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Tinnitus: from the Latin word tinnire meaning to ring
Tinnitus is
a subjective disorder characterized as chronic ringing, roaring,
buzzing, humming, chirping, or hissing in the ears in the absence of
environmental noise (ATA 2002). Symptoms of tinnitus are frequently
found in elderly persons and are often associated with hearing loss
related to the aging process (presbycusis). Although the cause is
usually unknown, tinnitus can be a symptom of almost any ear disorder,
including infection (otitis media), a blocked ear canal (ear wax) or
eustachian tube, otosclerosis (overgrowth of bone in the middle ear),
labyrinthitis, and Meniere's disease. Even blast injury from explosions
has been known to cause symptoms of tinnitus. Additionally, adverse
side effects from some drugs (e.g., aspirin and antibiotics) cause
tinnitus symptoms.
Sometimes tinnitus is called "head noise." In tinnitus, the acoustic
nerve transmits impulses to the brain that are not the result of
vibrations produced by sound waves. Instead the impulses are the result
of stimuli that originate inside the head or within the ear. In healthy
ears, thousands of auditory cells maintain an electrical charge. There
are microscopic hairs on the surface of each auditory cell that move in
relation to the pressure of sound waves. Movement of the hairs
discharges electrical charges through the hearing nerve to the brain.
The brain interprets these electrical signals as sound. If the hairs
are damaged, they move erratically and are in a constant state of
irritation. As a result, the auditory cells cannot hold their charge
and random electrical impulses flow to the brain as noise (MFMER 2001).
In most persons, the noise of tinnitus is present continuously, even
if the person is not always aware of it. Tinnitus can change in nature
or intensity. Tolerance of tinnitus varies from person to person and is
largely determined by personality. Many people accept tinnitus without
significant distress, but for some the noise is almost intolerable (ATA
2002).
Tinnitus affects 35-50 million persons in the United States, with 12
million people being severely affected (ATA 2002). Tinnitus may
disappear independently or it can disappear when an underlying problem
is successfully treated. In cases of chronic tinnitus for which there
is no treatable underlying problem, a variety of therapies and
suggestions may help to provide substantial relief for persons who
suffer from the symptoms.
DiagnosIS
See a physician to discuss your symptoms: when they began, their
severity, and what seems to make them worse. Be sure to include
information about any health conditions you have (e.g., high blood
pressure) and what medicines you take. First, any accumulation of
earwax or an infection will be eliminated as a possible cause. The
physican will also attempt to hear the noise you describe using a
stethoscope. If noise can be heard from a vascular condition, you have
objective tinnitus. However, if damage to the inner ear is causing your
tinnitus, you will be the only person who can hear the noise
(subjective tinnitus) (MFMER 2001). Your physician may refer you to
other specialists such as an otolaryngologist or audiologist in an
attempt to learn more about the cause of your tinnitus.
TreatmeNT
The treatment of tinnitus depends on the cause. As noted earlier, if
the tinnitus is caused from a health condition, there may be steps your
physician can take to eliminate or reduce the noise: removing earwax,
treating an ear infection, correcting a vascular condition, changing or
discontinuing a medicine, or recommending a hearing aid (MFMER 2001).
If tinnitus is caused by age-related hearing loss or damage to your
ears from exposure to excessive noise, there is no treatment to reduce
the noise (MFMER 2001; NIH 2001). Instead, treatment consists largely
of managing the condition. Not every suggested treatment works for
everyone, so you may need to try several to find one that will help. It
is important to avoid anything that could make your tinnitus worsen,
including smoking, alcohol, and loud noises. If you are a construction
worker, an airport worker, a hunter, or are often exposed to loud noise
at home or at work, you should wear ear plugs or special ear protection
(muffs) to protect your hearing (NIH 2001).
Lifestyle Changes
Sometimes
symptoms of tinnitus improve with time. However, many people must learn
to make adjustments to their lifestyle (coping skills) (MFMER 2001; NIH
2001). Try some of these techniques to help reduce the severity of
tinnitus and to increase your tolerance of it:
- Avoid irritants.
Tinnitus can be aggravated by loud noises, nicotine, caffeine, tonic
water containing quinine (used to treat malaria), alcohol, and
excessive doses of aspirin. Nicotine and caffeine constrict blood
vessels, increasing the force of blood through veins and arteries.
Alcohol also increases the force of blood by increasing the speed of
blood flow.
- Mask or cover up noise.
A fan or soft music can help mask the noise of tinnitus. Tinnitus
maskers are devices that are similar to hearing aids in appearance, but
they produce a pleasant sound. Listening to recordings of soothing
music or sounds such as ocean waves may help cover the unwanted noise,
especially while sleeping. There are some electronic sound devices that
provide several relaxing sounds to facilitate sleep by masking
tinnitus.
- Use a hearing aid.
If you have tinnitus that is accompanied by a loss of hearing, a
hearing aid can amplify outside sounds and possibly make tinnitus noise
less noticeable.
- Reduce stress.
Stress seems to make tinnitus worse. Learn how to relax when the noise
in your ears is frustrating. Practicing stress management (relaxation
therapy, biofeedback, or exercise) may provide some relief. Engaging in
regular exercise may also provide relief by increasing blood
circulation to the head.
- Reduce use of salt. This can increase the buildup of fluid in the ear.
Dietary Supplements
Ginkgo Biloba
A
plant extract used to reduce the symptoms of cognitive deficits such as
decreased memory function, poor concentration, and reduced alertness,
ginkgo biloba has been shown to have positive results in the treatment
of tinnitus and dizziness in the scientific literature (Stange et al.
1975; Jung et al. 1998). Studies have shown that 120-240 mg a day of
pharmaceutical-grade ginkgo biloba extract can alleviate tinnitus,
although some earlier studies failed to show benefits (Burschka et al.
2001). The therapeutic effect of ginkgo biloba is attributed to several
active constituents with vasoactive and free-radical-scavenging
properties.
In a study conducted in Denmark, tinnitus and dizziness were reduced
after a treatment of 4-6 weeks with ginkgo biloba. Researchers also
noted that there were minimal side effects in patients who followed the
recommended dosage (Soholm 1998).
Another controlled study showed that ginkgo extract caused a
statistically significant decrease in behavioral manifestation in the
animal model of tinnitus (Jastreboff et al. 1997). In human studies, it
was shown in patients who had cerebrovascular insufficiency (a common
condition associated with normal aging) that ginkgo extract produced a
significant improvement in the symptoms of vertigo, tinnitus, headache,
and forgetfulness (Holstein 2001; Morgenstern et al. 2002).
Melatonin
Rosenberg
et al. (1998) evaluated a treatment for subjective tinnitus at the Ear
Research Foundation in Sarasota, Florida. Patients were given 3 mg of
melatonin nightly for 30 days. In patients with difficulty sleeping due
to the symptoms of tinnitus, an overall improvement was seen in 46% of
the study group as opposed to 20% in the group given placebo. The
researchers also concluded that patients with bilateral (two-sided)
tinnitus showed significant improvement over those with unilateral
(one-sided) tinnitus. Because of the minimal side effects associated
with melatonin, it is considered a safe alternative treatment for
chronic tinnitus (Rosenberg et al. 1998).
B Vitamins
According
to Michael Seidman, M.D. (Tinnitus Center in Bloomfield, Michigan),
there are specific nutrients that have been suggested to benefit
persons with tinnitus. B-complex supplements lead this category because
deficiencies in the B vitamins have been shown to result in tinnitus.
The B vitamin complex stabilizes nerves and appears to have a
beneficial effect on some tinnitus patients. However, only anecdotal
evidence is available on this therapy.
Some patients say vitamin B1 (thiamine) supplemented at 100-500 mg
daily has provided them with relief from symptoms. Vitamin B3 (niacin)
is the subject of numerous anecdotal reports that purport it to help
reduce symptoms. Dr. Seidman usually recommends a starting dosage of 50
mg twice a day of niacin, up to a maximum of 500 mg twice a day, but he
believes that if there is no improvement within 3-4 months, it is
unlikely to occur.
There may also be some correlation between the decline in vitamin
B12 levels and the increasing prevalence of tinnitus in the elderly. A
study by Shemesh et al. (1993) showed that there was a high prevalence
(47%) of vitamin B12 deficiency in patients with chronic tinnitus. This
deficiency was more widespread and severe in the tinnitus group that
was associated with noise exposure, suggesting a relationship between
vitamin B12 deficiency and dysfunction of the auditory pathway.
Supplemental cobalamin was found to provide some relief in several
patients with severe tinnitus.
Zinc
Studies
have shown that there is a high content of zinc in the inner ear. Ochi
et al. (1997) demonstrated that patients who had tinnitus had
significantly decreased zinc levels and that supplementation with doses
of 34-68 mg of zinc for more than 2 weeks significantly improved their
tinnitus. Excellent results were also found by combining niacin with 25
mg zinc gluconate twice daily.
Magnesium
People
in large cities are exposed to potentially damaging loud noises on a
daily basis. Studies have shown that noise exposure causes magnesium to
be excreted from the body (Mocci et al. 2001). It is possible that
supplementing with magnesium could reduce noise-induced ear damage and
thus reduce the likelihood of new-onset tinnitus. Few studies document
that magnesium relieves tinnitus symptoms, but many patients have
experienced relief by using magnesium (Attias et al. 1994).
Other Supplements
Hydergine,
the ergot derivative, at a dosage level of 10-15 mg daily, has been
shown to alleviate tinnitus in some people. In one study as little as
4.5 mg a day improved tinnitus by 57.1% (Jimenez-Cervantes et al.
1990). Vinpocetine, the cerebral vasodilator, can also be effective at
a dosage of 20-40 mg daily. In one study, after acoustic trauma,
tinnitus was improved 66% by using vinpocetine (Konopka et al. 1997).
SUMMARY
- Obtain a medical workup to rule out other underlying conditions that can cause tinnitus.
- Make the recommended lifestyle changes.
- Ginkgo biloba may improve symptoms of tinnitus along with other cerebrovascular symptoms, 120-240 mg daily.
- Melatonin may relieve symptoms and will help induce sleep, 300-6000 mcg each night for sleep and for symptom relief.
- The B vitamins have been shown to be deficient in some people with tinnitus. Consider taking:
- Vitamin B1 (thiamin), 100-500 mg daily
- Vitamin B3 (niacin), starting
dosage of 50 mg twice daily, up to a maximum of 500 mg twice a day,
along with 25 mg of zinc twice daily and 2 mg of copper daily
- Vitamin B12 (methylcobalamin) orally as a lozenge, 5-20 mg daily or intramuscularly as advised by a physician 2 times a week
- Vinpocetine may improve blood flow and increase oxygen and glucose to the brain, 20-40 mg daily.
- Magnesium may help noise-induced ear damage, 500-1000 mg of elemental magnesium daily
- Hydergine, a medication prescribed for memory loss may improve symptoms, 10-15 mg daily
For more informatiON
Contact the American Tinnitus Association, P.O. Box 5, Portland, OR 97207; (503) 248-9985.
Product availabiliTY
Ginkgo biloba extract; melatonin; vitamins B1, B3, and B12 (methylcobalamin); vinpocetine; magnesium citrate; zinc; and copper
are available by calling (800) 544-4440 or by ordering online.
Hydergine is available to Americans for personal use from offshore
suppliers. Contact the Foundation for a listing. |
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