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Tinnitus

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  • 概述
  • 理论
  • 诊断
  • 治疗
  • 随访
  • 资源
最后审阅： 7 Mar 2026
最后更新： 03 Mar 2026

小结

定义

病史和体格检查

关键诊断因素

  • history of noise exposure
  • episodic sounds
  • hearing loss
  • vertigo
  • pulsatile sounds
  • clicking sounds
  • visual changes
  • presence of bruits or hums
  • cranial nerve palsies
  • cerumen (ear wax)
  • abnormal otoscopy
  • abnormal Weber test
  • abnormal Rinne test
完整详情

其他诊断因素

  • history of ototoxic drug use
  • slow-onset progressive hearing loss
  • high pitch
  • low pitch
  • unilateral
  • bilateral
  • worse with chewing
  • polyuria/polydipsia
  • diarrhea
  • palpitations
  • foreign body
完整详情

危险因素

  • aging and older age
  • hearing loss
  • loud noise exposure
  • vestibular schwannoma
  • migraine
  • use of ototoxic drugs
  • exposure to heavy metals
  • history of cerebrovascular disease
  • history of multiple sclerosis
  • history of head trauma
  • history of depression
  • history of anxiety
  • micronutrient deficiency
完整详情

诊断性检查

首要检查

  • audiometry
完整详情

需考虑的检查

  • CBC
  • thyroid function tests
  • lipid profile
  • fasting glucose
  • antinuclear antibodies, double-stranded (ds) DNA, Smith antigen
  • fluorescent treponemal antibody absorption assay
  • MRI of internal auditory canal
  • CT temporal bones
  • magnetic resonance angiography (MRA) or CT angiography
  • carotid angiography
  • auditory brainstem response (ABR)
  • minimum masking level
  • residual inhibition
  • loudness and pitch matching
  • loudness discomfort level testing
  • otoacoustic emissions
完整详情

新兴检查

  • functional MRI
  • PET scan
  • magnetoencephalographic

治疗流程

急症处理

known etiology

troublesome tinnitus

持续性治疗

hearing loss on audiogram

normal hearing

撰稿人

作者

Michael D. Seidman, MD, FACS

Chair Department of Otolaryngology-Head and Neck Surgery Central Division Advent Health

Medical Director Otologic/Neurotologic/Skull Base Surgery

Medical Director Wellness

Advent Health Medical Group

Professor of Otolaryngology-Head and Neck Surgery

University of Central Florida

Collaborative Prof of Oto-HNS University of South FLa

Visiting Professor Embry Riddle Aeronautical University

Past Board of Directors American Academy of Otolaryngology-Head and Neck Surgery

Celebration

FL

利益声明

MDS is a consultant for Acclarent, the founder of PEAK 365 Nutrition and Body Language Vitamins, and is involved in post-market studies for Envoy (noncompensated) and research for MicroTransponder, Inc (noncompensated), Auris Medical, and the National Institutes of Health and the Department of Defense. He receives royalties from two of his nine patents. MDS is the author of several books and references cited in this topic.

鸣谢

Dr Michael D. Seidman would like to gratefully acknowledge Dr Hamid Djalilian, Dr Alice Lee, Dr Vanessa Rothholtz, and Dr Sanaz Hamidi, the previous contributors to this topic.

利益声明

AL, VR, and SH declare that they have no competing interests. HRD holds stocks in Cactus Medical LLC, Elinava Technologies and has a pending patent on electric stimulation device and combination therapy for treatment of ear condition.

同行评议者

Hamid R. Djalilian, MD

Director of Otology, Neurotology, and Skull Base Surgery

Professor of Otolaryngology, Neurological Surgery, and Biomedical Engineering

University of California

Irvine

CA

利益声明

HRD holds stocks in Cactus Medical LLC, Elinava Technologies and has a pending patent on electric stimulation device and combination therapy for treatment of ear condition.

Andrew McCombe, MD, FRCS(ORL)

Consultant ENT Surgeon

Frimley Park Hospital

Portsmouth Road

Frimley

Surrey

UK

利益声明

AM declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Dalrymple SN, Lewis SH, Philman S. Tinnitus: diagnosis and management. Am Fam Physician. 2021 Jun 1;103(11):663-71.全文  摘要

Tunkel DE, Bauer CA, Sun GH, et al. Clinical practice guideline: tinnitus. Otolaryngol Head Neck Surg. 2014 Oct;151(suppl 2):S1-40.全文  摘要

American College of Radiology. ACR Appropriateness Criteria: tinnitus. 2023 [internet publication].全文

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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