耳鸣是最常见的耳科疾病，病因众多，机制不明，对耳鸣进行一定的分类是提高疗效的关键。本文对听觉系统，听觉系统外系统，心理情绪系统，管控系统在耳鸣中的发病机制做简要综述，并提出了实用的耳鸣临床分类：1.明显耳部疾病引起的耳鸣，主要和相当程度的听力损失相关；2.耳鸣的管控系统疾病，包括心理因素以及睡眠，女性激素水平、偏头痛、过敏、可能影响咽鼓管的鼻腔鼻窦病变、咽喉返流、呼吸睡眠暂停（OSAHS)等因素；3.混合性耳鸣为以上两种因素的混合；4.危险的耳鸣则要警惕可能的颅内病变以及精神疾病；5.原因不明的耳鸣。采用这个分类对耳鸣进行针对性的治疗，将大大提高耳鸣治疗的有效率。%Tinnitus is the most common otological disorder and remains a clinical enigma. Auditory system, non-audi-tory systems, emotional systems and other tinnitus modulating systems all play a certain role in tinnitus. This article is a re-view of its possible pathogenesis and proposes a simplified clinical algorithm for the management of tinnitus patients: 1. Disturbances of the hearing system–is there stable, significant or fluctuant hearing loss;2. Disturbances of tinnitus modu-lating systems, including the eustachian tube system and sleep systems and migraine,sleep changes related to stress, meno-pause in the female and obstructive sleep apnea (OSA) in the male, eustachian disorders possibly related to silent chronic rh-inosinusitis or laryngopharyngeal reflux;3. Mix of 1 and 2;4. Potentially dangerous tinnitus;5. Idiopathic subjective tinni-tus. Managing tinnitus patients following this clinical algorithm may result in improved outcomes.
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