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Revista de otorrinolaringología y cirugía de cabeza y cuello

versión On-line ISSN 0718-4816

Resumen

PENA M, Alejandro. Physiopathological bases of subjective tinnitus treatment: Role of the efferent auditory system. Rev. Otorrinolaringol. Cir. Cabeza Cuello [online]. 2008, vol.68, n.1, pp.49-58. ISSN 0718-4816.  http://dx.doi.org/10.4067/S0718-48162008000100008.

Tinnitus is, at present, a problem of difficult solution for the ENT specialist. Current knowledge makes easier to discern peripheral from central tinnitus, with the latter being by far more common. Tinnitus is triggered by a GABA-glutamate imbalance of the afferent auditory system. As a consequence of this, a neuronal reorganization of the auditory cerebral cortex takes place, by neural plasticity secondary toiglutamate excitotoxicity resulting thus in an "auditory epilepsy". This imbalance could originate in a dysfunction of the efferent auditory system, which could be caused by damage of the outer hair cells that regulate basilar membrane movement. This would result in excessiveiglutamate release by the inner hair cells. in addition, there is a pathological dynorphin post-synaptic peripheral release, through the olivocochiear lateral efferent fibers; which could lead to an enhancement of NMDA receptor- mediated synaptic transmission. in addition to habituation techniques, therapeutic choices could be: a) to pharmacologically correct the GABA-glutamate imbalance. At present, there are some drugs that might modify, in some cases, this imbalance; b) to act directly over the cortical hyperactive auditory locus by means of electrical stimuli, thus inhibiting its activity. However, our current knowledge on this topic does not provide a suitable solution for most patients suffering from tinnitus

Palabras clave : Tinnitus treatment; neurotransmitters in auditory pathways; efferent auditory system.

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