Official Journal of the Neurootological and Equilibriometric Society
Official Journal of the Brazil Federal District Otorhinolaryngologist Society
Research Article Pages:91-96
Authors: Henk M Koning, Bas C Ter Meulen
Introduction: The second cervical nerve ganglion bar appears to be beneficial in patients with treatment safe tinnitus. As far as anyone is concerned, the viability of this methodology in patients with tinnitus has never been evaluated.
Objectives: The point of this investigation was to decide the adequacy of beat radiofrequency of C2 dorsal root ganglion for treating patients with tinnitus, and all the more explicitly, to survey the parameters related with a long haul advantage so as to improve understanding determination.
Design: Subjects were 61 back to back patients who went to our facility from October 2016 to October 2018 for discussions on their tinnitus that endured for one month or more and were treated with beat radiofrequency of C2 dorsal root ganglion. Clinical information structure these patients were explored reflectively. An autonomous spectator assesses the long haul impact of the treatment by phone meet.
Results: In a partner of patients with tinnitus that persevered for one month or more, 25% of the patients reacted with a decrease of their tinnitus after a beat radiofrequency of C2 dorsal root ganglion. The vast majority of the patients with a positive reaction appraised the impact of treatment as a decrease of half or more. At 13.5 months, half of at first effective treated patients still encountered an advantage. Unfavorable occasions of the beat radiofrequency of C2 dorsal root ganglion at 7 weeks of follow-up were an expansion of the force of the tinnitus in 7% of the patients. In patients with an age under 43 years at the time tinnitus began, 45% of them had a decrease of their tinnitus at 7 weeks following treatment with beat radiofrequency of C2 dorsal root ganglion.
Conclusion: Pulsed radiofrequency of C2 dorsal root ganglion can lessen the power of tinnitus extensively and for the long haul in 25% of the patients with tinnitus without genuine antagonistic impacts. We prescribe this treatment in patients with an age under 43 years at the time tinnitus began
Keywords: Tinnitus, pulsed radiofrequency, dorsal root ganglion, dorsal cochlear nucleus, cervical spine
Tinnitus can be brought about by ear issues, for example, hearing disorder or commotion injury, anyway it can likewise be prompted by auxiliary variations from the norm of the cervical spine[1,2]. In spite of the high pervasiveness of the amalgamation of tinnitus and cervical spine issue, the pathogenesis of tinnitus actuated by cervical spine issue stays indistinct. The second cervical nerve (C2) might be identified with tinnitus, and C2 ganglion barricade appears to be advantageous in patients with treatment safe tinnitus[4,5]. As far as anyone is concerned, the adequacy of this methodology in patients with tinnitus has never been surveyed. Subsequently, the point of this investigation was to decide the viability of beat radiofrequency of C2 dorsal root ganglion for treating patients with tinnitus and to discover tolerant qualities related with long haul positive advantage.
The Medical research Ethics Committees United (Nieuwegein, the Netherlands) endorsed the present observational examination and deferred the solicitation for educated assent for the momentum study because of its review plan. A review outline survey was directed. All patients that were treated with beat radiofrequency of C2 dorsal root ganglion in our facility between October 2016 and October 2018 for tinnitus that endured for multi month or longer were incorporated. There were no rejection criteria. All patients were recently counselled by an otorhinolaryngologist and all patients who endured with one-sided tinnitus basic variations from the norm of the inward ear and cerebropontine edge discounted by MRI. The work-up of a patient with tinnitus comprised of an institutionalized clinical history, an institutionalized twosided clinical audiogram and a cervical spine radiograph. The institutionalized clinical history included tinnitus qualities (left side or potentially right side, awful reason, term of protests and period of beginning, and attending manifestations (self-revealed hearing misfortune, the nearness of step awkwardness, coordination issues, discombobulation, and cervicalgia). The edge between the back fringe of sequential cervical vertebrae, the intervertebral plate space stature, and the size of the front osteophyte were estimated from the radiographs of the cervical spine, as recently portrayed.
Treatment of pulsed radiofrequency of C2 dorsal root ganglion
All beat radiofrequency of C2 dorsal root ganglion were performed by an accomplished anesthesiologist (HMK) in a standard way on an outpatient premise5. Just patients with tinnitus that has endured longer than multi month were dealt with. The methodology of beat radiofrequency of C2 dorsal root ganglion barricade was completed with the patient in inclined position with the head somewhat flexed on a X-beam (Table 1). No premedication or sedation was utilized. Under X-beam direction, a 23-measure radiofrequency top-post needle with a functioning tip of 5 mm (Top Neuropole needle XE-S, Tokyo, Japan) was embedded. In anteroposterior projection, the passage purpose of the needle was picked at the degree of the center of the atlantoaxial joint. In the wake of sanitizing the cut site with 60% chlorhexidine in liquor, the needle was acquainted parallel with the radiographic projection and was anticipated as a dab at the center of the atlantoaxial joint (Figure 1A). The radiographic projection was then changed to horizontal, and the needle was gradually best in class until the tip was arranged at the back outskirt of the atlantoaxial joint between the vertebrae C1 and C2 (Figure 1B). Subsequent to affirming the needle position, beat radiofrequency was performed for 120 seconds with a span of 20 ms current (2 Hz, 45 V), utilizing the NeuroTherm TLG 10 radiofrequency sore generator (Neurotherm Inc, Wilmington, MA, USA). No temperature observing was utilized. The patients were being watched and checked for a negligible of 30 minutes and were rethought 7 weeks following treatment.
|Contents||Prevalence||Median||Q1 ? Q3|
|Age (year)||-||56||50.5- 63.5|
|Self-perceived hearing loss||64%||-||-|
|Period of tinnitus (year)||-||4||2.0 -17.0|
|Hearing loss (dB) at:||-||-||-|
|250 Hz||-||15||10.0 ? 30.0|
|500 Hz||-||15||10.0 ? 30.0|
|1 KHz||-||15||10.0 ? 37.3|
|2 KHz||-||20||10.0 ? 38.8|
|4 KHz||-||40||20.8 ? 57.3|
|8 KHz||-||50||30.0 ? 70.0|
|dB: Decibel; Hz: Hertz; KHz: Kilohertz;Q1?Q3: Inter-Quartile Range|
Table 1: Clinical characteristics of the patients with tinnitus.
Patient outlines were investigated reflectively to distinguish the individuals who experienced a treatment with beat radiofrequency of C2 dorsal root ganglion for tinnitus. Information recorded from these patients are persistent qualities (age, sex), tinnitus attributes (left side as well as right side, horrendous, term of objections, and time of beginning), comorbidity (self-detailed hearing misfortune, the nearness of walk awkwardness, dazedness, and cervicalgia), self-announced profit by treatment following 7 weeks on a 4 point Likert scale (none [0%], slight [less than 25%], moderate [25% to 50%], great [50% or more]), time of advantage and, if material, backslide. Treatment of tinnitus was preceded at 7 weeks of follow-up when required. On the off chance that the patient experienced another treatment for tinnitus while the person still had an improvement of the beat radiofrequency of C2 dorsal root ganglion, at that point the time of advantage from the first as of recently treatment was noted. No institutionalized tinnitus survey was utilized before the methodology. A standard clinical audiogram was evaluated. Every ear was presented to unadulterated tones going from 250 Hz to 8 kHz (250, 500, 1000, 2000, 4000, and 8000 Hz) at expanding forces until the limit of location was demonstrated. The audiogram of the overwhelming side of the tinnitus was utilized for examination. In instances of two-sided tinnitus with equivalent force, the mean of the aftereffects of the audiogram of the two sides was processed and utilized. All patients with a decrease of tinnitus who got beat radiofrequency of C2 dorsal root ganglion, and who did not report any backslide, were incorporated for an appraisal by poll. In December 2018, a free onlooker led a subsequent appraisal of the treatment by phone meeting of the patients, utilizing an institutionalized poll to assess the aftereffects of treatment and the hour of repeat of the first tinnitus objections.
Statistical analysis was performed with Minitab 18 (Minitab Inc., State College, PA, USA). Student’s t-test was used for continuous variables and χ2 test was used for dichotomous variables. The duration of effect of treatment was investigated using survival analysis techniques (Kaplan–Meier plot). Two multiple regression analysis were performed. One was used to obtain a regression model from patient characteristics to predict a positive effect on tinnitus after 7 weeks. The second multiple regression analysis tested the predictive variables of the audiogram. Discriminant analysis for division in two groups was used to evaluate the correlation of the most significant variables with the self-reported benefit from pulsed radiofrequency of C2 dorsal root ganglion in patients with tinnitus. A value of p<0.05 was considered statistically significant.
From October 2016 to October 2018, 61 patients experienced treatment with beat radiofrequency of C2 dorsal root ganglion to treat its tinnitus. Out of 61 patients, 15 patients (25%) are reactions with the decrease of their tinnitus. These 15 patient responders evaluated the measure of alleviation from their tinnitus (53% great, 40% moderate, and 7% somewhat). Antagonistic occasions of the beat radiofrequency of C2 dorsal root ganglion announced at 7 weeks of follow-up were an expansion of the power of their tinnitus in 1 patient (7%). Figure 2 demonstrates a Kaplan–Meier plot speaking to the likelihood of continued tinnitus alleviation after beat radiofrequency of C2 dorsal root ganglion in patients with tinnitus who were dealt with effectively. At 13.5 months, half of the patients effectively treated with beat radiofrequency of C2 dorsal root ganglion for tinnitus still had an advantage. Patients with a constructive outcome of beat radiofrequency of C2 dorsal root ganglion on the tinnitus at 7 weeks were contrasted and the nonresponders (Table 2). The nearness of a more youthful age and a more youthful age toward the beginning of tinnitus was measurably critical related with a positive reaction to treatment (p=0.022 and p=0.016 separately). Multivariate measurable examination showed that the age of the patient toward the beginning of tinnitus could foresee a beneficial outcome of beat radiofrequency of C2 dorsal root ganglion on the tinnitus at 7 weeks the best (Table 3). In patients with an age under 43 years at the time tinnitus began, 45% of them had a decrease of their tinnitus at 7 weeks following treatment with beat radiofrequency of C2 dorsal root ganglion. In 24% of them the decrease of the tinnitus was half or more and none had an intensifying of their tinnitus after treatment. An age under 43 years has an affectability of 67% and an explicitness of 73% in anticipating a decent reaction to beat radiofrequency of C2 dorsal root ganglion treatment in patients with tinnitus. The positive and negative prescient qualities were 45% and 89% separately. Multivariate measurable investigation with the factors of the audiogram gave no factors who could factual huge anticipate a constructive outcome of beat radiofrequency of C2 dorsal root ganglion on the tinnitus at 7 weeks.
|Parameters||Positive effect of therapy of ganglion C2 (n=15)||No effect of therapy of ganglion C2 (n= 46)||p-value|
|Self-perceived hearing loss||73%||-||-||61%||-||-||0.383||-|
|Age at the start of tinnitus (year)||-||37.6||3.4||47.7||2||0.016||Sign.|
|Hearing loss (dB) at:|
|Angle between vertebrae C2 and C6 (degrees)||9.7||3.1||-||7.6||1.8||0.558||-|
|Farfan’s measurement of disc space height (%):|
|Size of anterior osteophyte (%) at:|
|dB: Decibel; Hz: Hertz; KHz: Kilohertz; SEM: Standard Error of the Mean; Sign: Significant; Prev: Prevalence|
Table 2: Patients with a positive effect of pulsed radiofrequency of C2 dorsal root ganglion on their tinnitus at 7 weeks were compared with non-responders.
|Contents||Positive effect||Self-reported benefit of 50% or more||Prevalence||An increase of tinnitus therapy|
|Age at start tinnitus <43 years||45%||24%||37%||0%|
|Age at start tinnitus of 43 years or more||13%||8%||63%||11%|
Table 3: The age at the start of tinnitus predict a positive effect of pulsed radiofrequency of C2 dorsal root ganglion on the tinnitus at 7 weeks.
In an associate of patients with tinnitus that continued for one month or more, 25% of the patients reacted with a decrease of their tinnitus after a beat radiofrequency of C2 dorsal root ganglion. The greater part of the patients with a positive reaction appraised the impact of treatment as a decrease of half or more. At 13.5 months, half of the first fruitful treated patients still encountered an advantage. Unfavourable occasions of the beat radiofrequency of C2 dorsal root ganglion at 7 weeks of follow-up were minor: just a single patient report an expansion of the force of the tinnitus. Physical or somatosensory tinnitus is a subtype of tinnitus, where somatosensory data emerging from the cervical spine or temporomandibular joint causes patient's tinnitus recognition7. The neural generator for tinnitus may happen in the cochlear core which gets somatosensory data from the neural frameworks innervating the head, neck and shoulders[1-8]. Likewise, C2 can assume a job in causing the objections of tinnitus and C2 ganglion treatment has been supported in treatment safe tinnitus4,5. Further research has been prescribed to all the more likely exhibit and comprehends the beneficial outcome of C2 ganglion barricade in tinnitus. In our investigation, 25% of the patients with tinnitus saw a long haul decrease of the power of their tinnitus after a beat radiofrequency of C2 dorsal root ganglion. The Dorsal Cochlear Core (DCN) is significant in the etiology of tinnitus. It is the primary neural site of sound-related somatosensory incorporation and may go about as a versatile channel for dropping self-produced sounds[10,11]. Somatosensory contribution from the dorsal root ganglia and trigeminal ganglia is transmitted to the ventral cochlear core, dorsal cochlear core, and second rate colliculus. Incitement of somatosensory pathways brings about concealment or improvement of ensuing acoustically evoked releases. In ordinary conditions there is an equalization of sound-related and somatosensory exercises. Notwithstanding, harm to the sound-related info pathway expands the unconstrained paces of those neurons that get excitatory somatosensory information and results in a more noteworthy affectability of DCN neurons to trigeminal incitement. DCN hyperactivity is viewed as a direct neural connect of tinnitus. The DCN ends up hyperactive after introduction to extraordinary commotion. Additionally, cervical spine issue can prompt a somatosensory pathway-initiated disinhibition of DCN action in the sound-related pathway. Incitement of the C2 brings out possibilities in the DCN, evoking examples of restraint and excitation of the DCN head cells. In our investigation, the impact of C2 ganglion treatment was not identified with hearing misfortune or cervical spinal issue on X beam. We infer that in patients who reacted to C2 ganglion treatment the alleged hyperactivity in the DCN was interceded uniquely by the C2 and not related with hearing issue or cervical spine issue. Tinnitus is viewed as profoundly heterogeneous concerning its etiology, and to the reaction to explicit mediations, for example, treatment of the temporo-mandibular joint issue. Subtyping is prescribed. In our investigation, the result of this treatment couldn't be related to physical issue of the cervical spine or to the consequences of the audiogram. The age at which tinnitus began could anticipate the impact of a beat radiofrequency of C2 dorsal root ganglion on tinnitus. In patients with an age under 43 years at the time tinnitus began, 45% of them had a decrease of their tinnitus at 7 weeks following treatment with beat radiofrequency of C2 dorsal root ganglion. In writing, the period of beginning of tinnitus has been considered as an extra affecting variable in the pathophysiology of tinnitus. How the time of beginning of tinnitus can be identified with C2 pathology in patients with tinnitus can be the item for further investigations. Limitations are found in the current retrospective study. A prospective follow-up study is recommended to confirm these results. Also, a limitation is the number of patients in this study. Even though these numbers are sufficient to demonstrate an effect in this study, re-evaluation of these predictors in a larger cohort is necessary to support our conclusions.
Beat radiofrequency of C2 dorsal root ganglion can lessen the power of tinnitus significantly and for the long haul in 25% of the patients with tinnitus without genuine antagonistic impacts. This treatment can be viewed as patients with an age under 43 years at the time tinnitus began.
The authors declare no potential conflict of interest on publishing this paper.
1Department of Pain therapy, Pain Clinic de Bilt, Netherlands
2Department of Neurology, OLVG, Amsterdam, Netherlands
3Zaans Medisch Centrum, Zaandam, Netherlands
Send correspondence to: Henk M. Koning Department of Pain therapy, Pain Clinic de Bilt, Netherlands, E-mail: [email protected], Phone: +0031302040753.
Citation:Koning HM, Meulan BCT. Pulsed radiofrequency of C2 dorsal root ganglion in patients with tinnitus. Int Tinnitus J. 2019;23(2): 91-96.
Paper submitted to the ITJ-EM (Editorial Manager System) on September 03, 2019; and accepted on September 17, 2019