tratamiento de urgencia del acúfeno

En el libro "el acúfeno como señal de malestar"
los autores

Miguel A. López González
Bioquímico
Otorrinolaringólogo
Hospital Universitario Virgen del Rocío
Sevilla
Francisco Esteban Ortega
Jefe de Servicio de Otorrinolaringología
Hospital Universitario Virgen del Rocío
Sevilla
Profesor Numerario de Otorrinolaringología
Universidad de Sevilla


nos señalan

Tratamiento de urgencia del acúfeno 

donde aparte de la medicación , resalto que los autores recomiendan terapia cognitiva-conductual,

 Ante cuadros de pacientes que solicitan asistencia de urgencia 
debido al síntoma acúfeno, se puede administrar medicación específica
junto con terapia conductual. 


Dexclorfeniramina

 
Una gragea de 6 mg como dosis inicial, continuando con 2 mg (un
comprimido) cada 8 horas hasta la disminución o desaparición del
acúfeno.
Alternativamente, una ampolla de 5 mg intramuscular, continuando
con 2 mg (un comprimido) cada 8 horas.

Sulpirida 

Un comprimido de 200 mg como dosis inicial, continuando con 50
mg (una cápsula) cada 8 horas hasta la disminución o desaparición
del malestar.
Alternativamente, una ampolla de 100 mg intramuscular,
continuando con 50 mg (una cápsula) cada 8 horas.

Diazepam 

 
Un comprimido de 25 mg como dosis inicial, continuando con 5 mg
(un comprimido) cada 8 horas hasta la disminución o desaparición
del malestar.
Alternativamente, una ampolla de 10 mg intramuscular como dosis
inicial, continuando con 5 mg (un comprimido) cada 8 horas.

Juntamente con la medicación, hay que realizar una terapia cognitiva-conductual que va a ser la que resuelva el caso definitivamente.

 Se investigarán los factores biopsicosociales incidentes para conseguir 
mediante los cambios pertinentes en la actitud o afrontamiento de los 
eventos, por parte del paciente, la superación o aceptación de sus 
circunstancias.  

Publicado por OTIN en 20:32
Fuente: Blog la puerta de la esperanza
 http://otinylucas.blogspot.com.ar/2012/12/tratamiento-de-urgencia-del-acufeno.html 

White Noise sound machines

White Noise Sound Machines: Top 5!

If you suffer from ringing in the ears or tinnitus, chances are you have a tough time getting a good night’s sleep. For most sufferers, their tinnitus symptoms such as ringing in the ears, buzzing or clicking wake them up in the middle of the night, interrupt your REM cycle and disturb your sleeping pattern.
Numerous tinnitus patients suffer from insomnia, nervousness, anxiety and depression, in addition to ringing in the ears and hearing loss.

White noise sound machines are gaining popularity as an alternative to sleep medications.
According to Consumer Reports, white noise machines are almost as effective at inducing restful sleep as sleep medications.
Physicians often recommend that tinnitus patients use a white noise machine at bedtime.
Listing to the soothing sounds of breezes, raindrops or bonfires may help you get to sleep quicker, making it easier for you to wake up every morning and feel refreshed.
Below is list of the top five white noise machines!

1. Brookstone Tranquil Moments Sound Therapy System (Brookstone.com)- $129.95. With this white noise machine you can choose from 5 different nature sounds, in addition to 7 white noise programs.
2. Sound Screen and SleepMate (Marpac.com)-$59.95. This emits white noises that sound like rushing air and effectively masks out unwanted noises such as tinnitus ringing.
3. Homedics SoundSpa (Walmart.com)- $19.97. This SoundSpa is lightweight, compact and is programmed with six soundtracks, including ocean breeze, rain forest, rain shower, waterfall rapids, nighttime and gentle heartbeat.
4. Marsona (Target.com)- $69.99. This white noise machine is small enough to put in a carry-on bag. There are two adjustable settings that emit a constant stream of white noise to help you sleep better.
5. Ecotiones Duet (Amazon.com)- $129.99. This machine reacts to the level of environmental noise and automatically adjusts its volume accordingly. There are ten sounds that mimic the sounds of nature.

Above are the top five suggested white noise machines for tinnitus and ringing in the ears. The symptoms of tinnitus can be frustrating and even more so when you are trying to go to sleep. If you haven’t already, try one of the white noise machines above to help you get a restful nights sleep!

Fuente: The Buzz Stops Hear
Wednesday, January 25th, 2012
 http://thebuzzstopshear.com/tag/tinnitus-remedies/

Residual tinnitus after the medical treatment of sudden deafness

Osaka Rosai Hospital, Japan

 

 

Authors

• Takahiro Michiba^a,
• Tadashi Kitahara^{a, b, ,} ,
• Noriko Hikita-Watanabe^b,
• Munehisa Fukushima^a,
• Yoshiyuki Ozono^a,
• Ryusuke Imai^a,
• Hidenori Inohara^b

• ^a Department of Otolaryngology-Head and Neck Surgery, Osaka Rosai Hospital, Japan
• ^b Department of Otolaryngology-Head and Neck Surgery, Osaka University Hospital, Japan

---

Abstract

Objectives

Some patients with sudden sensorineural hearing loss (SSNHL) are frustrated by residual tinnitus even after accomplishment of the treatment for SSNHL. 

In the present prospective study, we examined patients’ backgrounds of sex, laterality and age together with changes in hearing level and the tinnitus score after the onset of SSHNL to determine the prognostic factors of residual tinnitus after the final day of medical treatment for SSNHL.

Methods

Forty-four patients with SSNHL were all treated with systemic administration of steroids for 2 weeks and oral intake of vasoactive drugs and vitamin B12 for 6 months before accomplishment of the treatment for SSNHL. 

The hearing improvement rate (HIR) was determined by comparing the hearing level before and 6 months after the start of treatment.

Tinnitus was subjectively evaluated by the tinnitus scoring questionnaire before, 6 and 24 months after the start of treatment. 

The score of a five-step evaluation of subjective tinnitus feelings, “loudness”, “duration” and “annoyance”, was recorded.

Results

HIR was significantly correlated with tinnitus score improvement (TSI) in “duration” at 6 months after the start of treatment compared with before treatment. 

The tinnitus score of all 3 items was significantly improved 6 months after the start of treatment compared with that before treatment but it was not significantly changed between 6 and 24 months after the start of treatment. 

TSI in “duration” between 6 and 24 months was significantly correlated with the patients’ age and HIR using multiple regression analysis.

Conclusion

According to the tinnitus scoring questionnaire, “duration” is the most reliable item for subjective evaluation of tinnitus accompanied by SSNHL. 

Generally, subjective feelings for residual tinnitus 6 months after the start of treatment for SSNHL are supposed to be almost the same, even at the 24th post-treatment month. 

Especially, younger patients with better hearing improvement are predicted to achieve further improvement of tinnitus between 6 and 24 months after the start of treatment.

Abbreviations

• HIR, hearing improvement rate;
• PTA, pure-tone audiometry;
• SSNHL, sudden sensorineural hearing loss;
• TSI, tinnitus score improvement;
• TSQ, tinnitus score questionnaire

---

Corresponding author at: Department of Otolaryngology-Head and Neck Surgery, Osaka University, School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan. Tel.: +81 6 6879 3951; fax: +81 6 6879 3959.

Fuente:  Auris Nasus Larynx

 http://dx.doi.org/10.1016/j.anl.2012.06.007

 

A dose–response analysis of the effects of L-baclofen on chronic tinnitus caused by acoustic trauma in rats

Abstract

Subjective tinnitus is a chronic neurological disorder in which phantom sounds are perceived.  

---

Drugs that increase GABAergic neurotransmission in the CNS are sometimes used as a treatment. 

One such drug is the GABA_B receptor agonist L-baclofen. 

The aim of this study was to investigate the effects of L-baclofen on the psychophysical attributes of tinnitus in rats.

The effects of 1, 3 or 5 mg/kg L-baclofen (s.c.) on the psychophysical attributes of tinnitus were investigated using a conditioned lick suppression model, following acoustic trauma (a 16 kHz, 110 dB pure tone presented unilaterally for 1 h) in rats. 

In pre-drug testing, acoustic trauma resulted in a significant increase in the auditory brainstem-evoked response (ABR) threshold in the affected ear (P < 0.008) and a significant decrease in the suppression ratio (SR) compared to sham controls in response to the 20 kHz tones, but not the broadband noise or the 10 kHz tones (P < 0.002). 

The 3 and 5 mg/kg doses of L-baclofen significantly reversed the frequency-specific decrease in the SR in the acoustic trauma group, indicating that the drug reduced tinnitus.

Following washout from the 3 mg/kg dose, but not the 5 mg/kg dose, the significant decrease in the SR for the acoustic trauma group returned, suggesting a return of the tinnitus. 

These results suggest that L-baclofen should be reconsidered as a drug treatment for tinnitus.

This article is part of a Special Issue entitled ‘Post-Traumatic Stress Disorder’.

---

---

---

Highlights

► We tested whether the GABA_B receptor agonist L-baclofen could reduce tinnitus. 
► Tinnitus was induced in rats using acoustic trauma. 
► L-baclofen significantly reversed the frequency-specific tinnitus. ► L-baclofen may be useful as a treatment for tinnitus.

Abbreviations

• SR, suppression ratio;
• ABR, auditory brainstem evoked response;
• SPL, sound pressure level;
• BBN, broad band noise

---

Figures and tables from this article:

Fig. 1. Examples of ABR recordings (A: pre-exposure and B: post-exposure recorded in response to a 20 kHz, 60 dB SPL tone) and ABR thresholds (C) for the ipsilateral and contralateral ears of acoustic trauma-exposed and sham control animals before and after exposure, as a function of intensity in dB SPL and frequency in kHz. Bars represent means +1 SE.

Figure options

Fig. 2. SRs for the acoustic trauma-exposed and sham control animals before any drug or vehicle administration, as a function of intensity in dB SPL and frequency in Hz: Broadband noise (BBN), 10 kHz and 20 kHz. Symbols represent means ±1 SE. In this and the following figures, 0 dB represents silence.

Figure options

Fig. 3. Summary of SRs for the acoustic trauma-exposed and sham control animals following different treatments, as a function of intensity in dB SPL at 20 kHz. Symbols represent means ±1 SE.

Figure options

Fig. 4. SRs for the acoustic trauma-exposed and sham control animals following the 3 mg/kg s.c. L-baclofen administration, as a function of intensity in dB SPL and frequency in Hz: Broadband noise (BBN), 10 kHz and 20 kHz. Symbols represent means ±1 SE.

Figure options

Fig. 5. SRs for the acoustic trauma-exposed and sham control animals following the 5 mg/kg s.c. L-baclofen administration, as a function of intensity in dB SPL and frequency in Hz: Broadband noise (BBN), 10 kHz and 20 kHz. Symbols represent means ±1 SE.

Authors

• Yiwen Zheng^{a, b},
• Shweta Vagal^{a, b},
• Emily McNamara^{a, b},
• Cynthia L. Darlington^{a, b, 1},
• Paul F. Smith^{a, b, , 1,}

• ^a Department of Pharmacology and Toxicology, School of Medical Sciences, University of Otago Medical School, P.O. Box 913, Dunedin, New Zealand
• ^b Brain Health Research Centre, University of Otago, Dunedin, New Zealand

Corresponding author. Department of Pharmacology and Toxicology, School of Medical Sciences, University of Otago Medical School, P.O. Box 913, Dunedin, New Zealand. Tel.: +64 3 4795747; fax: +64 3 4799140.

1

These authors contributed equally to this work.

Fuente: 

Neuropharmacology

Volume 62, Issue 2, February 2012, Pages 940–946

 http://dx.doi.org/10.1016/j.neuropharm.2011.09.027

Post-Traumatic Stress Disorder

Terapia sonora en sordera súbita

Autores

• Miguel A. López-González^{a, ,} ,
• Esther Cambil^b,
• Antonio Abrante^a,
• Rocío López-Fernández^b,
• Francisco Esteban^a

• ^a UGC Otorrinolaringología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
• ^b Centro Integral de Acúfenos, Sevilla, Spain

---

Resumen

Introducción y objetivos

La hipoacusia neurosensorial súbita idiopática es un trastorno auditivo de causa desconocida. 

El índice de recuperación espontánea puede variar, según la literatura, en un rango del 50–75% de los pacientes. 

Experimentos científicos mediante terapia sonora en animales hipoacúsicos avalan el presente estudio en pacientes con sordera súbita tratados con sonidos.

Pacientes y métodos

Estudio sin aleatorización de una serie retrospectiva de casos. Durante el período 2003-2009, pacientes con hipoacusia neurosensorial súbita idiopática fueron tratados con corticosteroides, piracetam y antioxidantes, en presencia y ausencia de terapia sonora de música y palabra.

Resultados

Cuando se comparan los resultados de los pacientes tratados con medicación (n = 65) y los tratados con medicación más terapia sonora (n = 67), se observa que los segundos tienen mayor recuperación. 

En este grupo, 25 (37%) se recuperaron completamente, 28 (42%) tuvieron buena recuperación, 11 (16%) ligera recuperación y 3 (5%) pobre recuperación o ninguna recuperación.

Conclusión

El 54% de los pacientes del grupo con medicación ha recuperado más de la mitad de la audición perdida y el 79% del grupo que recibió medicación y terapia sonora. 

La recuperación auditiva no sufrió alteraciones, al menos, en los siguientes 12 meses del tratamiento.

  Abstract

Introduction and goals

Idiopathic sudden sensorineural hearing loss is a hearing disorder of unknown cause. The spontaneous recovery rate ranges from 50% to 75% of the patients. Scientific experiments on animals support the present study in patients with sudden deafness treated with sounds.

Patients and methods

During the period 2003–2009, patients with idiopathic sudden sensorineural hearing loss were administered steroids, piracetam and antioxidants, together with the addition of sounds by means of music and words.

Results

Comparing the results of patients treated with medication (n=65) and those treated with medication and sounds (n=67), it was observed that patients treated with medication and sounds had higher recovery. Within the group of patients treated with medication and sounds, 25 (37%) experienced complete recovery, 28 (42%) good recovery, 11 (16%) slight recovery and 3 (5%) poor or no recovery.

Conclusion

The patients who recovered more than half of their audition accounted for 54% in the group treated with medication and for 79% in the group of patients receiving medication and sounds. Auditory recuperation showed no alterations, at least up to 12 months after therapy.

---

---

Figures and tables from this article:

Figure 1. Recovery rate in patients with sudden deafness. Control: patients treated with medication. Sounds: patients treated with medication plus sound therapy (Chi-square, P<.050).

Figure 2. Patients with sudden deafness treated with medication plus sound therapy in relation to the recovery time. The Y-axis represents the percentage of patients with hearing recovery. The X-axis represents the duration of treatment in months. Hearing recovery was achieved mainly during the first month of treatment.

Figure 3. Pure tone audiometry of patients with sudden deafness. (A) Patients with normal hearing before sudden deafness who were treated with medication. (B) Patients with sensorineural hearing loss before sudden deafness who were treated with medication. (C) Patients with normal hearing before sudden deafness who were treated with medication plus sound therapy. (D) Patients with sensorineural hearing loss before sudden deafness who were treated with medication plus sound therapy. Results are expressed as mean±standard error (-■- hearing before sudden deafness; -▾- hearing after treatment of sudden deafness; -□- hearing at the time of diagnosis of sudden deafness).

Corresponding author.

Fuente: 

Acta Otorrinolaringologica (English Edition)

Volume 63, Issue 3, May–June 2012, Pages 165–172

http://dx.doi.org/10.1016/j.otoeng.2012.05.002

Isoflurane blocks temporary tinnitus

Research paper

AUTHORS

• Madeleine Norman,
• Katherine Tomscha,
• Michael Wehr^,

• Institute of Neuroscience, Department of Psychology, 1254 University of Oregon, Eugene, OR 97403, USA

---

Abstract

Temporary tinnitus is a common consequence of noise exposure, and may share important mechanisms with chronic tinnitus. 

Noise-induced hearing loss is the most prevalent cause of chronic tinnitus. 

The reversibility of temporary tinnitus offers some practical experimental advantages. 

We therefore adapted a behavioral method based on gap detection to measure temporary tinnitus following brief acoustic trauma. 

Although anesthesia is often used during acoustic trauma exposure, many anesthetics can protect against noise-induced hearing loss.

Whether anesthesia during acoustic trauma affects temporary tinnitus therefore remains an open question that directly affects experimental design in tinnitus studies. 

Here we tested whether anesthetizing rats with isoflurane during trauma had any effect on tinnitus. 

We found that gap-detection deficits, a behavioral measure of tinnitus, were 5 times stronger and lasted 10 times longer when isoflurane was not used. 

This suggests that isoflurane largely prevents temporary noise-induced tinnitus.

---

Highlights

► We used a behavioral gap-detection method to measure temporary tinnitus in rats following brief acoustic trauma. 
► We tested whether anesthetizing rats with isoflurane during trauma had any effect on on tinnitus. 
► We found that tinnitus was 5 times stronger and lasted 10 times longer when isoflurane was not used. 
► These results suggest that isoflurane largely prevents temporary noise-induced tinnitus.

---

Figures and tables from this article:

Fig. 1. Gap detection measure of temporary tinnitus. a) Example of startle responses (arrows) of an animal to a white noise burst embedded in background narrow-band noise. Top panel shows the startle response to the noise burst presented in isolation (black lines: 20 individual trials; red line: mean across trials; grey line: stimulus). Stimulus is clipped. Bottom panel shows that the startle response is reduced when the white noise burst is preceded by a 50 ms gap in the background noise. Startle response amplitude is in arbitrary units. b) Peak startle response amplitudes for the raw data shown in (a). Black circles: 20 individual trials; grey dots: mean across trials; *indicates that the gap caused a significant decrease in peak startle amplitude (p < 10⁻²). The decreased startle response demonstrates successful gap detection by the animal, with a tinnitus index (see Methods) of 0.0002 (i.e., no tinnitus). c) Schematic of time course for a typical experiment (G: gap detection task, N: noise detection task. Blocks of tasks were repeated (indicated by…) until performance returned to baseline. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Figure options

Fig. 2. Isoflurane blocks temporary tinnitus. a) Time course of temporary tinnitus following brief noise trauma. Animals (n = 10) were not anesthetized with isoflurane during pure-tone trauma. Note that tinnitus index rose sharply after trauma and remained elevated for hours. Symbols in a, b, e, f indicate different animals. b) Time course of tinnitus when animals were anesthetized with isoflurane during noise trauma. These are the same 10 animals as in (a), but tested at least 2 days apart. c) The maximum tinnitus index was significantly greater when isoflurane was not used (p < 10⁻²). d) Tinnitus duration was significantly longer when isoflurane was not used (p < 0.05). Tinnitus duration was defined as the amount of time that the tinnitus index exceeded 0.05. e) A reduction in %GPIAS (consistent with presence of tinnitus) showed a similar time course as the increase in tinnitus index in (a) for animals not anesthetized with isoflurane during trauma. f) Animals anesthetized during trauma showed no reduction in %GPIAS. g) The maximal change in %GPIAS from baseline was significantly greater when isoflurane was not used (p < 10⁻²). Error bars in c, d, g indicate standard errors of the mean.

Figure options

Fig. 3. Narrow band noise detection thresholds. a) Example of startle responses of an animal to a white noise burst without any background noise. In the top panel, the white noise burst is presented in isolation. In the lower panels, the burst is preceded by a narrow-band prepulse, with the prepulse level indicated at left (prepulse bandwidth was ⅓ octave and center frequency was 6 kHz). Note that the startle response was progressively reduced as the prepulse level was increased. Startle response amplitude is in arbitrary units. b) Peak startle response amplitudes for the raw data shown in (a). Black circles: 20 individual trials; grey filled circles: mean across trials; *indicates that the prepulse caused a significant (p < 0.05) decrease in peak startle amplitude. We used the lowest prepulse level that significantly reduced startle as an estimate (upper bound) of detection threshold (50 dB in this example). c) Time course of detection threshold, expressed as dB relative to the background noise level used in the gap detection task. Detection threshold averaged −19 ± 6 dB and never exceeded −5 dB, indicating that animals could always hear the background noise used in the gap detection task.

Figure options

Corresponding author.

Fuente: 

Hearing Research

Volume 290, Issues 1–2, August 2012, Pages 64–71

http://dx.doi.org/10.1016/j.heares.2012.03.015