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Alternative Management of
Tinnitus by Michael D. Seidman, M.D., F.A.C.S.,
Dept of Otolaryngology-Head
and Neck Surgery, Co-Chair of the Complementary/Alternative Initiative, Medical
Director-Tinnitus Center, Henry Ford Health System, 6777 W. Maple Rd., W.
Bloomfield, MI 48323, Office: 248-661-7211, Lab: 313-876-1016, E-mail:
Mseidlmjk@aol.com
Complementary and alternative
medicine (CAM) practices are diverse. They represent a potpourri of
interventions that vary based upon the culture and background of their
community of origin. Acupuncture is considered mainstream in Asian countries
but is clearly considered alternative in the U.S. Similarly, herbal medicine is
practiced widely in Europe, Pakistan, and India while its use in America is
limited. Thus, what is considered alternative here is often mainstream or the
primary therapy in other parts of the world.
There is an astounding increase
in both use and acceptance of complementary and alternative medicine by the
American population. According to the Journal of the American Medical
Association, 40% of people in the U.S. have used some form of alternative
therapy. However, it is estimated that more than 70% of Americans who use CAM
do not tell their conventional physicians that they do. This probably has many
derivatives including the fact that most physicians in the U.S. tend to
distrust these forms of intervention. Since most physicians do not have much
experience with alternative therapies, their opinions are not usually based on
first-hand knowledge. I believe that skepticism is healthy and prudent. I also
believe that as physicians we must be willing to consider all types of medical
management B
complementary and alternative included B
for the health and wellness of our patients.
The alternative therapies
presented below represent additional avenues of therapy to try in the pursuit
of relief from the often intolerable symptom of tinnitus.
Part I B Vitamin and Mineral
Therapies
Because there is not one cause
of tinnitus, there is likely not one cure. However, it is considered imperative
that people with tinnitus adhere to an excellent diet based on all food groups
and that they reduce or eliminate their use of caffeine, alcohol, salt and
simple sugars.
There are also many specific
nutrients that have been suggested to benefit tinnitus patients. The leading
vitamin candidates are the B-complex supplements. Deficiency in these vitamins
has been shown to result in tinnitus. By adding these vitamins to the diet, it
is possible that the tinnitus can be treated.
Since there is no hard science
about dosages for tinnitus relief, the dosages stated throughout this article
are suggestions only. The recommended length of time to try these therapies is
3-6 months.
B Vitamins
Most B-complex vitamins cannot
be stored in the body and must be replaced daily from food sources or
supplements. B vitamins help maintain healthy skin, eyes, muscle tone, and
support the functions of the liver and central nervous system. They are also
extremely important in helping to deal with depression, stress, and anxiety.
The variety of B vitamins are normally taken together, but occasionally one B
vitamin is used to treat a particular disorder. Deficiency in B vitamins can
result in weakness, low blood counts, skin and hair problems, nervousness, poor
night vision, tinnitus, and hearing loss.1
Vitamin B-complex supplements
appear to be effective in some patients with tinnitus by providing a
stabilizing effect on the nerves. Only anecdotal evidence is available
regarding this treatment method.
Vitamin B-1 (Thiamine)
The Recommended Dietary
Allowance (RDA) for B-1 is 1.5 mg per day. Some patients have noted that
Vitamin B-1 supplements relieve their tinnitus. The mechanism of action seems
to be via a stabilization of the nervous system, especially in the inner ear.
Daily dosages ranging from 100 to 500 mg have been used.
Vitamin B-3 (Niacin,
niacinamide, nicotinic acid)
Vitamin B-3 is essential for the
proper breakdown of carbohydrates, fats, and proteins. Vitamin B-3 also
supports circulation, healthy skin, and aids in the functioning of the central
nervous system.
Niacin, at any dose, can result
in a flush or pins-and-needles-like sensation, a natural reaction that is
harmless, but that can be uncomfortable. A non-flush form of niacin exists that
is better tolerated by some patients. However, patients who use the non-flush
form of niacin have a greater incidence of liver problems so I usually do not
recommend it.
There is no accepted standard
niacin dosing for tinnitus. Typically, though, I recommend beginning at 50 mg
twice per day. If there is no improvement after two weeks, the dose is
increased by 50 mg at each interval to a maximum dose of 500 mg twice per day.
If there is no appreciable response in 3-4 months, then it is not likely that
niacin will be of benefit. Higher doses can be used, but the patient is advised
to have liver function tests. (Doses exceeding 1000 mg per day can cause liver
toxicity.) High amounts should be used with caution by those who are pregnant
and those who have stomach ulcers, gout, glaucoma, diabetes, and liver disease.
There is no clinical proof for
the effectiveness of niacin in treating tinnitus. However, there are numerous
anecdotal reports of response to niacin to treat tinnitus.2,3
There may be some correlation
between the decline in vitamin B-12 levels and the increasing prevalence of
tinnitus in the elderly. Also, a study by Shemesh, et al., showed a high
prevalence (47%) of vitamin B-12 deficiency in patients with chronic tinnitus.
This deficiency was more widespread and severe in the tinnitus group that was
associated with noise exposure. This suggests a relationship between vitamin
B-12 deficiency and dysfunction of the auditory pathway. Supplemental cobalamin
was found to provide some relief in several patients with severe tinnitus.4
The RDA for vitamin B-12 is 2
micrograms for adults, 2.2 micrograms for pregnant women, and 2.6 micrograms
for nursing mothers.5 Because B-12 is poorly absorbed when consumed,
a suggested daily dose is 1000 mcg. Vitamin B-12 is better absorbed if it is
dissolved under the tongue, and best absorbed if it is given by injection.
Vitamin B-6 (pyridoxine)
Vitamin B-6 is water soluble and
cannot be stored in the body. It is involved in the breakdown of carbohydrates,
fats, and proteins and in the manufacturing of hormones, red blood cells, and
enzymes. Vitamin B-6 is also required for the production of serotonin, a brain
neurotransmitter that controls our moods, appetite, sleep patterns, and
sensitivity to pain.3
Supplemental vitamin B-6 is used
as a treatment for nausea, morning sickness, depression, and tinnitus. Foods
that are highest in vitamin B-6 include brewers yeast, carrots, chicken, eggs,
fish, avocados, bananas, and whole grains. The RDA for vitamin B-6 is 2 mg per
day, but most B-complex formulas contain between 10 to 100 mg of it.
Vitamin B-6 is one of the few
vitamins that can be toxic. Doses up to 500 mg per day are uncommon but safe.
However, doses above 2000 mg per day can lead to irreversible neurological
damage.
Folic Acid (folate)
Folic acid is a water soluble
nutrient belonging to the B-complex family that seems to have a stabilization
effect on the nervous system. This might explain the anecdotal evidence regarding
the supplementation of folic acid in certain patients to alleviate their
tinnitus. The dosages range from 400 to 800 mcg per day and usually required
two to four months to achieve results.6
Zinc
Zinc is a mineral involved in
the function of more than 100 important enzymes. Mild deficiency causes growth
retardation in children. More severe deficiency is associated with growth
arrest, infertility, poor wound healing, behavioral changes, taste and smell
disorders, and tinnitus.
Studies have shown a high
content of zinc in the inner ear. This finding prompts speculation on the role
of zinc in inner ear function. A correlation between low zinc levels and
tinnitus has been reported.7 In an uncontrolled trial by Gersdorff
et al., zinc given in doses ranging from 10 to 25 mg was found to reduce
tinnitus.8 (The RDA of zinc in adults is 15 mg per day.) Ochi, et
al., demonstrated that patients suffering from tinnitus had a significant
decrease in zinc levels, and that supplementation with doses of 34-68 mg of
zinc over two weeks significantly decreased tinnitus. Excellent results were
also found with combining niacin with 25 mg zinc gluconate twice a day.7
If the tinnitus was of a recent onset, complete resolution was possible. Zinc
therapy, when prescribed in high doses (90-150 mg per day), is often
accompanied by blood tests to monitor copper levels. Copper and zinc compete
for absorption, so chronic ingestion of zinc may result in a copper deficiency.
Calcium
Calcium supplementation has been
shown to improve tinnitus symptoms in certain patients. In conjunction with
magnesium, calcium also plays a vital role in the regulation of electrical
impulses in the central nervous system. Some patients have experienced
improvement in their tinnitus after starting a regimen of vitamin and nutrient
supplementation that included calcium.9 Dosages ranged from 1000 to
1500 mg per day for several months.
Magnesium
Magnesium is essential for the
function of enzymes and is critical for cell development. This mineral is also
required for nerve conduction and transport of small molecules across the cell;
deficiency could result in a variety of abnormalities and medical problems,
including tinnitus.10
In a study by Attias, et al.,
300 young healthy male military trainees were repeatedly exposed to high levels
of noise. Each recruit received either 167 mg of magnesium or a placebo daily.
Permanent hearing loss was significantly more frequent and more severe in the
placebo group than in the magnesium group.
People in large cities are
exposed to potentially damaging loud noise on a daily basis. Studies have shown
that noise exposure causes magnesium to be excreted from the body. It is
possible that supplementing with magnesium could reduce noise-induced ear
damage and thus reduce the likelihood of new onset tinnitus. Few studies have
documented that magnesium relieves tinnitus symptoms, but many patients have
experienced relief with this method. A suggested dose is 250-1000 mg per day.
Manganese
Manganese is a mineral that
supports the immune system, regulates blood sugar levels, and is involved in
the production of energy and bone growth.
The RDA for
manganese is 2 mg per day. Since the average daily intake of manganese from
food sources is 2-9 mg, deficiencies of this mineral are relatively unusual.
Foods high in manganese include avocados, blueberries, nuts and seeds, egg
yolks, whole grains, legumes, and green leafy vegetables. Anecdotal evidence
has shown a reduction of tinnitus in certain patients after supplementation
with manganese.2,9
Dr. Seidman's article will conclude in
the next issue of Tinnitus Today with AAlternative
Management of Tinnitus, Part II B
Herbal Remedies.@
REFERENCES
1. Delva M: Vitamin B12
Replacement: To B12 or not to B12? Canadian Family Physician 1997; 43:
917-922.
2. Tolonen M, Vitamins and
Minerals in Health and Nutrition. E Horwood: New York, 1992.
3. Sheehy T, editor: Vitamin
Deficiency and Toxicity. Medcom, Garden Grove, CA, 1985.
4. Shemesh Z, Attias J, Ornan M:
Vitamin B12 Deficiency in Patients with Chronic Tinnitus and Noise-Induced
Hearing Loss. American Journal of Otolaryngology 1993; 14: 94-99.
5. National Research Council
(U.S.): Subcommittee on the Eleventh Edition of Recommended Dietary Allowances.
National Academy Press, Washington, D.C., 1997.
6. Balch J, Balch P: Prescription
for Nutritional Healing. 2nd Edition, Balch Publishing, 1997.
7. Ochi K, Ohashi T, Kinoshita
H: Serum Zinc Levels in Patients with Tinnitus and the Effect of Zinc
Treatment. Journal of the Oto-Rhino-Laryngological Society of Japan
1997; 100 (9): 915-9.
8. Paaske P, Kjems G, Pedersen
C: Zinc in the Management of Tinnitus. Annals of Otol Rhinol Laryngol
1991; 100: 647-649.
9. Letter to the Editor. Tinnitus
Today. p. 6, Sept. 1997, June 1999.
10. Attias J, Weisa, G, Almog S, Shahar A, Wiener M, et al:
Oral Magnesium intake reduced permanent hearing loss induced by noise exposure.
Am J Otolaryngology 1994; 15: 26-32.
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