8 best tinnitus medications

Review of the best according to the editorial board. On the selection criteria. This material is subjective and does not constitute advertising and does not serve as a purchase guide. Before buying, you need to consult with a specialist.

Tinnitus, or tinnitus, is a condition that can significantly impair quality of life, although the person does not experience any pain and can move around normally. But his whole life, and especially in silence, sometimes passes under the influence of almost constant noise, and this is very painful. It is estimated that almost 40% of people sometimes feel tinnitus, 8% call it constant, and every hundredth person suffers almost constantly from debilitating noise, which interferes not only at night, but also during the day.

This problem is most studied in the United States, where 2 million patients with tinnitus are disabled, and 18 million patients are treated for tinnitus of varying severity. Surprisingly, absolutely deaf patients who were born deaf never complain of noise. It is also interesting that on the basis of complaints of noise, it is impossible to make an accurate diagnosis of any disease (it is not a pathognomonic symptom). It is clear, however, that the overwhelming majority of patients with noise have some degree of hearing loss.

How to identify tinnitus? This is a condition in which sound is felt in the ears or head, but there is no external acoustic impact. What is this unpleasant, disturbing sensation?

Varieties of noise

Tinnitus can be classified according to various parameters. It is convenient for ENT doctors to distribute and classify noise, for example, for its causes. There may be vascular noise caused by damage to the structures of the outer and middle ear, associated with muscle tension, as well as peripheral and central types of noise.

In addition, noise can be objective or subjective. In the first case, the noise really exists, and the doctor can hear it, and determine it using diagnostic research methods. But subjective noise is the same tinnitus, noise-phantom. It is only felt, but in reality it does not exist.

Objective noise is very rare and can be heard even by a stranger. An example is the carotid-cavernous anastomosis, with overflow-discharge of blood from one basin to another in the cranial cavity, which causes characteristic noises. It shouldn't be normal.

The noise can be on one side or on both sides, it can be periodic or constant. Some patients give off a pulsating noise and is monotonous, consisting of low frequencies or high frequencies, it can be very intense or weak.

Finally, noise may be the patient's main complaint at the doctor's appointment, or a minor one. And this is very convenient for the doctor: to distribute the noise according to three degrees of 'importance':

1. the first degree is the absence of active complaints of noise, and this complaint is opened, updated by the doctor's inquiring questions, the patient does not complain on his own;
2. second degree – when the patient complains, but considers the noise to be not the main problem;
3. finally, if noise in the ears or in the head is the leading complaint that interferes with his life, and he came to the doctor with it, then we are talking about severe tinnitus.

Why is there noise and what are its sources?

A little about the reasons

The human body really has something to make noise. There may be a sound from the contraction of various muscles, from the movement of the temporomandibular joint and its ligaments, from the blood flow in the vessels of large and medium caliber. But usually, in a healthy person, all these sound phenomena are very well disguised and not detected. What are the most likely reasons for the development of noise that another person can hear, that is, objective? Here they are: arthrosis of the temporomandibular joint, wide gaping of the auditory tube, myoclonus of the muscular structures of the middle ear, its tumors, narrowing of arterial vessels, and their abnormal location, the presence of various shunts, or pathological connection of arteries and veins, leading to a direct discharge of blood from from one pool to another, bypassing the capillary network. All this creates a noise that is actually heard.

Subjective tinnitus, which is actually absent, may be the result of metabolic disorders and intoxication. It leads to hepatitis, diabetes, atherosclerosis, a sharp drop in blood sugar, that is, hypoglycemia, dysfunction of the thyroid gland. Much more often, the pathology of the ENT organs leads to subjective noise: otitis media, sulfur plug, otosclerosis of various degrees, sensorineural hearing loss and barotrauma, inflammation of the inner ear, that is, labyrinthitis and Meniere's disease, and other pathology.

Tumors of the cerebellopontine angle are quite common, and especially acoustic neuroma, which can be a source of noise. Many medications are to blame for the onset of tinnitus. These are ototoxic antibiotics such as kanamycin. It can also be methyl alcohol, it causes more than blindness. In some cases, osteochondrosis of the cervical spine is to blame, which causes neurovascular symptoms, production factors, and multiple sclerosis. There are other reasons, to understand which is the task of both an ENT doctor and an otoneurologist.

Listen to the noise!

As a rule, if the labyrinth and the snail are damaged, then the noise is very strong and painful. If there is an intracranial tumor, the murmur is usually associated with a headache. The more the head hurts, the stronger the tinnitus, while it is able to decrease with a decrease in intracranial pressure. If the patient has a tumor of the posterior cranial fossa, then the noise will react to a change in the position of the body in space, and if there is a suspicion of a tumor of the cerebellopontine angle, then the noise will be asymmetric and localized in half of the head, in the back of the head or on the side of one ear. The vascular murmur will pulsate and the patient will say it has a soft blowing or hissing tone. If you press on the jugular vein of such a patient, then you can sometimes hear from him complaints about the increase in such a noise.

If a person has a dysfunction of the auditory tube, or the sound-conducting systems of the middle and outer ear, then most often the noise has a low frequency, hearing falls, and congestion is felt in the affected ear. The typical course of Meniere's disease causes tinnitus. Usually, the noise increases before the onset of the disease, it reaches its greatest strength at the height of the attack, and then decreases.

Finally, there are many congenital and hereditary conditions in which tinnitus is characteristic. This is Arnold-Chiari syndrome, with a violation of the structure of the arches of the atlas and lowering of the cerebellar tonsils below the anatomical boundaries, hereditary neuroma of the auditory nerve, anomalies in the development of the vertebrae, hereditary lesion of the geniculate ganglion.

If you sniff sharply, dive quickly or rise from a depth, during takeoff and landing of an aircraft, tinnitus may occur as a consequence of barotrauma. In extreme cases, there is ear pain, deafness, nausea and dizziness. Very often, explosions and shots at close range from the ear lead to barotrauma.

In the event that there is a tumor of the middle ear, then there may be a combination of hearing loss with one-sided pulsating noise. The doctor should take particular care in taking a history if he suspects that the murmur was induced by any medicine. Currently, it is caused by many aminoglycoside antibiotics, diuretics, often found non-steroidal anti-inflammatory drugs – Diclofenac, Indomethacin and Ibuprofen, pressure drugs – Enalapril, Monopril. These can be Nifedipine, depression medications, and other drugs. The most ototoxic antibiotics are gentamicin, streptomycin, kanamycin and tobramycin.

Who to contact and what to do?

In some cases, it is quite easy to diagnose the cause of the noise, and sometimes a lengthy diagnostic search is required. First of all, it is necessary for an ENT doctor, audiologist, or otoneurologist to thoroughly characterize the noise, taking into account all its criteria, to study its dynamics, frequency, and localization. It is imperative for the patient to listen to the head with an ordinary phonendoscope. There is nothing funny in the fact that the doctor listens to the head with a phonendoscope, because in many cases you can hear myoclonic muscle twitching, muscle contraction of the soft palate, or vascular noise, indicating the presence of various shunts and anastomoses.

The second important examination besides the appointment of an ENT doctor is an audiological examination. This is an audiogram recording, impedance measurement, a study of auditory evoked potentials, electrocochleography. It is very important to hand over analyzes, both biochemical and general clinical, ultrasound examination of the vessels of the head and neck, transcranial Doppler ultrasonography. Sometimes MRI of the brain and cervical spine, X-ray of the neck with rotary tests is required. A patient with suspected pathology of the ENT organs may, according to indications, undergo microotoscopy, endoscopic nasopharyngoscopy, in order to carefully examine all available organs.

Treatment

Finally we got to the treatment for tinnitus. But, before proceeding with the description of drugs, it should be recalled that the true cause of the noise is not always determined by doctors. Noise can be a symptom of many diseases. And in the event that the underlying disease is successfully treated, for example atherosclerosis or diabetes, then tinnitus also disappears or significantly decreases.

Tinnitus can be treated both conservatively and with surgery. What medications are used for tinnitus? These are various vascular drugs, nootropics, muscle relaxants and vitamins, antihistamines and anesthetics, diuretics and drugs that normalize the blood supply to the auditory analyzer. Consider those drugs that are most often used in their practice by ENT doctors, which allow to normalize the patient's condition and reduce the noise, or completely get rid of it.

At the beginning of the description of each drug, its international non-proprietary name, or INN, is indicated, followed by the names of the drugs. The first is usually named the best original drug, first developed and introduced into clinical practice, and then its commercial copies, or generics. The price range is also given, both for the original drug and for its analogues. The cost of medicines is relevant for pharmacies of all forms of ownership in the Russian Federation for September 2019. And let's start the review with drugs that normalize metabolism and blood supply in the area of ​​the hearing organ.

The best drugs for tinnitus

Nomination	a place	Name of product	price
DRUGS REGULATING BLOOD CIRCULATION AND EXCHANGE	1	Vinpocetine (Cavinton, Telektol)	RUB 103
	2	Ginkgo biloba (Tanakan, Bilobil, Ginkoum, Memoplant)	568 r
	3	Cinnarizine (Stugeron, Vertizin)	35 RUB
	4	Trimetazidine (Preductal MV, Angiosil, Deprenorm, Rimecor, Trimectal)	RUB 70
	5	Dihydroergocriptine + Caffeine (Vasobral)	986 r
Preparations of other groups	1	Betagistin (Betaserk, Betaver, Vasoserk, Vertran, Vestibo, Tagista)	RUB 71
	2	Aminazine	RUB 145
	3	Milgamma	332 RUB

Means that normalize blood circulation and metabolism

These drugs include vinpocetine, Ginkgo Biloba derivatives, ergot, slow calcium channel blockers, and antihypoxants. Of course, they are used not only for tinnitus, but also for other diseases. After all, a special medicine that is used only for noise in the ears, and nowhere else, is still unknown to science.

Vinpocetine (Cavinton, Telektol)

Popularity rating: 4.9

Vinpocetine has already been repeatedly described in various drug reviews as a remedy for chronic cerebral ischemia, to improve memory and attention. Vinpocetine is a modified vinca alkaloid, its task is to optimize cerebral blood flow, it dilates blood vessels, and reduces aggregation, or adhesion of platelets to each other. In addition to tinnitus and hearing loss, the drug is indicated for vascular dementia, ischemic strokes. Cavinton is prescribed for vertebrobasilar artery syndrome, for retinal degeneration, encephalopathy and Meniere's disease. It is indicated for cerebral atherosclerosis, various forms of headache, with the consequences of traumatic brain injury and memory loss.

Cavinton and Vinpocetine are taken after meals, and there is a new form – Cavinton Comfort. It is more active, contains 2 tablets of the usual Cavinton, 5 mg each, that is, the dose is 10 mg. The drug is taken one to 3 times a day, and comes in tablets that dissolve and do not need to be swallowed. The tablets have a pleasant orange flavor.

Cavinton Comfort 0.01 No. 30 costs from 240 to 420 rubles in pharmacies, it is a Hungarian drug from the company Gedeon Richter. The cheapest domestic Vinpocetine can be purchased at a price of 25 rubles, produced by the Irbit Chemical Pharmaceutical Plant, dosage 5 mg No. 20.

Advantages and disadvantages

The disadvantage of Cavinton is the fact of a slight increase in the heart's need for oxygen, and therefore it is not prescribed for angina pectoris, heart failure, and heart rhythm disturbances. If Cavinton is administered parenterally intravenously, then it must be administered very slowly.

Ginkgo biloba (Tanakan, Bilobil, Ginkoum, Memoplant)

Popularity rating: 4.8

All drugs Ginkgo Biloba improves metabolism and blood flow, or its rheological properties. In addition, the funds are easy to stimulate, have a mild antidepressant effect, and are most indicated for patients with short-term exposure to ear noise. Significantly, Tanakan has documented himself well in modern double-blind, placebo-controlled studies.

It is very important that the herbal raw materials in Tanakan, which are used for medicines, are precisely dosed and standardized. Reception of Tanakan is indicated for any form of cognitive deficit, pathology of the arteries of the lower extremities, and the presence of intermittent claudication, vascular disorders of vision and hearing, as well as Raynaud's syndrome and disease. Tanakan can be used for hearing disorders and tinnitus, one tablet three times a day, while the course of treatment is long, at least 3 months. You can take Tanakan for up to six months or even longer, but only as directed by a doctor.

Tanakan, produced by Bofur Ipsen, is one of the best and most purified medicines containing Ginkgo Biloba leaf extract. Pack of 40 mg tablets, 90 pcs. will cost from 1200 to 1900 rubles, a French-made drug. Much cheaper is the drug Bilobil, 60 capsules of which in the same dosage can be bought at prices from 550 rubles, produced in Slovenia, Krka. The drug Ginkoum, which is produced by the domestic company Evalar in the same dosage, in the same amount, Tanakan costs you from 530 to 860 rubles.

Advantages and disadvantages

Tanakan is usually very well tolerated and has no overdose effects. However, the drug can in rare cases, less than 1%, cause headache, nausea, rash, dizziness. The experience of using Tanakan has shown that the severity of side effects does not depend on the duration of treatment, but if they occur, the drug should be discontinued. Despite good tolerance, Tanakan in tablets (and there are also in syrup) is contraindicated in erosive gastritis, gastric ulcer, stroke and acute myocardial infarction, with a decrease in blood clotting. The medicine is not recommended for pregnant and lactating women. Tanakan tablets contain lactose, so it should not be prescribed to patients with congenital disorders of lactose metabolism. Perhaps the biggest drawback is the high cost, and the need to take it for several months, but in the case of tinnitus, all drugs are taken for a long time.

Cinnarizine (Stugeron, Vertizin)

Popularity rating: 4.7

Stugeron is a fairly old drug, it was used in the Soviet Union, and among the indications should also be called migraine, transient ischemic attacks, various forms of dizziness, the recovery period after strokes, both ischemic and hemorrhagic, vascular disease, and memory loss. Quite often, it has been prescribed as a remedy for headaches. This drug belongs to calcium channel blockers, which are especially capable of improving vestibular blood flow as well as peripheral blood flow in the coronary vessels of the heart. Also, Cinnarizine improves the body's resistance to hypoxia.

Cinnarizine is available in 25 mg tablets, and its effect is to inhibit the release of vasoactive substances. These are adrenaline, dopamine, histamine, bradykinin. It improves the ability of erythrocytes to deform, reduces blood viscosity and increases its fluidity. With tinnitus, you need to take the drug 25 mg, that is, one tablet three times a day. It is also indicated for air sickness or seasickness, that is, with kinetosis, half an hour before the flight or dispatch of a sea vessel.

The drug Stugeron, which is produced by the Hungarian company Gedeon Richter, will cost from 186 rubles, these are 50 tablets of 25 mg each. The cheapest cinnarizine of the same dosage can be purchased at a price of 35 rubles, and it will be a Bulgarian drug from Sopharma.

Advantages and disadvantages

Despite the effectiveness, strict control is necessary, since long-term use of cinnarizine in high doses can enhance the depressive effect and induce the development of drug-induced parkinsonism.

Stugeron also has quite pronounced side effects. These are abdominal discomfort and dry mouth, increased body weight with prolonged use and sweating, headache and bouts of drowsiness, the development of jaundice and allergies. It should also be remembered that the effect of Stugeron can be enhanced by the intake of antidepressants, as well as alcohol.

Trimetazidine (Preductal MV, Angiosil, Deprenorm, Rimecor, Trimectal)

Popularity rating: 4.6

These are antihypoxic drugs that increase the resistance of the tissues of the middle and inner ear, the labyrinth to a low amount of oxygen, and help increase cerebral and labyrinth blood flow. The most effective Preductal and its analogues for tinnitus will be if the patient has a peripheral disorder, for example, cochleovestibular syndrome, and at the same time – in combination with cardiac pathology. In this case, Preductal will increase both myocardial reserves and its resistance to hypoxia. It is necessary to use Preductal one tablet twice a day, with meals.

The best quality is considered to be the original drug Preductal with sustained release (MB) produced by Servier (France), but it is not always available in pharmacies. One pack of 35 mg No. 60 capsules can be purchased at pharmacies at a price of 2964 rubles. The cheapest trimetazidine is probably 20 mg tablets No. 30, which will cost from 70 rubles. and higher. This is a domestic trimetazidine produced by Ozon. What kind of substance is there, and why it is so cheap is unknown.

Advantages and disadvantages

When taking Preductal, contraindications must be taken into account. These are disorders of the extrapyramidal system, Parkinson's disease and restless legs syndrome, severe renal failure, pregnancy, breastfeeding, and persons under 18 years of age. There may be side effects, among which the most common are abdominal pain, diarrhea, dizziness and unsteadiness of gait, skin rash.

Dihydroergocriptine + Caffeine (Vasobral)

Popularity rating: 4.5

This medication is a derivative of ergot alkaloids with added caffeine to balance the effects. As a result, this drug blocks alpha-adrenergic receptors, which are located in the vessels, and simultaneously stimulates the structure of the central nervous system, which regulate the synthesis of serotonin and dopamine. When exposed to the drug, vascular permeability decreases, the aggregation of blood corpuscles decreases, blood flow increases, and metabolism in the brain structures intensifies. All this leads to an increase in the stability of tissues, and their ability to tolerate hypoxia. Caffeine additionally stimulates the cerebral cortex, improves the functioning of the vasomotor and respiratory centers, and improves mental performance, reduces fatigue.

In addition to tinnitus and tinnitus, Vasobral is indicated for cerebral atherosclerosis, in complex therapy for rehabilitation measures after a stroke, with Meniere's disease, and in the treatment of acute and chronic labyrinthitis. It is necessary to apply Vasobral inside 1 tablet 2 times a day, the duration of treatment is at least 2 months, and if necessary, the courses can be repeated up to 2 times a year. Vazobral is not cheap, a pack of 30 tablets will cost from 986 rubles.

Advantages and disadvantages

The disadvantage of Vasobral can be considered its high cost, as well as some side effects, which are most often manifested by nausea, abdominal discomfort, and symptoms of dyspepsia, that is, a feeling of heaviness in the abdomen, bloating, belching, and so on. In the event of such symptoms from the gastrointestinal tract, as the official instructions say, the drug should not be canceled. Tachycardia, a decrease in blood pressure, and interactions with certain blood pressure medications that increase their effect are very rare.

Preparations of other groups

Since the drugs used for the treatment of tinnitus from other groups are used piece by piece, we decided to combine them all together. This will include drugs that modulate histaminergic transmission, various phenothiazine derivatives that are antipsychotics, and block pathological autonomic afferentation. These are tranquilizers, which are also prescribed in the complex therapy of ear noise and sleep disturbance, phenobarbital, which has a pronounced sedative effect, and is used as drugs of the 2nd stage. This also includes psychostimulants, which are used with anticholinergics, and antihistamines, which potentiates their effect. They are also vitamins of group B, and other drugs, we will consider some of them in more detail.

Betagistin (Betaserk, Betaver, Vasoserk, Vertran, Vestibo, Tagista)

Popularity rating: 4.9

Betahistine belongs to histamine receptor blockers, modulates the transmission of histamine and serotonin, and is effective not only for tinnitus, but also for other vestibular disorders: dizziness, nausea and vomiting.

Betaserc causes expansion of the arterial part of the capillaries, normalizes the pressure gradient of the endolymph in the labyrinth and in the cochlear tissues, which improves the condition in patients with dizziness. Along the way, it increases the tone of the smooth muscles of the bronchial tree and the gastrointestinal tract, which leads to an increase in the secretion of gastric juice. Betahistine is indicated for vestibular neuronitis, for benign positional vertigo, as a means of prophylaxis after neurosurgical operations, for vertebrobasilar insufficiency.

It is desirable to take the drug at the beginning of therapy, 8 mg or 16 mg 3 times a day. Treatment should be long-term, but the duration is determined by the doctor.

The drug has a different dosage, 16 mg tablets in the amount of 30 pieces will cost from 608 rubles. Tablets 24 mg 20 pieces from 529 rubles, and tablets 24 mg 60 pieces will cost from 1283 rubles. Betaserc is manufactured by Abbott, The Netherlands.

The cheapest domestic Betagistin can be found in a pharmacy from 71 rubles, this is 16 mg No. 30.

Advantages and disadvantages

The tool is fairly well tolerated, but has a small range of side effects. It is undesirable to prescribe it for bronchial asthma, exacerbation of a stomach ulcer, as well as in the presence of pheochromocytoma. Naturally, the drug is contraindicated in pregnant women, especially in the first trimester, as well as during breastfeeding. If dyspeptic symptoms are caused in the patient, then Betahistine is best taken after meals. If the patient has an allergy, and he takes antihistamines, then they reduce the effect of taking Betaserc, this must be remembered.

Aminazine

Popularity rating: 4.8

Aminazine blocks autonomic impulses in the parasympathetic nuclei and in the cortical regions of the auditory analyzer. It blocks the central contacts between adrenergic and dopaminergic synapses. The drug is rarely prescribed, in complex therapy and only in severe cases. Aminazine belongs to antipsychotics, which means that it is strictly a prescription drug. Usually they are treated with psychoses, phobias, withdrawal symptoms and alcoholic delirium, that is, delirium tremens. In addition, it is used to treat delusions and hallucinations, so the main range of applications is psychiatry, large and small. However, it is also used in the treatment of dermatitis, vomiting in pregnant women, Meniere's disease and other disorders of hearing and vestibular function, including tinnitus.

The drug is available in tablets and ampoules, for the treatment of tinnitus, it is used only in complex therapy, in severe cases and in small doses, which is determined by the doctor.

A pack of 10 50 mg chlorpromazine tablets can be purchased at a price of 200 rubles, produced by the Russian pharmaceutical company Valenta Pharmaceuticals.

Advantages and disadvantages

Aminazine cannot be used for a long time, this drug is exclusively prescription, and even ENT doctors may have difficulties prescribing it. It is contraindicated in all severe disorders of the function of internal organs, including cardiovascular pathology, and prostatic hyperplasia. Aminazine has severe side effects, including extrapyramidal and parkinsonian reactions, a drop in blood pressure, jaundice and leukopenia may occur. On the background of admission, impotence may develop, the menstrual cycle may be disrupted and body weight increase.

There are many special indications, for example, the prohibition of alcohol intake during treatment with chlorpromazine, and there are also many drug interactions. So, chlorpromazine lowers the threshold of convulsive readiness, if it is used together with anticonvulsants, if it is prescribed together with drugs for increased thyroid function, then it adversely affects the blood. But in some cases, it can still stop the pronounced symptoms of noise, and it is recommended for use by official instructions, which is why it is on the list.

Milgamma

Popularity rating: 4.7

Finally, since impaired nerve conduction, decreased trophism of the afferent portions of the auditory nerve, impaired transmission of nerve impulses and the appearance of noise play a great role in the pathogenesis of tinnitus, the use of B vitamins, which are neurotropic, is indicated in complex therapy. One of these drugs will be the well-known Milgamma Compositum, which is available both in tablets and in dragees. Milgamma compositum contains vitamins B1, B6, and the ampouled preparation Milgamma also contains B12. In addition to tinnitus, Milgamma is prescribed for neurological diseases: trigeminal neuralgia, shingles, polyneuropathy, including diabetic and alcoholic, shooting back pain, that is, lumbago with sciatica.

The drug must be used one tablet a day, according to the doctor's indications, the dose can be increased to one tablet three times a day. Treatment is usually 1 month. Dragee Milgamma compositum in the amount of 30 pieces, designed for a month of treatment, will cost from 625 rubles, and it is produced by the German company Vorvag Pharma.

Advantages and disadvantages

Milgamma also has drawbacks, these are symptoms of an overdose, which can even lead to a neurotoxic effect, and if the medicine is used for longer than six months, then sensitivity disorders and weakness in the arms and legs may occur, that is, the opposite effect. Despite the seeming harmlessness of vitamins, there may be side effects. This is itchy skin, urticaria and rash, Quincke's edema. Sometimes there may be nausea, increased sweating, and tachycardia, so it is still better to use Milgamma on the recommendation of a doctor and under his supervision.

Perhaps there are no more drugs that can cure this disorder, and even these alone can hardly do anything in advanced cases. Tinnitus is treated in a comprehensive manner, using physiotherapy methods of treatment, with hearing aids, especially if tinnitus is combined with hearing loss. In some cases, even surgical treatment is indicated. One of the methods affects the cervical sympathetic nodes, and the second is the effect on specific auditory structures. This is tympanoplasty, stapedoplasty. Such operations can be used to reduce tinnitus, the source of which is the organ of hearing.

The popularity rating is based on the analysis of demand data from the wordstat.yandex.ru service.

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