[CONTROLLING THE WAY OF THINKING, THE MENTAL STRESS AND THE ATTENTION ABILITY TO ALLEVIATE THE TINNITUS NUISANCE BY MEANS OF COGNITIVE BEHAVIORAL THERAPY (CBT)].

INTRODUCTION: About 15% of the population suffers from tinnitus but only in 2-3% of cases the tinnitus is severe with great functioning difficulties. The distress caused by tinnitus is mostly caused by the reaction to the tinnitus and not by the tinnitus itself. AIMS: Methods to alleviate the tinnitus distress are presented with emphasis on the importance of the primary detailed explanation to the patient. METHODS: The management of the severe response to tinnitus is based on the ability to control it instead of being controlled by it. This task is accomplished by explaining the essence of the tinnitus and imbuing the patient with control of three things: the way of thinking, the mental stress and attention ability. CONCLUSIONS: The methods to mitigate tinnitus distress are presented. The importance of the primary detailed explanation to the patient is emphasized. The treatment is based on providing methods of mastering the way of thinking, controlling mental stress and managing the attention ability using the CBT technique. DISCUSSION: Ear, nose, and throat (E.N.T) practitioners lack knowledge of treatment of the emotional reaction to tinnitus which results in frustration when dealing with the patient's complaints. In this article the basic tools of Cognitive Behavioral Therapy (CBT) treatment method are presented, along with explanations about the method with regard to coping with the emotional reaction to tinnitus.

[Compliance with diagnostic MRI in the workup of sudden sensorineural hearing loss].

INTRODUCTION: Sudden sensorineural hearing loss (SSNHL] can be the presenting symptom of an acoustic neurinoma. High sensitivity and specificity rates define magnetic resonance imaging (MRI) of the brain and internal acoustic canal as the gold standard for the diagnosis of retro-cochlear pathologies. A previous study revealed low compliance rates (49%] for performing an MRI after an episode of SSNHL; 15% of patients who had an MRI were diagnosed with a retro-cochlear pathology. AIM OF STUDY: To evaluate current compliance rates for performing an MRI of the brain and internal acoustic canal after an episode of SSNHL. MATERIAL AND METHODS: The study cohort included 41 patients, 24 females and 17 male, with an average age of 49.8 +/- 16.8 years (range, 16-78 years), who were diagnosed with SSNHL and admitted for treatment between December 2009 and June 2010. RESULTS: Two months after discharge from hospitalization, only 29 patients (70.7%) returned for the scheduled followup. Only 21 patients (51.2% of those admitted) had an MRI of the brain and internal acoustic canal, as was recommended upon their discharge. Three of those who had an MRI were diagnosed with a retro-cochlear pathology. In 20 patients [48.8%) who did not perform an MRI, a retro-cochlear pathology could not be ruled out. CONCLUSIONS: Compliance rates for performing an MRI after an episode of SSNHL haven't changed in recent years. The main reason seems to be poor patients' compliance, as well as their general practitioners and health insurance companies. Ruling out retro-cochlear pathologies by means of MRI is highly important and considered common medical practice. Guidelines regarding the importance of MRI after an episode of SSNHL should be updated and reinforced.

Optokinetic nystagmus as related to neonatal position.

The objective of this study was to assess the role of the newborn vestibular system on the infant's preferred position. Neonatal electronystagmography was recorded from 80 full-term healthy neonates in the prone and supine positions. Records were analyzed by the clinical ranking of dysmetria and dysrhythmia and computerized fractal analysis. A significantly (P < .002) decreased organization of the electronystagmography signal was observed in the prone compared with the supine position. These results concur with the previously documented, more optimal physiologic functioning in the supine compared with prone position in infancy. It is possible that the vestibular system, among other factors, plays a role in the more protective supine position in infancy.

Mal de debarquement and posture: reduced reliance on vestibular and visual cues.

OBJECTIVE: The neural mismatch theory assumes that the intersensory conflicts leading to motion sickness are resolved by changes in the relative weighting of the various senses that contribute to orientation. If this sensory rearrangement persists after disembarkment, it might result in mal de debarquement (MD): ataxia and a rocking sensation sometimes felt after landing. The objective of the present study was to examine possible changes in sensory organization in naval crew members with differing susceptibility to MD with computerized dynamic posturography (CDP). STUDY DESIGN: Cross-sectional parallel-group design. METHODS: Seventeen subjects susceptible to MD (SMD) and 17 subjects nonsusceptible to MD (NSMD) (healthy male volunteers aged 18-22) participated in the study. CDP was performed twice with each subject, before and immediately after sailing, using the EquiTest system (NeuroCom, Inc., Clackamas, OR). RESULTS: The SMD group showed a significant reduction in their scores on sensory organization tests 3, 4, and 5 after sailing. Sensory pattern analysis revealed reduced use of inputs from the vestibular and visual systems to maintain balance. Prolonged latencies of the motor responses to unexpected pitch perturbations were also recorded in the postsailing CDP of the SMD group. Reduced performance on the presailing CDP task, which presents the greatest challenge to the vestibular system, was found to control for the presence of MD postsailing. CONCLUSIONS: The results show that MD is associated with postural instability, slower motor reflexes, and larger sways in response to abrupt changes in the body's center of gravity. These findings may be explained by under reliance on vestibular and visual inputs and increased dependence on the somatosensory system for the maintenance of balance.

Vertigo as a prognostic sign in sudden sensorineural hearing loss.

Several prognostic indicators of favorable outcome in idiopathic sudden sensorineural hearing loss (ISSHL) have been proposed: an initial profound hearing loss, a down-sloping audiometric curve, advanced age, and the presence of vertigo. The latter has been disputed in the literature. The present study addressed the correlation between vertigo and outcome of ISSHL. Sixty-seven patients with ISSHL, aged 52 years on average, were treated with tapered doses of oral prednisone and complete bed rest. Factors found to have a statistically significant prognostic value as indicators of outcome in ISSHL were tinnitus on admission (positive indicator, p < .041) and a descending type of audiometric curve (negative indicator, p < .009). The presence of vertigo was also found to be significantly correlated with the lack of improvement in hearing, but only at the 8-kHz frequency. Dizziness was reported by 27% of the patients. The correlation between the presence of vertigo and persistent high-frequency ISSHL may be explained by the anatomic contiguity of the basal turn of cochlea and the vestibule.

Nephrotoxicity of combined treatment with cisplatin and gentamicin in the guinea pig: glomerular injury findings.

The drugs cisplatin and gentamicin are given consecutively to various cancer patients suffering from infections. Little information exists about the ultrastructural alterations of kidney glomeruli caused by treatment with these drugs. Renal glomeruli of guinea pigs treated with cisplatin alone and in combination with gentamicin were studied by transmission electron microscopy. The findings revealed foci of damage induced by cisplatin and especially by cisplatin/gentamicin in all glomerular components: glomerular capillaries, including their endothelial cells; basement membrane, epithelial podocytes, mesangial cells, and parietal cells of Bowman's capsule. The damage was expressed by endothelial cytoplasmic extrusions into the vascular lumen, thickening and lamination of capillary basement membrane, focal foot process fusion of podocytes, vacuolization in cytoplasm of endothelial cells of epithelial podocytes and of parietal cells, and the presence of lipid bodies and myeloid bodies in all glomerular cell types. Additionally, injurious effects to cytoplasmic organelles such as mitochondria, nuclei, and endoplasmic reticulum were observed. The results indicate that cisplatin alone and in combination with gentamicin is toxic to renal glomerular tissue. Since these drugs were previously found toxic for strial capillaries in the inner ear and since the main glomerular component is the glomerular capillaries, potential vascular damage and vascular complications in different body systems have to be taken into consideration when these drugs are needed in clinical use.