Preparati

Kompozitna formula kod zujanja u ušima MKB-10 H93.1

Formula composita ad Tinnitus ICD-10 H93.1

TINITUS STOP 7 MIX sadrži u 100 mL mešavinu homeopatskih matičnih tinktura u sledećem odnosu:

25,0 mL Verbascum thapsus (Scrophulariaceae)
12,5 mL Apium graveolens (Apiaceae)
12,5 mL Allium ursinum (Liliaceae)
12,5 mL Camellia sinensis (Theaceae)
12,5 mL Capsicum annuum (Solanaceae)
12,5 mL Rosmarinus officinalis (Lamiaceae)
12,5 mL Zingiber officinale (Zingiberaceae)

CINK; GINKO BILOBA B VITAMINI B12 VITAMIB Kali Iodium; Bai Zhi (Angelica root); Gui Zhi (Cinnamon bark); Sheng Jiang (Ginger root); Gan Cao (Licorice root); Huang Qin (Scutallaria root);

TINITUS
Tinitus označava medicinski stručni izraz za šumove, za koje se zna i pod imenom zujanje, zviždanje ili šuštanje u uvu. Karakteristično je za ove šumove da po pravilu za njih nisu odgovorni spoljašnji izvori zvuka i da se gotovo uvek mogu čuti samo od strane osobe koja pati od tinitusa.
Uzrok nastanka
Česti uzrok šumova u uvu (do oko 30%) jeste oštećenje nežnih slušnih ćelija bukom ili praskom. Tu spadaju pre svega muzika koju omladina sluša u slobodno vreme (vokmen, diskoteke, rok-koncerti), ali i buka na radnom mestu. Traume praskom mogu se skoro uvek izlečiti pravovremenim tretmanom. Smetnje cirkulacije su od strane lekara najčešci pretpostavljeni razlog za nastanak tinitusa, te je na ovoj pretpostavci zasnovano i lečenje.
Osim ovih glavnih uzroka postoje još brojni drugi uzroci na koje treba misliti: oboljenja vratne kičme, bolesti u području zuba i zgloba vilice, presbiakuzija (smanjenje sluha uslovljeno starenjem), acusticus neurinoma (tumor slušnog živca), morbus Menière (kružne vrtoglavice povezane sa nagluvošću), oboljenja srca i krvotoka, metabolički poremećaji, oboljenja bubrega, hormonalni poremećaji, otoskleroza, hronične upale srednjeg uva, funkcionalne smetnje Eustahijeve tube, trovanja (intoksikacije) naročito lekovima, povrede lobanje i mozga, oboljenja centralnog nervnog sistema, anestezija, naročito u kičmeni kanal (spinalna anestezija).
Klinička slika
Tinitus je, bar u početnoj fazi, simptom bolesti. Simptom je važno upozorenje da se na telesnom i/ili psihičkom polju dešava nešto što dovodi do oštećenja ili bolesti. Tinitus doživljavamo kao potpuno različite zvukove, kao na primer pištanje, šuštanje, zviždanje, lupanje, zvonjenje, grebanje. Kada je u vezi sa teškim oštećenjima sluha možemo ga registrovati i kao melodije. Ponekad se dešava da se istovremeno pojavi više šumova. Ovi šumovi se mogu registrovati u jednom uvu, u oba uva ili u glavi.
Kod skoro svake pete osobe, odnosno kod oko 20% opšte populacije, povremeno se javlja šum različitog tipa i trajanja. Kod oko 5 % populacije se javlja stalni šum, najčešće jačeg inteziteta, koji subjektivno smeta pojedincu i ometa ga u svakodnevnom životu. Kod starije populacije javljanje šuma još je učestalije. Individualno je u kojoj meri pojedinoj osobi smeta šum. Kod nekih ljudi jači šum ne mora izazivati veće subjektivne smetnje, dok kod drugih i šum manjeg intenziteta može uzrokovati veće subjektivne tegobe. Najučestalijie smetnje vezane za šum su nemogućnost koncentracije, smetnje spavanja ili hiperakuzija (pojačana osetljivost na normalan zvuk).
Dijagnoza
Potrebna je kompletna audiološka obrada, kao i analiza stanja organa za ravnotežu. Potrebno je uraditi CT (skener) temporalne kosti i NMR (nuklearna magnetna rezonanca) glave. Pulsirajući tinitus zahteva obradu kardiovaskularnog sistema, posebno vratnih i arterija glave.
Lečenje
Tinitus nije bolest već simptom, tako da ne postoji jedinstvena terapija u njegovom lečenju. Postoji mnogo različitih lekova koji se primenjuju. Najčešće su to lekovi koji poboljšavaju cirkulaciju krvi u mozgu ili u unutrašnjem uhu. Takođe, bihevioralno lečenje može pomoći pacijentima sa tinitusom.
Pacijent se upoznaje sa mehanizmom nastanka šuma što mu omogućava prihvatanje šuma u podsvesti kao nešto prirodno, a ne kao nešto što predstavlja opasnost ili upućuje na bolesno stanje uzrokujući negativne emocije.
Cilj te metode nije smanjenje intenziteta šuma, već smanjenje bolesnikove reakcije na šum i habituacija, odnosno privikavanje na šum. Lečenje šuma može se sprovoditi i pomoću generatora širokopojasnog šuma, koji pomaže maskiranje šuma. Sekundarne psihičke tegobe, kao što su teskoba, depresija ili nesanica, treba takođe lečiti. Bolesnici sa šumom moraju da izbegavaju potpunu tišinu. Potrebno je izbegavati i buku radi sprečavanja daljeg oštećenja sluha i pogoršanja šuma. retreninga (Tinnitus retraining therapy) zasniva na neurofiziološkom modelu.
Muzikoterapija predstavlja lečenje muzikom. U medicini postoji više bolesti ili stanja koja se mogu lečiti muzikom, a jedna od njih je tinitus. Muzika pomaže pacijentu da prestane da primećuje tinitus koji ga ometa. Laser je elektromagnetno zračenje u vidljivom delu spektra (svetlo). U medicini se laser koristi u lečenju različitih bolesti, a u bolestima uva koristi se za tinitus, Meniereovu bolest i iznenadnu nagluvost. Lečenje laserom je u potpunosti bezbolno i sigurno. stetoskop

Tinitus
Tinitus je šum u ušima; osjeti ga 10 do 15% ljudi. Subjektivni tinitus je osjet zvuka bez zvučnog podražaja, a čuje ga samo bolesnik. Objektivni tinitus nastaje zbog šuma koji stvara krvožilno tkivo u blizini uha te ga, u nekim slučajevima čuje i liječnik.

Tinitus može biti opisivan kao zujanje, zvonjenje, hučanje, zviždanje ili siktanje, a ponekad je različit i složen. Može biti povremen, trajan ili pulsatilan (sinkron s udaranjem srca). Trajni je tinitus u najmanju ruku neugodan, a često i prilično uznemirujući. Neki se bolesnici lakše privikavaju na njegovo postojanje; ponekad se razvija depresija. U pravilu, stres dovodi do pogoršanja tinitusa.

Etiologija
Subjektivni tinitus se može pojaviti uz gotovo bilo koju bolest uha. Česti uzroci obuhvaćaju zvučnu traumu (bukom izazvan osjetno–živčani gubitak sluha), osjetno–živčani gubitak sluha iz drugih razloga, začepljenje zvukovoda cerumenom ili stranim tijelom; infekcije (upalu vanjskog uha, miringitis, upalu srednjeg uha, labirintitis, petrositis, sifilis, meningitis) i začepljenje Eustahijeve cijevi. Visoke doze salicilata mogu izazvati rezevrzibilni tinitus. Aminoglikozidni antibiotici i neki kemoterapeutici (npr. cisplatina) mogu izazvati gubitak sluha praćen tinitusom.

Objektivni tinitus, koji je rijedak i predstavlja čujni, pulsatilni šum, može biti uzrokovan turbulentnim protokom kroz karotidnu arteriju ili jugularnu venu. Objektivni tinitus mogu uzrokovati i jako prokrvljeni tumori srednjeg uha (npr. tumori glomusa tympanicuma ili glomusa jugulare) i arterio–venske malformacije (AVM) tvrde moždane ovojnice.

Obrada
Anamneza: Izlaganje jakoj buci ili nekim lijekovima prije pojave tinitusa ukazuje na zvučnu traumu, odnosno na ototoksičnost. Jednostrani tinitus, osobito kad je povezan s gubitkom sluha, može ukazivati na akustični neurom. Akutni jednostrani gubitak sluha i vrtoglavica, osobito nakon barotraume, mo že ukazivati na perilimfatičnu fistulu. Povremeni tinitus, osjećaj punoće u uhu, jaka vrtoglavica i fluktuirajući ili trajni gubitak sluha u istom uhu ukazuju na Meniereovu bolest (vidi str. 794).

Fizikalni pregled: Brujanje ili venski šum prilikom auskultacije vrata ukazuje na žilno podrijetlo. Brujanje čujno samo prilikom auskultacije uha pomoću elektronskog stetoskopa ili stetoskopa s vrškom poput masline ukazuje na duralnu AVM.

Pretrage: Učini se audiogram, te, ukoliko se pronađe gubitak sluha, pretrage za razlikovanje provodnog, osjetnog i živčanog gubitka sluha (vidi str. 785); MR pomoću gadolinija u slučajevima jednostranog tinitusa isključuje akustični neurom, osobito uz gubitak sluha. Druge pretrage ovise o kliničkoj slici. Kod jednostranog, pulsatilnog i objektivnog tinitusa može biti potrebna pretraga sustava karotidne i vertebralne arterije pomoću arteriograma. U tim slučajevima se mora odvagnuti opasnost od izvođenja arteriograma naprama mogućem otkrivanju i liječenju (embolizacijom) moguće duralne AVM. Angiografija magnetskom rezonancijom nije dovoljno osjetljiva za otkrivanje većine duralnih AVM.

Liječenje
Liječenje osnovne bolesti može ublažiti tinitus. Korigiranje nagluhosti (npr. pomoću slušnog aparata) ublažava tinitus u oko 50% bolesnika. U nekim slučajevima prepoznavanje i liječenje depresije ublažava tinitus, ukazujući na psihološku sastavnicu. Međutim, ne treba pretpostaviti kako je uzrok psihološke prirode.

Premda ne postoji specifična farmakoterapija niti kirurški zahvat, mnogi bolesnici otkrivaju kako pozadinski zvukovi prikrivaju tinitus, što im može pomoći da zaspu. Nekima koristi prikrivač tinitusa, naprava nalik slušnom aparatu, a koja stvara tihi zvuk koji potiskuje tinitus. Električna stimulacija unutarnjeg uha, poput one umjetnom pužnicom ponekad smanjuje tinitus, no opravdana je samo u bolesnika s teškom gluhoćom.

TCM AKUPUNKTURA + BILJNI LEKOVI

Of the eight remedies included, five are traditionally indicated for ringing in the ears: Cinchona Officinalis,
Chininum Sulphuricum, Kali Carbonicum, Kali Iodium, and Salicylicum Acidum. Among these,
Cinchona Officinalis is also traditionally indicated for hyperacusis, Kali Iodium is also traditionally
indicated for buzzing, and three—Chininum Sulphuricum, Kali Carbonicum, Salicylicum Acidum—are
also traditionally indicated for roaring. Lycopodium is traditionally included to treat roaring and deafness,
and Kali Carbonicum and Calcarea Carbonica are indicated for crackling sounds. For hissing sounds,
graphites are also included.
The Chinese herbs used in Clear Tinnitus® mostly fall into the category of herbs that release the exterior:
Ge Gen (Pueraria root), Bai Zhi (Angelica root), Xin Yi Hua (Magnolia flower), Qiang Huo (Notoptergii
root), Gui Zhi (Cinnamon bark), and Sheng Jiang (Ginger root). Among these, Ge Gen (Pueraria root) is
indicated for wind-heat; the rest are indicated for wind cold. Qiang Huo (Notoptergii root) and Gui Zhi
(Cinnamon bark) are also used to transform dampness and mucus, and Sheng Jiang (Ginger root) is used
to warm the middle jiao.
Another four herbs are used to transform phlegm: Jie Geng (Platycodon root), Yi Yi Ren (Coix seed),
Chen Pi (Tangerine peel), Gan Cao (Licorice root). Of these, Yi Yi Ren (Coix seed) and Gan Cao
(Licorice root) also tonify the spleen, and Chen Pi (Tangerine peel) regulates qi. The remaining three
herbs are used to subdue wind. Huang Qin (Scutallaria root) reduces wind by draining fire to calm
ascending liver yang, while Bai Shao (Peony root) and Chuan Xiong (Ligustici root) subdue wind through
their effects on blood, by tonifying and regulating blood respectively. Five also have the effect of
lowering blood pressure—Ge Gen (Pueraria root), Chuan Xiong (Ligustici root), Bai Shao (Peony root),
Xin Yi Hua (Magnolia flower), and Huang Qin (Scutallaria root)—but the mechanisms of action vary.

Traditionally, two herbs directly effects the ear: Ge Gen (Pueraria root) is indicated for the treatment of
tinnitus and Qiang Huo (Notoptergii root) alleviates any type of ear congestion. Consequently, this
combination is likely beneficial for patients whose tinnitus has an etiology of wind. Although some of the
herbs regulate blood to subdue deficiency-type wind, the largest single category represented is for herbs
of excess-type (exterior) wind conditions.
The eustachian tube is the part of the middle ear that links the ear to the nasopharynx. The tubes help
drain fluid from the ears to the back of the throat, and help regulate the pressure in the ears. Swelling,
which can be caused by exterior conditions such as a cold, allergies, or a sinus infection, can prevent the
eustachian tubes from opening and closing, resulting in a change in middle ear pressure.

Summary
The aforementioned research indicates that acupuncture and herbal medicine are effective modalities for the alleviation of tinnitus. An intractable disorder, the treatment of tinnitus has long been a challenge for all medical practitioners, including licensed acupuncturists.
The research demonstrates important protocols that may bring significant relief to patients with tinnitus. Patients with tinnitus are encouraged to consult with their local licensed acupuncturists to discuss treatment options.

Diagnosis
Your doctor will examine your ears, head and neck to look for possible causes of tinnitus. Tests include:

Hearing (audiological) exam. As part of the test, you’ll sit in a soundproof room wearing earphones through which will be played specific sounds into one ear at a time. You’ll indicate when you can hear the sound, and your results are compared with results considered normal for your age. This can help rule out or identify possible causes of tinnitus.
Movement. Your doctor may ask you to move your eyes, clench your jaw, or move your neck, arms and legs. If your tinnitus changes or worsens, it may help identify an underlying disorder that needs treatment.
Imaging tests. Depending on the suspected cause of your tinnitus, you may need imaging tests such as CT or MRI scans.
The sounds you hear can help your doctor identify a possible underlying cause.

Clicking. Muscle contractions in and around your ear can cause sharp clicking sounds that you hear in bursts. They may last from several seconds to a few minutes.
Rushing or humming. These sound fluctuations are usually vascular in origin, and you may notice them when you exercise or change positions, such as when you lie down or stand up.
Heartbeat. Blood vessel problems, such as high blood pressure, an aneurysm or a tumor, and blockage of the ear canal or eustachian tube can amplify the sound of your heartbeat in your ears (pulsatile tinnitus).
Low-pitched ringing. Conditions that can cause low-pitched ringing in one ear include Meniere’s disease. Tinnitus may become very loud before an attack of vertigo — a sense that you or your surroundings are spinning or moving.
High-pitched ringing. Exposure to a very loud noise or a blow to the ear can cause a high-pitched ringing or buzzing that usually goes away after a few hours. However, if there’s hearing loss as well, tinnitus may be permanent. Long-term noise exposure, age-related hearing loss or medications can cause a continuous, high-pitched ringing in both ears. Acoustic neuroma can cause continuous, high-pitched ringing in one ear.
Other sounds. Stiff inner ear bones (otosclerosis) can cause low-pitched tinnitus that may be continuous or may come and go. Earwax, foreign bodies or hairs in the ear canal can rub against the eardrum, causing a variety of sounds.
In many cases, the cause of tinnitus is never found. Your doctor can discuss with you steps you can take to reduce the severity of your tinnitus or to help you cope better with the noise.

Treatment
Treating an underlying health condition
To treat your tinnitus, your doctor will first try to identify any underlying, treatable condition that may be associated with your symptoms. If tinnitus is due to a health condition, your doctor may be able to take steps that could reduce the noise. Examples include:

Earwax removal. Removing impacted earwax can decrease tinnitus symptoms.
Treating a blood vessel condition. Underlying vascular conditions may require medication, surgery or another treatment to address the problem.
Changing your medication. If a medication you’re taking appears to be the cause of tinnitus, your doctor may recommend stopping or reducing the drug, or switching to a different medication.
Noise suppression
In some cases white noise may help suppress the sound so that it’s less bothersome. Your doctor may suggest using an electronic device to suppress the noise. Devices include:

White noise machines. These devices, which produce simulated environmental sounds such as falling rain or ocean waves, are often an effective treatment for tinnitus. You may want to try a white noise machine with pillow speakers to help you sleep. Fans, humidifiers, dehumidifiers and air conditioners in the bedroom also may help cover the internal noise at night.
Hearing aids. These can be especially helpful if you have hearing problems as well as tinnitus.
Masking devices. Worn in the ear and similar to hearing aids, these devices produce a continuous, low-level white noise that suppresses tinnitus symptoms.
Tinnitus retraining. A wearable device delivers individually programmed tonal music to mask the specific frequencies of the tinnitus you experience. Over time, this technique may accustom you to the tinnitus, thereby helping you not to focus on it. Counseling is often a component of tinnitus retraining.
Medications
Drugs can’t cure tinnitus, but in some cases they may help reduce the severity of symptoms or complications. Possible medications include the following:

Tricyclic antidepressants, such as amitriptyline and nortriptyline, have been used with some success. However, these medications are generally used for only severe tinnitus, as they can cause troublesome side effects, including dry mouth, blurred vision, constipation and heart problems.
Alprazolam (Xanax) may help reduce tinnitus symptoms, but side effects can include drowsiness and nausea. It can also become habit-forming.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Lifestyle and home remedies

Often, tinnitus can’t be treated. Some people, however, get used to it and notice it less than they did at first. For many people, certain adjustments make the symptoms less bothersome. These tips may help:

• Avoid possible irritants. Reduce your exposure to things that may make your tinnitus worse. Common examples include loud noises, caffeine and nicotine.
• Cover up the noise. In a quiet setting, a fan, soft music or low-volume radio static may help mask the noise from tinnitus.
• Manage stress. Stress can make tinnitus worse. Stress management, whether through relaxation therapy, biofeedback or exercise, may provide some relief.
• Reduce your alcohol consumption. Alcohol increases the force of your blood by dilating your blood vessels, causing greater blood flow, especially in the inner ear area.

Alternative medicine

There’s little evidence that alternative medicine treatments work for tinnitus. However, some alternative therapies that have been tried for tinnitus include:

• Acupuncture
• Hypnosis
• Ginkgo biloba
• Melatonin
• Zinc supplements
• B vitamins

Neuromodulation using transcranial magnetic stimulation (TMS) is a painless, noninvasive therapy that has been successful in reducing tinnitus symptoms for some people. Currently, TMS is used more commonly in Europe and in some trials in the U.S. It is still to be determined which patients might benefit from such treatments.

Coping and support

Tinnitus doesn’t always improve or completely go away with treatment. Here are some suggestions to help you cope:

• Counseling. A licensed therapist or psychologist can help you learn coping techniques to make tinnitus symptoms less bothersome. Counseling can also help with other problems often linked to tinnitus, including anxiety and depression.
• Support groups. Sharing your experience with others who have tinnitus may be helpful. There are tinnitus groups that meet in person, as well as internet forums. To ensure that the information you get in the group is accurate, it’s best to choose a group facilitated by a physician, audiologist or other qualified health professional.
• Education. Learning as much as you can about tinnitus and ways to alleviate symptoms can help. And just understanding tinnitus better makes it less bothersome for some people.

Preparing for your appointment

Be prepared to tell your doctor about:

• Your signs and symptoms
• Your medical history, including any other health conditions you have, such as hearing loss, high blood pressure or clogged arteries (atherosclerosis)
• All medications you take, including herbal remedies

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

• When did you begin experiencing symptoms?
• What does the noise you hear sound like?
• Do you hear it in one or both ears?
• Has the sound you hear been continuous, or does it come and go?
• How loud is the noise?
• How much does the noise bother you?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Have you been exposed to loud noises?
• Have you had an ear disease or head injury?

After you’ve been diagnosed with tinnitus, you may need to see an ear, nose and throat doctor (otolaryngologist). You may also need to work with a hearing expert (audiologist).