Tag Archives: Georgetown University Medical Center

Tinnitus

Definition:   Tinnitus is noise or ringing in the ears.It may be a the sensation of hearing ringing, buzzing, hissing, chirping, whistling, or other sounds. The noise can be intermittent or continuous, and can vary in loudness. It is often worse when background noise is low, so you may be most aware of it at night when you’re trying to fall asleep in a quiet room. In very rare cases, the sound beats in sync with your heart (pulsatile tinnitus)……..CLICK & SEE THE PICTURES 

A common problem, tinnitus affects about 1 in 5 people. Tinnitus isn’t a condition itself — it’s a symptom of an underlying condition, such as age-related hearing loss, ear injury or a circulatory system disorder.

Although bothersome, tinnitus usually isn’t a sign of something serious. Although it can worsen with age, for many people, tinnitus can improve with treatment. Treating an identified underlying cause sometimes helps. Other treatments reduce or mask the noise, making tinnitus less noticeable.

There are two kinds of tinnitus:

Subjective tinnitus is tinnitus only one can hear. This is the most common type of tinnitus. It can be caused by ear problems in the outer, middle or inner ear. It also can be caused by problems with the hearing (auditory) nerves or the part of your brain that interprets nerve signals as sound (auditory pathways).

Objective tinnitus is tinnitus the doctor can hear when he or she does an examination. This rare type of tinnitus may be caused by a blood vessel problem, an inner ear bone condition or muscle contractions.
Symptoms:
Tinnitus can be perceived in one or both ears or in the head. It is usually described as a ringing noise but, in some patients, it takes the form of a high-pitched whining, electric buzzing, hissing, humming, tinging or whistling sound or as ticking, clicking, roaring, “crickets” or “tree frogs” or “locusts (cicadas)”, tunes, songs, beeping, sizzling, sounds that slightly resemble human voices or even a pure steady tone like that heard during a hearing test and, in some cases, pressure changes from the interior ear. It has also been described as a “whooshing” sound because of acute muscle spasms, as of wind or waves. Tinnitus can be intermittent or it can be continuous: in the latter case, it can be the cause of great distress. In some individuals, the intensity can be changed by shoulder, head, tongue, jaw or eye movements.

Most people with tinnitus have some degree of hearing loss: they are often unable to clearly hear external sounds that occur within the same range of frequencies as their “phantom sounds”. This has led to the suggestion that one cause of tinnitus might be a homeostatic response of central dorsal cochlear nucleus auditory neurons that makes them hyperactive in compensation to auditory input loss.

The sound perceived may range from a quiet background noise to one that can be heard even over loud external sounds. The specific type of tinnitus called pulsatile tinnitus is characterized by hearing the sounds of one’s own pulse or muscle contractions, which is typically a result of sounds that have been created from the movement of muscles near to one’s ear, changes within the canal of one’s ear or issues related to blood flow of the neck or face.

Causes:
Prolonged exposure to loud sounds is the most common cause of tinnitus. Up to 90% of people with tinnitus have some level of noise-induced hearing loss. The noise causes permanent damage to the sound-sensitive cells of the cochlea, a spiral-shaped organ in the inner ear. Carpenters, pilots, rock musicians, street-repair workers, and landscapers are among those whose jobs put them at risk, as are people who work with chain saws, guns, or other loud devices or who repeatedly listen to loud music. A single exposure to a sudden extremely loud noise can also cause tinnitus...CLICK & SEE : 

A variety of other conditions and illnesses may lead to tinnitus and they are as follows:
*Blockages of the ear due to a buildup of wax, an ear infection, or rarely, a benign tumor of the nerve that allows us to hear (auditory nerve)

*Certain drugs — most notably aspirin, several types of antibiotics, anti-inflammatories, sedatives, and antidepressants, as well as quinine medications; tinnitus is cited as a potential side effect for about 200 prescription and nonprescription drugs.

*The natural aging process, which can cause deterioration of the cochlea or other parts of the ear

*Meniere’s disease, which affects the inner part of the ear

*Otosclerosis, a disease that results in stiffening of the small bones in the middle ear

*Other medical conditions such as high blood pressure, cardiovascular disease, circulatory problems, anemia, allergies, an underactive thyroid gland, and diabetes

*Neck or jaw problems, such as temporomandibular joint (TMJ) syndrome

*Multiple sclerosis

*Injuries to the head and neck

*External ear infection

*Acoustic shock

*Cerumen (earwax) impaction

*Middle ear effusion

*Superior canal dehiscence

*Sensorineural hearing loss

*Acoustic neuroma*Mercury or lead poisoning

*Neurologic disorders

*Temporomandibular joint dysfunction

*Giant cell arteritis

*Metabolic disorders like thyroid disease, hyperlipidemia, vitamin B12 deficiency, iron deficiency anemia, psychiatric disorders,diabetis

*Psychiatric disorders like depression, anxiety
Tinnitus can worsen in some people if they drink alcohol, smoke cigarettes, drink caffeinated beverages, or eat certain foods. For reasons not yet entirely clear to researchers, stress and fatigue seem to worsen tinnitus.

Diagnosis:
The basis of quantitatively measuring tinnitus relies on the brain’s tendency to select out only the loudest sounds heard. Based on this tendency, the amplitude of a patient’s tinnitus can be measured by playing sample sounds of known amplitude and asking the patient which they hear. The volume of the tinnitus will always be equal to or less than that of the sample noises heard by the patient. This method works very well to gauge objective tinnitus (see above). For example: if a patient has a pulsatile paraganglioma in their ear, they will not be able to hear the blood flow through the tumor when the sample noise is 5 decibels louder than the noise produced by the blood. As sound amplitude is gradually decreased, the tinnitus will become audible and the level at which it does so provides an estimate of the amplitude of the objective tinnitus.

Objective tinnitus, however, is quite uncommon. Often, patients with pulsatile tumors will report other coexistent sounds, distinct from the pulsatile noise, that will persist even after their tumor has been removed. This is generally subjective tinnitus, which, unlike the objective form, cannot be tested by comparative methods. However, pulsatile tinnitus can be a symptom of intracranial vascular abnormalities and should be evaluated for bruits by a medical professional with auscultation over the neck, eyes and ears. If the exam reveals a bruit, imaging studies such as transcranial doppler (TCD) or magnetic resonance angiography (MRA) should be performed.

The accepted definition of chronic tinnitus, as compared to normal ear noise experience, is five minutes of ear noise occurring at least twice a week. However, people with chronic tinnitus often experience the noise more frequently than this and can experience it continuously or regularly, such as during the night when there is less environmental noise to mask the sound.

Treatment:
Psychological:
The best supported treatment for tinnitus is a type of counseling called cognitive behavioral therapy (CBT) which can be delivered via the internet or in person. It decreases the amount of stress those with tinnitus feel. These benefits appear to be independent of any effect on depression or anxiety in an individual. Relaxation techniques may also be useful. A program has been developed by the United States Department of Veterans Affairs.

Medications:
There are no medications as of 2014 that are effective for tinnitus and, thus, none is recommended. There is not enough evidence to determine if antidepressants or acamprosate is useful. While there is tentative evidence for benzodiazepines, it is insufficient to support usage. Anticonvulsants have not been found to be useful.

Botulinum toxin injection has been tried with some success in cases of objective tinnitus (palatal tremor)

Others:
The use of sound therapy by either hearing aids or tinnitus maskers helps the brain ignore the specific tinnitus frequency. Although these methods are poorly supported by evidence, there are no negative effects, which makes them a reasonable option. There is some tentative evidence supporting tinnitus retraining therapy. There is little evidence supporting the use of transcranial magnetic stimulation. It is thus not recommended.

Alternative   Therapy :
Ginkgo biloba does not appear to be effective. Tentative evidence supports zinc supplementation and in those with sleep problems, melatonin. The American Academy of Otolaryngology, however, recommends against melatonin and zinc.

Doing YOGA EXERCISE daily with PRANAYAMA (specially Anuloma belome , Kapalabhati and Bhramari ) may help a lot to improve and sometimes cure totally.
Prognosis:
Most people with tinnitus get used to it over time; for a minority, it remains a significant problem.

Prevention:
Prolonged exposure to sound or noise levels as low as 70 dB can result in damage to hearing (see noise health effects). This can lead to tinnitus. Ear plugs can help with prevention.

Avoidance of potentially ototoxic medicines. Ototoxicity of multiple medicines can have a cumulative effect and can increase the damage done by noise. If ototoxic medications must be administered, close attention by the physician to prescription details, such as dose and dosage interval, can reduce the damage done.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
https://en.wikipedia.org/wiki/Tinnitus
http://www.mayoclinic.org/diseases-conditions/tinnitus/multimedia/tinnitus/
http://www.webmd.com/a-to-z-guides/understanding-tinnitus-basics

Sperm Stems Sugar

Scientists have developed a novel cure for diabetes by which male patients can grow insulin-producing cells from their own testes.

Stem cells hatched from human testes may offer a cure for diabetes in the near future. A team of US researchers, including a young Indian American student, has shown that men suffering from Type-1 diabetes may be able to grow their insulin-producing cells from their testicular tissue.

The scientists, led by G. Ian Gallicano of the Georgetown University Medical Center (GUMC) in the US, have found that when these bio-engineered cells are grafted into diabetic mice, they function quite like beta-islet cells, the insulin-secreting cells normally found in the pancreas.

By decreasing the animals’ blood glucose levels, the human derived islet cells demonstrated their potential to counter diabetic hyperglycemia in humans, Gallicano told scientists at an annual meeting of the American Society of Cell Biology (ASCB) in Philadelphia yesterday.

Anirudh Saraswathula, an undergraduate student at Duke University, is a co-author of the work. Under a mentoring programme, Saraswathula — who was a student at the Thomas Jefferson High School for Science and Technology in Alexandria — worked in Gallicano’s lab last year. His contribution to the work won Saraswathula — whose parents hail from Hyderabad — several prizes at national level innovation competitions in the US earlier this year.

The current work draws from an earlier breakthrough by GUMC researchers, including Gallicano. The scientists had shown that spermatogonial stem cells (SSCs) — that produce sperm — can be converted back into pluripotent embryonic-like stem cells that are capable of morphing into any cell type that a body needs, from brain neurons to pancreatic tissue. Embryonic stem cells — as the name suggests — are derived from human embryos. Their use in clinical application is mired in ethical issues.

“No stem cells, adult or embryonic, have been yet induced to secrete enough insulin to cure diabetes in humans, but we know SSCs have the potential to do what we want them to, and we know how to improve their yield,” Gallicano said in a release issued by the ASCB.

This could work in certain types of Type-2 diabetes as well, particularly in those patients whose beta cells are shut down. “Actually our hope is for it to serve as a cure, not just a treatment. Previous attempts at curing or treating diabetes have not quite panned out,” Gallicano told KnowHow.

Despite the rising tide of diabetes patients and dire predictions of worse to come, diabetes treatment has advanced little for decades beyond blood testing and insulin replacement. The only radically new approach to Type-I diabetes in recent years has been the Edmonton Protocol, named after the Canadian city where the technique was standardised, for transplanting insulin-producing beta-islet cells from deceased donors into the pancreas of diabetic patients who can no longer survive on insulin injections. Islet cell transplantation is plagued by problems of donor shortage and death of these cells in the body because of immune-mediated rejection.

Researchers have also cured diabetes in mice using induced pluripotent stem (IPS) cells — adult stem cells that have been reprogrammed with other genes to behave like their embryonic counterparts. The technique, however, has its downside because it can give rise to tumours since the procedure requires the use of cancer genes.

However, to date, numerous barriers surround and prevent stem cell therapies from treating diabetes. With respect to embryonic stem cells, immune rejection, risk of teratoma (tumour) formation, and ethical dilemmas remain at the forefront of their delay in clinical application. Conventional adult stem cells have not lived up to their billing either as they are difficult to generate in the quantities necessary, and they, too, can face immune rejection, explains Gallicano.

As a result, the search has gone on to find a stem / progenitor cell that is deemed “suitable” by the Food and Drug Administration for use in the clinic. “In light of this, we believe our preliminary data using SSCs show significant promise in addressing these critical barriers. Our cells do not need external genes to become pluripotent. There are no ethical dilemmas we are aware of. Our cells do form teratomas — but it takes 10 times more cells to do so when compared to IPS or ES cells, and they secrete very high levels of insulin once we differentiate them,” says Gallicano. For the present experiment, the scientists used SSCs harvested from deceased human organ donors.

Another advantage of the procedure, according to Gallicano, is that there is no chance of immune rejection, a major bottleneck of most organ transplants. That’s because these beta-islet cells are obtained from the patient’s own testes.

“If pluripotent stem cells could be derived from a patient’s own testes, problems of organ shortage and immune rejection could be bypassed. This research holds great promise for Type-1 diabetes patients,” says Anoop Misra, head of the department of diabetes, obesity and metabolic diseases at Fortis Hospital, New Delhi.

The scientists are hopeful that a similar methodology may yield a potential cure for female diabetics as well. “The fundamental approach of transforming male gametes (male sperm cells) into pluripotent stem cells might be applicable to the female counterpart — that is, oocytes,” Gallicano observes.

Source: The Telegraph ( Kolkata, India)