[The estimation of the efficacy of manual therapy included in the combined treatment of cochlear-vestibular disorders based on the results of computed stabilography]

The objective of the present study was to estimate the efficacy of the combined treatment of spondylogenic cochlear-vestibular disorders with the use of both medicamental and non-medicamental modalities. Computed static stabilometry was applied for diagnostics of postural disbalance and evaluation of the treatment outcomes. It was shown that the application of manual therapy for the management of 56 patients presenting with spondylogenic cochlear-vestibular disorders resulted in the decrease of tinnitus and the improvement of vestibular and cochlear functions.

Intratympanic corticotherapy and tinnitus control after sudden hearing loss

INTRODUCTION

Sudden deafness is characterized by an abrupt onset, often idiopathic and tinnitus is present, and becomes the main complaint in up to 80% of patients.

OBJECTIVE

To review carefully all studies of the past 10 years on sudden deafness and tinnitus and analyze the effectiveness of oral and intratympanic steroids for tinnitus control in eight patients with sudden deafness and severe disabling tinnitus.

METHOD

An analytical prospective in which 64 patients after sudden deafness with tinnitus were monitored and 08 of these suffering with severe disabling tinnitus underwent hearing evaluation and application of the Tinnitus Handicap Inventory and Visual Analogue Scale before, during and after sudden deafness treated with oral and intratympanic steroids. It was made a systematic review of publications on the topic in the library of PubMed/MedLine, keywords: Sudden deafness and tinnitus.

RESULTS

Eleven scientific studies were analyzed. Eight patients treated with intratympanic and oral corticosteroids were selected, just two patients showed improvement over the hearing but seven of them showed big improvement in their tinnitus, which was demonstrated by an improvement in the values of the degrees of severity of tinnitus.

CONCLUSION

Patients with sudden deafness and severe disabling tinnitus, and underwent intratympanic and oral corticosteroids showed, in this study, significant reduction and/or remission of tinnitus.

A dose-response analysis of the effects of L-baclofen on chronic tinnitus caused by acoustic trauma in rats

Subjective tinnitus is a chronic neurological disorder in which phantom sounds are perceived. Drugs that increase GABAergic neurotransmission in the CNS are sometimes used as a treatment. One such drug is the GABA(B) receptor agonist L-baclofen. The aim of this study was to investigate the effects of L-baclofen on the psychophysical attributes of tinnitus in rats.The effects of 1, 3 or 5 mg/kg L-baclofen (s.c.) on the psychophysical attributes of tinnitus were investigated using a conditioned lick suppression model, following acoustic trauma (a 16 kHz, 110 dB pure tone presented unilaterally for 1 h) in rats. In pre-drug testing, acoustic trauma resulted in a significant increase in the auditory brainstem-evoked response (ABR) threshold in the affected ear (P < 0.008) and a significant decrease in the suppression ratio (SR) compared to sham controls in response to the 20 kHz tones, but not the broadband noise or the 10 kHz tones (P < 0.002). The 3 and 5 mg/kg doses of L-baclofen significantly reversed the frequency-specific decrease in the SR in the acoustic trauma group, indicating that the drug reduced tinnitus. Following washout from the 3 mg/kg dose, but not the 5 mg/kg dose, the significant decrease in the SR for the acoustic trauma group returned, suggesting a return of the tinnitus. These results suggest that L-baclofen should be reconsidered as a drug treatment for tinnitus. This article is part of a Special Issue entitled 'Post-Traumatic Stress Disorder'.

Improvement in cochlear flow in patients with tinnitus with the complex supplement Acustop: a product evaluation

AIM

Patients with tinnitus constitute a very large group without a real, specific therapeutic solution. With noninvasive, color duplex it is possible to measure flow in the cochlear artery and to follow duplex flow changes due to treatments in most patients. The aim of this preliminary evaluation was to study flow variations in patients with "mild-to-moderate" tinnitus, possibly associated to cochlear hypo-perfusion, after administration of Acustop (used as a food supplement). The aim was to improve cochlear flow decreasing the level of tinnitus.

METHODS

Patients with "mild-to-moderate", "idiopathic", monolateral tinnitus, present for at least 4 weeks were included; no vertigo or important hearing loss had been observed. The origin of tinnitus had been sudden (hours or days). The tinnitus was associated to a decrease in cochlear flow measured by color Duplex at the affected ear. A group of 42 patients was evaluated; 25 used Acustop; there were 17 controls (follow-up only). Groups were comparable for their clinical problem and other details. The average duration of treatment was 4 weeks.

RESULTS

No side effects were observed and no drop-outs were recorded. Flow velocity at the level of the affected inner ear was significantly lower (both the diastolic and systolic components; P<0.05) in comparison with the other ear. This was considered an indication of the vascular origin of the tinnitus. With Acustop treatment there was a significant improvement in systolic (P<0.05) and diastolic flow velocity (P<0.05). The increase in flow velocity was not significant in controls. An analogue scale line was used to measure symptoms in the Acustop group: it was 8.2;2 at inclusion; it decreased to 3.1;1.5 at 4 weeks (P<0.05). The score was 8.4;2 in controls at inclusion; at 4 weeks the score was 7.1;2.2 (not significant). Tinnitus scale: the value at inclusion of the tinnitus scale in the Acustop group a was 8.5;1.1 versus 8.3;1.2 in controls. After 4 weeks the score was 3.1;1.1 (P<0.05) in the Acustop group vs 7.2 in controls; the difference between the two groups was significant; P<0.025).

CONCLUSION

In conclusion, these results suggest that in selected patients with tinnitus and altered inner ear perfusion Acustop appears to be effective in relieving tinnitus possibly by improving cochlear flow. More studies should be planned to evaluate better the potential applications of Acustop in this very interesting field. This clinical problem affects a large number of patients, without a real therapeutic solution at the moment, decreasing their quality of life and their performing abilities.

Anticonvulsants for tinnitus

BACKGROUND

Tinnitus is the perception of sound or noise in the absence of an external or internal acoustic stimulation. It is a common and potentially distressing symptom for which no adequate therapy exists.

OBJECTIVES

To assess the effectiveness of anticonvulsants in patients with chronic tinnitus.

SEARCH STRATEGY

We searched the Cochrane Ear, Nose and Throat Disorders Group Specialised Register, CENTRAL (2010, Issue 2), MEDLINE, EMBASE, bibliographies and additional sources for published and unpublished trials. The date of the most recent search was 26 May 2010.

SELECTION CRITERIA

We selected randomised controlled trials in patients with chronic tinnitus comparing orally administered anticonvulsants with placebo. The primary outcome was improvement in tinnitus measured with validated questionnaires. Secondary outcomes were improvement in tinnitus measured with self-assessment scores, improvement in global well-being or accompanying symptoms, and adverse drug effects.

DATA COLLECTION AND ANALYSIS

Three authors assessed risk of bias and extracted data independently.

MAIN RESULTS

Seven trials (453 patients) were included in this review. These studies investigated four different anticonvulsants: gabapentin, carbamazepine, lamotrigine and flunarizine. The risk of bias of most studies was 'high' or 'unclear'. Three studies included a validated questionnaire (primary outcome). None of them showed a significant positive effect of anticonvulsants. One study showed a significant negative effect of gabapentin compared to placebo with an increase in Tinnitus Questionnaire (TQ) score of 18.4 points (standardised mean difference (SMD) 0.82, 95% confidence interval (CI) 0.07 to 1.58). A second study showed a positive, non-significant effect of gabapentin with a difference compared to placebo of 2.4 points on the Tinnitus Handicap Inventory (THI) (SMD -0.11, 95% CI -0.48 to 0.25). When the data from these two studies are pooled no effect of gabapentin is found (SMD 0.07, 95% CI -0.26 to 0.40). A third study reported no differences on the THI after treatment with gabapentin compared to placebo (exact numbers could not be extracted from the article).A meta-analysis of 'any positive effect' (yes versus no) based on a self-assessment score (secondary outcome) showed a small favourable effect of anticonvulsants (RD 14%, 95% CI 6% to 22%). A meta-analysis of 'near or total eradication of tinnitus annoyance' showed no effect of anticonvulsants (risk difference (RD) 4%, 95% CI -2% to 11%). Side effects of the anticonvulsants used were experienced by 18% of patients.

AUTHORS' CONCLUSIONS

Current evidence regarding the effectiveness of anticonvulsants in patients with tinnitus has significant risk of bias. There is no evidence from studies performed so far to show that anticonvulsants have a large positive effect in the treatment of tinnitus but a small effect (of doubtful clinical significance) has been demonstrated.

Drug-mediated ototoxicity and tinnitus: alleviation with melatonin

This review evaluates the published basic science and clinical reports related to the role of melatonin in reducing the side effects of aminoglycosides and the cancer chemotherapeutic agent cisplatin, in the cochlea and vestibule of the inner ear. A thorough search of the literature was performed using available databases for the purpose of uncovering articles applicable to the current review. Cochlear function was most frequently evaluated by measuring otoacoustic emissions and their distortion products after animals were treated with cytotoxic drugs alone or in combination with melatonin. Vestibular damage due to aminoglycosides was evaluated by estimating hair cell loss in explanted utricles of newborn rats. Tinnitus was assessed in patients who received melatonin using a visual analogue scale or the Tinnitus Handicap Inventory. Compared to a mixture of antioxidants which included tocopherol, ascorbate, glutathione and N-acetyl-cysteine, melatonin, also a documented antioxidant, was estimated to be up to 150 times more effective in limiting the cochlear side effects, evaluated using otoacoustic emission distortion products, of gentamicin, tobramycin and cisplatin. In a dose-response manner, melatonin also reduced vestibular hair cell loss due to gentamicin treatment in explanted utricles of newborn rats. Finally, melatonin (3 mg daily) limited subjective tinnitus in patients. These findings suggest the potential use of melatonin to combat the ototoxicity of aminoglycosides and cancer chemotherapeutic agents. Additional studies at both the experimental and clinical levels should be performed to further document the actions of melatonin at the cochlear and vestibular levels to further clarify the protective mechanisms of action of this ubiquitously-acting molecule. Melatonin's low cost and minimal toxicity profile supports its use to protect the inner ear from drug-mediated damage.

Phase 2 study examining magnesium-dependent tinnitus

BACKGROUND

Recent studies in noise-induced and idiopathic sensorineural hearing loss have suggested that magnesium supplementation may lessen both hearing loss and the severity of tinnitus in patients. Further epidemiological evidence indicates that all age groups of Americans fall short of the recommended daily allowance for magnesium by 100 mg daily.

PURPOSE

The purpose of this study was to examine any potential benefit in lessening the severity of tinnitus in patients taking supplemental magnesium.

RESEARCH DESIGN

The study was a single-arm, open-label, before-and-after study of oral magnesium (532 mg per day) in 26 patients for 3 months. Tinnitus severity was evaluated and recorded daily by the patient using the Tinnitus Distress Rating (TDR) scale of 0 (no tinnitus) to 10 (worst possible tinnitus). The Tinnitus Handicap Inventory (THI) was administered before and at the end of the study, and scores were converted to the grades of the 5-item Tinnitus Severity Scale (TSS). The purpose of this phase 2 study was to investigate whether the treatment was effective at all, and, as such, a placebo control was not performed. All data were collected at Mayo Clinic in Scottsdale, Arizona, between March 6 and December 10, 2008.

STUDY SAMPLE

Patients with moderate to very severe tinnitus (TDR score of 3 through 8).

INTERVENTION

Daily magnesium supplementation, 532 mg; patient completion of the THI; and daily self-report of TDR.

DATA COLLECTION AND ANALYSIS

The main outcome measures were mean TDR scale scores and THI scores as converted to TSS grades. The primary analysis was done on the basis of intention to treat.

RESULTS

Twenty-six patients were enrolled; 19 completed the study. The extent of handicap, as measured by THI/TSS, for subjects with slight or greater impairment was significantly decreased (P=.03). Patients who ranked slight or greater on the THI/TSS before intervention showed a significant decrease in the severity of their tinnitus at post-testing (P=.008).

CONCLUSION

The results suggest that magnesium may have a beneficial effect on perception of tinnitus-related handicap when scored with the THI.

Simvastatin and Ginkgo biloba in the treatment of subacute tinnitus: a retrospective study of 94 patients

OBJECTIVES

Studies suggest that hypercholesterolemia promotes the development of inner ear disorders such as tinnitus. However, the underlying pathomechanisms are still not clearly defined.

METHODS

A retrospective study was performed to assess whether a reduction of serum cholesterol by 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors may result in a relief of subacute tinnitus. Remission rates of 58 patients were investigated after 4 months of treatment with simvastatin (40 mg). Results were compared to treatment with Ginkgo biloba (120 mg; n = 36) as control group. Differences between tinnitus score at the day of first treatment and after 4 months were used as main outcome measure.

RESULTS

After treatment with simvastatin or G biloba, tinnitus score decreased from 41.3 ± 10.4 to 37.4 ± 17.3 and from 44.7 ± 11.2 to 41.2 ± 8.7, respectively. However, independently of the treatment regimen, differences of tinnitus scores were considered not significant.

CONCLUSIONS

After administration of simvastatin over 4 months, this retrospective study has shown no significant efficacy in treatment of subacute tinnitus. For a more conclusive answer, further prospective, double-blind, and placebo-controlled studies with a larger number of patients are needed.

Improvement in cochlear flow with Pycnogenol® in patients with tinnitus: a pilot evaluation

AIM

The aim of this preliminary evaluation was to study the efficacy of Pycnogenol in improving cochlear flow in patients with mild-to-moderate tinnitus present for at least two weeks (without vertigo or important hearing loss), possibly associated with cochlear hypo-perfusion.

METHODS

Patients with mild-to-moderate, idiopatic, monolateral tinnitus present for at least 2 weeks were included; no vertigo or important hearing loss had been found in a specific examination. The origin of tinnitus had been sudden (hours or days). Fifty-eight patients used Pycnogenol: 24 used 150 mg/day (group A; mean age 43.2+/-4.3) and 34 patients 100 mg/day (group B: mean age 42.4+/-3.8). Controls included 24 patients (mean age 42.3+/-4.5). The groups were comparable for their clinical problem and age and sex. The average duration of treatment was 34.3+/-3.1 days. No side effects were observed and no drop-outs occurred.

RESULTS

The variations in cochlear flow velocity (in cm/s at the cochlear artery), at inclusion and after four weeks of treatment indicated that flow velocity at the level of the affected ear was significantly lower (both the diastolic and systolic components; P<0.05) in comparison with the other ear. The treatment favored an improvement in systolic (P<0.05) and diastolic flow velocity (P<0.05) in the two treatment groups A+B. The increase in flow velocity was very limited and not significant in controls.

CONCLUSION

These results suggest that in selected patients with tinnitus and altered perfusion, Pycnogenol is effective in a short period of time in relieving tinnitus symptoms by improving cochlear blood flow. The effect is more pronounced with higher Pycnogenol dosage. More studies should be planned to better evaluate the pathology and potential applications of Pycnogenol in a larger number of patients who are currently without a real therapeutic solution.

The effects of the Chinese herbal medicine EMF01 on salicylate-induced tinnitus in rats

AIM OF THE STUDY

Traditional Chinese medicine (TCM) has been reported to successfully alleviate tinnitus, although well-controlled studies have not been conducted. In this study, we attempted to test a TCM, Er Ming Fang (EMF01) containing Rehmannia glutinosa, Cornus officinalis, Salvia mittiorrhiza, Pueraria, Schisandra chinensis, Poria cocos and Platycodon grandiflorum, on salicylate-induced tinnitus in rats, using a conditioned lick suppression paradigm.

MATERIALS AND METHODS

A pilot study examined the effect of 8.75 g/kg and 17.5 g/kg EMF01 (delivered by oral gavage for 20 days) and showed a slight decrease in the suppression ratio (SR) in the 8.75 g/kg group. In order to confirm the possible effect of EMF01 on tinnitus at 8.75 g/kg, a further study was carried out with a larger sample size.

RESULTS

While there were statistically significant differences between the treatment groups, post hoc tests revealed that EMF01 did not have any significant effect on salicylate-induced tinnitus.

CONCLUSIONS

While this study does not support the efficacy of EMF01 in the treatment of salicylate-induced tinnitus, further studies should be conducted to determine if it alleviates tinnitus associated with acoustic trauma.

Tinnitus in postherpetic neuralgia

We describe a woman who developed postherpetic neuralgia (PHN) located on the skin areas of the left ophthalmic division of the fifth cranial nerve without ocular involvement. PHN was associated with tinnitus, which was located ipsilaterally to the painful side and increased in proportion to the intensity of pain. Tinnitus was responsive to treatment with duloxetine, 60 mg daily, and subsided when the PHN resolved. This is the first description of tinnitus in PHN.

Tinnitus as a prognostic factor of sudden deafness

CONCLUSIONS

The 'tinnitus-rare' group had a poorer prognosis for hearing than the 'tinnitus-often' group in all sudden sensorineural hearing loss (SSNHL), although the 'shorter duration' group had better prognosis than the 'longer duration' when restricted to SSNHL accompanied by tinnitus. This indicates that tinnitus itself may not be a sign for poor hearing prognosis but might be an essential sound for the initiation of repair of a damaged auditory system.

OBJECTIVES

We examined the hearing improvement rate (HIR) and tinnitus at the onset of SSNHL to elucidate the prognostic value of tinnitus accompanying SSNHL.

PATIENTS AND METHODS

Fifty patients with SSNHL were treated with systemic administration of steroids. Hearing recovery was determined by comparing the hearing levels before and after treatment. Tinnitus was subjectively evaluated by the tinnitus scoring questionnaire. The score for the five-step evaluation of the subjective tinnitus feelings 'loudness', 'duration' and 'annoyance' was obtained at the onset.

RESULTS

In terms of 'duration', when we divided all the cases into 'tinnitus-rare' group and 'tinnitus-often' group, HIR in the 'tinnitus-rare' group was significantly lower than that in 'tinnitus-often' group. When restricted to the 'tinnitus-often' group, HIR for 'shorter duration' was significantly higher than that for 'longer duration'.

Tinnitus Retraining Therapy (TRT): outcomes after one-year treatment

The aim of the study is to present our results regarding the efficacy of TRT for tinnitus relief in patients with clinically significant tinnitus compared to a group treated with vasoactive agents. In a nonrandomized prospective study, 63 patients with disabling tinnitus were recruited. Greek translation of the Tinnitus Handicap Inventory (THI) and visual analogue scale (VAS) for annoyance caused by tinnitus when conducting four major activities of everyday life (work, sleep, relaxation and concentration) were examined in a 12-month period. The THI score was significantly improved in the TRT group, as well as mean VAS scores, in all measures. Comparison of the mean improvement of THI and VAS scores after treatment showed significant differences between the two groups, favoring TRT treatment. Our data suggest that TRT is an effective treatment. It reduces the level of annoyance induced by tinnitus and improves the ability of patients to work, sleep, relax or be concentrated.

Otosclerosis 2: the medical management of otosclerosis

The rationale for medical therapy for otospongiosis is to slow down and eventually stop the phase of bone resorption. There is some increase in the incidence of stapedial otospongiosis in a low-fluoride area compared with a high-fluoride area. Sodium fluoride treatment has a role to play in preventing the onset and progression of hearing loss in patients suffering from otosclerosis. Sodium fluoride therapy has been shown to have some beneficial effect on dizziness associated with otosclerosis. In view of the possibility of systemic side effects of sodium fluoride therapy, a regular follow up of patients is warranted. Biphosphonates can be used as an alternative treatment to sodium fluoride in cases where the patient is intolerant to sodium fluoride therapy. Hearing aid is also a treatment option, but it does not halt the disease process.

Tinnitus

INTRODUCTION

Up to 18% of people in industrialised societies are mildly affected by chronic tinnitus, and 0.5% report tinnitus having a severe effect on their daily life. Tinnitus can be associated with hearing loss, acoustic neuromas, drug toxicity, ear diseases, and depression. Tinnitus can last for many years, and can interfere with sleep and concentration.

METHODS AND OUTCOMES

We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for chronic tinnitus? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2009 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).

RESULTS

We found 27 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.

CONCLUSIONS

In this systematic review, we present information relating to the effectiveness and safety of the following interventions: acamprosate; acupuncture; antidepressant drugs; benzodiazepines; carbamazepine; cinnarizine; electromagnetic stimulation; ginkgo biloba; hearing aids; hypnosis; psychotherapy; tinnitus-masking devices; and tinnitus retraining therapy.

The effects of alprazolam on tinnitus: a cross-over randomized clinical trial

BACKGROUND

Tinnitus remains a phenomenon with an unknown pathophysiology and for which few therapeutic measures are available. To date there has been insufficient evidence to support the use of alprazolam in the treatment of tinnitus. We sought to evaluate the efficacy of alprazolam for relief of tinnitus.

MATERIAL/METHODS

Thirty-six tinnitus sufferers participated in this cross-over, randomized, triple-blind, placebo-controlled trial. Inclusion criteria included patients between ages 21 and 65, with a complaint of non-pulsatile tinnitus of more than 1 year duration. Patients with depressive or anxiety disorders were excluded, as were those using hearing aids. Participants received alprazolam 1.5 mg daily versus placebo in each period. Primary outcome variables included the Tinnitus Handicap Inventory (THI), a Visual Analog Scale (VAS), and tinnitus loudness.

RESULTS

Thirty patients completed the study. The average age of patients was 47.58+/-7.65 years. Alprazolam in comparison with placebo did not result in statistically significantly greater relief in THI score and tinnitus loudness. There was a significant improvement in VAS score in the alprazolam group compared with the placebo group (p<0.001).

CONCLUSIONS

These results suggest that although alprazolam did not improve the THI score or sensation level of loudness significantly, it has a desirable effect on VAS. Further work is needed to determine the beneficial effects of alprazolam in distressed or depressed patients.

Tinnitus: etiology, classification, characteristics, and treatment

Tinnitus is the perception of sound with the absence of acoustic stimulus. It affects approximately 10% of the population. This is a symptom with a broad differential diagnosis. In some cases, tinnitus impacts significantly on patients' activities of daily living. Understanding how to differentiate between subjective and objective tinnitus is essential to the evaluation and management of these patients. The various causes of each type of tinnitus will be discussed. This review presents a general approach to tinnitus in order to facilitate timely diagnosis and management of this complex symptom.

[Effects of er-long-zuo-ci-wan on the spontaneous activities of auditory central nucleus in rat model of tinnitus induced by salicylate acid]

AIM

Observe the effects of er-long-zuo-ci-wan (EIZCW, a compound of Chinese Traditional Medicine) on the spontaneous discharge of external cortex of inferior colliculus (ICx) and secondary auditory cortex (AII) of chronic tinnitus model rats induced by salicylate acid, to explore the neural mechanisms underlying ELZCW preventing tinnitus.

METHODS

30 adult SD rats were involved and divided into three groups, normal control group, chronic tinnitus model group and ELZCW prevention group. Extracellular recording techniques and stereotaxic method were used. The spontaneous spikes were recorded and analyzed from ICx and all in different group rats. The average rate of spontaneous discharge and the interspike interval histogram of spontaneous activities were used as indexes.

RESULTS

(1) Compared with normal control group, the average rate of spontaneous discharge recorded from the ICx in the chronic tinnitus model group increased significantly (4.57 +/- 0.54 Hz vs. 3.14 +/- 0.40 Hz, P < 0.05). Furthermore analysis showed that the discharge rate of short spike interval from the ICx in the chronic tinnitus model group increased than that of the normal group (0-40 ms: 58% vs. 40%; 0-4 ms: 9% vs. 5%). And there was an increasing tendency of the average rate of spontaneous discharge recorded from the AII in the chronic tinnitus model group compared with that in the normal group. (2) Compared with the chronic tinnitus model group, the average rate of spontaneous discharge recorded from the ICx and AII in the ELZCW prevention group significantly decreased than that in the chronic tinnitus model group (ICx: 2.41 +/- 0.21 Hz vs. 4.57 +/- 0.54 Hz, P < 0.01. AII: 2.24 +/- 0.24 Hz vs. 4.57 +/- 0.54 Hz , P < 0.01). And the discharge rate of short spike interval from the ICx and AII in the chronic tinnitus model group decreased than that in the normal control group (ICx: 0-40 ms 50% vs. 58%, 0-4 ms 4% vs. 9%. All: 0-22 ms: 24% vs. 31%, 0-8 ms 19% vs. 16%).

CONCLUSION

If the increasing of the spontaneous activities of ICx and AII in chronic tinnitus rats means tinnitus, the use of ELZCW could decrease this kind of changes.

The effect of intravenously administered mexiletine on tinnitus-a pilot study

The effect of intravenously administered mexiletine on subjective tinnitus and hearing was studied in six patients, who initially responded positively to lidocaine. Distinct mexiletine-induced decreases in tinnitus loudness were demonstrated in three subjects, as reflected by maximum VAS (visual analogue scale) level reduction of 34%, 95%, and 100%, respectively. One subject reported change in tinnitus pitch, another one showed a slight (18% on VAS) tinnitus reduction, and one subject disclosed no effect. Side effects were seen only during one of seven infusions. Mexiletine induced shifts in pure-tone threshold, transient evoked otoacoustic emission, and acoustic reflex threshold, probably reflecting a reversible interference in the function of organ of Corti. The concentration effect relationship remained unclear and no general 'therapeutic' level could be identified. This study confirms the effect of mexiletine on the auditory function and its potential as a possible therapeutic agent or a model for further development in tinnitus pharmacotherapy.

[A study on relationship between distortion product otoacoustic emissions and therapeutic effects in tinnitus]

OBJECTIVE

To find mechanism of tinnitus and explore effective treatment for tinnitus.

METHOD

The 133 tinnitus patients were assigned into two groups by relationship between Distortion product otoacoustic emissions and frequencies of tinnitus: relationship group (73 cases) and non-relationship group (60 cases). All 133 cases were treated with drug, such as injection of Lipo PGE1, Vitamin B1 and Vitamin B12. After 14 days of treatment the efficacy of the medicines in two groups was observed.

RESULT

The effective rate of two groups mentioned above were 75.3% and 36.7% respectively (P < 0.01). Furthermore, effective rate was correlative to the course of the tinnitus.

CONCLUSION

Drug therapy can be a choice for patients who have relationship between DPOAEs and frequencies of tinnitus, especially for acute tinnitus. Personalized treatment should be provided.

Treatment of subjective tinnitus: a comparative clinical study of intratympanic steroid injection vs. oral carbamazepine

BACKGROUND

Over the last decade, more and more otologists have been using the intratympanic perfusion of steroids to treat SSHL, tinnitus, and vertigo. However, results of the treatment in the literature are controversial because most of the reports were retrospective and uncontrolled. Therefore a prospective random single-blind trial was conducted at the Affiliated Drum Tower Hospital of Nanjing University Medical School, P. R. China. The results were compared with oral carbamazepine treatment. Carbamazepine is a medication routinely used to treat tinnitus.

MATERIAL/METHODS

Seventy-nine patients (84 ears) with subjective tinnitus which failed to respond to a minimum of four-week systemic medical therapy were assigned to a study group and a control group by a random, single-blind method. The study group was further randomly divided into two subgroups. The participants in the study group received either 0.5-ml intratympanic injections of prednisolone (study group 1) or dexamethasone (study group 2). The patients in the control group only took carbamazepine. The effective rates at the end of the therapy and the control rates at the end of a six-month follow-up were analyzed statistically.

RESULTS

There were no statistical differences in the effective and control rates among the three groups.

CONCLUSIONS

Intratympanic steroid injection has positive effects similar to those of oral carbamazepine in subjective tinnitus. Intratympanic steroid injection may be considered an alternative treatment for subjective tinnitus.

Management of tinnitus: oral treatment with melatonin and sulodexide

The main problem arising from tinnitus is the disturbance it causes in day-to-day life and disturbance in sleep leading to fatigue and general discomfort. We attempted to study the effect of melatonin in conjunction with Sulodexide as a treatment method for tinnitus and evaluate its effectiveness. We studied 102 patients suffering from tinnitus with a Prospective Randomised Controlled Study conducted in a tertiary care ENT department. After randomisation, 34 patients were treated with melatonin and Sulodexide, another 34 were treated with melatonin alone, and the remaining 34 (control group) were managed without therapy in order to evaluate spontaneous variations in quality of tinnitus. Patients were assessed prospectively with Tinnitus Handicap Inventory and Acufenometry both pre-treatment and post-treatment. Among the patients we studied, we found better results with both Tinnitus Handicap Inventory and Acufenometry in the group who received melatonin and Sulodexide as against melatonin alone. Any improvement was noted in the control group. In conclusion, our opinion is that melatonin in combination with Sulodexide is a viable treatment option for patients suffering from central or sensorineural tinnitus.

Treatment of central and sensorineural tinnitus with orally administered Melatonin and Sulodexide: personal experience from a randomized controlled study

Since very little is understood about the exact aetiology of tinnitus, this has made treatment of the condition difficult. Even though approximately 10-15% of the general population suffer from tinnitus, only 2% consider it serious enough to warrant any treatment. The main problem arising from tinnitus is the disturbance it causes not only in day to day life but also in sleep, leading to fatigue and general discomfort. The present study focused on the effect of Melatonin in conjunction with Sulodexide as a treatment method for tinnitus. Overall, 102 patients suffering from tinnitus were evaluated in a prospective randomised controlled study conducted in a tertiary care ENT department. After randomisation, 34 patients were treated with Melatonin and Sulodexide, another 34 were treated with Melatonin alone, while the remaining 34 (control group) were managed without treatment in order to evaluate spontaneous variations in the quality of tinnitus. Patients were assessed prospectively with the Tinnitus Handicap Inventory and Acufenometry, both pre- and post-treatment. Among the patients studied, better results with both Tinnitus Handicap Inventory and Acufenometry were found in the group who received Melatonin and Sulodexide compared to those receiving Melatonin alone. No improvement was observed in the control group. In conclusion, Melatonin in combination with Sulodexide is, in our opinion, a viable treatment option for patients suffering from central or sensorineural tinnitus.