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Author: admin | 13.12.2015 | Category: Ginkgo Biloba Tinnitus

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A sequential program emerges as one of the most promising, research-based methods to help veterans manage their tinnitus.
In order to help patients, it is necessary to mitigate the functional effects of tinnitus, such as difficulties with sleep, concentration, and relaxation. People who experience tinnitus have most typically been exposed to loud noise that caused peripheral auditory damage, resulting in both tinnitus and hearing loss. Military personnel are exposed to numerous hazards associated with tinnitus and hearing loss, including but not limited to high levels of noise. These auditory problems can become significantly greater following military discharge due to aging and further insults to the auditory system. Although many therapies for tinnitus are available, most are not supported by rigorous scientific research.
Our research efforts in Portland have led to the development of Progressive Tinnitus Management (PTM), a detailed, comprehensive program endorsed by the VA central office for use at VA medical centers. An initial referral is followed by a hearing evaluation and brief assessment of tinnitus impact.
If needed, the patient is advised to attend education workshops designed to provide patients with skills to self-manage their tinnitus. If the patient still experiences problematic tinnitus following the workshops, an interdisciplinary (audiology and psychology) evaluation is completed. PTM was developed specifically for efficient implementation at VA medical centers, but there are still some barriers to providing comprehensive tinnitus services at all VA medical centers. To address these issues and as part of an overall effort to make tinnitus services available to all veterans, we conducted a pilot program to provide national in-home tinnitus education.
Since telemedicine technology is advancing rapidly, it is now possible to develop PTM as a full telemedicine program using different delivery models.
In addition, the infrastructure for conducting telemedicine is already in place at most VA medical centers.
Tinnitus is a problem that is recognized at all levels of the Veterans Health Administration. INTRODUCTION: Musical training positively influences the cortical plasticity of the brain and has proven to be effective in treating chronic tinnitus. OBJECTIVES: A neuro-music therapy concept, the "Heidelberg Neuro-Music Therapy" treatment was developed and evaluated.
MATERIALS AND METHODS: N = 135 patients (mean age 47 years) with chronic, tonal tinnitus attended a standardized protocol for Neuro-Music Therapy (either "standard therapy" ST or "compact therapy" CT). CONCLUSIONS: The "Heidelberg Neuro-Music Therapy" is a method with fast onset and long lasting effect for patients with "tonal" tinnitus. Apart from emotional disturbances such as anxiety, depression, sleep impairments or irritation1, the main complaints of the persons concerned with ringing in the ear are difficulties in concentrating their attention2 and in auditory perception3.
Data from human neuroimaging support the hypothesis of a final common pathway for tinnitus6 and propose a compromised "noise cancellation mechanism"7 to be liable for the enduring tinnitus percept. It is known that pleasant music verifiably reduces activities in the amygdala and enhances activity in nucleus accumbens and thalamus8,9.
Disadvantages are the rather lengthy application and the passive "sounding" of the tinnitus instead of an active exposition to the tinnitus sound. Therefore a short-term Neuro-Music Therapy based on active treatment modules seems to be fruitful in treating chronic tinnitus. The novel treatment according to the "Heidelberg Model of Neuro-Music Therapy" is based on the notion that tinnitus is experienced as an auditory percept - just as musical stimuli are experienced as auditory percepts. Two standardized protocols for tinnitus music therapy were defined: a "standard therapy" (ST) and a "compact therapy" (CT) (see patient flow-chart). All patients receive a comprehensive psycho-educative counseling in order to establish a cognitive model of tinnitus20. As the specific modules used in therapy are based on the individual tinnitus sound, a tinnitus-equivalent has to be set up by means of a commercially available sinus generator.
In the Resonance Training the patient learns a vocal exercise stimulating the cranio-cervical resonating cavities. The Neuroauditive Cortex Training uses tone sequences performed live by the therapist on a piano which have to be vocally imitated by the patient.
The Tinnitus Reconditioning offers coping mechanisms related to stress control along with a sound based habituation procedure.
During the relaxation exercise, the tinnitus sound will be integrated intermittently into the background music. Patients were eligible if they suffered from chronic tinnitus (duration > six months) which could be musically compiled (distinct frequency) and had no psychiatric co-morbidity. Since patients were recruited nationwide it was not possible to randomize the patients to the groups in the true sense of the word. Based on data from a pilot study23 we calculated the a priori power and thus estimated the minimum control group size with the power analysis program "GPOWER"24 to n = 15. As part of the medical history, psychosomatic and audiologic co-morbidities as well as socio-demographic data and tinnitus characteristics were assessed.
On the whole 69% of the patients presented with high frequency hearing loss (> 20 dB hearing impairment present in at least three test frequencies > 3000 Hz) and about 42% presented with low frequency hearing loss (> 30 dB hearing impairment present in at least one test frequency 0-2000 Hz).
Due to the stratified group allocation, no group differences in socio-demographic data were obtained.
Patients in the music therapy groups ST and CT received a treatment according to the "Heidelberg Model of Neuro-Music Therapy" as described above. Patients in the control group PT received a psychosocial intervention based on psychological tinnitus treatment strategies25 combined with placebo music therapy elements. Assessment of tinnitus symptoms was performed three times, at admission ("pre"), at discharge ("post") and six months after therapy ("follow-up FU"). Apart from statistical significance, individual changes were assessed according to the concept of clinical significance27.
At discharge all patients of the music therapy groups had the opportunity to rate their subjective therapy satisfaction. Statistical analysis of the data was performed using parametrical and non-parametrical tests in SPSS 16 (SPSS Inc.
In order to predict parameters possibly influencing therapy outcome, a logistic regression model (CATREG, SPSS 16.0) was calculated using TQ-score immediately after therapy as an indicator for therapy success as a dependent variable.
Analysis of TQ scores revealed a highly statistically significant reduction pre-post (p p =.913).
The overall reduction in the music therapy groups can be explained by significant changes in distinct sub-scales of the TQ, especially of "E = emotional problems" (p p p p p >.05).
According to the concept of "clinical significance", more than 80% of the patients the music therapy groups (ST and CT) achieved a reliable reduction in their tinnitus scores from admission to discharge and could thus be categorized as "responder". On a subjective level, 67% of the patients treated with music therapy regarded their symptoms as "better", 22% observed no change and 11% stated to be worse off.
Apart from immediate therapy-related effects, there could be other factors influencing therapy outcome ("moderator variables"). In order to set the results in the context of existing therapies, a psychologically based treatment group was used as control group. Animal models 29 as well as results from research on tinnitus treatments30 suggest the use of very specific stimuli, i.e.
The "Heidelberg Model of Neuro-Music Therapy" on the other hand integrates some well known psychological techniques and strategies in order to reduce the tinnitus sensitivity by means of an immediate exploration of the tinnitus sounds by the patient. The rather low positive feedback rate of the Neuroauditive Cortex Training (only about a quarter of the patients rated this module as helpful) might have been due to the wording during the therapy.
The Resonance Training is a purely vocal exercise that stimulates the auditory pathway by means of somatosensory innervations and enables the patients to control their tinnitus perception. It is known that there are manifold cross-modalities in processing somatosensory and auditory stimuli 35.
The Neuroauditive Cortex Training contains a detailed "intonation-training" with purpose-built musical stimuli, based on the individual tinnitus frequency in order to increase the patients" discriminative abilities and enhance their attentive skills. In chronic tinnitus characteristic auditory cortical reorganizations are traceable, which seem to be frequency specific 40,41. Tinnitus Reconditioninghas distinct features in that it combines musical distractors with psychophysiological relaxation and imagination of mental well-being. Since the application of the "well-being image" is linked to acoustic stimuli (relaxation music, tinnitus equivalent sound), the connection "well-being image - relaxation - tinnitus reduction" can be explained in terms of classical conditioning 46. The neurological basis seems to be in an endogenous system located in the medial temporal lobe system (MTLS) 6 and the reticular formation (RF) 47. On the whole, music therapy is a method with short duration, fast onset and long lasting effect for patients with "tonal" tinnitus and light to moderate tinnitus severity (Figure 1 and 2). Paper submitted to the RBCMS-SGP (Publishing Management System) on April 1, 2012; and accepted on August,16, 2012. We summarize our long-tean clinical experiences with an inner-ear drug delivery system (DDS) for control of tinnitus. The dangers of perforating the eardrum and of inciting the discomfort of vertigo as a result of the transtympanic injection of dexamethasone are minimal. The management of tinnitus has been the topic of many articles and special meetings of scientific societies. Our clinical trials of an inner-ear drug delivery system (DDS) for control of inner-ear problems began in 1974 [1]. Consequently, in 1981, we began to use liquid dexamethasone for STT to the inner ear, to control various kinds of inner-ear diseases and symptoms [3]. The procedure we employed for our therapeutic modality has already been reported elsewhere [4-7]. To evaluate the control effects of this therapy on tinnitus, a 10-division subjective evaluation system was used. Short-term effects on tinnitus were evaluated 2 weeks after the fourth intratympanic dexamethasone perfusion.
The short-term overall effects on tinnitus of dexamethasone perfusion into the tympanic cavity were positive in 75% of patients. Figure 2 depicts the effectiveness of drug management of tinnitus in the presence of various underlying diseases. The effects of our DDS trials on tinnitus control and average hearing levels ranged between 64% and 72%. Evaluation of the effects on various pitches of tinnitus indicates that high-tone tinnitus was less improved than was low-pitched tinnitus. The long-term effects on tinnitus of dexamethasone perfusion into the tympanic cavity were evaluated at approximately 6 months after the last injection. In this intratympanic dexamethasone perfusion technique, it is assumed that the medicine that was introduced directly into the tympanic cavity acts on the plexus tympanicus, is absorbed through the round window, and acts on the inner ear [8-13] .
The short-term side effects of the inner-ear DDS that we describe include pain at the time of tympanic puncture and temporary vertigo immediately after the injection.
Fifteen neuro-otological patients have been investigated for post-traumatic vertigo, hearing loss and tinnitus. The neurotological clinical manifestations of posttraumatic vestibular lesions demonstrate variation. Accidental head injury and its sequelae constitute major medical problems in Europe and America. The Glasgow Coma Scale has reported data from 1248 patients: 21% had severe head trauma, 24% moderate, and 55% minor head injuries. Craniocorpography (CCG) is a simple and more rapid method for the evaluation of vestibular function than Computerized Electronystagmography (CNG).4,5,6 Both techniques were performed in a group of 15 patients with post-traumatic vertigo in an attempt to establish the value of each test for the identification of the site of lesion. The clinical charts of all patients with a diagnosis of posttraumatic vertigo between 1990 - 1995 seen at the Audiologic and Otoneurology Clinic were reviewed. Sex, age, type and degree of head trauma, time interval that elapsed between the onset of head trauma and the complaints of hearing loss, tinnitus and vertigo, results of audiologic and otoneurologic studies were recorded.
The history included questions to elicit complaints reflecting involvement of other cranial nerves.
CCG is a test initially developed as a screening procedure in occupational medicine for patients with the chief complaint of vertigo.


CNG was performed with both horizontal and vertical leads to record extra-ocular eye movements. Fifteen neurotological patients with a diagnosis of posttraumatic vertigo were selected for this study. All completed the neurologic examination including the history form NODEC IV (Germany) and Neurophysiology Otoophthalmologic (Argentina) ENT examination, CCG, and ENG tests.
The incidence of occurrence of head trauma and post traumatic vertigo was found to be greater in male patients by a ratio of 2 to 1.
Evaluation of the Craniocorpography (CCG) and Computerized Electronystagmography (ENG) revealed an association between both.
Fifteen patients with the diagnosis of post-traumatic vertigo completed a neurotologic examination which included audiometry and equilibriometry tests.
CCG is considered a useful test in the diagnosis of central and peripheral lesions of the vestibular system secondary to head trauma. The incidence of occurrence of head trauma and posttraumatic vertigo was found to be greater in male patients by a ratio of 2 to 1. CCG and the Butterfly Calorigram are considered significant tests to establish the diagnosis of central and peripheral lesions of the vestibular system secondary to head trauma. For age-related hearing loss, there is no cure, but hearing aids and other listening devices help treat the problem and improve quality of life. Qui, petit, n'a pas deja reve d'etre astronaute et d'admirer la lune d'un peu plus pres, voire meme d'y poser un pied ? Venu tout droit des Etats-Unis via les reseaux sociaux, le phenomene a rapidement mis l'eau a la bouche de nos blogueuses.
Anything that can cause hearing loss can also cause tinnitus, including noise exposure, and the odds of having tinnitus increase as hearing loss increases.
In spite of awareness about these potential exposures and increased efforts to use hearing protection in the field, a substantial number of military personnel still experience auditory damage.
The Veterans Benefits Administration reports that in fiscal year 2011, tinnitus was the most prevalent service-connected disability, with 840,865 affected. A cure for tinnitus does not yet exist, and despite claims to the contrary, no method has been proven to provide long-term suppression of tinnitus loudness and intensity. Two years later, the VA National Center for Rehabilitative Auditory Research was established at the same location, which included tinnitus research. After possibly receiving a hearing aid at this time, the patient is assessed to determine if tinnitus-specific intervention is needed.
This in-depth assessment of the patient’s tinnitus needs determines whether the patient requires individualized support. As reported in the Journal of Rehabilitation Research and Development in 2012, it demonstrated the feasibility and efficacy of performing PTM intervention over the telephone, with educational materials provided by mail. The VA Rehabilitation, Research, and Development Service has supported most of the tinnitus research that we have conducted, as well as studies conducted by other investigators. Heidelberg Neuro-Music Therapy for chronic-tonal tinnitus - treatment outline and psychometric evaluation.
But more than 80% of the music therapy patients (both ST and CT) revealed a reliable improvement ("responder") compared to 44% in the PT group.
A number of potential working factors accounting for the treatment success are highlighted. The main reason seems to be the permanent awareness of the tinnitus and the diminished ability to habituate to the sounds4.
According to these assumptions, the tinnitus sounds originate from lesions in the auditory pathways.
Therefore the patients shall be enabled to actively control the sounds in order to reorganize the underlying neuronal mechanisms maintaining the tinnitus17.
The overall therapeutic dose rate (500 minutes of therapy) was equal just as were the intervention modules (including the counseling). The aim is not to reproduce a psychometrical pitch-matched tone but rather a sound that is subjectively equivalent to the patients" "ear sounds". A systematic and targeted training of inaccurately intonated musical sounds enables the patients to exert influence on their auditory processes since they learn to actively filter out irrelevant information and to concentrate on relevant acoustic stimuli.
By means of music as calming background stimulus, the balance between the activity of the sympathetic and the parasympathetic branches of the autonomic nervous system shall be restored. The volume is adapted to the individual hearing level compensating for a potential hearing deficit. The therapy concept was announced by press releases (newspapers and magazines, radio and TV) and offered to patients at the outpatient department of the local ENT-clinic of the university hospital.
The therapy was designed as group intervention with five weekly sessions a 90 minutes and an additional individual counselling (50 minutes) leading to therapy duration of 500 minutes equal to the music therapy intervention. The main outcome criteria were the absolute scores of the German version of the tinnitus questionnaire ("Tinnitus-Fragebogen", abbreviated "TQ") by Goebel and Hiller26 as well as the relative decrease in TQ scores. They had to answer three specific questions a) "Was your tinnitus percept changed by the music therapy?" (Answers: worsened - unaffected - improved) and b) "Which elements from therapy did you consider helpful?" (open question).
In the logistic regression demographic, therapy and tinnitus related factors were entered in the model to define those factors that are associated with tinnitus and may therefore contribute to therapy success. Therefore there is an urge for a short term therapy with preferably minimal effort but long lasting effect.
In terms of treatment outcome this group was target underperforming since just less than half of the patients achieved the desired symptom reduction. At the core of the "Heidelberg Model of Neuro-Music Therapy", the patients are actively "confronted" with their individual tinnitus sounds and are told to deal with their tinnitus explicitly instead of trying to take no notice of the tinnitus. These modules enhance the self-determination and the control beliefs of the patients since they learn techniques in order to actively influence their tinnitus.
The patients possibly did not know the scientific label of the intervention thus the answers in the feedback-sheet were blurred because the patients could not label this intervention. One specific of the "Heidelberg Model of Neuro-Music Therapy" is the establishment of a tinnitus-equivalent sound. Many patients can voluntarily change the percept of their tinnitus by for example teeth clenching, pressure on the occiput, forehead, vertex and temples, head turning and shoulder abductions 36. Frequency discrimination training may interrupt the cortical representations that are generating tinnitus 42,43. This module increases the auditory filtering and supports a modified emotional processing of the tinnitus sound. The MTLS is suspected to be responsible for the establishment of a "tinnitus memory" similar to the pain memory. Further studies are needed in order to evaluate which elements of the music therapy contribute most to the overall effect and to scrutinize the proposed working factors of the modules.
The treatment of tinnitus related psychological distress is part of the music therapy concept, though the duration is very short and music therapy presents a focal therapy and no in-depth psychotherapy will be possible. University Hospital for Ear, Nose, and Throat - University of Heidelberg - Heidelberg - Germany.
Tinnitus outpatient department - German Center for Music Therapy Research - Heidelberg - Germany.
The inner-ear DDS consist of transtympanic perfusion of 2 or 4 mg dexamethasone to the round window via the middle ear.
We believe that the transtympanic infusion technique is an effective DDS for control of inner-ear diseases and symptoms. In this article, we describe some 15 years of clinical experience with steroid targeting therapy (STT) to the inner ear for control of tinnitus. The inner-ear DDS that we employ consists of transtympanic perfusion of medicine to the round window via the middle ear. The intratympanic injection was performed in our outpatient clinic with the patient in the sitting or the supine position. The subjects were 3,978 ears of 3,041 patients who received intratympanic dexamethasone perfusion for the management of vertigo, tinnitus, and the like. Patients then were investigated 6 months after the injection, at which time the long-term effects on tinnitus were evaluated.
Effects on tinnitus of intratympanic dexamethasone perfusion in the presence of various underlying diseases.
Effects on tinnitus of intratympanic dexamethasone perfusion in relation to disease duration. The same 10-division subjective evaluation was used as was applied for the short-term evaluation.
The mechanism of action of this therapeutic modality is multifactorial, including sedative effects, a metabolic improving effect, and an edema-relieving effect, which may eliminate abnormal excitation of auditory hair cells, which are believed to cause tinnitus. Itoh A, Sakata E: Treatment of vestibular disorderIntratympanic dexamethasone injection and inner ear anesthesia with lidocaine.
Ristow W: Zur Behandlung der Meniereschen Krankheit mittels tympanaler Labyrinthanaesthesie. Clinical examination and laboratory tests included audiometry and equilibriometry in all patients. Correlations for vertigo with the type of head trauma, nystagmus frequency, Slow Phase Velocity (SPV), and associated complaints of hearing loss and tinnitus were analyzed.
A detailed questionnaire (NO DEC IV (Germany); and Neurophysiology Otoophthalmologic (Argentina) ENTexamination was completed for each patient. The past history was explored to identify underlying disease with emphasis on past or recent post-traumatic vertigo.
The test is simple to perform, less time consuming, objective, and a quantitative equilibriometric test. The polygraphic Electronystagmogram was analyzed for coordinated or dissociated eye movements. Localization of peripheral vestibular disease can be easily differentiated from central states of dysequilibrium. The correlation of SPY and frequency of 40ºC left ear with LD right suggests an indirect response of the site of lesion and a central lesion. On the other hand the SPY right 40ºC showed a direct response suggesting a peripheral lesion. Claussen CF, De Sa J: Clinical Study of Human Equilibrium by Electronystagmography and Allied Tests. Hickey SA, Ford GR, Buckley JG, Fitzerald O-Connor: Unterberger stepping test: a useful indicator of peri pheral vestibular dysfunction? Claussen CF, Schneider D, Marcondes LG, Patil NP: A computer analysis of typical CCG Patterns in 1021 Neuro-otological Patients. A 384 400 kilometres de notre planete bleue, elle brille chaque nuit et continue de faire rever les plus petits et les plus grands. On ressort donc les vieux bocaux de nos grands-meres, que l'on remplit d'eau plate ou gazeuse. Tinnitus was also the most prevalent service-connected condition for veterans who first began receiving benefits (87,261 veterans).
As a result, in order to help patients, it is necessary to mitigate the functional effects of tinnitus, such as difficulties with sleep, concentration, and relaxation.
Many methods of sound therapy have been developed, and numerous companies are promoting sound therapy products. Our tinnitus research has remained focused on developing effective, evidence-based methods of tinnitus management for veterans.
Additionally, for PTM intervention to be effective, veterans must travel multiple times to a VA medical center, which some veterans are simply not able to do. The workshops, evaluations, and individualized support efforts in PTM are ideally suited to telemedicine implementation. We will continue to develop and evaluate these methods to improve tinnitus services and to make them available to all veterans who need them.
James Henry [author of the accompanying story] that was available to veterans and involved several types of treatments. Tinnitus distress was assessed using the German version of the Tinnitus-Questionnaire (TQ) at admission, at discharge and six months after therapy. Therapy impact seems to be lasting since TQ scores remained stable until follow-up at six months. For that reason the predominant wish of the patients is to get rid of the "annoying" and "intrusive" sounds5 and to regain confidence in their sense of hearing. Usually these sounds should be blocked off by feedback connections from limbic regions before reaching the auditory cortex. Musically based interventions11,12,13 also have proven to be highly effective in treating chronic tinnitus - possibly by correcting tinnitus evoking neuronal mechanisms14. If they could actively influence their tinnitus, their control beliefs will rise and thus let down the strains15.


Purpose-built music therapeutic interventions were merged to modules and integrated into a standardized manual. During the interval between the sessions, the patients have to exercise themselves in Resonance Training for three minutes every hour.
For this purpose, before the training session starts, the patients have to set the background music to a convenient level such that they can easily listen to the music while still being able to follow verbal instructions from the therapist. Only patients coming from the proximity of Heidelberg were allocated in a randomized way (computer generated) either to the ST group or the PT group.
The regression analysis reveals a highly significant relationship between the tinnitus score and the independent variables (p 2= 0.43). The proposed therapy concept "Heidelberg Model of Neuro-Music Therapy" seems to be a potential completion of the therapy spectrum. Given that this group received also placebo music therapeutic elements (active listening to preselected musical pieces) and an individual counseling, it seems reasonable to argue that the positive and long lasting effect of the music therapy according to the "Heidelberg Model of Neuro-Music Therapy" is due to the far more specific and active musical training aiming directly at the individual tinnitus sound. There exists a variety of procedures using a combination of counseling and acoustic stimulation.
In doing so, the duration of the therapy does not exceed ten weeks (standard therapy) and can even be compacted to five days (compact therapy). Many patients stated though that they would enjoy singing or listening to music subsequent to the therapy. Levine 37 proposed interactions between auditory perception and somatosensory input at the dorsal cochlear nucleus. Experimental data indicate that it is more efficient to train at normal hearing frequencies rather than in the region of hearing loss or tinnitus frequency 44,45. Biocybernetics of attention in the tinnitus decompensation: An integrative multiscale modeling approach. Development and psychometric adequacy of the screening version of the tinnitus handicap inventory. Final common pathway for tinnitus: theoretical and clinical implications of neuroanatomical substrates. Intensely pleasurable responses to music correlate with activity in brain regions implicated in reward and emotion. The rewards of music listening: response and physiological connectivity of the mesolimbic system.
Auditive stimulation therapy as an intervention in subacute and chronic tinnitus: a prospective observational study. A multi-centre study on the long-term benefits of tinnitus management using Neuromonics Tinnitus Treatment. Listening to tailor-made notched music reduces tinnitus loudness and tinnitus-related auditory cortex activity. A cognitive model of tinnitus and hyperacusis; a clinical tool for patient information, appeasement and assessment. Musiktherapie bei Tinnitus: Interdisziplinare Pilotstudie zur Uberprufung des Heidelberger Modells. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research.
Enriched acoustic environment after noise trauma reduces hearing loss and prevents cortical map reorganization. Treatment of tinnitus with a customized, dynamic acoustic neural stimulus: underlying principles and clinical efficacy.
Cross-modal interactions of auditory and somatic inputs in the brainstem and midbrain and their imbalance in tinnitus and deafness.
The effect of a new treatment based on somatosensory stimulation in a group of patients with somatically related tinnitus. Auditory discrimination training for tinnitus treatment: the effect of different paradigms.
Auditory perceptual learning at normal hearing frequencies affects changes in tinnitus intrusiveness and percept. Tinnitus suppression by low-rate electric stimulation and its electrophysiological mechanisms. Classical conditioning as the basis for the effective treatment of tinnitus-related distress. The dorsal cochlear nucleus as a participant in the auditory, attentional and emotional components of tinnitus.
Therapeutic results of steroid targeting therapy to the inner ear were evaluated in 3,978 ears of 3,041 patients. At the beginning of our clinical trials of this system, we used 4% lidocaine hydrochloride to alleviate distressing inner-ear symptoms of tinnitus, recruitment, fullness or stiffness in the ear, and vertigo. Dexamethasone, 2 or 4 mg, was introduced into the middle-ear cavity through a fine needle, just as is done in tympanic puncture. The severity or annoyance of tinnitus before the injection was regarded as being at level 10, and the level after the injection of drug was expressed as a score from 1 to 10. In contrast, the effec-tiveness of our therapeutic regimen on tinnitus accompanied by streptomycin deafness was 48% and, in the presence of head injury, this figure dropped to 42%. Overall positive effects on tinnitus were seen in 75% of cases immediately after intratympanic dexamethasone perfusion and in 68% after 6 months. In Meniere's disease, steroid injection to the middle ear might improve endolymphatic hydrops. It is more frequent in men than women with a ratio of 2 to 1; and was found of increased incidence of occurrence in patients age 20 and above. Vertigo was categorized to be of five sub-groups: tilting, lift, rotation, falling, and blackouts. The methods of statistical analysis included Chi Square and Pearson's for dependence or independent variable; and Spearman correlation for association. In our series a significant associated complaint in patients with post-traumatic vertigo was identified. Treatment depends on the specific cause if known as well as the extent, type and configuration of the hearing loss.
Clearly, tinnitus is a high-priority healthcare issue for the military and the Department of Veterans Affairs (VA). It remains unknown, however, if there is any difference among the various sound therapy methods. Eighteen tinnitus projects have been funded, including four that are currently in progress.
The infrastructure for providing in-home tinnitus self-help education is fully developed, and participants are being recruited into the study. The western heptatonic musical tonality forms the basis of the active music therapy procedures.
The most common side effects are headache and laryngitis if the exercise is not executed properly, either too often, too long or with too much pressure. Group differences of sociodemographic data and audiometric tinnitus characteristics were analyzed with the c2-test or univariate analysis of variance (ANOVA). About 80% of the patients accomplished a reliable decrease of tinnitus pathology in the course of music therapy and about two thirds of the patients describe their tinnitus symptoms as "improved" after therapy. Often the musical stimuli are spectrally modulated in order to account for hearing impairments31,32 and are incorporated as a passive means patients have to listen to for rather lengthy intervals (months up to years). The main parts of the therapy consist of active music therapy modules; hence there is no need and no purpose for spectrally changing the music used. We therefore propose that it is possible to alter the internal tinnitus spectrum by means of the Neuroauditive Cortex Training, which represents a specific perceptual training within the normal hearing frequencies. RF neurons coordinate sensory and motor functions and influence cortical activity via the thalamus. Tinnitus improved in 75% of these patients immediately after treatment and in 68% after 6 months. Although the injection of 4% lidocaine hydrochloride is very effective for controlling inner-ear problems, patients complained of vertigo for several hours after the injection of medicine [2].
Before the procedure, the patient was asked to try to hold his or her posture steady and to avoid swallowing during the injection and for approximately 15 minutes thereafter to prevent the escape of dexamethasone through the Eustachian tube. A level of 0-2 for the residual symptoms represented good effects, 3-6 represented fair effects, and 7-10 represented poor effects. The improvement of tinnitus with labyrinthine hydrops was good, but effectiveness for noise-or druginduced tinnitus was poor. It appears that, to some degree, tinnitus control via our therapeutic regimen remained constant.
Takahashi K, Ohtsu K: Pathology and treatment of cochlear tinnitus by blocking with 4% lidocaine and dexamethasone infusion. Correlations for vertigo with the type of head trauma, nystagmus frequency Slow Phase Velocity (SPV) and associated complaints of hearing loss and tinnitus were analyzed.
Neurootological symptoms like vertigo and tinnitus were subjectively difficult to describe and to classify; and frequently varied over time and following treatment.
It provides a photographic, quantifiable record using a video-camera and a computer that receives, analyzes, and prints physiologic graphic significant data of the response of the patient to stimulation by stepping and standing. Our guide to the common types and causes of hearing loss, from infection to traumatic exposure to noise. I was thoroughly evaluated for hearing loss and was given a masker and a hearing aid, which have been a big help to me in coping with the tinnitus.
Mutual stimulation via both the thalamic and paralimbic pathways ultimately lead to tonotopic changes in the auditory cortex7 while reciprocal innervations of the medial temporal lobe system give rise to memory consolidation leading to a paradoxical "tinnitus memory"6.
Therefore the Neuro-Music Therapy is indicated only if the patients indentify their tinnitus as "tonal" (sinus tones). Any psychiatric disorder or ongoing medication with antidepressants or antipsychotic drugs yields to exclusion of the patients. Selection of the musical pieces was based on the individual musical taste and preferences as well as on the emotion evoking impact of the musical pieces. Therapy outcome as assessed by the TQ and the CPT were evaluated using univariate analysis of variance (ANOVA) for repeated measure procedures.
This effect was independent of the patient"s treatment allocation to standard therapy or compact therapy.
Additionally, a tinnitus-equivalent sound provides the possibility to deal with the symptoms in an immediate and direct way.
Therefore an activation of cranio-cervical and cranio-facial muscles and nerves by means of the Resonance Training might correct the auditory pathway by means of indirect stimulation of the joint "relay-station" cochlear nucleus 36.
Furthermore it is very important to ensure the training regime is intrinsically motivating.
Stress is considered to potentiate the severity of tinnitus due to the proposed accompanying reduction and alteration in auditory masking 6.
However, when tinnitus is continuous and loud, it can interfere with a person's quality of life and may be so annoying as to incite neurosis.
The ma-jority of the patients could not be treated successfully by oral administration of vasodilators or mild sedatives. Some authors consider vertigo to be a consequence of the concussion and not due to alteration only of the ear. According to the results from the regression analysis, there was - apart from tinnitus masking level - no influence of tinnitus characteristics or otological co-symptoms on therapy success. A deliberate regulation of emotional responses towards the tinnitus sounds might enhance gate control mechanisms and restore misdirected "filter functions" of thalamic and limbic areas.
The improvement of tinnitus in the presence of labyrinthine hydrops was good, whereas the effects on noise-or drug-induced tinnitus were poor. Some patients with an inner-ear problem experience such overwhelming tinnitus that they would "cut off their ear" or "poke a hole in it with an ice pick" to try to relieve the noise.
Depending on the clinical situation, some patients received a second course of four injections 3 months after the first course. Head trauma is well recognized as a cause of vertigo and is a common disturbance of the nervous system. Our results indicate that in high-tone tinnitus, the effects were poor, but they were good for low-pitched tinnitus. Nevertheless, the relative reduction and the individual improvement (reliable change index) were independent from the basic TQ-value - therefore also patients with comparatively lower strains still benefit from the therapy in equal measure.



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