Tinnitus and hearing loss treatment,tinnitus aurium behandlung,constant ringing sound in head - Test Out

Author: admin, 09.12.2013
In some patients with occupational noise-induced hearing loss, a significant aspect of the handicap concerns the concomitant tinnitus; thus, this disorder must be considered in evaluating a disability percentage in the insurance context. In clinical practice, tinnitus is a fairly common symptom in patients with chronic acoustic trauma and noise-induced hearing loss (NIHL) [1]. The method proposed in this article is based on a rational, ranked progression in decision making: At each of four steps, a fairly large number of elementary (cellular) decisions, easily made and reproducible among different experts, leads to a higher decision level (Fig. 3.2 Besides reporting the tinnitus, does the patient also demonstrate an occupational hearing loss? In case of one or more nonaffirmative responses, the expert must judge whether to come to a final positive or negative decision for each question of level 3.
2.5 Does the hearing loss show the characteristics of NIHL at a functional hearing assessment? 2.7 Is the anamnesis and is the history of complaints suggestive of progressive occupational hearing loss?
2.8 Does the functional assessment of tinnitus (tinnitometry) suggest the etiology of cochlear noise damage?
2.9 Does the medical history demonstrate compatibility of tinnitus with the etiology of cochlear noise damage?
2.10 Is the anamnesis and is the history of complaints suggestive of tinnitus related to progressive occupational hearing loss?
2.11 Are there convincing objective elements for the nature and severity of impairment, disability, or handicap? 2.12 Are there convincing subjective elements for the nature and severity of impairment, disability, or handicap?
To check for agreement among different experts of first-level decisions and for concordance in higherlevel decisions, we selected 10 exemplary files from among the patient material of the Institute of Occupational Disorders.
A variant of Cohen's Kappa [4] was applied, as this statistical test takes into account the possibility of chance agreement among raters (as no more than three choices are possible).
Tinnitus is frequently associated with occupational hearing loss and can be an additional item of claim in countries applying a specific insurance system for occupational disorders. This research was presented at the Thirty-First Congress of the Neurootological and Equilibriometric Society, Bad Kissingen, Germany, March 25-27, 2004.


In a medicolegal context, tinnitus is mostly a subsidiary item of claim, additional to that for NIHL. The essentially subjective nature of tinnitus renders very difficult - at least in some patients - the choice of equitable medicolegal decisions about the presence and severity of tinnitus. The four progressive levels of decision making (1-4), consisting of 65, 12, 4, and 1 decision, respectively. Adequate decision making, even at an elementary level, requires exhaustive and encyclopedic knowledge of otoneurology. Note: If tinnitus is accepted, the expert must define the percentage of impairment or invalidity.
A positive decision about all four of these essential aspects is requested for acknowledging the tinnitus as a part of the occupational disease and for providing compensation. Similarly, documents proving that the patient has sought relief of tinnitus before making any claim for compensation are highly relevant in this context (repeated medical consultation, acupuncture, purchase of tinnitus maskers, etc.).
All files were examined by four different medical specialists (otorhinolaryngologists) interested in legal and forensic medicine.
Fund for Occupational Diseases, Brussels, Belgium and Institute of Phoniatrics, Utrecht University Medical Center, the Netherlands. To reach a maximum of medicolegal objectivity, a system was developed within the Belgian Institute of Occupational Disorders (Brussels) in the form of a four-level decision structure, after exhaustive but noninvasive assessment of patients. This difficulty implies that assessment must involve a large set of parameters combining subjective and objective items [3]. The four levels are worked through in progression from level 1 to level 4 and consist of 65,12,4, and 1 decision, respectively.
Each specialist was required to make his or her decision according to the pathway proposed in this protocol.
The test reveals a Kappa value of 0.74, demonstrating a high interrater consistency at the first level. A decision - making system based on an exhaustive assessment and a four - level decision structure proves to be helpful.
An aggregate of multiple-choice responses (affirmative, neutral, negative) to elementary questions leads to a decision of the next level, which in turn determines - together with the other decisions at the same level - the conclusion at a still higher level.


Further, as in some cases tinnitus may cause devastating (and objectionable) effects on one's lifestyle and ability to work, it may attract levels of compensation higher than those for hearing loss [2].
The ultimate decision is to accept or reject the tinnitus as a true component of the occupational disorder (noise-induced cochlear damage). An aggregate of multiplechoice decisions (affirmative, neutral, negative) on elementary questions leads to a decision at the next level, which in turn determines - together with the other decisions at the same level - the conclusion at a still higher level. A positive outcome on all four level-3 questions is required for recognition of noise-induced hearing loss-related tinnitus as an occupational disorder and for financial compensation (final decision, level 4). Directly related to this decision is a determination of the percentage of disability or impairment that may be attributed to this tinnitus component.
When, within an exhaustive assessment, those topics for which a patient's assertion can be objectively controlled systematically demonstrate reliability, a reasonable assumption is that those for which such an objective control is impossible are also credible.
A variant of Cohen's Kappa for multiple raters demonstrated high interrater consistency at the first level (10 cases, 4 raters). We assessed 10 exemplary files on which this system was applied by four experts rating independently.
The main goals are to reach an optimal consistency among experts in these decisions and to offer optimal transparency in case of litigation. A variant of Cohen's Kappa for multiple raters demonstrated high interrater consistency at the first level. In this way, the final medicolegal decision relies on standardized criteria and becomes perfectly transparent in cases of litigation. In this way, the final medicolegal decision relies on standardized criteria and becomes perfectly transparent.



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