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Tinnitus

Tinnitus

Description

Tinnitus

Or ringing in the ears is an extremely common symptom in adults, particularly in the elderly. As well as a ringing sound an individual may perceive buzzing, roaring, whistling or hissing sounds. Tinnitus may be intermittent or continuous depending on the cause.

Meniere's disease

Is a result of dilation of the membranous labyrinth of the inner ear. It is much more common in males than in females. It usually involves only one ear and is characterized by vertigo (dizziness) lasting anywhere from a few hours to a full day. The vertigo is often accompanied by tinnitus, deafness, nausea and vomiting. In the early stages symptoms may be quite mild, as the disease progresses symptoms get much worse. The tinnitus may be constant or intermittent, and may be worse before, after, or during an attack of vertigo.

Treatment of tinnitus is directed toward the underlying disease (see causes). In Meniere's disease, conservative treatment involves the use of a salt-free diet, ammonium chloride (1-2 grams 4 times daily) and nicotinic acid (50-150 mg 4 times daily). More aggressive therapy involves the use of a variety of drugs (anticholinergics, dramamine, barbiturates, etc.) or surgery on the labyrinth or vestibular nerve in severe cases.

Causes

Tinnitus
May occur as a symptom of nearly all ear disorders, including obstruction of the external auditory canal due to cerumen and foreign bodies; infectious processes involving the outer, inner, or middle ear; eustachian tube obstruction; allergies; otosclerosis (hardening of the ear drum); noise-induced hearing loss; trauma; and Meniere's disease. Tinnitus may also be associated with systemic conditions such as hypertension, atherosclerosis, anemia and hypothyroidism or be a result of exposure or consumption of heavy metals, carbon monoxide, aspirin, certain diuretics, certain antibiotics, quinine and ethanol.

Low frequency vibratory clicks, pops, roarings, etc., are usually due to contraction of muscles of the eustachian tube, middle ear, palate or pharynx.

Allergies, including food allergies, have been implicated as a cause of Meniere's disease. Allergies can cause fluid retention in the labyrinth which may lead to the characteristic dilation of the membranous labyrinth observed in Meniere's disease.

Signs & Symptoms

A ringing, buzzing, whistling, roaring, or hissing sound heard in the absence of an acoustic stimulus.

Nutritional Supplements

Structure & Function: Immune System Support

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General Supplements
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Calcium*
Coenzyme Q10*
Hydroxyethylrutoside**
Magnesium*
Niacin50-150 mg.
Vitamin A10,000 - 25,000 iu
Vitamin B-625-100 mg.
Vitamin E400 iu




** A bioflavonoid, related to rutin.

Note:

All amounts are in addition to those supplements having a Recommended Dietary Allowance (RDA). Due to individual needs, one must always be aware of a possible undetermined effect when taking nutritional supplements. If any disturbances from the use of a particular supplement should occur, stop its use immediately and seek the care of a qualified health care professional.

Discussion:

Niacin increases circulation to the ear. (Mitchell)

References:

Mitchell, W & Batchelder, HJ: Naturopathic specific condition review: Tinnitus. The Protocol J. of Botanical Medicine, 2(1):168-171.


Dietary Considerations


Rule out allergy/sensitivity

Elimination of food allergies may prove quite beneficial for some individuals. Therefore an Elimination Diet is recommended.


Rule out aluminum toxicity


Reduce fat and cholesterol

Avoid sugar

Restrict sodium

A sodium restricted diet is a widely used treatment for Meniere's disease presumably in an attempt to reduce the edema (swelling) in the membranous labyrinth.

Mild Sodium Restriction Diet
Moderate Sodium Restriction Diet, or
Severe Sodium Restriction Diet



Treatment of the underlying condition/s ( e.g. anemia, atherosclerosis, carbon monoxide poisoning, heavy metal toxicity, hypertension, hypothyroidism, etc. ) may involve supplementation with additional nutrients. Please see appropriate condition for supplementation program.

Homeopathic Remedy

There are over 100 remedies for tinnitus.

1. Antipyrinum- 30C or try 30X long term
2. Salicidum acidum - 30C
3. Carboneum sulphuratum - 30C

Tinnitus (Meniere's)

1. Chenopodium anthelminticum - buzzing, high-frequency better - 3X to 30C
2. Natrum salicylicum - 30C low-tone, vertigo, deafness
3. Calcarea fluorica tinct. - 12X to 15C

Treatment Schedule

Doses cited are to be administered on a 3X daily schedule, unless otherwise indicated. Dose usually continued for 2 weeks. Liquid preparations usually use 8-10 drops per dose. Solid preps are usually 3 pellets per dose. Children use 1/2 dose.

Legend

X = 1 to 10 dilution - weak (triturition)
C = 1 to 100 dilution - weak (potency)
M = 1 to 1 million dilution (very strong)
X or C underlined means it is most useful potency

Asterisk (*) = Primary remedy. Means most necessary remedy. There may be more than one remedy - if so, use all of them.

References
Boericke, D.E., 1988. Homeopathic Materia Medica.

Coulter, C.R., 1986. Portraits of Homeopathic Medicines.

Kent, J.T., 1989. Repertory of the Homeopathic Materia Medica.

Koehler, G., 1989. Handbook of Homeopathy.

Shingale, J.N., 1992. Bedside Prescriber.

Smith, Trevor, 1989. Homeopathic Medicine.

Ullman, Dana, 1991. The One Minute (or so) Healer.

Herbal Approaches

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Herbs
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Black cohosh
Ginkgo
Goldenseal
Gotu kola
Oregon grape root

Note: The misdirected use of an herb can produce severely adverse effects, especially in combination with prescription drugs. This Herbal information is for educational purposes and is not intended as a replacement for medical advice.

Discussion:

Meniere's disease is a frequent precursor to tinnitus.

Meniere's disease:

Ginkgo may offer considerable benefit for some individuals. Ginkgo biloba extract has shown remarkable effect in alleviating many symptoms common in the elderly including tinnitus and vertigo. These symptoms are quite common in elderly individuals suffering from cerebral vascular insufficiency. It appears to be effective as a vasorelaxant. (40 mg q.i.d.)

Ginkgo biloba leaf extract is uniquely mentioned by the German Commission E for tinnitus.

Ginger is helpful in relieving nausea and vomiting. In one study, ginger was found more effective than dramamine in preventing motion sickness.

Tinnitus

Black cohosh has traditionally been combined with Goldenseal to add its spasmolytic effects to the astringent and antiinflammatory effects of Goldenseal. Because Goldenseal may be endangered, Oregon grape root may be substituted. However, it is not as effective for catarrhal-induced inner ear imbalance. Oregon grape root or Goldenseal have antibacterial action and a special affinity for mucous membranes.

Treatment of the underlying condition (hypertension, atherosclerosis, anemia, hypothyroidism, heavy metal toxicity, carbon monoxide poisoning) may involve the use various herbs. Please see appropriate condition for supplementation program. Ginkgo biloba extract has shown remarkable effect in alleviating many symptoms common in the elderly including tinnitus. (DeFeudis, 1991)

Herbalist David Winston considers Ginkgo particularly indicated when tinnitus results from head injuries, as well as impairments associated with old age e.g. reduced circulation and dizziness. He recommends combining Ginkgo with periwinkle (Vinca minor or Vincamine). Vincamine may improve dizziness.

Gotu kola increases blood circulation in the head. It has a traditional use as a neuroleptic agent which may calm the troublesome effects of tinnitus.

References:

Blumenthal, M (Ed.): The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin, TX. 1998.

Coles, R: Trial of an extract of Ginkgo biloba (EGb 761) for tinnitus and hearing loss. Clin. Otolaryngol. 1988(13):501-504.

DeFeudis, F: Ginkgo biloba Extract (EGb 761): Pharmacological Activities and Clinical Applications. Elsevier, Paris. 1991.

Holgers, K et al., Ginkgo biloba extract for the treatment of tinnitus. Audiology, 1994(33):85-92.

Mitchell, W & Batchelder, HJ: Naturopathic specific condition review: Tinnitus. The Protocol J. of Botanical Medicine, 2(1):168-171.

Winston, D: Eclectic specific condition review: Tinnitus. The Protocol J. of Botanical Medicine, 2(1):174.

Aromatherapy - Essential Oils

Onion Essence.

Related Health Conditions

        Anemia
        Atherosclerosis
        Carbon monoxide poisoning
        Heavy metal toxicity
        Hypothyroidism

Current Abstracts

Alcohol

Chronic tinnitus sufferers (# 100) attending an outpatient clinic completed self-report questionnaires assessing their alcohol consumption and its effect on their tinnitus.

Results showed a mixed effect: 22% reported that drinking worsened tinnitus, 62% reporting no effect and 16% reporting improved tinnitus.

Significantly more units of alcohol were consumed by those sufferers who reported that alcohol improved their tinnitus. However, overall, drinking behaviour was not significantly different to that of the general population.

Pugh R et al., Patients' reports of the effect of alcohol on tinnitus. Br J Audiol, 29(5):279-83 1995 Oct.

Characteristics

A profile of audiological and psychological characteristics, obtained before starting tinnitus management training, is presented for 96 subjects with tinnitus.

A history of headaches, neck or back pain, or balance problems was not related to the ability to cope with tinnitus. The coping strategies used were influenced by the beliefs held about tinnitus, but were not necessarily effective.

No gender differences were found in coping ability or overall stress levels, although there were gender differences on some psychological measures and stress influences.

Subjects who had previously sought assistance differed from those who had not in the complexity of the tinnitus sounds, the level of emotional reaction and the use of coping behaviours.

Dineen R et al., Audiological and psychological characteristics of a group of tinnitus sufferers, prior to tinnitus management training. Br J Audiol, 1997, 31(1):27-38.

Daily life of Meniere patients

Investigated the impact of the symptoms in Meniere's disease on the daily life of patients and analyzed the relationships between the cardinal symptoms and environmental, emotional and activity factors.

Results showed that vertigo, hearing impairment and tinnitus had a strong negative influence on the daily life of patients. 75% of the subjects avoided certain everyday activities, or situations, because of the disease.

Most of the subjects experienced premonitory symptoms of the attacks and 80% reported relations between external factors and vertigo attacks.

Melin L et al., The influence of vertigo, hearing impairment and tinnitus on the daily life of Meniere patients. Scand Audiol, 26(2):69-76 1997

Deafness & HRT

Whilst the oral contraceptive pill (OC) has been implicated on a number of occasions as a cause of sensorineural hearing loss, there are no published reports linking hormone replacement therapy (HRT) to otological symptoms.

A case of sensorineural loss with tinnitus following commencement of HRT is described, followed by a discussion outlining the fundamental differences between the OC and HRT, thus explaining why a vascular etiology is unlikely.

Otological symptoms may be due to the effect of estrogens on electrolyte balance disturbing inner ear function and also a direct effect on the auditory pathways mediated in part by alterations in neurotransmitter receptor concentrations.

Strachan D: Sudden sensorineural deafness and hormone replacement therapy. J Laryngol Otol, 110(12):1148-50 1996 Dec

Electromagnetic stimulation

Determined whether pulsed e-stimulation, applied over the mastoid bone, caused an improvement in the level of tinnitus in long-standing tinnitus sufferers.

At the end of one week of treatment 45% of the patients were improved by the active device, but only 9% by placebo.

Electromagnetic stimulation may be an effective treatment.

Roland NJ et al., Electromagnetic stimulation as a treatment of tinnitus: a pilot study. Clin Otolaryngol, 1993 Aug, 18(4):278-81.

High volume music

Students between 16 and 25 years of age (# 277), were questioned about their hearing behaviour and instructed in the consequences of hearing impairment resulting from listening to loud music. Furthermore audiometrics were offered and there was possibility to measure the loudness of the walkman used.

A majority visited "discos" and/or used walkman.

Over 80% claimed their hearing is good, over 75% knew that loud music can cause damage to hearing. The walkman users suffered more frequently from tinnitus and failed to hear a door bell more often.

After the instruction 75% of the pupils were willing to protect their hearing in future. Eight of 89 pupils had a hearing reduction of up to 40 dB(A). The average sound pressure level of the walkman was 104 dB(A).

Becher S et al., Risk of hearing loss caused by high volume music--presenting an educational concept for preventing hearing loss in adolescents]. Gesundheitswesen, 58(2):91-5 1996 Feb.

Pregnancy

Investigated the presence of tinnitus in pregnancy by postal questionnaire.

Both pregnant and non-pregnant groups were similar in age, previous noise exposure and the presence of ear disease, or operations.

25% of the pregnant women reported tinnitus compared with 11% of controls.

There is significantly increased prevalence of tinnitus in pregnant women compared with a similar non-pregnant control group.

Gurr P et al., Tinnitus in pregnancy. Clin Otolaryngol, 18(4):294-7 1993 Aug

Treatments

Tinnitus is a common problem for which many treatments have been proposed and implemented.

4 groups were obtained: No treatment (n = 24), acupuncture (n = 19), relaxation (n = 13), and other treatments (n = 13).

Clinicians should be aware of the fact that patients may have tried at least 1 treatment when entering the audiology clinic.

Andersson G: Prior treatments in a group of tinnitus sufferers seeking treatment. Psych. Psychosom, 1997, 66(2):107-10.

Update

The study of a disorder such as tinnitus is fraught with difficulties. Tinnitus, like pain, is a subjective symptom. Therefore, it is difficult to measure any improvements in the condition, objectively.

For example, it has been reported that sectioning the VIII cranial nerve does not abolish tinnitus in a majority of patients; therefore, central mechanisms must act to preserve the tinnitus. Finally, we know that tinnitus can occur in a host of conditions other than ototoxicity, aging, and noise exposure, including: migraine headache with auditory aura, temporal lobe seizures, and head injuries.

It is naive to conceptualize that tinnitus has a unitary origin and a unitary "cure".

Seidman MD & Jacobson GP: Update on tinnitus. Otolaryngol Clin North Am, 29(3):455-65 1996 Jun

Vertigo

To characterize otologic causes for vertigo.

The diseases were: Meniere's disease, vestibular schwannoma, benign paroxysmal positional vertigo, vestibular neuritis, sudden deafness, and traumatic vertigo. The prevalence of tinnitus in the study population was 76%.

The most severe forms of vertigo and nausea were found in vestibular neuritis, whereas the most severe case of tinnitus appeared in Meniere's disease.

Of the patients with vestibular schwannoma, 49% had had vertigo.

A linear discrimination analysis using case history classified 90% of the patients into correct groups. The key questions concerned the frequency and duration of vertigo attacks, the duration of hearing loss and vertigo, and the occurrence of head injury.

Neurotologic and audiometric information was of minor value in distinguishing between these six diseases.

Kentala E: Characteristics of six otologic diseases involving vertigo. Am J Otol, 17(6):883-92 1996 Nov

Vitamin B12 Deficiency

Evaluated the incidence of vitamin B12 deficiency in 3 groups of noise exposed subjects (army personnel).

Patients with tinnitus and noise-induced hearing loss exhibited vitamin B12 deficiency, defined as blood levels lesser than or equal to 250 pg/ml, in 47% of the cases.

This was significantly more compared to the noise-induced hearing loss individuals and normal subjects, who exhibited vitamin B12 deficiency in 27% and 19%, respectively.

There is a relationship between vitamin B12 deficiencies and dysfunction of the auditory pathway. There was some improvement in tinnitus and associated complaints in patients who received vitamin B12 replacement therapy.

These patients received 1,000 ugs of vitamin B12 per week until the levels were raised above 350 pg/ml in the blood. Vitamin B12 deficiency was only measured by serum levels of vitamin B12.

"Vitamin B12 Deficiency in Patients With Chronic-Tinnitus and Noise- Induced Hearing Loss", Shemesh, Z et al, American Journal of Otolaryngology, March-April 1993;14(2):94-99.

Well-being

The Health and Nutrition Examination Survey of 1971-75 contains valuable information because it provides unbiased estimates of the state of hearing in the general population.

Examined 3 facets of the subjective aspects of hearing loss: frequent and bothersome tinnitus, ratings of hearing, and general well-being.

The period prevalence of frequent, bothersome tinnitus varied with race and gender (13 to 17%) with higher rates among blacks and females.

The mean air-conduction thresholds (0.5 to 4 kHz) of those reporting frequent and bothersome tinnitus did not exceed 32 dB HL.

There was no clear relationship between audiometric thresholds and well-being.

Cooper JC Jr: Health and Nutrition Examination Survey of 1971-75: Part II. Tinnitus, subjective hearing loss, and well-being. J Am Acad Audiol, 5(1):37-43 1994 Jan.

Zinc,

Patients with tinnitus may require 6 times more zinc than the RDA. Calcium supplemented patients who do not take zinc have decreased zinc levels.

Calcium supplementation may interfere with mobilization of zinc from bone during resorption. Bone retains the largest store of zinc in the body.

Vitamin A is used as an adjunct to zinc at the level of the RDA since it is in very high concentration in the cochlea and sensory receptor cells of the ear.

Reduction of fat, cholesterol and caffeine avoidance, as well as balancing electrolytes, aids in tinnitus treatment. Potassium iodide supplementation has produced and resolved tinnitus symptoms.

Magnesium imbalance may also cause tinnitus and salicylate-free diets have shown benefit in tinnitus.

"Zinc and Diet For Tinnitus", Debartolo, HM., Jr. Clinical Vignette, 1990.

Abstracts

References

Andersson G & Lyttkens L: Acupuncture for tinnitus: time to stop? Scand Audiol, 25(4):273-5. 1996.

Andersson G: Prior treatments in a group of tinnitus sufferers seeking treatment. Psychother Psychosom, 66(2):107-10. 1997

Balle, V. & Linthicum, F.H.: Histologically proven cochlear otosclerosis with pure sensorineural hearing loss. Ann. Otol. Rhin. Laryngol. 1984, 93(2 Pt 1. ): 105-111.
Becher S et al., Risk of hearing loss caused by high volume music--presenting an educational concept for preventing hearing loss in adolescents]. Gesundheitswesen, 58(2):91-5. 1996 Feb.

Berkow R, et al, eds. The Merck Manual, 14th edition. Merck Sharp & Dohme Research Laboratories, Rahway, NJ, 1982, pp1944,1955-6

Brookes, G.B.: Vitamin D deficiency - A new cause of cochlear deafness. J. Laryngol. Otol. 1983, 97(5): 405-420.

Brookes, G.B.: Vitamin D deficiency and otosclerosis. Otol. Head & Neck Surg. 1985, 93(3): 313-321.

Browning, G.G. et al: Blood viscosity as a factor in sensorineural hearing loss. Laryngoscope, 1988, 98(2): 165-169.

Chole, Q.: Vitamin A in the cochlea. Arch. Otol. 1978, 124: 379-382.

Cooper JC Jr: Health and Nutrition Examination Survey of 1971-75: Part II. Tinnitus, subjective hearing loss, and well-being. J Am Acad Audiol, 5(1):37-43. 1994 Jan.

DeBartolo, H. M.: Zinc and Diet For Tinnitus. Clinical Vignette. Am. J. Otol. 1989, 10(3): 256.

Dineen R et al., Audiological and psychological characteristics of a group of tinnitus sufferers, prior to tinnitus management training. Br J Audiol, 31(1):27-38 1997 Feb

Duke, W.W.: Meniere's syndrome caused by allergy. JAMA. 1923, 81: 2179.

Gersdorff, M. et al: A clinical correlation between hypozincemia and tinnitus. Arch. Otorhin. 1987, 244(3): 190-193.

Ikeda, K. et al: The effect of vitamin D deficiency on the cochlear potentials and the perilymphatic ionized calcium concentration of rats. Acta Otol. (Stockh) 1987(Supp 435): 64-72.

Kentala E: Characteristics of six otologic diseases involving vertigo. Am J Otol, 17(6):883-92 1996 Nov

Krumdiek, C.L. 1976. Folic Acid. Present Knowledge In Nutrition, 4th ed. The Nutrition Foundation, New York, Washington.

Laganiere, S. & Fernandes, G.: High peroxidizability of subcellular membrane induced by high fish oil diet is reversed by vitamin E. Clin. Res. 1987, 35: A565.

Lewy A & Fox N: Clinical notes. New instruments and technics. Pyridoxine B6 used in the treatment of vertigo. Arch Otolaryngology Nov, 1947.

Lobel, M.J.: Is hearing loss due to a nutritional deficiency? Arch. Otol. 1951: 515-526.

Lohle, E.: The influence of chronic vitamin A deficiency on human and animal ears. Arch. Otol. 1982, 234: 167-173.

Melin L et al., The influence of vertigo, hearing impairment and tinnitus on the daily life of Meniere patients. Scand Audiol, 26(2):69-76 1997

Mowrey, Daniel B. & D.E. Clayson. Motion sickness, ginger, and psychophysics. Lancet I :655-7, 1982.

Omaye, S. Safety of megavitamin therapy. Advances in experimental Medicine and Biology 177:169-203, 1984.

Petersdorf, R.G. & R.D. Adams. 1983. Harrison's Principles Of Internal Medicine. 10th ed. McGraw Hill Pub Co., New York. 2212 pp.

Powers W.H. Meniere's disease - metabolic and allergic aspects.

Pugh R et al., Patients' reports of the effect of alcohol on tinnitus. Br J Audiol, 29(5):279-83 1995 Oct

Roland NJ et al., Electromagnetic stimulation as a treatment of tinnitus: a pilot study. Clin Otolaryngol, 18(4):278-81 1993 Aug

Romeo, G.: The therapeutic effect of vitamins A and E in neurosensory hearing loss. Acta Vut. Enz. 1985, 7(Supp): 85-92.

Sato, K.: Pharmacokinetics of coenzyme Q10 in recovery of acute sensorineural hearing loss due to hypoxia. Acta Otol. (Stockh) 458 Supp: 95-102.

Seidel SJ: Optivite as a nutritional supplement. ORL Head Neck Nurs, 12(3):21 1994 Summer.

Seidman MD & Jacobson GP: Update on tinnitus. Otolaryngol Clin North Am, 29(3):455-65 1996 Jun

Shambaugh, G.E. Jr.: Zinc: an essential trace element. Clin. Ecology, 1984, 2(4): 203-206.

Shambaugh, G.E. Jr.: Zinc for tinnitus, imbalance and hearing loss in the elderly. Am. J. Otol. 1986, 7(6): 476-477.

Shemesh, Z. et al: Vitamin B12 Deficiency in Patients With Chronic-Tinnitus and Noise- Induced Hearing Loss. American Journal of Otolaryngology, March-April 1993;14(2):94-99.

Sikora, M.A. et al: Diet-induced hyperlipidemia and auditory dysfunction. Acta Otolaryngol. (Stockh) 1986, 192(5-6): 372-381.

Spak, C-J et al: Tissue response of gastric mucosa after ingestion of fluoride. BMJ, 1989, 298: 1,686-1,687.

Spencer, J. Hyperlipoproteinemia and inner ear disease. J. Int. Acad. Metabology, 1975, 4: 38-42.

Spencer, J.T. Jr: Hyperlipoproteinemia, hyperinsulinism and Meniere's disease. South. Med. J. 1981, 74: 1,194-1,197.

Strachan D: Sudden sensorineural deafness and hormone replacement therapy. J Laryngol Otol, 110(12):1148-50 1996 Dec

Sun, A.H.: A preliminary report on combined traditional Chinese and Western medicine in sensorineural hearing loss. An analysis of 108 cases. J. Trad. Chin. Med. 1982, 2:215-22.

Vorberg, G. Ginkgo biloba extract (GBE) - A long-term study of chronic cerebral insufficiency in geriatric patients. Clinical Trials Journal 22:149-157, 1985.

Weille, F.R.: Hypoglycemia in Meniere's disease. Arch. Otol. 1968, 87:129.

Yanick, P.: Holistic applications to ear disorders. J. Int. Acad. Prev. Med. 1983: 24-27.

Yanick, P. & Clark, J.D. (Eds.): Tinnitus and its Management. CC Thomas, Springfield, IL. 1984.

Yanick, P.: Dietary and lifestyle influences on cochlear disorders and biochemical status: a 12 month study. J. App. Nutr. 1988, 40(2): 75-84.