Emerging pharmacotherapy of tinnitus.
Tinnitus, the perception of sound in the absence of an auditory stimulus, is perceived by about 1 in 10 adults, and for at least 1 in 100, tinnitus severely affects their quality of life. Because tinnitus is frequently associated with irritability, agitation, stress, insomnia, anxiety and depression, the social and economic burdens of tinnitus can be enormous. No curative treatments are available. However, tinnitus symptoms can be alleviated to some extent. The most widespread management therapies consist of auditory stimulation and cognitive behavioral treatment, aiming at improving habituation and coping strategies. Available clinical trials vary in methodological rigor and have been performed for a considerable number of different drugs. None of the investigated drugs have demonstrated providing replicable long-term reduction of tinnitus impact in the majority of patients in excess of placebo effects. Accordingly, there are no FDA or European Medicines Agency approved drugs for the treatment of tinnitus. However, in spite of the lack of evidence, a large variety of different compounds are prescribed off-label. Therefore, more effective pharmacotherapies for this huge and still growing market are desperately needed and even a drug that produces only a small but significant effect would have an enormous therapeutic impact. This review describes current and emerging pharmacotherapies with current difficulties and limitations. In addition, it provides an estimate of the tinnitus market. Finally, it describes recent advances in the tinnitus field which may help overcome obstacles faced in the pharmacological treatment of tinnitus. These include incomplete knowledge of tinnitus pathophysiology, lack of well-established animal models, heterogeneity of different forms of tinnitus, difficulties in tinnitus assessment and outcome measurement and variability in clinical trial methodology.
Langguth
Berthold
B
University of Regensburg, Interdisciplinary Tinnitus Clinic, Department of Psychiatry and Psychotherapy, Universitaetsstrabetae 84, 93053 Regensburg, Germany. Berthold.Langguth@medbo.de
Salvi
Richard
R
Elgoyhen
Ana Belén
AB
D000971:Antineoplastic Combined Chemotherapy Protocols; D001007:Anxiety / Q000209:etiology; D015992:Body Mass Index; D063387:Cannabinoid Receptor Antagonists; D003072:Cognition Disorders / Q000209:etiology; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000209:etiology*; D003866:Depressive Disorder / Q000150:complications / Q000178:diet therapy* / Q000503:physiopathology; D006304:Health Status; D006801:Humans; D007508:Irritable Mood; D008175:Lung Neoplasms / Q000209:etiology; D011788:Quality of Life; D011859:Radiography; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology*; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology; D011795:Surveys and Questionnaires; D013997:Time Factors; D014012:Tinnitus / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000523:psychology; D014481:United States; D014486:United States Food and Drug Administration
D063387:Cannabinoid Receptor Antagonists