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Dramamine tinnitus. Pharmacotherapy for Tinnitus: A Comprehensive Review of Treatment Options

by alexxlab

What are the most effective pharmacological treatments for tinnitus. How do lidocaine and tocainide compare in managing tinnitus symptoms. Can intravenous medications provide relief for chronic tinnitus sufferers. What role do local anesthetics play in tinnitus management. Are there any promising emerging therapies for tinnitus treatment.

Содержание

Understanding Tinnitus: Causes, Classification, and Neurological Basis

Tinnitus, often described as a ringing or buzzing in the ears, is a complex auditory phenomenon that affects millions of people worldwide. To effectively treat this condition, it’s crucial to understand its underlying causes and mechanisms.

What is tinnitus and how is it classified?

Tinnitus is the perception of sound in the absence of an external acoustic stimulus. According to Coelho et al. (2020), tinnitus can be classified into multiple categories, reflecting its diverse origins. These classifications help in tailoring treatment approaches to individual cases.

What is the neurological basis of tinnitus?

Eggermont and Roberts (2004) explain that tinnitus is not just an ear problem but also involves complex neural processes. The neuroscience of tinnitus suggests that it results from abnormal neural activity in the auditory pathways, which the brain interprets as sound.

Lidocaine: A Pioneering Treatment for Tinnitus

Lidocaine has been one of the most extensively studied pharmacological treatments for tinnitus. Its use dates back to the early 20th century and continues to be a subject of research and clinical interest.

How effective is intravenous lidocaine for tinnitus?

Several studies have investigated the efficacy of intravenous lidocaine in treating tinnitus. Duckert and Rees (1983) conducted a double-blind randomized trial that showed promising results. Melding et al. (1978) and Martin and Colman (1980) also reported positive outcomes with intravenous lidocaine treatment.

What are the mechanisms behind lidocaine’s effect on tinnitus?

Trellakis et al. (2006) explored the differential sensitivity of human voltage-gated potassium channels to lidocaine, providing insights into how this local anesthetic might influence auditory processing and tinnitus perception.

Tocainide: An Alternative to Lidocaine for Tinnitus Management

Tocainide, a structural analog of lidocaine, has been investigated as a potential oral alternative for tinnitus treatment. Its use in tinnitus management stems from its similarities to lidocaine and its oral bioavailability.

How does tocainide compare to lidocaine in tinnitus treatment?

Emmett and Shea (1980) studied the effects of tocainide hydrochloride on tinnitus patients. While tocainide showed some promise, its efficacy and safety profile differed from that of lidocaine. Cathcart (1982) and Hulshof and Vermeij (1985) conducted further assessments of tocainide’s value in tinnitus treatment.

What are the potential side effects of tocainide?

Winkle et al. (1980) discussed the efficacy and side effects of tocainide in the context of ventricular arrhythmias, which provides valuable information on its safety profile when considering its use for tinnitus.

Emerging Pharmacological Approaches to Tinnitus Treatment

As our understanding of tinnitus pathophysiology evolves, new pharmacological approaches are being explored to target specific mechanisms involved in tinnitus generation and perception.

What are some promising new drugs for tinnitus?

Langguth et al. (2009) and Elgoyhen and Langguth (2010) review emerging pharmacotherapies for tinnitus. These include drugs targeting neurotransmitter systems, ion channels, and neuroplasticity mechanisms involved in tinnitus.

How do these new approaches differ from traditional treatments?

Unlike older treatments that often aimed to mask or suppress tinnitus symptoms, many emerging therapies seek to address the underlying neural mechanisms. This approach may lead to more effective and long-lasting relief for tinnitus sufferers.

Combination Therapies and Multimodal Approaches

Given the complex nature of tinnitus, combination therapies and multimodal approaches are gaining attention in the field of tinnitus management.

Can combining different treatments improve outcomes for tinnitus patients?

Research suggests that combining pharmacological treatments with other modalities, such as sound therapy or cognitive behavioral therapy, may enhance overall treatment efficacy. Hazell et al. (1985) studied the use of tinnitus maskers, which could potentially be combined with drug therapies for improved outcomes.

What role do non-pharmacological treatments play alongside medication?

Non-pharmacological treatments, including cognitive behavioral therapy, sound enrichment, and tinnitus retraining therapy, can complement pharmacological approaches. Savage and Waddell (2014) discuss various treatment options for tinnitus, emphasizing a comprehensive management strategy.

Challenges in Tinnitus Pharmacotherapy Research

Despite advances in tinnitus research, developing effective pharmacological treatments remains challenging due to the heterogeneous nature of the condition and the complexities of conducting clinical trials.

Why is it difficult to develop a one-size-fits-all drug for tinnitus?

The diverse causes and manifestations of tinnitus make it unlikely that a single drug will be effective for all patients. Individual variations in tinnitus characteristics and responses to treatment further complicate drug development efforts.

What are the main obstacles in conducting tinnitus clinical trials?

Challenges in tinnitus clinical trials include the subjective nature of tinnitus assessment, placebo effects, and the need for long-term follow-up to evaluate treatment efficacy. These factors make it difficult to definitively prove the effectiveness of new treatments.

Future Directions in Tinnitus Pharmacotherapy

The field of tinnitus pharmacotherapy continues to evolve, with ongoing research aiming to develop more targeted and effective treatments.

What new approaches are being explored for tinnitus drug development?

Researchers are investigating novel drug targets based on recent advances in our understanding of tinnitus neurobiology. These include drugs that modulate specific neurotransmitter systems, influence neuroplasticity, or target neuroinflammation associated with tinnitus.

How might personalized medicine impact tinnitus treatment in the future?

The future of tinnitus treatment may lie in personalized approaches that take into account individual patient characteristics, tinnitus subtypes, and genetic factors. This tailored approach could lead to more effective and targeted pharmacological interventions.

In conclusion, the pharmacological treatment of tinnitus remains an active area of research with both established and emerging therapies. While drugs like lidocaine and tocainide have shown some efficacy, their use is limited by side effects and the need for careful administration. Newer approaches targeting specific neural mechanisms offer hope for more effective treatments in the future. As research progresses, a combination of pharmacological and non-pharmacological approaches, tailored to individual patients, may provide the best outcomes for those suffering from tinnitus.

Review of Pharmacotherapy for Tinnitus

1. Langguth B., Salvi R., Elgoyhen A.B. Emerging pharmacotherapy of tinnitus. Expert. Opin. Emerg. Drugs. 2009;14:687–702. doi: 10.1517/14728210903206975. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

2. Flores E.I., Tiznado G.E., Díaz R., Orozco E.I.F., Galletti C., Gazia F., Galletti F. Effect of a Mandibular Advancement Device on the Upper Airway in a Patient with Obstructive Sleep Apnea. J. Craniofac. Surg. 2020;31:e32–e35. doi: 10.1097/SCS.0000000000005838. [PubMed] [CrossRef] [Google Scholar]

3. Coelho C.B., Santos R., Campara K.F., Tyler R. Classification of Tinnitus: Multiple Causes with the Same Name. Otolaryngol. Clin. N. Am. 2020;53:515–529. doi: 10.1016/j.otc.2020.03.015. [PubMed] [CrossRef] [Google Scholar]

4. Eggermont J.J., Roberts L.E. The neuroscience of tinnitus. Trends Neurosci. 2004;27:676–682. doi: 10.1016/j.tins.2004.08.010. [PubMed] [CrossRef] [Google Scholar]

5. Elgoyhen A.B., Langguth B. Pharmacological approaches to the treatment of tinnitus. Drug Discov. Today. 2010;15:300–305. doi: 10.1016/j.drudis.2009.11.003. [PubMed] [CrossRef] [Google Scholar]

6. Savage J., Waddell A. Tinnitus. Am. Fam. Physician. 2014;15:471–472. [PubMed] [Google Scholar]

7. Duckert L.G., Rees T.S., Duckert L.G. Treatment of tinnitus with intravenous lidocaine: A double-blind randomized trial. Otolaryngol. Head Neck Surg. 1983;91:550–555. doi: 10.1177/019459988309100514. [PubMed] [CrossRef] [Google Scholar]

8. Barany R. Die Beeinflussung des Ohrensausens durch intravenös injizierte Lokalanästhetica. Acta Otolarngol. 1935;23:201–203. doi: 10.3109/00016483609123219. [PubMed] [CrossRef] [Google Scholar]

9. Melding P.S., Goodey R.J., Thorne P.R. The use of intravenous lignocaine in the diagnosis and treatment of tinnitus. J. Laryngol. Otol. 1978;92:115–121. doi: 10.1017/S002221510008511X. [PubMed] [CrossRef] [Google Scholar]

10. Martin F.W., Colman B.H. Tinnitus: A double-blind crossover controlled trial to evaluate the use of lignocaine. Clin. Oto-laryngol. 1980;5:3–11. doi: 10.1111/j.1365-2273.1980.tb01622.x. [PubMed] [CrossRef] [Google Scholar]

11. Emmett J.R., Shea J.J. Treatment of tinnitus with tocainide hydrochloride. Otolaryngol. Head Neck Surg. 1980;88:442–446. doi: 10.1177/019459988008800422. [PubMed] [CrossRef] [Google Scholar]

12. Majumdar B., Mason S.M., Gibbin K.P. An electrocochleographic study of the effects of lignocaine on patients with tinnitus. Clin. Otolaryngol. 1983;8:175–180. doi: 10.1111/j.1365-2273.1983.tb01423.x. [PubMed] [CrossRef] [Google Scholar]

13. Trellakis S., Benzenberg D., Urban B.W., Friederich P. Differential lidocaine sensitivity of human voltage-gated potassium channels relevant to the auditorysystem. Otol. Neurotol. 2006;27:117–123. doi: 10.1097/01.mao.0000186443.11832.8a. [PubMed] [CrossRef] [Google Scholar]

14. Gejrot T. Intravenous xylocaine in the treatment of attacks on Meniere’s disease. Acta Otolaryngol. 1976;82:301–302. doi: 10.3109/00016487609120911. [PubMed] [CrossRef] [Google Scholar]

15. Israel J.M., Connelly J.S., McTigue S.T., Brummett R.E., Brown J. Lidocaine in the Treatment of Tinnitus Aurium: A Double-blind Study. Arch. Otolaryngol. Head Neck Surg. 1982;108:471–473. doi: 10.1001/archotol.1982.00790560009003. [PubMed] [CrossRef] [Google Scholar]

16. Perucca E., Jackson P. A controlled study of the suppression of tinnitus by lidocaine infusion: (Relationship of therapeutic effect with serum lidocaine levels) J. Laryngol. Otol. 1985;99:657–661. doi: 10.1017/S0022215100097437. [PubMed] [CrossRef] [Google Scholar]

17. Brusis T., Loennecken I. Treatment of tinnitus with iontophoresis and local anesthesia. Laryngol. Rhinol. Otol. 1985;64:355–358. doi: 10.1055/s-2007-1008159. [PubMed] [CrossRef] [Google Scholar]

18. Winkle R.A., Mason J.W., Harrison D.C. Tocainide for drug-resistant ventricular arrhythmias: Efficacy, side effects, and lidocaine responsiveness for predicting tocainide success. Am. Heart J. 1980;100:1031–1036. doi: 10.1016/0002-8703(80)90209-4. [PubMed] [CrossRef] [Google Scholar]

19. Cathcart J.-M. Assessment of the value of tocainide hydrochloride in the treatment of tinnitus. J. Laryngol. Otol. 1982;96:981–984. doi: 10.1017/S0022215100093397. [PubMed] [CrossRef] [Google Scholar]

20. Hazell J.W.P., Wood S.M., Cooper H.R., Stephens S.D.G., Corcoran A.L., Coles R.R.A., Baskill J.L., Sheldrake J.B. A clinical study of tinnitus maskers. Br. J. Audiol. 1985;19:65–146. doi: 10.3109/03005368509078966. [PubMed] [CrossRef] [Google Scholar]

21. Hulshof J.H., Vermeij P. The value of tocainide in the treatmnet of tinnitus. A double-blind controlled study. Arch Otorhi-nolaryngol. 1985;241:279–283. doi: 10.1007/BF00453701. [PubMed] [CrossRef] [Google Scholar]

22. Blayney A., Phillips M., Guy A., Colman B. A sequential double blind cross-over trial of tocainide hydrochloride in tinnitus. Clin. Otolaryngol. Allied Sci. 1985;10:97–101. doi: 10.1111/j.1365-2273.1985.tb01175.x. [PubMed] [CrossRef] [Google Scholar]

23. El Hoekstra C., Rynja S.P., A Van Zanten G., Rovers M. Anticonvulsants for tinnitus. Cochrane Database Syst. Rev. 2009 doi: 10.1002/14651858.cd007960. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

24. Donaldson I. Tegretol: A double blind trial in tinnitus. J. Laryngol. Otol. 1981;95:947–951. doi: 10.1017/S0022215100091659. [PubMed] [CrossRef] [Google Scholar]

25. Hulshof J., Vermeij P. The value of carbamazepine in the treatment of tinnitus. ORL J. Otorhinolaryngol. Relat. Spec. 1985;47:262–266. doi: 10.1159/000275781. [PubMed] [CrossRef] [Google Scholar]

26. Lechtenberg R., Shulman A. The Neurologic Implications of Tinnitus. Arch. Neurol. 1984;41:718–721. doi: 10.1001/archneur.1984.04050180040014. [PubMed] [CrossRef] [Google Scholar]

27. Han J.S., Park J.M., Park S.Y., Vidal J.L., Ashaikh H.K., Kim D.K., Park S.N. Typewriter tinnitus: An investigative comparison with middle ear myoclonic tinnitus and its long-term therapeutic response to carbamazepine. Auris Nasus Larynx. 2020;47:580–586. doi: 10.1016/j.anl.2020.01.005. [PubMed] [CrossRef] [Google Scholar]

28. Witsell D.L., Hannley M.T., Stinnet S., Tucci D.L. Treatment of tinnitus with gabapentin: A pilot study. Otol. Neurotol. 2007;28:11–15. doi: 10.1097/01.mao.0000235967.53474.93. [PubMed] [CrossRef] [Google Scholar]

29. Piccirillo J.F., Finnell J., Vlahiotis A., Chole R.A., Spitznagel E., Jr. Relief of idiopathic subjective tinnitus: Is gabapentin effective? Arch. Otolaryngol. Head Neck Surg. 2007;133:390–397. doi: 10.1001/archotol.133.4.390. [PubMed] [CrossRef] [Google Scholar]

30. Bakhshaee M., Ghasemi M., Azarpazhooh M., Khadivi E., Rezaei S., Shakeri M., Tale M. Gabapentin effectiveness on the sensa-tion of subjective idiopathic tinnitus: A pilot study. Eur. Arch. Otorhinolaryngol. 2008;265:525–530. doi: 10.1007/s00405-007-0504-9. [PubMed] [CrossRef] [Google Scholar]

31. Ciodaro F., Mannella V.K., Cammaroto G., Bonanno L., Galletti F., Galletti B. Oral gabapentin and intradermal injection of lidocaine: Is there any role in the treatment of moderate/severe tinnitus? Eur. Arch. Otorhinolaryngol. 2015;272:2825–2830. doi: 10.1007/s00405-014-3304-z. [PubMed] [CrossRef] [Google Scholar]

32. Goodey R.J. Drugs in the Treatment of Tinnitus. Novartis Found. Symp. 2008;85:263–294. [PubMed] [Google Scholar]

33. Menkes D.B., Larson P.M. Sodium valproate for tinnitus. J. Neurol. Neurosurg. Psychiatry. 1998;65:803. doi: 10.1136/jnnp.65.5.803. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

34. Aazh H., Refaie A.E., Humphriss R. Gabapentin for tinnitus: A systematic review. Am. J. Audiol. 2011;20:151–158. doi: 10.1044/1059-0889(2011/10-0041). [PubMed] [CrossRef] [Google Scholar]

35. Mihail R., Crowley J., Walden B., Fishburne J., Reinwall J., Zajtchuk J. The tricyclic trimipramine in the treatment of subjective tinnitus. Ann. Otol. Rhinol. Laryngol. 1988;97:120–123. doi: 10.1177/000348948809700204. [PubMed] [CrossRef] [Google Scholar]

36. Dobie R.A., Sakai C.S., Sullivan M.D., Katon W.J., Russo J. Antidepressant treatment of tinnitus patients: Report of a randomized clinical trial and clinical prediction of benefit. Am. J. Otol. 1993;14:18–23. [PubMed] [Google Scholar]

37. Podoshin L., Ben-David Y., Fradis M., Malatskey S., Hafner H. Idiopathic Subjective Tinnitus Treated by Amitriptyline Hy-drochloride/Biofeedback. Int. Tinnitus J. 1995;1:54–60. [PubMed] [Google Scholar]

38. Bayar N., Böke B., Turan E., Belgin E. Efficacy of amitriptyline in the treatment of subjective tinnitus. J. Otolaryngol. 2001;30:300–333. doi: 10.2310/7070.2001.19597. [PubMed] [CrossRef] [Google Scholar]

39. Robinson S.K., Viirre E.S., Stein M.B. Antidepressant therapy in tinnitus. Hear. Res. 2007;226:221–231. doi: 10.1016/j.heares.2006.08.004. [PubMed] [CrossRef] [Google Scholar]

40. Sigyn Z., Jan S., Kajsa-Mia H. The effects of sertraline on severe tinnitus suffering—A randomized, double-blind, place-bo-controlled study. J. Clin. Psychopharmacol. 2006;26:32–39. [PubMed] [Google Scholar]

41. Dib G.C., Kasse C.A., Alves de Andrade T., Gurgel Testa J.R., Cruz O.L. Tinnitus treatment with Trazodone. Braz. J. Otorhino-laryngol. 2007;73:390–397. doi: 10.1016/S1808-8694(15)30084-7. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

42. Baldo P., Doree C., Lazzarini R., Molin P., McFerran D. Antidepressants for patients with tinnitus. Cochrane Database Syst. Rev. 2006 doi: 10.1002/14651858.cd003853.pub2. [PubMed] [CrossRef] [Google Scholar]

43. Hulshof J.H., Vermeij P. The Value of Flunarizine in the Treatment of Tinnitus. ORL. 1986;48:33–36. doi: 10.1159/000275839. [PubMed] [CrossRef] [Google Scholar]

44. James A., Burton M.J. Betahistine for Ménière’s disease or syndrome. Cochrane Database Syst. Rev. 2001;2001:CD001873. doi: 10.1002/14651858.cd001873. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

45. Wegner I., Hall D.A., Smit A.L., McFerran D., Stegeman I. Betahistine for tinnitus. Cochrane Database Syst. Rev. 2018;12:CD013093. doi: 10.1002/14651858.CD013093.pub2. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

46. Fitzsimons R., Van Der Poel L. -A., Thornhill W., Du Toit G., Shah N., A Brough H. Antihistamine use in children. Arch. Dis. Child. Educ. Pract. Ed. 2015;100:122–131. doi: 10.1136/archdischild-2013-304446. [PubMed] [CrossRef] [Google Scholar]

47. Sieghart W. Pharmacology of benzodiazepine receptors: An update. Pharmacology of benzodiazepine receptors: An up-date. J. Psychiatry Neurosci. 1994;19:24–29. [PMC free article] [PubMed] [Google Scholar]

48. Jufas N.E., Wood R. The use of benzodiazepines for tinnitus: Systematic review. J. Laryngol. Otol. 2015;129:S14–S22. doi: 10.1017/S0022215115000808. [PubMed] [CrossRef] [Google Scholar]

49. Busto U., Sellers E.M., Naranjo C.A., Cappell H., Sanchez-Craig M., Sykora K. Withdrawal reaction after long-term therapeutic use of benzodiazepines. N. Engl. J. Med. 1986;315:854–859. doi: 10.1056/NEJM198610023151403. [PubMed] [CrossRef] [Google Scholar]

50. Schleuning A.J., Johnson R.M., Vernon J.A. Evaluation of a tinnitus masking program: A follow-up study of 598 patients. Ear Hear. 1980;1:71–74. doi: 10.1097/00003446-198003000-00004. [PubMed] [CrossRef] [Google Scholar]

51. Melding P., Goodey R. The treatment of tinnitus with oral anticonvulsants. J. Laryngol. Otol. 1979;93:111–122. doi: 10.1017/S0022215100086837. [PubMed] [CrossRef] [Google Scholar]

52. Michele F., Matteo M. Tinnitus psychopharmacology: A comprehensive review of its pathomechanisms and management. Neuropsychiatr. Dis. Treat. 2010;6:209–218. [PMC free article] [PubMed] [Google Scholar]

53. Kay N.J. Oral Chemotherapy in Tinnitus. Br. J. Audiol. 1981;15:123–124. doi: 10.3109/03005368109081425. [PubMed] [CrossRef] [Google Scholar]

54. Johnson R.M., Brummett R., Schleuning A. Use of alprazolam for relief of tinnitus. A double-blind study. Arch. Otolaryngol. Head Neck Surg. 1993;119:842–845. doi: 10.1001/archotol.1993.01880200042006. [PubMed] [CrossRef] [Google Scholar]

55. Bahmad F.M., Jr., Venosa A.R., Oliveira C.A. Benzodiazepines and GAB Aergics in treating severe disabling tinnitus of predom-inantly cochlear origin. Int. Tinnitus J. 2006;12:140–144. [PubMed] [Google Scholar]

56. Jalali M.M., Kousha A., Naghavi S.E., Soleimani R., Banan R. The effects of alprazolam on tinnitus: A cross-over randomized clinical trial. Med. Sci. Monit. 2009;15:PI55–PI60. [PubMed] [Google Scholar]

57. Han S.-S., Nam E.-C., Won J.Y., Lee K.U., Chun W., Choi H.K., Levine R.A. Clonazepam Quiets tinnitus: A randomised crossover study withGinkgo Biloba. J. Neurol. Neurosurg. Psychiatry. 2012;83:821–827. doi: 10.1136/jnnp-2012-302273. [PubMed] [CrossRef] [Google Scholar]

58. Donaldson I. Tinnitus: A theoretical view and a therapeutic study using amylobarbitone. J. Laryngol. Otol. 1978;92:123–130. doi: 10.1017/S0022215100085121. [PubMed] [CrossRef] [Google Scholar]

59. Marks N.J., Onisiphorou C., Trounce J.R. The effect of single doses of amylobarbitone sodium and carbamazepine in tinnitus. J. Laryngol. Otol. 1981;95:941–945. doi: 10.1017/S0022215100091647. [PubMed] [CrossRef] [Google Scholar]

60. Davies E., Knox E., Donaldson I. The usefulness of nimodipine, an L-calcium channel antagonist, in the treatment of tinnitus. Br. J. Audiol. 1994;28:125–129. doi: 10.3109/03005369409086559. [PubMed] [CrossRef] [Google Scholar]

61. Risey J.A., Guth P.S., Amedee R.G. Furosemide Distinguishes Central and Peripheral Tinnitus. Int. Tinnitus J. 1995;1:99–103. [PubMed] [Google Scholar]

62. Futaki T., Kitahara M., Morimoto M. A Comparison of the Furosemide and Glycerol Tests for Meniere’s Disease. Acta Oto-Laryngol. 1977;83:272–278. doi: 10.3109/00016487709128845. [PubMed] [CrossRef] [Google Scholar]

63. Denk D.M., Heinzl H., Franz P., Ehrenberger K. Caroverine in tinnitus treatment. A placebo-controlled blind study. Acta Otolaryngol. 1997;117:825–830. doi: 10.3109/00016489709114208. [PubMed] [CrossRef] [Google Scholar]

64. Domeisen H., Hotz M.A., Häusler R. Caroverine in tinnitus treatment. Acta Otolaryngol. 1998;118:606–608. [PubMed] [Google Scholar]

65. Figueiredo R. R., Langguth B., Mello de Oliveira P., Aparecida de Azevedo A. Tinnitus treatment with memantine. Otolaryngol. Head Neck Surg. 2008;138:492–496. doi: 10.1016/j.otohns.2007.11.027. [PubMed] [CrossRef] [Google Scholar]

66. Azevedo A.A., Figueiredo R.R. Treatment of tinnitus with acamprosate. Prog. Brain Res. 2007;166:273–277. [PubMed] [Google Scholar]

67. Sharma D.K., Kaur S., Singh J., Kaur I. Role of acamprosate in sensorineural tinnitus. Indian J. Pharmacol. 2012;44:93–96. doi: 10.4103/0253-7613.91876. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

68. Suckfüll M., Althaus M., Ellers-Lenz B., Gebauer A., Görtelmeyer R., Jastreboff P.J., Moebius H.J., Rosenberg T., Russ H., Wirth Y., et al. A randomized, double-blind, placebo-controlled clinical trial to evaluate the efficacy and safety of neramexane in patients with moderate to severe subjective tinnitus. BMC Ear Nose Throat Disord. 2011;11:1. doi: 10.1186/1472-6815-11-1. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

69. Westerberg B.D., Roberson J.B., Stach B.A. A double-blind placebo-controlled trial of baclofen in the treatment of tinnitus. Am. J. Otol. 1996;7:896–903. [PubMed] [Google Scholar]

70. Murai K., Tyler R.S., Harker L.A., Stouffer J.L. Review of pharmacologic treatment of tinnitus. Am. J. Otol. 1992;13:454–464. [PubMed] [Google Scholar]

71. Kong X., Ma F., Xin Y., Zhao Y., Li N. Efficacy of carbamazepine combined with flunarizine hydrochloride for treating tinnitus. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2008;22:1016–1018. [PubMed] [Google Scholar]

72. Shaia F.T., Sheehy J.L. Sudden Sensori-Neural Hearing Impairment: A Report of 1,220 Cases. Laryngoscope. 1976;86:389–398. doi: 10.1288/00005537-197603000-00008. [PubMed] [CrossRef] [Google Scholar]

73. Rubin W. Nutrition, biochemistry, and tinnitus. Int. Tinnitus J. 1999;5:144–145. [PubMed] [Google Scholar]

74. Singh C., Kawatra R., Gupta J., Awasthi V., Dungana H. Therapeutic role of Vitamin B12 in patients of chronic tinnitus: A pi-lot study. Noise Health. 2016;18:93–97. doi: 10.4103/1463-1741.178485. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

75. Berkiten G., Yildirim G., Topaloglu I., Ugras H. Vitamin B12 levels in patients with tinnitus and effectiveness of vitamin B12 treatment on hearing threshold and tinnitus. B-ENT. 2013;9:111–116. [PubMed] [Google Scholar]

76. Atkinson M. Vitamin A in treatment of tinnitus and chronic progressive deafness: Results of an investigation. AMA Arch. Otolaryngol. 1954;59:192–194. doi: 10.1001/archotol.1954.00710050204010. [PubMed] [CrossRef] [Google Scholar]

77. Hulshof J.H., Vermeij P. The effect of nicotinamide on tinnitus: A double-blind controlled study. Clin. Otolaryngol. 1987;12:211–214. doi: 10.1111/j.1365-2273.1987.tb00189.x. [PubMed] [CrossRef] [Google Scholar]

78. Takakura M. Effectiveness of ATP in inner ear deafness and tinnitus. Jibiinkoka. 1962;34:707–710. [PubMed] [Google Scholar]

79. Bernhard O., Martin C., Hempel J.M., Mazurek B. , Suckfüll M. Effect of atorvastatin on progression of sensorineural hearing loss and tinnitus in the elderly: Results of a prospective, randomized, double-blind clinical trial. Otol Neurotol. 2007;28:455–458. [PubMed] [Google Scholar]

80. Prayuenyong P., Kasbekar A.V., Baguley D.M. The efficacy of statins as otoprotective agents: A systematic review. Clin. Otolaryngol. 2020;45:21–31. doi: 10.1111/coa.13457. [PubMed] [CrossRef] [Google Scholar]

81. Lopez-Gonzalez M.A., Santiago A.M., Esteban-Ortega F. Sulpiride and Melatonin Decrease Tinnitus Perception Modulating the Auditolimbic Dopaminergic Pathway. J. Otolaryngol. Suppl. 2007;36:213–219. doi: 10.2310/7070.2007.0018. [PubMed] [CrossRef] [Google Scholar]

82. Drew S., Davies E. Effectiveness of Ginkgo biloba in treating tinnitus: Double blind, placebo controlled trial. BMJ. 2001;322:73. doi: 10.1136/bmj.322.7278.73. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

83. Schneider D., Schneider L., Shulman A. , Claussen C.F., Just E., Koltchev C., Kersebaum M., Dehler R., Goldstein B., Claussen E. Gingko biloba (Rökan) therapy in tinnitus patients and measurable interactions between tinnitus and vestibular disturbances. Int. Tinnitus J. 2000;6:56–62. [PubMed] [Google Scholar]

84. Morgenstern C., Biermann E. The efficacy of Ginkgo special extract EGb 761 in patients with tinnitus. Int. J. Clin. Pharmacol. Ther. 2002;40:188–197. doi: 10.5414/CPP40188. [PubMed] [CrossRef] [Google Scholar]

85. Hilton M.P., Zimmermann E.F., Hunt W.T. Ginkgo biloba for tinnitus. Cochrane Database Syst. Rev. 2013;28:CD003852. doi: 10.1002/14651858.CD003852.pub3. [PubMed] [CrossRef] [Google Scholar]

86. Miroddi M., Bruno R., Galletti F., Calapai F., Navarra M., Gangemi S., Calapai G. Clinical pharmacology of melatonin in the treatment of tinnitus: A review. Eur. J. Clin. Pharmacol. 2015;71:263–270. doi: 10.1007/s00228-015-1805-3. [PubMed] [CrossRef] [Google Scholar]

87. Rosenberg S.I., Silverstein H. , Rowan P.T., Olds J. Effect of melatonin on tinnitus. Laryngoscope. 1998;108:305–310. doi: 10.1097/00005537-199803000-00001. [PubMed] [CrossRef] [Google Scholar]

88. Hurtuk A., Dome C., Holloman C.H., Wolfe K., Welling D.B., Dodson E.E., Jacob A. Melatonin: Can it stop the ringing? Ann. Otol. Rhinol. Laryngol. 2011;120:433–440. doi: 10.1177/000348941112000703. [PubMed] [CrossRef] [Google Scholar]

89. Megwalu U.C., Finnell J.E., Piccirillo J.F. The effects of melatonin on tinnitus and sleep. Otolaryngol. Head Neck Surg. 2006;134:210–213. doi: 10.1016/j.otohns.2005.10.007. [PubMed] [CrossRef] [Google Scholar]

90. Hartmann A., Tsuda Y. A controlled study on the effect of pentoxifylline and an ergot alkaloid derivative on regional cere-bral blood flow in patients with chronic cerebrovascular disease. Angiology. 1988;39:449–457. doi: 10.1177/000331978803900507. [PubMed] [CrossRef] [Google Scholar]

91. Salama N.Y., Bhatia P., Robb P.J. Efficacy of Oral Oxpentifylline in the Management of Idiopathic Tinnitus. ORL. 1989;51:300–304. doi: 10.1159/000276078. [PubMed] [CrossRef] [Google Scholar]

92. Yilmaz I., Akkuzu B., Çakmak Ö., Özlüoglu L.N. Misoprostol in the Treatment of Tinnitus: A Double-Blind Study. Otolaryngol. Neck Surg. 2004;130:604–610. doi: 10.1016/j.otohns.2003.08.027. [PubMed] [CrossRef] [Google Scholar]

93. Bretlau P., Causse J., Causse J.B., Hansen H.J., Johnsen N.J., Salomon G. Otospongiosis and sodium fluoride. A blind experi-mental and clinical evaluation of the effect of sodium fluoride treatment in patients with otospongiosis. Ann. Otol. Rhinol. Laryngol. 1985;94:103–107. doi: 10.1177/000348948509400201. [PubMed] [CrossRef] [Google Scholar]

94. Cesarani A., Capobianco S., Soi D., Giuliano D.A., Alpini D. Intratympanic dexamethasone treatment for control of subjective idiopathic tinnitus: Our clinical experience. Int. Tinnitus J. 2002;8:111–114. [PubMed] [Google Scholar]

95. Herraiz C., Plaza G., Aparicio J.M., Gallego I., Marcos S., Ruiz C. Transtympanic steroids for Ménière’s disease. Otol. Neurotol. 2010;31:162–167. doi: 10.1097/MAO.0b013e3181c34e53. [PubMed] [CrossRef] [Google Scholar]

96. Topak M., Sahin-Yilmaz A., Ozdoganoglu T., Yilmaz H.B., Ozbay M., Kulekci M. Intratympanic methylprednisolone injections for subjective tinnitus. J. Laryngol. Otol. 2009;123:1221–1225. doi: 10.1017/S0022215109990685. [PubMed] [CrossRef] [Google Scholar]

97. Shim H.J., Song S.J., Choi A.Y., Lee R.H., Yoon S.W. Comparison of various treatment modalities for acute tinnitus. Laryngoscope. 2011;121:2619–2625. doi: 10.1002/lary.22350. [PubMed] [CrossRef] [Google Scholar]

98. Choi S.J., Lee J.B., Lim H.J., In S.M., Kim J.Y., Bae K.H., Choung Y.H. Intratympanic dexamethasone injection for refractory tinnitus: Prospective placebo-controlled study. Laryngoscope. 2013;123:2817–2822. doi: 10.1002/lary.24126. [PubMed] [CrossRef] [Google Scholar]

99. Park C.W., Do N.Y., Rha K.S., Chung S.M., Kwon Y.J. Korean Academy of Medical Sciences Development of guideline for rating the physical impairment of otolaryngologic field. J. Korean Med. Sci. 2009;24:S258–S266. doi: 10.3346/jkms.2009.24.S2.S258. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

100. Kumral T.L., Yıldırım G., Berkiten G., Saltürk Z., Ataç E., Atar Y., Uyar Y. Efficacy of Trimetazidine Dihydrochloride for Reliev-ing Chronic Tinnitus: A Randomized Double-Blind Study. Clin. Exp. Otorhinolaryngol. 2016;9:192–197. doi: 10.21053/ceo.2015.00619. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

101. Ochi K., Ohashi T., Kinoshita H., Akagi M., Kikuchi H., Mitsui M., Kaneko T., Kato I. The serum zinc level in patients with tin-nitus and the effect of zinc treatment. Nihon Jibiinkoka Gakkai Kaiho. 1997;100:915–919. doi: 10.3950/jibiinkoka.100.915. [PubMed] [CrossRef] [Google Scholar]

102. Person O.C., Puga M.E., Da Silva E.M., Torloni M.R. Zinc supplementation for tinnitus. Cochrane Database Syst. Rev. 2016;11:CD009832. doi: 10.1002/14651858.CD009832.pub2. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

103. Vanneste S., De Ridder D. The use of alcohol as a moderator for tinnitus-related distress. Brain Topogr. 2012;25:97–105. doi: 10.1007/s10548-011-0191-0. [PubMed] [CrossRef] [Google Scholar]

104. Landier W. Ototoxicity and cancer therapy. Cancer. 2016;122:1647–1658. doi: 10.1002/cncr.29779. [PubMed] [CrossRef] [Google Scholar]

105. Pearson S.E., Taylor J., Patel P., Baguley D.M. Cancer survivors treated with platinum-based chemotherapy affected by ototox-icity and the impact on quality of life: A narrative synthesis systematic review. Int. J. Audiol. 2019;58:685–695. doi: 10.1080/14992027.2019.1660918. [PubMed] [CrossRef] [Google Scholar]

106. Hofmeister M. Do dietary factors significantly influence tinnitus? Aust. J. Gen. Pract. 2019;48:153–157. doi: 10.31128/AJGP-07-18-4643. [PubMed] [CrossRef] [Google Scholar]

107. Figueiredo R.R., de Azevedo A.A., Penido N.D.O. Tinnitus Features According to CAFFEINE Consumption. Volume 262. Elsevier BV; Amsterdam, The Netherlands: 2021. pp. 335–344. [PubMed] [Google Scholar]

108. Ghahraman M.A., Farahani S., Tavanai E. A comprehensive review of the effects of caffeine on the auditory and vestibular systems. Nutr. Neurosci. 2021;22:1–14. doi: 10.1080/1028415X.2021.1918984. [PubMed] [CrossRef] [Google Scholar]

109. Jason Qian Z., Jennifer C. Alyono an association between marijuana use and tinnitus. Am. J. Otolaryngol. 2020;41:102314. doi: 10.1016/j.amjoto.2019.102314. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

110. Risser A., Donovan D., Heintzman J., Page T. NSAID prescribing precautions. Am. Fam. Physician. 2009;80:1371–1378. [PubMed] [Google Scholar]

111. Vessey M., Painter R. Oral contraception and ear disease: Findings in a large cohort study. Contraception. 2001;63:61–63. doi: 10.1016/S0010-7824(01)00176-7. [PubMed] [CrossRef] [Google Scholar]

112. Dille M.F., Konrad-Martin D., Gallun F., Helt W.J., Gordon J.S., Reavis K.M., Bratt G.W., Fausti S.A. Tinnitus onset rates from chemotherapeutic agents and ototoxic antibiotics: Results of a large prospective study. J. Am. Acad. Audiol. 2010;21:409–417. doi: 10.3766/jaaa.21.6.6. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

113. Rizzi M.D., Hirose K. Aminoglycoside ototoxicity. Curr. Opin. Otolaryngol. Head Neck Surg. 2007;15:352–357. doi: 10.1097/MOO.0b013e3282ef772d. [PubMed] [CrossRef] [Google Scholar]

114. Huang M.Y., Schacht J. Drug-induced ototoxicity. Pathogenesis and prevention. Med. Toxicol. Adverse Drug Exp. 1989;4:452–467. doi: 10.1007/BF03259926. [PubMed] [CrossRef] [Google Scholar]

115. Mostyn R.H.L. Tinnitus and Propranolol. BMJ. 1969;2:766. doi: 10.1136/bmj.2.5659.766. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

116. Jastreboff P.J., Brennan J.F., Sasaki C.T. Quinine-Induced Tinnitus in Rats. Arch. Otolaryngol. Head Neck Surg. 1991;117:1162–1166. doi: 10.1001/archotol.1991.01870220110020. [PubMed] [CrossRef] [Google Scholar]

117. Du Y., Liu J., Jiang Q., Duan Q., Mao L., Ma F. Paraflocculus plays a role in salicylate-induced tinnitus. Hear. Res. 2017;353:176–184. doi: 10.1016/j.heares.2017.06.013. [PubMed] [CrossRef] [Google Scholar]

118. Puel J.-L., Guitton M.J. Salicylate-Induced Tinnitus: Molecular Mechanisms and Modulation by Anxiety. Volume 166. Elsevier BV; Amsterdam, The Netherlands: 2007. pp. 141–146. [PubMed] [Google Scholar]

Ménière’s Disease – Health Information Library

What is Ménière’s disease?

Ménière’s (say “men-YEERS”) disease is an inner ear problem that affects your hearing and balance. It normally occurs in only one ear at a time. But over time, it develops in the other ear in up to half of those who have it.

The disease usually occurs in people ages 40 to 60, but anyone can have it.

What causes it?

The cause of Ménière’s disease is not known. But it may be related to a fluid called endolymph in the inner ear. In people with Ménière’s disease, too much of this fluid builds up. This creates pressure in the parts of your inner ear that control balance. Experts aren’t sure why this fluid builds up. It may be that your body produces too much of the fluid. Or maybe the fluid doesn’t drain as it should from the inner ear. Or it may be both.

It’s hard to predict who will get Ménière’s disease. But your risk may be higher than normal if you have:

  • Another family member who has it.
  • An autoimmune disease, such as diabetes, lupus, or rheumatoid arthritis.
  • Had a head injury, especially if it involved your ear.
  • Had a viral infection of the inner ear.
  • Allergies.

What are the symptoms?

Ménière’s disease can cause symptoms that come on quickly and last from hours to days. During an attack, you may have:

  • Vertigo, the feeling that you or your surroundings are spinning. This may last from minutes to hours. It may be bad enough to cause nausea and vomiting.
  • Tinnitus, a low roaring, ringing, or hissing in your ear.
  • Hearing loss, which may be temporary or permanent.
  • A feeling of pressure or fullness in your ear.

Most people have repeated attacks over a period of years. Attacks usually happen more often during the first few years of the disease and then come less often after that.

In some cases, each attack damages the inner ear. Over time your inner ear may become so badly damaged that it no longer works as it should. Then the attacks may stop, but you may be left with:

  • Poor balance.
  • Permanent hearing loss.
  • Roaring or hissing in the affected ear.

A few people with Ménière’s disease have “drop attacks.” A drop attack is a sudden fall while you stand or walk. It occurs without warning. It may feel like you are suddenly being pushed to the ground. People who have these attacks don’t pass out, and they recover within seconds or minutes.

See a doctor right away if you think you have Ménière’s disease. Prompt diagnosis and treatment may reduce both the discomfort of the attacks and your risk of hearing loss.

How is it diagnosed?

To diagnose the disease, your doctor will do a physical exam that includes checking your ears, eyes, and nervous system. The doctor will also ask questions about your past health and your symptoms, such as:

  • How you feel when you have a vertigo attack.
  • How long an attack usually lasts.
  • Whether anything seems to trigger an attack, like changing your position.
  • Whether you have other symptoms along with vertigo, like hearing loss or nausea.

Your doctor may also do tests to confirm a diagnosis of Ménière’s. These tests may include:

  • Hearing tests, including one to find out if the nerve from the inner ear to the brain is working as it should.
  • A test called an electronystagmogram (ENG), which measures your eye movements. This can help the doctor find where the problem is that’s causing vertigo.
  • Imaging tests such as an MRI or CT scan of the head. These tests can find out if the symptoms are caused by a brain problem.

How is Ménière’s disease treated?

Ménière’s disease can’t be cured. But you can work with your doctor to find ways to decrease your symptoms and reduce how often you have attacks. Certain lifestyle changes like limiting sodium in your diet and reducing stress may help.

Medicines

Your doctor may prescribe a diuretic medicine. Diuretics help rid your body of excess fluid, so they may help prevent the buildup of fluid in your inner ear. And that may mean you have fewer attacks.

Your doctor may also prescribe medicines to use when you have an attack, such as:

  • Medicines that reduce the vertigo. These include antihistamines such as dimenhydrinate (for example, Dramamine), sedatives such as diazepam (for example, Valium), and the scopolamine patch (Transderm Scop).
  • Medicines that reduce nausea and vomiting caused by vertigo. These are called antiemetics.

Other treatments

If symptoms are severe and don’t respond to medicine, your doctor may suggest another treatment. This may include a steroid injection into the inner ear to reduce the fluid or pressure in the inner ear. The goal is to get rid of your symptoms while saving as much of your hearing as possible.

In rare cases of severe, lasting Ménière’s disease, doctors may suggest a treatment to destroy the balance center in the inner ear (labyrinth), which can prevent vertigo. Options include:

  • Chemical ablation. During this procedure, an antibiotic (usually gentamicin) is injected into the inner ear to destroy the labyrinth.
  • Surgery to remove the labyrinth. This is called labyrinthectomy.

These treatments can cause permanent hearing loss, so they are usually done only as a last resort.

What can you do at home?

Ménière’s can be hard to manage and tough to live with. But there are some things you can do that may help reduce the number of attacks you have:

  • Eat low-salt foods. Salt makes your body hold on to excess fluid. If you eat less salt, you may have less buildup of fluid in the ear. So you may get vertigo less often.
  • Avoid caffeine, alcohol, and tobacco.
  • Try to reduce the stress in your life.

To reduce your symptoms when you have an attack:

  • Lie down and hold your head very still until the attack goes away.
  • Take your medicines for vertigo and nausea as soon as you can.

You can also take steps to help protect yourself when you have attacks:

  • Do exercises to improve your balance. This can reduce your risk of falling and hurting yourself or others.
  • Make changes to reduce your risk of injury during a vertigo attack. For example, install grab bars in your bathroom. Wear shoes with low heels and nonslip soles. And don’t drive during an attack.

Noise in the head and ears: causes, treatment

Many patients of general practitioners, cardiologists, neurologists complain about noise in the head. This non-specific symptom is called tinnitus – a person hears a sound, but without a noise source. Noise in the ears and in the head with the same frequency occurs in both men and women, both in young and in old age. Tinnitus reduces the quality of life and interferes with work and daily activities. The cause of noise in the head can be a serious illness or a slight deviation in health indicators. In any case, it is recommended to consult a doctor for diagnosis.

At the MedEx Personal Medicine Clinic, you can get an examination for noise in the head and get advice from an experienced general practitioner. We will help you get rid of tinnitus and restore the quality of life.

What is noise in the head like? noises. Normally, they are masked by external sounds. Noise and ringing in the head become audible when perception is heightened or when anomalous limits are reached.

Types of tinnitus:

  • Constant monotonous noise. The sound is not loud, without a strong ringing. Most patients get used to the monotonous tinnitus and stop paying attention to it until the accompanying symptoms appear;
  • Pulsating noise. The buzz in the head occurs paroxysmal, at the same time it can lay the ears. Pulsation appears when blood circulation is disturbed. The patient cannot cope with the attack on his own;
  • Ringing (whistling). This is one of the signs of hearing loss. It becomes difficult for a person to make out the words of other people, external sounds. To make out something because of the whistle, you have to listen.

Why is the noise in my head?

The most common cause of tinnitus is muscle and/or vascular disease. There is an opinion that as a result of damage, the cells of the hearing aid become hypersensitive. They react to the body’s own sounds and send an alarm signal to the brain. The first attacks of noises seem frightening and ominous, but gradually the patient gets used to them.

Symptoms can be differentiated by origin. If there is constant noise in the head, the pulsations of sound are synchronous with the heartbeat, then a vascular disease is likely. With an increase in blood pressure, the hum intensifies.

Muscle noises occur intermittently. The sounds are not related to the heartbeat and are more like crackling, clicking, machine-gun fire.

Other possible causes of persistent noise in the head:

  • depression, depression;
  • overwork;
  • Meniere’s disease;
  • hypertension;
  • cerebral aneurysm;
  • acoustic neuroma;
  • arrhythmia;
  • hormonal disorders;
  • iron deficiency anemia;
  • oncopathology;
  • osteochondrosis of the cervical spine;
  • consequences of taking medicines;
  • traumatic brain injury;
  • pathological changes in the auditory pathway, etc.

For some people, tinnitus can cause normal sleep deprivation or fatigue. To get rid of noise, it is necessary to eliminate its cause: how to relax and sleep. In old age, noise and pain in the head often occur due to the natural aging of the body. Doctors can help the patient adjust to the new condition in order to maintain quality of life and normal sleep.

Important!

If the noise in the head is accompanied by pain, dizziness, auditory hallucinations, other unpleasant sensations, it is necessary to go to the doctor as soon as possible. Such manifestations may indicate damage to the central nervous system.

Diagnosis for noise in the head

At the first appointment, the doctor asks the patient about the time of onset of symptoms, their nature and frequency. The doctor also collects information about the hereditary predisposition to diseases, the presence of provoking factors, for example, working in an enterprise with a high noise level, etc. Then the patient is examined, and basic neurological tests are performed.

Additional examinations are required to clarify the diagnosis:

  • audiometry – measuring the level of auditory perception;
  • sound level – determination of the nature of sounds;
  • angiography of cerebral vessels;
  • CT or MRI according to indications in difficult cases;
  • Doppler echocardiography.

Based on the results of the examination, the doctor establishes a diagnosis and prescribes treatment. If no abnormalities are found, the patient is advised to take a leave of absence from work and restore their own peace of mind.

Lunyushkin Igor Nikolaevich

Find time for yourself!

Vertebrologist, chiropractor

Experience 38 years

Treatment for head noise

Therapy depends on the cause of tinnitus. For example, noise in the head with osteochondrosis requires complex treatment with non-steroidal anti-inflammatory drugs, muscle relaxants, and vitamins. The patient is prescribed a course of massage, physiotherapy and exercise therapy.

If noise and congestion are caused by otitis media, diseases of the hearing organs, an otolaryngologist will treat the person. The patient will be prescribed antibiotics, drops.

Noise in the ears and in the head with pressure is the competence of a cardiologist. The doctor must determine the cause of hypertension and select medications that will help normalize the patient’s condition. To get rid of tinnitus, you need to control your blood pressure.

In general, the treatment will be complex, including conservative therapy, physical and psychotherapeutic techniques. In severe cases, surgery is required.

To relieve symptoms, your doctor may prescribe:

  • medicines: antidepressants, vitamins, nootropics, vasoactive drugs, antihistamines, vasodilators, anesthetics, diuretics;
  • physiotherapy: electrophoresis, iontophoresis, phototherapy, reflexology;
  • non-traditional methods of treatment: acupuncture, aromatherapy, hirudotherapy;
  • physical activities: classes with an exercise therapy instructor, swimming, hiking in the fresh air.

It should be understood that it is not always possible to get rid of the noise in the head completely. The doctor can ease the symptoms so that the patient can return to their usual way of life. To improve falling asleep, you can constantly use audio maskers – turn on classical music or sounds of wildlife. Some patients respond well to the sound of rain, birdsong.

Make an appointment at the MedEx clinic so that the noise in your head does not prevent you from enjoying life. Our doctors treat with methods with proven effectiveness, according to individually drawn up schemes, advise in detail on recovery and prevention of relapses.

Sources:

  • A. I. Melekhin. The use of cognitive-behavioral psychotherapy in otolaryngology on the example of patients with tinnitus – Scientific article, II International Conference on Counseling Psychology and Psychotherapy, dedicated to the memory of Fedor Efimovich Vasilyuk: collection of materials, 2020
  • Ya. L. Shcherbakova, V. E. Kuzovkov, S. M. Megrelishvili, A. V. Shaporova. Methods for assessing the effectiveness of therapy in patients with tinnitus – Journal of Russian Otolaryngology, 2013

classification, causes of tinnitus, methods of treatment

Tinnitus (tinnitus) is a condition when a person hears various sounds, but their obvious source is absent. Patients describe the sensations in different ways: as a low rumble, similar to the operation of an engine, or a monotonous constant noise. Often they hear a squeak or ring. Some compare the auditory sensation to crackling or rumbling. Noise occurs suddenly, and it is not always possible to trace the connection between the impact of any external factors and its appearance. It lasts from several minutes to several days, and sometimes even weeks. This significantly reduces performance and affects the emotional background, up to the onset of depression.

Tinnitus can be both unilateral and bilateral, accompanied by intense pain in the temples and ear, hearing loss, balance disorders and dizziness. Sometimes it is so strong that it completely drowns out the sounds of the surrounding world.

Classification

According to the sound characteristics, the noise is divided into tonal (smooth sound of the same frequency, such as rumble, whistle, ringing) and non-tonal (rumble, crackle, clicks). According to the duration, tinnitus is divided into acute (up to 3 months), subacute (3-12 months), chronic (more than 1 year). In clinical practice, it is classified by reason of appearance:

  • Subjective. Often due to prolonged exposure to loud sound on the auditory analyzer. Extraneous noises are heard only by the patient, this prevents him from concentrating on the conversation, doing the work.
  • Neurological. Caused by damage to nerve receptors in the inner ear, such as Meniere’s disease. A strong hum is usually accompanied by dizziness.
  • Somatic. Associated with damage to any organ, pathological impulses from which irritate the auditory analyzer. May be provoked by touch and movement.
  • Objective. The disorder is due to the pathology of the muscular system, deformation of the vessels of the ear. The doctor may hear a pulsating sound when using the stethoscope.

To assess discomfort, Soldatov’s classification is used, dividing noise according to severity:

  1. A person adapts to extraneous sounds, working capacity is maintained.
  2. Intense noise appears during the night.
  3. A strong constant hum interferes with daily activities.
  4. The functionality is completely lost.

Causes of tinnitus

  • Acoustic injury.

The condition can be triggered by a single exposure to very high volume (rock concerts, fireworks, gunshots) or continuous exposure (loud music on headphones, work in sewing shops and factories). With an acute injury, hearing temporarily disappears, against the background of this, a squeak in the ears or a monotonous ringing occurs. Sometimes disturbed by dizziness, throbbing severe pain in the temples. With constant exposure to sound stimuli, a gradual increase in symptoms is noted. First, there is a short-term noise after being in rooms with loud sounds. Then the hum in the ears is accompanied by hearing loss and becomes permanent.

  • Age-related changes.

Every fifth among people aged 55-65 periodically notes the occurrence of extraneous sounds, after 65 years, up to 40% of people suffer from ringing and buzzing in the ears. The most common complaint is bilateral noise, very quiet at first but tends to build up. Due to its increase at night, patients often suffer from insomnia. In older people, these phenomena are due to degenerative changes in the inner ear.

  • Hypertension.

Tinnitus is typical for patients suffering from high blood pressure, the intensity of auditory sensations is affected by the BP indicator. The reason for the occurrence of extraneous sounds is the turbulent movement of blood through the narrowed vessels. Usually, hypertensive patients hear a slight hum that appears against the backdrop of a headache. Its amplification, accompanied by flickering of “flies”, nausea, may indicate a hypertensive crisis.

  • Pathological processes in the ear.

Noise may indicate damage to the auditory analyzer. After the relief of the underlying pathology, the ringing and hum cease to disturb. With some lesions, tinnitus becomes permanent (otitis media, otitis externa, eustachitis, foreign bodies, sulfur plugs, otosclerosis).

  • Vascular disorders.

Tinnitus most often occurs with atherosclerosis – lipid plaques on the walls of the vessels of the inner ear interfere with the normal movement of blood, which is felt as a pulsating noise. In most patients, the hum is more pronounced on one side.

  • Tumors.

Noise is characteristic of acoustic neuroma, a benign formation. The first symptom of a neoplasm is unilateral tinnitus. With the development of pathology, hearing on the side of the lesion worsens, sound sensations increase. Unilateral pulsating noise in combination with asymmetry of the palpebral fissure, swallowing disorder is a sign of a glomus tumor of the ear.

  • Cervical osteochondrosis.

A buzz or ringing in the ears in case of problems with the spine occurs when the head is turned or tilted sharply, or if you stay in an uncomfortable position for a long time. The reason is the squeezing of the vessels going from the neck to the ear and brain.

  • Traumatic brain injury.

Mild head bruising accompanied by short ringing or tinnitus without significant discomfort. With more serious damage, unusual auditory sensations occur against the background of severe headaches, nausea. The symptom may appear several days after the injury.

  • Complications of pharmacotherapy.

Tinnitus may develop 7 to 14 days after starting treatment for serious bacterial infections due to the ototoxic effects of the drugs. This side effect is provoked by antibiotics (macrolides, tetracyclines), diuretics (furosemide, hydrochlorothiazide), high doses of NSAIDs (indomethacin, diclofenac), tranquilizers (Phenazepam, Tranxen).

Diagnosis

When tinnitus occurs, the patient is referred to an otolaryngologist to identify otogenic causes. The examination uses laboratory and instrumental methods. The most informative of them:

  • Inspection of the ear canal. Otoscopy eliminates tympanic membrane rupture, inflammation of the outer and middle ear.
  • Audiometry. With the help of special devices that generate sounds of a given frequency, hearing impairments are detected. Tuning fork tests make it possible to differentiate between the pathologies of the inner and middle ear.
  • X-ray examinations. Often, tinnitus is provoked by neurological problems, so patients are prescribed x-rays of the bones of the skull. In patients with osteochondrosis, the spine is examined. To visualize formations and structural disorders of the brain, MRI and CT of the head are prescribed.
  • Angiography. If there is a suspicion of an aneurysm or atherosclerotic lesion of the cerebral vessels, an angiogram with contrast is performed to visualize the structure of the vascular bed and establish the localization of pathological changes.

Laboratory methods are used as auxiliary methods – general and biochemical blood tests, serological reactions (PCR, RIF, ELISA). With inflammation, accompanied by discharge from the ear, bacteriological culture is performed. In difficult cases, to identify the cause of tinnitus, consultations of various specialists (oncologist, neurologist) are required, sometimes a psychiatric examination is indicated.

Doctor’s expert opinion

Sokolova Elena Igorevna

Neurologist, vestibulologist

When to contact a specialist and which one?

Often, tinnitus is a sign of a disease, the treatment of which should be started as soon as possible. It is urgent to consult a doctor if symptoms such as hearing loss, severe headaches, discomfort in the heart muscle area, nausea, vomiting, dizziness, and impaired coordination join tinnitus. With bilateral noise, you need to make an appointment with a general practitioner or a neurologist, with one-sided noise, you should start with an otorhinolaryngologist.

Treatment

Complete elimination of noise is possible only if the underlying disease is eliminated, so a visit to the doctor should not be postponed. To initially reduce discomfort, sedative herbal preparations, herbal teas are indicated. Ear massage can help.

Conservative therapy

The treatment regimen is selected depending on the underlying disease and concomitant pathology. A prerequisite is the elimination of the provoking factor (change of work, refusal of loud music). Treatment includes antibiotics, angioprotectors, antihistamines, and anti-inflammatory drugs. For symptomatic treatment of noise, sedatives, antidepressants, and tranquilizers are used.

Experimental treatment

Tinnitus retraining therapy (TRT) is a type of cognitive behavioral therapy. During an individual lesson, a person is taught techniques for switching attention, methods of relaxation. One of the components of the treatment is individual sound therapy (the rustle of leaves, the sound of rain, the splashing of waves). Gradually, the brain learns to block these sounds, which helps to reduce the perception of pathological noise.

Surgical treatment

If purulent inflammation is the cause of extraneous sounds, the tympanic cavity is opened and drained. Detected tumors of the auditory analyzer are removed with mandatory cytomorphological examination. For the treatment of malignant neoplasms, surgery is prescribed in conjunction with radiation and chemotherapy. In aneurysms, the affected vessel is clipped.

EuroCityClinic uses modern techniques to eliminate tinnitus. Experienced otorhinolaryngologists will identify the cause of the pathology and develop an effective treatment regimen. We will make every effort to improve the patient’s quality of life.

FAQ

Drug therapy includes drugs that improve blood circulation and oxygen excretion (derivatives of ginkgo biloba, vinpocetine), histaminergic drugs (betahistine dihydrochloride), anticonvulsants and vitamins of group B. If the noise is caused by neuropsychiatric factors, tranquilizers are prescribed. All medicines are taken only as prescribed by a doctor.