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Tinnitus

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Alise Adovia

2016./2017.m.g. ORL SZP 2.sdes prezentcija "Tinnitus". Autore: Jana Kra跳e (RSU MF IV kursa studente)

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Tinnitus Autors: Jana Kra跳e, MF4, 8.grupa Mentors: Dr.Gunta Sumeraga
Tinnitus lat朝niski tinnere = skant, trink邸跳t Ar tinnitus specilisti apz朝m troksni aus朝. Rakstur朝gs, ka 邸iem trok邸iem nav rju trok邸u avotu un to uztver tikai pats cilvks, ttad tas ir subjekt朝vs simptoms. rstam ir 勅oti svar朝gi pacienta izteikumi, s笛dz朝bas, jo kaut ar朝 tas ir subjekt朝vs rd朝tjs, tomr t 勅oti svar朝ga informcija slim朝bas smaguma noteik邸anai. Bez tam ir vajadz朝gi ar朝 objekt朝vi kritriji, balstoties uz kuriem vartu izvrtt tinnitus problemtiku. 3% l朝dz 5% cilvku j笛t troksni k izteikti traucjo邸u normlai dz朝vei. Ar 邸o problmas saskaras 30-35% cilvku, kas vecki par 50 gadiem, jauniem cilvkiem t ir retk sastopama problma.
Iedal朝jums pc smaguma pakpes I pakpe - Tinnitus ir labi kompensts, neietekm dz朝ves kvalitti II pakpes - Tinnitus prsvar pards klusum un darbojas traucjo邸i pie stresa un slodzes III pakpe - Tinnitus ilgsto邸i nelabvl朝gi ietekm k privto t darba sfru. Rodas traucjumi emocionl, kognit朝v un fizisk jom IV pakpe - Tinnitus izraisa piln朝gu dekompensciju privt sfr un darba nespju.
Tinnitus
Patofiziolo庁ija The most recent pathophysiologic theory suggests that the central nervous system is the source or generator of tinnitus Positron emission tomography (PET) scanning and functional magnetic resonance imaging (fMRI) studies indicate that a loss of cochlear input to neurons in the central auditory system (such as occurs in cochlear hair cell damage or a lesion of the vestibulocochlear nerve) can result in abnormal neural activity in the auditory cortex . This activity is linked to the perception of tinnitus. In addition, there is also a loss of suppression of the neural feedback loops which help tune and reinforce auditory memory in the central auditory cortex . Disruption of this feedback loop leads to the disinhibition of normal synapses and the creation of uncontrolled alternative neural synapses which lead to the abnormal auditory perception of tinnitus
Izpausme Trok邸a raksturs: k 邸alkoa, aboa, urdoa vai svilpo邸ana, k 笛dens skalo邸ans, l朝dz pat motora troksnim galv vai aus朝, bez rji atpaz朝stama skaas avota . Domin augstas frekvences trok邸i Rakstur朝gas tinnitus ska勅uma svrst朝bas Izteiktks troksnis mier, klusum , vakar vai nakt朝 To mask apkrtjs vides trok邸i Ja pacients ir vjdzird朝gs, tad troksnis bie転i tiek uztverts ska勅k, apkrtjs vides trok邸i neiedarbojas maskjo邸i.
Tinnitus veidi: Var b笛t at邸跳ir朝gs ska勅uma, frekvences un ilguma zi Patstv朝gs, pulsat朝vs vai prejo邸s Ar vai bez dzirdes pasliktinjuma Nav slim朝ba k tda, bet simptoms da転diem traucjumiem vai slim朝bm (no akustiskas traumas l朝dz ototoksisko medikamentu lieto邸anai); Objekt朝vs Subjekt朝vs
Diagnostika
Tinnitus
姻壊岳擢邸温稼温
Tinnitus
Terapija ar skau rjs vides trok邸u stimulcija Visvienkr邸k metode tinnitus mazin邸anai, izmantojot apkrtjs vides trok邸us, ir zinma vairk nek 50 gadu. Var izmantot relaksjo邸u m笛ziku vai dabas skaas, piemram, 笛denskrituma vai str笛klakas skau. Pacientam jklauss skaas, lai novrstu vai mazintu uzman朝bu no trok邸iem aus朝s Dzirdes apartu lieto邸ana Pacientam, kam troksni pavada dzirdes traucjumi, iesaka lietot dzirdes apartu. Skau terapija pacientam ar dzirdes traucjumiem iespjama tikai reiz ar dzirdes aparta izmanto邸anu, lai pastiprintu pilna spektra skaas. Programmto digitlo dzirdes apartu izmanto邸ana bez papildu modultm skam pati par sevi var ievrojami mazint tinnitus.
Totla skau maskjo邸 terapija Totlaj skau maskjo邸aj terapij lieto skaas ar tdu spektra raksturojumu un ska勅umu, kas pa邸a trok邸us padara piln朝gi nedzirdamus. Pacienti lieto skaas 庁eneratoru, moduljot skaas frekvenci un ska勅umu, lai piln朝gi masktu pa邸a troksni, taj pa邸 laik modult skaa nedr朝kst b笛t pacientam kaitino邸a. Kognit朝v uzved朝bas terapija Kognit朝v uzved朝bas terapija ir psihoterapijas veids, ko pamato uzskats, ka normla reakcija uz maznoz朝m朝gm fona skam ir pieradums un distress no trok邸iem aus朝s rodas no nespjas pie tm pierast. Apmc朝bas metodik ir reakcijas trenii uz emocionli noz朝m朝gm un maznoz朝m朝gm skam kombincij ar relakscijas tehniku. Elektriska stimulcija Elektrisk stimulcija tinnitus rst邸an zinma kop邸 19. gadsimta. M笛sdiens izmanto transkutno elektrisko stimulciju mastoidlaj rajon.
Galvenie profilaktiskie noteikumi Izvair朝ties no trok邸a Lietot ausu aizsargl朝dzek勅us trok邸ain darba vid Dita: izslgt stimulantus ( alkohols, kofe朝ns, ...) Saglabt stabilu asinsspiedienu
永擢岳庄逮顎馨壊
Effect of melatonin on tinnitus. OBJECTIVE: Evaluate melatonin as a treatment for subjective tinnitus. STUDY DESIGN: Randomized, prospective, double-blind, placebo-controlled crossover trial. Patients were given 3.0 mg melatonin, which was taken nightly for 30 days followed or preceded by a placebo nightly for 30 days, with a 7-day washout period between medications.
MAIN OUTCOME MEASURES: Tinnitus matching, Tinnitus Handicap Inventory (THI), patient questionnaire and interview. RESULTS: The average pretreatment THI score was 33.91 as compared with 26.43 after the placebo and 26.09 after melatonin. The difference in the THI scores between melatonin and placebo treatment were not statistically significant. The average pretreatment THI score for patients who reported overall improvement with melatonin was statistically higher (P = 0.02) than the average pretreatment THI score for patients who reported no improvement with melatonin. Among subjects reporting difficulty sleeping attributable to their tinnitus, 46.7% reported an overall improvement after melatonin compared with 20.0% for placebo (P = 0.04). There was also a statistically significant difference in improvement with melatonin for those patients with bilateral tinnitus compared with those with unilateral tinnitus (P = 0.02).
CONCLUSION: Melatonin has been shown to be useful in the treatment of subjective tinnitus. Patients with high THI scores and/or difficulty sleeping are most likely to benefit from treatment with melatonin. In light of its minimal side effects, melatonin should be a part of the physician's armamentarium in the treatment of tinnitus. https://www.ncbi.nlm.nih.gov/pubmed/9504599
https://starkeypro.com/pdfs/THI_Questionnaire.pdf
Tinnitus atbalsta organizcijas pasaul: American Tinnitus Association American Speech-Language-Hearing Association American Academy of Otolaryngology - Head and Neck Surgery American Academy of Audiology Australian Tinnitus Association The British Tinnitus Association French Tinnitus Association German Tinnitus League The Netherlands Tinnitus Association Royal National Institute for Deaf People Tinnitus Association of Canada Tinnitus Association of Victoria Deafness Research UK
http://www.doctus.lv/2011/2/tinnitus-jeb-troksnis-ausis https://www.ata.org/managing-your-tinnitus/treatment-options http://tinnitus.lv/Tinnitus-tests.php https://www.ncbi.nlm.nih.gov/pubmed/9504599 http://www.mayoclinic.org/diseases-conditions/tinnitus/home/ovc- 20180349 http://www.entnet.org/content/clinical-practice-guideline-tinnitus http://www.hear-it.org/Tinnitus-1
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Tinnitus

  • 1. Tinnitus Autors: Jana Kra跳e, MF4, 8.grupa Mentors: Dr.Gunta Sumeraga
  • 2. Tinnitus lat朝niski tinnere = skant, trink邸跳t Ar tinnitus specilisti apz朝m troksni aus朝. Rakstur朝gs, ka 邸iem trok邸iem nav rju trok邸u avotu un to uztver tikai pats cilvks, ttad tas ir subjekt朝vs simptoms. rstam ir 勅oti svar朝gi pacienta izteikumi, s笛dz朝bas, jo kaut ar朝 tas ir subjekt朝vs rd朝tjs, tomr t 勅oti svar朝ga informcija slim朝bas smaguma noteik邸anai. Bez tam ir vajadz朝gi ar朝 objekt朝vi kritriji, balstoties uz kuriem vartu izvrtt tinnitus problemtiku. 3% l朝dz 5% cilvku j笛t troksni k izteikti traucjo邸u normlai dz朝vei. Ar 邸o problmas saskaras 30-35% cilvku, kas vecki par 50 gadiem, jauniem cilvkiem t ir retk sastopama problma.
  • 3. Iedal朝jums pc smaguma pakpes I pakpe - Tinnitus ir labi kompensts, neietekm dz朝ves kvalitti II pakpes - Tinnitus prsvar pards klusum un darbojas traucjo邸i pie stresa un slodzes III pakpe - Tinnitus ilgsto邸i nelabvl朝gi ietekm k privto t darba sfru. Rodas traucjumi emocionl, kognit朝v un fizisk jom IV pakpe - Tinnitus izraisa piln朝gu dekompensciju privt sfr un darba nespju.
  • 5. Patofiziolo庁ija The most recent pathophysiologic theory suggests that the central nervous system is the source or generator of tinnitus Positron emission tomography (PET) scanning and functional magnetic resonance imaging (fMRI) studies indicate that a loss of cochlear input to neurons in the central auditory system (such as occurs in cochlear hair cell damage or a lesion of the vestibulocochlear nerve) can result in abnormal neural activity in the auditory cortex . This activity is linked to the perception of tinnitus. In addition, there is also a loss of suppression of the neural feedback loops which help tune and reinforce auditory memory in the central auditory cortex . Disruption of this feedback loop leads to the disinhibition of normal synapses and the creation of uncontrolled alternative neural synapses which lead to the abnormal auditory perception of tinnitus
  • 6. Izpausme Trok邸a raksturs: k 邸alkoa, aboa, urdoa vai svilpo邸ana, k 笛dens skalo邸ans, l朝dz pat motora troksnim galv vai aus朝, bez rji atpaz朝stama skaas avota . Domin augstas frekvences trok邸i Rakstur朝gas tinnitus ska勅uma svrst朝bas Izteiktks troksnis mier, klusum , vakar vai nakt朝 To mask apkrtjs vides trok邸i Ja pacients ir vjdzird朝gs, tad troksnis bie転i tiek uztverts ska勅k, apkrtjs vides trok邸i neiedarbojas maskjo邸i.
  • 7. Tinnitus veidi: Var b笛t at邸跳ir朝gs ska勅uma, frekvences un ilguma zi Patstv朝gs, pulsat朝vs vai prejo邸s Ar vai bez dzirdes pasliktinjuma Nav slim朝ba k tda, bet simptoms da転diem traucjumiem vai slim朝bm (no akustiskas traumas l朝dz ototoksisko medikamentu lieto邸anai); Objekt朝vs Subjekt朝vs
  • 12. Terapija ar skau rjs vides trok邸u stimulcija Visvienkr邸k metode tinnitus mazin邸anai, izmantojot apkrtjs vides trok邸us, ir zinma vairk nek 50 gadu. Var izmantot relaksjo邸u m笛ziku vai dabas skaas, piemram, 笛denskrituma vai str笛klakas skau. Pacientam jklauss skaas, lai novrstu vai mazintu uzman朝bu no trok邸iem aus朝s Dzirdes apartu lieto邸ana Pacientam, kam troksni pavada dzirdes traucjumi, iesaka lietot dzirdes apartu. Skau terapija pacientam ar dzirdes traucjumiem iespjama tikai reiz ar dzirdes aparta izmanto邸anu, lai pastiprintu pilna spektra skaas. Programmto digitlo dzirdes apartu izmanto邸ana bez papildu modultm skam pati par sevi var ievrojami mazint tinnitus.
  • 13. Totla skau maskjo邸 terapija Totlaj skau maskjo邸aj terapij lieto skaas ar tdu spektra raksturojumu un ska勅umu, kas pa邸a trok邸us padara piln朝gi nedzirdamus. Pacienti lieto skaas 庁eneratoru, moduljot skaas frekvenci un ska勅umu, lai piln朝gi masktu pa邸a troksni, taj pa邸 laik modult skaa nedr朝kst b笛t pacientam kaitino邸a. Kognit朝v uzved朝bas terapija Kognit朝v uzved朝bas terapija ir psihoterapijas veids, ko pamato uzskats, ka normla reakcija uz maznoz朝m朝gm fona skam ir pieradums un distress no trok邸iem aus朝s rodas no nespjas pie tm pierast. Apmc朝bas metodik ir reakcijas trenii uz emocionli noz朝m朝gm un maznoz朝m朝gm skam kombincij ar relakscijas tehniku. Elektriska stimulcija Elektrisk stimulcija tinnitus rst邸an zinma kop邸 19. gadsimta. M笛sdiens izmanto transkutno elektrisko stimulciju mastoidlaj rajon.
  • 14. Galvenie profilaktiskie noteikumi Izvair朝ties no trok邸a Lietot ausu aizsargl朝dzek勅us trok邸ain darba vid Dita: izslgt stimulantus ( alkohols, kofe朝ns, ...) Saglabt stabilu asinsspiedienu
  • 16. Effect of melatonin on tinnitus. OBJECTIVE: Evaluate melatonin as a treatment for subjective tinnitus. STUDY DESIGN: Randomized, prospective, double-blind, placebo-controlled crossover trial. Patients were given 3.0 mg melatonin, which was taken nightly for 30 days followed or preceded by a placebo nightly for 30 days, with a 7-day washout period between medications.
  • 17. MAIN OUTCOME MEASURES: Tinnitus matching, Tinnitus Handicap Inventory (THI), patient questionnaire and interview. RESULTS: The average pretreatment THI score was 33.91 as compared with 26.43 after the placebo and 26.09 after melatonin. The difference in the THI scores between melatonin and placebo treatment were not statistically significant. The average pretreatment THI score for patients who reported overall improvement with melatonin was statistically higher (P = 0.02) than the average pretreatment THI score for patients who reported no improvement with melatonin. Among subjects reporting difficulty sleeping attributable to their tinnitus, 46.7% reported an overall improvement after melatonin compared with 20.0% for placebo (P = 0.04). There was also a statistically significant difference in improvement with melatonin for those patients with bilateral tinnitus compared with those with unilateral tinnitus (P = 0.02).
  • 18. CONCLUSION: Melatonin has been shown to be useful in the treatment of subjective tinnitus. Patients with high THI scores and/or difficulty sleeping are most likely to benefit from treatment with melatonin. In light of its minimal side effects, melatonin should be a part of the physician's armamentarium in the treatment of tinnitus. https://www.ncbi.nlm.nih.gov/pubmed/9504599
  • 20. Tinnitus atbalsta organizcijas pasaul: American Tinnitus Association American Speech-Language-Hearing Association American Academy of Otolaryngology - Head and Neck Surgery American Academy of Audiology Australian Tinnitus Association The British Tinnitus Association French Tinnitus Association German Tinnitus League The Netherlands Tinnitus Association Royal National Institute for Deaf People Tinnitus Association of Canada Tinnitus Association of Victoria Deafness Research UK
  • 21. http://www.doctus.lv/2011/2/tinnitus-jeb-troksnis-ausis https://www.ata.org/managing-your-tinnitus/treatment-options http://tinnitus.lv/Tinnitus-tests.php https://www.ncbi.nlm.nih.gov/pubmed/9504599 http://www.mayoclinic.org/diseases-conditions/tinnitus/home/ovc- 20180349 http://www.entnet.org/content/clinical-practice-guideline-tinnitus http://www.hear-it.org/Tinnitus-1

Editor's Notes

  • #4: Autors iedal朝jumam?
  • #5: 鳥oti labs slaids!
  • #8: Objekt朝vs to var dzirdt ar朝 neiesaist朝tas personas, piemram, rsts ar stetoskopu var dzirdt 邸o troksni. Objekt朝vu tinnitus bie転k izraisa vaskulra vai muskulra patolo庁ija, tam ir pulsat朝vs raksturs:pie arteriovenozas fistulas vai malformcijas;miega artrijas stenozes vai disekcijas;dzirdes nerva vaskulras kompresijas;glomus jugulare audzja vidusaus朝;otosklerozes;pastiprinta sirds pulsa, bie転i anmijas vai gr笛tniec朝bas laik;vnu trok邸iem- pie papla邸injuma vai anomlijas, piemram, pie j笛ga vnas kompresijas ar otra cervikl skrieme勅a procesus transversus. Subjekt朝vs - to var dzirdt tikai pats pacients. Unilaterls:ar redzamu patolo庁iju aus朝, saist朝b ar ausu sra kor跳i vai timpnisks membrnas perforciju;bez redzamas patolo庁ijas aus朝: to pavada dzirdes pasliktinjums un reibonis (Menjra slim朝ba) vai citi neirolo庁iski simptomi, tdi k multipl skleroze, smadzeu stumbra audzjs (cerebellopontina le跳a tumors, 邸vannoma), smadzeu stumbra infarkts; bilaterls- ar un bez ietekmes uz dzirdi, var b笛t saist朝ts ar:otosklerozi, vecuma nedzird朝bu;ototoksisko stvokli, ko izraisa prmr朝gi trok邸i vai ototoksiskie medikamenti (piemram, aspir朝ns, salicilti, aminoglikoz朝di, kofe朝ns, cilpas diurti跳i);paaugstintu asinsspiedienu vidusauss asinsvados;ja dzirdama runa vai balsis- psiho足gns. idioptisks subjekt朝vs tinnitus- izsldzot iepriek邸 mintos iemeslus.
  • #10: Tas jau vairk pie diagnostikas, nevis rst邸anas!
  • #11: Benzodiazep朝ni-75%pacientiem s笛dz朝bas mazins,7%-reducjas Karbamazep朝ns- izvles medikaments pie vienpusja neregulra intermitjo邸a staccato tin朝ta.
  • #12: Benzodiazep朝ni-75%pacientiem s笛dz朝bas mazins,7%-reducjas Karbamazep朝ns- izvles medikaments pie vienpusja neregulra intermitjo邸a staccato tin朝ta.