An evaluation of tinnitus treatment

Myofascial trigger point:a possible way of modulating tinnitus

In order to investigate whether myofascial trigger points can modulate tinnitus, as well as the association between tinnitus and myofascial trigger points, 94 individuals with and 94 without tinnitus, matched by age and gender, were analyzed by means of bilateral digital pressure of 9 muscles. Temporary modulation of tinnitus was frequently observed (55.9%) during digital pressure, mainly in the masseter. The rate of tinnitus modulation was significantly higher on the same side of the myofascial trigger point subject to examination in 6 out of 9 muscles. An association between tinnitus and the presence of myofascial trigger points was observed (p < 0.001), as well as a laterality association between the ear with the worst tinnitus and the side of the body with more myofascial trigger points (p < 0.001). Thus, this relationship could be explained not only by somatosensory-auditory system interactions but also by the influence of the sympathetic system.

Efeito da timpanoplastia no zumbido de pacientes com hipoacusia condutiva: seguimento de seis meses

O timpanoplastia tem como objetivos erradicar a doença da orelha média e restaurar os mecanismos de condução sonora. Contudo, alguns pacientes apresentam incômodo com o zumbido e muitas vezes questionam o médico sobre os resultados da cirurgia em relação ao zumbido. OBJETIVO: Avaliar a evolução do zumbido em pacientes com hipoacusia condutiva após timpanoplastia. Forma de Estudo: Coorte prospectiva. CASUÍSTICA E MÉTODO: Foram avaliados 23 pacientes com queixa de zumbido e diagnóstico de otite média crônica simples com indicação cirúrgica. Os pacientes foram submetidos a um protocolo de investigação médica e audiológica do zumbido antes, 30 e 180 dias após a timpanoplastia. RESULTADOS: 82,6% dos pacientes apresentaram melhora ou abolição do zumbido. Melhora significante do incômodo do zumbido no pré-operatório (5,26) em relação ao pós-operatório (1,91 com 30 e 180 dias), assim como entre o incômodo da perda auditiva pré-operatória (6,56) e pós-operatória (3,65 e 2,91). A audiometria revelou melhora do limiar tonal em todas as freqüências, com exceção de 8KHz, havendo fechamento ou gap máximo de 10dB NA em 61% dos casos. Pega total do enxerto em 78% dos casos. CONCLUSÃO: Além da melhora da perda auditiva, a timpanoplastia também proporciona bons resultados sobre o controle do zumbido.

The effect of timpanoplasty on tinnitus in patients with conductive hearing loss: a six month follow-up

Tympanoplasty is done to eradicate ear pathology and to restore the conductive hearing mechanism (eardrum and ossicles). Some patients, however, do not tolerate tinnitus and question physicians about the results of surgery when tinnitus persists.

AIM

to evaluate the progression of tinnitus in patients with conductive hearing loss after tympanoplasty.

STUDY DESIGN

a prospective cohort study.

MATERIAL AND METHODS

23 consecutive patients with tinnitus due to chronic otitis media underwent tympanoplasty. The patients underwent a medical and audiological protocol for tinnitus before and after tympanoplasty.

RESULTS

82.6% of patients had improvement or elimination of tinnitus after tympanoplasty The mean score of postoperative intolerance to tinnitus (1.91 for 30 and 180 days) was significantly different from preoperative scores (5.26). As to hearing loss, patients improved medically 30 and 180 days after surgery (3.65 and 2.91) compared to the preoperative condition (6.56). Audiometry revealed improvement at all frequencies from 0.25 to 6KHz, except at 8KHz. The air-bone gap was closed or was within 10dB in 14 cases (61%). An intact tympanic membrane was achieved in 78% of the cases.

CONCLUSION

Aside from the classical improvement of hearing loss, tympanoplasty also offers good control of tinnitus.

The Effect of Stapedotomy on Tinnitus in Patients with Otospongiosis

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.