Tinnitus 17 years old is,sensorineural hearing loss help,left ear ringing 9am vancouver - Plans On 2016

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INTRODUCTION: Sudden deafness is characterized by an abrupt onset, often idiopathic and tinnitus is present, and becomes the main complaint in up to 80% of patients.
OBJECTIVE: To review carefully all studies of the past 10 years on sudden deafness and tinnitus and analyze the effectiveness of oral and intratympanic steroids for tinnitus control in eight patients with sudden deafness and severe disabling tinnitus. METHOD: An analytical prospective in which 64 patients after sudden deafness with tinnitus were monitored and 08 of these suffering with severe disabling tinnitus underwent hearing evaluation and application of the Tinnitus Handicap Inventory and Visual Analogue Scale before, during and after sudden deafness treated with oral and intratympanic steroids. Sudden sensorineural hearing loss (SSHL) was first described by De Kleyn in 1944 and defined as a hearing loss of at least 30 dB in three sequential frequencies in the standard pure-tone audiogram over 3 days or less1. Population studies of SSHL show a wide distribution, ranging from 5 to 30 cases per 100.000 per year, with an average of 50-60 years and no sex preference.
Hypotheses are proposed to explain the pathogenesis of sudden hearing loss as the vascular, the viral, the autoimmune and the rupture of membranes one.
Patients with tinnitus and SSHL are very frustrated by residual tinnitus even after accomplishment of the treatment for SSHNL. All patients received information about the risks and expectations of therapy and signed a free informed consent form.
Next, salvage therapy with intratympanic methyl-prednisolone was offered to XX patients with a diagnosis of SHL, after systemic therapy failed and no improvements were demonstrated audiometrically.
All patients underwent tonal and vocal audiometry and speech recognition rate analysis done by audiologists before and after treatment.
Prior to any procedure, patients were oriented as to the risks and expectations about the procedure and signed a free informed consent form.
After intratympanic application of the steroid, the patient remained in the supine position and cervical rotation at 45? for 30 minutes to maximize exposure of the round window membrane to the solution. The criteria for defining successful recovery after therapy vary in the literature on intratympanic therapy. All patients underwent Questionnaire Tinnitus Handicap Inventory (THI)5 and the Visual Analogue Scale (VAS) to assess quantitatively and qualitatively the therapeutic response in relation to tinnitus. The search strategy employed in the literature review was guided by the combination of two descriptors indexed in MeSH (Medical Subject Headings): sudden deafness and tinnitus. Most of the patients had vertigo associated with sudden deafness, being classified as mild in 75% of cases and severe in 12.5%.
We performed a literature search with the following aliases: sudden hearing loss and tinnitus. Their ages ranged from 26-73 years with a mean of 39,5 years and the ear most affected was the left ear (n = 5). In this study, we chose to intratympanic corticosteroid associated with oral corticosteroids and showed that this association was particularly effective in relation to tinnitus, from the eight cases analyzed, seven of these showed a significant improvement verified by THI and EVA.
Several factors may affect the prognosis of the PANSS (eg, hearing loss severity, symptoms duration before treatment, vertigo, type of audiogram, and the patients ages). Regarding hearing improvement, only two patients had good responses to therapeutic intervention.
Given the results, we note that in addition to the proposed intervention, especially those cases where there were no improvement or even where there were worsening of symptoms over time, there are other recommended therapies such as cognitive-behavioral and Tinnitus Retraining Therapy. Some therapies for tinnitus tend to focus on the impact of noise on the quality of life and humor, and include antidepressants, anticonvulsants and benzodiazepines, or attempt to mask their own noise with white noise generators.
In 2005, a review of published randomized clinical trials addressing the correlation between sudden sensorineural hearing loss and tinnitus and treatment by hyperbaric oxygen therapy (HBOT).
The sudden sensorineural hearing loss (SSHL) is a considerable diagnostic challenge because it can be caused by many different diseases and there is still no definitive treatment for PANSS universally accepted. In search of a therapeutic approach, the efficacy of enoxaparin sodium associated with venous hemofiltration was studied. In 2008, Ishida et al.15 investigated how the symptoms of ear fullness, tinnitus and otoacoustic emissions (OAE) varied over the course of recovery thresholds in pure tone audiometry in SSHL. Kleinjung et al.16, in 2009, described the case of a man of 55 years who suffered from tinnitus in the right ear as a result of a SSHL. Hikita-Watanabe et al.17, in 2010, in an article entitled "Tinnitus as a prognostic factor of sudden deafness", rebound that in the group "buzzing rare" there was a worst prognosis to hear than in the group "buzz often". In 2012, Fioretti et al.18 described the case of a 67 years-old women with severe and disabling tinnitus in the right ear, hyperacusis and mild headache. In 2012, a research was also conducted by Ramos et al.10, in which the authors assessed the effectiveness of cochlear implants in patients with SSHL and disabling tinnitus. The tinnitus severity was assessed using the Tinnitus Handicap Inventory (THI) and the Visual Analogue Scale (VAS) before and after deployment.
Given the results, it can be concluded that the reduction of tinnitus after cochlear implantation may be due to several mechanisms such as habituation, acoustic masking, direct stimulation of the cochlear nerve and reorganization of cortical areas.
Michiba et al.19, in 2013, highlighted the fact that many patients are frustrated with the SSHL residual buzz, even after complete SSHL treatment. The hearing improvement rate was determined by comparing the thresholds before and 6 months after initiation of treatment. The improvement of hearing thresholds were significantly correlated with improvement in the score of tinnitus 6 months after initiation of treatment compared with before treatment. Generally, subjective feelings for the ringing residual 6 months after initiation of SSHL treatment are almost the same as 24 months after treatment.
Patients that carriers sudden deafness and severe disabling tinnitus, and underwent intratympanic and oral corticosteroids showed, in this study, significant reduction or remission of tinnitus.
Paper submitted to the ITJ-SGP (Publishing Management System) on September 4, 2013; and accepted on October 4, 2013.
Sound Therapy, based on discoveries by the ear specialist Dr Tomatis, is safe, easy, cost effective and pleasurable. Like many other areas of health dysfunction, the causes and manifestation of tinnitus are complex. Sound therapy has been a component of India's ancient system of Ayurvedic medicine for centuries. However, Tomatis' application of sound therapy to exercise the muscles of the middle ear is new. For those who are unsure, I encourage you to test out Sound Therapy for yourself in your journey towards health and wellbeing.
Thank you Rafaele for writing this book that easily unravels this confusing and often debilitating condition. On my recommendation, my mother was one of the first clients of the Canadian doctor when he opened his clinic in Montreal.
More importantly, this book explores the preventative steps that can be taken along with wholistic options for general health. We evaluated the results of the use of Clarion (Advanced Bionics, USA) implants in 30 Indian patients.
Our cochlear implant program started in 1987 in Bombay and, since its inception, we have placed implants in 123 patients. The 30 patients who underwent surgery with Clarion implants from 2000 to 2003 were from India, Bangladesh, and Sri Lanka. The speech strategy options [2] available with the different devices were fully simultaneous analog stimulation of electrodes (SAS) [3,4], multiple pulsatile stimulation of electrodes (MPS), non-simultaneous continuous interleaved sampling of electrodes (CIS) [3,4] (Fig. The ages of 15 prelingual patients ranged between 1 year 8 months [7] and 8 years, and those of 9 older prelingual patients were between 9 and 41 years. All patients were subjected to an inverted J incision and to a simple mastoidectomy, a posterior tympanotomy, and a cochleostomy according to the Clarion gauge [8]. Rehabilitation was carried out in seven languages: English, Hindi, Marathi, Gujarati, Bengali, Tamil, and Singhalese. The results [11] in the first three postlingual patients [12], with vowel-consonant-vowel, sentence recognition, paragraph tracking, and open-set discrimination after the first, fourth, and twelfth weeks (Fig. We observed that the average test score results in postlingual patients with CIS strategy in all types of cochlear implants were similar [15] but were achieved faster in postlingual patients using the HiRes strategy (Fig.
The overall results of cochlear implantation in India with the Clarion implant in postlingual and prelingual patients were very encouraging. Tinnitus is associated with the most important symptoms in neurootology besides vertigo, nausea, and hearing loss. Since about 1985, via vestibular evoked potentials (VestEP) and brain electrical activity mapping (BEAM), the Wurzburg Neurootology Group of Claussen et al.
For this study, we randomly selected a sample of 757 patients suffering from an endogenous tinnitus according to the tetrad of tinnitus differentiation described. We followed with a thorough audiometric investigation to obtain measurements of the hearing threshold, the acoustic discomfort threshold, the calculation of the acoustic dynamics, tinnitus masking, impedanciometry, and stapedial muscle reflexes. In assessing the vestibulospinal pathways, we regularly applied craniocorpography (CCG) in the form of ultrasonographic computed craniocorpography (UCCCG). The test results from our analyses helped us to demonstrate that these 757 patients were suffering from an endogenous tinnitus.
At the Neurootological Research Institute at Bad Kissingen, we recorded statistics from our 757 patients suffering from an endogenous tinnitus. After exploring the vertigo mechanisms, we analyzed the different sensations in hearing distortion in our patient sample (Fig. Figure 20 shows our analysis of trigeminal nerve complaints: Although no patient reported trigeminal nerve disorders, the medical investigators found such disorders by direct inspection relative to patients' obtained medical history. The special set of questions regarding our patients' history dealt with specific neurological disorders (Fig. Very well known is that after head and neck trauma, many patients complain of various types of tinnitus. Cardiovascular diseases were very important background disorders for our neurootological patients. We also questioned our patients about diabetes mellitus and categorized these cases with respect to their therapy.
For this study, we randomly selected 757 tinnitus patients who reported that they felt better in a noisy environment. The question underlying this study is whether tinnitus is a monosymptomatic disease or is bound into a complex spectrum of complaints within a multisensory disorder.
We saw a very varied picture in the subjective descriptions of the quality of tinnitus sensations. Of background disorders, various cardiovascular diseases showed a high occurrence rate (Fig. All in all, we must conclude that our evaluations in studying our 757 cases demonstrate that the spectrum of subjective complaints is very complex and individually mingled. Overall, our evaluation of 757 patients with endogenous tinnitus posits that the most important accompanying general diseases are cardiovascular.
From all these patterns of interactive complaints, we also must conclude that endogenous tinnitus points to a "cybernetopathia" deriving from dysfunctions at various points of the statoacoustic and interrelated supportive neurosensory pathways. How to cite this article Matsushima J, Sakai N, Uemi&# N, Miyoshi&# S, Sakajiri&# M, Ifukube&# T. An electrical tinnitus suppressor developed at the Hokkaido University was implanted in two women and five men, aged 44-77 years old.
The AI registered at a severe level in five patients and a moderate level in two patients before implantation of the suppressor.
The TII registered as extreme in all patients before implantation of the suppressor, although the intensity of tinnitus varied from patient to patient according to the loudness balance test. After the operation, at TST, AI, and TII results were positively correlated (p =.01), though there was no correlation among these parameters before the operation.
There is a clear agreement among implant groups that the majority of patients can experience tinnitus suppression while using an implanted electrical tinnitus suppressor [1]. An electrical tinnitus suppressor incorporating the use of an extracochlear stimulator has been developed at Hokkaido University [2]. Although we often speak of tinnitus as if it were a single entity, tinnitus actually consists of sensory and affective components [5]. The differences in the degree of affective disorders that patients perceive are explained by a stress model for tinnitus [7]. Such affects as insomnia, annoyance, anxiety, and interference in communication capability that are induced by tinnitus would constitute stress that is highly associated with patients' quality of life. Therefore, a good assessment of the impact of tinnitus on patients' lives should be based on the amount of stress induced by tinnitus. Few questionnaires are available to ascertain the degree of tinnitus that would affect patients' lives [9,10]. Patient 1, 57-year-old woman, complained chiefly of bilateral hearing loss and tinnitus in the left ear. Patient 2, a 61-year-old woman, complained chiefly of bilateral hearing loss and right-ear tinnitus at the first consultation. Patient 5, a 67-year-old man, was chiefly concerned with bilateral hearing loss as a result of ear infections in childhood and tinnitus in both ears. In Patient 7, a 44-year-old man, audiography showed moderate hearing loss in the right ear due to Meniere's disease. The electrical tinnitus suppressor consists of an external coil inside a behind-the-ear type of hearing-aid case and an implanted coil in the mastoid [3]. Seven patients in whom a tinnitus suppressor was implanted received three self-evaluative tests in April 1996: the TST, the tinnitus intensity index (TII), and the annoyance index (AI). Annoyance refers to interference in lifestyle-that is, vocational, recreational, and social activities as well as sleep. Tinnitus in six patients disappeared for several hours to a half-day after electrical promontory stimulation at the outpatient clinic Table 2. Before device implantation, five patients registered an extreme level on the TST, one patient was at a moderate level, and one was at a severe level.
All patients reported an extreme score on the TII before device implantation, although the intensity of tinnitus varied from patient to patient based on the loudness balance test. The TII finding revealed the loudness of tinnitus as perceived by the patients before and after the operation; the implanted tinnitus suppressor was effective for improving the sensory component in all patients. The AI scores revealed a severe level in five patients and a moderate level in two patients before device implantation. Patient 1 experienced a small amount of persistent tinnitus in the left ear all day after device implantation in the right ear, although tinnitus reappeared during a common cold and when the patient was very tired.
Patient 2 abandoned use of the stimulator because of the electrode trouble she experienced in 1996. Patient 3 experienced tinnitus disappearance for several hours in the implanted ear after 30 minutes of stimulation. Patient 4 has experienced no tinnitus in the unimplanted ear after usage of the suppressor.
In Patient 5, tinnitus in the unimplanted ear has completely disappeared, and tinnitus in the implanted ear usually disappears after several electrical stimulations per day. Patient 6 had never experienced relief from tinnitus since the first consultation at our outpatient clinic.
After use of the suppressor, hearing in Patient 7 improved to normal (Figure 4) and tinnitus completely disappeared except when he was suffering from a common cold or from extreme tiredness.
We recommended two female and five male tinnitus patients for implantable tinnitus suppressors. Patients selected for the implantable suppressor should have experienced tinnitus disappearance for more than a few hours after electrical promontorium tympani stimulation at an outpatient clinic. In addition, the intensity of alternating current stimulation for tinnitus relief was emphasized because the stimulator is designed to be portable. Previously, we reported the outcome of treatment of tinnitus with an implanted tinnitus suppressor in 3 of 7 patients considered in this study [11]. For Patient 2 in the earlier report, we noted that the effect on tinnitus suppression was unstable. The third report in our earlier publication (concerning Patient 6 from the present study) noted that the patient experienced tinnitus all day despite using the stimulator twice daily.
A discrepancy was demonstrated among these patients regarding the degree of annoyance and tinnitus intensity before the operation.
Subjective improvement in hearing was reported in the ear with tinnitus relief after combination therapy of tinnitus masking and external electrical stimulation, although no change in the hearing threshold was demonstrated by audiometric testing [13].
The patients have been investigated with electronystagmography, dynamic posturography, pure-tone audiometry, and speech audiometry before and after the gentamicin treatment. Six patients were given three instillations, whereas 25 patients were given four instillations (either according to the quadruple method or via a repeated dual method). With use of the initial method of daily drug instillation until the effect was obvious, three ears became deaf. For patients treated by the original unlimited method, the mean hearing loss after treatment was 12 dB.
We wished to determine whether the pure-tone threshold level was predictive of the hearing result after treatment.
After gentamicin treatment, the endolymph-producing dark cells in the stria vascularis are damaged and, possibly, their function is diminished [12,13]. Dynamic posturography reveals that in the weeks immediately subsequent to gentamicin treatment, an ataxia is present that gradually disappears and, after 3 months, is no longer detectable [16].
Without vestibular rehabilitation and physiotherapy, there is a risk for some permanent ataxia and slight vertigo. In addition to the shunt operation, other surgical procedures such as labyrinthectomy or vestibular nerve sectioning might be performed.
Eight patients treated with intratympanic and oral corticosteroids were selected, just two patients showed improvement over the hearing but seven of them showed big improvement in their tinnitus, which was demonstrated by an improvement in the values of the degrees of severity of tinnitus. In most cases, there is a unilateral hearing loss, with bilateral involvement reported en less than 5%1. However, the current trend is to consider the sudden deafness as a disease of multifactorial etiology2.
In idiopathic cases, the oral corticosteroids are widely used, although the supporting evidence is weak. However, there are few theories trying to explain its mechanism, one of than associates this symptom with a maladaptive attempts of a cortical reorganization process due to peripheral deafferentation4. The majority ask doctors about the prognosis of residual tinnitus at the final day of medical treatment for SSNHL.
From June 2011 to July 2013, 64 patients with a diagnosis of sudden sensorineural hearing loss were seen at the otorhinolaryngology outpatient and emergency unit of our Center, Eight was suffering from severe disabling tinnitus. A detailed clinical history was taken, followed by an otoneurological examination, and an initial audiological assessment by tonal and vocal audiometry, impedance testing, speech recognition rate (SRR), laboratory tests, and an image exam (magnetic resonance imaging with contrast of the inner auditory canal).
Eight patients suffering from severe disabling tinnitus agreed to undergo rescue therapy and signed the free informed consent form to be included in this study.
All patients with fluctuating hearing loss or suspected Meniere's disease were also excluded from this study.


A second injection was done if there was any possibility that the first injection was not adequate. A 20 dB improvement at 0.5, 1 and 2KHz, or a 20% improvement in discrimination was enough to consider the intervention as successful.
In the Visual Analogue Scale (VAS) score ranges from 1 to 10, where 10 represents the highest degree of tinnitus severity.
However, corticosteroids seem to have universal acceptance and are the ones with proven effectiveness. Such treatments aim to improve inner ear oxygenation and include vasodilators, plasma expanders, steroids and anticoagulants11.
In the EVA, it is observed that 100% of patients had a score greater than or equal to 7 and a significant reduction in scores of patients 1, 2, 3, 4, 7 and 8, in order to reduce at least two points on score and the same was observed in the degree of severity in THI (Table 1). Patient 2, despite their age, presents a clinical STD (sexually transmitted disease) that could prevent or reduce the effectiveness of the proposed treatment. The administration of hyperbaric oxygen is based on the argument that both the hearing loss and the tinnitus may result from a hypoxic event in the cochlea, and that hyperbaric oxygen therapy may be able to reverse the oxygen deficit. Eight patients were followed with improvement in SSHL auditory thresholds (Group A) and eight patients with poor hearing improvement (Group B), to elucidate the behavior of these symptoms in your ongoing recovery. Several therapeutic efforts including intravenous steroids and graft in the round window showed no positive responses.
All subjects had SSHL, although the group "short" had a better prognosis than the group "longer duration" when restricted to SSHL accompanied by tinnitus. Ten patients with sudden hearing loss and severe-profound unilateral tinnitus associates were implanted with a mean age of 42.7 years deployment. It was conducted a prospective study that analyzed gender, laterality and age of patients, along with changes in the level of hearing and tinnitus, after scoring early SSHL to determine the prognostic factors of residual tinnitus after the last day of treatment for SSHL. The tinnitus was assessed subjectively by a questionnaire before, 6 and 24 months after initiation of treatment. The scores of tinnitus in all three items were significantly better 6 months after initiation of treatment comparing with the last treatment. Especially younger patients with hearing improvement achieve an improvement of tinnitus in the period between 6 and 24 months after initiation of treatment.
Specialist in Otology and Neurotology by Harvard Medical School, Boston, MA, USA, PhD in Medical Sciences from the University of Brasilia, Professor at Health Sciences School - University of Brasilia - Brasilia - DF - Brazil. There actually was never a course in my graduate work on tinnitus and its relationship to hearing. My mother did not have tinnitus, but she had two other hearing problems for which Sound Therapy was recommended. Cases included in the study were prelingual and postlingual patients in whom the cochlea was normal and prelingual patients in whom the cochlea had a Mondini defect or was ossified.
3), and high-resolution (HiRes) with twice the number of stimulation channels as SAS, CIS, or MPS. Simultaneous analog stimulation (SAS) , multiple pulsatile stimulation (MPS), and continuous interleaved sampling (CIS).
In patients in the abnormal group, four prelingual patients with a Mondini defect [5] received an enhanced bipolar electrode without a positioner, and one received a HiFocus I. Postoperative electrodes of a ClI Bionic Ear in a 2-year-old prelingual patient with normal cochlea.
Two patients were fitted with CII behind-the-ear speech processors (BTEs), 4 were fitted with platinum BTEs, 13 with an S series speech processor, and 11 with a platinum series body-worn processor.
The results after rehabilitation [10] were tabulated at 1 week, 4 weeks, and 3 months after speechprocessor fitting in the postlingual group and at 1 week, 4 weeks, and 6 months after fitting in the younger prelingual and the older prelingual patients. Speech perception and speech production [16,17] developed faster in young and older prelingual patients with the enhanced bipolar, HiFocus I, and HiFocus II devices with SAS and MPS.
Often, we find multisensory syndromes combined with tinnitus, hearing impairment, vertigo, and nausea.
Low-tone tinnitus is more frequently found in Meniere's disease and some other cochleo-apical disorders. In the high-tone range, most frequently tinnitus is matched and related to such conditions as noise trauma, whiplash, head and skull trauma, cardiovascular failures, stress, and toxic events, including pharmaceutical use, nicotine or drug abuse, and acoustic neuromas.
Owing to the size of the workload, we limited ours efforts to constructing a sample from those 757 patients randomly selected from a major group of neurootological patients (we process more than 10,000 files of neurootological patients, many of whom suffer from one or another type of tinnitus). We then conducted objective and quantitative electrophysiological measurements of the acoustic pathways via otoacoustic emissions, acoustic brainstem-evoked potentials, and acoustic late or cortical evoked potentials.
We performed vestibulospinal recording of the CCG with the Romberg standing test and the Unterberger-Fukuda stepping test using USCCG and the human space trail.
However, for this study, we present the broad spectrum of subjective complaints as reported by the patients with a broad variety of findings.
This is shown for instance, in Figures 6 and 7, wherein the typical tinnitus phenomena are matched on different hearing zones in the audiograms of the right and left sides. Therefore, we prepared a specific, detailed analysis of the background of head and neck trauma (Fig. Our search presented us with a great amount of data (more than 500 parameters per case), which we transferred into a digital version of the databank to preserve the anonymity of this sample of patients. The other identification indicators (weight, height, body mass index, and average systolic and diastolic blood pressure) lie within the expected range of this sample taken for Germany. For vegetative symptoms, such as the occurrence of nausea in perhaps one of four patients, see Figure 9.
Acoustic, vestibular, and behavioral and psychosomatic symptoms are intertwined and seemingly interact with one another. In a subsequent publication, we will deal with the outcome of the objective and quantitative measurements in audiology, equilibriometry, and the like in our group of 757 cases of endogenous tinnitus. However, the AI improved after the operation, being moderate in three patients and mild in two, and achieving no level in two patients. After device implantation, the TII did not register any level in two patients, was mild in another two patients, was moderate in yet two more patients, and was severe in a patient whose device had electrode trouble. However, implantation for tinnitus suppression previously was not performed in patients with nearly normal hearing because of the cost and potential damage to the cochlea.
This device is likely to result in minimal damage to the cochlea because the stimulating electrode is near the round window. The sensory component is a sound sensation, whereas the affective components are many, including insomnia, annoyance, anxiety, and interference in communication capability [6]. It is hypothesized that both the hippocampus and the amygdala of the medial temporal lobe system are significant for transition from the sensory to the affective component.
The tinnitus stress test (TST) is a tool for monitoring the efficacy of treatment, control, and relief procedures for tinnitus.
She has suffered from chronic otitis media that has resulted in bilateral eardrum perforations. In procedure A, each of 16 questions was equally weighted and scored on a 5-point rating scale.
The index was rated by each individual as 0 for no tinnitus and 7 for the loudest imaginable.
The AI was rated by each individual as mild (1 or 2), moderate (3, 4, or 5), or severe (6 or 7).
The duration of residual tinnitus inhibition with the implanted suppressor was similar to that at the outpatient clinic except in one patient in whom the electrode broke free from the promontory.
Post-operatively, the results of TST improved except in one patient who experienced electrode trouble (Figure 2). After the operation, results of the TII reveal no level in two patients, a mild level in two other patients, a moderate level in two patients, and a severe level in a single patient (Figure 3). Only Patient 6 did not experience tinnitus disappearance, although the intensity was diminished relative to that before the operation.
Tinnitus did not disappear in the implanted ear if the patient was suffering from a common cold or was very tired.
The tinnitus weakened so dramatically after the operation that he was satisfied with the suppressor. No vertigo, ear blockage, headache, or worsening of residual hearing level was reported either.
For patient selection, we emphasized the evaluation of residual tinnitus suppression after transtympanic electrical stimulation. Patient 6 never experienced the disappearance of tinnitus at an outpatient clinic, and so in this patient we could not guarantee tinnitus disappearance even if he continued to use the implantable device. In our earlier report, Patient 1 still experienced slight tinnitus all day after using the device, and tinnitus reappeared during a common cold or when the patient was tired. When the patient began using the device, she experienced little tinnitus all day after 1 hour or more of stimulation two or three times daily. All patients before the operation thought that the intensity of tinnitus was the loudest imaginable.
Patient 5 also reported improvement in his hearing" but the hearing threshold did not improve after use of the implantable suppressor.
It should be noted, however, that among the 69 patients involved in this study, only 3 failures of the vertigo treatment were seen. The quadruple method caused a mean hearing loss of 8 dB, whereas in the patients treated by the dual strategy, no mean hearing loss was noted. In Figure 3, a comparison is made between the pure-tone threshold before treatment and the change in pure-tone average after treatment. Also, the vestibular epithelium is damaged or destroyed, causing a unilateral vestibular loss that results in a destruction type of nystagmus and caloric loss [14].
Also, if a full effect of gentamicin is not experienced with a few instillations of the drug, a risk for vertigo attacks remains. The labyrinthectomy offers relief from the attacks of vertigo but also abolishes hearing totally and so should not be used.
If correctly applied, gentamicin treatment is the method of choice and should be attempted before destructive surgery is even considered. Lange G: Die Indikation zur intratympanalen Gentamycin- Behandlung der Meniereschen Krankheit. Beck C, Schmidt C: Ten years of experience with intratympanally applied streptomycin (gentamycin) in the therapy of morbus Meniere.
Magnusson M, Padoan S: Delayed onset of ototoxic effects of gentamicin in treatment of Meniere's disease. Tran Ba Huy P, Deffrennes D: Aminoglycoside binding sites in the inner ears of guinea pigs. In many cases, the etiology remains unknown and constitutes a major challenge, even after complete otologic evaluation, and these cases are classified as idiopathic sudden deafness3. Intratympanic dexamethasone has been trialled in patients with sudden sensorineural hearing loss, because it provides a high concentration of steroids in the labyrinth in animal models1, although its evidence are conflicting.
This study was approved by the institutional review board of the Medical School and the University Hospital in which it was carried out. Below are the details of inclusion criteria, the audiometric assessment, application technique, analysis of The Tinnitus Handicap Inventory and Analogue Visual Scale for Tinnitus and outcome of recovery of Hearing Loss and Tinnitus. The speech recognition rate (SRR) was based on the percentage of correct answers for monosyllables. EMLA cream was placed in the outer ear canal and the tympanic membrane and left for 30 to 45 minutes, after which it was removed. Failure of oral prednisolone therapy was absence of improvement, as just described, after 14 days of treatment. In relation to the mean-tone, obtained as a result of the following classifications: mild (25%), moderate (25%), severe (25%) and deep (25%).
Sudden hearing loss can occur mainly in the age group 43-53 years7, with equal gender distribution.
Already Patient 4 also showed no change in auditory thresholds, showed a significant change in their tinnitus.
Significant increase of 25% was found in the hearing threshold of patients undergoing this type of therapy, but in relation to tinnitus, the study was not conclusive13.
Seven patients (70%) treated with enoxaparin sodium and venous hemofiltration (group A) had reduced subjective tinnitus and four patients (40%) showed a complete hearing recovery after the first procedure.
Given the failure of the rapies performed, it was suggested the cochlear implant that, according to the authors, is a routine procedure for patients with profound bilateral sensorineural hearing loss, and succeeded, some reports showed a suppression of tinnitus as a side effect after implantation. This indicates that the tinnitus by itself cannot be a problem sign in the prognosis of hearing, but may be an essential sound for the early recovery of the damaged auditory system.
Shortly after the standard fitting procedure, the patient reported a reduction of tinnitus, hyperacusis, and the headache disappeared completely in the follow-up of 3, 6 and 12 months.
Seven patients experienced an improvement inTHI in different degrees and in only one patient there was no change.
44 patients with SSHL were followed, all treated with systemic steroids administration for 2 weeks and oral ingestion of vasoactive drugs and B12 vitamin for 6 months.
Among the comparison between 6 and 24 months after initiation of treatment, there was no significant change. Oral vs intratympanic corticosteroid therapy for idiopathic sudden sensorineural hearing loss: a randomized trial.
Intratympanic dexamethasone injections as a treatment for severe, disabling tinnitus: does it work? Cochlear implant in patients with sudden unilateral sensorineural hearing loss and associated tinnitus.
Hyperbaric oxygen therapy for idiopathic sudden sensorineural hearing loss and tinnitus: a systematic review of randomized controlled trials. Sodium enoxaparin and venovenous hemofiltration in treating sudden sensorineural hearing loss and tinnitus.
Otoacoustic emissions, ear fullness and tinnitus in the recovery course of sudden deafness.
Curing tinnitus with a Cochlear Implant in a patient with unilateral sudden deafness: a case report. We found that multiple speech strategies available with the Clarion implant were a distinct advantage.
The rate of stimulation with CIS was 6,800 pulses per second; with MPS, it was 13,600 pulses per second, with SAS, 104,000 samples per second and, with HiRes, 91,000 pulses per second. On computed tomography (A), cochlea is seen to be communicating with internal auditory meatus. In the fourth patient (aged 75 years), the speech perception score fluctuated, with an average of 69%. However, with the prelingual patients, we observed that the speech perception scores at 6 months were higher with the SAS and MPS strategies (Figs.15, 16). SA-CIS preference study in postlingually deafened adults implanted with CLARION cochlear implant.
Congenital malformations of the ear and cochlear implantation in children: Review and temporal bone report of common cavity. Cochlear implantation in children under the age of two; the MHH [Medizinische Hochschule Hannover] experience with the CLARION cochlear implant. The Clarion Multi-Strategy Cochlear Implant-surgical technique, complications, and results of a single institutional experience. Speech perception results in adults implanted with the CLARION Multi- Strategy Cochlear Implant. From more than 10,000 cases, we evaluated 757 randomly selected neurootological patients suffering from endogenous tinnitus. However, what could be proved by various authors since 1985 is that endogenous tinnitus is significantly related to dysfunctions in the human temporal lobe (Brodmann area 41). We administered a full spectrum of neurootometric testing to all 757 patients; the investigation protocol for thorough data analysis (more than 500 parameters) included five procedures.
After all the files of the patients were transferred into digital lists and nets of digital data, we could select the various groups of complaints to derive a representative statistic.
The most frequent quality of tinnitus distortion reported was a whizzing sound in either ear or in both (54.02%).
Figure 21 demonstrates a specific differentiation with respect to facial nerve paralysis cases.
We easily designated a group of patients who demonstrate a genuine objective sound in the head as experiencing bruits. In future, this must be taken into consideration in developing a spectrum of therapeutic procedures not only in the field of pharmacotherapy but in psychotherapy and physiotherapy and in applying such physical measures as magnetotherapy. We found diabetes mellitus more frequently in the group with the exogenous or unmaskable tinnitus, whereas hyperlipidemia was reported twice as often in the group with endogenous or maskable tinnitus as in those with the unmaskable type.
On the functional state of central vestibular structures in monaural symptomatic tinnitus patients.
About the Strength of the Neck in Linking the Head to the Trunk as Measured by the US-CCG . Interdisciplinary clinical vertigo studies in whiplash lesions to the ligamenta alaria by means of dynamic MRI-findings in combination with ultrasound cranio-corpo-graphy (USCCG). Medical classification of tinnitus between bruits exogenous and endogenous tinnitus and other types of tinnitus. Die Differenzierung zwischen endogenem und exogenem Tinnitus [The differentiation between endogenous and exogenous tinnitus]. Residual inhibition results found at outpatient clinics and at the homes of patients with implanted suppressors were closely correlated except in one patient in whom the device's electrode was free from the promontorium tympani.
After the operation, the TST improved except in one patient whose device had electrode trouble. In addition, the small size of the implanted chip coil (6 mm wide, 5 mm thick, and 10 mm long) in the mastoid contributes to the avoidance of injury risk [3,4]. The severity of the affective component is not always commen-surate with the severity of the sensory component. The transition is purported to be modulated by the influence of stress, according to the level of cortisone [7]. The tinnitus described by this patient was white noise at an intensity of 95 dB in the right ear and 75 dB in the left ear. Endolymphatic shunt surgery was performed 2 years before implantation of the tinnitus suppressor but failed to improve this patient's hearing loss or to decrease the number of vertigo attacks. The electrical stimulator weighs approximately 300 g, and the electrical pulse is provided by 100-V alternating current.
Briefly, the silicon-covered coil is implanted in the mastoid after mastoidectomy using a postauricular incision. The TIl was rated by each individual as mild (1 or 2), moderate (3, 4, or 5), or severe (6 or 7).


Six patients' responses registered as no or mild level on the TST, and only one patient still reported an extreme level on this test. Filled bars show the level on the tinnitus stress test before the operation, whereas open bars indicate postoperative levels.
Tinnitus in two patients who registered as no level disappeared for the entire day, although tinnitus reappeared if the patient suffered from a common cold or was severely tired.
Filled bars show the scores on the tinnitus intensity index and annoyance index before the operation, whereas open bars indicate postoperative scores. Patient 2, in whom the electrode was problematic, still perceived her tinnitus as the loudest imaginable because the suppressor did not work well. Three patients were at a moderate level, two were at a mild level, and two registered no level after the operation. A positive correlation after the operation (at the .01 level of significance using the t-test) was observed although no correlation was observed among those tests before the operation. The TII was lower than that before the implantation because tinnitus that reappeared was weaker than the preoperative condition.
Tinnitus did not disappear in the implanted ear when the patient suffered from a common cold or was very tired. Therefore, the TST, AI, and TII dramatically improved in this man after device implantation. No patient experienced extrusion of the wire under the external skin, although the stimulating electrode has broken free from the promontorium tympani in one patient. The degree of tinnitus suppression using the implanted device was consistent with that reported from outpatient clinics, as shown in Table 2; that is, the duration of residual inhibition using the suppressor was not longer in home users of the device than at outpatient clinics, but tinnitus intensity improved. As expected, Patient 6 did not experience tinnitus disappearance after use of the implanted suppressor.
The patient was becoming so dependent on the device that the stimulation time extended to four or more times per day.
However, not all patients were severely affected by tinnitus even while reporting that it was the loudest imaginable. One patient had a labyrinthectomy, and 2 others had vestibular nerve sectioning after the gentamicin treatment failed. With use of the dual method, no ear has lost hearing, but one ear that was re-treated and ultimately received a total of four doses of gentamicin experienced a pure-tone threshold increase of 65 dB. In the latter group, there was a mean 0.3 dB gain and a median hearing improvement of 5 dB. No correlation exists between the pretreatment level and the change in threshold after gentamicin treatment. Vestibular nerve sectioning is associated with a 20% risk for added hearing loss, which exceeds the risk for hearing loss that is associated with gentamicin treatment.
The risk for cochlear damage is minimized if the dual method of gentamicin administration is used.
Presented at the Third International Symposium on Meniere's Disease, Rome; Italy, October 20-23, 1993. Only 2 patients had improvement of hearing (from severe to normal, mild to normal), keeping unchanged all other results and no worsening (Table 2 and Figure 2). Patient 8, 73 years, has hypertension and diabetes, as well as probable hearing loss due to presbycusis before the episode of sudden deafness. In group B, eight patients (80%) treated with conventional therapy showed a reduction of subjective tinnitus and hearing score also improved in eight patients (80%) - the hearing remained unchanged in two patients (20%).
All patients in both groups had ear fullness and tinnitus in association with the onset of the SSHL.
One year after the onset of symptoms on the right side, the cochlear implant was performed, and resulted in a complete suppression of tinnitus after activating the implant.
It was concluded that, according to the survey of tinnitus, the time factor is the most reliable item for subjective tinnitus. The postlingual patients fared better with speech discrimination in noise using the high-resolution strategy, and young prelingual patients developed hearing and speech faster using simultaneous analog stimulation and multiple pulsatile stimulation strategies. The internal component that was surgically implanted was an enhanced bipolar device in which the electrode cable was precurved, with 8 electrodes on the medial side and 8 on the lateral side, or the CII Bionic Ear or the HiFocus I (Advanced Bionics, USA), wherein the 16 electrodes were medially oriented and mounted perpendicular to the medial wall of the cochlea (Fig. The commonest cause of deafness in prelingual patients was congenital disorder, and in the postlingual patients was progressive hearing loss and chronic serous otitis media with bilateral mastoidectomy (Table 2). Two patients developed an endolymph leak on the second and fourth postoperative day and had a lumboperitoneal shunt implanted. The patient's speech strategy then was changed from CIS to the HiRes strategy, and the score increased to 80%.
In addition, speech production in the prelingual patients with MPS and SAS was achieved much earlier. Patients with Mondini cochleas could undergo cochlear implant surgery with full insertion of all electrodes of the enhanced bipolar device and achieved better hearing and improved good speech production. First, we classified the 10,000 patients into those suffering from the basic tetrad of tinnitus forms: bruits, endogenous (maskable) tinnitus, exogenous (nonmaskable) tinnitus, and other syndromes such as the slow brainstem syndrome.
Patients with a maskable or endogenous tinnitus prefer covering up their tinnitus by external sounds. We found typical shortenings in the latencies of the vestibular evoked quantitative electroencephalography (QEEG), an enlarged DC shift of the vestibular evoked QEEG, and typical cortical electrical burst expansion in three phases on the brain surface as shown by BEAM. First we recorded a thorough neurootological history with a systematic preprinted history scheme of Neurootologisches Anamneseschema Claussen (Neurootological History Scheme). As the sum of all the tinnitus spots being masked amounts to 141.74%, we were able to derive that nearly one-half of the sample suffered from a bilateral maskable tinnitus. The majority of patients (consistent through all age groups) reported so-called whiplash-related tinnitus problems after a car accident. The frequently reported sensation of a roaring in the right or the left ear occurred in only 0.13% (left ear) in our sample. In Vertigo, Nausea, Tinnitus and Hearing Loss in Central and Peripheral Vestibular Diseases . In JM Aran, R Dauman (eds), Proceedings of the Fourth International Tinnitus Seminar, Bordeaux, 1991 . Some patients can accept tinnitus with little affective disorder, although they still perceive a tinnitus sensation.
The location of cortisol control under stress is considered to be in the hippocampus, not in the hypothalamus [8]. The objective of this article is to evaluate benefits of the implanted tinnitus suppressor on the basis of the TST. Audiography revealed profound mixed deafness in the right ear and slight sensorineural deafness in the left ear. The frequency of the tinnitus was 125 Hz at an intensity of 50 dB in the right ear and 125 Hz at an intensity of 65 dB in the left ear. The Pt-Ir ball electrode, covered with polyalcoholic gel, is placed on the promontorium tympani, and the return electrode is fixed to the subcutaneous tissue at the tip of the mastoid. Ten items-questions 1, 2, 4, 5, 7-9, 12, 14, and 15-were given zero points for a response of "not at all," 1 point for "a little bit," 2 points for "moderate," 3 points for "quite a bit," and 4 points for "extremely." The remaining seven items-questions 3, 4, 6, 10, 11, 13, and 16-received double the points for each category. The two patients with a mild TII level sometimes perceive tinnitus, indicating that the effects of one-time stimulation sometimes were not long-lasting enough to relieve tinnitus altogether. In Patient 2, the AI results worsened after the operation (from moderate to severe), owing to the electrode problem.
For others, the maximum current was set at less than 600 μA owing to the requirement for a more intense current to make tinnitus disappear.
It should be noted that even during the era of unlimited numbers of gentamicin instillations, some patients had a nystagmus response after two, three, or four installments (Figure 2) [10,11]. The head-shaking test may unveil a unilateral vestibular loss, but other clinical tests will be negative. Furthermore, if vestibular nerve severing is not performed by an extremely experienced surgeon, the complications can be severe. The procedure is well tolerated and relatively easy to perform as outpatient procedure performed under local anesthesia (topical), general anesthesia can be avoided, most patients understand the concept of intratympanic therapy and easily accepts the proposed therapy. Regarding the THI scores, it ranged from 58 to 96, prior to initiation of therapy, 8-82 and 30 days after.
Such comorbidities could not justify the improvement in hearing thresholds after the proposed therapy.
None of the patients experienced side effects from this treatment, and the authors concluded that this option can be beneficial as adjuvant therapy for hearing improvement in patients with PANSS, but cost factors are the main obstacles to the use of this therapy14. However, these symptoms improved only in Group A, showing a significant relationship between recovery of hearing thresholds and improvement of aural fullness.
Clinical improvement was also reflected by a decrease in the scores of questionnaires THI and VAS. The hearing recovery was determined by comparing the hearing levels before and after treatment and tinnitus was subjectively evaluated by using a questionnaire. Moreover, in Mondini cases, all electrodes could be inserted using the enhanced bipolar device.
Using the enhanced bipolar device, it was possible to insert all the electrodes into the cochlea in the Mondini cases, thereby achieving better results. Next, we examined all the patients otologically, including bilateral microscopical inspection of the outer ear, ear canal, and tympanic membrane. They also reported posttraumatic complaints of whiplash injury (also consistent through all the age groups but especially frequent in the age group 30-40 years). Significantly different from the group identified as having endogenous tinnitus are the behavior and the sensation of those with exogenous tinnitus or nonmaskable tinnitus, who find relief in a completely silent environment.
The majority of our patients described their tinnitus as lasting from one to several years (as seen in Fig.
We found that 3.70% of patients complained about a reduced acuity in their taste (hypogeusia).
However, some patients are disturbed by affects (especially the severe disabling type of tinnitus).
She visited our outpatient clinic with concerns about the discharge from both ears and increased hearing loss in the left ear. On August 11, 1992, the patient had visited our outpatient clinic with complaints of ear discharges and bilateral hearing loss. These categories addressed standard of living, socialization, coping with anger, depression, and fear. The duration of the residual inhibition was so much longer than that of other patients that the number of uses per day (once or twice) is smaller than that of other patients.
Because of the limitations of the stimulator, the maximum current delivered to the promontorium tympani, however, appeared to be less than 300 μA.
Initially, this apparent dependency was attributed to the patient's personality, not to problems with the electrode, which were the actual cause. Nonetheless, a positive correlation at the .01 level of significance was observed among the postoperative TII, AI, and TST scores [12].
Broadfrequency rotatory testing using pseudorandomized stimulation unveils the asymmetry that is not obvious in sinusoidal tests [15]. Gentamicin should be used particularly in patients who suffer a significant and severe hearing loss, and these patients should be warned about the possibility of additional hearing deficit. However, it should be emphasized again that in relation to complaints of tinnitus, it has undergone a significant change, in which catastrophic change of the degree to mild (Table 1). Given this, the authors suggested the use of cochlear implants as a possible therapy for tinnitus persisted after sudden deafness. The external component was a sound processor worn either on the body or behind the ear (Fig.
Another two patients had a radical mastoid cavity, which was obliterated with a muscle graft. The results in the first 11 young prelingual patients [2], including 2 Mondini cases, using detection of speech sound, discrimination and recognition of vowels, discrimination and recognition of consonants, and recognition of words (Figs.
Moreover, the electrodes were on both sides of the cable, thereby ensuring that the spiral ganglia in these cases were stimulated. Car accidents and whiplash occur more frequently in the younger age groups, whereas reports of cerebral concussions are more frequent in the old-age group (> 70 years).
Finally, via our complex neurootometric tests, we demonstrated slowing deregulations in the statoacoustic pathways.
We heard no complaints about trigeminal disorders; however, we found both peripheral and central facial nerve paresis, though in a small number (see Fig. 28) played a minor role in our sample, as was evident for the major hormonal diseases (Fig.
Tinnitus in the ears opposite the device implantation site in patients 4 and 5 completely disappeared. Patient 5 felt that the intensity of his tinnitus was the loudest imaginable preoperatively, although it annoyed him only slightly.
Patients reported that tinnitus did not disappear if they were suffering from a common cold or were very tired.
The patient reported that she was apt to pay too much attention to the existence of the implanted coil in the mastoid. This finding indicates that patients can so much more easily manage tinnitus after use of the stimulator than before such use that tinnitus no longer scares patients. In patients 1 and 2, the effects of middle-ear infection on the hearing threshold were taken into account.
Although relief from tinnitus cannot be promised, the world literature indicates that most patients suffer less severe tinnitus after gentamicin treatment [17].
We obtained an average difference of 38.6 points among patients who reported an improvement in tinnitus before and after the course of oral steroids and intratympanic.
In group A, the OAE responses appeared simultaneously with the improvement in hearing levels in five patients (63%). In all patients, including those with Mondini and ossified cochleas, all electrodes were inserted. The statistical results demonstrate that tinnitus is interconnected to a multifactorial disease background with a broad spectrum of individual complaints. Only 0.13% of our patients described a subjective roaring sound in the left ear, whereas none attributed it to right ear. In such cases, the visual acuity problems were corrected most frequently by use of eye glasses (74.50%). The frequency of the left-ear tinnitus was 250 Hz at an intensity of 95 dB 1 month after the first visit (September 18, 1992). Bone conduction hearing thresholds before and after the operation also are shown show the bone conduction hearing thresholds on June 1994; [and] on August 11, 1992.
After use of the suppressor, the tinnitus annoyed him far less, indicating that the suppressor might be beneficial even to those patients in whom tinnitus is only slightly annoying. Takirig into account such situations as a common cold or tiredness, we should select for suppressor implantation those patients in whom less than 200 μA of maximum current is necessary to make tinnitus disappear. She reported trying to push down the switched button of the stimulator repeatedly, but her tinnitus was not reduced.
However, in Patient 7, we should not dismiss improvement in the hearing threshold (see Figure 4), although we also could not ascertain the reason for hearing threshold improvement in the ear with the implanted device.
Referring to EVA, there was a change from 7 to 10 points before therapy and from 1 to 8 points after it, in relation to intensity. It was concluded that patients with hearing improvement PANSS (Group A) tend to have OAE responses and sensations of fullness in the ear and tinnitus improved almost simultaneously with the hearing improvement. A modified Stenver's view of the cochlea was taken in all cases on a digital subtraction angiography machine to visualize the electrodes (Figs. The result at 6 months in the six older prelingual patients [13,14], including the two Mondini cases, using vowel-consonant-vowel recognition, word recognition, and closed-set speech recognition was 89% (Fig.
Finally, the topodiagnostics of the functional neurootometric analysis shows that this type of endogenous tinnitus constitutes decidedly more central than peripheral statoacoustic pathology. Astonishingly, even the number of occurrences of basic neurological disorders (paralysis, paresthesias, apoplexies, epilepsia, Parkinson's disease, and brain tumors) was very low (as shown in Fig. Because we were afraid that the operation would worsen a preexisting hearing loss in the left ear, the suppressor device was implanted in the patient's right ear. Finally, the patient abandoned use of the stimulator and felt despair because she thought that she could not escape from tinnitus. Approximately 9 months after the im was a response in the form of ataxia or destruction-type nystagmus. In relation to the nuisance, there was a change from 7 to 10 points before and 0-08 points after therapy. The high-frequency tinnitus often develops close to the C5 dip and can be masked below the hearing threshold (see Fig. Clearly, a typical interrelation of tinnitus with a single major disease group is highly unlikely. The patient's desperation caused her to feel impatient, and she registered an extreme score on the TST.
In the period 1989-1992, the number of instillations was limited to four (the so-called quadruple method) [6,7].
The authors concluded that patients with poor hearing improvement tend to have absent OAE and ear fullness and tinnitus persisted. The average test score of the four Mondini cases separately was 77%, and the score of the patient with an ossified cochlea was 78%.
We now are able to see the electrode tip through the eardrum and are aware that the decreasing efficacy of the suppressor was caused by problems with the electrode trouble, not by the patient's personality. Alternatively, the dual strategy was used as suggested by Magnusson and Padoan [8] in 1991, in which gentamicin is instilled on 2 consecutive days and thereafter the patient's condition is observed and drug is administered as needed; if there is a substantial caloric loss or the vertigo attacks cease, no more gentamicin is instilled. After the patient was supplied with an upgraded stimulator and the free electrode again touched on the eardrum, the patient's TST score leveled off to her preoperative level. With both the dual method [8] and the quadruple method [7], one must be prepared to administer additional drug after 1 or several months.
Even if the initial therapeutic regimen almost always causes a unilateral caloric loss, and some relapses occur that necessitate additional instillations of gentamicin.



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