I. Treatment of tinnitus.
1. Definition: Tinnitus is called as a subjective sound sensation in the ear without external sound source stimulation. It is a symptom rather than a disease.
2. Classification: Tinnitus is usually classified into conductive tinnitus, sensorineural tinnitus and central tinnitus according to the location of the lesion.
3.Treatment: The treatment of tinnitus is as difficult or even more difficult as the other two of the three major otologic problems – deafness and dizziness. Since there are many diseases and factors that cause tinnitus, it is sometimes difficult to make a correct diagnosis of the cause and lesion site, and even if a diagnosis of the cause and lesion site can be made, treatment of the cause is sometimes extremely difficult. Therefore, although there are many ways to treat tinnitus, there is no specific effective method to date. However, in clinical practice, otologists cannot categorically tell patients that there is no treatment for tinnitus in order to avoid causing new psychological barriers for them. The evaluation of the effectiveness of tinnitus treatment is: the reduction of tinnitus and the relief of anxiety.
(1) Etiological treatment: Tinnitus, like other diseases, is often effective if it is treated for its cause. For example, if cerumen is attached to the tympanic membrane in the external ear canal, it can be removed through cerumen removal; if inflammation in the external ear or middle ear causes tinnitus, the tinnitus can disappear through inflammation control. The reversible stage of Meniere’s disease and delayed endolymphatic effusion, tinnitus can be controlled by limiting salt intake, diuretics, cochlear vasodilators, calcium antagonists, and histamine derivatives as the disease itself gets better. Otosclerosis with tinnitus is treated with sodium fluoride, which can reduce tinnitus. Systemic diseases such as thyroid abnormalities, diabetes, anemia, hyperlipidemia, blood pressure abnormalities, increased blood viscosity, autoimmune disorders, etc., can be treated with specific medications to reduce tinnitus as the underlying disease improves or is controlled. In addition, vitamin B (especially vitamin B12), zinc preparations, and ginkgo biloba preparations may help in the treatment of non-selective tinnitus, but the efficacy has yet to be confirmed by clinical research. Hypoglycemia can be the cause of tinnitus. If tinnitus is aggravated after sleep or early in the morning, glucose water can be consumed, which can be confirmed if the tinnitus is reduced after 10 to 20 minutes. However, many diseases, even if they are treated, such as treating Meniere’s disease so that the vertigo has been controlled, treating other sensorineural deafness so that the hearing has been improved, or surgically treating otosclerosis so that the hearing has been improved; but the tinnitus of these patients may not always disappear, which also needs to be advised to be treated properly.
(2) Medication: Treating tinnitus with medication is still one of the most commonly used methods in clinical practice. It has the advantages of being fast and reliable, and does not require active cooperation from the patient, and is probably the most promising kind of tinnitus therapy.
①Vasodilators and neurotrophic drugs: The aim is to improve blood circulation and promote metabolism in the inner ear, which helps to restore function and thus obtain tinnitus control.
(ii) Nerve blocking drugs: The aim is to reduce the hyperfunction of the central and peripheral nerves, thus improving tinnitus.
Barany (1935) first found that tinnitus was relieved by procaine injection into the inferior turbinate, and Lewy (1937), Gejort (1963) and Englesson (1976) successively reported the effect obtained by intravenous lidocaine injection for the treatment of tinnitus caused by Ménière’s disease and other diseases. The recommended routine dose of intravenous lidocaine is: 1-2mg/kg (for severe vertigo: lidocaine 0.2g in 0.9% saline 500ml IV drip).
③ Anticonvulsants: usually treated with carbamazepine, patients who choose lidocaine effectively, take this drug is more effective.
Shen (1978) introduced its treatment method as follows: first use 100mg of lidocaine plus 5ml of water for injection intravenously and finish injecting in 30s. The appropriate dose is when the tinnitus is relieved. This dose was continued for one week and then reduced by 100 mg per week to 100 mg per day as maintenance dose. Of the 54 cases with severe tinnitus, 43 (80%) had a positive lidocaine test; 27 of them were treated with carbamazepine, 21 (78%) had relief, 1 (4%) had complete disappearance of tinnitus, and 5 (18%) were ineffective. Complications were few and mild, and disappeared after discontinuation of the drug. There is a synergistic effect when taking carbamazepine together with doxorubicin.
A: Antidepressants: The ones with less side effects are: a Doxepin orally 25mg, 3 times/d, which is effective within a week. b Meptyline orally 25mg, 3 times/d. B: Anxiolytics. Usually applied: a Sulforaphane orally 1mg, 3 times/d. b Methyltriazolam, also known as alprazolam, orally 0.4mg, 2 times/d.
(3) Masking therapy: Patients with mild tinnitus only feel tinnitus in quiet environment. If there are sounds in the environment, such as radio, TV, alarm clock, electric fan and machine, the tinnitus will be reduced or disappeared, which is the effect of masking. After the tinnitus is masked and the masked sound is removed, the tinnitus does not return immediately.
Masking devices are usually
a. Ambient sound as a tinnitus masker (clock, electric fan).
b. Specialized tinnitus masking devices.
c. Hearing aids as tinnitus maskers.
d. Small radio or box type monophone.
Masking time: The masking starts at a certain time before the patient feels the tinnitus making it the most annoying time. The most effective time of action for tinnitus sometimes needs to be after 1 month.
(4) Psychotherapy: A patient with tinnitus often complains that when he or she feels in good health, is happy and sleeps well, the tinnitus often decreases, while when fatigue, general discomfort, emotional distress and poor sleep increase. So, it is obviously impossible and unfounded to say that some tinnitus patients belong to the category of psychological disorders or mental illnesses based on the existence of such phenomena. However, the phenomenon of psychological disorders in tinnitus patients exists objectively, and it is a vicious circle in which tinnitus and tinnitus are causally related to each other. Since psychological activity inevitably produces physiological reactions, and if the adverse psychological reactions persist for too long, they can lead to organic pathophysiological processes, psychological treatment should be carried out once the presence of psychological disorders and personality factors in tinnitus patients is established.
It is said that the best treatment for tinnitus is to “ignore it”. This means explaining to the patient that tinnitus is only a symptom and generally has no serious consequences. This explanation is especially important for patients who are afraid of developing tumors and who have concerns in their minds. However, many patients do come to us for treatment because they cannot stand the disturbance of tinnitus, and physicians should try to treat them to reduce or cure their tinnitus.
(5) Surgical treatment of tinnitus: At present, the effect of surgical treatment of tinnitus is better for objective tinnitus, while the effect of surgery for subjective tinnitus is not satisfactory.
The causes of objective tinnitus are mainly vascular, muscular, abnormal opening of the eustachian tube and four kinds of temporomandibular joint disease.
(6) Acoustic information therapy for tinnitus: In conclusion, many experts at home and abroad have made research on tinnitus in many aspects, but until now there are still no satisfactory results on the diagnosis and treatment of tinnitus. The causes of tinnitus are diverse and so are the methods of treatment. In the future, research on tinnitus, especially on diagnosis, treatment and lesion localization, must be conducted in close cooperation with specialists in internal medicine, otology, audiology, pharmacology and psychoneurology, with equal emphasis on the basic and clinical aspects, and with joint efforts to explore them.
II. Treatment of deafness.
1.Definition: Deafness is a general term for hearing impairment of different degrees due to organic or functional lesions in the auditory conduction pathway.
2. Classification of deafness: Deafness can be divided into different types according to the occurrence and nature of deafness. Hearing impairment caused by lesions in the outer ear and middle ear is called conductive deafness; those caused by lesions in the inner ear, auditory nerve and auditory center are called sensorineural deafness; those with both are called mixed deafness. Sensorineural deafness can be subdivided into central deafness, neurological deafness and sensorineural deafness according to the location of the lesion, but at present, the three are still together called sensorineural deafness.
3. Deafness classification: The internationally accepted deafness classification is the standard published by the International Organization for Standardization (ISO) in 1964, and the World Health Organization (WHO) also introduced similar standard in 1980. Based on the average hearing threshold of 500Hz, 1000Hz and 2000Hz, hearing loss of 26~40dB is considered as mild deafness, while 41~55dB, 56~70dB, 71~90dB and >91dB are considered as moderate deafness, moderately severe deafness, severe deafness and profound deafness in that order.
4.Treatment of deafness.
(1) Treatment of conductive deafness: The diagnosis of conductive deafness is not difficult because the etiology is clearer, and corresponding treatment can be performed according to the etiology. Tympanic membrane repair and tympanoplasty of various types are still the main methods of treatment for conductive deafness.
A. Inflammation: Acute and chronic suppurative otitis media, acute and chronic secretory otitis media, adhesive otitis media, herpetic tympanitis, acute mastoiditis, and inflammation of the external ear canal, boils that narrow or even occlude the external ear canal and affect the movement of the tympanic membrane.
B. Trauma: Temporal bone fracture involving the middle ear, tympanic membrane trauma, interruption of the auditory chain, etc.
C. Foreign body or other mechanical obstruction: foreign body in the external ear canal, cerumen embolism, tumor, cholesteatoma, etc.
D. Malformation: congenital atresia of the external auditory canal, malformation of the auditory chain, absence of the tympanic membrane, vestibular window, cochlear window hypoplasia, etc.
(2) Sensorineural deafness: Prevention of sensorineural deafness is more important and effective than treatment. (Strengthening research on hearing health care for the aging population, reducing environmental noise, standardizing protective measures*, avoiding the use of ototoxic drugs, etc.). There are no specific drugs or surgical treatments that can completely restore hearing in patients with sensorineural deafness. The principles of treatment are early detection, early diagnosis, early treatment, striving to restore or partially restore the lost hearing, preserving and using the residual hearing as much as possible, timely auditory speech training, and appropriate application of artificial hearing. Specific treatment methods are as follows.
A. Pharmacotherapy: timely and correct medication at the early stage of onset is the key to successful treatment. First of all, appropriate drugs should be selected according to the cause and type of deafness. For example, gene therapy can be explored for hereditary deafness where genetic defects have been identified at the molecular level; antiviral and antibacterial drugs can be tried in the early stage of deafness caused by viral or bacterial infections; glucocorticoids and immunosuppressive drugs can be tried for autoimmune deafness; drugs to supplement the lack of elements or to correct the metabolic disorders can be tried for sensorineural deafness caused by metabolic disorders of certain essential elements. In addition, the more commonly used clinical adjuvant drugs for deafness include vasodilators, blood viscosity reduction and thrombolytic drugs, neurotrophic drugs and energy preparations, which can be used as appropriate.
B. Hyperbaric oxygen therapy: The treatment of sensorineural deafness by hyperbaric oxygen alone has no certain efficacy, but it has some auxiliary therapeutic effect on early drug deafness, noise deafness, sudden deafness and traumatic deafness.
C. Surgical therapy: Focuses on improving local blood circulation and restoring function to the reversible damaged part of the inner ear. For patients with severe or profound deafness in both ears, the more severe side can be selected for trial operation of muscular vascular connection of the internal auditory canal or endolymphatic sac revascularization.
D. Cochlear implantation: The entire process of successful cochlear implantation, including preoperative evaluation, implantation surgery, and postoperative training and language rehabilitation, takes several years and requires the long-term collaboration and cooperation of the patient, the surgeon, the audiologist and the patient’s family.
E. Hearing aid: It is a device to increase the intensity of sound, which can help some deaf patients to make full use of their residual hearing and improve their speech communication ability.
F. Sound information therapy.
(3) Mixed deafness.
Functional deafness: also known as psychological deafness, non-organic deafness, hysterical deafness, psychiatric deafness, etc., caused by psychosomatic factors. Diagnosis should pay attention to collecting history about psychosomatic trauma. Pure tone audiometry examination is mostly severe or total deafness in both ears, and may be unilateral in slow onset cases. The diagnosis of deafness should be based on a history of psychological trauma. Treatment: In patients with sudden onset and short duration of the disease, suggestion therapy is more effective. The key to the success of suggestion therapy is to identify and remove the psychological trigger. However, for patients with long duration of illness, especially those with slow onset, general suggestion therapy may not be effective. Lidocaine 2% closure can be tried along with verbal suggestion therapy. Simulated surgical suggestion, hypnosis, and anesthesia can be tried.
Pseudo-deafness: i.e., feigned deafness with no organic lesions in the auditory system and normal hearing. In pseudo-deafness, there is no psychological trauma, but the person knows that his or her hearing is normal, but intentionally pretends to be deaf for some reason. Pure tone audiometry is often completely deaf, while objective audiometry is completely normal. Audiological examination can help to identify pseudo-deafness, but care should be taken to distinguish it from functional deafness.
III. Sudden deafness.
It is a sudden, unexplained sensorineural hearing loss. The patient’s hearing usually drops to its lowest point within minutes or hours, and in a few patients it can be within 3 days; it can be accompanied by tinnitus and vertigo; there are no other cranial nerve symptoms except for the VIIIth cranial nerve. Although the disease has a tendency to heal spontaneously, it is important not to wait and see or give up treatment. There is a relationship between the early start of treatment and the prognosis, therefore, early treatment should be sought by all means possible.
Treatment principles.
(1) Apply drugs to reduce blood viscosity, activate blood circulation and remove blood stasis.
(2) Apply vasodilators.
(3) Apply drugs that promote local metabolism.
(4) Physiotherapy.
(5) Symptomatic treatment.
(4) Acoustic information therapy.
Sound information therapy instrument is an original and new type of treatment instrument, which brings an unprecedented treatment means to clinical medicine. Its use of patented design sound frequency, individualized quantification of sound intensity to treat disease, fast, effective, no adverse reactions. The treatment time is once a day (30 minutes), 5 days a course of treatment, the cost is cheaper.
(1) Scope and efficacy of acoustic information therapy: Acoustic information therapy instrument can treat tinnitus and deafness caused by various reasons, and also treat or assist in treating vertigo, trigeminal neuralgia, facial palsy, hallucinations, vascular headache, somatization disorders (such as social tension, anxiety, insomnia, dizziness and dizziness, abnormal skin sensation, muscle throbbing sensation, precordial discomfort, breath suffocation, foreign body sensation in the throat, stomach discomfort, abdominal distension, etc.) (— a group of diseases whose onset is related to psychosocial factors, without symptoms of organic diseases).
(2) The treatment mechanism is: the patient’s cerebrovascular condition, blood pressure, heart rate, hearing and other clinical symptoms are input into the instrument, and the computer in the instrument combines various data and adjusts the instrument to produce different acoustic information, which acts on both ears of the patient through high-fidelity headphones. This specific frequency sound intensity acts on the patient’s auditory system and cerebral cortex according to the principle of individualization to eliminate abnormal inhibition of the auditory nerve and related centers, regulate the function of the vegetative nerves and improve the cerebrovascular blood supply.