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Approvo

Carlo Govoni MD

Otorhinolaryngologist head and neck surgeon  Master in vestibology

Phone  (+39) 3358040811     NO SMS   
ON THIS SITE NO COMMERCIAL ADVERTISEMENTS 

He visits adults and children by appointment only at private clinic

Cochlear tinnitus is the subjective noise associated with sensorineural hearing loss that usually involves the high frequencies. This is not always true.

acufeni orecchio govoni otorino carlo ent

 

The most common diseases and injuries are listed in the table below.

    Disease or trauma   

Typology
of the Audiogram  

Audiogram

Vestibular testing   

 Tinnitus  References  
 01   Explosion acoustic trauma     Higth-pitched usually  3000 / 4000 Hz   Unilateral sensorineural hearing loss
with steep downslope
 Normal or signs of peripheral vertigo  Tinnitus of variable frequency -
 higth-pitched  3000 / 4000 Hz
 werywellmind.com/ acoustic-trauma 
 02  Shotgun shot  Higth-pitched usually  4000 / 6000 Hz

Asymmetric higt-frequency. 
Anyone who rests the rifle against
the right shoulder damages the left ear.
The opposite in left-handers. 

 Normal or signs of peripheral vertigo  Tinnitus of variable frequency
is usualy present. Higth-pitched   
4000 / 6000 Hz.
 
 03  Cronic acoustic trauma after 
occupational noise exposure
 Higth-pitched usually  4000 / 6000 Hz

 Higth-frequency sensorineural loss 
 Usually bilateral
 Positive recruitment

 Normal

 Tinnitus of variable frequency
is usualy present. Higth-pitched   
4000 / 6000 Hz

 
 04  Transverse temporal bone
fracture
 Non-specific unilatéral damage  Unilatéral sensorineural hearing loss  Non-specific or
paretic nystagmus
  Tinnitus of variable frequency
is usualy present. Higth-pitched   
2000 / 8000 Hz
 
 05  Blunt Head Trauma with no
fracture about the ear
 Non-specific or steep downslope  Unilateral or bilateral sensorineural
hearing loss.  The damage in often
asymmetrical. Deafness
 Non-specific  Tinnitus of variable frequency
is usualy present.
 
 06  Acute acoustic trauma after 
occupational noise exposure
  Bilateral or Asymmetric
  Higth-pitched usually   
4000 / 6000 Hz
 Bilatéral or asymmetric or unilateral
sensorineural hearing loss
 Nonspecific  Tinnitus of variable frequency
is usualy present. 
 
 07  Drugs and substances

 Bilateral hearing loss more evident for high frequencies

 Bilateral and symmetrical sensorineural
hearing loss.

 Normal or
  nonspecific
 Tinnitus with higly variable
  characteristics.
 
 08

 Vestibular schwannoma
(commonly called acoustic neuroma)
   or other cerebellopontine-angle
   tumors

 Unilatéral higt-pitched usually 4000 / 8000 Hz  Unilatéral sensorineural hearing loss.
  Slow and progressive hearing loss
 Unsteadiness in walking  Tinnitus of variable frequency
is usualy present. Unilateral 
higth-pitched   4000 / 8000 Hz
 Nuttal AL et al.  Peripheal process
  involved in tinnitus. In Snow JB:
  "Tinnitus: theory and management"
  Ontario, 2004.
 09  Menière disease

 Sensorineural hearing loss on   low-frequencies or high and  low-frequencies combined

 Unilateral sensorineural hearing loss
 In advanced stages it can become bilateral.
  Positive recruitment
  Nonspecific   Tinnitus of variable frequency,
 often with a low-frequency tone
 125 / 500 Hz
 
 10

 Autoiimune Inner Ear Disease AIED
   Lupus
   Psoriasis
   Cogan's syndrome
   Sjögren's syndrome
   Reumathoid Arthritis

 No audiogram specificity  Sensorineural hearing loss often
  starts in one ear and then spreads
  to the other.
  Nonspecific   Tinnitus with higly variable characteristics.  
 11  Emotional stress  No audiogram specificity  Normal or hearing loss   Nonspecific  Tinnitus with higly variable
  characteristics.
 
 12   Presbycusis  No audiogram specificity  Sensorineural hearing loss;
 in rare case mixed hearing loss.
  Nonspecific  Tinnitus of variable frequency  
 13   Otosclerosis  In most case, people with otosclerosis have conductive hearing loss in both ears.  10-15% hearing loss in one ear.  Conductive hearing loss   Vertigo is rare   Tinnitus present in the majority of cases  
 14   Cochlear otosclerosis  Unilateral or asymmetric hearing loss  Sensorineural or mixed
    hearing loss 
  Vertigo is rare  Unilateral tinnitus often present  
 15   Sudden deafness  Non specific unilateral damage  Unilateral sensorineural hearing
    loss
  There is no vertigo  Unilateral tinnitus often present  
 16   Sudden deafness and 
     vestibular neuritis

 Non specific unilateral
   damage

 Unilateral sensorineural hearing
    loss
 Noticeable instability and dizziness  Unilateral tinnitus  
 17   Tympanic glomus tumor  Unilateral hearing loss  frequencies 250/1000 Hz

 Unilateral conductive hearing   
    loss

  There is no vertigo   Unilateral pulsating tinnitus  
 18   Neurovascular conflict in
  cerebello pontine angle
 Non specific unilateral damage  Unilateral sensorineural hearing
    loss
 Nonspecific or unsteadiness in walking   Unilateral tinntus, often pulsating  
 19   Lyme disease   No audiogram specificity   Normal or sensorineural hearing
    loss
 Unsteadiness in
  walking
 Tinnitus with higly variable
   characteristics
 

 

 Any disease of the auditory system and auditory nerve pathway or any decrease in auditory perception has the potential to produce tinnitus.

 

In this table Drugs and Substances that can causes tinnitus

 A   Analgesics      

 Acetysalicylic acid   
 Non steroidal antinfllammatory drugs  (FANS)
    - Ibuprofen
    - Naproxen   

 B  Antibiotics  Aminoglycosides
 Chloramphenicol
 Erytromicin
 Vancomycine
 Tetracycline
 C  Chemotherapeutics    Bleomycin
 Cispaltin - Carboplatin
 Vincristine
 Methotrexate
 D  Loop diuretics  Furosemide
 Ethacrynic acid
 Bumetanide
 E  Antidepressants  Monoamine oxidase inhibitor  (MAOIs)
 Norepinephrine and Dopamine reuptake inhibitors (NDRIs) 
 Selective Serotonin reuptake inhibitors (SSRIs)
 Serotonin and Norepinephrine reuptake inhibitors (SNRIs)
 Serotonin antagonist and reuptake inhibitors (SARIs)
 Tricyclic antidepressants (TCAs)
 Tetracyclic antidpressants (TeCAs)
 F  Benzodiazepines  Alprazolam, Clonazepam, Diazepam,  Lorazepam,
 Triazolam, Temazepam, Oxazepam
 G  Malaria drug  Hydroxychloroquine (Plaquenil)
 Quinine

 

 telephonic number carlo govoni ent surgeon

 

 

 

 

 

 milano columbus clinic centre center carlo govoni villa romeo

   Milan - Columbus Clinic Center - via Buonarroti, 48 - City Life zone

   Tinnitus - Ear Ringing

   Causes and Treatment

   Carlo Govoni MD  Otolaryngologist
  

milano columbus clinic center palazzina liberty e parte nuova

 

  Columbus Clinic Center - new building

 

 

 

 

See also:

       - Sudden deafness

 

 

 

.

 

This study was published in Italy in 1986 (*) and the efficacy and side effects of Tocainide Hydrochloride on tinnitus were verified. In 1980 Emmett J.R. and Shea J.J. (**) studied the use of Tocainide HCl in patients with chronic tinnitus and sensitive to the Lidocaine test.

Five patients where studied in order to verify the effect of  Tocainide Hydrochloride in chronic tinnitus. All cases uderwent several clinical tests to avoide every external, middle and inner ear deseases and tried a treatment by traditional drugs without success. The patients were selected by a test based on intravenous injection of Lydocaine. On the base of this preliminary report it is possible to grant the theraputic effect of Tocainide against tinnitus  but further about collateral effects and efficacy will be needed.

 

1986 Tocainide acufeni Govoni 1 titolo

 

Lidocaine and Tocainide Hydrochloride are drugs more effective on multisynaptic systems. The acoustic pathway, as can be seen from this image, is a multisynaptic sensory pathway.

1986 Tocainide acufeni Govoni 5 vie acustiche

 

 

___________

(*)  Procaccini A, Govoni C, Cavalca V, Caroggio A.  Dati preliminari sull'impiego della Tocainide Cloridrato nella terapia degli acufeni. La nuova audiométrie 2, 4-8, 1986.

(**) Emmett JR. Shea JJ.  Treatment of Tinnitus with Tocainide Hydrochloride. Otolaryngol Head Neck Surg. Jul-Aug 1980;88(4):442-6.

 

 

 milano columbus clinic centre center carlo govoni villa romeo

  Milan - Columbus Clinic Center - via Buonarroti, 48

  Tinnitus - Buzzing - Ear Ringing

  Causes and Treatment

  Carlo Govoni MD
  

 

 

 

See also:

 

- Searching for the audiometric threshold, a fundamental examination of audiology

 

- Sudden deafness

 

- Developing news strategies for therapeutic interventions in otorhinolaryngology

 

 .

 

 

.

 

Having tinnitus means hearing an annoying sound that is not there, this definition is strange, but for many people it is real and is a serious problem. Tinnitus is a buzz, a hiss, a rustle that constantly or occasionally makes the lives of many people unhappy. It is not possible to establish exactly how many people are affected by this disorder. I believe it is reliable to think of 8% in the adult population and I believe that it reaches 15% if we consider the elderly population (over 65 years). There is no substantial difference between males and females.

orecchio esterno medio interno in sezioneThe diseases that cause tinnitus or ringing
almost always affect the MIDDLE and INTERNAL EAR.
Very rarely the external ear.
Tinnitus often occurs in the cochlea (8) or in the cochlear nerve (10).

Vestibular neve (9) diseases can also generate tinnitus.
Acoustic neuroma is typical.

 

 

I am convinced that in most cases this symptom is a consequence of a disease of the hearing system. My approach is to evaluate the auditory function already in the first approach. Extraotological tinnitus is very rare.
At the Columbus Clinic Center in Milan I met several people affected by this problem and I believe that with the equipment I have it is possible to carry out a good evaluation. In many cases it is possible to hypothesize a precise clinical diagnosis. A correct diagnosis is not always able to identify a correct therapy.

milano columbus clinic center otorino entColumbus Clinic Center entrance

 

The difficulties in eliminating tinnitus are mainly proportional to the time of onset. If the tinnitus has arisen recently and there are evident audiological signs, there are possibilities to achieve an attenuation or even disappearance.

 

 

 

 milano columbus clinic centre center carlo govoni villa romeo

  Milan - Columbus Clinic Center - via Buonarroti, 48 - City Life - Phone +39 3358040811

  Tinnitus - Ear Ringing

  Causes and Treatment

  Carlo Govoni MD  - Otolaryngologist
  

 

 

 

See also:

- Ringing, tinnitus, whistling, buzzing are noise in the ear

 - Tinnitus and sensorineural hearing loss.

- Searching for the audiometric threshold, a fundamental examination of audiology

- Sudden deafness

 

- Tocainide Hydrochloride in the treatment of tinnitus

 

- Fondation Pormann - Course on ear surgery and temporal bone dissection

 

 

 

.

 

 

Roaring or ringing or tinnitus is a sound that does not exist in the environment, but is within us, it can be continuous or intermittent, it is always a noise that is difficult to accept. Tinnitus causes sleepless nights, mood swings, anxiety, depression, exhaustion and stress. The sound is in the head with no external source.

Tinnitus is not a disease.  This concept is more important: Tinnitus is a symptom.

It means that it is a feature of a number of diseases. Many ear diseases present with tinnitus. It is a symptom of ear infections, sudden hearing loss, Meniére's syndrome, otosclerosis, ototoxic drugs, diseases of the inner ear, vestibular neuritis, glomus tumors and many other pathologies. Tinnitus is also a symptom of diseases that do not affect the ear such as hypertension, headache, diabetes, etc.

 

When dealing with a patient with tinnitus it is necessary to address both the physiological and psychological impact. Overall health, nutrition, emotional health and habits play an important role. These factors must always be acted upon if the negative effect of tinnitus is to be reduced. There is and will never be a one-size-fits-all method. It is essential to understand the disease that generated the ringing. It is almost always an ear disease. Only in a few cases the cause is extraotological (arterial hypertension, drugs, temporomandibular joint disorders, intracranial diseases, etc.).

Once the disease causing the tinnitus has been identified, then a therapy can be proposed for that disease and for that single patient.

 

1986 Tocainide acufeni Govoni 5 vie acustiche

 Drawing of the afferent and efferent acoustic pathways.
In almost all cases, tinnitus is the expression of damage
to the cochlea and / or the acoustic pathways.
By Procaccini A, Govoni C, Cavalca V, Caroggio A. 
Dati preliminari sull'impiego della Tocainide Cloridrato nella terapia degli acufeni.
(Preliminary data on the use of Tocainide Hydrochloride in the treatment of tinnitus.)
La nuova audiométrie 2, 4-8, 1986.

 

 

 milano columbus clinic centre center carlo govoni villa romeo

  Milan - Columbus Clinic Center - via Buonarroti, 48

  Tinnitus - Ear Ringing

  Causes and Treatment

  Carlo Govoni MD
  

 

 

 

See also:

 

- Sudden deafness

 

 

 

.

 

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