Tinnitus Healing and Our Approaches

Most of the questions we have received from tinnitus patients is about how well the treatments work. People wonder about this question much. Moreover, people seek for similar patients and similar situations, with which they can identify their tinnitus. However, the first thing to know is that tinnitus is a subjective complaint. People can even have difficulty in giving the information about this subjective situation to the doctor. Because each person's tinnitus sounds are different and the sound level and tone they feel are different. The interactions in their lives are also different. Again, social and psychological interactions are also different. While these factors don't affect some people, others are severely affected. Therefore, differences shown by such subjective factors means that tinnitus is an individual condition that differs from person to person. So, it is just as fingerprint. This situation also brings forward different results in treatments. Due to the differences in expectations, treatment results are reflected with different responses. While expectations of some people from tinnitus treatment are a tolerable level, some people expect symptoms to be disappeared completely. The major problem of disease is the absence of an objective condition that can be touched or seen. However, there are template-based surveys, assessment forms and advanced objective tests that help the physician to make this tangible and visible. These supplementary factors are the factors that can reflect the subjective state of the person objectively, both before and after treatment. Whether or not one has tinnitus, people hardly give respond when they are asked such non-objective and intangible questions as "what were you thinking about five days?", "how were your feelings?" or "what were you doing 10 days ago?, were you upset?, how much were you upset?". People forget about their past very quickly. These difficulties can also occur in tinnitus treatments. Some can express themselves very well, but others express very difficult. What is important is the place of tinnitus in their lives, how much it gets interacted, how much it can be socially and psychologically tolerated, and how much the severity can be reduced. Decrease of level, of course, differentiates for the situation that they are in and differs in every person according to his/her statements. This is because feelings are subjective, and each person's emotions and thoughts are different. Tinnitus is the sound that is felt somewhere in the head. It is not a sound heard from the outside. Only the person feels himself. The sound that is felt is either in the ear or around ear, or sides and upper regions of the head. For this reason, it is necessary to think of the sound as a phantom sound. Moreover, it should not be forgotten that this sound is recorded in the brain memory stores like every acquired sound. It is heard like weak sometimes after treatment. Even it couldn't affect the person, it is the case of recall from the recorded system in memory. To make it clearly, tinnitus disappears or becomes tolerable with the improvement of the element creating tinnitus in the brain, that is to say pathological place. Recall from the memory store is a situation that is felt with remembering from record stores in the brain. To make an emulating, it is like recalling any event that happened in the past. There are some situations fallen to the person in order to take the case under control adequately. It is necessary to ensure that the functional structures in room, i.e. the doors of memory stores, are not opened as much as possible. As in everything, one should forget by putting things behind. It is important not to use this recorded part in the memory stores located in different parts of the brain at all, which will produce an indirect effect when the pathological sound producing point is being treated. For this reason, our advice is that they should be kept away from any factor that will remind them of anything, as possible. If they have reached a relief with tinnitus therapies, we recommend our patients avoiding social media, forms, books, correspondences, and many other factors that will irritate them by remembering more. We don’t want the healed situation to go back into a chaotic atmosphere. It should not be forgotten that tinnitus-treated people may encounter with some factors that may irritate tinnitus again. Similarly, we witness that these situations irritate the secondary people with tinnitus. These situations arise and are experienced by the effects of social media. These situations sometimes happen at advanced stages. Sometimes people prefer to change or close their social media accounts, and sometimes they can get rid of those irritant effects by giving defensive responses to impatient intense questions. In such situations, it will be one of the most right thing to grab the doors to reminders of tinnitus remedies. It is part of the treatment to reduce the reminder factors. It's just like asking constantly a patient, who has been treated for cancer, about his disease. If patients with tinnitus are motivated to continue their life without any irritation after treatment, that is, how they overtake their diseases, they progress so well in the future.

Treatments sometimes respond quickly, but sometimes more time is required. Patients may sometimes feel themselves very good, but sometimes they suppose to be unable to have enough benefit from the treatment. Many scientific studies have reported that the healing process of tinnitus can sometimes be long.

There is no 100% treatment for tinnitus yet. With our scientific innovative therapies, this chance varies from 60-70%. While immediate response can be taken for treatment with our r-TMS and appropriate treatment courses, simultaneously or afterwards, according to the situation of patient, sometimes these processes can be extended to 20-25 weeks as stated in the results of scientific studies. This process is related to the condition of the pathology in the region causing tinnitus. One should be patient in such situations. It is necessary to being stubborn and not to give up in fighting with this difficult situation. If the duration of treatment process is prolonged, people should not be demoralized. It must be kept in mind that the distorted nerve cells in the hearing pathways or the pathologies in those regions will also affect the time of treatment. Hearing nerve cells are known to be more susceptible and easily affected than other nerve cells. This is due to the weakness of the outer sheath of the hearing nerve cells, i.e. the myelin layer, or the weakness of the regenerative properties of the inner ear cells.

When we look at the tangible and realistic side of the situation that holds such a subjective character; our approach to tinitus is as follows:

We have a preliminary idea about the tinnitus of person with our evaluation, patient query form and examination. We use template-based questionnaires, assessment forms, and tests that are known as the world standard and give objective information about the person's pre-and post-treatment subjective status. Even though the person can not express himself clearly, these evaluations give us a clear guide before and after treatment. It has been proven by scientific studies that internationally standardized forms are highly reliable surveys.

The forms we use respectively; 1. Visual Analogue Scale, 2. Beck Depression Scale, 3. Tinnitus Inventory Handicap.

As a result of all these evaluations and scaling, hearing tests and blood laboratory tests are requested if not done before. After comprehensive evaluation result acquired, the point is determining the tinnitus-causing factor. The interview evaluation phases should be very precise, these first rounds take about an hour.

We use the featured MRI type, called as FMRI examination, in the objective detection of the pathologic element that makes the subjectjunction innitus. Classical MRI examinations do not give micro details because they focus on gross conditions. For this reason, cell-level detail is required. It is now suggested in scientific studies that FMRI (Multi-paremetric Functional MRI Imaging) examination should be performed for tinnitus. Before this test is initiated, tinnitus levels and tinnitus status of the patient are mutually shared with the physician in the radiology department and, the brain and all factors that can create tinnitus are investigated. In the diagnostic process, communication between us and the radiologist is very important. FMRI procedures are carried out in the Radiology Service of Acıbadem (Taksim) Hospital, which is independent of us. There is no other second unit on tinnitus that could provide these features or imaging in this regard. An experienced team is available for these operations in that hospital. FMRI process takes about one and a half hours. This process can sometimes cause worries before the examination in people with MRI phobia, namely those who have phobia of staying in closed areas or who have panic attacks. Special preparations are made for those people having such troubles, and the processes can be completed easily. Since the analysis of thousands of images takes hours, it takes one or two days for us to receive the results.

After procedures are completed, patient visit us again with FMRI report results. It takes approximately half an hour for us to examine test results with clinical findings together. After this interview, appropriate treatments are decided for the findings of person. In addition, the duration of treatments are determined depending on the findings of person. These processes and maintenance treatments can sometimes take one month, sometimes six months, and sometimes a year, depending on the severity and findings of tinnitus. Findings are essential in the selection of treatment type. Sometimes new-generation medical treatments, sometimes r-TMS treatments, and sometimes both, are applied to the patients.

R-TMS treatment is not performed for vascular tinnitus. However, if there is a negative interaction on the nerve cells of the auditory pathways, the treatments mentioned above can be applied. When 70% of our patients are applied r-TMS treatment, we apply different treatments in 30% due to the differences of findings. So, diagnosis and findings are very important. It provides you objective information about your situation. How much this objective finding is important for tinnitus is an invaluable information. Moreover, if it is thought that these procedures are performed in limited places around the world, it is a great chance for patients in this matter. We are already among the major treatment units in the world as a disciplinary unit that provides treatment with scientific medical innovative testing and treatment methods.