Oral gabapentin and intradermal injection of lidocaine: is there any role in the treatment of moderate/severe tinnitus?

The Placebo Effect on Tinnitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

OBJECTIVE

To quantify the placebo effect in randomized clinical trials treating tinnitus with oral or intratympanic placebo treatment.

DATA SOURCES

CINAHL, PubMed, and Scopus were searched for articles from conception to October 2022. MESH and key terms such as "tinnitus," "placebo," and "medication" were used to find randomized, placebo-controlled trials. The search was limited to articles in English.

METHODS

Randomized controlled trials with adult subjects evaluating tinnitus pretreatment and posttreatment with an oral or intratympanic medication versus a placebo arm were included. Crossover studies, studies involving middle/inner ear operations or devices, and studies that exclusively included nonidiopathic etiologies of tinnitus were excluded. Mean tinnitus symptom survey scores for the Tinnitus Handicap Inventory (THI), Tinnitus Severity Index, Tinnitus Functional Index, Tinnitus Handicap Questionnaire, and Visual Analog Scales for tinnitus Intensity/Loudness (VAS-L), Annoyance (VAS-An), and Awareness (VAS-Aw) were extracted for both placebo and experimental groups.

RESULTS

953 studies were screened with 23 studies being included in the final analysis. Meta-analysis of mean difference (MD) was calculated using RevMan 5.4. MD between pretreatment and posttreatment THI scores of the placebo arms was 5.6 (95% confidence interval, 3.3-8.0; p < 0.001). MD between pretreatment and posttreatment VAS scores of the placebo groups for Loudness, Annoyance, and Awareness were 0.8 (0.0 to 1.6, p = 0.05), 0.2 (-0.2 to 0.5, p = 0.34), and 0.3 (-0.0 to 0.7, p = 0.08), respectively.

CONCLUSIONS

Placebo treatment has shown effectiveness in improving patient-reported evaluations of tinnitus when using some standardized metrics such as THI and VAS-L; however, the improvement is not as substantial as nonplacebo treatment.

Review of Pharmacotherapy for Tinnitus

Various medications are currently used in the treatment of tinnitus, including anesthetics, antiarrhythmics, anticonvulsants, antidepressants, antihistamines, antipsychotics, anxiolytics, calcium channel blockers, cholinergic antagonists, NMDA antagonists, muscle relaxants, vasodilators, and vitamins. To date, however, no medications have been specifically approved to treat tinnitus by the US Food and Drug Administration (FDA). In addition, medicines used to treat other diseases, as well as foods and other ingested materials, can result in unwanted tinnitus. These include alcohol, antineoplastic chemotherapeutic agents and heavy metals, antimetabolites, antitumor agents, antibiotics, caffeine, cocaine, marijuana, nonnarcotic analgesics and antipyretics, ototoxic antibiotics and diuretics, oral contraceptives, quinine and chloroquine, and salicylates. This review, therefore, describes the medications currently used to treat tinnitus, including their mechanisms of action, therapeutic effects, dosages, and side-effects. In addition, this review describes the medications, foods, and other ingested agents that can induce unwanted tinnitus, as well as their mechanisms of action.

Voltage-gated Sodium Channels in Sensory Information Processing

Objective & Background:

Voltage-gated sodium channels (VGSCs) and potassium channels are critical in the generation of action potentials in the nervous system. VGSCs and potassium channels play important roles in the five fundamental senses of vision, audition, olfaction, taste and touch. Dysfunctional VGSCs are associated with clinical sensory symptoms, such as hyperpselaphesia, parosphresia, and so on.

Conclusion:

This short review highlights the recent advances in the study of VGSCs in sensory information processing and discusses the potential role of VGSCs to serve as pharmacological targets for the treatment of sensory system diseases.

Use of 3D Volume Rendering Based on High-Resolution Computed Tomography Temporal Bone in Patients with Cochlear Implants

Case series

Patients: Male, 50 • Male, 3 • Female, 55

Final Diagnosis: Malposition of the array

Symptoms: Deafness

Medication: —

Clinical Procedure: Cochlear Implant 3D rendering

Specialty: Audiology

Tinnitus: Prospects for Pharmacological Interventions With a Seesaw Model

Chronic tinnitus, the perception of lifelong constant ringing in ear, is one capital cause of disability in modern society. It is often present with various comorbid factors that severely affect quality of life, including insomnia, deficits in attention, anxiety, and depression. Currently, there are limited therapeutic treatments for alleviation of tinnitus. Tinnitus can involve a shift in neuronal excitation/inhibition (E/I) balance, which is largely modulated by ion channels and receptors. Thus, ongoing research is geared toward pharmaceutical approaches that modulate the function of ion channels and receptors. Here, we propose a seesaw model that delineates how tinnitus-related ion channels and receptors are involved in homeostatic E/I balance of neurons. This review provides a thorough account of our current mechanistic understanding of tinnitus and insight into future direction of drug development.