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Would knowing that oxymetazoline spray is the generic form of the off the shelf Dristan nasal spray? OBJECTIVE: to evaluate the effectiveness of stapes surgery for improving tinnitus symptoms. MATERIALS AND METHODS: This prospective study included 29 patients with surgically proven otosclerosis, who had undergone stapedectomy or stapedotomy. CONCLUSION: We conclude that stapes surgery is quite effective for treatment of tinnitus as well as improvement of hearing. Otosclerosis is a common cause of progressive hearing loss in patients with an intact tympanic membrane. Several treatment options such as hearing aids, fluoride, biphosphonates, and stapes surgery are available1. The goal of this study was to determine the incidence of tinnitus, and its discomfort level in otosclerosis patients, using the Newman method16, and to evaluate the effectiveness of stapes surgery for improving tinnitus as well as hearing levels. This prospective study included 29 patients with otosclerosis aged between 13 and 65 years old. Stapes surgery was performed under general anesthesia in 12 patients and local anesthesia in 18 patients depending on the patient's or surgeon's preference. Before and after the surgery standard audiometry including speech recognition threshold (SRT), speech discrimination score (SDS), air bone gap (ABG), pure tone average for air conduction (AC) and bone conduction (BC) at 4 frequencies (0.5, 1, 2, 4 kHz), and a tympanogram were performed in all patients.
A total of 29 patients with a mean age of 39 years (range: 13-65) were included in the study, 20 were female and 9 were male.
On the first day after surgery, tinnitus was aggravated in 3 patients, unchanged in 5 patients, and improved in 21 patients. Interestingly, 2 of the 3 patients who did not have tinnitus before surgery experienced a short episode of tinnitus postoperatively which disappeared completely within one month of surgery.
The mean of the pre- and post-operative SRT, ABG, AC, and BC results are presented in Table 3.
In this study discomfort from tinnitus before surgery was not associated with hearing level. In another approach, Gristwood studied 1014 otosclerotic patients who had a 65% incidence of tinnitus and observed that preoperative tinnitus was significantly correlated with gender, mean AC, mean BC, and ABG. In terms of predicting post-operative outcomes, Ayache and Szymanski stated in their studies that there was not any parameter that could predict the tinnitus status postoperatively5,10. Stapes surgery can successfully improve tinnitus as well as hearing levels in patients with otosclerosis. Paper submitted to the RBCMS-SGP (Publishing Management System) on April 20, 2012; and accepted on August 16, 2012. Ear Candling is an ancient and natural therapy handed down to the modern world via the native American Hopi Indians of North Arizona.
This induces a pleasant feeling of warmth and a balance of pressure in the ears, forehead and sinuses. This physical effect is often described directly after the treatment as a soothing, pressure and pain relieving sensation, mainly in the ear and head area.
The sound of the flame creates a vibration that travels through the ear candle penetrating the eardrum which in turn vibrates the inner ear bones at such a frequency it is like an inner ear massage.
The heat from the ear candle and the vibration help to soften and break up any ear wax or mucus that is blocking the head and ears, and once broken down the body finds it easier to flush the waste through the lymphatic system. Following a consultation in which we will discuss your medical history, you will be made comfortable lying on your side on the couch with your head on a pillow and you will be covered with a warm blanket.
Sound levels are almost exclusively measured with units called Decibels, abbreviated as dB. Decibels are the measurement of the exact levels of sound pressure reaching your eardrums. Once you start getting close to 100 dB or so a set of relatively cheap ear plugs starts looking like a sound investment (pun intended again).
120-130 dB – jackhammers and some other heavy construction tools, a loud car stereo, band practice. 60-70dB – most conversation, average street traffic, a TV set, dishwasher or vacuum cleaner. To help you minimize the risk of dangerous sound levels, HEAROS ear plugs have created several different ear plug styles and noise reduction ratings (up to NRR 33) to protect your hearing.
We compared symptomatic (tinnitus, hearing loss, and vertigo) and audiological findings obtained before and after surgery. When deciding upon management in patients with otosclerosis the presence of tinnitus should be considered as well as hearing level.

The study protocol was approved by the ethics committee of Mashhad University of Medical Sciences and informed consent was obtained from all patients.
Stapedectomy was performed in 4 cases and 25 patients underwent stapedotomy, where the same technique was used for all procedures.
The level of discomfort caused by tinnitus was graded using Newman's method with scores from grade I to V. Fisher's Exact test and Student's paired t-test were used to compare hearing levels and tinnitus discomfort levels before and after surgery.
According to Newman's grading method, 2 patients had grade I tinnitus, 4 patients had grade II, 11 patients had grade III, and 9 patients had grade IV tinnitus.
One week after surgery tinnitus was worsened in one patient, unchanged in 5 patients, and improved in 23 patients in comparison with the preoperative status.
Vertigo happened during the surgery in 9 out of the 18 patients who did not receive general anesthesia. Patients with otosclerosis often also suffer from subjective tinnitus that can be severe and disabling. However, it wasn't associated with age, duration of hearing loss, and degree of footplate involvement21. However, Gersdorff and Sakai showed that the surgical technique used was important in the outcomes related to tinnitus and that better results were achieved by stapedotomy as opposed to stapedectomy7- 8. Thus, patients suffering from discomfort caused by tinnitus could be good candidates for stapes surgery. Otorhinolaryngology-Head & Neck Surgery - Mashhad University of Medical Sciences - Mashhad - AC - Iraque. Otorhinolaryngology-Head & Neck Surgery, Otorhinolaryngology-Head & Neck Surgery Department, Imam Reza Educational Hospital - Mashad University of Medical Sciences - Mashhad - Iraque. MD; Associate professor of the Ear, Nose and Throat Research Center, Emmam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences. Otorhinolaryngology-Head & Neck Surgery Department - Mashhad University of Medical Sciences - Mashhad - Iraque. The candles are still made today on the basis of the old traditional formula originating from the Hopi Indians. A light suction action (chimney effect) and the movement of the flame create a vibration of air in the ear candle, generating a massage-like effect on the eardrum. The treatment may also spontaneously cause freer nasal breathing and an improved sense of smell, even when the nose was blocked before treatment.
This then pushes further into the eustachian tubes and the sinuses helping to push out any blocked pressure.
This treatment is therefore detoxifying, and is still working in the body up to 48 hours after the treatment. The entire range of effective human hearing occurs between one and two bels — so a smaller unit is required. Excessively loud volumes damage the cochlear hairs, especially if sustained for extended periods of time. HEAROS offers earplugs for loud noises, loud snoring spouses, shooting (hunting, target practice), motorsports and traveling.
Using Newman's method the level of discomfort caused by tinnitus was scored from grade I to V pre- and postoperatively. The technique has been shown to improve hearing, is well established with a long history, and has been proven to be effective in several studies. A total of 25 Teflon-piston and 4 titanium (Big Easy) prostheses, one of which was offset (inclined), were used in this study. Follow-up visits were conducted on the first day, the end of the first week, and the end of the first month after surgery and the patients were asked about tinnitus and vertigo. We evaluated the association of presumed risk factors with the outcome of surgery on tinnitus using Pearson's correlation and Student's independent t-test.
One patient had pure conductive hearing loss and all others had a concomitant bone conduction deficit to some extent (mixed hearing loss).
On the third visit, one month after surgery, 24 patients had complete or partial recovery (82.8%) from tinnitus and in 5 patients their tinnitus remained unchanged.
In the first day after the operation, 2 patients had severe vertigo which required medical therapy and another 13 patients reported mild vertigo. In this study, tinnitus was present in 89.7% of our otosclerosis patients, 31% of whom suffered from severe disabling tinnitus. Causse and Vincent proposed that some causes of tinnitus in otosclerotic patients could include poor vibration of the inner ear fluid, fixation of the foot plate, proteolysis of Corti hair cells, acoustic trauma, and spiral ligament hyalinization that impairs blood supply to the inner ear via the stria vascularis18-19.

Similarly, in this study we didn't find any risk factors for predicting tinnitus discomfort before surgery or its recovery one month later. Incontrast, Merchese and House achieved similar hearing results (ABG closure) with both techniques13- 14.
The comparative analysis of clinical symptomatology before and after the operation of otosclerosis. There is also the added benefit of the herbal essences within the ear candle transferring through the skin and into the blood stream helping to relax and calm you.
The eardrum vibrates as pressure waves strike it, causing the hairs of the inner ear area called the cochlea, to vibrate as sound level increases.
It is a dimensionless unit, meaning that Decibels are not measured from some objective absolute zero value.
Sound levels can also vary due to factors like the acoustics of one’s surroundings and individual hearing loss.
You don’t have to be popping off shotgun rounds every week or working at the airport to do it, either.
Also, HEAROS makes waterproof ear plugs to protect your ears from infections like swimmers ear.
The pathological process underlying the disease is an inflammatory lysis and remodeling of the bony labyrinth and a variety of etiologies such as genetic, vascular, viral (especially Measles), and hormonal factors are believed to play a role in the development of the condition. Although surgery is not traditionally indicated for treating tinnitus alone, many patients report alleviation of tinnitus after surgery5-15. The grade of tinnitus present was determined at each of the post-operative visits and postoperative audiometry was done one month after surgery. In 16 patients hearing loss was bilateral and we selected the ear with the worst hearing for stapes surgery.
Grade IV and V tinnitus is considered to be severe disabling tinnitus and 9 cases were included in this group; the other 17 patients with tinnitus had mild to moderate discomfort.
Similarly, Ayache reported the presence of tinnitus in 74% of otosclerosis patients, 24.6% of whom had severe disabling tinnitus5. Tinnitus in otosclerosis could also be attributed to stapes immobility and conductive hearing loss which may be capable of causing limited and reversible changes in central auditory pathways. Sparano and Sobrinho indicated that smaller postoperative ABG was associated with better tinnitus recovery11-12, but in Terzic's study gap closure was not associated with tinnitus improvement22. The exclusion criteria were previous stapes surgery on the same ear and unconfirmed stapedius fixation during surgery.
Before the procedure all patients had negative Rinne tests at 512 Hz in the ear selected for surgery. There was no significant association between tinnitus severity and other parameters such as age, sex, and family history of otosclerosis.
One month after surgery 3 patients had mild vertigo and the rest of them had no balance complaints. In studies by Oliviera and Del Bo, 91% and 56% of patients, respectively, were reported to be annoyed by tinnitus6,17. In our study significant hearing improvement was achieved after surgery with ABG measurements of less than 20 dB one month after surgery observed in 24 patients (82.8%).
Patients are frequently between 15 to 50 years old on presentation and one half of patients also have a positive family history of the disease1-4. Patients' data, including age, gender, family history of otosclerosis, and the occurrence of vertigo, were recorded in a checklist. Furthermore, the patients' levels of tinnitus discomfort were not associated with their preoperative hearing levels (SRT, ABG, and AC) (Table 1). In our study 3 patients did not complain of tinnitus before surgery, in 2 of them tinnitus ensued after surgery but was completely resolved within one month. Stapes surgery not only reduces conductive hearing loss but also improves the mechanics of the cochlear fluid, as explained by Szymanski10, and this may account for tinnitus recovery without hearing improvement in some patients.
In addition, tinnitus recovery after surgery was positively correlated with conductive hearing recovery (SRT, mean AC, ABG).
In Del Bo's study tinnitus started in 7% of patients postoperatively, contrary to Ayache, who reported no similar cases5,17.

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