Tinnitus: Pathophysiology, Management with Glutamate Receptor Antagonists and Antioxidants – A Clinical Study.

Abstract

Background: Tinnitus, the perception of sound without an external stimulus, is a common symptom in sensorineural hearing loss (SNHL). It is frequently associated with excitotoxicity caused by excessive glutamate release and reactive oxygen species (ROS), leading to cochlear and neuronal damage.

Objective: To evaluate the efficacy of caroverine and antioxidant combination therapy in patients with cochlear-origin subjective tinnitus associated with SNHL.

Methods: This prospective study included 20 patients aged 20–66 years with subjective tinnitus of cochlear/synaptic origin. Exclusion criteria included objective tinnitus, retrocochlear pathology, Meniere’s disease, drug-induced ototoxicity, and middle ear disease. All patients underwent clinical ENT evaluation, audiometry, and were treated with caroverine (20 mg twice daily) and a combination of rebamipide (100 mg), alpha-lipoic acid (100 mg), and acetylcysteine (100 mg), twice daily for 8 weeks. Those with giddiness received cinnarizine (25 mg) and dimenhydrinate (40 mg). Patients were followed up at 15, 30, and 60 days with repeat pure tone audiometry and clinical evaluation.

Results: Of the 20 patients (10 male, 10 female), complete resolution of tinnitus was observed in 11 cases, partial improvement in 7, and no improvement in 2. Hearing improved in 4 cases and partially in 8; 2 showed no improvement. Giddiness improved completely in 2, partially in 1, and was persistent in 1 case. Thirteen patients were fully satisfied, 3 partially satisfied, and 4 not satisfied with treatment outcomes.

Conclusion: Caroverine and antioxidant combination therapy significantly improved tinnitus symptoms in SNHL patients by antagonizing NMDA and AMPA glutamate receptors and reducing oxidative stress. This approach may offer a safe and effective management option for cochlear-synaptic tinnitus.

Keywords: Tinnitus; Sensorineural Hearing Loss; Glutamic Acid; Antioxidants.