Tinnitus (귀울림, 이명)

The Root of Ambulatory Care (외래 진료 지침서) 전체 목록 보기
KEYWORDS: < Common causes of Tinnitus > ..외부자극없이 한쪽 또는 양쪽에서 소리가 난다고 호소하는 증상으로 대개 난청, 현기증, 이 충만감, 이통 등의 증상과 두통, 전신권태 등의 전신증상이 동반되는 경우가 많다. 흔히 윙하는 소리, 쉬하는 소리, 벨소리 등으로 표현된다. ..이명은 치명적인 질환과 연관된 경우는 드물다. Tinnitus Hearing loss Otologic (presbycusis, Noise-induced) (90%) Meniere’s disease Acoustic neuroma Subjective tinnitus Ototoxic medications Aspirin, NSAIDs, Quinine, Tricyclic (non-pulsatile) or substances antidepressants, Aminoglycoside etc Neurologic Multiple sclerosis, Head injury Metabolic Thyroid disorder, Hyperlipidemia, Vitamin B12 deficiency Psychogenic Depression, Anxiety, Fibromyalgia Vascualr Arterial bruit, Venous hum, A-V Objective tinnitus malformation, Vascular tumors (usually pulsatile) Neurologic Palatomyoclonus, Idiopathic stapedial muscle spasm Patulous eustachian tube 121 The Root of ambulatory care Tinnitus Subjective Unilateral MRI With vertigo and deafness alone : Meniere’s disease, acoustic neuroma Vertigo and deafness with other neurologic signs : multiple sclerosis, brain-stem tumor, infarction Bilateral Pulsatile CT/MRA Vascular etiology Patulous eustachian tube, palatal myoclonus, stapedial muscle spasm MRI Continuous Normal ear examination Abnormal ear examination Cerumen impaction, Infection otosclerosis, presbycusis, ototoxicity (medication, noise) Metabolic causes, psychogenic ototoxicity (medication, noise) Head trauma Hearing loss No hearing loss Objective History, physical examination, audiometry Fig 1. Diagnostic approach to Tinnitus Key treatment Tinnitus 1. Eliminate all medications that may be contributing to the tinnitus 2. Avoid the use of stimulants - especially nicotine & caffeine - which may worsen the symptoms. 3. If a bilateral high-frequency loss is detected and the patient's primary complaints occur at bedtime, suggest a radio at low volume to mask the tinnitus. 4. If significant hearing loss and tinnitus coexist, referral to an audiologist and evaluation for a hearing aid and masking device are indicated. 5. If depression or an anxiety disorder exists, vigorously treat with appropriate antidepressants, antianxiety drugs, and psychotherapy 6. In patients without confirmed anxiety or depression, alprazolam, nortriptyline, biofeedback, and relaxation therapy have been used with varying degrees of success. ..아직 뚜렷히 규명된 약물은 없지만 몇몇 보고에 의하면 Carbamazepine, primidone, diphenylhydrantoin 과 Lidocaine이 효과가 있다고 밝히고 있으며, Carbamazepine 600-1000mg/day 투여로 50-60%에서 효과를, 100-400mg/day 투여로 80%에서 효과를 보였다는 보고가 있다. ..Complete audiometric testing should be performed on all patients. ..Pulsatile tinnitus requires a complete evaluation for intracranial and extracranial vascular disease. ..Depression and anxiety commonly coexist in patients with intractable tinnitus. 참고 문헌 Richard W. Crummer, M.D., Ghinwa A. Hassan, M.D.: Diagnostic approach to Tinnitus. A journal of the American Family Physicains 2004 ; 69 :120-126, 127-128 Paul T. Cullen : Tinnitus, in Saunders Manual of Medical Practice, 2nd ed, Robert E. Rakel(ed). Philadelphia, Saunders, 2000, P 75-77 최환석 : 이명, in 가정의학 임상편. 서울, 계측문화사, 2002, P 542-545