Botulinum toxin A (BOTOX) has been suggested by some to not only block acetylcholine, but also to inhibit release of other neurotransmitters and neuropeptides important in the pathways that may be connected to tinnitus. It is thought that the blockage of these pathways with Botox might reduce the perception of tinnitus.
In a randomized, double-blind study, Stidham and colleagues (2005) explored the use of botulinum toxin A injections for the treatment of tinnitus in thirty patients with unilateral or bilateral tinnitus. The patients ranged in age from 31 to 73 years, with duration of symptoms from five months to 30 years. Patients were randomized to receive three injections of Botox near the ear followed by placebo (Salt water) injections four months later; a second group received salt water injections first followed by botulinum toxin A four months later. Twenty-six patients completed both injections.
After injections, subjective patient responses to treatment were recorded at one month and again at four months. Following treatment with Botox, subjective tinnitus improved in seven patients, worsened in three, and 16 were unchanged. Following placebo (salt water), two patients were improved, seven worsened, and 17 were unchanged. These numbers are similar, though the authors thought there was an improvement.
However, using the standardized Tinnitus Handicap Inventory scale to judge response to treatment, there was no difference at one month between Botox and salt water injections. A THI marginal statistical difference was reached only in the comparison of pre-botulinum toxin A to 4 months post treatment (p=0.042). However, no other significant differences were noted when comparing the two treatments at one and four months after injections. This study is limited by its small patient numbers.The authors concluded a larger study is needed before drawing conclusions regarding the potential benefit of Botox in the treatment of tinnitus.
Advantages of Botox for tinnitus treatment
No advantages as it is ineffective
Disadvantages of Botox for tinnitus therapy
It requires multiple needle sticks into the skin around the ear
It is very expensive ($500-$1000)
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- Stidham KR, Solomon PH, Roberson JB. Evaluation of botulinum toxin A in the treatment of tinnitus. Otolaryngol Head Neck Surg. 2005; 132(6):883-889.