From relief to aggravation: The intriguing tinnitus-opioid withdrawal paradox

Introduction:Opioids have been documented to induce tinnitus. However, tinnitus exacerbation with opioid withdrawal and relief upon re-administration of opioids has not been described.

Methods:Case report:A 37-year-old male presented with a persistent ringing sensation in his ears for three years after cessation of chronic heroin abuse. The constant static tinnitus was accompanied by high and low-pitched sounds. Heroin one gram IV or morphine 125 mg IV temporarily alleviated the tinnitus for 6-8 hours, necessitating recurrent injections. Buprenorphine 8 mg, thrice a day, significantly reduced the intensity of tinnitus. The patient experienced auditory hallucinations independent of tinnitus.

Results:Neurological examination: Cranial nerve VIII: Calibrated. Finger Rub Auditory Screening Test: standard. Weber and Rinne's tests: Negative. Decreased tinnitus intensity from 9/10 to 5/10 with mouth wide open. Psychiatric evaluation: Orientation: X 3. Suicidal thoughts with sad and congruent affect. Intact attention. Hypo-verbal speech. Slow thought process. Poor judgment and limited insight.

Discussion:Tinnitus linked to heroin withdrawal and its relief with heroin or opioids implies a temporal relationship. The reduction in tinnitus with the mouth wide open would be consistent with the sound not being derived from the auditory apparatus but rather as a variant of central psychosis auditory hallucinations ascribed to micro-laryngeal movements. Cortically mediated opening of mouth widely inhibits micro-laryngeal movements and thus auditory hallucinations. Opioids may inhibit tinnitus through their cortical effects rather than otological effects. Investigation for tinnitus in those with opioid dependence may reveal a subgroup of patients who may benefit from tinnitus-alleviating medications, thus reducing the risk of relapse.

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Title: ScienceOpen Posters

Publisher: ScienceOpen

Publication date (Electronic preprint): 18 September 2023

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[1 ] Smell and Taste Treatment & Research Foundation Ltd, Chicago, USA;

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[* ]Email: nikitamehdiratta24@ 123456gmail.com .

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Nikita Mehdiratta https://orcid.org/0000-0002-4541-3779

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DOI: 10.14293/P2199-8442.1.SOP-.PVB7TN.v1

SO-VID: 5c2ed77e-b867-49be-8f6c-7ab9145b79c5

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This work has been published open access under Creative Commons Attribution License CC BY 4.0 , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Conditions, terms of use and publishing policy can be found at www.scienceopen.com .

History

Date received : 18 September 2023

References

Bauer Carol A.. Tinnitus. New England Journal of Medicine. Vol. 378(13):1224–1231. 2018. Massachusetts Medical Society. [Cross Ref]
Fornaro Michele. Tinnitus psychopharmacology: A comprehensive review of its pathomechanisms and management. Neuropsychiatric Disease and Treatment. 2010. Informa UK Limited. [Cross Ref]
Busto Usoa, Sellers Edward M., Naranjo Claudio A., Cappell Howard, Sanchez-Craig Martha, Sykora Kathy. Withdrawal Reaction after Long-Term Therapeutic Use of Benzodiazepines. New England Journal of Medicine. Vol. 315(14):854–859. 1986. Massachusetts Medical Society. [Cross Ref]
Robles Bayón A., Tirapu de Sagrario M.G., Gude Sampedro F.. Auditory hallucinations in cognitive neurology. Neurología (English Edition). Vol. 32(6):345–354. 2017. Elsevier BV. [Cross Ref]
Saifan Chadi, Glass Daniel, Barakat Iskandar, El-Sayegh Suzanne. Methadone Induced Sensorineural Hearing Loss. Case Reports in Medicine. Vol. 2013:1–5. 2013. Hindawi Limited. [Cross Ref]

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[1] Bauer Carol A.. Tinnitus. New England Journal of Medicine. Vol. 378(13):1224–1231. 2018. Massachusetts Medical Society. [Cross Ref]

[2] Fornaro Michele. Tinnitus psychopharmacology: A comprehensive review of its pathomechanisms and management. Neuropsychiatric Disease and Treatment. 2010. Informa UK Limited. [Cross Ref]

[3] Busto Usoa, Sellers Edward M., Naranjo Claudio A., Cappell Howard, Sanchez-Craig Martha, Sykora Kathy. Withdrawal Reaction after Long-Term Therapeutic Use of Benzodiazepines. New England Journal of Medicine. Vol. 315(14):854–859. 1986. Massachusetts Medical Society. [Cross Ref]

[4] Robles Bayón A., Tirapu de Sagrario M.G., Gude Sampedro F.. Auditory hallucinations in cognitive neurology. Neurología (English Edition). Vol. 32(6):345–354. 2017. Elsevier BV. [Cross Ref]

[5] Saifan Chadi, Glass Daniel, Barakat Iskandar, El-Sayegh Suzanne. Methadone Induced Sensorineural Hearing Loss. Case Reports in Medicine. Vol. 2013:1–5. 2013. Hindawi Limited. [Cross Ref]