쉐도잉 연습: SVINutes: Pulsatile Tinnitus - 영상으로 영어 말하기 배우기
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Hello, my name is Dr. Fazeev Siddiqui.
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I'm a clinical adjunct professor at the University of Michigan at Michigan State University.
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Today, I will guide you through the evaluation of pulsatile tinnitus, a condition that can reveal critical underlying vascular abnormalities.
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Pulsed-style tinnitus is a rhythmic sound often in sync with the heartbeat.
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Unlike common tinnitus, typically a ringing sound, pulsed-style tinnitus is often caused by vascular abnormalities that create vibrations transmitted to the ear.
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Pulse slide tinnitus can be heard as whooshing, thumping, or whooping noises.
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A thorough assessment is crucial.
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The first step, always take a comprehensive history.
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Ask about the timing and onset and if it's unilateral or bilateral.
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Next, move to the physical exam.
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Pay close attention to blood pressure as hypertension can contribute.
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Don't forget to auscultate the neck and skull for any bruise, indicating turbulent blood flow pointing to an underlying vascular issue.
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If the initial assessment is concerning, the next step is imaging.
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A brain MRI with MR angiography
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or a CT angiogram is typically the first line modality to evaluate for vascular abnormalities like arteriovenous malformation or dural fistula.
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A diagnostic cerebral endogram can be performed if there is a strong suspicion on screening non-invasive imaging.
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Common causes include arteriovenous malformation, dural arteriovenous fistula, and carotid artery stenosis.
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Other less common causes include venous sinus stenosis, sigmoid diverticulum, aberrant carotid artery, and cerebral aneurysm.
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Recognizing these early can prevent severe complications like a stroke or hemorrhage.
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A dual arterial systula is an abnormal connection between arteries and veins within the dual matter.
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This bypasses the normal capillary system, forcing high-pressure arterial blood directly into the venous system.
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The result is turbulent blood flow in the dual venous sinuses.
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This turbulence generates vibrations which can be transmitted through the surrounding tissue to the cochlea, causing pulsed tinnitus.
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If left untreated, dural arterioleus fistula can lead to complications like intracranial hemorrhage or venous congestion, making early diagnosis critical.
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Another common vascular cause of pulsed tinnitus is carotid artery stenosis, which occurs when and the carotid artery narrows due to plaque buildup or other factors.
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This narrowing creates turbulent blood flow as the high-pressure blood moves through the constricted segment.
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Carotid artery stenosis is a significant risk for ischemic stroke and, if identified early, can be managed safely with carotid enderectomy or stenting.
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Venous disorders are another important cause of pustile tinnitus.
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Common conditions include venous sinus stenosis, which narrows major venous pathways like the the transfer sinus or sigmoid sinus,
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leading to turbulent blood flow and elevated venous pressure.
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Other venous causes include jugular bulb abnormalities, such as high riding bulb or diverticulum, which may create vibrations that propagate to the inner ear.
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Recognizing venous causes early is crucial, as they may contribute to symptoms of intracanial hypertension or other complications requiring targeted treatment.
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Let's look at a quick case.
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A 78-year-old man with a remote history of pulsoil tinnitus presented with headaches.
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An MRI brain revealed a cerebellar hematoma.
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A diagnostic angiogram demonstrated a high-grade complex arteriovenous fistula with multiple arterial feeders.
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Multiple arterial embolization attempts could not completely resolve the fistula.
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Hence, a coil embolization of the non-functional left transfer sinus was performed.
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A complete cure was achieved after the venous sinus sacrifice the patient did well clinically the patient did well clinically.
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To sum up, pulse light tinnitus should always prompt a careful history, physical exam, and if needed, vascular imaging.
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Early identification of vascular causes is essential for preventing complications.
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쉐도잉(Shadowing)은 원래 전문 통역사 훈련을 위해 개발된 언어 학습 기법으로, 다언어 학자인 Dr. Alexander Arguelles에 의해 대중화된 방법입니다. 핵심 원리는 간단하지만 매우 강력합니다: 원어민의 영어를 들으면서 1~2초의 짧은 지연으로 즉시 소리 내어 따라 말하는 것——마치 '그림자(shadow)'처럼 화자를 따라가는 것입니다. 문법 공부나 수동적인 청취와 달리, 쉐도잉은 뇌와 입 근육이 동시에 실시간으로 영어를 처리하고 재현하도록 훈련합니다. 연구에 따르면 이 방법은 발음 정확도, 억양, 리듬, 연음, 청취력, 말하기 유창성을 크게 향상시킵니다. IELTS 스피킹 준비와 자연스러운 영어 소통을 원하는 분들에게 특히 효과적입니다.