# Subjective tinnitus

- Category: chronic
- Review status: reviewed (every claim checked against a document named on this page)
- 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 date: 2026-08

## Verified against

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

## Treatment metadata

- Cinnarizine — 25 mg — oral.solid

## Complete treatment card

```text
SUBJECTIVE TINNITUS
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)
Review status: REVIEWED against 2 sources listed above  (2026-08)

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
  Source  StatPearls "Tinnitus" - disease-level clinical article
  Status  traced to the source above

1. CINNARIZINE                                            [1st line]
   Adult    2 tablets 2 hours before you travel and 1 tablet every 8 hours during your journey.
   Peds     5 to 12 years: One half the adult dose.
            (Children 5 to 12 years: One half the adult 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
   Caution  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.
   Egypt    CEREBAL 25 MG 20 TABS.           ALEXANDRIA          16.00 EGP (0.80/unit)
            STUGERON 25 MG 30 TAB.           MINA PHARM > ...    34.50 EGP (1.15/unit)
            CINNARIZINE 25MG 20 TAB.         ARAB DRUG COM...    24.00 EGP (1.20/unit)

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

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Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement.

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