tinnitus = ear ringing objective ( vessels anomalie, dysfunction of middle ear ) subjective …the...
TRANSCRIPT
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 tinnitusCochlear
Neural
Cortical
Combined ... …
Single / double sided /
Transient
Famous persons….
TinnitogenesisGenerator damage to hair cells (frequency!! ...)
Mostly connected with hearing loss
Phantom ... (cochlear)The impaired neuro / cortical pathwaysPathologic metabolism of cortical acoustic field (SPECT, PET)
Tinnitus typesCochlear
Neural
Cortical
Combined ... ...
Single / double sided / transient
Epidemiology of tinnitus
"Civilized States" 10-15% of the population and therefore hundreds of millions of peoplereactivity 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 tonesFrequency (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
TherapyIs different for acute tinnitus vs.chronic
Rather Focused on acuteRather polypragmatic in chronic ...
Therapy tinnitus 2patient will come in time
Corticosteroids,
rheologically active drugs (Vinca minor, pentoxyphyllin)
HBOGood 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 therapyLaser - must be of sufficient strength 400 mW
probe 230 m ...Continuous / dyskontinuos beam, 5 min, 10-15 sessionSensitization EGB 761
Combined therapyCombined treatment (ginkgo, vincamine,
betahistine, laser, rehab, lidocaine) ... Slow all goodGingko three weeks and then laser - success 40-50%.
The combination of drugs Max.2 event.fyziatric / physical therapy
musculo relaxing therapyRehabilitation soft technology
AutorehabilitaceNot forgetting the Costena (about 15% of tinnitus ...)
Rehabilitation soft technologyAutorehabilitaceNot 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 VASThe 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