Tinnitus patients initially seeking help in our Tinnitus Hyperacusis Center Frankfurt are often severely decompensated and in states of desperation. Their tinnitus has sometimes driven them into extreme forms of anxiety, into panic attacks and states of phobic excitation. Some patients even feel persecuted, haunted and threatened by their tinnitus. In such critical cases we treated our patients using fluspirilene (Imap) in order to be able to even start TRT with them.
The MGN of the auditory system is connected to structures of the limbic system (Jastreboff, 1990, 2000) that is involved in the formation of negative emotional associations. Is the tinnitus wrongly assigned to a high priority and dangerousness, it dominates the perception of the patient and pushes other sensations into the background. Fluspirilene is a diphenylpiperidine with an antipsychotic effect by its ability to block domanine receptors (dopamine D2 receptor antagonist). Thereby it promotes mental balance and dissociation from psychotic experiences. Gianelli and Zarattini (1983) showed an efficacy of IMAP also in anxious patients with different forms of somatisations. This spectrum of activity suggests using fluspirilene as a preliminary therapy to enable tinnitus-retraining-therapy for our patients with massive psychic symptoms. Fluspirilene is able to support the decoupling of the perception of tinnitus and its emotional validation by the limbic system in a medicamentous way.
In our study we investigated the therapeutic effect of a transient treatment using fluspirilene in 15 patients. Inclusion criteria were psychotic symptoms or severe anxiety and panic as a consequence of their decompensated tinnitus. We used i.m. weekly dosages of 1.5 mg dependent on the body weight. Tinnitus intensity, discomfort and the impact of tinnitus on life quality were analysed using a scale between 0 and 10. The patients scored these criteria before and after application of IMAP.Additionally we measured the effect on side symptoms like sleep disturbance, nervousness, depression etc.
We found an improvement in all criteria in 80% of the patients. Even the intensity of the tinnitus itself increased. The rate of improvement of side symptoms turned out to be very high.
Our results suggest that fluspirilene is a very promising therapeutic agent in the management of acute crisis of tinnitus patients. It is used only for a transient short period of time however, until the tinnitus-retraining-therapy is made possible.