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Author: admin | 11.05.2015 | Category: One Ear Ringing

We recruited 46 adult patients affected by disturbing tinnitus lasting for at least 3 years. The patient's ability to tolerate tinnitus varies; those patients who seek treatment have not been able to develop the habit of living with the symptom. This study was carried out with the objective of assessing in a prospective and controlled way the effectiveness of two different therapeutic strategies for which preliminary effectiveness tests gave conflicting results. The placebo group of patients received a device identical to the active one in terms of appearance and weight; because the laser irradiation does not cause any sensation, it was impossible for any patient to detect the real nature of the stimulation received. Patients were subjected to a general otological evaluation consisting of medical history, otomicroscopy, audiometry, and impedance audiometry.
No patient presented with deterioration or other significant changes in the audiometric threshold at the end of the trial. Intergroup differences (LLS- and LLS+) between nominal variables were analyzed with the chi-squared test. In the present study, a nonselected group of patients affected by chronic disturbing tinnitus was treated with a combined counseling method integrating hypnotherapeutic and muscle relaxation techniques. In our study, counseling and hypnotherapy had a generally good effect on the entire observed group.
Our study also confirmed a significant difference in the benefit of treatment between the LLS .
The limited sample studied (in any case limited to tens of patients) and the differences in application protocols do not allow a careful comparison of our work with other studies.
Michael Zazzio at the Audio Laser Clinic, has since the end of the 1990's been working with examination and investigation of patients suffering from hearing and balance disorders. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Michael Zazzio is a medical researcher in the field of hearing and balance disorders and his clinical treatment study on hyperacusis (oversensitivity to sound) is published in the international scientific MEDLINE indexed journal Photomedicine ans Laser Surgery, Mary Ann Liebert Incorporated Publishers and the study PHO-2008:2347 is available for purchase at the homepage of the publicist. Three Spanish researchers have repeated the laser therapy part of Michael Zazzio's study regarding hyperacusis. Beside treating hearing and balance disorders, the Audio Laser Clinic is treating cerebellar disorders.
Patients who are eager to come to the clinic for a treatment should come to an examination before the treatment is planned to start. Autumn 2016: therapy period starts on 19 September - finishes at the latest on 25 November. Effectiveness of Combined Counseling and Low-Level Laser Stimulation in the Treatment of Disturbing Chronic Tinnitus. All were treated with a combined counseling protocol constituting hypnotherapeutic and muscle relaxation techniques. It often is a disabling symptom of different disorders affecting the auditory system, and it can be associated with a wide range of pathological conditions. The general belief is that most of the people who seek treatment for "auditory buzzing" benefit simply from clinical examination and from the doctor's reassurance about the benign nature of the symptom.
This constituted 10 sessions of 40 minutes each regularly distributed during the 3-month treatment period.
If necessary for diagnostic purposes, we carried out auditory brainstem response, electronystagmography, magnetic resonance imaging, and otoacoustic emission tests. As to the differences between the groups, we performed the analysis of variance (ANOVA) for continuous variables, whereas we performed a chi-square analysis for single variables. No statistically significant difference for tinnitus side, auditory threshold class, or tinnitus classification were found. The THI score, the main tinnitus severity index considered here, was significantly reduced after treatment, whereas audiometric characteristics of tinnitus were unchanged.
Relaxation techniques were used also at home, in difficult moments and to aid the subject in getting to sleep, which is a critical moment for patients affected by tinnitus because the perception of sounds in the ear is facilitated by silence. The primary site of neuronal absorption is represented by mitochondria, with consequent release from cytoplasm of H+ protons. The results of our trial should therefore be confirmed through a larger, multicentric controlled clinical trial with an accurate definition of the indicators.
The patients have been treated with laser therapy and pulsed electromagnetic field therapy (rTMS), which is determined to have evidence for the treatment of tinnitus and pain. Photobiostimulating laser therapy is the only known, non-chemical treatment method that brings along an increased ATP production in the cells and thereby increases cell activity, metabolism and synthesis in the cells of the body.
Pain Threshold Improvement for Chronic Hyperacusis Patients in a Prospective Clinical Study. The treatment results in the Spanish study are almost identical with those in Michael Zazzio's hyperacusis treatment study. We randomly assigned 26 patients to the group receiving low-level laser stimulation treatment and 20 to the placebo group. Tinnitus must be distinguished from real auditory hallucination, which is a symptom of psychiatric or neurological disorders. Yet, for those needing further treatment, several different therapeutic approaches are available today, and they are usually multidisciplinary.

The recruitment criterion was that patients had to be adults suffering for at least 3 months with disturbing nonintermittent subjective tinnitus. The system was composed of an emitting body equipped with a probe to be placed at the entrance of the external auditory canal from where the laser ray was directed toward the eardrum. Combined counseling consisted of the combination of two different approaches: a cognitive and a psychosomatic approach.
The objective is to rehabilitate the cerebral center responsible for the perception of the problem by favoring filtering and blocking of the signal that causes the tinnitus. Moreover, for descriptive purposes, we performed tinnitus tests (loudness and pitch match, minimum masking levels). All patients affected by significant hearing loss regularly wore air-conduction hearing aids. The protocol used by Shiomi's group involved irradiation for 9 minutes per time for 10 or more weeks.
This controlled trial involved 50-mW laser stimulation (wavelength 830 nm) and a placebo group. The irradiation was transmeatal in this case also, and the power used was 60 mW supplied for 6 minutes once weekly for 4 weeks. In Tauber's trial, power emissions were lower than those used in the trials mentioned previously (7.8 and 20 mW). The cellular membrane permeability for Na and K is reduced, with consequent reduction in action potential [29].
Nonetheless, preliminary data suggest a favorable effect of low-level laser stimulation in the otologist's therapeutic equipment. Tinnitus: Psychosomatic Aspects of Complex Chronic Tinnitus (Occurrence, Effects, Diagnosis and Treatment). A multiple-baseline evaluation of the treatment of subjective tinnitus with relaxation training and biofeedback. The management of chronic tinnitus-comparison of a cognitive-behavioural group training with yoga.
Comparison between self-hypnosis, masking and attentiveness for alleviation of chronic tinnitus. Ericksonian hypnosis in tinnitus therapy: Effects of a 28-day inpatient multimodal treatment concept measured by Tinnitus- Questionnaire and Health Survey SF-36.
Transmeatal cochlear laser (TCL) treatment of cochlear dysfunction: A feasibility study for chronic tinnitus. Neural correlates of transmeatal cochlear laser (TCL) stimulation in healthy human subjects. The functional neuroanatomy of tinnitus: Evidence for limbic system links and neural plasticity. Effects of 780 nm diode laser irradiation on blood microcirculation: Preliminary findings on time-dependent T1-weighted contrastenhanced magnetic resonance imaging (MRI). Power density and exposure time of He-Ne laser irradiation are more important than total energy dose in photobiomodulation of human fibroblasts in vitro. Increase of proton electrochemical potential and ATP synthesis in rat liver mitochondria irradiated in vitro by helium-neon laser. The laser method results in a better chance for the cells of the body to repair themselves. The Spanish study is congress reported at the 7th TRI International Tinnitus Congress in Barcelona in May 2013.
If you need an urgent contact with the clinic or an instant answer to a question, then you should make a phone call to the clinic instead of sending an email. These are specific treatments, aimed to reduce the negative effects of the disorder; however, treatment leads in only rare cases to complete disappearance of tinnitus. The hypnotic techniques used are those described by Erickson [5], aimed at developing a higher ability to handle the symptom by increasing the patient's reactive potential and by causing a "change" in the response to the symptom.
In the placebo group (LLS-), the grading remained unchanged in 9 patients (45%), whereas it improved in 7 (35%)-a one-grade improvement occurred in 6 patients (30%) and a two-grade improvement in 1 (5%)- and worsened in 4 patients (20%).
The effect of the various relaxation techniques in patients suffering from chronic tinnitus has been assessed in a number of controlled trials [9-13]; although no final proof exists of the effectiveness of these techniques on the perception of tinnitus, a reduction in the symptoms associated with stress and anxiety-and thus an improvement in the acceptance of the symptoms-was observed. They enjoyed increasing their care for their body and finding new strategies to reduce concomitant physical troubles (dyspnea, muscle-tension pain due to arthritis). The random anomalous distribution of age that resulted in the group subject to laser stimulation being younger than the placebo group must be considered (as the sampling procedure did not take into account each patient's age); this result must be traced back to the different stimulation applied. In their trial, however, the administration of a drug (Tebonin) was combined with a stimulation protocol that involved 12 laser applications, each of a 10-minute duration, to the top of the mastoid bone. The 28 patients recruited for the trial had to give a score to their symptoms on a 5-point scale before and after treatment had concluded. The result indicators considered were based on a questionnaire submitted to 45 recruited patients. The effect of inhibiting the action potential was shown through a trial after laser stimulation of the cochlea through the round window [20]. If there is a case of emergency (sudden deafness or any similar condition) you must call the emergency cell phone number.

Recruited patients received detailed information about the objectives of the trial, its possible benefits, and its potential risks. Thus, the experimental group (LLS+) received combined counseling and lowlevel laser stimulation, and those in the control group received only the counseling combined with the faked stimulation device, which appeared identical to the active one but had no laser emission (placebo). Our objective was to promote habituation and thus eliminate the problem by removing any negative association to tinnitus. The objective of hypnosis is to change the patient's behavior, sensory responses, and state of consciousness by providing new ways of thinking, feeling, and acting about the symptom. The effect of hypnosis has been documented in different studies [14-18], sometimes with conflicting results but with a general trend toward higher tolerance to symptoms by those involved in the research. Having more spare time, these patients could exercise at home more regularly than younger people. No other difference was revealed between subgroups LLS+ and LLS- as regards the characteristics of the population, such as the duration of symptoms or the distribution according to hearing loss levels, tinnitus side, or perceived pretreatment seriousness.
The trial lasted 3 weeks, and the success criterion was based solely on patients' judgment [19]. Because an improvement in loudness and annoyance level was reported in 55% and 58%, respectively, the authors concluded that laser therapy deserves a trial in patients affected by untreatable tinnitus. Among the 49 patients recruited, no statistically significant difference was revealed between the placebo and the active groups for a series of indicators, including visual analog scales for loudness, annoyance, and attention, as well as THI score [21]. Between the active and the placebo group, no differences were reported in terms of loudness, duration, quality, and annoyance of tinnitus. The 45 recruited patients responded to a questionnaire in which the symptoms were classified according to a 5-point scale before and after treatment. Another postulated mechanism is the increase of blood flow [30] attributable to sympathetic neural inhibition. Emails are answered as soon as possible but there are not always a possibility for a daily check of emails, sometimes not even weekly.
The Tinnitus Handicap Inventory (THI) questionnaire was submitted at the beginning and at the end of treatment. Random assignment to treatment was carried out by one of the authors, but the actual type of stimulation applied was not revealed to the second author until assessment of the entire population was completed.
It consisted of exhaustive discussions about the causes and the meaning of tinnitus and about the anatomy and physiology of ears and auditory pathways so as to promote understanding of the symptom and to demystify it. To meet these objectives, different resources taken from Erickson, such as metaphors and direct hypnosis, were used. Regular exercise became an important part of their daily life and led to positive thinking.
Therefore, 61.6% of the patients treated with laser improved by at least one class as compared to 35% of the placebo group (see Fig.
Moreover, a patient receiving irradiation presented with acute hearing deterioration after the third irradiation session. However, alternative mechanisms, such as an increase in cell proliferation [31], adenosine triphosphate synthesis [32], and collagen [33] are also possibilities. Please, call the clinic if you as soon as possible want to come to the clinic for an examination. The THI scores improved in the entire sample after treatment but more significantly in the group receiving low-level laser stimulation. Classes of severity were codified as follows [8]: slight tinnitus (THI score, 0-25), medium (score, 26-50), severe (score, 51-75), and catastrophic (76-100). The chance to talk was perceived by these patients as a sign of care, which balanced the frequent absence of affection for the elderly.
Indirect support for the conclusions of that trial comes from a recent study carried out by Siedentopf et al.
From the point of view of clinical classification, approximately 61% of irradiated patients had tinnitus severity decreased by one class, in comparison to 35% of the placebo group.
This method consists of letting the patient contract muscle segments or groups and then letting those segments or groups progressively relax over a variable period of time.
The opportunity to practice a therapeutic technique that could help the patients to relax and observe the single elements that compose their pathological "syndrome" acted as a tranquilizer: as a matter of fact, the fragmentation of symptoms reduced their impact.
These exercises are effective in patients who are scarcely aware of their body and their tonic response. It must be emphasized that our protocol was different, using lower power for a longer period (5 mW for 20 minutes) than that employed by Nakashima's team. The placebo application, randomly alternated to laser stimulation and indistinguishable by the patient, did not determine any neurological activation. Surprisingly, the activated cerebral areas correspond to those affected in tinnitus patients, as shown by positron emission tomography surveys [26,27].

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