8 best drugs for tinnitus

*Overview of the best according to the editors of Healthy Food Near Me. About selection criteria. This material is subjective, is not an advertisement and does not serve as a guide to the purchase. Before buying, you need to consult with a specialist.

Tinnitus is one of the few conditions that significantly impairs the quality of life of a person without any pain, without lack of movement, with the ability to maintain oneself and help other people. But despite this, the life of a patient with severe tinnitus can be unbearable and painful. This pathology is sometimes confusing, very difficult to diagnose and successfully treat, if only because the noise can be objective, that is, exist independently of the patient’s perception, and subjective.

In the second case, there really is no real noise, but the patient hears it, and it interferes with his life and sleep. About objective and subjective noise, their causes, will be discussed below. And now we can only mention that 40% of all adults have experienced an episode of tinnitus at least once. At the same time, about 80% of them complain about constant noise, and about 1% of the population suffers from a severe form of noise, which is heard both at night and during the day.

It goes without saying that this problem is most studied in countries with a high standard of living, for example, in the United States, and Western European countries. In countries with totalitarian regimes, such a trifle is usually ignored, because sometimes there are not enough funds even to fight especially dangerous infections. Therefore, let us turn to the experience of the United States. In this country, more than 15 million people are regularly treated for various forms of tinnitus, and about 2 million have disabilities due to this disease.

Interestingly, people with congenital deafness do not have any complaints of tinnitus. Noise is a “floating” symptom, which in itself, without confirmation, cannot be the basis for a diagnosis. There is no such disease, the diagnosis of which could be accurately set by the presence of only one complaint of noise. Nevertheless, if we take a number of patients with impaired and impaired hearing, then most of them sooner or later present periodic or constant complaints of tinnitus. What is the difference between objective noise and subjective form?

Objective and subjective noise: causes

Subjective noise can be heard by various devices, and even by other people. The source of sound may be the movement of blood through the vessels, muscle tension, if we are talking about the muscles of the skull. In some cases, noise can be heard even by strangers, and during auscultation, that is, listening to the skull with a conventional phonendoscope. We are talking, for example, about the carotid-cavernous fistula. This is a special vascular malformation that shunts, or dumps blood in the cranial cavity from one pool to another.

The patient hears a throbbing, hissing or blowing noise that actually exists and interferes with the patient’s life. In fact, this noise is not tinnitus, since it is felt by all the structures of the skull, but still, the patient, in the presence of such an anastomosis, which is closed surgically, first of all, complains of tinnitus.

Noise also causes arthrosis of the temporomandibular joint, myoclonus of the muscles in the middle ear, that is, the state of their convulsive twitches and increased tone. Patients do not associate such muscle noise with blood pressure, with pulse beats, and perceive it as rumbling, trembling, or compare it with the crackling of a grasshopper. The characteristic feature of such muscle noise is its clicking character.

Noise in the ears can occur due to the wide mouth of the Eustachian, or auditory tube, in the presence of a tumor and vasospasm in the middle ear, with an increase in blood pressure due to a hypertensive crisis. Such forms of noise exist objectively.

The noise that doesn’t really exist is called tinnitus. It affects about 5% of the world’s population. Tinnitus, like objective noise, can have different characteristics. It can be felt on one side or asymmetrically, constantly or periodically, it can pulsate or be constant, be whistling or buzzing, that is, different in frequency and intensity. It is imperative to find out from the patient whether the noise in the ears or in the head is the main complaint, or is it still a minor symptom.

The cause of subjective, phantom noise, or tinnitus, is varied. It can really arise on the basis of objective changes in the ENT organs, or systemic pathology. For example, otosclerosis, diving barotrauma, sensorineural hearing loss, the effects of chronic otitis, the presence of cerumen, chronic labyrinth, and Meniere’s disease can lead to tinnitus. Tumors of the cerebellopontine angle, such as acoustic neuroma, can lead to tinnitus.

The cause may be toxic damage to the nerves, for example, due to the abuse of alcohol surrogates, and especially methyl alcohol. The classic picture of poisoning is blindness, but it should be remembered that methanol affects not only the optic nerves, but can also harm other cranial nerves, which are conductors of not only visual images, but also auditory ones.

If a person awkwardly turned his neck at night during sleep, then “vessel pinching” by osteophytes on the vertebrae can cause a temporary reduction in blood flow through the vertebral artery, and, as a result, a shortage of blood supply to the posterior parts of the brain, including the auditory analyzer. Therefore, osteochondrosis of the cervical spine, manifested by vertebral artery syndrome, can also be the cause of periodic tinnitus.

Of the systemic pathology, it should be noted a disorder of the thyroid gland, a decrease in the level of sugar in the blood plasma, that is, hypoglycemia, which can occur with type XNUMX diabetes. A sharp drop in pressure, that is, collapse or fainting, can also cause noise or ringing in the ears, just like atherosclerosis. The cause is chronic hepatitis, and other diseases that cause neurovascular symptoms. Sometimes occupational hazards, demyelinating diseases, such as multiple sclerosis, are to blame.

The list of pathologies that can cause both objective and subjective noise is very wide, and an ENT doctor, a neurologist, and especially an otoneurologist, whose competence includes the diagnosis and treatment of various types of tinnitus, both objective and and tinnitus.

However, statistics show that the most common cause of tinnitus is still the pathology of the cochlea, or the primary auditory analyzer. The leading hypothesis for the occurrence of subjective noise states that it occurs during spontaneous activation of the receptors of the peripheral auditory analyzer. In fact, this activation occurs without the objective pressure of the sound wave, that is, in silence. There is an imitation of a sound signal, but there is no signal itself. This is reminiscent of a panic on the stock exchange from the influence of rumors, which, in the end, will lead to a collapse in stock prices, although there are no objective prerequisites for this.

The same thing happens in the brain: an imitation of a sound signal enters the central part of the auditory analyzer, and the brain has to decipher false information in order to give some meaning to incomprehensible information. As a result, an incomprehensible sound signal is formed, the awareness of which is often unpleasant and frightening.

Basics of differential diagnosis

Patients themselves, without consulting a doctor, can try to determine the source of the noise. Here are some signs that are important for self-diagnosis (unlike self-treatment, there is nothing wrong with self-diagnosis):

usually, if the patient has a diagnosis of chronic labyrinthitis, or the cochlea is affected, then the noise will have not only great strength, but also a painful shade;

if the cause of the noise is a growing volumetric formation in the cranial cavity, that is, a tumor, then usually the attacks will be accompanied by attacks of headache: the more the head hurts, the stronger and more pronounced the noise. When a person is prescribed a drug to reduce intracranial pressure, such as diacarb, the headache attacks decrease, and the noise along with them;

if we are talking about tumors localized in the posterior cranial fossa, then when turning and tilting the head, the nature of the noise will also change, that is, it begins to respond to a change in the position of the body in space;

if the patient has a tumor of the cerebellopontine angle, for example, acoustic neuroma, then this process is asymmetric, located on the right or left. And the noise, accordingly, will be localized exactly in that half of the head where the tumor is located. Noise will have a clear occipital shade, located behind, from the side of the ear;

if the patient has a pulsating pulse rate, and the pulsation frequency coincides with the heart rate, then this is most likely a vascular murmur. Doctors say it’s a soft, blowing noise, perhaps with a whistling or hissing tone. You can put pressure on your jugular veins yourself, and then the nature of the noise will change. Most likely, it will intensify due to a decrease in the outflow of venous blood from the cranial cavity;

with pathology of the ENT organs, for example, dysfunction of the Eustachian tube, or the system of sound-conducting ossicles in the middle ear, narrowing of the lumen of the external auditory canal, then patients usually complain of low-frequency, buzzing noise. There is a concomitant hearing loss, and in the ear in which it makes noise, there is quite often a feeling of congestion;

if the patient suffers from regular attacks of Meniere’s disease, then usually attacks of noise in the ear with its intensification appear before the attack of the disease, and make the most noise in the ear at the height of the attack, and then the noise either decreases or disappears with the end of the attack;

neurosurgical patients also complain about tinnitus. One such characteristic example is the Arnold-Chiari syndrome, when the tonsils of the cerebellum descend lower than expected, and even descend into the foramen magnum with the risk of infringement when intracranial pressure rises. There may also be hereditary forms of acoustic neuroma, schwannomas, damage to the geniculate ganglion, or anomalies in the development of the upper cervical vertebrae. All this can also cause noise, or tinnitus;

severe barotrauma followed by subsequent murmur. Sometimes, even with the injury itself, there is noise, deafening, sharp pain in the ear, nausea and vomiting, and even bleeding from the ear with a possible rupture of the membrane. The usual mechanism of barotrauma is a rapid rise from depth, takeoff and landing of an aircraft, and severe barotrauma is explosions and shots above the ear.

Finally, there are the so-called iatrogenic forms of tinnitus, which are caused by the intake or overdose of certain drugs. A particularly serious disorder is caused by first-generation aminoglycoside antibiotics: gentamicin, kanamycin, streptomycin. Of the more modern – tobramycin. Their use can even lead to deafness and disability. These antibiotics are even called ototoxic. In a milder form, tinnitus can be caused by taking diuretics that cause a decrease in blood pressure, some drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs), ACE inhibitors, calcium blockers. Some antidepressants also have this effect.

In fairness, it should be recalled that there is a special category of patients. We are talking about auditory hallucinations, which quite often occur in patients with delirium tremens, that is, alcoholic delirium, some forms of schizophrenia, and other diseases accompanied by pathological production. In particular, patients may complain about noise, and here the psychiatrist faces a rather difficult task: to distinguish between auditory hallucinations, which in a rough form can proceed in the form of simple noises, with a really organic form of noise. After all, a mentally ill person can, nevertheless, have a concomitant diagnosis, pathology of the ENT organs, atherosclerosis, hypertension. He can have all the diseases that are described above.

Pharmacotherapy for noise and tinnitus

The modern treatment of tinnitus has a long history. A variety of drugs were used: vascular, muscle relaxants and nootropics, histaminolytics, vitamins, diuretics. Some drugs have taken their rightful place in official protocols and treatment regimens, and they are still used for the pharmacological treatment of tinnitus and tinnitus.

Other drugs did not show their effectiveness, and in double-blind randomized trials, in relation to the endpoints, they did not reduce the quantitative and qualitative characteristics of the noise, and acted on a par with placebo. Such drugs that should not be prescribed due to their low effectiveness include vitamins, including nicotinic acid, and B vitamins. There is a rare exception: if the patient has an initial malnutrition and nutritional deficiencies, who then can vitamins help. But if a person eats fully, his diet is balanced, then there is no need for them.

The same can be said about zinc preparations. Until now, some otoneurologists with tinnitus prescribe zinc oxide, sulfate or aspartate, and in quantities that exceed the daily requirement by 6-10 times. Studies have not shown the effectiveness of high concentrations of zinc in reducing noise and improving hearing function.

Finally, no proven efficacy has been found in the long-term administration of ginkgo biloba preparations, drugs such as bilobil, and even the “flagship” of this line, the Tanakan drug from Bofur Ipsen. There was no proven therapeutic effect that could really be calculated statistically.

So here are 8 medications that have been proven effective for various forms of tinnitus and tinnitus. They belong to anticonvulsants, antidepressants, histamine receptor blockers, cerebrovascular stimulants, and other groups of drugs. However, there is not a single drug that has been created specifically “for tinnitus”, which would treat only noise and has not been used anywhere else.

Rating of the best drugs for tinnitus

First, an international non-proprietary name is given, that is, INN. After that, the names of the trade names of the drug come in brackets, and the first, as a rule, is the original remedy that was first created, and to which all other commercial copies, or generics, are equal. This medicine is called the original drug. The original drug always costs a little more than the rest, but it is the leader, it is always of higher quality. For the original remedy, there is the largest number of studies, both in terms of effectiveness and safety. Sometimes it takes many years and many hundreds of millions, and sometimes billions of dollars, to create a drug. Therefore, it must be remembered that the price of the original drug is always justified.

On the other hand, one should warn and warn against buying the cheapest, as a rule, domestic generics. It is impossible to save on health, since the extreme degree of cheapness does not say anything about quality. The following is a breakdown of prices relevant for May 2020 for pharmacies of all forms of ownership in the Russian Federation.

The drugs included in the list are all present in the National and international recommendations, introduced into the algorithms and protocols for managing patients with tinnitus. There is no promotional purpose of listing or delisting any drug, and the material provided below is for informational purposes only.

Anticonvulsants

Anticonvulsant drugs have long been used successfully in the fight against tinnitus. The thing is that subjective noise, chronic pain, and convulsive syndrome, or true genuin epilepsy, have some common points of pathogenesis. However, not all patients benefit from anticonvulsant therapy. In order to find out in advance whether the medicine will help or not, a so-called lidocaine test is performed. In the absence of contraindications (first of all, cardiac arrhythmias), patients are injected intravenously with 20 ml of 1% lidocaine solution.

This test must necessarily be carried out against the background of existing tinnitus. If the patient confidently notes at least a temporary decrease, or the complete disappearance of the noise on the introduction of this drug, then it makes sense for him to prescribe anticonvulsants, or anticonvulsants.

The standard of anticonvulsants is carbamazepine, doctors have the right to expect high efficiency, up to 100% of cases. If the patient notes a slight effect on the administration of lidocaine, then in this case, anticonvulsants can be used as a means of partial noise control. They are prescribed when the noise is painful and unbearable, and the physical means of acoustic masking (about them at the very end of the review) do not help.

You can also prescribe drugs from the valproate group, when there is resistance to carbamazepines, but there is no therapeutic effect. Valproates can also be given for a negative lidocaine test, but they do not work as well as carbamazepine. In addition to valproates, lamotrigine, also known as Lamictal, has been clinically proven effective against tinnitus. Consider one of the most highly effective carbamazepines, namely Tegretol.

Carbamazepine (Tegretol, Finlepsin)

Rating: 4.9

It is produced by the well-known pharmaceutical company Novartis, and 50 tablets of 200 mg each will cost in May 2020 at a price of 340 to 390 rubles. Carbamazepine leads to stabilization of the membranes of overexcited neurons, suppresses their discharges, and reduces the transmission of excitatory impulses. The main mechanism of action of carbamazepine is the “calming” of depolarized neurons, and the prevention of action potentials. Therefore, in addition to various forms of epilepsy, in addition to the blockade of neuropathic pain, the drug also helps to eliminate such false potentials that arise in the afferent structures of the auditory nerve in patients with tinnitus.

It is necessary to apply Tegretol with a half dosage, 100 mg 3 times a day. Gradually, the dosage should be increased, up to 600-1000 mg per day, but always under the supervision of a physician. As soon as a stable effect occurs, treatment is continued for two to three months. Unfortunately, if you start to reduce the dose or completely stop the drug, then the noise very often returns again, to its initial state. This period of return to noise lasts 2-3 weeks. As practice shows, if you prescribe carbamazepine in a small dosage, for example, 400 mg per day, then the effectiveness of such a small dose is much lower.

Advantages and disadvantages

Be sure to take into account the side effects, which depend on the dose. It must be understood that high doses of carbamazepine, which are good for severe tinnitus, can produce other unpleasant symptoms. Most often it is dizziness, drowsiness and general weakness, headache, various allergic skin reactions, such as urticaria, a decrease in plasma leukocytes, platelets, and an increase in eosinophils. While taking the drug, such a serious complication as agranulocytosis may appear, and therefore carbamazepine must be prescribed under the control of a complete blood count. Liver enzymes may also increase, nausea, dry mouth, diarrhea or constipation appear, swelling, fluid retention and other side effects may occur.

If the patient is ready to put up with them, and the noise is unbearable, then it is necessary to inform him of the possibility of such effects before prescribing the drug in high dosages. Carbamazepine is prohibited in the presence of atrioventricular blockade, aplastic anemia, in the case of taking MAO inhibitors, or in case of hypersensitivity to this drug. When it comes to prescribing carbamazepine to pregnant and lactating women, then special care is needed, as well as in case of impaired liver and kidney function.

Antidepressants

It can be said that antidepressants do not directly affect the mechanism of formation and conduction of noise, and do not even affect the mechanism of perception of this noise by the auditory part of the temporal lobe of the cerebral cortex. But at the same time, they do an important job: namely, they change the emotional coloring of the noise, and make it not so painful, that is, they really work like antidepressants. Moreover, benzodiazepine derivatives, and specifically oxazepam and clonazepam, cope with this task in the best way.

The positive effect lies in the subjective decrease in the intensity of the sound, and, most importantly, in the improvement of its tolerance: the noise can even remain almost the same in strength, but loses its painful tone. The dosage of antidepressants is 30mg daily for oxazepam and 500mcg 3 times daily for clonazepam. Quite often, amitriptyline is used to treat tinnitus, at an initial dosage of 50 mg daily, and then 100 mg for a month and a half. At the same time, the efficiency of noise control can reach up to 95%. A combination of antidepressants and mild neuroleptics, such as Eglonil, or Sulpiride, can also be very useful. This improves the noise control profile. Alprazolam is considered one of the most effective antidepressants that cope with noise.

Alprazolam

Rating: 4.9

Each tablet of alprazolam contains 1 mg of the active ingredient. This is also a derivative of benzodiazepine, it causes sedative, hypnotic, anticonvulsant effects, and relaxes muscles. Using alprazolam in patients with tinnitus, it is possible to achieve a decrease in emotional stress, fear and anxiety, and the painful expectation of noise attacks. The drug helps to fall asleep, shortens the period of falling asleep, sleep becomes longer, and night awakenings decrease in frequency and become shorter. Therefore, alprazolam is primarily indicated for patients who either cannot fall asleep due to nocturnal noise, or wake up and cannot fall asleep again. Such a valuable effect of alprazolam is associated with its effect on the reticular formation.

It is necessary to prescribe the drug first at 250-500 mcg 3 times a day, and you can increase the dosage to a maximum of 4,5 mg. As again it has become known through numerous studies and clinical practice, the optimal duration of the course of taking alprazolam for tinnitus should be 3 months. Currently, alprazolam is sold infrequently, and only in large cities. It is not cheap, but it is also spent economically. Thus, 50 tablets of alprazolam, 1 mg each, produced by domestic Organic enterprises, will cost 950 rubles. for packing.

Advantages and disadvantages

Since the packaging of alprazolam is 1 mg in each tablet, then at first, in the first days, it is necessary to break the tablet into 4 parts, and in the first days take 3-4 quarters, and then break it into halves, and take 3 halves, this is not quite comfortable. It is necessary to cancel or reduce the dosage of this medicine only gradually, and no more than half a tablet, or 500 mcg, every three days, no more often. Alprazolam also has contraindications: this is the presence of a diagnosis of myasthenia gravis, angle-closure glaucoma, chronic alcoholism and especially acute ethanol poisoning, as well as sleeping pills. It is contraindicated in obstructive pulmonary diseases with respiratory failure, as well as in the presence of severe depression, due to the possible development of suicidal tendencies. It is not shown to children and persons under the age of eighteen. Alprazolam also has various side effects, which most often include drowsiness, dizziness and fatigue, dry mouth, a decrease in white blood cells, urinary retention and itchy skin.

Betahistine (Betaserc, Betaver, Vertran, Vestibo, Tagista)

Rating: 4.8

The drug betahistine, and its original representative – Betaserc is a reference tool for the treatment of vestibular vertigo and relief of tinnitus. Betahistine is also called a vestibulolytic. He has a solid evidence base, he is able to increase blood flow in the cochlea, reduce the activity of the vestibular nuclei that lie in the brain. It is the second factor that is very important in the treatment of that noise, the source of which is the structures of the cochlea, the vestibular apparatus and the peripheral part of the auditory analyzer.

In the presence of tinnitus, the optimal dosage is considered to be 48 mg per day, that is, one tablet 2 times a day, in the case of buying Betaserc 24 mg. Especially well reduces vestibular noise Betaserk in the presence of Meniere’s disease, which occurs before an attack, and treatment should be long: a total of 3-4 months. The best dosage that exists for the treatment of dizziness is 24 mg No. 20. Thus, one package is enough for 10 days of treatment. Betaserk is produced by Abbott from France, and the cost of the drug will be from 410 to 520 rubles.

Advantages and disadvantages

Perhaps it can be said that Betaserc is one of the central drugs for the treatment of peripheral vestibular tinnitus. It is contraindicated, except for hypersensitivity to the drug, in the presence of a hormone-producing tumor of the adrenal glands, or pheochromocytoma, with exacerbation of gastric and duodenal ulcers, bronchial asthma and in the first trimester of pregnancy. Of the side effects, nausea, a feeling of heaviness in the upper abdomen, occasionally urticaria, itching and rash occur most often. If there is severe dyspepsia, nausea and vomiting, then Betahistine should be taken either during or after meals, but not on an empty stomach. Betahistine, in addition to tinnitus, is good for dizziness, including nausea and vomiting, with vertebrobasilar insufficiency and post-traumatic encephalopathy.

Improvement of cerebral circulation

Improving cerebral circulation is one of the important steps in reducing noise, or even eliminating it. After all, with tinnitus, when there is no real potential, but there is a signal “invented” by neurons, it can be generated due to a violation of neuronal trophism and a deterioration in blood supply. Nerve fibers that are in a state of ischemia, despite the presence of the blood-brain barrier, are more capable of “mistaking” and transmitting non-existent signals.

Vinpocetine (Cavinton)

Rating: 4.9

Currently, there are many drugs, such as papaverine, eufillin, platifillin, nicotinic acid, but they have not proven their effectiveness. One of the best means for improving the blood supply to the cochlea and the peripheral parts of the vestibular analyzer is vinpocetine, the original drug is Cavinton from Gideon Richter. Cavinton is available in several versions of the tablet form. The most famous tablets are 5 mg, there are also 10 mg tablets, which are called Cavinton forte. A simple Cavinton at a dosage of 5 mg No. 50 will cost about 100 rubles, it is produced by the well-known Hungarian company Gedeon Richter.

Cavinton is a modified vinca alkaloid, and can also be produced in ampouled form for intravenous slow infusion. It prevents platelet aggregation, reduces brain tissue hypoxia, dilates blood vessels, protects neurons from hypoxia, and optimizes cerebral blood flow. It is advisable to use this medicine in case of tinnitus at a dosage of 10 mg 3 times a day, that is, one tablet of Cavinton forte, but not more than 30 mg daily. A significant effect develops about a week after taking the drug, and the usual course of treatment lasts at least 3 months. In addition to tinnitus, it is used to improve blood flow after ischemic strokes, in the presence of encephalopathy, as well as in the case of chronic diseases of the retina and its choroid.

Advantages and disadvantages

The disadvantage of Cavinton is that alone, without the concomitant prescription of anticonvulsants, or histamine receptor blockers, he cannot cope with bouts of tinnitus. But in complex therapy, it shows its effect. The drug is contraindicated in severe coronary heart disease, in case of severe cardiac arrhythmias, and in case of hypersensitivity to the drug. Also, it is not prescribed to pregnant and lactating women, and to persons under 18 years of age. Without side effects, there may occasionally be ECG changes, in the form of ST segment depression and prolongation of the QT interval. There may be dizziness, dry mouth, and allergic reactions.

Calcium antagonists: nimodipine (Nimotop, Dilceren, Nemotan, Nimopine)

Rating: 4.8

Nimodipine, also known as Nimotop, is a drug that has proven itself primarily for the treatment of vasospasm in neurosurgery, with subarachnoid hemorrhage and an increase in the blood flow velocity of cerebral vessels with the development of ischemia of brain tissues. In this case, Nimotop is administered parenterally, intravenously. If we talk about dizziness and tinnitus, which is of a vascular nature, then it is possible that they are also caused by vasospasm, with an increase in blood flow and a decrease in perfusion in the peripheral sections of the auditory and vestibular analyzer, as well as with the development of ischemia in various sections auditory cortex.

The use of Nimodipine allows you to relax the blood vessels, and reduce the central murmur of vascular origin, both with and without the presence of cochlear components. Nimodipine affects receptors on blood vessels in the brain that are associated with calcium channels, resulting in stabilization of nerve cell function, and improves ischemia tolerance by reducing neuronal oxygen demand without causing steal syndrome.

Nimopin is produced in tablets (there are simply no other drugs in Russia so far) by the Indian company Simpeks Pharma, and a package of 30 tablets of 30 mg will cost about 600 rubles. It is advisable to prescribe nimodipine for tinnitus at a dose of 90 mg per day, that is, one tablet three times a day.

Advantages and disadvantages

Nimodipine is a serious drug and contraindications should be carefully assessed before starting treatment. It should not be used in severe liver dysfunction, it should not be prescribed together with epilepsy drugs or rifampicin, anti-tuberculosis antibiotics. You can not appoint it together with phenobarbital, during pregnancy, breastfeeding and under the age of 18 years. Nimodipine is not recommended for low blood pressure, unstable angina, and severe renal impairment when the filtration rate is less than 20 ml/minute. For a solution used as an intravenous infusion, there are additional contraindications, but we will not consider them, since the medicine is prescribed in tablets for tinnitus. Of the side effects, the most common is a decrease in the number of platelets in the blood, headache, tachycardia, nausea, allergic skin reactions and an excessive decrease in blood pressure.

Improving microcinculation: Pentoxifylline (Trental 400, Agapurin, Vasonite, Pentomer, Trenpental, Flexital)

Rating: 4.8

Pentoxifylline, or Trental 400, has proven itself well in acute vestibular disorders of vascular origin. The appointment of Trental 400 4 times a day, that is, in a total daily dose of 1600 mg, improves blood flow in the structures of the cochlea, reduces tinnitus, and reduces the severity of hearing loss and dizziness. Moreover, it is desirable to prescribe Trental, or other trade names of pentoxifylline, for such disorders when there is a pronounced vestibular component, that is, tinnitus is also accompanied by dizziness. This is when pentoxifylline works better than cinnarizine. Cinnarizine is also prescribed for tinnitus and dizziness, but Cinnarizine copes with dizziness somewhat worse.

Pentoxifylline improves blood flow and reduces its viscosity. Erythrocytes become more resistant to deformations, their ability to stick together, or aggregation, decreases, the concentration of fibrinogen decreases, and leukocyte activity decreases. The effects of pentoxifylline are associated with inhibition of phosphodiesterase. In addition, pentoxifylline slightly dilates the coronary vessels, which is a means of preventing acute myocardial ischemia. Trental 400 is produced by the Indian branch of Sanofi, and a package of 20 tablets, designed for 5 days of taking with vascular tinnitus, will cost from 500 to 700 rubles.

Advantages and disadvantages

When prescribing Trental, contraindications should be taken into account. These are bleeding, bruising and hemorrhage, a tendency to bleed, and other manifestations of hemorrhagic syndrome, including those from gastric and duodenal ulcers. This is an extensive retinal hemorrhage, a history of hemorrhagic stroke, acute heart attack, as well as pregnancy, breastfeeding and age up to 18 years.

It is necessary to be extremely careful when prescribing Trental to 400 patients with cardiac arrhythmias, low blood pressure and symptoms of chronic heart failure. You can not use it together with theophylline, there is a high risk of bleeding in conjunction with the appointment of antiplatelet agents: this is clopidogrel, and even acetylsalicylic acid. Side effects include headache, sleep disturbance, tachycardia, hot flashes, and dry mouth. There may be an increase in the activity of liver enzymes, skin itching and Quincke’s edema, but very rarely. If Trental is used as a combination therapy, for example, together with Cavinton and Tegretol, then its dosage can be reduced, which will also lead to a decrease in the severity of side effects, but this should be decided by the attending physician.

Nootropics: Piracetam (Nootropil)

Rating: 4.7

Nootropil and Piracetam, both in tablets and in ampoules for parenteral administration, are nootropic drugs. Their task is to improve blood circulation in the brain, the utilization of glucose by brain tissue, and improve microcirculation in areas of cerebral ischemia. Nootropics have antiplatelet properties. Piracetam protects the brain during hypoxia and intoxication. At the same time, the drug does not cause psychostimulation, or a sedative effect.

It is important that with tinnitus it is necessary to inject the drug parenterally, and at the same time, intramuscular injections do not have the necessary effect. Piracetam must be administered intravenously. Intravenous administration of Piracetam is usually started at a dose of 10 g per day, this is the initial dose. The usual course of treatment is 10 intravenous infusions. Piracetam is produced in injection solution by the Italian company YUSB Pharma, in one package 12 ampoules of 5 ml, 20% solution. 1 ml of the solution contains 200 mg, therefore, speaking of a dosage of 10 grams, we are talking about 10 ampoules that can be diluted with 400 ml of saline.

Advantages and disadvantages

The drug is not very convenient to administer, since it is required to open several ampoules at once, and this is not very convenient. Alone, alone, Piracetam, like many drugs for the treatment of tinnitus, is not able to cope with the pathology, but they work well together, that is, as part of complex therapy. In addition to tinnitus, the medicine helps with dizziness, emotional lability, reduced concentration and memory impairment, after traumatic brain injuries, and in the treatment of withdrawal symptoms and psychoorganic syndrome in chronic alcoholism.

Of the contraindications, only severe renal failure, cerebral hemorrhage and hypersensitivity are noted. The advantage of Piracetam is its good tolerance, even when administered intravenously. Side effects may include nervousness, sleep disturbance, weakness, or increased sexual activity, but all this is quite rare.

Misoprostol (Topogin)

Rating: 4.7

Misoprostol is a little “knocked out” from the general list, since this drug is an analogue of prostaglandin E 1, synthesized in the laboratory. It has a good effect on subjectively pronounced tinnitus and reduces or even eliminates it in 1/3 of all cases. Usually this medicine has a gastroprotective, antiulcer effect, and also tones the smooth muscles of the uterus, cervix, and provokes a miscarriage or abortion. Presumably, with tinnitus, the drug acts on the muscles of the structures of the middle ear and on the vessels.

Treatment should begin with a dose of 200 micrograms, that is, one tablet per day, and increase the dose by the same amount every 5 days, up to an effective dosage of 800 mg per day. The course of treatment lasts one month. Topogin is produced by the French company Delpharm Lille, and this drug cannot be called cheap. One package contains 4 tablets of 200 micrograms, and upon reaching an effective dose of 800 micrograms per day, the patient will take one package of 4 tablets daily. One such package will cost 220 rubles. at retail, which means that a monthly course of treatment will cost 6500 rubles.

Advantages and disadvantages

Misoprostol is strictly contraindicated during pregnancy, so as not to cause miscarriage in the early stages. With caution, it is taken with a pronounced violation of the liver and kidneys, with low blood pressure, with epilepsy, in old age. The drug can cause abdominal pain, in women of childbearing age – menstrual irregularities, dysmenorrhea and spotting. But since patients with tinnitus usually belong to the older age category, usually there are no such symptoms. As in all cases, treatment should be under the supervision of an otoneurologist, and be comprehensive.

Conclusion: Treating Noise Without Drugs

Do not think that tinnitus can only be treated with medication. There are other treatments as well. First of all, this is hearing aid, when the patient’s susceptibility to pure tones improves, he begins to understand speech, and the available ambient sounds begin to drown out the subjective noise. It helps some patients.

To facilitate the tolerance of noise, special masking devices can be used. To do this, the noise must have special frequency-amplitude characteristics, and the auditory analyzer must be affected on the periphery. Then the noise can be easily masked. Finally, white noise can also be used for masking. In some cases, the effect of subjective noise can be achieved by psychotherapy sessions, surgical treatment, pneumomassage of the tympanic membrane, and other methods.

Attention! This material is subjective, is not an advertisement and does not serve as a guide to the purchase. Before buying, you need to consult with a specialist.