Tinnitus: Causes, Symptoms, and Related Conditions - Otolaryngology

Dr. Ye Dawei reply Otolaryngology

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The doctor mentioned above is correct.
As long as it does not affect hearing, it is unrelated to surgery.

This article will be organized later on the 【Yeh Da-Wei ENT Clinic website/Health Education】.
Everyone is welcome to cite this article, but please indicate the source.
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【"Local Surrounding Central" – The Correct Concept for Treating Tinnitus】
Mr.
Chang Chun-Hong from the Democratic Progressive Party wrote a small book years ago titled "The Path to Governance – The Theory and Practice of 'Local Surrounding Central'." In it, he discussed how the opposition DPP could first gain local governance through elections of county and city mayors in Taiwan, and then advance towards the central government and even the presidential election.
This strategy of surrounding the center from the local level can also be applied to the diagnosis and treatment of the bothersome condition known as tinnitus.
Tinnitus is a very subjective experience; after a basic local examination by an ENT doctor, which rules out earwax or otitis media, the doctor often arranges for a hearing test.
If hearing loss is present and is due to nerve damage, the doctor can only advise medication to prevent further deterioration of hearing, but there is no specific remedy for tinnitus.
If the hearing test shows normal results, it is often considered purely a psychological issue.
The concept of "Local Surrounding Central" suggests that tinnitus is rarely a singular event; patients often have other underlying conditions accompanying their tinnitus, and it is very likely that tinnitus is just one clinical manifestation of these diseases.
If treatment can be approached from the perspective of other clinical symptoms, and if these objective symptoms (like the "local") improve, leading to the subjective tinnitus (like the "central") disappearing, we can consider the treatment successful.
With the prosperity of society and economy, there has been a relative increase in patients with hypertension and hyperlipidemia.
Changes in entertainment among younger populations, such as KTV, concerts, and portable music players, are also major causes of noise-induced tinnitus.
Additionally, the intense competition in industrial society causes vascular spasms in the cochlea, and the aging population has led to more cases of age-related vascular tinnitus.
These are all factors that an ENT doctor must consider when treating tinnitus.
Below is an introduction to diseases related to tinnitus.
● Classification of Tinnitus
"Tinnitus is the gradual onset of deafness," and "if tinnitus persists, it will lead to deafness," these ancient phrases highlight the potential for tinnitus to cause serious hearing loss.
The English term for tinnitus comes from the Latin word meaning "to ring." Scholars currently classify tinnitus based on its causes as follows:
○ Cochlear Tinnitus
Cochlear tinnitus, as the name implies, is caused by changes in the inner ear.
The most well-known conditions are "Meniere's disease" and the increasingly common "sudden sensorineural hearing loss." I have discussed this in my article "A Casual Talk on Dizziness," and I will reiterate it here.
1.
Meniere's Disease
When the general public thinks of dizziness, they often think of "Meniere's," and even general practitioners may diagnose it as such.
However, there are not as many cases of Meniere's disease as one might think; many patients complain of dizziness and are overdiagnosed by doctors.
Therefore, if the number of Meniere's cases is disproportionately high among patients in a neurotology clinic, the physician's competence may be called into question.
In simple terms, if a patient presents with dizziness, tinnitus, and hearing loss, the doctor will consider this disease.
The famous Japanese physician Ichiro Kitabatake even described it as a "7 points disease" due to the following characteristics:
1) Severe dizziness: It feels as if the world is spinning and can last for several hours, with the first episode being the most intense.
2) Spontaneous dizziness: It occurs without any triggers and can strike suddenly.
3) Recurrent dizziness: Patients with Meniere's disease often experience repeated episodes rather than just a single occurrence.
4) Reversible dizziness: There are periods of complete normalcy between episodes; it does not last for several days.
5) Dizziness accompanied by cochlear nerve symptoms: Patients often have fluctuating hearing, with severe tinnitus during acute episodes, and sometimes perceive sounds at different frequencies.
6) Hearing loss is often evident in the low frequencies.
7) There is a "reverberation phenomenon," where patients often complain of discomfort in noisy environments such as markets or stations.
To date, there is no laboratory test that can definitively diagnose Meniere's disease, making detailed medical history and basic physical examination crucial.
Patients often experience unforgettable episodes of severe dizziness accompanied by tinnitus, a feeling of ear fullness, and hearing loss.
These episodes do not occur daily, and their duration is not as brief as "benign paroxysmal positional vertigo," nor as prolonged as "vestibular neuritis." Most patients experience dizziness for about 3 to 4 hours before gradually alleviating, but episodes may recur weeks later.
Many elderly patients report having experienced recurrent dizziness since their youth, with gradually worsening hearing and persistent tinnitus.
This condition typically occurs between the ages of 20 and 40 and has a maternal inheritance pattern.
The cause is endolymphatic hydrops in the inner ear, leading to a sensation of ear fullness.
Treatment primarily involves medical management, including neurotropic agents, vasodilators, and mild sedatives.
If episodes occur once a month, treatment should last at least four months; if they occur every two months, treatment should last at least five months, which is the interval between symptom occurrences plus three months.
If medication is ineffective or the patient cannot tolerate long-term medication, endolymphatic decompression surgery may be considered.
2.
Sudden Sensorineural Hearing Loss
"Sudden" means that the patient can clearly identify a specific day or even a moment when they suddenly lost hearing or experienced significant ringing.
This is considered an ENT emergency, and patients are generally advised to seek immediate medical attention.

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Reply Date: 2000/11/17