Combined tinnitus therapy

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Combined tinnitus therapy

• Ales Hahn
• Ivan Sejna. Lenka Sommerova, Gabriela Valesova
• Charles University Prague, 3rd Medical Faculty
• ENT Dept.
• Czech Republic

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Introduction

• Sensory disturbances
• Complicate patients life
• Contemporary negative factors (environmental,
  life style, etc.)
• Comorbidity of the patients gt often polypragmasy
• Tinnitus as a symptom
• Troubles patients
• Difficult to treat
• Usually associated with hearing loss
• In this study we would like to evaluate the
  effect of the various therapeutical modalities

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Diagnostic protocol at ENT Dpt. Royal Vineyards

• Subjective data - patients evaluation of
  tinnitus, history
• Otomicroscopy
• Audiometry-vestibulometry
• PTA, SA
• BERA
• Tinnitometry - intensity (dB) and frequency (Hz)
• Facultative/additional
• ENG, calorimetry, rotatory tests, CCG, CPG
• Complementary Examinations
• Neurology
• Internal
• Labs
• X-ray (CT, NMR), etc.

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Material and Methods

• In 2001- 2003 we treated a group of 121
  in-patients with audiometrically defined
  tinnitus. Single method or combination of methods
  was used for tinnitus treatment.
• Mean age
• men 52 years (16- 77 years)
• women 54 years (16- 81 years)
• Mean duration of treatment 7 days (4- 14 days)
• Mean duration of tinnitus 6,9 years (1 day- 80
  years)
• Type of hearing loss (tinnitus combined with
  hearing loss in 75 )
• apicocochlear 4
• basocochlear 50
• pancochlear 21

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Therapeutic methods I

• Pharmacotherapy
• Vasoactive drugs
• Pentoxiphyllin
• Corticosteroids - Hydrocortison, Solumedrol
• Vinca alcaloids - Cavinton
• EGb 761 - Tanakan
• Local anestetics - Lidocain
• Rehabilitation of cervical spine
• Soft technics, postisometric relaxation,
  mobilisation, exercise
• Laser
• Surgery (IEC)
• Hyperbaric oxygenation
• Psychoterapy
• Alternative (acupuncture),Chinese
  Medicine
• Combined therapy

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Therapeutic Methods II

• Combined therapeutical approach
• Vasoactive drugs (PTXPH,VINCA,CORTICOIDS,EGb 761)
• Anaesthetic (LIDOCAIN)
• Physiotherapy (CERVICAL SPINE!)
• Physical Therapy (LASER
• Most used combinations
• PTXF (Vinca Minor) RHB
• LIDOCAIN RHB
• LIDOCAIN RHB LASER
• EGb 761LASERRHB
• Follow-up
• 3-4 times per year
• Similar therapy as it has been given in
  infusion

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Evaluation

• Subjective
• Visual Analog Scale (VAS)
• evaluation 3 times a day
• intensity 1 (minimal) .. 10 (maximal)
• character of tinnitus
• lenght of tinnitus
• Objective
• Audiometry
• Tinnitometry - frequency (Hz), intensity (dB)

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Duration of acute tinnitus
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Duration of chronic tinnitus
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Type of hearing loss
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Visual Analog Scale (VAS)
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Subjective changes of tinnitus after therapy

• without effect 34
• improvement 60
• impairment 6

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Objective changes of tinnitus after therapy

• Quite a big amount of non-classified cases
  includes
• tinnitus masking unsuccessful
• tinnitus located in a head
• tinnitus disappeared after headphones application
• pacient is unable to assess tinnitus intensity

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Comparison of subjective therapy effect -
pharmacotherapy 1
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Comparison subjective effect of therapy-
pharmacotherapy 2
Acute tinnitus Chronic
tinnitus
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Lidocain vs. Cavinton, RHB
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Discussion

• According to results is worth to treat both
  chronic and acute tinnitus
• Most effective is combination of methods
• In acute tinnitus treatment was the most
  effective Pentoxiphyllin
• In chronic tinnitus treatment was the most
  effective Corticosteroids

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Thank you for your attention...