flunarizine and Tinnitus

Tinnitus is the perception of sound or noise in the absence of an external or internal acoustic stimulation. It is a common and potentially distressing symptom for which no adequate therapy exists.. To assess the effectiveness of anticonvulsants in patients with chronic tinnitus.. We searched the Cochrane Ear, Nose and Throat Disorders Group Specialised Register, CENTRAL (2010, Issue 2), MEDLINE, EMBASE, bibliographies and additional sources for published and unpublished trials. The date of the most recent search was 26 May 2010.. We selected randomised controlled trials in patients with chronic tinnitus comparing orally administered anticonvulsants with placebo. The primary outcome was improvement in tinnitus measured with validated questionnaires. Secondary outcomes were improvement in tinnitus measured with self-assessment scores, improvement in global well-being or accompanying symptoms, and adverse drug effects.. Three authors assessed risk of bias and extracted data independently.. Seven trials (453 patients) were included in this review. These studies investigated four different anticonvulsants: gabapentin, carbamazepine, lamotrigine and flunarizine. The risk of bias of most studies was 'high' or 'unclear'. Three studies included a validated questionnaire (primary outcome). None of them showed a significant positive effect of anticonvulsants. One study showed a significant negative effect of gabapentin compared to placebo with an increase in Tinnitus Questionnaire (TQ) score of 18.4 points (standardised mean difference (SMD) 0.82, 95% confidence interval (CI) 0.07 to 1.58). A second study showed a positive, non-significant effect of gabapentin with a difference compared to placebo of 2.4 points on the Tinnitus Handicap Inventory (THI) (SMD -0.11, 95% CI -0.48 to 0.25). When the data from these two studies are pooled no effect of gabapentin is found (SMD 0.07, 95% CI -0.26 to 0.40). A third study reported no differences on the THI after treatment with gabapentin compared to placebo (exact numbers could not be extracted from the article).A meta-analysis of 'any positive effect' (yes versus no) based on a self-assessment score (secondary outcome) showed a small favourable effect of anticonvulsants (RD 14%, 95% CI 6% to 22%). A meta-analysis of 'near or total eradication of tinnitus annoyance' showed no effect of anticonvulsants (risk difference (RD) 4%, 95% CI -2% to 11%). Side effects of the anticonvulsants used were experienced by 18% of patients.. Current evidence regarding the effectiveness of anticonvulsants in patients with tinnitus has significant risk of bias. There is no evidence from studies performed so far to show that anticonvulsants have a large positive effect in the treatment of tinnitus but a small effect (of doubtful clinical significance) has been demonstrated.

Topics: Administration, Oral; Amines; Anticonvulsants; Carbamazepine; Chronic Disease; Cyclohexanecarboxylic Acids; Flunarizine; Gabapentin; gamma-Aminobutyric Acid; Humans; Lamotrigine; Randomized Controlled Trials as Topic; Tinnitus; Triazines

Recent research on the pharmacologic treatment of tinnitus is reviewed, emphasizing studies in which controls have been used. Several double-blind cross-over studies have found that lidocaine can reduce tinnitus in about 50 to 75 percent of subjects. Unfortunately, it cannot be used clinically because it must be administered intravenously and its effects are very brief. Other drugs have been much less successful. A few controlled studies have found success rates between 33 and 56 percent using oxazepam, clonazepam, sodium amylobarbitone, flunarizine, and eperisone hydrochloride. None of these studies have been replicated, however. Closely controlled studies using specified etiologic subgroups with subjective and objective psychophysical measurements are needed.

Topics: Antidepressive Agents; Antipsychotic Agents; Carbamazepine; Double-Blind Method; Female; Flunarizine; Humans; Lidocaine; Male; Streptomycin; Tinnitus

To determine whether carbamazepine is effective in treating the subjective tinnitus.. Randomized, prospective,double-blind,controlled trial was used in our study. The study group consisted of 100 adult patients who consulted our outpatient clinic complaining of subjective tinnitus, excluded objective tinnitus and the patients who had tinnitus caused by obvious diseases, such as outer and middle ear diseases, 50 patients were given carbamazepine and Flunarizine Hydrochloride, 50 patients were given Vitamin B6 and Flunarizine Hydrochloride. After a week the effect of the different group of medicines was observed. Tinnitus questionnaire was performed before the treatment, and pure tone audiogram, tinnitus pitch and loudness matching were performed at the end of the treatment.. Completion of treatment, tinnitus loudness matching assessment showed that the efficacy of the carbamazepine group was similar to that of the control group. The efficacy of treatment was respectively 26% by intend to treat (ITT) and 28.3% by per protocol (PP) in the carbamazepine group and 26% by ITT and 27.7% by PP in the control group. The efficacy of treatment has no statistically significance for tinnitus loudness of the experimental group and the control group. The subjective tinnitus improvement rate showed no difference between two groups. Pure tone thresholds fluctuated within 10 dB in the beginning and at the end of the treatment. There were serious side effects in the carbamazepine group. The side effects rates were respectively 55.3% and 16.7% in the carbamazepine group and the control group, respectively. The difference had statistical significance.. Our results showed that the efficacy of carbamazepine combined with Flunarizine Hydrochloride is similar to that of the control group. There was no improvement in listening. But the side effects of it were more serious than that of the control group. It should not be recommended for the treatment of tinnitus.

Topics: Adolescent; Adult; Aged; Carbamazepine; Double-Blind Method; Drug Therapy, Combination; Flunarizine; Hearing Tests; Humans; Middle Aged; Prospective Studies; Tinnitus; Young Adult

To determine whether Betahistine mesilate is effective in treating tinnitus.. Randomized, prospective, double-blind, controlled trial was used in our study. The study group consisted of 60 adult patients who consulted our outpatient clinic complaining of subjective tinnitus, excluded objective tinnitus and the patients who had tinnitus caused by obvious diseases, such as outer and middle ear diseases. Thirty patients were given Betahistine mesilate and Flunarizine Hydrochloride as an experimental group, 30 patients were given Vitamin B6 and Flunarizine Hydrochloride as a control group. After a week of treatment the efficacy of the medicines in two groups was observed. Tinnitus questionnaire was performed before the treatment, and pure tone audiogram, tinnitus pitch and loudness matching were performed both in the beginning and at the end of the treatment.. Completion of treatment, tinnitus loudness matching assessment showed that the efficacy of the Betahistine mesilate group was better then the control group. The efficacy of treatment was respectively 65.5% by per protocol (PP) and 63.3% by intend to treat (ITT) in the Betahistine mesilate group and 39.3% by PP and 36.7% by ITT in the control group. The difference of tinnitus loudness improvement rate between the experimental group and control group was statistically significant. But the subjective tinnitus improvement rate showed no difference between two groups. There were not serious side effects in the two groups.. Betahistine mesilate can be a choice for tinnitus treatment clinically. Further studies of larger series and placebo-controlled trial are needed.

Topics: Adolescent; Adult; Aged; Betahistine; Double-Blind Method; Drug Therapy, Combination; Flunarizine; Humans; Middle Aged; Prospective Studies; Tinnitus; Treatment Outcome; Young Adult

Two rheologically active and 8 vasoactive and metabolically active substances were compared in eight independent studies, some of which were randomised and double blind, on 400 patients who had suffered acute acoustic trauma. The control group was given saline. Spontaneous recovery was excluded as far as possible. The following substances were tested: Dextran 40, hydroxyethyl starch 40/0.5, naftidrofurylhydrogenoxalate, Vinpocetin, betahistine, pentoxifylline, flunaricine, Regeneresen AU 4 and 0.9% saline. All groups showed superior results to the control group in both long-term and short-term tests with respect to hearing gain and tinnitis improvement. The rheologically effective substances showed no statistically significant variations. None of the vasoactive or metabolically active substances used as adjunctive therapy improved the results achieved with rheologically effective substances alone. These results demonstrate that acute acoustic trauma can be most effectively treated by rheologically active substances; vasoactive and metabolically active substances are unnecessary. Hyperbaric oxygenation is advantageous as an adjunctive therapy.

Topics: Adult; Betahistine; Dextrans; Drug Therapy, Combination; First Aid; Flunarizine; Hearing Loss, Noise-Induced; Humans; Hydroxyethyl Starch Derivatives; Male; Meniere Disease; Military Personnel; Nafronyl; Pentoxifylline; Rheology; Sodium Chloride; Tinnitus; Vasodilator Agents; Vinca Alkaloids

The suppressive effect of flunarizine on tinnitus was assessed in a double-blind trial in 50 patients with tinnitus due to various causes. The duration of the study was 6 weeks. Serum levels of the drug were determined. The patient's subjective assessment of the effect was taken as criterion for the evaluation; objective tests were found to be unsuitable for this purpose. Ten of the patients suffered from dizziness as a secondary complaint. For the group as a whole, there was no difference between flunarizine and the placebo with respect to the effect on tinnitus, but in the 10 patients with dizziness as well there was a significant difference in favor of the drug. Conclusions cannot be drawn as to the reason for this divergence, because the number of patients was too small.

Topics: Adult; Aged; Cinnarizine; Clinical Trials as Topic; Double-Blind Method; Female; Flunarizine; Humans; Male; Middle Aged; Tinnitus

The anti-vertigo activity of flunarizine has been evaluated in a 16-week double-blind placebo-controlled cross-over trial involving 41 patients. After a 4-week open running-in treatment with 10 mg flunarizine daily, the 40 responders were either further treated with flunarizine--at the same dose--or given matching placebo. After another 6 weeks, they were switched to the alternative medication. Severity of vertigo, and frequency and duration of the attacks were quickly and significantly reduced with the open flunarizine dose. Continuation of the drug further produced a slight improvement whereas switching over to the placebo resulted in a significant deterioration of the patients' condition. Tinnitus seemed to be less responsive to treatment. The level of untoward effects (sedation) was low and similar for both medications.

Topics: Adult; Chronic Disease; Cinnarizine; Clinical Trials as Topic; Double-Blind Method; Drug Administration Schedule; Female; Flunarizine; Humans; Male; Middle Aged; Piperazines; Placebos; Tinnitus; Vertigo

Ninety-eight patients with idiopathic sudden deafness were treated with a modified defibrinogenation (DF) therapy including batroxobin, low molecular dextran, vasodilators and vitamins. Hearing improvement was evaluated with two methods: categorical judgement and improvement rate (%). By categorical judgement, 60 patients (61% of the total) were classified into recovery or good improvement categories. The improvement rate was calculated for each of the 93 patients, and the average value was 64%. Modified DF therapy was effective especially for patients with severe hearing loss of 70-90 dB with flat audiogram. Although serum fibrinogen significantly decreased after batroxobin administration there was no correlation between the concentration of fibrinogen and hearing recovery. When prognostic factors were studied, the interval between the onset of hearing loss and start of treatment, initial hearing level, and the existence of vertigo all had significant correlation with the degree of hearing recovery.

Topics: Adenosine Triphosphate; Adolescent; Adult; Aged; Aged, 80 and over; Audiometry, Pure-Tone; Batroxobin; Dextrans; Female; Fibrinogen; Flunarizine; Hearing; Hearing Loss, Sudden; Humans; Male; Middle Aged; Prognosis; Time Factors; Tinnitus; Vertigo; Vitamin B 12