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Vijayakumar KA, Cho GW, Maharajan N, Jang CH. A Review on Peripheral Tinnitus, Causes, and Treatments from the Perspective of Autophagy. Exp Neurobiol 2022; 31:232-242. [PMID: 36050223 PMCID: PMC9471415 DOI: 10.5607/en22002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 08/03/2022] [Accepted: 08/10/2022] [Indexed: 01/18/2023] Open
Abstract
Tinnitus is the perception of phantom noise without any external auditory sources. The degeneration of the function or activity of the peripheral or central auditory nervous systems is one of the causes of tinnitus. This damage has numerous causes, such as loud noise, aging, and ototoxicity. All these sources excite the cells of the auditory pathway, producing reactive oxygen species that leads to the death of sensory neural hair cells. This causes involuntary movement of the tectorial membrane, resulting in the buzzing noise characteristic of tinnitus. Autophagy is an evolutionarily conserved catabolic scavenging activity inside a cell that has evolved as a cell survival mechanism. Numerous studies have demonstrated the effect of autophagy against oxidative stress, which is one of the reasons for cell excitation. This review compiles several studies that highlight the role of autophagy in protecting sensory neural hair cells against oxidative stress-induced damage. This could facilitate the development of strategies to treat tinnitus by activating autophagy.
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Affiliation(s)
- Karthikeyan A Vijayakumar
- Department of Biology, College of Natural Science, Chosun University, Gwangju 61452, Korea.,BK21 FOUR Education Research Group for Age-Associated Disorder Control Technology, Department of Integrative Biological Science, Chosun University, Gwangju 61452, Korea
| | - Gwang-Won Cho
- Department of Biology, College of Natural Science, Chosun University, Gwangju 61452, Korea.,BK21 FOUR Education Research Group for Age-Associated Disorder Control Technology, Department of Integrative Biological Science, Chosun University, Gwangju 61452, Korea
| | - Nagarajan Maharajan
- Department of Biology, College of Natural Science, Chosun University, Gwangju 61452, Korea.,BK21 FOUR Education Research Group for Age-Associated Disorder Control Technology, Department of Integrative Biological Science, Chosun University, Gwangju 61452, Korea
| | - Chul Ho Jang
- Department of Otolaryngology, Chonnam National University Medical School, Gwangju 61469, Korea
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Abstract
The highly structurally similar drugs flupirtine and retigabine have been regarded as safe and effective for many years but lately they turned out to exert intolerable side effects. While the twin molecules share the mode of action, both stabilize the open state of voltage-gated potassium channels, the form and severity of adverse effects is different. The analgesic flupirtine caused drug-induced liver injury in rare but fatal cases, whereas prolonged use of the antiepileptic retigabine led to blue tissue discoloration. Because the adverse effects seem unrelated to the mode of action, it is likely, that both drugs that occupied important therapeutic niches, could be replaced. Reasons for the clinically relevant toxicity will be clarified and future substitutes for these drugs presented in this review.
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Xiong S, Song Y, Liu J, Du Y, Ding Y, Wei H, Bryan K, Ma F, Mao L. Neuroprotective effects of MK-801 on auditory cortex in salicylate-induced tinnitus: Involvement of neural activity, glutamate and ascorbate. Hear Res 2019; 375:44-52. [PMID: 30795964 DOI: 10.1016/j.heares.2019.01.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 01/17/2019] [Accepted: 01/30/2019] [Indexed: 12/14/2022]
Abstract
Tinnitus may cause anxiety, depression, insomnia, which impair the quality of life of millions worldwide. However, the mechanism of tinnitus remains to be understood, it has been previously hypothesized that the activation of N-methyl-D-aspartate (NMDA) receptor is involved in the tinnitus processes and blockade of the NMDA receptor is regarded as a therapeutic strategy for tinnitus treatment even if the rescue treatment is still proved invalid in some cases. To demonstrate the therapeutic effect of the NMDA receptor blocker on tinnitus, we examined here the spontaneous firing rate (SFR) and the neurochemical dynamics in the auditory cortex (AC) of rats after sodium salicylate (SS) injection, which is a widely used model for tinnitus research. We also recorded their responses to MK-801 treatment. Electrophysiological studies showed that MK-801 significantly suppresses SFR in AC of rats with SS-induced tinnitus. In addition, by using a technique that combining in vivo microdialysis with an online electrochemical system (OECS) and a high-performance liquid chromatography (HPLC), we found that the levels of both glutamate and ascorbate in AC dramatically increased after SS injection and that MK-801 administration attenuated those response. Further studies found that MK-801 given at a time point of 30 min pre- or post-injection of SS were more effective than that given at a time point of 60 min post-SS injection, indicating that the time point of MK-801 intervention has a critical impact on the therapeutic effect. These findings suggest that MK-801 plays a neuroprotective role against hyperactivity during tinnitus induced by SS and that the therapeutic effect depends on the time point of MK-801 intervention, which would advance the studies on understanding of the therapeutic potential of NMDA receptor antagonist in tinnitus therapy.
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Affiliation(s)
- Shan Xiong
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Yu Song
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Junxiu Liu
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Yali Du
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Yujing Ding
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Huan Wei
- Beijing National Laboratory for Molecular Sciences, Key Laboratory of Analytical Chemistry for Living Biosystems, Institute of Chemistry, The Chinese Academy of Sciences, Beijing, 100190, China
| | - Kevin Bryan
- Junipero Serra High School, San Mateo, CA, USA
| | - Furong Ma
- Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, Beijing, 100191, China.
| | - Lanqun Mao
- Beijing National Laboratory for Molecular Sciences, Key Laboratory of Analytical Chemistry for Living Biosystems, Institute of Chemistry, The Chinese Academy of Sciences, Beijing, 100190, China.
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Puljak L. Randomized controlled trial about pain medication flupirtine ignores recent pharmacovigilance warnings. J Pain Res 2018; 11:177-180. [PMID: 29560967 PMCID: PMC5769781 DOI: 10.2147/jpr.s154447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Livia Puljak
- Laboratory for Pain Research, University of Split School of Medicine, Split, Croatia.,Department for Development, Research and Health Technology Assessment, Agency for Quality and Accreditation in Health Care and Social Welfare, Zagreb, Croatia
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Imsuwansri T, Hoare DJ, Phaisaltuntiwongs W, Srisubat A, Snidvongs K. Glutamate receptor antagonists for tinnitus. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Thanarath Imsuwansri
- Ministry of Public Health; Institute of Medical Research and Technology Assessment, Dept of Medical Services; Tiwanon Nonthaburi Thailand 11000
| | - Derek J Hoare
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham; NIHR Nottingham Hearing Biomedical Research Unit; Ropewalk House, 113 The Ropewalk Nottingham UK NG1 5DU
| | - Wanasri Phaisaltuntiwongs
- Sirindhorn Hospital, Medical Service Department; Otorhinolaryngology Section; Bangkok Metropolitan Administration Onnut Road, Prawet District Bangkok Thailand 10250
| | - Attasit Srisubat
- Ministry of Public Health; Institute of Medical Research and Technology Assessment, Dept of Medical Services; Tiwanon Nonthaburi Thailand 11000
| | - Kornkiat Snidvongs
- Chulalongkorn University; Department of Otolaryngology, Faculty of Medicine; Bangkok Thailand
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Beebe Palumbo D, Joos K, De Ridder D, Vanneste S. The Management and Outcomes of Pharmacological Treatments for Tinnitus. Curr Neuropharmacol 2016; 13:692-700. [PMID: 26467416 PMCID: PMC4761638 DOI: 10.2174/1570159x13666150415002743] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/12/2015] [Accepted: 04/09/2015] [Indexed: 01/28/2023] Open
Abstract
Tinnitus, a phantom sensation experienced by people around the world, currently is endured
without a known cure. Some find the condition tolerable, while others are tortured on a daily basis
from the incessant phantom noises. For those who seek treatment, oftentimes, they have a comorbid
condition (e.g., depression, anxiety, insomnia), which is treated pharmaceutically. These products aim
to reduce the comorbities associated with tinnitus thereby minimizing the overall burden present.
Because of the phantom nature of tinnitus, it is often compared to neurologic pain. Since pain can be managed with
pharmaceutical options, it is reasonable to assume that similar agents might work to alleviate tinnitus. The effects of
antidepressants, benzodiazepines, anticonvulsants, and glutamate antagonists are reviewed in this paper. Table 1 summarizes
the pharmaceutical products discussed. Due to the variety of comorbid factors and potential causes of tinnitus, there may
not be one pharmaceutical treatment that will combat every type of tinnitus. Nevertheless, a product that finally addresses
the true cause of tinnitus, and not just its comorbidities, will benefit millions of people worldwide.
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Affiliation(s)
| | | | | | - Sven Vanneste
- Lab for Auditory & Integrative Neuroscience, School of Behavioral & Brain Science, University of Texas at Dallas, W 1966 Inwood Rd, Dallas, Texas 75235, USA
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Langguth B, Elgoyhen AB, Schlee W. Potassium channels as promising new targets for pharmacologic treatment of tinnitus: Can Internet-based ‘crowd sensing’ initiated by patients speed up the transition from bench to bedside? Expert Opin Ther Targets 2016; 20:251-4. [DOI: 10.1517/14728222.2016.1125884] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Interdisciplinary Tinnitus Clinic, University of Regensburg, Regensburg, Germany
| | - Ana Belén Elgoyhen
- Instituto de Investigaciones en Ingeniería Genética y Biología Molecular Dr Héctor N Torres, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
- Department of Pharmacology, University of Buenos Aires, School of Medicine, Buenos Aires, Argentina
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Interdisciplinary Tinnitus Clinic, University of Regensburg, Regensburg, Germany
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Abstract
Tinnitus is a common medical symptom that can be debilitating. Risk factors include hearing loss, ototoxic medication, head injury, and depression. At presentation, the possibilities of otological disease, anxiety, and depression should be considered. No effective drug treatments are available, although much research is underway into mechanisms and possible treatments. Surgical intervention for any otological pathology associated with tinnitus might be effective for that condition, but the tinnitus can persist. Available treatments include hearing aids when hearing loss is identified (even mild or unilateral), wide-band sound therapy, and counselling. Cognitive behavioural therapy (CBT) is indicated for some patients, but availability of tinnitus-specific CBT in the UK is poor. The evidence base is strongest for a combination of sound therapy and CBT-based counselling, although clinical trials are constrained by the heterogeneity of patients with tinnitus.
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Affiliation(s)
- David Baguley
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Anglia Ruskin University, Cambridge, UK.
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Local NMDA receptor blockade attenuates chronic tinnitus and associated brain activity in an animal model. PLoS One 2013; 8:e77674. [PMID: 24282480 PMCID: PMC3834860 DOI: 10.1371/journal.pone.0077674] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 09/09/2013] [Indexed: 01/10/2023] Open
Abstract
Chronic tinnitus has no broadly effective treatment. Identification of specific markers for tinnitus should facilitate the development of effective therapeutics. Recently it was shown that glutamatergic blockade in the cerebellar paraflocculus, using an antagonist cocktail was successful in reducing chronic tinnitus. The present experiment examined the effect of selective N-methyl d-aspartate (NMDA) receptor blockade on tinnitus and associated spontaneous brain activity in a rat model. The NMDA antagonist, D(-)-2-amino-5-phosphonopentanoic acid (D-AP5) (0.5 mM), was continuously infused for 2 weeks directly to the ipsilateral paraflocculus of rats with tinnitus induced months prior by unilateral noise exposure. Treated rats were compared to untreated normal controls without tinnitus, and to untreated positive controls with tinnitus. D-AP5 significantly decreased tinnitus within three days of beginning treatment, and continued to significantly reduce tinnitus throughout the course of treatment and for 23 days thereafter, at which time testing was halted. At the conclusion of psychophysical testing, neural activity was assessed using manganese enhanced magnetic resonance imaging (MEMRI). In agreement with previous research, untreated animals with chronic tinnitus showed significantly elevated bilateral activity in their paraflocculus and brainstem cochlear nuclei, but not in mid or forebrain structures. In contrast, D-AP5-treated-tinnitus animals showed significantly less bilateral parafloccular and dorsal cochlear nucleus activity, as well as significantly less contralateral ventral cochlear nucleus activity. It was concluded that NMDA-mediated glutamatergic transmission in the paraflocculus appears to be a necessary component of chronic noise-induced tinnitus in a rat model. Additionally, it was confirmed that in this model, elevated spontaneous activity in the cerebellar paraflocculus and auditory brainstem is associated with tinnitus.
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Sahley TL, Hammonds MD, Musiek FE. Endogenous dynorphins, glutamate and N-methyl-d-aspartate (NMDA) receptors may participate in a stress-mediated Type-I auditory neural exacerbation of tinnitus. Brain Res 2013; 1499:80-108. [DOI: 10.1016/j.brainres.2013.01.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 01/03/2013] [Accepted: 01/04/2013] [Indexed: 12/12/2022]
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Michel MC, Radziszewski P, Falconer C, Marschall-Kehrel D, Blot K. Unexpected frequent hepatotoxicity of a prescription drug, flupirtine, marketed for about 30 years. Br J Clin Pharmacol 2012; 73:821-5. [PMID: 22044433 DOI: 10.1111/j.1365-2125.2011.04138.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AIMS To determine efficacy of the analgesic flupirtine in the treatment of overactive bladder syndrome in a proof-of-concept study. METHODS Double-blind, double-dummy, three-armed comparison of flupirtine extended release (400 mg/day, titrated to 600 mg/day), tolterodine extended release (4 mg/day) and placebo for 12 weeks. RESULTS When major elevations of liver enzymes (more than three times the upper normal limit) were detected in several flupirtine-exposed patients, the study was prematurely discontinued. Based on study-end data, hepatotoxicity was detected in 31% of patients receiving flupirtine for ≥ 6 weeks. CONCLUSIONS Unexpected frequent and relevant toxicity can occur when testing an established drug for a new indication.
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Affiliation(s)
- Martin C Michel
- Department of Pharmacology & Pharmacotherapy, Academic Medical Center, Amsterdam, The Netherlands.
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Coelho C, Figueiredo R, Frank E, Burger J, Schecklmann M, Landgrebe M, Langguth B, Elgoyhen AB. Reduction of Tinnitus Severity by the Centrally Acting Muscle Relaxant Cyclobenzaprine: An Open-Label Pilot Study. ACTA ACUST UNITED AC 2012; 17:179-88. [DOI: 10.1159/000335657] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 12/06/2011] [Indexed: 12/31/2022]
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Hwang JH, Chen JC, Yang SY, Wang MF, Liu TC, Chan YC. Expression of COX-2 and NMDA receptor genes at the cochlea and midbrain in salicylate-induced tinnitus. Laryngoscope 2011; 121:361-4. [PMID: 21271589 DOI: 10.1002/lary.21283] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 07/28/2010] [Indexed: 11/11/2022]
Abstract
OBJECTIVE/HYPOTHESIS The expression of the genes for cyclooxygenase (COX) and NMDA receptor (NR) has seldom been reported in tinnitus. We hypothesized that expression of COX-2 and NR was altered in the cochlea and midbrain in salicylate-induced tinnitus. STUDY DESIGN Experimental study on mice. METHODS We evaluated the tinnitus score and mRNA expression levels of COX-2 and NR subtype 2B (NR2B) in the cochlea and midbrain in response to intraperitoneal injections of salicylate for 4 days. RESULTS At day 4 of tinnitus induction, the mean weights of the whole body and midbrain did not change greatly in both control and salicylate groups. The tinnitus score was not elevated from day 1 to day 4 in the control group, but increased day by day in the salicylate group. The mRNA expression level of COX-2 decreased slightly in the salicylate group in the cochlea (1.1 ± 0.33 vs. 1.3 ± 0.49, P = .0752) and in the midbrain (0.9 ± 0.10 versus 1.0 ± 0.35, P = .0489). Inversely, the expression levels of the NR2B gene increased moderately in the salicylate group in the cochlea (3.7 ± 0.47 versus 2.3 ± 1.13, P < 0.0001) and in the midbrain (1.6 ± 0.64 versus 1.0 ± 0.44, P = .0007). CONCLUSIONS Salicylate induced tinnitus and altered the expression of the COX-2 and NR2B genes in the cochlea and midbrain of mice. These findings might contribute to further understanding of pathophysiology and therapy of tinnitus.
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Affiliation(s)
- Juen-Haur Hwang
- Department of Otolaryngology, Buddhist Dalin Tzu-Chi General Hospital, Chiayi, Taiwan
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Holt AG, Bissig D, Mirza N, Rajah G, Berkowitz B. Evidence of key tinnitus-related brain regions documented by a unique combination of manganese-enhanced MRI and acoustic startle reflex testing. PLoS One 2010; 5:e14260. [PMID: 21179508 PMCID: PMC3002264 DOI: 10.1371/journal.pone.0014260] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Accepted: 11/10/2010] [Indexed: 11/19/2022] Open
Abstract
Animal models continue to improve our understanding of tinnitus pathogenesis and aid in development of new treatments. However, there are no diagnostic biomarkers for tinnitus-related pathophysiology for use in awake, freely moving animals. To address this disparity, two complementary methods were combined to examine reliable tinnitus models (rats repeatedly administered salicylate or exposed to a single noise event): inhibition of acoustic startle and manganese-enhanced MRI. Salicylate-induced tinnitus resulted in wide spread supernormal manganese uptake compared to noise-induced tinnitus. Neither model demonstrated significant differences in the auditory cortex. Only in the dorsal cortex of the inferior colliculus (DCIC) did both models exhibit supernormal uptake. Therefore, abnormal membrane depolarization in the DCIC appears to be important in tinnitus-mediated activity. Our results provide the foundation for future studies correlating the severity and longevity of tinnitus with hearing loss and neuronal activity in specific brain regions and tools for evaluating treatment efficacy across paradigms.
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Affiliation(s)
- Avril Genene Holt
- Department of Anatomy and Cell Biology, Wayne State University School of Medicine, Detroit, Michigan, United States of America.
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Knipper M, Zimmermann U, Müller M. Molecular aspects of tinnitus. Hear Res 2010; 266:60-9. [DOI: 10.1016/j.heares.2009.07.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 07/28/2009] [Accepted: 07/28/2009] [Indexed: 01/18/2023]
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Abstract
Tinnitus, the perception of sound in the absence of an auditory stimulus, is perceived by about 1 in 10 adults, and for at least 1 in 100, tinnitus severely affects their quality of life. Because 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 behavioral 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 providing replicable long-term reduction of tinnitus impact in the majority of patients in excess of placebo effects. Accordingly, there are no FDA or European Medicines Agency 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 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 different forms of tinnitus, difficulties in tinnitus assessment and outcome measurement and variability in clinical trial methodology.
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Affiliation(s)
- Berthold Langguth
- University of Regensburg, Interdisciplinary Tinnitus Clinic, Department of Psychiatry and Psychotherapy, Universitaetsstrabetae 84, 93053 Regensburg, Germany.
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Arfeller C, Vonthein R, Plontke SK, Plewnia C. Efficacy and safety of bilateral continuous theta burst stimulation (cTBS) for the treatment of chronic tinnitus: design of a three-armed randomized controlled trial. Trials 2009; 10:74. [PMID: 19698089 PMCID: PMC2739195 DOI: 10.1186/1745-6215-10-74] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Accepted: 08/21/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tinnitus, the perception of sound and noise in absence of an auditory stimulus, has been shown to be associated with maladaptive neuronal reorganization and increased activity of the temporoparietal cortex. Transient modulation of tinnitus by repetitive transcranial magnetic stimulation (rTMS) indicated that these areas are critically involved in the pathophysiology of tinnitus and suggested new treatment strategies. However, the therapeutic efficacy of rTMS in tinnitus is still unclear, individual response is variable, and the optimal stimulation area disputable. Recently, continuous theta burst stimulation (cTBS) has been put forward as an effective rTMS protocol for the reduction of pathologically enhanced cortical excitability. METHODS 48 patients with chronic subjective tinnitus will be included in this randomized, placebo controlled, three-arm trial. The treatment consists of two trains of cTBS applied bilaterally to the secondary auditory cortex, the temporoparietal associaction cortex, or to the lower occiput (sham condition) every working day for four weeks. Primary outcome measure is the change of tinnitus distress as quantified by the Tinnitus Questionnaire (TQ). Secondary outcome measures are tinnitus loudness and annoyance as well as tinnitus change during and after treatment. Audiologic and speech audiometric measurements will be performed to assess potential side effects. The aim of the present trail is to investigate effectiveness and safety of a four weeks cTBS treatment on chronic tinnitus and to compare two areas of stimulation. The results will contribute to clarify the therapeutic capacity of rTMS in tinnitus. TRIAL REGISTRATION The trial was registered with the clinical trials register of http://www.clinicaltrials.gov (NCT00518024).
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Affiliation(s)
- Carola Arfeller
- University Hospital of Tübingen, Department of Psychiatry and Psychotherapy, Tübingen, Germany.
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