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07.06.2014

Hearing loss and vertigo and tinnitus, tinnitus yoga exercises - Plans Download

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At the Center for Cooperative Medicine, we are studying the effects of laser light at low intensity in ear disorders, including tinnitus, hearing loss and Meniere’s disease. Almost anyone with hearing loss, tinnitus, vertigo or other disorders related to the ear according to Dr.
Tinnitus, the perception of sound without an external cause, is an emergency signal by cells in the inner ear according to Dr. In modern society background noise is omnipresent, often at high levels, and our sense of hearing has been universally challenged. Tinnitus is another frequent consequence of trauma to the ear in which nerves are stimulated to send impulses to the brain perceived as sound but without an external cause. Henry et al (2005) reported that noise was an associated factor for 22% of cases, followed by head and neck injury (17%), infections and neck illness (10%), and drugs or other medical conditions (13%).
Thus it can see that there are numerous factors that are weakly correlated with tinnitus, and that hearing impairment is the most strongly associated. Most tinnitus comes from damage to the inner ear, specifically the cochlea (the snail like thing on the right of figure 1, labeled '9').
Patients with Meniere's disease often describe a low pitched tinnitus resembling a hiss or a roar. Tinnitus can also arise from damage to the nerve between the ear and brain (8th nerve, labeled 6, auditory nerve). Tinnitus arises more rarely from injury to the brainstem (Lanska et al, 1987), and extremely rarely, to the brain itself (e.g. Tinnitus can be associated with Basilar Artery Migraine (BAM), and also tinnitus can be more bothersome when one is having a migraine (Volcy et al, 2005), like sound and light and smells.
In our opinion, people are very quick to blame drugs for their tinnitus, but it is rare that this is borne out. Often people bring in very long lists of medications that have been reported, once or twice, to be associated with tinnitus. As tinnitus is essentially subjective, malingering of tinnitus as well as psychological causes of tinnitus is certainly possible.
In malingering, a person claims to have tinnitus (or more tinnitus), in an attempt to gain some benefit (such as more money in a legal case). Schecklmann et al (2014) suggested that tinnitus is associated with alterations in motor cortex excitability, by pooling several studies, and reported that there are differences in intracortical inhibition, intra-cortical facilitation, and cortical silent period.
Cartoon of the middle ear showing muscles that attach to ossicles (ear bones), and ear drum. ABR (ABR) testing may show some subtle abnormalities in otherwise normal persons with tinnitus (Kehrle et al, 2008). We occasionally recommend neuropsychological testing using a simple screening questionnaire -- depression, anxiety, and OCD (obsessive compulsive disorder) are common in persons with tinnitus. Microvascular compression of the 8th nerve is not a significant cause of tinnitus (Gultekin et al.
Other entities that can sometimes be seen on radiological testing and that can cause pulsatile tinnitus, include AVM's, aneurysms, carotid artery dissection, fibromuscular dysplasia, venous hums from the jugular vein (found in half the normal population), vascular tumors such as glomus, ossifying hemangiomas of the facial nerve, osseous dysplasias such as otosclerosis and Paget's, elevated intracranial pressure. Disrupted sleep is the most significant complaint, and affects between 25-50% of tinnitus patients.
The algorithm that we use in our practice to diagnose and treat tinnitus is here (a PDF graphic). There is a small literature concerning use of intravenous and local anesthesia for tinnitus.
Liu et al (2011) reported use of botox for tinnitus due to tensor tympani myoclonus, by inserting gelfoam with botox through a perforation in the tympanic membrane. Pramipexole was recently reported effective for tinnitus in a study of 40 patients with age related hearing loss in Hungary. Most of the discussion of devices for tinnitus are discussed, as is proper, under the placebo page.
Cochlear implants, which are used for severe bilateral unaidable hearing loss, usually improve tinnitus (Amoodi et al, 2011). These are devices based on the idea that tinnitus is usually worst when things are very quiet. Friedland and associates (2008) reported results of brain electrical stimulation in 8 patients. Occasionally persons with Meniere's disease have relief or reduction of tinnitus from transtympanic gentamicin. Microvascular compression syndrome, in theory, may cause tinnitus, but we have had very little success when the few patients we have seen with this syndrome have undergone surgery. Tinnitus usually improves in profoundly deaf individuals who undergo cochlear implantion (Olze, 2015). Avoid exposure to loud noises and sounds, avoid environments that are very quiet (as this makes tinnitus more noticeable). Tinnitus Retraining Therapy (TRT) is a method of treating tinnitus helpful for some (Wang et al, 2003). We sometimes refer patients for TRT, but the time required and general lack of health insurance support for long term psychotherapy are significant barriers. Hoare DJ, Kowalkowski VL, Kang S, Hall DA.Systematic review and meta-analyses of randomized controlled trials examining tinnitus management. Mahboubi H, Ziai K, Brunworth J, Djalilian HR.Accuracy of tinnitus pitch matching using a web-based protocol. Piccirillo JF, Garcia KS, Nicklaus J, Pierce K, Burton H, Vlassenko AG, Mintun M, Duddy D, Kallogjeri D, Spitznagel EL Jr.Low-frequency repetitive transcranial magnetic stimulation to the temporoparietal junction for tinnitus Arch Otolaryngol Head Neck Surg. Wineland AM, Burton H, Piccirillo J.Functional Connectivity Networks in Nonbothersome Tinnitus. Sudden Sensorineural Hearing Loss (SSHL) is defined as the sudden loss of hearing of at least 30 decibels occurring within a three day period.
About one-third of people with SSHL discover their hearing loss when they wake up in the morning. Previous treatment options included oral steroids, antiviral agents, and various medications.
Now there is new evidence that a hormone produced by the adrenal glands, aldosterone (al-dos’-te-rone) may play a pivotal role in the prevention and treatment of SSHL and may also be helpful for people with presbycusis (age-related hearing loss). The aldosterone story begins with researchers at Oregon Hearing Research Center (OHSU) in Portland, OR. The researchers at OHSU wanted to see if prednisone’s activation of aldosterone receptors, as opposed to suppression of the immune system, was actually causing the improvements in hearing when people used prednisone. Next they compared the effects of aldosterone and prednisone in animals with autoimmune hearing loss.
Six months later, Tom had a serious setback and experienced sudden hearing loss in his left ear, as well. In the study, 47 healthy men and women between 58 and 84 years old were given several types of hearing tests in addition to having their aldosterone blood levels measured.
Aldosterone can be obtained from a Canadian compounding pharmacy with a US doctor’s prescription and can be shipped directly from Canada.
Lutz Wilden, virtually everyone responded positively, and average hearing capacity increased by nearly 21%.
Wilden believes that tinnitus, hearing loss, vertigo, and altered sensation within the ear are often the result of “biological exhaustion of the inner ear”, and this may be due to acute or chronic exposure to sound, antibiotics, other drugs and many other stressors. The IXX Annual Meeting of The American Society for Laser Medicine and Surgery, Lake Buena Vista, Florida.
Musical hallucinations in patients without psychiatric disturbance is most often described in older persons, years after hearing loss, but they have also been reported in lesions of the dorsal pons (Schielke et al, 2000).
It is surprising that TMJ's correlation is nearly as high as hearing impairment, and more than depression or stress. Distinct causes are microvascular compression syndrome, viral infections of the 8th nerve, and tumors of the 8th nerve. For example, Tandon (1987) reported that 1% of those taking imiprimine complained of tinnitus.
We doubt that this means that motor cortex excitability causes tinnitus, but rather we suspect that these findings reflect features of brain organization that may predispose certain persons to develop tinnitus over someone else.
Wax should be removed, and the examiner should note whether the ear drum is intact, inflamed, scarred, or whether it is moving.


Because papilloedema is so rare, and tinnitus is so common, it is very unusual to find this dangerous condition. A brain MRI is used for the same general purpose and covers far more territory, but is roughly 3 times more expensive. This is not surprising considering how disturbing tinnitus may be to ones life (Holmes and Padgham, 2009). This is because of the very high correlation between anxiety and depression with tinnitus-related annoyance and severity (Pinto et al, 2014).
At that date there were 4 double-blind placebo controlled trials of antidepressants for tinnitus. Stidham et al (2005) injected botox into the area of the ear(above, and 2 places behind), the arm, and compared with placebo. A recent trial in older people showed that atorvastatin had no effect on the rate of hearing deterioration but there was a trend toward improvement in tinnitus scores over several years. This is a drug designed for heart disease, that is marketed in Europe for vertigo and tinnitus.
If you have tinnitus associated with a hearing loss, a hearing aid is a reasonable thing to try. Nearly all states mandate a 1-month money-back guarantee built into hearing aid dispensing.
Listening to the interstation static on the FM radio, tapes of ocean surf, fans, and the like may be helpful. For venous tinnitus, possibilities include jugular vein ligation, occlusion of the sigmoid sinus, or closure of a dural fistula.
The effects of unilateral cochlear implantation on the tinnitus handicap inventory and the influence on quality of life. Medium-term results of combined treatment with transcranial magnetic stimulation and antidepressant drug for chronic tinnitus. Comparison of auditory brainstem response results in normal-hearing patients with and without tinnitus. Maintenance repetitive transcranial magnetic stimulation can inhibit the return of tinnitus.
They go to bed with normal hearing and, in the morning, realize they are deaf in one or both ears.
Unfortunately, there is no single treatment that has proven effective in reversing this type of hearing loss. German researchers used oral Ginkgo biloba on patients whose hearing loss occurred less than 10 days before they were included in the study. The primary purpose of aldosterone is to regulate sodium and potassium metabolism in the kidneys.
They found aldosterone to be more effective than prednisone, leading them to conclude that what had been previously believed to be autoimmune hearing loss might not be autoimmune after all, since aldosterone has no immune suppressing effect. Wright monitored Tom’s aldosterone levels, which increased to 15.8 micrograms after two months and 35 micrograms after 6 months.
In 2005, researchers reported a correlation between low blood levels of aldosterone and hearing loss in older individuals. Individuals with severe hearing loss had approximately half as much aldosterone as those with normal hearing, a highly significant difference. Effect of treatment with Ginkgo biloba extract EGb 761 (oral) on unilateral idiopathic sudden hearing loss in a prospective randomized double-blind study of 106 outpatients. Higher serum aldosterone correlates with lower hearing thresholds: A possible protective hormone against presbycusis. Most cases of tinnitus are subjective, but occasionally the tinnitus can be heard by an examiner.
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The degree of improvement correlated with patients’ age and the duration of their condition.
Just as placing pressure on the eyes with a finger causes one to see stars, so tinnitus may be the result of stress to the cells responsible for our sense of hearing in the inner ear. According to Park and Moon (2004), hearing impairment roughly doubles the odds of having tinnitus, and triples the odds of having annoying tinnitus. Loudness was correlated with values in the thalamus, bilateral hippocampus and left caudate.
Somatic tinnitus means that the tinnitus is coming from something other than the inner ear. In a double-blind trial of paroxetine for tinnitus, 3% discontinued due to a perceived worsening of tinnitus (Robinson, 2007).
Specialists who care for patients with ear disease, usually know very well which drugs are problems (such as those noted above), and which ones are nearly always safe. It seems to us that response to carbamazepine is not a reliable indicator of microvascular compression as this drug stabilizes nerves and lowers serum sodium. Of course, tumors are a very rare cause of tinnitus, as tinnitus is at least 100 times more common than tumors of the inner ear area. On the other hand, Hoekstrat et al (2011) suggested that in general these drugs do not work for tinnitus.
This study suggested that Botox might improve tinnitus to a small extent (7 improved with active, 2 improved with placebo).
Be sure that you try the hearing aid before buying one, as tinnitus is not always helped by an aid. Given that smartphone apps do the same thing as tinnitus maskers, and that most newer hearing aids are blu-tooth capable, we see little reason to pay for a masker-hearing aid when one already owns a cell phone. Generally though, hearing aids or implantable devices are much more successful than surgery. Surgery seems worth considering only in extreme situations - -the tinnitus is extremely loud, very distressing, and there is a methodology to decide whether or not the tinnitus can be improved with surgery. On the other hand, very few individuals with tinnitus are deaf enough to qualify for cochlear implants. These include ototoxic medications, Meniere’s disease, acoustic neuroma, head trauma, circulatory problems in the ear, immunological diseases and viral infections. Also the methodology included varying dosages and the time at which outcome was measured was not specified.
The researchers used two dosages of 24 mg and 240 mg daily and compared the groups in a randomized, double-blind study. They were able to electronically monitor Auditory Brainstem Response (ABR) before, during and after treatment, which provided data on hearing loss.
He decided to stop taking them at one point but within 10 days his hearing began to fail again. Otologic problems, especially hearing loss, are the most common causes of subjective tinnitus. The longer someone has been experiencing tinnitus, hearing loss or ear-related vertigo, the greater the time and laser energy likely to be necessary. Similar statistics are found in England (Dawes et al, 2014) and Korea (Park and Moon, 2014). Practically, as there is only a tiny proportion of the population with objective tinnitus, this method of categorizing tinnitus is rarely of any help. In other words, the changes in the brain associated with tinnitus seem to be associated with emotional reaction (e.g. In a large study of tinnitus, avoidance of occupational noise was one of two factors most important in preventing tinnitus (Sindhusake et al.
Tinnitus from a clear cut inner ear disorder frequently changes loudness or pitch when one simply touches the area around the ear. There are case reports concerning tinnitus as a withdrawal symptom from Venlafaxine and sertraline (Robinson, 2007).
Nevertheless, this quality of tinnitus probably justifies a trial of oxcarbamazine (a less toxic version of carbamazepine). Lainez and Piera suggested that the mechanism was reduction of peripheral inputs from cervical, temporal, frontal and periauricular pathways.
TMS seems to be somewhat helpful for depression and migraine, and one would think that a modality that worked for these, would also work to some extent for tinnitus.


If tinnitus is reduced by intratympanic lidocaine injection, it seems reasonable to us that surgical treatment may also be effective (for unilateral tinnitus).
Since it was known that high doses of prednisone can spill over from their intended purpose and activate aldosterone receptors, they decided to study whether the activation of aldosterone receptors was the mechanism that restored hearing in SSHL patients. Wright has been practicing natural and nutritional medicine since 1973 and is the author of several books on nutritional therapy and regular columns in Prevention and Let’s Live magazines. Wright that the prednisone had worked and the hearing in his left hear had returned to its previous level.
Common causes of conductive hearing loss include external ear infection, cerumen impaction, and middle ear effusion. It seems to us that it should be possible to separate out tinnitus into inner ear vs everything else using some of the large array of audiologic testing available today. The exact prevalence of TMJ associated tinnitus is not established, but presumably it is rather high too.
In our clinical practice, we have occasionally encountered patients reporting worsening of tinnitus with an antidepressant, generally in the SSRI family.
When this doesn't happen, the treatments that work the best for tinnitus are those that alter ones emotional state -- antidepressants and antianxiety drugs, and ones that allow you to get a full night's sleep.
Robinson reported that tinnitus in depressed patients appears more responsive to antidepressants than in non-depressed patients. Because it is easily available in the US, and has a rather benign side effect profile, we think that it is a good candidate for medication trials. Prednisone also has a laundry list of side effects, including hypertension, ulcers, diabetes, cataracts, substantial weight gain, interference with healing, and many others. They concluded, “A higher dosage of EGb 761 (Ginkgo biloba) appears to speed up and secure the recovery of SSHL patients, with a good chance that they will recover completely, even with little treatment.”3 Premium-grade Ginkgo biloba extract is one of the primary ingredients in Arches Tinnitus Relief Formula. Aldosterone is necessary to keep blood pressure in a range that the heart can pump it and to regulate electrolytes in the bloodstream.
This led them to hypothesize that the real solution to so-called “autoimmune” hearing loss might come from increasing levels of aldosterone and not by suppressing the immune system. He published an article in the Townsend Letter for Doctors and Patients in January 2007 called “Take control of your hearing loss before it’s too late”. Sensorineural hearing loss may be caused by exposure to excessive loud noise, presbycusis, ototoxic medications, or Meniere's disease. We have encountered patients who have excellent responses to cervical epidural steroids, and in persons who have both severe tinnitus and significant cervical nerve root compression, we think this is worth trying as treatment.
Having TMJ increases the odds that you have tinnitus too, by about a factor of 1.6 (Park and Moon, 2014). Mechanisms for impovement were suggested to be direct effects of increased serotonin on auditory pathways, or indirect effects of tinnitus on depression or anxiety. This was an easy decision because aldosterone is a natural hormone, necessary for life, and bio-identical hormones have no more side effects than the normally produced ones. Objective tinnitus usually is caused by vascular abnormalities of the carotid artery or jugular venous systems.
Initial evaluation of tinnitus should include a thorough history, head and neck examination, and audiometric testing to identify an underlying etiology. MRI studies related to audition or dizziness must be interpreted with great caution as the magnetic field of the MRI stimulates the inner ear, and because MRI scanners are noisy. Unilateral or pulsatile tinnitus may be caused by more serious pathology and typically merits specialized audiometric testing and radiologic studies.
In patients who are discomforted by tinnitus and have no remediable cause, auditory masking may provide some relief.
Epidemiologic data reveal that approximately one fourth of persons with tinnitus are discomforted by it, whereas the remaining three fourths experience the condition without significant symptoms.3Tinnitus takes different forms and has different classification proposals. One classification system stresses distinctions between vibratory and nonvibratory types, while another system groups the different forms of tinnitus into subjective or objective classes.Vibratory tinnitus is caused by transmission to the cochlea of vibrations from adjacent tissues or organs. Nonvibratory tinnitus is produced by biochemical changes in the nerve mechanism of hearing.Subjective tinnitus, which is more common, is heard only by the patient. Objective tinnitus can be heard through a stethoscope placed over head and neck structures near the patient's ear.The mechanism that produces tinnitus remains poorly understood.
Tinnitus may originate at any location along the auditory pathway from the cochlear nucleus to the auditory cortex.
Some leading theories include injured cochlear hair cells that discharge repetitively and stimulate auditory nerve fibers in a continuous cycle, spontaneous activity in individual auditory nerve fibers, hyperactivity of the auditory nuclei in the brain stem, or a reduction in the usual suppressive activity of the central auditory cortex on peripheral auditory nerve activity.4This article discusses the causes of subjective and objective tinnitus, and techniques used for evaluating tinnitus. A thorough history and physical examination should be directed at ruling out serious disorders. Conductive hearing loss is caused by the inhibition of sound transmission to the inner ear. The most common etiologic factors are noise-induced hearing loss (NIHL), or the progressive loss of acuity that occurs with advancing age (presbycusis).NIHL is the most common type of acquired hearing loss.
Screening for exposure to excessive or loud noises can be performed during routine health maintenance visits.11 Continued counseling about the risk of hearing loss is warranted if the patient is exposed to damaging sounds. Patients should be encouraged to avoid long-term exposure to hazardous noises and to use hearing protection when necessary.
It is continuous and less disturbing than the tinnitus of Meniere's disease.14Ototoxic medications or substances are another common cause of bilateral tinnitus.
Temporomandibular joint disorder has been associated with vertigo and tinnitus, although the exact mechanism is unclear.Various metabolic abnormalities may be associated with tinnitus.
These abnormalities include hypothyroidism, hyperthyroidism, hyperlipidemia, anemia, and vitamin B12 or zinc deficiency.Many patients with tinnitus exhibit signs of psychologic disorders.
Although tinnitus may be a contributing factor to the development of depression, the common association of tinnitus and depression may be the result when depressed patients, particularly those with sleep disturbances, focus and dwell on their tinnitus more than patients who are without an underlying psychologic disorder.OBJECTIVE TINNITUSObjective tinnitus is rare. Patients with objective tinnitus typically have a vascular abnormality, neurologic disease, or eustachian tube dysfunction.4Patients with vascular abnormalities complain of pulsatile tinnitus. The petrous carotid system is the most common source.2 Patients experience worsening of symptoms at night and usually do not have other otologic complaints. This type of tinnitus is a soft, low-pitched venous hum, which can be altered by head position, activity, or pressure over the jugular vein.4Congenital arteriovenous shunts are usually asymptomatic, while the acquired type often are associated with pulsatile tinnitus.
The symptoms may disappear with Valsalva's maneuver or when the patient lies down with the head in a dependent position.Evaluation of TinnitusHISTORYThe evaluation of a patient with tinnitus begins by taking a thorough history. Precipitous onset can be linked to excessive or loud noise exposure or head trauma.LocationUnilateral tinnitus can be caused by cerumen impaction, otitis externa, and otitis media. Tinnitus associated with unilateral sensorineural hearing loss is the hallmark of acoustic neuroma.PatternContinuous tinnitus accompanies hearing loss.
The external canal and tympanic membrane should be inspected for signs of cerumen impaction, perforation, or infection.
The cranial nerves should be examined for evidence of brain-stem damage or hearing loss.9 Auscultation over the neck, periauricular area, orbits, and mastoid should be performed. Tinnitus of venous origin can be suppressed by compression of the ipsilateral jugular vein.Specific testing for sensorineural or conductive hearing loss is the next part of the examination.
In the Weber test, the tuning fork is struck and placed on the midline of the forehead, the nasal bridge, or the chin. The sound lateralizes to the opposite ear in patients with a sensorineural hearing loss, but to the same side in those with a conductive hearing loss.
Patients with normal hearing or equal deafness in both ears hear the sound at the same level in both ears.In the Rinne test, the tuning fork is placed against the mastoid process to measure the conduction of sound by bone. If air conduction is greater than bone conduction, hearing is normal or sensorineural hearing loss is present. Pure tone testing primarily tests the function of the peripheral portion of the hearing apparatus. Further investigation should be dictated by the index of suspicion created by the history, physical examination, and audiometric profile (Figure 1). Patients with unilateral or pulsatile tinnitus are more likely to have serious underlying disease and typically merit referral to an otolaryngologist.2,5 A full clinical evaluation should precede radiologic studies. Because pulsatile tinnitus suggests a vascular abnormality, the preferred imaging study is contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) of the brain21 (Figure 2).



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Comments to “Hearing loss and vertigo and tinnitus”

  1. Janna:
    And the jugular vein -- that are very close not just resulting in Ringing in the ears.
  2. ToTo_iz_BaKy:
    Case, other therapies -- both conventional and policy (Your.