Effectiveness of bimodal auditory and electrical stimulation in patients with tinnitus: A feasibility study.

Background: Tinnitus is a common symptom, affecting about 10-15% of the adult population. When input from the somatosensory system can influence and/or elicit tinnitus, this type of subjective tinnitus is called somatosensory tinnitus. Recently, a new type of bimodal neurostimulation treatment has shown promising results for a specific subgroup within the somatosensory tinnitus population. It is, however, not clear if this bimodal stimulation is also effective in patients with other types of subjective tinnitus. Aim: The aim of this study was to evaluate the feasibility and efficacy of non-invasive bimodal auditory-somatosensory stimulation in reducing tinnitus severity among a general population of people with subjective tinnitus. Methods: Chronic subjective tinnitus patients were recruited from the ENT department of the Antwerp University Hospital. Somatosensory stimulation was delivered by Transcutaneous Electrical Nerve Stimulation (TENS), and it was combined with auditory stimulation via headphones. The therapy comprised six sessions of thirty minutes twice a week for a period of 3 consecutive weeks. Follow up measurements were scheduled 9-12 weeks after the last treatment session. The change of the Tinnitus Functional Index (TFI) score, a questionnaire evaluating tinnitus burden and effects on the quality of life, was the primary outcome measure. Results: Twenty-nine patients were enrolled in the study. A linear mixed-effects model was used to analyze the efficacy of bimodal treatment. The results of this analysis showed a statistically significant decrease (by 6, 9 points) in average TFI score at the follow up visit when compared to baseline. The ability to modulate tinnitus did not have an influence on the treatment results. Conclusion: Our study showed that bimodal stimulation is a feasible and safe method of tinnitus treatment. The method might be an effective treatment for some participants with tinnitus, especially those who have accompanying neck/temporomandibular problems, although, the evidence from this trial is quite weak. Additional research is needed toward establishing the optimal treatment protocol, as well as selecting the most appropriate inclusion criteria.

Standardised profiling for tinnitus research: The European School for Interdisciplinary Tinnitus Research Screening Questionnaire (ESIT-SQ).

BACKGROUND: The heterogeneity of tinnitus is substantial. Its numerous pathophysiological mechanisms and clinical manifestations have hampered fundamental and treatment research significantly. A decade ago, the Tinnitus Research Initiative introduced the Tinnitus Sample Case History Questionnaire, a case history instrument for standardised collection of information about the characteristics of the tinnitus patient. Since then, a number of studies have been published which characterise individuals and groups using data collected with this questionnaire. However, its use has been restricted to a clinical setting and to the evaluation of people with tinnitus only. In addition, it is limited in the ability to capture relevant comorbidities and evaluate their temporal relationship with tinnitus. METHOD: Here we present a new case history instrument which is comprehensive in scope and can be answered by people with and without tinnitus alike. This 'European School for Interdisciplinary Tinnitus Research Screening Questionnaire' (ESIT-SQ) was developed with specific attention to questions about potential risk factors for tinnitus (including demographics, lifestyle, general medical and otological histories), and tinnitus characteristics (including perceptual characteristics, modulating factors, and associations with co-existing conditions). It was first developed in English, then translated into Dutch, German, Italian, Polish, Spanish, and Swedish, thus having broad applicability and supporting international collaboration. CONCLUSIONS: With respect to better understanding tinnitus profiles, we anticipate the ESIT-SQ to be a starting point for comprehensive multi-variate analyses of tinnitus. Data collected with the ESIT-SQ can allow establishment of patterns that distinguish tinnitus from non-tinnitus, and definition of common sets of tinnitus characteristics which might be indicated by the presence of otological or comorbid systemic diseases for which tinnitus is a known symptom.

Sequencing of exons 4, 5, 12 of COCH gene in patients with postlingual sensorineural hearing loss accompanied by vestibular lesion.

INTRODUCTION: Mutations at the DFNA9 locus on chromosome 14q12 are the third most common form of DFNA hearing loss, which is clinically characterized by late onset (in adulthood) progressive sensorineural hearing loss accompanied by vestibular dysfunction. The aim of the study was to search for COCH gene mutations (P51S, V66G, G87W, G88E, V104del, I109N, W117R, A119T, M512T, C542Y) in patients with severe or profound sensorineural hearing loss accompanied by a vestibular lesion. MATERIAL AND METHODS: The study was based on a group of 30 patients. Qualification criteria comprised the presence of progressive postlingual, severe to profound sensorineural hearing loss with tinnitus, early age of sensorineural hearing loss onset, before the 40th year of life, and a positive family history of early onset hearing loss. All patients were diagnosed with peripheral vestibular lesions. RESULTS: The authors did not find P51S, V66G, G87W, G88E, V104del, I109N, W117R, A119T, M512T, or C542Y mutations in the COCH gene in the tested group (no differences were found in the nucleotide sequences of exomes 4, 5 and 12 when compared to the published cDNA sequence of the COCH gene). CONCLUSIONS: No cochlin mutations were found in the group of patients with severe to profound sensorineural hearing impairment accompanied by a vestibular lesion. The COCH gene needs further exploration and analysis of genotype-phenotype correlations.

Excitation of the Auditory System as a Result of Non-invasive Extra-Cochlear Stimulation in Normal Subjects and Tinnitus Patients.

One of possible approach that may suppress tinnitus is electrical stimulation of the ear. At first invasive techniques were used (promontory or round window stimulation), nowadays a non-invasive method, namely hydrotransmissive electric stimulation (ES) through external acoustic canal, has been developed. The aim of the study is to investigate the effect of applying ES with positive and negative current polarities on the ears of healthy subjects and on the tinnitus ears of patients with tinnitus. This comparison further clarifies the mechanisms of operation of non-invasive extra-cochlear ear ES. A second aim is to assess the effects of ES on tinnitus in tinnitus patients. The material was composed of two groups: tinnitus group-49 patients suffering from tinnitus, and healthy students group-34 healthy individuals. ES was performed with the use of a custom-made apparatus. The active, silver probe-was immersed inside saline filling external ear canal. The passive electrode was placed on the forehead. Positive and next negative DC stimulation was provided with the use following frequencies: 0.25, 1, 2, 3, 4, 5, 6, 7, 8 kHz. We checked for the presence of the auditory percept (AP) and, if AP was present, the minimum current amplitude necessary to produce AP was measured. In our research both positive and negative polarities were efficient to evoke AP in the participants. This effect, however, was more pronounced for positive polarity in no tinnitus and normal hearing individuals (healthy students group). In the tinnitus group, current intensity needed to evoke AP was higher than in the healthy students group. However, comparing normal hearing vs. hearing loss patients within the tinnitus group, we did not observe the relationship between hearing threshold and current intensity evoking AP. Afterwards, we analyzed the effect of multi-frequency ES on tinnitus. It appeared to be effective in 75% of tinnitus ears (with a high score of disappearance-22%). Our study proved that extracochlear ES with positive and negative current was efficient to stimulate the auditory system. Stimulating tinnitus ears with two polarities we obtained a higher ratio of improvement (75%) comparing to positive stimulations.

Increased sensibility to acute acoustic and blast trauma among patients with acoustic neuroma.

The article shows 2 cases of unusual presentation of acute acoustic trauma and blast injury due to occupational exposure. In the case of both patients the range of impaired frequencies in pure tone audiograms was atypical for this kind of causative factor. Both patients had symmetrical hearing before the accident (which was confirmed by provided results of hearing controls during their employment). A history of noise/blast exposure, the onset of symptoms directly after harmful exposure, symmetrical hearing before the trauma documented with audiograms, directed initial diagnosis towards acoustic/blast trauma, however, of atypical course. Acute acoustic and blast trauma and coexisting acoustic neuroma (AN) contributed to, and mutually modified, the course of sudden hearing loss. In the literature there are some reports pointing to a higher sensitivity to acoustic trauma in the case of patients with AN and, on the other hand, indicating noise as one of the causative factors in AN. Int J Occup Med Environ Health 2018;31(3):361-369.

Innovations in Doctoral Training and Research on Tinnitus: The European School on Interdisciplinary Tinnitus Research (ESIT) Perspective.

Tinnitus is a common medical condition which interfaces many different disciplines, yet it is not a priority for any individual discipline. A change in its scientific understanding and clinical management requires a shift toward multidisciplinary cooperation, not only in research but also in training. The European School for Interdisciplinary Tinnitus research (ESIT) brings together a unique multidisciplinary consortium of clinical practitioners, academic researchers, commercial partners, patient organizations, and public health experts to conduct innovative research and train the next generation of tinnitus researchers. ESIT supports fundamental science and clinical research projects in order to: (1) advancing new treatment solutions for tinnitus, (2) improving existing treatment paradigms, (3) developing innovative research methods, (4) performing genetic studies on, (5) collecting epidemiological data to create new knowledge about prevalence and risk factors, (6) establishing a pan-European data resource. All research projects involve inter-sectoral partnerships through practical training, quite unlike anything that can be offered by any single university alone. Likewise, the postgraduate training curriculum fosters a deep knowledge about tinnitus whilst nurturing transferable competencies in personal qualities and approaches needed to be an effective researcher, knowledge of the standards, requirements and professionalism to do research, and skills to work with others and to ensure the wider impact of research. ESIT is the seed for future generations of creative, entrepreneurial, and innovative researchers, trained to master the upcoming challenges in the tinnitus field, to implement sustained changes in prevention and clinical management of tinnitus, and to shape doctoral education in tinnitus for the future.

An Increase in Alpha Band Frequency in Resting State EEG after Electrical Stimulation of the Ear in Tinnitus Patients-A Pilot Study.

In our clinic invasive transtympanal promontory positive DC stimulations were first used, with a success rate of 42%. However, non-invasive hydrotransmissive negative DC stimulations are now favored, with improvement being obtained in 37.8% directly after the treatment, and 51.3% in a follow up 1 month after treatment. The further improvement after 1 month may be due to neuroplastic changes at central level as a result of altered peripheral input. The aim of the study was to determine how/whether a single electrical stimulation of the ear influences cortical activity, and whether changes observed in tinnitus after electrical stimulation are associated with any changes in cortical activity recorded in EEG. The study included 12 tinnitus patients (F-6, M-6) divided into two groups. Group I comprised six patients with unilateral tinnitus - unilateral, ipsilateral ES was performed. Group II comprised six patients with bilateral tinnitus-bilateral ES was performed. ES was performed using a custom-made apparatus. The active, silver probe-was immersed inside the external ear canal filled with saline. The passive electrode was placed on the forehead. The stimulating frequency was 250 Hz, the intensity ranged from 0.14 to 1.08 mA. The voltage was kept constant at 3 V. The duration of stimulation was 4 min. The EEG recording (Deymed QEST 32) was performed before and after ES. The patients assessed the intensity of tinnitus on the VAS 1-10. Results: In both groups an improvement in VAS was observed-in group I-in five ears (83.3%), in group II-in seven ears (58.3%). In Group I, a significant increase in the upper and lower limit frequency of alpha band was observed in the central temporal and frontal regions following ES. These changes, however, were not correlated with improvement in tinnitus. No significant changes were observed in the beta and theta bands and in group II. Preliminary results of our research reveal a change in cortical activity after electrical stimulations of the ear. However, it remains unclear if it is primary or secondary to peripheral auditory excitation. No similar studies had been found in the literature.

Correlations between Apnea/Hypopnea Index and selected morphological and clinical parameters in patients with unilateral or bilateral impairment of nasal patency.

INTRODUCTION: The aim of this work was to evaluate the correlation between Apnea/Hypopnea Index (AHI) and selected parameters of morphological and clinical character in the patients with a unilateral or bilateral impairment of nasal patency. MATERIAL AND METHODS: The study covered 60 adults, including 37 male and 23 female subjects, 19-69 years of age. In the Department, these subjects were divided into 3 groups: I - 20 patients with unilateral impairment of nasal patency, II - 20 patients with bilateral impairment of nasal patency, III - controls with normal nasal patency. METHODOLOGY: A subjective examination (questionnaire with a sleepiness scale), an objective examination (general examination of the neck and waist diameter, body weight, height, length of the uvula), otorhinolaryngological examination (Pirquet test of the palatine tonsils), X-ray and CT of the head and paranasal sinuses) to determine the cause and location of the obturation of air passages, physiological tests and polysomnography. The correlations between the neck circumferenceheight ratio (NHR) and AHI, waist-hip ratio (WHR) and AHI. The statistical analysis of the study results was conducted in Stata®/Special Edition Program, 14.1 version (StataCorp LP, College Station, Texas, USA). RESULTS: Clinically, the study group revealed: shallow breathing in 47.5% and apnea in 52.5% of the studied patients whereas the control group did not show any sleep disorders. Statistical fluctuations between controls and the study groups were noticed (p<0.001). CONCLUSION: By the Epworth scale, moderate and severe sleepiness was found in merely 12.5% of the patients. The differences in the length of the uvula and the size of the pharyngeal tonsils between the studied groups were not statistically significant. No statistical significance was found between NHR and AHI, BMI and AHI, WHR and AHI in the studied group.

GJB2 sequencing in deaf and profound sensorineural hearing loss children.

INTRODUCTION: GJB2 mutations are the most frequent reason of genetic congenital hearing loss. The aim of the study was to assess the prevalence of GJB2 mutations in the deaf and profound hearing loss children. MATERIAL AND METHODS: The material of the study was a group of 61 patients divided into two groups. Group I - 35 deaf or with profound sensorineural hearing loss children (the pupils of the deaf and hard of hearing school), aged 5-17 years (average 9.2 years), 14 males, 21 females, II - control group comprised 26 normal hearing patients, aged 5-16 years (average 10.4years), 14 males, 12 females (patients of Department of Pediatric Otolaryngology, Audiology and Phoniatrics, Medical University of Lodz). In both groups, exon 2 sequencing of GJB2 gene was performed. RESULTS: In group I in 6 patients (17%) 35delG in GJB2 gene was found. The patients were homozygotes, with negative family history of hearing loss. No other mutations in GJB2 gene were found. In group II no mutations in GJB2 were observed. CONCLUSIONS: The most frequent cause of hearing impairment in the deaf and profound sensorineural hearing loss children was 35delG mutation in GJB2 gene. No other mutations in GJB2 gene were detected.

Systematic review of outcome domains and instruments used in clinical trials of tinnitus treatments in adults.

BACKGROUND: There is no evidence-based guidance to facilitate design decisions for confirmatory trials or systematic reviews investigating treatment efficacy for adults with tinnitus. This systematic review therefore seeks to ascertain the current status of trial designs by identifying and evaluating the reporting of outcome domains and instruments in the treatment of adults with tinnitus. METHODS: Records were identified by searching PubMed, EMBASE CINAHL, EBSCO, and CENTRAL clinical trial registries (ClinicalTrials.gov, ISRCTN, ICTRP) and the Cochrane Database of Systematic Reviews. Eligible records were those published from 1 July 2006 to 12 March 2015. Included studies were those reporting adults aged 18 years or older who reported tinnitus as a primary complaint, and who were enrolled into a randomised controlled trial, a before and after study, a non-randomised controlled trial, a case-controlled study or a cohort study, and written in English. Studies with fewer than 20 participants were excluded. RESULTS: Two hundred and twenty-eight studies were included. Thirty-five different primary outcome domains were identified spanning seven categories (tinnitus percept, impact of tinnitus, co-occurring complaints, quality of life, body structures and function, treatment-related outcomes and unclear or not specified). Over half the studies (55 %) did not clearly define the complaint of interest. Tinnitus loudness was the domain most often reported (14 %), followed by tinnitus distress (7 %). Seventy-eight different primary outcome instruments were identified. Instruments assessing multiple attributes of the impact of tinnitus were most common (34 %). Overall, 24 different patient-reported tools were used, predominantly the Tinnitus Handicap Inventory (15 %). Loudness was measured in diverse ways including a numerical rating scale (8 %), loudness matching (4 %), minimum masking level (1 %) and loudness discomfort level (1 %). Ten percent of studies did not clearly report the instrument used. CONCLUSIONS: Our findings indicate poor appreciation of the basic principles of good trial design, particularly the importance of specifying what aspect of therapeutic benefit is the main outcome. No single outcome was reported in all studies and there was a broad diversity of outcome instruments. PROSPERO REGISTRATION: The systematic review protocol is registered on PROSPERO (International Prospective Register of Systematic Reviews): CRD42015017525 . Registered on 12 March 2015 revised on 15 March 2016.

Toward a Global Consensus on Outcome Measures for Clinical Trials in Tinnitus: Report From the First International Meeting of the COMiT Initiative, November 14, 2014, Amsterdam, The Netherlands.

In Europe alone, over 70 million people experience tinnitus; for seven million people, it creates a debilitating condition. Despite its enormous socioeconomic relevance, progress in successfully treating the condition is somewhat limited. The European Union has approved funding to create a pan-European tinnitus research collaboration network (2014-2018). The goal of one working group is to establish an international standard for outcome measurements in clinical trials of tinnitus. Importantly, this would enhance tinnitus research by informing sample-size calculations, enabling meta-analyses, and facilitating the identification of tinnitus subtypes, ultimately leading to improved treatments. The first meeting followed a workshop on "Agreed Standards for Measurement: An International Perspective" with invited talks on clinimetrics and existing international initiatives to define core sets for outcome measurements in hearing loss (International classification of functioning, disability, and health core sets for hearing loss) and eczema (Harmonizing outcome measures for eczema). Both initiatives have taken an approach that clearly distinguishes the specification of what to measure from that of how to measure it. Meeting delegates agreed on taking a step-wise roadmap for which the first output would be a consensus on what outcome domains are essential for all trials. The working group seeks to embrace inclusivity and brings together clinicians, tinnitus researchers, experts on clinical research methodology, statisticians, and representatives of the health industry. People who experience tinnitus are another important participant group. This meeting report is a call to those stakeholders across the globe to actively participate in the initiative.

Direct current stimulation of the ear in tinnitus treatment: a double-blind placebo-controlled study.

The objectives of the study are assessment of the influence of direct current electrical stimulations of the ear in tinnitus treatment, comparison of the results with placebo group and evaluation of hearing after electrical stimulations. The study comprised 120 tinnitus and sensorineural hearing loss patients (n = 184 tinnitus ears). In group one (n = 119 tinnitus ears) the authors applied a non-invasive hydrotransmissive electrical stimulation (15) of the ear, in group two (n = 65 tinnitus ears)--placebo electrical stimulation. Direct rectangular, positive polarization current was used. The frequency of stimulation was adjusted according to tinnitus frequency. In group two, the authors used similar procedure, but no current was delivered through the active electrode. Evaluation of tinnitus and hearing was conducted. In groups one and two, directly after the treatment, the number of ears with permanent tinnitus decreased considerably. In group one in 40 ears (33.6%) tinnitus disappeared; in group two, tinnitus disappeared in four ears (6.1%). After 30 days, statistically significant changes were observed in group one (p < 0.05), which were comparable with results returned 90 days later (p > 0.05). Changes in group two (after 30 and 90 days) were not significant (p > 0.05). The authors recognized audiometric improvement of hearing (in pure tone audiometry). The application of direct current electrical stimulation of the hearing organ, with current frequencies similar to tinnitus frequencies (selective electrical stimulation), was an efficient method in severe tinnitus treatment. We did not observe a harmful effect of direct current on hearing organ.

[Anatomical anomalies of the vertebral and carotid arteries in patients with vertigo and hearing disorders]. / Anomalie anatomiczne tetnic doczaszkowych u chorych z zawrotami glowy i zaburzeniami sluchu.

INTRODUCTION: The aim of this work was the analysis of the frequency and type of anatomical anomalies of the arteries to the cranium such as vertebral arteries and carotid arteries in patients with vertigo and hearing disorders. MATERIAL AND METHODS: Between 2007 and 2011, in the Department of Otolaryngology and Laryngological Oncology, the number of the patients diagnosed due to vertigo and hearing disorders amounted to 2,167. In CT-angiogram anatomical anomalies were confirmed in 29 of these patients. The studied group included 22 women aged 22-68 and 7 men aged 21-53. Each patient underwent a subjective and objective structured laryngological interview, audiological and otoneurological examinations, laboratory tests, USG and angio-CT of the arteries to the cranium. RESULTS: The most common anatomical anomaly of the arteries to the cranium was hypoplasia of the right vertebral artery in 58.7% of the cases, out of which 51.7% in women and 6.9% in men. Hypoplasia of the left vertebral artery was diagnosed in 24.7% of the studied group, 13.8% of women and 10.3% of men. Hypoplasia of the right internal carotid artery was found in 3.4% of the female patients while hypoplasia of the left internal carotid artery was identified in 6.8% of the studied cases, 3.4% of women and 3.4% of men. Hypoplasia of the right common carotid artery was confirmed in 3.4% of the male patients whereas critical stenosis of the left subclavian artery with the subclavian steal syndrome was found in 3.4% of the studied female patients. Tinnitus was reported in 88.2% of the patients with diagnosed right vertebral artery hypoplasia, and in 58.8% vertigo and in 52.9% hearing disorders were confirmed. Tinnitus was the most common complaint in the studied group, both in men and women. Less frequent complaints referred to vertigo (65.5% altogether) and hearing impairment (55.2% altogether). CONCLUSIONS: In the analyzed group, diagnosed anatomical anomalies were not indications for vascular surgery nor neurosurgery, therefore, the applied treatment was strictly conservative.

The application of direct current electrical stimulation of the ear and cervical spine kinesitherapy in tinnitus treatment.

OBJECTIVE: The aim of the study was to evaluate the effectiveness of electrical stimulations of the hearing organ in tinnitus treatment adapting the frequency of stimulation according to tinnitus frequency, to assess the influence of cervical spine kinesitherapy on tinnitus, as well as to evaluate hearing after electrical stimulations alone and together with cervical spine kinesitherapy. METHODS: The study comprised 80 tinnitus, sensorineural hearing loss patients (119 tinnitus ears) divided into two groups. In group I (n - 58 tinnitus ears) electrical stimulation of the hearing organ was performed, in group II (n - 61 tinnitus ears) electrical stimulation together with cervical spine kinesitherapy. Hydrotransmissive, selective electrical stimulations were conducted using direct, rectangular current. The passive electrode was placed on the forehead, the active--a silver probe--was immersed in the external ear canal in 0.9% saline solution. The treatment involved fifteen applications of electrical stimulations (each lasted for 4 min) administered three or four times a week (whole treatment lasted approximately 30 days). The evaluation of the results considered a case history (change from permanent to temporary tinnitus), questionnaires (the increase/decrease of the total points) and the audiometric evaluation of hearing level. RESULTS: Before the treatment, group I comprised 51 ears (87.93%) with permanent, and 7 ears (12.07%) with temporary tinnitus; group II - 55 ears (90.17%) with permanent and 6 ears (9.83%) with temporary tinnitus. After the treatment, in both groups the number of ears with permanent tinnitus decreased considerably obtaining the pauses or disappearing of tinnitus. Directly after the treatment, group I comprised 25 ears (43.11%) with permanent, and 10 ears (17.24%) with temporary tinnitus, in 23 ears (39.65%) tinnitus disappeared; group II - 33 ears (54.1%) with permanent and 11 ears (18.03%) with temporary tinnitus, in 17 ears (27.87%) tinnitus disappeared. Regarding questionnaires, improvement was observed in group I - in 43.11% of ears, in group II - 32.8%. In both groups audiometric improvement of hearing was recognized. CONCLUSIONS: (1) Electrical stimulation of the hearing organ, with the application of current frequencies according to tinnitus frequencies (selective electrical stimulation), was an efficient method in severe tinnitus treatment. (2) Cervical spine kinesitherapy in the treatment of tinnitus, using electrical stimulation, did not have any supporting influence.

[Electrical stimulation as an alternative method of tinnitus treatment]. / Elektrostymulacja jako alternatywna metoda leczenia szumów usznych.

INTRODUCTION: The aim of the study was to evaluate the influence of the selective electrical stimulation of the hearing organ on tinnitus in people with sensorineural hearing loss. MATERIAL AND METHODS: The study comprised 248 tinnitus patients treated by using electrical stimulation. The material was divided into two groups, regarding the method of stimulation. In group I--168 people, transtympanal electrical stimulation of the promontory was applied, whereas in group II--80 people, hydrotransmissive technique was used. ENT examination, audiological and radiological diagnostics, as well as the evaluation of the audiometric parameters of tinnitus was performed. The patients were asked to fill in the questionnaire concerning tinnitus. In 80 patients hydrotransmissive electrical stimulation was conducted using the own prototype device, in 168 patients--transtympanal stimulation, after local anaesthesia with Xylocain gel. RESULTS: On the whole, in group of 248 patients, subjective improvement (decrease in the severity of tinnitus) was noticed in 130 people (52.4%), comprising 32 cases (13%) of total relief. In 93 patients (37.5%) tinnitus remained unchanged, and in 25 (10.1%) the deterioration was observed. The comparison of the results of two electrical stimulation methods, showed the superiority of hydrotransmissive one (improvement in 58.75% of patients), however, the number of cases of total relief was greater in the case of transtympanal method (15.5%). Considering subjective evaluation, as well as audiometric (the intensity and the frequency parameters, MML) the hydrotransmissive method appeared to be more effective (improvement in 53.75%) comparing to transtympanal stimulation (improvement in 44.6%). CONCLUSIONS: On the basis of studies conducted in the Clinic and the long history of the electrical stimulation administration in tinnitus treatment, it can be stated that this method may by applied in cases, in which other therapeutical methods failed.

[Tinnitus treatment by using electrical stimulation]. / Hydrotransmisyjna elektrostymulacja narzadu sluchu w leczeniu szumów usznych.

INTRODUCTION: The aim of the study was to evaluate the influence of electrical stimulation on severe tinnitus. MATERIAL AND METHODS: The study comprised 46 patients (66 ears) suffering from severe tinnitus, persistently or temporarily, 27 women and 19 men, ranging in age from 22 to 84 years, on average 55. The material was divided into two groups. Group I was treated using electrical stimulation, whereas group II was being applied additionally the kinesitherapy of the cervical part of the vertebral column. The average duration of tinnitus was similar in both groups and equals 4.5 years. All the patients were administered medicines, without expected result. Otolaryngological, audiological diagnostics was conducted as well as head and cervical computer tomography. The patients were asked to fill in the questionnaire concerning tinnitus. The electrical stimulation was performed using silver electrode which was dipped in saline solution in external auditory canal. Direct current was used, the intensity ranged from 0.15 mA to 1.15 mA. Fifteen electrical stimulations were entire treatment administered twice or three times a week. Before and after treatment the subjective evaluation of tinnitus was made. RESULTS: The subjective improvement was noticed in 36 people (n 46 ears--71%). Persistent tinnitus was registered in 30 ears and temporary in 30 ears, in 6 tinnitus disappeared completely. On the basis of audiometric tests improvement was noticed in 33 ears (55%). In group I in 17 ears (44%)--in 4 ears tinnitus disappeared, in 13 partial relief was noticed, 10 ears were without any change and in 12 ears the intensification of tinnitus was recognized. In group II in 16 ears improvement was observed, in 2 of them tinnitus disappeared, in 14 decreased. In 9 ears no change was obtained and in 2 intensification was noticed. CONCLUSIONS: Electrical stimulation can be an alternative therapy in severe tinnitus treatment. The administration of kinesitherapy of cervical column may have an additive effect on tinnitus treatment.

[Hearing evaluation in patients with vertigo]. / Ocena stanu sluchu u chorych z zawrotami glowy.

INTRODUCTION: Vertigo is one of the most frequent and disturbing sensations that the practicing otolaryngologist is called upon to treat. Vertigo is the illusory sensation of motion. True vertigo is caused by pathology in the peripheral end organ, the vestibular nerve, and the pathways that connect them in the brainstem and rarely, in the cortex. AIM: The aim of this study was to evaluate hearing in people with vertigo according to the etiology of balance disorders. The study comprised 127 patients treated in our clinic between 1999 and 2004, 88 women and 39 men (254 ears) aged 24-90 years. The average age was 56. METHODS: Hearing tests (pure tone audiometry, speech audiometry, impedance audiometry, auditory brainstem responses, OAE) as well as vestibular function tests (electronystagmography, rotational chair tests, caloric tests) were performed. In order to evaluate the nature of vertigo radiological diagnostics (head and cervical computer tomography, vascular diagnostics using Doppler sonography) was performed. RESULTS: Audiometric testing showed impaired hearing in 71 of 127 subjects. Among 73 patients with vertigo of vascular origin caused by vertebrae-basilar insufficiency, bilateral cochlear lesion was noticed in 33 cases and unilateral in 9. In 8 patients with cervical ankylosing spondylitis 3 had cochlear hearing loss (1--unilateral, 2--bilateral). CONCLUSIONS: In our group of patients with vertigo in the most of cases the hearing loss was on cochlear origin.

[Distortion product otoacoustic emissions before and after one year exposure to impulse noise]. / Emisje otoakustyczne produktu znieksztalcen nieliniowych (DPOAE) przed i po okresie rocznego narazenia na halas impulsowy.

INTRODUCTION: Firearms are a common source of impulse noise that may be very harmful to the auditory organ. Impulse noise from weapons and explosions continually produces hearing damage among military personnel. The discovery of otoacoustic emission (OAE) has given a new possibility of early diagnosis of noise induced hearing loss. The transiently evoked otoacoustic emission (TEOAE) and distortion product otoacoustic emission (DPOAE) are non-invasive, objective and frequency specific audiometric tests for evaluating outer hair cell function. The aim of the study was to asses the effects of exposure to impulse noise on DPOAE after one year of the obligatory military service. MATERIAL AND METHODS: The study comprised 92 (184 ears) soldiers, subjected to impulse noise during military service. The examine group was divided according total noise exposure. The control group consisted of secondary school students not exposed to noise. DPOAE was recorded before and after one year of military service. RESULTS: After military service significant deterioration of DPOAE level was observed at frequencies of 1, 3, and 4 kHz on the right ear and 2, 5 and 6 kHz left one. CONCLUSIONS: 1. Reduction of DPOAE amplitude connected all frequencies. 2. We did not notice significant differences between groups connected total noise exposure.

[Impulse noise influence on hearing]. / Ocena wplywu halasu impulsowega na stan sluchu.

UNLABELLED: Impulse noise from weapons and explosions produces hearing damage among military service. The discovery of otoacoustic emissions (OAE) has given a new possibility of early diagnosis of noise induced hearing loss. The aim of the study was to assess the effects of exposure to impulse noise on TEOAE, SNR and PTA. MATERIAL AND METHODS: the study comprised 92 (184 ears, aged 18.5-20 years) soldiers, subjected to impulse noise during one year of military service. The soldiers were divided in to three groups according exposure to noise. Group I the highest exposure 2222, 9 kPa2/s, group II--611, 8 kPa2/s and group III--103-109 kPa2/s. The control group consisted of 60 (120 ears) secondary school students. Hearing evaluation was performed before and after one year of military service, using extended pure tone audiometry, tympanometry, TEOAE and SNR. RESULTS: after military service significant deterioration of hearing was observed on average 1-2 dB for 0.125-3 kHz and 4-6 dB for 4-12 kHz for all examined soldiers without differences between groups. TEOAE reductions were registered predominantly at frequencies of 3 and 4 kHz, for both ears and SNR mean values reduction for the frequencies of 2, 3 and 4 kHz. CONCLUSIONS: TEOAE especially in cases where clinical audiometry is less sensitive can monitor small changes in the cochlea. There were no differences between groups and ears.