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Author: admin | 16.08.2015 | Category: Homeopathic Treatment For Tinnitus

Instillation of gentamicin in the middle ear to cure severe Meniere's disease is of considerable value in the control of vertigo.
Meniere's disease is characterized by a combination of fluctuating hearing loss and the presence of aural fullness, tinnitus, and intense rotatory vertigo attacks.
Conservative treatment, including a low-salt diet and the regulation of internal medical disorders, a stress-free life, and pharmacological therapy may help some patients such that no further treatment is necessary. Ototoxic treatment in the middle ear offers a relatively safe way to treat this disabling form of Meniere's disease, carrying with it only the risk of damage to one's hearing ability. Since 1980, sixty-nine patients with a disabling form of Meniere's disease have been treated with gentamicin instillation in the middle ear.
During the period 1980-1988, gentamicin was instilled daily through the tympanic membrane until there plantation, Patient 7 suffered from Meniere's disease in the left ear. Previously, an articulation test of grammatically correct but nonsense Japanese four-segment sentences improved after electrical stimulation of the ear. The side on which the device is implanted is very important, especially in bilateral tinnitus patients. We used a 10-khz sinusoidal wave for a carrier frequency because of the efficacy of the magnetic conduction system [15].
When a fistula forms, blood from an artery under high pressure and flow goes directly into a vein, which is a low pressure and low flow structure.  Even though the fistula is not directly on or within the brain, it can nevertheless lead to brain dysfunction by congesting the brain venous system, as will be explained below.
Finally, many patients who have dural fistulas of all sizes and locations can have a myriad of symptoms such as different kinds of headache, tiredness, loss of concentration, memory problems, even hallucinations, psychosis or other psychiatric problems.  Unfortunately, in these patients the diagnosis of dural fistula can be significantly delayed because dural fistulas are relatively rare, while the above symptoms are very common and usually not due to a fistula. For an in-depth presentation on treatment of Brain Dural AV Fistulas, primarily geared towards neurointerventional professionals, you can visit Techniques: Brain Dural AV Fistula Embolization page. Below are pictorial diagrams of what a fistula is like and how it can be treated.  The actual anatomy is much more complicated, but the pictures provide a frame of reference. Finally, post-embolization views, showing the coils in the cavernous sinus (white arrows) and no evidence of fistula on injections of the external carotid artery (brown arrows).  This approach, though technically challenging, can be quite successful when other venues prove unfeasible.
This patient developed a fistula on the dural covering that separates the back part of the brain, called cerebellum, from the overlying occipital lobe.
MRA images (top) and stereo MRA composite (MIP) images on the bottom, demonstrating multiple intracranial and extracranial vessels (red arrows) feeding the fistula.
The microcatheter has been positioned into another branch of the middle meningeal artery, showing residual fistula and aneurysm.  More glue is injected from this position. Post-embolization views of the left common carotid artery, showing that the fistula is gone. The drug causes diminished endolymph production and, most often, a peripheral vestibular loss.
The attacks are accompanied by intense nystagmus, which often changes direction during an attack. However, if conservative treatment is unsuccessful, pressure treatment or an endolymphatic shunt operation may be necessary. Gentamicin intratympanic treatment for Meniere's disease was developed by Lange, [1-3] and later used by Beck and Schmidt [4] and Ödkvist et al. For ipsilateral tinnitus patients, the side of implantation was the ear having the worst hearing threshold.
However, Shulman [5] reported that electrical stimulation with transtympanic electrode placement produced a sensation of vibration, auditory perception, electrical masking, tinnitus suppression, and pain.

We compared the burst wave of a 10-kHz frequency with the continuous sinusoidal wave of a 10-khz frequency.
Lange G: Die Indikation zur intratympanalen Gentamycin- Behandlung der Meniereschen Krankheit.
Beck C, Schmidt C: Ten years of experience with intratympanally applied streptomycin (gentamycin) in the therapy of morbus Meniere. Magnusson M, Padoan S: Delayed onset of ototoxic effects of gentamicin in treatment of Meniere's disease.
Tran Ba Huy P, Deffrennes D: Aminoglycoside binding sites in the inner ears of guinea pigs. Our group at the NYU Langone Medical Center is one of the premier neurointerventional centers in the world. When a fistula forms between an artery and a vein within the dura, it is called Brain Dural Fistula, or Brain Dural Arteriovenous Fistula, or BDAVF, etc.
The total amount of radiation delivered to the patient at conclusion of a dynamic CT scan, however, can be VERY high — in some cases resulting in (usually temporary) hair loss. The bottom picture is venogram obtained by directly injecting the cavernous sinus to demonstrate the basal vein (dark blue) and ophthalmic vein (light blue arrows).  Some coils have already been placed into the sinus. After vestibular rehabilitation, led by a physiotherapist, the ataxia should be resolved as a result of central compensation. During the initial attacks, a hearing loss can usually be unveiled with pure-tone audiometry and, during the periods between attacks, the hearing may return to normal. Some patients with Meniere's disease reach a state of repeated severe vertigo attacks that diminish the quality of life.
Four had been operated on using the shunt method and had experienced relapse of the disease process.
Patient 7 underwent endolymphatic shunt surgery in the left ear at another hospital in February 1997. Therefore, improved hearing after electrical stimulation may be due to improved cognitive processing in the central auditory system in addition to improved hearing at the cochlea. Hence, the suppressor was implanted in the ear with tinnitus in patients 2 and 7 because the hearing threshold in that ear was worse than that of the other ear. For example, in Patient 4, the intensity of tinnitus was the same in both ears, but the hearing level of the right ear was slightly worse than that of the left ear. According to a sensagram proposed by Shulman [5], auditory sensation was preceded by tinnitus suppression.
When the burst wave of a 10-kHz chiem' damage is minimized if the dual method of gentamicin administration is used. Presented at the Third International Symposium on Meniere's Disease, Rome; Italy, October 20-23, 1993. The details of any treatment are best discussed with the specialist performing the procedure. Fifteen to twenty percent of the patients experience an added hearing loss in the treated ear, although this percentage is reduced if the treatment is given as a single instillation on 2 consecutive days.
As a rule, the vertigo attacks are present for some time and then absent for a longer period of months or even years. In those instances, sur-gical sectioning of the vestibular nerve may be helpful, though this type of surgery carries some risks for damage to hearing and to the facial nerve and even the intracranial structures.

Ten of the patients had been treated with pressure-chamber therapy but either had not responded or had suffered a relapse. In Patient 1, the hearing threshold in the left ear (with tinnitus) was better than that of the right ear (without tinnitus), as shown in Figure 1. Shulman [5] also suggested that the most desirable outcome is to attain the tinnitus suppression threshold before auditory sensations are experienced. After several years and many attacks, the hearing loss does not return to normal between attacks.
To exclude other lesions in the internal meatus and the posterior fossa, imaging studies were performed with magnetic resonance imaging or computed tomography. In July 1997, we treated the left ear with electrical promontory stimulation for tinnitus relief.
In addition, this patient uses a hearing aid in the left ear because hearing in her right ear is too poor to benefit from hearing aid use. In bilateral tinnitus patients, the effect on tinnitus in ears without the implant is very encouraging.
According to his theory, our patients with implantable devices are the most desirable candidates for electrical suppression of tinnitus. Gentamicin should be used particularly in patients who suffer a significant and severe hearing loss, and these patients should be warned about the possibility of additional hearing deficit.
Often, the end result is an ear with a pure-tone threshold of 60-80 dB and very low speech discrimination. Patients were fully informed so that they understood the concept of a unilateral vestibular loss and the central compensation enhanced by rehabilitation. Surprisingly, hearing loss in the left ear recovered to the nearly normal level after this treatment, as shown in Figure 5. Tinnitus in the ear opposite the site of implantation in patients 4 and 5 disappeared completely postoperatively. Therefore, we should select patients whose tinnitus suppression threshold is lower than that of the auditory sensation for the implantation. Although relief from tinnitus cannot be promised, the world literature indicates that most patients suffer less severe tinnitus after gentamicin treatment [17]. Before the operation, we ascertained that electrical stimulation of the right ear (without tinnitus) made tinnitus disappear from the left ear.
Likewise, tinnitus at the unimplanted side sometimes disappeared in Patient 3 after the operation. The result in Patient 1 after the implant operation was the same as that at outpatient clinics.
In Patient 6, whose tinnitus did not disappear at outpatient clinics, tinnitus in both ears did not disappear but did improve after the operation.

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