Jack Vernon

Tinnitus: A New Management†

Tinnitus Clinic was established at the University of Oregon Medical School and the result of treatment for 158 patients is discussed. Patients received three forms of masking as treatment: masking from hearing aids, masking from the Tinnitus Masker, and FM‐Masking. Conditions leading to each kind of recommendation are discussed. The examination procedures used in the Tinnitus Clinic are presented. The phenomenon of residual inhibition is explained and discussed in relation to possible long‐term or permanent relief of tinnitus.Future plans for the clinic and needs of tinnitus patients are presented.

Combined effects of noise and neomycin. Cochlear changes in the guinea pig.

Cochlear damage resulting from the combination of neomycin with acoustic overstimulation was investigated in guinea pigs. Four groups of animals received subcutaneous injections and exposure to broad band noise daily for 7 days, as follows: I. Neomycin (200 mg/kg) followed by 10 hours of noise at 115 dB SPL; II. Saline followed by 115 dB noise: III. Neomycin followed by low intensity noise (45 dB as an acoustic control); or IV. Saline followed by 45 dB noise. After a 30 day stabilization period, each ear was examined electrophysiologically and histologically. Measures of cochlear integrity included AC cochlear potentials from 100 Hz through 20 kHz as well as outer hair cell (OHC) counts. A marked interaction leading to augmentation of damage was found when neomycin was combined with 115 dB noise (Group I). Losses in cochlear sensitivity, averaged across all frequencies, amounted to 62 dB in Group I, whereas the averaged losses for Groups II and III were only 16 dB and 17 dB respectively. Loss of OHCs was close to 100% in Group I, while OHC losses were only 17% in Group II and 26% in Group III.

Identification of Tinnitus: A Plea for Standardization

The subjective nature of tinnitus is not the only feature which imposes difficulties upon the identification of tinnitus. The patients who must provide information about their tinnitus are greatly handicapped in this task and for the simple reason that there is very little vocabulary available to them. Thus it is not only important that the clinician listen very carefully to the patient but it is increasingly important that standardized tests be used to identify, measure and classify tinnitus.

Attempts to suppress tinnitus with transcutaneous electrical stimulation.

Various electrical stimuli were tested for their ability to suppress or relieve severe tinnitus. Stimulation was applied transdermally by electrodes placed on the preauricular and postauricular regions and on the two mastoids. Of the 50 patients tested, only 14 (28%) obtained relief that met the criterion of a reduction in the tinnitus by 40% or more. When relief was obtained, it usually extended for several hours into the poststimulation period. There was only one positive response (2%) In the placebo trial, which was administered to all patients. It was concluded that transdermal electrical stimulation such as that used in this research Is not a practical therapeutic procedure for the relief of tinnitus.

Transmeatal low-power laser irradiation for tinnitus.

Objective To evaluate effectiveness of 60-mW laser irradiation in the treatment of tinnitus. Study Design Prospective, randomized double-blind study. Methods This investigation included 68 ears in 45 patients with disabling unilateral or bilateral tinnitus. The active or placebo laser treatment was administered transmeatally once a week for 6 minutes. Laser irradiation was performed four times during a 4-week period. A questionnaire was administered to evaluate the loudness, duration, quality, and annoyance of tinnitus before and after irradiation. The loudness and pitch match for tinnitus were obtained, and distortion product otoacoustic emissions were also examined. Results No significant difference was observed between the active and placebo laser groups with regard to outcome of loudness, duration, quality, and annoyance of tinnitus. In one patient who received active laser treatment, acute hearing deterioration occurred after the third irradiation. Conclusion Transmeatal low-power laser irradiation with 60 mW is not effective for the treatment of tinnitus.

Reduction of Acoustically-Induced Auditory Impairment by Inhalation of Carbogen Gas:I. Permanent Noise-induced Cochlear Damage

The possible beneficial effects of carbogen gas (95% O2/5% CO2) inhalation on noise-induced permanent cochlear impairment were investigated. Groups of guinea pigs were exposed to daily 3 1/2-hour presentations of 120 dB of broad-band noise in an atmosphere of either carbogen gas or normal air. Other groups received carbogen or normal air with a low intensity (50 dB) acoustic exposure. After a 30-day stabilization period each ear was examined electrophysiologically and histologically. Measures included a.c. cochlear potentials from 100 Hz through 20 kHz as well as counts of missing inner hair cells (IHCs) and outer hair cells (OHCs). Statistically significant improvement in the 1 microV isopotential function of the a.c. cochlear potential over all test frequencies and significant reduction in the number of missing IHCs and OHCs was found to result from inhalation of carbogen gas. Blood gas analysis demonstrated a rapid and marked elevation in arterial PCO2 and PO2 with a corresponding drop in pH to result from inhalation of carbogen. The vasodilating effects of increased arterial carbon dioxide tension are discussed in terms of current speculations regarding the role of vasoconstriction in noise-induced hearing loss.

Committee on Geriatric Otolaryngology

Spindle cell carcinoma (pseudosarcoma) is a rare biphasic tumor with longstanding controversy in the literature concerning histogenesis and appropriate management. This study was performed to elucidate the tumors biologic behavior, clarify its pathologic features and probable histogenesis, identify prognostic factors, and determine treatment results. We reviewed the clinical records of 34 cases of laryngeal (25) and hypopharyngeal (9) spindle cell carcinomas treated at our institution from 1960 to 1990. All cases were studied by paraffin section immunostains, and 31 underwent ploidy analysis of the sarcomatoid component. Of the 31 patients who underwent their initial treatment at our institution, there were 25 men and six women with a median age at presentation of 64.6 years. A T1 glottic tumor was most common (16 cases), usually seen as an exophytic, firm mass. The spindle cells were nondiploid in 84%, and keratin immunostains were positive in 74%. The median length of follow-up was 3.7 years. Recurrent tumor after partial or total laryngectomy/pharyngectomy occurred in 10 patients. At last contact, eight patients had died of their disease. The Kaplan-Meier estimate of surviving at least 3 years after initial treatment is 56.8%. Keratin positivity adversely affected overall survival (p <0.02). The survival of patients with hypopharyngeal tumors was worse than those with laryngeal lesion (p <0.01). The presence of keratin positivity and nondiploid DNA content in the spindle cell population supports the neoplastic epithelial origin of these tumors (sarcomatoid carcinoma). Because the entire lesion represents a malignant epithelial neoplasm rather than a reactive process, it should be treated appropriately. Overall tumor behavior and surgical therapy appear comparable to similar staged squamous cell carcinomas. Additional clinical and pathologic features of prognostic significance will be presented.