倍他司汀联合盐酸氟桂利嗪治疗耳鸣的效果观察

目的观察使用倍他司汀联合盐酸氟桂利嗪对耳鸣的治疗效果和安全性,以提高耳鸣的治疗效果。方法2011年2月～2012年11月收治的70例耳鸣患者随机分为两组,实验组（35例）患者使用倍他司汀联合盐酸氟桂利嗪治疗;对照组（35例）患者单独使用盐酸氟桂利嗪治疗,比较两组患者的治疗效果。结果实验组总有效31例,对照组总有效15例,两组患者的治疗效果比较,差异具有统计学意义（P〈0．05）;实验组患者的不良反应与对照组患者比较,差异无统计学意义（P〉0．05）。结论使用倍他司汀联合盐酸氟桂利嗪对耳鸣患者进行治疗具有较好的治疗效果,且安全性更高,值得临床推广。     

The low-power laser in the treatment of tinnitus

The purpose of this study was to evaluate the low-power laser on the treatment of tinnitus. In a randomized, prospective, double-blind, placebo-controlled trial, either active or placebo low-power laser irradiation was given through the external acoustic meatus of the affected ear towards the cochlea. The active laser applied 50mW (cw, 830 nm) over a period of 10 min per session. Forty-nine patients with severe, chronic uni- or bilateral tinnitus were studied. The main outcome was measured using psychoacoustical match of tinnitus loudness and pitch, Visual Analogue Scale (VAS) ratings of subjective loudness, annoyance and attention involved, scores on the Tinnitus Handicap Inventory (THI), the Tinnitus Coping Style Questionnaire (TCSQ), and a number of psychosocial questionnaires. The results showed only moderate (18%) subjective improvement with no statistically significant differences between the effects of the active laser and placebo treatments. Also, there were no statistically significant differences in prepost measurements of tinnitus loudness, VAS scores, THI scores, or TCSQ scores for patients treated with active laser compared with those treated with placebo. We conclude that low-power laser treatment is not indicated in the treatment of tinnitus. Reports of significant benefits of this treatment in previous, mostly uncontrolled or single-blinded studies may be explained by the placebo effect.     

The medical treatment of tinnitus

Currently there are three methods of treating patients with intractable tinnitus, a physical one using masking (Vernon, 1977), a psychosomatic method using biofeedback (House et al., 1977), and a chemical treatment using intravenous lidocaine and the oral anticonvulsants--carbamazepine, primidone and lidocaine amine. The latter seems to be the most promising, being easier to use, less time-consuming, more accurate to assess, and relying less on the patient's active participation and intelligence. The only disadvantages of the chemical method are the serious side-effects of the drugs in use. This can be managed by careful administration of these drugs and monitoring of the patient. In the future, new anticonvulsants with fewer side-effects will certainly be produced. It may be that chemical treatment can be combined with the masking and/or the biofeedback methods with a synergistic result. Another possible use of carbamazepine is in the treatment of palatal myoclonus and other similar disorders. Further clinical studies are needed to corroborate this application of the treatment.     

Use of betahistine in the treatment of peripheral vertigo

Conclusion: Clinical studies and meta-analyses demonstrated that betahistine is effective and safe in the treatment of Ménière’s disease, BPPV (benign paroxysmal positional vertigo), vestibular neuronitis, and other types of peripheral vertigo. Objectives: The goal of this paper is to review the pharmacological profile of betahistine and the evidence for its effectiveness and safety in the treatment of peripheral vertigo. Methods: Selection criteria for the publications on betahistine included randomized clinical trials that evaluated the effectiveness and safety of betahistine vs placebo or active control in the treatment of peripheral vertigo. Recent meta-analyses were also included. Databases searched included PubMed, the Cochrane Ear, Nose and Throat Disorders Group Trials Register, and ICTRP. The review also presents an update on the mechanisms of action, pharmacodynamics, and pharmacokinetics of betahistine. Results: Efficacy and safety of betahistine has been demonstrated in numerous clinical trials. The precise mechanism of action of betahistine is still not completely understood, but the clinical experience demonstrated the benefit of betahistine in different types of peripheral vertigo. In more than 40 years of clinical use, betahistine has shown an excellent safety profile with the usual dose range from 8–48 mg daily. According to clinical studies, betahistine 48 mg daily during 3 months is an effective and safe option for the treatment of peripheral vertigo.     

The value of flunarizine in the treatment of tinnitus

The suppressive effect of flunarizine on tinnitus was assessed in a double-blind trial in 50 patients with tinnitus due to various causes. The duration of the study was 6 weeks. Serum levels of the drug were determined. The patient's subjective assessment of the effect was taken as criterion for the evaluation; objective tests were found to be unsuitable for this purpose. Ten of the patients suffered from dizziness as a secondary complaint. For the group as a whole, there was no difference between flunarizine and the placebo with respect to the effect on tinnitus, but in the 10 patients with dizziness as well there was a significant difference in favor of the drug. Conclusions cannot be drawn as to the reason for this divergence, because the number of patients was too small.     

The value of tocainide in the treatment of tinnitus

Summary We assessed the value of tocainide in the treatment of tinnitus by performing a double-blind controlled trial in which each of 48 patients with annoying tinnitus received either tocainide HCl 900 mg/day or a placebo. Before the trial, the effect of intravenous lidocaine was evaluated in each patient so that both lidocaine and tocainide could be compared in altering tinnitus. We found that tocainide appeared to have no better effect than the placebo, whereas lidocaine suppressed tinnitus in 81% of the patients treated. The mechanisms of action of both drugs as well as their influence on tinnitus are discussed, as are the side effects of tocainide.     

The value of carbamazepine in the treatment of tinnitus

A double-blind controlled trial on the use of oral carbamazepine in the treatment of tinnitus is reported. The effects of carbamazepine and intravenous lidocaine on tinnitus were compared. Carbamazepine had less effect than the placebo.     

血管源性耳鸣诊断及治疗

目的探讨血管源性耳鸣(vascular tinnitus,VT)客观检测的临床应用和治疗效果。方法采用血管源性耳鸣与心电图同步监测技术(VT-ECG),对VT组46例,对照组60例(主观性耳鸣30例,正常人30名)进行了检测及分析。部分VT患者予以中药治疗,并对46例VT相关病因进行分类。结果VT-ECG同步监测技术与听诊器听诊和声阻抗声顺异常的检查阳性率分别为95.4%,25.6%和4.7%;VT病因主要为三类(动、静脉性、心输出量增加性、不明原因);部分患者服用中药治疗有效率为63.7%。结论血管源性耳鸣与心电图同步监测可对VT的诊断和疗效评估提供帮助;中药治疗对VT有效。     

Electroencephalographic evaluation of acoustic therapies for the treatment of chronic and refractory tinnitus

Background

To date, a large number of acoustic therapies have been applied to treat tinnitus. The effect that produces those auditory stimuli is, however, not well understood yet. Furthermore, the conventional clinical protocol is based on a trial-error procedure, and there is not a formal and adequate treatment follow-up. At present, the only way to evaluate acoustic therapies is by means of subjective methods such as analog visual scale and ad-hoc questionnaires.

Methods

This protocol seeks to establish an objective methodology to treat tinnitus with acoustic therapies based on electroencephalographic (EEG) activity evaluation. On the hypothesis that acoustic therapies should produce perceptual and cognitive changes at a cortical level, it is proposed to examine neural electrical activity of patients suffering from refractory and chronic tinnitus in four different stages: at the beginning of the experiment, at one week of treatment, at five weeks of treatment, and at eight weeks of treatment. Four of the most efficient acoustic therapies found at the moment are considered: retraining, auditory discrimination, enriched acoustic environment, and binaural.

Discussion

EEG has become a standard brain imaging tool to quantify and qualify neural oscillations, which are basically spatial, temporal, and spectral patterns associated with particular perceptual, cognitive, motor and emotional processes. Neural oscillations have been traditionally studied on the basis of event-related experiments, where time-locked and phase-locked responses (i.e., event-related potentials) along with time-locked but not necessary phase-locked responses (i.e., event-related (de) synchronization) have been essentially estimated. Both potentials and levels of synchronization related to auditory stimuli are herein proposed to assess the effect of acoustic therapies.

Trial registration

Registration Number: ISRCTN14553550. ISRCTN Registry: BioMed Central. Date of Registration: October 31st, 2017.

     

The medical audiological evaluation of tinnitus patients

We outline our routine approach to tinnitus patients, highlighting the different aspects of our examination: the clinical history, objective ear, nose, and throat and general examination, and audiovestibular testing. We emphasize the interest in testing not only the cochlear but the vestibular function of the inner ear. In our view, this testing is of paramount importance, for the cochleovestibular system is a unit, acting as a whole. All these data are stored in a database bank. Then we present our preliminary results. Currently, we have 83 patients suffering from tinnitus, and their results are statistically presented. We characterize the population in terms of its gender distribution and mean age. The localization and characteristics of tinnitus and the associated symptoms also are noted. The results of the audiovestibulometric examinations-pure-tone audiometry, vocal audiometry, and brain evoked response audiometry craniocorpography and electronystagmography are discussed. We concluded that many tinnitus patients, even those who had no vestibular symptoms, showed some disturbances in the vestibular tests. This fact highlights the need for a complete cochleovestibular investigation in all patients complaining of tinnitus.     

The low-power laser in the treatment of tinnitus.

The purpose of this study was to evaluate the low-power laser on the treatment of tinnitus. In a randomized, prospective, double-blind, placebo-controlled trial, either active or placebo low-power laser irradiation was given through the external acoustic meatus of the affected ear towards the cochlea. The active laser applied 50 mW (cw, 830 nm) over a period of 10 min per session. Forty-nine patients with severe, chronic uni- or bilateral tinnitus were studied. The main outcome was measured using psychoacoustical match of tinnitus loudness and pitch, Visual Analogue Scale (VAS) ratings of subjective loudness, annoyance and attention involved, scores on the Tinnitus Handicap Inventory (THI), the Tinnitus Coping Style Questionnaire (TCSQ), and a number of psychosocial questionnaires. The results showed only moderate (18%) subjective improvement with no statistically significant differences between the effects of the active laser and placebo treatments. Also, there were no statistically significant differences in prepost measurements of tinnitus loudness, VAS scores, THI scores, or TCSQ scores for patients treated with active laser compared with those treated with placebo. We conclude that low-power laser treatment is not indicated in the treatment of tinnitus. Reports of significant benefits of this treatment in previous, mostly uncontrolled or single-blinded studies may be explained by the placebo effect.     

Medical evaluation of tinnitus

It has been estimated that 15% of the population in the United States has tinnitus which lasts greater than 5 minutes. It has also been estimated that 155 million patients have previously sought care for this symptom. It is clear that the incidence of tinnitus increases with age and by 70 years of age at least 25 to 30% of patients experience tinnitus constantly. In addition, noise exposure and noise induced sensorineural hearing loss are most often seen in tinnitus patients. Furthermore, of interest to the physician, 94% of patients who have sought medical care have not been offered treatment for their tinnitus, rather they have been informed that nothing could be done for them, and they should "live with it".     

The use of flupirtine in treatment of tinnitus

CONCLUSION: Flupirtine, a functional NMDA antagonist, does not seem to be efficacious in the treatment of tinnitus. OBJECTIVES: The purpose of this study was to investigate whether flupirtine has any beneficial effect on tinnitus perception. PATIENTS AND METHODS: Twenty-four patients were selected (6 female and 18 male patients) with continuous subjective tinnitus. Eight patients suffered left-sided tinnitus, 4 right-sided tinnitus and 12 bilateral tinnitus. We assessed the burden of the tinnitus by loudness visual analogue scale (VAS) and tinnitus questionnaire (TQ) according to Hallam et al., and Hiller and Goebel. All patients were treated with a 2 x 100 mg daily dosage of oral flupirtine for 3 weeks in an open prospective design. RESULTS: There was no statistical effect on VAS and TQ of the treatment with flupirtine. Only one patient (4.2%) experienced a positive effect on the tinnitus but discontinued the treatment because of amnesia and concentration disorders.     

The use of sodium enoxaparin in the treatment of tinnitus

Tinnitus is a pathological event caused by abnormal stimulation of any point along the acoustic pathway. Generally, it produces a sharp tone accompanied by hearing impairment. Currently, no widely used standard protocol for treatment of this condition exists, and vascular microthrombotic factors are considered as the main determinants. Prompted by such observations, we implemented a protocol using an anticoagulant, sodium enoxaparin. It is a kind of heparin with a low molecular weight and is endowed with antithrombotic activity. We studied 40 patients (ages 20-65 years) who had been experiencing tinnitus for at least 2 months. We divided patients into two groups: To the first group, enoxaparin was administered for 10 days; the patients in the second group were treated with traditional therapy (corticosteroids, vasoactive agents, multivitamins, and anticoagulants). At the beginning and at the end of the therapy period, the patients were evaluated by instrumental examinations. All patients treated with anticoagulant therapy have shown an evident abatement of their tinnitus symptom. No patient experienced side effects from this treatment. The results indicate that administration of sodium enoxaparin is an excellent mode of therapy for patients with tinnitus.     

The contribution of otoneurological evaluation to tinnitus diagnosis

Tinnitus has been reported for nearly 80% of patients referred to the otolaryngology services. Usually, its evaluation is based on tonal and vocal audiometry, tympanometry, brainstem-evoked potentials, electrocochleography, and otoacoustic emissions. However, as the cochleovestibular system works as a unit, the use of vestibular tests has been proposed to evaluate tinnitus. Many patients with tinnitus have altered vestibular test results even in the absence of vestibular symptoms. This finding accounts for the indication of complete vestibular and audiological evaluation of tinnitus. The aim of this study is to analyze the contribution of otoneurological evaluation in the diagnosis of tinnitus. Patients were selected and divided into two groups. Group 1 was composed of patients complaining about tinnitus only, whereas group 2 was composed of patients with tinnitus associated with dizziness, hearing loss, and fullness. All submitted to otoneurological evaluation based on directed clinical history, physical examination, tonal and vocal audiometry, tympanometry, and vestibular examination. A total of 195 patients were analyzed. The otoneurological evaluation was conclusive in the diagnosis in 48 cases (75%) in group 1 and in 94 cases (72%) in group 2. The present study showed that otoneurological evaluation contributes to the etiological diagnosis of tinnitus.     

The use of intravenous lignocaine in the diagnosis and treatment of tinnitus

The effect of intravenous lignocaine upon the symptom of tinnitus has been assessed in seventy-eight patients and the results correlated with associated hearing loss. Lignocaine appears to be highly effective in suppressing tinnitus in patients with presumed damage or degeneration of the Organ of Corti and is less effective in other groups. It is postulated that tinnitus in patients with Organ of Corti damage is the result of abnormal hyperactivity in the auditory pathway following deafferentation.     

The effect of fibromyalgia treatment on tinnitus

ObjectivesWe investigated the frequency of tinnitus in fibromyalgia patients and the effect of drugs used for routine fibromyalgia on tinnitus.MethodsWe included 101 diagnosed fibromyalgia patients. After detailed ear nose throat examination, audiometric tests and tinnitus handicap index (THI) were performed. After the tests, routine treatment for fibromyalgia was started by the physical therapy and rehabilitation department. Two months after the beginning of the treatment, THI were repeated again and the results were statistically evaluated.ResultsAll patients included in the study were women. 74.3% of the patients had tinnitus. Pregabalin and selective serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressant-treated patients were evaluated; In both groups, there was a statistically significant difference between pre- and post-treatment tinnitus levels (p < .001). However, there was no statistically significant difference between pregabalin group and diloxetine group according to treatment results.ConclusionsThe incidence of tinnitus is high in fibromyalgia patients. That pregabalin and duloxetine agents routinely used in fibromyalgia require further experimental and human studies in order to be able to use in tinnitus.