Treatment with bisphosphonate may significantly improve tinnitus associated with otosclerosis, finds study

The common cause of both hearing loss and tinnitus often found is the normal resultant of abnormal bone growth in the middle ear, otosclerosis. Tinnitus takes the form of a ringing or buzzing sensation in the ears and may be very distressing for patients. Management of tinnitus associated with otosclerosis has been relatively restricted, at least for patients who do not respond to surgical interventions like stapedotomy or hearing aids. This study was planned to determine whether third-generation bisphosphonates, which are at present used for several types of bone disorders, can serve as a new treatment modality.

This was a prospective case-control study of 100 patients suffering from tinnitus along with otosclerosis. All patients were divided into two groups: -

Group A (Control): 25 patients received routine supplements orally. Vitamin D and calcium supplements were also administered by the patients in this group.

Group B (case): 75 patients on oral bisphosphonate therapy with vitamin D and calcium supplement. The group was categorized into:

Group B1: 25 patients having no prior treatment.

Group B2: 25 patients having persistent tinnitus for more than 6 months after an uncomplicated stapedotomy.

Group B3: 25 patients having persistent tinnitus for more than 6 months after hearing aid fitting.

Tinnitus was both evaluated subjectively (by intensity, frequency and using a tinnitus questionnaire) and objectively (by measuring intensity and frequency of tinnitus).

• The female-to-male ratio was 1.6:1, and the patients were in the range of 40 to 61 years. No significant differences between groups A and B were found before the treatment started.

• The patients on bisphosphonates were found to have substantially improved 6 months after the initiation of treatment, and in this regard, the group B patients were absolutely much better as the medians of scores of tinnitus questionnaire were 16 in group B.

• On the other hand, the patients of control group A were bad, and their medians of scores of tinnitus questionnaires being considerably higher at 52 (IQR 24), it meant that much graver tinnitus was the condition prevailing in the control group.

• Tinnitus severity scores at the study's end for group B were a median of 20 (IQR: 30) compared to 52 (IQR: 42) in the control group.

• In both treatment groups, complete improvement of tinnitus symptoms had been demonstrated in 40% of patients in group B, while no patient within the control group A had been completely improved.

The results of the study showed third-generation bisphosphonates to significantly improve the symptoms of tinnitus for patients with otosclerosis and even better than conventional vitamin D and calcium alone. The results show complete relief of the symptoms of tinnitus in 40% of the bisphosphonate group, which makes this therapy a promising new avenue of treatment for those suffering from this highly disabling condition.

Reference:

Fouad, A., Mandour, M., Tomoum, M. O., & Lasheen, R. M. (2024b). Effectiveness of bisphosphonate for alleviating tinnitus associated with otosclerosis: a prospective case–control study. European Archives of Oto-Rhino-Laryngology: Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. https://doi.org/10.1007/s00405-024-08935-z