Combined tinnitus therapy

Ales Hahn

Ivan Sejna. Lenka Sommerova, Gabriela Valesova

Charles University Prague, 3rd Medical Faculty

ENT Dept.

Czech Republic

Introduction

Sensory disturbances: Complicate patients life Contemporary negative factors (environmental, life style, etc.) Comorbidity of the patients => 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

Diagnostic protocol at ENT Dpt. Royal Vineyards

Subjective data - patient´s 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.

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 %

Therapeutic methods IPharmacotherapy

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

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 761+LASER+RHB

Follow-up

3-4 times per year

Similar therapy as it has been given in infusion

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)

Duration of acute tinnitus

Duration of chronic tinnitus

Type of hearing loss

Visual Analog Scale (VAS)

Subjective changes of tinnitus after therapy

without effect: 34%

improvement: 60%

impairment: 6%

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

Comparison of subjective therapy effect - pharmacotherapy 1

Comparison subjective effect of therapy- pharmacotherapy 2

Acute tinnitus Chronic tinnitus

Lidocain vs. Cavinton, RHB

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

Thank you for your attention...