Three major departments to consult tinnitus

Many people have symptoms of tinnitus, especially the elderly. Because the causes of tinnitus are very complicated, from the ears to the auditory nerve to the auditory center, problems may occur in any link in the entire auditory conduction process. Experts from otolaryngology, neurology and traditional Chinese medicine are invited to talk about the diagnosis and treatment of tinnitus.

Otorhinolaryngology: The inner ear nerves are easily injured
Clinically, there are many causes of tinnitus, especially those caused by ENT diseases. According to different lesions, it is often divided into conductive tinnitus and neurogenic tinnitus.

Conductive tinnitus refers to tinnitus caused by obstruction due to inflammation and swelling, eardrum congestion, indentation, perforation, middle ear effusion or infection, or otosclerosis. It often occurs on the side of the lesion, and the pitch is low, such as “rumble”, “rumble” and “buzz”.

The treatment of conductive tinnitus must first find the cause. If it is caused by inflammation, it can be treated with drugs under normal circumstances. However, some tinnitus that has a long period of inflammation, such as patients with chronic otitis media with pus for many years, is usually not pure conductive tinnitus. Bacteria and toxins in the ears stimulate nerve endings for a long time, and it is easy to turn into mixed tinnitus. It is necessary to treat conductive tinnitus first, and then neurogenic tinnitus.

Neurotic tinnitus may be a problem with nerve endings, or a problem with the nerve pathways in the brain. The sound-sensing part of the ear is the inner ear cochlea. In the case of inner ear concussion, edema, acoustic neuroma, etc., tinnitus will occur, which is mostly bilateral, and the sound is high, such as cicadas or hissing, which is intermittent. In addition, when kidney disease, hepatobiliary disease, diabetes, tuberculosis, chronic bronchitis, etc. cause systemic dysfunction, it causes nerve reflexes, often sensorineural tinnitus, which usually disappears with the recovery of the original disease.

In addition, drug poisoning can also damage the inner ear nerves. For example, the use of large doses of quinine, quinidine, chloroquine and other drugs can cause severe tinnitus, but it will get better after stopping the drug, and most of it will not affect hearing. Gentamicin, streptomycin, kanamycin and other drugs can damage the auditory nerve and vestibular nerve, and tinnitus can occur. If the drug is not stopped in time, it can quickly develop into deafness, and it is difficult to recover. Tinnitus caused by drug allergy or poisoning is often high-pitched and bilateral in nature. However, patients with unilateral high-pitched tinnitus should go to regular hospitals for regular check-ups in order to get accurate and timely diagnosis and treatment.

When the patient has tinnitus symptoms, it is recommended to go to the otolaryngology department first, and then go to the neurology department after the ear problem is ruled out.

Neurology: MRI is very important
Neurology treatment of tinnitus is divided into neurology and neurosurgery, and tinnitus is divided into functional and organic.

The diagnosis of tinnitus is not difficult, but to distinguish between functional and organic, a specialist must be judged. The occasional tinnitus caused by fatigue or cold and poor rest is generally functional tinnitus, which can be relieved after rest without excessive tension. However, some functional tinnitus is very complicated. Even if the existing examination methods are used, any abnormalities cannot be found, such as auditory hallucinations in mental illness, tinnitus in traumatic brain syndrome, tinnitus in women’s menopause, and “ears ringing” associated with mental illness. “.

The most common organic tinnitus in neurosurgery is caused by cerebrovascular tumors compressing the auditory nerve or brain tumors, but the symptoms of tinnitus are different between the two. Vascular compression is often accompanied by dizziness, but the hearing impairment is not obvious; and tinnitus caused by tumors such as acoustic neuroma or meningioma will gradually show hearing loss over time. Tinnitus caused by organic disease is difficult to prevent because of the primary disease. Only when the primary disease is resolved, tinnitus will disappear accordingly. For patients with functional tinnitus, regular life and reasonable diet are effective in preventing occurrence. method.

Long-term, persistent tinnitus accompanied by hearing loss or other neurological symptoms should be taken seriously and seek medical attention as soon as possible, such as a magnetic resonance examination, to rule out intracranial organic diseases.

Some diagnosed brain or brain stem lesions can be treated surgically, but there are too many complications that seriously affect daily life. Radiosurgery treatments such as precision radiotherapy can also be considered; for inoperable lesions, there is no effective method , Often relieve the disease by expanding blood vessels and taking drugs that nourish the nerves.

Department of Traditional Chinese Medicine: Diagnosis and treatment of viscera
Traditional Chinese medicine believes that tinnitus is a manifestation of the dysfunction of the body’s internal organs. It is divided into empirical and deficient syndromes. It is often a sign of deafness or concurrent symptoms, and may also be a sign of intracranial lesions. From the perspective of TCM syndrome differentiation, the following lists a few cases of unknown etiology or poor prognosis in Western medicine.

1. Liver and gallbladder are fierce. This type of tinnitus is similar to the sound of tide, squally, and thunder. It is common in people with violent temperament. After a sudden, it is often accompanied by restless sleep, headache, swelling of eyes, dizziness, red eyes, dry mouth and throat. Symptoms such as restlessness. There is a saying in traditional Chinese medicine that “anger leads to qi up” and “violent anger hurts the liver”, which leads to liver disorders, stagnation of qi, and upper ears disturbing the orifice. First, let the patient calm down, adjust the mentality, and cooperate with Chinese medicine to clear the liver and reduce the fire before treatment.

2. Deficiency of kidney essence. This kind of tinnitus is more like the sound of cicadas, from light to heavy, quiet and obvious, easy to be upset and insomnia, hearing loss, accompanied by weak waist, frequent nocturia, dizziness and memory loss. Clinical observations have found that most of these patients are between 50 and 70 years old, and a large part of them have auditory nerve conduction and brainstem dysfunction. Such patients are mostly due to acquired loss of support, or sexual intercourse, or due to insufficient kidney essence in the elderly. For such patients, traditional Chinese medicine treatment focuses on invigorating the kidney, filling the essence and regenerating the marrow.

3. Weak spleen and stomach. This tinnitus is characterized by aggravation after fatigue, or when squatting and standing, there is emptiness in the ears, craniofacial chills around the ears, accompanied by fatigue, low diet, abdominal distension after eating, and loose stools. Not forming, the complexion is yellow and ruddy. The theory of traditional Chinese medicine states that the spleen governs the promotion of clearness, the spleen and stomach are weak, the clearness does not rise, and the ear orifices cannot be promoted. In the treatment of such patients, the main treatment is to invigorate the spleen and replenish qi, and promote the yang to relieve the orifice.

4. Other card types. Qi stagnation and blood stasis type tinnitus lasts for a long time, accompanied by earache, headache, or a history of trauma, and the tongue is dark red or has petechiae, and the veins under the tongue are bruised. It is advisable to invigorate blood and promote qi. Liver-qi stagnation, qi depression and fire-type tinnitus are often aggravated when irritable, anxious, or emotional, often accompanied by insomnia, dreams, dry mouth and bitter mouth. The treatment is mainly to relieve the liver and relieve depression, promote qi to relieve the orifice, and coordinate with emotions. Unblock.

It is especially emphasized that for patients with no obvious organic diseases, psychological counseling and correction of bad life and eating habits should be given first, and patients’ anxiety and fear of tinnitus should be eliminated, and then drugs and other treatments should be started.