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Intratympanic dexamethasone as an adjuvant to oral imipramine hydrochloride (Tofranil, a TCA) 25 mg twice daily in management of idiopathic unilateral subjective tinnitus

The Egyptian Journal of Otolaryngology volume 35, pages 300–306 (2019)Cite this article

Abstract

Background

In this report, we summarize our clinical experience with intratympanic (IT) dexamethasone treatment for control of idiopathic unilateral tinnitus when used as an adjunct treatment with Tricyclic antidepressant (TCA) imipramine hydrochloride 25mg twice daily for 1 month.

Objectives

To assess the clinical benefit of adding dexamethasone by IT route to the tricyclic antidepressant imipramine hydrochloride in the management of idiopathic unilateral subjective tinnitus.

Study design

A prospective randomized clinical trial was conducted.

Results

Results from this study showed significant subjective improvement of patients with unilateral subjective tinnitus when comparing the two arms of the study, both to pretreatment assessment and between the two arms, giving significant advantage to the group treated with combination of intratympanic dexamethasone with imipramine hydrochloride 25mg twice daily for 2 weeks using tinnitus handicap inventory questionnaire, subjective tinnitus loudness as measured by a visual analog scale, and tinnitus awareness score.

Conclusion

Intratympanic dexamethasone injection in combination with TCA imipramine maleate could be subjectively beneficial when compared with imipramine hydrochloride alone.

References

  1. Albu S, Chirtes F. Intratympanic dexamethasone plus melatonin versus melatonin only in the treatment of unilateral acute idiopathic tinnitus. Am J Otorhinolaryngol Head Neck Med Surg 2014; 35:617–622.

    Google Scholar 

  2. Langguth B, Elgoyhen AB. Current pharmacological treatments for tinnitus. Exp Opin Pharmacother 2012; 13:2495–2509.

    Article  CAS  Google Scholar 

  3. Cima RF, Maes IH, Joore MA, Scheyen DJ, El Refaie A, Baguley DM, et al. Specialised treatment based on cognitive behaviour therapy versus usual care for Tinnitus: a randomised controlled trial a. Lancet 2012; 379:1951–1959.

    Article  PubMed  Google Scholar 

  4. Tyler RS. Patient preferences and Willingness to pay for tinnitus treatments. J Am Acad Audiol 2012; 23:115–125.

    Article  PubMed  Google Scholar 

  5. Robinson SK, Viirre ES, Stein MB. Antidepressant therapy in tinnitus. Hear Res 2007; 226:221–231.

    Article  CAS  PubMed  Google Scholar 

  6. Langguth B, Landgrebe M, Kleinjung T, Sand GP, Hajak G. Tinnitus and depression. World J Biol Psychiatry 2011; 12:489–500.

    Article  PubMed  Google Scholar 

  7. Mico JA, Ardid D, Berrocoso E, Eschalier A. Antidepressants and pain. Trends Pharmacol Sci 2006; 27:348–354.

    Article  CAS  PubMed  Google Scholar 

  8. Jahnke K. The blood-perilymph barrier. Arch Otorhinolaryngol 1980; 228:29–34.

    Article  CAS  PubMed  Google Scholar 

  9. Soliman S, Fathalla A, Shehata W. Development of the Arabic staggered spondaic words (SSW) tes. Proc 8th Annual Ain Shans Cong 1985; 2:1220–1226.

    Google Scholar 

  10. Soliman S. Speech discrimination audiometry using Arabic phontically balanced words. Ain Shams Med J 1976; 27:27–30.

    Google Scholar 

  11. Newman CW, Jacobson GP, Spitzer JB. Development of the tinnitus handicap inventory. Arch Otolaryngol Head Neck Surg 1996; 122:143–148.

    Article  CAS  PubMed  Google Scholar 

  12. Newman CW, Sandridge SA, Jacobson GP. Psychometric adequacy of the Tinnitus Handicap Inventory (THI) for evaluating treatment outcome. J Am Acad Audiol 1998; 9:153–160.

    PubMed  CAS  Google Scholar 

  13. Beck DL. Progressive tinnitus management, habituation, and more: an interview with James A. Henry, PhD. Hear Rev 2017; 24:38–40.

    Google Scholar 

  14. Sakata E, Ito Y, Itoh A. Clinical experiences of steroid targeting therapy to inner ear for control of tinnitus. Int Tinnitus J 1997; 3:117–121.

    PubMed  CAS  Google Scholar 

  15. Shim HJ. Intratympanic steroid injection in tinnitus management. Hanyang Med Rev 2016; 36:125–130.

    Article  CAS  Google Scholar 

  16. Thompson DM, Hall DA, Walker D-M, Hoare DJ. Psychological therapy for people with tinnitus –a scoping review of treatment components. Ear Hear 2016; 38:149–158.

    Article  Google Scholar 

  17. An YH, Yu KK, Kwak MY, Yoon SW, Shim HJ. Prognostic factors for the outcomes of intratympanic dexamethasone in the treatment of acute subjective tinnitus. Otol Neurotol 2014; 35:1330–1337.

    Article  PubMed  Google Scholar 

  18. Sakata E, Itoh A, Itoh Y. Treatment of cochlear-tinnitus with dexamethasone infusion into the tympanic cavity. Int Tinnitus J 1996; 2:129–135.

    CAS  PubMed  Google Scholar 

  19. Shulman A, Goldstein B. Intratympanic drug therapy with steroids for tinnitus control: a preliminary report. Int Tinnitus J 2000; 6:10–20.

    PubMed  CAS  Google Scholar 

  20. Cesarani A, Capobianco S, Soi D, Giuliano DA, Alpini D. Intratympanic dexamethasone treatment for control of subjective idiophatic tinnitus: our clinical experience. Int Tinnitus J 2002; 8:111–114.

    PubMed  CAS  Google Scholar 

  21. Araújo MF, Oliveira CA, Bahmad FM Jr. Intratympanic dexamethasone injections as a treatment for severe, disabling tinnitus: does it work? Arch Otolaryngol Head Neck Surg 2005; 131:113–117.

    Article  PubMed  Google Scholar 

  22. Parelkar K, Thorawade V, Jagade M, Nagle S, Nataraj R, Pandare M, et al. Intratympanic injections: an unsolved mystery. Int J Otolaryngol Head Neck Surg 2015; 4:124–132.

    Article  Google Scholar 

  23. Pitovski DZ, Drescher MJ, Drescher DG. Glucocorticoid receptor in the mammalian inner ear. Hear Res 1994; 77:216–220.

    Article  CAS  PubMed  Google Scholar 

  24. Rarey KE, Lonhuis PJ, ten Cate WJ. Response of the stria vasularis to corticosteroids. Laryngoscope 1991; 101:1081–1084.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of ORL & Audiology, Ain Shams University, 1156, Cairo, Egypt

    Tamer A. Abo El Ezz, Fathy N. Fattoh &  Tahany Rabie (Assistant Professor)

Authors
  1. Tamer A. Abo El Ezz
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  2. Fathy N. Fattoh
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  3. Tahany Rabie
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Corresponding author

Correspondence to Tahany Rabie.

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Ezz, T.A.A.E., Fattoh, F.N. & Rabie, T. Intratympanic dexamethasone as an adjuvant to oral imipramine hydrochloride (Tofranil, a TCA) 25 mg twice daily in management of idiopathic unilateral subjective tinnitus. Egypt J Otolaryngol 35, 300–306 (2019). https://doi.org/10.4103/ejo.ejo_82_17

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  • DOI: https://doi.org/10.4103/ejo.ejo_82_17

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