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All of 1,420 children seen for clarification of a hearing disorder or to follow up for known difficulty in hearing were questioned as to whether they experienced tinnitus. The number of patients who suffer from tinnitus has risen clearly within the last decades, and the frequency of tinnitus in children has increased. We questioned as to whether they had tinnitus l,420 children seen for clarification of a hearing disorder or to follow up known hardness of hearing.
A total of 102 children, their parents, or the people who had referred them to us said at the interview that tinnitus had appeared or was still present.
The frequent appearance of tinnitus in connection with the deterioration of an existing sensorineural hearing loss was striking in the patients in our group.
We compared the information of children with normal hearing and of those with existing hardness of hearing. Seven-year-old patient 1 was introduced to us a few weeks after she suffered a case of bacterial meningitis because she complained of tinnitus and could no longer hear well. In the case of patient 1, the cause of the lesions was bacterial meningitis, damage from which can be localized in both inner ears or in the peripheral area of the nerve statoacusticus (eighth cranial nerve) (Fig. Patient 2 was an ll-year-old girl who came to examination with a presumptive diagnosis of hearing loss. At the beginning of the checkup that we performed almost a year later (summer 2000), the diagnosis was still uncertain.
In the case of patient 2, we assumed a disturbance in sensory perception because she experienced difficulty in hearing, although the audiometric test results were normal. Patient 4, a 12-year-old girl, was introduced to our clinic because of hearing problems in the right ear.
The results of this study show that 102 (7.2%) of 1,420 children examined in our center complained of tinnitus.
The accumulation of hearing disorders among our patients, however, is not representative of the population as a whole but rather is explained by the function of our facilities, which provides support to children who are hard of hearing and to their families.
The contributions of Nodar [1, 2], of Graham and Butler [3], and of Shulman [4] are considered landmarks in the field of pediatric tinnitus [5, 6]. Compared with that of adults, the level of disability connected with tinnitus was altogether lower in the children. We received information about possible causes of the appearance of tinnitus from a large number of the patients.
The mechanisms of development of tinnitus were, however, not as clear in a large proportion of the children. We were interested in determining the efficacy of Arlevert therapy in vertigo and tinnitus patients, especially as it compared to the efficacy ofthe drug's two component agents, dimenhydrinate and cinnarizine. Owing to the modernization and far-reaching industrialization of our everyday lives, the number of so called civilization's diseases has increased.
Two Czech ear, nose, and throat clinics in Brno and Plzen are participating in a clinical trial with three in-ternational study groups. Figure 1 displays a subjective assessment of patients' vertigo symptoms, obtained before and after the first and fourth weeks of therapy. The mean ENG frequency for all patients began within the normal range (20-60 beats) and showed little change during the study. Figure 4 depicts the CCG results: Group A patients fared better than group D patients, who in turn were better off than were those in group C. In this study are presented the results of subjective observations of our patients and objective tests including CCG, ENG, and audiologic assessments.
From this study, we conclude that Arlevert has good antivertiginous and antiemetic properties. This study was presented at the Twenty-Fifth Ordinary Scientific Congress of the Neurootological and Equilibriometric Society, March 19-22, 1998, Bad Kissingen, Germany. The interview was carried out after a hearing test was conducted, which was based on play audiometry or normal pure-tone threshold audiometry, depending on the age of the child.
The interview was carried out after the hearing test, which was based on play audiometry or normal pure-tone threshold audiometry, depending on the age of the child. The deterioration did not happen in a way similar to that in acute hearing loss but more slowly. In many of the children examined in our center, meningitis was the cause of acquired hearing disorders. Wheezing or beeping and murmur are the most frequent sensations characterized by the children questioned.
The hearing test showed residual hearing on the right side; on the left side, it revealed moderate sensorineural hearing loss with a mild hearing loss in the low and high frequencies.
Pure-tone threshold audiogram of a 7-year-old girl (patient 1) with leftsided tinnitus after meningitis.
During the course of the examination, however, it was discerned that the curves of bone conduction eventually lay at 0 dB and the curves of air conduction at 5-15 dB, whispered speech was finally understood from 4 meters, and normal speech was understood on both sides from more than 6 meters away. She remains under pressure at school, however, and the tinnitus in conjunction with the alleged hearing difficulty are likely signs of emotional pressure (Fig. Pure-tone threshold audiograms from an ll-year-old girl (patient 2) with tinnitus of probable psychogenic origin. In 1996, he complained of a sensory hearing loss bordering on deafness in the right ear and only residual hearing in the left ear.
Pure-tone threshold audiograms from a 13-year-old boy (patient 3) with progressive hearing loss and tinnitus. Pure-tone threshold audiogram from a 12-year-old girl (patient 4) with tinnitus, hearing loss, and vertigo after head trauma. Only 27 (26.4%) of the 102 children with tinnitus had come to the examination primarily because of existing tinnitus concurrent with normal hearing.
Nodar found in a group of children screened for hearing impairment that 13% with normal hearing had tinnitus. Many children first indicated tinnitus during questioning, and it was also a surprise for parents to learn that their child had tinnitus. The most frequent information given (in 29.4%) was the progression of an existing hardness of hearing. This condition might also represent a noise-induced hearing loss in the inner ear, which may be caused by powered hearing aids that are not adjusted correctly or limited sufficiently.
Because children seldom complain about their tinnitus, their problems must always be taken seriously.

We conducted a comparative, randomized, double blind, multicenter, parallel group study involving a group of patients (n = 122) with vertigo and tinnitus of peripheral or central origin.
Vertigo and tinnitus of both peripheral and central origin are high on the list of such diseases. Subjective assessment of patients' vertigo symptoms, obtained before and after the first and fourth weeks of therapy. Vegetative symptoms were improved most among the patients receiving Arlevert, though dimenhydrinate patients fared better than did those receiving cinnarizine in this evaluation.
Especially as regards tinnitus, Arlevert patients benefited most, followed by dimenhydrinate and then cinnarizine patients. In Table 1, statistical evaluations (Kruskal-Wallis test) of vertigo symptoms, vegetative symptoms, and CCG parameters after 4 weeks therapy are presented. From these statistical evaluations, we are able to summarize that Arlevert produced the best results, followed by dimenhydrinate and then cinnarizine.
It proved to be effective therapy for patients with vertigo or tinnitus of peripheral vestibular or central origin. Gutner LB, et al: Action of dimenhydrinate (Dramamine) and other drugs on vestibular function.
Halama P: Erfarungen bei der Therapie des vestibularen und zerebralen Schwindels mit Arlevert.
When being interviewed, l02 children reported that tinnitus had appeared or was still present. Their complaints are minimized or not taken seriously by adults, particularly those of more sensitive children.
Supplementary tests included those of otoacoustic emissions, auditory evoked potentials, and impedance audiometry.
It was so distinctive, however, that children, along with their parents, noticed the deterioration in their hearing. In a large number of them, the hearing fluctuated after a long period of meningitis, in which tinnitus might have been present simultaneously. In affected children, cerebral damage with lesions of central processing structures must originate from head trauma at a very early age, from oxygen deficiency during birth, from infections, and the like.
Some children claimed difficulty in hearing and wanted hearing aids, although their hearing was normal.
She was a good pupil but, in school, her teachers observed that within the last 2 months her reactions were diminished when she was addressed. The tympanogram and the transitory evoked otoacoustic emissions were within normal ranges on both sides.
We discussed degeneration of the right inner-ear structures, which might be responsible for the tinnitus (Fig.
One year before the examination, she suffered skull or brain trauma in a car accident, after which her symptoms appeared. As a result of our findings, it can be assumed that there is a commotio labyrinthi on the right side. In this study, children with sensory hearing loss showed a 59% occurrence of tinnitus, and 3% complained spontaneously about tinnitus. The deterioration in those who were hard of hearing was found to be more serious than was the tinnitus itself.
The damage to the sensory epithelium of the inner ear by hearing aids was discussed recently and remains controversial, with the result that some children with residual hearing are not being properly provided with hearing aids [18-20]. Hearing loss or impaired equilibrium (or both) frequently develop during or after a period of meningitis. In these children, pressure situations in school and in the parental home play an important role in tinnitus development (60%). The diagnostic workup should exclude metabolic disturbances, possible damage to the sensory level of the central nervous system, and evaluation of the circulation. Die Bedeutung der In-situ-Messung zur Einschatzung der wirksamen Horgerate-Verstarkung bei hoheren Schalldruckpegeln. Fruh- und Spatschaden im auditiven und vestibularen Bereich nach Meningitis im Kindes- und Jugendalter. The three test groups, nearly equal in size, were administered three times daily for 4 weeks one of the three agents being evaluated. We composed a group of patients (n = 122) with vertigo and tinnitus of peripheral or central origin, excluding Meniere's disease and BPPV. For evaluation of therapeutic success, we studied patients' vertigo symptoms (dystasia, unsteadiness while walking, staggering, rotary sensations, tendency to fall, lift sensations, and scotodinia), concomitant vegetative symptoms (nausea, vomiting, sweating, tachycardia, tinnitus, and impaired hearing), CCG parameters, and electronystagmographic (ENG) and audiometric parameters. Vegetative symptoms were assessed on the same schedule, and here too the best results were observed in group A, though group D patients fared better than those in group C in this evaluation (Fig. The best results are seen in the Arlevert patients, followed by those treated with cinnarizine and, finally, by those receiving dimenhydrinate.
For only those patients (very few) whose initial frequencies exceeded 60 beats per 30 seconds before treatment, the frequencies climbed after 1 week of therapy to near-normal range and, during second to fourth weeks, changed very little.
Arlevert patients fared better than did dimenhydrinate patients and, in turn, were better off than were cinnarizine patients. Our statistical evaluations show Arlevert to be more effective than either of its constituent drugs (dimenhydrinate and cinnarizine) used separately. This is often the case when tinnitus does not appear to be connected with any illness or other problems.
Vestibular examination with electronystagmographic recording and posturography was performed in some children. The parents could not offer reasons for this deterioration, as there was no sign of medical illness.
The appearance of tinnitus could also be seen in 36 children in certain situations (Table 5).
The vestibular examination showed profound functional loss of the right labyrinth, with spontaneous nystagmus to the left; the function of the left labyrinth was normal. In 1997, he came to a checkup and reported a deterioration of hearing that we were able to confirm. A minimal temporal bone fissure is also conceivable; however, this condition could not be proved by x-ray examination (Fig. Degenerative processes and hereditary factors probably playa large role in inner-ear disorders [5,8,13,14-16].

We have since discovered that children with hearing disabilities are seriously dependent on powered hearing aids with respect to their hearing and speech development.
To evaluate therapeutic success, we studied patients' vertigo symptoms, concomitant vegetative symptoms, CCG parameters, and electronystagmographic and audiometric parameters. We also studied factors that give rise to vertigo, including change of position, bowing, rising from bed, and driving by car or other motor vehicle. Thus, we have observed very good results in treatment of vertigo and tinnitus, not only that of peripheral origin but also that of central origin [6-9].
The most frequently obtained information (29.4%) was the progression of an existing hearing loss.
However, often to the astonishment of adults, when asked specifically, children describe the exact symptoms that prove the existence of tinnitus. The audiometric picture can be very different and varies between normal hearing and various levels of deafness. In this group, tinnitus was present in 15 children who were under pressure, in 9 in the evening, in 3 in the morning, in 5 after school, in 3 while under stress, and in 1 during noise. The hearing test at an ear, nose, and throat practice led to the assumption of a moderate hearing loss.
In the pure-tone threshold audiogram (spring 1997), a deterioration was confirmed on the right side of (at most) 100 dB.
We detected a profound hearing loss on the right side, which could be verified with transitory evoked otoacoustic emissions.
We also found that children's toys, toy pistols, and noise during leisure activities represent important factors in the emergence of hearing disorders and tinnitus, as shown by a number of researchers [21-25].
Especially as regards tinnitus, group A patients benefited most, followed by group D and then group C patients (Fig. The final audiometric results showed very little or no change during the course of study for all three medications. The small effects in threshold audiometric and ENG results can be explained by the fact that the majority of our patients had suffered hearing loss for 3-5 or more years and so could not be expected to exhibit very marked changes in these tests. Meningitis is an important cause of hearing loss and of tinnitus and could be identified in 20% of our patients. The aim of our study was to analyze the appearance, characteristics, and frequency of tinnitus in children.
In 12, we found that symptoms were caused by problems in the parental home and in their social environment or by the pressure of high performance requirements.
At the interview, this patient told us that she had hearing problems and a feeling of tinnitus in the form of a wheeze for approximately 10 minutes in the morning. In particular, distinctive damage to the inner-ear structures is seen in connection with bacterial meningitis [26]. Our results led us to conclude that Arlevert is more effective than either of its component drugs alone in treating vertigo and tinnitus. This agent is formed from two components-cinnarizine and dimenhydrinate-each of which has a high anti vertiginous influence. Among the "fresh" cases, patients (only a few in this group, and most young) usually recovered considerably-to the physiological level in both audiometric threshold and ENG tests. We also considered as a cause of tinnitus skull or brain trauma, acute hearing loss, and stapes surgery. Table 1 shows the audiological findings in examined children with respect to various levels of hearing loss in the right and left ears.
In four children, the condition appeared after skull or brain trauma and, in three, the condition appeared after acoustic trauma.
At the hearing test (summer 1999) the curves of air conduction lay within 50-60 dB on both sides; the curves of bone conduction in the similar area, however, were uncertain.
We also encountered a clear cause of tinnitus resulting from skull or brain trauma, in acute hearing loss, and after stapes surgery with cerebrospinal fluid gusher [24,27].
The aim of this study is to inform readers about Arlevert and its two components, about its efficacy and tolerability, and about how the two components compare to each other. Both tinnitus and impaired hearing improved during the course of the 4-week study, though no significant differences were noted in the responses to the three medications. Hopefully next year we can pull it off.I think the last time I saw Wilco was the MassMOCA Benefit show they did in 2012. A clear frequency or intensity determination and the measuring of masking curves were not possible except in a few cases.
One child had acute hearing loss, and one developed tinnitus after stapes surgery (Table 2). Whispered speech was understood on both sides from 3 to 4 meters, and normal speech was comprehended from more than 6 meters' away. The hearing ability did not appear to have deteriorated with the use of a hearing aid on the right. Wilco had decided that Solid Sound would be every other year going forward and, I believe, wanted to help make up for some of the revenue MassMOCA would be missing out on in that first years absence. No ยท additional information that might lead to an understanding of the hearing loss was available for 14.7% of the patients studied. Twenty-four children (23.5%) reported vertiginous complaints in addition to their tinnitus. The discrepancy between the pure-tone audiogram and measurement of hearing distance suggested a probable psychogenic hearing disorder.
It was GA in the Hunter center, we we're center and a few yards deep and they blew the lid off the place. Tinnitus is a frequent symptom in childhood and, because children seldom complain about their tinnitus, such hearing problems that they report must always be taken seriously. The tinnitus characteristics could not be specified, as they were not present on the day of examination.
The diagnosis should exclude metabolic disturbances, possible damage to the sensory level of the central nervous system, and circulatory disturbances.
In addition, the physician should always consider emotional problems and disturbances of perception.

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