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Antioxidant Therapy in Tinnitus

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Antioxidant Therapy in Tinnitus British Journal of Medicine & Medical Research 10(7): 1-7, 2015, Article no.BJMMR.20125 ISSN: 2231-0614 SCIENCEDOMAIN international www.sciencedomain.org Antioxidant Therapy in Tinnitus Oguz Kadir Egilmez1 and M. Tayyar Kalcioglu1* 1Department of Otorhinolaryngology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey. Authors’ contributions This work was carried out in collaboration between all authors. Author OKE designed the study, wrote the protocol, and wrote the first draft of the manuscript. Authors OKE and MTK managed the literature searches, analyses of the studies performed previously. All authors read and approved the final manuscript. Article Information DOI: 10.9734/BJMMR/2015/20125 Editor(s): (1) Shashank Kumar, Department of Biochemistry, University of Allahabad, Allahabad, India. Reviewers: (1) Henrique Furlan Pauna, University of Campinas, Brazil. (2) Gauri Mankekar, PD Hinduja Hospital, Mumbai, India. (3) Ibrahim El-Zraigat, The University of Jordan, Jordan. Complete Peer review History: http://sciencedomain.org/review-history/10674 Received 13th July 2015 th Mini-review Article Accepted 11 August 2015 Published 24th August 2015 ABSTRACT Oxidative stress and reactive oxygen species (ROS) have been working in the pathophysiology of various chronic diseases. Under normal circumstances, the human cochlea has some antioxidant molecules which can scavenge the oxidant substances and ROS to avoid the possible damage into the inner ear. In tinnitus therapy, several forms of complementary and alternative medicine (CAM) are increasingly popular but they are generally selected with or without professional guidance. Although several antioxidant agents like vitamin A, C, E and glutathione can be used in the treatment of tinnitus as CAM, melatonin, N-acetyl cysteine (NAC) and coenzyme Q10 (CoQ10) were especially used as alternative for classic antioxidants. According to the literature, it seems antioxidant therapy in patients with idiopathic tinnitus may reduce oxidative stress and damage to the inner ear. And also it can reduce the intensity and discomfort of tinnitus. Further clinical studies are necessary to determine antioxidants’ protective role and to choose the appropriate therapeutic protocol. Keywords: Antioxidant; tinnitus; alternative medicine. _____________________________________________________________________________________________________ *Corresponding author: Email: [email protected]; Egilmez and Kalcioglu; BJMMR, 10(7): 1-7, 2015; Article no.BJMMR.20125 1. INTRODUCTION presently considered to be part of conventional medicine’ [10]. Some factors, such as the feeling Tinnitus, also referred as ‘ringing in the ears’ is of despair about the problem, dissatisfaciton with defined as a perceived sound without definite conventional medicine, the wish to play a major acoustic stimulation. Ten to fifteen percent of role in own treatment, proorer health status, general population are affected by tinnitus but anxiety and chronic pain are the reasons for approximately 2-3% are estimated to suffer from using CAM as a alternative care. In this review, intense disabling tinnitus and consider to be an PUBMED database search was done and the important problem interfering with work, sleep articles related with antioxidant therapy used in and decreasing the quality of life [1,2]. tinnitus treatment were evaluated and discussed. Tinnitus is mainly classified into two categories; 2. HOW CAN THE OXIDATIVE STRESS which are subjective and objective tinnitus. AFFECT THE EAR? Because this disorder is mainly subjective in nature and there is limited knowledge about its Oxidative stress can be involved in the pathophysiology, treatment of tinnitus has been pathogenesis of several diseases such as limited, yet, quite often unsuccessful [3]. Several autoimmune, endocrine, cardiovascular and strategies including, habituation therapy, metabolic diseases, and also associated with electrical stimulation, dietary modification, intense muscular activity and tobacco smoking antidepressants, anxiolytics, surgical inter- and treatment with progestagens [7]. Lesions vention, herbal therapies and tinnitus induced by free radicals are seen mostly in the management program have been tried to treat endothelium and microcirculation, especially the tinnitus and reduce its severity and improve terminal type. The red blood cells are important patients’ quality of life [4]. Some pharmacological for oxygen and carbonic anhydrase transport and treatment has been studied and some used to also removing toxic substances. The inactivation reduce tinnitus severity, but there are no specific of cascade of the red blood cells can cause agents recommended to this purpose [3]. Most membrane peroxidation and hemoglobin common prescribed and used drugs for tinnitus denaturation leading to cell damage [7]. When include sedatives, antidepressants, anticon- they are damaged by ROS, their cellular vulsants, antihistaminics, antiphsychotics, local membranes could be injured, membrane lipids anesthetics and botulinum toxin [5,6]. could be damaged and there could be membrane instability and increased permeability. So one Oxidative stress and reactive oxygen species important component of antioxidant system is (ROS) have been working in the pathophysiology blocked by ROS. of various chronic diseases and aging [7]. The major impact of radical-induced lesions is on the Under physiological conditions, ROS and free endothelium and the damage is mostly seen in radicals are components of normal cellular redox microcirculation, particularly in the kidney and state which comes from two reactions related brain [7,8]. It has been recently established that with electron transfer; reduction and oxidation. ROS play an important role also in the pathology And their toxicity is controlled by antioxidant of the inner ear microcirculation and peripheral system [11]. In such conditions, like ischemia- and central pathways [7]. Under normal reperfusion injury, free radicals and ROS can circumstances, the human cochlea has some affect the tissue by overcoming the antioxidant molecules like vitamins, glutathione, reactive capability and induce damage to biological transcription factors and enzymes which can structures and leads to cell death [12]. work together to scavenge the oxidant substances and ROS to avoid the possible In inner ear, ROS can damage the planum damage [7,9]. semilunatum (which is located near the crista ampullaris of the semicircular canal) and stria In tinnitus therapy, several forms of vascularis (which is located on the upper portion complementary and alternative medicine (CAM) of the spiral ligament and contains several are increasingly popular in western countries and capillary loops and small blood vessels) [7]. In they are generally selected with or without some reports, it was noted that oxidative stress professional guidance [3]. According to National could impair the labyrinth’s sensorineural Institutes of Health in US, CAM has been defined epithelium and also acoustic and vestibular as ‘a group of diverse medical and health care nervous system [13,14]. ROS produced by systems, practices and products that are not oxidative stressors interacts with the 2 Egilmez and Kalcioglu; BJMMR, 10(7): 1-7, 2015; Article no.BJMMR.20125 phospholipidic structures of the sensorial cells of tinnitus were evaluated with tinnitus intensity and aldehyde lipids like the 4-hydroxynonenal measurements which were visual analog scale are produced and induce the apoptosis for (VAS) and tinnitus loudness. And they suggested auditory neurons and hair cells [7]. that using antioxidant therapy in patients with idiopathic tinnitus reduced oxidative stress and Oxidative harm can emerge during treatment probably damage to tisseus in the inner ear [7]. with aminoglycoside antibiotics and platinum- based chemotherapeutic drugs. Also it was Interest in using melatonin to treat tinnitus was reported that some psychological and emotional initiated by a study of Rosenberg et al. [33] stress could increase the production of ROS and instead of they prescribed patients with a dose of cause oxidative damage to the inner ear [15,16]. 3 mg melatonin daily for 30 days. They found Because of correlation between oxidative stress significant reduction in tinnitus especially in and the relevant pathology, using antioxidants in patients with bilateral tinnitus and sleep tinnitus treatment was suggested in several disturbance because of tinnitus. As a result, the studies [1,3,7]. Particularly, antioxidants can authors recommended melatonin usage in protect the biological structures from oxidative treating subjective tinnitus [33]. damage by playing a role as reducing agent and counteracting overproduction of reactive species A prospective, randomized, double-blind, [3]. placebo controlled study was reported by Lopez- Gonzalez et al. [34]. They showed the alleviation 3. ANTIOXIDANTS IN TINNITUS of subjective tinnitus by using melatonin. In this report, melatonin (3 mg, daily) was compared Although several antioxidant agents like vitamin with sulpiride- D2 dopamine receptor antagonist A, C, E and glutathione i.e. can be used for (50 mg, daily) or combination of both for treatment of tinnitus, especially melatonin, N- perception of tinnitus. The duration of treatment acetyl cysteine (NAC) and coenzyme Q10 was 30 days and at the end of the treatment, it (CoQ10) were used as alternative for classic was found that melatonin reduced tinnitus by antioxidants. 40%, sulpiride lowered it by 56%
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