In der HNO-Sprechstunde präsentieren sich regelmäßig Patienten mit funktionellen Beschwerden verschiedenster Art. Nicht selten hängen diese Beschwerden mit Nervenreizungen an der HWS und der Kaumuskulatur zusammen, werden aber nur in wenigen Fällen diesen Ursachen zugeordnet. Eine Lokalanästhesie des Gangliom oticum kann dabei zur Verbesserung beitragen. Aus der ambulanten Sprechstunde wurden 66 Patienten (44% weiblich, 51,3±12,6 Jahre) mit funktionellen HNO-Beschwerden identifiziert und mit 1 bis 3 transoralen Injektionen von Lidocain 2% in das Ganglion oticum ein- oder beidseitig therapiert und nachuntersucht. 26 Patienten litten unter einem durch Kopf- oder Kieferbewegungen beeinflussbaren Tinnitus, 12 unter infraorbitalen Cephalgien ohne Anhalt für Abschottung der korrespondierenden Kieferhöhle, 12 unter einem Bruxismus mit craniomandibulärer Dysfunktion, 10 unter Tubenventilationsstörungen, die nicht auf topische Steroide ansprachen und 6 unter einem Fremdkörpergefühl beim Schlucken mit Hustenattacken. Insgesamt profitierten 83% der Patienten von der Therapie nach 1,9 bis 2,5 Injektionen, in 41% verschwanden die Beschwerden vollständig, teilweise bereits nach einer oder zwei Injektionen. Tubenventilationsstörungen und Tinnitus sprachen mit 91 bzw. 82% am besten auf die Therapie an. Trigeminale Affektionen spielen eine nicht zu vernachlässigende Rolle bei funktionellen Beschwerden im Mittelgesicht. Eine Verbindung des N. Trigeminus zum Innenohr besteht über den Nucleus cochlearis dorsalis. Für eine effektive und einfache Hilfe dieser Patienten sind das Bewusstsein des Untersuchers für Störungen des Trigeminus und die fachliche Expertise für eine Lokalanästhesie des Ganglion oticum neben Kenntnissen der manuellen Medizin und der Neuraltherapie essentiell.

In the out-patient practice, patients frequently present with functional complaints of different expression, like tinnitus, tube ventilation disorders, dysphagia, bruxism, projected headache. Not infrequently, these complaints correspond with neural irritations of the cervical spine and the masticatory muscles, but are assigned to these causes in a low number of cases, however. Otic ganglion local anesthesia may help patients to improve.

We are writing as European physicians who have established working relationships with colleagues in Myanmar over the past 10 years. Friendships have developed through these relationships. We have all learned from each other, clinically and culturally. We have paid regular visits to Mandalay and other cities to teach surgery and conduct surgical courses, and our Burmese colleagues have visited our clinics to advance their surgical skills. The aim of our exchange has been to teach the teachers of medicine.In otolaryngology, our area of expertise, a main goal is to improve hearing and improve quality of life with cochlear implants for patients (mainly children) who are deaf. Lucy, now aged 4 years old, was born deaf and diagnosed during our most recent visit to Mandalay in January, 2020. Since that visit, Lucy has received a cochlear implant delivered by our Burmese colleague, and videos of Lucy talking and counting in Burmese and English make us very proud of her and the international community working together.We have not been able to meet our colleagues and friends in person since 2020, both as a consequence of the COVID-19 pandemic and, primarily, because of the Feb 1, 2021 military coup.1BBCMyanmar coup: Aung San Suu Kyi detained as military seizes control.https://www.bbc.com/news/world-asia-55882489Date: Feb 1, 2021Date accessed: October 2, 2022Google Scholar Our colleagues in Myanmar are now suffering—they use words such as hell to describe the situation. Battles mainly occur in rural areas; however, there are also gunfights and frequent bomb threats in the biggest cities.2Win S Aung KK Stylianou N The deadly battles that tipped Myanmar into civil war.https://www.bbc.co.uk/news/world-asia-60144957Date: Feb 1, 2022Date accessed: October 2, 2022Google Scholar Physicians committing to the Civil Disobedience Movement (CDM) are trying to provide health care remotely and in person within battle areas—the latter of course being extremely dangerous as health-care workers risk being arrested by the military.3Tatum M Escalating threats to health workers in Myanmar.Lancet. 2022; 399: 619Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar The Ministry of Health, controlled by the military, holds a list of health-care workers in those areas of conflict so they cannot leave the country or renew their passports because they are on blacklists. The only way to leave is by crossing the border to Thailand as refugees. Fortunately, the exact location of our colleagues within the country is unknown.Universities and hospitals are military-controlled areas4Head J Myanmar coup: the doctors and nurses defying the military.https://www.bbc.co.uk/news/world-asia-59649006Date: Jan 7, 2022Date accessed: October 2, 2022Google Scholar and health care is provided by non-CDM health-care staff to patients on the non-CDM side only—that is, to those collaborating with or accepting the military rule. Although some physicians are committed to the CDM, other colleagues are collaborating with the military for various reasons—for example, to protect their own family. We must keep in mind that the main goal of any physician, whatever side of the conflict she or he may be on, should be to comply with the Declaration of Geneva and help patients regardless of their relation to the conflict.5UN Security CouncilSecurity Council adopts Resolution 2286 (2016), strongly condemning attacks against medical facilities, personnel in conflict situations.https://www.un.org/press/en/2016/sc12347.doc.htmDate: May 3, 2016Date accessed: October 2, 2022Google ScholarWe have been asking ourselves, how can we be most helpful? We have even wondered whether to pause our work with our Burmese colleagues and establish relationships with another country. But one cannot abandon friends and colleagues. Instead, we established weekly online meetings during which medical questions can be asked and discussed in a group. Participants can remain anonymous by joining the calls without using their real names and without switching on their video function. Anyone can take part; all we ask for is a commitment to basic human rights.These meetings have been fruitful and educational for all involved, and friends from other countries, some equally affected by conflict, have joined. We have not forgotten our friends in Myanmar and urge our international colleagues to support our global vision of treating all patients regardless of their political or ethnic background. We want to foster educational advancement as global physicians. Please join our meetings.We declare no competing interests. We thank our colleagues in Myanmar, particularly Myo, for their contributions to this Correspondence.To join the online meetings see https://www.carematters.de We are writing as European physicians who have established working relationships with colleagues in Myanmar over the past 10 years. Friendships have developed through these relationships. We have all learned from each other, clinically and culturally. We have paid regular visits to Mandalay and other cities to teach surgery and conduct surgical courses, and our Burmese colleagues have visited our clinics to advance their surgical skills. The aim of our exchange has been to teach the teachers of medicine. In otolaryngology, our area of expertise, a main goal is to improve hearing and improve quality of life with cochlear implants for patients (mainly children) who are deaf. Lucy, now aged 4 years old, was born deaf and diagnosed during our most recent visit to Mandalay in January, 2020. Since that visit, Lucy has received a cochlear implant delivered by our Burmese colleague, and videos of Lucy talking and counting in Burmese and English make us very proud of her and the international community working together. We have not been able to meet our colleagues and friends in person since 2020, both as a consequence of the COVID-19 pandemic and, primarily, because of the Feb 1, 2021 military coup.1BBCMyanmar coup: Aung San Suu Kyi detained as military seizes control.https://www.bbc.com/news/world-asia-55882489Date: Feb 1, 2021Date accessed: October 2, 2022Google Scholar Our colleagues in Myanmar are now suffering—they use words such as hell to describe the situation. Battles mainly occur in rural areas; however, there are also gunfights and frequent bomb threats in the biggest cities.2Win S Aung KK Stylianou N The deadly battles that tipped Myanmar into civil war.https://www.bbc.co.uk/news/world-asia-60144957Date: Feb 1, 2022Date accessed: October 2, 2022Google Scholar Physicians committing to the Civil Disobedience Movement (CDM) are trying to provide health care remotely and in person within battle areas—the latter of course being extremely dangerous as health-care workers risk being arrested by the military.3Tatum M Escalating threats to health workers in Myanmar.Lancet. 2022; 399: 619Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar The Ministry of Health, controlled by the military, holds a list of health-care workers in those areas of conflict so they cannot leave the country or renew their passports because they are on blacklists. The only way to leave is by crossing the border to Thailand as refugees. Fortunately, the exact location of our colleagues within the country is unknown. Universities and hospitals are military-controlled areas4Head J Myanmar coup: the doctors and nurses defying the military.https://www.bbc.co.uk/news/world-asia-59649006Date: Jan 7, 2022Date accessed: October 2, 2022Google Scholar and health care is provided by non-CDM health-care staff to patients on the non-CDM side only—that is, to those collaborating with or accepting the military rule. Although some physicians are committed to the CDM, other colleagues are collaborating with the military for various reasons—for example, to protect their own family. We must keep in mind that the main goal of any physician, whatever side of the conflict she or he may be on, should be to comply with the Declaration of Geneva and help patients regardless of their relation to the conflict.5UN Security CouncilSecurity Council adopts Resolution 2286 (2016), strongly condemning attacks against medical facilities, personnel in conflict situations.https://www.un.org/press/en/2016/sc12347.doc.htmDate: May 3, 2016Date accessed: October 2, 2022Google Scholar We have been asking ourselves, how can we be most helpful? We have even wondered whether to pause our work with our Burmese colleagues and establish relationships with another country. But one cannot abandon friends and colleagues. Instead, we established weekly online meetings during which medical questions can be asked and discussed in a group. Participants can remain anonymous by joining the calls without using their real names and without switching on their video function. Anyone can take part; all we ask for is a commitment to basic human rights. These meetings have been fruitful and educational for all involved, and friends from other countries, some equally affected by conflict, have joined. We have not forgotten our friends in Myanmar and urge our international colleagues to support our global vision of treating all patients regardless of their political or ethnic background. We want to foster educational advancement as global physicians. Please join our meetings. We declare no competing interests. We thank our colleagues in Myanmar, particularly Myo, for their contributions to this Correspondence. To join the online meetings see https://www.carematters.de To join the online meetings see https://www.carematters.de To join the online meetings see https://www.carematters.de

As for hypertension, chronic pain, epilepsy and other disorders with particular symptoms, a commonly accepted and unambiguous definition provides a common ground for researchers and clinicians to study and treat the problem. The WHO's ICD11 definition only mentions tinnitus as a nonspecific symptom of a hearing disorder, but not as a clinical entity in its own right, and the American Psychiatric Association's DSM-V doesn't mention tinnitus at all. Here we propose that the tinnitus without and with associated suffering should be differentiated by distinct terms: "Tinnitus" for the former and "Tinnitus Disorder" for the latter. The proposed definition then becomes "Tinnitus is the conscious awareness of a tonal or composite noise for which there is no identifiable corresponding external acoustic source, which becomes Tinnitus Disorder "when associated with emotional distress, cognitive dysfunction, and/or autonomic arousal, leading to behavioural changes and functional disability.". In other words "Tinnitus" describes the auditory or sensory component, whereas "Tinnitus Disorder" reflects the auditory component and the associated suffering. Whereas acute tinnitus may be a symptom secondary to a trauma or disease, chronic tinnitus may be considered a primary disorder in its own right. If adopted, this will advance the recognition of tinnitus disorder as a primary health condition in its own right. The capacity to measure the incidence, prevalence, and impact will help in identification of human, financial, and educational needs required to address acute tinnitus as a symptom but chronic tinnitus as a disorder.

Einleitung Subjektiver Tinnitus ist eine Wahrnehmung von Geräuschen oder Tönen ohne das Vorhandenseins eines Stimulus. Aufgrund der Heterogenität dieses Patientenkollektives existiert kein einheitliches Therapiekonzept. Zahlreiche Studien zeigten Zusammenhänge zwischen somatischen Manövern der Halswirbelsäule und des Kiefergelenks und der Tinnituswahrnehmung. Daher wurde die Idee entwickelt, Lidocain-Injektionen an trigeminalen Strukturen therapeutisch einzusetzen. Methoden: Die Daten von zwei Untersuchungen mit 19 und 20 im HNO-Zentrum Traunstein behandelten Patienten wurden retrospektiv durch das Universitätsklinikum Regensburg ausgewertet. Nach drei Injektionen in anatomischer Nähe zum Ganglion oticum und zum Ganglion trigeminale über einen enoralen Zugang erfolgte eine Beobachtung über 12 Wochen. Neben möglichen Veränderungen der subjektiven Tinnitusbeschwerden wurden eventuell vorhandene Nebenwirkungen erfasst. Ergebnisse: Wir konnten zeigen, dass Patienten bei nur geringfügig vorhandenen Nebenwirkungen eine Reduktion der Tinnitusbeschwerden in beiden Studien hatten. Der Effekt auf den TQ und den CGI Score war höher bei Patienten mit Kopfschmerzen als bei denen ohne Kopfschmerzsymptomatik. Schlussfolgerung: Die Analyse zeigt, dass durch Injektionen in die Region von trigeminalen Strukturen Veränderungen der Tinnitusbeschwerden erzielt werden können. In einer weiteren Untersuchung erfolgte eine Placebo-kontrollierte Gabe, um die Effekte detaillierter zu untersuchen, und mit diesen Ergebnissen dann diesen neuen Therapieansatz genauer zu evaluieren.

Introduction Tinnitus is defined as the perception of noise without an acoustic stimulus. Due to the heterogenity among the group of tinnitus patients there is a lack of an unique therapeutic concept. Many studies showed associations between somatic manouvers of the neck and the temporomandibular joint and perception of tinnitus. Therefore, the concept of a therapeutic use of injections of lidocain in trigeminal structures was developed.

Tinnitus is defined as the perception of noise without an external acoustic stimulus. Due to the heterogeneity of tinnitus, no treatment has proven equally beneficial to every single of these patients. Previous studies have shown that trigeminal input can interfere with the perception of tinnitus. Therefore, we aimed to explore the therapeutic potential of lidocaine injections in trigeminal structures. We conducted a pilot study with 19 participants to explore feasibility and tolerability of this approach. The intervention consisted of three injections of lidocaine in the anatomical area of the trigeminal ganglion and the ganglion oticum via an oral approach corresponding to the affected side of tinnitus. We performed an assessment that included the Mini-TQ, CGII, and numeric rating scales of tinnitus loudness and severity at different time points over a follow-up period of 12 weeks. In addition to changes of subjective tinnitus complaints, potential adverse events were documented. Patients were treated at the Centre of Otorhinolaryngology in Traunstein, Germany, and data were analyzed at the University of Regensburg, Germany. We did not observe any relevant side effects. There was a significant reduction of tinnitus distress (Mini-TQ, Tinnitus severity) and loudness (measured subjectively) over time. Our pilot data suggests that lidocaine injections targeting trigeminal structures may be able to reduce tinnitus complaints. Future studies should investigate the effects of lidocaine injections in placebo-controlled trials in an extended sample size to further explore the potential benefits of this therapeutic approach on tinnitus.

This paper discusses otorhinolaryngological symptoms associated with functional disorders of the upper cervical spine. Hints aimed to avoid misdiagnoses of cross-organ otorhinolaryngological symptoms as phobic or psychogenic disorders are presented. Clinically relevant neuroanatomical convergence of the upper cervical spine (occiput to C3) is fundamental for the interpretation of functional otorhinolaryngological symptoms. Based thereon, evidence for the most common cervical differential diagnoses of dizziness, tinnitus, dysphagia, and craniomandibular dysfunction is presented separately. The corresponding therapeutic options and their contraindications are discussed in the concluding chapter. The importance of interdisciplinary cooperation in related fields is emphasized.

Zusammenfassung Wie das Beispiel eines kleinen Teams – in Myanmar seit 2010 tätig – zeigt, ist mit relativ wenig Aufwand eine nachhaltige Arbeit hinsichtlich Aus- und Weiterbildung, hier in der Mittelohrchirurgie, im Ausland möglich. Voraussetzungen hierfür sind hervorragende Kommunikation des Teams untereinander und mit den Kolleginnen und Kollegen, Behörden und Organisatoren vor Ort, ein achtsames und rücksichtsvolles Arbeiten im Gastland, die kulturellen Besonderheiten berücksichtigend, der interkulturelle Austausch und insbesondere die Motivation der Kolleginnen und Kollegen im Gastland. Verbunden mit einem verlässlich regelmäßigen gegenseitigen Besuch kann eine konstante fachliche Entwicklung entsprechend den aktuellen Bedürfnissen entstehen.

Eine 65-jährige Frau stellte sich in unserer Praxis mit rezidivierenden Beschwerden am rechten Ohr vor. Sie gab an, seit 6 Jahren ein Druckgefühl und Otorrhö zu haben, Fieber oder Schmerzen wurden verneint. Zudem litt sie seit 1 Jahr unter intermittierenden Schwindelanfällen. Das linke Ohr war nicht betroffen.

Der vorliegende Artikel beschäftigt sich mit denjenigen Symptombildern aus dem HNO-ärztlichen Behandlungsgebiet, die auf funktionelle Störungen der oberen Halswirbelsäule zurückgeführt werden können. Es werden Hinweise gegeben, wann Vorsicht geboten ist, organübergreifende HNO-Symptome vorschnell als phobisch oder psychogen einzustufen. Als Grundlage für funktionelle Symptome im HNO-Bereich werden einleitend die klinisch relevanten neuroanatomischen Konvergenzen der oberen Halswirbelsäule (Okziput bis C3) aufgezeigt. Darauf aufbauend werden separat empirische und evidenzbasierte Charakteristika der wichtigsten zervikalen Differenzialdiagnosen von Schwindel, Tinnitus, Schluckstörungen und kraniomandibulärer Dysfunktion dargestellt. Die zugehörigen Therapieoptionen und deren Kontraindikationen werden im abschließenden Kapitel abgehandelt. Hervorgehoben wird die Bedeutung der interdisziplinären Zusammenarbeit der angrenzenden Fachgebiete.

Übereinstimmende Annahme ist, dass die subjektive Vertikale (SV) aus einer multimodalen Sensorintegration resultiert. Um die zervikalvestibuläre Sensorkompetenz für die SV besser einschätzen zu können, war es Ziel der Pilotstudie, unter lotrechter Kopffixierung eine isolierte subjektive Rumpfvertikale (SRV) zu bestimmen.

Zusammenfassung Der vorliegende Artikel beschäftigt sich mit denjenigen Symptombildern aus dem HNO-ärztlichen Behandlungsgebiet, die auf funktionelle Störungen der oberen Halswirbelsäule zurückgeführt werden können. Es werden Hinweise gegeben, wann Vorsicht geboten ist, organübergreifende HNO-Symptome vorschnell als phobisch oder psychogen einzustufen. Als Grundlage für funktionelle Symptome im HNO-Bereich werden einleitend die klinisch relevanten neuroanatomischen Konvergenzen der oberen Halswirbelsäule (Okziput bis C3) aufgezeigt. Darauf aufbauend werden separat empirische und evidenzbasierte Charakteristika der wichtigsten zervikalen Differenzialdiagnosen von Schwindel, Tinnitus, Schluckstörungen und kraniomandibulärer Dysfunktion dargestellt. Die zugehörigen Therapieoptionen und deren Kontraindikationen werden im abschließenden Kapitel abgehandelt. Hervorgehoben wird die Bedeutung der interdisziplinären Zusammenarbeit der angrenzenden Fachgebiete.

Since somatic or somatosensory tinnitus (ST) was first described as a subtype of subjective tinnitus, where altered somatosensory afference from the cervical spine or temporomandibular area causes or changes a patient's tinnitus perception, several studies in humans and animals have provided a neurophysiological explanation for this type of tinnitus. Due to a lack of unambiguous clinical tests, many authors and clinicians use their own criteria for diagnosing ST. This resulted in large differences in prevalence figures in different studies and limits the comparison of clinical trials on ST treatment. This study aimed to reach an international consensus on diagnostic criteria for ST among experts, scientists and clinicians using a Delphi survey and face-to-face consensus meeting strategy. Following recommended procedures to gain expert consensus, a two-round Delphi survey was delivered online, followed by an in-person consensus meeting. Experts agreed upon a set of criteria that strongly suggest ST. These criteria comprise items on somatosensory modulation, specific tinnitus characteristics, and symptoms that can accompany the tinnitus. None of these criteria have to be present in every single patient with ST, but in case they are present, they strongly suggest the presence of ST. Because of the international nature of the survey, we expect these criteria to gain wide acceptance in the research field and to serve as a guideline for clinicians across all disciplines. Criteria developed in this consensus paper should now allow further investigation of the extent of somatosensory influence in individual tinnitus patients and tinnitus populations.

The majority of tinnitus patients are affected by chronic idiopathic tinnitus, and almost 60 different treatment modalities have been reported. The present study is a multidisciplinary systematic analysis of the evidence for the different forms of treatment for chronic tinnitus. The results are used to form the basis of an S3 guideline. A systematic search was carried out in PubMed and the Cochrane Library. The basis for presenting the level of evidence was the evidence classification of the Oxford Centre of Evidence-based Medicine. Whenever available, randomised controlled trials were given preference for discussing therapeutic issues. All systematic reviews and meta-analyses were assessed for their methodological quality, and effect size was taken into account. As the need for patient counselling is self-evident, specific tinnitus counselling should be performed. Due to the high level of evidence, validated tinnitus-specific, cognitive behavioural therapy is strongly recommended. In addition, auditory therapeutic measures can be recommended for the treatment of concomitant hearing loss and comorbidities; those should also be treated with drugs whenever appropriate. In particular, depression should be treated, with pharmacological support if necessary. If needed, psychiatric treatment should also be given on a case-by-case basis. With simultaneous deafness or hearing loss bordering on deafness, a CI can also be indicated. For auditory therapeutic measures, transcranial magnetic or direct current stimulation and specific forms of acoustic stimulation (noiser/masker, retraining therapy, music, and coordinated reset) for the treatment of chronic tinnitus the currently available evidence is not yet sufficient for supporting their recommendation.