1. Tinnitus = ear ringing Objective ( vessels anomalie, dysfunction of middle ear ) Subjective …the examiner are not able to hear it

2. Diagnostic and therapeutic strategies for the treatment of tinnitus Aleš Hahn

3. Characteristics of chronical tinnitus  nagging  stressful  permanent  discontinuous  Whistling, hissing,....  most high-frequency

4. Types of tinnitus Cochlear Neural Cortical Combined... … Single / double sided / Transient

5. Famous persons….

6. Tinnitogenesis Generator damage to hair cells (frequency!!...) Mostly connected with hearing loss Phantom... (cochlear) The impaired neuro / cortical pathways Pathologic metabolism of cortical acoustic field (SPECT, PET)

7. Tinnitus types Cochlear Neural Cortical Combined...... Single / double sided / transient

8. Epidemiology of tinnitus "Civilized States" 10-15% of the population and therefore hundreds of millions of people reactivity affected

9. Tinnitus The hearing loss (HL) Solitary isolated less often.

10. Duration of tinnitus Acute... ≤ 14 days Short-term ≤ 6 weeks Subacute ≤ 6 months

11. Diagnosis (1) Patient,s data Audiometric testing possible in peripheral (cochlear) tinnitus Masking of pure tones Frequency (Hz), intensity (dB)

12. Diagnosis (2) Frequency (Hz), intensity (dB) Standard audiometric testing Tone (PTA) and speech audiometry BERA (optional when?)

13. Diagnosis (3) BERA always with sudden or progressive hearing loss... It is necessary to exclude retrocochlear pathology (neuroma of N.VIII.)

14. Diagnosis (4) Cervical and even entire spine, TMJ (Costen is more often than we thought...) ORL Neurology Doppler X-ray (CT, NMR, HRCT...)... And more... as needed

15. Therapy Is different for acute tinnitus vs.chronic Rather Focused on acute Rather polypragmatic in chronic...

16. Therapy tinnitus 2 patient will come in time Corticosteroids, rheologically active drugs (Vinca minor, pentoxyphyllin) HBO Good perspective - mostly disappear (diminishes) in parallel with the improvement of hearing

17. Therapy chronical tinnitus pharmacologicall Physical (laser, HBO, magnetic coil, iontophoresis...) Fyziatric (cultivation axial musculoskeletal segment) Psychiatry (psychological) Music Therapy Combined Surgical IEC, neurektomie Bio - feedback "maskers"... TRT

18. Pharmacotherapy Vasodilators (Cavinton ®, Agapurin ®) corticosteroids vitamins Nootropics (EGB 761-Tanakan ®, Tebokan pills ®) Sedatives / Anxiolytics Antihistamines (Betaserc ®) Anticonvulsants (carbamazepine) antibiotics

19. Physical therapy Laser - must be of sufficient strength 400 mW probe 230  m... Continuous / dyskontinuos beam, 5 min, 10-15 session Sensitization EGB 761

20. Combined therapy Combined treatment (ginkgo, vincamine, betahistine, laser, rehab, lidocaine)... Slow all good Gingko three weeks and then laser - success 40-50%. The combination of drugs Max.2 event.fyziatric / physical therapy

21. musculo relaxing therapy Rehabilitation soft technology Autorehabilitace Not forgetting the Costena (about 15% of tinnitus...)

23. Hospitalization Vinca minor + reha + (laser) Reha + laser + pentoxyphyllin Lidocain???

24. Targeted surgical approach IEC - steroids, gentamycin Aplikation 14 - 24 dnů continual

25. Efficiency of whole therapy Typically the decrease in frequency (Hz) and intensity (dB) In 70% agreement with the VAS The residue after about 15% disapproval.

26. Visual analogue scale

27. Conditions of positive results Cooperation of patient, patience, their good compliance understanding of physician Harmony of the patient's surroundings