Tehran University of Medical Sciences Auditory and Vestibular Research 2423-480X 23 6 2017 07 31 45 56 Vahid Moradi Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Iran Mansoureh Adel Ghahraman Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Iran Akram Pourbakht Department of Audiology, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran Soufia Naghdi Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Iran Shohreh Jalaie Biostatistics, School of Rehabilitation, Tehran University of Medical Sciences, Iran 2017 05 15 Background and Aim: Creatine plays an important role in the regulation of cellular energy in high energy demand organs such as the inner ear. It is also believed to play a protective role. This article reviewed the mechanisms and effects of creatine on the auditory and vestibular systems. Recent Findings: Creatine transporters and creatine kinase enzymes are involved in converting creatine to creatine phosphate. Phosphate is a fuel cell available in the cochlear and vestibular hair cells and the protective cells, striavascularis, peripheral and central neural pathways to the auditory cortex. It provides essential ATP for auditory and vestibular system performance. Creatine kinase prevents cochlear damage by regulating the metabolism of energy in marginal layers of the striavascularis and preventing free radical production in stressful situations. It also plays an important role in vestibular compensation. Creatine kinase dysfunction leads to an increase in the threshold of auditory brainstem potentials and a reduction in vestibular performance. The use of creatine improves vestibular evoked myogenic potentials and neurologic symptoms. Conclusion: Creatine and creatine kinase protein is essential for normal hearing and balance function and sensitivity. Creatine kinase deficiency impairs the functioning of these two systems; however, creatine consumption may boost the sensitivity of the vestibular system and neurological performance. Effects of the creatine consumption on the auditory system have not yet been examined. https://avr.tums.ac.ir/index.php/avr/article/view/204