小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 药物治疗史
- 噪声暴露史
- 发作性耳鸣
- 听力损失
- 眩晕
- 搏动性耳鸣
- 滴答声
- 视觉变化
- 出现杂音或哼鸣
- 颅神经麻痹
- 耵聍（耳垢）
- 耳镜检查异常
- 韦伯试验异常
- 林纳试验异常
其他诊断因素
- 缓慢起病的进行性听力损失
- 高调
- 低调
- 单侧耳鸣
- 双侧耳鸣
- 咀嚼时加重
- 烦渴/多饮
- 腹泻
- 心悸
- 异物
危险因素
- 老年
- 听力损失
- 噪声暴露
- 前庭神经鞘瘤
- 耳毒性药物
- 重金属暴露
- 脑血管病史
- 多发性硬化的病史
- 颅脑创伤病史
- 抑郁史
- 焦虑病史
诊断性检查
首要检查
- 听力测定
需考虑的检查
- 全血细胞计数 (FBC）
- 甲状腺功能检测
- 血脂检查
- 空腹血糖
- 荧光密螺旋体抗体吸收试验
- 头部 MRI
- 颞骨 CT
- MR 血管成像或 CT 血管造影术
- 颈动脉血管造影术
- 听性脑干反应（ABR）
- 最小掩蔽级
- 残余抑制
- 强度和音调匹配
- 最大不适阈测试
新兴检查
- 耳声发射
- 功能性MRI：
- PET 扫描
- 脑磁图描记术
治疗流程
已知病因。
困扰患者的耳鸣
听力敏度图显示听力损失
正常听力
撰稿人
作者
Michael D. Seidman, MD, FACS
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
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 (non-compensated) and research for MicroTransponder, Inc (non-compensated), Auris Medical, and the National Institutes of Health. He receives royalties from seven patents. MDS is the author of several 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
HD, AL, VR, and SH declare that they have no competing interests.
同行评议者
Aaron Benson, MD
Clinical Adjunct Professor
Division of Neurotology
Department of Otolaryngology Head and Neck Surgery
University of Michigan
Ann Arbor
MI
Consulting Staff
Toledo ENT
Toledo
OH
利益声明
AB declares that he has no competing interests.
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.
鉴别诊断
- 梅尼埃病
- 听神经瘤（神经鞘瘤）
- 血管球瘤
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