tinnitus = ear ringing objective ( vessels anomalie, dysfunction of middle ear ) subjective …the...
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Tinnitus = ear ringing• Objective ( vessels anomalie,
dysfunction of middle ear )
• Subjective …the examiner are not able to hear it
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Diagnostic and therapeutic strategies for the treatment of tinnitus
Aleš Hahn
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Characteristics of chronical tinnitus
nagging
stressful
permanent
discontinuous
Whistling, hissing,....
most high-frequency
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Types of tinnitusCochlear
Neural
Cortical
Combined ... …
Single / double sided /
Transient
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Famous persons….
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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)
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Tinnitus typesCochlear
Neural
Cortical
Combined ... ...
Single / double sided / transient
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Epidemiology of tinnitus
"Civilized States" 10-15% of the population and therefore hundreds of millions of peoplereactivity affected
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Tinnitus
The hearing loss (HL)
Solitary isolated less often.
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Duration of tinnitus
Acute ... ≤ 14 days
Short-term ≤ 6 weeks
Subacute ≤ 6 months
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Diagnosis (1)Patient,s data
Audiometric testing possible in peripheral (cochlear) tinnitus
Masking of pure tonesFrequency (Hz), intensity (dB)
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Diagnosis (2)Frequency (Hz), intensity (dB) Standard
audiometric testing
Tone (PTA) and speech audiometry
BERA (optional when?)
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Diagnosis (3)BERA always with sudden or progressive hearing
loss ...
It is necessary to exclude retrocochlear pathology (neuroma of N.VIII.)
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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
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TherapyIs different for acute tinnitus vs.chronic
Rather Focused on acuteRather polypragmatic in chronic ...
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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
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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
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Pharmacotherapy Vasodilators (Cavinton ®, Agapurin ®)
corticosteroids
vitamins
Nootropics (EGB 761-Tanakan ®, Tebokan pills ®)
Sedatives / Anxiolytics
Antihistamines (Betaserc ®)
Anticonvulsants (carbamazepine)
antibiotics
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Physical therapyLaser - must be of sufficient strength 400 mW
probe 230 m ...Continuous / dyskontinuos beam, 5 min, 10-15 sessionSensitization EGB 761
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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
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musculo relaxing therapyRehabilitation soft technology
AutorehabilitaceNot forgetting the Costena (about 15% of tinnitus ...)
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Rehabilitation soft technologyAutorehabilitaceNot forgetting the Costena (about 15% of tinnitus ...)
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Hospitalization
Vinca minor + reha + (laser)
Reha + laser + pentoxyphyllin
Lidocain???
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Targeted surgical approach
IEC - steroids, gentamycin
Aplikation 14 - 24 dnů
continual
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Efficiency of whole therapy
Typically the decrease in frequency (Hz) and intensity (dB)In 70% agreement with the VASThe residue after about 15% disapproval .
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Visual analogue scale
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Conditions of positive results
Cooperation of patient, patience, their good compliance
understanding of physician Harmony of the patient's surroundings