Tinnitus of the right ear 05,noise in ear when closing eyes walking,tenis para basketball bogota 472 - PDF Review

05.05.2015
We have gained experience in examining the otolithic organ with what we call electrootolithography [1].
Electrootolithography is useful in the hands of experienced audiologists who have the ability to detect the window of activity within the evolving time-series signal on a monitor. To overcome these problems and with the aim of developing a robust signal-processing method for routine clinical evaluation, we investigated several different statistical methods. For recording, the active electrode remained in the tympanic recess after electrocochleography; the reference electrode was fixed on the ear lobe, and the common ground electrode was fixed just beneath the frontal hairline. Several responses also were obtained from subjects subjected to the sound of a tuning fork (512 Hz) held in front of the external ear canal, after clenching the teeth and shaking the head. This method presents statistical information showing the median, twenty-fifth, and seventy-fifth percentiles shown as the top and bottom of the boxes with error bars showing the cutoffs and minimum-maximum values (SigmaPlot version 8.02). Table 1 gives a numerical data description of the scaling behavior in head resting versus ipsilateral and forward head tilt in a subject without vestibulocochlear symptoms.
Instead of a numerical data description, a visual format, such as box plots, provides the same statistics. Figure 3 shows the interquartile range analysis in a normal subject, comparing ipsilateral with contralateral and forward head tilt with backward head tilt.
In normal subjects, we typically found that the interquartile range coefficient (Q m) of ipsilateral head tilt was always larger than the interquartile range coefficient of contralateral head tilt, representing the response of the utriculus. This relationship could be expressed in a new ratio between the Qm coefficients (Equation 2).
Recordings in resting position during teeth clenching showed an immediate and obvious response (Fig.
Figure 6 compares resting position with the presentation of a 512-Hz tuning fork to the test ear. To reduce interference from muscle activity or a disturbance from a moving electrode in the tympanic recess-or even contamination by the semicircular canals-we performed recordings using a tilt table while subjects were completely relaxed.
We usually performed recordings over a period of 3-5 seconds while swiftly tilting the head.
The recordings of a patient after the removal of an acoustical neuroma from the left ear are shown in Figure 9.
Figure 10 shows the response of a patient with benign paroxysmal positioning vertigo before canalith repositioning and before the otolithic organ had recovered. Short-lived positioning attacks of vertigo are generally conceded to result from movement of dislodged, gravitysensitive otoconia that somehow found their way into a semicircular canal. Benign paroxysmal positioning vertigo, therefore, is an ideal clinical condition in which to study the electrical response of the inner ear before and after treatment and to compare responses with normal subjects. In contralateral head tilt and backward head tilt, possibly owing to inhibition, cross-striolar or commissural, response of the vestibular nerve is comparatively reduced.
Our results are consistent with the clinical presentation of symptoms but also give us additional information based on the unique anatomical arrangement of hair cells in the otolithic organ [5]. In the sacculus, we can distinguish between an anterior portion and a posterior portion of the macula, and the polarization of the hair cells along the reversal line of the striola is opposite that of the utriculus (Fig.
Also here, the unique arrangement of hair cells and the size of the coefficients can give us a clue as to where in the sacculus the deficit is to be expected. We usually performed recordings over a period of 3-5 seconds while subjects swiftly tilted the head. Though the quality of electrootolithography is dependent on the experience of the examiner and therefore is a far more subjective test, performing the amplitude range analysis test is easier, and it is more objective. We do not believe that the movement of otoconia is responsible for the abnormal box-plot pattern in benign paroxysmal positioning vertigo.
We are routinely performing amplitude range analyses of the otolithic organ, although the results with this technique can be regarded as preliminary. Finally, this technique can be transferred to the caloric examination of the lateral semicircular canal.
From examining directly all three units of the inner ear with a single electrode placed in the tympanic recess, our understanding of inner-ear disorders is gradually changing.
Benign paroxysmal positioning vertigo is a suitable clinical condition in which to examine the inner ear's response to head tilting in roll and in pitch using electrocochleography techniques. Dorntherapy was developed in the 1980s by Dieter Dorn, a nonmedical person, to cure his and his family members' vertebral problems. The craniocervical junction, the upper part of the vertebrae, includes the atlanto-occipital region, the atlanto-axial region, and the C2 and C3 segments [l]. Dysfunctions of the craniocervical junction affect the central nuclei via the afferent system, in particular the vestibular nuclei, thus leading to disturbances of the efferent profile [l]. Traditionally, dysfunctions of the vertebrae are treated, for example, by chiropractic therapy, meaning high velocity and minimal impact.
However, in the last few years, a new method known as Dorntherapy has been fairly successfully employed for treating problems of the vertebrae.
This study employed the technology of quantitative electroencephalography (EEG) to prove that correction of the craniocervical dysfunction by Dorntherapy induces changes in electroencephalographic activity. All EEG data were visually inspected for artifacts due to movements and to muscular activity before the records were subjected to quantitative analysis and interpretation. All EEG data were collected under controlled conditions with the subject reclining comfortably in an armchair with eyes closed in a sound-attenuated, electrically shielded room. Our study included 10 tinnitus patients with craniocervical dysfunctions and additional dysfunctions of other vertebral parts.
Subdividing the alpha band into alpha), alpha2, and alpha3, the statistical analysis revealed a significant increase (p 2 band (9-11 Hz) (Fig. Owing to increased noise exposure, a dramatic rise in subjects suffering from tinnitus is expected. Biofeedback allows the control of physiological processes, such as body temperature or heart frequency. This article was presented at the Twenty-Ninth Neurootological and Equilibriometric Society Meeting in Bad Kissingen, Germany, March 15-17, 2002.
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It is an ideal clinical condition in which to study the electrical response of the inner ear with electrocochleography techniques. In this technique, which is similar to extratympanic electrocochleography, an electrode is placed in the tympanic recess. What is needed is a reductionist technique that can display the averaged (region-of-interest) signal in real time. Initially, we applied a range of fractal methods using physical wavelet analysis for the examination of two types of signals (baseline resting position and head tilting) to establish first that the signals were different and, second, that this difference was statistically significant [2,3]. The active electrode was secured with tapes on the pinna so as to avoid movement during head tilting. After obtaining a baseline response, we tested subjects in roll (ipsilateral head tilt to the electrode side and contralateral head tilt away from the electrode side, stimulating the utriculus) and in pitch (forward head tilt and backward head tilt, stimulating the sacculus). We tested four normal subjects on a tilt table so as to avoid possible contamination by the semicircular canals, and in four patients we recorded responses after a head tilt lasting 10 seconds.
We have built a breakout box connected to an existing interface unit (Navigator; Biologic, Chicago, IL).
The median is the pivot point above which and below which an equal number of values appear. We were particularly interested in the Qm values (seventy-fifth through twenty-fifth percentiles) of the amplitude range of each response (size of the box in the box-plot analysis).
This is a suitable format for clinicians who can see at a glance, as in reading an audiogram, whether a response is diverse from the norm (Fig.
Left to right: box plot of raw data for both headresting controls, followed by ipsilateral tilt, then forward tilt.
Similarly, we found that the interquartile range coefficient of forward head tilt tended to be equal to or larger than the interquartile range coefficient of backward head tilt, representing the response of the sacculus. The ratio was obtained by dividing Qm of contralateral tilt by the Qm of ipsilateral tilt, representing the response of the utriculus (Equation 3). The marked regression from the zero line creating artifacts affects the size of the box plots. Head shaking reveals major artifacts, which affect the size of the box plot, here compared with the baseline. Clenching the teeth demonstrates an immediate response, which is most likely due to muscle activity.
The box plot during this sound stimulus was larger than in resting position without stimulus. The presentation of a tuning fork to the test ear shows a strong response, suggesting that this technique is suitable for recording inner-ear responses.
Tilt-table recordings show a pattern comparable to that of a swift head tilt, suggesting that contamination from the semicircular canals can possibly be ignored. Tilting the head for the 10 seconds and then recording shows a reversed pattern of the box plots, possibly due to adaptation phenomena. Box-plot analysis in a subject with benign paroxysmal positioning vertigo (BPV) before a repositioning maneuver. The utriculus is divided by the reversal line of the striola into a medial portion and a lateral portion of the macula, and the hair cells have opposite polarization, with the kinocilia facing each other (Fig. Hair cells of the macula utriculi are separated by the reversal line of the striola, and the hair cells have polarization opposite, with the kinocilia facing one another.


Because a deficit can equally affect both the medial and the lateral portions of the utriculus, a normal coefficient could possibly be seen.
Hair cells of the macula sacculi are separated by the reversal line of the striola into a posterior and an anterior portion, and the kinocilia of hair cells have an orientation opposite to the utriculus. The hair cell area of the anterior portion of the sacculus compares to the posterior portion, and responses in normal subjects are suspected to be fairly equal. The recording is performed in a relatively short period during which movement of the otoconia hardly becomes effective.
We believe that contamination by muscle activity or responses from the semicircular canals can be ignored.
Pilot studies so far support this assumption, and the examination of the lateral semicircular canal already forms part of our test battery using this technique. Amplitude range analysis is a more objective test than is electrootolithography, and a statistical summary can be displayed in box plots. Dorntherapy: Its Effect on Electroencephalographic Activity in Tinnitus Patients with Craniocervical Dysfunction.
This technique achieves correction of dysfunctions of the vertebrae and joints simply by using natural movements of arms and legs Or by applying gentle pressure (thumb) to the spinous process. This area, rich in neuronal sensors, is neurophysiologically and mechanically fairly different from the rest of the cervical spine.
Other therapies employed for the correction of dysfunction of the vertebrae are Brugger therapy, craniosacral therapy, straincounterstrain, and the specific adjustment technique.
Possible dislocations of the vertebrae are localized by moving thumbs gently up and down the spinous process. Quantitative EEG was undertaken using the Electro-cap (Electro-cap International, Inc., Eaton, OH). Unless stated otherwise, the data used for topographical color maps have been manually screened for eye blink movements, and only eye blinkfree epochs were used in the preparation of quantitative results, including spectral averages and topographical maps.
After completion of the tests, the EEG data were analyzed to reject artifacts due to eye movements, blinks, and muscle activity.
All 10 patients complained of tinnitus, headache, nausea, and concentration problems and exhibited restricted head and neck movement and segmental vertebral dysfunctions. In 1986, he fell 36 feet from a ladder, fracturing several ribs and his right wrist and receiving a mild traumatic brain injury.
Percentage of change in power of (A) delta, theta, alpha, and beta frequency bands and (B) alpha1, alpha2, and alpha3 frequency bands after Dorntherapy. Neurofeedback is a form of biofeedback linked to aspects of the electrical activity of the brain, such as frequency, location, or amplitude of specific EEG activity. Gillard and told him the whole story as concisely as possible, i sent him the images i sent you. The breakout box collected raw data and diverted them to a new data acquisition system for further processing of the incoming signals.
If the array has equal numbers of values, the median is the average of the two middle numbers.
The Qm values were used for statistical analysis (Student's t-test) and ultimately led to a new coefficient describing the response of the utriculus and the sacculus.
The lower one-half of the diagram contains the interquartile range analyses, displayed in box plots. Equally, the ratio representing the sacculus was obtained by dividing the Qm of backward head tilt by the Qm of forward head tilt (Equation 4).
These artifacts should be discarded before the final analysis, and most likely they are the result of an electrode movement in the tympanic recess.
The difference was obvious and showed that this technique will record innerear responses, although the recordings look very much like microphonics. These results compared well with those obtained from a subject sitting at the edge of an examination table and swiftly tilting the head (Fig. Box plots also show a marked digression of the median (lower bar in the box) from the mean (upper bar in the box). This reversed pattern of the box sizes was typical for benign paroxysmal positioning vertigo.
The contralateral interquartile range ratio is larger than the ipsilateral interquartile range ratio, suggesting a deficit in the right utriculus. The coefficient ratio of the utriculus has returned to normal, and the coefficient ratio of the sacculus has remained within normal limits. The Dix-Hallpike maneuver is also suitable for reviewing the treatment outcome after canalith repositioning.
In amplitude range analysis, interquartile ranges will consequently be smaller, owing to a reduced vestibular nerve response. Ipsilateral head tilt mainly stimulates the medial macula utriculi, whereas contralateral head tilt will mainly stimulate the lateral macula utriculi. However, in that case, an interaural difference in the size of the boxes is to be expected. Thus, forward head tilt will mainly stimulate the anterior portion of the macula sacculi, and backward head tilt will stimulate mainly the posterior portion. Forward head tilt will mainly stimulate the anterior portion of the sacculus, whereas backward head tilt will mainly stimulate the posterior portion.
Thus, different clinical techniques will give different results, and adhering to a specific technique is necessary so as to obtain consistent results.
Those researchers found that the medial portion of the utriculus has a hair cell area comparatively larger than the lateral portion. Clinical experience with benign vertigo demonstrates the existence of a delay of several seconds before a nystagmus is observed in the Dix-Hallpike maneuver or the patient experiences vertigo. The rule is that the cochlea, the otolithic organ, and the semicircular canals are all part of a combined response to an insult inflicted on the inner ear, although individual responses and the combination therein may vary. Normal subjects show a different pattern as compared with those from patients with benign paroxysmal positioning vertigo.
Sstatistical approaches to temporal frequency analysis of otolithic responses-signal processing with physical wavelets, fractals, other filters and Mathematica.
Organization of the sensory hairs in the gravity receptors in utricle and saccule of the squirrel monkey. Response to static tilt of peripheral neurons innervating otolith organs of the squirrel monkey. Various observations suggest that craniocervical dysfunction can lead to tinnitus, thus causing changes in the electroencephalographic patterns. Being the end point of the statomotoric system, the craniocervical junction can also be affected by dysfunctions of other parts of the vertebrae [1-3].
A diagnosed dislocation of the vertebrae is corrected via a gentle pressure against the spinous process while the patient is moving an arm or leg back and forth. The quantitative EEG frequency bands chosen were delta (2-4 Hz), theta (4-7 Hz), alpha (8-13 Hz), and beta (14-21 Hz), with sub-alpha bands of alpha1 (7-9 Hz), alpha2 (9-11 Hz), and alpha3 (11-13 Hz). In addition, he experienced a bilateral tinnitus (left-sided tinnitus duration, 6 years; right-sided tinnitus duration, 2 weeks). Neurofeedback has been employed for treatment of patients experiencing attention deficit-hyperacti vity disorder, generalized anxiety disorder, depression, conduct disorder, epilepsy, and posttraumatic stress disorder and for patients with closed-head injury and drug addiction [6-12].
This report hints at the involvement of the craniocervical system and muscular dysfunction in the pathogenesis of tinnitus (C.F.
The most prominent changes are associated with the 8-to 13-Hz band and the 9-to 11-Hz band.
Effects of central cortical EEG feedback training on seizure incidence in poorly controlled epileptics. Neurotherapy and drug therapy in combination for adult ADHD, personality disorder and seizure disorder:A case report. Cortical representation of the vestibular system as evidenced by brain electrical activity mapping of vestibular late evoked potentials. Effects of EEG guided alpha train ing in patients suffering from chronic tinnitus [in German]. With this technique we found that the amplitude range and scaling behavior of recorded raw data for the baseline resting position versus the stimulus position was statistically different in both patients and normal subjects. Generally, roll is conceded mainly to stimulate the utriculus, whereas pitch mainly stimulates the sacculus. The quality of recordings also can vary, as the chosen averaging frequency might not be exactly in tune with a harmonic of an individual response frequency. Our aim was to perform data acquisition and analysis that can show at a glance, as in reading an audiogram, whether a response differs from the norm.
Initially, we used physical wavelet analysis for data classification after acquisition [4]. Although the differences are quite obvious, they might not be a suitable format for clinicians. Note that these recordings have been conducted under extreme and nonphysiological conditions to test the responsivity of the method. The interquartile range calculation (Equations 3 and 4) showed a reversed pattern, where contralateral tilt and backward tilt now showed a larger interquartile range.
These fluctuations had a frequency of 72 cycles per minute and coincided with the patient's pulse. The baseline recordings show a sinusoidal pattern at a frequency of 72 per minute, which coincided with the patient's pulse.


In this case, the contralateral box was larger than the ipsilateral box, rendering a coefficient above 1.1 and suggesting a deficit in the right utriculus. In amplitude range analysis, we would consequently expect larger interquartile ranges due to an increased vestibular nerve response. Thus, an ipsilateral tilt (bending hairs toward the kinocilia) appears mainly to stimulate the medial portion of the macula utriculi, and contralateral tilt stimulates mainly the lateral portion of the macula utriculi. That these two different techniques stimulate different hair cell units that have different characteristics appears possible. In squirrel monkeys, the proportion is 60:40, and one can assume that it is similar in humans. Tilting the head in roll and in pitch also is not performed in the optimal plane of the semicircular canals, rendering movement of the otoconia more difficult.
Presented at the Thirty-Second Annual International Congress of the Neurootological and Equilibriometric Society, March 23-25, Melbourne, Australia, 2005. Relation between afferent discharge properties and peripheral innervation patterns in the utricular macula. This study demonstrates that the successful application of Dorntherapy induced prominent changes of the electroencephalographic activity. The differences in lengths of legs are very often a sign of torsion of the vertebrae; however, these differences can also cause torsion of the vertebrae by themselves, thus inducing rotatory dysfunction of the vertebrae and dysfunction of the craniocervical junction. It is best described as follows: A therapist uses the natural movements of a patient with a gentle pressure to the spinous process to correct the dysfunction.
Dysfunctions of the cervical vertebrae are corrected while the patient is slowly shaking the head.
In the last few years, two new therapeutic concepts have been advanced:neurofeedback and tinnitus retraining therapy (TRT). Comparison of EEG data before and after neurofeedback revealed significant changes of EEG parameters and items of the Göbel Tinnitus Questionnaire. These findings clearly indicate the necessity for correcting vertebral dysfunctions prior to starting any other therapies.
In GK Siebert (ed), Facial Pain and Headache: An Interdisciplinary Overview for Medical Doctors, Dentists and Psychologists [in German].
Ten patients had normal hearing levels; the majority had a symmetrical mild sensorineural hearing loss sloping toward the high frequencies. Typically, ipsilateral and forward head tilt show larger box plots than do contralateral and backward head tilt. Also here, we observed that boxes of ipsilateral head tilt were larger than boxes of contralateral head tilt. We believe that the reversed pattern was most likely due to adaptation phenomena or that responses came from different areas of the maculae. The frequency of these fluctuations and the strength of the response seemingly remained during stimulation in roll and in pitch. One technique might preferentially stimulate irregular discharging units, which are suspected to be located in the striola, whereas another technique might preferentially stimulate regular discharging units, which are suspected to be located in the extrastriolar region [6]. Those results compare well with our findings, in which the coefficient of the sacculus response hovers around 0.9 instead of around 1. Above all, experience with electrootolithography shows that a successful repositioning can eliminate positioning attacks of vertigo but not necessarily a remaining instability during quick head movement.
Data analysis revealed a significant increase in the power of the alpha (8-13 Hz) and the alpha2 (9-11 Hz). Dysfunctions of the lower part of the vertebrae will significantly affect the mobility of the craniocervical junction, thereby affecting central regulation mechanisms via the afferent systems [3,4]. Dislocation of the vertebrae is corrected via gentle pressure against the spinous process while the patient moves an arm or a leg back and forth.
Again, a gentle pressure is projected to the spinous process to place the vertebra in its appropriate position. TRT is based on the assumption that nonauditory systems, particularly the limbic system and the autonomic nervous system, playa crucial part in each case of troublesome tinnitus. This technique promises to become a valuable addition to electrical examination techniques of the inner ear. However, the principle of this averaging is different, as we do not employ multiple stimuli; instead, we stimulate once only. In addition, averaging is not phase-locked to the maximum amplitude of the response; therefore, the signal varies in strength. If the data array is an odd number, Q1 includes the median; Q1 is known as the twenty-fifth percentile.
Because patients generally-and particularly the elderly-had problems in holding the head in a tilted position and more artifacts were seen, we no longer use this method. We also observed more artifacts, possibly due to the movement of the electrode in the tympanic recess.
The remaining instability is due to a continuing measurable deficit in the otolithic organ [1].
Besides electrophysiological effects, changes in the quality of tinnitus and in the intensity of the tinnitus were noted. This can lead to vertigo, dizziness, nausea, tinnitus, diplopia, concentration problems, and headache, to name but a few effects [4-6]. These movements induce changes of the muscle tension, thus enabling a soft correction of the dislocated vertebra. For both approaches, the natural movements of muscles and vertebrae are used; thus, the corrections are not performed against increased tensions. The power spectrum data analysis revealed a significant decrease of the power of the delta band. According to this model, the annoyance of tinnitus is determined exclusively by the limbic and autonomic nervous system. A highly significant change was noted for emotional distress and annoyance from the tinnitus.
Because the vestibular organ shows rhythmicity, the responses that are averaged are phase-locked to a harmonic of an individual response frequency.
Generally, we observed a vestibular pattern of voltage changes during raised intracranial pressure [4]. We digitized raw data from the electrodes and plotted as voltage amplitude versus time using a medically rated analog-todigital converter.
This suggested that interference from muscle activity or contamination by the semicircular canals can possibly be ignored; when using a tilt table, they could be avoided.
Conversely, a positive Dix-Hallpike maneuver indicates only that otoconia have found their way into a semicircular canal. The basic idea of this concept is the treatment of the complete vertebrae, not the treatment only of the problem zones. TRT has two key elements:directive counseling and sound therapy to achieve habituation of the tinnitus. These reports prompted us to evaluate, with the assistance of quantitative EEG analysis, the role of vertebral dysfunctions in patients suffering from tinnitus.
There's a big debate over here whether to privatise our National Health Service at the minute, i say sooner the better. Brainstem audiometry showed normal tracings and latencies in all these subjects, and none suggested retrocochlear pathology. Normally, we recorded the baseline and four head-tilt positions, and we displayed individual box plots for comparison.
If the data array is an odd number, Q3 includes the median; Q3 is known as the seventy-fifth percentile. The maneuver does not indicate whether the otolithic organ has a deficit, and we might find a normal response of the otolithic organ. Of great additional importance is the correction of possible different lengths of legs [5]. Habituation is the point at which affected patients no longer are aware of the tinnitus except when they focus on it.
The correction of vertebral dysfunctions in tinnitus patients was achieved by Domtherapy [5].
Dorntherapy permits the correction of dysfunctions without any risk of injuring muscles or tendons (or both).
The patient reported a remission of the right-sided tinnitus and a decrease in the tinnitus intensity in the left ear.
Evaluation of the recorded EEG data revealed significant changes within the alpha range and prominently in the alphaz band. We displayed ratios for the utriculus and sacculus to classify the shape of the data distribution. An acoustical neuroma had been removed from his left ear 6 months before this investigation.
Box plots are useful in exploratory data analysis when two or more data sets are being compared.



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