Abstract：
Physicians will frequently encounter patients who report tinnitus. Tinnitus is a symptom whereby there is the perception of sound or sounds in the ear or head in the absence of an external source of sound. Most individuals experiencing tinnitus will have a neutral reaction to the percept, but in a small proportion of patients, tinnitus can be a debilitating symptom. When it causes burden, patients can be affected in multiple different facets of life, including impairment in sleep, hearing cognition and psychological and psychiatric well-being, often resulting in high healthcare utilisation and societal costs. Hence, chronic, disabling tinnitus is a complex condition with multifactorial causes and multiple perpetuating biopsychosocial factors. Despite efforts to increase knowledge about its pathophysiology and research into treatments, little impact on real-world clinical practice has been seen. There are no proven effective pharmacological treatments or complementary medicines specifically for chronic, disabling tinnitus. Despite this, there is a role for treating this condition through a multidisciplinary approach specifically targeting comorbid active psychiatric conditions, using hearing aids in appropriate clinical settings such as in those with a coassociated confirmed hearing loss, and specialised cognitive behavioural therapy for patients reporting bothersome tinnitus. Cognitive behavioural therapy remains the most valuable evidence-based intervention in this regard. This narrative review attempts to summarise the current understanding in terms of pathophysiology, assessment and treatment of tinnitus for the internal physician who may encounter patients with disabling, chronic tinnitus.
摘要：
医生经常会遇到报告耳鸣的患者。耳鸣是一种症状,其中在没有外部声源的情况下在耳朵或头部中感知到声音或声音。大多数经历耳鸣的人对感知会有中性反应，但是在一小部分患者中，耳鸣可能是一种使人衰弱的症状。当它造成负担时，患者可能会在生活的多个不同方面受到影响，包括睡眠障碍，听力认知以及心理和精神健康，往往导致高医疗保健利用率和社会成本。因此，慢性，致残性耳鸣是一种复杂的疾病，具有多种因素和多种持续的生物心理社会因素。尽管努力增加对其病理生理学的了解和对治疗的研究，对现实世界的临床实践影响不大。目前尚无经证实有效的药物治疗或专门用于慢性、禁用耳鸣。尽管如此,有一个作用是通过多学科的方法来治疗这种情况，特别是针对共同的活动性精神病，在适当的临床环境中使用助听器，例如与确认的听力损失相关的助听器，对报告令人烦恼的耳鸣患者进行专门的认知行为治疗。在这方面，认知行为疗法仍然是最有价值的循证干预措施。这篇叙述性综述试图总结目前在病理生理学方面的理解，对可能遇到致残患者的内科医生耳鸣的评估和治疗，慢性耳鸣.
