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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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