59 Klinik Psikofarmakoloji Bülteni, Cilt: 19, Say›: 1, 2009 / Bulletin of Clinical Psychopharmacology, Vol: 19, N.: 1, 2009 - www.psikofarmakoloji.org INTRODUCTION Fluvoxamine, which is a member of the selective serotonin reuptake inhibitors (SSRI), is a widely prescribed antidepressant. It is true that SSRIs all have several properties in common, not the least of which is the blockade of the serotonin transporter that leads to elevation of serotonin levels throughout the central nervous system (CNS) and also throughout the entire body. Increases in serotonin levels in specific regions of the brain result in the therapeutic actions of the SSRIs. Unfortunately, the action of SSRIs on the serotonin transporter is not regionally specific, and elevation in serotonin levels in some regions of the CNS and peripheral nervous system lead to side effects (1). The most common adverse reactions to the SSRIs are gastrointestinal and neuropsychiatric, such as nausea, headache, and tremor (1,2) . It is also known that in the central auditory pathway, serotonin can be found in many structures, from cochlear nuclei to the auditory cortex, constituting one of the most important neuromodulatory circuits in hearing processing Hearing Loss and Tinnitus During Fluvoxamine Treatment: A Case Report* Duru Gündo¤ar 1 , Fevzi Sefa Dereköy 2 , Deniz Y›lmaz 3 Olgu Sunumlar› / Case Reports ÖZET: Fluvoksamin tedavisi s›ras›nda oluflan iflitme kay- b› ve tinnitus: Olgu sunumu Fluvoksamin, yayg›n olarak reçete edilen bir seçici seroto- nin geri al›m inhibitörüdür (SSG‹). Serotoninin iflitme süreç- leri kapsam›nda önemli bir a¤ oluflturdu¤u bilinmektedir. Son dönemde serotonin ve SSG‹’lerin iflitme ifllevleri üze- rindeki etkisini inceleyen çal›flmalar yap›lmaktad›r. Ancak, serotoninin iflitme üzerindeki etkisi net olarak belirleneme- mifltir. Bu yaz›da, fluvoksamin tedavisi s›ras›nda tinnitus ve iflitme kayb› gözlenen ve tedavi kesildikten sonra bu yak›n- malar›n ortadan kalkt›¤› bir olgu sunulmufltur. Majör dep- resyon tan›s›yla fluvoksamin kullanmakta olan 54 yafl›nda kad›n hastada, sa¤ kulakta tinnitus ve iflitme kayb› flikayet- leri ortaya ç›kt›. Hastan›n t›bbi öyküsünde herhangi bir özelli¤e rastlanmad›, baflka herhangi bir ilaç kullanm›yordu ve kulak-burun-bo¤az muayenesi tamamen normaldi. Odi- ometride, sa¤ kulakta mikst iflitme kayb› gözlendi. Geçici otoakustik emisyon kay›tlar›nda, sa¤ kulakta düflük üretile- bilirlik (reproducibility) ve düflük sinyal/gürültü oran› oldu- ¤u gözlendi. Fluvoksamin tedavisi kesildikten sonra yap›lan kontrol incelemelerinde, iflitme ifllevleri normale dönmüfl- tü. Hastam›zda oluflan iflitme kayb›n›n, fluvoksamin’in fasi- yal sinir ifllevleri üzerindeki etkisine ve/ veya serotoninin iflitsel sensorinöral iletim üzerindeki etkisine ba¤l› olabile- ce¤i düflünülmüfltür. Olgu, klinisyenlerin SSG‹ kullan›m› s›- ras›nda oluflabilecek iflitsel yan etkiler konusunda fark›nda- l›¤›n› art›rmak amac›yla sunulmaya de¤er bulunmufltur. Anahtar sözcükler: Fluvoksamin, serotonin geri al›m inhi- bitörleri, iflitme kayb›, tinnitus Klinik Psikofarmakoloji Bülteni 2009;19:59-63 ABSTRACT: Hearing loss and tinnitus during fluvoxamine treatment: a case report Fluvoxamine is a widely prescribed selective serotonin reuptake inhibitor (SSRI). Although it is known that serotonin constitutes an important network in the hearing process and there are recent studies investigating the effects of serotonin and SSRI’s on the auditory functions, its exact role is not well characterized. In this paper we present a case with hearing loss and tinnitus which developed during fluvoxamine treatment and disappeared after discontinuation of fluvoxamine. A 54-year-old female patient with major depression had complaints about tinnitus and hearing loss in her right ear during fluvoxamine treatment. There were no significant abnormalities in her medical history, she was not taking any other medications, and ear-nose-throat examination was within normal limits. Audiometry revealed mixed hearing loss and transient otoacoustic emission (TOAE) recordings revealed a low reproducibility and low signal to noise ratio in the right ear. The control investigations after discontinuation of fluvoxamine revealed that the auditory functions were restored. The hearing loss in our patient might be due to the interference of fluvoxamine with facial nerve functioning or the effects of serotonin on the auditory sensorineural transmission. This case was considered to be noteworthy to publish, in order to increase clinicians’ awareness of the possible side effects of SSRI’s on the auditory functions. Key words: Fluvoxamine, serotonin reuptake inhibitors, hearing loss, tinnitus Bulletin of Clinical Psychopharmacology 2009;19:59-63 *Presented as a poster at the 39th National Psychiatry Congress, Antalya, Turkey, 14-19 October 2003. 1 Assistant Professor of Psychiatry Suleyman Demirel University, School of Medicine Department of Psychiatry, Isparta-Turkey 2 Associate Professor of Otolaryngology Afyon Kocatepe University, School of Medicine, Department of Otolaryngology Afyon-Turkey 3 Associate Professor of Otolaryngology Afyon Kocatepe University, School of Medicine, Department of Otolaryngology Afyon-Turkey Yaz›flma Adresi / Address reprint requests to: Duru Gundogar, PK:4, 32000 Isparta-Turkey Telefon / Phone: +90-246-232-8902 Faks / Fax: +90-246-237-0240 Elektronik posta adresi / E-mail address: durugundogar2000@yahoo.com Kabul tarihi / Date of acceptance: 10 Nisan 2007 / April 10, 2007 Ba¤›nt› beyan›: D.G..; F.S.D. ve D.Y.: yok. Declaration of interest: D.G..; F.S.D. and D.Y.: none