Impact of Acamprosate on Chronic Tinnitus: A Randomized-Controlled Trial

Abstract

Objectives: Tinnitus is a common and distressing otologic symptom, with various probable pathophysiologic mechanisms, such as an imbalance between excitatory and inhibitory mechanisms. Acamprosate, generally used to treat alcoholism, is a glutaminergic antagonist and GABA agonist suggested for treating tinnitus. Thus, we aimed to evaluate the efficacy and safety of acamprosate in the treatment of tinnitus. Methods: The current randomized-controlled trial study included 20 subjects with chronic tinnitus. After performing psycho-acoustic, psychometric and electrophysiological evaluations, all studied tinnitus subjects were randomly divided into two groups of acamprosate and placebo. The first group received oral acamprosate (two tablets of 333 mg/d, three times a day), whereas the second group was given placebo treatment (two tablets, three times a day). After the first 30 days, all evaluations were repeated for the studied groups just in the same manner before the study. Subsequently, the final results of each evaluation were compared together with the baseline values. Results: Nine studied subjects randomly received acamprosate, whereas eleven others received a placebo. There was no significant improvement in the psycho-acoustic tests, except a decrease was observed in the pitch match of tinnitus ( P = .039). For those subjects who were receiving acamprosate, a significant reduction was observed in tinnitus handicap inventory ( P = .006), tinnitus questionnaire scores ( P = .007), and the visual analog scores ( P = .007) compared to the placebo group. There was a significant reduction in Action Potential latency ( P = .048) as well as an increase in the amplitude of distortion product otoacoustic emissions at 4 kHz ( P = .048). Conclusions: The study results indicated a subjective relief of tinnitus as well as some degree of the electrophysiological improvement at the level of the cochlear and the distal portion of the auditory nerve among the subjects who received the acamprosate. Clinical trial registration code: IRCT2013121115751N1

Objective Detection of Tinnitus Based on Electrophysiology

“…After treatment, the reduction of latency of CAP was statistically significant, which indicates a robust and synchronized firing of the neuron fibers, along with the improvement of the self-report tinnitus questionnaire scores among tinnitus patients. However, SP/AP ratios did not change significantly in one study [ 179 ]. CAP amplitudes were suppressed and thresholds increased in tinnitus patients induced by sodium salicylate in one study [ 180 ].…”

“…Moreover, some indirect evidence, such as EcochG can be used to detect synaptopathy, and synaptopathy can cause tinnitus [ 32 , 177 ]. After some time of treatment, tinnitus is relieved and the electrocochleogram is also changed [ 179 , 181 , 182 ]. These pieces of evidence show that electrocochleogram has the potential to detect tinnitus, but more in-depth research needs to be carried out in the future.…”

“… Flow chart of full-text results [ 30 , 31 , 32 , 34 , 44 , 60 , 87 , 91 , 93 , 99 , 100 , 101 , 103 , 104 , 108 , 109 , 114 , 134 , 137 , 138 , 139 , 140 , 141 , 177 , 179 , 180 , 181 , 182 , 184 ]. …”

The Placebo Effect on Tinnitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Most studies (13 of 23) reported THI metrics both before and after treatment (14,15,(20)(21)(22)(23)(24)(25)(27)(28)(29)31,33). Three studies reported TSI metrics (16,18,33), 2 studies reported TFI metrics (26,29), 2 studies reported THQ metrics (17,30), 11 studies reported VAS-L measurements (12,13,18,19,21,22,25,28,(32)(33)(34), 2 studies reported VAS-Aw measurements (25,28), 5 studies reported VAS-An measurements (25,28,29,31,34), 3 studies reported frequency matching measurements (25,29,33), 7 studies reported loudness matching measurements (17,19,21,25,26,29,33), 4 studies reported the MML (19,21,…”

Efficacy of pharmacologic treatment in tinnitus patients without specific or treatable origin: A network meta-analysis of randomised controlled trials

“…Furthermore, in tinnitus patients without specific or treatable origin, there were abnormal hyperactivity in brain multiple regions [11] . Therefore, new pharmacologic strategy for managing brain abnormal hyperactivities had been proposed [12] . However, there is a lack of clarity regarding the evidence about the efficacy for most of these alternative treatments.…”