Caroverine for Refractory Tinnitus
No, caroverine should not be prescribed for this patient, as the American Academy of Otolaryngology-Head and Neck Surgery explicitly advises against routinely recommending pharmacological treatments—including investigational agents like caroverine—for persistent, bothersome tinnitus due to insufficient evidence and potential side effects. 1
Guideline-Based Recommendation Against Pharmacotherapy
The American Academy of Otolaryngology-Head and Neck Surgery does not recommend antidepressants, anticonvulsants, anxiolytics, or intratympanic medications for primary treatment of persistent tinnitus due to insufficient evidence and potential side effects. 1
Dietary supplements, including Ginkgo biloba, melatonin, zinc, or other supplements, should not be recommended due to lack of consistent benefit. 1
Prescribing medications without clear evidence of benefit that may cause side effects or worsen tinnitus should be avoided. 1
Why Caroverine Does Not Meet Evidence Standards
Caroverine is an NMDA and non-NMDA glutamate receptor antagonist that has been investigated for cochlear synaptic tinnitus, but it lacks FDA approval for tinnitus treatment and is not mentioned in current American Academy of Otolaryngology-Head and Neck Surgery guidelines. 2, 3
A 2024 quasi-experimental study showed 53.3% reduction in mild tinnitus with oral caroverine versus standard care, but this was a small, non-randomized trial without placebo control, representing low-quality evidence insufficient to override guideline recommendations. 2
A 2019 randomized controlled study found that intravenous caroverine provided immediate but non-sustained relief (improvement lost at 3-month follow-up), further demonstrating lack of durable benefit. 4
No effective drug treatments are available for tinnitus, although much research is underway into mechanisms and possible treatments. 5
What Should Be Done Instead
For a patient who has already completed hearing-aid fitting, education, sound therapy, and cognitive-behavioral therapy without adequate relief:
Reassess for alternative diagnoses such as Menière's disease, otosclerosis, or delayed acoustic neuroma, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery. 1
Screen for severe anxiety or depression because these mental-health conditions are linked to increased suicide risk in tinnitus patients; patients identified with severe symptoms should receive immediate psychiatric intervention. 1
Consider a multidisciplinary team approach involving otolaryngology, audiology, and mental health professionals for optimal management, with long-term follow-up necessary as some patients will have underlying causes identified only after extended observation. 1
Evaluate for implantable hearing solutions (e.g., cochlear implants, bone-anchored hearing aids) for individuals with severe hearing loss and persistent bothersome tinnitus. 1
Critical Clinical Pitfall
- The low success rates of tinnitus therapy lead to frustration of physicians and patients alike, but this does not justify prescribing unproven pharmacological agents. 6 The appropriate response is continued supportive care, psychiatric screening, and reassessment for treatable underlying conditions—not off-label prescribing of medications lacking robust evidence. 1