Conductive tinnitus

Introduction The cause of conductive tinnitus is the obstruction of the conductive part of the auditory system, such as swelling of the external auditory canal, occlusion, perforation of the tympanic membrane, invagination, inflammation of the middle ear, adhesion, and hardening. The sound barrier reduces the ability to listen to the outside world, weakens its role in masking the sounds that occur in the body, allowing it to feel and become tinnitus. Moreover, the sound transmitted into the ear through the bone conduction is blocked by the conduction barrier, and the outward escape channel is blocked, thereby improving the feeling of the sound in the ear, becoming a low-frequency, whirling sound like a wind. . We can try it ourselves, use one hand to cover the ear, and feel the sound of the thunder in the ear. This is the typical conductive tinnitus.

Cause

Conductive tinnitus is caused by lesions in the middle ear of the outer ear, which causes obstacles in the sound conduction process and causes tinnitus. Common causes of convulsions are external auditory canal, foreign body, inflammation, congenital ear canal atresia, acute and chronic suppurative otitis media, acute and chronic non-suppurative otitis media, congenital malformation, tumor, bullous tympanitis, early stage of otosclerosis. The summary is summarized as follows:

1 occlusion of the external auditory canal, such as congenital or acquired external ear canal malformation or atresia, external auditory canal embolism, osteophytes, foreign bodies, tumors, inflammation, etc.

2 Middle ear dysplasia, such as tympanic membrane and ossicular chain absent or deformed.

3 inflammatory diseases in the middle ear, such as middle ear purulent or non-suppurative inflammation.

4 ossicular fixation, such as tympanosclerosis or otosclerosis.

5 trauma, such as the middle ear, tympanic membrane trauma, ossicular chain interruption.

an examination

Related inspection

Otolaryngology CT examination of cerebrospinal fluid sodium

1. Ambient noise has a slight hearing disturbance to patients with conductive paralysis. This patient's ability to accept language in a noisy environment is often similar to that of a normal person.

2, the hearing loss of conductive sputum generally does not exceed 60 decibels, because more than 60 decibels of sound can be directly transmitted to the inner ear through the skull.

3. Tuning fork inspection: Liner test air conduction is greater than or equal to bone conduction, Weber test is biased to the affected side ear, and Schwabach test bone extension is extended.

4. Electrical audiometry: The bone conduction curve is normal or close to normal, and the air conduction curve has a hearing loss between 30 and 60 dB. Generally, the low frequency hearing loss is heavier and there is a gas bone conduction distance.

5, acoustic impedance test: through the tympanogram and acoustic reflection to judge.

6. Speech audiometry: Speech audiometry is a method of testing a subject's speech threshold and speech resolution score. Under normal circumstances, the speech discriminant score can reach 90%-100%, and the discriminative threshold of the conductive sputum is not affected. The sensory neuropathic sputum caused by cochlear lesions not only improves the verbal discriminant threshold, but also reduces the speech discriminant score. The decline in speech discrimination scores of auditory neuropathy is more pronounced.

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. catarrhal otitis media: often have low-pitched, irregular tinnitus, tinnitus can disappear after the eustachian tube is blown, but easy to relapse.

2. Acute and chronic suppurative otitis media and its sequelae: low-pitched tinnitus is 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, tinnitus is high pitch or whistle, humming. 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: It 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: common in the elderly over the age of 60, mostly bilateral, high-pitched tinnitus. Tinnitus is often a precursor to deafness.

5. Acoustic neuroma: Tinnitus is characterized by unilateral, high-pitched sounds 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. Hypertension: 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: common in women's puberty or menopause, tinnitus is variable, sometimes high pitch, sometimes low-pitched tone, there are alternating ears in one ear, sometimes persistent, time-severing. 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.

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