Clonazepam in the pharmacological treatment of vertigo and tinnitus

We carried out a retrospective survey of 25 years of clinical experience with the use of clonazepam as a vestibular and tinnitus suppressant in the pharmacological treatment of vestibular or cochleovestibular disorders due to different causes. We reviewed the medical records of 3,357 outpatients treated with a 0.5 or 1.0-mg daily dosage of oral clonazepam during 60-180 days. Complete or substantial control of vertigo or nonvertiginous dizziness was achieved in 77.4% of the vertigo patients. Tinnitus was improved in 32.0% of the tinnitus patients. Light or mild drowsiness, depression, nightmares, or lowering of libido, reported by 16.9% of the patients as adverse side effects, tended to subside with continued therapy. We concluded that clonazepam is a very useful and safe drug for the symptomatic treatment of patients suffering from cochleovestibular disorders.

Intratympanic dexamethasone treatment for control of subjective idiopathic tinnitus: our clinical experience

In this report, we summarize our clinical experience with intratympanic dexamethasone treatment (IDT) for control of tinnitus. From March 2000 through February 2001, we observed 54 patients (23 women, 31 men; mean age, 49.6 +/- 7.2 years; range, 24-71 years) suffering from subjective idiopathic tinnitus (SIT). After common audiological tests had been performed; all patients underwent specific topodiagnostic tests to verify the cochlear SIT genesis. The 50 subjects with positive results from a furosemide test and negative results from caraverine and carbamazepine tests were selected for the IDT, consisting of transtympanic perfusion of 4 mg dexamethasone to the round window via the middle ear. The treatment was repeated three times daily for 3 consecutive months. Its short-term effects were evaluated 2 weeks after the last perfusion. In 17 of 50 of these patients (34%), the SIT disappeared; 20 of the 50 (40%) reported a significant decrease of the symptom; and the remaining 13 of the 50 (26%) did not experience any improvement. Therefore, we believe that IDT represents an effective drug delivery system for SIT control, as long as the condition arises from inner ear disorders only and treatment occurs within 3 months of symptom onset.

Ménière's disease in childhood

We report 3 rare cases of Ménière's disease in children. In Case 1 and 3, vertigo, hearing loss and tinnitus recovered soon after medical therapy. In Case 2, however, vertigo recurred and the hearing level on the right side markedly deteriorated. The equal-loudness contours on three-dimensional audiogram showed that right-sided aggravated hearing loss fluctuated for 4 years at middle-and low-frequencies despite medication. Finally intratympanic injection of gentamicin sulfate was performed. The patient has had no definitive spell of vertigo after gentamicin therapy. At our department, the incidence of Ménière's disease in pediatric patients with vertigo was 2.9%.

A case of sensorineural deafness following ingestion of Ecstasy

Ecstasy is a substance of abuse commonly associated with the dance scene and taken by many young people. A brief history of Ecstasy and its side-effects is given. A case of ototoxicity is presented, as an additional side-effect to the long list of complications caused by Ecstasy.

Efficacy of amitriptyline in the treatment of subjective tinnitus

We investigated the effect of amitriptyline, a tricyclic antidepressant, on patients with subjective tinnitus. The study group consisted of 37 adult patients admitted to the Ear, Nose, and Throat and Audiology Department of Hacettepe University. The amitriptyline group consisted of 20 patients and the placebo group consisted of 17 patients. All of the patients were evaluated using a questionnaire, audiologic evaluation, high-frequency audiometry, impedancemetric tests, auditory brainstem response, tinnitus frequency, and loudness matching assessed by audiometric methods at the beginning and end of the study. The patients in the amitriptyline group received 50 mg/day amitriptyline in the first week and 100 mg/day for the following 5 weeks. In the placebo group, the patients received tablets consisting of lactose starch for 6 weeks, with a dosage of 1 tablet/day. The subjective complaints of the patients in the amitriptyline group decreased, and the "present" symptoms resulted in fewer complaints. The severity of tinnitus decreased in the amitriptyline group by means of subjective and audiometric methods. In the placebo group, no significant change was observed. The success of treatment was 95% in the amitriptyline group and 12% in the placebo group. Amitriptyline therapy was concluded to be effective.

Objective pulsatile tinnitus caused by intrapetrous dissecting aneurysm

Intrapetrosal dissections is a special kind of intracranial dissection since it is located intracranially but extradurally. Only three reports of spontaneous intrapetrosal dissection have been published so far, the posttraumatic intrapetrosal dissections caused by penetrating or blunt trauma not included. Based on the clinical and radiological presentation a treatment with anticoagulantia (a coumarine derivative) was successfully installed. A short review of the major studies concerning intracranial dissection is presented. Firm guidelines for the treatment cannot be provided based on these data but the etiology of the dissection, whether it was posttraumatic or spontaneous, seems to be important. The diagnostic problem of pulsatile tinnitus is briefly discussed.

The efficacy of medication on tinnitus due to acute acoustic trauma

Seventy-two young males suffering from acute acoustic trauma with tinnitus due to gunshots were included prospectively in the study. Forty of the subjects had the left ear affected, four the right ear and the remaining 28 sustained bilateral acoustic traumas. The mean time of admission after onset of symptoms was 28 days (5-88 days). The subjects were randomly categorized into three groups: group A received trimetazidine, prednisolone and complex B vitamins; group B were treated only with trimetazidine; and group C received prednisolone and complex B vitamins. At 3-month follow up, tinnitus had been completely eradicated in only eight subjects and had in 17. No statistically significant difference was found between the three groups concerning improvement of tinnitus. However, it was found that early admission predisposed towards better prognosis. The degree of hearing improvement after medication did not seem to correlate with the relief of tinnitus.

Intradermal injection vs. oral treatment of tinnitus

Local pharmacological intradermal infiltration is a therapy being used more and more thanks to the positive results achieved, particularly for all those therapies acting on the microcirculation. In trying to better the results obtained with medical therapy for tinnitus sufferers, to assess the effect of a vasoactive drug, the method of administration by the intradermal route, which allows a strengthening of the pharmacological effect, has been added. The present study comprised 120 tinnitus sufferers who underwent intradermal auricle infiltration with a vasoactive drug. The control group includes 115 tinnitus sufferers who underwent systemic vasoactive therapy with the same drug. Forty-five days after beginning intradermal treatment the symptom improved and continued to do so following further infiltrations which patients underwent every 15 days. In the control group we noticed a moderate improvement 45 days after the beginning of oral therapy; thereafter the results reached a plateau by the 60th day. Intradermal vasoactive therapy for idiopathic tinnitus seems to be a new success, which will be an interesting progression in the therapy of this kind of symptom.

Palatal myoclonus and clicking tinnitus in a 12-year-old girl--case report

Palatal myoclonus is a rare neurological disorder of the soft palate and other oropharyngeal muscles, which causes clicking tinnitus. The latter is audible both to the patient and to an observer. The aetiology may be a brain stem lesion, and it is only rarely that a cause cannot be identified. The condition has been described in adults, but seldom in children. We present here a case of palatal myoclonus with distressing tinnitus in a 12-year-old girl and its successful treatment with electromyography (EMG)-guided injections of Clostridium botulinum toxin.

Gabapentin for the treatment of tinnitus: a case report

The objective of this article is to discuss the clinically effective use of gabapentin in patients with tinnitus. The author describes the case of a man who came to the office complaining of tinnitus of 10 months' duration. The patient was started on gabapentin and maintained on a regimen of 500 mg/day in divided doses. Subsequently, he reported that he was free of tinnitus approximately 23 days a month and that he experienced a 75% decrease in symptoms during the remaining days. At 2 years' follow-up, he remains noise- and pain-free on 500 mg/day of gabapentin.

[Rheologic infusion therapy, neurotransmitter administration and lidocaine injection in tinnitus. A staged therapeutic concept]

BACKGROUND AND OBJECTIVE

Cochlear dysfunction and tinnitus are treated by means of hemorrheological infusions in order to increase the cochlear oxygen supply and restore function of hair cells, neurotransmission and central processing of auditory information.

PATIENTS/METHODS

In a retrospective analysis of the charts of 123 patients treated between February 1993 and May 1994, we analyzed effectiveness and safety of a gradual therapeutic regimen, consisting of dextrane/procaine infusions, lidocaine i.v. injection and infusion therapy with the neurotransmitter glutamic acid.

RESULTS

Tinnitus decreased in 83.7% of patients with acute tinnitus (AT) and 16.1% of patients with chronic tinnitus (CT) during dextrane/procaine infusion. The majority (89%) experienced their tinnitus relief during the first 5 days. Treatment with glutamic diethylester and glutamic acid resulted in a 26.5% overall improvement. Application of lidocaine intravenously over a period of 10 min diminished tinnitus loudness or frequency in 16.7% (AT) and 38.9% (CT) of cases respectively. The long-term effects of therapy were investigated by a follow-up mailing action: 66.7% of the AT and 15.6% of the CT sufferers stated a clear therapy effect over time. Nonserious side effects were noted in 4% of the treated patients. Therefore safety was excellent.

CONCLUSIONS

For acute and chronic tinnitus a gradual therapeutic regimen is recommended: (1) infusions with dextrane and procaine over 5 days; (2) intravenous application of 100 mg lidocaine over 10 min; and if necessary (3) administration of glutamic diethylester and glutamic acid for 3 days. This resulted in overall tinnitus relief in 95.3% of the acute and 26.7% of the chronic tinnitus sufferers.

[Ginkgo special extract EGb 761 in tinnitus therapy. An overview of results of completed clinical trials]

In a systematic search of the literature 19 clinical trials investigating the effects of tinnitus treatment with Ginkgo biloba special extract EGb 761 were identified and evaluated. The results of eight controlled studies on tinnitus due to cerebrovascular insufficiency or labyrinthine disorders of varying genesis for the most part show a statistically significant superiority of treatment with the Ginkgo biloba special extract EGb 761 as compared with placebo or reference drugs applied of periods of one to three months. Open studies, too, some involving large numbers of patients, revealed appreciable improvements under ginkgo treatment. Therapeutic success was not directly correlated with either the genesis or the duration of tinnitus. However, investigations of prognostic factors revealed that short-standing disorders have a better prognosis, so that better results can be expected from early-onset treatment. The tolerability of Ginkgo biloba special extract EGb 761 was excellent, and in this respect the controlled clinical trials revealed little difference between drug-treated and control groups.

Treatment of cochlear tinnitus with transtympanic infusion of 4% lidocaine into the tympanic cavity

Tinnitus is an otological symptom that is encountered often, yet its treatment is difficult. If tinnitus is of cochlear origin, a reasonable assumption is that a total depression of the cochlear function will abolish cochlear tinnitus. To achieve this depression, transtympanic infusion of a local anesthetic (4% lidocaine) to anesthetize the inner ear was conducted in a patient suffering from tinnitus. Transtympanic infusion of 4% lidocaine was performed as a treatment for cochlear tinnitus, and its efficacy was investigated. The overall efficacy rate for the 292 patients with 369 affected ears was 81%. In the investigation of the treatment results in cases of different underlying ear diseases, the efficacy rate was high for tinnitus accompanying sudden deafness and labyrinthine vertigo. However, vestibular symptoms, such as vertigo and nausea, developed after lidocaine infusion. No permanent side effects were noted. Lidocaine infusion is thought to be a useful treatment option for tinnitus and should be considered before surgical treatment. Inner ear anesthesia into the tympanic cavity has been carried out in patients who had cochlear tinnitus and in whom conservative methods of therapy, such as oral medication, had proved unsuccessful. This treatment method is useful as a local therapy for cochlear tinnitus.

[Evaluating effects of some medicine on tinnitus with animal behavioral model in rats]

OBJECTIVE

To develop a valid behavioral animal model of tinnitus and to determine the animals whether have the perception of tinnitus and to evaluate effects of nimodipine and Chinese herbs on tinnitus using the behavioral model.

METHODS

Adult male albino rats (n = 60) were fell evenly and randomly into ten groups. Animals in Group I and II were administrated sodium salicylate 350 mg/kg/d (i.p.). Instead, animals in control groups (Group III and IV) were saline injected. Pure tone (8 kHz, 65 dBSPL) was given to rats in Group V and VI instead of sodium salicylate. Nimodipine (1 mg/kg) were administrated to animals in Group VII and VIII. Gushenshuerfang, one kind of Chinese herbs were administrated to animals in Group IX and X. Medicine or pure tone were being given to all animals in Group I, III, V, VII, IX before conditioned reflex. Animals in Group II, IV, VI, VIII, X began to have medicine or pure tone after conditioned reflex. Thirsty animals (deprived of water for several days) were breeded in sound-proofed room and listened a persistent white noise (55 dB SPL) and trained daily with our instrument system, according to the procedure based on Pavlovian conditioned suppression paradigm. Subjects were permitted to lick water at an automatic dispenser during daily training sessions and the number of licks was recorded automatically. Noise offset (silence) was the conditioned stimulus and the electrical shock was the unconditioned stimulus. After two or three days training, subjects learnt rapidly to associate noise offset with shock and then established a behavioral conditioned reflex. Because of shock fear they decrease or even stop licking with the presentations of conditioned stimulus. However, subjects gradually forgot or ignored the fear without any shock present in extinction test sessions.

RESULTS

Animals' licking recovered to their pre-training levels respectively at the following days: Group I--5 days, Group II--2 days, both Group III and IV--4 days, Group V--5 days, Group VI--2 days, Group VII--5 days, Group VIII--4 days, Group IX--5 days, Group X--4 days. There were much significant differences among all groups and all training days (F test, P < 0.001). Above results provided sufficient evidence for that tinnitus was induced by salicylate and tinnitus presented with noise offset. In group I, tinnitus became additional conditioned stimulus. Therefore, the fear of animals was much severe and the numbers of licking were much fewer. Extinction lasted longer. In group II, animals ignored the noise offset much easily and the extinction lasted much shorter. Moreover, results from group V and VI, pure tone instead of salicylate, indicated that sensation (tinnitus) sounded like pure tone. The groups VII, VIII, IX, X demonstrated that nimodipine and Gushenshuerfang, one kind of Chinese herbs can cure the tinnitus induced by salicylate.

CONCLUSION

All behavioral evidence indicated that animals perceived tinnitus induced by salicylate and this animal model could be used in evaluating curative effects of some medicine on tinnitus.

[Bilateral acoustic trauma after air bag inflation]

Airbag inflation is associated with a loud noise. This very short noise has a peak amplitude of 170 dB sound pressure level and can make otologic injuries. We report a case of acoustic trauma after airbag inflation. The 24-year-old man has hearing loss both side in the 3000- to 6000-Hz range and in the deep-frequency. The possibility of acoustic trauma from airbag noise are probably much more common and need more attention in the clinic.

The efficacy of Arlevert therapy for vertigo and tinnitus

We were interested in determining the efficacy of Arlevert therapy in vertigo and tinnitus patients, especially as it compared to the efficacy of the drug's two component agents, dimenhydrinate and cinnarizine. We conducted a comparative, randomized, double blind, multicenter, parallel group study involving a group of patients (n = 122) with vertigo and tinnitus of peripheral or central origin. The three test groups, nearly equal in size, were administered three times daily for 4 weeks one of the three agents being evaluated. To evaluate therapeutic success, we studied patients' vertigo symptoms, concomitant vegetative symptoms, CCG parameters, and electronystagmographic and audiometric parameters. We also obtained subjective assessments of outcomes from the test patients. Our results led us to conclude that Arlevert is more effective than either of its component drugs alone in treating vertigo and tinnitus. The drug also was well tolerated.

A tinnitus objectivization: how we do it

The medical therapy of tinnitus should be oriented by objective measurement of the disorder. Preferably, it should be qualitative, indicating the exact neural mechanism to be neuromodulated by neuroprotective medication. The neurophysiological approach in objectivization of tinnitus is presented by means of auditory brainstem response and middle latency response. These tests could be applied in functional follow-up of medical therapy, as these are more sensitive and harmless methods as compared to standard morphological methods.

[Transient evoked otoacoustic emissions (TEOAE) in tinnitus patients treated with xylocaine]

The group of patients suffering from tinnitus was treated with intravenous Xylocaine. Ten consecutive doses of Xylocaine (2 mg/kg b.m.) were administered during a period of ten days. Changes of amplitudes of TEOAE in relation to tinnitus suppression was assessed. In 91.5% of cases we observed correlation between amplitude changes and complaint abatement. Both amplitude changes and the time of tinnitus suppression increased after ten days of treatment in comparison with single dose of Xylocaine. The differences of amplitude variations between tinnitus and non tinnitus ear group was statistically significant (Wilcoxon test p < 0.05). The treatment with Xylocaine was considered to be the beginning of long-term procedure aimed at causing habituation of tinnitus in patients conscience (TRT).

[Round window microcatheter administered microdose of gentamycin: an alternative in the treatment of tinnitus in patients with Menière's disease]

BACKGROUND

In this study, we review the results of Menière's disease treatment using microdose gentamycin delivered directly to the round window using a new microcatheter system.

PATIENTS AND METHODS

11 patients were treated by 1.25 mg gentamycin on the 3rd and 7th day after insertion of the new microcatheter at the niche of the round window membrane, while a second group of 7 patients was treated by a gentamycin dosage of 1 microliter/h continuously applied by a minipump over a period of 10 days. Electrocochleography was derived by an integrated electrode and the microcatheter was removed after 10 days. The results were analysed with a follow-up ranging from 6 to 12 months.

RESULTS

In 15 of 18 patients (83%) tinnitus was improved significantly throughout the follow-up period. Vertigo was eliminated in all patients, and pressure was relieved in 17 of 18 (94%).

CONCLUSIONS

These preliminary data suggest that gentamycin delivered by the Round-Window-Microcatheter is a safe and effective treatment for the reduction of tinnitus, vertigo, and pressure associated with Menière's disease.