necksolutions.com Blog

July 25, 2009

Association between cervical curvature and sympathetic symptoms

Filed under: Arthritis, Neck Pain, Tinnitus — Administrator @ 11:22 am

Association between cervical curvature and cervical sympathetic symptoms

From: Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2009 Jun;31(3):381-2

To investigate the association between cervical curvature and cervical sympathetic symptoms, the clinical data of 318 patients with cervical spondylosis who underwent surgical treatment in our department between July 2003 and December 2007 were retrospectively analyzed. All patients were divided into group without sympathetic symptoms (n = 284) and group with sympathetic symptoms (n = 34). The curvatures of both groups on cervical lateral radiographs were measured using Borden method and statistical analysis was performed.

The incidence of abnormal cervical curvature in group with cervical sympathetic symptoms were 67.6% (23/34), which was significantly higher than that in group without cervical sympathetic symptoms (50.7%, 144/284). Cervical curvature abnormality may be an independent factor that affects the cervical sympathetic symptoms.

In Zhonghua Wai Ke Za Zhi. 2008 Sep 15;46(18):1424-7, Treatment and mechanism of cervical spondylosis with sympathetic symptoms concluded: The sympathetic nerve fibers distributed in the cervical posterior longitudinal ligament maybe another one significant factor causing sympathetic symptom of cervical spondylosis.

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March 29, 2009

Tinnitus and electromagnetic hypersensitivity

Filed under: Tinnitus — Administrator @ 2:38 pm

Association of tinnitus and electromagnetic hypersensitivity: hints for a shared pathophysiology?

From: PLoS ONE. 2009;4(3):e5026. Epub 2009 Mar 27

Tinnitus is a frequent condition with high morbidity and impairment in quality of life. The pathophysiology is still incompletely understood. Electromagnetic fields are discussed to be involved in the multi-factorial pathogenesis of tinnitus, but data proofing this relationship are very limited. Potential health hazards of electromagnetic fields have been under discussion for long. Especially, individuals claiming themselves to be electromagnetic hypersensitive suffer from a variety of unspecific symptoms, which they attribute to electromagnetic fields exposure. The aim of the study was to elucidate the relationship between electromagnetic field exposure, electromagnetic hypersensitivity and tinnitus using a case-control design.

Tinnitus, the perception of sound in the absence of an external sound, is a frequent disorder of auditory perception, which is very difficult to treat. Tinnitus as a phantom perception of a meaningless sound has to be differentiated from auditory hallucinations which mainly occur in the context of psychiatric diseases and are characterized by e.g. the perception of voices. About 10–20% of the adult population experiences some degree of tinnitus. Many learn to ignore the sounds and experience no major effects, but for about 1 in 100 adults, the noise interferes significantly with daily life. In those patients, tinnitus is frequently associated with neuropsychiatric co-morbidity such as depression, anxiety or sleep disorders, which underlines the clinical and socio-economic importance.

Even if the pathophysiology of tinnitus remains incompletely understood, there is growing evidence that dysfunctional neuroplastic processes in the brain are involved. In particular, it is assumed that tinnitus might be the correlate of maladaptive neuroplastic changes due to distorted sensory input. Accordingly functional imaging studies demonstrated neuroplastic alterations in the central auditory system. However tinnitus related alterations of neural functioning are not limited to the central auditory system, but also encompass non-auditory regions such as frontal and limbic areas.

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February 23, 2009

Abnormal resting state cortical coupling in chronic tinnitus

Filed under: Tinnitus — Administrator @ 10:59 pm

Abnormal resting-state cortical coupling in chronic tinnitus

From: BMC Neurosci. 2009 Feb 19;10(1):11. [Epub ahead of print]

Patients that suffer from chronic tinnitus complain of an ongoing perception of a phantom sound in the absence of any physical source for it. About 5-15 % of the population in western societies experience a phantom tinnitus sound and 1-3% of the population suffer from severe tinnitus that affects their daily life and is accompanied in 50 % of the cases by depression, in 40 % of the cases by insomnia and about 20% of the patients complain of an important decrease in their quality of life. Unfortunately, the underlying mechanisms responsible for the tinnitus perception is currently not known. Tinnitus therapies typically concentrate on coping with the tinnitus but there is no therapy that reliably reduces the perception of tinnitus.

Tinnitus is often accompanied by damage to the peripheral hearing system and a series of plastic changes in the central auditory system are observed in parallel to that. It is thought that a deafferentation of the hearing system triggers a series of reorganization processes at all levels of the auditory system. Indeed, abnormal neuronal activity in tinnitus has been demonstrated for the auditory nerve fibers, the dorsal cochlear nucleus, the inferior colliculus, the primary and the secondary auditory cortex. Furthermore, it has been found that a dissection of the auditory nerve in tinnitus patients does not lead to relief in tinnitus and most of the patients still experience tinnitus after surgery. Thus, there is an agreement that the tinnitus phantom sound is generated in the central nervous system – most likely as a result of the reorganization that is going on in the auditory system after hearing loss.

However, there are also studies that demonstrated tinnitus-related cortical abnormalities outside the auditory system. Using methods as different as Positron Emission Tomography (PET), Voxel Based Morphometry (VBM) and Magnetoencephalography (MEG) differences in cortical activity have been shown for the frontal cortex, the parietal lobe, mesial posterior regions and the subcollosal region including the nucleus accumbens. As hypothesized earlier by Jastreboff it might be that tinnitus is generated within the auditory system while non-auditory regions are involved in encoding the conscious percept well as the emotional evaluation of it. This idea also fits with a recently established model of the global neuronal workspace by Deheane and colleagues. This group suggests the existence of workspace neurons that are located mainly in the parietal lobe, the frontal, the cingulate cortex and the sensory systems. In order to form a conscious percept of a stimulus, two conditions are required: First, neuronal activity of the sensory cortex of the respective modality. Second, an entry into the global neuronal workspace and thus long-range coupling between the widely distributed workspace neurons. According to this model, coupling within this frontoparietal-cingulate network is needed for conscious perception (i.e. awareness of the stimulus). Activity of the sensory areas without this coupling would remain preconscious.

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February 13, 2009

Multidisciplinary management study of tinnitus

Filed under: Tinnitus — Administrator @ 9:26 pm

Cost effectiveness of multidisciplinary management of Tinnitus at a specialized Tinnitus centre

From: BMC Health Serv Res. 2009 Feb 11;9(1):29. [Epub ahead of print]

Subjective tinnitus is the involuntary perception of the concept of a sound without the presence of an external source. It is a chronic condition that is highly prevalent, especially among hearing impaired individuals. Studies show a prevalence of 10% to 20% in the general population and among hearing impaired individuals prevalence has been estimated at 75% to 80%. Of the Dutch population at least 2 million individuals suffer from some form of tinnitus, 340,000 individuals indicate to hear the tinnitus continuously and 60,000 individuals claim to be severely impaired in their daily activities. Among severe sufferers it causes disability associated with severe affective problems, major declines in concentration, sleeping difficulties, hypersensitivity to sounds and problems in re-directing attention. The combination of these complaints makes them feel exhausted and frustrated resulting in diminished quality of life. Tinnitus is known to occur as a concomitant of almost all the dysfunctions that involve the human auditory system and it is postulated that the aetiology of tinnitus is diverse and that different activation circumstances can be present. Little is known about the pathophysiology and there is no known drug or curative therapy at present though considerable research effort has been expended in this regard.

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November 6, 2008

Simplified tinnitus retraining therapy

Filed under: Tinnitus — Administrator @ 11:15 am

Simplified form of tinnitus retraining therapy in adults: a retrospective study

From: BMC Ear Nose Throat Disord. 2008 Nov 3;8(1):7 [Epub ahead of print]

Tinnitus retraining therapy is aimed at removing negative associations of the tinnitus signal to enable the natural habituation process to occur. The goal is to achieve this through retraining counseling and sound therapy. Retraining counseling is a crucial part of tinnitus retraining therapy; it teaches patients the components of the neurophysiological model of tinnitus and encourages them to reclassify their tinnitus as a neutral signal. Sound therapy is assumed to facilitate tinnitus habituation by decreasing the strength of tinnitus signal. The tinnitus retraining therapy protocol requires that the patient adheres to the regimen for 12-24 months (typically attending for seven sessions over that time), except for patients experiencing weak tinnitus, which hearing aids little impact on everyday life.

Since the first description of tinnitus retraining therapy in the 1990s, clinicians have modified and customised the method of tinnitus retraining therapy to suit their practice and their patients. A simplified form of tinnitus retraining therapy hearing aids been used at Ealing Primary Care Trust (PCT) Audiology Department since 2005. This is different from tinnitus retraining therapy in the type and (shorter) duration of retraining counseling. Although the counseling used in simplified tinnitus retraining therapy also aims to get the patient to reclassify tinnitus as a neutral stimulus, it is different from the counseling used in tinnitus retraining therapy in the following ways: (1) there is no teaching about basic functions of the auditory system; (2) there is no presentation of the basics of brain function and the interactions of various systems of the brain; (3) there is no explanation of the theoretical basis of habituation based on the Jastreboff neurophysiological model; and (4) the duration of the initial counseling of simplified tinnitus retraining therapy is 30 minutes in comparison to 90 minutes for the initial tinnitus retraining therapy counseling.

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August 28, 2008

Neck disorders and tmj in tinnitus

Filed under: Neck Pain, TMJ Pain, Tinnitus — Administrator @ 11:08 am

Assessment of temporomandibular and cervical spine disorders in tinnitus patients

From: Prog Brain Res. 2007;166:215-9

In treating patients with temporomandibular joint (TMJ) dysfunction it was noticed that tinnitus and vertigo were common in such patients and there was also muscular tension in jaw and neck. During treatment of these patients it was also noted that injection of lidocaine in a jaw muscle reduced not only their muscular problems but also that the tinnitus was reduced while the local anesthetic was active. Evaluation of 39 patients with disabling tinnitus, and all suffered from tinnitus, revealed that 10 of them had bilateral tinnitus and TMJ disorders revealed that pain in the face, temples or jaw occurred often among these patients. Many of such patients had also symptoms of cervical spine disorders, head, neck and shoulder pain, and limitations in side bending and rotation were also frequent complaints. One-third of these patients could influence tinnitus by jaw movements and 75% could trigger vertigo by head or neck movements. Treatment of jaw and neck disorders in 24 patients with Ménière’s disease had a beneficial effect on not only their episodic vertigo but also on their tinnitus and aural fullness. At the 3-year follow-up, intensity of all symptoms were significantly reduced.

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August 11, 2008

Whiplash injuries can be visible by functional magnetic resonance imaging

Filed under: Neck Pain, Tinnitus, Whiplash — Administrator @ 4:12 am

Whiplash injuries can be visible by functional magnetic resonance imaging

From: Pain Res Manag. 2006 Autumn;11(3):197-9

Whiplash trauma can result in injuries that are difficult to diagnose. Diagnosis is particularly difficult in injuries to the upper segments of the cervical spine (craniocervical joint complex). Studies indicate that neck injuries in that region may be responsible for the cervicoencephalic syndrome, as evidenced by headache, balance problems, vertigo, dizziness, eye problems, tinnitus, poor concentration, sensitivity to light and pronounced fatigue. Consequently, diagnosis of lesions in the craniocervical joint region is important.

Functional magnetic resonance imaging is a radiological technique that can visualize injuries of the ligaments and the joint capsules, and accompanying pathological movement patterns. Three severely injured patients that had been extensively examined without any findings of structural lesions were diagnosed by functional magnetic resonance imaging to have injuries in the craniocervical joint region. These injuries were confirmed at surgery, and after surgical stabilization the medical condition was highly improved. It is important to draw attention to the urgent need to diagnose lesions and dysfunction in the craniocervical joint complex and also improve diagnostic methods in whiplash injuires.

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August 9, 2008

The role of the cervical spine and the craniomandibular system in tinnitus

Filed under: Neck Pain, Tinnitus — Administrator @ 4:12 pm

The role of the cervical spine and the craniomandibular system in the pathogenesis of tinnitus. Somatosensory tinnitus

From: HNO. 2008 Jul;56(7):673-7 Article in German

The causes of tinnitus, vertigo, and hearing disturbances may be pathological processes in the cervical spine – neck and temporomaxillary joint. In these cases, tinnitus is called somatosensory tinnitus. For afferences of the cervical spine, projections of neuronal connections in the cochlear nucleus were found. A reflex-like impact of the cervical spine on the cochlear nucleus can be assumed. The tinnitus treatment concept of the Charité University Hospital in Berlin involves the cooperation of ENT specialists with many other disciplines in an outpatient clinic. A standardized examination protocol has been established, and physical therapy has been integrated into the interdisciplinary tinnitus treatment. For tinnitus modulating therapy of muscular trigger points, local anesthetics as well as self-massage or treatment by a physiotherapist or osteopath are useful.

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