A doctor is treating a patient with tinnitus; the picture is a situational photo, the patient in the picture is not related to this article. (Photo provided by Chen Jianzhi)
Text / Chen Jianzhi
A 55-year-old woman has been hearing a rather sharp and fine “cha~cha~cha” in her right ear for 5 years, as if listening to the sound of rain through the window, and the sound will become louder when it is quiet at night.
When talking to someone, as long as the other person speaks in a low volume or too fast, the right ear cannot hear clearly, many words are confused, and the meaning is often misunderstood, so I have to tilt my head and listen with my left ear. When you close your eyes, you feel your body leaning to the left; when you turn your head quickly, you feel dizzy.
Please read on…
When I went to the doctor for an audiological examination, as the frequency of the test tone became higher and higher, the hearing impairment in the right ear became more and more serious, and the audiogram showed a downward slope. When asked to look to the left, her eyeballs would rapidly rotate to the left, but when she looked to the right, there was no eye vibration. When she held her cheek with both hands and turned her head to the right quickly, her eyeballs could not fix their eyes on the front, and would first float to the right and then return to the right.
damage to the auditory nerve due to basilar artery disease
This patient actually suffers from proximal auditory neuropathy syndrome, and the neurological hearing and balance function of the affected side will be deteriorated together. According to anatomy, the proximal auditory nerve is close to the brainstem, and blood circulation mainly comes from the auditory nerve artery, which originates from the basilar artery. Once basilar artery lesions, such as arteriosclerosis, tortuosity or lumen stenosis, affect the blood flow of the auditory nerve artery, the proximal auditory nerve is damaged, cannot transmit high-frequency sound completely (requires more nerve fibers), neurological hearing impairment and compensation occur Sexual tinnitus. Because the vestibular nerve is also damaged, the balance signal from the semicircular canal and vestibule cannot be correctly transmitted. As long as the head is turned quickly, the difference in the balance signal on both sides will be highlighted, resulting in eye vibration and dizziness.
The treatment of this disease mainly focuses on blood lipid lowering, oral antiplatelet agents and drinking enough water. It is recommended to take high-purity polyunsaturated fatty acids, especially eicosapentaenoic acid (EPA), along with regular exercise, to utilize the blood in the arteries. Fast flow, remove lipids deposited on the vascular endothelium, avoid continued stenosis or blockage of the artery, and prevent the hearing of the affected ear from gradually worsening.
Recently, ear specialists have discovered that more and more senile hearing impairment or tinnitus is not entirely attributable to aging, but may be caused by ischemia of the inner ear or auditory nerve, just like “chronic ear stroke”. Treatment may be able to preserve hearing.
(The author is a physician at Yuanjing Otolaryngology Neurology Clinic)
At the entrance of the basilar artery, the auditory nerve artery stenoses (indicated by the blue arrow), causing ischemia of the auditory nerve artery (red and white stripes) and injuring the proximal auditory nerve (purple area). (Photo provided by Chen Jianzhi)
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