Glomus jugulare

January 1, 2011     Jeffrey D. Suh, MD, Ashley E. Balaker, MD, Brian D. Suh, MD, and Keith E. Blackwell, MD

A critical evaluation of Web sites offering patient information on tinnitus

January 1, 2010     Stephen M. Kieran, AFRCSI, Liam J. Skinner, FRCS (ORL-HNS), Martin Donnelly, FRCS (ORL-HNS), and David A. Smyth, FRCS (ORL-HNS)


The Internet is a vast information resource for both patients and healthcare professionals. However, the quality and content often lack formal scrutiny, so we examined the quality of patient information regarding tinnitus on the Internet. Using the three most popular search engines (google.com, yahoo.com, and msn.com), we found pertinent Web sites using the search term tinnitus. Web sites' accountability and authorship were evaluated using previously published criteria. The quality of patient information about tinnitus was assessed using a new 10-point scale, the Tinnitus Information Value (TIV). Statistical analysis was performed using the independent sample t-test (p ≤ 0.05). An electronic database of 90 Web sites was constructed using the first 30 English-language Web sites identified by each search engine. After duplicates and sites only containing links to other Web sites were eliminated, 39 remained. The mean score for accountability was 2.13 on scale of 0 to 7. The mean TIV was 5.0 on a scale of 0 to 10. Only 12 sites (30.8%) had their authors clearly identified. Twenty-two (56.4%) sites were sponsored by commercial interests or represented private practices. The mean TIV was significantly higher (p = 0.037) for noncommercial (personal, academic institution, or charity) sites (5.88 ± 2.39 SD) than those representing commercial interests (4.32 ± 2.10 SD). Tinnitus information available on the Internet is indeed variable, and care should be taken in recommending tinnitus Web sites to patients.

An approach to tinnitus management

October 31, 2008     Kenneth H. Brookler, MD, MS, FRCSC and Mohamed A. Hamid, MD, PhD

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


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


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.


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

Glomus tympanicum

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

Glomus tympanicum tumor

March 31, 2007     Troy Hutchins, MD; Enrique Palacios, MD

Ramsay Hunt syndrome, type I

March 1, 2007     Jagan Gupta, MD; Troy Hutchins, MD; Enrique Palacios, MD

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

Tinnitus and brain activation: Insights from transcranial magnetic stimulation

April 1, 2006     Renata Marcondes, MD; Felipe Fregni, MD, PhD; Alvaro Pascual-Leone, MD, PhD
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.
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