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Author: admin | 18.03.2014 | Category: Tinnitus Causes And Treatments

Over the last 6 months, all patients seen at the otologic clinic of Brasilia University Medical School answered a questionnaire designed to identify and describe the symptom of tinnitus. The senior author's interest in tinnitus began in 1989 during research fellowship under professor Harold Schuknecht at the Massachusetts Eye and Ear Infirmary.
Through the questionnaire applied to all our otology clinic patients, we identified 500 tinnitus sufferers in the most recent 6 months. For the 1% of patients with tinnitus of the severe disabling type, we started a protocol for treatment with dexamethasone intratympanic injection.
A comparison of the diagnosis we arrived at in our tinnitus patients with those listed in Table 1 of the senior author's study of 1990 [1] reveals a remarkable coincidence.
The fact that we were able to assemble 500 tinnitus patients in only 6 months from our otology clinic shows how frequent the symptom truly is among otologic patients.
Although very preliminary, our results point out clearly a strong placebo effect on tinnitus sufferers. Even though tinnitus is a very common symptom among otologic patients in Brasília, only 1% of them have the severe disabling type that demands innovative treatments.
This study evaluated the interference of tinnitus on the quality of life for noiseexposed workers enrolled in a hearing conservation program. Most tinnitus research has focused on effective treatments and the mechanisms of the cause, detection, and perception of tinnitus. In addition to its medical and audiological aspects, the psychosocial consequences of tinnitus can be of significance and have also been investigated. Tinnitus is a common complaint among noise-exposed workers, and in some countries it is even recognized as a work-related condition for compensation purposes. The objective of our study is to evaluate the impact of tinnitus on the quality of life of workers who are exposed to noise and enrolled in a corporate hearing conservation program.
We enrolled participants from a meat-packing facility in the state of Rio Grande do Sul, Brazil.
We administered a questionnaire to all the employees of the company (N = 372) at the beginning of the training sessions of their hearing conservation program.
To assess the workers' hearing status, we performed otoscopy and pure-tone audiometry, according to the requirements of the Brazilian legislation [10]. We administered to the 52 participants the Brazilian version of the Tinnitus Handicap Inventory (THI) questionnaire, elaborated by Newman et al.
We calculated Pearson coefficients of linear correlation and tested their significances via the Student's t -test and Fisher's exact test, using a significance level of 5%.
Eighty-two workers (22%) of the total population of 372 workers in the studied company reported tinnitus in the first interview of this study. Company records also indicated that 15% of the participants who were exposed to noise were also exposed to other hazards.
The results of the relationship between tinnitus and the three THI scales are presented in Figure 2.
Table 2 displays the correlations between the functional, emotional, and catastrophic scales and medical history. Table 3 presents the correlations of the THI results with the health problems described by the participants (n = 52).
We separated the participants into two groups: The first was composed of 37 participants with normal hearing (71%), and the second included 6 participants (12%) with a bilateral high-frequency notch. Twenty-two percent of the noise-exposed participants complained of tinnitus, a finding comparable to rates of 25% reported by Sahley and Nodar [14] and 15.5% reported by Zimmermann [15].
Seventy-one percent of the participants with tinnitus complaints presented normal audiometric results, which suggests that tinnitus can be an early indicator of auditory risk from exposure to noise. The application of the Brazilian version of the THI was both easy and expedient, as indicated by Newman et al. In Table 2, we found significant results involving the functional scale results with the use of prescription drugs and the catastrophic scale results with consumption of coffee. Concerning the degree of severity of tinnitus, 44% presented degree 1 or "slight" tinnitus according to the classification by McCombe et al. We observed a significant correlation between tinnitus severity and exposure to noise and chemical pollutants, predominantly CO.
We observed a significant correlation between the duration of noise exposure and the emotional scale for the participants with high-frequency notches, suggesting an extra-auditory effect of noise. The results of this study demonstrated that the prevalence of tinnitus was high (22%) in this population, despite the fact that study participants were young individuals who had a short duration of noise exposure. The Brazilian version of the THI proved to be an easy instrument to use for evaluating the impact of tinnitus on the quality of life of noise-exposed workers. Join tens of thousands of doctors, health professionals and patients who receive our newsletters.
About one in five people experience tinnitus, the perception of a sound--often described as ringing--that isn't really there. This is a 3-D image of the left brain hemisphere of a patient with tinnitus (right) and the part of that hemisphere containing primary auditory cortex (left). The observations reveal just how different tinnitus is from normal representations of sounds in the brain. In the new study, Sedley and The University of Iowa's Phillip Gander contrasted brain activity during periods when tinnitus was relatively stronger and weaker.
The researchers found the expected tinnitus-linked brain activity, but they report that the unusual activity extended far beyond circumscribed auditory cortical regions to encompass almost all of the auditory cortex, along with other parts of the brain. The discovery adds to the understanding of tinnitus and helps to explain why treatment has proven to be such a challenge, the researchers say.
These new insights may help to inform treatments such as neurofeedback, where patients learn to control their "brainwaves," or electromagnetic brain stimulation, according to the researchers. Please use one of the following formats to cite this article in your essay, paper or report:MLAPress, Cell. For any corrections of factual information, or to contact our editorial team, please see our contact page.
Please note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. After summarizing the neurophysiological aspects of whiplash injury, the author proposes a guide for neurootological evaluation in relation to the pathophysiology of the injury.
The legal redress for bodily injury goes back to the very ancient concept of "an eye for an eye and a tooth for a tooth." It is really a kind of revenge fee for bodily damage. We suggest a guide for the neurootological approach to patients suffering from whiplash injury.
Whiplash-associated disorders (WAD) should be distinguished from sprained neck, traumatic disk protrusion, and damage to cord and nerve roots. The so-called posterior cervical sympathetic syndrome of Barre is a disputed cause of vertigo arising from cervical lesions.
Hinoki (first in 197 1 and then in detail in 1985) [2, 3] proposed a hypothesis in which the hypothalamus occupied a fundamental place to explain vertigo due to whiplash injury. Abnormal centripetal impulses arising from the injured cervical soft tissues may ascend along the spinoreticular tract to the brain stem.
Furthermore, this tract changes neurons in the medulla oblongata, the pons, and the midbrain and terminates in the superior colliculus. The reticulospinal tract also originates in the brainstem reticular formation of both the medulla oblongata and the pons and is connected to the somatomotor cells in the ventral column. The cerebellum is, of course, involved in the development of this type of vertigo, as it is connected closely to the proprioceptors of the cervical and lumbar regions and to the brain stem (Fig. Posture tests can be used to examine static or dynamic posturography (or both); several systems exist. As we have written in the report of the first meeting of the European Federation of Otorhinolaryngologic Societies [7], a great discordance exists not only between the members of the medical profession but between the rules and laws concerning disability throughout Europe. Presented at the Twenty-Seventh International Congress of the Neurootological and Equilibriometric Society, Bad Kissingen, Germany, March 23-26,2000.
INTRODUCTION: Tinnitus Handicap Inventory (THI) was developed in English to quantify the handicap caused due to tinnitus. OBJECTIVES: India being a multilingual country needs to develop and standardize THI in Indian languages.
MATERIALS AND METHODS: Questions from English version of THI were translated and modified by two professionals who have a degree of MA Kannada. RESULTS: Analysis revealed 14% of the patients fall under the category of Slight, 38% under Mild, 26% under Moderate, 16% under Severe and 6% under Catastrophic group.
CONCLUSION: Scores of Cronbach-alpha test shows that Kannada version of THI is a standard and reliable tool for measuring the handicap caused by tinnitus and can successfully classify individuals on a severity basis. Recent interest has surfaced in symptom - specific handicap outcome measures for many audiological and otological diseases4. A symptom specific assessment of many otological disorders will aid in understanding the severity of the symptom and effects of this on routine life.
The English version of THI which is shown in Appendix 1 was the only tool available for quantifying the handicap caused by tinnitus. The beta version of THI developed by Newman and Jacobson in 1996 consists of 25 questions under the 3 sub scales of emotional, functional and catastrophic. Individuals who were suffering from tinnitus with or without any otological diseases were selected for the study. Tinnitus questionnaire was administered on the participants using a structured interview by the clinician to have a record of the demographic details and to cognize the type, nature, and the lateralization of the tinnitus, factors that affect tinnitus, presence of hearing loss, and the concern about the tinnitus. Following the administration of the tinnitus questionnaire, the participants were instructed regarding the self - assessing Kannada version of THI, its importance and the system to grade it.
Among all the participants, 94% of the participants had a minimum qualification of SSLC and a maximum qualification of a degree and could fill up the Kannada version of THI without the help of the clinician. The results of the THI and the self assessing questionnaire were tabulated and are graphically represented below in Graph 1. After the complete analysis of the obtained data, the percentages of the patients coming under various severities were found out. The purpose of this study was to develop a handicap inventory in native language (Kannada), to obtain a standard measurement instrument for evaluating tinnitus in patients to apprehend the effects caused due to tinnitus.
From the study, we could observe that the perception of tinnitus handicap differs drastically between subjects as demonstrated by high values of standard deviations, which may be due to effective coping starategies5. Related to the emotional aspects, the Kannada THI allows assessing the relation between tinnitus and manifestation of stress, depression, anxiety & frustration. The result of the current study shows good reliability and internal consistency as indicated by the Cronbach alpha test. Hence this inventory can serve as an effective tool to successfully classify the individuals into different grades according to the symptoms.
Since the main focus of this study was to develop and standardize the THI into Kannada language, and to be administered on all Kannada patients who complain of tinnitus.
The main aim of this study was to develop and standardize the Tinnitus Handicap Inventory in Kannada; hence it can be administered on Kannada patients without difficulty.
Paper submitted to the ITJ-SGP (Publishing Management System) on December 17, 2012; and accepted on January 17, 2013. Portable videonsystagmography is equipment to detect nystagmus or other eye movements independent from time, place and medical specialists.
Recording of eye movements can be carried out by electronystagmography (ENG), photoelectronystagmography (PENG), and videonystagmography (VNG). Portable videonystagmography can be used in hospitals for teaching purposes, to record eye movements on the ward and for medical legal determinations.
Application of portable videonystagmography has shown high acceptance by our patients and was carried out without complications in use or a break-down of the equipment. Detection and recording of nystagus in combination with dizziness is an important tool for the physician to draw conclusions in order to find the diagnosis of peripheral vestibular alterations.
Transcranial Magnetic Stimulation (TMS) has been approved since 2009 for the treatment of patients who have major depression.
Further studies will be made by enrolling 10-15 patients who will receive treatment five times a week. About Latest Posts Shinji TutoruShinji has been writing for The PreScouter Journal since 2012. Both the increasing usage of intratympanic medication to the inner ear through the round window and the popularity of cochlear implantation have raised interest in the anatomy of the round-window niche (RWN). The fine anatomy of the round-window niche (RWN) has been addressed recently in several publications [1-5]. We undertook a prospective study of CT scans of 214 patients referred for imaging as a part of their medical investigation. We performed all CT studies with a fast (four-slice) helical CT scanner (Lightspeed Plus, GE Medical Systems, Milwaukee, USA). We collected measurements of width, length, angle, and shape (conical or cylindrical; see Figs. The measurements presented are arbitrary, although they could represent some typical parameters of the RWN dimensions as demonstrated in the CT scan. We collected data from 214 patients (428 ears) and excluded ears with an inflammatory condition (n = 14) to avoid false results. Consequently, membranes frequently seen in middle-ear surgeries at the RWN opening are mucosal folds external to the RW membrane and are not the RW membrane. To demonstrate the bony configurations of the RWN, we suggest the technique just presented, which reveals them most clearly.
In summary, as endoscopies of the middle ear still have limited value [22,23], imaging is important and is less invasive for evaluation of the RWN. Our aim was to elucidate the importance of anatomical aspects in planning local therapies for inner-ear diseases. Intratympanic administration of drugs for inner-ear disease therapy started when Schuknecht [1,2] presented the results of this novel treatment for vertigo in Meniere's disease in eight patients, using the ototoxic drug streptomycin.
Today, we know that the round-window membrane is involved with several physiological aspects of the ear's function. During the almost 50 years since the publication of the Schuknecht study, intermittent enthusiasm has occurred for methods using intratympanic administration of an agent to treat an inner-ear disease, particularly because of the variable results obtained with the use of any drug, either in abating the symptoms or in deleterious effects on hearing.
Several studies emphasized the importance of anatomical conditions of the round-window niche in the variability of responses to local therapies for the treatment of inner-ear diseases [4,5]. The purpose of our study was to investigate the importance of anatomical aspects in planning local therapies for inner-ear diseases. We dissected 20 fresh temporal bones obtained in the pathological unit of the Department of Otolaryngology, Hospital de Egas Moniz, Lisbon, Portugal. We found mucoperiosteal folds partially or completely obstructing the round-window niche in five temporal bones (25%; Fig. A remarkable result of our study is the demonstration of the proximity of the true membrane to the false membrane in the anterior edge of the window. When promised clinical results do not materialize suitably, sometimes investigation must come back to basics. The first and only study directly addressing the implications of the round-window patency for perfusion of the inner ear via intratympanic instillation of medications was published by Silverstein et al.
Our study undertook the anatomical evaluation, from a surgical-approach perspective, of the relationship between false and true round-window membranes. At that time, he tried to find a pathological correlate for cochlea-generated tinnitus, and the results were reported in two publications [1,2]. 1) describing the symptom of tinnitus was submitted to every patient seen at our otology clinic during the last 6 months. Brasília University Hospital Otology Clinic questionnaire used to identify tinnitus patients and to describe the symptom. Brasília University Hospital Otology Clinic questionnaire used to evaluate results of tinnitus treatment with intratympanic dexamethasone injection. However, 81% of the tinnitus patients had a very mild complaint that probably would not be mentioned had 'we not specifically asked about it. Table 1 summarizes the results of treating two patients with saline injections, reporting much improvement of the symptom for 5 months and some improvement for 2 months. Efficacy of intratympanic dexamethasone injection for treatment of severe disabling tinnitus must await the results of prospective double-blind randomized trials to be proclaimed unequivocally. Noise measurements, a questionnaire, a Brazilian version of the Tinnitus Handicap Inventory (THI), and pure-tone audiometry were conducted with 52 participants (mean age, 29 years) who suffered from tinnitus.
Among the risk factors for tinnitus, the most prominent are age, gender, various diseases (otological, metabolic, neurological, and vascular alterations and dental factors), hearing loss, and exposure to noise, ototoxic drugs, caffeine, nicotine, and alcohol [1-4]. Tinnitus can alter an individual's ability to function in professional, social, and leisure activities and in family relationships, hence affecting the quality of life [5,6].
In addition to being beneficial for clinical applications, the tinnitus questionnaires are valuable for understanding the relationship between personality and the psychopathology of tinnitus, its impact on the daily life of persons who suffer from tinnitus, the difficulties and the perception of social support in relation to the problem, and the incapacities and the difficulties produced by tinnitus that can seriously affect quality of life [7-9]. Occupational hearing loss prevention initiatives rarely focus on the prevention and management of tinnitus. The company employs 372 workers (120 female, 252 male) working in two fixed 8-hour and 48-minute shifts.
The questionnaire gathered information on demographics and occupational and medical histories for each worker. We also used Spearman's rank correlations to examine the results of exposure information versus the outcome. Because of attrition, we were able to study only 52 workers (14% of total population of the plant).
Of those, 62% were exposed to carbon monoxide (CO), 13% to CO and vibration, 12% to hydrochloric acid, and 13% to sodium hydroxide. We observed that of the 52 participants, 71% had normal audiometric results, whereas 12% presented a bilateral high-frequency notch and 17% presented audiometric configurations of hearing loss due to causes other than noise, such as unilateral losses and flat audiometric configuration.


Median of hearing thresholds for the groups with normal hearing (all thresholds 25 dB hearing level [HL]), hearing loss configurations suggestive of noise-induced hearing loss (NIHL), and hearing loss from various causes. The distribution of poorest scores across scales of the Tinnitus Handicap Inventory, in percent (n = 52). We observed a significant correlation between headaches (p = .0458) and the duration of tinnitus.
We did not include the remaining 9 individuals (17%), who displayed other audiometric configurations of hearing loss in the statistical analysis. The prevalence of tinnitus complaints in male subjects was 16% and in female subjects was 9%, similar to what has been reported [16-18]. Schleuning [2] explained that caffeine and nicotine could aggravate tinnitus because they are stimulants and can induce the constriction of blood vessels.
The participants of the study who had such combined exposure had a higher degree of tinnitus severity.
Moreover, a negative impact of tinnitus on the subjects' quality of life could de detected. The 22% tinnitus rate among workers, most of whom nonetheless had normal hearing, suggests a need to address tinnitus in occupational hearing loss prevention initiatives.
Rick Davis and Robert Randolph (National Institute for Occupational Safety and Health, USA) and Alberto Behar (University of Toronto, Canada) provided helpful critiques of the manuscript. Now, researchers reporting in the Cell Press journal Current Biology, have taken advantage of a rare opportunity to record directly from the brain of a person with tinnitus in order to find the brain networks responsible. The study was only possible because the 50-year-old man they studied required invasive electrode monitoring for epilepsy. WAD can be associated with central nervous system lesions, such as postconcussion syndrome.
Barre [1] proposed that cervical lesions might irritate the sympathetic vertebral plexus and result in a decreased blood flow to the labyrinth, owing to constriction of the internal auditory artery.
According to Hinoki [2], patients with whiplash injury present with a hypertonicity of the soft supporting tissues of the neck, owing to the overexcitation of the cervical proprioceptors.
Among the ascending pathways from the cervical and lumbar proprioceptors to the brainstem, the spinoreticular tract seems to be the most important, as most of its fibers ascend along the lateral fasciculus and the anterior column and terminate in the reticular formation of both the medulla oblongata and the pons.
Generally accepted is that the reticular formation of these parts of the brain and of Deiter's nucleus and the superior colliculus are active in both ocular and spinal reflexes related to body equilibrium.
As previously mentioned, this tract is thought to have a close relationship with the spinoreticular tract. Anatomical pathways possibly involved in neurootological aspects of whiplash-associated disorders.
Such a study would consist of saccadic tests - measures of accuracy, hypermetry, hypometry, latency, amplitude, duration, and peak velocity. A spontaneous nystagmus test would include analysis of eyes open in several directions of gaze and eyes closed and evaluated via electronystagmography (ENG) or videonystagmography (VNG). Gait tests, among others, are effective in vegetative disturbance analysis and in testing corticoequilibrium. Such testing would include tonal audiometry, suprathreshold and speech audiometry, and tests for malingering.
Translated inventory was given to 50 native Kannada speakers for the familiarity check & the most familiar sentences were included in the study.
According to the data obtained from the National Center for Health Statistics, tinnitus is more commonly seen in males than females and increases in prevalence with advancing age. There are two important aspects of symptom - specific evaluation that is generally done by a valid and reliable inventory5. A Tinnitus Handicap Inventory (THI) was developed in order to measure the handicap caused by tinnitus. India being a multilingual country with a multicultural background, there is no such inventory available in any of the Indian languages other than in Tamil. For the present study, the English version of THI was translated to Kannada using the standard Translation-back-translation method (Bardley, 1994) by two professors who have a degree of MA in Kannada.
Participants were interviewed briefly regarding tinnitus and those who complained tinnitus for more than 3 months were included for the further procedures, so that, they can quantify accurately the physical, emotional and catastrophic impacts of tinnitus on their daily acvtivities.
Thereafter based on the subject's grading for all the questions, the total scores were calculated. Rest percentages of participants were from a lower socio-economic status and could fill up the questionnaire only with the help of the clinician due to their inability to read and understand Kannada. Cronbach alpha test was administered to check for the internal consistency and reliability of the Kannada version of the THI and also an Item-Total Correlation was also carried out. Thus, according to the Cronbach alpha score, the Kannada version of THI has got a good internal consistency and reliability to administer on the tinnitus patients in the Kannada population.
With the administration of Kannada THI it was found that, all the subjects could quantify the severity of tinnitus from slight degree to catastrophic degree, and thus fulfilled the aim of the study. Tinnitus assessment not only involves to match the tinnitus, ascertain the intensity of the tinnitus and to find out the intensity of wide band noise that can mask the tinnitus, but also involve administration of various inventories like THI to rate and assess the severity of tinnitus in order to help the clinician to counsel the patient as well as to know the level at which the management options should begin8.
With respect to the functional aspect, the Kannada THI allows to identify the relationship between tinnitus and activities involving concentration, hearing acuity, attention & reading.
This inventory could easily be understood to all the laymen and 94% of patients could fill the inventory without any help from the clinician. Following all the analysis and standardization, the Kannada version of THI came out successfully for the evaluation of tinnitus and found to be reliable. The Kannada version will help the patients with tinnitus to comprehend the severity and intensity of their problem and also considered as a reliable instrument for the verification of the impairment in the quality of life due to tinnitus.
Department of Speech Language Pathology - All India Institute of Speech & Hearing - Mysore - India.
1) were constructed and connected with the smallest available video recorder from the Sony Company (Fig. Patients can carry the bag with the machine to their home and use it indoors or at work to objectively record their complaints. The quality of the video tape was high and allowed us to precisely differentiate between a nystagmus, fixation movement, and other pathological eye movements. To ease the recording of eye movements out of the hospital and to give the basis for earlier therapy, portable videonystagmography has shown its importance in the test battery of vestibular disturbances. Wolf SR, Christ P, Raid T: Patient use of telemetric ENG to register nystagmus in the private sphere. Watanable I, Ikeda M: Electronystagmography outside the hospital using a pocket-sized electrocardiography. A transcranial magnetic stimulation (TMS) therapy in a non-invasive way may help individuals who are suffering from tinnitus commonly known as the ringing in the ears. Also, there are 2 million Americans who are seriously incapacitated by the ringing in their ears.
The patient simply sits on a padded chair then a magnetic coil is placed next to the left side of the head. He writes about new science discoveries and innovations involving 3D printers, biofuels, and other breakthroughs in renewable energy. I recently had to fill out a form and spent an enormous amount of time trying to find an appropriate I just filled out NYC RPIE-2010 Instruction with an online software. The objectives of this study were to measure the RWN and to standardize a computed tomographic projection for measuring it.
Two recent developments - cochlear implantation [2-6] and intratympanic medication of the inner ear through the round-window (RW) membrane [7-11] - have increased interest in this anatomy and in the imaging of the RWN. In the study, we included only CT scans of normal middle ears, with no evidence of inflammatory middle-ear disease in the patients' history and on the CT findings (such as effusion). Oblique reconstruction of the internal ear showing the oval and round windows in the same plane.
Creating an oblique reconstruction in a plane parallel to the posterior semicircular canal-basal turn of the cochlea.
The point of maximal convexity, as opposed to an arbitrary point on the bony wall opposite the end of the operculum, was easy to define (see Fig. The points from which the measurements were taken were those that could be easily identified in the CT image. In patients who had a unilateral middle-ear disease, we included the contralateral normal ears.
The size of the RWN in all age groups was similar, indicating that it reached its final size in early life.
In keeping with a report by Alzamil and Linthicum [5], 32% of ears in our patients (133) should have folds. Our study contributes to the demonstration of the RWN in two ways: a technical imaging method that can be used as a standard view of the RWN (as well as for some other structures of the ear) and the assessment of the RWN's dimensions. Round-Window Anatomical Considerations in Intratympanic Drug Therapy for Inner-Ear Diseases. The study undertakes the anatomical evaluation, from a surgical-approach perspective, of the relationship between the false and true round-window membranes. That study started a new era of interest about the round window and round-window membrane, particularly in aspects related to permeability of the membrane by several substances and pathogens [3]. First, in its auditory function, it serves as a compensatory area of the bony labyrinth, permitting movement of inner-ear fluids in association with movement of the stapedial footplate. A natural consequence is to investigate the reasons why standardization of these techniques has not yet been obtained. A great variability in the middle-ear anatomy-particularly in the roundwindow niche opening-and three-dimensional configuration is easily documented in the images of the most important anatomical textbooks [6].
The dissection started with an exploratory tympanotomy and atticotomy, exposing the tympanic cavity that included the oval and round-window regions.
1), we drilled the promontory in the vicinity of the roundwindow opening (anterosuperior edge of the roundwindow niche) until the round-window membrane was completely exposed (Fig. When the round-window region is exposed by the tympanomeatal flap approach, the round-window niche is only partially exposed, and the round-window membrane is not visible. Only after extensive drilling on the anterosuperior (promontory) edge of the oval-window niche can the ovalwindow membrane be seen clearly. This proximity renders making a clear distinction between the two very difficult from a surgical approach. As to the intratympanic administration of drugs to treat inner-ear diseases, anatomical particularities of the roundwindow niche had been mentioned as one factor accounting potentially for variability of responses [5]. We started with the temporal bone in the usual surgical position, where the round-window content is almost completely hidden, and we ended with the complete exposure of the round-window membrane. All patients who had the symptom underwent otoscopy and careful head and neck physical examination, including auscultation of the great vessels and temporomandibular joint palpation.
Other miscellaneous diagnoses included middle-ear tumors and some with no clear-cut diagnosis, among them three cases of severe disabling tinnitus. Vestibular suppressants (diazepam), calcium channel blockers (flunarizine), anticonvulsant drugs (clonazepam), and gingko biloba were the drugs used frequently in treating these patients.
The patients of the 1990 study were selected from the temporal bone collection of the Massachusetts Eye and Ear Infirmary who conformed to one criterion: having had cochleagenerated tinnitus at some point during their lifetime. This outcome, indeed, is not unexpected, as we know that a final common pathway [5] for tinnitus must exist where affect is associated with the symptom. THI results indicated that tinnitus had the greatest influence in the functional scale (54%). We used the overall result to identify the degree of severity of tinnitus for each individual and for completing an analysis of the total scores by scales. Of all noise-exposed female workers in the plant, 11 (9%) reported having experienced tinnitus, and 41 (16%) of the noise-exposed male workers reported the condition. Spearman's rank correlation coefficient results indicated a significant correlation between noise levels and how often workers experience tinnitus (p = .01). We also observed a significant correlation between the duration of noise and the functional scale (p = .039). It is important to notice that the average age of the population of our study (29.2 years) is younger than in other studies, which reported results from groups whose mean ages varied from 40 to 50 years and who had a short duration of noise exposure (average, 7 years)[18-21] . According to that author, doctors believe that 50% of patients with complaints of tinnitus improve significantly when they stop smoking or reduce caffeine intake.
In recent decades, studies have demonstrated that simultaneous chronic exposure to CO and noise represents a potential risk to hearing, but reports of tinnitus exist only for cases of intense poisoning from CO [24].
This supports the inclusion of tinnitus prevention initiatives alongside workplace hearing loss prevention initiatives because of shared causal factors. Information on tinnitus prevention and treatment could have a measurable, positive impact on a person's quality of life. The authors thank all those who participated in the study for their time, interest, and cooperation. Guidelines for the grading of tinnitus severity: The results of a working group commissioned by the British Association of Otolaryngologists. Colored circles indicate electrodes at which the strength of ongoing brain activity correlated with the current strength of tinnitus perceived by the patient.
He also happened to have a typical pattern of tinnitus, including ringing in both ears, in association with hearing loss. Hence, our purpose is not to define a disability scale but to determine whether we believe that a common approach to the medicolegal problem is necessary.
Although numerous clinical reports of Barre syndrome have been published, few objective data exist to support an association between episodic vertigo and cervical sympathetic dysfunction.
The condition is caused by an excitation of sympathetic beta-receptors in the muscle spindles. However, some fibers of this tract ascend directly to the midbrain and are connected to Deiter's nucleus. Among the descending paths from the brainstem, the median longitudinal fasciculus is important in cases of vertigo, because this tract originates in the brain stem and is connected to both the oculomotor nuclei and the somatomotor cells in the ventral column.
Thus, the median longitudinal fasciculus and the reticulospinal tract seem especially important in the development of disequilibrium because of whiplash injury.
A positional nystagmus test would assess with VNG a patient's assumption of sitting, lying, and lateral left and right decubitus positions. Evoked potentials are part of audiological assessment and entail brain stem evoked response audiometry, middle latency response audiometry, and cortical audiometry. Our proposal for a standard battery of tests will be the first step in the right direction. The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system. Observations upon the mechanism of positional nystagmus of the so-called benign paroxysmal type. Tinnitus questionnaire was then administered, followed by the Kannada version of THI on 140 patients and total scores were obtained.
The diagnosis and rational management of tinnitus is one of the legacies of the past millennium, which the medical profession has carried unsolved to this century2. Initially, the self-assessment tool assesses the severity of symptoms and provides objective data about the severity of the symptomand later, the evaluation allows investigators to accurately assess and compare the pre-treatment and post-treatment periods.
THI is a method of quantifying the impact that tinnitus has on an individual's daily living conditions. The translated form of the inventory was given to 50 native Kannada speakers who were exposed to Kannada language or had first language as Kannada, who were able to read and write Kannada, for the content validation. Individuals with any significant neurological history, history of psychiatric or psychological counseling with regard to their tinnitus were excluded from the study.
Under the functional subscale, 30% of responses were for YES and 50% of responses were for NO and 20% of responses were for SOMETIMES.
38% of patients fall under the category of mild, 26% of patients fall under the category of Moderate, and 16% fall under the category of severe and 6% fall under the category of catastrophic group which is represented in Graph 2.
Also a comparative study was carried out between the English version of THI and the Kannada version of THI. The quality and intensity of tinnitus can affect daily routine of an individual which have an effect on the individual's psychological functioning7. The catastrophic aspect of Kannada THI allows identification of negative sensations produced by the tinnitus in the patient's lives such as intolerance, loss of control of the sensation. The English version of THI is currently used by most of the audiologists and otorhinolaryngologist to find out the severity of the problem in different patient population and found to be difficult to administer on native speakers of Karnataka.
The recruited subjects for this research presented changes in their Quality of Life (QL) as regards to the functional, emotional and catastrophic aspects due to tinnitus.
The functional neuroanatomy of tinnitus: evidence for limbic system links and neural plasticity.
Validity of the Italian adaptation of the Tinnitus Handicap Inventory; focus on quality of life and psychological distress in tinnitus-sufferers. Brazilian Portuguese Language version of the "Tinnitus Handicap Inventory": validity and reproducibility. If nystagmus and abnormal vestibular function is absent, the diagnosis is less plausible and therapy can be performed earlier. Short pulses of magnetic fields are sent to the surface of the brain that stimulate the brain cells.
Patients can instantly continue with their normal activities since the therapy does not cause seizures or memory loss. Stewart and Belal [3] described the anatomy of the RW and mentioned the presence of membranes in the RWN but did not study them.
Using imaging data acquired from routine basic CT acquisitions and without additional radiation or positions, we processed special enlarged views of the RWN for evaluation. The structure overhanging the niche from its lateral aspect was referred to only as anteroinferior overhang in that article and was not named in another by Frantz et al.


We conducted image postprocessing after transferring all images to a workstation (Advantage Windows adw4.0, GE). It did not grow with age, in contrast to skull width, which grew especially in the first two decades of life and continued throughout the entire life in both genders. Therefore, we could not contribute to the demonstration of membranous folds in the RWN, which are so important for the diffusion mechanism of intratympanic medications. As no collection of fluid was demonstrated in any of those patients, we can presume that the RWN is not completely obstructed by those folds. Its size does not change with age; this finding bears out the fact that the ear reaches its final size at birth.
Topographical relationships among the facial nerve, chorda tympani nerve and round window with special reference to the approach route for cochlear implant surgery. Intratympanic dexamethasone for sudden sensorineural hearing loss: Clinical and laboratory evaluation. Bacterial cytolysin perturbs round window membrane permeability barrier in vivo: Possible cause of sensorineural hearing loss in acute otitis media. Sinus tympani: anatomic considerations, computed tomography and a discussion of the retrofacial approach for removal of disease. Establishment of normative cochlear and vestibular measurements to aid in the diagnosis of inner ear malformations. Morphology of the normal human ear: A cross-sectional study from adolescence to mid-adulthood. Role of transtympanic endoscopy of the middle ear in the diagnosis of perilymphatic fistula in patients with sensorineural hearing loss or vertigo.
As our design, we chose a human temporal bone dissection study, for which we used 20 fresh temporal bones. Second, the roundwindow membrane has a definite role as a soft-tissue barrier between the middle and inner ear, and permeability of the membrane to substances can be altered drastically by diseases, particularly otitis media. Surely that morphological variability will have consequences in administering drugs intratympanically to the inner ear, independent of the method or the device used for the application. When the edge of the round window was dissected, the false membrane was disrupted, and the round-window niche and membrane were then exposed.
Nomura [7] described investigations of human temporal bones in which the round-window niche was found to be limited by mucoperiosteal folds in 70% of specimens (the so-called false round-window membrane). In that study, endoscopic evaluation of the roundwindow niche obstruction through a tympanostomy hole was performed in 41 ears before inner-ear perfusion. The results of our study confirmed the results of previous studies, wherein mucoperiosteal folds partially or completely obstructing the round-window niche were found in a significant proportion of ears. Anatomical particularities of the round-window niche account, at least partially, for the great variability of the results of these treatments.
Intratympanic gentamicin instillation as treatment of unilateral Meniere's disease: Update of an ongoing study. In their order of frequency, presbycusis, chronic otitis media, otosclerosis, acoustic trauma, Meniere's disease, ototoxicity, and vestibular schwannoma were found. As for severity of tinnitus, it was mild in 81%, moderate in 18%, and of the severe disabling type in 1%.
We did not use tinnitus maskers, but hearing aids were fitted whenever necessary for hearing loss, with secondary benefits for the symptom of tinnitus. After the injection, affected patients remained supine with the head turned 45 degrees and the injected ear up for 20 minutes. Therefore, a seemingly reasonable assumption is that the vast majority of the tinnitus population with which we are dealing in this study also had cochlea-generated tinnitus.
As we had good reasons to believe that most of our patients had cochleagenerated tinnitus, we decided to use intratympanic dexamethasone injection to treat those with the severe disabling type.
We hope to be able to answer the question about effectiveness of dexamethasone intratympanic injection for tinnitus treatment in 1 year, as more patients are enrolled and treated according to our protocol.
Eighty-two individuals (22% of the total population) had experienced tinnitus and were invited to participate in the study. The equipment used was an Interacoustics audiometer, model AD 229, with TDH-39 earphones, calibrated according to ISO 8253.
The average age of the sample was 29.2 years, and the average duration of noise exposure was 7 years.
Moreover, significant results were found for the degree of tinnitus and exposure to chemical pollutants (p = .02).
The THI indicated that even the degree 1 "slight" tinnitus experienced by most of the participants who reported tinnitus nevertheless had an impact on their quality of life. For instance, lesions in the neck and the middle ear and sinusitis and headaches increase the risk of tinnitus from 28% to 35%. The findings underscore the need for noise control and other effective strategies to mitigate causal factors.
The use of an instrument designed to evaluate the impact of tinnitus on a person's life, such as the THI, can contribute to a greater understanding of the needs of a specific person or group (or both). Experiencia do hospital das clinicas da faculdade de medicina da Universidade de Sao Paulo. Different colors indicate different frequencies of brain activity (blue = low, magenta = middle, orange = high) whose strength changed alongside tinnitus. This referee is the expert: He or she must be neutral and must detail the extent of the lesions. Because intracranial circulation is autoregulated independently of cervical sympathetic control, lesions in the vertebrosympathetic plexus are unlikely to produce focal constriction of the vasculature to the inner ear. Hinoki [2] has demonstrated the development of granular vesicles at the end of unmyelinated nerve fibers near motor nerve endings of these spindles. The hypothalamus also must play an important role in producing vertigo due to whiplash injury, as most of Hinoki's patients [3] who had vertigo after whiplash injury had various autonomic symptoms, such as lacrimation, abnormal sweating, and palpitation. Positional nystagmus mainly would involve Hallpike and Rose [4,5] positions with or without VNG. For further information on the subject, we recommend particularly a book, Whiplash Injuries: Diagnosis and Treatment, written by several members of our society.
Meeting of the First European Conference of the European Society of Otorhinolaryngology, Paris. The THI was developed by the British Association of Otolaryngologist, Head and Neck surgeons, which consists of 50 questions6.
The speakers were given a five-point rating scale to grade the items from very familiar to non-familiar. A score of 4 was given for YES and a score of 0 was given for NO and a score of 2 was given for SOMETIMES. The overall Cronbach alpha score of both the THI versions and the individual scores for all the three subscales in both the versions were compared.
From the current study, it is clear that the Kannada version of THI is readily available, easy to understand and is a reliable tool for measuring the handicap occurring due to tinnitus.
If this therapy becomes very effective then it can provide relief to at least fifty million Americans who suffer from this condition.
The currents affect the mood-regulatory circuits in the brain which benefited patients who suffer depression. We measured computed tomographic images acquired from 214 patients aged 4-85 years and included 414 ears and excluded 14 inflamed "wet" ears.
We carried out a correlation between the RWN size and skull width in all age groups and analyzed several parameters. For each ear, we performed oblique multiplanar reconstruction (MPR) in the plane parallel to the posterior semicircular canal and centered to the RW. Many variations were found in this opposite wall that made it difficult in some cases to locate an exact point. After an exploratory tympanotomy and atticotomy, we drilled the anterosuperior (promontory) edge of the round-window niche until the true round-window membrane was completely exposed.
Third, the round-window membrane can be the place of delivery of drugs influencing inner-ear activity, either as a primary or as an iatrogenic effect. In each case, we registered the absence or presence and the extent of the mucoperiosteal folds or veils (false round-window membranes) on the round-window niche. In the same study, in 30% of the temporal bones, the roundwindow niche was completely occluded by these folds. The authors found that the round-window niche was partially obstructed in seven ears (17%) and completely obstructed in five ears (12%). The relationship between the degree of round-window niche obstruction and the results of inner-ear perfusion should be addressed in future studies so as to standardize the techniques of local therapy for inner-ear diseases.
After this appearance, several young members of the otolaryngology department at Brasília University Medical School also became interested in the symptom of tinnitus, and we decided in our department to set up a protocol for the study of tinnitus. Complete audiometric evaluation was carried out in all patients with tinnitus, and brainstem evoked response audiometry was performed whenever necessary for the diagnosis. These were not controlled by usual medical treatment and therefore needed some new answer to their problem.
Previous studies [3,4] were not doubleblind, prospective, and randomized, so we decided to follow such methods in this study. For now, at least, the need for prospective, double-blind, randomized trials of this treatment method seems fairly clear. Twenty (24%) of the 82 were not able to participate because they lost their jobs before collection of data, 5 (6%) declined to participate saying that they no longer had symptoms of tinnitus, and 5 (6%) were on vacation at the time of data collection.
We performed puretone audiometry for all subjects at frequencies of 0.5, 1, 2, 3, 4, 6, and 8 kHz. The functional subscale, composed of 11 questions, evaluates the limitations that tinnitus induces in the mental, social, occupational, and physical areas. Table 1 displays the findings pertaining to the health problems and auditory and medical histories described by the participants.
In the THI, tinnitus was shown to have the greatest relationship to the functional scale (54%), indicating that its impact is more noticeable in social, daily, and reading activities involving concentration, auditory acuity, attention, and rest.
The analysis of the THI results along with the audiometric results indicated that a considerably greater number of significant correlations were verified in the group with altered hearing, which was expected because the two conditions-compromised hearing and tinnitus-are often associated.
Information dissemination on the risks and prevention alternatives is of great importance, as is the management of tinnitus. Finally, it could be used in the design of appropriate strategies to manage tinnitus in the workplace. Green squares indicate sites where the interaction between these different frequencies changed alongside changes in tinnitus.
The vestibuloocular reflex study also would cover head-shaking nystagmus, rotatory tests with ENG or VNG, and caloric analysis according to Dix and Hallpike [4], with ENG and VNG, including the measure of the ocular fixation index as described first by Demanez [6]. Later, a modified beta version with 25 questions was developed by Newman et al.5 which is in the form of a self-assessment report that a person suffering from the condition can fill in. In such circumstance administering these inventories becomes difficult and sometimes impossible too. Later, all the 50 filled inventories were assessed to find out if all the words and the meaning of the questions were understood by the Kannada speakers.
Once the subject finished rating the questions, they were grouped under 5 categories based on the severity that is Slight, Mild, Moderate, Severe and Catastrophic.
The therapy produced good results to patients who suffer from both depression and tinnitus. We then used the produced MPR images for orthogonal two-dimensional measurements of the RW and adjacent recess (Fig.
The measurements we obtained were accurate and close to one another, verifying that this demonstration of the RWN can be used as a standard view of this anatomy.
In contrast to the RWN, which reaches its final size in early life, skull dimensions demonstrated a slow and continuous growth throughout a subject's entire life [21]. We registered the presence or absence and the extent of the false round-window membranes on the round-window niche. This article describes the protocol and reports on some preliminary results of ongoing investigations. Therefore, the final sample of the study consisted of 52 participants: 11 females (9% of the total of 120 noiseexposed female workers in the studied plant) and 41 males (16% of the total of 252 noise-exposed male workers in the studied plant). The emotional subscale, composed of 9 questions, includes affective answers for tinnitus (anger, frustration, irritability, and depression).
All participants exposed to noise levels greater than 85 dB are required to use ear muffs, and information on their use and maintenance are given when workers are hired.
The emotional scale was the second most affected and is related to manifestations of nervousness, frustration, irritation, depression, anxiety, insecurity, and difficulty in relationships with family and friends.
Estabelece diretrizes e parametros minimos para avaliacao e acompanhamento da audicao dos trabalhadores expostos a niveis de pressao sonora elevados. The self report has been developed subsequent to previous studies that have thrown up reliable data that can be used to classify tinnitus into different grades according to the degree to which the tinnitus has affected a subject.
As this inventory quantified the alterations of the daily life of an individual due to tinnitus and due to the non capability of multilingual Speech & Hearing professionals to translate accurately the English version of THI to the regional languages and to avoid communication interpretation, there is a need to develop and standardize the Tinnitus Handicap Inventory in Indian languages. The questions which were rated as 1 or 2 were selected for the inventory and any questions with ratings over 3 were re-framed according to the familiarity of the speakers.
All the participants underwent assessment by an otorhinolaryngologist and complete audiological evaluation prior to the administration of the inventory. The RWN dimensions did not change with age, whereas the skull width increased with age in both genders throughout the patients' entire life. We found false round-window membranes obstructing the round-window niche partially or completely in five temporal bones (25%). Central vasodilators, vestibular suppressants, calcium channel blockers, anticholinergic drugs, anticonvulsant drugs, and gingko biloba were used with variable results. We also performed daily biological calibration checks on the audiometer immediately before testing subjects. Last, the catastrophic subscale is composed of 5 questions and examines the most severe reactions from tinnitus (desperation, loss of control, inability to face problems, inability to escape tinnitus, and fear of having a serious ailment)[12]. Walkthrough observations suggest that use of the hearing protection is high, but no information exists on the consistency of hearing protection use. The catastrophic scale demonstrated alterations related to desperation, intolerance to tinnitus, and loss of control in situations when experiencing tinnitus (see Fig. THI consists of 25 questions under the 3 sub-scales of emotional, functional and catastrophic. In our study, factors such as gender, age, tobacco, and exposure to firearms were not significantly associated with tinnitus.
The THI beta version is one of the best and most standardized tinnitus measuring tools and has got a good reliability, validity and a good internal consistency to administer on tinnitus patients. In conclusion, a special oblique projection that clearly demonstrates the RWN was reconstructed, and this reconstruction allows for standardized measuring.
We found mucoperiosteal folds obstructing the round-window niche partially or completely in a significant proportion of the ears. Treatment failed in the 1% with severe disabling tinnitus, and they were entered in a double-blind, randomized protocol for intratympanic dexamethasone injection.
Thus far, we have entered five patients in this protocol, the results of which are shown in Table 1. Coles [26], among several authors, reported that the worse the hearing is, the more probable is the occurrence of tinnitus.
Recorded eye movements can be analyzed afterwards by counting nystagmus beats on the screen or by running a computer program. These anatomical particularities could account, at least partially, for the great variability of the results of intratympanic therapies for inner-ear diseases.
Alzamil and Linthicum [5] described in detail the presence of membranes and soft tissue inside the RWN in 32% of 202 temporal bones.
Patients remained supine for 20 minutes with the injected ear up and received four injections at 1-week intervals. Approximately 20% of the patients with hearing loss present complaints of tinnitus, whereas 90% of those with severe tinnitus had hearing loss.
Their findings question the efficacy and mechanism of intratympanic medication in obstructed RWNs.
The variations in RWN dimensions found in the aforementioned articles and in others [13-17] initiated the need for an accurate imaging evaluation of the RWN anatomy. Tinnitus is a very frequent symptom among our otologic patients, but most of them would not mention the symptom spontaneously, probably because for 81% it was mild. Evaluation of inner-ear anomalies is another aspect of the importance of the detailed study of the RWN. Curiously, the 5% of the severely disabling type tend to exhibit no clear cause, whereas the mild and moderate cases usually have an identifiable etiology. Standardizing a method of examination affords better correlation of the findings in various subjects. Studies based on CT evaluation have been published [12,18,19], but no standard method exists for evaluation.
In this study, we assessed the RWN dimensions and analyzed whether and how they correlated to age.



Ringing in the ears sounds like
Ears making ringing sound ringtone
Tinnitus nach stress lauter neues


Comments to “Tinnitus medical journal rankings”

  1. The course of sinus and ear.
  2. Runs a health which is used for therapy of alcohol addiction has been reported to give.


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