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Alternative Management of Tinnitus

Part II B Herbal Remedies

by Michael Seidman, M.D.,FACS, 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

 

For more than two thousand years, herbs have been employed in the treatment of medical conditions.1 Combinations of Chinese herbs, exotic fruits, plant roots, and seed oils have been effective in the treatment of many medical disorders. What most of these herbal treatment regimens lack is solid medical evidence derived from double-blind research studies. This form of experimentation which would legitimize the use of these non-conventional treatments. However, to the patient whose conventional treatments have met with failure, anecdotal stories of effective treatments are often proof enough to justify the use of an alternative intervention.

 

I encourage you to keep your doctors advised about your use of herbal treatments, and to heed your doctor=s advice should he or she offer it. Remember that herbs can act on the body=s systems (which is why we take them!), and that they can interact with other herbs and with other drugs.

 

Ginkgo Biloba

Ginkgo biloba leaves have been used therapeutically for centuries by the Chinese for the treatment of asthma and bronchitis. Ginkgo biloba was believed at one time to have magical powers. Today, many feel that ginkgo has a legitimate medicinal role. The active ingredient has been isolated as EGB 761 and there have been many studies related to the effectiveness with a variety of medical disorders. It has been shown to increase circulation throughout the body. Numerous studies have shown the effectiveness of ginkgo on relieving leg cramping, decreased circulation to the brain, and symptoms of tinnitus.2 Typical dosages range from 120-160mg per day, divided equally at mealtime. In Western countries, a standardized 50:1 concentrate of 24% ginkgoflavonoids is used, either in liquid or capsule form. Many studies showed that between 30-70% of subjects had reduced symptoms over a 6-12 week period. No serious side effects were observed for either group.

 

In terms of tinnitus, a study by Hobbs in 1986 proved the statistical significance of the effectiveness of treatment with ginkgo extract for tinnitus: the ringing completely disappeared in 35% of the patients tested, with a distinct improvement in 70 days.3 Similarly, when 350 patients with hearing loss and tinnitus due to advanced age were treated with ginkgo extract, the success rate for improved hearing and in many cases improved tinnitus was 82%.


 

Opinions differ as to the efficacy of this herbal remedy. While some people with tinnitus swear by Ginkgo biloba, others claim that it has no effect on their symptoms. We had hoped that the question of the true value of this agent would be answered conclusively last year when the results of the first large-scale double-blind randomized ginkgo study were published. (One thousand tinnitus patients participated in this study at Birmingham University in the U.K.) But the results were not decisive. Despite the inconclusive outcome of the study, many people with tinnitus believe that ginkgo improves their symptoms and will likely continue to use it.

 

Published studies have shown that 120 to 240 mg a day of pharmaceutical-grade ginkgo extract can alleviate tinnitus.2,4 The most recent human study showed that, in patients suffering from reduced blood supply to the brain, ginkgo extract produced a significant improvement in symptoms of vertigo, tinnitus, headache, and forgetfulness.5 The German Commission E, considered an authoritative reference on the medicinal use of herbs, rates ginkgo as Apositive@ and recommends 240 mg twice per day for tinnitus and vertigo.4

 

One of the appealing aspects of Ginkgo biloba with regard to the treatment of tinnitus has been the fact that it is relatively inexpensive and has negligible side effects, such as increase risk for nose bleeds. However, there was one report of a woman who, after using ginkgo for two years, developed a hemorrhage in the brain. When she discontinued taking ginkgo, the bleeding subsided. It was not possible to prove if ginkgo was the cause. It is generally advised to not take ginkgo with other blood thinning medications like coumadin or heparin. Some also advocate care when mixing aspirin with ginkgo, although the likelihood of problems is low.

 

All herbal preparations are not the same. It is clear that some of the less expensive brands of ginkgo are less effective and produce more gastrointestinal upset. When patients who were taking the less expensive brands changed to more respected brands, their gastrointestinal side effects improved and their response was typically better.

 

Black Cohosh

The popular herb, black cohosh (Cimicifuga racemosa), has an extensive history of safe use by Native Americans who revered it as a remedy for a host of common ailments including fatigue, neuralgia, rheumatism, sore throat, asthma, bronchial spasms, bronchitis, and whooping cough.6,7 Black cohosh has been used for centuries by women to stimulate menstrual flow, ease the strains of childbirth, and confer relief from pre-menstrual syndrome and menopause. With its mildly sedative and relaxing effect, black cohosh is used also to treat anxiety, nervousness, and chronic tinnitus. Some patients have reported improvement in their tinnitus while using this herbal preparation.

 

There are few known health concerns regarding black cohosh, but consuming large amounts (5 grams per day) are known to cause dizziness, vomiting, lowered blood pressure, and limb pain. Black cohosh has traditionally been used to calm the nervous system. It is theorized that it might improve cerebral blood flow, providing relief from tinnitus in some patients. The recommended dosage of black cohosh for tinnitus is 20 to 40 mg per day in liquid or powder form.

 


Ligustrum

Ligustrum (ligustrum lucidum) has been advocated by traditional herbalists for the management of tinnitus. Classically, it is considered a powerful liver and kidney protectant and supports adrenal function. Additional teachings suggest that it can be used for premature graying, back pain, dizziness, and tinnitus. The recommended dosage is 400 mg three times per day. There are no known side effects with the use of this herb in the specified dosage.

 

Mullein

Mullein (Verbascum Densiflorum) has a long history in herbal medicine. Its botanical family name Scrophulariaceae is derived from scrofula, an old term for chronically swollen lymph glands, later identified as a form of tuberculosis. Early on, this herb gained reputation as a respiratory remedy. Physicians from India to England touted it as a treatment for coughs and chest congestion, earaches, and tinnitus.6

 

There has been little real research on mullein itself, and even less study into its treatment of tinnitus. However, some patients with severe tinnitus claim that it is very valuable. Mullein seems to have a slight diuretic effect and may alleviate inflammation thereby stabilizing the nervous system.

 

The dosage reported to provide relief from tinnitus is 3 to 4 grams per day. There have been no reports of mullein causing adverse effects, except for mild irritation of the skin when in contact with the living plant.7 (This herb is also available as a tea.)

 

Pulsatilla

Although it is recommended for certain diseases of the eyes, ears, and upper respiratory tract, and is used routinely in homoeopathy, Anemone pulsatilla has been considered somewhat dangerous as the plant itself is poisonous.1 The chief action of this medicine is a depressant on the circulatory, respiratory, and nervous systems. An overdose of this herb may cause slow heart rate and respiration, decreased temperature, paralysis, and death. Extended skin contact can lead to blister formation.

 

The much lowered dose (in tincture form) of A.pulsatilla is beneficial in relief of headaches and neuralgia, and as a remedy for exhaustion in women. Herbalists have used this tincture for years for the treatment of tinnitus and have shown anecdotal success.3

 

Lycium Fruit

Lycium fruit (Lycium barbarum or Lycium chinense) has been used effectively in the treatment of tinnitus, night blindness, dizziness, and blurred vision. This herb is also used to treat coughs, diabetes, back pain, impotence, and nocturnal emission.4 Consult with a herbalist for dosages.

 

Cornus


Cornus (Cornus officinalis) is an example of an alternative therapeutic intervention, which alone does not seem to relieve the symptoms of tinnitus, but when used in combination with Chinese fox glove root and Chinese yam proves to be effective in the treatment of tinnitus, low-back pain, and urinary frequency.8 Preparation of this combination should be done by an herbalist or naturopathic physician. Chinese herbalists advise against the usage of cornus in combination with several other herbs, including platycodon, siler, and stephania. Exercise caution when combining cornus with fox glove. The heart medication digitalis is a direct derivative of fox glove.

 

Cuscuta

The active ingredients of Cuscuta chinensis medication can be found in grayish yellow seeds also known as Chinese dodder seeds. Cuscuta seeds are used alone and in combination with astragalus seeds (Astragalus complanatus), in the treatment of tinnitus, dizziness, and blurred vision.8

 

Foxglove Root

Chinese foxglove root (Rehmannia glutinosa) is used in the treatment of many illusive medical conditions. This drug (which is prepared by being cooked in wine) has been effective in treating tinnitus, lightheadedness, hearing loss, palpitations, blurred vision, constipation, and insomnia.1 The cooked preparation is recommended over the raw version for the treatment of tinnitus. Consult a Chinese medicine practitioner regarding dosages and combining Chinese foxglove root with other herbal remedies.

 

The cooked Chinese foxglove root can distend the abdomen, and has been associated with loose stools. Consequently, those with digestive problems should use this medication with caution. Caution must always be used with the preparation of foxglove, which is the origin of digitalis, as it can affect the heart.

 

Alisma

Alisma (Alisma plantago-aquatica) is a plant that has long been prescribed as a diuretic for weak, elderly patients who cannot tolerate the effects of the stronger conventional diuretics. This powdery, white plant is used in the treatment of tinnitus, dizziness, edema, diarrhea, and dysentery. If you use this medication in the treatment of tinnitus, discuss specific dosages and combinations with a Chinese pharmacist or naturopathic doctor. No health hazards are known in conjunction with proper administration of designated therapeutic dosages.6

 

St. John=s Wort, Valerian Root and Kava Kava

Although none of these herbs are routinely considered for the treatment of tinnitus, they are worthy of mention. I have had two patients who noted significant improvement of their tinnitus after using St. John's wort for three to four weeks. Two patients had improvement after several days= use of Valerian root or Kava.

 


St. John's wort (hypericum perforatum) has been used for mild to moderate depression, viral infections, and for wound healing. It functions as an antidepressant and should not be used in conjunction with monoamine oxidase inhibitors, antidepressants, or anti-seizure medications, nor should it be taken while pregnant. The primary side effect is photosensitivity (one needs to avoid being in the sun). The recommended dosage is 300 mg three times a day with food.

 

Valerian root (valeriana officinalis) has been used primarily for its ability to promote sleep. The effects of valerian root are similar to those of some anti-anxiety drugs. Therefore, it should not be combined with other anxiolytics, sedatives, or antidepressants. The primary side effects are drowsiness, withdrawal symptoms like increased heart rate and breathing, and cardiac complications in patients taking very high doses (530mg - 2g up to 5 times daily) for many years. The recommended dosage: fluid extract 1-3 ml, tablets 150 - 300mg 30 minutes prior to sleep.

 

Kava kava (piper methysticum) is also an anti-anxiety drug and helps with insomnia. In high doses it promotes sleep and can be used as a muscle relaxant. Kava should not be used in patients with depression or during pregnancy or lactation. Additionally, it should not be used for more than three months continuously without medical advice. The primary side effects are drowsiness, balance disturbances, and mild gastrointestinal upset. It should not be taken simultaneously with central nervous system depressants such as alcohol, benzodiazepines or anti-psychotics. The usual dosage is 60-120 mg kavalactones daily.

 

Conclusion

Tinnitus is a significant medical problem affecting 40-50 million Americans, with 12 million being severely affected. Once a thorough evaluation has been performed by a qualified otolaryngologist, and no life-threatening condition has been identified, the opportunity for treatment still exists. Treatment options are extensive and range from approved protocols such as masking and TRT to anecdotal remedies such as those presented here. While tinnitus may not miraculously disappear with any of these therapies, many of these options can help to make the tinnitus more manageable.

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