Current Opinion in Otolaryngology & Head and Neck Surgery

• Treatment of tinnitus.

  Langguth, Berthold, 2015-08-08 08:00:00 AM

  Purpose of review: Tinnitus, the perception of sound in the absence of a corresponding external acoustic stimulus, is a highly prevalent and frequently severely impairing disorder with worldwide impact. In this article after a short overview about epidemiology and pathophysiology the currently available treatment options will be discussed with specific consideration of the available evidence, their mechanisms of action and their limitations. Recent findings: During the last decades, advances in neuroimaging methods and the development of animal models have contributed to an increasing understanding of the neuronal correlates of tinnitus and have motivated the development of innovative brain-based treatment approaches for directly targeting the neuronal correlates of tinnitus. A further important development has been the insight that there exist different forms of tinnitus that differ in their pathophysiology and their response to specific treatments. Summary: Treatment of tinnitus should be based on a comprehensive diagnosis of etiologic and concomitant aspects of an individual's tinnitus. Already today a large variety of therapeutic interventions are available, which can efficiently reduce tinnitus severity. Several innovative treatment approaches are currently under development. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.
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• Tinnitus treatment with precise and optimal electric stimulation: opportunities and challenges.

  Zeng, Fan-Gang; Djalilian, Hamid; Lin, Harrison, 2015-08-08 08:00:00 AM

  Purpose of review: Electric stimulation is a potent means of neuromodulation that has been used to restore hearing and minimize tremor, but its application on tinnitus symptoms has been limited. We examine recent evidence to identify the knowledge gaps in the use of electric stimulation for tinnitus treatment. Recent findings: Recent studies using electric stimulation to suppress tinnitus in humans are categorized according to their points of attacks. First, noninvasive, direct current stimulation uses an active electrode in the ear canal, tympanic membrane, or temporal scalp. Second, inner ear stimulation uses charge-balanced biphasic stimulation by placing an active electrode on the promontory or round window, or a cochlear implant array in the cochlea. Third, intraneural implants can provide targeted stimulation of specific sites along the auditory pathway. Although these studies demonstrated some success in tinnitus suppression, none established a link between tinnitus suppression efficacy and tinnitus-generating mechanisms. Summary: Electric stimulation provides a unique opportunity to suppress tinnitus. Challenges include matching electric stimulation sites and patterns to tinnitus locus and type, meeting the oftentimes-contradictory demands between tinnitus suppression and other indications, such as speech understanding, and justifying the costs and risks of electric stimulation for tinnitus symptoms. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.
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• Current opinion: the management of tinnitus.

  Seidman, Michael D.; Ahsan, Syed F., 2015-08-08 08:00:00 AM

  Purpose of review: The purpose of this review is to describe our experience with management of chronic tinnitus and to review the recent literature on the best treatment options available for treating patients who are troubled by their tinnitus. In addition, we want to highlight our experience and approach to this very common problem. Recent findings: Treatment options for patients are based on the severity of the tinnitus and any associated problems. The use of nutritional supplements has a place in the treatment of mild-to-moderate tinnitus. Ginkgo biloba and B-complex vitamins may have an impact on selected patients. Treatment of underlying or accompanying anxiety disorders especially with cognitive behavior therapy can help to reduce the distress associated with tinnitus. Surgical treatment options, such as cochlear implant, have been shown to be very effective in reducing tinnitus in patients with sudden unilateral hearing loss as the cause of tinnitus. Other surgical approaches, such as repetitive transcranial magnetic stimulation and vagal stimulator, have had some limited benefits. Summary: Treatment for subjective tinnitus can range from the conventional to the investigational modalities. Best treatment options take into account the possible cause of the tinnitus and other associated symptoms. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.
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• Update on management of frontal sinus osteomas.

  Rokade, Ashok; Sama, Anshul, 2015-08-08 08:00:00 AM

  Purpose of review: Endoscopic approaches are used increasingly as an alternative to external approaches in removal of frontal sinus osteoma. The purpose of this article is to review and highlight the recent articles on the management of frontal sinus osteoma over the past 24 months. Recent findings: The evolution in endoscopic sinus surgery has allowed rhinologists to expand its indications in managing a wide range of frontal sinus pathologies, including frontal sinus osteomas. The surgeons are attempting endoscopic removal of higher grades of osteomas from frontal sinus, previously thought to be amenable only to external approach on its own or combined with endoscopic approach. Although recent retrospective studies have reported such successful attempts, open approaches, particularly osteoplastic flap, remain an important surgical technique when endoscopic approaches are limited. Summary: The endoscopic approach is effective in surgical management of low-grade osteomas. For higher-grade (grade III and IV) osteomas endoscopic removal is technically challenging and requires availability of advanced instrumentation, including surgical navigation systems, along with surgical expertise. Open approaches to frontal sinus, particularly osteoplastic flap approach, are still valuable as it is a simple and well tolerated method for complete removal of higher-grade osteomas. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.
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