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22.04.2014
Varie sono le classificazioni degli acufeni proposte dagli studiosi nell'arco di mezzo secolo. La classificazione spesso proposta fra acufeni "soggettivi" ed "obiettivi" in base alla possibilita di obiettivare cioe di registrare direttamente con strumenti biomedici la presenza di acufeni a noi non appare sufficientemente realistica in quanto ad oggi non esiste ancora, tranne rarissimi casi, tale possibilita.
E stato calcolato che nella popolazione priva di difetti uditivi un soggetto su dieci soffre od ha sofferto di acufeni, mentre nella popolazione con ipoacusia, cioe con riduzione uditiva, ne soffre circa il 50%. Purtroppo questo disturbo, solo apparentemente banale, tende a creare un vero e proprio stato invalidante, coinvolgendo l'assetto psicologico ed emozionale del malato, la sua vita di relazione, il ritmo sonno-veglia, le attitudini lavorative, il livello di attenzione e concentrazione, inducendo o potenziando stati ansioso-depressivi, in una parola interferendo sulla qualita della vita. I numerosissimi soggetti colpiti da questo disturbo attendono da tempo che la scienza, riesca a dare loro nuove e concrete speranze e che la fatidica ed angosciante frase "mi dispiace non c'e niente da fare, si rassegni a convivere con questo disturbo" ancora troppo spesso pronunciata dallo specialista alla fine della visita, venga superata da proposizioni terapeutiche efficaci. Non si puo piu affermare che gli acufeni sono incurabili: oggi abbiamo raggiunto oltre l'ottanta percento di miglioramenti e successi. Millions of people have the perception of sounds when no external sound is present: for many of them the "TINNITUS" (medical word from Latin) or "ACUFENE" (from Greek) is the trouble so severe to alter deeply their quality of life. Starting from 1998 we are carrying on with success an integral program of diagnosis, medical and rehabilitant treatment of the Tinnitus with a new multi therapeutic approach, without hospitalisation. In the presentation we would like to illustrate the program to give hope of recovery to many people who live without any help to solve their own problem. We are working following two main stages with subdivisions: A 1) preliminary explicative and A2) to frame the patient clinically and diagnostically then B) therapeutics. The TINNITUS is a real difficult problem that, with a correct but complex approach, can be solved to give again people a reasonable good quality of life.
As we know "tinnitus" ("acufene" in Italian) is the perception of sounds, ringing, hissing or any other sound when no external sound is present.
Practically every one had experience of tinnitus just like a temporary nuisance, but, for millions of people it a life altering condition.
Many patients are so seriously debilitated to ask for medical assistance because they can not have a normal life. The exact physiological causes of tinnitus are not well known but we begin to understand many things. Extrinsic: vascular cause, muscular, from secretion, from joints and arthritis, otosclerosis, etc. Intrinsic o "idiopathic": identifiable in auditive neuro-sensorial or without apparent cause.
With Extrinsic tinnitus we have to follow the traditional medical approach (clinic, pharmacological or surgical). With Intrinsic or "idiopathic" tinnitus we get very good results with AIRS "Tinnitus Integrated Program" TIP Therapy based on the deep analysis of the global hearing mechanism.
We start to work on the problem on 1985 with research on Cochlear mechanics and Spontaneous Otoacoustic Emission.
The STAFF is compound of physicians, specialist and therapist on rehabilitation, volountairs specialist on the field.
In the past, before the 1998, in our first experience, we had 32% of patients with improvements, 64% unchanged and 4% worse. From 1999 we have now the evolution of the first multitreatment: we have developed an intensive and continuative program "Tinnitus Integrated Program" TIP with very excellent and important results.
At the end of year 2000, with almost 300 patients, after a follow-up of 12 months, we had: 8% of patients with total disappearance of Tinnitus (our STAR) , 31% of patients with improvements and period of total disappearance of the trouble (EXCELLENT), 32% with a reduction of the Tinnitus perceptibility (GOOD), 22% with increase of the endurance (SUFFICIENT), 8% unchanged (INSUFFICIENT) and 0% worse. Glutamate is the main afferent neurotransmitter at the IHC and it may have excito-toxicity on the IHC, mediated by its ionotropic receptors AMPA and NMDA, balanced by Dopamine. The activity of IHC afferent stimuli can be monitored by OAEs in the active cochlear mechanism (also DPOAEs during the GDEE infusion treatment). With Intrinsic or "idiopathic" tinnitus we get the best results with TIP: I think that the most important starting point of the TIP Therapy is the deep analysis of the global hearing mechanism.
Sound and external acoustical signals are first codified at cochlear synaptic level in electro magnetic impulses and transmitted to the VIII acoustical nerve. The impulses travels trough some shunting stations to the brain (central and under cortical path) where we have the "detection" of the acoustical signal. Tinnitus can origin in the "perception" area where we have the "emotions": is the "limbic" area or system, where all our sense are passing throw, especially the acoustical signals, and where we have the control center of our vegetative nervous system. The modified TRT follow such approach and act on the reeducation of the patient on the reshuffle and the unconscious fear of tinnitus. We have seen that an incomplete treatment can give poor effects but we can conclude with the communication that Tinnitus, in many case, can be treated with success: "Tinnitus Integrated Program" TIP, if completely applied, offer the best results. Per ototossicita si intende la possibilita, come effetto collaterale del farmaco, di determinare lesioni all'orecchio, nel senso di un danno all'organo dell'udito o disturbi uditivi.


AIRS ONLUS: (Statuto del Centro Acufeni) Associazione per la ricerca sulla sordita, organizzazione non lucrativa di utilita sociale. L'AIRS si occupava di tutti i problemi legati al disturbo ed ai danni uditivi; in particolare ha aperto il primo centro nazionale per la cura degli acufeni (tinnitus o fischi uditivi) con importanti risultati clinici.
Patients suffering from Meniere's disease are particularly sensitive to negative pressure in the middle ear. Meniere's disease is a disorder of the inner ear characterized by attacks of vertigo associated with hearing loss and tinnitus. Clinical experience shows that those afflicted with Meniere's disease frequently show sensitivity to negative pressure. In conjunction with the Ear Institute, Queenswood, Pretoria, South Africa, we have conducted a clinical trial to investigate the effectiveness of positive-pressure pulses delivered by a handheld, manually operated bellow device called the P-100 (Enttex, Port Melbourne, Australia). A ventilation tube was inserted either in the office setting or, alternatively, in the operating theater. The Meniett device consisted of an electronic pulse generator that produced a quick succession of pulses for 1 minute. In contrast, the P-100 consisted of a handheld, manually operated device that could also produce only positive pressures not exceeding 250 mm H2O (Fig. We recorded symptoms before and after treatment with positive-pressure pulses following the protocol pictured in Figure 3. Among the symptoms that improved significantly were vertigo, fullness in the ear, and nausea (Fig.
We believe that positive-pressure pulses on the roundwindow membrane could have the effect of an ion shift, particularly potassium, which has, as Horner [8] pointed out, an increased concentration within the scala tympani in patients with Meniere's disease. This hypothesis is supported by electrophysiological observations in patients with Meniere's disease. The diagram in Figure 6 shows the effect in the electrocochleogram after the insertion of a ventilation tube, with a clear improvement of the action potential.
Both the insertion of a middle-ear ventilation tube and positive-pressure pulse treatment address a disturbed relationship between the middle ear and the inner ear. The authors thank Colin Anderson, PhD, Associate Professor, Department of Anatomy and Cell Biology, University of Melbourne, Australia, for his assistance in the statistical analysis.
Sicuramente oggi la comunita medica e scientifica e in grado di assumere di fronte al problema degli acufeni un atteggiamento piu costruttivo rispetto al passato. Centro Acufeni, si e sperimentato e perfezionato un protocollo terapeutico sviluppato, sulla base di studi, ricerche e confronti a livello internazionale, che ha portato a risultati e successi notevoli. Mattia ha presentato una relazione al 17^ Congresso Internazionale di Acustica tenutosi a Roma dal 2 al 7 settembre 2001, illustrando i successi ottenuti. For example, attacks of vertigo can be triggered by a descent in an aircraft when ventilation of the middle ear can become critical. Morphologically, we find an endolymphatic hydrops in the inner ear, but it remains unclear as to whether this is causally linked to the symptomatology.
Five days after the insertion of the ventilation tube, a decision was made regarding whether to proceed with the trial. The P-100, a handheld, manually operated device, is smaller than a mobile phone and easily stored in a pocket or handbag . Numbers from 1 to 5 indicated the severity of symptoms and corresponded in ascending order to never, seldom, sometimes, often, or always. Tinnitus and hearing remained practically unchanged after treatment with positive-pressure pulses.
It is explained by a reduction in the endolymphatic fluid volume by redistribution through the inner-ear pressure communication routes [6]. In early stages of Meniere's disease, we can observe that the improvement of symptoms after the insertion of a ventilation tube parallels an improvement of the summating potential-action potential ratio in the electrocochleogram and that this improvement is linked to an action potential effect. Electrocochleogram after insertion of a ventilation tube in a patient with early-stage Meniere's disease. Our clinical trial confirms that positive-pressure pulse treatment in Meniere's disease is a true alternative to current treatment modalities. American Academy of Otolaryngology Head and Neck Foundation, Inc., Committee on Hearing and Equilibrium.
Cianfrone and me, founded the Italian Association for Research on Hearing Loss and we start the first integrated and multitreatment approach on Tinnitus. Positive-pressure pulse treatment has been shown to have a beneficial effect on the symptomatology and is now a true alternative in the treatment of Meniere's disease. In animal experiments, we can create an endolymphatic hydrops, but typical symptoms are missing.


As a consequence of this observation, exposure to positive pressure, as demonstrated in pressure chambers, was found to have a beneficial effect on the symptomatology [1].
All patients participating in this trial had a confirmed diagnosis of Meniere's disease and had frequent attacks. Although some patients experienced an improvement of their symptoms, 19 were keen to proceed with the positive-pressure pulse treatment. After obtaining a seal in the ear canal with the ear plug, we asked patients to compress the bellow some 10 times in succession. We performed statistical testing using a nonparametric, Kruskal-Wallis single-factor analysis of variance by rank [5]. A slight difference was evident between the two devices, with the Meniett not performing quite as well as the P-100. Three patients thought that hearing improved a little, and one patient thought that hearing was slightly worse. Although patients with Meniere's disease in general show type A tympanograms, to assume that Eustachian tube function is normal is misleading. The P-100 is the preferred device (as compared to the Meniett) for its convenience of use and its considerably lower cost. Immediate relief of symptoms during acute attacks of Meniere's disease, using a pressure chamber. The effect of transtympanic micropressure treatment in people with unilateral Meniere's disease. Immediate effects of middle ear pressure changes on the electrocochleographic recordings in patients with Meniere's disease: A clinical placebo-controlled study. Mario Mattia, Professor of acoustics and ergonomy for hearing trouble and noise pollution. In this study, we compared two devices that produced positive-pressure pulses delivered to the inner ear via the external ear canal and after the insertion of a middle-ear ventilation tube. Positive-pressure pulses as treatment for Meniere's disease is now a well-established form of management [2,3].
Of these, 19 were seeking further treatment options for relief of their symptoms, as the insertion of a ventilation tube alone did not give enough relief. Positive-pressure treatment was conducted either with the Meniett device (Metronic Xomed Inc., Minneapolis, MN, USA) or the P-100 (Enttex).
Patients were allowed to use it according to their needs but not more than eight times daily.
We considered each symptom separately, comparing the mean rank before and after treatment with either the P-100 or the Meniett device. The latter was not a concern, as other more important symptoms, such as vertigo and nausea and fullness in the ear, had improved.
Since the introduction of the modified Holmquist test, one can regularly observe that patients with Meniere's disease invariably are unable to equalize negative pressure in the middle ear [9].
Both devices (Meniett and P-100) were equally successful and confirmed that positive-pressure pulse treatment is a true alternative to current treatment modalities. The P-100 is small (smaller than the size of a mobile phone) and very light and stores easily in a pocket or handbag.
If we detected a significant difference between means, we used post hoc, nonparametric multiple comparisons for unequal sample sizes to determine which mean ranks differed [5].
The discrepancy might have been due to the convenience of the P-100, which was immediately available when needed and did not require a cumbersome setup of the device.
Three patients refused to return the P-100 after the clinical trial: The device had improved their life so much that they did not want to part with it. As all such patients had type A tympanograms, we concluded that the Eustachian tube dysfunction must be very mild. However, the P-100 is the preferred device, particularly for its convenience of use and its cost, which is considerably lower. We saw a slight difference also between the severities of symptoms in both groups, which finding could have accounted for the discrepancy, but this difference was not significant. The diagnosis of Meniere's disease was made following the criteria of the American Academy of Otolaryngology [4].



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