tinnitus
Introduction
Introduction to tinnitus Tinnitus is a subjective perception of the human ear without external sound or electrical stimulation. It is worth noting that tinnitus is an illusion that occurs in the auditory system and is a symptom rather than a disease. Some people often feel that there are some special sounds in their ears, such as squats, squats or sharp whistle, but there is no corresponding sound source around them. This is tinnitus. Tinnitus makes people upset and restless, and serious people can affect normal life and work. basic knowledge The proportion of illness: 0.12% Susceptible people: good for young men and women Mode of infection: non-infectious Complications: otitis media Eustachian tube obstruction
Cause
Causes of tinnitus
Organic factor (30%):
1. External ear canal obstruction lesions in the middle ear acute and chronic inflammation, patella fixation, etc., tinnitus mostly low-key and inconsistent degree of deafness. 2. Inner ear receptor lesions and auditory nerve damage Auditory signals caused by stimulation of hair cells may be the most important cause of tinnitus. The stimulating state of hair cells (depolarization) may be induced by transient hypoxia. A transient tinnitus. If hair cell degeneration and poor contact between the cilia and the cover film, persistent tinnitus can occur. For localized hair cell damage, the nature of tinnitus is close to that of purely cochlear nerve fibers. If mechanical stimulation is used, it can directly act on nerve cells to induce abnormal nerve impulses, causing rhythmic tinnitus. Under normal circumstances, the efferent pathway of the cochlea has the effect of regulating nerve conduction, and any obstacle of the bundle can also cause tinnitus. Ischemic disease common in the brainstem.
Neurological reflex factors (30%):
1. Tympanic plexus reflex because the tympanic plexus belongs to the central plexus through the contact of the glossopharyngeal nerve, the trigeminal nerve and the carotid sympathetic nerve fibers. After receiving the excitatory stimulation, it transmits to the central forehead to form tinnitus. 2. Visceral chronic disease The vascular motility of the intraocular arteries is derived from the fusion of the subcortical ganglion with the first ganglion. The stellate ganglion is connected to the abdominal organs through the vagus nerve. Therefore, the internal organs produce nerve impulses, which can cause vasospasm in the inner ear. Contraction or expansion changes the blood supply to the inner ear, causing tinnitus.
Prevention
Tinnitus prevention
1. Noise: Both the shock sound and the long-term noise contact can cause hearing loss and tinnitus. Pay attention to noise protection for high-risk groups (working in high-intensity noise environment). Such as reducing noise sources or wearing protective earmuffs, earplugs, etc. Also, be careful not to use the Walkman headphones in a noisy environment at high volume for long periods of time.
2, mental stress and fatigue: when the long-term mental stress and fatigue in the body are easy to make the tinnitus worse. Therefore, it is beneficial to adjust the rhythm of the work, relax the mood of the patients with tinnitus, and shift the attention to tinnitus.
3, special drugs: patients with tinnitus due to other diseases, please do not forget to tell the doctor that they have tinnitus. Because some drugs can make your existing tinnitus symptoms worse.
4, bad habits: caffeine and alcohol often make tinnitus symptoms worse: smoking can make blood oxygen drop, while inner ear hair cells are a kind of cells that are extremely sensitive to oxygen, so hypoxia will cause damage to hair cells, so Pay attention to changing bad habits.
Complication
Tinnitus complications Complications Otitis eustachian tube obstruction
1, external ear lesions: sputum embolism, active foreign body, etc., due to its contact with the tympanic membrane, can cause tinnitus when the head is active.
2, inner ear cochlear lesions Early Meniere's disease damages the cochlear pericardial spiral when low frequency tinnitus occurs. High-frequency tinnitus can be accompanied by ototoxic drugs, noise and senile cochlear damage, accompanied by sensorineural spasm.
3, middle ear lesions: otitis media, eustachian tube obstruction, otosclerosis, etc. are common causes of tinnitus. Lesions around the middle ear tympanic cavity, such as jugular spheroid tumors, jugular vein or arterial anatomy, arteriovenous fistula, etc. can cause pulsating tinnitus.
4, cardiovascular disease: is one of the most common causes of tinnitus, of which about 10% are high blood pressure. Tinnitus is often pulsating, synchronized with the pulse and heartbeat. Atherosclerosis, pulsatile tinnitus can also occur due to lumen shrinkage and stenosis. Anemia causes pulsating tinnitus due to increased cardiac output.
5, endocrine and metabolic diseases: hyperthyroidism or hypothyroidism can cause pulsating tinnitus, the former due to increased cardiac output, the latter due to increased cell fluid or increased lymphatic pressure. Diabetes, autoimmune diseases, vitamin deficiency, iodine or zinc deficiency, and kidney disease have a higher incidence of tinnitus.
Symptom
Tinnitus symptoms Common symptoms Tinnitus conduction tinnitus vertigo otogenic vertigo hearing loss pulsating tinnitus
The tone of tinnitus can be high or low, often described as humming, whistling, whistling, rumble, wind, slap, etc. Some manifestations are intermittent, some are persistent, and some are accompanied by symptoms such as hearing loss and dizziness.
Examine
Tinnitus examination
ordinary inspection
(1) Whole body examination. It should include the fundus, temporomandibular joint; abnormal vascular pulsation and vascular murmur in the neck and ear; the effect of neck rotation and compression of the neck and veins on tinnitus.
(2) Otolaryngology examination.
Auxiliary inspection
(1) Otoscopy: Observe the presence or absence of redness, stenosis, sputum embolism, foreign body, secretions, and collapse of the posterior superior wall. Whether the tympanic membrane is congested, invaginated, thickened, perforated, atrophied, calcified plaque and tympanic effusion.
(2) Audiological examination: pure tone hearing threshold, threshold function test, acoustic impedance test, electrical response audiometry, otoacoustic emission test, etc.
(3) Tinnitus tone test and loudness test: Test the intensity of the main tone and loudness of the patient's tinnitus tone. Most tinnitus has a sensory level between 10-15 dB.
(4) Tinnitus masking audiogram: Test the minimum intensity level of pure tone or narrowband noise of each frequency that can cover the tinnitus. Connect it as a tinnitus masking audiogram or a tinnitus masking hearing curve.
(5) Examination of other systems of the whole body: suspected tinnitus caused by diseases such as internal medicine, surgery, neurology, psychiatry, etc., should be checked by relevant systems.
(6) Psychological evaluation: Because tinnitus is more related to psychological factors such as anxiety, patients with severe tinnitus should be assessed psychologically.
Diagnosis
Tinnitus diagnosis
Diagnostic points
(1) Whether tinnitus has combined hearing loss and dizziness, and the order of time between the three occurs.
(2) The time, duration, and process of change of tinnitus.
(3) The location of tinnitus, intracranial or intra-orbital, left or right ear, unilateral or bilateral.
(4) The tone of tinnitus is a single sound, or a composite sound of two or more sounds; whether it is high-key, medium-tone or low-key; whether the specific description is such as humming, whistling, whistling, wind, slap or "" "Sound", "Rumble", "Card", etc.; is pulsating or non-pulsating, whether pulsation is synchronized with heartbeat or pulse, whether it is related to breathing.
(5) Inducing factors of tinnitus, such as insomnia, fatigue, the influence of psychological state, the influence of environmental sound, the head position and the change of body position leopard.
(6) Past medical history that may be related to tinnitus, such as history of otolaryngology, history of sound, history of head trauma, history of nervous system disease, history of cardiovascular disease, history of allergic disease, history of use of ototoxic drugs, etc.
