Tinnitus in patients on therapy with proton pump inhibitors (PPI) and in PPI non-users

Objective: We wished to observe the prevalence of tinnitus in subjects on therapy with proton pump inhibitors (PPI). A possible favourable effect of the commercially available proton pump inhibitors (PPI) on inner ear disorders was recently outlined. In order to investigate this possibility the prevalence of tinnitus (an indicator of labyrinthine sufferance in general terms) among PPI users and non-users was analysed. Study design: An observational study on the prevalence of tinnitus among PPI users and non-users was carried out. Between June 2012 and March 2013 a cohort of consecutive patients who were referred to S. Orsola-Malpighi University Hospital of Bologna for various non-audiological disorders was included in the study. Each patient was instructed to complete an anonymous validated questionnaire on hearing problems. The Ethics Committee of S. Orsola Malpighi Hospital had been informed about collection of the data. Results: In the age class 60-69 years there was a statistically significant lower prevalence of non-specified tinnitus in PPI users, compared to non-users. Conclusion: Even if a favourable effect on this symptom derived from the treatment of gastroesophageal reflux cannot be excluded, a direct regulatory effect on inner ear homeostasis, through the action of PPI on the gastric type proton pump of the inner ear, cannot be ruled out. Another possible effect could depend upon vasomotor activity enabling better peripheral perfusion without significantly modifying blood pressure values, thus contributing to the stabilization of inner ear oxygenation. Additionally, a certain degree of anti-inflammatory effect could yield another kind of non-specific favourable influx. In conclusion, even if the supposed benefit deriving from the use of PPI in treating inner ear affections of unknown origin is still unclear with regard to its significance and limits, the reported results demonstrate that longitudinal studies could be useful in order to verify the possibility of a new therapeutic perspective.