TINNITUS• Tinnitus is not a disease in itself…• is a ringing, swishing, or other type of noise

that seems to originate in the ear or head.• Most of us will experience tinnitus or sounds

in the ears at some time or another. (15 %)• 12 percent of men who are 65 to 74 years of

age are affected by tinnitus• identified more frequently in white

individuals

• Tinnitus can arise in any of the four sections of the hearing system:

• the outer ear, • the middle ear, • the inner ear, • and the brain.

Causes and risk factors

It’s particularly related to ageing (presbyacusis).• Exposure to noise• Presence of earwax• Head injury• Stress• Ear Infections• Ménière's disease• Some medication, such as aspirin• Overactive thyroid gland or anaemia

• Tinnitus that occurs in only one ear should be taken more seriously as it may be caused by an acoustic neuroma

• The symptoms of tinnitus can affect different people in different ways, and the severity of the noises that are heard can range from mild to severe.

TYPES(symptoms)• a sound of crickets or roaring, buzzing, hissing, whistling, and high-

pitched ringing.

• clicking or pulsatile tinnitus (the noise accompanies your heartbeat).

• subjective tinnitus, meaning that you hear a sound but it cannot be heard by others.

• objective tinnitus, meaning your doctor may sometimes actually hear a sound when he or she is carefully listening for it.

TREATMENT

• Since tinnitus can be caused by a wide variety of different health conditions, the treatment that is recommended will depend on the underlying cause

• For example, if caused by a severe or long-term ear infection, antibiotics may be prescribed. If by a build up of earwax, then eardrops or ear irrigation is recommended

• However, in most cases of tinnitus, there is no cure and so treatment is aimed at managing the symptom on a day-to-day basis.

Objective tinnitus:• Gamma knife radiosurgery (glomus jugulare)• Shielding of cochlea by teflon implant• Botulinum toxin (palatal tremor)• Propranolol and clonazepam (arterial

anatomic variation)• Clearing ear canal (in the case of earwax plug)• Using a Neurostimulator

Subjective tinnitus:• Drugs and nutrients Lidocaine, niacin,Benzodiazepines (lorazepam,

clonazepam) • Electrical stimulation Transcranial magnetic stimulation Transcutaneous electrical nerve stimulation• Surgery Repair of perilymph fistula• External sound Tinnitus masker• Psychological Cognitive-Behavioral Therapy

(Tens)Transcutaneous electrical nerve stimulation

Repetitive_transcranial_magnetic_stimulation

Tinnitus masker

Self Help remedies• Relaxation- Stress can make your tinnitus worse. Regular

exercise, such as yoga, may help you relax. Listening to music- Calming music and sounds may also help you to relax and fall sleep at bedtime.

• Sound generators- These are also known as white noise generators or tinnitus maskers. They may be useful for drowning out the sound of tinnitus (see Sound therapy above).

• Hearing aids- If you have hearing loss, using a hearing aid may help with your tinnitus. This is because hearing sounds that you would not otherwise be able to hear may help override the tinnitus noise.

• Support groups-Sharing your experiences

Comprehensive Laser Rehabilitation Therapy of Tinnitus

• Irradiation points:• procesus mastoideus aiming in the direction of

contra-lateral orbit• meatus acusticus externus in the direction of

the acoustic duct.• 2 – 3 times a week• 8 - 10 applications in total• 4 – 6 weeks break

Picture 3 – Irradiation of Meatus Acusticus Externus

Picture 4 – Irradiation of Meatus Acusticus Externus -detail

Picture 5 – Irradiation of Procesus Mastoideus

Picture 6 – Irradiation of Procesus Mastoideus

techniques of LLLT application

1. application on meatus acusticus externus - in the direction of the axis of the auditory duct - continuous beam 50J/cm2 followed by 25 J/cm2, frequency modulation of 5 Hz,

2. irradiation of processus mastoideus - directed on the center, the vector of the beam in the direction of counterlateral orbit, continuous beam 90 J/cm2 , followed by 45 J/cm2 with 5 Hz pulse frequency.