- Original article
- Open Access
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)
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.
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.
A prospective randomized clinical trial was conducted.
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.
Intratympanic dexamethasone injection in combination with TCA imipramine maleate could be subjectively beneficial when compared with imipramine hydrochloride alone.
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.
Langguth B, Elgoyhen AB. Current pharmacological treatments for tinnitus. Exp Opin Pharmacother 2012; 13:2495–2509.
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.
Tyler RS. Patient preferences and Willingness to pay for tinnitus treatments. J Am Acad Audiol 2012; 23:115–125.
Robinson SK, Viirre ES, Stein MB. Antidepressant therapy in tinnitus. Hear Res 2007; 226:221–231.
Langguth B, Landgrebe M, Kleinjung T, Sand GP, Hajak G. Tinnitus and depression. World J Biol Psychiatry 2011; 12:489–500.
Mico JA, Ardid D, Berrocoso E, Eschalier A. Antidepressants and pain. Trends Pharmacol Sci 2006; 27:348–354.
Jahnke K. The blood-perilymph barrier. Arch Otorhinolaryngol 1980; 228:29–34.
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.
Soliman S. Speech discrimination audiometry using Arabic phontically balanced words. Ain Shams Med J 1976; 27:27–30.
Newman CW, Jacobson GP, Spitzer JB. Development of the tinnitus handicap inventory. Arch Otolaryngol Head Neck Surg 1996; 122:143–148.
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.
Beck DL. Progressive tinnitus management, habituation, and more: an interview with James A. Henry, PhD. Hear Rev 2017; 24:38–40.
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.
Shim HJ. Intratympanic steroid injection in tinnitus management. Hanyang Med Rev 2016; 36:125–130.
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.
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.
Sakata E, Itoh A, Itoh Y. Treatment of cochlear-tinnitus with dexamethasone infusion into the tympanic cavity. Int Tinnitus J 1996; 2:129–135.
Shulman A, Goldstein B. Intratympanic drug therapy with steroids for tinnitus control: a preliminary report. Int Tinnitus J 2000; 6:10–20.
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.
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.
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.
Pitovski DZ, Drescher MJ, Drescher DG. Glucocorticoid receptor in the mammalian inner ear. Hear Res 1994; 77:216–220.
Rarey KE, Lonhuis PJ, ten Cate WJ. Response of the stria vasularis to corticosteroids. Laryngoscope 1991; 101:1081–1084.
This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
About this article
Cite this article
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
- intratympanic dexamethasone