Medium-term results of combined treatment with transcranial magnetic stimulation and antidepressant drug for chronic tinnitus.

We compared the effects of repetitive transcranial magnetic stimulation (rTMS) and paroxetine [a selective serotonin reuptake inhibitor (SSRI)] on tinnitus in terms of effectiveness and medium-term results. This is a randomised, double-blind, placebo-controlled study. Seventy-five patients with moderate tinnitus were divided into five equal groups. Each group was treated for 1 month as follows: group 1 received rTMS alone at 1 Hz frequency; group 2 received rTMS alone at 10 Hz frequency; group 3 received rTMS at 1 Hz frequency combined with paroxetine; group 4 received paroxetine alone; and group 5 received a placebo (sham rTMS). Participants were tested using the Tinnitus Handicap Inventory (THI), Tinnitus Severity Index (TSI), the Beck Anxiety Scoring (BAS), and Psychiatric Sign Screening (PSS) tests. THI, TSI, BAS, and PSS were measured prior to treatment, and at the first and sixth month post-treatment. The THI and TSI scores improved after treatment in all groups, except the placebo group. The THI scores in groups 1 and 2 showed a statistically significant improvement after the first and sixth month compared to pretreatment scores, whereas a significant improvement in THI scores occurred only after the sixth month in groups 3 and 4. The TSI scores in group 3 showed a significant improvement at the first and sixth month marks after treatment. The rTMS and SSRI play potential roles in the reduction of tinnitus severity, but without cumulative or synergistic effects when a combination of treatment regimens is applied. These positive effects might be due to the relationship between the auditory cortex areas related to emotions and tinnitus.

Assessment of cricopharyngeal muscle aging with apoptotic markers.

OBJECTIVES: The aims of this study were to evaluate histochemical markers of apoptosis in the cricopharyngeus muscle, which is the gatekeeper of the pharyngoesophageal region during the swallowing process; to investigate the effects of primary aging on this muscle; and to determine whether a relationship exists with gastroesophageal reflux disease. MATERIALS AND METHODS: The study included 30 fresh cadavers with a time of death of 12 hours or less obtained from the Turkish Ministry of Justice Forensic Medicine Unit. All cadavers were dissected with routine postmortem skin incisions to extract specimens from the cricopharyngeus muscle and the esophagocardiac junction mucosa. Muscle degeneration and primary aging were demonstrated by immunodetection of Bax, Bcl-2, and Caspase-3 proteins as markers of the apoptosis. Esophageal specimens were examined for the presence of reflux esophagitis. RESULTS: The mean age was 41.5 (14-74) years, and the study included 18 male and 9 female cadavers. Three of them were excluded because of fixation artifacts. The mean Bax, Bcl-2, and Caspase scores showed no statistically significant relationship with age (P = 0.94). The right and left sides of the muscle were investigated separately, and the Bax scores of the right side of the cricopharyngeus muscle showed a statistically significant decrease with age (P = 0.026), whereas the Bax and Bcl-2 scores were increased with age (P = 0.035 and 0.049, respectively) on the left side. Evaluation of the 23 esophagus specimens revealed 10 cases of esophagitis. No relationship was found between the mean of each apoptotic marker and esophagitis. CONCLUSIONS: It is histopathologically not possible to demonstrate muscle death due to either primary aging or reflux. This might be attributable to the defensive capability of this unique muscle to maintain the feeding process.

Watch peripheral arterial tonometry in the diagnosis of obstructive sleep apnea: influence of aging.

OBJECTIVES/HYPOTHESIS: To investigate the consequences of aging and associated peripheral vascular tone impairment on peripheral arterial tonometry (Watch PAT)-based sleep and respiratory disturbance analysis in obstructive sleep apnea (OSA) diagnosis. STUDY DESIGN: Prospective, nonrandomized, clinical trial. METHODS: A total of 56 subjects with age ranges of 20 to 35 years (group I, n = 27) and 50 to 65 years (group II, n = 29) referred to the sleep laboratory for overnight polysomnography (PSG) with suspected OSA were enrolled. All patients underwent simultaneous overnight PSG and Watch PAT monitoring. The data derived from PSG and Watch PAT records, including apnea-hypopnea index (AHI), rapid eye movement (REM) AHI, non-rapid eye movement (NREM) AHI, oxygen desaturation index (ODI), mean O(2) saturation (mean O(2) sat), minimum O(2) saturation (min O(2) sat), sleep duration, and the percentages of NREM sleep stages 1-2 and 3 and of REM sleep were used for comparisons. The calculated ΔPSG-Watch PAT of the two groups were compared statistically. The correlations between the PSG-Watch PAT measurements in each group were assessed. RESULTS: The comparison of AHI, REM AHI, NREM AHI, ODI, mean O(2) sat, min O(2) sat, NREM sleep stage 1-2, and REM sleep ΔPSG-Watch PAT between the two groups did not reveal statistical significance. The difference between the two groups in terms of ΔPSG-Watch PAT of sleep duration and sleep stage 3 was statistically significant. CONCLUSIONS: In addition to the good agreement confirmed between PSG and Watch PAT data in each group, aging did not negatively impact Watch PAT recorded data in terms of included parameters, except the difference in ΔPSG-Watch PAT of sleep stage 3, which may be attributable to aging and impaired vascular tone.

Cricopharyngeal muscle electromyography findings in patients with gastroesophageal reflux disease.

OBJECTIVE: To analyze the grade of reflux and the behavior of the cricopharyngeal muscle (CPM) in patients with gastroesophageal reflux (GER) by means of electromyographic (EMG) analysis of CPM. STUDY DESIGN: Prospective clinical study. SETTING: Istanbul Training and Research Hospital. SUBJECT AND METHODS: Motor unit potential (MUP) recordings and kinesiological recordings of CPM were performed using a concentric needle electrode during dry material swallowing and 3-, 5-, and 10-mL water swallowing. Twenty-four patients with GER were compared with 21 healthy volunteers. RESULTS: GER was mild in 15 patients and moderate-to-severe in 9 patients. MUP recordings were normal in both groups during the preswallowing/postswallowing periods. Kinesiological investigations revealed that the number of patients who did not show a preswallow EMG burst had a positive correlation with the severity of reflux and the amount of liquid swallowed. Rebound bursts were observed in the patient and the control groups. Duration of preswallow and rebound bursts was similar in all groups. Duration of swallowing was shorter in mild GER patients compared with healthy volunteers and moderate-to-severe GER patients. Piecemeal deglutition during 10-mL liquid swallowing was higher in moderate-to-severe GER patients. We also found a positive correlation between the number of swallows and the severity of reflux. CONCLUSION: Needle EMG of the upper esophageal sphincter was normal in GER patients. Kinesiological evaluations showed increased piecemeal deglutition and number of swallows that correlated positively with the severity of GER.

Factors influencing the outcome of idiopathic sudden sensorineural hearing loss treated with hyperbaric oxygen therapy.

Idiopathic sudden sensorineural hearing loss (ISSNHL) is an otologic emergency with an incidence of about 5-20 per 100,000 of the population per year. There is no universally accepted standard protocol for the treatment of patients with ISSNHL. Hyperbaric oxygen therapy (HBOT), was first reported to improve the outcome following acute inner ear disorders during the late 1960s by both French and German authors. The increase in perilymph oxygenation produced by HBOT provides logical basis for the use of this treatment modality in ISSNHL. We reviewed the records of 97 cases that received HBOT for SSNHL to identify the factors that may affect the treatment outcomes. The effects of age, gender, affected ear, status of the contralateral ear, symptoms associated with hearing loss, presence of a cardiovascular disease, dyslipidemia, history of diabetes mellitus, seasonal factor, smoking, degree of hearing loss, audiogram type, medical treatments provided prior to HBOT, onset time, and number of HBOT sessions were evaluated. The mean hearing gain in all cases after the HBOT was 29.5 dB. The gains were statistically significant in the following cases: early onset of HBOT (p = 0.016), higher number of HBOT sessions (p < 0.01), steroid usage (p = 0.009), low frequency-ascending and total audiogram configuration (p < 0.01) and profound hearing loss (p = 0.011). The success rate was significantly lower in cases with high frequency-descending audiogram configuration (p < 0.001). The most important factor affected the prognosis favorably was found as steroid therapy. This retrospective study and our clinical experience suggest that HBOT has beneficial effects when administered in the early phase of the disease together with steroids. HBOT is a safe practice when used properly by an experienced hyperbaric team. In the treatment of ISSNHL, 20 sessions of HBOT at 2.5 ATA can be tolerated well besides some minor side effects. HBOT should be considered for the cases especially with total or profound hearing loss.