TINNITUS TREATMENT

DOC I NEED TINNITUS TREATMENT

Treatment depends on the type of hearing loss and degree of tinnitus.
A.Medicines and others
1.antianxiety or antidepressant medication

2.relaxation techniques help when stress is a factor.

3.Avoiding caffeine which may worsen symptoms.

4.Biofeedback may  diminish tinnitus in some patients.

5.Avoid aspirin  in large quantities

6.protection of hearing and avoiding loud noises

B.Non-invasive.
The treatment can be in the form of
1.hearing aid,
Hearing Aid  may have dual functions. It helps to improve hearing acuity, clearer speech understanding as well as to cover the tinnitus effect. However, it may be unsuitable for people with a reduced sound tolerance level, and sensitivity to loud, unpleasant sounds .

2.Tinnitus Retraining Therapy (TRT),
Tinnitus Retraining Therapy (TRT) has been widely used for many years.
The approach is to desensitize the tinnitus via a broadband tinnitus masker (such as the sound of a fan, radio, or white noise machine) along with a specific course of counselling to retrain the brain of sufferers until they are habituated to the tinnitus and it is no longer disturbing.

The therapy may be long-term and time-consuming.

3.Neuromonics tinnitus treatment -very successful in ‘desensitizing’ patients towards their tinnitus.
The sound stimulus is transmitted at specific intervals coordinated with embedded music  2-3 hours a day when the tinnitus is most disturbing.
The idea is to desensitize the brain’s limbic system until patients becomes used to it and get relief.
The treatment can occur while reading, relaxing, doing house chores, computer work or before going to bed. During the treatment process, patients are guided through an interactive and progressive programme of care with the audiologist, as they adjust to each stage of treatment. The audiologist will then assess the patients’ progress.

It is a 6 months program involving the following stages:
1.Pre-conditioning stage (first 2 months) – use of special shower sound to interact with the tinnitus.
2.Active stage (subsequent 4 months) – constant interaction with the tinnitus.

At the end of 6 months program, the sufferer enters the maintenance stage when he/ she can manage without clinical support.
Generally, the treatment involves stimulating the hearing pathways affected by tinnitus or hearing loss with a customized music therapy.

Over 90% reported:
a.A relief from their tinnitus
b.Ability to sleep well
c.A sense of control over their tinnitus
d.A decreased sound disturbance from tinnitus

4.Counselling & Educational Support
If the tinnitus is not serious, the patients can see a counsellor or a psychologist for direct counselling program, and educational support. The purpose is to provide :
a.advice and information about tinnitus;
b.explain what self-help strategies are available for patients and how they work;
c.current medical treatment and management,
d.availability of group support and facilities.

C.Surgery
Surgery of the acoustic nerve to block the tinnitus only for individuals who're becoming or definitely deaf.

Other surgeries may be used when the tinnitus is caused by a tumor across the ear,  the tumor is usually eliminated.

Prognosis:
Depending on the type of tinnitus, symptoms will tend to recur over time.
Stress level, diet, and  noise exposure can worsen tinnitus.
Many people find their tinnitus annoying but can learn to adapt without difficulty.

Prevention:
1.Protect your hearing at work.
2.When around any noise that bothers your ears (a concert,  hunting), wear hearing protection or reduce noise levels.
3.Everyday noises such as blow drying the hair or using a lawnmower can require noise protection.Keep ear plugs or earmuffs handy for these activities.

TINNITUS

DOC I HAVE TINNITUS

Tinnitus is the symptom of perception of sound in the human ear or head in the absence of external sounds.
It is not a illness.
The sound is sometimes accompanied by hearing loss and dizziness in a syndrome known as Meniere's diseas

It affects a large proportion of adult population.
Almost 12 percent of men who are 65 to 74 years of age are affected by tinnitus.
1.Construction site workers
2.MP3 player users
3.Rock concert goers
4.Gun and rifle users

The causes of Tinnitus are:
1.hearing loss is the most common cause.
Age or trauma to the ear (through noise, drugs, or chemicals)cause the damage of the portion of the ear for hearing (the cochlea) becomes damaged.
Because the cochlea do not send the normal signals to the brain, the brain becomes confused and essentially develops its own sound (the tinnitus) to make up for the lack of normal sound signals.

2.ear trauma is usually noticed in both ears, because both ears are usually exposed

3.the harmful effects of excessively loud noise from firearms, high intensity music, or other sources is a very common cause of tinnitus because of  hearing damage

4.ear infection or excess wax in the ear can affect  the ear.

5.drugs such as aspirin (if overused), aminoglycoside antibiotics and quinine may damage the hearing nerve.

6.brain tumor known as an acoustic neuroma which grow on the nerve that supplies hearing can cause tinnitus.
This tinnitus usually affects one ear unlike  the hearing loss  seen in both ears.

Signs & Symptoms
The sound that they perceive in the ear or head has been described as:
1.ringing,
2.whistling,
3.vacuuming,
4.hammering,
5.buzzing
6.humming sounds.

About 2% of tinnitus sufferers have:
1.Disturbed sleeping patterns.
2.Anxiety and depression.
3.Inability to relax and concentrate.
4.Sensitivity to loud sounds and noises.
5.A negative impact on work, family and social life.

An ENT doctor may be consulted for tinnitus:

1.When medical and/or surgical contraindications are not present.
2.family members are worried or concerned about the “non-stop” tinnitus.
3.Your sleep, concentration and general health is affected.

Exams and Tests
1.complete history and physical examination of the head and neck
2.A complete hearing test (audiogram)
3.auditory brainstem response
4.brain scan such as a computerized tomography (CT) scan or magnetic resonance imaging (MRI) may also be required.
5.blood tests for hyperthyroidism may be taken.
6.spinal tap may be rarely performed to measure the fluid pressure in the skull and spinal cord.

A Simple Guide to Meniere's Disease

A Simple Guide to Meniere's Disease
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What is Meniere's Disease?
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Meniere's Disease is a disease of the inner ear which is characterised by the triad of episodic vertigo(giddiness), tinnitus(buzzing sound in ear) and progressive hearing loss.

It is more common in adults between 30-60years of age and in men more than women.

It usually occurs more in one ear.

What are the causes of Meniere's Disease?
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The exact cause of Meniere's Disease is unknown.

It is believed to be due to distension of the membranous labyrinth with increased pressure and fluid in the endolymph of the inner ear.

As a result the balance in one ear is affected leading to dizzines

The possible triggers of this condition may be:

1.middle ear infection,
2.head injury
3.upper respiratory tract infection
4.the effect of aspirin,
5.smoking
6.alcohol
7.caffeine
8.salt

Some invetigators believed that there is a link with the herpes zoster virus which is activated when the immune system is low, resulting in inflammation of the eight nerve(hearing).

What are the symptoms and signs of Meniere's Disease?
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Symptoms:
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The classical triad of symptoms are:

1.recurrent bouts of vertigo of varying degrees which may last from hours to days.
Recurrences may be as often as 1 week to several years.

2.Slow progressive loss of hearing in one ear or rarely in both ears starting at low pitch sounds first.

3.Unilateral tinnitus (buzzing sound in one ear), sometimes in both ears

Beides these symptoms, there is also :

4.feeling of pressure9fullness) in one or both ears.

5.Nausea and vomiting sometimes occur with the vertigo

6.hypersensitivity to sound

7.nystagmus(uncotrollable jerky eye movements)

8.cognitive performance

How is the diagnosis of Meniere's Disease established?
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1.classical history

2.audiometry shows impairment of hearing

3.MRI scan of the head - to exclude a tumour of the eighth cranial nerve (vestibulocochlear nerve)

What is the Treatment of Meniere's Disease?
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Initial treatment:

1.Acute attacks are treated symptomatically with injections of stemetil, maxolon, dimenhydrinate


Other treatments:
1. Oral stemetil, maxolon, dimenhydrinate

2. mild diuretic

3.vitamin B6

4.antihistamines,

5.anticholinergics,

6.corticosteroids orally or injection of steroid medication behind the eardrum

7.Bed rest

8.stress reduction.

9.low-sodium diet.

10.avoid caffeine, alcohol and cigarettes



Surgery :
is only required if the above treatment does not control the vertigo

1.Decompression of the endolymphatic sac may help to relieve symptoms.

2.Permanent surgical destruction of the balance part of one ear may be done where the disease is severe and affects one ear.
This usually causes permanent deafness.

a.chemical labyrinthectomy: a drug (such as gentamicin) that can cause destruction of the balance portion of the inner ear is injected into the middle ear.

b.vestibular neurectomy where section of the nerve to the balance portion of the inner ear is done surgically

c.surgical removal of the inner ear (labyrinthectomy).

Usually balance returns to normal after sugery but hearing may be permanently damaged in one ear.

3.In the belief that Meniere's disease is caused by herpes virus, acyclovir an antiviral drug is given and has been found to relieve symptoms.

What is the prognosis of Meniere's Disease?
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Symptoms may remain the same, worsen or disappear spontaneously.

1.Vertigo symptoms may be worse and more frequent but sometimes disappear spontaneously.

2.Hearing symptoms usually become worse and patients may become deaf in the affected ear.

3.Tinnitus usually is more pronounced with time.

A Simple Guide to Dizziness

A Simple Guide to Dizziness
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What is Dizziness?
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Dizziness has been used to describe different sensations.
Some may liken it to giddiness, light-headedness, unsteadiness or simply feeling faint.

The symptom of "dizziness" needs to be separated from vertigo, which is a feeling that the room is moving or spinning, or that the person is moving when they are not (or even a floating sensation).

Balance difficulty is also a separate topic where a person feels they are about to fall, has difficulty staying balanced, or may actually fall.

What are the Causes of Dizziness?

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There are many causes of dizziness:
1.insufficient blood flow to the brain

2.Lack of sleep

3.Low blood sugar

4.Low or very high blood pressure

5.Anaemia

6.Fever

7.Stress & Anxiety

6.Cochlea imbalance(Motion Sickness)

7.Cold or Influenza

8.heart disease9. Medicines

10.Brain condition such as Parkinson,brain tumours

Most dizzy spells are minor and go away after a while.

However, dizziness can also point to more serious disorders. These include:

1.Vertigo

There is a spinning sensation or feeling that your surrounding is moving around you.

It is often accompanied by nausea and vomiting.

Nystagmus, a jerky movement in the eye, is a common sign.
Vertigo often indicates an inner ear problem.

Viruses, such as those causing the common cold or flu, can also attack the inner ear and its nerve connections to the brain, resulting in severe vertigo.
In a more serious case, a bacterial infection such as mastoiditis can make a person lose his hearing and sense of balance.
Poor blood flow to the inner ear can also lead to vertigo. This is often due to the hardening of the arteries (arteriosclerosis) which is commonly seen in patients with diabetes, high blood pressure or high blood cholesterol.

2.Light-headedness

A typical form of light-headedness occurs when you stand up too fast for the blood to reach your brain. This form of light-headedness is often transient and harmless. More persistent forms of light-headedness can be caused by:

Loss of body fluids, for instance, loss of water in excessive sweating.

Changes to your blood pressure caused by medicines such as anti-hyptensives, diuretics and anti-depressants.

Medical conditions such as diabetes, Parkinson's disease and Anaemia.

3.Motion sickness or sea-sickness

People prone to this condition can experience nausea and even vomiting when travelling in cars, airplanes, boats, or ships.
Motion sickness occurs when the central nervous system receives conflicting messages from four different systems of the body. They are the inner ears, the eyes, pressure receptors in our skin and sensory receptors in the muscles and joints.

It is the complex interaction of these four systems that gives us our sense of balance and equilibrium.

The inner ears, specifically the three semicircular canals in each ear, detect motion in three dimensions, that is, forward-backward, up-down, and left-right.

The central nervous system (that is, the brain and spinal cord) receives all the information from the four systems to make some sense of the body's position in relation to the environment.
Thus, if you are sitting in the back seat of a moving car, your inner ears and skin receptors will detect the motion of your travel. And if your eyes see the same motion, you will not become "car sick". But if you are reading in the car, your eyes see only the pages of your book, so your brain receives conflicting signals and you become "car sick."

How to diagnose Dizziness?
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History:
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1.duration of dizziness - to determine if acute or chronic.

2.any evidence of vertigo i.e. episodic sudden sensation of circular turning motion of your body or your surroundings - this is a sign of nervous system or ear disease.

3.sensation of lightheadedness, floating, giddiness, unsteadiness, fainting - all known as pseudovertigo and are more likely to be a sign of cardiovascular disease. 4.occasional dizziness episodes - e.g. benign positional vertigo attacks are brief, usually lasting a minute, and then subside rapidly.

5. Continous dizziness episodes may indicate Meniere's syndrome which is characterized by paroxysmal attacks lasting 30 minutes to several hours of vertigo, tinnitus, nausea and vomiting, sweating and pallor and progressive deafness.

6. effect of position (of head or body) or a change in posture on the dizziness - e.g. benign positional vertigo is a common type of vertigo that is induced by changing head position, especially tilting the head backwards, changing from lying to sitting position or turning to the affected side.

Physical examination

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1.Observe for pallor of skin or conjunctiva. Moderate or severe anemia will cause lightheadedness and dizziness, but usually not true vertigo

2.Blood pressure taken when lying down and again after rapidly arising to standing position. Very High blood pressure may cause true vertigo or lightheadedness.

Low blood pressure or postural drop in blood pressure is more likely to cause lightheadedness not true vertigo

3.Examine the ear for abnormalities. Abnormalities on ear examination with no other abnormalities found on nervous system examination may suggest ear wax, otitis media (middle ear infection), cholesteatoma or petrositis

4.Complete nervous system examination should be performed including visual acuity, inspecting for nystagmus, cranial nerve and cerebellar signs.

If abnormalities are found may suggest multiple sclerosis, advanced brain stem tumor, acoustic neuroma or basilar artery insufficiency

What is the Treatment of Dizziness?
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Treatment of dizziness depends on whether the symptom indicates a more serious condition.

Most cases of dizziness and motion sickness are mild and self-treatable disorders.

1.Medications given usually act to balance the inner ear nerves or increase blood flow to the inner ear. Iron and vitamin supplements may be given to treat anaemia.

Other than medicines, the following may relieve some of your discomfort:
2.Avoid rapid changes in position, especially standing up quickly from lying down or turning around from one side to the other.

3.Avoid extremes of head motion (especially looking up) or rapid head motion (especially turning or twisting).

4.Remove or reduce using products that impair circulation, e.g. nicotine, caffeine, and salt.

5.Avoid stress or anxiety, or substances that can trigger dizziness. These include substances that you are allergic to.

6.Avoid hazardous activities such as driving a car, operating dangerous equipment or climbing a ladder.
7.Avoiding motion sickness

Always travel in a manner such that your eyes will see the same motion that your body and inner ears feel.

When in a car, look forward into the distance.

On a ship, watch the horizon

In a plane, choose the window seat if you can, and look out of the window.
Do not read while travelling and do not sit in a seat facing backwards.

8.Treating balance disorders

The main way is to treat the underlying disease or disorder that may be causing the imbalance in the first place. These diseases include ear infection, stroke, multiple sclerosis and other diseases of the nerve.