manages human emotions and memory. The limbic system associates tinnitus with irritability, lack of concentration, insomnia and other boredom and memorizes the unpleasant sensations. If this connection can be broken, tinnitus will no longer be a nuisance. For example, several patients who have had tinnitus for many years, surprisingly, they are usually very optimistic and will tell their “new” patients who are troubled by tinnitus and extremely annoyed that “adjust your mind and just get used to it”. Because they are used to the existence of tinnitus, they do not lose sleep and feel uncomfortable because of it. But before that, they had been suffering from tinnitus for years, even more than ten years. The practice therapy is designed to shorten this “adaptation period” so that the patient can get used to the tinnitus as soon as possible. The doctor will give the patient a special “prescription” – a music CD with soft music, insects, birds, waves, etc. The patient can choose the music he or she likes to listen to. When listening, tune the music to the same loudness as the tinnitus, so that you can hear both the tinnitus and the music. Over time, the brain will “identify” the tinnitus as a “background sound”. This music should be listened to four times a day for 30 minutes each time, and for a longer period of time. It often takes several months of treatment for the patient to get used to the tinnitus, and it may take about 1 to 2 years for the tinnitus to disappear,” Zheng reminded. This long “ineffective period” seriously tests the patient’s confidence and patience. It’s like everyone knows that jogging every day can strengthen the body and keep it in shape. However, how many people can keep up with it? Even women who are worried about their body shape can hardly find time to go jogging every day. Therefore, even for patients who are deeply troubled by tinnitus, it is not easy to persist for a month or two, listening to music and doing therapy every day. At this point, the doctor’s help becomes more important. In addition to spiritual encouragement and psychological counseling, there are also some objective examinations that can clearly present the small changes in the condition that perhaps even the patient himself is not aware of yet. Let’s say that a Tinnitus Disability Scale assessment is performed, with a score out of 100, the higher the score, the greater the impact of the manifestation of tinnitus on the quality of life. Most tinnitus patients, before starting treatment, have a high score, which can slowly decrease as their condition improves. Looking at the decreasing scores, the patient’s confidence in the treatment can gradually rise. These are some confidence boosters, and there are other ways to help tinnitus patients get through the adjustment period. To achieve this, there are two approaches that can be tried, both of which can be used to supplement the habituation therapy and fill in the gaps before the habituation takes effect. The first is masking therapy, which works well for tinnitus caused by lesions in the cochlea. Masking therapy also involves having the patient listen to music. But it has the music at a volume that is louder than the tinnitus, allowing the sound of the music to mask the sound of the tinnitus. “Tinnitus patients often experience a milder level of tinnitus during the day, which worsens in the evening. This is mainly because the outside noise masks the tinnitus during the day, and masking therapy uses this principle.” Chen Bing (Professor of Audiology and Speech Disorders at the Eye, Ear, Nose and Throat Hospital of Fudan University in Shanghai) explains. Usually a doctor will equip a patient with the right sound for him, based on the results of a hearing test. For example, after a sudden deafness, Xu’s hearing was basically restored to normal after treatment, but he was left with a “rustling” sound in his ears. So the doctor used the sound of waves, which was similar to his tinnitus, to mask it. The masking time was also 30 minutes, and the patient was able to enjoy a few minutes of silence after the masking music was removed. Thus, masking therapy is usually used when the patient is feeling most irritable and is used to help reduce the distress that tinnitus causes in life and emotions. At other times, the volume of the music should be turned down to allow the music to coincide with the sound of the tinnitus. In addition, some patients cannot help but worry. Isn’t it said that listening to music often, especially with headphones, can cause hearing loss? The volume used for masking therapy is only 5 to 10 decibels higher than the loudness of the tinnitus. In more than 90% of patients, the tinnitus loudness is at 30~40 decibels, and the loudness that is eventually used for treatment is below 50 decibels, and this loudness does not cause hearing loss. However, even with such a small loudness, some patients still feel very uncomfortable, so masking is not appropriate for this group of patients. Another way to make the tinnitus stop temporarily is to give intravenous lidocaine. Some doctors call this method “closing the ear”. This is because lidocaine “closes” certain parts of the nerves in the brain so that the abnormal signals that cause tinnitus cannot reach the brain, making the tinnitus disappear. “When using this method, be careful of its adverse effects, so it must be done in a hospital.” Professor Zheng Yiqing emphasized. And lidocaine should not be used for too long. If it is effective, the treatment should last for 3 to 5 days, at most a week, and then it can be changed to oral carbamazepine. Lidocaine has a slightly longer “sealing” effect than masking. Like masking, it is designed to reduce the irritability of the patient as he or she adjusts to the tinnitus. Lidocaine also makes up for some of the shortcomings of masking because it targets a lesion that is primarily the auditory nerve. That is, masking may work for one group of tinnitus patients and lidocaine for another. But “most patients have lesions in several areas at the same time, so several methods have to be used together.” Professor Zheng Yiqing points out. For tinnitus, you can also treat the symptoms. In tinnitus treatment, in addition to directly targeting tinnitus, you can also give medication to help with some of the patient’s symptoms. For example, for patients who are anxious and very worried about tinnitus and cannot relax even after counseling, medications such as Valium can be used to help reduce anxiety and keep them calm. About half of the patients with tinnitus are also depressed to some degree, and Prozac can be used to reduce depression in these patients. Most patients with tinnitus also have inadequate blood supply to the cochlea and nerve damage, so medications that improve blood supply to the cochlea and nourish the nerves will also be beneficial in the treatment of tinnitus. There are many methods that can help treat tinnitus. However, the more important “medicine” for tinnitus patients should be their own life. Many tinnitus patients go to a quiet place to hear if they have tinnitus and what it sounds like. These are not right. If a candle is placed in front of your eyes in a bright sunny day, you may not be able to feel its light; but in the dark, the light of the candle will be very bright. For the same reason, tinnitus patients should avoid quiet environments. This does not mean that the patient should go to a place full of noise like a karaoke room, but a place where the patient can feel the tinnitus less easily. If you have to be alone in a room, find a way to put on some music and make some noise in the room. It is also important to interact with people and engage in your studies and work to take your mind off of the tinnitus. Even if you just sit in the room, listen to music and read a book, it will be beneficial to your condition. Chen Bing calls this “finding a new excitement” and thus starting a better life.