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Tinnitus
 

Tinnitus

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  • Tinnitus masking uses background noise to distract you from hearing your tinnitus. It has been offered as a treatment for tinnitus for over a century. We have a tool that will allow you to mask your tinnitus on your computer or on a portable device, allowing you to break free from your tinnitus whenever you feel the need.

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  • http://www.youtube.com/watch?v=0n68WU5ptbw

    Nice set of slides!
    My elderly Mohter suffered with tinnitus for years and it was the bane of her life.
    She has now passed away now but I found this interesting ebook via You tube explaining how this condition can be cured.
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    Tinnitus Tinnitus Presentation Transcript

    • Tinnitus A Clinical Update Jennifer L Smullen, MD Fred F Telischi, MD MEE FACS February 17, 2005
    • Definition
      • Perception of noise in the absence of acoustic stimuli
      • Aberrant auditory phenomenon unrelated to an external source of sound
      • Sensation of sound arising within the head
    • Tinnitology
      • Discipline first described in 1987 devoted to understanding how the perception of an aberrant auditory phenomenon can be translated into sensation and effect
    • Definitions
      • Objective
      • Subjective
      • Pulsatile
    • Pulsatile Tinnitus
      • Etiology
      • Evaluation
      • Management
    • Etiology of Pulsatile Tinnitus
      • Arterial
        • Atherosclerosis
        • AV malformation or fistula
        • High flow states
        • Vascular loop
        • Glomus tumors
        • Aberrant carotid artery
        • Persistent stapedial artery
      • Venous
      • Nonvascular
    • Etiology of Pulsatile Tinnitus
      • Arterial
      • Venous
        • Dehiscent jugular bulb
        • Sigmoid sinus thrombosis
        • Pseudotumor cerebri
      • Nonvascular
    • Etiology of Pulsatile Tinnitus
      • Arterial
      • Venous
      • Nonvascular
        • Palatal myoclonus
        • Middle ear myoclonus
        • Patulous ET
    • Evaluation of Pulsatile Tinnitus
      • History
      • Otoscopy
      • Auscultation
      • Palpation and IJ compression
      • Complete ENT exam
      • Ophthalmology and Neurology as indicated
    • Evaluation of Pulsatile Tinnitus
      • Audiogram
      • Impedance audiometry
      • ABR if Pseudotumor cerebri suspected
      • CBC, TSH
      • Duplex carotid US
      • MRI/MRA
      • CT
    • Management of Pulsatile Tinnitus
      • Arterial
        • Atherosclerosis
        • AV malformation or fistula
        • High flow states
        • Vascular loop
        • Glomus tumors
        • Aberrant carotid artery
        • Persistent stapedial artery
    • Management of Pulsatile Tinnitus
      • Venous
        • Dehiscent jugular bulb
        • Sigmoid sinus thrombosis
        • Pseudotumor cerebri
          • Diamox
          • Weight loss
          • VP shunt
    • Management of Pulsatile Tinnitus
      • Nonvascular
        • Palatal myoclonus
        • Middle ear myoclonus
        • Patulous ET
    • Subjective Tinnitus
      • Paresthesia of the somatosensory system
      • Central neuropathic pain
      • Unilateral or bilateral
      • Constant or fluctuating
      • Variety of sounds
      • Associated with hyperacusis, phonophobia and SNHL
    • Epidemiology
      • 36 million Americans affected
      • Approximately 2 million severely
      • Age 50-71 highest prevalence
      • 12% men over 65
      • 7% women over 65
      • 64% adults with normal hearing perceive tinnitus in silence
      • Tucker et al, Otol Head & Neck Jan 2005
    • Where is Tinnitus?
      • Ear
      • Brain
      • Both
    • What Causes Tinnitus?
      • Uncoupled OHC’s
      • Aberrant afferent activity
      • Loss of GABAergic inhibitory neurons
    • Measuring Tinnitus
      • Audiometric evaluation
      • Outcome measures
        • Tinnitus Outcome Profile
        • Tinnitus Intensity Index
        • Tinnitus Annoyance Index
        • Tinnitus Stress Index
        • Tinnitus Handicap Inventory
        • Measurement of Depression Scale
    • Animal Models of Tinnitus
      • Jastreboff and the thirsty rat
      • Bauer et al
        • Chinchilla
        • Food lever
        • Sound-induced tinnitus
        • Behavioral evidence
        • Physiologic evidence
          • Increased firing in DCN
          • Bauer et al Otolaryngologic Clinics of North America 2003(2)
    • Treatment of Subjective Tinnitus
      • Meniett
      • Hyperbaric oxygen
      • Acupuncture
      • Benzodiazepines
      • Lidocaine
      • Steroids
      • Stapedectomy
      • Electrical stimulation
      • Eighth nerve section
      • Habituation
      • Masking
      • Cochlear implant
      • Misoprostol
      • Enoxaparin
      • SSRI’s
      • Gabapentin
      • Gentamicin
      • Ginkgo Biloba
    • Meniett Device
      • Randomized ,double-blind, placebo-controlled study of tinnitus in Meniere’s disease
      • NO EFFECT
      • Thompsen et al Otol Neurotol Jan 2005
    • Hyperbaric Oxygen
      • Meta analysis
      • 256 patients with SSNHL
      • NO EFFECT
      • Bennett et al, Cochrane Database Syst Rev. 2005 Jan
    • Acupuncture
      • 2 unblinded studies showed improvement
      • 4 blinded studies showed no effect
        • NO EFFECT
      • Park J et al Arch Otolaryngol Head Neck Surg 2000 Apr
      • Birch S J Altern Complement Med. 2004 Jun
    • Benzodiazepines
      • Tinnitus caused by reduction in inhibition
      • GABA neurotransmitter of inhibition in auditory pathways
      • Benzodiazepines enhance GABA effects
      • Review of 3357 patients
      • 32% control with clonazepam
      • 67% control with alprazolam
      • EFFECTIVE
      • Vernon JA, Otolaryngol Clin North Am 2003;36(2)
      • Shulman A et al, Int Tinnitus J 2002;8(1)
    • Lidocaine
      • Amide local anesthetic
      • Axoplasmic sodium channel blockade
      • Kroath 1960 IT Lidocaine
      • Sakata 220 ears
        • 34% resolved, 50% decreased, 10% unchanged
        • Returned to baseline in 4 weeks
      • Side effects: vertigo, nausea vomiting
      • EFFECTIVE
      • Sakata E et al, Auris Nasus Larynx 1984;11(1)
    • IT Steroids
      • 50 patients
      • Treated 3 times daily for 3 months
      • 37 resolved or improved permanently
      • Consistent with other studies showing an average of 70% improved
      • EFFECTIVE
      • Cesarani A et al Int Tinnitus J. 2002;8(2)
    • Otosclerosis
      • Stapedectomy 40 patients
        • 85% improved
        • 12% had no change
        • 2.5% worse
        • 52.5% complete resolution
      • Prospective Study 48 patients 91% improved
      • EFFECTIVE
      • Sparano A et al, Int Tinnitus J. 2004;10(1)
      • Sobrinho PG et al, Int Tinnitus J. 2004;10(2)
    • Electrical Stimulation
      • First used in 1800’s
      • Extradural implanted electrodes
      • TENS
      • Cochlear implants
      • EFFECTIVE
      • De Ridder D J Neurosurg. 2004 Mar;100(3)
    • Tinnitus Retraining Therapy
      • Habituation exercises designed by Jastreboff
      • 12-18 months
      • Decouples tinnitus and the emotional response to tinnitus
      • No more effective than directed counseling
      • Possibly EFFECTIVE
    • Masking
      • Wearable Maskers
        • Hearing aids
        • Tinnitus maskers
        • Tinnitus instruments
        • High frequency bone conduction
          • HiSonic Tinnitus Relief Device
      • Environmental Maskers
        • Recorded sound- Petroff Audio Technologies
        • White noise
        • EFFECTIVE
    • Ultra High Frequency Muscle Vibration
      • 15 patients
      • Tactaid transducer
      • 60% had relief after one treatment
      • Effects lasted up to 4 months
      • Possibly EFFECTIVE
      • Lenhardt ML et al, Int Tinnitus J. 2003;9(1)
    • Antidepressants
      • Amitriptyline
      • Selective serotonin reuptake inhibitors, SSRI’s
      • Tricyclic antidepressants
      • EFFECTIVE
    • Ginkgo Biloba
      • Randomized placebo-controlled double-blind trial and meta-analysis of randomized trials
      • NO EFFECT
      • Rejali D et al, Clin Otolaryngol. 2004 Jun;29(3)
    • Electromagnetic therapy
      • Randomized, prospective, double-blind, placebo-controlled pilot study
      • 37 patients received 30-minute treatments with the Diapulse device three times a week for 1 month
      • NO EFFECT
      • Ghossaini SN Laryngoscope. 2004 Mar;114(3)
    • Enoxaparin
      • Anticoagulant, low molecular weight heparin
      • Randomized, placebo-controlled study of 40 patients
      • Hospitalized for 10 days
      • 2000 IU BID
      • All patients had complete relief
      • EFFECTIVE
      • Mora R et al, Int Tinnitus J. 2003;9(2)
    • Summary
      • Probably Effective
      • Lidocaine
      • Benzodiazepines
      • Antidepressants
      • Electrical Stimulation
      • Enoxaparin
      • Dexamethasone
      • Mixed Effects
      • TRT
      • Gentamicin
      • Muscle vibration
      • Likely Not Effective
      • Acupuncture
      • Carbamazepine
      • Ginkgo Biloba
      • Gabapentin
      • Pulsed EM
      • HB O2
      • Meniett