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Our Experience with the Application of Vinpocetine (Cavintone) in the Treatment of the Cochleo-Vestibular Impairment Due to Acute Otitis Media

*R. Benchev, *Zl. Zhelyaskova, †D. Vicheva

*Department of Otorhinolaryngology, Medical Institute of Ministry of Interior, Sofia, Bulgaria
†Department of Otorhinolaryngology, Medical University, Plovdiv Bulgaria

ABSTRACT

Objective: The treatment of acute otitis media (AOM) with antibiotics and myringotomy is well established, but sometimes complications affecting the inner ear occur, especially in AOM of viral origin. In such cases we start treatment with Vinpocetine (Cavintone) as soon as possible. The application of Vinpocetine is directed against one of the pathogenic mechanisms of the AOM related cochleo-vestibular disorder – the damage of the inner ear, caused by the vascular changes associated with the inflammation.
Study Design: Randomized study.
Setting: Department of Otorhinolaryngology, Medical Institute of Ministry of Interior, Sofia and Department of Otorhinolaryngology, Medical University, Plovdiv.
Patients: A retrospective study of 41 patients with AOM related cochleo-vestibular disorders treated with Vinpocetine was performed. The patients were divided into 2 groups: I group – 17 cases with inner ear impairment during the course of AOM; II group – 24 cases with post AOM cochleo-vestibular disorders.
Results: After the treatment improvement of the sensorineural hearing loss was found in 11 (65%) of the cases in the I group, while in the II group no real hearing improvement was found. In both groups a decrease of the level of the subjective noise and stabilization of the vestibular function was noted.
Conclusions: Based on the results of the therapy with Vinpocetine (Cavintone), we recommend the medicine as an effective additional treatment agent in acute cases and as useful supportive one in chronic AOM related cochleo-vestibular disorders.
Keywords: Acute Otitis Media, Cochleo-Vestibular Disorders, Vasodilators.
Pro Otology 2-3: 109-110, 2003

Introduction

The treatment of acute otitis media (AOM) with antibiotics and paracentesis is well established, but sometimes complications affecting the inner ear occur, especially in AOM of viral origin. The pathological changes in such cases of cochleo-vestibular impairment are degenerative and atrophic and affect predominantly the cochlear part of the inner ear. It is accepted that the vascular changes associated with AOM, play significant role in the pathogenesis of the inner ear affection. That is why, the application of vasodilators is quite important (1,2). Vinpocetine (Cavintone) is a potent vasodilator, which improves the brain circulation, suppresses the thrombocyte aggregation, facilitates the oxygen transport to the tissues, and could be used inpatiently or outpatiently as well (3,4).

The aim of the present article is to share our experience with the application of Vinpocetine (Cavintone) in the treatment of the cochleo-vestibular impairment due to AOM.

Material and Methods

A retrospective study of 41 patients with AOM related cochleo-vestibular disturbances, treated from 1999 to 2001, was performed. The patients were divided into 2 groups: I group – 17 cases (41.5%) with inner ear impairment during the course of AOM; and II group – 24 cases (58.5%) with post AOM cochleo-vestibular disorders (labyrinthoneuritis, vestibulopathy, laby-rin-tho-pathy). Twenty-seven (65%) of them were male and 14 (35%) were female. The average age of the patients was 34 years. In 26 (64%) of them the damage of the inner ear was bilateral and in 15 (36%) unilateral.

All patients suffered from hearing loss, subjective noise was found in 34 cases and vestibular problems in 20 cases.

The following methods of examination were used: otoscopy, pure tone audiometry, BERA, otoneurological examination, posturography.

The hearing loss was determined in dB as an average rate of the 4 basic frequencies: 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz. By this method the hearing function was divided into 4 grades:

Mild (20-40 dB)

Moderate (45-65 dB)

Severere (70-85 dB)

Profound (> 90 dB)

The assessment of the hearing loss was always for the ear with better hearing.

The treatment with Vinpocetine (Cavintone) was performed with intravenous infusions for 15 days in AOM complicated with neuritis of the acoustic nerve and about 10 days in post AOM cochleo-vestibular disorders. The treatment started with 10 mg Vinpocetine with gradually increased up to the optimal dose of 30-40 mg for 4-9 days and then tappered to the supporting dose of 10 mg. Doses higher than 40 mg. were not used. The dose of 10-15 mg was continued for 1 month or more.

Results

The hearing loss in the first group was as follows: moderate 12 patients; severe 4 patients; profound 1. In the second group 20 patients were with moderate and 4 with severe hearing loss.

The otoneurological examination and stabilography showed the following data: in the I group 7 patients had vertigo, 3 vegetative disorders, 4 LNy, 4 changes of the posturography (R>1.4); in the II group 13 had vertigo, 12 LNy and 2 were with changes of the posturography (R>1.4).

After the treatment with Vinpocetine (Cavintone), the hearing improvement in the acute cases of cochleo-vestibular disorders was found in 11 patients (65%) and full recovery for 4 patients (24%). The average hearing increase for the speech frequencies was about 25 dB.

In the patients with post AOM hearing impairment no actual improvement of the hearing function was found, in spite of the fact that many of them had subjective improvement.

After the treatment, the subjective noise in 15 patients (44%) stopped or decreased significantly; in 15 cases (44%) the level of the noise decreased slightly and in 4 cases (12%) it remained unchanged. Dramatic decrease of the subjective noise was found mainly in patients from the I group, while in the II group the decrease of noise was slight or insignificant. Vestibular changes like vertigo and vegetative symptoms subsided after the treatment with Vinpocetine.

Discussion

The results of our study showed clearly that the intravenous application of Vinpocetine (Cavintone) was effective mainly in AOM combined with sensorineural impairment. In 24% of the cases full recovery of the hearing was found, and in 65% of the patients – improvement. The aim of the treatment in such cases is improvement of the microcirculation, the metabolism and the oxygenation of the affected structures, thus limiting the size of the damage or full recovery of the tissues (5). An important factor for the favorable outcome of the treatment is the urgent start of the therapy with vasodilators – up to 10 days from the beginning of the complaints. Usually the improvement of the symptoms – hearing loss, subjective noise and vestibular disorders – was found in the first 3-4 days of the treatment in the acute cases. In such cases the intravenous therapy with Vinpocetine continued up to 15 days and after that another 30 days with tablets up to 15 mg daily.

The aim of the treatment of the patients in the II group is to delay the atrophic and degenerative processes in the structures surrounding the damage by improvement of the circulation and metabolism, because in such cases the affected structures are irreversibly impaired. The use of Vinpocetine improves the circulation and the nutrition of the central auditory paths and the cortex (6,7). Thus we can explain the subjective feeling of hearing improvement. Probably, it is connected with better speech understanding, as a result of the decrease of the subjective noise.

Vinpocetine has favorable effect on the vestibular system as well. Vertigo and vegetative symptoms vanished in all 20 patients. Posturography showed marked improvement after the treatment. The annoying subjective noise decreased in about 80% of the cases in the second group.

The intravenous treatment with Vinpocetine was used for fast stabilization and improvement of the status. It continued for about 10 days, after that the patients were treated with supportive peroral doses of 15-30 mg for several months.

The adverse effects of the treatment with Vinpocetine were flashing of the face in 8 patients, headache in 5, hypotonia in 3 cases. They were slightly expressed and did not lead to stop of the treatment.

In conclusion, based on the results of the treatment with Vinpocetine and its minor adverse effects, we could recommend it as an effective medicine for the treatment of acute and chronic AOM related cochleo-vestibular disorders.

REFERENCES

  1. Kuzuya F. Effect of vinpocetine on platelet aggregatibility and erythrocite deformation. Geriatric Medicine 1982;20:11-26.

  2. Schuknecht H. The pathology of sudden sensorineural hearing loss. Arch. Orolaryngol 1986;1:234-8.

  3. Itoh T. Effect of Vinpocetine on platelet aggregation in patients with cerebrovascular disease. Ap. Pharm. And Therapy 1982;20:151-6.

  4. Karpati E, Szporm L, Biro K, Rosdy B. Effect of Cavintone on cerebral circulation, hypoxia and metabolism. VII International Congress of Pharmacology, Reims 1978.

  5. Janczewski G et al. Cavinton treatment in vertigo of circulatory origin and acute deafness. Pro Memoria (Medimpex) 1980;21:11-26.

  6. Osawa M., Muriama S. Effect of Vinpocetine on blood viscosity in ischemic cerebrovascular disease. Ther Hung 1985;33:7-13.

  7. Ribari O., Zelen B., Kollar B. Ethyl apovincamine in the treatment of sensorineural impairment of hearing. Arzneim-Forsch (Drug Res) 1976;26:1977-80.

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