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Πέμπτη, 15 Δεκεμβρίου 2016

Relação entre perda auditiva senil e atividade vestibular [Livre artigo]

Relação entre perda auditiva senil e atividade vestibular [Livre artigo]: Hanifi Kurtaran, Baran Acar, Emre Ocak, Emre Mirici
Braz J Otorhinolaryngol 2016;82:650-3

Resumo - Texto Completo - PDF
Braz J Otorhinolaryngol 2016;82:650-3
Relação entre perda auditiva senil e atividade vestibular
Hanifi Kurtarana, Baran Acarb, Emre Ocakb, Emre Miricib
a Turgut Ozal University Medical Faculty, Department of Otorhinolaryngology, Ankara, Turquia
b Kecioren Training and Research Hospital, Department of Otorhinolaryngology, Ankara, Turquia
Resumo
Introdução: Um número considerável de pacientes com PANS também sofre de tonturas e sintomas vestibulares relacionados.

Objetivo: Avaliar a associação entre disfunção vestibular e perda auditiva neurossensorial (PANS) em pacientes adultos.

Método: Estudo prospectivo, duplo-cego e controlado com 63 pacientes adultos, sem quaisquer sintomas vestibulares ou doença vestibular diagnosticada. A audição foi avaliada por meio de audiometria tonal e o sistema vestibular, com potenciais evocados miogênicos vestibulares (PEMV). Os pacientes foram divididos em dois grupos: grupo de estudo (pacientes com PANS) e grupo de controle (pacientes sem PANS). Os resultados dos PEMV dos grupos foram calculados e comparados.

Resultados: As latências médias de P1 (23,54) e N1 (30,70) encontravam-se prolongadas no grupo de estudo (p < 0,001), e as amplitudes no grupo de estudo estavam significantemente reduzidas (p < 0,001). Ambos os parâmetros do teste de PEMV foram anormais no grupo de estudo quando comparados aos do grupo controle. Conclusões: Nossas achados sugerem que a PANS relacionada à idade pode ser acompanhada por hipofunção vestibular, mesmo na ausência de possíveis fatores predisponentes para vestibulopatia. Resumo Introduction: A considerable high number of SNHL patients also suffer from dizziness and related vestibular symptoms. Objective: To evaluate the association of vestibular dysfunction and sensorineural hearing loss (SNHL) in adult patients. Methods: Prospective, double-blinded, controlled studies composed by 63 adult patients without any vestibular symptoms or diagnosed vestibular diseases. Audiological status was measured with pure tone audiometry and the vestibular system was tested with vestibular evoked myogenic potential (VEMP). Patients were divided into two groups: a study group (patients with SNHL) and a control group (patients without SNHL). VEMP results of the groups were calculated and compared. Results: Mean P1 (23.54) and N1 (30.70) latencies were prolonged in the study group (p < 0.001) and the amplitudes of the study group were significantly reduced (p < 0.001). Both parameters of the VEMP test were abnormal in the study group when compared to the control group. Conclusions: These findings suggest that age-related SNHL may be accompanied by vestibular weakness without any possible predisposing factors for vestibulopathy. Palavras-chave Perda auditiva neurossensorial; Disfunção vestibular; Audiometria tonal; Potenciais evocados miogênicos vestibulares Keywords Sensorineural hearing loss; Vestibular dysfunction; Pure tone audiometry; Vestibular evoked myogenic potentials Introdução A perda auditiva neurossensorial (PANS) é o tipo mais comum de deficiência sensorial, afetando mais de 360 milhões de pessoas em todo o mundo, sendo considerada um problema de saúde pública, independentemente da etiologia.1 Um número considerável de pacientes com PANS também sofre de tonturas e sintomas vestibulares relacionados. Portanto, é altamente possível uma relação entre PANS e disfunção vestibular, sem que haja evidência de qualquer doença sistêmica ou da orelha interna que poderia causar vestibulopatia. Muitos pacientes comparecem em clínicas de otorrinolaringologia com queixas de tontura e perda auditiva sem uma doença óbvia e são diagnosticados com presbiacusia ou vestibulopatia relacionada com a idade. Este estudo tem como objetivo avaliar a relação entre as subestruturas de órgãos vestibulares e auditivos com a mesma origem embrionária. As doenças que afetam uma subestrutura da orelha interna podem, portanto, causar uma disfunção em outras com a mesma origem embrionária. Partindo dessa premissa, investigamos o sáculo como uma parte do sistema vestibular com os potenciais evocados miogênicos vestibulares (PEMV), por ser uma das formas mais precisas e práticas para avaliar a integridade e função do sáculo e do nervo vestibular inferior. O princípio dessa ferramenta diagnóstica resulta da ativação seletiva dos aferentes do nervo vestibular que inervam o sáculo. As respostas dos PEMV cervicais são gravadas pela eletromiografia (EMG) do músculo esternocleidomastoideo (ECM), após o início de um estímulo em clique no canal auditivo externo.2 É uma resposta bifásica para avaliar o reflexo sáculo-cólico. O número de estudos relevantes é limitado e relatos de casos constituem a maioria desses estudos. Essa falta de dados nos motivou a buscar mais conhecimento sobre esses pacientes. Neste estudo, investigamos a relação entre PANS e disfunção vestibular em adultos com base na hipótese de que o mau funcionamento de uma subestrutura da orelha, possa ocasionar disfunção em partes do sistema vestibular -auditivo que tem a mesma origem embrionária. Método Estudo prospectivo, duplo-cego e controlado foi realizado em pacientes adultos. O grupo de estudo consistiu em pacientes que deram entrada em nossa instituição com queixa de perda auditiva, diagnosticados com PANS bilateral de moderada a grave. O grupo controle foi formado por indivíduos saudáveis, sem perda auditiva, com características demográficas semelhantes. Os pacientes com perda auditiva do tipo mista, doenças do canal auditivo externo, membrana timpânica perfurada, anormalidades da orelha média, qualquer tipo de doença vascular ou neurológica diagnosticada, doenças vestibulares periféricas confirmadas ou história de cirurgia otológica ou da base lateral do crânio foram excluídos. Audiometria tonal (AT) foi realizada com um dispositivo AD629 Interacoustics® (Dinamarca, 2012) em uma sala à prova de som para avaliar a audição de cada participante nas frequências de 250 a 8.000 Hz. Um limiar de tons puros na faixa de 41-60 dB NA foi considerado como PANS moderada e de 61-80 dB NA como PANS grave.3 As funções da orelha média foram avaliadas por meio de timpanometria e do reflexo acústico. Função sacular foi testada por PEMV. Cliques breves de banda larga de 0,1 msn foram usados como estímulo e uma EMG da superfície do músculo ECM foi registrada. O eletrodo não inversor foi colocado sobre o terço superior do músculo e o eletrodo inversor sobre o tendão do ECM acima da clavícula. Os pacientes foram colocados em posição ereta e instruídos a virar a cabeça para o lado contralateral da orelha a ser testada. O estado de contração do ECM foi equalizado antes da estimulação por meio de um sistema de controle de pré-carga. A resposta do músculo na EMG foi registrada como formas de ondas bifásicas de acordo com as latências (P1 e N1), em um nível de estímulo de 95 dB NA, 500 Hz de tom súbito com tempo de 4 msn de elevação/diminuição e 2 msn de platô, com uma taxa de repetição de 5,5s. As latências e amplitudes do PEMV em cada orelha foram calculadas para cada grupo e comparadas. Os testes auditivo e vestibular foram realizados de modo duplocego por pesquisadores independentes. Consentimento informado foi obtido de todos os participantes, e este estudo foi aprovado pelo Conselho de Revisão Institucional (CRI 682). Análise estatística As estatísticas descritivas foram obtidas de cada grupo, e foram calculados os valores médios, desvios padrão e medianas. O teste exato de Fisher e o teste do Qui-quadrado foram usados para comparar os resultados do PEMV entre os grupos. O programa SPSS 15.0 para Windows (SPSS Inc., Chicago, EUA) foi usado para todas as análises estatísticas, e um valor-p inferior a 0,05 foi considerado estatisticamente significante. Resultados No total, 63 pacientes com média de idade de 65,1 anos (mín-máx 55-82 anos) foram incluídos no estudo. A média de idade no grupo de estudo foi de 67,2 anos, e de 64,2 no grupo controle (p > 0,05). Havia 39 pacientes do sexo feminino e 24 do sexo masculino (p > 0,05), sem preponderância quanto ao gênero e idade entre os grupos. Os grupos de estudo e controle continham 31 e 32 pacientes, respectivamente. O valor médio da AT foi de 20,71 dB (mín-máx 10-25) no grupo controle e 63,53 dB (mín-máx 50-83) no grupo de estudo (p < 0,05). As médias das latências e amplitudes de P1 e N1 dos grupos estão resumidas na tabela 1. Ambas as latências de P1 e N1 se encontravam significantemente prolongadas no grupo de estudo, em relação ao grupo controle (p < 0,001) (fig. 1). As amplitudes também estavam significantemente reduzidas no grupo de estudo (p < 0,001) (fig. 2).



Figura 1. Comparação das médias das latências de P1 e N1 nos grupos de estudo e controle.


Figura 2. Médias das amplitudes de P1 e N1 dos grupos de estudo e controle.

Discussão

A relação entre PANS e o sistema vestibular é complexa e ainda não totalmente esclarecida. O mecanismo de interação entre os sistemas auditivo e vestibular em pacientes com PANS permanece obscuro. Estudos anteriores centraram-se na possibilidade de uma relação entre perda auditiva induzida por ruído e funções vestibulares prejudicadas.4 Em um estudo com pacientes diagnosticados com perda auditiva induzida por ruído, 50% dos indivíduos apresentaram resultados anormais no PEMV.5 Além disso, a proximidade anatômica entre o sáculo e a platina do estribo pode ter um potencial papel na disfunção vestibular, particularmente em pacientes com história de exposição ao ruído crônico. Em outro estudo, Singh et al.6 relataram uma possível relação com base na redução significante observada nas amplitudes dos resultados do PEMV em crianças com PANS grave a profunda.

Sob o ponto de vista embriológico, o sáculo e a cóclea se desenvolvem a partir da mesma origem no labirinto membranoso, o qual é inervado pela porção inferior do nervo vestibular. Além disso, o sáculo atua como órgão de sensibilidade acústica em espécies inferiores;7,8 portanto, como órgão de sensibilidade vestibular, ele pode ser considerado como um desenvolvimento tardio em humanos.9,10

Muitos pacientes com diferentes tipos de presbiacusia sofrem de disfunção vestibular. Ainda não está claro se essa vestibulopatia é devida a mudanças relacionadas à idade no sistema nervoso central ou se existe uma associação entre PANS e doença vestibular. Portanto, no presente estudo, os grupos foram constituídos de forma homogênea, eliminando dessa forma quaisquer fatores que pudessem causar disfunção vestibular. Os períodos prolongados das latências de P1 e N1 e a redução das amplitudes observados no grupo de estudo sugeriram um déficit vestibular periférico nos pacientes com PANS. Esta pesquisa foi baseada na hipótese de que as patologias que afetam uma subestrutura da orelha interna podem causar uma disfunção naquelas com a mesma origem embrionária. Nossos resultados sugerem que a PANS pode estar acompanhada por hipofunção vestibular sem que haja qualquer fator predisponente para a vestibulopatia.

Uma limitação do presente estudo foi a falta de dados relativos ao PEMV ocular e canal de reflectância, que podem ser expressões de comprometimento global da orelha interna, bem diferentes do envelhecimento. A correlação entre perda auditiva e disfunção vestibular pode depender de múltiplas variáveis. Portanto, mais estudos com um número maior de pacientes e apoiados por diferentes tipos de testes vestibulares para avaliar a integridade do sistema vestibular irão expandir o conhecimento sobre o tema.

Grande parte dos pacientes com PANS, independentemente da etiologia, apresenta algum grau de disfunção vestibular. Exceto pelo diagnóstico de doenças vestibulares periféricas, a maioria deles são acompanhados por diferentes especialidades, incluindo cardiologia, medicina interna, geriatria ou fisioterapia e reabilitação, em busca do diagnóstico de sua doença. Muitos otorrinolaringologistas também examinam esses pacientes em sua rotina diária. À luz de nossos resultados, podemos concluir que as informações detalhadas sobre o estado da porção inferior do sistema vestibular, em conjunto com as funções auditivas, podem guiar o clínico na direção certa para a avaliação desses pacientes.

Conclusão

Nossos achados sugerem que a PANS relacionada à idade pode estar acompanhada por hipofunção vestibular, sem que hajam quaisquer fatores predisponentes possíveis para a vestibulopatia.

Conflitos de interesse

Os autores declaram não haver conflitos de interesse.

Recebido em 18 de setembro de 2015;

aceito em 12 de novembro de 2015

* Autor para correspondência.

E-mail:hkurtaran@gmail.com (H. Kurtaran).

☆ Como citar este artigo: Kurtaran H, Acar B, Ocak E, Mirici E. The relationship between senile hearing loss and vestibular activity. Braz J Otorhinolaryngol. 2016;82:650-3.

DOI se refere ao artigo: http://dx.doi.org/10.1016/j.bjorl.2015.11.016

Bibliografia
1
Strategies for developing novel therapeutics for sensorineural hearing loss. Front Pharmacol. 2014;5:1-5.
2
Evaluation of the patient with dizziness. Em: Flint PW, Haughey BH, editores. Cummings otolaryngology head & neck surgery. Philadelphia: Mosby Elsevier Press; 2010. p. 2305-27.
3
Diagnostic audiology. Em: Flint PW, Haughey BH, editores. Cummings otolaryngology head & neck surgery. Philadelphia: Mosby Elsevier Press; 2010. p. 1887-903.
4
Vestibular implications of noise-induced hearing loss. Br J Audiol. 1982;16:227-32.
5
Vestibular evoked myogenic potentials in chronic noise-induced hearing loss. Otolaryngol Head Neck Surg. 2007;137:607-11.
6
Vestibular evoked myogenic potentials in children with sensorineural hearing loss. Int J Pediatr Otorhinolaryngol. 2012;76:1308-11.
7
Psychophysics and neurophysiology of temporal factors in hearing by the goldfish: amplitude modulation detection. J Neurophysiol. 1980;44:312-32.
8
Scanning electron microscopic study of the sacculus and lagena in several deep-sea fishes. Am J Anat. 1980;157: 115-36.
9
Vestibular evoked myogenic potentials in humans: a review. Acta Otolaryngol. 1999; 119:6-15.
10
A saccular origin of frequency tuning in myogenic vestibular evoked potentials? Implications for human responses to loud sounds. Hear Res. 2000;141:180-8.

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Tinnitus

1. Chadha NK, Gordon KA, James AL, Papsin BC. Tinnitus is prevalent in children with cochlear implants. International Journal of Pediatric Otorhinolaryngology. 2009;73:671-675. [abstract]

2. Akdogan O, Ozcan I, Ozbek C, Dere H. Tinnitus after cochlear implantation. Auris Nasus Larynx. 2009;36:210-212. [abstract]

3. Pan T, Tyler RS, Ji H, Coelho C, Gehringer AK, Gogel SA. Changes in the tinnitus handicap questionnaire after cochlear implantation. American Journal of Audiology. 2009;18:144-151. [abstract]

4. Andersson G, Freijd A, Baguley DM, Idrizbegovic E. Tinnitus distress, anxiety, depression, and hearing problems among cochlear implant patients with tinnitus. Journal of the American Academy of Audiology. 2009;20:315-319. [abstract]

5. Rothholtz VS, Tang Q, Wu EC, Fine EL, Djalilian H, Zeng F-G. Exploring the parametric space of tinnitus suppression in a patient with a cochlear implant. Laryngoscope. 2009;119.

6. Di NW, Cianfrone F, Scorpecci A, Cantore I, Giannantonio S, Paludetti G. Transtympanic electrical stimulation for immediate and long-term tinnitus suppression. International Tinnitus Journal. 2009;15:100-106.[abstract]

7. Litre CF, Theret E, Tran H et al. Surgical treatment by electrical stimulation of the auditory cortex for intractable tinnitus. Brain Stimulation. 2009;2:132-137. [abstract]

8. Evans RW, Ishiyama G. Migraine with transient unilateral hearing loss and tinnitus. Headache: The Journal of Head & Face Pain. 2009;49:756-759. [abstract]

9. Pirodda A, Brandolini C, Raimondi MC, Ferri GG, Borghi C. Tinnitus as a warning for preventing vasovagal syncope. Medical Hypotheses. 2009;73:370-371. [abstract]

10. Anderson JE, Teitel D, Wu YW. Venous hum causing tinnitus: case report and review of the literature. Clinical Pediatrics. 2009;48:87-89. [abstract]

11. Liess BD, Lollar KW, Christiansen SG, Vaslow D. Pulsatile tinnitus: a harbinger of a greater ill? Head & Neck. 2009;31:269-273. [abstract]

12. Singh DP, Forte AJ, Brewer MB, Nowygrod R. Bilateral carotid endarterectomy as treatment of vascular pulsatile tinnitus. Journal of Vascular Surgery. 2009;50:183-185. [abstract]

13. Delgado F, Munoz F, Bravo-Rodriguez F, Jurado-Ramos A, Oteros R. Treatment of dural arteriovenous fistulas presenting as pulsatile tinnitus. Otology and Neurotology. 2009;30:897-902. [abstract]

14. Cowley PO, Jones R, Tuch P, McAuliffe W. Pulsatile tinnitus from reversal of flow in an aberrant occipital artery: Resolved after carotid artery stenting. American Journal of Neuroradiology. 2009;30:995-997. [abstract]

15. Stimmer H, Borrmann A, Loer C, Arnold W, Rummeny EJ. Monaural tinnitus from a contralateral inferior colliculus hemorrhage. Audiology & Neurotology. 2009;14:35-38. [abstract]

16. Latifpour DH, Grenner J, Sjodahl C. The effect of a new treatment based on somatosensory stimulation in a group of patients with somatically related tinnitus. International Tinnitus Journal. 2009;15:94-99. [abstract]

17. Department of Health. Provision of services for adults with tinnitus: a good practice guide. 2009. [full text]

18. DH. Tinnitus Map of Medicine care pathway. 2010. [Full text]

19. BTA. Tinnitus: guidelines for primary care. 2010. [Full text]

20. Schneider P, Andermann M, Wengenroth M et al. Reduced volume of Heschl's gyrus in tinnitus. NeuroImage. 2009;45:927-939. [abstract]

21. Landgrebe M, Langguth B, Rosengarth K et al. Structural brain changes in tinnitus: grey matter decrease in auditory and non-auditory brain areas. NeuroImage. 2009;46:213-218. [abstract]

22. Melcher JR, Levine RA, Bergevin C, Norris B. The auditory midbrain of people with tinnitus: Abnormal sound-evoked activity revisited. Hearing Research. 2009;257:63-74. [abstract]

23. Lanting CP, de KE, van DP. Neural activity underlying tinnitus generation: Results from PET and fMRI. Hearing Research. 2009;255:1-13. [abstract]

24. Kaltenbach JA. Insights on the origins of tinnitus: an overview of recent research. Hearing Journal. 2009;62:26-31. [Full text]

25. Shulman A, Goldstein B, Strashun AM. Final common pathway for tinnitus: theoretical and clinical implications of neuroanatomical substrates. International Tinnitus Journal. 2009;15:5-50. [abstract]

26. Schutte NS, Noble W, Malouff JM, Bhullar N. Evaluation of a model of distress related to tinnitus. International Journal of Audiology. 2009;48:428-432. [abstract]

27. Hesser H, Pereswetoff-Morath CE, Andersson G. Consequences of controlling background sounds: the effect of experiential avoidance on tinnitus interference. Rehabilitation Psychology. 2009;54:381-390.[abstract]

28. Argstatter H, Krick C, Bolay HV. Music therapy for chronic tinnitus. Heidelberg treatment model. Psychotherapeut. 2009;54:17-26. [abstract]

29. Lugli M, Romani R, Ponzi S, Bacciu S, Parmigiani S. The windowed sound therapy: A new empirical approach for an effective personalized treatment of tinnitus. International Tinnitus Journal. 2009;15:51-61.[abstract]

30. Langguth B, Salvi R, Elgoyhen AB. Emerging pharmacotherapy of tinnitus. Expert Opinion on Emerging Drugs. 2009;14:687-702. [abstract]

31. Campbell KCM. Emerging pharmacologic treatments for hearing loss and tinnitus. ASHA Leader. 2009;14:14-18. [Full text]

32. Hesser H, Westin V, Hayes SC, Andersson G. Clients' in-session acceptance and cognitive defusion behaviors in acceptance-based treatment of tinnitus distress. Behaviour Research & Therapy. 2009;47:523-528. [abstract]

33. Hesser H, Andersson G. The role of anxiety sensitivity and behavioral avoidance in tinnitus disability. International Journal of Audiology. 2009;48:295-299. [abstract]

34. Shulman A, Goldstein B. Subjective idiopathic tinnitus and palliative care: a plan for diagnosis and treatment. Otolaryngologic Clinics of North America. 2009;42:15-38. [abstract]

35. Forti S, Costanzo S, Crocetti A, Pignataro L, Del BL, Ambrosetti U. Are results of tinnitus retraining therapy maintained over time? 18-month follow-up after completion of therapy. Audiology & Neuro-Otology. 2009;14:286-289. [abstract]

36. Bessman P, Heider T, Watten VP, Watten RG. The tinnitus intensive therapy habituation program: a 2-year follow-up pilot study on subjective tinnitus. Rehabilitation Psychology. 2009;54:133-138. [abstract]

37. Gudex C, Skellgaard PH, West T, Sorensen J. Effectiveness of a tinnitus management programme: A 2-year follow-up study. BMC Ear, Nose and Throat Disorders. 2009;9. [Full text]

38. Henry J, Zaugg T, Myers P, Kendall C, Turbin M. Principles and application of educational counseling used in progressive audiologic tinnitus management. Noise and Health. 2009;11:33-48. [abstract]

1. Hazell JW, Jastreboff PJ. Tinnitus. I: Auditory mechanisms: a model for tinnitus and hearing impairment. J Otolaryngol. 1990;19:1-5. [Abstract]

2. Jastreboff PJ, Jastreboff MM. Tinnitus Retraining Therapy (TRT) as a method for treatment of tinnitus and hyperacusis patients. J Am Acad Audiol. 2000 Mar;11(3):162-77. [Abstract]

3. Marcondes RA, Sanchez TG, Kii MA, Langguth et al. Repetitive transcranial magnetic stimulation improve tinnitus in normal hearing patients: a double-blind controlled, clinical and neuroimaging outcome study. Eur J Neurol. 2009. [Epub ahead of print] ) [Abstract]

4. Cannon SC Pathomechanisms in channelopathies of skeletal muscle and brain. Annu Rev Neurosci. 2006;29:387-415. [Abstract]

5. Davies E, Knox E, Donaldson I. The usefulness of nimodipine, an L-calcium channel antagonist, in the treatment of tinnitus. Br J Audiol. 1994;28:125-129. [Abstract]

6. Baguley DM, Jones S, Wilkins I, Axon PR, Moffat DA. The inhibitory effect of intravenous lidocaine infusion on tinnitus after translabyrinthine removal of vestibular schwannoma: a double-blind, placebo-controlled, crossover study. Otol Neurotol. 2005;26:169-176. [Abstract]

Eggermont JJ. Cortical tonotopic map reorganization and its implications for treatment of tinnitus. Acta Otolaryngol Suppl. 2006;9-12. [Abstract]

Hoke ES, Muhlnickel W, Ross B, Hoke M. Tinnitus and event-related activity of the auditory cortex. Audiol Neurootol. 1998;3:300-331. [Abstract]

Mirz F, Pedersen B, Ishizu K et al. Positron emission tomography of cortical centers of tinnitus. Hear Res. 1999;134:133-144. [Abstract]

Muhlnickel W, Elbert T, Taub E, Flor H. Reorganization of auditory cortex in tinnitus. Proc Natl Acad Sci U S A. 1998;95:10340-10343. [Abstract]

Norena AJ, Eggermont JJ. Enriched acoustic environment after noise trauma abolishes neural signs of tinnitus. Neuroreport. 2006;17:559-563. [Abstract]

Schlee W, Hartmann T, Langguth B, Weisz N. Abnormal resting-state cortical coupling in chronic tinnitus. BMC Neurosci. 2009;10:11. [Full text]

Schlee W, Mueller N, Hartmann T, Keil J, Lorenz I, Weisz N. Mapping cortical hubs in tinnitus. BMC Biol. 2009;7:80. [Full text]

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To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art.

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All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.

If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot."

MAIMONIDE'S PRAYER

"Almighty God, Thou has created the human body with infinite wisdom. Ten thousand times ten thousand organs hast Thou combined in it that act unceasingly and harmoniously to preserve the whole in all its beauty the body which is the envelope of the immortal soul. They are ever acting in perfect order, agreement and accord. Yet, when the frailty of matter or the unbridling of passions deranges this order or interrupts this accord, then forces clash and the body crumbles into the primal dust from which it came. Thou sendest to man diseases as beneficent messengers to foretell approaching danger and to urge him to avert it.

"Thou has blest Thine earth, Thy rivers and Thy mountains with healing substances; they enable Thy creatures to alleviate their sufferings and to heal their illnesses. Thou hast endowed man with the wisdom to relieve the suffering of his brother, to recognize his disorders, to extract the healing substances, to discover their powers and to prepare and to apply them to suit every ill. In Thine Eternal Providence Thou hast chosen me to watch over the life and health of Thy creatures. I am now about to apply myself to the duties of my profession. Support me, Almighty God, in these great labors that they may benefit mankind, for without Thy help not even the least thing will succeed.

"Inspire me with love for my art and for Thy creatures. Do not allow thirst for profit, ambition for renown and admiration, to interfere with my profession, for these are the enemies of truth and of love for mankind and they can lead astray in the great task of attending to the welfare of Thy creatures. Preserve the strength of my body and of my soul that they ever be ready to cheerfully help and support rich and poor, good and bad, enemy as well as friend. In the sufferer let me see only the human being. Illumine my mind that it recognize what presents itself and that it may comprehend what is absent or hidden. Let it not fail to see what is visible, but do not permit it to arrogate to itself the power to see what cannot be seen, for delicate and indefinite are the bounds of the great art of caring for the lives and health of Thy creatures. Let me never be absent- minded. May no strange thoughts divert my attention at the bedside of the sick, or disturb my mind in its silent labors, for great and sacred are the thoughtful deliberations required to preserve the lives and health of Thy creatures.

"Grant that my patients have confidence in me and my art and follow my directions and my counsel. Remove from their midst all charlatans and the whole host of officious relatives and know-all nurses, cruel people who arrogantly frustrate the wisest purposes of our art and often lead Thy creatures to their death.

"Should those who are wiser than I wish to improve and instruct me, let my soul gratefully follow their guidance; for vast is the extent of our art. Should conceited fools, however, censure me, then let love for my profession steel me against them, so that I remain steadfast without regard for age, for reputation, or for honor, because surrender would bring to Thy creatures sickness and death.

"Imbue my soul with gentleness and calmness when older colleagues, proud of their age, wish to displace me or to scorn me or disdainfully to teach me. May even this be of advantage to me, for they know many things of which I am ignorant, but let not their arrogance give me pain. For they are old and old age is not master of the passions. I also hope to attain old age upon this earth, before Thee, Almighty God!

"Let me be contented in everything except in the great science of my profession. Never allow the thought to arise in me that I have attained to sufficient knowledge, but vouchsafe to me the strength, the leisure and the ambition ever to extend my knowledge. For art is great, but the mind of man is ever expanding.

"Almighty God! Thou hast chosen me in Thy mercy to watch over the life and death of Thy creatures. I now apply myself to my profession. Support me in this great task so that it may benefit mankind, for without Thy help not even the least thing will succeed."

Information for Health Professionals

Information for Patients

Modern challenged parts of the oath:

  1. To teach medicine to the sons of my teacher. In the past, medical schools gave preferential consideration to the children of physicians.
  2. To practice and prescribe to the best of my ability for the good of my patients, and to try to avoid harming them. This beneficial intention is the purpose of the physician. However, this item is still invoked in the modern discussions of euthanasia.
  3. I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan. Physician organizations in most countries have strongly denounced physician participation in legal executions. However, in a small number of cases, most notably the U.S. states of Oregon,[10] Washington,[11]Montana,[12] and in the Kingdom of the Netherlands,[13] a doctor can prescribe euthanasia with the patient's consent.
  4. Similarly, I will not give a woman a pessary to cause an abortion. Since the legalization of abortion in many countries, the inclusion of the anti-abortion sentence of the Hippocratic oath has been a source of contention.
  5. To avoid violating the morals of my community. Many licensing agencies will revoke a physician's license for offending the morals of the community ("moral turpitude").
  6. I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art. The "stones" referred to are kidney stones or bladder stones, removal of which was judged too menial for physicians, and therefore was left for barbers (the forerunners of modern surgeons). Surgery was not recognized as a specialty at that time. This sentence is now interpreted as acknowledging that it is impossible for any single physician to maintain expertise in all areas. It also highlights the different historical origins of the surgeon and the physician.
  7. To keep the good of the patient as the highest priority. There may be other conflicting 'good purposes,' such as community welfare, conserving economic resources, supporting the criminal justice system, or simply making money for the physician or his employer that provide recurring challenges to physicians
http://www.worldallergy.org/educational_programs/world_allergy_forum/barcelona2008/rabe/

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