Tinnitus is a common symptom of ear diseases. Patients feel that there are sounds in their ears with varying loudness. High-pitched tinnitus can annoy patients and affect their sleep and work. It may occur intermittently or continuously. Sometimes tinnitus may be the first symptom or accompanying symptom of certain diseases.
symptom
Classification
1. According to the origin of tinnitus, it is divided into otopathic tinnitus and non-otopathic tinnitus.
2. According to the location of the lesion, tinnitus is divided into conductive tinnitus, sensorineural tinnitus and central tinnitus.
3. According to the pathophysiological characteristics of tinnitus, it can be divided into physiological tinnitus, pathophysiological tinnitus, pathological tinnitus, psychological tinnitus, pseudotinnitus, etc.
4. According to the patient’s feelings, it is divided into subjective tinnitus and objective tinnitus.
5. According to the occurrence of tinnitus, it is divided into spontaneous tinnitus and induced tinnitus.
6. According to the source of tinnitus, it can be divided into neurogenic tinnitus, vascular tinnitus, myogenic tinnitus, respiratory tinnitus, etc.
7. According to the tone of tinnitus, it can be divided into low-pitched tinnitus, high-pitched tinnitus, and complex-tone tinnitus.
8. According to the duration of tinnitus, it can be divided into continuous tinnitus, intermittent tinnitus and paroxysmal tinnitus.
9. According to the hearing condition, it is divided into tinnitus with hearing loss, tinnitus without hearing loss, etc.
Typical manifestations
Tinnitus is a clinical symptom with complex etiology and many diseases involved. Even though it is the same tinnitus, the characteristics vary greatly. Its clinical characteristics can be described from different aspects:
1. Tone
There are low, medium and high tones, and the sound characteristics include wind, blowing, whistle, cicadas, mouth sounds, clapping sounds, thunder, and a mixture of multiple sounds.
2. Loudness
From very light, barely perceptible, to very loud, unbearable.
3. Duration
There are intermittent and continuous types.
4. Side
Single or bilateral attacks. For unilateral attacks, more attention should be paid to the presence of diseases such as tumors.
5. Characteristics of the attack
(1) Some tinnitus has a time pattern: for example, it occurs at a certain time period, which may be related to the patient’s other physical conditions or the surrounding environment. For example, nocturnal tinnitus may be related to the quiet environment at night, which makes the tinnitus sound not well masked, or high blood pressure at a certain time period, which causes tinnitus.
(2) Some are related to body position: the tinnitus condition may change with changing body position. For example, in patients with abnormally open Eustachian tube, the tinnitus may disappear immediately when the head is lowered. The tinnitus caused by vascular pulsation may disappear or be alleviated when the blood vessels in the neck or occipital area are compressed.
(3) Some patients experience tinnitus alone, while others experience other symptoms, such as deafness, dizziness, headache, etc. The characteristics and accompanying symptoms of tinnitus may vary significantly depending on the disease.
Associated symptoms
1. Hearing loss
Hearing loss is the most common accompanying symptom, and both conductive tinnitus and neurological tinnitus can be accompanied by hearing loss, such as cerumen embolism, external auditory canal cholesteatoma, external auditory canal foreign body and other obstructive factors, as well as sudden deafness, presbycusis, drug-induced deafness, acoustic neuroma and other cochlear or retrocochlear lesions.
2. Dizziness
Tinnitus and vertigo at the same time, especially true vertigo, often indicate the presence of vestibular disease. For example, patients with sudden deafness may have tinnitus and vertigo in the early stages; patients with herpes zoster oticus may also experience vertigo due to viral invasion.
3. Headache
Patients with trauma, intracranial tumors, etc. may experience headaches, but tinnitus may also occur along with headaches.
4. Balance Disorders
It occurs when there are diseases of the vestibular endings and central nervous system.
5. Changes in blood pressure
Both high and low blood pressure can cause tinnitus. Early tinnitus occurs along with changes in blood pressure, but when the blood pressure changes persist for a long time, the blood supply to the inner ear is disrupted, resulting in persistent tinnitus.
6. Others
Such as bleeding, anemia, systemic allergic reactions, symptoms related to kidney disease, etc.
complication
If tinnitus persists for a long time or recurs, it may affect the patient’s daily life, leading to insomnia, auditory dysfunction, dizziness, inattention, emotional agitation, anxiety, depression, loneliness, etc.
reason
Overview
There are many causes of tinnitus, which can be mainly divided into physiological tinnitus, true tinnitus, and body tinnitus (objective tinnitus). Among them, true tinnitus is caused by diseases of the ear or other parts, and is a sound heard subjectively without sound source stimulation; body tinnitus is an abnormal sound caused by tissues and organs caused by certain diseases, that is, an abnormal sound heard in the ear caused by a sound source (sound source in the body).
Cause of symptoms
1. Physiological tinnitus
Around the ear, breathing movements, joint movements, blood vessel pulsation, blood flow, muscle contraction, etc. all produce certain sounds. Under normal circumstances, the external sounds are stronger than the sounds produced by these physiological activities, masking them and making them unnoticed. However, in a quiet environment, sometimes a faint sound can be felt in the ear, which is physiological tinnitus.
2. True tinnitus
(1) External ear lesions: such as those caused by obstruction of the external auditory canal, including cerumen embolism, cholesteatoma of the external auditory canal, foreign bodies in the external auditory canal, bleeding, tumors, etc.
(2) Middle ear lesions: Tympanic membrane perforation, especially in the early stages of traumatic tympanic membrane perforation, can cause severe tinnitus. Acute and chronic otitis media, secretory otitis media, Eustachian tube dysfunction, and ossicular chain abnormalities can all cause tinnitus.
(3) Inner ear diseases: otosclerosis, Meniere’s disease, inner ear infection, trauma, delayed hydrops muscularis, sudden deafness, etc.
(4) Certain systemic diseases: such as anemia caused by various reasons, low body weight caused by wasting diseases, endocrine dysfunction, diabetes, autoimmune diseases, abnormal blood pressure, renal failure, etc., which may lead to abnormal nerve function due to inner ear blood supply disorders, neurotrophic deficiency, and toxemia.
(5) Drugs: Improper use of certain ototoxic drugs, such as vancomycin, methotrexate, and certain antidepressants, can cause tinnitus.
(6) Decline in overall function in the elderly: manifestations include presbycusis, noise damage, and transient tinnitus of unknown cause.
(7) Psychological factors: Tinnitus in some patients may be related to mental disorders such as sleep disorders, nervous tension, and mood swings.
(8) Others: acoustic neuroma, craniocerebral trauma, etc.
3. Somatic tinnitus (objective tinnitus)
(1) Vascular tinnitus: It is common in clinical practice and is mostly pulsatile tinnitus, which is consistent with the pulse rhythm. The sound is higher when caused by arterial pulsation and lower when caused by venous pulsation. If it is caused by arteriovenous pulsation, it is mostly a blowing murmur. Those without organic lesions often have intermittent attacks, which may be related to body position, fatigue, and mental state. Those with organic lesions often have continuous tinnitus, and other symptoms may accompany or appear at the same time. The diseases included include hypertension, abnormal vascular compression, arteriovenous fistula, aneurysm, and jugular glomus tumor. Among them, vascular compression and twisting are the most common.
(2) Muscular tinnitus: The most common is palatal myoclonus, and the tinnitus is a “clicking” sound synchronized with the myoclonus. Cervical spondylosis, neck sprains, etc. increase the tension of the muscles around the neck, and spasms of the tensor tympani and sphenoid muscles cause tinnitus.
(3) Respiratory tinnitus: It is common in patients with abnormally open Eustachian tubes. The patient may hear his or her own breathing or feel uncomfortable because the sound of his or her own voice is too loud. Some thin patients may experience this.
(4) Tinnitus caused by mandibular joint dysfunction: Malocclusion of the mandibular joint causes abnormal noise when the joint moves, which can often be heard by others.
Common diseases
Cerumen embolism, external auditory canal cholesteatoma, external auditory canal foreign body, external auditory canal bleeding, external auditory canal tumor, tympanic membrane perforation, acute and chronic otitis media, secretory otitis media, Eustachian tube dysfunction, ossicular chain abnormality, otosclerosis, Meniere’s disease, inner ear infection, trauma, delayed membranous hydrops, sudden deafness, anemia, diabetes, renal failure, neurotrophic deficiency, toxemia, acoustic neuroma, craniocerebral trauma, hypertension, arteriovenous fistula, aneurysm, jugular glomus tumor, palatine myoclonus, cervical spondylosis, neck sprain, abnormal opening of Eustachian tube, mandibular joint malocclusion
Medical treatment
Emergency (120) Indications
1. Repeated attacks of short-term headaches, tinnitus, nausea or vomiting, blurred vision or transient limb weakness in a short period of time; or sudden severe headaches, vomiting, visual impairment, paralysis or coma, etc.
2. After severe head trauma, persistent headache, tinnitus, blurred vision, confusion or coma, etc.
3. Other life-threatening symptoms occur.
In all cases above, you must call the emergency number or go to the emergency room for treatment in time.
Outpatient Indications
1. Repeated or persistent tinnitus;
2. Accompanied by ear pain and hearing loss;
3. Accompanied by dizziness, headache, high blood pressure, etc.;
4. Accompanied by balance disorder;
5. Other severe, persistent or progressive symptoms and signs occur.
If tinnitus is accompanied by the above conditions, you must seek medical attention immediately.
Department
1. If there is a serious injury, sudden severe headache, coma or other critical conditions, go to the emergency department immediately.
2. If you have simple tinnitus or other ear disease symptoms, you should go to the ENT department.
3. If you suspect that hypertension is the cause, you can first go to the cardiovascular department to regulate your blood pressure.
4. If you suspect that it is related to vestibular dysfunction, you can go to the neurology department for consultation.
5. If the cause of tinnitus or even auditory hallucinations cannot be found, you can consult the department of psychiatry and psychology.
Medical preparation
1. If tinnitus is severe and causes hearing loss, be sure to go out accompanied by others to avoid accidents.
2. Make an appointment in advance and bring your ID card, medical insurance card, medical card, etc.
3. The doctor may need to examine the ears. Avoid wearing ornaments such as earrings as they may interfere with the examination.
4. If you have had medical treatment recently, please bring relevant medical records, examination reports, test results, etc.
5. If you have used certain medications to relieve symptoms recently, you can bring the medicine box with you.
6. Patients can prepare a list of questions they want to ask in advance.
Questions your doctor may ask you
1. When did your tinnitus begin? Has the symptom worsened over time?
2. Under what circumstances will tinnitus become worse or better?
3. In addition to tinnitus, do you also have dizziness, hearing impairment, etc.?
4. Will tinnitus affect your sleep?
5. Have you ever had tinnitus before? What caused it?
6. Have your ears been affected by strong noise recently?
7. Have you had a cold, ear injury, or head injury recently?
8. Do you have high blood pressure, diabetes or other diseases? Are you taking medication to control them?
9. Have you ever used medication to treat tinnitus? What medication?
10. Do you smoke? How long have you been smoking? How much do you smoke every day?
11. Do you like drinking alcohol or coffee?
Questions patients can ask their doctors
1. What is the most common cause of my tinnitus?
2. Is my condition serious? Will I become deaf?
3. What tests do I need to take? Do I need to be hospitalized?
4. What treatment do I need now? Can it be cured?
5. Are there any risks with these treatments? Will they affect hearing?
6. If medication is used, what are the usage, dosage, and precautions?
7. I have other diseases. Will this affect my treatment?
8. What should I pay attention to in my daily life? How should I take care of myself after returning home?
9. Do I need follow-up examinations? How often?
examine
Estimated inspection
The doctor will first conduct a physical examination on the patient to get a preliminary understanding of the situation. Then the doctor will recommend the patient to undergo an audiological examination, a vestibular function examination, a tinnitus test, a psychological scale examination, and, if necessary, an MRI, CT scan, etc. to clarify the cause of the disease.
Physical examination
The doctor will focus on the examination of the ear, observe whether the eardrum is retracted, understand the location and size of the eardrum perforation, the state of the tympanic cavity and the ventilation of the Eustachian tube. If it is pulsating tinnitus, auscultation of the head, neck and ears should be performed to understand whether there is pulsating sound of blood vessels, and the neck should be rotated to understand the effect of compressing the jugular vein on tinnitus.
Imaging tests
Doctors may use MRI, CT and other examinations to determine whether the patient has structural abnormalities related to tinnitus.
Other tests
1. Audiological examination
It includes tuning fork test, pure tone audiometry, supraaudiometry, speech audiometry, impedance audiometry and electrical response audiometry. It is extremely important for the diagnosis of tinnitus, especially for determining the cause and location of the lesion and evaluating the effect of treatment. However, it should be noted that a small number of patients may have completely normal hearing. For subjects who have not been found to have hearing loss, expanding the high-frequency pure tone audiometry test may sometimes reveal abnormal findings and help with diagnosis.
2. Vestibular function test
Vestibular function examinations should include spontaneous and induced vestibular function tests, nystagmus recordings, posturography examinations, etc., which can help diagnose and evaluate tinnitus associated with vestibular dysfunction.
3. Tinnitus test
(1) Frequency matching of tinnitus tone: The frequency of the tone or the main tone that is most annoying to the patient is determined through tone matching. In clinical practice, only pure tone audiometry is required for matching.
(2) Loudness matching of tinnitus: Loudness matching should be performed to understand the intensity required to completely mask tinnitus.
(3) Minimum masking level: also known as tinnitus masking curve test, which is used to determine the minimum intensity level of the test sound that can just mask the tinnitus.
(4) Masking therapy test: In preparation for masking therapy, the time attenuation, aftereffect suppression, loudness discomfort threshold, etc. of the mask should be tested.
4. Psychological scale examination
Able to assess the impact of tinnitus on patients’ psychological state and quality of life, and help identify and treat psychological problems related to tinnitus.
diagnosis
Diagnostic principles
The doctor will ask in detail about the onset of the disease, the history of use of ototoxic drugs, etc., and make a diagnosis based on the patient’s accompanying symptoms, such as dizziness and blood pressure changes, and the results of physical examination, hearing test, and tinnitus test. The results of experimental treatment are also helpful to the doctor’s diagnosis. Attention should be paid to distinguishing it from auditory hallucinations.
Diagnosis
1. Ask medical history and analyze the condition
(1) The doctor will ask in detail about the onset of the disease, the nature, degree, side of the tinnitus, and the regularity of the attacks.
(2) The doctor will find out whether the patient has any ear disease and use of ototoxic drugs, a history of craniocerebral trauma, noise damage, vertigo, or excessive smoking and drinking, and understand the medical history of the cardiovascular and nervous systems.
2. Analysis of associated symptoms
Patients may experience symptoms such as hearing loss, dizziness, headache, balance disorders, and blood pressure changes.
3. Auxiliary examination
The doctor will recommend that the patient undergo appropriate physical examinations, hearing tests, tinnitus tests, etc., and make a diagnosis based on the specific examination results.
4. Therapeutic observation
Experimental treatment has a certain significance for the diagnosis of tinnitus. If the tinnitus is alleviated or disappears after the pharyngeal drum is puffed and stretched, it can be concluded that the lesion is located in the sound transmitter. On the contrary, if the tinnitus is not improved despite long-term puffing and stretching, the lesion may be located in the sound sensor.
Differential Diagnosis
Tinnitus should be distinguished from auditory hallucinations. Tinnitus is often a monotonous noise, such as roaring, buzzing, hissing, ringing, cicadas or whistles, while auditory hallucinations are a kind of hallucination caused by mental disorders. Patients often complain of music, talking, chorus or other difficult to explain sounds.
treat
Expected treatment
First, the cause needs to be found and treated, while relieving the patient’s tinnitus symptoms. For example, for otitis media with effusion, you can choose to blow or tympanostomy to extract fluid. For tinnitus caused by noise, you need to leave the noisy environment. For those with surgical indications, choose surgical treatment. To relieve symptoms, you can use drugs to improve blood supply to the cochlea, improve energy metabolism and nutrition in the inner ear, or use masking therapy to inhibit the increase in spontaneous excitation of the cochlea or auditory nerve, and use biofeedback therapy to relax the patient.
Treatment of the cause
If the primary lesion can be found and targeted treatment is taken, both subjective and objective tinnitus can achieve good results. For example, the tinnitus of secretory otitis media often disappears immediately after blowing or tympanocentesis; the tinnitus caused by early noise-induced hearing loss can generally be relieved or disappear after leaving the noisy environment. Objective tinnitus also often disappears after the cause is corrected. For example, after conservative or surgical treatment of abnormal patency of the Eustachian tube, the tinnitus can be relieved or disappear after its excessive patency is relieved; arteriovenous fistulas or malformations can be relieved by surgical correction; tinnitus caused by lesions of the vertebral artery communicating branches often disappears after the communicating branches and lesions are removed.
Drug treatment
1. Improve blood supply to the cochlea
Poor blood supply, such as vasospasm and vascular embolism, is a common cause of cochlear function. The use of vasodilators, such as niacin, can improve blood circulation in the inner ear to achieve the purpose of treating inner ear diseases and eliminating or reducing tinnitus.
2. Improve energy metabolism or neurotrophy of inner ear tissue
Such as adenosine triphosphate, vitamin B1, etc., can help promote the regeneration of nerve fibers and restore their conduction function.
3. Anticoagulants
For example, low molecular weight dextran can improve blood circulation in the inner ear and help improve tinnitus symptoms.
4. Anticonvulsants
The effect of this type of drug may be to block the multi-axon system in the brainstem, especially the reticular formation. Common ones include diazepam, chloral hydrate, etc.
5. Antibiotic treatment
When a patient develops an infection, doctors use antibiotics to treat it.
6. Antidepressant and anti-anxiety medications
They can reduce the effects of tinnitus, but these drugs have side effects to varying degrees, and some may even aggravate tinnitus, so they should be used with caution and not in excess. Commonly used drugs include doxepin, maprotiline, estazolam, alprazolam, etc.
Related drugs
Niacin, adenosine triphosphate, vitamin B1, low molecular weight dextran, diazepam, chloral hydrate, doxepin, maprotiline, estazolam, alprazolam, Xiasangju granules (such as Jiangzhong Xiasangju granules), Gengnianan tablets (such as Sanghai)
Surgery
Some causes of objective tinnitus can be cured by surgery, such as removing tumors and cysts. Currently, there is no definite effect on the treatment of subjective tinnitus. In subjective tinnitus, if the primary ear disease itself has surgical indications, then surgical treatment can be performed. If the surgical indication itself is not strong, it is not appropriate to perform it to solve the tinnitus.
Traditional Chinese Medicine Treatment
For patients with tinnitus, they can use Chinese patent medicines under the guidance of professional Chinese medicine practitioners after diagnosis.
1. Xiasangju granules (such as Jiangzhong Xiasangju granules)
It has the effects of clearing the liver and improving eyesight, dispersing wind and heat, removing dampness and arthritis, and relieving sores and toxins. It is used for wind-heat colds, red eyes and headaches, dizziness and tinnitus, sore throat, carbuncle and swelling.
2. Menopause tablets (such as Sanghai)
It has the effects of nourishing yin, clearing away heat, relieving restlessness and calming the mind. It is used for hot flashes, sweating, dizziness, tinnitus, insomnia, and irritability that occur during menopause.
Other treatments
1. Masking therapy
The main purpose is to use external sounds to inhibit the spontaneous excitation of the cochlea or auditory nerve. The short-term effect of masking therapy is good, and the long-term effect still needs to be followed up. However, tinnitus maskers can only relieve tinnitus symptoms to relieve the patient’s pain, but cannot cure tinnitus. Masking therapy still has an after-effect inhibition for some tinnitus patients, that is, after stopping masking, the tinnitus still disappears temporarily.
2. Biofeedback therapy
Biofeedback therapy uses different biofeedback signals to train patients to enter a relaxed state. The principle of treatment is to teach patients to consciously control the sensations of various parts of the body, so that patients can change their body’s reactions through learning. For example, controlling muscle tension and blood flow, etc., allows patients to enter a relaxed state and restore relative balance in the body, so as to achieve the purpose of treating tinnitus.
3. Tinnitus Retraining Therapy
Let the brain gradually get used to the sound of tinnitus, filter out the sound at the subconscious level, and make the patient unaware of the sound.
4. Others
Cognitive behavioral therapy, electrical stimulation therapy, hypnosis therapy, acupuncture therapy, etc. have certain effects on tinnitus.
Treatment cycle
The treatment cycle is affected by factors such as the severity of the disease, treatment plan, timing of treatment, age and physical condition, and may vary from individual to individual.
Estimated cost of treatment
There may be significant individual differences in treatment costs, and the specific costs are related to the selected hospital, treatment plan, medical insurance policy, etc.