Tinnitus - the sensation of ringing or noise, the source of which is perceived by the patient in the ear. There are physiological and pathological tinnitus. Pathological tinnitus divided into objective and subjective. In order to deliver to the patient the correct diagnosis, it is necessary to conduct a survey.

Physiological tinnitus

Physiological tinnitus occurs in the absence of diseases in the ear, if the person is in complete silence. Appearing at the same time spontaneous auditory sensations may have the character of sounds of different frequencies and intensities. This phenomenon appears to be associated with the perception of blood vessels and capillaries in the inner ear, and with the biochemical processes that take place at the level of the hair cells of the inner ear or auditory nerve neurons.

The diagnosis of physiological tinnitus is set on the basis of complaints of the patient after his examination and rule out any diseases of the ear.

Pathological objective tinnitus

Objective pathological tinnitus differs from the subjective fact that he hears not only the patient, but the doctor can hear with the help of special methods of investigation, such as listening stethoscope.

Objective pathological tinnitus may depend on the slight twitch muscles lining the tympanic cavity, the muscles of the Eustachian tube (which connects the cavity of the ear with the nasopharynx) and soft palate, changes in blood flow, such as the sudden expansion (aneurysm) or narrowing (stenosis) of the carotid arterial sclerotic changes in the arteries that feed the brain. There may be such a noise and changes in the temporomandibular joint, the change of pressure in the middle ear (eg, in inflammatory processes in the Eustachian tube or with a change in atmospheric pressure). Objective pathological tinnitus is rare and is not accompanied by hearing loss.

Subjective tinnitus pathology

Subjective tinnitus pathology is different from the objective fact that it only hears the patient. Such noise may be due to pathological changes in the middle or inner ear, as well as background toxicity of certain drugs (such as antibiotics Antibiotics - whether they will help you in the foreseeable future? , Has a toxic effect on the organ of hearing, salicylates, etc.), toxic substances containing arsenic or mercury. Subjective tinnitus can occur during the flu, pneumonia, mumps (mumps) and some other acute and chronic infections.

It explains the appearance of subjective tinnitus in the inner ear that there are physical and chemical changes are accompanied by changes of the pressure and electrolyte imbalance (the ratio of salt). Such changes may occur in the nervous tissue of the acoustic analyzer, leading to the development of edema in it Prevention and treatment of edema - it is important to understand the root cause , Hemorrhage and destruction of cells.

Other reasons for the emergence of subjective tinnitus (noise reflex) is the presence of a foreign body in the ear canal, pathological changes in the nose, throat and teeth.

Subjective abnormal noise can be permanent or temporary, intense or weak, unilateral or bilateral. According to the characteristics that give it the sick, the noise may resemble the chirping of a grasshopper, babbling brook, the noise of the engine, of the sea and so on.

Diagnostics

Pathological diagnosis of objective tinnitus is based on the survey data of the patient and hearing noises on auscultation. The nature of the noise may be different depending on the cause. For example, vascular noises are usually vague, with pathology in the temporomandibular joint is heard the rough noise during movement of the mandible.

In the diagnosis of pathological subjective tinnitus is very important a thorough questioning of the patient about the nature of the noise, his tone, intensity, causes the appearance. The idea of ​​the tone of tinnitus can give a study using a tuning fork or audiometer.

Treatment of pathological tinnitus

Treatment and prognosis of pathological objective tinnitus depends on the nature of the underlying disease that caused the noise.

Treatment of pathological subjective tinnitus reflex character aimed at the elimination of pathological changes in other organs, to restore the nervous system, sleep Dreams: how to understand our dreams , The removal of metabolic disorders. Of great importance is the correct mode of the day, good nutrition, smoking cessation and alcohol. With the success are different types of acupuncture Reflexology - a policy of non-drug therapies   (acupuncture, electroacupuncture, and so on).

Local treatment is aimed at elimination of existing pathological changes in the outer and middle ear to restore sound conduction mechanism. With a pronounced subjective tinnitus is sometimes carried out the operation, the nature of which depends on the causes of noise. In some cases, eliminate the noise can not be subjective.

Galina Romanenko

Enalapril - a drug used to treat high blood pressure. It belongs to the class of drugs called angiotensin converting enzyme (ACE) inhibitors. ACE - an enzyme the body, stimulates the formation of angiotensin II. Angiotensin II, in turn, causes a narrowing of the arteries in the body, thereby increasing blood pressure. Enalapril prevents the formation of angiotensin II, relaxes the artery wall reduces the pressure and improves heart function in patients with heart failure.

Enalapril is a prescription medication.

Application

Indications for use are enalapril hypertension and heart failure. Sometimes it is prescribed to people who have had a heart attack - it improves the functioning of the damaged heart muscle. When the effect of the patient oral medication is not possible, it is administered intravenously.

Acceptance of enalapril is not recommended if you are allergic to any ACE, aortic stenosis, coronary heart disease, certain autoimmune diseases, diabetes Diabetes - threatening and incurable disease , Hepatic and renal failure Kidney failure - when treatment is vital . In addition, it is contraindicated in pregnant and lactating women, patients under 18 years of age and older people.

Dosage regimen

In the treatment of arterial hypertension with enalapril assigned dose of 2.5 to 40 mg daily. The dose can be divided into two equal portions and taken twice per day.

The dose for patients with heart failure - 2.5-20 mg daily; The drug is taken twice a day. When using a solution for intravenous injection is administered 1.25 mg enalapril every six hours.

Drug Interactions

Simultaneous treatment with enalapril and diuretics can lead to a sharp decrease in blood pressure. To prevent this, you need to temporarily stop taking the diuretic or increasing the salt intake prior to taking enalapril. If the patient does not stop taking diuretics for at least two hours after he began taking enalapril - until the pressure returned to normal, you need constant supervision of a specialist.

Enalapril may increase potassium levels in the blood (hyperkalemia), so it is not recommended to take supplements containing potassium.

When using ACE inhibitors and lithium may increase the concentration of lithium in the blood.

Nonsteroidal anti-inflammatory drugs such as ibuprofen, indomethacin, naproxen, and reduce the effectiveness of enalapril.

Generally enalapril is well tolerated; side effects in most cases are mild and pass quickly. Side effects of enalapril are: persistent dry cough Dry cough - whether to worry about it? , Abdominal pain, diarrhea, dizziness, fatigue, headache, loss of appetite, nausea and vomiting, chest pain Chest pain is one symptom - a lot of diseases , Fainting, numbness or tingling in the hands and feet, skin rash, sore throat. In rare cases, the drug causes liver dysfunction and jaundice.