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Author: admin, 09.05.2014. Category: Severe Tinnitus Symptoms

HEARING VISION provides Tinnitus Masker as a device which can give instant relief for Tinnitus sufferer, and it is a non-invasive alternative to minimize the symptoms of Tinnitus. Tinnitus Masker shape is similar to hearing aid, either hidden in the ear canal or placed behind the ear.
It will produce a similar sound to urban noise (also called WHITE NOISE) with loudness and noise types adjusted to the Tinnitus patient’s need. While in use, the tinnitus sound will instantly be covered, thus becoming an instant reliever.
If the Tinnitus symptom is also accompanied with hearing loss, we also provide a device to correct both at the same time. Clinical medicine teaches that the key to achieving positive treatment results for any diagnostic category of patient complaints is based on the clinical establishment of an accurate diagnosis.
The definition of tinnitus, originally defined as the perception of a sound unrelated to an external source of sound stimulation (1979), is considered to be dynamic, reflecting advances in what is and is not known of the cochleovestibular system and brain function.
A tinnitus-targeted therapy (TTT), a combined treatment of medication and instrumentation focusing on pharmacotherapy, has evolved from an ongoing clinical experience since 1977 (in more than 10,000 patients with SIT 1. Briefly, the identification of principles of tinnitology for diagnosis and treatment of SIT patients has evolved from our ongoing TTT experience since 1977. At this time, the principles of tinnitology are divided into those for diagnosis (Table 1) and treatment (Table 2). Our clinical experience with the MATPP has been the development of a rationale for establishing an accuracy in tinnitus diagnosis and attempting tinnitus relief 1,9. Critical for both the SIT patient and tinnitus professionals attempting tinnitus relief is to be aware of the realities of the state of the art of tinnitus diagnosis and treatment at this time. The following definitions are considered significant in reporting results of modalities of tinnitus treatment and relief.
The medical significance of a symptom or disease process in a patient is defined as "a clinical manifestation of abnormal function of a living cell, tissue, organ, or organ system(s)" 4. Treatment of a symptom or disease is "the management or care of a patient or the combating of a disease or disorder. Tinnitogenesis is a seizure-type activity resulting in the perception of an aberrant auditory stimulus (tinnitus) 12.
The sensory component of tinnitus refers to the subjective perception of the sensation of the aberrant auditory stimulus-tinnitus-as described by tinnitus patients. Clinical types of SIT have been identified based upon the clinical history and metabolic and electrophysiological correlates of brain activity and cochleovestibular function.
Neurodegeneration, in this report, is a term "reflective of process(es) involved in the progressive damage or death of neurons and reflected clinically in a gradual deterioration and interference in function of the affected neural substrates of the nervous system" 17,18. Neuroprotection refers to "processes involved in the maintenance and repair and restoration of normal neuronal function" 17-19.
The final common pathway (FCP) for tinnitus has been hypothesized for all clinical types of tinnitus.
The tinnitus dyssynchrony-synchrony theory is a hypothesis that considers tinnitus to be an abnormal, conscious, auditory percept.
We present an update on TTT, a combined treatment of medication and instrumentation focusing on pharmacotherapy 1.
The clinical course of tinnitus, particularly SIT, is highlighted by its individuality and chronicity. To appreciate clinical advances that have been made for tinnitus diagnosis and treatment since 2006, it is necessary to briefly review the past. Clinically, however, tinnitus is still considered by many professionals and patients to be a unitary symptom. The recent publication of the Tinnitus Research Initiative (TRI) database has recognized the clinical reality that tinnitus is not a unitary symptom 25!
The classic site of lesion audiometric hearing threshold testing of 250 Hz-kHz is recommended in tinnitus patients to be extended to include the ultra-high frequencies of 10 to 20 kHz.
For patients with either unilateral or bilateral tinnitus and an asymmetrical sensorineural hearing loss, completion of tests of auditory brainstem response or magnetic resonance imaging (or both) of the brain and internal auditory canals with gadolinium is recommended to identify the presence or absence of acoustic tumor. The incidence of SEH occurrence in our experience continues to be approximately 35% overall. Evaluating tinnitus includes identifying its psychophysical and psychoacoustical characteristics, cochleovestibular testing, and masking curves 28. Supplemental testing with auditory brainstem responses, nuclear medicine brain imaging with SPECT and PET, and quantitative electroencephalography (QEEG) are reserved for SIT patients resistant to conventional modalities attempting relief.
A special clinical type of a predominantly centraltype SIT has been identified in a cohort of SIT patients with cerebrovascular disease, epilepsy, and memory and cognitive disorders, reflecting neurodegenerative disease 17,18. Masking is a term used to refer to the effect of one tone or one sound on another tone or sound or combinations thereof 35. Auditory masking, the replacement of one source of acoustic stimulation by another, a "covering up" or "blockage" of one sound by another, is a normal function of the auditory system. Tinnitus treatment recommendations continue to focus on identifying the tinnitus etiology and on the conceptualization of the past that tinnitus is a unitary symptom.
Although no tinnitus cure is available in our experience for patients at this time, protocols of combined treatment modalities that are available attempt to provide accuracy in diagnosis and identifying the medical significance of the tinnitus and tinnitus treatment, relief, and control 9,40. The neuro-otological consultation focus is on the clinical history, clinical course of the complaint, neuro-otological physical examination, and review of past medical records. Hypotheses of the role of biophysiological mechanisms in producing tinnitus are selected for translation to the attempt to establish accuracy for the tinnitus diagnosis and attempted treatment.
The selection of a particular modality of treatment is individualized for each patient and differentiated between the components of the tinnitus (see Figs. Basic pharmacotherapeutic management principles have been followed since 1979 1 (see Table 6). Instrumentation is recommended to tinnitus patients resistant to pharmacotherapeutic modalities for attempting tinnitus relief, approximately 10% to 15% since 2000.
Step 2: Removal of keratotic debris and cerumen from external canal and tympanic membrane as appropriate. In our experience, a majority of the patients report significant tinnitus relief and control after completing steps 1 to 4 and do not require instrumentation. Innovative receptor-targeted therapies (RTT) based on identification of the underlying neurotransmitter systems 37. Titration of gabapentin should begin at the lowest possible dose: The goal is to do no harm. A psychiatric consultation is recommended for evaluation and treatment of associated anxiety and depression or both and to consider the drug Klonopin if no medical contraindication (see Table 4).
Step 6: Tinnitus patients, predominantly central type, resistant to attempts tinnitus relief in steps 1-5 are recommended instrumentation in consultation with audiology. Transcranial magnetic stimulation (TMS) research protocols have reported significant short-term tinnitus relief 48,49. In general, the results of surgery, both clinical and as research protocols for tinnitus relief, have increased since 2006. Significant tinnitus relief with intratympanic steroid therapy has been reported for a predominantly cochleartype tinnitus 51,52. We look to the future for advances in the discipline of tinnitology for tinnitus theory, diagnosis, and auditory neuroscience of sensation and brain function to provide translation for development of new and increased efficacy of existing modalities of therapy for all clinical types of tinnitus.
These advances will reinforce the alteration in the paradigm of thinking of tinnitus, as recommended in 1983, from a focus on the ear and the psychoacoustic and psychophysical characteristics of the tinnitus to that of the ear and associated multiple brain functions as reflected clinically in the heterogeneity of tinnitus at this time.
In summary, we look forward to the pharmacological evolution of tinnitopharmaco-proteogenomics, defined as pharmacology for tinnitus based on what is known of the genetic diversity and protein functions demonstrated by tinnitus patients with different clinical types of tinnitus. We hypothesize that future identification of epilepsy genes can provide an insight into the molecular basis of neuronal excitability and brain function, which will have application for a particular central-type tinnitus.
For surgery, we look forward to expansion of intratympanic drug delivery systems, with a focus on hearing conservation, which we predict will result in increasing degrees of reported tinnitus relief. Alternate therapies will report in the future an increased significance for tinnitus relief with cognitive therapy and acupuncture as an accompaniment of anticipated advances in understanding brain function. The MATPP is presented as a dynamic neurootological-audiological protocol reflecting advances in tinnitology and neuroscience; it provides increased diagnostic accuracy, a monitoring system for all clinical types of tinnitus, and translation for increased efficacy of tinnitus relief.
A paradigm switch for clinical thinking of tinnitus is recommended to concentrate on brain function responses to an aberrant dyssynchronous auditory sensory input and in particular consciousness and affect, respecting the psychophysical and psychoacoustic characteristics of the tinnitus.


A biochemical marker, the GABA-A receptor, that has been identified provides translation for treatment, called RTT-GABA, of a predominantly central-type tinnitus. Find the latest statistics and figures on the prevalence of hearing loss or hearing damage and tinnitus in the United States. NutriBiotic® Topical Ear Drops are formulated to help support the health of the ear c when used as directed. Acoustic neuromas (vestibular schwannomas) are benign Schwann cell tumors that typically arise from the vestibular portion of the eighth cranial nerve.
If the device is used for certain duration during the day as recommended by the audiologist, slowly the brain will be trained to neglect the tinnitus sound (called the technique Habituation ), and overtime the loudness of the Tinnitus Masker may be reduced until such time that the device is no longer needed. Background: The completion of a MATPP has been recommended since 1977 for each tinnitus patient in an attempt to establish an accurate diagnosis. The term tinnitus in this article refers to subjective idiopathic tinnitus of the severe disabling type (SIT). Tinnitology is an integrated multidiscipline of basic science, neuroscience, and clinical and nuclear medicine used in an attempt to understand an aberrant auditory phenomenon unrelated to an external source of sound and how it becomes transformed into one of affect. Principles of diagnosis and treatment for SIT have evolved from the TTT experience, which provide a rationale for attempting tinnitus relief. The clinical application is resulting in a significant increase in the efficacy of modalities of therapy available for attempting tinnitus relief for all clinical types of tinnitus. Repetitive findings both from the clinical history and the MATPP in this combined neuro-otological-audiological approach for SIT are the basis of what we identified initially to be principles of tinnitology 1,4; (see Tables 1 and 2).
Anything that lessens tension or strain, or offers a pleasing change as to the mind or eye 10.
Its identification provides an objective basis for an innovative anti-seizure medication attempting tinnitus relief for a predominantly central SIT.
They are (1) the sensory component (sensory stimulus), (2) the affect component (behavioral response to the sensory stimulus), and (3) the psychomotor component (the motor response to express the behavioral response to the sensation) 13. The affect component of tinnitus refers to the emotional response of the patient to the sensory component.
Tinnitus is believed to originate as an initial dyssynchrony in pre- or postsynaptic neuronal transmission within the peripheral or central nervous system (cortical or subcortical). All have visited the tinnitus clinic at the Downstate Medical Center of the State University of New York (DMC-SUNY) and the Martha Entenmann Tinnitus Research Center, Inc. Our clinical experiences for both tinnitus diagnosis and treatment since 1977 were summarized in 1991 and updated in 2006. The principles of diagnosis and treatment (see Tables 1 and 2), , and modalities of treatment available at the present time (see Tables 3-5), are presented not as menu-driven recommendations for tinnitus treatment, control, and relief but rather as a selection based on a rationale targeting hypothesized underlying biophysical processes. A paradigm change is recommended in clinical thinking both for the symptom itself and for the response to treatment. At this time, tinnitus is considered clinically to be a symptom, heterogeneous in its etiology, clinical course, and clinical manifestation as different clinical types.
Algorithm for tinnitus diagnosis and treatment: the medicalaudiological tinnitus patient protocol. The original concept of clinical types of tinnitus (CTT) 23 is considered to be fundamental for translation to any and all attempts for tinnitus relief. The establishment of this data base will be a significant advance for both diagnosis and translation for an increased efficacy for any and all modalities of therapy attempting tinnitus relief and control. Tinnitus patients with hearing thresholds within the range of "normal" (250 Hz-8 kHz) have been found to have elevated thresholds in excess of what is expected for their age. These modalities are used in the attempt to improve the accuracy of the tinnitus diagnosis and provide a monitoring system for evaluating the efficacy of therapeutic modalities aimed at tinnitus, which included control of factors influencing the clinical course of the tinnitus and a previous trial of instrumentation 33,34. Identifying and treating this particular central-type SIT has been accompanied with relief.
Itard 23,35 believed that utilizing external sounds to interfere with the tinnitus was the most effective relief procedure. Algorithms of the final common pathway (sensory, affect, psychomotor components) and tinnitus treatment. The brain functions associated with each component of the aberrant auditory sensory stimulus (tinnitus) are integrated in each algorithm with the involved neuroanatomical substrates.
The clinical course of SIT, a stressor, becomes clinically manifest with increased severity by a reduction in the inhibitory activity of the GABA-A receptor, which is deficient and cannot inhibit the aberrant auditory signal 7. A menu-driven approach is that of the majority of tinnitus professionals for recommendations of instrumentation, medication, or surgery.
The MATPP has provided our team with a basis for the selection of existing modalities of treatment with resultant increased efficacy of tinnitus treatment, relief, and control, which we have called a tinnitustargeted therapy (TTT) 1, 9. We have focused on masking, glutamate neuroexcitotoxicity theory, inhibition, benzodiazepine deficiency, neurodegeneration, neuroprotection, calpain theory of apoptosis, kindling, long-term potentiation, lateral inhibition, epileptogenesis, stress, neurotransmitter action at synaptic levels of activity and alteration in the homeostasis of function between the fluid compartments of ear and brain 5,12,20-22,37, 41 For the associated compliant of hyperacusis, a plan for sound attenuation utilizing white noise is recommended. The goal is pharmacological short-term tinnitus relief therapy, but planning must be made for long-term benefit. If the clinical type of tinnitus is a predominantly cochlear type, intratympanic drug therapy with steroids, preceded by computed tomography of the temporal bones is recommended 43.
If the clinical type of tinnitus is a predominantly the central type, innovative drug therapies are recommended. There should be some indication of involvement of the CNS before use of an innovative application of AEDs 9,16,33,37.
Tinnitus relief with auditory cortical stimulation has been reported 53 as has the surgical application of a cochlear implant in a tinnitus patient 54. Cortical brain approaches with extra- or intracranial TMS (electrical stimulation), alone or in combination with drug therapies, will offer to patients with predominantly central-type tinnitus an increased degree of efficacy for tinnitus relief. A "cure" for tinnitus is the ultimate goal of both tinnitus patients and all professionals involved in tinnitology. Tinnitopharmacolgy and tinnitopharmacoproteogenomics is the future for pharmacotherapeutic treatment of different clinical types of tinnitus. Strashun, MD, Director, Nuclear Medicine, and Matthew J Avitable, MD, Director Scientific Computing Center; and the support of Richard Rosenfeld, MD, Prof.
Rothschild G, Nelkon I, MizrahiA: Functional organization and population dynamics in the mouse primary auditory cortex. Advances in medicine, especially imaging technology have made the identification of small Acoustic Neuromas (AN) possible. A tinnitus-targeted therapy (TTT), a combined treatment of medication and instrumentation focusing on pharmacotherapy, has evolved from our ongoing clinical experience since 1977 (now in excess of 10,000 SIT patients) [1-4]. It is believed to originate as an initial dyssynchrony in pre- or postsynaptic neuronal transmission within the peripheral or central nervous system (cortical or subcortical). All patients visited the tinnitus clinic at the Downstate Medical Center at the State University of New York (DMC-SUNY) and the Martha Entenmann Tinnitus Research Center, Inc.
Future advances in tinnitology are expected to add to, subtract from, or modify the principles of tinnitology as set forth in this manuscript. The psychomotor component of the tinnitus refers to a patient's motor response accompanying the emotional and subjective perception of the sensation of the aberrant auditory stimulus (tinnitus). They have been identified as involved in sensory processing underlying cochleovestibular function (peripheral and central) and in the neuroscience of brain function. Since 1979, our team has continued to report the clinical identification of clinical types and subtypes of tinnitus, particularly for a predominantly central-type SIT. These findings provide a basis for understanding the heterogeneity in the quality of the tinnitus as described by tinnitus patients and for the future potential application for attempting tinnitus control.
The ultra-high frequency findings, when positive, have clinical application for both diagnosis and treatment 28,29. These factors include cerumen in the external auditory canal with or without tympanic membrane involvement, fluctuating aeration in middle ears, SEH, noise exposure, stress, metabolic abnormalities in glucose, cholesterol, triglyceride or thyroid function, and hypertension with or without fluctuation and occurring either alone or in combination.
Such drugs include the vasodilator papaverine for cerebrovascular insufficiency, clopidogrel bisulfate (Plavix) in transient ischemic attack and poststroke patients, and anti-seizure drugs for epilepsy. The FCP proposes clinical consideration of auditory masking to be predominantly a brain function with peripheral and central components.
The reciprocal interacting neuroanatomical substrates of the three components complete a circuit-the final common pathway sensory-affect transformation.
All patients are interviewed by telephone prior to receiving the appointment and are requested to have undergone a complete physical examination within 6 months prior to neuro-otologicalaudiometric consultation and to provide past hearing and balance testing, imaging and pharmacological record results, and a short narrative of the clinical course of the tinnitus for review.


The clinical types of tinnitus in this group are predominantly of the middle ear and cochlea, alone or in combination.
Ultra-quiet therapy utilizing ultra-high-frequency stimulation has provided tinnitus relief in a particular cohort of SIT patients , however is not available at this time 47. It will come as an accompaniment of advances reported in auditory neuroscience and that of sensation and brain function. Tinnitus dyssynchrony-synchrony theory: A translational concept for diagnosis and treatment and a model for the clinical diagnosis of different clinical type(s) of tinnitus. Central tinnitus-diagnosis and treatment: Observations of simultaneous auditory brainstem responses with monaural stimulation in the tinnitus patient. Neuroprotective drug therapy: A medical and pharmacological treatment for tinnitus control. Final common pathway for tinnitus: Theoretical and clinical implications of neuroanatomical substrates.
The Tinnitus Research Initiative TRI database: A new approach for delineation of tinnitus subtypes and generation of predictors of treatment outcome. Adaptive, behaviorally gated, persistent encoding of task-relevant auditory information in the ferret frontal cortex. GABA-A- benzodiazepinechloride receptor-targeted therapy for tinnitus control: Preliminary report. Fluid dynamics vascular theory brain and inner ear function in traumatic brain injury: A translational hypothesis for diagnosis and treatment. Worldwide experience with sequential phase-shift sound cancellation treatment of predominant tone tinnitus. Transcranial magnetic stimulation for the treatment of tinnitus: A new coil positioning method and first results. Transcranial magnetic stimulation: Summary of the Proceedings of the 26th Annual Meeting of the International Tinnitus Forum.
Incapacitating unilateral tinnitus in single-sided deafness treated by cochlear implantation. Principles for SIT treatment have evolved from the TTT experience that provides a rationale for attempting tinnitus relief.
It interferes in the excitatory and inhibitory process or processes involved in maintaining homeostasis for brain neurofunction in multiple neural substrates and acts as an aberrant auditory stimulus to express this dysfunction via the auditory system 5. It is expected that these principles will be expanded and modified to reflect future advances in tinnitology. Neuroanatomical substrates that have been identified in brain contribute to an evolving pathophysiology for all clinical types of tinnitus. According to the definition of tinnitus, the perception of tinnitus is a central function in all CTT . Particularly significant for tinnitus is the finding of a labyrinthine asymmetry that, when correlated with the symptom of ear blockage and a positive Metz test for recruitment, provides the basis for the clinical diagnosis of a secondary endolymphatic hydrops (SEH) 30. Identification, treatment, and maintenance of normal aeration of the middle ears, when identified and treated, have resulted in tinnitus relief and control in approximately 15% of our SIT patients. For memory and cognition, we recommend the neuroprotective drugs donepezil hydrochloride (Aricept), Cognex (tacrine), memantine hydrochloride, gabapentin, and clonazepam (Klonopin). The manifestation of the symptom of tinnitus is considered to be a reduction in the normal auditory masking function in the brain: The neuroanatomical substrates are hypothesized to involve the cochlea, the brainstem, the thalamus, and multiple cerebral cortices (Figure 2).
Similarly, tinnitus relief, when reported, is clinically considered by our team to reflect a return of adequate masking.
Second, drug selection should take into account agents that have a short half-life so as to minimize the incidence and duration of side effects.
The dose for the sensory component is based on the tinnitus intensity index (TII) and the tinnitus annoyance index (TAI), both on a scale from 0 to 7. Understanding the pathophysiology of this transformation in brain is considered to be fundamental to diagnosing and treating tinnitus of all clinical types. The CTT are identified by the correlation of the clinical history, physical examination, electrophysiological correlates of cochleovestibular function, and an evaluation of metabolic and electrophysiological activity in brain. Visual suppression of the vestibuleocular reflex, a sign of cerebellar dysfunction, is significant for the identification of a central component for the tinnitus and involvement of the acousticomotor system 31.
These drugs may influence the SIT by improving the underlying neuronal anatomic substrate(s) that may be contributing to SIT 1. The cerebellum, via the acousticomotor system, has reciprocal projections to and from the somatosensory cortex, IC, thalamus, PAC, and parietal lobe [18]. We recommend selection of RTT-GABA for patients with SIT of more than a year's duration and a diagnosis of a predominantly central-type tinnitus based on completion of the MATPP. In H Feldmann (ed), Proceedings of the Third International Tinnitus Seminar, Munster, 1987.
When viewed in terms of sensory processing, the FCP hypothesis is considered to be expanded and broader in its application for all sensations, normal or aberrant 8,20. Critical for attempting tinnitus treatment, control, and relief for any and all clinical types and subtypes of tinnitus is the clinical establishment of accuracy for the tinnitus diagnosis 14,24.
Again, the accuracy of the tinnitus diagnosis is the key to selecting modalities of treatment in attempting tinnitus treatment, relief, and control.
Hyperpolarization and depolarization of GABA-influenced thalamic neuron activity results in thalamocortical oscillations in a synchronous signal at brain cortex [204,254].
Plans should be made for longterm treatment, particularly for the affective behavioral component. For the future, it is hypothesized, a particular clinical type of a predominantly central tinnitus, now considered to be a symptom, will be identified to be a specific disease entity. Reciprocal innervation from the thalamus to the medial temporal lobe system (MTLS), including the amygdala (AG), hippocampus (HP), paparahippocampal formation (PH), entorhinal cortex (EC), perirhinal cortex (PC), ACG, and hypothalamus (HYP), comprise an endogenous system of the CNS as hypothesized for sensory processing [53,54]. The main clinical manifestation of tinnitus is that of multifactorial characteristics; therefore, single drugs may have multiple sites of action. For tinnitus, the endogenous system is hypothesized to result in the establishment of a "paradoxical memory" for the aberrant auditory sensory stimulus (tinnitus) and has a reciprocal interaction with the thalamus [16].
We recommend a combination drug strategy to increase the efficacy of attempts at tinnitus relief.
The associated brain function processes within the neuroanatomical substrates of the sensory component include memory, stress, masking, fear, reward, and autonomic functions. For the affect component, particular attention is directed with pharmacotherapy to avoid drug tolerance and or habituation.
Response to treatment is monitored by telephone communication and follow-up office visits as determined by the clinical course of the SIT 1,37. Stress is considered to be a modulator of the clinical course of the tinnitus with the accompanying reduction and alteration in auditory masking [2,230-232]. Algorithm 2, Affect (Emotional-Behavioral) Component: The neuroanatomical substrates of the affect (emotional) component are highlighted by the OFC, PFC of the frontal lobe, PAC, MTLS of the temporal lobe, and insula. Reciprocal innervation is hypothesized to occur between the PAC of the sensory component and the OFC, ACG, PFC, MTLS, and insula. The insula, by its central location, is hypothesized to exert a modulating effect among the sensory, affect, and psychomotor components. The thalamic activity is ongoing with reciprocal projections to the PFC, OFC, and parietal lobe. Algorithm 3, Psychomotor Component: The neuroanatomical substrates of the psychomotor component include the insula, parietal lobe, striatum, and cerebellum.
The thalamic activity is ongoing with reciprocal innervation of the parietal lobe, OFC, and PFC.
Significant for the sensory-affect transformation is considered to be the interaction between the striatum, parietal lobe, and OFC via the insula.



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