What is the role of medications in the treatment of tinnitus?

Updated: Feb 27, 2020
  • Author: Aaron G Benson, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Answer

Pharmacologic therapy helps in the treatment of tinnitus for the 80% of patients who endure related depression. Administration of nortriptyline (50 mg at bedtime) is the most helpful treatment. Nortriptyline may induce dry mouth, often causing patients to terminate treatment before achieving therapeutic effect. Often, 3-4 weeks of therapy are necessary before benefits appear. Other antidepressants may be useful in treating tinnitus, but judgment in their use is paramount. Selective serotonin reuptake inhibitors are considered to have a better safety profile compared with tricyclic antidepressants. Paroxetine (Paxil) in low doses of 10 mg at bedtime has recently been shown to be helpful. Also, sertraline (Zoloft), at a fixed dose of 50 mg/d, demonstrated a significant reduction in tinnitus severity, as well as a reduction in anxiety and depressive symptoms.

Many physicians have used benzodiazepines to treat tinnitus. The theory has been that this is an anxiety disorder and the benzodiazepines should help. Unfortunately, because depression and obsessive-compulsive disorders predominate in this group, the benzodiazepines can cause more harm than good. Thus, they should be avoided as initial therapy.

A 2009 study by Jalali determined that alprazolam improved visual analog scale (VAS) scores in tinnitus patients who did not have depression or anxiety disorders. [18]

Hurtuk et al conducted a prospective, double-blind, cross-over study comparing 3 mg of melatonin HS to placebo in adults with chronic tinnitus. There was a significant reduction of tinnitus severity scores on 2 of 3 measures of tinnitus severity. Melatonin was more effective in men, subjects with severe tinnitus, and those who had not had prior treatment. [19]

A study by Albu and Chirtes indicated that combining an intratympanic corticosteroid with melatonin can improve treatment results in tinnitus over those obtained with melatonin therapy alone. In a prospective, randomized, controlled, double-blind trial, 30 patients with acute unilateral idiopathic tinnitus were treated with melatonin alone, while another 30 patients with the condition were treated with melatonin and intratympanic dexamethasone, with results after three months being evaluated using tinnitus loudness and awareness scores, the THI, the Beck Depression Inventory, and the Pittsburgh Sleep Quality Index. Although both groups in the study demonstrated significant improvement, the investigators determined that significantly greater improvement occurred in the dexamethasone/melatonin patients. [20]


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