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06.07.2014

Middle ear tinnitus treatment, pulsatile (like a heartbeat) tinnitus treatment - For You

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Erectile dysfunction (ED) becomes more common in men in middle age, but the range of treatments means most men can find something that works for them. Constant noise in the head -- such as ringing in the ears -- rarely indicates a serious health problem, but it sure can be annoying. Tinnitus (pronounced tih-NITE-us or TIN-ih-tus) is sound in the head with no external source.
Almost everyone has had tinnitus for a short time after being exposed to extremely loud noise. While there's no cure for chronic tinnitus, it often becomes less noticeable and more manageable over time.
Sound waves travel through the ear canal to the middle and inner ear, where hair cells in part of the cochlea help transform sound waves into electrical signals that then travel to the brain's auditory cortex via the auditory nerve.
Most people who seek medical help for tinnitus experience it as subjective, constant sound, and most have some degree of hearing loss.
Tinnitus can arise anywhere along the auditory pathway, from the outer ear through the middle and inner ear to the brain's auditory cortex, where it's thought to be encoded (in a sense, imprinted). Most tinnitus is "sensorineural," meaning that it's due to hearing loss at the cochlea or cochlear nerve level. Tinnitus that's continuous, steady, and high-pitched (the most common type) generally indicates a problem in the auditory system and requires hearing tests conducted by an audiologist. Your general health can affect the severity and impact of tinnitus, so this is also a good time to take stock of your diet, physical activity, sleep, and stress level — and take steps to improve them. If you're often exposed to loud noises at work or at home, it's important to reduce the risk of hearing loss (or further hearing loss) by using protectors such as earplugs or earmuff-like or custom-fitted devices. In addition to treating associated problems (such as depression or insomnia), there are several strategies that can help make tinnitus less bothersome. There is no FDA-approved drug treatment for tinnitus, and controlled trials have not found any drug, supplement, or herb to be any more effective than a placebo. Not all insurance companies cover tinnitus treatments in the same way, so be sure to check your coverage. Tinnitus is the perception of an insistent, unpleasant ringing, buzzing or other consistent noise, located in or near the skull but without a definable external source. Tinnitus is often perceived as a ringing or persistent high tone very close to or within the ear. Tinnitus is often regarded as a symptom of auditory conditions, such as damage to the tissues in the ear that control the perception of tones and frequencies.
An increasing number of researchers argue that tinnitus is a disorder of the connections between the inner ear and certain areas of the brain.
Some scientists had developed a theory that tinnitus was associated with deficiencies in vitamin B12. Chronic inflammation of the middle ear (otitis media) may also be associated with some cases of tinnitus.
Tinnitus related to otitis media may be improved by surgery to correct damage caused by this inflammation. The most common types of tinnitus are ringing or hissing ringing and roaring (low-pitched hissing). Tinnitus is usually static noise in the auditory system that is associated with loss of sound from the external environment.
People who take large amounts of aspirin may experience tinnitus which goes away if they stop the aspirin.
Pulsatile tinnitus (tinnitus that beats with your pulse) can be caused by aneurysms, increased pressure in the head (hydrocephalus), and hardening of the arteries. Because tinnitus is a symptom rather than a disease, it is important to evaluate the underlying cause. In persons with pulsatile tinnitus, additional tests may be proposed to study the blood vessels and to check the pressure inside the head. Based on these tests, tinnitus can be separated into categories of cochlear, retrocochlear, central, and tinnitus of unknown cause.
If a specific cause for tinnitus is determined, it is possible that treating the cause will eliminate the noise. In most cases of tinnitus, the sound is an abnormal auditory sense perception of a sound that is really neither in the body nor coming from the outside. Similarly, we have found that tinnitus can be diminished by not listening to it; ignoring the abnormal perception of sound until it is no longer bothersome.
We do know that individuals who focus on the tinnitus and listen to it constantly seem to aggravate the degree to which it is bothersome and seem to enhance the abnormal perception of the sound. We recommend that persons with tinnitus limit salt (no added salt), and refrain from drinking caffeinated beverages, other stimulants (like tea), and chocolate.
Because tinnitus has been linked to changes in neural activity within the brain, stimulation of the nerves within the cortex has been studied as a treatment option.
Anxiety or depression that often accompanies tinnitus may be as big a problem as the tinnitus itself. The American Hearing Research Foundation is a non-profit foundation that funds research into hearing loss and balance disorders related to the inner ear, and to educating the public about these health issues. Active middle ear implants are an alternative to conventional hearing aids that allow more power delivered to the cochlea, especially at high frequencies, and can also be used when middle ear ossicles are damaged. A study supported by the Tinnitus Research Initiative (TRI) and MED-EL of the effect of a middle ear implant showed that individuals with severe tinnitus and high-frequency hearing loss achieved relief of their tinnitus after implantation. Some patients had complete relief of their tinnitus after activation of the middle ear implant. Individuals who have significant residual inhibition of their tinnitus and high-frequency hearing loss seem to be the best candidates for implantations. Individuals with tinnitus, who also suffer from hearing loss, often benefit from amplification. It has been reported that up to 67% of individuals who received unilateral hearing aids and 69% of individuals who received bilateral hearing aids report improvement in their tinnitus [1].
Hearing aids often increase the perceived quality (color, crispness, clarity, pureness) of sounds, which could be important in reducing tinnitus annoyance, but unfortunately is not measured in routine clinical practice and is difficult to define. Today’s digital hearing instruments are very advanced, offering maximum performance and reducing many of the difficulties encountered in earlier designs. Relocating the loudspeaker to the outer ear canal increased the performance of amplification in the high frequency range.
Recognizing these problems and the fact that sound quality will always be an issue for those who use traditional hearing instruments and individuals with tinnitus, promoted the development of active middle ear implants. With customized active middle ear implants, there is no need for a “loudspeaker” (receiver), thus reducing the distortion and reduction in the quality of sounds that occurs in traditional hearing aids. Middle ear implants started in 1935 when Wilska [3] experimented with iron particles placed on the tympanic membrane. Today, three general types of transducers are used in middle ear implants, each with advantages and disadvantages related to power, performance, frequency range, and reliability. Yanagihara and his colleagues [6] described an implantable piezoelectric device attached to the head of the stapes and performed the earliest human trials using these devices [7–12]. Soundbridge is the middle ear implant with the longest clinical experiences, 3,000 patients so far (2009). In 2000, a patient implanted on both sides with middle ear implants reported that this tinnitus disappeared completely after activating the implant.
After the operation, the audio processor was activated, and the reaction of his tinnitus was surprising: the tinnitus shifted from his left side to his right side. Picture 6 shows the result: because of the remaining tinnitus, there was no improvement regarding annoyance after 2 months, and the person did not develop any habituation. Picture 7 shows the functional gain (green line) after the implantation of the Soundbridge in both ears. The first patient of a new study, sponsored by the company Med-El® with five participants with unilateral tinnitus and reproducible residual inhibition, received a Soundbridge implantation in June 2008.


Implantable hearing aids have shown to be effective in reducing tinnitus in individuals with severe hearing loss and tinnitus, where the hearing loss was caused by middle ear or cochlear pathologies.
Things that cause hearing loss (and tinnitus) include loud noise, medications that damage the nerves in the ear (ototoxic drugs), impacted earwax, middle ear problems (such as infections and vascular tumors), and aging. One of the most common causes of tinnitus is damage to the hair cells in the cochlea (see "Auditory pathways and tinnitus"). Pulsatile tinnitus calls for a thorough evaluation by an otolaryngologist (commonly called an ear, nose, and throat specialist, or ENT) or neurotologist, especially if the noise is frequent or constant. You may also be able to reduce the impact of tinnitus by treating depression, anxiety, insomnia, and pain with medications or psychotherapy.
CBT uses techniques such as cognitive restructuring and relaxation to change the way patients think about and respond to tinnitus. Masking devices, worn like hearing aids, generate low-level white noise (a high-pitched hiss, for example) that can reduce the perception of tinnitus and sometimes also produce residual inhibition — less noticeable tinnitus for a short time after the masker is turned off.
Other treatments that have been studied for tinnitus include transcutaneous electrical stimulation of parts of the inner ear by way of electrodes placed on the skin or acupuncture needles, and stimulation of the brain using a powerful magnetic field (a technique called repetitive transcranial magnetic stimulation, or rTMS).
If you're willing to enroll in a research study, you may be able to receive a cutting-edge treatment free. Age-related hearing impairments, or disorders of the circulatory system around the ear, may also be related to this complaint.
Some scientists conclude that tinnitus is in fact related to damage of the nervous tissue in or around the auditory cortex of the brain. A recent study including 100 patients with tinnitus found that 63 of these had low vitamin B12 levels.
As the natural molecule histamine is associated with the regulation of both inflammation and some auditory nervous tissue, drugs that block its receptors in the brain are currently proposed as treatments for tinnitus. Darius Kohan is renowned for his otology expertise and has been highlighted on several outlets such as a CBS spotlight on tinnitus and is often cited in WEB MD and other medical outlets.
Tinnitus is common — nearly 36 million Americans have tinnitus and more than half of the normal population has intermittent tinnitus. Therefore, tinnitus is common and in most, but not all, cases it is associated with some degree of hearing loss. Anything that increases blood flow or turbulence such as hyperthyroidism, low blood viscosity (for example, anemia), or tortuous blood vessels may cause pulsatile tinnitus.
Persons who experience tinnitus should be seen by a physician expert in ear disease, typically an otolaryngologist. The temporomandibular joints (TMJ) of the jaw should also be checked, since about 28% of persons with TMJ syndrome experience tinnitus.
For many people with tinnitus, the sound is usually masked, or covered up, when there is a usual level of noise in the environment.
Therefore, it is very important to understand that the individual is very much in control of the degree to which the tinnitus is distracting or annoying.
In general, we are not very enthused about medication treatment as the side effects can be substantial and the results are often unimpressive. A review by Smith (2005) concluded that high quality clinical trials do not support the use of ginko, although earlier trials found it beneficial. You should certainly consider surgery if your tinnitus is due to a tumor and also if it is due to a venous source (usually pulsatile in this situation). If you have tinnitus associated with a hearing loss, a hearing aid is the first thing to try.
At the American Hearing Research Foundation (AHRF), we have funded basic research on tinnitus in the past, and are interested in funding sound research on tinnitus in the future. The use of hearing aids in tinnitus patients may make the patient less aware of the tinnitus as well as improve communication by reducing masking by the tinnitus.
This is a problem in connection with suppression of tinnitus, which requires that high-frequency sounds are delivered to the ear at sufficient intensity.
Wilska generated a magnetic field from an electromagnetic coil inside an earphone, which caused the iron filings to vibrate in synchrony with the magnetic field. The types of transducers used in middle ear implants consist of piezoelectric, electromagnetic, and electromechanical transducers.
The magnet is attached to the ossicular chain, tympanic membrane, or the inner ear (round window or oval window). The indication here refers to a destroyed middle ear, such as after removal of the petrosal bone, malformations, cholesteatoma, sclerosis of the footplate, etc.
Facing the fact that this individual now had tinnitus on the right side, we also implanted the right side with the Soundbridge 12 weeks after the original implantation. The patient describes that his tinnitus decreases already by switching on the device, although he is not able to hear the receiver noise. The reason the middle ear implantable devices provide relief of tinnitus may be masking, but it seems more likely that the benefit is caused because these devices provide effective activation of the auditory nervous system, and thereby counteract the effect of deprivation of sound input that had activated neural plasticity causing the tinnitus. Rutschmann J (1959) Magnetic audition: Auditory stimulation by means of alternating magnetic fields acting on a permanent magnet fixed to the eardrum. Yanagihara N, Sato H, Hinohira Y, Gyo K, Hori K (2001) Long-term results using a piezoelectric semi-implantable middle ear hearing device: The Rion device E-type. Suzuki J-I, Yanagihara N, Kadera K (1987) The partially implantable middle ear implant, case reports. Suzuki J, Kodera K, Nagai K, Yabe T (1994) Long-term clinical results of the partially implantable piezoelectric middle ear implant.
Sterkers O, Boucarra D, Labassi S (2003) A middle ear implant, the Symphonix Vibrant Soundbridge. Huttenbrink K-B, Zahnert T, Bornitz M, Beutne D (2008) TORP Vibroplasty: a new alternative for the chronically disabled middle ear. Goebel G, Hiller W (1998) Tinnitus-Fragebogen (TF) Ein Instrument zur Erfassung von Belastung und Schweregrad bei Tinnitus.
Some medications (especially aspirin and other nonsteroidal anti-inflammatory drugs taken in high doses) can cause tinnitus that goes away when the drug is discontinued. This stimulates abnormal activity in the neurons, which results in the illusion of sound, or tinnitus.
Tinnitus can also be a symptom of Mnire's disease, a disorder of the balance mechanism in the inner ear. If you have age-related hearing loss, a hearing aid can often make tinnitus less noticeable by amplifying outside sounds.
The aim is to habituate the auditory system to the tinnitus signals, making them less noticeable or less bothersome.
Others have found associations between increased activity in further brain regions, age of tinnitus onset and distress caused by the syndrome. Other new and emerging treatments for tinnitus focus on the potential indicated by the studies into its links with abnormal brain activity, as mentioned earlier. The most common causes of tinnitus are damage to the high frequency hearing by exposure to loud noise or elevated levels of common drugs that can be toxic to the inner ear in high doses.
We know of people who have focused on and listened to tinnitus until it dominated their lives.
For venous tinnitus, possibilities include jugular vein ligation, occlusion of the sigmoid sinus, or closure of a dural fistula.
Be sure that you try the hearing aid before buying one, as tinnitus is not always helped by an aid. Direct intracranial electrical stimulation of the cortex also has positive effects on tinnitus (De Ridder et al 2007a, Seidman et al 2008).
A recent systematic review of the literature concluded that CBT was an effective treatment of tinnitus distress, although the authors cautioned that larger studies should be completed (Hesser et al 2011). Learn more about donating to American Hearing Research Foundation (AHRF) to diagnose tinnitus. Theta, alpha and beta burst transcranial magnetic stimulation: brain modulation in tinnitus.


Transcranial magnetic stimulation and extradural electrodes implanted on secondary auditory cortex for tinnitus suppression.
Methodological considerations in treatment evaluations of tinnitus distress: a call for guidelines. A systematic review and meta-analysis of randomized controlled trials of cognitive-behavioral therapy for tinnitus distress. Effect of daily repetitive transcranial magnetic stimulation for treatment of tinnitus: comparison of different stimulus frequencies. Transcranial magnetic stimulation (TMS) for treatment of chronic tinnitus: clinical effects.
Sulpiride and melatonin decrease tinnitus perception modulating the auditolimbic dopaminergic pathway. Effects of repetitive transcranial magnetic stimulation on chronic tinnitus: a randomised, crossover, double blind, placebo controlled study. Drug treatments for subjective tinnitus: serendipitous discovery versus rational drug design. Hearing aids may also reduce the tinnitus, because they provide input to the nervous system that may reverse some of the plastic changes from deprivation of sound that has caused tinnitus and may counteract the deprivation of sound that causes some forms of tinnitus.
It was therefore of great advantage in the treatment of some forms of tinnitus, occurring together with hearing loss, when devices that provide sound delivered directly to the middle ear bones or directly into the cochlea were developed. This vibration in turn caused the eardrum to vibrate and allowed sound to be transduced to the cochlea in normal fashion. All patients continue to use their middle ear implant as of August 2009 without any technical problems. The participants had sensorineural hearing loss at high frequencies and tinnitus and had been given middle ear implants. With the activation of both audio processors, the annoyance due to tinnitus diminished, and the quality of life improved. Immediately after the fitting process, the patient’s tinnitus disappeared completely after switching on the device.
This means that the effect of the implanted hearing aids on tinnitus is similar to that of cochlear implants. Methoden zur Erfassung tinnitusspezifischer Beeintrachtigungen und Prasentation des Tinnitus- Beeintrachtigungs-Fragebogens (TBF-12).
Many people can hear their heartbeat — a phenomenon called pulsatile tinnitus — especially as they grow older, because blood flow tends to be more turbulent in arteries whose walls have stiffened with age.
The main components of TRT are individual counseling (to explain the auditory system, how tinnitus develops, and how TRT can help) and sound therapy. Individual studies have reported improvements in as many as 80% of patients with high-pitched tinnitus. In two small trials, rTMS compared with a sham procedure helped improve the perception of tinnitus in a few patients.
Tinnitus may have a significant negative impact on the life quality of those affected by it. Different research groups have concluded that chronic tinnitus may be associated with an impaired connection between the cerebral cortex, which controls advanced functions such as memory, perception of the environment and cognition, and the thalamus, which supplies the cortex with sensory information.
A recent study, including 974 patients, indicated that hearing aids were preferable and more effective in treating blast-related tinnitus compared to noise generators. Presuming further research confirms the findings of these studies, deep brain stimulation (a form of implant placed in the brain to correct this activity) may be a viable option for severe treatment-resistant tinnitus. A blood vessel may be close to the eardrum, a vascular tumor such as a glomus tumor may fill the middle ear, or a vein similar to a varicose vein may make enough noise to be heard. For example, after you have been to a loud rock concert you may experience tinnitus for a while in association with dulling of hearing. Tinnitus may be heard when there is a temporary conductive hearing loss due to ear infection or due to blockage of the ear with wax, or may be associated with any other cause of conductive hearing loss. Transelectrical nerve stimulation (TENS) is the application of a small electrical force to the skin near the ear, in an effort to affect the cochlear nerve. If you can ignore tinnitus rather than obsess about it, this may be the best way to handle it. It was surprising that most patients, who simultaneously suffered from tinnitus, reported that the middle ear implant largely reduced their tinnitus which could not have been achieved by traditional hearing aids. Although they were once greatly bothered and annoyed by the tinnitus, the activation of the device gave complete relief. Pulsatile tinnitus may be more noticeable at night, when you're lying in bed, because more blood is reaching your head, and there are fewer external sounds to mask the tinnitus. The resulting electrical noise takes the form of tinnitus — a sound that is high-pitched if hearing loss is in the high-frequency range and low-pitched if it's in the low-frequency range. Tinnitus can be a side effect of many medications, especially when taken at higher doses (see "Some drugs that can cause or worsen tinnitus").
A device is inserted in the ear to generate low-level noise and environmental sounds that match the pitch, volume, and quality of the patient's tinnitus.
In a Cochrane review of the one randomized trial that followed Jastreboff's protocol and met the organization's standards, TRT was much more effective in reducing tinnitus severity and disability than a technique called masking (see below). If the tinnitus goes away and hearing seems to come back, this is called a temporary threshold shift. Tinnitus is typically associated with the fluctuation in hearing that occurs with Meniere’s disease. Masking of the sound by providing noise from the outside was a popular area of focus in the treatment of tinnitus for several years, but has not proven long-term to be the solution to cure that was hoped. Occasionally persons with Meniere’s disease have relief or reduction of tinnitus from transtympanic gentamicin.
They were studied for 1 year using a visual analogue scale (VAS), Goebel–Hiller score [19], and the Tinnitus Handicap Inventory (the German TBF-12 [20, 21]). Many people worry that tinnitus is a sign that they are going deaf or have another serious medical problem, but it rarely is. If you notice any new pulsatile tinnitus, you should consult a clinician, because in rare cases it is a sign of a tumor or blood vessel damage.
This kind of tinnitus resembles phantom limb pain in an amputee — the brain is producing abnormal nerve signals to compensate for missing input. An enlarged jugular bulb on the involved side is common in persons with venous type pulsatile tinnitus. Some permanent damage to the delicate hair cells in the inner ear has probably occurred from the noise trauma, so it is important that you prevent further injury from noise exposure. For example, the carotid artery (the main supply of blood to our brains) runs right next to the inner ear and yet we usually do not hear the pulse or heart sounds that are carried in the artery. Studies have shown that there is not a correlation between the loudness or pitch of the tinnitus and the degree to which it bothers the individual.
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. The interested reader is referred to Meng (2011) for a recent meta-analysis of TENS as a treatment for tinnitus.
Controlling the perception by ignoring it is such a simple and effective approach for most individuals that it is the first line of coping with tinnitus for the vast majority of people. Or, tinnitus which pulsates in time with your blood pulse may be due to a vascular problem that can be corrected. Steady, constant tinnitus is usually due to some cause of hearing loss, but people with no measurable hearing loss may hear tinnitus if they are in a totally quiet environment in which little sound is coming into their auditory system from the outside.



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