Hearing aid stigma is French toast

October 9, 2009:

Ninety-two percent of the French population would be willing to use hearing aids, if necessary, according to a new study.



The French have a positive disposition towards the use of hearing aids. Ninety-two percent of those responding to a survey, conducted by the Ipsos polling firm said they would be willing to use hearing aids. The survey was associated with the ” journée nationale de l’audition”, the national hearing day. The respondents were particularly pleased with the design and functionality of modern hearing aid technology.

The survey indicated a generally high degree of confindence in hearing aids among the population of France. Fifty-seven percent of the respondents said that they believe hearing aids can help in restoring hearing fully or partially, and 60 percent said they were convinced that the transition back to a normal life with hearing aids is relatively brief.

Changes in attitude

The positive attitudes towards hearing aids seems to be part of a general change in attitudes towards hearing loss. Today, 68 percent of the population in France are aware that hearing loss occurs at all ages, and hearing aids are no longer just associated with older age groups.

At the same time, the French recognise that they are personally responsible for their hearing. More than half of them believe that hearing loss is mainly a result of exposure to excessive noise in risk zones and failure to protect the ears.

Generation gap

However, the survey demonstrated a gap in attitudes between generations. Young Frenchmen speak more highly about hearing aids, whereas the 60 years and older generation appears to be generally more skeptical and dissatisfied with, what they see as poor effects, high prices and high co-pay of hearing aids. The older age group also believes that hearing loss is primarily genetically coinditioned.

Source: Ipsos.fr
Fuente: Hear-it

Renuevan red roja en hospital de Pochutla

Escrito por Maymont

Lunes, 14 de Diciembre de 2009 19:19
Directores de unidades médicas de primer nivel de la Costa renovaron compromisos en la referencia de mujeres embarazadas al Centro de Salud con Servicios Ampliados (CESSA) y al Hospital de San Pedro, Pochutla, respectivamente, a fin de garantizar una atención de calidad.

Y es que para el titular de los Servicios de Salud de Oaxaca (SSO), Martín Vásquez Villanueva, el compromiso de cuidar de las mujeres costeñas que cursan por un embarazo es fundamental, por lo que urgió el reforzamiento de la Red de Servicios de Salud.

Durante una reunión con médicos responsables de la región, el director de Atención Médica de los SSO, Juan Carlos Wolf Sepúlveda, dijo que es vital ofrecer una atención de calidad y calidez, pero sobre todo, oportuna, a las costeñas.

Detalló que la agilización de acciones de referencia y contra referencia de pacientes con embarazos de riesgo de las unidades de primer nivel, deberán realizarse de forma inmediata al CESSA u hospital, antes mencionados, para evitar desenlaces fatales.

El médico explicó, que este reforzamiento de la red de servicios está enfocado a disminuir los índices de mortalidad materna en la región, así como a ofrecer a cada mujer costeña una gestación segura.
Abundó que la Red Roja del Hospital de Pochutla está compuesta por nueve Centros de Salud y los Hospitales Materno Infantiles de la misma localidad y de Santa Cruz Huatulco.

Expresó que el fortalecimiento de las unidades médicas se basa en los lineamientos de la administración del Gobernador Ulises Ruiz Ortiz, quien afirma, la salud de la mujer es una prioridad.

Sin embargo, Wolf Sepúlveda argumentó que los esfuerzos de los SSO serán insuficientes sin la participación de las mujeres embarazadas, quienes deben cuidar de su salud y acudiendo a revisiones médicas de manera periódica, y atendiendo las indicaciones de los especialistas.

Destacó finalmente, que las féminas en gestación deben acudir de inmediato a la unidad de salud más cercana ante la presencia de mareos, náuseas, dolor de cabeza, zumbidos en los oídos o sangrados vaginales ya que son signos de que su salud y la de su bebé están en riesgo.
Fuente; NSS Oaxaca

Tinnitus: Psychological Treatment And Neurostimulation Offer Hope

ScienceDaily (Nov. 24, 2008) — A remarkable number of patients with tinnitus demonstrate withdrawal behaviour and have a negative view of life. Feelings of anxiety and depression result in patients experiencing the complaint as a major burden on their quality of life. In addition to psychological treatment, neurostimulation now also appears to be a very promising therapy.
This is the result of research conducted by Hilke Bartels of the University Medical Center Groningen. She will be awarded a PhD by the University of Groningen on 26 November 2008.

Patients with tinnitus hear noises that do not originate outside but within the body itself. They can be squeaks, whistles or whooshing noises, or even rumbles, knocking or rustling sounds. It is estimated that 10-30 percent of the Dutch suffer from tinnitus. Four to five percent of these people feel seriously limited as a result; for example, they can’t concentrate properly anymore, or have trouble sleeping. The complaint usually starts when people are between the ages of 40 and 60 and their hearing is not what it used to be.

Overactive brains

For a long time it was assumed that the cause of tinnitus lay in the auditory organ itself. However, it is now clear that the brain is responsible: overactive parts of the brain in the auditory region emit continuous signals that are the cause of the ‘phantom noise’. This over-activity is usually the result of hearing loss. However, noise (buzzing in the ears after visiting a concert or discotheque), an infection or an operation on the ear, or a jaw or neck problem can also cause the symptoms. With the help of the image-forming technologies PET and fMRI, Bartels mapped the over-activity of the relevant parts of the brain. She was thus able to confirm existing theories about the complaint.

Negative attitude

Bartels’s research has revealed that a remarkable number of tinnitus patients are depressed and have a negative attitude towards life. They do not dare to share these feelings with others, which means they experience little social support, which in turn leads to withdrawal behaviour. This is also described as the so-called ‘type D personality’. No fewer than 94 of the 265 tinnitus patients investigated had such a personality type. These patients experienced significantly more psychological discomfort, the research revealed. Anxiety and depression appear to strengthen the effect of tinnitus. People with a type D personality in particular should undergo treatment that concentrates on the reduction of anxiety and depression, according to Bartels.

Effective neurostimulation

A psychological approach is not the only light on the horizon, however. Between 2001 and 2003, the UMCG started an experimental treatment regime whereby the relevant brain areas were continuously stimulated with the help of a pulse generator, a sort of pacemaker. An evaluation revealed that four of the six patients treated in this way had significantly positive long-term results. The patients indicated that the ‘noise’ was reduced to manageable levels and awarded the treatment a mark of 7 out of 10. Neurostimulation with a magnet outside the skull also looks like an interesting treatment option. The tinnitus of 5 of the 24 patients who underwent this experimental treatment was temporarily suppressed.

Recommendations

Thus far no treatment has been shown to be effective for the majority of tinnitus patients. Current treatment options have either a medical, an audiological or a psychological basis. According to Bartels, a multidisciplinary approach is essential. She also calls for the use of validated questionnaires to chart the nature and the impact of tinnitus

Fuente: APA-MLA
University of Groningen (2008, November 24). Tinnitus: Psychological Treatment And Neurostimulation Offer Hope. ScienceDaily. Retrieved December 15, 2009, from http://www.sciencedaily.com­ /releases/2008/11/081120175851.htm

Ways To Minimize Tinnitus Troublesome Noises In The Ears

scienceDaily (Feb. 15, 2009) — Ringing, whining, whistling, hissing or whooshing. Any of those sounds in one or both ears when there is no external noise present could be a sign of tinnitus.
The February issue of Mayo Clinic Women’s HealthSource provides an overview of this common condition. It’s estimated that 10 percent to 15 percent of adults have prolonged tinnitus that often requires medical evaluation. This form of the problem can interfere with sleep, concentration and daily activities.

Tinnitus -- pronounced as either TIN-i-tus or ti-NIGHT-us, often is caused by age-related hearing loss. Exposure to loud noises also can damage hearing and lead to tinnitus. Tinnitus can be caused by something as simple as a buildup of wax blocking the ear canal. Some medications, certain antibiotics and cancer drugs can cause or worsen tinnitus. Aspirin -- taken in excessive amounts -- can cause temporary ringing in the ears, too.

The treatment depends on the root cause. But so far, there is no cure. A medication change or removal of earwax may diminish symptoms for some people.

“One of the frustrating things about tinnitus is that there aren’t any universal successful treatments,” says Charles Beatty, M.D., a Mayo Clinic specialist in head and neck disorders. “The good news is that the problem usually isn’t associated with a serious medical condition, and there are ways we can try to make the tinnitus less annoying and disruptive.”

Treatment strategies that may be beneficial include:

1. Amplifying hearing with a hearing aid. This may help because the brain would rather process external sounds than be distracted by an internal noise.
2. Avoiding excessive noise. Ear plugs can be helpful when operating noisy machines.
3. Avoiding stimulants. Caffeine, nicotine and decongestants can aggravate tinnitus.
4. Adding background noise. Turning on quiet music, a fan or other background noises can distract the brain from the internal noise.
5. Using behavioral therapy. Relaxation techniques can help people cope with tinnitus or keep it controlled.
6. Using medications. Sedatives or antidepressants can help when the condition interferes with sleep or causes a high level of anxiety or stress

Story Source:
Adapted from materials provided by Mayo Clinic, via Newswise.
FUENTE:SCIENCE DAYLY- http://www.sciencedaily.com/releases/2009/02/090204165913.htm

Non-Invasive Imaging Technique Can Help Diagnose Tinnitus

ScienceDaily (Oct. 5, 2009) — It's a ringing, a buzzing, a hissing or a clicking - and the patient is the only one who can hear it.
Complicating matters, physicians can rarely pinpoint the source of tinnitus, a chronic ringing of the head or ears that can be as quiet as a whisper or as loud as a jackhammer.

Now a Henry Ford Hospital study finds that a non-invasive imaging technique can actually aid in the diagnosis of tinnitus and may detect a reduction in symptoms after different treatments, offering hope to the more than 50 million patients with tinnitus.

"Until now, we had no way of pinpointing the specific location of tinnitus in the brain," says study co-author Michael D. Seidman, M.D., F.A.C.S., director of the Division of Otologic/Neurotolgic Surgery in the Department of Otolaryngology-Head & Neck Surgery at Henry Ford Hospital.

This imaging technique, magnetoencephalography (MEG), can determine the site of perception of tinnitus in the brain, which could in turn allow physicians to target the area with electrical or chemical therapies to lessen symptoms, according to study results being presented Saturday, Oct. 3 at the American Academy of Otolaryngology–Head & Neck Surgery Foundation Annual Meeting & OTO EXPO.

"Since MEG can detect brain activity occurring at each instant in time, we are able to detect brain activity involved in the network or flow of information across the brain over a 10-minute time interval," explains co-author Susan M. Bowyer, Ph.D. bioscientific senior researcher, Department of Neurology at Henry Ford Hospital. "Using MEG, we can actually see the areas in the brain that are generating the patient's tinnitus, which allows us to target it and treat it."

Imaging techniques currently used to study tinnitus in the brain – PET and fMRI – provide a general location but are not successful at determining the specific site in the brain that is generating tinnitus symptoms.

MEG, by comparison, measures the very small magnetic fields generated by intracellular electrical currents in the neurons of the brain. Only 20 sites in the U.S., including Henry Ford, are equipped with a MEG scanner. MEG is presently used at these sites for pre-surgical brain mapping for patients undergoing surgery for brain tumor removal or Epilepsy treatment.

"With PET and fMRI, most of the auditory cortex of the brain lights up with activity during imaging. MEG, however, is a much more sophisticated machine and it can identify a specific tone or topic point, so only a small area in the brain lights up. It's like having the lights on in only the city of Detroit, compared to having the lights on in the entire state of Michigan," explains Dr. Seidman, director of the Otolaryngology Research Laboratory and co-director of the Tinnitus Center at Henry Ford.

For the study, Dr. Seidman and his colleagues collected MEG results from 17 patients with tinnitus and 10 patients without tinnitus. MEG data were collected for 10 minutes, and then digitally filtered. Study participants wore ear plugs to eliminate outside sounds, and kept their eyes open and fixated on one point on the ceiling in the room during testing.

With tinnitus patients who have ringing in one ear (unilateral tinnitus), MEG imaging detected the greatest amount of activity in the auditory cortex on the opposite site of the brain from their perceived tinnitus. For patients with ringing in the head or both ears (bilateral tinnitus), MEG imaging revealed activity in both hemispheres of the brain, with greater activity appearing in the opposite side of the brain of the strongest perception of tinnitus.

Patients without tinnitus had multiple small active areas in the brain, but no particular areas were found to be highly coherent during the 10-minute MEG scan.

Ultimately, Dr. Seidman says the study establishes MEG as an effective clinical tool for localizing the probably source of tinnitus in patients' brains. It also has the potential to assist with the development of future interventional strategies to alleviate tinnitus.

About Tinnitus

The American Tinnitus Association estimates that more than 50 million Americans experience tinnitus to some degree; about 12 million have severe enough tinnitus to seek medical attention; and about two million patients are so seriously debilitated that they cannot function on a day-to-day basis.

The exact physiological cause or causes of tinnitus are not known. There are, however, several likely sources, all of which are known to trigger or worsen tinnitus, including exposure to loud noises, wax build-up in the ear, ear or sinus infections, head and neck trauma, and certain disorders, such as hypo- or hyperthyroidism, Lyme disease, fibromyalgia, and thoracic outlet syndrome can have tinnitus as a symptom.

Although there is no known cure for tinnitus, Henry Ford offers several options for coping with the condition, including hearing aids, sound generators and medication, and all come with ongoing counseling. The goal is to provide patients with relief from their tinnitus and a better quality of life.

Story Source: Adapted from materials provided by Henry Ford Health System, via EurekAlert!, a service of AAAS.
Fuente:Sience dayly- http://www.sciencedaily.com/releases/2009/10/091004141223.htm

Tinnitus Patients Are Told ‘Nothing Can Be Done To Ease The Condition’

Research News RSS
Saturday, November 07, 2009

Reports say despite the fact that tinnitus is a very distressing condition, not enough is being done to support patients who experience the problem, according to an extensive research review.

As many as one in seven people will experience tinnitus, or ringing in their ears, at some time of their life, but most patients are told that nothing can be done to ease the condition.

"Despite the fact that it is a very distressing condition and can affect people's lifestyle and quality of life, around 94 percent of patients are simply told that nothing can be done to alleviate the condition," says Professor Susan Holmes from Canterbury Christ Church University, Kent, UK.

"Tinnitus is a widespread condition that affects millions of people across the world and there is considerable debate about its causes. The condition, which can be permanent or temporary and acute or chronic, increases with age and can also occur after bereavement or during stressful periods.

"It is sometimes referred to as a 'phantom sensation' as the sound - often a high-pitched noise with mechanical, electrical or musical qualities - is experienced in the absence of external stimuli," Holmes added.

Holmes collaborated with Nigel Padgham, an ear nose and throat surgery specialist from Kent and Canterbury Hospital, to conduct an extensive research review of nearly 150 papers published since 1983.

This showed that although considerable research has been carried out on the subject, nurses - who are often the first people patients turn to - have received very little guidance or information on the condition.


"We believe that affected patients need considerable support and advice on healthcare options, encouragement to try different treatments and recognition that help and hope are available," Holmes said.

"Though patients may have to learn to live with tinnitus, the most important thing is that they recognize that help is available," Holmes added.

The research review appears in the November issue of the Journal of Clinical Nursing.

Source-ANIARU
Fuente: http://www.medindia.net/news/Tinnitus-Patients-Are-Told-Nothing-Can-Be-Done-To-Ease-The-Condition-60501-2.htm

Scientists Show How Tiny Cells Deliver Big Sound In Cochlea

Medical illustration of the human osscous labyrinth, from "1870 Gray's Anatomy Descriptive And Surgical Book - First Edition". (Credit: iStockphoto/Mark Strozier)

ScienceDaily (Oct. 23, 2009) — Deep in the ear, 95 percent of the cells that shuttle sound to the brain are big, boisterous neurons that, to date, have explained most of what scientists know about how hearing works. Whether a rare, whisper-small second set of cells also carry signals from the inner ear to the brain and have a real role in processing sound has been a matter of debate.
Now, reporting on rat experiments in the October 22 issue of Nature, a Johns Hopkins team says it has for what is believed to be the first time managed to measure and record the elusive electrical activity of the type II neurons in the snail-shell-like structure called the cochlea. And it turns out the cells do indeed carry signals from the ear to the brain, and the sounds they likely respond to would need to be loud, such as sirens or alarms that might be even be described as painful or traumatic.

The researchers say they've also discovered that these sensory cells get the job done by responding to glutamate released from sensory hair cells of the inner ear. Glutamate is a workhorse neurotransmitter throughout the nervous system and it excites the cochlear neurons to carry acoustic information to the brain.

"No one thought recording them was even possible," says Paul A. Fuchs, Ph.D., the John E. Bordley Professor of Otolaryngology-Head and Neck Surgery and co-director of the Center for Sensory Biology in the Johns Hopkins University School of Medicine, and a co-author of the report. "We knew the type II neurons were there and now at last we know something about what they do and how they do it."

Working with week-old rats, neuroscience graduate student Catherine Weisz removed live, soft tissue from the fragile cochlea and, guided by a powerful microscope, touched electrodes to the tiny type II nerve endings beneath the sensory hair cells. Different types of stimuli were used to activate sensory hair cells, allowing Weisz to record and analyze the resulting signals in type II fibers.

Results showed that, unlike type I neurons which are electrically activated by the quietest sounds we hear, and which saturate as sounds get louder, each type II neuron would need to be hit hard by a very loud sound to produce excitation, Fuchs says.

The cell bodies of both type I and type II neurons sprout long filaments, or axons that head to the brain, and some others that connect to sensory hair cells. Unlike the big type I neurons, each of which make one little sprout that touches one sensory hair cell in one spot, the type II cells have projections that contact dozens of hair cells over a relatively great distance.

"Somewhat counter-intuitively, the type II cell that contacts many hair cells receives surprisingly little synaptic input," Fuchs says. "In fact, all of its many contacts put together yield less input than that provided by the one single hair cell touching a type I neuron."

Fuchs and his team postulate that the two systems may serve different functional roles. "There's a distinct difference between analyzing sound to extract meaning -- Is that a cat meowing, a baby crying or a man singing? -- versus the startle reflex triggered by a thunderclap or other sudden loud sound." Type II afferents may play a role in such reflexive withdrawals from potential trauma."

This study was supported by the National Institute on Deafness and Other Communication Disorders, and a grant from the Blaustein Pain Foundation of Johns Hopkins.

Authors on the paper are Fuchs, Weisz and Elisabeth Glowatzki, all of the Center for Hearing and Balance and the Center for Sensory Biology, Johns Hopkins University School of Medicine.

fuente: http://www.sciencedaily.com/releases/2009/10/091022114319.htm
23-octubre 2009

New Therapies Fight Phantom Noises of Tinnitus

By KATE MURPHY
Published: April 1, 2008


Modern life is loud. The jolting buzz of an alarm clock awakens the ears to a daily din of trucks idling, sirens blaring, televisions droning, computers pinging and phones ringing -- not to mention refrigerators humming and air-conditioners thrumming. But for the 12 million Americans who suffer from severe tinnitus, the phantom tones inside their head are louder than anything else.

Often caused by prolonged or sudden exposure to loud noises, tinnitus (pronounced tin-NIGHT-us or TIN-nit-us) is becoming an increasingly common complaint, particularly among soldiers returning from combat, users of portable music players, and aging baby boomers reared on rock 'n' roll. (Other causes include stress, some kinds of chemotherapy, head and neck trauma, sinus infections, and multiple sclerosis.)

Although there is no cure, researchers say they have never had a better understanding of the cascade of physiological and psychological mechanisms responsible for tinnitus. As a result, new treatments under investigation -- some of them already on the market -- show promise in helping patients manage the ringing, pinging and hissing that otherwise drives them to distraction.

The most promising therapies, experts say, are based on discoveries made in the last five years about the brain activity of people with tinnitus. With brain-scanning equipment like functional magnetic resonance imaging, researchers in the United States and Europe have independently discovered that the brain areas responsible for interpreting sound and producing fearful emotions are exceptionally active in people who complain of tinnitus.

''We've discovered that tinnitus is not so much ringing in the ears as ringing in the brain,'' said Thomas J. Brozoski, a tinnitus researcher at Southern Illinois University School of Medicine in Springfield.

Indeed, tinnitus can be intense in people with hearing loss and even those whose auditory nerves have been completely severed. In the absence of normal auditory stimulation, the brain is like a driver trying to tune in to a radio station that is out of range. It turns up the volume trying but gets only annoying static. Richard Salvi, director of the Center for Hearing and Deafness at the State University of New York at Buffalo, said the static could be ''neural noise'' -- the sound of nerves firing. Or, he said, it could be a leftover sound memory.

Adam Edwards, a 34-year-old co-owner of a wheel repair shop in Dallas, said he developed tinnitus four years ago after target shooting with a pistol. ''I had all the risk factors,'' he said. ''I grew up hunting, I played drums in a band, I went to loud concerts, I have a loud work environment -- everything but living next to a missile launch site.'' His tinnitus, which he described as a ''computer beeping'' sound, was so intense and persistent that he needed sedatives to sleep at night.

Mr. Edwards says he has gotten relief from a device developed by an Australian audiologist, which became widely available in the United States last year. Manufactured by Neuromonics Inc. of Bethlehem, Pa., it looks like an MP3 player and delivers sound spanning the full auditory spectrum, digitally embedded in soothing music.

Similar to white noise, the broadband sound, tailored to each patient's hearing ability, masks the tinnitus. (The music is intended to ease the anxiety that often accompanies the disorder.) Patients wear the $5,000 device, which is usually not covered by health insurance, for a minimum of two hours a day for six months. Since completing the treatment regimen last year, Mr. Edwards said his tinnitus had ''become sort of like Muzak at a department store -- you hear it if you think about it, but otherwise you don't really notice.'' A small, company-financed study in the journal Ear & Hearing in April 2007 indicated that the Neuromonics method was 90 percent successful at reducing tinnitus. A larger study is under way to determine its long-term effectiveness.

Anne Howell, an audiologist at the Callier Center for Communication Disorders at the University of Texas at Dallas, said the Neuromonics device was a big improvement over older sound therapies that required wearing something that looked like a hearing aid all the time and took 18 to 24 months.

''The length of time was discouraging for many patients,'' she said. ''And a lot of them told me that wearing something that looks like a hearing aid would cause a problem in their professional life.''

Other treatments showing promise include surgically implanted electrodes and noninvasive magnetic stimulation, both intended to disrupt and possibly reset the faulty brain signals responsible for tinnitus. Using functional M.R.I. to guide them, neurosurgeons in Belgium have performed the implant procedure on several patients in the last year and say it has suppressed tinnitus entirely.

But the treatment is controversial. ''It's a radical option and not proven yet,'' said Jennifer R. Melcher, an assistant professor of otology and laryngology at Harvard Medical School.

The magnetic therapy, similar to treatments used for depression and chronic pain, involves holding a magnet in the shape of a figure eight over the skull. Clinicians use functional M.R.I. to aim the magnetic pulses so they reach regions of the brain responsible for interpreting sound. Patients receive a pulse every second for about 20 minutes. ''It works for some people but not for others,'' said Anthony Cacace, professor of communication science and nerve disorders at Wayne State University in Detroit. Since tinnitus has so many causes, Dr. Cacace said, the challenge now is to find out which ''subsets of patients benefit from this treatment.''

Researchers in Brazil have published a study indicating that a treatment called cranial-sacral trigger point therapy can relieve tinnitus in some head and neck trauma cases by releasing muscles that constrict hearing and neural pathways.

And drugs intended to treat alcoholism, epilepsy, Alzheimer's and depression that alter levels of various neurotransmitters in the brain like serotonin, dopamine and gamma-aminobutyric acid have quieted tinnitus in some published animal and human studies.

''We've never been so hopeful,'' said Dr. Salvi, of SUNY Buffalo, ''of finding treatments for a disorder that haunts people and follows them everywhere they go.''

Fuente: The New York Times, Science,
http://query.nytimes.com/gst/fullpage.html?res=9407EEDD163CF932A35757C0A96E9C8B63

All That Noise Is Damaging Children’s Hearing

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By JANE E. BRODY
Published: December 8, 2008

Michael became hooked on headphones in his early teens. He walked the streets of Brooklyn day after day with his favorite music blasting directly into his ears. By his early 20s, the sensory hair cells in his inner ears had been permanently damaged and Michael had lost much of his upper-range hearing.
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The Children’s Hearing Institute reports that hearing loss among children and young adults is rising in the United States, and that one-third of the damage is caused by noise.

According to the American Academy of Audiology, about one child in eight has noise-induced hearing loss. That means some five million children have an entirely preventable disability that will stay with them for life.

The academy has begun a “turn it to the left” (the volume dial, that is) awareness campaign in hopes of protecting current and future generations of youngsters from unwittingly damaging their hearing. Often, the problem is not detected until children develop persistent ringing in the ears or begin to have learning or behavior problems in school because of trouble understanding speech.

Although newborns are now routinely screened for hearing loss, there is no federal mandate for screening the hearing of school-age children. What testing is done often fails to check hearing at high enough pitches, a federal research team pointed out in the journal Pediatrics.

Surrounded by Noise

We live in a noisy world. Young and old alike are beset by sounds over which we may have little or no control: power mowers, leaf blowers, snow blowers, car and house alarms, sirens, motorcycles, Jet Skis, loudspeakers, even movie previews.

We attend rock concerts, weddings, parties and sports events at which the music is so loud you can hardly hear the person sitting next to you. At home, televisions, stereos and computer games are often turned up so loud that listeners cannot hear a doorbell or a telephone.

Many “modern” restaurants have opted for noise enhancement instead of abatement. And try having a conversation in a school cafeteria at lunchtime.

Any time you need to shout to be heard by someone near you, your hearing is most likely to be in a decibel danger zone.

As if environmental noise were not enough, now we besiege children with noisy toys and personal listening devices that can permanently damage their hearing. Toys that meet the safety standards of the American Society for Testing and Materials can produce sound up to 138 decibels, as loud as a jet taking off. Yet workplace rules require hearing protection for those exposed to noise above 85 decibels.

A series of studies conducted in 2002 among 116 infants by researchers at Johns Hopkins indicated that even moderate background noise can interfere with how they learn language. The effect on babies’ hearing in a noisy house is similar to what an older person with age-related hearing loss may encounter at a crowded cocktail party.

A landmark study in 1975 found that children in classrooms on the noisy side of a school had lower reading scores than those whose classes were on the quiet side.

Noise-induced hearing loss can come about in two ways: from a brief exposure to a very loud noise or from consistent exposure to moderate-level noise. Thus, there is much concern about the lasting effects of MP3 players that are turned up loud enough to block out surrounding sound, like street noise. An MP3 player at maximum volume produces about 105 decibels — 100 times as intense as 85 decibels, where hearing damage begins. (For every 10 decibels, sound intensity increases tenfold.)

The National Institute for Occupational Safety and Health says 110 decibels can produce hearing damage after just 1 minute, 29 seconds of exposure. The League for the Hard of Hearing cautions that “noise levels above 85 decibels will harm hearing over time” and that levels above 140 decibels — the pain threshold — can damage hearing after just one exposure.

New bone-conduction headphones that hook over the ears and pass sound through the skull to the inner ear may not solve the problem. While they allow listeners to hear an oncoming car or a person speaking, users may turn up the volume to overcome ambient noise, damaging the 15,000 tiny hair cells in the inner ear that transfer sound energy to the brain.

Once damaged, hair cells can neither be repaired nor replaced. The damage makes it difficult to hear high-pitched sounds, including certain speech sounds and the voices of women and children. Tinnitus, a continuous ringing, roaring or clicking in the ears, can also result.

Protecting Young Ears

Before buying noisemaking toys, parents would do well to listen to how loud they are. If the item comes with a volume control, monitor its use to make sure it is kept near the lowest level. Consider returning gifts that make loud noises, or disable the noise-making function. Or restrict the use of noisy toys to outside play areas.

Children who play computer games and stereo equipment should be warned to keep the volume down. Time spent in video arcades, where the noise level can exceed 110 decibels, should be strictly limited. Most iPods have a control that allows parents to set a maximum volume.

Avoid taking children to loud action movies. If you do go and the sound seems deafening, ask the management to turn down the volume or insist on your money back. Children who play in bands and teenagers who use power tools, gardening equipment or guns should be made to wear hearing protection, available at pharmacies and hardware and sporting goods stores.

The League for the Hard of Hearing urges parents to encourage participation in quiet activities, like reading, watching family-oriented films, doing puzzles, making things with construction toys, playing educational computer games, drawing and painting, and visiting libraries and museums.

A version of this article appeared in print on December 9, 2008, on page D7 of the New York edition.

Fuente: The New York Times, HEALTH,
http://www.nytimes.com/2008/12/09/health/09brod.html

Senses: Bad News for Nerves of Aging Fans of Heavy Metal

Published: January 24, 2006
The New York Times, Haelth, Vital Signs

Longtime exposure to loud noise may increase the risk of developing a benign nerve tumor called an acoustic neuroma, Swedish research suggests.
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The tumor, which grows inside the skull, can cause constant ringing in the ears, affect balance and result in deafness. It occurs mainly in people over 50.

The findings, published online in The American Journal of Epidemiology, will appear in the Feb. 15 print edition.

The researchers studied a population of 3.9 million people covered by Swedish tumor registries and interviewed 146 people with acoustic neuromas. They were compared with a randomly selected control group of 564 people who did not have the tumors. The participants discussed their lifetime exposure to noise exceeding 80 decibels, about the noise level of city traffic.

In general, the longer people were exposed to loud noises the more likely they were to develop acoustic neuroma.

Compared with those exposed to little noise, people steadily facing construction noise were 1.7 times as likely to have a tumor, and those exposed to screaming children, sports events and noise in restaurants and bars were 1.4 times as likely to be affected.

But exposure to loud music presented the greatest risk. People who regularly listened to loud music, including those in the music industry, were more than twice as likely as others to have the tumors.

Colin G. Edwards, a doctoral student at Ohio State University and the lead author of the paper on the findings, pointed out that the data depend on the participants' own reports and that people with tumors may, in an effort to find a cause for the problem, make errors in recollections of past activities.

"Our study," he concluded, "is not proof that loud noise causes acoustic neuroma, but it suggests a possible link. The results need to be confirmed in other studies."

Fuente: http://www.nytimes.com/2006/01/24/health/24sens.html?_r=1

TINNITUS

Tinnitus is the medical term for "hearing" noises in your ears when there is no outside source of the sounds.

The noises you hear can be soft or loud. They may sound like ringing, blowing, roaring, buzzing, hissing, humming, whistling, or sizzling. You may even think you are hearing air escaping, water running, the inside of a seashell, or musical notes.
See All » News & Features

* All That Noise Is Damaging Children’s Hearing
* In a Host of Ailments, Seeing a Brain Out of Rhythm
* New Therapies Fight Phantom Noises of Tinnitus
* Senses: Bad News for Nerves of Aging Fans of Heavy Metal

Reference from A.D.A.M.
Back to TopAlternative Names

Ringing in the ears; Noises or buzzing in the ears; Ear buzzing
Back to TopConsiderations

Tinnitus is common. Almost everyone experiences a mild form of tinnitus once in awhile that only lasts a few minutes. However, constant or recurring tinnitus is stressful and can interfere with your ability to concentrate or sleep.
Back to TopCommon Causes

It is not known exactly what causes a person to "hear" sounds with no outside source of the noise. However, tinnitus can be a symptom of almost any ear problem, including ear infections, foreign objects or wax in the ear, and injury from loud noises. Alcohol, caffeine, antibiotics, aspirin, or other drugs can also cause ear noises.

Tinnitus may occur with hearing loss. Occasionally, it is a sign of high blood pressure, an allergy, or anemia. Rarely, tinnitus is a sign of a serious problem like a tumor or aneurysm.
Back to TopHome Care

* Tinnitus can be masked by competing sounds, such as low-level music, ticking clocks, or other noises. Tinnitus is often more noticeable when you go to bed at night because your surroundings are quieter. Any noise in the room, like a humidifier, white noise machine, or dishwasher, can help mask tinnitus and make it less irritating.
* Learn ways to relax. Feeling stressed or anxious can worsen tinnitus.
* Avoid caffeine, alcohol, and smoking.
* Get enough rest. Try sleeping with your head propped up in an elevated position. This lessens head congestion and noises may become less noticeable.

Back to TopCall Your Health Care Provider if

Call your doctor if:

* Ear noises start after a head injury.
* The noises are associated with other unexplained symptoms like dizziness, feeling off balance, nausea, or vomiting.
* You have unexplained ear noises that bother you even after self-help measures.

Back to TopWhat to Expect at Your Health Care Provider's Office

The health care provider will perform a physical examination, which will include looking in your ears. You may be questions, such as:

* What does the noise sound like?
* Is the sound throbbing or rhythmic?
* Is it in one or both ears?
* What other symptoms do you have?

The following tests may be done:

* Audiology/audiometry to test hearing loss
* Head CT scan
* Head MRI scan
* Blood vessel studies (angiography)
* X-rays of the head

If your doctor can determine the cause, fixing the problem (for example, removing ear wax) may make your symptoms go away.

Many medicines have been used to relieve symptoms of tinnitus, but no drug works for everyone. Medications may include anti-arrhythmics (usually used for irregular heart rhythms), antidepressants, vasodilators, tranquilizers, anticonvulsants, and antihistamines.

A tinnitus masker is a device worn like a hearing aid. This helps some people. It delivers low-level sound directly into the ear to cover or disguise the ear noise that is bothering you.

A hearing aid may help reduce ear noise and make outside sounds louder.

Sometimes, counseling may help you learn to live with tinnitus. Your doctor may recommend biofeedback training. This method helps you learn to control body functions by monitoring specific responses (such as tightness of a muscle group) and altering this response through relaxation.

Some people have tried alternative therapies to treat tinnitus. These includes:

* Acupuncture
* Craniosacral therapy
* Hypnosis
* Vitamins or herbal supplements, including zinc, magnesium, ginkgo, melatonin, or B vitamins

However, such methods have not been entirely proven. Talk to your doctor before trying any of these alternative therapies.

The American Tinnitus Association is a good resource center and support group.
Back to TopPrevention

Wear ear protection in any situations where ear damage is possible (such as loud concerts or jackhammers). If you have hearing loss, avoid further damage to your hearing by avoiding excessive noise.

Make sure your blood pressure is normal by maintaining proper body weight, exercising regularly, and seeing your doctor for yearly check ups.
Back to TopReferences

Heller AJ. Classification and epidemiology of tinnitus. Otolaryngol Clin North Am. 2003; 36(2): 239-248.

Sismanis A. Tinnitus. Advances in evaluation and management. Otolaryngol Clin North Am. 2003; 36(2): xi-xii.
More Information on This Topic

* News & Features

Review Date: 2/19/2007
Reviewed By: Alden J. Pearl, M.D., Clinical Assistant Professor, Department of Otolaryngology, State University of New York Health Science Center at Brooklyn, Brooklyn, NY. Review provided by VeriMed Healthcare Network.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

FUENTE: http://health.nytimes.com/health/guides/symptoms/tinnitus/overview.html

The Buzz on Tinnitus

By TARA PARKER-POPE


Tinnitus, an annoying hum or ringing in the ears, affects about one in five people, making it one of the most common medical afflictions.

One well-known tinnitus sufferer is Dr. Jerome Groopman, author of “How Doctors Think” and other popular dispatches from the front lines of medicine. Dr. Groopman writes in this week’s New Yorker about his own efforts to learn about and treat his condition in the article “That Buzzing Sound: The Mystery of Tinnitus.” He writes:

I noticed the sound one evening about a year ago. At first, I thought an alarm had been set off. Then I realized that the noise — a high-pitched drone — was mainly in my right ear. It has been with me ever since. The tone varies, from a soft whoosh like a shower to a piercing screech resembling a dental drill. When I am engaged in work at the hospital or in the laboratory, it seems distant. But in idle moments it gets louder and more annoying, once even jarring me from a dream.

Dr. Groopman explores the history and causes of the disorder as well as an emerging group of tinnitus sufferers: young soldiers returning from Iraq. He also writes about his own efforts to find a solution, and how simple hearing aids have helped.

For more information, check out the Times Health Guide on tinnitus, including information on new therapies to treat it.
Fuente; "The New York Times"February 2, 2009,
http://well.blogs.nytimes.com/2009/02/02/the-buzz-on-tinnitus/

Se ha vuelto flojo

Famosos | DIAaDIA

Ozzy Osbourne, "El príncipe de las tinieblas", está casi sordo y acosado por los miedos.

Así dijo el músico en una entrevista que le concedió al diario alemán Süddeutsche Zeitung. "A mi mujer Sharon, la vuelvo loca porque no entiendo nada o entiendo todo mal. Desde hace años sufro de tinnitus".

El cantante habló abiertamente de su vida de excesos: "Estuve borracho 40 años. Siempre había un motivo: aburrimiento, estrés, miedo a las actuaciones".

Dijo que estaba lleno de miedos. "Hoy me dan miedo las cosas más tontas, la altura, por ejemplo. No puedo subir una escalerilla sin marearme. Y ni hablar de ver películas de terror". ¡Quien diría que esto le pasaría a este hombre que antes hasta comía muerciélagos!
fuente: www.diaadia.com.pa

Cuando oír duele

"Histérico" o "con una audición demasiado buena" son las ideas erróneas más comunes acerca de un paciente con hiperacusia.


Los ladridos de los perros, las risas, los timbres de teléfonos, el agua corriente de un grifo o las ruidosas aspiradoras son sonidos diarios comunes. No son muy altos y, por supuesto, no dañinos. Al menos no para el oído normal.

Pero para los pacientes con hiperacusia, estos sonidos diarios pueden causar dolor, frustración e, incluso, terror. Se ha observado a niños alejándose de sonidos específicos, angustiosos para ellos - pero inofensivos para el resto.

Una falta de compresión es otro problema para las personas que tienen este problema. Con frecuencia, se les acusa de ser hipersensibles, incluso histéricos. "Oyes demasiado bien", es una idea errónea muy común.

En un estudio publicado en la revista International Journal of Audiology, 2002, no. 8, se entrevistaron a más de 1.000 personas acerca de sus experiencias con los sonidos. Los investigadores descubrieron que el 6, 8 por ciento sufría hiperacusia, y se asociaba con tensión y dificultades para concentrarse.

Sin embargo, las personas con hiperacusia poseen una audición perfectamente normal. No pueden oír "mejor que nadie", sino que se reduce su tolerancia a sonidos específicos y niveles de sonido que no se suelen considerar altos. Para algunos pacientes, el problema surge con niveles de sonido tan bajos como 25 dB - imposibilitando el diagnóstico adecuado con los equipos normales para pruebas acústicas de las clínicas, ya que dichos equipos funcionan con niveles de sonidos mucho más elevados - 80 dB o superior.

Los expertos en este problema de audición poco común aconsejan a las familias y médicos mostrar en primer lugar comprensión. El hecho de ser víctima de "tortura acústica" ya es un problema, pero la falta de comprensión y empatía de la familia y los médicos sólo empeora la situación.

La hiperacusia puede ser un problema especialmente difícil para los niños ya que puede ser duro para ellos hacer entender a los adultos que el hecho de taparse los oídos y correr fuera de la clase no es sólo "ser travieso", sino que es por motivo de un sonido.

Los médicos se atreven a señalar que la cura no es el silencio ni los tapones. Al contrario, el ruido demasiado bajo puede empeorar el problema, haciendo que gradualmente el paciente no pueda llevar una vida normal. En su lugar, las personas que sufren una tolerancia reducida a los sonidos deben rodearse de sonidos agradables de bajo nivel en todo momento. Es posible utilizar radios con un volumen bajo o incluso un generador de ruido para una estimulación constante para ayudar al cerebro a readaptarse a los sonidos diarios normales.

Fuente: "hear-it" http://spanish.youth.hear-it.org/page.dsp?page=5628

Volume turned down on MP3 players

December 13, 2009 at 7:53 am

An mp3 player

New safety measures are set to be imposed on all personal music players on sale in Europe within the next few months.

The European Commission wants all MP3 players, including iPods, to share the same volume limits after a scientific report last year warned that up to 10m people in the EU might be facing permanent hearing loss as a result to prolonged use of personal players at high volume.

European Union scientific experts have agreed that the default maximum setting should be 85 decibels. The user will be able to override this setting, and reach a top limit of 100 decibels.

In January a two-month consultation of all EU standardisation bodies will begin on these proposals, with a final agreement expected in the spring.

Some personal players examined in testing facilities have been found to reach 120 decibels, the equivalent of a jet taking off, and no safety default level currently applies, although manufacturers are obliged to print information about risks in the instruction manuals.

Dr Robin Yeoh

Modern personal players are seen as more dangerous than stationary players or old fashioned cassette or disk players because they can store hours of music and are often listened to while in traffic with the volume very high to drown out outside noise.

Dr Robin Yeoh, an audiology consultant at the Epsom and St Helier NHS Trust said: "More and more young people are referred to me by their GPs with tinnitus or hearing loss as a direct result to exposure to loud music.

"It’s the sort of damage that in the old days would have come from industrial noise.

"The damage is permanent and will often play havoc with their employment opportunities and their personal lives."

‘Personal choice’

DigitalEurope, the Brussels-based body representing the industry, agrees safety must be improved.

But according to their spokesman Tony Graziano, "the solution must lie in a balance between safety and enjoyment of the product by the consumer".

"Eighty five decibels would not be appropriate because noise coming from traffic, engines and so on would obliterate the sound," he said.

Conservative MEP Martin Callanan, who sits on the European Parliament’s Environment, Public Health and Food Safety Committee said: "Kids have always listened to their music loud and this is not going to stop them."

He added: "You have to educate them to the risks but ultimately you have to allow personal responsibility and personal choice".

The Politics Show broadcasts at 1200 GMT on BBC1 and for seven days after on the BBC iPlayer

Fuente: This article is from the BBC News website. © British Broadcasting Corporation, The BBC is not responsible for the content of external internet sites.

Idiopathic Normal Pressure Hydrocephalus: A Systematic Review of Diagnosis and Outcome

Autores
Hebb, Adam O. M.D.; Cusimano, Michael D. M.D., Ph.D.
Collapse Box
Abstract

OBJECTIVE: Patient selection for cerebrospinal fluid diversion is difficult, because idiopathic normal pressure hydrocephalus (INPH) mimics other neurodegenerative disorders and no findings reliably predict outcome. The literature was reviewed to identify diagnostic criteria that predict shunt response and to formulate prognostic expectations.

METHODS: MEDLINE was searched, and 44 articles meeting predetermined criteria were included.

RESULTS: Clinical series were frequently retrospective with small patient numbers and unstandardized outcome evaluation. Clinical findings suggestive of shunt responsiveness were the complete triad (gait disturbance, urinary incontinence, and dementia) with early gait disturbance. Degree of hydrocephalus was not correlated with clinical improvement. Reduction of the subcortical low-blood flow area was correlated with improvement in three small studies. Clinical response to prolonged cerebrospinal fluid drainage predicted shunt outcome in all cases in two small series. Overall, 59% (range, 24-100%) of patients improved after shunting, and 29% (range, 10-100%) of patients experienced prolonged improvement. Complications occurred in 38% (range, 5-100%) of patients, additional surgery was required in 22% (range, 0-47%) of patients, and there was a 6% (range, 0-35%) combined rate of permanent neurological deficit and death.

CONCLUSION: Shunting INPH is associated with an approximately 29% rate of significant improvement and a 6% significant complication rate. Enlargement of the subcortical low-flow area and clinical improvement secondary to prolonged lumbar drainage may provide additive predictive value above clinical and computed tomographic criteria. A multicenter clinical trial that focuses on the value of ancillary tests, defines the clinical course of a patient with a ventriculoperitoneal shunt, and evaluates the cost effectiveness of shunting INPH is needed to better describe outcome from shunting in INPH.

Fuente:
1- http://journals.lww.com/neurosurgery/Abstract/2001/11000/Idiopathic_Normal_Pressure_Hydrocephalus__A.28.aspx

2- eurosurgery:
November 2001 - Volume 49 - Issue 5 - pp 1166-1186
Topic Review

Carta de Lectores Sobre el síndrome de Hakim Adams

VIERNES 11
DICIEMBRE 2009
En la revista "Viva" del 29 de noviembre aparece una nota sobre la hidrocefalia normotensiva, o síndrome de Hakim Adams, allí se describen ajustadamente sus características clínicas y tratamiento. En el Servicio de Otorrinolaringología del Hospital de Clínicas "General San Martín" de Buenos Aires, descubrimos que este síndrome tiene dos síntomas precoces que son acúfenos (zumbidos de oídos) y una hipoacusia perceptiva (disminución de la audición), que aparecen años antes que el síndrome se manifieste con trastornos de la marcha, alteración del control de esfínteres y demencia. Oportunamente, presentamos y publicamos este hallazgo con el título "Hipoacusia perceptiva en el síndrome de Hakim Adams", en las actas del XVIII Congreso Argentino de Otorrinolaringología y Especialidades Conexas, realizado en Iguazú, Misiones, en 1984.

Darío Roitman
OTORRINOLARINGOLOGO
darioroitman@hotmail.com

Hidrocefalia de presion normal

Hidrocefalia crónica del adulto (¿Hidrocefalia Normotensiva?).

Dr. J. Sales Llopis ; Dr. J.Abarca Olivas; Servicio de Neurocirugía del Hospital General Universitario de Alicante.

Fecha de la ultima actualización:08/06/2006

Características principales
• tríada clásica: demencia, trastornos de la marcha, incontinencia urinaria
• se observa hidrocefalia comunicante en TC o RM
• la presión es normal en las PL aleatorias
• los síntomas pueden resolverse con una derivación de LCR.

Definición.-

Enfermedad que cursa con: Trastornos de la marcha:el más característico, deterioro mental del tipo de lóbulo frontal e Incontinencia urinaria (síntoma tardio)(Cuidado:Paciente con demencia puede padecer incontinencia urinaria).

En su descripción inicial, el diagnóstico de esta entidad requería como criterio ineludible la obtención de un valor normal de la presión del LCR medida por punción lumbar. Sin embargo,

la aplicación de la monitorización continua de la presión intracraneal (PIC) como un instrumento diagnóstico nos permite afirmar que la denominación de hidrocefalia de presión normal sólo se sustenta por la tradición, ya que el control continuo de la PIC ha objetivado que los pacientes afectos de este síndrome pueden presentar elevaciones transitorias o continuas de la PIC. Por ello, en la actualidad, la denominación más aceptada y extendida para hacer referencia a esta entidad es la de “hidrocefalia crónica del adulto” ,aunque recientemente se debate la posibilidad de que exista la hidrocefalia crónica de la infancia.

Estos síntomas suelen mejorar tras el drenaje de LCR aunque tampoco es patognomónico.

Historia.-

Entidad clínica descrita en 1965 por Hakim y Adams. Fué descrito originalmente en Colombia en la tesis de grado No.957 de la Universidad Javeriana de Bogotá (marzo de 1964), que fue elaborada bajo la dirección y asesoría del neurocirujano colombiano Salomón Hakim Dow, quien a la sazón prestaba sus servicios en el Hospital Militar Central de Bogotá. La autora – Olga de Heredia- fue compañera de estudios del editor de Tensiómetro Virtual. La tesis llevó el título de Algunas observaciones sobre la presión del LCR. Síndrome hidrocefálico en el adulto, con presión normal del líquido céfalo-raquídeo. Posteriormente el doctor Hakim –junto al neurocirujano Raymond Adams (profesor de la Universidad de Harvard), hizo al año siguiente una publicación indexada del estudio en la revista Journal of Neurological Sciences. De allí salió la famosa Válvula (programada) de Hakim, a la que este profesor ha dedicado su vida, perfeccionándola constantemente.

Hakim demostró elegantemente el fenómeno de la prensa hidráulica (mayor fuerza a mayor área del continente) donde la hidrocefalia se produce por la fuerza que ejerce el LCR retenido sobre las paredes de los ventrículos laterales del cerebro. Posteriormente Donald Price demostró la migración del líquido a través de las paredes del epéndimo ventricular, algo que claramente se puede apreciar con la resonancia magnética.



Epidemiología.-

Edad más frecuente mayores de 60 años y preponderancia ligera de sexo masculino.

Tipos.-

Hidrocefalia idiopática y no idiopática

Etiología de la hidrocefalia no idiopática:

1. poshemorrágica (HSA)
2. postraumática
3. posmeningítica
4. secundaria a una intervención de la fosa posterior
5. tumores, incluida la meningitis carcinomatosa
6. también observada en 15% de los pacientes que padecen DSSA (enfermedad de Alzheimer)
7. defecto de absorción de las granulaciones aracnoidales
8. la estenosis del acueducto puede ser una causa no valorada adecuadamente.

Fisiopatología.-

El mecanismo presumiblemente sea una insuficiente capacidad de absorción del LCR , pero el mecanismo exacto del desarrollo de los síntomas clínicos se desconocen.

Clínica.-

La tríada no es patognomónica, y también puede observarse en la demencia vascular.
1. trastornos de la marcha: por lo general, precede a otros síntomas. El paciente marcha con pasos cortos (braquibasia), arrastrados, con aumento de la base de sustentación e inestabilidad al girar. Frecuentemente, sienten que están "pegados al suelo" (denominada "marcha magnética") y puede resultarles dificultoso iniciar la marcha o los giros. No se observa ataxia de los miembros.
2. demencia: principalmente se expresa por alteración de la memoria y bradifrenia (lentitud de pensamiento) y bradicinesia.
3. incontinencia urinaria: por lo general, no es consciente (es importante destacar que un paciente que padece demencia de cualquier etiología puede ser incontinente).

Diagnóstico.-

Exploración neurológica:-Trastorno de la marcha con base amplia de sustentación, pasos cortos y dificultad de dar la vuelta.

EEG: no se observan hallazgos específicos en la HNT.

Tests Neuropsicológicos:

Los tests deben ir encaminados a detectar trastornos subcorticales como en la enfermedad vascular subcortical isquémica.

En este sentido recientemente se ha validado la HIV Dementia Scale como útil y especialmente en aquellos pacientes con un test minimental normal.

Déficits leves tras el exámen minimental. (Bradifrenia y Bradiquinesia).
Aunque los tests Mini-Mental State Examination, el Seven-Minute Screening Test y el Memory Impairment Screen son más adecuados en la detección de síntomas cognitivos con componentes corticales como en la enfermedad de Alzheimer.

Tests de detección de disfunción de lóbulo frontal(Stroop test...) positivos (1) .

NPH Score


No existe ninguna prueba ni estudio radiologico que sea patognomonico para hacer un diagnostico positivo indudable de la HNT. Se han propuesto numerosas pruebas y criterios diagnosticos para establecer que pacientes probablemente respondan a una derivacion ventricular y cuales no, a fin de evitar posibles complicaciones y operaciones innecesarias, sin por ello dejar de darle la oportunidad a quienes puedan resultar beneficiados. Si bien ninguno de estos procedimientos tiene fiabilidad probada, se describen algunos a continuacion con propositos informativos.

PUNCIÓN LUMBAR

La presión normal de la apertura (PdeA) debe ser < 180 mm H2O. La respuesta a una sola PL (con la extracción de 15-30 ml de LCR o la reducción de la PdeA en = 1/3) o a PL seriadas puede tener algún valor pronóstico. Puede con-templarse la colocación de un drenaje lumbar ambulatorio (véase adelante) en quienes no respondan a la prueba de la PL simple. EL LCR extraído debe enviarse siempre al laboratorio para realizar estudios de rutina.
Cabe destacar que los pacientes en los que la PdeA inicial es > 100 mm H2O tienen un índice mayor de respuesta a la derivación.

Monitoreo continuo de la presión del LCR
Algunos pacientes que tienen una PdeA normal en la PL pueden presentar, con el monitoreo continuo, picos de presión > 270 mm H2O u ondas B recurrentes. Estos pacientes también suelen tener un índice mayor de respuesta a la derivación.

MONITORIZACIÓN DE LA PRESIÓN INTRACRANEAL
Se determinará la presencia de ondas A plateu y el porcentaje de ondas B (aunque estas no parecen tener relación a la hora de determinar si la hidrocefalia es comunicante o no comunicante) (2) .

Drenaje lumbar ambulatorio
El drenaje lumbar subaracnoideo se coloca con una aguja Touhy y se conecta con un catéter con cámara de goteo a un colector cerrado; el colector se ubica a la altura del pabellón auricular si el paciente está recostado o a la altura del hombro si está sentado o deambulando.
Un sistema de drenaje que funciona adecuadamente debe extraer = 300 ml de LCR por día.
Si aparecen síntomas de irritación de las raíces nerviosas durante el drenaje, habrá que retirar el catéter algunos milímetros. Es necesario controlar a diario el recuento de células de LCR y hacer cultivos bacteriológicos (cabe esperar una pleocitosis de = 100 células/mi con sólo la presencia del dispositivo de drenaje).
Se recomienda hacer la prueba durante no más de 5 días (tiempo promedio en que se observan mejorías: 3 días).

EXAMEN NEURORADIOLOGICO

(NO HAY EXAMEN NEURORADIOLOGICO QUE SEA PATOGNOMONICO DE HIDROCEFALIA NORMOTENSIVA).

Características en la TC y en la RM:hidrocefalia no obstructiva.

1. condición necesaria: hidrocefalia cuadriventricular (comunicante)
2. características que se correlacionan con una respuesta favorable a la derivación (estas características permiten pensar que la dilatación ventricular no se debe únicamente a atrofia):
A. hipodensidad periventricular en la TC o hiperintensidad en el T2 de la RM: generalmente, representan absorción transependimaria del LCR que habitualmente desaparece tras la colocación de la derivación
B. colapso de los surcos corticales de la convexidad (en ocasiones, pueden observarse dilataciones focales de los surcos, lagos aracnoidales que constituyen reservónos atípicos de LCR, que suelen desaparecer después de colocar una derivación y que, por lo tanto, no deben considerarse atrofia)
C. astas frontales de aspecto redondeado
Si bien algunos pacientes mejoran sin presentar cambios en los ventrículos, la mejora clínica muy frecuentemente viene acompañada de una reducción del tamaño ventricular.

1.


Índice de Evans


(A/E) Esquema del índice de Evans. Este índice, descrito ini­cialmente para calcular el tamaño ventricular en ventriculografías, se obtiene a partir del cociente entre la distancia máxima existente entre las dos astas frontales de los ventrículos laterales (A) y la distancia máxima entre las dos tablas internas en el mismo corte de TC en el que se ha evaluado el parámetro ante­rior (E). Los índices superiores a 0,30 indican dilatación ventricular. Este índice resulta adecuado para el seguimiento de un mismo paciente y para la comparación entre distintos grupos.

2.


Índice III ventrículo


(C/E)

3.


Índice Cella media


(D/F)

4.


Ventricular score


(A + B + C + D)/E x 100

A: distancia ventricular bifrontal máxima.
B: distancia entre los n.caudados a nivel del foramen Monroe
C: anchura máxima del III ventrículo
D: anchura mínima entre ambas cella media
E: diametro de tabla a tabla interna a nivel de A y B
F: maximo diametro craneal externo a nivel de la medición de D.

RM Cerebral:Medición de volumen del hipocampo normal (Diagn.dif. con Enf. de Alzheimer).

RM espinal: Para descartar obstrucción a nivel espinal.

ClSTERNOGRAFÍA RADIOISOTÓPICA
La utilidad de este estudio todavía está en discusión. Una publicación relativamente reciente postuló que la cisternografía no aumenta la seguridad diagnóstica de los criterios clínicos y tomográficos.
Técnica: se inyecta en el espacio lumbar subaracnoideo un radioisótopo (p. ej., 2,7 mCi de Tecnecio 99m DTPA diluidos en 1 mi de solución salina). Las imágenes se obtienen mediante gammagrafía planar 3, 6 y 24 horas después de la inyección del trazador (es posible obtener imágenes al cabo de 48 hs si aún se observa franca actividad ventricular en las imágenes obtenidas después de 24 horas; sin embargo, si se desea efectuar ese control tardío es necesario utilizar otro radioisótopo de vida media más larga, p. ej., Indio 111).
Criterios convencionales de un estudio normal: la radiactividad está distribuida con simetría por toda la convexidad a las 24 horas de aplicado el contraste, y no se observa actividad ventricular en ningún momento del estudio. No obstante, en un trabajo se sostiene que hasta 41% de los estudios normales muestran actividad transitoria en los ventrículos (hasta las 24 horas, pero no transcurrido más tiempo).
Hallazgos que pueden indicar mejores probabilidades de respuesta a una derivación: de todos los descriptos a continuación, sólo el no. 2 constituye un indicador confiable de la presencia de HNT.
1. barrido inicial (4-6 horas después de la inyección): radiactividad en los ventrículos (se presume que el reflujo es causado por una obstrucción del flujo saliente). También puede observarse en casos normales.
2. barrido tardío (al cabo de 48-72 horas): persistencia de la actividad ventricular. Los pacientes que presentan este hallazgo son los que tienen mayor probabilidad de mejorar con la derivación (= 75% de probabilidad)
3. actividad persiste en la convexidad: estos pacientes son los que tienen menor probabilidad de mejorar
4 cisternografía cuantitativa
A. se considera que los pacientes en los que desaparece más de 50% de la radiactividad intracraneal total al cabo de 24 horas tienen una velocidad adecuada de absorción general y, por ende, es improbable que mejoren con una derivación. No obstante, otros estudios no han hallado ninguna correlación entre la eliminación de la radiactividad y la respuesta a una derivación
B. un estudio halló que si la proporción entre la actividad ventricular y la intracraneal total (V/T) al cabo de 24 horas es > 32%, habría una respuesta satisfactoria a la derivación, mientras que la proporción V/T < 32% no excluía por completo la posibilidad de mejoría.

Medición del flujo cerebral: si bien algunos estudios indican lo contrario, la medición del flujo cerebral no muestra hallazgos característicos en la HNT; por ende, no son de utilidad para pronosticar qué pacientes pueden tener buena respuesta a la derivación. Sin embargo, el aumento del flujo cerebral que se produce después de una derivación se correlaciona claramente con la mejoría clínica.

3) Test de Infusión:


CANDIDATO IDEAL

-Triada clínica en un periodo corto de evolución y demencia leve.

-Presion inicial de LCR tras PL mayor de 100 mm H2O.

-Presiones con picos mayores de 270 mm H2O o ondas B recurrentes y presión media mayor de 180 tras monitorizacion continua de la presión de LCR.

-TAC y RNM que muestren signos de absorción tranependimaria,compresión de los sulcos cerebrales y balonamiento de las astas frontales.

¿A que pacientes debería realizarse un estudio para descartar hidrocefalia?

¿?

Quizá:

Cualquier síntoma de la triada clínica

Índice de Evans igual o mayor 0,3

Rout mayor de 12

Protocolo malagueño de Estudio

Vía Clínica propuesta

Diagnóstico diferencial.-

Enfermedad vascular subcortical isquémica.
Enfermedad de Alzheimer

Tratamiento.-

Antes de pasar a realizar un tratamiento quirúrgico en estos pacientes, es necesario hacer un estudio minucioso para detectar o descartar una demencia senil.
El procedimiento de elección es la derivación ventrículoperitoneal.

Las derivaciones lumboperitoneales se han utilizado, pero tienden a producir sobredrenaje. En general, se aconseja utilizar una válvula de presión media (presión de cierre de 90 mm H2O) para minimizar el riesgo de que se formen hematomas subdurales, aunque la respuesta del paciente puede ser más rápida si se utiliza una válvula de presión baja. Una vez colocada la válvula, el paciente tiene que ir sentándose gradualmente en un período de varios días; este proceso debe ser más lento en quienes presenten cefaleas por hipotensión. Es necesario realizar un seguimiento clínico y tomográfico durante = 6-12 meses.
Los pacientes que no mejoran y cuyos ventrículos no muestran cambios deben ser evaluados en busca de un mal funcionamiento del sistema. Si no se halla obstrucción, será necesario probar con una válvula de menor presión.

Complicaciones.-

El índice de complicaciones puede alcanzar = 35% (debido a la fragilidad cerebral de los ancianos).
Las complicaciones posibles son:
1. hematomas o higromas subdurales: el riesgo es mayor con una válvula de baja presión y en los pacientes mayores, que habitualmente tienen atrofia cerebral. Por lo general, se presentan acompañados de cefalea y la mayoría es de resolución espontánea o permanece estable. Aproximadamente un tercio requiere evacuación y desinstalación de la derivación (temporaria o permanente). El riesgo puede verse reducido si se moviliza al paciente poco a poco después de la intervención
2. infección de la derivación
3. hemorragia intraparenquimatosa en el cerebro
4. convulsiones
5. entre las complicaciones tardías se incluyen la obstrucción o desconexión del sistema de derivación.

El síntoma que tiene mayores probabilidades de mejorar con la derivación es la incontinencia, en segundo lugar los trastornos de la marcha y, por último, la demencia.

Candidato ideal:

• aspectos clínicos: presencia de la tríada clásica. La mayoría de los pacientes que presentan trastornos de la marcha como síntoma primario mejoraron con la derivación; es infrecuente que los pacientes dementes que no padecen trastornos de la marcha respondan a la derivación.
• punción lumbar: PdeA > 100 mm H2O
• cisternogammagrafía: características típicas de HNT. Las características mixtas o normales no se correlacionan con la respuesta favorable a la derivación
• registro continuo de la presión del LCR: presión > 180 mm H2O u ondas B de Lundberg frecuentes.
• TC o RM: ventrículos dilatados y surcos colapsados (poca atrofia)
La respuesta es más satisfactoria cuando los síntomas han estado presentes durante un lapso corto.
Cabe destacar que, por razones desconocidas, muchos pacientes (en especial, los que padecen la enfermedad de Alzheimer) experimentan una mejoría transitoria con las derivaciones VP (podría tratarse de una mejoría de la circulación cerebral y una reducción de la PIC).
Algunos pacientes que responden al tratamiento pueden deteriorarse posteriormente, pero antes de atribuir este deterioro al curso normal de la afección, es necesario descartar que la derivación esté funcionando mal o que se hayan formado acumulaciones subdurales.

El primer síntoma que mejora es la incontinencia urinaria después los trastornos de la marcha y por último la demencia.

Bibliografía.-

Hakim S, Adams RD. The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Observations on cerebrospinal fluid hydrodynamics. J Neurol Sci 1965;2:307–27.

Adams RD, Fisher CM, Hakim S, et al. Symptomatic occult hydrocephalus with “normal” cerebrospinal fluid pressure. A treatable syndrome. N Engl J Med 1966;273:117–26.

Adams RD. Further observations on normal pressure hydrocephalus. Proc R Soc Med1966;59:1135–40.

Conner ES, Foley L, Black PM, et al. Experimental normal-pressure hydrocephalus is accompanied by increased transmantle pressure. J Neurosurg 1984;61:322–7.

Di Rocco C, Di Trapani G, Pettorossi VE, et al. On the pathology of experimental hydrocephalus induced by artificial increase in endoventricular CSF pulse pressure. Childs Brain 1979;5:81–95.

Matsuda M, Nakasu S, Nakazawa T, et al. Cerebral hemodynamics in patients with normal pressure hydrocephalus: correlation between cerebral circulation time and dementia. Surg Neurol 1990:34:396–401.

Hayashi H, Tanaka K, Naruse H, et al. Changes in dementia after shunt surgery for normal pressure hydrocephalus. No To Shinkei 1992;44:429–34. (In Japanese.)

Kimura M, Tanaka A, Yoshinaga S. Significance of periventricular hemodynamics in normal pressure hydrocephalus. Neurosurgery 1992;30:701–4; discussion:704–5.

Ojemann RG, Fisher CM, Adams RD, et al. Further experience with the syndrome of “normal” pressure hydrocephalus. J Neurosurg 1969;31:279–94.

Dauch WA, Zimmermann R. Normal pressure hydrocephalus. An evaluation 25 years following the initial description. Fortschr Neurol Psychiatr 1990;58:178–90.

Larsson A, Wikkelso C, Bilting M, et al. Clinical parameters in 74 consecutive patients shunt operated for normal pressure hydrocephalus. Acta Neurol Scand 1991;84:475–82.

Katzman R. Dementias. Postgrad Med 1978;64:119–25. 13 Nadeau SE. Multi-infarct dementia, subcortical dementia, and hydrocephalus. South Med J 1991;84(5 suppl 1):S41–52.

Haines A, Katona C. Dementia in old age. Occas Pap R Coll Gen Pract 1992:62–6.

Elble RJ, Hughes L, Higgins C. The syndrome of senile gait. J Neurol 1992;239:71–5.

Sheehan JP, Polin RS, Sheehan JM, et al. Factors associated with hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery 1999;45:1120–7;discussion: 1127–8.

Udvarhelyi GB, Wood JH, James AE, et al. Results and complications in 55 shunted patients with normal pressure hydrocephalus. Surg Neurol 1975;3:271–5.

Katzman R, Hussey F. A simple constant-infusion manometric test for measurement of CSF absorption. I. Rationale and method. Neurology 1970;20:534–44.

Hussey F, Schanzer B, Katzman R. A simple constant-infusion manometric test for measurement of CSF absorption. II. Clinical studies. Neurology 1970;20:665–80.


Ekstedt J. CSF hydrodynamic studies in man. 1. Method of constant pressure CSF infusion. J Neurol Neurosurg Psychiatry 1977;40:105–19.

Ekstedt J. CSF hydrodynamic studies in man. 2 . Normal hydrodynamic variables related to CSF pressure and flow. J Neurol Neurosurg Psychiatry 1978;41:345–53.

Borgesen SE, Gjerris F, Sorensen SC. The resistance to cerebrospinal fluid absorption in humans. A method of evaluation by lumbo-ventricular perfusion, with particular reference to normal pressure hydrocephalus. Acta Neurol Scand 1978;57:88–96.

Borgesen SE. Conductance to outflow of CSF in normal pressure hydrocephalus. Acta Neurochir 1984;71:1–45.

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1. Miyoshi N, Kazui H, Ogino A, Ishikawa M, Miyake H, Tokunaga H, Ikejiri Y, Takeda M: Association between Cognitive Impairment and Gait Disturbance in Patients with Idiopathic Normal Pressure Hydrocephalus. Dement Geriatr Cogn Disord 20:71-76, 2005.

2. Stephensen H, Andersson N, Eklund A, Malm J, Tisell M, Wikkelso C: Objective B wave analysis in 55 patients with non-communicating and communicating hydrocephalus. J Neurol Neurosurg Psychiatry 76:965-970, 2005.

Acúfeno II

Daniel Sánchez Arévalo

Nací en Madrid, en 1970. Siempre pensé que era la reencarnación de John Wayne, hasta que un día descubrí que murió en 1979. La decepción de no ser el espíritu errante de un cowboy me llevó a estudiar Empresariales.Me aburría tanto en clase de Estadística que acabé descubriendo (o inventándome) una tardía vena literaria. Eso sí, adquirí suficientes conocimientos financieros como para darme cuenta de que iba a ganar mucho más dinero escribiendo guiones para la tele que vendiendo seguros de vida.

Así inicié mi carrera como guionista en series de ficción: Farmacia de guardia, Querido maestro, Ellas son así, Hospital central, etc. Una oportuna beca Fulbright para estudiar un Master de Cine de la Universidad de Columbia (Nueva York) me sacó de la paz y soledad del escritor y me puso en mitad de Central Park detrás de una cámara de SVHS. Allí experimenté por primera vez la magia de transformar en imágenes lo que había escrito, tal y como lo había concebido. Para bien y para mal.

Más de una docena de cortos, entre los que destacan Gol, Exprés (nominado a los Goya), Profilaxis, Física II (preseleccionado a los Oscars) y La culpa del Alpinista (Sección oficial Mostra de Venecia 61), me dieron suficiente experiencia y confianza (a mí y sobre todo a los productores) como para afrontar mi primer largometraje: Azul OscuroCasi Negro, producido por Tesela PC. Estreno el 31 de marzo de 2006 - el día que la audiencia decidirá si es mejor que me dedique a vender seguros de vida.







La gente ha dejado de leer, porque ahora todos escriben.
Y algunos ruedan…
Y algunos escriben y ruedan…
Y algunos ruedan y escriben…
Y algunos posan pareciendo que hacen las dos cosas…
Y algunos ni leen, ni escriben, ni ruedan, ni posan…
Algunos sólo escuchan un pitido.
Pipipipipipipipipiiiiii…
Escrito por Daniel Sánchez Arévalo a las 11:26



Acúfeno 10/04/2008

Fue hace ya más de cuatro meses. A principios de diciembre. De repente me empezó a pitar el oído. No le di mayor importancia. Esas cosas pasan, ¿no? Esas cosas vienen y se van. Pipipipipipipi… Otorrino. Pipipipipipipi… Osteópata. Pipipipipipipi… Técnicas sacrocraneales. Pipipipipipipi… Masajes. Pipipipipipipi… Homeópata. Pipipipipipipi…, Más otorrinos. Pipipipipipipi… Han pasado cuatro meses con un infinito y continuo pipipipipipipipi metido en mi oído izquierdo. Mañana me hacen una resonancia magnética. No vaya a ser que tenga un tumor. Es poco probable. Pero… Pipipipipipipi…

Es en el oído izquierdo, el que uso para hablar por el móvil. El oído por el que se me mete la vida de los demás. Pobre, cuánta mierda tiene que aguantar y tragar. ¿Y si cambio el móvil de oído para hablar? Igual se marcha el acúfeno. O igual me sale otro en el oído derecho. Pipipipipipipi…

Lo he pasado mal. Lo paso mal. Hay días que no me deja ni dormir. Hay momentos en los que me quiero arrancar el oído, volar la tapa de los sesos,... Pipipipipipipipi… Porque además el hijodeputa cambia de frecuencia. Es constante pero variable. Es como si me estuviera mandando código morse. Es como si alguien (o algo) me quisiera hacer llegar un mensaje encriptado. Pipipipipipipi… Tengo un extraterrestre en el oído. Mi oído es la central de operaciones para una invasión extraterrestre. Y a juzgar por la intensidad que ha cobrado el acúfeno últimamente, la invasión debe ser inminente. Acaparen víveres. Y sobre todo, tapones para los oídos.

También tengo otra teoría, aunque mucho menos factible y más descabellada que la anterior. Y es que dentro de diez días comienzo a rodar mi segunda película, Gordos. Los expertos dicen que los acúfenos no son tintineos en el oído sino en el cerebro. Es ruido neuronal. Es el cerebro hablando, mandando señales. Igual el acúfeno es una señal de alarma, de stress, de aviso. Para que no me duerma, para que esté alerta. Pero ya digo, casi mejor que me decanto por lo de la invasión acúfena extraterrestre. Pipipipipipipi…

El caso es que yo para vivir necesito siempre arrastrar algún tipo de lastre. No puedo estar bien y sólo bien. Pipipipipipipi… No puedo ser feliz al lado de la chica más maravillosa del mundo sin que tenga un precio. Pipipipipipipi… No puedo hacer mi segunda película sin pagar un peaje. Pipipipipipipi… No puede ser que todo vaya bien. No, eso no. Pipipipipipipi…

Claro que si lo piensas, un acúfeno es un precio pequeño para que todo vaya bien, ¿no? Un insoportable pitido a cambio del éxito garantizado. Algunos venden su alma al diablo, otros se encomiendan a vírgenes y santos, otros peregrinan de rodilla. Yo me vendo, me encomiendo y peregrino de rodillas hasta mi santuario acúfeno. Así que por favor, acúfeno, no me dejes, no me abandones ahora que estoy a punto de meterme de lleno en esta gran aventura emocional y profesional. Prometo protegerte y cuidarte. Prometo ponerte velas. Prometo darte tus dosis diarias de radiaciones vía móvil. Prometo dedicarte la película. Prometo escucharte más que a mi novia. Prometo hasta ponerte nombre. Pipipipipipipi…

Escrito por Daniel Sánchez Arévalo a las 14:49

fuente: http://www.clubcultura.com/diariode/25/DanielS%C3%A1nchezAr%C3%A9valo.html