What Is the Difference Between Tinnitus and Hyperacusis?

If the collapse of loudness tolerance (Vernon & Press 1988) makes the sound stimulation extremely sensitive and uncomfortable to listen to any sound, even whispering sounds harsh, we call it "Hearing hypersensitivity" (hyperacusis).

Auditory allergy

Hearing allergy

If the collapse of loudness tolerance (Vernon & Press 1988) makes the sound stimulation extremely sensitive and uncomfortable to listen to any sound, even whispering sounds harsh, we call it "Hearing hypersensitivity" (hyperacusis).

Description of auditory allergy

A patient once described that if someone has a loud voice in the conversation, his ears immediately feel tight, tinnitus emerges and he has a headache, and he recovers at least 10 minutes later. Hearing a sudden sound (not necessarily loud) will have a shock reaction. Your heartbeat speeds up and it takes about 5 to 10 minutes to calm down.

Another so-called "musician" has a good sense of sound and is sensitive to the sound of the music. If there is a slight inconsistency in the tone, the five tones are incomplete, and you can't stand it.

Although auditory allergies are less common, once they occur, they are very disturbing. Some patients feel insecure without earplugs and are scared to go out. Compared with tinnitus, it is more unbearable and often affects work. General social activities also become impossible. In severe cases, it may affect the limbic system's emotional response and the autonomic nervous system, leading to "phonophobia." Hearing the sound will trigger panic. "Listening" becomes a terrible nightmare!

Hearing allergy is not the same as "recruitment" (recruitment). Most of the people with resurgence are associated with cochlear hearing impairment, and the dynamic range of hearing is narrowed due to cochlear disease, especially the outer hair cells. Caused by injury. Hearing tests in people with hearing allergies are generally normal. As the gain of the central auditory system increases and the suppression decreases, the loudness discomfort level (LDL) decreases.

The cause is caused by a failure in the auditory pathway, and the specific cause has not yet been determined. It does not rule out that issues related to allergies (related to allergies) are difficult to carry out. TCM literature can find this disease. Clinically, auditory allergies are not uncommon, and many diseases may be complicated by this symptom:

· The most commonly mentioned is tinnitus. The so-called subjective idiopathic tinnitus (SIT) generally refers to hearing a sound from an unknown source on your head, which is an illusion of auditory cognition. Due to the gain of the central auditory system, silence becomes audible, and tinnitus is felt. Some people think that auditory allergy is the pretinnitus of this kind of tinnitus, and the two are related.

· Eustachian tube opening: incomplete closure of the Eustachian tube, middle ear cavity and nasopharyngeal cavity, larger resonance cavity, feeling ear plugs, sound sounds echo, so-called "autophony" phenomenon, patients often complain Hearing allergies.

· Facial nerve palsy: It is usually caused by a virus infection. If the lesion affects the nerve branch that governs the stapedius muscle, causing abnormal auditory reflexes, auditory allergies will occur.

· When treating otosclerosis, the stapedius tendon must be severed, and the auditory reflex disappears after surgery, and auditory allergies may also occur.

· In the case of external lymphatic vessels, the lymphatic fluid outside the labyrinth of the inner ear leaks to the middle ear cavity through the extratubes, and the inner ear presents relative internal lymphatic effusion, which makes it difficult to tolerate loud sounds.

Meniere's disease, which is idiopathic endolymphatic edema of the labyrinth of the inner ear, is often afraid of hearing loud sounds at the beginning of the lesion.

· In cases of severe deafness caused by the loss of the labyrinth of the inner ear, in addition to hearing impairment, it is often complained that it is very uncomfortable to hear sharp sounds.

· Migraine: Whether with or without aura, that is classic (common) or common (common) migraine, symptoms such as fear of loud noise and phobia usually appear.

· In mental disorders, such as depression or panic disorder, patients often have auditory allergies or fear of sound.

· Autism: Autistic children close themselves in a blank and empty world of themselves, and do not develop relationships with others. He may not be able to hear certain sounds, but is particularly sensitive to some sounds (hearing distortion?). He will hear the sound of water flowing from the walls, pipes, or toilet flushes upstairs. Loud, just like thunder. Some hear the sound of blood flowing in their own blood vessels all day, or the sound of their own breathing. Some people even don't want to speak because they don't like listening to the voice, which makes learning language difficult.

It is not clear why auditory allergies occur, which can be summarized into 4 possible hypotheses:

(1) 5-hydroxytryptamine (5-HT; Serotonin) hypothesis:

According to animal experiments, serotonim (serotonim) inhibits auditory stimulation of the forebrain; a reduced serotonin content in the brain will enhance the auditory startle response. The occurrence of tinnitus is probably related to the serotonin (serotonin) dysfunction in the central nervous system; other diseases related to auditory allergy in the human body, such as migraine, also show low serotonin.

(2) The opioid peptides hypothesis:

The descending efferent axons originating from the lateral brain stem nucleus are connected to the spiral ganglion dendrites of the inner ear canal. The function of these outgoing "oliveria" is still unclear. In addition to acetamide, it also releases Other neuroactive opioids are believed to enhance auditory sensitivity and promote high auditory vigilance in life-threatening situations.

(3) Assumption of the neuroplasticity of the ascending auditory system:

r-aminobutyric acid (GABA) -mediated neurons strongly inhibit neural activity in the auditory cortex of the brain, and damage to the terminal auditory system will cause GABA-mediated inhibition of the inferior inferior colliculus. , Enhanced the auditory evoked potential of inferior colliculus neurons, and as a result, weak abnormal signals in the auditory cortex escaped, which may be the mechanism of tinnitus.

Changes in the neuroplasticity or functional reorganization of the ascending auditory system will change auditory cognition. Due to the increase of its own gain, the inhibition significantly decreases, resulting in the excessively enhanced spontaneous activity of the auditory nerve, causing auditory allergies.

(4) Cochlear hypothesis:

The aforementioned various inner ear diseases, such as sensorineural hearing impairment and Meniere's disease, may be combined with auditory allergies, so it is inferred that the cause may originate from the peripheral auditory system-the cochlea.

The treatment of auditory allergies is very tricky. Some doctors in the United States used surgery to destroy the small ear bone chain in the middle ear of patients, and deliberately caused conductive hearing disorders. They wanted to help patients reduce the volume of sound stimulation, but the results were unsatisfactory. This is like for patients with half face facial pumping, intentionally causing facial nerve injury with middle ear mastoid surgery, artificial facial nerve paresis, trying to and face facial pumping caused by hyperfunction of face and ginger Alas, it seems reasonable in theory, but the results are disappointing.

As for the medical treatment, there is no so-called specific medicine, and few attempts have been made. In addition to giving high units of "vitamin B6" or supplementing "magnesium", it is also mentioned that "Baclofen" is used for treatment. Baclofen can inhibit the hypothalamus. Yuan, so it is used to treat lesions in the upward auditory path, but the effect is not obvious.

For hearing allergies, the mainstream method currently adopted in the world is tinnitus fitness therapy

· Tinnitus Habituation Therapy (Tinnitus Habituation Therapy) was invented by Jastreboff, a well-known American ear specialist. The classical method of auditory allergy is also the only method, but the name of this therapy has not changed.) Hearing treatment to desensitize the sound. Professor Wang Hongtian of the General Hospital of the People's Liberation Army has a classic question and answer on hearing allergies in the classic question and answer on Good Doctor's personal website online. It mentioned that pink noise should be used to help desensitization training for patients with hearing allergies. Professor Gong Shusheng, Director of Otology, Tongren Hospital Your good doctor's online personal website also mentions pink noise habituation therapy for auditory allergies. General patients can go to the two professors' personal websites for accurate treatments of auditory allergies.

The specific implementation of TRT for auditory allergies is to listen to pink noise for about 6 hours a day, and the volume is at the maximum level that the patient feels comfortable with. It can have a significant effect in 6 months, and 80% of patients can be in 6 months to 1 year. Get well within time.

Regarding the recommended sound, pink noise is preferred, but it must be recorded with very good pink noise. If it is rough, it will hurt the ears. If you use digital playback, you must use the .wav or .assi format. The mp3 format will lose some key voice signals, and the effect is very bad. The best CDs are recorded so that there is no distortion of the voice signal.

· Do not use earplugs often and avoid over protecting your ears.

Because wearing earplugs will filter out the low-frequency surrounding environmental noise, but it will promote the deterioration of auditory allergies. Patients can bring their own simple sound level meter (with sound volume level of 65 decibels as a boundary). Really loud sounds must be avoided, absolutely noisy environment, low I do nt wear earphones at the 65 dB sound pressure level, I hope I can slowly adjust to normal volume, and gradually turn A back to normal life.

In addition, patients with auditory allergies should also pay attention to the relationship between auditory allergies and tinnitus: Many people only have auditory allergies at the beginning, but eventually they gradually develop into tinnitus. Causes a lot of psychological distress to patients. At the moment, there is no effective treatment method. Some people say that the cure may be just the condition itself. It has nothing to do with treatment. It is internationally recognized that there are no effective drugs and treatment methods. In addition to using TRT to adapt. About 90% of patients with auditory allergies are accompanied by tinnitus. About 50% of patients develop auditory allergies first, and then gradually develop what is called tinnitus, and the interval between them is also irregular. So also Some experts call auditory allergy a pre-tinnitus condition, and believe that auditory allergy and tinnitus are two symptoms of a disease. From the prognosis, 85% of auditory allergies can be cured, but once tinnitus is cured, It's almost impossible to get cured, so keep that in mind.