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Author: admin | 08.04.2015 | Category: Relieve Tinnitus

Episodic vertigo is the most common reason for patients to seek and pursue treatment for Meniere’s disease. If episodes of vertigo persist despite changes in diet, medication called diuretics can be helpful.
Other options are available and include transtympanic decadron or gentamicin, decadron perfusion of the inner ear, endolymphatic sac surgery, vestibular neurectomy and labyrinthectomy surgery.
Steroid treatment of the inner ear may offer beneficial effects for the symptoms of Meniere’s disease. A powerful way of delivering steroid to the inner ear is by injection into the middle ear through the tympanic membrane. There is a 1% chance of a persistent 1 mm perforation of the eardrum at the injection site.
This form of treatment involves injection of medication through the eardrum into the middle ear. A shunt is placed in the endolymphatic sac, a reservoir for endolymph, to shuttle fluid out of the sac and into a cavity created in the mastoid.
Step 3: A mastoidectomy is done exposing the semicircular canals, venous sinus, and dura covering the brain. Step 4: Spinal fluid is drained and the brain relaxes, exposing the trigeminal nerve (responsible for the conduction of facial sensation), the vestibulocohlear nerve (hearing and balance), and the facial nerve. This is an operation to divide the balance nerves and interrupt the connection between the inner ear and the brain. The middle fossa approach is the least commonly used and involves an incision above the ear followed by removal of bone over the brain.
Another approach is the retrolabyrinthine approach, which involves incisions behind the ear similar to the endolymphatic shunt procedure.
A third approach is the suboccipital approach, which involves an incision further behind the ear and removal of bone over the covering of the brain. Learn how Metropolitan NeuroEar Group gives back to the community through numerous philanthropic efforts.
Objetivo: Observar a evolucao da surdez subita em pacientes incluidos em diferentes grupos de tratamento, de acordo com o tempo de evolucao da doenca e com as contra-indicacoes para uso das medicacoes. Objective: Determine the follow-up between pacients sudden sensorineural hearing loss treated in five different groups according to duration of disease and the drugs used for treatment.
INTRODUCAOA surdez subita (SS) e definida como perda auditiva (PA) neuro-sensorial, igual ou maior que 30 decibel (dB), em 3 ou mais frequencias consecutivas, instalada num periodo de ate 3 dias (1).
Sudden sensorineural hearing loss is hearing loss that results from damage to either the cochlea or the cochlear nerve.
The inflammation that develops and certain kinds of cell-releasing enzymes that break up protein are initially destructive. We recommend treatment with prednisone at a very high dose initially that gradually tapers over nine days. A more powerful way of delivering the steroid is to inject it into the middle ear through the tympanic membrane. Reducing or eliminating smoking is not only good for Meniere’s disease but also good for your health in general. Administration of steroids to the inner ear is an attempt to reduce the inflammation within the inner ear. From here, the steroid diffuses through the round window (one of the two openings into the cochlea of the inner ear)membrane and enters the inner ear. The medication, which is then taken up by the inner ear, destroys the hair cells of the inner ear. Of the surgical options, this is the most conservative operation with minimal risk to hearing. The mastoid bone is entered and the endolymphatic sac is decompressed, meaning that the bony covering is removed.
The ear may protrude slightly shortly after surgery, but it should return to its original position in two to three weeks.
90-95 percent of patients who undergo this operation for Meniere’s disease will not have another spell of vertigo.
The roof of the canal through which the balance nerves run is removed and the nerves are then divided.
Nearly all patients with Meniere's disease will be vertigo-free after a labyrinthectomy.

Using a high-powered drill, the mastoid bone is entered and the semicircular canals are removed. Sanjay Prasad MD FACS is a board certified physician and surgeon with over twenty years of sub-specialty experience in Otology, Neurotology, advanced head and neck oncologic surgery, and cranial base surgery. The side effects of prednisone treatment are mood disturbances, insomnia, blood sugar alterations in diabetics, and gastric hyperacidity. Close monitoring of blood pressure and potassium levels by your primary care physician is recommended.
During the procedure, the eardrum is elevated and the round window (one of the two openings into the cochlea of the inner ear) membrane is perfused with high-dose steroid.
The medication, Gentamicin, is an antibiotic that is toxic to the hair cells of the hearing and balance organ.
Unfortunately, control of vertigo occurs in only 60 percent of patients undergoing this operation.
After the operation, disequilibrium lasts until the brain learns to compensate and adapt to the lack of input from one inner ear. He is chief surgeon and founder of the private practice, Metropolitan NeuroEar Group, located in the metropolitan Washington D.C.
Metodo: Analise de pacientes atendidos no Ambulatorio de surdez subita submetidos a tratamento padronizado de janeiro de 1996 a janeiro de 2006, divididos em cinco grupos de tratamento para receber expansor plasmatico, dexametasona, aciclovir, acido nicotinico, cloridrato de papaverina e ou vitamina A. Method: Review of patients records included in a standardized protocol of treatment of the sudden sensorineural hearing loss outpatient unit between January 1996 and January 2006. Em cerca de um terco dos casos podem ocorrer queixas associadas como zumbido, vertigem ou tontura e plenitude aural (2,3). During the procedure the eardrum is elevated and the round window membrane is perfused with high-dose steroid.
This is a relatively painless procedure that involves anesthetizing the tympanic membrane and then injecting the steroid thereafter. The fluid that would normally enter the sac is shunted away from the inner ear and into the cavity created by the surgery, where it is then reabsorbed. This is an operation that is recommended to patients who have no useful hearing in the dysfunctional ear. A audiometria foi realizada antes (inicial) e apos o inicio da terapia (30, 90, 120 e 180 dias).
Inclusion criteria were sudden sensorineural hearing loss occurring within 72 hours and 30 dB or more at three serial frequencies.
This is a relatively painless procedure that involves anesthetizing the tympanic membrane with injection thereafter. Avoiding adding salt to meals and curtailing intake of snacks high in sodium, including canned foods and fried foods, can be helpful. Just as in vestibular neurectomy, after the operation, disequilibrium lasts until the brain learns to compensate and adapt to the lack of input from one inner ear.
Pacients were included in five treatment groups and had received Dextran®, dexamethasone, acyclovir, nicotinic acid, papaverine chloridrate and or vitamin A. Dentre os fatores associados temos os disturbios metabolicos que sao mais frequentes entre cocleo-vestibulopatas do que na populacao geral (7). These electrodes detect contractions of the facial muscles, and the signals are transmitted to a speaker so the surgeon may hear the responses. Resultados: A amostra compreende 139 pacientes com idade media de 45,4 anos, 52,5% do sexo feminino e 47,5% masculino, em 92,8% a surdez subita era unilateral e em 7,2% bilateral. Outcome was determined by subtracting baseline PTA (first day of the medical assessment) from final PTA (after 180 days). Nao pode ser detectada diferenca significante na resposta audiometrica entre os grupos de tratamento. Results: Complete data were collected for 139 subjects, mean age were 45,4 years, 52,5% were female and 47,5% were male, 92,8% had unilateral sudden sensorineural hearing loss and 7,2% had bilateral one. Observamos correlacao linear inversa significante entre o tempo decorrido do inicio da doenca e o primeiro atendimento e a evolucao ou resposta audiometrica. Conclusoes: O expansor plasmatico nao melhorou a eficacia da associacao entre o corticoide e o aciclovir no tratamento da surdez subita.
Nevertheless, no significant difference could be noted in audiometric assessment between treatment groups. Foram incluidos neste grupo aqueles que possuiam contra-indicacao clinica ao uso do expansor plasmatico (hipertensao arterial sistemica, cardiopatia, disturbio da coagulacao e insuficiencia renal).

We observed a significant linear correlation between time from sudden sensorineural hearing loss onset to initial visit and audiometric recovery.
Conclusion: Dextran® did not provide more benefit than steroid and acyclovir in the treatment of SSHL. As soon as treatment begins better will be the outcome prognosis for sudden sensorineural hearing loss. Nestes casos, a audiometria tonal limiar foi realizada em dias alternados,sendo programada a suspensao da medicacao e alta hospitalar na ausencia de melhora dos limiares auditivos apos tres dias. Nos casos de melhora audiometrica, o esquema terapeutico foi mantido por ate 10 dias.Para documentacao da variacao audiometrica foi utilizado o PTA, pure tone average ou limiar tonal puro. O PTA para frequencias graves foi determinado pela media dos limiares tonais das frequencias de 250, 500 e 1000 Hertz (Hz) e o PTA para frequencias agudas a partir da media das frequencias de 2000, 4000 e 8000 Hz. A evolucao ou resposta audiometrica dos pacientes entre os diversos grupos de tratamento foi determinada subtraindo-se o PTA inicial (primeiro dia de avaliacao medica) do final (apos 180 dias).Para analise estatistica dos resultados, foram utilizados o teste t de Student e a analise de variancia (ANOVA).
O nivel de significancia considerado foi de p RESULTADOSEm 129 (92,8%) pacientes a surdez subita (SS) era unilateral e em apenas 10 (7,2%) era bilateral. Quanto a etnia 77 (55,4%) eram brancos, 35 (25,2%) eram negros e 4 (2,9%) eram da raca amarela. Assim, para as frequencias graves observamos um coeficiente de correlacao de Spearman r = - 0,45 (p Grafico 1. Correlacao entre o tempo de inicio do tratamento e a evolucao nas frequencias graves.Grafico 2. Correlacao entre o tempo de inicio do tratamento e a evolucao nas frequencias agudas.DISCUSSAOA literatura mostra que a idade media dos pacientes com surdez subita (SS) varia de 43 a 53 anos, que a distribuicao por sexo e equivalente e que o acometimento em mais 95% dos casos e unilateral, semelhante ao que observamos neste levantamento (2, 4, 13, 15, 16). O unico levantamento epidemiologico de SS publicado ate o momento foi feito no Japao em tres anos distintos, em diferentes decadas e mostra que o tempo entre o inicio da SS e o primeiro atendimento variou de 11,6 ± 12,1 dias em 1974, 9,1 ± 9,8 dias em 1987 a 8,1 ± 9,1 dias em 1993 (15).
Nao podemos comparar diretamente nossa casuistica com a de NAKASHIMA et al (15), pelo tipo de desenho e por serem populacoes diferentes, porem observamos retardo ate o primeiro atendimento o que pode ser atribuido em parte a descaso dos pacientes em relacao ao sintoma ou a dificuldade de acesso ao medico.Partindo de grupos homogeneos quanto as medias iniciais do PTA e considerando-se todos os casos atendidos, houve reducao significante na media do PTA. Esta media de melhora (PTA inicial - final) foi de 21,6dB para frequencias graves e de 16,7dB para as agudas.
Apesar de nao haver grupo controle para comparacao, a literatura mostra que a melhora espontanea (sem tratamento) ocorre em 32% dos casos de SS e e em media de 15dB de PTA (3, 8), portanto menor do que a observada neste estudo. A recuperacao audiometrica estimada com o tratamento e de aproximadamente 25dB de PTA (3), semelhante a que observamos para frequencias graves.Quanto a evolucao dos pacientes (PTA inicial - PTA final) nos cinco grupos de tratamento, a diferenca observada nao se mostrou significante, tanto para frequencias graves como para agudas. Embora nao tenhamos observado significancia estatistica, a melhora do PTA foi menor nos pacientes dos grupos IV e V, que iniciaram o tratamento apos 15 dias do inicio da SS. Os grupos I, II e III iniciaram o tratamento nos primeiros 15 dias de SS, porem o melhor PTA foi observado no grupo II, o unico a nao receber expansor plasmatico por contra-indicacao clinica. Embora algumas doencas de base sejam capazes de interferir na microcirculacao da orelha interna dificultando a melhora clinica da SS, as comorbidades apresentadas pelos pacientes do grupo II, aparentemente nao significaram fatores de pior prognostico. Em nosso levantamento, o expansor plasmatico nao contribuiu para potencializar os efeitos do corticosteroide e do aciclovir no tratamento da SS, uma vez que o grupo que melhor respondeu a terapia nao o utilizou.Observamos uma correlacao linear inversa significante entre o tempo decorrido ate o inicio do tratamento e a resposta audiometrica apresentada pelo paciente, tanto para frequencias graves quanto para agudas.
Oral steroid treatment of sudden sensorineural hearing loss: a ten year retrospective analysis. Sudden complete or partial loss of function of the octavus system in apparently normal persons. Antiviral treatment of idiopathic sudden sensorineural hearing loss: a prospective, randomized, double-blind clinical trial. Treatment of idiopathic sudden sensorineural hearing loss with antiviral therapy: a prospective, randomized, double-blind clinical trial. Prognosis for sudden sensorineural hearing loss: a retrospective study using logistical regression analysis. Clinicoepidemiologic features of sudden deafness diagnosed and treated at university hospitals in Japan. Assistente Doutor do Setor de Otoneurologia do Departamento de Otorrinolaringologia da FMUSP.2.

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