In the clinic, we often hear the words, “Give me a moment of peace, and I’ll be satisfied. Tinnitus is a major disease that affects people’s physical and mental health, and it is a common symptom of many diseases. It is even more painful when you hear some doctors tell patients that it is ‘neurological tinnitus’ and there is nothing good treatment for it. In fact, as long as the patient is treated in a more standardized way, the patient’s symptoms can still be greatly relieved.
Tinnitus is a certain ringing sound in the ear without the involvement of external sound. For example, if there is no cicada chirping around you, but there is a cicada chirping sound in your ear, this is tinnitus. Tinnitus is usually classified according to the nature of tinnitus, the cause of tinnitus, and the location of the tinnitus lesion.
(1) According to the nature of tinnitus; physiological tinnitus, pathological tinnitus; subjective tinnitus, objective tinnitus; persistent tinnitus, fluctuating tinnitus or throbbing tinnitus; monotonic tinnitus, polytonal tinnitus
(2) Classification according to the etiology of tinnitus: pharmacotoxic tinnitus, post-sudden deafness tinnitus, Meniere’s disease, otosclerosis, auditory neuroma, etc.
③Classification according to the site of tinnitus lesion: monaural tinnitus, binaural tinnitus, cranial tinnitus; otogenic tinnitus and non-otogenic tinnitus; peripheral tinnitus and central tinnitus. Peripheral tinnitus refers to tinnitus caused by lesions in the outer ear, middle ear, inner ear and auditory nerve. Central tinnitus refers to tinnitus caused by lesions in the auditory pathway above the cochlear nucleus up to the auditory cortex of the brain. Non-auricular tinnitus refers to tinnitus caused by diseases unrelated to the auditory organs, such as hypertension, heart disease, hyperthyroidism, neurasthenia, hyperlipidemia, etc. From the above classification, we can see that it is inaccurate to use neurological tinnitus to name tinnitus of unknown origin. Once the cause is identified, the diagnosis is based on the primary cause, and tinnitus is only an accompanying symptom.
The tests required for tinnitus are: ENT examination, audiological examination (pure tone audiometry, acoustic conductance, otoacoustic emission), frequency matching of tinnitus, vestibular function examination, systemic examination (such as cervical spine, cardiovascular, endocrine system, etc.), imaging and laboratory examination (CT, MRI, blood biochemistry, etc.). Among them: thin layer CT of temporal bone: for children to help determine the presence of congenital malformations; for adults to help determine the presence of otitis media, tumors and other diseases. Complete blood count can rule out anemia in patients with hyperdynamic circulation status.
Vit A levels and thyroid function tests are performed in patients with suspected benign intracranial hypertension syndrome. Serum lipids and glucose should be measured in patients with carotid atherosclerosis, and ultrasound of both carotid arteries should be performed prior to radiological examination, as this may be the only test needed to diagnose the disease. Among these tests, frequency matching of tinnitus sounds has greater clinical significance because low to moderate frequency tinnitus often indicates middle and inner ear pathology and is more effective, whereas high pitched tinnitus and cranial tinnitus indicate auditory nerve or auditory center pathology and are often less effective with medications; bilateral tinnitus with the same frequency often indicates central tinnitus; and tinnitus sounds that are polyphonic indicate pathology in multiple parts of the auditory pathway.
Characteristics of common tinnitus: The early symptoms of auditory neuroma are often unilateral persistent tinnitus and hearing loss, and severe tinnitus with facial paralysis and numbness. Tinnitus is a high-frequency sound, like a mosquito or a cicada, with a sharp and thin tone.
Tinnitus is a low-frequency sound in the middle ear. When the head moves or yawns or blows the nose, the sound of air passing through water can appear in the ear.
Pulsating tinnitus: The sound of one’s own heartbeat or a very loud “clattering noise.
Objective tinnitus: Patients can hear tinnitus not only by themselves, but also by others, in the form of squeaking or chucking or chucking sounds. Some people can control tinnitus by swallowing or by muscle movements in the pharynx.
Common causes of tinnitus.
(1) Otogenic tinnitus.
(1) Lesions of the sound-transmitting part (outer ear, middle ear): cerumen embolism of the outer ear canal, eczema of the outer ear canal, tympanitis, otitis media, and Eustachian tube malfunction. Tinnitus caused by these diseases is usually not serious, and it can mostly disappear after the cause is removed.
②Sensory part (inner ear) lesions: Meniere’s disease, noise deafness, ototoxic drug poisoning, sudden deafness, etc. Tinnitus caused by these diseases is more serious.
③Posterior cochlear lesions (auditory nerve): Hunter syndrome, auditory neuritis, auditory neuropathy, and auditory neuroma.
(iv) Central auditory lesions (from the cochlear nucleus to the auditory conduction pathway of the cerebral auditory cortex): efferent nerve dysfunction, cerebral hemorrhage, dorsolateral cerebral syndrome, etc. Tinnitus caused by this type of lesion is very persistent.
(2) Tinnitus caused by systemic diseases.
(1) Cardiovascular diseases: hypertension, hypotension, anemia, coronary heart disease, arteriosclerosis, cerebral thrombosis, hemangioma, and arteriovenous tumor. These diseases often cause ergogenic tinnitus, which is consistent with the pulse rate.
②Cervical spondylosis: cervical spine osteophytes or herniated discs compressing vertebral A.
③ Traumatic brain injury or neurological disorders: head trauma, concussion, encephalitis, meningitis. These diseases often cause tinnitus and high frequency hearing loss in sensorineural deafness.
④Psychiatric disorders: anxiety evidence, depression, schizophrenia, etc.
⑤ Metabolic diseases: hyperthyroidism, hypothyroidism, diabetes mellitus, hyperlipidemia, fiber bundle or micronutrient deficiency.
(6) Other diseases such as kidney disease, gynecological disease and gastrointestinal disease can also cause tinnitus.
(3) Tinnitus caused by psychological factors: tension, anxiety, depression, sleep disorders, anger, menopause, etc. can all cause tinnitus.
Tinnitus patients should pay attention to.
1. Tinnitus must be ruled out as a cranial disease.
2. As with sudden deafness, tinnitus should be intervened as early as possible.
3. Some tinnitus may be a precursor of ear disease and should be treated promptly.
4.Patients with tinnitus have reduced or disappeared the degree of tinnitus during the day while the symptoms reappear or worsen in the evening. This is because the outside noise masks the tinnitus during the day and the outside masking sound is missing when it is quiet at night.
5.Tinnitus has a memory situation, so it is more difficult to eliminate it completely, so you have to adapt to it, i.e., practice treatment.
6.Shift your attention.
7.In daily life, try to avoid all kinds of “injuries” to the ear, such as firecracker blast injury, tympanic membrane trauma, noise stimulation, especially long time listening to high decibel MP3 headphones, dance hall high decibel disco music, etc., which can easily cause inner ear damage and lead to tinnitus and deafness. Avoid ototoxic drugs such as streptomycin, gentamicin, kanamycin, vancomycin, neomycin, etc. Reduce the intake of fat in the diet to avoid atherosclerosis and thus avoid causing ischemia in the inner ear.