Medical and surgical treatments for tinnitus: the efficacy of combined treatment with sulodexide and melatonin.

AIM: Tinnitus is the perception of sound in the absence of an apparent acoustic stimulus. A widespread and highly debilitating disease difficult to cure. Several treatments have been advocated for tinnitus in the last years, including surgery, pharmacotherapy, counseling, cognitive behavioral therapy, sound therapy, but unfortunately without definitive conclusions. The surgery treatments could represent an important therapeutic choice on specific subgroups of tinnitus with defined causes but obviously this approach represent an invasive treatment and it should be considered with extreme caution and then, alternative pharmacological options should be investigated. METHODS: In this retrospective study 30 patients with tinnitus were treated with sulodexide (250 LSU BID, in the morning and in the evening) and melatonin (3 mg in the evening before going to sleep) for 80 days. The evaluations were performed comparing different parameters at basal (T0) and after 40 days (T1) and 80 days (T2) of treatment. RESULTS: The results of Tinnitus Handicap Inventory (THI) and acufenometry showed a significative improvement of tinnitus after treatment with sulodexide and melatonin. In particular, THI total score was reduced from 37±20 to 27±18 (P<0.001) and 21±19 (P<0.001) at T1 and T2, respectively. The percentage of patients with improved symptoms (i.e. reduced score at THI) was 76.7% at T1 and 90.0% at T2. Finally a significant improvement was also detected in the tone audiometry test. No side effects were observed during the treatment period. CONCLUSION: In conclusion, the combined use of sulodexide, a natural glycosaminoglycan with antithrombotic, profibrinolytic and vascular anti-inflammatory properties used in the treatment of many vascular diseases, included the vertigo of vascular origin and melatonin, a neurohormone produced by the pineal gland and related to multiple physiological functions, confirms to an important and promising therapeutically option in the tinnitus management.

Cytosolic and nuclear androgen receptor activity in the cancer of the larynx.

It is well known that the larynx is a target organ for androgens and the cancer of larynx is more frequent in male subjects. We have evaluated the androgen receptors (AR) in the cytosol (ACR) and in salt extractable (ANR) and salt resistant nuclear fraction (AMR) in a group of 24 male patients with cancer of the larynx surgically removed. In addition specimens obtained from the normal mucosa of the same subjects were analyzed. In 5 patients estrogen (ER) and progesterone (PgR) receptors were also assayed. In all subjects blood samples were taken before surgery for the assay of the following hormones: LH, FSH, estradiol, testosterone, dihydrotestosterone, delta 4-androstenedione, dehydroepiandrosterone sulfate, cortisol. The results observed showed that 18 out of 24 normal larynx mucosa specimens and 17 out of 24 larynx cancer specimens were positive for ACR or ANR or AMR. The 5 samples of normal and cancer tissues analyzed for ER and PgR were negative. In conclusion there is no significant correlation between AR positivity from one size, histology, degree of differentiation and invasivity of the cancer, age of patients and hormonal blood levels from the other. The high ANR and AMR positivity (normal hormonal translocation and binding on DNA acceptors) confirm that the normal and cancer larynx are target tissue for androgens and establish the hormone dependence of this cancer. Hormonal therapy could be envisaged as an alternative or a complementary therapy for this type of cancer at least in the cases in which the analysis of hormone receptors will prove to be positive.