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Author: admin | 22.04.2016 | Category: Ear Drops For Tinnitus

This study was undertaken to determine how many cases of chronic tinnitus in a clinic population resulted from cerumen removal procedures and to summarize cerumen management methodologies and recommendations that will reduce the likelihood of such serious complications. Irrigation of the external auditory canal to remove cerumen is performed on more than 150,000 ears per week in the United States [1]. We mailed detailed questionnaires to patients prior to their initial appointment at the Oregon Health & Science University (OHSU) Tinnitus Clinic between 1986 and 2000.
The average age of these 11 patients (53.2 years) and the fact that 7 3% of them are men are both consistent with patient demographics in this clinic.
All the patients represented in Table 1 complained of ear pain during the cerumen removal procedure that initiated their tinnitus.
Patient 1 also experienced mild hearing loss (HL) at 8,000 Hz (threshold increased from 5 to 30 dB HL) in her right ear as a result of curettage. At the time of her tinnitus clinic appointment, patient 3 had elevated pure-tone thresholds from 3,000 to 8,000 Hz in her left ear as compared to thresholds in the right. Only 11 patients (0.46%) of 2,400 who visited this tinnitus clinic between 1986 and 2000 reported that their tinnitus began as a result of cerumen removal procedures performed by clinicians. Two patients claimed that their own application of ear drops or hydrogen peroxide caused chronic tinnitus to start. Even though cerumen removal is usually performed with a minimum of complications, an important factor for clinicians to remember is that the potential for initiating chronic conditions (such as hearing loss or tinnitus or both) exists. According to Ballachanda and Peers [16], "Microscopes represent state-of-the-art visualization of the tympanic membrane and ear canal because they provide a three-dimensional view, free both hands, and offer variable amounts of magnification." Pender [6] also encouraged clinicians to use an office surgical microscope, especially when wax is impacted and binocular vision (depth perception) becomes a distinct advantage. Softening Impacted Cerumen Before Removal In the case of impacted cerumen, a different approach is advisable. Grossan [3] offered this advice: In both complex and simple cases, the procedure should never be continued beyond the patient's comfort level. Tinnitus Clinic, Oregon Hearing Research Center, Department of Otolaryngology, Oregon Health & Science University, Portland, OR.
Tinnitus is a noise, a ringing, or a roaring sound in the affected ear and is becoming an increasingly serious problem for health care systems. The term tinnitus is derived from the Latin tinnire ("ringing") and is defined as the perception of sound in the absence of any appropriate external stimulation.
The incidence of patients experiencing tinnitus in Germany and the Western world is approximately 10%. Today, such integrative therapy concepts as cognitive-behavioral treatment compiled from counseling, relaxation therapy, music therapy, and pharmacological preparations (lidocaine, neurotransmitters) are regarded as promising therapeutic approaches for managing tinnitus [7].
AST is a complex program of MT originally employed in the treatment of chronic pain and developed specifically for tinnitus treatment.
Finally, the objective of AST is to bring about a change in sound perception that induces relaxation, reduces anxiety, and stimulates changes in unfavorable behavior patterns, thus improving the emotional state. The outpatient therapy (duration, 2 weeks) with AST consisted of a total of 38 hours of therapy (20-hr psychological training, 10-hr MT [AST], 8-hr kinesi-therapy) and also included counseling by ear, nose, and throat experts, orthopedists, and dentists. At the Tinnitus Therapie Zentrum Krefeld (Germany), we performed an observational study on a multimodal treatment concept (Krefelder-Modell) being applied on an outpatient basis for subacute and chronic tinnitus over a projected period of 2 years. For an evaluation of the efficiency and sustained success of the therapy, we applied the t-test to show significant differences of tinnitus questionnaire scales after therapy. As the treatment concept presented in this study (Krefelder-Modell) is a multimodal concept, the different elements of treatment can be compared to achieve more detailed results on the efficiency of the MT training program (AST). To evaluate effectiveness of the therapy and to render the results comparable with each other and also with other treatment facilities in the health care sector, we calculated effect sizes according to Cohen [18] and corrected according to McGaw and Glass [19]. Patients were also asked how often they resorted to seeking assistance through the health care system over 6 months before treatment, and they had the option of several possible answers. The total score of the tinnitus questionnaire (Tinnitus Fragebogen [TF]) at the different measurement points is shown in Figure 2.
In a comparison of the individual therapies, AST was responsible for a surprisingly high percentage of the positive total result and clearly was preferred by patients, despite the fact that psychological training was twice as long (20 therapy session hours as compared to 10 for MT). In answer to the question of whether the therapy helped them to cope better with ringing in the ear, 40% of patients described the success as excellent, 29% as good, and 16.8% as satisfactory.
An analysis of the tinnitus problem, particularly from a traditional perspective, suggests a general confusion among most experts, although many scientists have explored the problem. In this study, we were able to demonstrate that the multimodal concept achieves highly significant changes. If we assume that tinnitus is not a disease but a symptom of an underlying process, singular symptom-oriented approaches will fail [2]. Our follow-up interview of patients after 6 months showed a high degree of sustained therapeutic success. The subjective symptom of tinnitus is a phenomenon that the unaffected cannot easily understand, as defining a cause is difficult in most cases. This study demonstrates that MT is an effective treatment approach and offers a way to make progress in tinnitus treatment. Researchers have uncovered brain abnormalities responsible for tinnitus, chronic pain and phantom pain. In the newest findings, researchers from the Georgetown University Medical Center and Germany’s Technische Universitat Munchen found brain abnormalities which can contribute to phantom pain as well as tinnitus and chronic pain.
Research findings showed how neural mechanisms that typically control noise and pain signals can become dysfunctional. The learning and reward centers of the brain are responsible for feeling these continued sensations.
The same area of the brain which creates these changes is the same area which can hopefully lead to restoration. Consultant neurologist, Markus Ploner, said, “Better understanding could also lead to standardized assessment of individuals’ risk to develop chronic tinnitus and chronic pain, which in turn might allow for earlier and more targeted treatment.
It is believed that phantom pain stems from the spinal cord and brain, although the exact cause is still unclear.
Some researchers believe phantom pain is the result of mixed signals in the brain as a response to an amputation.
Other studies have shown that amputation causes the brain to remap the missing body part’s sensory circuitry to another part of the body. Other factors that cause phantom pain include nerve damage, scar tissue and physical memory of pre-amputation. There is a rise in new treatments for phantom pain, including the use of an electrical prosthetic limb, stimulating the motor cortex, and the potential use of virtual reality technology. Statistics indicate that just over 30-million Americans experience low-back pain at some point in their lives.
On any matter relating to your health or well-being, please check with an appropriate health professional.
Rauschecker fund that the brain reorganizes itself after an injury or a very loud sound to prevent the normal reduction of pain sensation and the hearing of sounds that have no physical source. The nucleus accumbens, the ventromedial prefrontal cortex, and the anterior cingulate cortex were the regions of the brain found to be most involved in the brain malfunction that produced tinnitus and chronic ear pain. These questionnaires requested information about patients' medical, hearing, and tinnitus histories [13].
The average duration of tinnitus for these 11 patients at the time of their tinnitus clinic appointment was 22.9 months (range, 3 months-7 years). Two patients also experienced vertigo and nausea; one patient complained of loud noise exposure produced by the suction apparatus. Given the number of these procedures conducted every day, this small percentage of serious complications is encouraging. Several authors have suggested ways in which to minimize the risks associated with cerumen management. As a rule of thumb, Cerumenex should be avoided unless the ear is lavaged within 30 minutes after application in a supervised office environment" [17]. If the drum cannot be seen sufficiently to test its integrity by insufflating the canal with a balloon attached to the otoscope, one should at least inquire about any history of perforation or drainage.
Grossan [3] recommended that the Reiner-Alexander ear syringe should not be used because its "pressure is poorly controlled and the tip can block the ear canal, producing enormous pressure." Instead, he recommended other types of irrigators that allow the practitioner to control water pressure and direction perfectly.
Figure 2 is an example of what not to do during curettage, although this diagram was included in a study by Freeman [5] as a how-to illustration. However, clinicians should remain aware of the fact that serious complications can occur, especially if these procedures are conducted without the utmost care and caution.
Auditive Stimulation Therapy as an Intervention in Subacute and Chronic Tinnitus: A Prospective Observational Study .

Integrative treatment concepts are currently regarded as promising therapeutic approaches for managing tinnitus.
Some 1-2% of the population is severely disturbed by tinnitus, which may disrupt everyday activities and sleep [3]. In particular, music therapy offers the chance of a global treatment approach for tinnitus patients [14].
It consists of a total of 10 therapy sessions and employs specifically developed receptive music programs in combination with an education program.
Complete 2-week program of auditive stimulation therapy (AST) as a function of hours of therapy per day .
Data on treatment were collected and evaluated in a prospective observational study using several standardized questionnaires immediately before and after therapy and at follow-up after 6 months.
We carried out subgroup analysis of outcome measures according to the degree of tinnitus severity. Kinesitherapy having received a distinctly lower rating by patients, only the two treatment elements rated as most successful were compared with respect to their effectiveness: psychological training (PT) and music therapy (MT). The follow-up sample with regard to the TF total score did not differ significantly from that of the general population, which has been demonstrated [16]. Total score on the tinnitus questionnaire (TF) at the different measurement points, according to degree of disease severity. The details of this transition process will, however, be the subject of a following evaluation using Marcov-chains methods.
For further analysis of these findings, we calculated effect sizes at measurement times and related to the patients' subjective evaluation.
A great variety of models and treatment approaches are available, the effectiveness of which is still inconclusive.
The calculation of effect size, according to the tinnitus questionnaire results, illustrates that the most significant effect sizes occurred in the area of psychological stress and total score changes. Sixty-one percent of patients state that professional medical help was not of much use - a shockingly high figure in view of the numerous medical interventions. Furthermore, these interviews provide important feedback for therapists and show longer-term positive treatment results, specifically in the areas of well-being and reintegration of patients in their family environment, as amply demonstrated in our study. Hearing of sounds that are normally located externally is suddenly directed internally and, therefore, is difficult for others to imagine. Department of Medical Theory and Complementary Medicine, University of Witten Herdecke, Germany. Phantom pain is most recognized in those who have had a limb or extremity amputated or removed. Rauschecker added, “These areas act as a central gatekeeping system for perceptual sensations, which evaluate the affective meaning of sensory stimuli – whether produced externally or internally – and modulates information flow in the brain.
With the use of MRIs it has been shown that portions of the brain which were connected to the amputated limb still show activity; hence, the person is experiencing phantom pain.
The loss of input from the missing limb disrupts the spinal cord and brain, which makes them act in unpredictable ways. Essentially, because that body part is no longer there, pain may be felt in another body part.
Speak with your doctor about treatment methods while also utilizing the home remedies to best deal with phantom pain.
No statement herein is to be construed as a diagnosis, treatment, preventative, or cure for any disease, disorder or abnormal physical state. The continuous humming sound that accompanies tinnitus was thought to be a phantom pain that was not real.
All of the brain regions rely on the transmission of dopamine and serotonin to continue the sensations of chronic pain and ringing in the ears. These questionnaires requested information about patients' medical, hearing, and tinnitus histories. Information from these questionnaires was entered into a database known as the Oregon Tinnitus Data Registry [14,15]. Eleven of these patients reported that their tinnitus began soon (immediately to 3 days) after they underwent cerumen removal procedures performed by a clinician. Figure 1 gives the distribution of tinnitus durations for the last 2,337 patients who have been treated in this clinic. Before the physician began this procedure, the patient explained that she has small ear canals and asked him whether he was going to use the microscope, as her doctor usually does.
Of course, this statistic applies only to patients who sought treatment in this clinic and should not necessarily be applied to the general population.
Possibly these patients did not provide entirely accurate or complete accounts of what they did to their ears. If there is any doubt, one should assume that the drum is not intact or is at least vulnerable to injury" [9]. Grossan [3] also recommended that oral jet irrigators should not be used because "this type of irrigation causes unacceptable trauma to the stapes and cochlea." Dinsdale et al.
A curette in that position prying cerumen away from the tympanum would undoubtedly cause pain for the patient and could also produce hearing loss, chronic tinnitus, and other serious complications.
The curette in this position (prying cerumen from the tympanum) will surely cause pain for the patient and can also result in hearing loss, chronic tinnitus, and other serious complications. Complications associated with cerumen removal can include bleeding, ear pain, infection, dizziness, vertigo, and nausea. The aim of this study was to present the results of auditive stimulation therapy, a program of music therapy developed specifically for tinnitus treatment.
The term objective tinnitus is used for ear sounds based on genuine physical vibrations-oscillations that may be perceived by others or even measured [1]. If the symptoms continue for 6 months, we consider the condition to be chronic, the degree of which differs considerably from person to person and affects patients in different ways [4].
Harmony, for instance, as a connecting link between rhythm and melody also has a social function. Musical self-control (MSC) training is a music program designed on the basis of music psychology and MT, the effectiveness of which was demonstrated in a clinical study [16].
Apart from anamnestic data, the questionnaires asked for a subjective evaluation of treatment results. Therefore, Figure 3 shows the mean scale values of the tinnitus questionnaire before and after outpatient tinnitus therapy (n = 146) and also at follow-up after 6 months (n = 106).
The combination of MT-PT comprises the partial therapies MT and PT, and this suggests that the share of MT in this result is higher than that of PT.
The standard therapies in Germany include medication to improve blood circulation or, with increasing frequency, infusions as part of a hospitalization period, with disproportionate side effects as compared to the severity of the complaints [20].
In comparison with effect sizes of other studies with hospitalized patients and outpatients summarized in a meta-analysis by Schilter [21], the advantages of this treatment concept become evident. Much suggests a holistic treatment approach, in which ringing in the ear is viewed as a sign of particularly high stress. The affected individual suffers from a personal noise problem that is inaudible to others; consequently, others lack understanding. How we integrate sounds into our daily life and how they become perceived as noise or music is a complex activity involving the physiological, the psychological, and the social.
Metaanalyse zur Effektivitat medikamentoser und psychologischer Therapien bei chronischem subjektivem Tinnitus.
A preliminary study of creative music therapy in the treatment of children with developmental delay. A prior theory on phantom pain is that it is associated with a psychological problem, but research has shown a connection to the spinal cord sending signals to the brain.
By tracing the flow of signals, researchers were able to show where circuit breakers should be working but aren’t. Chronic pain can be a result of the brain continuing to feel pain long-after an injury has been healed. The statements herein have not been evaluated by the Foods and Drugs Administration or Health Canada. This discovery provides a target that may end the suffering of millions of people who experience chronic ear pain and tinnitus by using dopamine modulation to restore the brain circuits to their original configuration.
Records were analyzed to determine how many patients reported that their chronic tinnitus began as a result of cerumen removal procedures. We analyzed records in this database to determine how many patients reported that their chronic tinnitus began as a result of cerumen removal procedures.

Table 1 lists information related to these patients and the cerumen management procedures that were associated with the onset of their tinnitus. The substitute otolaryngologist decided to use his head mirror without any additional magnification.
Therefore, we cannot conclude that the procedure caused both additional hearing loss and tinnitus. In such an instance, the patient is instructed to instill a few drops of hydrogen peroxide or mineral oil daily for 2-3 days to soften the wax. Freeman recommended that "if the wax is hard, use a right-angle hook" with no suggestion that softening agents should be used.
Although unpleasant for patients, these symptoms usually resolve within a relatively short time. We collected data on outpatient treatment results from 155 tinnitus patients and evaluated them in a prospective observational study with three defined times of measurement (start, end, and 6 months after the end of treatment). The objective of MSC training is to improve patients' control of ear sounds and to relieve their feelings of helplessness. The tinnitus questionnaire designed by Goebel and Hiller [17], now the recommended standard tool throughout Germany, was used at all times for measurement. In addition, MT shows excellent effect sizes over longer periods, a clear indication of the quality of the concept of AST as to contents and didactic implementation. With an overall effect size of 0.63 from pretherapy to follow-up, other multimodal therapeutic strategies range far behind the results of the therapeutic approach described in this study. The question of whether the symptom is of a somatic or a psychosomatic nature seems to be of no importance in the treatment of subacute and chronic tinnitus. If a reorientation in terms of perception takes place, the consequences of this reorientation, as therapeutic effects, are best seen in follow-up assessments. A therapeutic intervention that incorporates these understandings appears to offer considerable benefits, not as a cure but as a healthy adaptation. Die verlorene Stille: Auswirkungen und psychotherapeutische Moglichkeiten beim komplexen chronischen Tinnitus.
In G Goebel (ed), Ohrgerausche-psychosomatische Aspekte des komplexen chronischen Tinnitus.
Josef Rauschecker, director of the Laboratory for Integrative Neuroscience and Cognition at Georgetown University Medical Center, is the first to show that chronic ear pain and tinnitus are caused by brain abnormalities that were produced when the ear was first injured.
Of 2,400 patients, 11 (0.46%) reported that their tinnitus began as a result of cerumen removal procedures performed by clinicians. Unfortunately, many articles about cerumen management mention only one or two of these potential complications likely to be encountered by clinicians [4,5]. Seven of the cerumen removal procedures were performed by otolaryngologists, two by family practice physicians, and two by family practice nurses. The patient's threshold for 8,000 Hz tones has remained elevated in her right ear for 2 years since this procedure was conducted. The same can be said for patients 2, 5, 7, 8, 9, 10, and 11: All had greater hearing loss in the tinnitus ear (the same ear that experienced pain during cerumen removal), but none of them had on file audiograms that predated the procedure. Therefore, the irrigation stream should be aimed at the superoposterior region of the ear canal, not directly at the ear drum. Chronic and debilitating conditions, such as hearing loss and tinnitus, can also occur as results of careless or inexperienced attempts to remove cerumen. Apart from anamnestic data and subjective evaluation of treatment, the major outcome parameter was the score of the tinnitus questionnaire. These components form the theoretical background for auditive stimulation therapy (AST), the music therapy (MT) program evaluated in this study.
Included in the evaluation were only those questionnaires in which more than 90% of the questions were answered properly.
The results appear to confirm in particular the intention of enabling patients to continue independently with MT and to make autonomous use of receptive music programs. An analysis not only of the biological but of the psychological and social needs of patients [22] provides a more comprehensive insight into and understanding of their situation. Three additional patients reported that chronic tinnitus began as a result of their own attempts to clean their ear canals. Informed consent was obtained in writing from patients prior to their participation in this study.
Three of these 11 patients filed malpractice lawsuits against clinicians who performed the wax removal procedures. She matched her tinnitus to a band of noise between 7 and 11 kHz at 28 dB sensation level (SL) in her right ear.
Three patients not listed in Table 1 reported that chronic tinnitus began as a result of their own attempts to clean their ear canals. By following the recommendations of experts in cerumen management techniques, clinicians can avoid catastrophic complications and subsequent litigation. If we encourage the ability of selective hearing, we can promote some sounds in the hierarchy of perception and ignore other sounds or regulate them until they become hardly perceptible. The most expressive results in this context certainly are those of the follow-up, as the data from these particular patients are available for all measurement times. Therefore, our nonpharmacological intervention achieves the high effect sizes of the drug-based therapies without their concomitant side effects.
MT AST is seen as salient to their problems among patients and as highly effective, perhaps because we are not making a direct, singular psychological intervention but an intervention in the same modality as that in which the symptom is experienced. This phenomenon is most obvious in Ludwig van Beethoven who composed without being able to hear. Chronic and debilitating conditions, such as hearing loss and tinnitus, can occur as results of attempts to remove cerumen.
However, none of these texts gives a complete listing of complications that might occur as a result of cerumen removal, and none of them mentions tinnitus in this context. High-frequency sounds are perceived far more often than are low-frequency sounds [2], and a hearing impairment is detectable in more than 50% of all cases. Although several case studies reported efficacy of these treatments, the empirical support in well-controlled studies is still weak [12,13]. The Krefelder-Modell treatment concept alone uses an MT training program embedded within a complex treatment approach, indicating that the advantage - compared to other treatment forms - is principally the influence of the specific MT intervention. By accommodating sound control within an ecology of other sounds, itself within a stress-reduction context, we are offering a form of self-control that is adapted to a personal environment [23-25].
By following the recommendations of experts in cerumen management techniques, clinicians can reduce the likelihood of catastrophic complications and subsequent litigation. The excellent study by Grossan [3] does mention tinnitus as a potential complication of cerumen removal but contains no reference to the fact that tinnitus resulting from this procedure can be chronic and debilitating for a patient.
Of the 155 patients, 137 (88%) were capable of gainful employment, which means that they fell in the age range between 18 and 65 years. On this extended basis of our knowledge about hearing, we should be able to develop for affected patients coping strategies that address the causes of the problem directly and thus render the symptom superfluous.
Neugebauer reminded us that a sensory stimulation must not necessarily result in a conscious perception, nor must a sensory experience necessarily be caused by a physical stimulus. Chronic tinnitus is often associated with insomnia [10], depression [11], anxiety [12], and other conditions that detract from patients' enjoyment and quality of life.
The duration of tinnitus was more than 6 months for 80% of patients, and 43% had been suffering from tinnitus for more than 3 years. The specific way in which music therapists or musicians hear may indeed be helpful or suitable in understanding tinnitus patients and also in explaining - taking a composer as an example - how such experiences of internal hearing may also be observed in different settings in which they are absolutely normal and by no means pathological. Aldridge [25] suggested that the purpose of MT is that patients are enabled to generate expressive potentials that reveal new possibilities for becoming healthy.
Closer investigations indicated that a combination of music therapy and psychological training rendered the best effect sizes. In the context of ear ringing, MT might help to create a context of meanings that integrates the sounds or noises into the music and thus removes them from conscious perception, which would clearly promote recovery. This study demonstrated that music therapy is an effective integrated treatment approach and offers a way to make progress in tinnitus treatment.
Sounds no longer perceived as disturbing, once brought under control, are perceived as musical.

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