페이지 2 페이지 7 이명은청각상실과가장자주관계되는매우흔한증상입니다. 많은경우이는청각상실의첫번째징후입니다. 이명은신체중상실된부분에서느끼는불편함인환상통과유사합니다. 귀의경우이명은귀의손상된부분으로부터듣게되는소리입니다. 이명은청각상실의결과이지원인이아닙니다. 울리는소리는귀가아

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1 페이지 8 질문 귀하의질문은저희에게중요합니다. 질문또는우려되는사항이있으면의사나의료제공자에게전화하십시오. UWMC 병원직원도도움을드리기위해대기하고있습니다. UWMC 이비인후과 Head and Neck Surgery Center: HMC 이비인후과 Head and Neck Surgery Center: 이명을가진경우이명을가진경우이비인후과의사를만나청력과귀를검사하는것이중요합니다. UWMC 이비인후과방문예약은 로전화하십시오. 본책자는다음기관에서간행하였습니다. 워싱턴대학 (University of Washington) Virginia Merrill Bloedel 청각연구소 (Virginia Merrill Bloedel Hearing Research Center) Box , Seattle, WA ; 팩스 bloedel@u.washington.edu Korean 환자교육 UWMC 이비인후과 이명 귀울림 이명 ( 티나이터스 ) 은귀에서소음이나울리는소리가일어나는것을말합니다. 대부분이러한소리는높은음이나종소리같이들립니다. 티나이터스라는단어는라틴어의 tinnire 에서온것으로이것은 딸랑거리거나종처럼울린다 라는뜻입니다. 이명은증상일뿐질병이아닙니다. 이명은일어났다멈추었다하거나지속적일수있으며, 증세가심각할수도약할수도있는것입니다. 또한낮은소리에서고음의소리까지변화할수있습니다. 이명을가진사람들의 99%(100 명중 99 명 ) 는이를가진사람만이듣습니다. 1% 의경우 (100 명중 1 명 ) 다른사람들도들을수있습니다. 본자료는청각이어떻게작동하고, 무엇이서로다른종류의이명을발생시키는지설명하고, 이명을다룰수있는조언을제공할것입니다. UWMC Otolaryngology - Head and Neck Surgery Center Box N.E. Pacific St. Seattle, WA University of Washington Medical Center Korean Published: 04/2005, 07/2011, 11/2011 Clinician Review:11/2011 Reprints on Health Online:

2 페이지 2 페이지 7 이명은청각상실과가장자주관계되는매우흔한증상입니다. 많은경우이는청각상실의첫번째징후입니다. 이명은신체중상실된부분에서느끼는불편함인환상통과유사합니다. 귀의경우이명은귀의손상된부분으로부터듣게되는소리입니다. 이명은청각상실의결과이지원인이아닙니다. 울리는소리는귀가아닌뇌에서생성되는것입니다. 보통청력상실이악화될수록이명도더커집니다. 청력문제가고쳐질수있는경우이명도보통개선됩니다. 일부청각질환은수술이나약물로고쳐질수있으며다른질환들은보청장치를이용해도움을받을수있습니다. 이명을고칠수있는치료법은없습니다. 하지만이명을가지고생활하기더편하도록도울치료법들은있습니다. 이명의특징이명의몇몇특징은다음과같습니다. 소리세기가변화한다. 장기간없어지는경우조차있습니다. 주의를기울이면증가하고, 무시하면감소합니다. 드물지만눈을움직이거나턱을다물때증가할수있습니다. 청력상실과이명의시점이나크기사이에는직접적인관계가없습니다. 어떤사람들은이명이일어나기수년전부터가벼운청력상실을가질수있습니다 잠든후에라디오가꺼지도록설정하는것과같이방안의소리를이용하십시오. 이러한소리는이명을덮고덜신경쓰이도록만듭니다. 이는조용한환경에서이명이더커지는것을발견하는사람들에게효과가있습니다. 베개로머리를받치고수면을취하십시오. 이는머리에피가몰리는것을줄이는데도움을주어이명이덜두드러지게만듭니다. 담당의료제공자에게진정제사용에대해문의하십시오. 장기적인치료방법은아니지만단기적으로안정을가져다줄수있습니다. 이명의대응방법이명에의해크게고통을받고심지어의기소침해지기까지하는사람들에게도움이될방법들이있습니다. 사람들이이증상을극복하도록돕기위해이들치료법중한가지이상을이용합니다. 문제해결에초점을맞추는종류의행동및인지치료 항우울증약물 이명을참는방법을배우는습관화훈련 상담및심리치료이명을중지시킨다고광고하는처방외치료법에주의하십시오. 이러한치료는없습니다. 그러한것이있다면잘알려지고사용되었을것입니다.

3 페이지 6 페이지 3 갑작스럽게큰소리에노출 매우큰소음에장기간노출 약물반응 노화 귀혈액공급에서의작은변화 내이의유체압력에영향을미치는모든상황 뇌이명 귀의손상은뇌에이어지는신경이작동하는정도를방해할수있습니다. 손상이발생하면뇌는상실된감각을보충하기위해자신의감각을발생시킵니다. 청각 은뇌가들어오는신호를처리하고이것을소리나단어로파악할때까지발생하지않습니다. 청각을허용하는뇌의일부를직접치료하는것은가능하지않습니다. 이는뇌기능을방해할것입니다. 그러나약물을이용하여이러한이명에영향을주는뇌의다른부분을치료하는것은가능합니다. 치료 이명의원인이발견되면종종치료가도움을줄수있습니다. 이러한원인의치료가가능하지않은경우에는다음과같이시도합니다 : 할수있는한스트레스를피하십시오. 스트레스는이명을악화시킬수있는신체적변화를야기합니다. 충분한휴식을취하고과로를삼가십시오. 커피 ( 카페인 ) 나흡연 ( 니코틴 ) 과같은신경자극을피하십시오. 이명이귀찮더라도받아들이고가능한한이를무시하십시오. 매우가벼운청력상실이있는일부사람들은이명으로심각한문제를안게될수있습니다. 청력상실이있는일부사람들은이명으로거의고통받지않을수도있습니다. 약 95% 의사람들 (100 명중 95 명 ) 은이명으로고통받지않습니다. 하지만 5% 의사람들 (100 명중 5 명 ) 은이명이매우성가시고산만하게만듭니다. 이명으로청각장애인이되지는않습니다. 이명이정신이상을만들지도않습니다. 이것은청력상실의가장흔한증상입니다. 청각은어떻게작동하는가 귀하가어떻게듣게되는지아는것은이명의가능한원인을이해하는데도움이됩니다. 청각은신체의 5 가지주요부분에의존합니다. 그것은외이, 중이, 내이, 신경경로그리고뇌입니다. 외이외이는귓바퀴와외이도로구성됩니다. 이들은음파를수집하고이것을고막으로전달하는구조물입니다. 중이중이는이도와내이사이의공간입니다. 중이는고막과 3개의소골 ( 작은뼈 ) 로이루어져있습니다. 이소골은각각추골, 침골, 등골입니다. 고막의진동은이들세개의소골에의해중이를지나전달됩니다. 세번째뼈 ( 등골 ) 는피스톤처럼움직이면서내이에서유체의파동을유발합니다.

4 페이지 4 페이지 5 내이의공간은코의속과유사하게일종의막이쳐져있습니다. 이것은점액샘과혈관을포함합니다. 이공간은유스타키오관이라고불리는작은관으로코의뒤와연결되어있습니다. 이관은중이와바깥공기사이의압력을균일하게만듭니다. 이것때문에여행중고도가높아지거나낮아지면귀가 뚫리는 것을느낄수있습니다. 내이 ( 달팽이관 ) 내이는 30,000개가넘는작은모세포와유체를포함한뼈같은캡슐안에있습니다. 이것은투명하고섬세한막이덮고있습니다. 작은혈관은피를내이로운반합니다. 이작은캡슐에서등골로부터유체의파동이모세포를구부립니다. 이것이음파를전기신호로바꾸고다시신경충동으로변환됩니다. 신경경로내이의모세포에서만들어진신경충동은청각신경에의해뇌로운반됩니다. 뇌로이어진이신경경로는작고뼈처럼생긴통로안에있는데, 이것은또한균형을잡고안면근육을움직이는신경들도포함하고있습니다. 이들신경경로는뇌의신경중추와연결되어있습니다. 뇌청각신경경로는뇌에도달하면분리됩니다. 뇌는이들신호를감지하여이를말, 음악, 소음등으로해석합니다. 이명의원인 외이이명외이의이명은이도가막혀발생할수있습니다. 귓밥, 이물질, 감염이이러한막힘을유발할수있습니다. 고막이나이도의혈관도확장하거나 ( 커지거나 ) 수축할 ( 좁아질 ) 수있으며이는청각신경의염증을유발합니다. 이러한이명의원인은치료될수있습니다. 중이이명중이의모든문제들은이명을유발할수있습니다. 이들문제에는알레르기, 감염, 상처, 혈관이상으로인한내막의팽창이포함됩니다. 알레르기, 감염또는유스타키오관장애로인해유체가압력, 청력상실, 이명을유발할수도있습니다. 감염, 상처또는이경화증 ( 일종의청력상실 ) 은중이에있는세개소골의움직임에영향을미칠수있으며이명도유발할수있습니다. 내이이명 모세포는귀에서가장민감한구조물입니다. 조금만붓거나방해를받아도이명을유발할수있습니다. 내이이명은다음과같은원인으로발생할수있습니다. 감염 유전질환 전신질환 ( 신체의다른부분에영향을미치는질환 )

Page 8 Patient Education UWMC Otolaryngology Head and Neck Surgery Center Questions? Your questions are important. Call your doctor or health care provider if you have questions or concerns.

5 Page 8 Patient Education UWMC Otolaryngology Head and Neck Surgery Center Questions? Your questions are important. Call your doctor or health care provider if you have questions or concerns. UWMC Otolaryngology Head and Neck Surgery Center: HMC Otolaryngology Head and Neck Surgery Center: If You Have If you have tinnitus, it is important that you see an ear doctor (otolaryngologist) to have your hearing checked and your ears examined. To schedule a visit to UWMC s Otolaryngology Department, please call This pamphlet is a publication of University of Washington Virginia Merrill Bloedel Hearing Research Center Box , Seattle, WA ; Fax bloedel@u.washington.edu Ringing in the ears (tin-eye-tuss) is noise or a ringing sound in the ear. Most times, the sounds are high-pitched and bell-like. The word tinnitus comes from the Latin word tinnire, which means to tinkle or ring like a bell. is a symptom, not a disease. It may occur off and on or all the time, and it may be mild or severe. It may also vary from a low sound to a high-pitched sound. In 99% of people with tinnitus (99 out of 100), it is heard only by the person who has it. In 1% of people (1 out of 100), others can also hear it. This handout explains how hearing works and what causes the different types of tinnitus. It also gives tips to help you deal with your tinnitus. UWMC Otolaryngology Head and Neck Surgery Center Box N.E. Pacific St. Seattle, WA University of Washington Medical Center Published: 04/2005, 07/2011, 11/2011 Clinician Review: 07/2011 Reprints on Health Online:

6 Page 2 Page 7 is a very common symptom that most often is linked with hearing loss. Many times, it is the first sign of hearing loss. is similar to phantom pain, which is a feeling of discomfort in a missing part of the body. In the case of the ear, tinnitus is sound that is heard from the damaged part of the ear. is the result, not the cause, of hearing loss. The ringing sound is produced in the brain, not the ear. Usually, if hearing loss gets worse, the tinnitus gets louder. If the hearing problem can be corrected, the tinnitus usually improves. Some hearing conditions can be fixed with surgery or drugs, and others are helped by hearing aids. There is no treatment to cure tinnitus. But, there are treatments that help make the tinnitus easier to live with. Features Some of the features of tinnitus are: It will vary in loudness. It may even be absent for long periods. It can increase when you pay attention to it, and decrease when you ignore it. Rarely, it can be increased by eye movement or jaw clenching. There is not a direct relationship between the hearing loss and the timing or the loudness of tinnitus. Some people can have mild hearing loss for years before tinnitus starts. Use sounds in your room, such as a radio you can set to turn off after you are asleep. The sounds will cover up the tinnitus and make it less annoying. This works well for people who find that their tinnitus gets louder in quiet surroundings. Sleep with your head raised on pillows. This will help reduce head congestion and may make the tinnitus less noticeable. Talk to your health care provider about using sedatives. They are not a long-term treatment option, but they may give short-term relief. Dealing with Your There is help for people with tinnitus who are very bothered or even depressed by it. To help people cope with their symptoms, one or more of these therapies are used: Behavioral and cognitive therapy, a type of therapy that focuses on problem-solving Antidepressant medicines Habituation training, to learn how to tolerate your tinnitus Counseling and psychotherapy Beware of any over-the-counter treatment that claims to stop tinnitus. There is no such treatment. If there were, it would be widely known and used.

7 Page 6 Page 3 Sudden exposure to a loud sound Long exposure to very loud noises Reaction to a drug Aging Tiny changes in the blood supply to your ear Anything that affects the fluid pressure in the inner ear Brain Damage to the ear interferes with how well the nerve to the brain works. When damage occurs, the brain produces its own sensations to make up for what is lost. Hearing does not happen until the brain processes the incoming signals and indentifies them as sounds or words. It is not possible to directly treat the part of the brain that allows you to hear. This would interfere with brain function. But, it is possible to use medicines to treat other parts of the brain that affect the tinnitus. Treatment If the cause of the tinnitus is found, treatment often helps. If treatment of the cause is not possible, try to: Avoid stress as much as you can. Stress causes physical changes that can make tinnitus worse. Get enough rest, and avoid getting too tired. Avoid nerve stimulants such as coffee (caffeine) and smoking (nicotine). Accept that tinnitus is annoying and ignore it as much as you can. Some people with very mild hearing loss have severe problems with tinnitus. Other people with severe hearing loss may hardly be bothered by tinnitus. About 95% of people (95 out of 100) are not bothered by their tinnitus. But, in 5% of people (5 out of 100), it becomes very annoying and distracting. will not cause you to go deaf. It will not make you lose your mind. It is a very common symptom of hearing loss. How Your Hearing Works Understanding how you hear may help you understand the possible causes of tinnitus. Hearing depends on 5 main parts of the body: the outer ear, the middle ear, the inner ear, the nerve pathway, and the brain. Outer Ear Your outer ear is made up of the auricle and the outer ear canal. These are structures that collect sound waves and transit them to your eardrum. Middle Ear Your middle ear is a chamber between the ear canal and the inner ear. The middle ear is made up of the eardrum and 3 ossicles (tiny bones): the malleus, the incus, and the stapes (hammer, anvil, and stirrup). Vibrations of the eardrum are carried across the middle ear by these 3 small bones. The third bone (stapes or stirrups) moves like a piston, causing waves of fluid in your inner ear.

8 Page 4 Page 5 The middle ear chamber is lined with a type of membrane similar to the lining of the nose. It contains mucous glands and blood vessels. This chamber connects with the back of your nose by a small tube called the Eustachian tube. This tube equalizes the pressure between your middle ear and the outside air. You feel this when your ears pop when you travel up or down in altitude. Inner Ear (Cochlea) The inner ear is inside a bony capsule that contains fluid and over 30,000 tiny hair cells. It is lined by a clear, delicate membrane. Tiny blood vessels bring blood to the inner ear. In this small capsule, fluid waves from movement of the stapes bend the hair cells. This transforms the sound waves into electrical signals, and then into nerve impulses. Nerve Pathways The nerve impulses created in the hair cells of the inner ear are carried to the brain by the hearing nerve. This nerve pathway that leads to the brain is inside a small, bony canal that also contains nerves that control balance and move the muscles in your face. These nerve pathways connect to nerve centers in the brain. Brain The hearing nerve pathways divide as they reach the brain. The brain detects these signals and interprets them as speech, music, noise, etc. Causes of Outer Ear in the outer ear can be caused by a blockage in the ear canal. Wax, a foreign body, or an infection might cause the blockage. Blood vessels in the skin of the ear canal or eardrum can also become dilated (enlarged) or constricted (narrowed), causing an irritation in the hearing nerve. These causes of tinnitus can be treated. Middle Ear Any problem in the middle ear may cause tinnitus. These problems include swelling of the lining membranes due to allergy, infection, injury, or vascular (blood vessel) abnormalities. Fluid from allergy, infection, or Eustachian tube blockage may cause pressure, hearing loss, and tinnitus. Infection, injury, and otosclerosis (a type of hearing loss) affect the motion of the 3 bones of the middle ear and may also cause tinnitus. Inner Ear The hair cells are the most delicate structures of the ear. Even a very small swelling or interference can cause tinnitus. Inner ear tinnitus may be caused by: Infection An inherited condition Systemic disease (a disease that affects other parts of your body)

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본문01 Ⅱ 논술 지도의 방법과 실제 2. 읽기에서 논술까지 의 개발 배경 읽기에서 논술까지 자료집 개발의 본래 목적은 초 중 고교 학교 평가에서 서술형 평가 비중이 2005 학년도 30%, 2006학년도 40%, 2007학년도 50%로 확대 되고, 2008학년도부터 대학 입시에서 논술 비중이 커지면서 논술 교육은 학교가 책임진다. 는 풍토 조성으로 공교육의 신뢰성과