Tinnitus

Treatment of tinnitus with a customized acoustic neural stimulus: A controlled clinical study

May 31, 2008     Paul B. Davis, PhD, Ron A. Wilde, PhD, Lyndall G. Steed, PhD, and Peter J. Hanley, PhD
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Abstract

In patients with tinnitus, achieving consistently positive treatment results is a challenge. We conducted a controlled clinical study of a new treatment approach (Neuromonics Tinnitus Treatment) that involves the use of a customized neural stimulus. This stimulus is delivered to the patient in the form of a pleasant acoustic sensation that is spectrally modified according to each patient's individual audiometric profile. This treatment approach is provided as part of a structured rehabilitation program. In our study, patients who received the customized stimulus (Neuromonics group) reported significantly greater and more consistent alleviation of tinnitus symptoms than did patients who participated in a counseling and support program with and without delivery of a broadband noise stimulus (Noise+Counseling group and Counseling-Only group, respectively). After 6 months of treatment, 86% of the Neuromonics patients met the minimum criterion for clinical success, defined as an alleviation of tinnitus disturbance of at least 40% (as determined by the Tinnitus Reaction Questionnaire score). By contrast, only 47 and 23% of the Noise+Counseling and Counseling-Only groups, respectively, reported a successful result according to this criterion. Mean improvements in tinnitus disturbance scores in the Neuromonics, Noise+Counseling, and Counseling-Only groups were 66, 22, and 15%, respectively. The differences between the Neuromonics group and the control groups were statistically significant. Significant differences were observed in other clinical outcomes. Patient reports of user acceptability were more consistently positive in the Neuromonics group.

Neuroendocrine carcinoma of the jugular foramen

February 1, 2008     John P. Leonetti, MD, Mobeen A. Shirazi, MD, Sam Marzo, MD, and Douglas Anderson, MD
article

Abstract

We describe what might have been the first reported case of a neuroendocrine carcinoma of the jugular foramen. A 50-year-old woman presented with progressive left-sided sensorineural hearing loss, vertigo, pulsatile tinnitus, headaches, and ataxia. Magnetic resonance imaging revealed a 4-cm left-sided jugular foramen tumor. The patient underwent near-total resection of the tumor. Despite lower cranial nerve preservation, postoperative paralysis of cranial nerves IX and X occurred, and vocal fold medialization was performed 5 days later. The final pathologic diagnosis was neuroendocrine carcinoma. The patient was treated with concurrent chemotherapy and intensity-modulated radiation therapy. This article will discuss the pathologic features and the management of jugular foramen tumors, along with the differential diagnosis of these rare tumors.

Tympanometry

October 31, 2007     Mohamed Hamid, MD, PhD and Kenneth H. Brookler, MD, FRCSC
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Glomus tympanicum

May 31, 2007     Joe Walter Kutz Jr., MD; William H. Slattery III, MD
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Glomus tympanicum tumor

March 31, 2007     Troy Hutchins, MD; Enrique Palacios, MD
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Ramsay Hunt syndrome, type I

March 1, 2007     Jagan Gupta, MD; Troy Hutchins, MD; Enrique Palacios, MD
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Endolymphatic sac tumor: A report of 3 cases and discussion of management

January 1, 2007     Joni K. Doherty, MD, PhD; Mona Yong, MD; Dennis Maceri, MD
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Tinnitus and brain activation: Insights from transcranial magnetic stimulation

April 1, 2006     Renata Marcondes, MD; Felipe Fregni, MD, PhD; Alvaro Pascual-Leone, MD, PhD
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Abstract
The mechanisms underlying tinnitus are still not completely elucidated, but advances in neuroimaging and brain stimulation have provided us with new insights. Evidence suggests that tinnitus might actually be generated by central rather than peripheral structures. To illustrate the importance of brain activity changes in the pathology of tinnitus, we report the cases of 2 patients who experienced a recurrence/worsening of their tinnitus after they had undergone treatment for major depression with repetitive transcranial magnetic stimulation. We suggest that the tinnitus in these 2 patients was induced by changes in brain activity resulting from transcranial magnetic stimulation of the prefrontal cortex. We also review the pathophysiology and other aspects of tinnitus, focusing on associated brain reorganization.

A woman with a 42-year history of Ménière's syndrome

December 1, 2005     Kenneth H. Brookler, MD
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A study of prognostic factors in sudden hearing loss

September 30, 2005     Aydin Mamak, MD; Süleyman Yilmaz, MD; Harun Cansiz, MD; Ender Inci, MD; Ender Güçlü, MD; Levent Dereköylü, MD
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Abstract
We investigated the prognostic significance of the presence or absence of vertigo and tinnitus, the timing of the initiation of treatment, the type and severity of hearing loss, and age in 72 patients who had experienced sudden hearing loss. We found that the factors associated with a positive prognosis were the absence of vertigo, the presence of tinnitus, initiation of treatment within 7 days, a greater degree of hearing loss in the low frequencies, and a hearing loss of less than 45 dB. Age had no effect on prognosis.

Glomus tympanicum

August 31, 2005     John W. House, MD; Jose N. Fayad, MD
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The effect of stapedotomy on tinnitus in patients with otospongiosis

June 30, 2005     Adriana da Silva Lima, MD; Tanit Ganz Sanchez, MD, PhD; Renata Marcondes, MD; Ricardo Ferreira Bento, MD, PhD
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Abstract
Stapedotomy is primarily performed to treat hearing loss secondary to otospongiosis, although some patients find that the accompanying tinnitus is more bothersome than the hearing loss. We prospectively studied 23 consecutive patients with tinnitus secondary to otospongiosis who had undergone stapedotomy, and we compared their pre- and postoperative medical and audiologic findings. Patients' annoyance with their tinnitus was quantified by means of a visual analog scale, and their air-conduction thresholds were determined by measurements of a 4-frequency pure-tone average (0.5, 1, 2, and 4 kHz). Statistical analysis was performed using the paired Student's t test and Fisher's exact test. In the group as a whole, the mean tinnitus annoyance visual analog scores were 8.34 preoperatively and 1.56 postoperatively, a highly significant difference. Clinically, 22 of the 23 patients (95.7%) achieved satisfactory control of their tinnitus (improvement or complete resolution) following stapedotomy. With respect to hearing loss, all patients clinically improved postoperatively, and audiometry confirmed improvement at all 4 frequencies between 0.5 and 4 kHz. An air-bone gap of less than 10 dB was noted in 17 patients (73.9%). We conclude that in addition to improving hearing, stapedotomy also provides good control of tinnitus.
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