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