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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 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 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 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 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.@



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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