您正在因為耳鳴而煩惱嗎？ 您的耳鳴的聲音到底是尖銳的？還是低沉的？或者多種聲音並存的？ 您的耳鳴的部伴到底是在耳內，還是耳外的後頭部，頭頂部或是側頭部，又抑或是其他地方？ 您的耳鳴是持續性的，還是間斷性的？或者兩者兼備？ 除了耳鳴以外，您還伴有聽力下降嗎？此外還有頸肩部僵硬疼痛，情緒障礙或失眠嗎？ 此外，您還有高血壓，心臟病等其他慢性疾病嗎？ 至今為止，您已經採取了哪些治療方法？效果如何？ 您的耳鳴是否屬於激痛點針灸的適應症？ 以下表格是我們的專業中醫師經過多年的研究，獨創的一種詳細、系統，深入了解耳鳴的詳細評估表，具體內容如下： Please enable JavaScript in your browser to complete this form.姓名Name *性别Gender女Femal男Man年龄(岁)Age电话号码 Phone Number *电邮Email联系地址 Address填表日期Date / TimeSection Divider您的耳鸣主要位于以下哪些位置？Where is the main place of your tinnitus?双耳both ears左耳the left ear右耳the right ear头顶the top of the head 侧头部the side of the head后头behind of the head头顶之上parietal您患耳鸣有多长时间了？天/周/月/年How long do you have tinnitus?您的耳鸣有多严重？How serious of your tinnitus? Selected Value: 0 请滑动鼠标，在0~100之间，表示您的耳鸣严重程度。您的耳鳴的聲音類型What is the tinnitus sounds like?蝉鸣声Humming乌乌声WuWu水滴声Water droplets冰箱发动机声Refrigerator engine sound火车发动机声Train engine sound电视机无信号时的声音The sound when the TV has no signal风吹声Wind blowing咕噜声GooLu沙沙聲VV聲闹钟声 Alarm clock电波声Electric wave sound与心跳一致的搏动声Beating sound consistent with the heartbeat吱吱声ZiZi其他您耳鳴的發作頻率？How often do you suffering from tinnitus ?持续性canstant间断性intermittent两者兼有both以下哪些因素会加重或减轻您的耳鸣？will the following scenarios worse or relieve the symptom of tinnitus? 白天daytime无变化no change加重worse减轻better晚上night无变化no change加重worse减轻better早晨morning无变化no change加重worse减轻better下午afternoon无变化no change加重worse减轻better转头时nutation movement无变化no change加重worse减轻better低头时lower your head无变化no change加重worse减轻better抬头时无变化no change加重worse减轻better躺下时lay down无变化no change加重worse减轻better张口时open mouth无变化no change加重worse减轻better咬牙时chewing无变化no change加重worse减轻better说话时talking无变化no change加重worse减轻better安静环境中quiet enviorment无变化no change加重worse减轻better嘈杂环境中noisy无变化no change加重worse减轻better天气变热时hot weather无变化no change加重worse减轻better天气变凉时cold weather无变化no change加重worse减轻better饮酒后after drinking alcohol不知道无变化no change加重worse减轻better喝咖啡后after drinking coffee不知道无变化no change加重worse减轻better吃某种或某些食物后eat some speical food不知道无变化no change加重worse减轻better睡眠不好时sleep insufficiency无变化no change加重worse减轻better情绪紧张时nervous无变化no change加重worse减轻better烦躁时boring无变化no change加重worse减轻better除了耳鳴以外，您還有哪些症狀？What symptoms do you suffering from aside from tinnitus?听力下降，或耳聋hearing loss耳胀ears swelling耳闭塞感Ear occlusion耳闷感Feeling of sorrow耳周疼痛Perioral pain耳内瘙痒Itching in the ears头晕Swirl视物模糊Blurred vision恶心呕吐感Nausea and vomiting眩晕感 Dizziness失眠 insomnia抑郁Depression易怒streakiness烦躁fret颈部不适或疼痛，或僵硬Neck discomfort or pain, or stiffness肩部不适或疼痛、或僵硬Shoulder discomfort or pain, or stiffness头痛headache张口受限Limited mouth肩部活动受限Limited shoulder activity颈部活动受限 Restricted neck activity咬合障碍Occlusal disorder磨牙mola常用单侧（左侧或右侧）牙咬食chewing using one side牙病Commonly used one-sided (left or right) teeth biting其他others除耳鳴以外，您還有哪些疾病？Which disease are you suffering from except for tinnitus?高血压hypertension糖尿病diabetes心脏病heart disease肾病Kidney disease甲状腺病Thyroid disease听神经瘤Acoustic neuroma耳水不平衡 unbalanced ear fluid脑血管疾病Cerebrovascular disease脑部肿瘤Brain tumor中耳炎Otitis media其他others您以前做過哪些治療？Have you receive tinnitus treatment(s)?please specify it(them).針灸Acupuncture中药Chinese medicine西药Western medicine骨伤orthopedics推拿Massage物理治疗Physiotherapy 脊医Chiropractor其他others您是从哪里知道我们的？How did you know us？亲人或朋友介绍introduce from relationship or friends其他医生介绍introduce from other doctors网上搜索searching online网上介绍或推荐recomending on the net 其他others提交Submit 歡迎致電3795 3033諮詢或點擊我要預約。 香港浸會大學新聞報導：激痛點針刺治療體感性耳鳴有效率達90%。 Hits: 1543
