Tinnitus and its current treatment–Still an enigma in medicine

Drug Discovery Today, 2010

Textbook of Tinnitus, 2011

Drugs of the Future, 2009

Subjective tinnitus, the phantom ringing or buzzing sensation that occurs in the absence of sound, affects 12-14% of adults; in some cases the tinnitus is so severe or disabling that patients seek medical treatment. However, although the economic and emotional impact of tinnitus is large, there are currently no FDA-approved drugs to treat this condition. Clinical trials are now underway to evaluate the efficacy of N-methyl-d-aspartate (NMDA) and dopamine D 2 antagonists, selective serotonin reuptake inhibitors (SSRIs), γ-aminobutyric acid (GABA) agonists and zinc dietary supplements. Previous off-label clinical studies, while not definitive, suggest that patients with severe depression may experience improvement in their tinnitus after treatment with antidepressants such as nortriptyline or sertraline. A small subpopulation of patients with what has been described as "typewriter tinnitus" have been shown to gain significant relief from the anticonvulsant carbamazepine. Preliminary studies with misoprostol, a synthetic prostaglandin E1 analogue, and sulpiride, a dopamine D 2 antagonist, have shown promise. Animal behavioral studies suggest that GABA transaminase inhibitors and potassium channel modulators can suppress tinnitus. Additionally, improvements in tinnitus have also been noted in patients taking melatonin for significant sleep disturbances. Like other complex neurological disorders, one drug is unlikely to resolve tinnitus in all patients; therapies targeting specific subgroups are likely to yield the greatest success. Individuals who experience severe and disabling tinnitus often seek medical treatment from an otologist, neurologist or psychiatrist with the hope of finding a drug or surgical treatment that can completely switch off their tinnitus and bring back silence. Disappointment and disbelief set in when patients are told by their physician that they must learn to live with it or

Expert Opinion on Emerging Drugs, 2009

Tinnitus, the perception of sound in the absence of an auditory stimulus, is perceived by about one in 10 adults, and for at least 1 in 100, tinnitus severely affects their quality of life. Since tinnitus is frequently associated with irritability, agitation, stress, insomnia, anxiety and depression, the social and economic burdens of tinnitus can be enormous. No curative treatments are available. However, tinnitus symptoms can be alleviated to some extent. The most widespread management therapies consist of auditory stimulation and cognitive behavioural treatment, aiming at improving habituation and coping strategies. Available clinical trials vary in methodological rigor and have been performed for a considerable number of different drugs. None of the investigated drugs have demonstrated to provide replicable long-term reduction of tinnitus impact in the majority of patients, in excess of placebo effects. Accordingly, there are no FDA-or EMEA-approved drugs for the treatment of tinnitus. However, in spite of the lack of evidence, a large variety of different compounds are prescribed off-label. Therefore, more effective pharmacotherapies for this huge and still growing market are desperately needed and even a drug that produces only a small but significant effect would have an enormous therapeutic impact. This review describes current and emerging pharmacotherapies with its current difficulties and limitations. In addition, it provides an estimate of the tinnitus market. Finally, it describes recent advances in the tinnitus field which may help overcome obstacles faced in the pharmacological treatment of tinnitus. These include incomplete knowledge of tinnitus pathophysiology, lack of well established animal models, heterogeneity of Correspondence to: Berthold Langguth, [email protected].

Review Article IntroductIon Tinnitus is derived from the Latin word tinnire and refers to a condition where patient experiences a ringing, buzzing, or hissing auditory sensation in the absence of an external sound. [1] Although many advances have been made in the medical sciences, tinnitus is still thought of as a scientific and clinical enigma for a clinician. [2] Tinnitus is broadly classified into subjective or objective. The objective type of tinnitus is rare and refers to a condition where a real sound is generated by internal biological activity, such as vascular turbulence or pulsations or spasm of the muscle in the middle ear, Eustachian tube, or soft palate. [3] Subjective tinnitus is the most common type and it refers to a phantom auditory sensation for which no objective sound can be identified. [4] The treatment goals for tinnitus patients are aimed at symptomatic relief and its associated distress. There are no standard protocols for treatment of the tinnitus. [5] Drug therapy is one of the treatment approaches for tinnitus. The literature related to pharmacotherapy for tinnitus is vast. Here, this review article will only focus on some of the recent pharmacotherapeutic treatments employed for tinnitus. Despite considerable developments in the understanding of tinnitus, its pharmacological treatment has little progress. The objective of this review article is to discuss the current pharmacological treatment of tinnitus.

Drug Discovery and Evaluation: Methods in Clinical Pharmacology, 2020

European Geriatric Medicine, 2015

IIP, 2024

Understanding and Functioning of Tinnitus: Insights into Categorization, Reasons, and Evaluation** Tinnitus, the perception of noise in the absence of external stimuli, has intrigued both medical experts and scholars. This article delves into the etymology of tinnitus, exploring technical terms such as "Tinnitus aurium," "Acousma," and "Leudet tinnitus." Pioneers in this field, integrated Jack Vernon and Pawel J. The dispute extends to the neural mechanisms behind tinnitus, emphasizing the intricate relationship between the auditory, somatosensory, limbic and independent systems. The article details conditions similar to personal tinnitus, shedding light on otological, cardiovascular, metabolic, neurological and pharmacological components. An in-depth investigation of evaluation protocols, including comparison of pitch and loudness, provides insight into the clinical evaluation of tinnitus. The article then navigates through the intricate reasons for tinnitus, visually represented in a tree diagram. Psychological effects are catalogued in tables that describe the signs of emotional, interpersonal, and somatic distress associated with tinnitus. The multifaceted reasons for tinnitus are summarized in a comprehensive figure that shows a holistic perspective of the intricate network that contributes to this phenomenon. Moreover, this chapter discusses about the Tinnitus management employs diverse strategies, including advice, hearing aids, and innovative approaches like Neuromonics. Pharmacological options, noninvasive methods like Transcutaneous Vagus Nerve Stimulation, and alternative therapies contribute to a multifaceted approach.

Journal of Otolaryngology-ENT Research, 2018

Even with the dramatic increase in the scientific publications addressing tinnitus as the main subject, there is still some disbelief about the possibility of some treatments resulting in total and long lasting remission of the symptom. Nevertheless, sometimes the suppression of tinnitus may be observed in clinical practice after certain treatments. The objective of this study was to report a didactic case where the early adoption of therapeutic approaches targeting the initial aetiological hypotheses (metabolic and somatosensory tinnitus) ended up in a long term, total remission of tinnitus for 4.5 years until now. This illustrative case report may be a starting point for future research, such as finding the common characteristics of other individuals who have reached total remission. We recommend that a detail oriented medical and audiological evaluation of patients with tinnitus be performed to optimize treatment targeted to certain subtypes of tinnitus patients.

2011

FDA-Food and drug administration MHRA-UK Medicines and Healthcare products Regulatory Agency NIHL-Noise-induced hearing loss RCT-Randomised controlled trials TCA-Tricyclic antidepressant THI-Tinnitus Handicap Inventory SSRIs-Selective serotonin re-uptake inhibitors