Meniere disease total hearing loss zedd,ear ringing stopped up toilet,at&t phones for hearing impaired loan,msa x30 hearing aid - Plans Download

Author: admin, 24.05.2016. Category: Buzzing In Ears

Role of worry in patients with chronic tinnitus and sensorineural hearing loss: a preliminary study. 1Department of Clinical Neurosciences, Villa San Benedetto Menni, Hermanas Hospitalarias, FoRiPsi, Via Roma 16, 22032, Albese con Cassano, Como, Italy.
3Department of Clinical Neurosciences, Villa San Benedetto Menni, Hermanas Hospitalarias, FoRiPsi, Via Roma 16, 22032, Albese con Cassano, Como, Italy. 4Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, The Netherlands. 5Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, University of Miami, Miami, FL, USA. Tinnitus-related distress appears to be more strongly associated with multiple psychological factors than with any perceptual properties of tinnitus.
Effect of local irradiation with 630 and 860 nm low-level lasers on tympanic membrane perforation repair in guinea pigs. Otolaryngology – Head and Neck Surgery Research Center, Rasool Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran. Objective: In this study, we evaluated the effect of low-level lasers on the healing of tympanic membrane perforation, one of the most common otological pathologies. Methods and materials: Twenty-four guinea pigs were randomly assigned to either the experimental or control group. Conclusion: The results show that the combined application of 630 and 860 nm lasers had a significant effect on the healing of tympanic membrane perforation, and on the prevention of thick fibrotic or atelectatic neomembrane formation.
Effect of low-level laser treatment on cochlea hair-cell recovery after acute acoustic trauma. We investigated the effect of low-level laser radiation on rescuing hair cells of the cochlea after acute acoustic trauma and hearing loss. Moderate and severe sudden deafness treated with low-energy laser irradiation combined with auricular acupoint sticking. Department of Rehabilitation Medicine, The First Affiliated Hospital of Xinxiang Medical College, Weihui 453100, Henan Province, China. To test the therapeutic effect on moderate and severe sudden deafness treated with low-energy laser irradiation on acupoint and external auditory canal combined with auricular point sticking (APS) and as compared with electroacupuncture.
Two hundred and fifty-eight cases of moderate and severe sudden hearing loss were randomly divided into an observation group 1, an observation group 2 and a control group, 86 cases in each group.
Both of low-energy laser irradiation on acupoint and external auditory canal combined with APS and electroacupuncture are able to decrease frequency audiometry, improve auditory function, and the therapeutic effects are better with prolongation of treatment time. Effect of low-level laser therapy on cochlear hair cell recovery after gentamicin-induced ototoxicity. Department of Otolaryngology-Head & Neck Surgery, Dankook University College of Medicine, Cheonan, Korea.
Intravenous laser irradiation of blood for the combined treatment of patients presenting with chronic sensorineural hearing loss.
A method for the treatment of chronic sensorineural hearing loss (CSNHL) is proposed that includes administration of trental followed by intravenous laser irradiation of blood (IVLBI).
The application of supravascular laser irradiation of blood for the treatment of cochleovestibular disorders. A total of 165 patients presenting with neurosensory impairement of hearing and Meniere’s disease were treated by supravascular (extracorporeal) laser irradiation of blood. Department of Otorhinolaryngology, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran. BACKGROUND: Despite the high prevalence and morbidity, tinnitus still remains an obscure symptom. METHODS: It was a self controlled clinical trial study on 61 outpatients with subjective tinnitus. CONCLUSIONS: Transmeatal low-level laser irradiation is effective for the treatment of tinnitus and some variables like age and job can affect the treatment outcome. Ear, Nose, and Throat Department, IRRCS San Raffaele Hospital, Vita-Salute University, Milan, Italy. OBJECTIVE: To assess the efficacy of low-level laser therapy (LLLT) for Meniere’s disease (MD). CONCLUSIONS: In our experience, LLLT seems to prevent vertigo spells in MD, although results indicate that it has a slower action than betahistine. OBJECTIVE: To evaluate effectiveness of 5 mW laser irradiation in the treatment of chronic tinnitus. CONCLUSION: Transmeatal, low power (5 mW) laser irradiation was found to be useful for the treatment of chronic tinnitus. The treatment of patients with chronic tinnitus is very problematic and therefore otologists are trying to discover more suitable courses of therapy.
Transmeatal cochlear laser (TCL) treatment of cochlear dysfunction: a feasibility study for chronic tinnitus. Department of Otolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University of Munich, D-81377 Munich, FRG.
Low-level-laser-therapy (LLLT) targeting the inner ear has been discussed as a therapeutic procedure for cochlear dysfunction such as chronic cochlear tinnitus or sensorineural hearing loss. Hyperacusis treatment with a combination of laser therapy, pulsed electromagnetic field therapy and reactive oxygen speciment control. Patients with grave hyperacusis seem to have the largest dB-improvements from this therapy. The IXX Annual Meeting of The American Society for Laser Medicine and Surgery, Lake Buena Vista, Florida.
A) The objective of the study was the documentation of the biostimulative effects of LLLL in high energetical dosages (measured in j) by audiometry changes of a statistically relevant number of patients. According to a study of the university of Cologne1) by 2030 every second German will be suffering from impairments of the inner ear. The audiometry belongs to the diagnostical standard equipment of medical offices and acousticians and is universally being used as a basic diagnostic by trade operative associations and industrial medicine for the purpose of examinations and appraisements. The energy was transmitted by 3 laser diodes with a wave length of 830 nm und 3 diodes with a wave length of 635 nm; it was administered via meatus and mastoid. In the case of the initial audiometrical results (pretherapeutical findings) the evaluation of the mean value of all readings reveals a clearly reduced average course of the hearing curves of the air and bone conductions over all frequencies, with low points in the frequency sector around 6 kc and the frequency sector around 12 kc (sensorineural hardness of hearing, oblique descension).As expected, the bone conduction is situated above the air conduction in all frequencies.
The comparison of all pre- and posttherapeutical readings over all frequencies reveals statistically highly significant results in the case of the air and bone conductions.The values of the air conduction, which are slightly higher as those of the bone conduction, indicate that the LLLL has additional positive therapeutical effects on the sound conducting structures of the middle ear. The grouping of the readings according to age groups and 3 frequency intervals results in findings that are biologically plausible as far as both the air and the bone conductions is concerned. As to the grouping of the readings according to the duration of the disease and 3 frequency intervals, the patient group with the shortest duration of the disease (0.6 years) has the best initial values and obtains the best final results with the smallest quantity of transfered energy. The grouping of the readings according to energy quantities reveals a clear correlation between the total quantity of the transfered energy and the therapeutical results that were obtained. In this respect, the results of the study at hand not only refer to the fundamental working model of the cellular energy transfer6) from 1998, which was based on quantum mechanics, but confirm its conclusions as well, namely, that cellular regeneration processes do take place, if the mitochondria in question are stimulated to an increased production of adenosine triphosphate (ATP) by sufficiently large quantities of LLLL. Patients suffering from hyperacusis were treated twice a week with a combination of therapeutic laser, pulsed electromagnetic field and the control and adjustment of Reactive Oxygen Species (ROS). 59 patients with neurosensory hypoacusis and 45 with Meniere’s disease underwent helium-neon laser intra- or supravascular radiation of blood. Lightdosimetric quantitative analysis of the human petrous bone: experimental study for laser irradiation of the cochlea. BACKGROUND AND OBJECTIVE: Application of laser irradiation targeting the inner ear has to be investigated for therapeutic effectiveness in cochlear injury and dysfunction.
RESULTS: The transmission of light across the tympanic cavity and the promontory depends strongly on wave-length of the laser and the position of the radiator. CONCLUSION: The strong dependence of the cochlear light distribution on various irradiation parameters demonstrates the impact of preclinical lightdosimetric investigations for effective individual laser irradiation of the human cochlea. The light distribution inside the cochlear windings produced by irradiation of the tympanic membrane was quantitatively measured ex vivo for wavelengths of 593, 612, 635, 690, 780 and 805 nm by means of video dosimetry.
Comprehensive laser rehabilitation therapy of tinnitus has proven successfull and beneficial for treatment of this widespread civilization disease. Tinnitus is an auditory perception apearing without an objective sonic source from the outer environment. Our last study on a group of 200 patients in the course of three years was finalized in February 2002 and published in June 2002. Our group consisted of 72 patients, 49 males, 23 females, age ranging between 16 to 92 years. We strictly appeal to maintain the direction of the vector of aiming the beam – in fact the target structure of the helix is a shape of several square milimeters.
Percentage scale – complaints evaluated 100 per cent at the beginning of therapy (Blue), according to the level of relief decreased (Green) to 80, 70 etc. This evaluation is identical with our previous study, and it enabled us to compare easily the results of both studies.
It was interesting to compare our latest results (LLLT only) with those of our previous studies, i. We have been positively surprised that in general the ratio of individual four groups remained similar.
In the group evaluating improvement as less than 50 per cent the leading role of LLLT can be evidenced best. 22.2 per cent patients suffering from tinnitus never more after treatment with therapeutic laser is a great success of LLLT. You should contact your physician IMMEDIATELY to have a thorough ear evaluation as soon as possible. We suggest that you plug your ear canal with a cotton ball that has been covered in a thin layer of vaseline prior to bathing.
The drops should be used as directed starting one week prior to your first visit after surgery. How to cite this article Nicolas-puel C, Faulconbridge RL, Guitton M, Puel J, Mondain M, Uziel A. The aim of this study was to highlight the clinical characteristics of tinnitus and to attempt a quantitative assessment in relation to any underlying etiologies.
Tinnitus constitutes an important public health problem; it is estimated that in France alone, there are 5 million tinnitus sufferers. One hundred twenty-three patients were treated in a specialist tinnitus clinic at Gui de Chauliac1 Hospital, Montpellier, France, between 1998 and 2000 [1]. The assessment was based on a questionnaire that was used to evaluate the clinical aspects of tinnitus (see the appendix at end of article). When asked, patients usually liken the sound of their tinnitus to environmental noise, such as the sound of the wind or the sound of an insect. To investigate the temporal variation of tinnitus, patients were asked whether the intensity of their tinnitus was stable or whether it fluctuated during the course of the day.
The aim of the clinical examination was to determine any underlying etiology that would explain the presence of tinnitus. The great majority of patients (almost 90%) presented with tinnitus associated with deafness of known etiology (Table 1). Hearing losses were divided into four groups: highfrequency (60%), low-frequency (25%), flat losses (11%), and dead ear (2%). Of the patients from the endocochlear group, 65% had stable tinnitus, and 32% had fluctuating tinnitus. Of patients with Meniere's disease or Meniere's-like syndrome, 84% described fluctuating tinnitus. Of patients with endocochlear deafness, 77% described their tinnitus as a high-pitched whistling, and 21 % described it as a low-pitched buzzing (Fig. In our study, 58 of the 77 patients with a stable high-pitched tinnitus (77%) had a high-tone hearing loss.
This study attests to the rare incidence of objective tinnitus: There was no case of objective tinnitus in this series. The study of the etiology of the underlying deafness offers interesting results for understanding tinnitus, especially in patients with high-frequency hearing loss. We have confirmed in this study that the general frequency of tinnitus pitch perceived by the patient is correlated in broad terms with the frequency of the hearing loss, in agreement with some other studies [7]. This study has raised interesting findings about the fluctuation of tinnitus after periods of sleep, especially in patients with low-frequency tinnitus.
We have shown in this study that audiometry can be used as a simple indirect test to evaluate tinnitus, as it correlates well with a visual analog scale of tinnitus intensity in the majority of our patients.
We thank Professors Bernard Guerrier and Remy Pujol, who supported and encouraged this work. The positive medical history of sonovestibular symptoms was confirmed objectively by CDP with sound stimulation with a high statistical significance.
The phenomenon of sound-induced vestibular symptoms and signs, termed the Tullio phenomenon (TP), has been known for six decades. The effect of inducing nystagmus and vestibular symptoms by acoustic stimulation depends on the functional integrity of the vestibular labyrinth alone and is reproduced in animals when the cochlea has been ablated.
Subsequently, TP was studied in terms of its physiological mechanism [4-9], nystagmic eye movements produced in response to intense sound [6,10-12], and the performance on a force platform with an acoustically stimulated vestibular system [10,13-15].
The presence of the TP was noted also in normal subjects (guinea pigs, monkeys, and humans) [19,20] and later even was found to be ubiquitous in normal subjects [21].
Previous reports show that the TP is provoked by a wide range of acoustic stimuli in terms of modes of delivery, intensity, and frequency. Most authors agree that the middle frequencies are the most effective in producing the TP in patients with inner ear pathology (Table 1) [6,12,14,15,24-26].
Vestibular dysfunction has been characterized in terms of deficits in the vestibuloocular reflex system and the vestibulospinal reflex system.
Posturography is an approach to the assessment of vestibular dysfunction that uses a force platform and provides various measures that reflect postural stability, such as the amount of body sway. The TP has been studied only by nystagmographic methods and by static posturography, as mentioned.
The changes in postural stability were monitored by CDP when subjects attempted to maintain balance on the platform under stimulation with sound. A pure-tone sound of 110 dB at 1,000 Hz generated by a portable audiometer was delivered by air conduction in continuous mode through earphones.
The extent of otological disease was established and documented in every case by history, physical examination, and audiometry. In addition, most subjects with audiovestibular disorders (groups A and B) underwent ENG with sound stimulation for the detection of spontaneous nystagmus, as in the classic method for the detection of the TP. The three study groups were matched in terms of age; consequently, differences between ages were not significant when compared statistically, as shown in Table 3.
The subjects in this study were not matched in terms of quantitative results of diagnostic tests; therefore, the gravity of their disorder did not constitute a prerequisite for their selection.
The 40 patients investigated first were classified according to their clinical diagnosis (Table 4). Patients' medical history focused on two pertinent symptoms: tinnitus and dizziness (Table 5), with special stress on severity, duration, and precipitating factors. Table 6 exhibits the results of audiological tests: pure-tone audiometry, speech reception thresholds, and performance intensity function for phonetically balanced words (speech discrimination scores). For the statistical approach of the results obtained in CDP before, during, and after acoustic stimulation, we calculated the means of the composite equilibrium scores and the mean individual sensory ratio scores for each study group in each trial.
For purposes of simplicity and a better expression, we preferred to plot the mean composite score and mean vestibular ratio obtained by the three study groups, instead of the individual scores achieved by each subject. Because the composite score is an average of all sensory conditions, it reflects the overall on-feet stability of the subject.
The variation among the three study groups was examined by means of one-way ANOVA followed by Bonferroni multiple range test (Table 9). Because in the study of the TP we were interested in both the overall equilibrium and the vestibular system in particular, the vestibular ratio score given by the CDP software was investigated next.
Once again the one-way ANOVA followed by the Bonferroni mUltiple range test (Table 11) analyzed the variation among the three study groups. The vision preference is one of the sensory ratios provided by the sensory analysis of the CDP's software.
The sensory analysis revealed a variety of disequilibrium types or sensory organization patterns according to the specific sensory system responsible for imbalance (Table 13). A more intriguing pattern-the combined vestibular and vision dysfunction-was observed in some group A patients on trials 2 and 3 (20% and 25%, respectively). A last sensory organization pattern observed on sound delivery in two patients in group A was a vestibular dysfunction combined with vision preference.
The current study focused on the postural stability of normal subjects and patients with otological impairments and on a third group of patients with similar otological disorders accompanied by a history of sonovestibular symptoms.
Hadj-Djilani [14,15] studied the performance on the force-plate under sound stimulation with exactly the same sound stimulus that we delivered in our work (1,000 Hz, 110 dB SPL). Our normal subjects and the patients with inner ear impairments without a medical history of Tullio symptoms showed no significant change in postural stability. The occurrence of vestibular disturbance complicated by vision dysfunction during exposure to strong acoustic stimuli in patients suffering from Tullio symptoms is not surprising, given the exposure of the hyperirritable "Tullio" ears to intense noise as a general excitation and discomfort.
The diagnosis of vestibular malfunction related to sound exposure may be of crucial clinical significance, beyond the obvious medicolegal implications.
An additional goal of this study had been to evaluate and compare the sensitivities of CDP and ENG in detecting vestibular impairment in the study participants. CDP and ENG were compared in a retrospective study of a mixed population of 375 patients with complaints of dizziness and imbalance [34]. Two additional retrospective studies [35,36] compared CDP and ENG results in patients with confirmed vestibular system deficits. Because of the nonoverlapping nature of the two tests, the foregoing three studies concluded that both vestibuloocular and vestibulospinal tests were essential components in the diagnostic workup. We have managed to learn since the inception of this study that many patients who experience attacks of vertigo when exposed to loud noise complain of these symptoms solely in circumstances of noisy environment.
A 43-year-old active ambulance driver was referred to the Otolaryngology Department of Bnai-Zion Medical Center 2 years before his admission to the current study.
A constant, very disturbing tinnitus of alternately low and high pitch had been complicating his condition ever since. The pure-tone audiogram exhibited a bilateral hearing loss of notched configuration in the higher frequencies, typical of NIHL (Fig. Prior to his admission to this study, the patient underwent ENG that revealed neither spontaneous nor gaze nor positional nystagmus, with no evidence of any vestibular pathology.
His temporary unsteadiness provoked by sound occurred because of an underlying vestibular dysfunction, as indicated by sensory analysis: The vestibular ratio is very low (Fig 6). This work constitutes the final wrap-up of the preliminary study presented at the Twenty-Fourth Neurootological and Equilibriometric Society Congress, 1997, and subsequently published in the International Tinnitus Journal 3:2, 1997.
One day after the induction of a 2 mm diameter, centred myringotomy in all animals, the tympanic membranes in the experimental group were irradiated with 630 and 860 nm lasers for 10 days. The distance from the external auditory canal wall to the malleus tip did not differ significantly between the two groups (p = 0.42). The clinical efficacy of above two the rapies on moderate and severe sudden deafness is superior remarkably to that of conventional treatment.
It is well established that antibiotic drugs such as gentamicin can damage hair cells and cause hearing loss. The study included 81 patients at the age from 20 to more than 60 years presenting with CSNHL. The study undertaken to evaluate the efficacy of this treatment confirmed its beneficial effect in patients with acute hearing disorders.
The patients were irradiated with a 650-nm, 5-mW soft laser for twenty days and twenty minutes per day.
The patients were randomly divided into two groups: group 1 patients received LLLT 20 min a day with a 5-mW soft laser for 6 mo, while group 2 received betahistine 16 mg twice a day for 6 mo.
Betahistine seems to have a faster action in spell reduction (p 0.05 comparing the 3-mo results between the two groups). A 5 mW laser with a wavelength of 650 nm, or placebo laser, was applied transmeatally for 15 minutes, once daily for a week.
In this study we wanted to evaluate the outcome of using a combination of EGb 761 and soft laser therapy. The patients underwent pure-tone audiometry, speech audiometry and objective audiometry tests.
Former studies demonstrate dose-dependent biological and physiological effects of LLLT such as enhanced recovery of peripheral nerve injuries, which could be of therapeutic interest in cochlear dysfunction.
The combined set of therapies in this study should be a first choice therapy for all hyperacusis patients. B) The energy was transmitted with 3 laser diodes with a wave length of 830 nm and 3 diodes with a wave length of 635 nm; it was administered via meatus and mastoid. Even at the present time, the number of people all over the world, who are inflicted with long-standing impairments or acute diseases of the inner ear, amounts to millions. The patients all received an out-patient treatment, which consisted exclusively of a monotherapy. The patient group with the longest duration of the disease (14.5 years) has the poorest initial values and furthermore needs the largest quantity of transfered energy. The larger the quantitity of transfered energy, the higher the db-reductions that could be observed. 6b clearly shows the correlative (parallel) connection between the total quantity of transfered energy and the total reduction. The same applies for an augmentation of the total quantity of the transfered energy in the course of the treatment phases or per unit; in the latter case further technological developements on the part of the laser industry are indispensable, though.


Dosinetric analysis for low-level-lasertherapy (LLLT) of the human inner ear at 593nm and 633nm.
Import of Radiation Phenomena of Electrons and Therapeutic Low-Level Laser in Regard to the Mitochondrial Energy Transfer. 245 observations in 42 ears on 26 patients were measured before therapy and after 10-20 therapeutic sessions. The treatment proved effective in acute neurosensory hypoacusis and Meniere’s disease. In vitro data demonstrate low-level laser-induced photochemical and photobiologic cell response, depending on cell type and irradiation parameters such as light dose. The external auditory meatus, the tympanic membrane (quadrants), and the mastoid bone were illuminated by a helium-neon laser (lambda = 593 nm) and diode lasers of different wavelengths (lambda = 635, 690, 780, and 830 nm).
Transtympanal irradiation results in spatial intensity variations of a factor 4 to 10 within the cochlear windings. Because of the observed spatial intensity variations, the optimal external light dose has to be chosen with regard to the tonotopy of the human cochlea. It is not natural for the dentist to ask, nor for the patient to inform the dentist about such a situation since it does not appear to be a dental indication. The transmission of light across the tympanic cavity and the promontory depends strongly on the wavelength. Tinnitus can be subjective (heard only by the patient) and objective (sound can be even heard also by others). We have published three studies on this particular issue, and we are of the opinion that our results are being followed in several countries (Brasil, Cyprus, Sweden, Switzerland, Slovakia, Turkey, Japan, Germany etc.) and implemented in numerous clinics with significant results. Since there have always been efforts to evaluate an exact role of LLLT in treatment of tinnitus, apart from medication and physiotherapeutic manipulation of neck vertebra as an integral part of the comprehensive therapy, we have decided to create a separate group of patients to be treated only with laser.
Since our long-term experience in comprehensive treatment of tinnitus has been based on the triad of physiotherapeutic manipulation, medication, and LLLT, we were at a loss whether we would not harm our patients in a way, giving them only a part of the treatrment, mere LLLT.
It only confirms the leading role of LLLT within comprehensive laser rehabilitation therapy of tinnitus. If the aid does not work after replacing the battery, we suggest you bring the hearing aid in for repair.
Characteristics of Tinnitus and Etiology of Associated Hearing Loss: A Study of 123 Patients. We undertook to study a population of 123 patients attending a tinnitus clinic between 1998 and 2000. Although previous studies have been descriptive, few have attempted a quantitative assessment of tinnitus qualities, such as its intensity, and have correlated it with the etiology of any associated hearing loss.
To allow its easy use during normal otological clinic visits, the questionnaire was based on a vertigo and hearing loss questionnaire already in use, and it was limited to certain aspects.
The frequency composition of tinnitus is extremely difficult both to describe and to understand, especially for those patients with low-pitched or complex tinnitus, even when using an audiometer or a synthesizer to define tinnitus pitch [2]. If the latter was the case, we asked them to evaluate this fluctuation on a visual analog scale, with the maximum value corresponding to the loudest intensity during the course of the day and the minimum value corresponding to the weakest intensity.
All patients underwent a full otological, audiological, and vestibular examination, which included audiometry, evoked otoacoustic emissions (OAEs), evoked auditory brainstem potentials, and videonystagmoscopy (two CCD cameras mounted on lightproof goggles).
All but one of the patients with tinnitus seen in this specialist clinic had an associated hearing loss. Evoked OAEs were performed in the first 50 patients only, because the high incidence of hearing thresholds greater than 30 dB in our patients meant that OAE assessment contributed little to the evaluation of the etiology. Patients with active endolymphatic hydrops described fluctuation of their tinnitus during vertiginous attacks but, interestingly, also every day between crises, even when they thought that their hearing was stable.
Obviously, our hospital population was selfselected and does not necessarily reflect the true epidemiology of tinnitus. This type of subjective tinnitus reflected a cochlear problem in the majority of cases: More than 80% were associated with an endocochlear hearing loss. A strong correlation was seen between clinical characteristics of tinnitus and the nature of the cochlear pathology. By simply having three categories of tinnitus pitch in the questionnaire (high pitch, low pitch, or other), we have avoided some of the problems associated with pitch matching using an audiometer.
Many studies report tinnitus associated with sleep disturbance, but a literature review does not reveal any other studies reporting such marked increase in tinnitus on waking. We believe that it is important to develop this clinically based approach, and we will continue to investigate further correlations in our clinic. Gui de Chauliac (1300- 1368) was a physician associated with the Montpellier School of Medicine; he wrote what became the standard book on surgery for the next two centuries. The Tullio phenomenon evaluated by computed dynamic posturography (CDP) under acoustic stimulation is reflected in postural unsteadiness, rather than in the classic nystagmus. This establishes the described method as a sensitive testing technique for validating the existence of the Tullio phenomenon in patients with a variety of disorders of the inner ear, especially chronic noise-induced hearing loss and acute acoustic trauma.
In his early works on labyrinthine physiology, Pietro Tullio [1-3] described how sound stimuli caused pigeons to sway in the plane of the horizontal semicircular canals when minute holes were created in these canals.
Blecker and deVries [4] showed that a microphonic, analogous to the cochlear microphonic, can be recorded from the cristae of the fenestrated semicircular canal of the pigeon and that the frequency response of this crystal microphonic parallels the frequency response curve for the TP. No difference in body sway was observed according to whether sound was delivered with monaural or binaural stimulation [13]. Lowfrequency noise (50-400 Hz) was shown also to induce responses in the vestibular neurons [9] by direct influence on vestibular end organs [3,9], and its influence on vestibular function was studied with infrasound stimuli of 25, 50, and 63 Hz at 130-132 dB [13,17]. Tests of the vestibuloocular reflex system-caloric irrigation, vertical axis rotation of the entire body, and ENG evaluations of spontaneous and positional nystagmus -provide information about the symmetry of a vestibular lesion affecting the horizontal semicircular canals.
One of the latest versions, computed dynamic posturography (CDP) (Equitest), attempts to ferret out the effects of various sensory inputs to the brain and to relate them to overall on-feet balance and stability [27-29]. We could not find any study of vestibular responsiveness to acoustic stimulation evaluated by CDP in the literature. Mean composite equilibrium scores in three consecutive sensory organization tests; the second trial was carried out with acoustic stimulation In conditions 5 and 6. From the wide range of acoustic stimuli used to provoke a sonovestibular response, we favored one of low intensity that efficiently, yet safely, elicits a Tullio response. Some patients were investigated by imaging studies (computed tomography or magnetic resonance imaging). Informed consent was obtained from the subjects, and the experimental protocol was approved by the local Ethics (Helsinki) Committee and the Israeli Ministry of Health. The only criteria in our choice were the established diagnosis of an audiovestibular disease and an accurate medical history concerning the presence or absence of sonovestibular complaints. The two dominating categories in this study, comprising a majority of 80% (70% in group A and 90% in group B), were patients demonstrating hearing loss caused by noise. By definition, all patients with sonovestibular complaints (clustered in group A) had to be suffering from either lightheadedness, true vertigo, or plain disequilibrium, with or without nausea and vomiting.
The binaural hearing loss percentage was based on the pure-tone thresholds at the speech frequencies of SOO, 1,000, 2,000, and 3,000 Hz and were calculated according to the formula used by the American Medical Association [32].
For a more accurate evaluation of hearing loss, basic statistical tests were run on several audiometric parameters. This was accomplished by the alternate binaural balance test administered to patients with a difference of 2S dB or more between the hearing thresholds of the two ears at the test frequency. As we have seen, this presumption about the nonsimilarity of the two sets of subjects with otological disorders eventually was proved partially correct. Vestibular ratios scores obtained in computed dynamic posturography in three consecutive sensory organization tests, the second under stimulation with sound. Switching to this representation is correct as long as the mean follows the trend of most individual values in the group.
The trend over repeated trials of SOT was studied by ANOVA for repeated measurements, followed by the Bonferroni test for repeated measurements, applied to the average composite score (Tables 7,8). The trend over repeated trials of SOT was again studied by making use of the ANOVA for repeated measurements, followed by the Bonferroni test for repeated measurements (Table 10; see also Table 8). It reflects the degree to which affected patients rely on visual information to maintain balance, even when the information is incorrect. In this pattern, the sensory ratio of condition 4 to condition 1 is abnormal, whereas those of the remaining pairs are within the normal range (the equilibrium scores for condition 4 are abnormally low relative to the scores on condition 1). In this pattern, the sensory ratios on both SOT condition 5 to condition 1 and condition 4 to condition 1 are abnormal, with normal 2 to 1 and 3 and 6 to 2 and 5 ratios.
Our two sets of pathological patients were picked by definition with regard to the medical history of inner ear disease and to the exclusion of neurological (somatosensory), orthopedic, and vision dysfunction. Both the ratio for conditions 5 and 1 and the paired analysis of conditions 3 and 6 relative to conditions 2 and 5 were abnormal.
Accomplishing that would have enabled a correct parallel and eventual contrast between the results and effectiveness of the two vestibular tests in evaluating the TP.
The postural responses were monitored on the Equitest (the CDP) in three consecutive sensory organization tests, with the second performed partially under binaural delivery of sound (1 IO dB at 1,000 Hz). This establishes the described method as a sensitive testing technique for validating the existence of the TP in patients with a variety of disorders of the inner ear, especially chronic noise-induced hearing loss and phonal trauma, even when employing stimuli of harmless intensities (110 dB) and short durations (6 × 20 sec). Three sensory systems are involved in the maintenance of balance: vestibular, visual, and somatosensory. As mentioned, ENG recordings were not made in some cases for a multitude of reasons, and the testing protocols were not identical in the remaining subjects.
CDP abnormalities were documented in 55% of the cases, whereas ENG revealed abnormality in only 26% of the patients.
In these more homogenous groups of 46 and 52 patients, ENG and CDP abnormalities were equally prevalent and occurred in approximately 50% of the cases. The contrast between ENG findings and CDP findings in the particular case of patients with sonovestibular symptoms, however, is an interesting aspect and remains one of our objectives for the future. Others may suffer anyway, but their symptoms are significantly exacerbated during sound stimulation. He presented with a history of dizziness attacks triggered suddenly by noise, such as loud music or at weddings, or the whine of jet engines on aircraft flying at low altitude. He had been an otherwise healthy person, except for a peptic ulcer, silent at the time of our investigation, for which he had been administered antacids and H2-receptor blockers in the past. ENG with acoustic stimulation included a 60-second continuous recording of ocular movements during binaural stimulation with the pure tone of 110 dB at 1,000 Hz. Individual and composite scores obtained from a patient with noise-induced hearing loss and the Tullio phenomenon in the sequence of three consecutive computed dynamic posturography sensory organization tests (SOTs). Sensory ratio scores obtained from the same patient as in Figure 5 (with noise-induced hearing loss and the Tullio phenomenon) in the sequence of three consecutive computed dynamic posturography sensory organization tests . Worry is a dispositional cognitive trait that involves a pervasive, non-specific, future-oriented proneness to fretting, which can foster negative affective states and catastrophic thinking about a specific trouble when the trouble is actual and present.
Based on the above treatment, the observation group 1 was treated with low-energy laser irradiation on acupoint and external auditory canal (such as Ermen (TE 21), Tinggong (SI 19) and Tinghui (GB 2)), combined with APS at Gan (liver), Shen (kidney) and Neifenmi (endorine), etc.
The therapy of low-energy laser irradiation on acupoint and external auditory canal combined with APS can replace the electroacupuncture therapy in treating moderate and severe sudden deafness.
It was equally effective as regards elimination of labyrinthine hydropsis in patients presenting with Meniere’s disease.
The sensation of tinnitus was measured on a Visual Analog Scale (VAS) before and two weeks after treatment and they were compared by means of Wilcoxon signed ranktest. According to American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines, the main outcome for vertigo control was considered to be the number of spells per month in the 6 mo before treatment compared with the same parameter in the 6 mo of therapy.
Audiometric examination did not show a statistically significant difference between the two groups.
In our opinion, increased blood flow in the inner ear is the main mechanism leading to the therapeutic results.
A questionnaire was administered which asked patients to score their symptoms on a five-point scale, before and two weeks after laser irradiation. To date, in patients with chronic tinnitus mastoidal and transmeatal irradiation has been performed without systematic dosimetric assessment.
Pulsed Electromagnetic Field Therapy was also used and Reactive Oxygen Specimen were measured and controlled by an additional intake of antioxidants per os. This study, however, only reports on the objective outcome of the audiometry, taken before and after therapy. The examination and therapy included 348 patients and 215 right and 187 left inner ear organs (cochlea). The basic diagnostic for the documentation of the functional quality of the cochlea is the audiometry. They were advised to take reasonable prophylactic measures against noise during (and after) the therapy. As expected, the bone conduction is once again situated above the air conduction in all frequencies; the intersection phenomena in the frequency sector between 6 and 8 kc show a downward tendency. One group was evaluated in short-term follow-up (immediately after therapy), another group was evaluated in long-term follow-up (4-6 months after therapy). The aim of the presented study was to determine the light dose received by the cochlear hair cells by using different irradiation modalities for the human petrous bone.
The spatial distribution of transmitted light in the cochlear windings was measured by means of a retrocochlearly positioned endoscopic CCD camera for image processing and was assigned to acoustic frequencies according to the tonotopic organization of the cochlea.
The obtained results are enabling us to apply defined laser light doses to different cochlear winding areas. Spatial intensity variations of a factor of 10 and more inside the cochlear windings have been measured. This investigation included 68 ears in 45 patients with disabling unilateral or bilateral tinnitus. Studies published by these clinics show results which are almost identical with our experience.
This was only possible thanks to our vast experience and long involvement in tinnitus treatments. We have to declare, that we have selected patients during the introductory examination, sorting out patients whose x-ray indicated a possibility of tinnitus caused by vertebral blockades.
This is obviously caused by the absence of medication and physiotherapy, showing their supportive efect. On the other hand we must stress the necessity to apply the two remaining parts of our therapeutic triad as well, since medication and physiotherapeutic manipulation are integral parts of the general care of our patients, and we should not deprive the suffering of the means and methods capable of bringing them more relief, which we are aware of.
We will contact you within one working day to inform as to whether your hearing aid may be repaired in our office or if the aid must be returned to the manufacturer for repair. We recommend that you contact your insurance company to determine the insurance company's policy regarding hearing tests.
Their answers on a questionnaire allowed detailed evaluation of the characteristics of tinnitus, including such variables as the circumstances in which the tinnitus was first noticed and evaluation of its intensity and frequency. If the assessment did not uncover any obvious precipitating events, the tinnitus was considered to have arisen spontaneously.
Tinnitus that was present on some days but entirely absent on others was designated as intermittent (Fig. Three categories of tinnitus emerged from our survey: tinnitus with a stable intensity over time, tinnitus perceived to fluctuate in relation to periods of sleep, and tinnitus perceived as intermittent (present on certain days but not on others). If it was necessary for diagnosing the hearing loss, we also performed supplementary investigations: videonystagmography when hearing loss was associated with vertigo, magnetic resonance imaging when retrocochlear hearing loss was suspected, or magnetic resonance angiography, Doppler imaging of the local vasculature, and tomodensitometry of the temporal bone to evidence vascular problems. Even though deafness had not been described by any of the patients, audiometry unmasked in each patient a high-frequency loss that was more marked (10 dB) in the ear affected with tinnitus.
At age 23, he described his tinnitus as "creaking"; it was precipitated by movement of his head.
Because such a significant number of patients with tinnitus had an endocochlear hearing loss (8l.3%), we looked in more detail at this subgroup.
Each portion of the chart represents tinnitus associated with endocochlear deafness according to its variability of intensity over time. It is interesting to note that the remaining 16% of patients with Meniere's disease or syndrome had had it for more than 5 years; they had a stable hearing loss and no vertiginous attacks for 2 years, and they described their tinnitus as stable (see Fig. Only 2% of patients were unable to categorize their tinnitus into either of these categories.
Each portion of the chart represents tinnitus associated with endocochlear deafness according to its frequency characteristics.
This correlation was calculated for those patients with stable, high-pitched tinnitus and a high-pitched hearing loss. Studies that use an audiometer or synthesizer for pitch matching have found the process to be very difficult, both because of the difficulty that patients have in matching complex tinnitus and because of the possible modulation of the tinnitus by the external sound [8]. He recommended fumigation of the ear with ox urine , vinegar, and myrrh for certain cases of tinnitus.
With such a method, the dangerous effects of noise-induced instability can be assessed and prevented. This vestibular microphonic can be recorded from any of the vestibular end organs and has been observed in many species.
A scan of the literature for the different stimuli used in different studies reveals that the sound pressure levels used to elicit a TP in healthy subjects were higher than those used in subjects with pathologies of the ear. These vestibular tests, however, do not characterize the vestibular deficit in terms of patients' functional status (the ability to stand and walk) because such patients are evaluated in "passive" positions in which balance is not required. CDP includes test conditions in which the platform and visual environment are moved to reduce subjects' ability to use visual and proprioceptive information for balance. Static posturography falls short of revealing pure vestibular malfunction, manifested clinically as unsteadiness when standing or walking. This SPL is well within safety limits (Table 2) in accordance with the Illinois Occupational Diseases Act [30] and the Occupational Safety and Health Administration Regulation [31]. All patients with abnormal visual, orthopedic, and neurological function (other than audiovestibular disorders) were excluded from the study. Therefore, patients in group A were intrinsically a "dizzier" and (as demonstrated later) a more "unstable" set of subjects than were those in group B.
Single-factor analysis of variance (ANOVA) revealed insignificant differences among hearing loss percentages, speech reception thresholds, and speech discrimination scores of the two pathological groups (see Table 6).
These study groups harbor a discrepancy with regard to symptomatology, whereas objective audiometry revealed a similar degree of hearing impairment.
In this way, excessive clutter in the illustration is avoided without generating any statistical error in this case. Thus, the severity of dizziness in these patients (as indicated by history) found a confirmation in terms of posturography by showing a worse balance even in the absence of sound.
In group A, the vestibular component of the equilibrium again demonstrates a decrease on stimulation with sound (see Fig 3). Thus, we got a confirmation of what theoretically was expected; the impaired on-feet stability is (at least in part) explained by a flawed vestibular system in patients with TP. The vision preference scores did not show a large variation, either over consecutive trials or across study groups (Table 12).
The initial proportion of vestibular dysfunction increased on acoustic stimulation to 55% in group A but subsequently decreased in the third trial.
As we know from the literature, this pattern is not observed commonly in patients with impairment limited to the vestibular system but rather are suggestive of central nervous system pathology, possibly in addition to that of the vestibular system. CDP performances demonstrated that 90% of the 40 subjects (groups A and B) showed either normal balance or vestibular dysfunction solely.
In these cases, the average equilibrium scores for conditions 3, 5, and 6 were not only below the normal limits but were abnormally low relative to the scores on conditions 1 and 2. Regrettably, not all 60 study subjects underwent ENG recording under stimulation with sound, and some of those who did were not evaluated identically in terms of duration of exposure to the acoustic stimulus for various reasons.
In comparing our results to those found in previous works in which static posturography methods were used, we must take note of the controversy surrounding the subject in the literature.
In these works, they studied the TP using low-frequency sound (25-63 Hz, 130 dB SPL) and observing the change in stability on a static posturograph. This stimulus is well within the noise exposure standards and therefore is safe, with a temporary threshold shift the only unwanted effect it produces.
When vestibular damage occurs and remains undiagnosed, the overall function of balance relies only on the other two systems. Conclusions based on such a methodological incongruity of the two diagnostic tests could be erroneous. Hence, CDP provided the only documented evidence of pathology in approximately 30% of the cases.
Both categories, especially the former, undergo extensive and protracted workup as the usual diagnostic tests fail to reveal the gravity of their otoneurological disease. He described these attacks as short (minutes), mainly lasting through the duration of the noise but sometimes beyond that, and always accompanied by nausea. As compared to relatively good overall equilibrium (composite score, 78) and competent sensory systems on the first trial (see Fig. The second trial was performed with acoustic stimulation during conditions 5 and 6, whereas the other two were quiet SOTs in the regular mode. Responses of squirrel monkey vestibular neurons to audiofrequency sound and head vibration.
Influence of pressure loading to the external auditory canal on standing posture in normal and pathological subjects. Tullio phenomenon and postural stability: experimental study in normal subjects and patients with vertigo. Effects of increasing intensity levels of intermittent and continuous 1000 Hz tones on human equilibrium. Adaptation to alter support and visual conditions during stance: patients with vestibular deficits. Effect of visual support surface references upon postural control in vestibular deficit subjects.


Computerized dynamic posturography: its place in the evaluation of patients with dizziness and imbalance. Comparison between dynamic posturography and ENG recordings in patients with peripheral vestibular disorders. We examined the relationship between worry and self-perceived anxiety and depressive symptoms and handicap in 54 outpatients with chronic tinnitus and sensorineural hearing loss who had been previously recruited for a randomized double-blind study on the efficacy of transmeatal low-level laser therapy for tinnitus. The observation group 2 was treated with electroacupuncture at the same acupoints as those point irradiation in observation group 1. Although many studies have indicated a positive effect of low-level laser therapy (LLLT) on neural cell survival, there has been no study on the effects of LLLT on cochlear hair cells. The method proved less efficacious for the management of long-standing hearing impairement and chronic loss of hearing, but it can be used to prevent the development of these conditions. A decrease of one scale point, regarding the loudness, duration and degree of annoyance of tinnitus, was accepted to represent an improvement. However, light-dosimetric studies on human temporal bones demonstrated that controlled application of laserlight to the human cochlea depends on defined radiator position within the external auditory meatus.
The hearing capacity of the patients was improved in all frequency sectors (average value = 20.6%). This holds good for both the air and the bone conduction.If one takes into consideration the energy quantity (j) transmitted in order to reach these results, it is obvious that the eldest age group needs the largest quantity of transfered energy.
For an estimation of the corresponding space irradiance in an intact cochlea, correction factors have been calculated by a Monte Carlo procedure on the basis of experimentally determined optical properties of skull bone.
For an irradiation of the mastoid, the light transmission within the cochlea is 10(3) to 10(5) times smaller compared with an irradiation of the tympanic membrane and is extremely variable for different specimens.
Mastoidal irradiation leads to therapeutically insufficient light doses within reasonable treatment times, whereas transmeatal irradiation is recommendable.
Low level lasers have been used to treat tinnitus patients with reasonable success, if sufficient energy and suitable treatment technique is used. The clinical study was performed with 30 patients suffering from chronic permanent tinnitus. The active or placebo laser treatment was administered trans-meatally once a week for 6 minutes. According to literature, fifteen per cent of entire population have experienced at least a tinitus episode some time, its incidence and severity rising with age up to approx. On the other hand, this selection led to a more pure evaluation of the role of LLLT in the treatment of tinnitus, leaving out both a possible cause and a corresponding treatment. The patients each underwent a full neurootological examination with the aim of diagnosing an etiology. The assessment of patients with tinnitus was similar to that for patients with vertigo and hearing loss, within the setting of a neurootology clinic. In each case, the patients were able to state the exact time and date of onset of their tinnitus. In none of these four patients did clinical or vascular examination identify an underlying cause. It is impossible to say whether the deafness was linked to the head trauma (although this is likely) or whether it preceded it. Tinnitus was stable in 65 cases, fluctuant in intensity in 32 cases, and intermittent in 3 cases. Tinnitus was perceived as a high-pitched whistling in 77 cases and as a low-pitched buzzing in 21 cases. The intensity of the tinnitus (x axis) was measured on a visual analog scale graduated from 0 to 100. In cases of active Meniere's disease or Meniere' s-like syndrome with low-frequency hearing loss, the tinnitus was almost always described as a fluctuating low-pitched noise, even between vertiginous crises. In J-M Aran, R Dauman (eds), Tinnitus 91: Proceedings of the Fourth International Tinnitus Seminar.
This should be carried out preferably by means of CDP with acoustic stimulation for an objective corroboration of their complaint before continuing activity in a noisy environment, thus preventing dangerous loss of balance when exposed to noise.
Tullio observed the currents created in the labyrinthine fluids in response to sound by watching the motion of dye particles introduced into the endolymph and perilymph.
Furthermore, information gathered from these studies may indicate that the vestibular response-evoking threshold intensity varies with the frequency of the stimulus: Normal subjects evidence sonovestibular responses at midfrequency range (l,000 Hz) over 120 dB [23]. CDP constitutes a comprehensive sensorial function test of the equilibrium by virtue of its inherent feature of isolating the vestibular, visual, and somatosensory contribution to overall balance, unlike older posturography techniques that served as mere systemic balance tests. We deem CDP a very appropriate technique for investigating the interaction between balance and sound within the labyrinth.
According to these noise exposure safety standards, subjects can be exposed safely to 110 dB for a half-hour daily before any otological damage would occur.
Subsequently, we summarized all the relevant medical information supplied by history and the battery of audiological tests. The findings were not suggestive of any correlation between recruitment and the presence or absence of sonovestibular symptoms. This is not surprising, considering that abnormal sensory preference is, in essence, the effect of a central pathology (arising from the vestibular nuclei or their higher connections), whereas all the subjects in this study were patients suffering from peripheral disease exclusively (arising from the labyrinth or vestibular nerve). The vestibular dysfunction percentages remained constant in the other two groups on repeated trials. The significance of this disclosure of a disturbance in the central connections responsible for equilibrium, triggered by acoustic stimulation in the patients with sonovestibular symptoms, has yet to be interpreted. Only 10% (two subjects in group A on trial 1 and two in group B on trial 3) revealed an inability to use input from the visual system to maintain balance. In general, patients with this kind of pattern are unable to use vestibular system inputs and are abnormally destabilized by orientationally inaccurate visual stimuli. Not only did the intense sound have no deleterious effect on the balance of normal subjects but they improved their postural stability during sound stimulation, probably through the alerting response.
Thus, it can be used routinely for detecting this disturbing and potentially dangerous phenomenon in patients who complain of sudden dizziness or report protean descriptions of feeling bad when they happen to be exposed to intense noise at a concert hall, discotheque, airfield, or work. Even though the functional impact of vestibular and vision dysfunction is limited to noise exposure in such patients, they require a stable support surface reference to maintain balance (somatosensory-dependent) in those instances.
When, in addition, other sudden sensory deprivation occurs or if new relationships develop between the sensory systems involved in balance, spatial disorientation may transpire under these circumstances. Among the cases with history of head injury, 100% had CDP abnormalities, whereas ENG results were normal in all of them. Among patients with abnormal ENG and normal SOT results, the majority had compensated unilateral lesions. Such patients' symptoms seldom improve, because the underlying damage is by and large permanent regardless of etiology. Additionally, he mentioned occasional vertiginous attacks caused by bending forward, always quite suddenly relieved by straightening out. Speech audiometry found binaural speech reception thresholds and speech discrimination scores of 20 dB and 100% at 55 dB, respectively.
5A), our patient demonstrated a sharp decrease in his overall balance when exposed to the pure tone of 110 dB at 1,000 Hz (composite score, 52) (see Fig. Cited by Erlich MA, Lawson W, The incidence and significance of the Tullio phenomenon in man.
Frequency-specific hearing levels were measured before the noise exposure and also after the 1st, 3rd to 5th, 8th to 10th and 12th irradiations. Therefore, the aim of this study was to elucidate the effects of LLLT on hair cell survival following gentamicin exposure in organotypic cultures of the cochlea of rats. The mean VAS score reduction was not statistically significant between male and female patients (p = 0.23). Moreover, a hearing test was performed before and after therapy and results were reported as the pure tone average of 500-, 1000-, 2000-, and 3000-Hz frequencies. This feasibility study first presents a laser application system enabling dose-controlled transmeatal cochlear laser-irradiation (TCL), as well as preliminary clinical results in patients with chronic cochlear tinnitus. Patients with hearing aids were advised to reduce the adjustments according to their improving hearing quality.
It has to be emphasized, though, that once again the most difficult patient group (average duration of the disease 14.5 years) needed the largest quantity of transfered energy. Further studies are mandatory for development of clinical devices for transmeatal irradiation of the cochlea. Only 26% of the patients reported improved duration, but 58% had  reductiont of loudness and 55% reduced annoyance. This study brings an additional overview of the role of LLLT (Low Level Laser Therapy) in the treatment.
Audiogram provides only for numeric range of perception of frequency of sounds, however it does not give us an objective evaluation of quality of hearing. The great majority of tinnitus patients had an endocochlear deafness and, among these patients, acoustic trauma, endolymphatic hydrops, and presbyacusis were the commonest diagnoses (32%,32%, and 23%, respectively). Zero corresponds to an absence of tinnitus; 100 corresponds to the loudest tinnitus you can imagine. One patient attending the tinnitus clinic was given a diagnosis of an acoustic neuroma, two patients of vascular loops in the internal auditory meatus, and two of cholesteatoma. Even though it was thought that his tinnitus had an origin in some head or neck joint and thus was a somatic noise, it was not possible to define it further.
All patients who described their tinnitus as fluctuating in intensity described a very clear increase in intensity of their tinnitus after periods of sleep (whether nighttime or siesta). The highfrequency hearing loss (y axis) was calculated as a mean of the thresholds over three frequencies (4 , 6, and 8 kHz). He noted that these currents were in perfect correspondence with the frequency of the applied tone. At low frequencies (25-63 Hz), the minimal intensity would be 145 dB [13], whereas at frequencies up to 2,500 Hz, the vestibular responses occur only at a sound pressure level (SPL) exceeding 120-160 dB [19]. This was followed 20 minutes later by a test carried out in quiet stance in SOTs I through 4 and with acoustic stimulation in SOT 5 and SOT 6 (Fig.
This duration is more than an order of magnitude larger than the total of 120 seconds for which our subjects were exposed during the sequence of two SOTs (5 and 6) repeated three times each. In vestibular dysfunction, the sensory ratio of condition 5 to condition 1 is abnormal, whereas those of the remaining pairs are within the normal range. This pattern was observed neither in those in group B nor in normal controls, whether stimulated acoustically or not.
None of the patients demonstrated somatosensory or central pathology, except for the "central" pattern exhibited by those in group A during and after exposure to sound, as discussed in the previous paragraph. As both the lack of visual and support surface inputs and conflicting visual inputs are destabilizing, these patients are more impaired functionally than are those with either vestibular dysfunction or vision preference alone.
In the absence of a stable surface, they do not make effective use of either vestibular or visual inputs [33]. Exposure to intense noise in unusual environmental settings (during flying under changing gravitational forces, diving, physical activity in darkness, or night driving) might produce conditions that in certain circumstances could even be life-threatening.
In contrast, patients with normal ENG and abnormal SOT results had clear positive symptoms of vestibular system disorder.
By the nature of his trade, he had been constantly exposed to the wail of the ambulance siren for almost two decades, and this had turned his everyday life for the last 7 years into a desperate condition. Capelli, 1929.) Cited by Erlich MA, Lawson W, The incidence and significance of the Tullio phenomenon in man. For the psychoacoustic tinnitus measures, we considered the loudness match and the minimum masking level.
The cochlea cultures were then divided into a control group (n=8), a laser-only group (n=8), a gentamicin-only group (n=8) and a gentamicin plus laser group (n=7). The improvement of rheoencephalographic characteristics was documented in the patients of all groups but was especially pronounced in group 1.
The novel laser TCL-system, consisting of four diode lasers (lambda=635 nm-830 nm) and a new specific head-set applicator, was developed on the basis of dosimetric data from a former light-dosimetric study.
The average improvement was 22.84 dB for 74 long time follow up observations (4-6 months after therapy).
There was a close correlation between the improvement of the hearing capacity and the age of the patients and the duration of their disease.
The authors conclude: ”Laser therapy seemed to be worth trying on patients with intractable tinnitus”.
A questionnaire was administered to evaluate the loudness, duration, quality, and annoyance of tinnitus before and after irradiation. Our results enable us to pinpoint laser as the leading element in the overall therapy of tinnitus.
Furthermore, the patients do not see the main improvement in a wider range of frequency of sounds, this remains usually on a similar level, but the main benefit is the absence of the additional burdening sound caused by tinnitus.
The aim of the clinical examination was to diagnose the etiology of any underlying hearing loss.
The second group (B) included 20 neurootological patients without a history of Tullio phenomenon. He also noted that at higher sound intensities, a nystagmus was produced, the frequency of which corresponded to the oscillations of the internal current. Bearing in mind that acoustic stimuli in unusual environmental conditions always affect both ears, we preferred to employ a binaural stimulation in the attempt to prove the hypothesized correlations in accordance to the hazards of quotidian reality. Thus, the equilibrium scores for condition 5 only, or for conditions 5 and 6, are abnormally low relative to the scores on condition 1. This abnormal pattern is described as occurring in patients with balance disorders secondary to traumatic head injuries but also was reported in other patient populations.
The balance functions during exposure to intense noise in such patients tend to be more impaired than in those with vestibular dysfunction, vision preference, or a combination of these pattems. In these patients, disorders were either more central or were presumed to effect peripheral components other than the horizontal semicircular canals (vestibuloocular system). Consequently, these patients continue to seek medical assistance, and their complaints seem to be psychologically aggravated by frustration accumulated through continual visits, referrals, and failing therapy. On the third (quiet) trial, 20 minutes later, his balance recovered completely (composite score, 80) (see Fig.
Compared to initial hearing levels at all frequencies, thresholds increased markedly after noise exposure. It is concluded that the proposed method significantly increases the efficiency of treatment of chronic sensorineural hearing loss. In a preliminary clinical study, the TCL-system was applied to 35 patients with chronic tinnitus and sensorineural hearing loss. Until now there hasn’t been any known potent therapeutic method improving hyperacusis. In conclusion it can be stated that if LLLT is administered in sufficiently high dosages to the inner ear (cochlea), it is possible to obtain and document significant biostimulative effects. Therefore the patients can better analyze sounds in general, their hearing is “refreshed” as they usually describe the result of the therapy.
Those patients with active Meniere's disease or Meniere's-like syndrome described a low-pitched buzzing tinnitus.
However, four patients did have a presbyacusis, and one had a mild hearing loss in the higher frequencies. Sounds reaching the ear of the animal produced a current in the open canal, also affecting all three semicircular canals simultaneously. In the latter two tests, subjects had only the vestibular system at their disposal (with inputs from other sensory systems canceled or inaccurate). The functional impact of this pattern dwells in the necessity of either a stable support surface or stable visual field to maintain balance. Indeed, one of our two patients with this disequilibrium pattern mentioned a head injury incurred several years prior to the current investigation (in addition to the NIHL from which he was suffering and for which he was selected).
Preferably, this should be carried out by means of CDP with acoustical stimulation for an objective corroboration of their complaint before continuing activity in a noisy environment, thus preventing dangerous loss of balance when exposed to noise. We deem the description of a typical case of TP pedagogically rewarding and suggestive of the problem and therefore appropriate. This suggests the usefulness of worry assessment when managing chronic tinnitus in clinical practice.
After the 12th irradiation, hearing threshold was significantly lower for the NL ears compared to the N ears. The chronic symptoms persisted after standard therapeutic procedures for at least six months, while retrocochlear or middle-ear pathologies have been ruled out. In some cases laser therapy alone will produce astonishing results, in others it has to be combined with traditional occlusal stabilisation procedures.
However, 40% of the patients reported a slight to significant attenuation of the tinnitus loudness of the treated ear. In one patient who received active laser treatment, acute hearing deterioration occurred after the third irradiation. Analysis of those patients with a stable high-pitched tinnitus associated with a high-frequency hearing loss shows a statistically significant correlation between the elevation of the audiometric thresholds and the loudness of the tinnitus. The quality of the bestfitting linear regression curve is indicated by r, and the number of patients by n.
A pure-tone stimulus of I,000 Hz at 110 dB was delivered binaurally for 20 seconds during condition 5 and condition 6 of the CDP sensory organization test. However, the current was predominant and the cristae more easily displaced in the fenestrated canal, accounting for visible movements only in the plane of this canal. The sensory analysis of the second patient showed mainly vestibular dysfunction and only a borderline visual preference abnormality. Early therapeutic interventions for reducing proneness to worry may facilitate better adaptation to tinnitus.
When observed using an electron microscope, the number of hair cells in the middle turn of the NL ears was significantly larger than that of the N ears. The gentamicin groups were exposed to 1 mM gentamicin for 48 h and allowed to recover (gentamicin-only group) or allowed to recover with daily irradiation (gentamicin plus laser group).
The pulsed electromagnetic field applicator generated a magnetic field of a maximum of 100 µT and it was placed behind the ear, over the area of the mastoid bone. Lutz Wilden of Bad Fussing, Germany reported on his 6 years of experience at a recent lecture before the members of the Swedish Laser Medical Society (Stockholm, May 1998). It is important for doctors to be aware of this subgroup of tinnitus patients since traditional therapies, and even laser therapy of the inner ears, will be ineffective if the CMD is not diagnosed and treated.
Transmeatal low-power laser irradiation with 60 mW is not effective for the treatment of tinnitus. For a large majority of patients with tinnitus, therefore, audiometry provides an indirect test for evaluating the tinnitus.
The sequence of six sensory organization conditions was performed three times with two intermissions of 15-20 minutes between the trials.
From the different reactions that Tullio observed by stimulating the ears of animals, he proposed that perhaps this was to become a potential diagnostic tool with which one could recognize the seat and nature of lesions in the different parts of the labyrinth. The latter is described in the literature as accountable to, among other causes, a declining performance caused by fatigue or by exacerbation of the patient's symptoms during repeated trials [29]. Our findings suggest that low-level laser irradiation promotes recovery of hearing thresholds after acute acoustic trauma. For evaluation of laser-induced effects complete otolaryngologic examinations with audiometry, tinnitus masking and matching, and a tinnitus-self-assessment were performed before, during and after the laser-irradiation. Before every therapy series with LLLL the patients actual hearing capacity (air and bone conductions) was examined by audiometry. ROS were measured and controlled by administrating different sorts of antioxidants such as Ginkgo biloba. The number of hair cells was significantly larger in the gentamicin plus laser group than in the gentamicin-only group. The first clinical use of the TCL-system has been well tolerated without side-effects and produced no observable damage to the external, middle or inner ear. At the end of each therapy series their hearing capacity was examined by the same method for a second time.
This was followed 20 minutes by a trial carried out in quiet stance in sensory organizations tests (SOTs) I through 4, and with acoustic stimulation in SOT 5 and SOT 6. The number of hair cells was larger in the laser-only group than in the control group, but the difference did not reach statistical significance.
These results suggest that LLLT may promote hair cell survival following gentamicin damage in the cochlea. After a follow-up period of six months tinnitus loudness was attenuated in 13 of 35 irradiated patients, while two of 35 patients reported their tinnitus as totally absent.
Total dosage 2000-4000 (sic) joules per treatment (60 minutes per session, 30 minutes per ear). This is the first study in the literature that has demonstrated the beneficial effect of LLLT on the recovery of cochlear hair cells.
C) The hearing capacity of the patients was ameliorated in all frequency sectors (average value = 20.6 %).
Doses may seem very high, but the thick bone behind the ear absorbs about 95% of the energy before reaching the inner ear. Further investigations by large double-blind placebo-controlled studies are mandatory for clinical evaluation of the presented TCL-system and its therapeutic effectiveness in acute and chronic cochlear dysfunction. There was a close (and biologically plausible) correlation as far as the amelioration of the hearing capacity and the age of the patients and the duration of their disease were concerned; this correlation was the higher, the more energy was transfered on the whole.



Tenis nike mercurial nuevos 2013 8vo
Ringing ears caused by stress 9.1
Bose noise cancelling earbuds bluetooth gratis


Comments to «Meniere disease total hearing loss zedd»

  1. Y_A_L_A_N_C_I writes:
    Leads a lot of to believe that the discover to manage reactions to the.
  2. 777777 writes:
    Audiologist is able to examine the ear was due to ingestion.