The treatment of tinnitus is one of the three major problems in otology (the other two are deafness and vertigo). Although there are many treatment methods, there is no particularly effective method.

(1). Etiological treatment: This treatment is the first and most ideal treatment method in medicine, but only less than 5% of the causes of tinnitus can be diagnosed and treated;

(2). Drug treatment: including basic disease treatment and symptomatic treatment, the latter including reducing the impact of tinnitus on patients (such as antidepressants, anti-anxiety drugs) and tinnitus suppressive drugs (such as lidocaine, clonazepam and carbamazepam) (Equality);

(3). Masking therapy: It is currently a more effective method to treat tinnitus;

(4). Psychological treatment: through verbal and non-verbal communication methods and Some methods are used to influence and change the mental state and psychological disorders of the treated person, thereby achieving the purpose of interrupting the vicious cycle and treating tinnitus. Psychological treatment is one of the important therapies.

(5). Electrical stimulation therapy: uses electric current to directly stimulate the auditory system to suppress tinnitus.

(6). Combined treatment of tinnitus: There are many treatment methods for tinnitus, and it is difficult to determine which treatment method is more effective. In addition to the treatment of the cause, combined treatment including drugs, biofeedback, sound masking, and electrical stimulation is more reasonable, in order to shorten the treatment time, reduce the dosage of drugs with side effects, increase the synergistic effect, and achieve a more effective treatment of tinnitus.

Tinnitus refers to the abnormal sound sensation that people have without any external stimulation. If you feel that there are monotonous or mixed sounds such as chirping, buzzing, hissing, etc. in your ears, there are actually no corresponding sounds in the surrounding environment, which means that tinnitus is just a subjective feeling. Tinnitus can be transient or persistent. Severe tinnitus can disturb a person's peace of mind and make them very nervous. If it is temporary tinnitus that comes and goes, it is usually a physiological phenomenon, so don’t be overly nervous and just let it go. If it is persistent tinnitus, especially if it is accompanied by other symptoms such as deafness, dizziness, headache, etc., you should be more vigilant and seek medical advice as soon as possible. Carefully investigate the cause of tinnitus

Based on the patient’s chief complaint. It is easy for doctors to determine whether a patient has tinnitus, but diagnosing the cause of tinnitus requires a series of examinations, including routine otolaryngology examinations, audiological examinations, tinnitus tests, etc., and sometimes even necessary neurological and systemic tests. Disease check. Therefore, patients should go to a regular large hospital to find a professional doctor for diagnosis. Only by ascertaining the nature, characteristics, and possible lesions of tinnitus can a targeted treatment plan be determined.

The causes of tinnitus are relatively complex and can generally be divided into two categories: ① Otogenic diseases (ie, related to ear diseases). It is often accompanied by hearing loss, such as caused by ototoxic drug poisoning, viral infection, insufficient blood supply to the inner ear, etc. ②Non-otogenic diseases. In addition to tinnitus, these patients are often accompanied by other symptoms of corresponding diseases, such as cardiovascular disease, hypertension, diabetes, brain trauma, etc.

Tinnitus is the same as other diseases. Early diagnosis and treatment can help the condition improve and recover. Because tinnitus often precedes other symptoms, this is undoubtedly an "alarm". For example, the ototoxicity of aminoglycoside antibiotics often causes tinnitus first, and then hearing loss. When tinnitus occurs, the drug should be stopped immediately; patients with anemia and hypertension If the patient develops tinnitus or the tinnitus worsens, it indicates that the condition is getting worse, and the patient should be vigilant. If tinnitus occurs after working in a noisy environment for a long time, a change of working environment should be considered. Some causes of tinnitus can be identified early, such as ear occlusion, secretory otitis media, etc. Corresponding treatment measures can be taken and the tinnitus will disappear. But about 40% of patients have no obvious cause of tinnitus. Doctors call it unexplained tinnitus. Treatment varies from person to person

Tinnitus patients should take targeted treatment measures after a doctor's systematic examination and clear condition. So, what kind of tinnitus needs treatment? ① Tinnitus caused by surgical lesions (such as retrocochlear lesions, vascular malformations, etc.) must receive surgical treatment as soon as possible. ② Caused by other diseases (such as hypertension, cervical spondylosis, secretory otitis media, Meniere's disease, etc.), treatment should be based on the principle of controlling these diseases. ③For patients whose tinnitus has seriously disturbed their normal work, life or sleep. You should fully understand the long-term and difficult nature of treatment, actively cooperate with doctors in treatment, and correctly understand the effects of treatment. ④ Some patients have a long history of tinnitus and initially feel the tinnitus is strong. As time goes by, the self-perception has adapted and the degree of tinnitus has not worsened. It does not affect work, life and sleep, and has been carefully examined by a doctor. No disease was found. No treatment is required, but regular follow-up visits are required. ⑤For patients with tinnitus and hearing loss, wearing hearing aids is the first choice.

At present, the treatment methods for tinnitus are divided into two categories in principle: conservative treatment and surgical treatment. Except for the discovery of surgical lesions that require surgical treatment, conservative treatments such as psychological therapy, masking, drugs, and relaxation therapy are generally adopted. Some things to note

Since tinnitus is affected by many factors, patients should also pay attention to the following things when treating tinnitus:

1 Have an optimistic and open-minded attitude towards life. Once you have tinnitus, don't be overly nervous and seek medical treatment promptly.

During the diagnosis and treatment process, follow the doctor's guidance and actively cooperate with the treatment. And you can proactively use other advantages (such as hobbies and love for your job, etc.) to distract yourself from tinnitus, adjust your life rhythm, and cultivate more points of interest.

2 Avoid staying in a strong noise environment for a long time or being exposed to excessive noise. Avoid or use ototoxic drugs with caution, smoke less, drink less, have a regular lifestyle, and do not sleep for too long (7-8 hours for young and middle-aged people, 6 hours for the elderly).

3 Since the onset of tinnitus is slow and the course of the disease does not occur in a short period of time, treatment generally takes a long time. For example, tinnitus masking therapy, relaxation therapy, etc. must complete a course of at least one month before the treatment can be evaluated. Effect. Therefore, patients must be persistent in cooperating with the treatment process and not give up easily.

Tinnitus has various manifestations, some are tinnitus on one side, and some are on both sides; some occur intermittently, and some are continuous; in mild cases, tinnitus is only felt when quiet, and in severe cases, tinnitus is felt when I feel noisy and uneasy when I'm in the city.

There are many causes of tinnitus:

① Mainly ear diseases, such as external ear diseases: otitis externa, cerumen embolism, foreign bodies in the external ear, etc., acute and chronic inflammation of the middle ear , tympanic membrane perforation, otosclerosis, Meniere's syndrome of the inner ear, and acoustic neuroma can all cause tinnitus.

② Tinnitus can also occur in vascular diseases, such as jugular globus tumor, dilation of small blood vessels in the ear, vascular malformations, hemangiomas, etc. Tinnitus from the veins is mostly noisy, while tinnitus from the arteries is consistent with the pulse. The beats are consistent.

③ Some other systemic diseases can also cause tinnitus: autonomic nerve disorders, lack of blood supply to the brain, pre-stroke, high blood pressure, hypotension, anemia, diabetes, malnutrition,

④ In addition, excessive use of drugs with toxic effects on the ear, such as gentamicin, streptomycin or kanamycin, can also cause tinnitus and hearing loss, and tinnitus appears earlier than hearing loss.

⑤ Excessive fatigue, lack of sleep, and excessive emotional stress can also lead to tinnitus.

For patients with tinnitus, we must first find out which cause is causing it, and then deal with it according to the specific situation:

① People who are overtired and sleep deprived should pay attention to rest and ensure adequate sleep; People who are emotionally stressed and anxious should relax their thoughts and take some sedatives, such as diazepam and phenergan, if necessary. Traditional Chinese medicine preparations such as Liuwei Dihuang Pills also have a certain effect on tinnitus.

② For tinnitus caused by ear diseases, the primary ear diseases must be actively treated. < /p>

④ If tinnitus occurs due to the use of ototoxic drugs such as "gentamicin", "streptomycin" or "kanamycin", you should stop the drug in time and take effective medical treatment Measures to eliminate tinnitus and restore hearing.

Syndrome differentiation and treatment

1. Patients with this type of wind-heat invasion type have an acute onset, but the symptoms are usually not serious. The tinnitus has a low pitch and there is swelling in the ears. Feelings of fullness and congestion are often characterized by enhanced self-talk. It is often accompanied by superficial lung meridian symptoms such as nasal congestion, runny nose, and cough. Western medicine diagnoses are mostly acute secretory otitis media. The tympanic membrane can be seen to be congested and inverted, the tongue is light red, the fur is thin and white, and the pulse is floating and rapid. The treatment of this syndrome type should adopt Liu Yuanyu's point of view of "treating deafness to the lungs", treating it from the perspective of the lungs, using the methods of dispelling wind, clearing the lungs, and clearing the orifices, and prescriptions such as Yinqiao Powder can be used. Commonly used medicines include Shuanghua, Forsythia suspensa, Platycodon grandiflorum, almond, Nepeta japonica, Fengfeng, Chanyi, and Acorus. For phlegm, add Trichosanthes, and for nasal congestion, Xianyi, Xanthium, and Angelica dahurica.

2. Patients with this type often have a sudden onset, severe symptoms, loud tinnitus, and are closely related to emotional changes. They often occur or worsen after being depressed or angry. It is often accompanied by symptoms of ascending liver-fire such as bitter mouth, upset, dizziness, headache, irritability, red tongue, yellow coating, stringy and rapid pulse. This type is caused by liver-fire that interferes with the clearing of the orifices. The method should be to clear the liver, purge heat and clear the orifices, and choose the modified Longdan Xiegan Decoction. Commonly used drugs include: Gallbladder, Scutellaria baicalensis, Gardenia, Angelica sinensis, Alisma, Radix Rehmanniae, Akebia, Bupleurum, Acorus, Vitex, and Magnetite.

3. Phlegm accumulation type: This type of disease usually has a long course and is characterized by tinnitus, dizziness, heavy head, heavy head, stuffy head, and obvious feeling of distension and congestion in the ears. It may be accompanied by chest tightness, anorexia, a thick and fat tongue with tooth marks on the edges, thick and greasy coating, and a stringy and slippery pulse. This type is caused by phlegm and turbidity blocking the clearing of the orifices. The treatment method should be to reduce phlegm and reduce turbidity, and to harmonize the stomach and open the orifices. Erchen Decoction is often used. Commonly used drugs include: Pinellia ternata, dried tangerine peel, Poria cocos, silkworm, calamus, raw Yiyiren, and Angelica dahurica. You can choose 1 to 2 blood-activating and blood-stasis-removing drugs, such as Salvia miltiorrhiza, peach kernel, safflower, Angelica tail, etc., to help by removing blood stasis. It is also in line with the theory of long-term illness and multiple blood stasis in traditional Chinese medicine. If there are signs of phlegm turning into heat, add skullcap, coptis, Trichosanthes, and Citrus aurantium.

4. Liver and kidney deficiency type: This type has a longer course of disease. According to clinical conditions, it mostly affects the elderly. It sounds like cicadas chirping in the ears, and the chirping sound is generally not very loud. It can be accompanied by symptoms of kidney meridian insufficiency such as weakness in the waist and knees, dizziness, dry eyes, etc. The concurrent symptoms are often not obvious, with a red tongue, less coating, and a weak pulse. thin. For elderly people with tinnitus and no other concurrent symptoms, most cases can be classified as this type.

The treatment is mainly to nourish the kidney and nourish the essence, nourish yin and quench yang. The prescription is Erdean Zuoci Pill. Commonly used drugs include raw and cooked rehmannia, cornus, yam, calamus, achyranthes, dodder, raspberry, cicada, magnet, Shenqu, and kudzu root. , Bupleurum. It is often seen clinically that tinnitus is accompanied by relatively obvious symptoms of inflammation of the heart fire, such as irritability, irritability, insomnia, sores on the mouth and tongue, red tip of the tongue, and thready pulse. It is more common in young people and may also occur in some elderly people. This is caused by insufficient liver and kidney, inability of water to relieve fire, inflammation of heart fire, and disturbance of clearing the orifices. Treatment should focus on clearing the heart fire, followed by nourishing kidney yin, and then choose Dao Chi Powder. Commonly used medicines include: Rehmannia glutinosa, Scutellaria baicalensis, Coptis chinensis, Bamboo leaves, Akebia, rush, Cuscuta, Ophiopogon japonicus, raspberry, Zizyphus spinosum.

5 Patients with spleen and stomach weakness type often show poor energy, fatigue, dizziness, symptoms worsened after exertion, poor appetite, pale tongue, thin white or thick coating, and weak pulse. To treat it by strengthening the spleen and replenishing qi, raising yang and clearing the orifices, you can choose prescriptions such as Buzhong Yiqi Decoction, Shenling Baizhu Powder, and Bazhen Decoction. Commonly used drugs include: Codonopsis pilosula, Astragalus membranaceus, Atractylodes macrocephala, Cimicifuga, Pueraria lobata, Bupleurum root, tangerine peel, Pinellia ternata, Angelica sinensis, and Acorus calamus.

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