Hauptstudie zur Erfassung von interindividuellen und intraindividuellen Effekten adjuvanter rezeptiver medizinischer Musiktherapie bei Glaukompatienten( glaucoma chronicum simplex )

Das Glaukom ist eine chronische und potenziell zur Erblindung führende Erkrankung multifaktorieller Äthiologie. Neben einem individuell zu hohen Augeninnendruck aufgrund eines erhöhten Abflusswiederstandes des Kammerwassers im Trabekelmaschenwerk ( Flammer, 2008 ) und einer verminderten okulären Dur...

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Bibliographic Details
Main Author: Bertelmann, Thomas
Contributors: Strempel, Ilse (Prof. Dr.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2009
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Table of Contents: Glaucoma is a chronic and a potentially blinding disease showing a multifactorial etiology. Pathogenetic factors disclose an elevated intraocular pressure, resulting mainly from elevated outflow resistance of aqueous humor in the trabecular meshwork ( Flammer, 2008 ), a minor ocular blood supply, caused by a primary vascular dysregulation ( PVD ) ( Flammer, 2008 ), and exceptionally a modified mental health due to a chronic mental stress exposure ( Erb, 1998; Strempel, 2009 ). Music therapy in Ophthalmology and especially as an adjuvant treatment option for patients, suffering from a diagnosed primary open angel glaucoma, is a world - wide novelty. Investigations, that have been performed at the University Eye Clinic in Marburg in the last two decades, show a beneficial effect of relaxation methods like autogenous training and hypnosis. As these methods revealed to be beneficial only for several patients, we searched for a general method that is helpful for every patient. For this purpose we created a new concept of music medicine especially for glaucoma patients. Further studies could not be found in the international literature. Music therapy can induce a profound state of stress relief in glaucoma patients, which has a beneficial influence on the development and the progression rate of glaucomatous optic atrophy. Previous pilot studies in Marburg had shown promising results in patients, receiving medical music therapeutic treatment, regarding e.g. lowering of intraocular pressure ( IOP ), increase of ocular blood flow ( OBF ) and improvement of the mental status ( Strempel, 2004, 2009; Eschstruth, 2004; Dippel, 2008 ). The purpose of our investigation was to show the interindividual and intraindividual effects of medical music therapy in patients with a diagnosed primary open angle glaucoma. Our study disclosed beside a treated group a control group, that was lacking in the studies mentioned above. As far as we know, this is the first investigation world - wide on music therapy in glaucoma patients, comparing the therapeutic effects between a treated and a control group immediately. We analysed the effects of music therapy on visual acuity ( V ), intraocular pressure ( IOP ), different biofeedback parameters ( EMG, SC, VP ) and subjective well - being. These parameters had been targets of interest in the pilot studies as well. Combined with the results of our study, the beneficial effects of music therapy has now been shown on a plenty of patients in three different studies. In our study we further investigated as an innovation the effects of music therapy on the blood count, on blood levels of different stress hormones ( Epinephrine, Norepinephrine, Cortisol, Testosterone, Endothelin ) and on cerebral effects by recording cerebral activity with electroencephalography ( EEG ).The CD, we used in our study, was a synergistic composition of relaxing inducing music elements in heart beat rhythm ( 60 beats/ per minute ), subliminal binauricular beats, texts for breathing and relaxation, instructions for visualisation and elements of the progressive muscle relaxation due to Jacobson. Our study is a monocenter, prospective, randomised trial. A total of 41 Patients with a diagnosed primary open angel glaucoma were enrolled, 26 into the therapy group, 15 into the control group. Each patient had to show up for ten consecutive days at the same day time. Each day, the examination period was round about 30 minutes. As patients in the therapy group received the music therapy via headphones, the control group were asked to relax without any support. Additionally all test persons had an appointment before and after the ten day investigation period. On both visits a visual acuity testing, a visual field testing and a water drinking test, this is a provocative test for IOP, were performed. On all ten days of the study phase we measured the IOP and performed a test for short term mental well - being ( KAB ) before and after the thirty minute study interval. During the study interval the biofeedback evaluation was performed. At days one and ten we took in both groups before and after the 30 minute interval over all four blood samples of each patient. We performed the EEG on those days as well. The POMS - questionnaire, to ask the patients about their long term mental situation, was done at day one before and at day 10 after the 30 minute study interval. Our results, as immediate effects on the eyes, show a significant increase in best corrected visual acuity after the ten days of investigation in patients of the therapy group in comparison to patients from the control group. IOP declines during the 30 minute interval at all ten days in the therapy group whereas it increases in the control group. There were statistic significant difference between both groups, except day seven. The water drinking test reveals minor fluctuations in IOP in the therapy group compared with the control group. Especially huge circadian variations in IOP, that can be unmasked in the water drinking test, are responsible for a fast progression of glaucomatous optic nerve damage. The results of the visual field testing show an improvement in the therapy group by trend but without statistic significance. Concerning the effects of music therapy on physiological parameters our results show differences in the galvanic skin response between patients from both groups, indicating a deeper relaxation in the treated group. In the therapy group patients had a greater reduction of the skin conductance during the thirty minute interval in comparison to probands from the control group. For long term and short term effects there are often significant differences between both groups. Concerning the electromyographie ( EMG ) and the volume puls ( VP ) we found inconsistent results between both groups. ForEMG and SC we could show a correlation between the underlying binauricular beats of the relaxation inducing music and results of the voltage of EMG and VP though, so that there is evidence of an immediate effect of the underlying beats to physiological parameters. Concerning the effects of music therapy on mental health and stress levels our results show in the daily performed test ( KAB ) oftentimes a significant difference in the short term and long term effect between both groups. Patients receiving our relaxation inducing music are less stressed and show a better well - being. The long term test ( POMS ) shows a stronger improvement of mental status in the therapy group than in the control group by trend. Concerning the effects of music therapy on neuro - endocrine parameters our results show in the long and short term comparison a stronger decrease of epinephrine blood levels in the therapy group than in the control group by trend. The blood levels of Cortisol were decreased in the therapy group after ten days by trend, but without a statistical significant difference. The blood levels of Norepinephrin, Testosterone and Endothelin as well as the different parameters of the blood count show inconsistant results in both groups; the intra - and interindividuall variations among patients are too different. The results of the electroencephalography ( EEG ) could not be integrated into the present analysis because of the huge amount of the data material. They will be published later separately. In summary our results show, that medical music therapy has a straight beneficial influence on physiological parameters, which are in interrelation with the occurrence and the progression rate of glaucomatous optic atrophy. Music therapy shows not only a beneficial effect by slowing the progression rate of the optic nerve damage but also an improvement of precise physiological parameters ( visual acuity, visulal field ). Music therapy has further a direct influence on the individual mental status and the level of well - being in glaucoma patients. Music therapy as a nonexpensive, adjuvant therapeutic option in a broad treatment concept of patients with a primary open angel glaucoma has no negative side effects. Patients can treat themselves easily anytime and everywhere. Music therapy has an tremendous impact on the social economic sector by reducing the overall expenses for glaucoma patients to a great extent. It especially achives sustained success in improving life quality of glaucoma patients. Music therapy is therefore not an elective adjuvant therapeutic option, but a should in a good and broad therapeutic concept for glaucoma patients.