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Application of Cavinton in Otorhinolaryngologic Practice

I. Jovchev, S. Konsulov, S. Andreeva, A. Beshkova, D. Pazardzhikliev

Clinic of Otorhinolaryngology, Medical Institute Plovdiv, Bulgaira

ABSTRACT

Objective: To assess the effect of Cavinton in cochleovestibular disorders.
Sudy Design: Randomized study.
Setting: ENT department HMI Plovdiv, Bulgaria.
Patients: 32 patients (15 male and 17 female) aged 10 to 57. 29 patients were with sensorineural hearing loss, 2 with acute vascular vestibulopathy, and one case with a sudden unilateral tinnitus without hearing loss.
Interventions: History, otorhinolaryngologic examination, pure tone audiometry, reflexometry, otoneurogical examination, laboratory tests, consultation with ophtalmologist, neurologist and intrernist, imaging diagnosis (radiography and computed tomography).
Main Outcome Measures: The findings on pure tone audiometry, nystagmus, statokinetic tests, subjective noise and the subjective overall impression of the treatment effect.
Results: Improvement of sensorineural hearing loss was detected in 12 (41%) of patients, 2 (24%) had complete restitution of normal hearing. 10 (35%) patients with were not susceptible to treatment.
Conclusions: Intravenous administration of Cavinton is effective in patients with acute cochleovestibular disorders of vascular origin and of idiopathic sudden deafness when it is applied in the early stages. Cavinton is well tolerated and even when administered intravenously and in large doses there are no side effects, it dose not influence peripheral circulation and blood pressure while improving cerebral circulation.
Key words: Cochleovestibular disorders, Vascular dilatation, Cavinton.
Pro Otology 2: 82-83, 2002

Sensorineural hearing loss and subjective noise, which we encounter more and more frequently are still a therapeutic problem for the otorhinolaryngologist. Treatment is very important, because they impair quality of life and lead to disabilities (1). Etiology and pathophysiology of acute cochleovestibular disorders are still not studied in detail. That is why etiologic and pathophysiologic treatment is still not introduced. Recovery of sensory cells after degeneration had occurred is impossible. That is why drugs that influence the cerebral circulation are of great importance (2-4).

According to preliminary clinical studies and experiments Cavinton increases the cerebral arteries bloodstream and assists for a better oxygen supply for brain and inner ear without influencing peripheral circulation and blood pressure (5,6).

The medicine is long known and routinely used in our clinic. In the present article we share our experience with Cavinton. Samples were supplied by the producer.

In our clinic we treated 32 patients (15 male and 17 female) aged 10 to 57.

We summoned the data from history, otorhinolaryngologic examination, pure tone audiometry, reflexometry, otoneurogical examination, laboratory tests, consultation with ophtalmologist, neurologist and intrernist, imaging (radiography and computed tomography) and we assumed sudden sensorineural hearing loss in 29 patients, acute vascular vestibulopathy in 2 patients, a sudden unilateral tinnitus without hearing loss in one case.

According to etiology we found the following distribution:

· Acute viral infection - 7 patients

· Acute grippous otitis - 2

· Herpes zoster ( Rumsay - Hunt) - 2

· After meningococcal meningitis

· Acoustic trauma - 3

· Head injury - 1

· Idiopathic - 12

In 71 % of the cases we began treatment no later than the 10th day of the disease. In the other cases treatment was delayed since patients referred later.

All the patients were hospitalized and while test were made to exclude other disease - demyelinating disease, acoustic neuroma etc. Intravenous Cavinton was administered in increasing dosage 10 - 40 mg followed by a ten days course of 40 mg. Depending on the effect treatment continued with Cavinton tablets 3x1t. daily for a period of 1 to 3 months. This was a part of the complex treatment with vitamins, steroids and in some cases antibiotics.

RESULTS AND DISCUSSION

We followed-up the findings on pure tone audiometry, nystagmus, statokinetic tests, subjective noise and the subjective overall impression of the treatment effect before its beginning and at the 3, 7, 15, and 30 day of treatment.

We found the following results:

· Improvement was detected in 12 (41%) of patients, while 2 (24%) had complete restitution of normal hearing. Most of these patients had sudden unilateral hearing loss and were hospitalized no later than a week since the start of the complaints. 10 (35%) patients with sensorineural hearing loss were not susceptible to treatment. These were linked with viral and bacterial infections, acoustic trauma, head injury. In these cases probably irreversible degeneration of the sensory cells had occurred and this was the reason for the failure of the dilatating effect of Cavinton.

· An essential part of the assessment of the treatment effect was the subjective noise. 11 (52%) of 20 patients with complaint of noise reported of decrease, drift of the permanent noise to intermittent or disappearance. In a case of a isolated sudden pulsatile permanent intense noise, without any changes in pure tone audiometry the noise disappeared after a seven days course of treatment. We suppose that cases like this are of vascular origin and the improvement of cerebral circulation improves that of the labyrinth.

· Treatment with Cavinton demonstrates good results even in cases of vertigo. This was applied in two cases with vascular vestibulopathy and in seven with cochleovestibular syndrom. In 7 patients the initial subjective improvement was followed by disappearance of nystagmus and restitution of balance around 5-10 day of treatment. In two patients (one with head injury and one with epidemic meningitis) objective and subjective vestibular signs were not susceptible to treatment. This was attributed to destruction of the receptor.

We observed complications and side effects in one case. The patient had fever, but we ascribe this not only to Cavinton, since we observed similar reactions in intravenous administration of other medicines.

CONCLUSION

Intravenous administration of Cavinton by the described scheme was effective in a certain group of our patients with acute cochleovestibular disorders of vascular origin and of idiopathic sudden deafness when it was applied in the early stages.

Sudden hearing loss is a serious issue, for the treatment of which it is necessary the patient to be hospitalized, exact diagnosis to be established and to exclude organic disease (multiple sclerosis, acoustic neuroma) and intravenous vasodilation treatment to be administered as soon as possible.

Cavinton is well tolerated and even when administered intravenously and in large doses there are no side effects, it dose not influence peripheral circulation and blood pressure while improving cerebral circulation.

Results of our study showed that Cavinton is suitable in the treatment of tinnitus and vertigo

REFERENCES

  1. Zener HP. Diseases of the ears, nose and throat. Sofia: MI "Sharov", 1998.

  2. Popova D, Varbanova S. Some aspects of the treatment of subjective noise with Tanakan. Otorhinolaryngologichni stranici 1995;3-4:5-6.

  3. Varbanova S, Popova D. On the treatment of sudden hearing loss with Tanakan. Otorhinolaryngologichni stranici 1995;3-4:7-10.

  4. Pavlov V, Hadzhiivanova T, Benchev R. Treatment of sudden hearing loss and tinnitus with Tanakan. Otorhinolaringologia 1998;90-91:99-103.

  5. Ribari O, Zelen B, Kollar B. Ethyl Apovincaminate in the treatment of sensoneural impairment of hearing. Drug Res 1976; 26:10-1.

  6. Jasper A. Action of Cavinton on hearing loss of different origin. Hungarian Medical Journal 1978;26:4-5.

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