pulsatile tinnitus
Introduction
Introduction Pulsating tinnitus is the patient's complaint that the ear has a heart-like or vascular pulse-like tinnitus. Some sounds like a wave or a pulse, which is very regular. The beat rhythm is carefully observed. Most of them are consistent with the number of heart beats. Such tinnitus is often summarized as objective tinnitus.
Cause
Cause
This type of tinnitus is mostly caused by vascular abnormalities: one is vascular lesions, such as abnormal skull base system, head and neck artery or venous malformation, etc. The most common clinical cause is high jugular spheroid tumor and mastoid guide. Venous malformation. The other type is hemodynamic abnormalities such as severe anemia, hyperthyroidism, hypertension, and arteriosclerosis.
In addition to the above-mentioned high-grade jugular spheroid tumor and mastoid venous malformation, there are also carotid aneurysms, carotid stenosis, arteriovenous fistula and cervical spondylosis. Vein and so on.
Anemia, hyperthyroidism, hypertension, and arteriosclerosis, due to abnormal blood viscosity, increased cardiac output, or changes in blood vessels, cause changes in blood flow to the intracranial and cochlear bloodstream, resulting in vascular murmurs. To the cochlea, it causes pulsating tinnitus.
Examine
an examination
Related inspection
Otolaryngology CT examination of ear, nose and throat swab bacterial culture
A detailed examination of the history of diseases in the ear and various systems of the body, such as the history of the use of ototoxic drugs, history of injury, history of otitis media, etc. are of great value in the diagnosis of tinnitus. Also, pay attention to the following points.
Tinnitus is mostly a subjective sensation and difficult to detect, but the intensity and frequency of tinnitus can be measured by a pure tone audiometer for frequency matching and loudness balance.
Objective tinnitus can be checked with a hearing aid or a stethoscope. If you suspect that you have a diaphragmatic palsy, you can use the EMG examination to put the electrodes in the muscles, and remember the relationship between potential changes and tinnitus during muscle activity. X-ray angiography can help diagnose vascular malformations, arteriovenous and vascular distribution. Cervical x-ray films can be used to check for the presence or absence of bone hyperplasia. X-ray tomography, CT skull scan to exclude intracranial lesions.
Diagnosis
Differential diagnosis
First, subjective tinnitus
(1) External auditory canal disease
Mainly sputum embolization of external auditory canal embolism, external auditory canal cholesteatoma, when the bath is shampooed by water, suddenly caused low-key tinnitus and hearing loss.
(two) middle ear disease
1. catarrhal otitis media: often have irregular tone tinnitus, the ear canal can be disappeared after the eustachian tube is blown, but easy to relapse.
2. Acute and chronic suppurative otitis media and its sequelae: low-pitched tinnitus is stubborn and difficult to treat.
3. Otosclerosis: Low-pitched tinnitus is often aggravated by inappropriate blow-up treatment, menstruation, and fatigue.
(3) Inner ear disease and auditory nerve injury
1. Lost blood circulation disorder: This is the most serious cause of subjective tinnitus. The tinnitus is high pitch or whistle, humming. Sudden onset may be due to abnormal changes in metastasis, endocrine, anemia, etc. caused by aberrant anemia or hyperemia, when the time is strong and weak, sometimes there is no persistence.
2. Ototoxic drug poisoning: All ototoxic drugs can cause tinnitus and tinnitus often appear before deafness. It can develop on one ear first, and gradually develop into binaural tinnitus as a high tone, and about half of the patients have head sounds. The symptoms of tinnitus can be alleviated or disappeared after the acute poisoning is stopped. The chronic poisoning does not disappear after stopping the drug.
3. Meniere's disease: causes low-key hair-like tinnitus often occurs before the onset of vertigo, or with deafness and dizziness at the same time during the remission of the disease, tinnitus can disappear or reduce. Repeated episodes can be converted to persistent high-pitched tinnitus.
4. Senile sputum: The elderly who are more than 60 years old are mostly bilateral, high-pitched tinnitus. Tinnitus is often a precursor to deafness.
5. Acoustic neuroma: Tinnitus is characterized by a unilateral high-pitched tone such as humming or whistling. The initial stage is intermittent, and gradually changes to continuous and often accompanied by other cranial nerve symptoms, such as headache, facial numbness and other internal auditory X-ray filming, CT internal auditory canal scan, brain electrical response audiometry can confirm the diagnosis.
(four) systemic diseases
1. Hypertension: Most of the tinnitus is bilateral and often coincides with the rhythm of the pulse. In addition to tinnitus, there are also symptoms of high blood pressure such as headache and dizziness. The hearing test is normal. Tinnitus can be alleviated or disappeared after taking blood pressure lowering drugs.
2. Autonomic dysfunction: common in women's puberty or menopause, tinnitus is changeable, sometimes high pitch, sometimes low tone has a single ear with alternating ears, sometimes persistent, time-limited and dizziness, insomnia and other dreams .
Second, objective tinnitus
(a) vascular tinnitus
Common in jugular bulbar carotid aneurysms, intracranial aneurysms, intracranial arteriovenous fistula and other such tinnitus is characterized by frequent frequency synchronization with the heartbeat or pulse, you can use the stethoscope to hear the sound, force the corresponding blood vessels when tinnitus Can be reduced or disappeared.
(B) muscle contraction tinnitus
The "Kata" sound caused by the clonic contraction of the levator muscles, the tympanic muscles, and the sacral muscles of the sacral muscles can be heard close to the ear of the patient.
