Herbal Medicine in the Management of Tinnitus

Tinnitus, which is commonly defined as “ringing in the ears” by the patients, is a perception of an auditory sensation without any accompanying external stimulation. It accounts for a notable part of visits in otolaryngology clinics and has been estimated to involve about 5–15% of adult population making serious problems in 3–5% of patients. Tinnitus causes a lot of problems for patients, their family, and guardians and significantly decreases quality of life of patients. Many treatment methods have been proposed and presented for Tinnitus since the first year of diagnosis. These methods range from conservative management and chemical medications to surgical methods. As the other diseases and conditions, herbal medicine has been trying to treat Tinnitus and a variety of medications have been proposed. In this chapter, we aimed to have a comprehensive review on the current herbal medications of Tinnitus from all over the world

Bilateral Facial Paralysis and Otitis Media as the First Presentations of Wegener’s Granulomatosis: A Case Report

Introduction: Cranial nerve palsy in Wegener’s granulomatosis is a curious incident, particularly if it occurs without kidney or lung involvement. In a review of medical articles, only 1 case of Wegener’s granulomatosis with bilateral facial nerve palsy was found. Case Presentation: The patient was a 16-year-old female who presented with pain and hearing loss in both ears and reduced muscle tone in the right side of her face. After myringotomy and ventilation tube embedding in both ears, she gradually developed infectious otorrhea in both ears. Despite antibiotic and antifungal therapy for 2 weeks after surgery, the patient developed paresis in the left facial nerve and gag reflex disorder. Both magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) tests were normal, but the C-anti-neutrophil cytoplasmic antibody (CANCA) test result was about forty times higher than normal, and a sinus biopsy also verified Wegener’s granulomatosis. The patient was then treated with pulse corticosteroid and cyclophosphamide therapy. Her gag reflex healed and the ear secretions stopped, but the facial nerve palsy continued. Conclusion: Although cranial nerve involvement in Wegener’s granulomatosis is an unusual incidence, it may occur in some cases. In the current case, otitis media and cranial nerve paresis without kidney or lung disorders were the only signs of disease onset; of course, computerized tomography (CT) scan revealed a right mandibular sinus disorder without any clinical signs. Another important point in this case is that other identified Wegener’s patients were in their fourth or fifth decade of life; thus, Wegener’s was the last choice for a diagnosis in the current case

Prevalence of Epileptiform Discharges in Children with Sensori-Neural Hearing Loss and Behavioral Problems Compared to Their Normal Hearing Peers

How to Cite This Article: Amirsalari S, Radfar Sh, Ajallouyean M, Saburi A, Yousefi J, Noohi S, Tavallaie SA, Hassanalifard M, Ghazavi Y. Prevalence of Epileptiform Discharges in Children with Sensori-Neural Hearing Loss and Behavioral Problems Compared to Their Normal Hearing Peers. Iran J Child Neurol. 2014 Spring 8(2):29-33.ObjectiveOveractivity and behavioral problems are common problems in children with prelingually profound sensorineural hearing loss (SNHL). Data on epileptiform electroencephalography (EEG) discharges in deaf children with psychologicaldisorders are so limited. The primary focus of this study was to determine the prevalence of epileptiform discharges (EDs) in children with SNHL and overactivity or behavioral problems.Materials & MethodsA total of 262 patients with prelingually profound SNHL who were referred to our cochlear implantation center between 2008 and 2010 were enrolled in this study. Children with SNHL who had diagnosis of overactivity and/or behavioralproblems by a pediatric psychiatrist, underwent electroencephalography (EEG).EEG analysis was carried out by a board-certified pediatric neurologist. The control group consisted of 45 cases with overactivity or behavioral problems and normal hearing.ResultsOne hundred thirty-eight children with mean age of 3.5±1.23 year were enrolled in the case group, of whom 88 cases (63.7%) were boy. The control group consisted of 45 cases with mean age of 3.2±1.53 years, of whom 30 (66.6%)cases were male. EDs were detected in 28 (20.02%) children of the case group (with SNHL) in comparison with 4 (8.88%) in the control group (without SNHL), which was statistically significantly different.ConclusionIn this study, we obtained higher frequency of EDs in deaf children with overactivity and/or behavioral problem compared to the children without SNHL. Further studies are required to evaluate the possible association of SNHL withEDs in overactive children.References1. Matsuura M, Okubo Y, Toru M, Kojima T, He Y, Hou Y, et al. A cross-national EEG study of children with emotional and behavioral problems: a WHO collaborative study in the Western Pacific Region. Biol Psychiatry 1993;34(1-2):59-65.2. Hindley P, Kroll L. Theoretical and epidemiological aspects of attention deficit and overactivity in deaf children. J Deaf Stud Deaf Educ 1998;3(1):64-72.3. [No author listed] . Clinical practice guideline: diagnosis and evaluation of the child with attentiondeficit/ hyperactivity disorder. American Academy of Pediatrics. Pediatrics 2000;105(5):1158-70.4. Klinkerfuss GH, Lange PH, Weinberg WA, O’Leary JL. Electroencephalographic abnormalities of children with hyperkinetic behavior. Neurology 1965;15(10):883-91.5. Millichap JJ, Stack CV, Millichap JG. Frequency of epileptiform discharges in the sleep-deprived electroencephalogram in children evaluated for attention-deficit disorders. J Child Neurol 2011;26(1):6-11.6. Fonseca LC, Tedrus GM, Moraes C, Vicente Machado A, Almeida MP, Oliveira DO. Epileptiform abnormalities and quantitative EEG in children with attentiondeficit/ hyperactivity disorder. Arq Neuropsiquiatr 2008;66(3A):462-7.7. Venkatesh C, Ravikumar T, Andal A, Virudhagirinathan BS. Attention - deficit/Hyperactivity Disorder in Children: Clinical Profile and Co-morbidity. Indian J Psychol Med 2012 ;34(1):34-8.8. Monastra VJ, Lubar JF, Linden M. The development of a quantitative electroencephalographic scanning process for attention deficit-hyperactivity disorder: reliability and validity studies. Neuropsychology 2001;15(1):136-44.9. Monastra VJ, Lubar JF, Linden M, VanDeusen P, Green G, Wing W, et al. Assessing attention deficit hyperactivity disorder via quantitative electroencephalography: an initial validation study. Neuropsychology 1999; 13(3):424-33.10. Barry RJ, Johnstone SJ, Clarke AR. A review of electrophysiology in attention-deficit/hyperactivity disorder: II. Event-related potentials. Clin Neurophysiol 2003;114(2):184-98.11. Magee CA, Clarke AR, Barry RJ, McCarthy R, Selikowitz M. Examining the diagnostic utility of EEG power measures in children with attention deficit/hyperactivity disorder. Clin Neurophysiol 2005;116(5):1033-40.12. Loo SK, Barkley RA. Clinical utility of EEG in attention deficit hyperactivity disorder. Appl Neuropsychol 2005;12(2):64-76.13. Venkateswaran S, Shevell M. The case against routine electroencephalography in specific language impairment. Pediatrics 2008;122(4):e911-6.14. Amirsalari S, Ajallouyean M, Saburi A, Haddadi Fard A, Abed M, Ghazavi Y. Cochlear implantation outcomes in children with Waardenburg syndrome. Eur Arch Otorhinolaryngol 2012; 269(10):2179-83.15. Amirsalari S, Yousefi J, Radfar S, Saburi A, Tavallaie SA, Hosseini MJ, et al. Cochlear implant outcomes in children with motor developmental delay. Int J Pediatr Otorhinolaryngol 2012;76(1):100-3.16. Holtmann M, Becker K, Kentner-Figura B, Schmidt MH. Increased frequency of rolandic spikes in ADHD children. Epilepsia 2003;44(9):1241-4.17. Richer LP, Shevell MI, Rosenblatt BR. Epileptiform abnormalities in children with attention-deficithyperactivity disorder. Pediatr Neurol 2002;26(2):125-9.18. Socanski D, Herigstad A, Thomsen PH, Dag A, Larsen TK. Epileptiform abnormalities in children diagnosed with attention deficit/hyperactivity disorder. Epilepsy Behav 2010;19(3):483-6.19. Fonseca LC, Tedrus GM. [Somatosensory evoked spikes and epileptiform activity in “normal” children]. Arq Neuropsiquiatr 2003;61(3B):793-5. [Article in Portuguese]20. Borusiak P, Zilbauer M, Jenke AC. Prevalence of epileptiform discharges in healthy children--new data from a prospective study using digital EEG. Epilepsia 2010;51(7):1185-8.21. Daneshi A, Hassanzadeh S. Cochlear implantation in prelingually deaf persons with additional disability. J Laryngol Otol 2007;121(7):635-8.22. Dye MW, Bavelier D. Attentional enhancements and deficits in deaf populations: an integrative review. Restor Neurol Neurosci 2010;28(2):181-92.

Effect of ESS on Olfactory Threshold of Patients with CRS without Nasal Polyps.

peer reviewed[en] OBJECTIVES: Chronic rhinosinusitis (CRS) is characterized by a long-time inflammatory disease of nasal and sinus mucosa. Olfactory dysfunction is common among CRS patients with a prevalence ranging from 48% to 83%. We aimed to assess the effect of ESS on olfactory function of patients with chronic rhinosinusitis without nasal polyps. METHOD: This randomized clinical trial was conducted on 30 patients with chronic rhinosinusitis without nasal polyps. Patients were randomly allocated to two intervention and control groups; patients in intervention group underwent endoscopic sinus surgery by a single surgeon and control group continued standard treatment with nasal irrigation of normal saline (4 times daily) and nasal corticosteroids (one puff in each nostril daily). Olfactory threshold was evaluated using smell threshold test (STT) before, one month and three months after intervention. RESULTS: Eventually 33 patients with a mean age of 42.70 ± 15.50 years in intervention and 43.12 ± 11.50 years in control group underwent analysis (p value=0.930). Mean olfactory threshold was 2.79 ± 0.73 in intervention and 2.67 ± 1.05 in control group prior to intervention (p value=0.345). Mean change of olfactory threshold was 0.30 ± 0.79 in intervention and 0.38±1.09 in control group one month after intervention (p value=0.214). Mean change of olfactory threshold was 0.13 ± 0.94 in ESS and 0.33 ± 0.60 in control group three months after intervention (p value=0.196). CONCLUSION: Our study revealed that changes in olfactory threshold were not significantly different between two ESS and standard medical therapy groups one and three months after intervention

Therapeutic effects of <i>Rosa Canina, Urtica Dioica</i> and <i>Tanacetum Vulgare</i> Herbal Combination in Treatment of Tinnitus Symptoms; A Double-blind Randomized Clinical Trial

BackgroundTinnitus is defined as the perception of sound in the ear or head in the absence of an external stimulus for which we have no definite treatment. Neurotec® is a medication of herbal origin with IFDA approval. Previous studies showed the neuroprotective effect of Neurotec®. In this study we evaluated the effectiveness of Neurotec in improving tinnitus symptoms.MethodsThis double-blind randomized clinical trial was performed on patients with tinnitus. Patients received Neurotec 100 mg capsules (BID) or placebo for three months. Pure tone audiometry (PTA) was measured at 0.5, 1, 2, 4 and 6 KHz frequencies. Using a Tinnitus Handicap Inventory (THI) questionnaire, tinnitus loudness, daily annoyance, daily life or sleep disturbance, daily perception and mood alteration were evaluated.ResultsFinally, 103 (69 male and 34 female) patients with a mean age of 51.33±13.91 years were analyzed. There was no significant difference between the intervention (n=53) and the control group (n=50) regarding baseline symptoms before and one month after the intervention (P>0.05). While, they were significantly different three months after the intervention (P0.05). The mean pure tone air conduction was not significantly different between the two groups before and three months after the intervention at 6 kHz (P>0.05).ConclusionA three-month treatment with Neurotec Capsules beside patient education can effectively control symptoms of patients with tinnitus

The Specificity and Sensitivity of Transient Otoacustic Emission in Neonatal Hearing Screening Compared with Diagnostic Test of Auditory Brain Stem Response in Tehran Hospitals

Objective: Since early detection (specially before 6 months of age) of deaf people leads to better hearing and speech outcome after treatment, several clinical trials have been performed in order to find a cost effective, short duration screening test for diagnosis of neonatal hearing impairment. The aim of this study was to assess the sensitivity and specificity of Transient Otoacustic Emission (TEOAE) test in newborns comparing with auditory brain stem response (ABR) in the age of 3 months and to analyze the association between risk factors and hearing loss in neonates. Methods: A cross-sectional study was conducted January2008 - May 2009 in Tehran. 1000 newborns (526 boys and 474 girls) were assessed. First, all of neonates were evaluated by TEOAE 24h after birth. If responses of OAE were failing, they were retested 10 to 15 days after birth by TEOAE. Also, All Neonates were assessed by ABR in the age of 3 months. Descriptive Statistics was used to analyze data. Findings: Eighteen out of 1000 neonates failed double–checked TEOAE tests, of which 6 were confirmed by ABR test (12 false positive results). Nine out of 1000 neonates had impaired ABR tests, from these patients, 6 had failed OAE as well, but 3 had normal OAE (3 false negative results). From these 9 patients 2 had profound hearing loss and received cochlear implantation. We found that OAE has 66.7% sensitivity and 98.8% specificity in diagnosis of neonatal hearing impairment. Its positive and negative predictive value was 33.3% and 99.7% respectively. Also we did not find statistically significant relationship between hearing loss and risk factors. Conclusion: TEOAE as a simple, non-invasive, short duration and cost effective method, is a suitable test for neonatal hearing screening. Even though only two thirds of patients were detected by this method, 99.7% negative predictive value makes it a good screening test. We recommend OAE as a suitable primary neonatal hearing screening all over the country

A Repot of Surgical Complications in a Series of 262 Consecutive Pediatric Cochlear Implantations in Iran

Objective: Cochlear implantations have become a routinely performed and successful surgical intervention in both adults and children. The current article reports the complications encountered in various age groups of consecutive children who underwent implantation in our center. Methods: We performed a prospective analysis of all profoundly deaf children who underwent cochlear implantation from March 2006 to July 2009 at Baqhiyatallah Cochlear Implantation Center. All patients were younger than 5 years old at the time of implantation. Findings: The minor complications occurred in 49 (18.7%) cases, The most common postoperative complications were temporary facial weakness detected in 15 cases (5.7%) all of which were reversible. Magnet wound was observed in 14 (5.3%) patients, keloid formation in 10 (3.8%), wound infection in 2 (0.8%), otitis media in 5 (2%), and electrode movement, meningitis, vertigo, Laryngospasm each in 1 (0.4%) case was detected among our patients. Conclusion: Cochlear implantation in children continues to be reliable and safe in experienced hands, with a low percentage of severe complications as long as the patient is monitored closely

Impact of Implantation on Anxiety and Depression in Mothers of Children under Cochlear Implant

Objective: The aim of our study is to determine the impact of cochlear implantation on anxiety anddepression in mothers of children with cochlear implant. Materials and methods: In a Cohort design, 35 mothers of deaf children with cochlear implantion admitted to the clinic of Baqiyatallah hospital during January 2008 – January 2010 were selected through systematic sampling. Information of demography, depression and anxiety are obtained from the parents by checklist and beck questionnaires, respectively. Results: Mean depression and anxiety scores in cochlear implant candidates were more than cochlear implant recipients. The difference was significant in depression and anxiety (P=0.001). Conclusion: It seems that cochlear implant use leads to decrease of depression and anxiety but still high prevalence of these complications than the normal population

Pharmacological therapies for management of opium withdrawal.

This review included the following 12 comparisons: baclofen versus clonidine, clonidine versus clonidine plus amantadine, clonidine versus buprenorphine, high-dose clonidine versus low-dose clonidine versus symptomatic management, clonidine versus methadone, methadone versus tramadol, methadone versus methadone plus gabapentin, gradual reduction of methadone versus sudden withdrawal of methadone, methadone plus amitriptyline versus methadone, diphenoxylate versus propoxyphene, three different protocols of tincture of opium, and tincture of opium versus methadone. The studies were carried out in three countries, Iran, India, and Thailand. Support from a pharmaceutical company in the form of free provision of medications was reported in only one study. The evidence is unclear as to whether any of the evaluated medications is more effective than another in the management of opium withdrawal. However, it seems that opium withdrawal symptoms are significant in the first days after discontinuation of opium. All of the assessed medications might be useful in alleviating symptoms. Use of clonidine might result in low blood pressure

Effect of Amphotericin B on Treatment of Chronic Rhinosinusitis: A Double-blind Randomized Clinical Trial

Background Chronic rhinosinusitis (CRS) is the inflammation of paranasal sinus mucous membranes. Considering the influence of fungi on chronic rhinosinusitis and different results concerning the effect of Amphotericin B on improvement of this condition; this study aimed to determine the effect of topical Amphotericin B on improvement of the symptoms in patients with CRS. Methods In this double-blind randomized clinical trial, 80 patients with chronic rhinosinusitis who visited the allergy clinic of Baqiyatallah Hospital from June to October 2014 were randomly allocated to two groups; the first group received 10 cc topical lavage of Amphotericin B (5 cc each nostril for every 12 hours) and the second group received placebo for three months. Symptoms, nasal mucusa smear, serum level of inflammatory cytokines, CT scan and rhinoscopy score changes were evaluated in both groups after three months. Results Fifty-five male and 25 female patients were evaluated in two groups. The mean age was 26.1 ± 2.36 and 27.9 ± 1.59 years in intervention and control groups respectively (P = 0.08). There were no significant differences in demographic data between the groups (P > 0.05). Nasal obstruction, post nasal drip (PND), reduced sense of smell, quality of life, CT scan and rhinoscopy scores were not significantly different between the two groups after intervention (P > 0.05). Facial pain severity score was significantly more reduced in intervention group in comparison with control group (P < 0.01). Conclusions We concluded that application of Amphotericin B as an adjunctive medication to other common treatments, does not seem to be an efficient method for improvement of CRS symptoms