Alternative medications and other treatments for tinnitus: facts from fiction

[Mikhail]

К обсуждению тиннитуса. Нашел интересный обзор. Желающим - высылаю фултекст PDF.
Кроме перечисленных в таблице, в ней обсуждаются бетагестин, вобэнзим, лазерная терапия.


Alternative medications and other treatments for tinnitus: facts from fiction


Michael D. Seidman, MD a , *
Seilesh Babu, MD b
a Department of Otolaryngology–Head and Neck Surgery
Henry Ford Health System
2799 West Grand Boulevard
Detroit, MI 48202, USA
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Since the dawn of human existence, nutritional supplements, herbs, and phytonutrients have been used to heal. Forty percent of Americans have used some form of complementary-integrative medicine (CIM) to treat a wide variety of chronic conditions. In 1998, expenditures on CIM in the United States approached $27 billion and increased to $32 billion in 2000 [1] . This paradigm shift to alternative forms of therapy is gaining acceptance for many reasons including patients' dissatisfaction with conventional medical care, which is perceived to be too intent on curing rather than preventing disease, and the fact that prescription medicines have many side effects and hence, patients are often con-compliant. Conversely, the conventional western physician is typically skeptical of CIM practices because of the lack of double-blind randomized placebo-controlled studies. This is a particularly difficult problem because the pharmaceutical industry is not routinely interested in funding studies to assess the efficacy of herbs and other supplements because patent protection is unlikely. Coupled with the fact that the cost to bring a compound through the US Food and Drug Administration averages $300 million or more, it is no wonder that studies into this arena are rare [2] .

Conventional medical fields, such as allopathic and osteopathic medicine, were only introduced in the United States less than 200 years ago. This subsequently led to the rapid reduction in CIM therapies because these were suddenly viewed as antiquated and a form of quackery. The unfortunate result of this skepticism was the overemphasis solely on conventional medicine as a means to heal and cure. In the best scenario, tapping into knowledge from both CIM and conventional medicine would likely lead to better overall care of patients.

The use of medication for treatment of tinnitus has largely been varied and anecdotal. Such drugs as nicotinic acid, carbamazepine, baclofen, and others have been tried and even tested in double-blind placebo-controlled trials (Table 1 ) [3] . Few have been shown to be significantly beneficial in adequately designed studies. Lidocaine has been studied in several carefully controlled double-blinded studies and shown to be beneficial. Lidocaine, however, must be given intravenously, has a very short half-life, and is often accompanied by undesirable side effects. Oral analogs of lidocaine, such as tocainide and flecainide acetate, did not improve tinnitus [4] . A double-blind, placebo-controlled study using melatonin (3 mg at bedtime) was found to have no advantage over placebo in relieving tinnitus. Among patients reporting difficulty sleeping attributable to their tinnitus, however, 46.7% reported an overall improvement after melatonin compared with 20% for placebo [4] . Benzodiazepines also may provide relief, especially for patients with concurrent depression. In one study, 76% of patients taking alprazolam had a reduction in the loudness of their tinnitus, whereas only 5% of the placebo group showed benefit [5] . Education, counseling, tinnitus retraining therapy, and medications remain the major modalities in the treatment of tinnitus. Many individuals have reported that these have provided either resolution of, or produced the greatest decrease in, their symptoms.



Table 1. Medications used to treat tinnitus
Anesthetics
Lidocaine/lignocaine (Xylocaine IV)

Procaine (Novocain IV)
Tocainide (Tonocard)-oral lidocaine analogue
Flecainide acetate (Tambocor)


Antidepressants Nortriptyline (Pamelor)
Paroxetine (Paxil)
Fluoxetine (Prozac)
Sertraline (Zoloft)
Bupropion (Wellbutrin)
Amitriptyline (Elavil)


Anticonvulsants Carbamezapine (Tegretol)
Phenytoin (Dilantin)
Primidone (Mysoline)


Anti-axiety Agents Alprazolam (Xanax)
Clonzaepam (Klonopin)
Diazepam (Valium)


Antispastic Baclofen (Lioresal)


Anthithistimines Chlorpheniramine (Chlor-Trimeton)
Meclizine


Diuretics Furosemide (Lasix)


Vasoactive medications Histamine
Hydergine
Vinpocetine
Pentoxifyline (Trental)


Herbs Ginkgo biloba
Black cohosh
Ligustrum
Mullein
Pulsatilla
St. John Wort


Vitamins and minerals Magnesium (400 mg d)
Calcium (1000 mg/d)
Potassium (2500 m/d)
Zinc
Manganese
Copper
Vitamin B12
Beta carotene
Selenium
Vitamin C
Vitamin E
Niacin


This article discusses treatment alternatives for chronic tinnitus. Examples include variations in diet, vitamin supplementation, herbal medicine, and other modalities. Although these options are considered alternative to many traditional physicians, it should be emphasized that there is currently no cure for tinnitus. The treatments discussed in this article have been beneficial for some people who have constant tinnitus, especially those whose tinnitus failed to respond to traditional treatment modalities. Altering one's diet has been shown to improve tinnitus in some patients. Many patients with tinnitus report that certain supplements seem to have a variable benefit in reducing their symptoms. Nutrient supplementation to treat tinnitus has been extensively studied. The following have generated the most interest and support: magnesium, calcium, potassium, lipoflavonoids, B vitamins, copper, selenium, zinc, and manganese. Herbal remedies for this ailment include Ginkgo biloba, black cohosh, mullein, and cornus. Other treatments, such as laser-light therapy, enzymatic therapy, tinnitus retraining, and vibrational therapy, are also discussed.