Prengel Jonas, Dobel Christian, Guntinas-Lichius Orlando
Laryngorhinootologie. 2023 Feb;102(2):132-145. doi: 10.1055/a-1824-1658. Epub 2023 Feb 7.
Tinnitus is a highly prevalent symptom and a common reason for seeing an otolaryngologist. Since tinnitus can go hand in hand with hearing loss, the step-by-step clarification of hearing loss is one of the essential ENT examinations for tinnitus sufferers. The anamnesis and medical history are relevant, since a multidimensional interaction with the tinnitus can be important for the treatment, especially in the case of a psychological comorbidity. In the vast majority of patients, no causal factor can be found. In the absence of external stimuli, phantom perceptions of tones or noises are held responsible for subjective tinnitus, which probably arises from pathological changes of the auditory pathway, but also in non-auditory cortical structures. In the case of acute tinnitus, a comprehensive audiological assessment is needed, and if the hearing threshold is normal, counseling is the priority. The patient must be informed about the nature of these benign symptoms. So far, there is no acute therapy that has been proven to increase the probability of healing, i.e. the disappearance of the acute tinnitus. Only if the hearing threshold descended, for instance in case of sudden idiopathic hearing loss, therapy of the underlying disease can also lead to improvement or healing of the acute tinnitus. Counseling for chronic tinnitus with high burden is also about reducing exaggerated expectations of healing that cannot be fulfilled. The training of habituation strategies is important. The standard of therapy for chronic tinnitus with psychological strain represents cognitive behavioral therapy for dealing with the tinnitus in a beneficial way. Tinnitus is a symptom of a very heterogeneous group of patients. In the future, it is to be hoped that digital applications and interventions in particular will be evaluated in quality-controlled clinical studies in order to be able to further personalize patient therapy.
耳鸣是一种非常普遍的症状,也是患者就诊于耳鼻喉科医生的常见原因。由于耳鸣可能与听力损失同时出现,因此逐步明确听力损失情况是耳鸣患者必不可少的耳鼻喉科检查项目之一。问诊和病史很重要,因为与耳鸣的多维度相互作用对治疗可能很关键,尤其是在存在心理共病的情况下。绝大多数患者找不到因果因素。在没有外部刺激的情况下,主观耳鸣被认为是由音调或噪音的幻听引起的,这可能源于听觉通路的病理变化,但也可能涉及非听觉皮层结构。对于急性耳鸣,需要进行全面的听力学评估,如果听力阈值正常,咨询是首要任务。必须告知患者这些良性症状的性质。到目前为止,尚无已被证实能提高治愈可能性(即急性耳鸣消失)的急性治疗方法。只有当听力阈值下降时,例如在突发性特发性听力损失的情况下,对基础疾病的治疗才可能使急性耳鸣得到改善或治愈。对负担较重的慢性耳鸣患者进行咨询,还包括降低其无法实现的过高治愈期望。习惯化策略的训练很重要。伴有心理压力的慢性耳鸣的标准治疗方法是认知行为疗法,以便以有益的方式应对耳鸣。耳鸣是一组非常不同的患者的症状。未来,希望能在质量可控的临床研究中对数字应用和干预措施进行评估,以便能够进一步实现患者治疗的个性化。