Tinnitus is the sensation of sound caused by the absence of external acoustic or electrical stimulation. It is only a symptom triggered by a variety of etiologies, a subjective sensation, and not a disease. Tinnitus has been written down for 2,000 years. In recent years, auditory research groups in the United Kingdom and the United States have found that tinnitus is an extremely common symptom, with a prevalence of 15-20% of the population; severe tinnitus accounts for about 0.4-2.8%.
The prevalence of tinnitus increases with age, accounting for 14.5% in the group younger than 40 years old and 22.2% in the group older than 60 years old. The prevalence of tinnitus is related to occupation. The prevalence of tinnitus is 20% in manual workers and 8.7% in non-manual workers. It is generally more common in women than in men. It seems that tinnitus is indeed troubling a large number of people. Because of the complex etiology of tinnitus, which may be mono- or multi-causal, the lack of external clinical signs, and the lack of objective evaluation methods, there are still problems of difficult localization and diagnosis, inadequate treatment methods, and little understanding of the mechanism of tinnitus occurrence.
Studies related to the mechanism of tinnitus
Because the etiology of tinnitus is complex, any part of the auditory system can cause tinnitus, and its exact mechanism is still unclear. Since the 1960s and 1970s, studies have been conducted on tinnitus patients with EcochG, ABR, TEOAE, and DPOAE tests, and the neurophysiological mechanisms of tinnitus have been thoroughly investigated, and it is generally believed that the main mechanism of tinnitus is that the spontaneous firing rhythm of the auditory nerve fibers and central neurons at all levels is abnormal, and the higher auditory centers mistakenly mistake this signal of the auditory pathway for the sound signal, and hear the tinnitus.
It is generally believed that the main mechanism of tinnitus is a rhythmical malfunction of the spontaneous firing of auditory nerve fibers and neurons at all levels of the central nervous system.
Tinnitus is a multifactorial symptom with an extremely complex etiology that is not only closely related to the auditory system itself, but also involves multiple factors such as the nervous system. This undoubtedly brings more difficulties to the exploration of the mechanism of tinnitus. At present, studies on neurophysiological methods and neurotransmitters such as 5-HT have yielded certain results, confirming that there are obvious abnormal firing activity changes in the auditory system during tinnitus. However, how to be able to capture the real tinnitus electrical activity information is still quite distant, and the current animal models are still very unsatisfactory. The neural mechanism of tinnitus, neurotransmitters, receptors, ion channels and other mechanisms that are closely related to the occurrence of tinnitus need to be continued to be explored.
Research on objective diagnosis of tinnitus
Since tinnitus is a subjective symptom, there is still no objective examination method, and there is no basis for objective diagnosis. At present, the clinical diagnosis of tinnitus is mainly based on the patient’s description of the nature of tinnitus, otological and audiological examinations (including pure tone audiometry, speech audiometry, tinnitus matching, suprathreshold function examination, acoustic conductance audiometry, auditory brainstem response, otoacoustic emission, etc.) to make a preliminary localized diagnosis of tinnitus. Roughly, it can be distinguished as cochlear and postcochlear lesions. However, the etiology of tinnitus is complex and influenced by many factors, making it difficult to localize tinnitus lesions.
Treatment of Tinnitus
Tinnitus is one of the most difficult symptoms to treat. Because of its multiple and complex causes, it is difficult to make a correct diagnosis of the cause and lesion site; sometimes even if the cause and lesion site can be determined, the primary cause is difficult to cure. In clinical practice, it has been observed that different methods should be applied to tinnitus patients for different conditions. By using different methods such as psychotherapy, medication, masking, surgery, or a combination of several methods, the therapeutic effect will be improved.
Psychological treatment
Tinnitus can cause a series of psychological disorders, leading to depression, excessive worry, irritability, mood swings, sleepless nights, and a sad face all day long, and the fear that tinnitus will cause deafness and affect work and rest. Such a psychological disorder will in turn aggravate tinnitus, which is a vicious circle of mutual cause and effect. Therefore, as any doctor who treats ear disease, he or she should make psychological counseling method a routine treatment for tinnitus, and use the utmost patience to alleviate or eliminate their psychological disorders, so as to cut off the vicious circle of tinnitus and psychological disorders.
The most common psychological treatment is cognitivetherapy (cognitive therapy), in which the doctor and the patient cooperate to solve the troubles caused by tinnitus and help the patient to solve the problem of tinnitus actively. First of all, the patient is helped to have a correct perception of tinnitus, and the patient is introduced to the causes of tinnitus, the characteristics of tinnitus, the various factors that trigger and relieve tinnitus, the main treatments and the prognosis. Explaining that tinnitus is a very common symptom and is generally not a fatal progressive disease, eliminating his psychological barriers, correcting his distorted thoughts about tinnitus and changing his misconceptions. It also illustrates that although there is no special treatment for tinnitus, there are more treatments that can reduce it and should be used in cooperation with the doctor, and different therapies or medications can be used to make the tinnitus go away. Treatment takes a long time and one must have confidence. After a reasonable arrangement of life, the patient’s confidence in treatment can be increased even more when the tinnitus is relieved under a happy mental condition.
When you open your eyes, everything outside is rotating, and when you close your eyes, you feel that you are spinning, sometimes there is a sense of shaking, floating, etc. In severe cases, it is often accompanied by nausea, vomiting, and cold sweat. Patients are very distressed and anxious, and they don’t know where to go to the doctor in fear.
If you are clear when you have a vertigo attack, you don’t need to be nervous, and you can go to otology for treatment. This function is performed by the three vestibular receptors in the inner ear: the vestibular canal, the ellipsoid bursa and the balloon, together with the vestibular nerve, the vestibular nerve center, the vision of the eyes and the proprioception of the muscles. That is why vertigo should be seen in otology after it occurs.
The most common cause of otologic vertigo is Ménière’s disease. Vertigo is often accompanied by tinnitus, deafness and dullness, and vertigo can be recurrent and hearing often fluctuates. It is usually controlled by medication, but some cases can be treated surgically if they cannot be controlled by medication.
”The scientific name for otoliths is benign paroxysmal positional vertigo. The otoliths are tiny calcium carbonate crystals that are invisible to the naked eye and cover the vestibular capsule. When some factors cause the otoliths to fall off, they fall into the ventral part of the semicircular canal with the lymphatic fluid in the inner ear and stimulate the vestibular receptors in the ventral part of the canal, resulting in vertigo, which occurs only in a certain head position, unlike the vertigo of Meniere’s disease. Otoliths are self-healing diseases.
Vestibular neuronitis is also a common form of vertigo, mostly caused by viral infections, and the vertigo lasts longer without deafness and tinnitus. Vertigo also occurs in otitis media with cholesteatoma or when inflammation spreads to the inner ear and invades the vestibule. Drug intoxication, head trauma to the inner ear, strong noise vibration, explosion injury, etc. can cause vertigo.
Patients with vertigo should go to otolaryngology department for otologic examination, audiological examination, vestibular function examination, balance function examination, and imaging examination (inner ear CT, MRI) if necessary.
The causes of vertigo are complicated in elderly people with hypertension, diabetes, hyperlipidemia, etc. The causes of vertigo need to be clarified after consultation with otology, neurology, orthopedics and other departments to get proper treatment.