Misoprostol for tinnitus

Randomized placebo-controlled trial of a selective serotonin reuptake inhibitor in the treatment of nondepressed tinnitus subjects

OBJECTIVE

To assess the efficacy of a selective serotonin reuptake inhibitor (paroxetine) for relief of tinnitus.

DESIGN

One hundred twenty tinnitus sufferers participated in a randomized double-blind placebo-controlled trial. Paroxetine or placebo was increased to a maximally tolerated dose (up to 50 mg/day), and patients were treated for a total of 31 days at the maximal dose.

METHODS

Patients with chronic tinnitus were recruited from our university-based specialty clinic by referral from otolaryngologists and audiologists in the local community and by advertisement. Patients with psychotic or substance use disorders or suicidal ideation were excluded, as were those using psychoactive medications (this resulted in only 1 subject with major depression in the study) or any other medications that interact with paroxetine and those with inability to hear at one's tinnitus sensation level. Fifty-eight percent of patients were male, 92% were Caucasian, and the average age was 57.

OUTCOMES MEASURES

Tinnitus matching, the Tinnitus Handicap Questionnaire, the question: How severe (bothered, aggravating) is your tinnitus? Quality of Well-Being and other psychological questionnaires.

RESULTS

Paroxetine was not statistically superior to placebo on the following tinnitus measures (tinnitus matching, 5- or 10-db drop, Tinnitus Handicap Questionnaire, quality of well-being measures, how severe, how bothered, positive change). There was a significant improvement in the single item question, How aggravating is your tinnitus? for those in the paroxetine group compared with the placebo group.

CONCLUSIONS

These results suggest that the majority of individuals in this study did not benefit from paroxetine in a consistent fashion. Further work remains to be done to determine if subgroups of patients (e.g., those who tolerate higher doses, those who are depressed) may benefit.

Efficacy of misoprostol in the treatment of tinnitus in patients with diabetes and/or hypertension

OBJECTIVE

To determine the efficacy of the prostaglandin E1 analogue misoprostol in the treatment of tinnitus in diabetic and/or hypertensive patients.

DESIGN

Double-blind, randomized, placebo-controlled trial.

SETTINGS

Tertiary care referral center.

METHODS

The subjects were 42 patients with hypertension and/or diabetes mellitus who had chronic tinnitus and had experienced tinnitus symptoms for a minimum of 6 months. Twenty-eight patients were randomly assigned to Group I (misoprostol treatment), and 14 patients to the Group II (placebo treatment). Misoprostol therapy was started at 200 microg per day, and was increased 200 microg every 7 days until a dose of 800 microg per day was reached. The same numbers of placebo tablets were given to the control group using the same schedule. Both groups were treated for 1 month. The changes in objective and subjective tinnitus findings from baseline to 1 month were assessed, and the group results were compared. The chi(2)-test, student's t-test and paired-samples t-test were used to analyze the study.

RESULTS

At the completion of treatment, objective assessment showed that tinnitus loudness decreased in 13 (46%) of the 28 patients in the experimental group, whereas this was observed in only two (14%) of the 14 subjects in the placebo group. Subjective tinnitus scoring revealed improvement rates of 29 and 14% for the misoprostol and placebo groups, respectively. When t-test relating to difference between rates were performed, the difference between improvement rate for tinnitus loudness of the experimental group and control group was found to be statistically significant (P = 0.05), but difference between improvement rate based on subjective tinnitus scoring was insignificant (P = 0.22).

CONCLUSION

Misoprostol is an effective and safe treatment for chronic tinnitus in hypertensive and/or diabetic patients. Our results are encouraging, but further studies of larger series are needed.

Misoprostol in the treatment of tinnitus: a double-blind study

OBJECTIVE

To test the efficacy of misoprostol as a treatment for tinnitus.

DESIGN

A prospective, placebo-controlled, double-blind study.

SETTING

Başkent University Otolaryngology Clinic.

PATIENTS

Forty adult patients who had had tinnitus for a minimum of 6 months and were free of systemic or otolaryngologic disease. Twenty-eight patients were randomly assigned to the experimental group (group I) and 12 to the control group (group II).

INTERVENTION

The respective groups received active drug and placebo in increasing doses for 4 months. The effect of medications on tinnitus were evaluated by determining improvement rates in tinnitus loudness and subjective tinnitus scoring.

RESULTS

In the experimental group, 18 of 28 patients showed improvement in tinnitus loudness, representing an improvement rate of 64%. The improvement rate based on subjective tinnitus scoring was 36% (10 of 28 patients). In the control group, the improvement rate for tinnitus loudness was 33% (n = 4), and the rate for subjective tinnitus scoring was 17% (n = 2). The difference between improvement rate for tinnitus loudness of the experimental group and control group was found to be statistically significant (P = 0.039), but difference between improvement rate based on subjective tinnitus scoring was insignificant (P = 0.119). When results in the experimental group were analyzed according to etiological factors, the improvement rate was highest in the sudden-onset subgroup (77%).

CONCLUSIONS

Misoprostol provided therapeutic relief for some patients with tinnitus we studied, but further investigation of larger groups is needed.

The role of zinc in the treatment of tinnitus

OBJECTIVE

This study was designed to investigate the role of zinc administration in treatment of tinnitus.

STUDY DESIGN

Randomized, prospective, placebo-controlled study.

SETTING

Patients with tinnitus were admitted to the ear, nose, and throat clinic of the authors' hospital.

PATIENTS

Patients with tinnitus with no know pathologic conditions of the ear, nose, and throat; the mean age of 28 patients receiving zinc was 51.2 years, and that of 13 patients given placebo was 55 years.

INTERVENTION

Blood zinc levels were measured. Frequency was detected by audiometry, and loudness of tinnitus was screened by tinnitus match test. A questionnaire that scored tinnitus subjectively between 0 and 7 was given to patients before zinc treatment. After 2 months of treatment (zinc 50 mg daily to zinc group, placebo pill containing starch to placebo group), all of the tests were performed again. There was no difference in age, sex, duration of tinnitus, and affected ears between the patients treated with zinc and those treated with placebo. Blood zinc levels were lower than normal in 31% of patients before treatment.

MAIN OUTCOME MEASURES

A decrease in tinnitus loudness by at least 10 dB was accepted as clinically favorable progress. A decrease of more than 1 point in subjective tinnitus scoring was accepted as valid.

RESULTS

Clinically favorable progress was detected in 46.4% of patients given zinc. Although this decrease was not statistically significant, the severity of subjective tinnitus decreased in 82% of the patients receiving zinc. The mean of subjective tinnitus decreased from 5.25 +/- 1.08 to 2.82 +/- 1.81 ( < 0.001). However, the decrease in severity of the tinnitus was not significant in patients receiving placebo.

CONCLUSION

It can be concluded that patients with tinnitus may have low blood zinc levels (31%) and clinical and subjective improvement can be achieved by oral zinc medication. However, it remains to be seen whether the longer duration of treatment has more significant results.

Recent advances in the pharmacological treatment of tinnitus

Tinnitus is an extremely prevalent condition that impinges on the lives of sufferers to varying degrees. In some people, it is a fairly minor irritation but, for many, the tinnitus intrudes to such a degree that it affects their ability to lead a normal life, and in some very extreme cases has resulted in suicide. Insomnia, inability to concentrate and depression are commonly reported to accompany the condition. Relief can be reliably obtained using intravenous lignocaine, which indicates that pharmacology can provide a route for effective alleviation of the condition. In this article, Julie Simpson and Ewart Davies review the potential pharmacological therapies, and emphasize that clinical research has been hampered by the absence of a reliable objective assessment of the tinnitus and by the variable nature of the complaint.

Current concepts in the clinical management of patients with tinnitus

The current management in tinnitus of sensorineural origin is reviewed. Epidemiological data demonstrates that 90% of patients with hearing loss experience some tinnitus. Approximately 1% of the population suffer from a chronic tinnitus that causes severe distress and requires some type of management intervention. Present non-surgical therapies include masking techniques, psychological counseling, and biofeedback. There are also a number of drugs that have been applied, the most common being antidepressants. These have had the most success in managing patients with tinnitus, although it is currently felt that antidepressants treat underlying psychological problems rather than directly affect the tinnitus. The other large class of drugs include benzodiazopans, in addition to a new synthetic analog of a natural prostaglandin E1, misoprostol. Despite the many drugs now available, none has been approved by the United States Food and Drug Administration for the treatment of tinnitus. Many surgical therapies have been advocated but are directed towards the treatment of concurrent vertigo or for tumors of the cerebellopontine angle, with tinnitus sometimes being relieved by the operation. Specific surgical procedures such as cochlear resection and microvascular decompressions lack clear-cut efficacy. Despite author bias and a myriad of treatment modalities at present, there is still no specific therapy that definitively relieves tinnitus clinically.