Tinnitus

Intratympanic methylprednisolone injections for subjective tinnitus

Objectives:

This study aimed to determine whether intratympanically injected methylprednisolone is effective in treating subjective tinnitus refractory to medical treatment.

Study design:

Prospective, randomised, placebo-controlled, single-blinded study.

Methods:

Seventy adult patients with subjective tinnitus of cochlear origin were randomly assigned to receive intratympanic injection of either methylprednisolone or saline solution. The treatment protocol comprised three intratympanic injections, one per week for three weeks. Improvement in tinnitus severity was measured by a self-rated tinnitus loudness scale and by the tinnitus severity index, at baseline and two weeks after the last injection.

Results:

Data for 59 patients were available for analysis. There was no significant difference between the two treatment groups regarding age, sex, pure tone average, pretreatment tinnitus intensity, tinnitus laterality or tinnitus duration. There was a significant post-treatment improvement in self-rated tinnitus loudness scale results in both groups. No significant post-treatment changes in the tinnitus severity index individual and total scores were observed in either group. The most frequently encountered side effects were pain during injection, vertigo, a burning sensation around the ear and in the throat, and a bitter taste. A burning sensation and bitter taste were observed more often in the methylprednisolone group compared with the placebo group

Conclusion:

The results of this study indicate that intratympanic methylprednisolone has no benefit, compared with placebo, for the treatment of subjective tinnitus of cochlear origin refractory to medical treatment.

Alprazolam for tinnitus

There is insufficient evidence to support the use of alprazolam in the treatment of tinnitus. The Johnson trial is the only study to date assessing the role of alprazolam, and at best it is an open-label trial demonstrating activity. There is a need for definitive double-blind, controlled, crossover studies of sufficient statistical power to resolve the issue. Furthermore, once efficacy is demonstrated, further studies are needed to determine the appropriate length of therapy, the necessity for maintenance therapy, the role of "drug holidays," appropriate dose tapering schedules, and a more careful delineation of which populations of patients are more likely to respond to alprazolam.