Abstract
Introduction. Serotonin is involved in filtering of auditory stimuli. Cochlear input is processed through complex interactions between serotonergic, glutamatergic, and GABAergic neurotransmitter systems. Options for treatment of tinnitus include selective serotonin reuptake inhibitors (SSRIs); however in rare instances this symptom may occur as a side effect of this class of medications. Case Presentation. A 50-year-old woman developed bilateral tinnitus after several weeks of being treated with sertraline 50 mg. She had been on a long-standing daily dose of aspirin 325 mg which had been discontinued shortly before starting sertraline. Medical work-up was negative for her symptom. Shortly after discontinuation of the medication, her tinnitus subsided completely. Discussion. Tinnitus is a rare side effect of sertraline and may be related to particular distribution of serotonin receptor subtypes within the auditory system, and serotonergic agents may reinforce or desensitize the activity of different receptors. Also, there may be a priming effect of salicylate agents on the auditory system, predisposing particular patients to be more sensitive to how auditory stimuli are processed.
Highlights
Serotonin is involved in filtering of auditory stimuli
In terms of the subtypes of serotonin receptors distributed in the cochlea [5], some may have a direct influence on glutamatergic functioning, such as the postsynaptic 5-HT1A receptor, which has a role in inhibiting adenylyl cyclase
Sertraline has generally not been associated with the development of tinnitus [8], though it has been described during the period of medication withdrawal [9]
Summary
Serotonin has a role in the filtering of auditory input [1], allowing for appropriate disregarding of trivial sensory input [2], and the development of tinnitus may reflect a disturbance in this function [2]. While tinnitus can be associated with a withdrawal period from selective serotonin reuptake inhibitors (SSRIs) and these medications (including sertraline) have been utilized to treat tinnitus [6] (through enhancement of inhibitory GABAergic interneurons), there is still conflicting evidence on how exactly the serotonergic drugs influence perception and processing of auditory stimuli [7]. This writer reports the case of a patient who developed relatively rapid-onset tinnitus while on a rather low dose of sertraline
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