Otosclerosis surgery tinnitus,is it possible to get rid of tinnitus xtc,c.c saha hearing aid kolkata - How to DIY

OBJECTIVE: to evaluate the effectiveness of stapes surgery for improving tinnitus symptoms. MATERIALS AND METHODS: This prospective study included 29 patients with surgically proven otosclerosis, who had undergone stapedectomy or stapedotomy. CONCLUSION: We conclude that stapes surgery is quite effective for treatment of tinnitus as well as improvement of hearing.
Otosclerosis is a common cause of progressive hearing loss in patients with an intact tympanic membrane. Several treatment options such as hearing aids, fluoride, biphosphonates, and stapes surgery are available1. The goal of this study was to determine the incidence of tinnitus, and its discomfort level in otosclerosis patients, using the Newman method16, and to evaluate the effectiveness of stapes surgery for improving tinnitus as well as hearing levels. This prospective study included 29 patients with otosclerosis aged between 13 and 65 years old.
Stapes surgery was performed under general anesthesia in 12 patients and local anesthesia in 18 patients depending on the patient's or surgeon's preference. Before and after the surgery standard audiometry including speech recognition threshold (SRT), speech discrimination score (SDS), air bone gap (ABG), pure tone average for air conduction (AC) and bone conduction (BC) at 4 frequencies (0.5, 1, 2, 4 kHz), and a tympanogram were performed in all patients. A total of 29 patients with a mean age of 39 years (range: 13-65) were included in the study, 20 were female and 9 were male. On the first day after surgery, tinnitus was aggravated in 3 patients, unchanged in 5 patients, and improved in 21 patients.
Interestingly, 2 of the 3 patients who did not have tinnitus before surgery experienced a short episode of tinnitus postoperatively which disappeared completely within one month of surgery. The mean of the pre- and post-operative SRT, ABG, AC, and BC results are presented in Table 3. In this study discomfort from tinnitus before surgery was not associated with hearing level.
In another approach, Gristwood studied 1014 otosclerotic patients who had a 65% incidence of tinnitus and observed that preoperative tinnitus was significantly correlated with gender, mean AC, mean BC, and ABG. In terms of predicting post-operative outcomes, Ayache and Szymanski stated in their studies that there was not any parameter that could predict the tinnitus status postoperatively5,10.
Stapes surgery can successfully improve tinnitus as well as hearing levels in patients with otosclerosis.
Paper submitted to the RBCMS-SGP (Publishing Management System) on April 20, 2012; and accepted on August 16, 2012. In 1981, Shea [1] stated that tinnitus in otosclerosis is caused by focuses of the disease involving the inner ear and is not affected by stapedectomy. In 1995, Causse and Vincent [3] determined the frequency of tinnitus in 643 otosclerosis patients preoperatively.
From this review, it is clear that otosclerosis is a major pathological diagnosis associated with tinnitus, and this symptom is very common in otosclerosis patients. A questionnaire asking about tinnitus was prospectively applied at the Department of Otolaryngology of the Brasilia University Medical School to all patients scheduled to have stapes surgery for otosclerosis: Was it present in the ear to be operated on? After surgery, the same questionnaire was applied early (4-14 months) and late (14-48 months), when possible. We recorded results of surgery measured by comparing four pre- and postoperative tonal average airbone gaps.
The Ethics Committee on Research Involving Human Subjects of the Brasilia University Medical School approved this protocol before the investigation was begun. Table 6 shows that the preoperative air-bone gap had no bearing on the intensity of tinnitus.
Table 11 shows that tinnitus pitch preoperatively in SDT patients does not influence postoperative tinnitus decrease. Table 13 shows that 26 patients contacted from 14 to 48 months after surgery reported no change in tinnitus status in relation to early follow-up.
Shea [1] and Causse and Vincent [3] tried to correlate pitch of preoperative tinnitus in otosclerosis patients and decrease of this symptom after stapes surgery.
We have measured the intensity of tinnitus preoperatively and postoperatively using a visual analog scale.
Larger air-bone gaps preoperatively had no influence on the intensity of tinnitus but correlated with greater decrease of the symptom (including SDT) after successful surgery.
It makes sense that larger preoperative air-bone gaps do not increase the magnitude of tinnitus before surgery, but closure of larger air-bone gaps enhances tinnitus reduction or remission in SDT. If the foregoing explanation is true, the only way in which stapes surgery can influence tinnitus in otosclerosis patients is by changing the conductive part of the equation. Finally, we must comment on lower levels of preoperative bone conduction producing a higher incidence of SDT before, and of total remission after, surgery. This work was supported by a grant from FINATEC (Fundacao de Empreedimentos Cientificos e Tecnologicos).
Abnormal growth of BONE tissue around the auditory ossicles in the middle EAR, causing one or more of the ossicles to become locked into place or fused against the other ossicles.
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We compared symptomatic (tinnitus, hearing loss, and vertigo) and audiological findings obtained before and after surgery.
When deciding upon management in patients with otosclerosis the presence of tinnitus should be considered as well as hearing level. The study protocol was approved by the ethics committee of Mashhad University of Medical Sciences and informed consent was obtained from all patients. Stapedectomy was performed in 4 cases and 25 patients underwent stapedotomy, where the same technique was used for all procedures. The level of discomfort caused by tinnitus was graded using Newman's method with scores from grade I to V. Fisher's Exact test and Student's paired t-test were used to compare hearing levels and tinnitus discomfort levels before and after surgery.
According to Newman's grading method, 2 patients had grade I tinnitus, 4 patients had grade II, 11 patients had grade III, and 9 patients had grade IV tinnitus.
One week after surgery tinnitus was worsened in one patient, unchanged in 5 patients, and improved in 23 patients in comparison with the preoperative status.
Vertigo happened during the surgery in 9 out of the 18 patients who did not receive general anesthesia. Patients with otosclerosis often also suffer from subjective tinnitus that can be severe and disabling.


However, it wasn't associated with age, duration of hearing loss, and degree of footplate involvement21. However, Gersdorff and Sakai showed that the surgical technique used was important in the outcomes related to tinnitus and that better results were achieved by stapedotomy as opposed to stapedectomy7- 8. Thus, patients suffering from discomfort caused by tinnitus could be good candidates for stapes surgery. Otorhinolaryngology-Head & Neck Surgery - Mashhad University of Medical Sciences - Mashhad - AC - Iraque. Otorhinolaryngology-Head & Neck Surgery, Otorhinolaryngology-Head & Neck Surgery Department, Imam Reza Educational Hospital - Mashad University of Medical Sciences - Mashhad - Iraque.
MD; Associate professor of the Ear, Nose and Throat Research Center, Emmam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences. Otorhinolaryngology-Head & Neck Surgery Department - Mashhad University of Medical Sciences - Mashhad - Iraque. Even though some papers have been published about the effect of stapes surgery on tinnitus, we still need to clarify important issues regarding tinnitus, otosclerosis, and stapes surgery: What is the prevalence of tinnitus in otosclerosis patients? We quantified tinnitus on a visual analog scale (1-10) preoperatively and after stapes surgery at two points: 4 - 14 months and 14 - 48 months postoperatively. All patients underwent pure-tone audiometry and a word discrimination test preoperatively and at each postoperative review (early and late). Tables 7 and 8, however, show that larger preoperative air-bone gaps predict total remission of tinnitus postoperatively in both SDT and less intense cases. Table 12 shows that lower preoperative bone conduction levels correlate with a higher incidence of SDT preoperatively and of total remission of the symptom postoperatively.
Therefore, we can say that tinnitus is a very prevalent and significant symptom in otosclerosis patients. Lower preoperative bone conduction correlated with a higher incidence of SDT preoperatively and a higher number of total remissions in SDT patients after surgery.
In a temporal-bone study searching for a pathological correlate for tinnitus, Oliveira and Schuknecht [5] found endolymphatic hydrops in 18% of the bones studied, normal histopathology in 11%, and otosclerosis in 11%.
This is precisely what we found in our patients: Larger preoperative gaps when closed by successful surgery allow effective masking of the symptom.
Again, Oliveira and Schuknecht [5] found better preservation of sensory and neural structures in patients with tinnitus than in patients with the same histopathological diagnosis but without tinnitus. Most commonly affected is the stapes (stirrup), the final of the three auditory ossicles in the sequence of sound wave amplification and transmittal. The otolaryngologist may request a COMPUTED TOMOGRAPHY (CT) SCAN or MAGNETIC RESONANCE IMAGING (MRI) to visualize the structures of the inner ear and to confirm the diagnosis. Using Newman's method the level of discomfort caused by tinnitus was scored from grade I to V pre- and postoperatively. The technique has been shown to improve hearing, is well established with a long history, and has been proven to be effective in several studies. A total of 25 Teflon-piston and 4 titanium (Big Easy) prostheses, one of which was offset (inclined), were used in this study.
Follow-up visits were conducted on the first day, the end of the first week, and the end of the first month after surgery and the patients were asked about tinnitus and vertigo. We evaluated the association of presumed risk factors with the outcome of surgery on tinnitus using Pearson's correlation and Student's independent t-test. One patient had pure conductive hearing loss and all others had a concomitant bone conduction deficit to some extent (mixed hearing loss). On the third visit, one month after surgery, 24 patients had complete or partial recovery (82.8%) from tinnitus and in 5 patients their tinnitus remained unchanged. In the first day after the operation, 2 patients had severe vertigo which required medical therapy and another 13 patients reported mild vertigo. In this study, tinnitus was present in 89.7% of our otosclerosis patients, 31% of whom suffered from severe disabling tinnitus.
Causse and Vincent proposed that some causes of tinnitus in otosclerotic patients could include poor vibration of the inner ear fluid, fixation of the foot plate, proteolysis of Corti hair cells, acoustic trauma, and spiral ligament hyalinization that impairs blood supply to the inner ear via the stria vascularis18-19.
Similarly, in this study we didn't find any risk factors for predicting tinnitus discomfort before surgery or its recovery one month later. Incontrast, Merchese and House achieved similar hearing results (ABG closure) with both techniques13- 14. The comparative analysis of clinical symptomatology before and after the operation of otosclerosis. Demographics, clinical history, and pre - and postoperative audiometry results were recorded. They stated that restoration of the normal elasticity of the oval-window mechanism corrects the distorted vibrations of the inner-ear fluids that cause low-tone tinnitus in otosclerosis patients. In 58% of their patients, tinnitus continued after surgery; 11% actually reported worsening of the symptom postoperatively, but most believed that the tinnitus was less disturbing after surgery. Light-microscopy study of 83 temporal bones of tinnitus patients revealed that 18% had endolymphatic hydrops, 11% had otosclerosis, and 11% had normal temporal bone histology. We studied gender, age, and several audiometric parameters, searching for correlations with tinnitus changes after stapes surgery. In a visual analog scale from 1 to 10, where 1 represented a very mild intensity and 10 an unbearable level of intensity, the patients were asked to indicate the subjective intensity of their tinnitus: Was tinnitus constant, occasional, occurring very often, or present only rarely?
All patients were operated on by senior residents of the otolaryngology department at Brasilia University Medical School under the supervision of two senior staff otologists. One female patient reported slight reduction of tinnitus, and two patients (one male and one female) reported no change after surgery.
Table 9 shows that smaller postoperative air-bone gaps do not correlate with a higher number of total remissions and significant reduction of tinnitus when all tinnitus cases are combined.
Causse and Vincent indicated that this kind of tinnitus is related to the elasticity of the oval-window mechanism, which is corrected by stapes surgery. We found that female patients report SDT much more frequently than do male otosclerosis patients. Possibly, tinnitus is a very early sign of cochlear lesion and tends to decrease as the lesion worsens. Conductive HEARING LOSS, which is the primary symptom of otosclerosis, occurs as movement of the auditory ossicles becomes increasingly limited. The pathological process underlying the disease is an inflammatory lysis and remodeling of the bony labyrinth and a variety of etiologies such as genetic, vascular, viral (especially Measles), and hormonal factors are believed to play a role in the development of the condition. Although surgery is not traditionally indicated for treating tinnitus alone, many patients report alleviation of tinnitus after surgery5-15.


The grade of tinnitus present was determined at each of the post-operative visits and postoperative audiometry was done one month after surgery. In 16 patients hearing loss was bilateral and we selected the ear with the worst hearing for stapes surgery. Grade IV and V tinnitus is considered to be severe disabling tinnitus and 9 cases were included in this group; the other 17 patients with tinnitus had mild to moderate discomfort. Similarly, Ayache reported the presence of tinnitus in 74% of otosclerosis patients, 24.6% of whom had severe disabling tinnitus5.
Tinnitus in otosclerosis could also be attributed to stapes immobility and conductive hearing loss which may be capable of causing limited and reversible changes in central auditory pathways. Sparano and Sobrinho indicated that smaller postoperative ABG was associated with better tinnitus recovery11-12, but in Terzic's study gap closure was not associated with tinnitus improvement22. A questionnaire asking about tinnitus (intensity, pitch) and including a visual analog scale quantifying the degree (1 - 10) of annoyance caused by the tinnitus was completed pre - and postoperatively (4 - 10 months and 14 - 48 months, respectively). The authors found no relation between tinnitus reduction and hearing results after stapes surgery.
Table 10, however, shows that smaller postoperative air-bone gaps do correlate with larger numbers of total remission and significant reduction of tinnitus after surgery when we consider only SDT patients. No significant vestibular symptom or sensorineural hearing loss was noted after surgery in the 48 patients studied. Our patients reported either high tone (whistle) or white noise (radio static, waterfall), and the pitch of preoperative tinnitus did not correlate with postoperative improvement. However, when we look at the overall incidence of the symptom (including less intense tinnitus), we find no difference between male and female patients. If we consider that tinnitus starts with a biochemical alteration in the inner-ear fluids, which in the beginning will not be detectable by light miscroscopy but later is seen as endolymphatic hydrops, and that otosclerotic focuses in the cochlea provoke these biochemical changes in endolymph and perilymph, we tie together these major histopathological diagnoses found in temporal bones of tinnitus patients. Of course, the ideas posited in the preceding paragraphs are far from being proved, but we believe that they comprise an interesting hypothesis to be investigated. Occasionally otosclerosis involves the COCHLEA, causing sensorineural hearing loss and sometimes vestibular dysfunction such as balance disturbances and VERTIGO.
An OPERATION to remove the immobilized ossicle and replace it with a prosthetic ossicle can permanently restore hearing in most people.
The exclusion criteria were previous stapes surgery on the same ear and unconfirmed stapedius fixation during surgery. Before the procedure all patients had negative Rinne tests at 512 Hz in the ear selected for surgery.
There was no significant association between tinnitus severity and other parameters such as age, sex, and family history of otosclerosis.
One month after surgery 3 patients had mild vertigo and the rest of them had no balance complaints. In studies by Oliviera and Del Bo, 91% and 56% of patients, respectively, were reported to be annoyed by tinnitus6,17.
In our study significant hearing improvement was achieved after surgery with ABG measurements of less than 20 dB one month after surgery observed in 24 patients (82.8%).
In this study, we considered as severe and disabling a tinnitus with a 7 or higher level on the visual analog scale. Possibly women are more sensitive to the symptom and therefore have a heightened perception of tinnitus, or cochlear otosclerosis is more severe among them. Surgery is less successful in restoring hearing loss due to cochlear otosclerosis, though a HEARING AID often can improve hearing. Patients are frequently between 15 to 50 years old on presentation and one half of patients also have a positive family history of the disease1-4. Patients' data, including age, gender, family history of otosclerosis, and the occurrence of vertigo, were recorded in a checklist. Furthermore, the patients' levels of tinnitus discomfort were not associated with their preoperative hearing levels (SRT, ABG, and AC) (Table 1).
In our study 3 patients did not complain of tinnitus before surgery, in 2 of them tinnitus ensued after surgery but was completely resolved within one month. Stapes surgery not only reduces conductive hearing loss but also improves the mechanics of the cochlear fluid, as explained by Szymanski10, and this may account for tinnitus recovery without hearing improvement in some patients. In addition, tinnitus recovery after surgery was positively correlated with conductive hearing recovery (SRT, mean AC, ABG). Highpitch (whistle) tinnitus was present in most patients, and white noise (radio static, waterfall, rain) was present in others.
After surgery, only 1 female patient reported no change in tinnitus intensity, whereas 10 reported total remission, 4 reported significant reduction (at least two levels on the visual analog scale), and 1 was slightly improved. In Del Bo's study tinnitus started in 7% of patients postoperatively, contrary to Ayache, who reported no similar cases5,17. Age did not influence the incidence of tinnitus in otosclerosis patients preoperatively or affect reduction of the symptom postoperatively. None of these articles quantified the intensity of the symptom, so they could not evaluate SDT.
Ninety-one percent of patients reported tinnitus reduction or total remission after surgery.
Ten of 19 patients with SDT reported complete remission of tinnitus, 7 reported improvement postoperatively, and 2 reported no change.
Small postoperative air-bone gaps (four tonal average) correlated with remission or reduction of tinnitus in SDT patients.
Tinnitus pitch, gender, and age of patients were not related to decrease of tinnitus postoperatively. A larger preoperative air-bone gap correlated with larger reduction of tinnitus after successful surgery. A lower preoperative bone conduction level correlated with more intense tinnitus before surgery and greater reduction postoperatively. We contacted 25 patients from 14 to 48 months after surgery, and all reported that their tinnitus status had not changed since the early follow-up. Tinnitus is very prevalent in otosclerosis patients; almost one-half of patients have SDT preoperatively, and stapes surgery improves this symptom in 9 1% of cases. Preoperative air-bone gap and bone conduction level and a postoperative airbone gap seem to influence the degree of postoperative tinnitus reduction.




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