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Therapy of hearing disorders - conservative procedures

Plontke S - GMS Curr Top Otorhinolaryngol Head Neck Surg (2005)

Bottom Line: A wide range of therapeutic strategies are available for the therapy of hearing disorders including pharmaceutical, acoustic, electrical, surgical, radiological, cognitive-behavioural and so-called "alternative" strategies.This review focuses on general conservative strategies and specific therapeutic approaches mainly for inner ear disorders, whereas surgical and device-based therapies including hearing aids and cochlear implants are described in other chapters in this volume.In addition to the systemic medication-based therapies for the treatment of hearing disorders, the rapidly growing field of local drug delivery to the inner ear as a promising therapeutic strategy is discussed on the background of unresolved issues.From a critical analysis - particularly of the clinical studies presented - conclusions are drawn for the therapy of hearing disorders in the future.

Affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, Tübingen Hearing Research Center (THRC), University of Tübingen, Germany.

ABSTRACT

A wide range of therapeutic strategies are available for the therapy of hearing disorders including pharmaceutical, acoustic, electrical, surgical, radiological, cognitive-behavioural and so-called "alternative" strategies. This review focuses on general conservative strategies and specific therapeutic approaches mainly for inner ear disorders, whereas surgical and device-based therapies including hearing aids and cochlear implants are described in other chapters in this volume.In addition to the systemic medication-based therapies for the treatment of hearing disorders, the rapidly growing field of local drug delivery to the inner ear as a promising therapeutic strategy is discussed on the background of unresolved issues. After description of non-drug-based therapeutic procedures, the conservative therapy of specific diseases and syndromes is reviewed.In general, there is a major discrepancy between promising animal studies up to regeneration and stem-cell transplantation, and uncontrolled experimental studies in humans on the one hand and the shortage of randomized controlled clinical trials with a high level of evidence on the other hand. Therefore, the review and comments on published clinical studies should assist the reader in making his/her own decision about the effectiveness of various, especially pharmaceutical treatments. From a critical analysis - particularly of the clinical studies presented - conclusions are drawn for the therapy of hearing disorders in the future.

Neuronavigation guided transcranial magnet stimulation to modify the perception of tinnitusNeuronavigation devices (e.g. BrainsightTM-Frameless, Magstim Co., Whitland, GB) allow the individual guidance of a TMS stimulation coil to a target identified by imaging (e.g. fMRT, PET, see fig. 10). In this way a targeted stimulation of predefined cortical areas is permitted (with kind permission of Dr C. Plewnia, Tübingen). A routine application of this procedure for tinnitus treatment is not justified on the basis of data obtained up until now.
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Figure 10: Neuronavigation guided transcranial magnet stimulation to modify the perception of tinnitusNeuronavigation devices (e.g. BrainsightTM-Frameless, Magstim Co., Whitland, GB) allow the individual guidance of a TMS stimulation coil to a target identified by imaging (e.g. fMRT, PET, see fig. 10). In this way a targeted stimulation of predefined cortical areas is permitted (with kind permission of Dr C. Plewnia, Tübingen). A routine application of this procedure for tinnitus treatment is not justified on the basis of data obtained up until now.

Mentions: With the help of imaging procedures, hyperactivity can be detected amongst tinnitus patients in cortical areas that otherwise are involved in the perception and processing of auditory information (Figure 9 (Fig. 9)) [209]. Analogies to modifications in the somatosensory system (e.g. with focal dystonia or phantom pain [210]) have led to the hypothesis that some forms of tinnitus are based on maladaptive neuroplastic modifications, that follow a decrease or other modification of the input of the auditory nerve to higher parts of the auditory pathway. The rTMS is therefore based on the neurophysiological model of disinhibition of the central auditory system that is reflected in an irregular hyperactivity of various sections of the auditory pathway. In a recently published paper, Plewnia et al. used a high-frequency rTMS (10 hertz) to generate a short-lasting functional lesion in the cortex by temporarily disrupting the activity of various brain areas that potentially participate in tinnitus perception [206]. The authors showed that immediately after rTMS the tinnitus had decreased in intensity or disappeared completely in most patients when stimulation was applied to left temporal or left temporo-parietal cortical areas (Brodman regions 42, 22, 21) (Figure 10 (Fig. 10)). Brain areas for which no effect on the cortex was to be expected upon stimulation served as intraindividual controls.

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Therapy of hearing disorders - conservative procedures

Plontke S - GMS Curr Top Otorhinolaryngol Head Neck Surg (2005)

Neuronavigation guided transcranial magnet stimulation to modify the perception of tinnitusNeuronavigation devices (e.g. BrainsightTM-Frameless, Magstim Co., Whitland, GB) allow the individual guidance of a TMS stimulation coil to a target identified by imaging (e.g. fMRT, PET, see fig. 10). In this way a targeted stimulation of predefined cortical areas is permitted (with kind permission of Dr C. Plewnia, Tübingen). A routine application of this procedure for tinnitus treatment is not justified on the basis of data obtained up until now.
© Copyright Policy - open-access
Figure 10: Neuronavigation guided transcranial magnet stimulation to modify the perception of tinnitusNeuronavigation devices (e.g. BrainsightTM-Frameless, Magstim Co., Whitland, GB) allow the individual guidance of a TMS stimulation coil to a target identified by imaging (e.g. fMRT, PET, see fig. 10). In this way a targeted stimulation of predefined cortical areas is permitted (with kind permission of Dr C. Plewnia, Tübingen). A routine application of this procedure for tinnitus treatment is not justified on the basis of data obtained up until now.
Mentions: With the help of imaging procedures, hyperactivity can be detected amongst tinnitus patients in cortical areas that otherwise are involved in the perception and processing of auditory information (Figure 9 (Fig. 9)) [209]. Analogies to modifications in the somatosensory system (e.g. with focal dystonia or phantom pain [210]) have led to the hypothesis that some forms of tinnitus are based on maladaptive neuroplastic modifications, that follow a decrease or other modification of the input of the auditory nerve to higher parts of the auditory pathway. The rTMS is therefore based on the neurophysiological model of disinhibition of the central auditory system that is reflected in an irregular hyperactivity of various sections of the auditory pathway. In a recently published paper, Plewnia et al. used a high-frequency rTMS (10 hertz) to generate a short-lasting functional lesion in the cortex by temporarily disrupting the activity of various brain areas that potentially participate in tinnitus perception [206]. The authors showed that immediately after rTMS the tinnitus had decreased in intensity or disappeared completely in most patients when stimulation was applied to left temporal or left temporo-parietal cortical areas (Brodman regions 42, 22, 21) (Figure 10 (Fig. 10)). Brain areas for which no effect on the cortex was to be expected upon stimulation served as intraindividual controls.

Bottom Line: A wide range of therapeutic strategies are available for the therapy of hearing disorders including pharmaceutical, acoustic, electrical, surgical, radiological, cognitive-behavioural and so-called "alternative" strategies.This review focuses on general conservative strategies and specific therapeutic approaches mainly for inner ear disorders, whereas surgical and device-based therapies including hearing aids and cochlear implants are described in other chapters in this volume.In addition to the systemic medication-based therapies for the treatment of hearing disorders, the rapidly growing field of local drug delivery to the inner ear as a promising therapeutic strategy is discussed on the background of unresolved issues.From a critical analysis - particularly of the clinical studies presented - conclusions are drawn for the therapy of hearing disorders in the future.

Affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, Tübingen Hearing Research Center (THRC), University of Tübingen, Germany.

ABSTRACT

A wide range of therapeutic strategies are available for the therapy of hearing disorders including pharmaceutical, acoustic, electrical, surgical, radiological, cognitive-behavioural and so-called "alternative" strategies. This review focuses on general conservative strategies and specific therapeutic approaches mainly for inner ear disorders, whereas surgical and device-based therapies including hearing aids and cochlear implants are described in other chapters in this volume.In addition to the systemic medication-based therapies for the treatment of hearing disorders, the rapidly growing field of local drug delivery to the inner ear as a promising therapeutic strategy is discussed on the background of unresolved issues. After description of non-drug-based therapeutic procedures, the conservative therapy of specific diseases and syndromes is reviewed.In general, there is a major discrepancy between promising animal studies up to regeneration and stem-cell transplantation, and uncontrolled experimental studies in humans on the one hand and the shortage of randomized controlled clinical trials with a high level of evidence on the other hand. Therefore, the review and comments on published clinical studies should assist the reader in making his/her own decision about the effectiveness of various, especially pharmaceutical treatments. From a critical analysis - particularly of the clinical studies presented - conclusions are drawn for the therapy of hearing disorders in the future.

View Similar Images In: Results  - Collection
View Article: PubMed Central - HTML -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=3200997&rFormat=json&query=null&req=5