Pentoxifylline uses in inner ear diseases

Labyrinth or the inner ear consists of the cochlea (for hearing) and vestibular system (for balance), with disorders affecting hearing, balance, or both, and symptomatology including hearing loss, tinnitus, and vertigo. Regulatory-approved medications for inner ear diseases are rare worldwide relative to the frequency of those diseases. There are no FDA-approved medications for any inner ear disease. This is due to multiple reasons, including the lack of conclusive evidence for various drugs that have been investigated. We aim to contribute to the review endeavor by addressing pentoxifylline (PTX), a medication that has been studied for cochlear and vestibular disorders, yet its efficacy and safety have not been systematically reviewed in a publication. More than a dozen databases from around the globe were systematically searched, including PubMed, EMBASE, Scopus, Web of Science, Cochrane/CENTRAL, ScienceDirect, Google Scholar, Europe PMC, ICTRP, ClinicalTrials.gov, EU-CTR, PsycInfo, LILACS, WPRIM, IBECS, SciELO, CNKI, VIP, and Wanfang, to methodically compile experimental and analytical studies. Search results are up to January 2025. This work focused on workable reports in which PTX had distinct or attributable results and organized them into overarching categories of vertigo, hearing loss, and tinnitus. Forty studies, including 15 randomized controlled trials (RCTs), were included. Each condition was addressed in seven RCTs, with some overlap. Studies on inner ear vertigo reported significant outcomes for PTX. A large proportion of the literature involved idiopathic sudden sensorineural hearing loss (ISSNHL), but its results were mixed. Studies on tinnitus suggest that PTX has similar efficacy to Ginkgo biloba extract and corticosteroids, two of the most prescribed medications. Adverse events were generally mild and rarely necessitated discontinuation. Pentoxifylline could improve inner ear vertigo and tinnitus. In ISSNHL, results are inconsistent in the context of spontaneous recovery rates, albeit leaning toward ineffectiveness. Over a variety of regimens, it sustained good safety. The rigor and designs of the reports could not produce robust recommendations.