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[Compensation for tinnitus in private accident insurance]. Laryngorhinootologie. 2007 Jan;86(1):27-36. [Article in German]. Michel O, Brusis T Klinik und Poliklinik fur Hals-Nasen-Ohren-Heilkunde, Universität zu Koln, Koln. Michel@uni-koeln.de

According to the provisions of private accident insurance, mental or psychic reactions are excluded from compensation. Until now, tinnitus was taken as fully psychic and therefore excluded. In two recently published judgments of the Federal Supreme Court in Germany the assessment of tinnitus in private accident insurance and particularly the exclusion clause section sign 2 Abs. 4 AUB 88 has been newly defined. According to this actual jurisdiction the compensation of tinnitus could be possible, when as phy- sical underlying reason a proved harm in the inner ear or the auditory pathway (hearing loss), which can be traced back to the accident according to the rules of causality. This leads to the question how Tinnitus could be compensated without modification of the general terms and conditions of the private accident insurance. A compensating table is proposed, which recognizes the somatic (physical) part of tinnitus and is based on medical and scientific findings of the relation between hearing loss and tinnitus.

Hyperbaric oxygen for idiopathic sudden sensorineural hearing loss and tinnitus. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD004739. Bennett M, Kertesz T, Yeung P

Background: Idiopathic sudden sensorineural hearing loss (ISSHL) with or without tinnitus is com- mon and presents a health problem with significant effect on quality of life. Hyperbaric oxygen therapy (HBOT) may improve oxygen supply to the inner ear and, it is postulated, may result in an improvement in hearing and/or a reduction in the intensity of tinnitus. Objectives: To assess the benefits and harms of HBOT for treating ISSHL and/or tinnitus. Search strategy: We initially searched in June 2004 and repeated the search in June 2006. Our search included the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Re- gister of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2 2006), MEDLINE (1951 to 2006), EMBASE (1974 to 2006), CINAHL, Database of Randomised Trials in Hyperbaric Medicine (DORC- THIM), AMED, LILACS, KOREAMED, INDMED, National Research Register (NRR), CSA, ISI PROCEE- DINGS and ZETOC. Selection criteria: Randomised studies comparing the effect on ISSHL and/or tinnitus of therapeutic regimens which include HBOT with those that exclude HBOT. Data collection and analysis: Three authors independently evaluated the quality of the relevant trials using the validated Oxford-Scale (Jadad 1996) and extracted the data from the included trials. Main results: Six trials contributed to this review (308 subjects). Pooled data from two trials involving 114 patients did not show any significant improvement in the chance of a 50% increase in hearing thres- hold on Pure Tone Average (PTA) when HBOT was used (relative risk [RR] with HBOT 1.53, 95% CI 0.85 to 2.78, P = 0.16), but did show a significantly increased chance of a 25% increase in PTA (RR 1.39, 95% CI 1.05 to 1.84, P = 0.02). There was a 22% greater chance of improvement with HBOT, and the number needed to treat (NNT) to achieve one extra good outcome was five (95% CI 3 to 20). A single trial involving 50 subjects also suggested significantly more improvement in the mean PTA threshold with HBOT, expressed as a percentage of baseline (WMD 37%, 95% CI 22% to 53%, P < 0.001). The signifi- cance of any improvement following HBOT in a subjective rating of tinnitus could not be assessed due to poor reporting. There were no significant improvements in hearing or tinnitus reported in the single study to examine chronic presentation (six months) of ISSHL and/or tinnitus. Authors conclusion: For people with early presentation of ISSHL, the application of HBOT significantly improved hearing loss, but the clinical significance of the level of improvement is not clear. We could not

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