Ergebnisse der Tinnitustherapie mit der Lidocain-Jontophorese

Welkoborsky, Hans-J.; Bumb, P.

doi:10.1055/s-2007-998500

Cited by 3 publications

(1 citation statement)

References 14 publications

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“…An der 1956 von Meyer zum Gottesberge gemachten Aussage «Der Tinnitus ist eine crux für den Patienten, eine crux aber auch für den behandelnden HNO-Arzt, der mit seinen Bemühungen den Beschwerden seines Patien ten weitgehend machtlos gegenüber steht» hat sich bis heute nicht viel geändert, da bis dato für die Symptom kontrolle Tinnitus keine in jeder Hinsicht rational über zeugende Therapie zur Verfügung steht [7][8][9][10][11][14][15][16][17][18][19][20][21][22][23][24], Dies beruht unter anderem auf der auch bisher noch weit gehend ungeklärten Ätiopathogenese des Symptoms Tin nitus und der Vielzahl der pathophysiologischen Erklä rungsmodelle, wobei Defekte auf cochleärer, neuraler oder zentralauditorischer Ebene diskutiert werden [8,25- [7,9,[14][15][16]22], Nach wie vor muss es Ziel einer Tinnitus-spezifischen Therapie sein, den pathophysiologischen Prozess zu be einflussen. Da bisher aber weder ein Tinnitus-spezifisches experimentelles Modell existiert, noch eine Objektivie rung des Symptoms Tinnitus möglich ist, und die patho physiologischen Prozesse nach wie vor ungeklärt sind, müssen auch weiterhin alle Therapieansätze als empirisch angesehen werden.…”

Section: Diskussionunclassified

Erfahrungen aus der Tinnitussprechstunde

Saumweber¹,

Wilhelm

Arnold³

1995

Otorhinolaryngol Nova

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In Zeitraum von 1993-1994 wurden an der HNO-Klinik der TU MÜnchen 188 Patienten mit seit lÄnger als 6 Monaten bestehendem Tinnitus im Rahmen einer Tinnitussprechstunde betreut. Alle Patienten hatten vorher eine durchblutungsfÖrdernde Infusionstherapie erhalten, ohne dass subjektiv eine Beschwerdebesserung eingetreten ware. Es wird Über Altersverteilung, Tinnituscharakter, subjektiv empfundene Tinnituslautheit sowie Über Ursachen des Tinnitus bei dem Patientenkollektiv berichtet. Trotz der z.T. frÜher bei HNO-Ärzten durchgefÜhrten Diagnostik konnten bei 8% der Patienten als Ursachen Glomustumore, GefÁssanomalien und SchilddrÜsenerkrankungen erstmals im Rahmen der Tinnitussprechstunde diagnostiziert werden. Trotz frÜherer Therapieversuche konnte mit einer nochmaligen individuellen medikamentÖsen Therapie bei 6 von 47 Patienten mit chronischem Tinnitus eine audiometrisch belegbare Tinnitusbesserung erreicht werden.

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Section: Diskussionunclassified

Erfahrungen aus der Tinnitussprechstunde

Saumweber¹,

Wilhelm

Arnold³

1995

Otorhinolaryngol Nova

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The effect of lidocaine iontophoresis for the treatment of tinnitus: a systematic review

Bülow

Best

Brugger

et al. 2022

Eur Arch Otorhinolaryngol

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Purpose Tinnitus is a common symptom with multiple causes and treatment options. Previous studies have investigated the effect of lidocaine iontophoresis. The aim of this review is to systematically present the effects on tinnitus and to derive possible effects. Methods In accordance to the PRISMA statement, the search and analysis were performed. An abstract in German or English and a performed intervention with lidocaine iontophoresis for the treatment of tinnitus, independent of the study design, were considered as inclusion criteria. Due to the heterogeneity of the studies, only a narrative synthesis was performed. Results The search yielded 179 studies of which 170 were excluded. Six full-texts and three abstracts were included. In total, 957 patients were treated with lidocaine iontophoresis. The percent improvement in symptoms after lidocaine iontophoresis ranged from 4% to 62%. The qualitative assessment of the studies resulted in an overall “weak” rating for all of them. Conclusions Due to the heterogeneity and the limited quality of the studies found, no clear statement can be made about the efficacy. The number of those who benefited from therapy varied widely. In addition, it cannot be ruled out that the effect was merely due to electrical stimulation of the cochlea.

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Drug delivery across the skin

Cevc

1997

Expert Opinion on Investigational Drugs

111

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Since the introduction of the first through the skin (TTS) therapeutic in 1980, a total of 34 TTS products have been marketed and numerous drugs have been tested by more than 50 commercial organisations for their suitability for TTS delivery. Most of the agents which have been tested have had low molecular weights, due to the impermeability of the skin barrier. This barrier resides in the outermost skin layer, the stratum corneum. It is mechanical, anatomical, as well as chemical in nature; laterally overlapping cell multi-layers are sealed by tightly packed, intercellular, lipid multi-lamellae. Chemical skin permeation enhancers increase the transport across the barrier by partly solubilising or extracting the skin lipids and by creating hydrophobic pores. This is often irritating and not always well-tolerated. The TTS approach allows drugs (< 400 kDa in size) to permeate through the resulting pores in the skin, with a short lag-time and subsequent steady-state period. Drug bioavailability for TTS delivery is typically below 50%, avoiding the first pass effect. Wider, hydrophilic channels can be generated by skin poration, with the aid of a small electrical current (> 0.4 mA/cm2) across the skin (iontophoresis) or therapeutic ultrasound (few W/cm2; sonoporation). High-voltage (> 150 V, electroporation) widens the pores even more and often irreversibly. These standard poration methods require experience and equipment and are therefore, not practical; at best, charged/small molecules (< or = 4000 kDa in size) can be delivered efficiently across the skin. In spite of the potential harm of gadget-driven skin poration, this method is used to deliver molecules which conventional TTS patches are unable to deliver, especially polypeptides. Lipid-based drug carriers (liposomes, niosomes, nanoparticle microemulsions, etc.) were proposed as alternative, low-risk delivery vehicles. Such suspensions provide an improved drug reservoir on the skin, but the aggregates remain confined to the surface. Conventional carrier suspensions increase skin hydration and/or behave as skin permeation enhancers. The recently developed carriers; Transferomes, comprise pharmaceutically-acceptable, established compounds and are thought to penetrate the skin barrier along the naturally occurring transcutaneous moisture gradient. Transfersomes are believed to penetrate the hydrophilic (virtual) channels in the skin and widen the former after non-occlusive administration. Both small and large hydrophobic and hydrophilic molecules are deliverable across the stratum after conjugation with Transfersomes. Drug distribution after transdermal delivery probably proceeds via the lymph. This results in quasi-zero order kinetics with significant systemic drug levels reached after a lag-time of up to a few hours. The relative efficiency of TTS drug delivery with Transfersomes is typically above 50 %; with the added possibility of regional drug targeting.

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Ergebnisse der Tinnitustherapie mit der Lidocain-Jontophorese

Cited by 3 publications

References 14 publications

Erfahrungen aus der Tinnitussprechstunde

Erfahrungen aus der Tinnitussprechstunde

The effect of lidocaine iontophoresis for the treatment of tinnitus: a systematic review

Drug delivery across the skin

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