Tinnitus or noise in the ear is a mysterious symptom that, despite numerous theories and efforts to discover its essence, remains an unresolved pathogenic mechanism. Tinnitus is defined as a subjective perception of sound in the ear or head, which does not exist, and which occurs without the apparent external sound, i.e. it is a phantom hearing augmentation. The question is, why does the brain create a listening experience in the absence of an external sound stimulus? Acupuncture or noise in the ear is generally manifested as buzzing, thumping, ringing or crackling in the ear. It is interesting, not only because of the frequent occurrence of people with hearing impairments, but also because it can occur in completely healthy people and people with normal hearing. There is no correlation between the intensity of the noise and the degree of human suffering. Sometimes a small noise can lead to major psychological problems and vice versa. The limbic system is responsible for the emotional component of the noise and the cerebral cortex serves for its conscious recognition. With each person there is a readiness of the tinnitus hearing system which is suppressed in our brain unconscious. Neuronal activity leading to tinnitus can occur in the nervous system with and without ear involvement due to the diverting of hearing information. The tinnitus is misreading our hearing impairments in the CNS and it is more common in males than in females, it is more common in people with higher education, and most commonly between 50 and 60 years of age. Research has shown that in 80% of these “patrons” the intensity of the noise does not exceed the limit of 20 dB above the hearing threshold and that it usually registers at a frequency of 500-8000 Hz.
There is a subjective, objective, primary and secondary noise, one-sided, double-sided, acute, chronic, permanent, occasional, pulsating, subtle, tweet, etc. In the course of tinnitus, it can be progressive, static, fluctuating, continuous, and intermittent. Somewhere around 5% of the general population complains
about daily noise and 20% on the occasional. If it is a double hearing loss, the noise more often affects a better ear. More than half of people who have noise in the ear have some hearing impairment. It has been observed that tinnitus, in people with normal hearing, leads to a higher degree of anxiety, anxiety, depression, etc. Also, an increase in the emotional response to tinnitus can lead to progression in the intensity of the noise. That’s why about 35% of patients with tinnitus continuously use sedatives. Over 25% of patients cannot find the right term to describe their murmur. It is thought that in Serbia, about a million inhabitants suffer from some form of noise in the ear.
Cerumen and foreign bodies in the external ear canal that touch the musculoskeletal, middle ear / middle ear infections, thympano sclerosis, otosclerosis, etc.), internal ear disorders (Meniere disease, labyrinth toxicosis, syphilis, etc.), damage to hearing ailments, nerves and central hearing cords in the CNS (acute and chronic acute trauma, presbiacus, brain disorders), tumors (neuron acusticus), head trauma, epilepsy, multiple sclerosis, use of ototoxic and other drugs, etc. The diagnosis of the noise includes a clinical examination with a number of functional oto-neurological tests, recording rtg, audiometry, tympanometry, tinnitusmetry, BERE, CT, NMR heads, Doppler of blood vessels of the neck, etc. In the treatment of acupuncture, it was tried using various methods and numerous pharmaceutical preparations, but the results were often not more successful than the placebo effect. Tinnitus is not a disease but a symptom and therefore does not have a unique therapy for its treatment. The therapeutic procedures include the following: hearing aids in hearing impaired persons, sound therapy, tinnitus masker, sound pad, laser (bio simulative laser 10 treatments for 20 minutes), medications (vasoactive substances, sedatives, tricyclic antidepressants, valium, vitamin B, zinc supplements,etc.), acupuncture, hypnosis, hyperbaric chamber, transcranial magnetic stimulation, intratampanal dexasone application, PM-
101 amp, AM-101, behavioral therapy, retraining technique, etc.
The aim of the paper is to present our results of treatment
of chronic unilateral tinnitus in patients with perceived hearing
a) Transtimpanic administration of dexasone.
b) Multi-month treatment of acupuncture with vasoactive
substances in combination with antidepressants.
In the period from 2014 to 2017, the study included 56
patients treated for tinnitus, as a primary symptom, associated
with perceptual reduction in low-grade hearing. The youngest
patient was 27 and the oldest 67 years. In 24 cases, a medication
therapy lasting more than three months was carried out, 12
patients were treated with acupuncture, and in 20, dexasone
was administered transtimpancally in the middle ear through
four sessions in a five-day interval. The effect of the therapy was
controlled based on the VAS scale before and after the threemonth
treatment and the patient’s testimony (Figure 1).
The best results were achieved after intratympanic dexasone
administration in people whose tinnitus had the characteristic
of noise and was of cochlear origin. In 35% of treated patients,
lesions completely disappeared, in 20% significantly decreased,
while in 44% it remained the same, and in about 5% treated it
even increased (Figure 2).
Tinnitus is wrongly processing our hearing impulses in the
CNS. The hypothalamus and limbic system are responsible for
the emotional component of the noise, while the cortex of the
great brain serves for its conscious recognition. It can occur
in completely healthy people and people with normal hearing.
There is no correlation between the intensity of the noise and
the degree of patient’s suffering [1,2]. A neuronal activity that
leads to tinnitus can occur in the nervous system with and without the involvement of the ear due to the diverting of hearing
information. With each person there is a readiness of the tinnitus
hearing system which is suppressed in our brain unconscious.
Tinnitus is a subjective phenomenon that is difficult to assess
objectively because it is measured only based on the patient’s
response. The Transtimpanic administration of dexasone in
the treatment of tinnitus, which was injected by Sakata and
associates in 1982 and [3,4] in the treatment of cochlear tinnitus,
led to over 70% significant improvement. Approximately similar
results were achieved by Hyun  whose success of satisfied
patients ranged around 64%. Comparing our results with the
results of these authors, we were convinced that the success of
treating acupuncture with this method is significantly weaker
in us. As a reason, Vukoje lists various criteria in assessing the
success of this method, patient selection, the etiology of noises,
etc. The principle of treating an intratemal steroid in the middle
ear is based on the reduction of edema and excitation of the
auditory cells. Stimulating the metabolism of the auditory cells
and altering the chemical reaction of the lymphoma in the inner
ear of dexamethasone also blocks the increased formation of
neurotransmitters (glutamate) in the cochlea in persons with
hearing impairment and increases microcirculation in the inner
ear which is imperative in the treatment of cochlear tinnitus.
The use of this corticosteroid is locally indicated in cases when
medication therapy did not produce results. Moreover, the local
application of this medication in the middle ear does not have
systemic bipolar effects and a high concentration of steroids is
achieved through a round window in the inner ear.
Medication therapy consists of the application of vasoactive
drugs, vitamins, antidepressants, and some supplements
(magnesium, zinc, selenium) . According to our research,
this type of treatment has given a weaker result, in terms of
noise disappearing, compared to Transtimpanic dexasone use,
and better in terms of noise reduction. Over 29% of the treated
people reported that the noise decreased by 50% after three
months of treatment. Acupuncture has led to a reduction in the
intensity of forests only during the period of administration,which means that this method is not an effective treatment
for tinnitus, although Bahran and associates  conclude that
acupuncture can help to relieve tinnitus. In patients in whom
the therapy did not deliver satisfactory results, laser therapy or
tinnitus management should be included [8,9].
Tinnitus Pen GREEN medical Laser uses low-level laser
therapy to modify the function of cells where the main
mechanism occurs in mitochondria . It is applied once a day
for 20 minutes, 10 minutes in front of the ear,10 minutes behind
the ear. In the case of bilateral tinnitus, a break of three hours
before the application to another ear is necessary. The therapy
usually lasts 90 days. In most cases, improvement occurs after
a couple of weeks. In the case of chronic tinnitus, more than
one session may be required . Tinnitus management means
various ways to overcome this condition including: Ignore it
and gain control over it; do something; do not just think about
it; avoid high volume music and strong noise; stop consuming
nicotine, caffeine and alcohol; do not isolate; and devote more to
sports and work activities with relaxation exercises, behave as if
there is no buzzing, and so on.
Our experience suggests that in tinnitus with cochlear
hearing impairment there is justification of the application
of the Transtimpanic application of dexasone, and in patients
with retrochronal hearing impairment associated with noise,
which has the character of the tone, the advantage is given
to medication therapy. Acupuncture exclusively at the time
of treatment led to subjective mitigation of the intensity of
noise in a third of patients, so that soon after the cessation of
the procedure, it would be recidivated in all noise. For young
people, as well as for those with longer duration of the noise, the
success is weaker. Patients with proper hearing and tinnitus of
unknown origin require a consultative collaboration of several
specialists in which psychologists and neuropsychiatrists should
be involved. The author believes that it is necessary to develop
more precise criteria for monitoring the success of treatment
and the choice of medication and other therapy in the treatment
of this unpleasant symptom.