Neurological tinnitus

Introduction

Introduction to neurological tinnitus

Neurological tinnitus is mainly caused by damage to the ear nerves and ear nerves (ear veins). For the diagnosis of neurological tinnitus, it is necessary to exclude other causes including tinnitus caused by external ear, middle ear disease, etc., and hearing detection has hearing impairment. Generally, for the treatment of neurological deafness, clinically, vasodilator drugs are often used to increase the blood flow of ischemic tissue, reduce endometrial edema and improve endolymphatic circulation to maintain the normal function of tissue cells. Neurological tinnitus is a disorder in the sensorineural nervous system of the auditory system. When the inner ear hearing receptor is sick, such as drug poisoning, noise trauma, Ménière's disease, etc.; the auditory nerve and auditory center suffer trauma or inflammation, poisoning, ischemia, tumor, etc.; and various intracranial lesions affect the auditory nerve or hearing Tinnitus occurs when the center is in the center. This kind of tinnitus is mostly high-frequency humming or harsh squeaking.

basic knowledge

The proportion of sickness: 0.2%

Susceptible people: no special people

Mode of infection: non-infectious

Complications: depression, insomnia

Pathogen

Neurological tinnitus

Ear disease, vascular disease (25%):

Mainly ear diseases, such as external ear diseases: external auditory canal, sputum embolism, foreign body of the ear, etc., acute and chronic inflammation of the middle ear, perforation of the tympanic membrane, otosclerosis and Meniere's syndrome of the inner ear, acoustic neuroma, can Causes tinnitus. Vascular diseases can also occur in tinnitus, such as jugular spheroid tumors, small blood vessels in the ear, vascular malformations, hemangioma, etc. The tinnitus from the veins is mostly noisy, and the tinnitus from the arteries is consistent with the pulse of the pulse.

Systemic diseases, drugs (30%):

Other systemic diseases can also cause tinnitus: autonomic disorders, lack of blood supply to the brain, pre-stroke, hypertension, hypotension, anemia, diabetes, malnutrition, and excessive use of drugs that are toxic to the ear, such as gentamica Tinnitus and hearing loss can also occur in hormones, streptomycin or kanamycin, and tinnitus appears earlier than hearing loss.

Other (35%):

Excessive fatigue, lack of sleep, and excessive emotional stress can also cause tinnitus. Noise: Shock and long-term noise contact can cause hearing loss and tinnitus. People working in high-intensity noise environments should pay attention to noise protection, such as reducing noise sources or wearing protective earmuffs, earplugs, etc. Also, be careful not to use the Walkman headphones in a noisy environment for long periods of time and at high volume. Bad habits: caffeine and alcohol can often aggravate the symptoms of tinnitus; smoking can reduce blood oxygen, while inner ear hair cells are a cell that is extremely sensitive to oxygen, so hypoxia can cause damage to hair cells, so pay attention to change bad habit.

The inner ear is the "factory" that produces sound. The work here is to convert the mechanical energy of sound waves into electron energy, so that the sound can be accepted by the brain with the auditory nerve. When the process of energy conversion is problematic, it will be manufactured. "by-products", these by-products are not received in a noisy work environment, that is, they are not heard, but in a quiet place, high-pitched sounds are heard in the ears.

The function of the ear to transform the sound energy is degraded by age, or the function of the ear is damaged by the noise, and the "by-product" is absorbed more and becomes louder, even on the noisy streets. There are three common causes of tinnitus:

(1) The hearing loss of the outer ear or the middle ear cannot absorb the sound around the inner ear, and the "by-product" produced by the inner ear becomes clear;

(2) If the inner ear is injured and loses the function of converting sound energy, the volume of by-product will become stronger, even in a very noisy environment;

(3) The sound from the middle ear and the inner ear: Some patients with kidney disease, the blood vessels in the head or neck near the ear hearing organ, the quality of the blood is poor due to the influence of kidney disease, making the blood supply and circulation less smooth. Some sounds will be produced, and the blood vessels of the smoker will be narrowed, which will hinder blood circulation to a certain extent, and will have the same consequences. Older people also have such problems due to poor blood quality due to physical exhaustion. Because of the closeness to the ear, these sounds, which are caused by poor blood circulation, are clearly heard to the ears and become tinnitus.

Prevention

Neurological tinnitus prevention

One: bathing in the ear, anti-fouling into the ear.

Bath bathing keeps the external auditory canal clean and is an important part of preventing ear disease. If the dirty water is in the ear, it can often cause pain in the ear canal, red and red swelling, and even perforation of the tympanic membrane. Therefore, when bathing, swimming, and shampooing, use clean cotton to block the outer ear canal to prevent water from entering the ear. When swimming in rivers and ponds, if the sewage is in the ear, clean the ear canal with clean cotton immediately.

Second: Pay attention to hygiene and quit ear.

The ear canal hole is deep and the tympanic membrane is very thin. If you use hard objects such as iron, wood, bone, etc. in a crowded environment, it is easy to cause ear injury due to collision, and even tympanic membrane trauma, so that the ear canal Pain, bleeding, swelling, or hearing loss, so you need to get rid of ear habits.

Three: educate children to prevent foreign bodies from falling into the ear.

Educate children not to put toys, beans, food, paper scraps and insects into the ear canal, so as not to cause foreign bodies in the ear canal. If the ear canal is painful, hearing impaired, or even pus in the running water, it must be checked in time to remove the foreign body.

Four: There are festivals and the volume is moderate.

The tympanic membrane is very thin, and if the volume is too large, it is susceptible to damage. Therefore, the volume of the Walkman, MP3, TV, recorder, and audio should be moderate, and the tone should not be too high or too low. If the sound is transmitted into the ear, there is discomfort, even a pain in the ear, or affecting face-to-face conversation and upset, indicating that the volume is too large, should avoid, or reduce the volume. Wear noise-proof earplugs if you are working in a noisy environment for a long time, and check your hearing regularly.

Complication

Neurological tinnitus complications Complications, depression, insomnia

Nervous breakdown, insomnia, depression and other diseases.

Symptom

Neurological tinnitus symptoms Common symptoms Tinnitus ear swelling ear vertigo on listening, sight, touch...

Neurological tinnitus refers to the abnormal sound sensation that people produce without any external stimuli. If you feel a monotonous or mixed sound such as humming, humming, or snoring in your ear, there is actually no corresponding sound in the surrounding environment, which means that tinnitus is only a subjective feeling. Tinnitus can be transient or persistent. Severe tinnitus can disturb people for a moment of peace and is very tense. If it is a short-term neglect of tinnitus, it is generally a physiological phenomenon, do not have to be too nervous, can listen to it. If you have persistent tinnitus, especially with other symptoms such as deafness, dizziness, headache, etc., be vigilant and seek medical attention as soon as possible.

Examine

Neurological tinnitus examination

1, routine examination of the ear

2. Electrical audiometry: The functional status of the auditory system can be objectively evaluated. When people have hearing impairment, the initial assessment of hearing impairment is based on electrical audiometry.

3. Acoustic admittance: the reciprocal of the acoustic impedance. The examination included: tympanic sound admittance test, tympanic muscle reflex, eustachian tube function test.

4. Auditory brainstem evoked potential

5. Otoacoustic emission: such as an "acoustic probe", provides a window for clinical understanding of the mechanical activity of the cochlea, especially the outer hair cells. It is of great significance for guiding clinical treatment and prevention.

6. Masking test

7, lidocaine test

8, imaging examination: feasible CT and MRI examination.

Diagnosis

Diagnosis of neurological tinnitus

diagnosis

It is generally not difficult to diagnose neurological tinnitus based on medical history or symptoms.

Differential diagnosis:

First, subjective tinnitus

(1) External auditory canal disease

Mainly sputum embolism, external ear canal embolism, external auditory canal cholesteatoma, when taking a bath, when the shampoo is wetted by water, it suddenly causes low-key tinnitus and hearing loss.

(two) middle ear disease

1. The catarrhal otitis media often has low-pitched, irregular tinnitus, and the tinnitus can disappear after the eustachian tube is blown, but it is easy to relapse.

2. Acute and chronic suppurative otitis media and its sequelae. The low-pitched tinnitus is very stubborn and difficult to treat.

3. Otosclerosis low-pitched tinnitus, often aggravated by inappropriate blow treatment, menstruation, 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 sound, humming sound. Sudden onset, may be due to abnormal reactions, endocrine, anemia, etc. caused by anemia or congestion. The intensity changes greatly, when the time is strong and weak, sometimes there is no, and there is persistence.

2. Ototoxic drug poisoning All ototoxic drugs can cause tinnitus. Tinnitus often appears before deafness. It can be first developed in one ear and gradually developed into both ears. Tinnitus is a high-pitched tone, and about half of the patients have a head. Tinnitus symptoms can be alleviated or disappeared after acute poisoning. Chronic poisoning patients do not disappear after stopping the drug.

3. Meniere's disease causes low-pitched hair-like tinnitus, which often occurs before the onset of vertigo, or at the same time as deafness and dizziness. Tinnitus can disappear or be alleviated during the remission period of the disease.

Repeated episodes can be converted to persistent high-pitched tinnitus.

4. Senile sputum is common in the elderly over the age of 60, mostly bilateral, high-pitched tinnitus. Tinnitus is often a precursor to deafness.

5. The characteristics of auditory neuroma and tinnitus are unilateral, high-pitched such as humming or whistling. Initially it was intermittent and gradually changed to continuous. Often accompanied by other cranial nerve symptoms, such as headache, facial numbness and so on. X-ray filming of the internal auditory canal, CT internal auditory canal scan, and brain electrical response audiometry can confirm the diagnosis.

(four) systemic diseases

1. Hypertensive tinnitus is mostly bilateral, often consistent with the rhythm of the pulse. In addition to tinnitus, you can also have high blood pressure symptoms 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 is common in women during puberty or menopause. Tinnitus is variable, sometimes high-pitched, sometimes low-pitched, with single ears with alternating ears, sometimes persistent and time-separated. There are also systemic symptoms such as dizziness, insomnia and more dreams.

Second, objective tinnitus

(a) vascular tinnitus

Common in jugular bulbar tumor, carotid aneurysm, intracranial aneurysm, intracranial arteriovenous fistula and so on. This kind of tinnitus is characterized by frequent frequency synchronization with the heartbeat or pulse. You can hear the sound with a stethoscope, and the tinnitus can be alleviated or disappeared when the corresponding blood vessel is pressed hard.

(B) muscle contraction tinnitus

The "Kata" sound caused by the clonic contraction of the sacral muscles, the levator muscles, the tympanic muscles, and the sacral muscles. The ear of such a sound examiner can be heard close to the ear of the patient.

It is generally not difficult to diagnose neurological tinnitus based on medical history or symptoms.

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