Interventions against hearing loss as an integral component of successful tinnitus therapy

Tinnitus very often develops from acute or chronic hearing loss, mainly inner ear deafness. The frequency of the tinnitus mostly corresponds to the frequency range of the hearing loss and is enhanced by down-regulation of inhibition in the central auditory pathway for these frequencies, in addition to focused attention and enhanced arousal for the disturbing sound. Therefore, interventions to improve hearing such as mid-ear surgery or-more often-electronic devices including hearing aids or cochlear implants (CI) are important for the treatment of tinnitus. In this review, the current German S3 guideline "Chronic tinnitus" and recent literature are discussed.

[Interventions against hearing loss are an integral component of successful tinnitus therapy. German version]

Tinnitus very often develops from acute or chronic hearing loss, mainly inner ear deafness. The frequency of the tinnitus mostly corresponds to the frequency range of the hearing loss and is enhanced by down-regulation of inhibition in the central auditory pathway for these frequencies, in addition to focused attention and enhanced arousal for the disturbing sound. Therefore, interventions to improve hearing such as mid-ear surgery or-more often-electronic devices including hearing aids or cochlear implants (CI) are important for the treatment of tinnitus. In this review, the current German S3 guideline "Chronic tinnitus" and recent literature are discussed.

Effect of delayed photobiomodulation therapy on neurosensory recovery in patients with mandibular nerve neurotmesis following traumatic mandibular fracture: A randomized triple-blinded clinical trial

INTRODUCTION

There is a possibility of neurotmesis of the inferior alveolar nerve (IAN) in mandibular fractures, which leads to neurosensory impairment. In this study, we aimed to investigate the efficacy of photobiomodulation therapy (PBMT) in patients with neurotmesis following trauma and mandibular fracture.

MATERIALS AND METHODS

This triple-blind randomized trial was carried out on patients who suffered neurotmesis of the IAN following mandibular angle and body fracture at least for 6 months. In the intervention group, laser irradiation was applied with a low-level GaAlAs diode laser (continuous wave of 810 nm wavelength, power of 200 mW, and energy density of 12-14 J/cm²). In the control group, the laser probe was turned off and placed on the affected area. LLLT was done for 12 sessions (2 times/week for 6 weeks). Light touch sensations, two-point discrimination, thermal discrimination (cold and warm stimulus), electric pulp test (EPT), and oral health impact profile (OHIP)-14 questionnaire were performed before the intervention, immediately after each PBMT session, and after 3, 6, 9 and 12 months.

RESULTS

In both groups, 3 and 23 patients were female and male, respectively. The results showed significantly improved light (cotton swab), light (wooden cotton swab), and sharp (dental needle) touch sensations, and two-point discrimination test in the PBMT group after the 10th, 11th, 10th, and 10th session, respectively. Two-way repeated measure ANOVA revealed that the trend of light touch sensation with cotton swab and two-point discrimination test was statistically significant (p-value = 0.002 and 0.001, respectively). The results of OHIP-14 test showed a significantly higher mean in the PBMT group 3 months after PBMT. There was no statistically significant difference in EPT and thermal discrimination tests regarding the patients' group.

CONCLUSION

PBMT could be an effective treatment for late post-traumatic nerve neurotmesis following a traumatic mandibular fracture.

Transient unilateral lingual nerve injury following the use of laryngeal mask airway Supreme: a case report

Lingual nerve injury rarely occurs after using the laryngeal mask airway (LMA). A 40-year-old woman with no comorbidities visited the hospital for left breast-conserving surgery. Anesthesia was performed using LMA Supreme™. She complained of decreased sensation in the right front part of the tongue postoperatively. She received prednisolone and tongue sensation returned on postoperative day 28. The lingual nerve could be damaged by the LMA, particularly the lateral edge of the tongue base and inner part of the mandible around the third molar. When using the LMA, it is necessary to check the cuff pressure to prevent lingual nerve damage.

Inferior alveolar nerve dysfunction in mandibular fractures: a prospective cohort study

Objectives

To assess the prevalence and recovery of inferior alveolar nerve dysfunction (IAND) in mandibular fractures.

Materials and Methods

This was a prospective cohort study. Clinical neurosensory testing was done preoperatively and the IAND was categorized as mild, moderate or severe. Postoperatively, neurosensory testing was repeated at 1 day, 1 week, 1 month, 3 months and every 3 months thereafter.

Results

A total of 257 patients with 420 fractures were included in the study with a mean age of 31.7 years. Body fractures (95.9%) had the highest incidence of IAND, followed by the angle fractures (90.1%) and symphysis fractures (27.6%). The condyle and coronoid fractures did not have any IAND and hence were excluded from further study. After eliminating those cases, 232 patients remained in the study with 293 fractures. The overall prevalence of IAND in fractures occurring distal to the mandibular foramen was 56.3%. The changes until 1 week were minimal. From 1 month to 6 months, there was a significant reduction in the severity of IAND. A significant number of cases (60.0%) were lost to follow-up between 6 and 9 months. At 6 months, 23.9% of cases still had some form of IAND and 95.0% of the symphysis, 59.0% of the angle and 34.8% of the body fractures with IAND had become normal.

Conclusion

This study documents the reduction in the degree of severity of IAND in the first six months and provides the basis for future studies with longer periods of follow-up.

[Pilot study: Determination of the subjective trunk vertical in upright head position]

BACKGROUND

Consensus has been established that the subjective vertical (SV) is a result of multimodal sensory integration. In order to be able to calculate the vestibulocervical sensory competence for the SV, the isolated subjective trunk vertical axis (STV) was measured under conditions of vertical head fixation.

MATERIALS AND METHODS

Young, healthy volunteers (n = 49) were compared to older, healthy volunteers (n = 50) on a three-dimensionally deflectable (tilt, torsion, pitch) trunk excursion chair in which the volunteer's head remains in an upright position. Another young, healthy group was divided into a placebo (n = 27) and a monophasic cervical transcutaneous electrical nerve stimulation (C-TENS; n = 22) group to examine verticality perception.

RESULTS

In the STV after trunk pitch, age was a significant variable (p = 0.021). The older, healthy group of subjects missed the physical vertical by an average of 1.8° more than the younger group. Only the placebo group showed an average improvement in STV of 4.3° after torsion.

CONCLUSION

Apart from the macular organs the vestibulocervical sensory afference is involved in finding the trunk vertical. A difference in age to the disadvantage of the older healthy subjects was observed, as well as a lack of learning success after applied C‑TENS. The presented pilot study was able to confirm that a correct vertical trunk sensation is caused by vestibulocervical sensory afference in upright head position.

Postural changes associated with ageing on the sensory organization test and the limits of stability in healthy subjects

OBJECTIVE

Acknowledgement of the age effects on postural control and balance is essential to differentiate between physiological changes and actual pathological alterations of the elderly. The aim of this study is to establish the age-related postural changes recorded by the Computerized Dynamic Posturography.

MATERIAL AND METHODS

70 healthy individuals (35 males and 35 females) with an average age of 44.9 years, evenly distributed in seven age groups. We carried out a Sensory Organization Test and Limits of Stability with the Neurocom Smart Balance Master(®) posturography platform. Statistical analysis was undertaken using ANOVA (p<0.05).

RESULTS

Increased age-related balance percentage for Condition 4 (p=0.022), reduced usage rate of ankle-strategy for Conditions 3 (p=0.027) and 4 (p=0.05) for the higher age groups were reported. Regarding limits of stability, the following were the results: age-related differences at an early stage, reaction time from 40 to 49 years, velocity of movement, excursion and directional control from 50 to 59 years.

CONCLUSIONS

Age only affects the balance rate under more complex sensory conditions. For healthy people, ankle strategy is more frequently used than hip strategy; however, the use of hip strategy increases under more difficult sensory conditions. Limits of stability get worse with age, namely after the age of 40-50 years.

Romberg ratio in quiet stance posturography--Test to retest reliability

We investigated test to retest reliability and intraindividual variability of Romberg ratios in quiet stance posturography. Thirty-six healthy young adults (17 males, 19 females aged 15-38 years) were divided into 3 groups with different time-intervals between consecutive trials (20 min, 3h and 24h respectively). Each group performed 5 posturography recordings in a randomized order of eyes open (EO) or closed (EC)+once after 3 months. We measured the torque variance in posturography and calculated Romberg ratios. Total postural sway as well as sway above and below 0.1Hz was analyzed.

RESULTS

Test to retest reliability was found to be poor for Romberg ratios (intraclass correlation coefficients (ICC) <0.4) despite that the individual EO and EC posturography recordings were consistent. For sway >0.1Hz the Romberg ratios were found to be more consistent (fair to good, ICC 0.49-0.71). The variation between two consecutive tests (absolute difference (%)) was high when using the traditional Romberg ratio (EC/EO), but became less varied if an alternate formula that includes the total postural sway was used ((EC-EO)/(EC+EO)×100).

CONCLUSION

In healthy young adults the evaluation of ratios from repeated quiet stance posturography show great intraindividual inconsistency. This questions the Romberg ratio as being a reliable tool for evaluation of postural performance and determination of sensory preference in postural control, at least in healthy controls. Whether test-retest reliability is acceptable in patient cohorts needs to be evaluated for proper validity of intervention and outcome studies and for detection of clinical relevance.