gms | German Medical Science

Tinnitus can be caused by the damage of sensory hair cells of inner ear and / or of upper parts of auditory pathway and auditory cortex in the brain [Ref. 1]. In the contemporary „industrial“ society the number of persons suffering from tinnitus increases gradually. This in USA 14 % of inhabitants ( i.e. about 20 – 30 milions ) are complaining because of haring tinnitus. According to the epidemiologic study done by … [Ref. 2] in the Europe, Japon and Australia, nowadays are more then 90 miliones person (> 10 %) suffering from tinnitus. This tinnitus - its presence and consequenties like neurotisation, depresive statuses, insomnie present very serious problem among our society.

For the treatment of tinnitus is of crutial importance if the duration disease is a few day ( a weeks) only and /or of tinnitus exists many months or event years.

Material and methods: On the ENT clinic of Charles Univesity Prague we had in the years 2003-2004 13 patients by whom we applied intra ear catheter (IEC). All those patients were previously treated with commonly used pharmacs likely pentoxyphyllin, Vinca minor and many others [Ref. 3] without satisfactory effect and / or duration of effect.

By these group of persons we decided to apply IEC (Purect Corporation, USA). Firstly we have spoken with the patients in order to explain then we were not able to assure them the succes on the level of 100 % probability and further to notice in that surgical approach there are also risk factorst like remaining perforation of ear drum and some others. All our patient were examined in pure tone and speach audiometry. There was done audiologic assesement of tinnitus i.e.tinnitus frequency, loudness pitch and masking. Into the study were admitted only patients suffering from masnable i.e.peripheral (cochlear) type of tinnitus.

All of patients have been given with a sheet with visual analogue (decimal) scala in order to notice three timas daily subjektive annoyance of tinnitus (0-zero means complete disappearing of symptoms, 10 was the worsiest subjective estimation of tinnitus). Concerning diagnosis our group of patients consist of persons suffering from chronical (vestibulo) cochlear insufficiency one men with total deafness after mumps an finaly one men with cochleear form of otosclerosis. By all of those persons was their leading complain tinnitus.

Under general anestesia was pushed up ear drum with annulus cortilogenons and the bulbe of two channel catheter was fixed onto round windov. There were used a special developed forceps for that step of operation. Catheter was fixed in its position with two sutures in the region of sulcus hellico tragicus and tympanomeatal flap was positioned in its original position and fixed with some pieces of gelfoan The catheter was connected with micropumpe. The following amounts of remedies have been applied into inner ear: by the persons with non – service able hearing 15,75 mg/ml of gentamycin and 3,15 mg of Solumedrol / 1 ml of physiologic solution by the patients with serviceable hearing. The therapy followed 10 – 14 days. 3rd, 7th and 10th the we replaced the contents of micropumpe. The patients have been asked to fill their guestionnaises (VAS) in and report their subjective fillings like vertigo. After operation we met only very slight vertigo, anyway all of the patients were able to perform their daily activities. After finishing the therapy IEC has been removed and a carefuly revision and re-positioning of intrameatal flap has been done. Before dimision there have been performad tinnitometry and evaluation of VAS as well as comparison betwenn results of tinnitometry and VAS.

Results: As a improvement we considered a reducing of VAS about > 2 grades and a diminishing of intensity of tinnitus > 20 dB. As noticed above the convergence between VAS and tinnitometry has been also folloved and evaluated. In our group of patients we achieved the improvement about > 2 grades in 10 patients, while by 2 persons tinnitus was reduced about 1 grade only by 2 other remained VAS unchanged. The mean reducing of tinnitus concerning its intensity actieved 25 dB in 9 patients. In 2 persons the reducing achieved less then 25 dB, by 2 other persons remained the values unchanged.

Convergence between tinnitometry and VAS was estimated in 9 cases. While in other cases either improvement in VAS (no improvement in tinnitometry) and / or improvement in tinnitometry (no improvement in VAS) have been observed. All persons who underwent IEC surgery are followed – up regularly – at least four times yearly. We are wondering if and how far positive effect of their therapy are lasting. Most decisive criterion is for us indeed – VAS with other words is subjective annoyance reduced. Now 8 patients of 10 by whom the improvement has been actived are reporting lasting positive effect even over one year or moore. Very interesting is also the observation some patients reported more expressed improvement not only just after surgery time but also after 3-4 months.

Discussion: Tendency to treat inner ear disturbances with direct application of pharmaceuticals has an old tradition. In the past time there were by attempts to perform „chemical labyrinthectomy“ dropping absolute alcohol into innear ear for tinnitus and vertigo. This procedures were applied in the persons with non – serviceable hearing [Ref. 4]; [Ref. 5]. Contemporary is used either corticoid and /or gentamycin in a transtympanal way.

Sakata [Ref. 6] has a large encouraging experienes with a big group of patient suffering from chronicle tinnitus. Our group of patients is relatively small nevertheless the achieved results can be estimaled very positively – 80 % patient have long lasting improvement in chronicle tinnitus.

Conclusion: The using of IEC in the therapy of chronicle tinnitus seems to be very effective methode in its therapy. It is recommandable in the patients suffering from cochleear type of tinnitus, therefore carefully audiometric evaluation should be done the prior to surgery. The patients are also demanding follow-up in order followed their status regularly.