Zeitschrift für Alkoholismus und Drogenabhängigkeit
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Investigating A Peculiar Case Of Opioid Withdrawal Induced Tinnitus

Shweta Kalita, Nikita Mehdiratta, Chiraag Ashokkumar, Richard Hirsch

Background: Tinnitus induced by various opioids has been documented; however, the inhibitory effect of opioids on
tinnitus, exacerbation during withdrawal, and relief upon re-administration has not been previously described.
Case presentation: A 37-year-old male with a history of daily intravenous heroin use since age 15 presented with a
new-onset constant static tinnitus in both ears, rated at 9 out of 10 in intensity. The tinnitus was alleviated by opioid
use but returned after a few hours, necessitating repeated administrations. Buprenorphine reduced the intensity from
9 to 5 out of 10. The patient also reported auditory hallucinations and displayed psychiatric symptoms during the
evaluation.
Results: Neurological examination revealed decreased tinnitus intensity when the patient opened his mouth widely.
The psychiatric assessment indicated depressive and anxious symptoms, limited insight, and poor judgment.
Discussion: The present case suggests that tinnitus experienced during opioid withdrawal is opioid-dependent and
can be eliminated by opioid administration. The reduction in tinnitus intensity when the mouth is opened widely
suggests a central auditory hallucination mechanism related to micro-laryngeal movements. The opioids may exert
their inhibitory effect on tinnitus through cortical modulation rather than direct effects on the auditory system.
Investigating tinnitus in individuals with opioid dependence may identify a subgroup that could benefit from
tinnitus-alleviating medications, potentially reducing the risk of opioid relapse.