Download Tinnitus

Tinnitus = ear ringing
• Objective ( vessels anomalie,
dysfunction of middle ear )
• Subjective …the examiner are not able
to hear it
Diagnostic and therapeutic
strategies for the treatment of
tinnitus
Aleš Hahn
Characteristics of chronical
tinnitus
 nagging
 stressful
 permanent
 discontinuous
 Whistling, hissing,....
 most high-frequency
Types of tinnitus
 Cochlear
 Neural
 Cortical
 Combined ... …
 Single / double sided /
 Transient
Famous persons….
Tinnitogenesis
 Generator damage to hair cells (frequency!! ...) Mostly
connected with hearing loss
 Phantom ... (cochlear)
The impaired neuro / cortical pathways
Pathologic metabolism of cortical acoustic field
(SPECT, PET)
Tinnitus types
 Cochlear
 Neural
 Cortical
 Combined ... ...
 Single / double sided / transient
Epidemiology of tinnitus
 "Civilized States" 10-15% of the population and
therefore hundreds of millions of people
reactivity affected
Tinnitus
 The hearing loss (HL)
 Solitary isolated less often.
Duration of tinnitus
 Acute ... ≤ 14 days
 Short-term ≤ 6 weeks
 Subacute ≤ 6 months
Diagnosis (1)
 Patient,s data
 Audiometric testing possible in peripheral (cochlear)
tinnitus
 Masking of pure tones
Frequency (Hz), intensity (dB)
Diagnosis (2)
 Frequency (Hz), intensity (dB) Standard audiometric
testing
 Tone (PTA) and speech audiometry
 BERA (optional when?)
Diagnosis (3)
 BERA always with sudden or progressive hearing loss
...
 It is necessary to exclude retrocochlear pathology
(neuroma of N.VIII.)
Diagnosis (4)
 Cervical and even entire spine,
 TMJ (Costen is more often than we thought ...)
 ORL
 Neurology
 Doppler
 X-ray (CT, NMR, HRCT ...)
... And more ... as needed
Therapy
 Is different for acute tinnitus vs.chronic
 Rather Focused on acute
Rather polypragmatic in chronic ...
Therapy tinnitus 2
 patient will come in time
 Corticosteroids,
 rheologically active drugs (Vinca minor, pentoxyphyllin)
 HBO
Good perspective - mostly disappear (diminishes) in
parallel with the improvement of hearing
Therapy chronical tinnitus
 pharmacologicall
 Physical (laser, HBO, magnetic coil, iontophoresis ...)

Fyziatric (cultivation axial musculoskeletal segment)
 Psychiatry (psychological)
 Music Therapy



Combined
Surgical IEC, neurektomie
Bio - feedback "maskers" ... TRT
Pharmacotherapy
 Vasodilators (Cavinton ®, Agapurin ®)
 corticosteroids

vitamins

Nootropics (EGB 761-Tanakan ®, Tebokan pills ®)

Sedatives / Anxiolytics

Antihistamines (Betaserc ®)
 Anticonvulsants (carbamazepine)
 antibiotics
Physical therapy
 Laser - must be of sufficient strength 400 mW probe
230 m ...
Continuous / dyskontinuos beam, 5 min, 10-15 session
Sensitization EGB 761
Combined therapy
 Combined treatment (ginkgo, vincamine, betahistine,
laser, rehab, lidocaine) ... Slow all good
Gingko three weeks and then laser - success 40-50%.
 The combination of drugs Max.2 event.fyziatric /
physical therapy
musculo relaxing therapy
 Rehabilitation soft technology
Autorehabilitace
Not forgetting the Costena (about 15% of tinnitus ...)
 Rehabilitation soft technology
Autorehabilitace
Not forgetting the Costena (about 15% of tinnitus ...)
Hospitalization
 Vinca minor + reha + (laser)
 Reha + laser + pentoxyphyllin
 Lidocain???
Targeted surgical approach
 IEC - steroids, gentamycin
 Aplikation 14 - 24 dnů
 continual
Efficiency of whole therapy
 Typically the decrease in frequency (Hz) and intensity
(dB)
In 70% agreement with the VAS
The residue after about 15% disapproval .
Visual analogue scale
Conditions of positive results
 Cooperation of patient, patience, their good compliance
 understanding of physician
Harmony of the patient's surroundings