Evaluation of various therapeutic schemes in the treatment of tinnitus due to acute acoustic trauma.

OBJECTIVES

We evaluated the effectiveness of various pharmaceutical therapeutic schemes in the treatment of tinnitus due to acute acoustic trauma.

PATIENTS AND METHODS

This prospective study included 108 military personnel (all males; mean age 22 years; range 18 to 31 years) with complaints of tinnitus due to acute acoustic trauma following firearm use. Involvement was in the left ear in 61 patients, the right ear in nine patients, and in both ears in 38 patients. The mean duration from trauma to treatment was 26 days (range 1 to 110 days). Before and after treatment, complaints of tinnitus were evaluated using a questionnaire and a visual analog scale. Treatment was carried out for 15 days in four randomized groups: oral administration of trimetazidine, prednisolone, and vitamin B complex; trimetazidine alone; prednisolone and vitamin B complex; and intravenous piracetam and prednisolone. Unresponsive patients were further treated with trimetazidine for a month. Evaluations were made 15 days and 45 days after the institution of treatment.

RESULTS

Thirteen patients (12%) had complete remission and 28 patients (25.9%) showed significant improvement. Further treatment with trimetazidine was beneficial in only seven (9.5%) patients. No significant differences were found between the groups in terms of tinnitus remission and improvement in hearing (p>0.05). Initiation of treatment, especially within the first week following acoustic trauma was significantly linked with higher rates of tinnitus regression (p<0.05). The degree of hearing improvement after medication did not correlate with improvement in tinnitus. Intravenous treatment was not advantageous over oral treatment.

CONCLUSION

A timely initiation of therapy, especially within the first week following acoustic trauma, increases the chance of improvement in tinnitus patients.