Download Lecture in the use of laser pen Tinnitus_Pen, True TBR Audiology

Tinnitus management
green laser Pen
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MEDICAL CITY
3-4/10/2012
Tinnitus pen
• Study 1. The Role of LLLT in Treatment of Tinnitus
• (Low Level Laser Therapy) used in the treatment of
tinnitus, is a Comprehensive laser rehabilitation
therapy of tinnitus which has proven successful
and beneficial for treatment of this widespread
civilization disease.
• Its long-term results are convincing, bringing
significant relief to 36 % of patients and even
leaving remarkable 26 % of patients without any
symptoms, in both gp = 62%..
• the results of study enable us to pinpoint laser as
the leading element in the overall therapy of
tinnitus.
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• Definition:- Tinnitus is an auditory perception
appearing without an objective ext environmental
source. Tinnitus can be subjective (heard only by
the patient) and objective (sound can be even heard
also by others).
• Our study, however, deals with patients suffering
from subjective tinnitus only.
• According to literature,50% of entire population
have experienced at least a tinnitus episode some
time,(10-15% of the population reports experiencing tinnitus with
regularity Beltone study) its incidence and severity rising
with age up to approx. 85% of population older
than 60 year
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• 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.
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Materials and methods
Our group consisted of 72 patients, 49 males, 23 females, age
ranging between 16 to 92 years. The age and sex is given in the
Table
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• Hearing threshold remains usually on a similar
level, but the main benefit is the absence of
the additional burdening sound caused by
tinnitus. Therefore the patients can better
analyze sounds in general, their hearing is
“refreshed” as they usually describe the result
of the therapy.
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Evaluation of the patients in pre & post treatment:Level of subjective complaints was evaluated according to three
scales:
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The Role of LLLT in Tinnitus Treatment:
26% less than 50%
31% more than 50%
22% no more tinnitus
Total
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79% has effect
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It was interesting to compare our latest results (LLLT only) with
those of our previous studies, i. e. our study made in 1998, longterm study between 1999 - 2001
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• Discussion
Hippocratic Oath orders us to treat patients to
the best of our knowledge and ability.
• Since our longterm 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 treatment, mere LLLT.
• All possible treatment should be given to the
patients ( laser, physiotherapy, medications, HA,
acupuncture, psychological support)
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• Conclusion
22.2 per cent patients suffering from tinnitus
never more after treatment with therapeutic
laser is a great success of LLLT. It only confirms
the leading role of LLLT within comprehensive
laser rehabilitation therapy of tinnitus.
• 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.
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Study 2. Comprehensive therapy of patients suffering
from tinnitus (laser + physio + medications)
• In an extended study over 3 years Prochazka
[1263] evaluated the effect of laser in a group of
200 patients.
• These patients were taking gingko biloba
preparations (73%) or Betahistadine (39%) and
also had physical therapy, mainly directed at the
neck vertebrae. Laser therapy was performed
with a 300 mW GaAlAs laser, 75 J/cm² into the
ear and 135 Joul/cm² behind the ear.
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• . We need an infrared laser beam with a sufficient
power output (we have been using an IR 300 mW laser
probe, we also tried using a 450 mili Watt probe but
part of our patients reported a subjectively unpleasant
thermic effect in the area of application). On the other
hand, we pay maximum attention to irradiation of a
sufficient dosage of energy.
• In our clinic we use the following techniques of LLLT
application on:
• 1. EAM- in the direction of the axis of the auditory duct
- continuous beam 50 J/cm² followed by 25 J/cm²,
frequency modulation of 5 Hz,
2. Mastoid processus - directed on the center, the
vector of the beam in the direction of counterlateral
orbit, continuous beam 90 J/cm² , followed by 45 J/cm²
with 5 Hz pulse frequency.
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Study 4. Tinnitus and vertigo + CMD
• This inner ear disease is a growing problem in noisy
modern society and the number of persons suffering
from tinnitus is increasing. Traditional treatment for
tinnitus is psychological support or various masking
procedures. Acupuncture and ging-ko extracts have
been tried with limited success. Laser therapy alone
offers a new and promising treatment modality.
• The correlation between tinnitus/vertigo and
cranomandibular disorders (CMD) has been known
for quite some time, yet few dentists seem to be
aware of this. It is not natural for the dentist to ask,
nor for the patient to inform the dentist about such
a situation.
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• However, quite a number of tinnitus/vertigo
patients will be relieved of their symptoms if a
proper CMD treatment is performed. Low level
lasers have been used to treat tinnitus patients
with reasonable success, if sufficient energy and
suitable treatment technique is used. These
lasers have also proved themselves successful in
the treatment of CMD.
• It is obvious, therefore, that LLLT is an
appropriate treatment modality for the yet
undefined subgroup of tinnitus/vertigo patients
with a CMD background.
• Laser therapy will reduce pain levels, ease
muscular spasms and revert the vicious circle.
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Study 5. Transmeatal cochlear laser (TCL) treatment of cochlear
dysfunction (tinnitus loudness)
• a feasibility study (‫ )دراسة عملية‬for chronic tinnitus.
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 SNHL.
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. To date, in patients with
chronic tinnitus mastoidal and transmeatal irradiation has
been performed without systematic dosimetric assessment.
However, light-dosimetric studies on human temporal
bones demonstrated that controlled application of laser
light to the human cochlea depends on defined radiator
position within the external auditory meatus.
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• The novel)‫ (رواية‬laser TCL-system: • The chronic symptoms persisted after standard therapeutic
procedures for at least six months, while retrocochlear or
middle ear pathologies have been ruled out .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.
• 1- Changes of tinnitus loudness and tinnitus matching have
been described.
• 2- After a follow-up period of six months tinnitus loudness
was attenuated in 13 of 35 irradiated patients, while 2 of
35 patients reported their tinnitus as totally absent.
• 3- Hearing threshold levels and middle ear function
remained unchanged.
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Study 6. Low-energy laser radiation in the combined
treatment of SNHL and Meniere's disease
• 59 patients with neurosensory hypoacusis and
45 with Meniere's disease underwent
helium-neon laser intra- or supravascular
radiation of blood.
• The treatment proved effective in acute
neurosensory hypoacusis and Meniere's
disease.
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• Study 7. Light dosimetry and preliminary clinical results
for low level laser therapy in cochlear dysfunction
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. The transmission of light across the tympanic
cavity and the promontory depends strongly on the
wavelength. Spatial intensity variations of a factor of 10 and
more inside the cochlear windings have been measured.
The clinical study was performed with 30 patients suffering
from chronic permanent tinnitus
• During and after irradiation there was no significant change
of hearing. However, 40% of the patients reported a slight
to significant attenuation of the tinnitus loudness of the
treated ear. There was no difference between the two
wavelength groups.
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Study 8
• 1- Infrared laser applied into the meatus acousticus (IR EAM),
once a week for 10 weeks.
2- The result of this non-controlled study is as follows
A -26% of the patients reported improved duration,
B- 58% reduced loudness and
C- 55% reported a general reduction in annoyance.
•
The same author [687] has also examined the effect of light on the
cochlea using guinea pigs. Direct laser irradiation was administered to
the cochlea through the round window. The amplitude of CAP was
reduced to 53-83% immediately after the onset of irradiation. The
amplitude then returned to the original level.
• The results of this investigation suggest that laser therapy might lessen
tinnitus by suppressing the abnormal excitation of the eighth nerve of
the organ of Corti.
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Study 9. Ex-vivo laser penetration study (mastoid rout)
• Ex-vivo laser penetration study
Dr. Tauber [1091] has performed an ex-vivo laser
penetration study. Based on these findings it was
possible to calculate the energy needed to obtain a
dose of 4 J/cm? in the cochlea itself.
Irradiation via the mastoid showed values 103 to 105
x times smaller (depending on wavelength) than
irradiation through the tympanic membrane. 30
patients were treated five times within 2 weeks. One
group was irradiated with 635 nm diode laser, the
other with 830 nm diode laser.
• By self-assessment around 40% of the patients
reported a slight to significant attenuation of the
tinnitus loudness of the irradiated ear.
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Study 10. Average duration of tinnitus of 10 years
•
Dr. Hahn [1310] examined 120 patients with an average
duration of tinnitus of 10 years.
• The patients underwent puretone audiometry, speech
audiometry and objective audiometry tests. The intensity
and frequency of tinnitus was also determined. EGb 761
was administered 3 weeks before the start of laser therapy.
• The patients underwent 10 sessions of laser therapy, each
lasting 10 minutes. An improvement in tinnitus loudness
was audiometrically confirmed in 50.8% of the patients; 10
dB in 18, 20 dB in 22, 30 dB in 10, 40 dB in 6 and 50 dB in 5
patients.
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10 session ,10 min each
• Table 9. Result of the
Research
• Decrease in Tinnitus
• 10 dB
• 20 dB
• 30 dB
• 40 dB
• 50 dB
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120 patients 10 ys
Patients #
• 18
• 22
• 10
• 6
• 5
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TREATMENT PROTOCOL
PRE-EXAMINATION EVALUATION
Co-operation between specialists
-neurology
-E.N.T
-rehabilitation (or physiotherapy)
Gathering anamnesic data
Acoustic trauma in the anamnesis - past hx - (regardless to one-time episode or
a chronic burden)
Abuse of potentially ototoxic medicaments (especially antibiotics, total
anesthesia)
Ocurrence of tinnitus in family anamnesis
Clinical examination
Thorough otoneurological examination
Thorough examination of axial skeleton
Nystagmus
Blood pressure
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•
•
•
•
•
•
•
•
•
•
•
Technical means of examination
Audiogram + masking of tinnitus
CT/NMR (nuclear MR)
X-ray of cervical vertebra
ENG --------------- vest syst
Tinnitogram
Lab tests
Especially detection of diabetes mellitus
Lipid metabolism disorders
Functional pathology of axial skeleton
Patients should always be examined by a
specialist on myoskeletal medicine
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1- Medication
a- Preferably indicated by an ENT specialist: vasoactive
medication, antihistaminics, nootropics
b- Good experience with Gingko biloba preparations: Egb 761,
Tanakan, Tebokan pills
Frequent changing of the scheme of medication not suitable
2- Rehab therapy
• Aimed at the axial skeleton
• a- Physiotherapy focussed on analgesia and relaxation of
muscle spasms [DD currents by Bernard, interferential
currents, pulsed magnetic field (these techniques applied on
distal parts of neck vertebra)].
• b-Traction therapy – horizontal tractions, preferrably devices
with pulsed modulation
• c- Mobilization (manipulation) of current functional blockades.
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During the irradiation
1- smoke
2- alcohol.
3- salt.
4- red meat +fat+ spice
5- dried fruits.
6- coffee
7- chocolate, caramel, candies, sorbes
8- coke, soda pop,…
9- loud music…. Use earplugs.
10- stress.
11- not tired yourself.
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• INTRODUCTION
• Laser consists of the first letters of “Light Amplification by
Stimulated Emission of Radiation”. Lasers only diffuse soft
energy. Lasers have been used in medical and cosmetic
sectors for more than 30 years. The benefits of Laser
technologies are improving continuously.
• Tinnitus Pen Soft Laser is the latest laser technology of our
day. Treatment is totally safe and painless. It has been
proven that the laser beams get into the bottom layers of
the skin and works as a treatment bio-simulation system on
the metabolism. Several diseases arise because of the lack
of ATPs which are the source of life for cells. ATP is a key
element for our cells. ATP provides the necessary energy
for Mitochondria that are being in process through the
glucose burning process. Lack of ATP may cause damage in
the cells, but powerful Tinnitus Pen Soft Laser light (650mm
wave length) imitates the glucose burning process.
Therefore, Tinnitus Pen Soft Laser may help the damaged
cells to renew themselves.
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How laser work?
A laser beam is made of photons, which are
absorbed by cells that are not functioning well
, the photon speedup the production of
healthy new cells by increasing the action of
ATPs(adenosphine triphosphate) a molecule
that carries energy in the cells take in
nutrients faster & get ride of waste product
sooner, laser increase blood flow to applied
area.
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• COMPARISION:• Lasers applied by professionals are more
powerful than the laser power of the Tinnitus Pen
Soft Laser. There is no need for professionals to
apply the Tinnitus Pen Soft Laser. Since Tinnitus
Pen Soft Laser has less beam power, it can be
applied by unprofessional people without any
risks.
• Tinnitus Pen Soft Laser should not be compared
with the beam of laser pointers
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