借用机器翻译了耳鸣的原理后，有读者反应：看不太懂。我说：那是我没有做好“功课”。

【你有耳鸣？或(多年不治的)慢性疼痛？（更新版）

https://blog.sciencenet.cn/home.php?mod=space&uid=306792&do=blog&id=1341885

耳鸣实际上是脑鸣

https://blog.sciencenet.cn/blog-306792-1341735.html】

我当时只想分享“造成耳鸣的原理”。如果做科普，需要从“头”开始。后面Mayo Clinic的关于耳鸣的网站，从“概论”开始介绍什么是耳鸣，到未来可能的治疗方法，内容非常全面，也通俗易懂。（不过，我没有翻译所有的内容。）

我知道的耳鸣个例，可能和连续吃感冒（中）药一个月有关。【感冒药是为了帮助病人减轻症状，不能吃太久。药的说明应该提醒病人这一点。】幸运的是，患者遇到“神医”，针灸减轻了她的耳鸣。（只剩下10%的噪音，而且心情好时，几乎感觉不到耳鸣。）

另外一个病人，去年得了耳鸣，到处看医生。现已恢复正常。具体情况不清楚。【是治疗成功，还是自愈？】

总的来说，得了病，需要看医生，包括耳鸣。【除非你知道 没问题。比方说，我扭腰后，没有看医生，因为我感觉没有必要。但是，我昨天和朋友聊天，她扭腰后看了医生。】

如果遇到好的医生，她会做许多检查，排除致病原因。

有可能，耳鸣的病因找不到。【不是所有的病都能找到原因的。】那时，需要靠自己说服自己：这是一种幻觉，是大脑“过度努力”制造的噪音（去抵消“并不存在“的外来噪音）。我们的大脑是非常聪明的。可惜，有时候聪明反被聪明误。耳鸣就是这样产生的。幻肢痛也是这样产生的。【幻肢痛是截肢后，依然感觉那条（已经不存在的腿）还在疼或痒。】

好了，有兴趣的，继续看。我收工了。

下面是Mayo Clinic的关于耳鸣的网站：

https://www.mayoclinic.org/diseases-conditions/tinnitus/diagnosis-treatment/drc-20350162

Overview

概述

Tinnitus is when you experience ringing or other noises in one or both of your ears. The noise you hear when you have tinnitus isn't caused by an external sound, and other people usually can't hear it. Tinnitus is a common problem. It affects about 15% to 20% of people, and is especially common in older adults.

耳鸣是指您的一只或两只耳朵出现铃音或其他噪音。耳鸣时听到的声音不是由外部声音引起的，其他人通常听不到。耳鸣是一个常见的问题。它影响大约 15% - 20% 的人，在老年人中尤其常见。

Tinnitus is usually caused by an underlying condition, such as age-related hearing loss, an ear injury or a problem with the circulatory system. For many people, tinnitus improves with treatment of the underlying cause or with other treatments that reduce or mask the noise, making tinnitus less noticeable.

耳鸣通常是由潜在疾病引起的，例如与年龄有关的听力损失、耳朵受伤或循环系统问题。对于许多人来说，耳鸣通过治疗根本原因或通过其他减少或掩盖噪音的治疗来改善，使耳鸣不那么明显。

Symptoms

Tinnitus is most often described as a ringing in the ears, even though no external sound is present. However, tinnitus can also cause other types of phantom noises in your ears, including:

·       Buzzing

·       Roaring

·       Clicking

·       Hissing

·       Humming

Most people who have tinnitus have subjective tinnitus, or tinnitus that only you can hear. The noises of tinnitus may vary in pitch from a low roar to a high squeal, and you may hear it in one or both ears. In some cases, the sound can be so loud it interferes with your ability to concentrate or hear external sound. Tinnitus may be present all the time, or it may come and go.

In rare cases, tinnitus can occur as a rhythmic pulsing or whooshing sound, often in time with your heartbeat. This is called pulsatile tinnitus. If you have pulsatile tinnitus, your doctor may be able to hear your tinnitus when he or she does an examination (objective tinnitus).

When to see a doctor

什么时候该去看医生

Some people aren't very bothered by tinnitus. For other people, tinnitus disrupts their daily lives. If you have tinnitus that bothers you, see your doctor.

有些人觉得耳鸣并不十分困扰。对于其他人来说，耳鸣扰乱了他们的日常生活。如果您有困扰您的耳鸣，请去看医生。

Make an appointment to see your doctor if:

·       You develop tinnitus after an upper respiratory infection, such as a cold, and your tinnitus doesn't improve within a week.

See your doctor as soon as possible if:

·       You have hearing loss or dizziness with the tinnitus.

·       You are experiencing anxiety or depression as a result of your tinnitus.

Causes

耳鸣的原因

A number of health conditions can cause or worsen tinnitus. In many cases, an exact cause is never found.

许多健康状况会导致或加重耳鸣。在许多情况下，永远找不到确切的原因。

Common causes of tinnitus

In many people, tinnitus is caused by one of the following:

·       Hearing loss. There are tiny, delicate hair cells in your inner ear (cochlea) that move when your ear receives sound waves. This movement triggers electrical signals along the nerve from your ear to your brain (auditory nerve). Your brain interprets these signals as sound.

If the hairs inside your inner ear are bent or broken — this happens as you age or when you are regularly exposed to loud sounds — they can "leak" random electrical impulses to your brain, causing tinnitus.

·       Ear infection or ear canal blockage. Your ear canals can become blocked with a buildup of fluid (ear infection), earwax, dirt or other foreign materials. A blockage can change the pressure in your ear, causing tinnitus.

·       Head or neck injuries. Head or neck trauma can affect the inner ear, hearing nerves or brain function linked to hearing. Such injuries usually cause tinnitus in only one ear.

·       Medications. A number of medications may cause or worsen tinnitus. Generally, the higher the dose of these medications, the worse tinnitus becomes. Often the unwanted noise disappears when you stop using these drugs.

Medications known to cause tinnitus include nonsteroidal anti-inflammatory drugs (NSAIDs) and certain antibiotics, cancer drugs, water pills (diuretics), antimalarial drugs and antidepressants.

Other causes of tinnitus

Less common causes of tinnitus include other ear problems, chronic health conditions, and injuries or conditions that affect the nerves in your ear or the hearing center in your brain.

·       Meniere's disease. Tinnitus can be an early indicator of Meniere's disease, an inner ear disorder that may be caused by abnormal inner ear fluid pressure.

·       Eustachian tube dysfunction. In this condition, the tube in your ear connecting the middle ear to your upper throat remains expanded all the time, which can make your ear feel full.

·       Ear bone changes. Stiffening of the bones in your middle ear (otosclerosis) may affect your hearing and cause tinnitus. This condition, caused by abnormal bone growth, tends to run in families.

·       Muscle spasms in the inner ear. Muscles in the inner ear can tense up (spasm), which can result in tinnitus, hearing loss and a feeling of fullness in the ear. This sometimes happens for no explainable reason, but can also be caused by neurologic diseases, including multiple sclerosis.

·       Temporomandibular joint (TMJ) disorders. Problems with the TMJ, the joint on each side of your head in front of your ears, where your lower jawbone meets your skull, can cause tinnitus.

·       Acoustic neuroma or other head and neck tumors. Acoustic neuroma is a noncancerous (benign) tumor that develops on the cranial nerve that runs from your brain to your inner ear and controls balance and hearing. Other head, neck or brain tumors can also cause tinnitus.

·       Blood vessel disorders. Conditions that affect your blood vessels — such as atherosclerosis, high blood pressure, or kinked or malformed blood vessels — can cause blood to move through your veins and arteries with more force. These blood flow changes can cause tinnitus or make tinnitus more noticeable.

·       Other chronic conditions. Conditions including diabetes, thyroid problems, migraines, anemia, and autoimmune disorders such as rheumatoid arthritis and lupus have all been associated with tinnitus.

Risk factors

Anyone can experience tinnitus, but these factors may increase your risk:

·       Loud noise exposure. Loud noises, such as those from heavy equipment, chain saws and firearms, are common sources of noise-related hearing loss. Portable music devices, such as MP3 players, also can cause noise-related hearing loss if played loudly for long periods. People who work in noisy environments — such as factory and construction workers, musicians, and soldiers — are particularly at risk.

·       Age. As you age, the number of functioning nerve fibers in your ears declines, possibly causing hearing problems often associated with tinnitus.

·       Sex. Men are more likely to experience tinnitus.

·       Tobacco and alcohol use. Smokers have a higher risk of developing tinnitus. Drinking alcohol also increases the risk of tinnitus.

·       Certain health problems. Obesity, cardiovascular problems, high blood pressure, and a history of arthritis or head injury all increase your risk of tinnitus.

Complications

Tinnitus affects people differently. For some people, tinnitus can significantly affect quality of life. If you have tinnitus, you may also experience:

·       Fatigue

·       Stress

·       Sleep problems

·       Trouble concentrating

·       Memory problems

·       Depression

·       Anxiety and irritability

·       Headaches

·       Problems with work and family life

Treating these linked conditions may not affect tinnitus directly, but it can help you feel better.

Prevention

预防耳鸣

In many cases, tinnitus is the result of something that can't be prevented. However, some precautions can help prevent certain kinds of tinnitus.

在许多情况下，耳鸣是无法预防的事情的结果。但是，一些预防措施可以帮助预防某些类型的耳鸣。

·       Use hearing protection. Over time, exposure to loud sounds can damage the nerves in the ears, causing hearing loss and tinnitus. Try to limit your exposure to loud sounds. And if you cannot avoid loud sounds, use ear protection to help protect your hearing. If you use chain saws, are a musician, work in an industry that uses loud machinery or use firearms (especially pistols or shotguns), always wear over-the-ear hearing protection.

·       Turn down the volume. Long-term exposure to amplified music with no ear protection or listening to music at very high volume through headphones can cause hearing loss and tinnitus.

·       Take care of your cardiovascular health. Regular exercise, eating right and taking other steps to keep your blood vessels healthy can help prevent tinnitus linked to obesity and blood vessel disorders.

·       Limit alcohol, caffeine and nicotine. These substances, especially when used in excess, can affect blood flow and contribute to tinnitus.

Diagnosis

耳鸣诊断

Your doctor will typically diagnose you with tinnitus based on your symptoms alone. But in order to treat your symptoms, your doctor will also try to identify whether your tinnitus is caused by another, underlying condition. Sometimes a cause can't be found.

您的医生通常会仅根据您的症状诊断您是否患有耳鸣。但为了治疗您的症状，您的医生还会尝试确定您的耳鸣是否是由另一种潜在疾病引起的。有时找不到耳鸣的原因。

To help identify the cause of your tinnitus, your doctor will likely ask you about your medical history and examine your ears, head and neck. Common tests include:

·       Hearing (audiological) exam. During the test, you'll sit in a soundproof room wearing earphones that transmit specific sounds into one ear at a time. You'll indicate when you can hear the sound, and your results will be compared with results considered normal for your age. This can help rule out or identify possible causes of tinnitus.

·       Movement. Your doctor may ask you to move your eyes, clench your jaw, or move your neck, arms and legs. If your tinnitus changes or worsens, it may help identify an underlying disorder that needs treatment.

·       Imaging tests. Depending on the suspected cause of your tinnitus, you may need imaging tests such as CT or MRI scans.

·       Lab tests. Your doctor may draw blood to check for anemia, thyroid problems, heart disease or vitamin deficiencies.

Do your best to describe for your doctor what kind of tinnitus noises you hear. The sounds you hear can help your doctor identify a possible underlying cause.

·       Clicking. This type of sound suggests that muscle contractions in and around your ear might be the cause of your tinnitus.

·       Pulsing, rushing or humming. These sounds usually stem from blood vessel (vascular) causes, such as high blood pressure, and you may notice them when you exercise or change positions, such as when you lie down or stand up.

·       Low-pitched ringing. This type of sound may point to ear canal blockages, Meniere's disease or stiff inner ear bones (otosclerosis).

·       High-pitched ringing. This is the most commonly heard tinnitus sound. Likely causes include loud noise exposure, hearing loss or medications. Acoustic neuroma can cause continuous, high-pitched ringing in one ear.

Treatment

耳鸣的治疗

Treatment for tinnitus depends on whether your tinnitus is caused by an underlying health condition. If so, your doctor may be able to reduce your symptoms by treating the underlying cause. 

耳鸣的治疗取决于您的耳鸣是否是由潜在的健康状况引起的。如果是这样，您的医生可能会通过治疗根本原因来减轻您的症状。

Examples include:

·       Earwax removal. Removing an earwax blockage can decrease tinnitus symptoms.

·       Treating a blood vessel condition. Underlying blood vessel conditions may require medication, surgery or another treatment to address the problem.

·       Hearing aids. If your tinnitus is caused by noise-induced or age-related hearing loss, using hearing aids may help improve your symptoms.

·       Changing your medication. If a medication you're taking appears to be the cause of tinnitus, your doctor may recommend stopping or reducing the drug, or switching to a different medication.

Noise suppression

耳鸣噪声的抑制

Many times, tinnitus can't be cured. But there are treatments that can help make your symptoms less noticeable. Your doctor may suggest using an electronic device to suppress the noise. 

很多时候，耳鸣是无法治愈的。但是有一些治疗方法可以帮助您减轻症状。您的医生可能会建议使用电子设备来抑制噪音。

Devices include:

·       White noise machines. These devices, which produce a sound similar to static, or environmental sounds such as falling rain or ocean waves, are often an effective treatment for tinnitus. You may want to try a white noise machine with pillow speakers to help you sleep. Fans, humidifiers, dehumidifiers and air conditioners in the bedroom also produce white noise and may help make tinnitus less noticeable at night.

·       Masking devices. Worn in the ear and similar to hearing aids, these devices produce a continuous, low-level white noise that suppresses tinnitus symptoms.

Counseling

“心理”治疗

Behavioral treatment options aim to help you live with tinnitus by helping you change the way you think and feel about your symptoms. Over time, your tinnitus may bother you less. 

行为治疗方案旨在通过帮助您改变对症状的思考和感觉方式来帮助您应对耳鸣。随着时间的推移，您的耳鸣可能会减少您的困扰。

Counseling options include:

·       Tinnitus retraining therapy (TRT). TRT is an individualized program that is usually administered by an audiologist or at a tinnitus treatment center. TRT combines sound masking and counseling from a trained professional. Typically, you wear a device in your ear that helps mask your tinnitus symptoms while you also receive directive counseling. Over time, TRT may help you notice tinnitus less and feel less distressed by your symptoms.

·       Cognitive behavioral therapy (CBT) or other forms of counseling. A licensed mental health professional or psychologist can help you learn coping techniques to make tinnitus symptoms less bothersome. Counseling can also help with other problems often linked to tinnitus, including anxiety and depression. Many mental health professionals offer CBT for tinnitus in individual or group sessions, and CBTprograms are also available online.

Medications

药物

Drugs can't cure tinnitus, but in some cases they may help reduce the severity of symptoms or complications. To help relieve your symptoms, your doctor may prescribe medication to treat an underlying condition or to help treat the anxiety and depression that often accompany tinnitus.

药物不能治愈耳鸣，但在某些情况下，它们可能有助于减轻症状或并发症的严重程度。为了帮助缓解您的症状，您的医生可能会开一些药物来治疗潜在的疾病或帮助治疗经常伴随耳鸣的焦虑和抑郁。

Potential future treatments

未来“可能提供的”治疗

Researchers are investigating whether magnetic or electrical stimulation of the brain can help relieve symptoms of tinnitus. Examples include transcranial magnetic stimulation (TMS) and deep brain stimulation.

研究人员正在调查大脑的磁刺激或电刺激是否有助于缓解耳鸣症状。例子包括经颅磁刺激 (TMS) 和深部脑刺激。

Lifestyle and home remedies

生活方式和家庭疗法

Often, tinnitus can't be treated. Some people, however, get used to it and notice it less than they did at first. For many people, certain adjustments make the symptoms less bothersome. 

通常，耳鸣无法治疗。然而，有些人习惯了它，并且比一开始注意到它的次数更少。对于许多人来说，某些调整会使症状减轻。

These tips may help:

·       Use hearing protection. Over time, exposure to loud sounds can damage the nerves in the ears, causing hearing loss and tinnitus. To keep your tinnitus from getting worse, take steps to protect your hearing. If you use chain saws, are a musician, work in an industry that uses loud machinery or use firearms (especially pistols or shotguns), always wear over-the-ear hearing protection.

·       Turn down the volume. Listening to music at very high volume through headphones can contribute to hearing loss and tinnitus.

·       Use white noise. If tinnitus is especially noticeable in quiet settings, try using a white noise machine to mask the noise from tinnitus. If you don't have a white noise machine, a fan, soft music or low-volume radio static also may help.

·       Limit alcohol, caffeine and nicotine. These substances, especially when used in excess, can affect blood flow and contribute to tinnitus.

Alternative medicine

其它的治疗方法

There's little evidence that alternative medicine treatments work for tinnitus. However, some alternative therapies that have been tried for tinnitus include:

·       Acupuncture

·       Ginkgo biloba

·       Melatonin

·       Zinc supplements

几乎没有证据表明别的治疗方法对耳鸣有效。然而，一些已经尝试过治疗耳鸣的疗法包括：

• 针灸

• 银杏

• 褪黑激素

• 锌补充剂

Preparing for your appointment

Be prepared to tell your doctor about:

·       Your signs and symptoms

·       Your medical history, including any other health conditions you have, such as hearing loss, high blood pressure or clogged arteries (atherosclerosis)

·       All medications you take, including herbal remedies