Journal of Otorhinolaryngology, Hearing and Balance Medicine

Background/Objectives: Coenzyme Q10 (CoQ10) is crucial for mitochondrial bioenergetics and redox balance and has been studied in hearing disorders. Its clinical use ranges from genetic mitochondrial deafness to acquired hearing loss associated with oxidative stress. This review aimed to map human clinical evidence on CoQ10 in hearing issues and differentiate its therapeutic roles based on underlying causes. Methods: This review was conducted following the PRISMA Extension for Scoping Reviews (PRISMA-ScR). A systematic search of PubMed, Europe PubMed Central, the Directory of Open Access Journals (DOAJ), and ClinicalTrials.gov was performed. Human clinical studies evaluating CoQ10 or water-soluble CoQ10 formulations with hearing-related outcomes were included and synthesized descriptively. Results: Fourteen studies met the inclusion criteria, including randomized controlled trials, non-randomized clinical studies, case series, and case reports. Two distinct therapeutic roles of CoQ10 emerged: in primary mitochondrial hearing disorders caused by defects in mitochondrial DNA or CoQ10 biosynthesis pathways, CoQ10 acted as a replacement therapy and was consistently linked to stabilization or prevention of progressive sensorineural hearing loss. Conversely, in acquired or age-related conditions—including presbycusis, noise-induced hearing loss, ototoxicity, tinnitus, and sudden sensorineural hearing loss—CoQ10 was used as an antioxidant or neuroprotective supplement, with outcomes showing functional preservation, symptom reduction, or decreased cochlear injury. Internal validity varied across studies: most evidence for replacement therapy was derived from observational designs, and antioxidant applications were mainly supported by small or preliminary clinical trials. Conclusions: The available evidence suggests two distinct clinical roles of CoQ10 in hearing disorders: (i) replacement therapy in genetically defined mitochondrial deafness and (ii) adjunctive antioxidant/neuroprotective use in acquired conditions. Given heterogeneity and limited study quality, further well-designed trials are needed before broad clinical recommendations can be made.

Background/Objectives: Despite the high prevalence (around 4.1–37.2%) and highly debilitating adverse impact, there has been inconclusive evidence regarding the efficacy of treatment for tinnitus management, especially for those patients with tinnitus who do not have a specific or treatable origin. The aim of this updated network meta-analysis (NMA) was to estimate the efficacy and safety of the different non-invasive brain stimulation (NIBS) interventions in tinnitus management in patients with chronic tinnitus without a specific or treatable origin. Methods: This NMA included randomized controlled trials (RCTs) of NIBS interventions in patients with chronic tinnitus. The current NMA was conducted using the frequentist model. The primary outcome was a change in tinnitus severity after the NIBS intervention. Results: We identified 45 eligible RCTs with a total of 2042 participants. The results of the current NMA showed that both excitatory and inhibitory NIBS interventions exerted significant effects on tinnitus severity, quality of life, or response rate. While several protocols showed a signal, the top-ranked intervention was preliminary and derived from a single, small study. All the NIBS interventions had fair acceptability compared to the controls. Conclusions: This NMA highlighted that both excitatory and inhibitory NIBS interventions exerted significant effects on tinnitus severity, quality of life, and/or response rate. Future well-designed RCTs with electroencephalogram applications are needed for replication over the proclamation of efficacy.

Background/Objectives: Dizziness is a symptom of many disorders across a wide range of etiologies. If dizzy patients are seen for vestibular evaluation with an audiologist and no vestibular reason for the patient’s dizziness is found, the medical referral pathway can become convoluted. This can leave patients feeling discouraged and unable to manage their symptoms. Clinically symptomatic chronic respiratory alkalosis (CSCRA) is an acid–base disorder that typically presents with dizziness but is unfamiliar to practitioners in vestibular and balance care settings. Methods: In a retrospective chart review deemed exempt by the Mayo Clinic Institutional Review Board, 74 patients at Mayo Clinic Arizona were included. All had consultations with both Audiology and Aerospace Medicine to assess their dizzy symptoms. Results: After completing vestibular testing, arterial blood gas (ABG) testing, and a functional test developed at Mayo Clinic Arizona called the Capnic Challenge test, 40% of patients were found to have CSCRA contributing to their dizzy symptoms. Many of these patients also had common comorbidities of CSCRA, like postural orthostatic tachycardia syndrome (POTS), migraines, and sleep apnea. Fewer than one-fourth of these patients had measurable vestibulopathies causing their dizziness. Half of the patients referred by the vestibular audiologist to Aerospace Medicine had a diagnosis of CSCRA. Conclusions: Assessment for CSCRA should be considered as a next step for patients presenting with dizziness without a vestibular component. Being aware of the prevalence of CSCRA and its comorbidities may help balance providers offer quality interprofessional referrals and improve patient quality of life.