chronic

Subjective tinnitus

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

NICE Guideline NG155 · Egyptian National Drug Formulary - Nervous System Disorders 2025 · Stugeron (cinnarizine) 15 mg tablets SmPC sections 4.2 and 4.4 (eMC product 371)

Verified against2 documents

Egyptian National Drug Formulary - Nervous System Disorders 2025
Stugeron (cinnarizine) 15 mg tablets SmPC sections 4.2 and 4.4 (eMC product 371)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (5)

Patients describe a ringing, buzzing or roaring, sometimes hissing or whistling in the ears
It may come and go, or run without stopping
Usually nobody but the patient can hear it
The sound is made by the body itself, not by anything outside it
Most of it is subjective, meaning no instrument can measure or reproduce what the patient hears

Signs — what you find (6)

Examination centres on the ear and the nervous system
Inspect the ear canal for discharge, a foreign body and wax [foreign body]
Inspect the drum for infection and for a red or bluish mass suggesting a tumour
Do a bedside hearing test
Test the cranial nerves, especially balance, plus limb power, sensation and reflexes
Listen with a stethoscope over the carotids, the jugular veins and beside the ear for a vascular noise

Tests (6)

Imaging is not routine unless hearing and balance differ between the ears without explanation
An audiogram measures hearing levels and shows the extent of any loss
The patient matches a tone to their own noise and estimates how loud it is
Bone conduction is set against air conduction; better hearing by bone suggests otosclerosis, which can be treated
Surgery for otosclerosis brings back air conduction, but the noise may ease, stay or worsen
The longer a masking tone suppresses the noise, the better the outlook

If not this — what else fits (8)

Infections to weigh: cytomegalovirus, Lyme disease, measles, meningitis and rubella
Neurosyphilis belongs on the list
High cholesterol is a listed cause
A growth or tumour can be responsible
Vascular causes include small vessel disease and stroke
Sickle cell anaemia is listed too
If you can hear it too then it is objective, and an aneurysm is one cause of that
Disease of the jaw joint and spasm of the tensor tympani muscle are the other two objective causes worth hunting

SourceStatPearls "Tinnitus" - disease-level clinical article

Presentation findings are traced to the source above.

CINNARIZINE

1st line

Strength25 mg

Formoral.solid

Adult dose and duration

2 tablets 2 hours before you travel and 1 tablet every 8 hours during your journey.

Paediatric dose

(Children 5 to 12 years: One half the adult dose.)

Dose by age
5 to 12 years:	One half the adult dose.

Dose source

Stugeron (cinnarizine) 15 mg tablets SmPC sections 4.2 and 4.4 (eMC product 371)

Why

Alternative labyrinthine sedative and microvascular circulation enhancer

Cautions

May induce extrapyramidal symptoms or parkinsonism in elderly patients with long-term use.
The UK label covers motion sickness only - 2 tablets two hours before travelling, then 1 every 8 hours. Using 15-30 mg three times daily for vestibular symptoms sits outside it, on continental labelling.
Drowsiness, particularly at the start. No driving until they know how it takes them.
Avoid in porphyria.
In patients with Parkinson's disease, Stugeron should only be given if the advantages outweigh the possible risk of aggravating this disease.
Drowsiness and anticholinergic side effects are common.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
CEREBAL 25 MG 20 TABS.	ALEXANDRIA	16.00 EGP (0.80/unit)
STUGERON 25 MG 30 TAB.	MINA PHARM > JANSSEN CILAG	34.50 EGP (1.15/unit)
CINNARIZINE 25MG 20 TAB.	ARAB DRUG COMPANY (ADCO)	24.00 EGP (1.20/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.