Multidimensional diagnosis and treatment of tinnitus in middle-aged people: etiological differentiation, vascular regulation and modern rehabilitation methods

Tinnitus refers to the sensation of sound in the ear or skull. It is not a disease in itself, but a symptom caused by various diseases. It is an abnormal perception of sound due to dysfunction of the auditory organs. The prevalence of tinnitus is high, increasing with age, with the most common age of onset between 41 and 70 years old. There are many causes of tinnitus. Diseases of the outer, middle, and inner ear can all cause tinnitus, such as cerumen impaction, Eustachian tube obstruction, various types of otitis media, noise-induced hearing loss, Meniere's disease, ear trauma, and acoustic neuroma. In addition, hypertension, hypotension, anemia, valvular heart disease, gastrointestinal diseases, liver disease, kidney disease, metabolic disorders, neurasthenia, and drug poisoning can also cause tinnitus. There are also some cases of tinnitus with unknown causes. Some people experience tinnitus due to mental stress, fatigue, blood pressure fluctuations, cerebrovascular and neurological diseases, while a few patients experience it due to medication. Mild tinnitus may resolve on its own, but severe cases often affect sleep and interfere with daily life and work, requiring treatment. First, the underlying cause should be addressed. In most cases of tinnitus in middle-aged individuals, the cause can be identified, and appropriate treatment can eliminate the tinnitus. Commonly used medications include niacin, dibazol, diazepam (Valium), phenobarbital (Luminal), vitamin B₁, vitamin B₆, and vitamin B₁₂. In recent years, the combined use of vasodilators and antihistamines has become common abroad. For example, chlorpheniramine 8 mg, once or twice daily, or propofol 6 mg, once or three times daily, is said to control tinnitus through autonomic nervous system regulation and is often used for tinnitus caused by vascular and middle ear diseases. Other options include carbamazepine, primidone, and lidocaine. The dosage is 250 mg, once daily in the first week, twice daily in the second week, three times daily in the third week, and four times daily in the fourth week, until effective. The above treatment can be used as a reference. At the same time, inhalation of mixed oxygen containing 5% carbon dioxide, oral dexamethasone, intravenous histamine, and low-salt diet are also treatment methods. Acupuncture can also be used on acupoints such as Tinggong, Yifeng, Fengchi, Hegu, and Zusanli. Traditional Chinese medicine such as Liuwei Dihuang Wan and Tianma Gouteng Wan (decoction) can be selected. Gouteng San is also used abroad to treat tinnitus. For patients who do not respond to drug treatment, hearing aids or tinnitus masking devices can be worn.