Are many people suffering from pulsatile tinnitus?

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Tinnitus is a subjective sound experienced by the human ear in the absence of external sound or electrical stimulation. It is a symptom rather than a disease. Worldwide, the incidence of tinnitus is 10%-30%, accounting for 17% in my country. If we conservatively estimate it at 10%, there are nearly 130 million tinnitus patients in China. Pulsatile tinnitus, as a relatively special type of ear disease, accounts for about 4%.


Are many people suffering from pulsatile tinnitus?

Q: What are the common causes of pulsatile tinnitus?

A: In fact, the causes of pulsatile tinnitus are very complicated, and some elimination methods need to be done.
Arterial tinnitus is most commonly caused by arteriovenous fistulas caused by skull base meninges, hemangioma, and trauma, commonly known as "vascular short circuits"; there are also stenosis of arteries in the neck and skull base, or arterial walls caused by trauma and atherosclerosis. Arterial dissection caused by hardening can produce a murmur consistent with the pulse due to changes in blood flow velocity. Including: cerebral arteriovenous malformation, skull base dural arteriovenous fistula, traumatic internal carotid artery cavernous sinus fistula, stenosis of the carotid artery near the skull base, and tortuous extension of the vertebrobasilar artery.

Venous tinnitus is basically caused by structural variation of the cerebral venous sinuses; common sinus stenosis at the junction of the transverse sinus and sigmoid sinus, stenosis of the jugular foramen of the sigmoid sinus combined with high position Or thick jugular bulb, and large sigmoid sinus diverticulum.


Q: How to check if pulsatile tinnitus is discovered?

A:

1. First go to the otology department to see a doctor. First, use a stethoscope to listen for any noise on the neck, in front and behind the ears, and around the eye sockets. If you can hear it, It is basically an arterial murmur;

2. Squeeze the internal jugular vein under the jaw, and if the tinnitus disappears, it is a venous murmur;
3. Do a tinnitus matching test to understand the frequency and loudness of the tinnitus;
4. Do MRA or CTA of the brain and neck blood vessels, as well as brain MRV or CTV, to see if there are any abnormalities in the structure of the blood vessels.
5. Go to the ophthalmologist to check the fundus, preferably take a photo to see if there is edema;
6. If necessary, do an MR or CT scan of the brain and neck with enhanced examination to rule out tumor growth. and other possible diseases.
7. If you have symptoms or discomfort in other parts of the body, see a doctor with relevant expertise for examination.

8. If the diagnosis is still difficult, invasive cerebral vasculature DSA angiography is the best and most reliable diagnostic method.


Q: What should I do after the cause of pulsatile tinnitus is clear?

A: There are only two options: treatment or conservative treatment. Treatment should be considered when the following situations occur:
1. The tinnitus is so loud that it seriously affects life, and even causes anxiety or depression;
br />2. The examination confirms that the primary lesion causing tinnitus is serious, such as severe arterial stenosis, which has a higher risk of cerebral infarction; or arteriovenous fistula, which has a higher risk of cerebral hemorrhage; ifWhen the venous sinuses are too narrow and there is obvious edema in the fundus, fatal cerebral venous sinus thrombosis and intracranial hypertension may follow.

For pulsatile tinnitus with mild symptoms, if the patient himself can adapt to and tolerate this stimulation, he can adjust his mood and continue to observe. Getting yourself used to tinnitus is a common approach! Clinically, most tinnitus patients can be relieved after psychological suggestion and symptomatic treatment. Therefore, corresponding drug treatment should be given to anxiety or depression caused by intractable pulsatile tinnitus. If it is ineffective and the above-mentioned vascular structural abnormalities are present, then consider treatment. Intervention.


Q: How to perform interventional treatment for pulsatile tinnitus?
A: If active intervention is adopted, interventional treatment is the common method of choice. Interventional treatment is mainly to use intravascular stent to form narrowed arteries or veins, or to deal with vascular malformations, arteriovenous fistulas and other lesions to restore the normal shape of the blood vessel cavity, and the abnormal blood flow will disappear, so that murmurs will not form. , the tinnitus can disappear.

Q: How effective is interventional treatment for pulsatile tinnitus? What should I pay attention to after surgery?
A: The technical problems of interventional stent treatment have been basically solved. Tinnitus basically disappears completely within a few days after surgery; recurrence is rare. The risks of surgery are always theoretically present, but relatively low. After surgery, you need to take antiplatelet drugs for 3-6 months (after arterial stent surgery) and warfarin for 6 months (after venous stent surgery); generally there will be no obvious drug side effects.

The first reaction to pulsatile tinnitus is to go to the hospital, because the treatment plan depends on the cause of the tinnitus. The patient needs to repair the blood vessels through drugs or surgery. Once the disease causing the tinnitus is treated, the tinnitus will stop. . Later, avoid noise on a daily basis. Don’t smoke and avoid strong tea: Nicotine causes blood vessels to spasm and aggravates tinnitus; caffeine affects and constricts cerebral blood vessels, aggravating tinnitus. Use ototoxic drugs with caution: streptomycin, gentamicin, kanamycin, etc. Maintain a stable and regular schedule, and pay attention to low-salt and low-fat diet.

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