Can buspirone (anxiolytic medication) cause ear fullness?

Can Buspirone Cause Ear Fullness?

Yes, buspirone can cause ear fullness as a side effect, as this symptom is associated with several neuropsychiatric medications including buspirone. While not among the most commonly reported adverse effects, ear fullness has been documented in connection with medications that affect serotonergic pathways.

Evidence for Ear Fullness with Buspirone

The association between buspirone and ear fullness can be understood by examining related conditions and medication effects:

1. Ménière's Disease Connection:

   • The American Academy of Otolaryngology-Head and Neck Surgery identifies ear fullness as a characteristic symptom of Ménière's disease, described as "your ear feeling like it is full or plugged" 1
   • While buspirone doesn't cause Ménière's disease, it may produce similar sensations of ear fullness through its effects on neurotransmitters

2. Serotonergic Effects:

   • Buspirone acts primarily through 5-HT1A receptors and affects serotonin synthesis and release 2
   • Serotonin pathways influence various sensory perceptions, including those in the inner ear

3. Neuropsychiatric Medication Side Effects:

   • Medications affecting neurotransmitter systems can cause sensory disturbances
   • In the context of SUNCT (Short-lasting Unilateral Neuralgiform headache with Conjunctival injection and Tearing), ear fullness is listed as a potential autonomic feature that can occur with neurological conditions affecting similar pathways 1

Clinical Considerations

Differential Diagnosis

When a patient on buspirone reports ear fullness, consider:

• Medication effect: Temporal relationship to starting buspirone
• Ménière's disease: Look for associated vertigo and hearing loss 1
• Acute otitis externa: Would present with pain, inflammation, and tenderness 1
• Sudden sensorineural hearing loss: More severe with actual hearing impairment 1
• Eustachian tube dysfunction: Often associated with pressure changes

Management Approach

If ear fullness occurs with buspirone:

1. Assess severity and impact:

   • Determine if the symptom is tolerable or significantly affecting quality of life
   • Check for associated symptoms like dizziness, hearing changes, or tinnitus

2. Consider options:

   • For mild symptoms: Monitor and reassure if anxiety benefits outweigh discomfort
   • For moderate symptoms: Dose adjustment may help (typical dosing range is 15-30 mg/day) 3
   • For severe symptoms: Consider alternative anxiolytics if ear fullness is intolerable

3. Documentation:

   • Record onset, duration, and pattern of ear fullness
   • Note correlation with medication timing and dosage

Important Considerations

• Benefit-risk assessment: Buspirone has a favorable side effect profile compared to benzodiazepines, with less sedation and no dependence issues 3, 2

• Onset timing: Some patients experience a 1-2 week delay before therapeutic effects of buspirone 3, but side effects may appear earlier

• Long-term use: Studies show buspirone remains safe for extended use up to one year, with no new side effects emerging over time 4

• Administration route matters: Standard oral administration has low bioavailability (approximately 4%), but alternative routes like intranasal administration can increase bioavailability and potentially enhance side effects 5

Conclusion

While ear fullness is not among the most commonly reported side effects of buspirone in clinical trials, it can occur due to the medication's effects on neurotransmitter systems. The symptom should be evaluated in context with other potential causes and the overall benefit of buspirone therapy for the patient's anxiety.