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DGDispatch 
Surgical Microvascular Decompression of Cochlear Nerve Relieves Tinnitus: Presented at AANSBy W. A. Thomasson Special to DG News CHICAGO, IL -- April 11, 2002 -- Surgical removal of small blood vessels that compress the cochlear nerve appears to improve and even cure otherwise intractable tinnitus. Yong Ko, MD, PhD, and his colleagues at Hanyang University Medical Center, in Seoul, Korea, reported the findings here Tuesday at the annual meeting of the American Association of Neurological Surgeons. The American Tinnitus Association estimates that 2 million Americans are so debilitated by the condition that they cannot function on a day-to-day basis, Dr. Ko noted. Dr. Ko and colleagues used microvascular cochlear nerve decompression to treat 187 patients with otherwise intractable tinnitus between 1996 and 1999. Hanyang University is the only institution in Korea performing this procedure, he said. All these patients had tinnitus throughout the day and had not responded to at least six months of medical therapy. None had previous otologic surgery for their condition. Magnetic resonance imaging supported the likelihood of vascular compression. Following surgery, 30 percent of the patients achieved reduction in tinnitus of at least 75 percent, which the researchers considered to be excellent outcome; 49 percent experienced a 50-74 percent decrease in tinnitus (good outcome). As follow-up was extended from one year to more than two years, there was a tendency for patients to move from the extreme groups (excellent or poor outcome) to the middle groups (good or fair). Dr. Ko believes that the improvement in patients with initially poor outcome is due to the time it takes for the nerve to recover from compression. Patients under the age of 40 years and those with tinnitus duration of less than six years had statistically better outcomes than other patients. A loop configuration of the artery was also associated with better outcome, as was normal brainstem auditory evoked potential. A physician in the audience expressed amazement that Dr. Ko and his colleagues had been able to perform 187 procedures - in his practice, he has yet to see a tinnitus patient. Perhaps American otolaryngologists need to be educated about the potential of surgical relief when all else fails, he said.
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