Chronic tinnitus causes pena,tinnitus therapy software 8520,causes of hearing loss in the outer ear hurts,ear blocked with ringing sound synonym - Step 1

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Chronic tinnitus affects a large number of people, with perhaps 3–5 percent of the tinnitus population significantly disturbed by their condition. Over the past decade animal models have contributed significantly to the neuroscience of tinnitus (Roberts et al., 2010).
Recent technical improvements have enabled the acquisition of well-resolved spectra from small tissue volumes. Hearing thresholds were determined immediately before and after exposure (for exposed rats) using auditory brainstem-evoked potentials (ABR). Prior to spectroscopy, each animal in its home cage, was placed in a double-wall sound insulated booth for 20 h without food but with freely available water.
Prior to spectrum acquisition, glass vessels 2 mm in diameter were prepared with either 10 mM of GABA or 10 mM of Glu dissolved in sterile normal saline.
At the conclusion of behavioral testing, the rats were individually imaged and volume-localized 1H-MRS spectra were determined. Significant tinnitus was evident in the exposed rats approximately four months after exposure. Independent of the type of ringing in the ears, the fine hair cells participate in the constant sound and the hearing process.
The so-called hair cells perceive the sound waves and relay them directly to the auditory nerve. However, tiny deposits in the fine blood vessels around the cochlea can limit the cellsa€™ supply. Often the ringing in the ears appears after a sudden deafness being described as a suddenly appearing deafness of the inner ear. The later specialist treatment is carried out the more increases the risk of a permanent tinnitus. Before the initiation of treatment it is important to check whether there is a specific cause of the ringing in the ears. Depending on the diagnosis, a specific treatment or the combination of several measures can be initiated then.
Important: Take action in due time to avoid that an acute tinnitus develops into a chronic one.
In particular with chronic tinnitus, measures adding to the reduction of the ringing in the ears and coping with the disease make good sense.
If stress cannot be avoided in everyday life it should be reduced and decreased deliberately in your leisure time. Lorem ipsum dolor sit amet, consectetuer adipiscing elit praesent vestibulum molestie lacus.
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. From 2001 to 2006, we performed a retrospective study of patients suffering from chronic unilateral or bilateral tinnitus that was previously ineffectively treated by oral drugs [betahistine (Betaserc), extract of Ginkgo biloba (EGb 761), tanakan (Tebokan), and cinnarizinedimenhydrinate (Arlevert), singly or in combination]. Tinnitus is the phantom perception of sound in the absence of overt acoustic stimulation [1]. We randomly divided the patients into seven distinct treatment groups and administered treatment as specified. The pentoxifylline (PTX) group received daily for 10 days an intravenous infusion of 100 mg pentoxifylline and 250 ml physiological saline.
In addition, there were groups treated by pentoxifylline plus physiotherapy (PTX-RHB) and pentoxifylline plus physiotherapy and soft laser (PTX-RHB-soft laser), which consisted of a total of 9 persons. The visual analog scale from 0 (no tinnitus) to 10 (unbearable tinnitus) was used for daily evaluation. We used an enhanced method for construction of a binary classification tree-a regression method computed by condition of maximized homogeneity of treatment methods used [by Agapurin (Trental), Cavinton, lidocaine] in terminal leaves. In computing progress, we found that treatment PTX and age metric were ambiguous and so we dropped them, with no effect on our results.
Combination of Cavinton and physiotherapy was the most effective treatment seen in all the groups (see Fig.
The groups treated by pentoxifylline plus physiotherapy (PTX-RHB) and pentoxifylline plus physiotherapy and soft laser (PTX-RHB-soft laser) consisted of a total of 9 persons, and the outcomes were considered to be statistically insignificant.
Because tinnitus is a subjective symptom, we used the subjective scale-the visual analog scale-as the only parameter.
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Exposure to damaging high-level sound is likely the leading cause of tinnitus in young people (Muhr and Rosenhall, 2011) and the second leading cause in older adults (Nondahl et al., 2002). While diverse, all animal models assume that the sensation of tinnitus results from relatively primitive alterations in central auditory processing.
Point-resolved spectroscopy (PRESS) can be used to optimize signal strength from small volumes, while ultra-short echo times can be used to reduce signal multiplets thereby improving peak dispersion and the resolution of complex spectra such as those obtained from brain tissue.
The brain spectra were calibrated against spectra obtained from glass phantoms, filled with known concentrations of GABA and Glu, and comparable in size to the VOI. Ten months prior to spectroscopy 16 of the animals participated in a study examining the effect of supplementary dietary taurine on tinnitus. Briefly, an operant conditioned-suppression procedure was used to determine the animal's perception of test tones and silent periods embedded in an ambient of low level (60 dB, SPL) broad-band noise (BBN).
Individual animal and group discrimination functions were derived from the final 3–5 sessions of each test series, where performance variability was minimal.
The objective was to equate the baseline acoustic environment for all subjects, and to reduce the acoustic ambient to a low-level.
Initial attempts to include one or more calibration vessels along with the brain during spectrographic data acquisition distorted the field, making shimming impossible. Calibration of GABA spectra using an array of phantoms, each containing 10 mM GABA in sterile normal saline, distributed across the imaging field of view.
Calibration spectra of GABA and Glu, obtained using the same scanning parameters (see Methods for details) used to capture VOI spectra. The protocol in the present experiment (exposure before psychophysical training and testing), reveals tinnitus as a downshift in discrimination functions. Examples of tinnitus in individual rats.(A) A rat with focal narrow-band tinnitus in the vicinity of 20 kHz, and (B) A rat with rather broad-band tinnitus localized between 10 and 24 kHz. Since not only organic diseases but also stress can cause the constant ringing, murmur, whistling or hissing in the ear. But if not enough oxygen and important nutrients are transported to the hair cells their ability to regenerate will be reduced significantly.
Physicians suspect acute perfusion disorders, virus infections or nervous disorders as possible causes. Therefore you should immediately seek professional help when a ringing in the ears lasts more than one or two days. In such situations, distraction with low music and hear books is a help to many people affected. Relaxation techniques such as yoga, biofeedback or progressive muscular relaxation can be a support.


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.
It is well known that chronic tinnitus is difficult to treat, though lots of modalities are used for treatment.
Because the studies available on MEDLINE report different outcomes [8,10-12,14], we tried to evaluate the most widely used therapeutic approaches in our hospital: drop infusion of lidocaine, vinpocetine, or pentoxifylline and combination of these drugs with low-level laser therapy and physiotherapy. Before and after treatment, each patient underwent basic ear, nose, and throat examination, including otomicroscopy, basic vestibular examination, pure-tone audiometry, and tinnitometry.
Those in the Cavinton group received daily for 10 days an intravenous infusion of 20 mg Cavinton plus 250 ml physiological saline, and oral Cavinton 2 Χ 10 mg (0-2-2). As the outcomes were considered to be statistically insignificant, the findings from these groups are not evaluated further. Patients' symptoms were evaluated as improved if their tinnitus was perceived to be better by two or more points on this scale. We had four metrics-age, duration of tinnitus, gender, and audiometry-each of which could be used to divide cases into branches. The boundary in the age metric was found at 62 years; in tinnitus duration, the value was 15 months. Effectiveness of therapy in each of seven treatment groups, determined by using a visual analog scale.
Only 1 patient of those 9 experienced a decrease in tinnitus intensity; the rest saw no change. The most effective treatment according to the age, tinnitus duration, and audiometric findings.
Many patients with positive tinnitus changes (according to the visual analog scale) experienced changes in quality of life, so the quality-of-life questionnaire should be used in further studies. Damage to the peripheral auditory system, in the long-term, reduces afferent input to the central auditory system and appears to stimulate compensatory central changes.
In animals, tinnitus is induced by manipulations, such as high-level sound exposure, that commonly produce tinnitus in humans. Insertion of asymmetric variable power RF pulses into the probe sequence can be used to reduce the otherwise intrusive water peak that obscures signals above 3 ppm (Mlynarik et al., 2008). GABA and Glu were selected for analysis because they are, respectively, the major inhibitory and excitatory neurotransmitters in the auditory pathway; their concentrations are at detectible levels in small brain volumes, and they have been identified as potentially playing a significant role in tinnitus.
The experimental protocol was approved by the Laboratory Animal Care and Use Committee of Southern Illinois University School of Medicine and the University of Illinois at Urbana Champaign. ABR measurements were obtained using either a TDT System 3 Real Time Signal Processing System running BioSig32 and SigGen (Tucker Davis Technologies, Alachua, FL, USA), or an IHS Smart EP System, running IHS High Frequency Software (v.
The key feature of the procedure was that animals were required to discriminate between the presence and absence of sound when tested with a variety of sounds varying in composition, frequency, and level.
The sound floor in this environment across the audible frequency range for rats was less than 10 dB (SPL). Therefore, calibration spectra were obtained either before or after acquisition of brain spectra. Using multiple phantoms arrayed throughout the field of view illustrates optimized field shimming and selection of the least-variant spectral peak, from among the multiplets at each location, used to quantify the compound of interest (in this example, GABA). The peak, from among the multiplets, used to quantify GABA and Glu is shown by the pointer. To reduce the displacement error of microvolume localized 1H-MRS, caused by large chemical shifts in the strong magnetic field, a hybrid short-pulse sequence, obtained from R. Peaks in closest approximation to the calibration peaks for GABA and Glu, were outlined, and the area under each curve (AUC) for each was determined. The statistics in each panel represent a comparison of exposed and unexposed groups for stimulus levels above the OFF setting. Data from seven initial rats were used to adjust and optimize experimental parameters and were not included in the final analysis.
GABA and Glu concentrations were significantly lower in the contralateral MGB of exposed animals. Although differences between exposed and unexposed animals were not statistically significant, significance levels may have been masked by measurement variability stemming from field anisotropy rather that neurochemical variability. Even if the symptoms mostly decrease after a little while an acute or chronic tinnitus often remains. However, personal hobbies and other activities can help to direct your attention to positive things. Doing without or moderate consumption of alcohol and nicotine are truly a€?music to your earsa€?. 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.


Treatments consisted of application of intravenous pentoxifylline, lidocaine, or vinpocetine (Cavinton) and combination of these agents with physiotherapy and soft laser. Guidelines for inclusion of each patient into an appropriate treatment group are still missing. All patients had previously been treated ineffectively by various oral drugs [betahistine (Betaserc), extract of Ginkgo biloba [EGb-761], tanakan [Tebokan], cinnarizine-dimenhydrinate (Arlevert)], or their combination] for at least 6 months. To those in the lidocaine group, we gave a daily intravenous infusion of 40 mg lidocaine hydrochloride plus 250 ml physiological saline for 10 days. According to audiometry, we had three subgroups: bilateral normal hearing, unilateral normal hearing, and bilateral hearing loss.
The output classification tree divided the patients into groups according to the metrics (Fig. As we compared the groups of either Cavinton or lidocaine infusion alone with groups who received one of these agents combined with physiotherapy with or without soft laser, the effectiveness of combination therapy was assessed as being better. The combinations of lidocaine with RHB and with RHB plus soft laser were assessed by the classification tree as being effective for patients younger than 62 years who had tinnitus lasting for more than 15 months (Fig. We hope that our outcomes will be helpful for patients suffering from chronic tinnitus, and we encourage our colleagues to undertake further research. Neuroprotective drug therapy: A medical and pharmacological treatment for tinnitus control.
Glutamate antagonists, steroids and antioxidants as therapeutic options for hearing loss and tinnitus and the use of inner ear drug delivery system. Vinpocetine prevents 4-aminopyridine- induced changes in the EEG, the auditory brainstem responses and hearing. The inhibitory effect of intravenous lidocaine infusion on tinnitus after translabyrinthine removal of vestibular schwannoma: A double-blind, placebo-controlled, crossover study.
Transmeatal cochlear laser (TCL) treatment of cochlear dysfunction: A feasibility study for chronic tinnitus.
Several potential compensatory neural processes have been identified, such as increased spontaneous activity. The presence of tinnitus can be revealed by appropriately designed psychophysical procedures (Brozoski and Bauer, 2008). Separation of spectral lines and extraction of weak signals can be further enhanced by using very high-level magnetic fields and additionally through the use of a tunable pickup coil (Odintsov, 2011). While the features of tinnitus in rats (and humans) cannot be directly known, it is certain that tinnitus cannot sound like silence.
Initial calibrations were done with GABA and Glu in combination with compounds, such as creatine, that were expected to produce unwanted spectral lines potentially obscuring those of GABA and Glu. The VOI for each auditory region was kept constant and its placement was made as standard as possible using image reference points. Relative rate of lever pressing, as indicated by the suppression ratio (see Text), is shown on the y-axis, and test stimulus across stimulus levels (dB, SPL) is shown on the x-axis.
As in Figure 3, relative lever pressing is shown on the y-axis and test stimulus across levels is shown on the x-axis.
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. In our study, we evaluated some of the current treatment modalities to define the most effective for a certain group of patients. The Cavinton-plus-physiotherapy (Cavinton-RHB) group received a daily intravenous infusion of 20 mg Cavinton plus 250 ml physiological saline, and oral Cavinton 2 Χ 10 mg, combined with physiotherapy (soft techniques, including temporomandibular joint massage), the entire procedure lasting 20 minutes once daily for 10 days. We crossed all boundaries that are created as a midpoint between all recorded numerical data on all metrics and sought maximized homogeneity. 1) treated by lidocaine (contains lidocaine infusion, lidocaine-RHB, and lidocaine-RHB-soft laser groups) or by Cavinton (contains Cavinton, Cavinton-RHB, and Cavinton-RHB-soft laser groups). In the present experiment, the brains of rats with psychophysical evidence of sound-induced chronic tinnitus were imaged, and point-resolved proton magnetic resonance spectra (1H-MRS) were obtained from tissue volumes localized to areas in the auditory pathway that have been identified in one or more studies as potentially involved in mediating tinnitus. Evoked responses were differentially recorded from a subcutaneous vertex needle electrode referenced to an electrode at the occiput.
The animals were tested daily in commercial operant test chambers (Lafayette Instruments, Mod. Spectrograms of the mixtures were used to identify GABA and Glu peaks, from among their multiplets, that provided the clearest separation from background. 1H-MRS spectra were obtained bilaterally in the order indicated in Table 2, with acquisition parameters optimized for each VOI. AUC values were copied to an Excel (2007, Microsoft, Redmond, WA) spreadsheet for analysis. Frequency-specific suppression was evident in both individual (Figure 3) as well as group data (Figure 4), between 16 and 24 kHz. Asterisk next to the axis label indicates the direct pathway with respect to the trauma-exposed ear. With chronic tinnitus, more importance is attached to stress-reducing measures so that the persons affected learn to handle their 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.
The aim of our study was to compare treatment modalities and define their effectiveness for tinnitus relief. For the Cavinton-RHB-soft laser group, we administered a daily intravenous infusion of 20 mg C Those in the lidocaine-RHB group were given a daily intravenous infusion of 40 mg lidocaine plus 250 ml physiological saline, combined with physiotherapy, for 10 days.
When we finished dividing by all metrics (or when it was superfluous to continue with such division), we decided on classification of terminal leaf by the bayesian method. We did not find any additional effect of soft laser, but we expect that the effect of soft laser on biostimulation cannot be observed during 10 days of therapy. Because central processing systems are integrated and well-regulated, compensatory changes in one system may produce reactive changes in others.
Analyzed areas included the dorsal cochlear nucleus (DCN), the inferior colliculus (IC), the medial geniculate body (MGB) or auditory thalamus, and primary auditory cortex (A1).
The sound was delivered monaurally using a speaker driver (FT17H, Fostex, Tokyo, Japan) in a custom enclosure funneling the sound to a flexible tube that fit snugly into the auditory canal. For subjects with tinnitus, test stimuli that resembled their tinnitus served as a signal for response (lever press) suppression.
Calibration and peak selection were further refined using arrays of phantoms distributed in the field of view as shown in Figure 1.
The AUC of each neurochemical was converted to concentration level (mM), taking into account VOI volume, calibration vessel volume, known calibration concentration, and calibration AUC, as indicated in Equation 1. Individual subjects showed some variation in the frequency range of their suppression, from rather narrow (Figure 3A) to broad (Figure 3B).
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. To those patients in the lidocaine-RHB-soft laser group, a daily intravenous infusion of 40 mg lidocaine plus 250 ml physiological saline, combined with physiotherapy and soft laser (for softlaser specifications, see earlier in this paragraph), were given for 10 days. Can alterations in the concentration of these compounds be directly detected in the brains of animals with objectively confirmed evidence of tinnitus? Digitized records of the evoked responses (40 μ sec resolution) were exported to Excel (Microsoft, Redmond, WA, USA) for analysis and threshold determination.
In contrast, for unexposed subjects without tinnitus, the signal for suppression was silence. Immediately before acquisition, animals were given a lethal dose of anesthetic (Euthasol, Virbac, Ft. Three hundred scan repetitions were adequate to resolve all spectra, with the exception of the DCN (Table 2). Acquisition of spectra from one animal, along with attendant field shimming, required approximately 7 h to complete. To examine the roles of GABA and Glu in tinnitus, high resolution point-resolved proton magnetic resonance spectroscopy (1H-MRS) was used to quantify their levels in the dorsal cochlear nucleus (DCN), inferior colliculus (IC), medial geniculate body (MGB), and primary auditory cortex (A1) of rats. All sound levels reported in the present experiment are unweighted pressure levels re 20 μ Pa.
Hearing thresholds for each ear were defined by the lowest stimulus level that produced statistically distinct and visually distinct evoked waveforms, defined as the maximum peak-to-peak deflection within the 10 msec window following stimulus onset. The behavior of interest was lever pressing during randomly presented test sounds (1 min duration) that substituted for some of the speaker-off presentations (also 1 min duration).
Worth, TX), decapitated, the mandible removed, and excess muscle tissue dissected away from the skull. None of the treatment modalities had an objective correlate of improvement, though improvement was reported by a visual analog scale.
Chronic tinnitus was produced by a single high-level unilateral exposure to noise, and was measured using a psychophysical procedure sensitive to tinnitus. The head was placed in a polyethylene holder along with a 1 mm diameter glass capillary filled with CuSO4 (3 mM).
Spectra for the four auditory areas of interest, DCN, IC, MGB, and A1, are summarized in Figures 5–8.
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. Decreased GABA levels were evident only in the MGB, with the greatest decrease, relative to unexposed controls, obtained in the contralateral MGB. The image phantom of the capillary indexed the left hemisphere, making VOI laterality unambiguous.
Each figure depicts selection of the VOI in the top panel, a representative individual spectrum from that VOI in the center panel, and estimated GABA and Glu average levels for exposed and control animals in the bottom panel. The remaining eight presentations were of a randomly selected tone or noise, with different levels in each presentation.
GABA and Glu estimated mM levels are reported separately for each hemisphere, ipsilateral, and contralateral, with respect to sound exposure. Although Glu levels showed considerable variation, Glu was moderately and bilaterally elevated both in the DCN and in A1. These bidirectional and region-specific alterations in GABA and Glu may reflect large-scale changes in inhibitory and excitatory equilibrium accompanying chronic tinnitus. The present results also suggest that targeting both neurotransmitter systems may be optimal in developing more effective therapeutics. A value of 0 is attained when lever pressing in the current minute is 0, a value of 0.5 when lever pressing in the current minute is equal to that of the previous minute and a value of 1 when lever pressing in the previous minute is zero.
R provided a running index of behavior, in 1 min segments, and enabled a quantitative comparison between subjects as well as unbiased compilation of group data.
Small GABA increases may have been present bilaterally in A1 (Figure 8) and in the contralateral DCN (Figure 5) however, these differences were not statistically significant. R is a useful index of perceptual performance in that it is very sensitive to short-term behavioral effects, such as those produced by sensory events, but it is very insensitive to gradual behavioral effects, such as those produced by changes in motivational status, for example, satiation. In the context of the present procedure, it was expected that exposed rats with tinnitus would have lower R values than unexposed rats, when tested with stimuli that resembled their tinnitus. Further details of the psychophysical procedure appear in an open-source document (Brozoski et al., 2012).




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