耳鸣观念的文艺复兴

Renaissance of Tinnitus management

耳鸣是最常见的耳科疾病,病因众多,机制不明,对耳鸣进行一定的分类是提高疗效的关键。本文对听觉系统,听觉系统外系统,心理情绪系统,管控系统在耳鸣中的发病机制做简要综述,并提出了实用的耳鸣临床分类:1.明显耳部疾病引起的耳鸣,主要和相当程度的听力损失相关;2.耳鸣的管控系统疾病,包括心理因素以及睡眠,女性激素水平、偏头痛、过敏、可能影响咽鼓管的鼻腔鼻窦病变、咽喉返流、呼吸睡眠暂停(OSAHS)等因素;3.混合性耳鸣为以上两种因素的混合;4.危险的耳鸣则要警惕可能的颅内病变以及精神疾病;5.原因不明的耳鸣。采用这个分类对耳鸣进行针对性的治疗,将大大提高耳鸣治疗的有效率。

Tinnitus is the most common otological disorder and remains a clinical enigma. Auditory system, non-auditory systems, emotional systems and other tinnitus modulating systems all play a certain role in tinnitus. This article is a review of its possible pathogenesis and proposes a simplified clinical algorithm for the management of tinnitus patients： 1.Disturbances of the hearing system – is there stable, significant or fluctuant hearing loss; 2. Disturbances of tinnitus modulating systems, including the eustachian tube system and sleep systems and migraine,sleep changes related to stress, menopause in the female and obstructive sleep apnea（OSA） in the male, eustachian disorders possibly related to silent chronic rhinosinusitis or laryngopharyngeal reflux; 3. Mix of 1 and 2; 4. Potentially dangerous tinnitus; 5. Idiopathic subjective tinnitus. Managing tinnitus patients following this clinical algorithm may result in improved outcomes.