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Author: admin, 09.01.2015. Category: Medicine For Tinnitus Over The Counter

In Belgium and in France, tinnitus has to be considered together with the study of hearing loss to determine a degree of disability. Otolaryngologists can be called on as expert witnesses in a legal case for any number of reasons.
In our countries, tinnitus must be considered as a symptom linked to a disease or an injury to the auditory system.
The language used by affected patients, their linguistic competence, and intellectual degree are the most crucial impediments to obtaining reliable results in vocal audiometry.
Brainstem evoked response audiometry (BERA) examination does not provide evaluation for separate frequencies. The late cortical auditory evoked potentials technique allows one to examine each frequency. Cortical audiometry appears to be an indispensable complement if the classic examinations fail to define an exact threshold.
In cases of occupational diseases, a special scale is applied (criteria for indemnification of occupational hearing loss and deafness). A common practice in calculating the loss of hearing ability in Belgium is to take the average of loss in excess of 1,000 Hz, 2,000 Hz, and 3,000 Hz, while ignoring the 500-Hz reading, as this can create an error in the evaluation of the level of industrial hearing loss. A maximum rate of 80% can be allowed, because a patient with total deafness loses virtually all possibility of finding employment in the job market. Clearly, in most evaluation scales of industrial disability, the degree of disability varies linearly with that of functional deterioration of the organ; however, in reality, it is not so.
Disability categories should in fact take into considerations that a simple raising of the voice is sufficient to produce understanding by a patient with 50- to 70-dB hearing loss. Evidently our decibel scale does not correspond truly to the progression of the degree of ability for social communion. In the other cases, an official Belgian disability scale (BOBI) is used legally for certain allowances for handicap people, war victims, and people injured in the military. The actual aim of the commission of the Belgium Otorhinolaryngology Society is to ask for standardization of these different scales, but doing so necessitates new legislative dispositions that are not the concern of the medical world. The evaluation of disability resulting from a hearing loss is based on pure-tone audiometry by air conduction, carried out in a sound-proofed room with headphones worn on naked ears and performed by a calibrated audiometer according to the ISO's latest regulations. According to article 712, the percentage of disability of a hearing deficiency is calculated by transposing the average loss in decibels of each ear (calculated by the following formula) on the x and y axes of the Pythagorean table (Table 2). According to article 713, speech audiometry and, more particularly, the auditive capacity index (ACI) can show a social hearing lower than indicated by tonal average loss.
Special scales are in use for the personnel of the NMBS (Belgian Railway) and for civil flying personnel. In case of occupational diseases in France, high-pitched traumatisms are compensated within the framework of industrial accidents.
Losses are not taken into account unless the average hearing loss of the best ear is equal to or greater than 35 dB.
In Belgium and France, tinnitus by itself is considered a weakly important symptom of invalidity. Sound Therapy, based on discoveries by the ear specialist Dr Tomatis, is safe, easy, cost effective and pleasurable.
Like many other areas of health dysfunction, the causes and manifestation of tinnitus are complex.

Sound therapy has been a component of India's ancient system of Ayurvedic medicine for centuries. However, Tomatis' application of sound therapy to exercise the muscles of the middle ear is new.
For those who are unsure, I encourage you to test out Sound Therapy for yourself in your journey towards health and wellbeing. Thank you Rafaele for writing this book that easily unravels this confusing and often debilitating condition.
On my recommendation, my mother was one of the first clients of the Canadian doctor when he opened his clinic in Montreal. More importantly, this book explores the preventative steps that can be taken along with wholistic options for general health. Either the case is designed in common law, or the cases involve work accidents or work-related diseases.
In the scope of forensic examinations, what has to be emphasized is that BERA does not permit a definition with exact and reliable thresholds. However, the threshold obtained by late cortical evoked potentials has to be brought into correlation with the other data of the examination [2]. This scale has been elaborated by a study group composed of university professors, other otolaryngologists, and medical doctors of the fund itself.
On the contrary, a screaming voice is necessary to bring about understanding in a patient with 80- to 100-dB hearing loss. If affected patients use a well-tolerated hearing aid, the industrial disability rate can be fixed in a category immediately below that obtainable without a hearing aid.
In certain cases, experts may apply other guidelines as long as they can provide acceptable medical reasons for doing so.
In other cases, this scale serves as a reference but is not obligatory and usually is questionable. The official Belgian disability scale has just been revised, and the commission has put forward certain new criteria for compensation of hearing loss. The ACI is the mean of speech intelligibility measured at 40,55, and 70 dB SPL, respectively.
The sum of this article with those of articles 712 and 713 should not be greater than a disability rate of 80%. Also, for granting a driver's license and for military service, special scales are applied. Compensation is evaluated by taking into account not only the physiological disability but the age, the general condition, and the professional qualifications of the individual being evaluated. Rebattu [1] makes use of four different compensation scales in his article about medicolegal assessment. Including it in a determination of a degree of invalidity necessitates combining it with the determination of certain hearing loss. There actually was never a course in my graduate work on tinnitus and its relationship to hearing. My mother did not have tinnitus, but she had two other hearing problems for which Sound Therapy was recommended.
They also can be asked to stand for insurance companies as an expert or as a consultant by colleagues who themselves are experts and require an ear, nose, and throat (ENT) specialist's opinion on a particular point.

In common law, victims have to receive restitution integrally to their states before an accident: Experts have to consider the state of victims before an accident and to compare it with the new situation. In Belgium, the Royal Society of Otorhinology, Laryngology, Head and Neck Surgery in 1986 proposed recommendations for forensic ENT examination.
Also used are pure-tone threshold audiograms, defined by increasing or decreasing intensity (or both) of the test tone, and measurement of the impedance and of the threshold of the stapedial reflex. A BERA threshold obviously better than the threshold of pure-tone audiometry (difference > 15 dB) is an indication for exaggeration without being able to define its degree. However, the threshold can vary as much as 10 dB from one examination to another and this depends on the sometimes unclear morphology of the curves at threshold, the experience of the examiner in identifying the curves, and the level of alertness and the fluctuations in the basic electroencephalogram. However, in certain cases, the subjective evaluation of the degree of deafness proves not to correspond to figures cited in Table 1.
These criteria, which were defined by an organization called Fonds des Maladies Professionnelles en Belgique, have been accepted by the forensic committee of the Belgian ENT Society.
In numerous cases, insurance companies have their own scale and, in assessments concerning railway workers.
They consist of tonal audiometry by bone conduction, supraliminal tests, study of the stapedius reflex, vocal audiometry, electrophysiological confirmation tests of threshold, and measurements (evoked response audiometry, electrocochleography). The legal audiometric techniques are tonal audiometry by air and bone conduction and speech audiometry executed by applying lists of disyllabic words in silence. The double-entry chart of industrial accidents and occupational diseases published in the official journal of the French Republic on December 30, 1982, enables the percentage of disability to be calculated on the basis of average hearing loss in each ear. In social matters (work accident or work-related disease), an important step is to consider the value of a victim in the job market. Depending on the case, examiners have access to testing with delayed stimulus (vocal or pure tone), the Azzi test of apparent modulation, a frequency sweep with constant intensity, the Stenger test, vocal audiometry- speech discrimination testing, and Bekesy audiometry. In such cases, examining doctors can grant disability percentages in excess to the established limits, provided they can offer sufficient justification based on more detailed examinations. These tests are performed after 12 hours' exposure of the patient to the usual noisy working environment. However, actually this scale does not have much authority, and different versions of it are found in different schools.
Experts have to evaluate the loss of physical integrity of function as it relates to the working capacity of the victim.
If one suspects exaggeration (or stimulation), the application of several tests is advised to define as closely as possible the real threshold.
Articles 712-714, expanded here, are new readings and, as of March 1998, were not yet being officially applied. Many books have been published on this subject, among which we mention those of Courtat and Elbaz (Table 4 [2]), Derobert [3], and Melennec [4]. Tinnitus gives a maximum handicap of 5%, with an exception in cases of military injury, for which special evaluation scales give an invalidity percentage up to 30%.

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