The cause of neurological tinnitus is still unclear, but it is generally believed to be related to vascular problems, viral infections leading to neuropathy, autoimmune problems, kidney deficiency, and other factors.
1.Neural nutrition
Commonly used drugs include: vitamin B, ATP, methylcobalamin (0.5mg/time, 3 times/day for 1 month, if it is not effective, no need to take it again). The neurotrophic factors that belong to the new drugs in recent years are: genetic recombinant basic fibroblast growth factor, mouse cochlear neurotrophic factor, murine nerve growth factor (Sutexan), cell growth peptide, etc.. The most important indications for these drugs are related to the damage of cochlear and auditory nerve conduction pathways.
2.Vasodilation
The main purpose is to improve the blood supply to the inner ear in order to restore the normal physiological function of the ear. It can be used together with antihistamine drugs (antihistamine drugs: 10mg of Xylamine, 4mg of Paracetamol, 25mg of Paracetamol, 10mg of Anchormin, 10mg of Desloratadine, 10mg of Loratadine, 10mg of Epinastine tablets, 2mg of Minchi (Nostatin), any one of them, taken orally, 1~2 times/day, or 1 time before bedtime). Common drugs are.
(1) Commonly used vasodilators, such as.
①Chuanxiongzin 100mg/time, 3 times/day;
②Brain quarizine 50mg/time, 2-3/day;
③Dibazol 10mg～20mg/dose, 2～3 times/day;
④Nicotinic acid 100mg/time, 3 times/day (the effect on the dilatation of inner ear blood vessels is not considered to be obvious at present, so it is preferred not to use this drug);
⑤654-2 5~10mg per time, 3 times/day;
⑥Compound salvia tablets 3 tablets, 3 times/day.
(⑦Popper jasmine 30mg orally or intramuscularly, 2-3/day, or 60-90mg in 5% glucose 500ml, IV, 1 time/day.
⑧Hexketone cocaine, 100mg orally, 3 times/day, or extended release, once a day.
⑨Nimodipine tablets, 20mg orally, 3 times/day. Generally choose 2 to 3 kinds.
(2) New drugs in recent years.
Vincamine (Oblan), vincristine extended release, vincristine, etc., taken orally, any one of them. The main effect is to improve inner ear microcirculation and increase blood oxygen content, which is beneficial to improve hearing and eliminate tinnitus, and is the most commonly used drug for treating neurogenic tinnitus and neurogenic deafness in recent years.
3.Anticoagulants
Heparin, viper antithrombin, urokinase, administered intravenously.
4.Anti-convulsant drugs
(1) Carbamazepine: use incremental method. The first 100mg orally at bedtime, and then increase 100mg daily for 1 week, to 200mg each time, 3 times a day, and stop the drug if it is ineffective for two weeks, if it is effective, reduce 100mg weekly to 100mg daily as maintenance. The side effects of carbamazepine are large and attention should be paid to the liver and kidney function during the drug administration.
(2) Phenytoin sodium: not suitable for those who use carbamazepine, intravenous injection, the effect is inferior to carbamazepine.
(3) Paracetamol: 0.15mg for the first time, then increase 0.25mg weekly to 700mg per day when stopped. The effect is similar to that of carbamazepine, with fewer side effects than carbamazepine, and no need to check liver function.
(4) Clonidine: 0.5mg each time, 1 time per night for 1 week. Ineffective change to 0.5mg twice a day for 1 week. Then 0.5mg, 3 times a day for 1 week, still ineffective that discontinue the drug.
5.Sedative drugs
(1) Valium, 2.5mg, 3 times a day orally, 1~week effective, no need to take long-term medication.
(2) Scholastin, 1mg, 1 to 2 times a day orally.
6.Anxiolytics (antidepressants)
Suitable for people with obvious depression and anxiety symptoms. Commonly used drugs are.
Amitriptyline, meperidine, promethazine, antiemetic, doxorubicin, alprazolam, sulpiride, etc. Choose any one of them.
7.Muscle relaxation
It is more suitable for tinnitus patients who have a sense of tightness, discomfort and fatigue in the head and neck. Commonly used drugs include: Eperisone (oral, better for cervicogenic tinnitus), tizanidine hydrochloride (oral when Eperisone is not effective), cerebral pulsation (oral), fenaral (oral), and maiona (oral for 2 weeks).
8.Glucocorticoids
In sudden deafness, Meniere’s disease attack, and neurogenic tinnitus of still short duration (caused by western drugs, or the cause is unknown), systemic medication (oral or intravenous) can be administered, and for other tinnitus, the eustachian tube route or tympanic membrane route can be used. Inject 2mg/0.5ml into the tympanic chamber, once every 2 weeks, 4-5 times a course of treatment. There is transient vertigo after injection.
9.Ciprofloxacin (Flunarizine Hydrochloride)
It is a calcium channel blocker and inhibits the transfer of excess calcium ions into the cells. It can improve microcirculation in the inner ear, reduce vestibular excitability and directly protect the brain cells from hypoxia. It is used for the treatment of peripheral and central vertigo, and the resulting tinnitus and deafness. Also improves sleep. 5mg orally once daily. Few side effects.
10.Anesthetics: Suitable for people with severe tinnitus, which can suppress tinnitus. Lidocaine is commonly used.
Take its anticonvulsant effect and inhibit the excessive activity of neurons in the reflex arc of the auditory conduction pathway, and its effect on low frequency tinnitus is better than that of high frequency tinnitus. The duration of effect on tinnitus relief is short, usually a few minutes to a few hours. When combined with long-acting sedation (e.g., fenadine, amitriptyline, etc.), it is helpful to maintain the effect of large amounts of intravenous lidocaine. Intravenous lidocaine can identify sexual tinnitus from inner ear tinnitus. Those with immediate, transient cessation of tinnitus after administration of the drug are considered to have central tinnitus, while those with no change are considered to have inner ear tinnitus. Test method: 100mg plus 5ml of water for injection, 30 seconds of injection, then observe the patient’s tinnitus and conduct an electrical audiometric examination. Those with a reduction in tinnitus loudness of 20 or more are considered positive, and those with positive results can be treated with carbamazepine with better results.
Treatment of tinnitus Usage.
(1) % lidocaine 10ml, intravenous injection, 1 to 2 minutes slowly.
(2) Intra-drum injection: 4% lidocaine 0.1~1ml. 1 time in 5 days, 4~5 times a course. The patient should be hospitalized for observation, fasting on the same day, taking antiemetic drugs 2 hours before injection, and injecting sodium bicarbonate 1 hour before injection. Patients should be kept quiet during injection, no talking and no swallowing action. The patient will experience transient nystagmus and strong vertigo 10-60 minutes after the injection, and the patient should lie on his side. 30 minutes is the worst reaction, and the ear function will be transiently reduced within 2-3 hours after the injection. The treatment is strongly reactive and should not be promoted.
(3) Inject slowly intravenously with 1% solution at 1 to 2mg/kg for 5 minutes. Once a day, 7 days as a course of treatment, rest 1 week feasible 2nd course of treatment. Usually need to be hospitalized, and need to rest in bed for 1 hour after treatment.
(4) 2% lidocaine 6m1, added to 10 glucose solution 500m]. Intravenous drip at a rate of 2m] per minute, followed by daily increments of 2ml until l2ml, with this concentration maintained for 3 days, and the procedure repeated every 3 days as previously described. The treatment was repeated every 3 days for a total of l5 days.
(5) 2% lidocaine dissolved in 10% glucose injection or 0.9% sodium chloride injection 500mL, intravenous drip, the first 100mg, and then increase the dose of 20mg daily to 200mg maintenance, 2 hours drip, when supplemented with hyperbaric oxygen and compound salvia injection, adenosine triphosphate (ATP), B vitamins, coenzyme A and other drugs treatment, 1 time / day, 14 days for 1 course of treatment.
11.Commonly used proprietary Chinese medicine for neurogenic tinnitus and neurogenic deafness
They can be divided into two categories:
One is to use the corresponding Chinese patent medicine according to the diagnosis and treatment.
The second category is to choose to use Chinese patent medicines that have the effect of activating blood circulation and removing blood stasis, improving blood rheology and improving cerebrovascular blood supply disorders. There are more such drugs, commonly used are: Ginkgo biloba, compound Danshin tablets, compound Danshin drops, compound Tianma Mihuangyan peptide tablets, Yixinone tablets, Guifeng Ningxin tablets, blood circulation and blood vessels tablets, anti-bolus capsules, Dengjianxiaoxin capsules, Zhenbenning capsules and so on.