Tinnitus
Tinnitus
Last Section Update: 08/2012
Contributor(s): Shayna Sandhaus, PhD
1 What is Tinnitus?
Tinnitus, which is characterized by persistent “ringing in the ears,” can become a severe obstacle in communicating and interacting with others, contributing to poor quality of life (Roberts 2010; Samson 2001; Peelle 2011; Dalton 2003).
Researchers are still working to understand the process behind tinnitus. One popular hypothesis is when the hair cells (specialized nerve cells that help translate sound waves into interpretable signals for the brain, not to be confused with hair follicles) in the cochlea are damaged, some of the associated neurons partially lose the inhibitory regulation that keeps them from firing when no sound is present. As a result, these neurons send signals that the brain perceives as persistent noise. Supporting this hypothesis is that many people who suffer from tinnitus perceive the “ringing” in their ears to be of the same or similar frequency to their hearing deficits (Roberts 2010).
2 Causes of and Risk Factors for Tinnitus
Although tinnitus can be triggered by a variety of causes, the majority of cases are associated with hearing loss. Consequently, similar processes that lead to hearing loss may also lead to tinnitus; thus, interventions that prevent hearing loss may also prevent tinnitus (Roberts 2010).
Some drugs also have the potential to cause hearing loss or tinnitus because they are ototoxic (ie, toxic to the ear). Examples of ototoxic drugs include high doses of aspirin, some antibiotics, some chemotherapy drugs, and some anti-inflammatory medications (Verdel 2008; Ligezinski 2002; Rybak 2007; Wecker 2004; Puel 2007). For example, high doses of aspirin in the range of 2,000 to 4,000 mg daily can cause tinnitus and hearing loss via peripheral effects on the cochlea and central effects on nerves involved in hearing. These effects usually subside within one to three days of discontinuing aspirin (Stolzberg 2012; McFadden 1984; Carlyon 1993; Day 1989).
3 Therapies for Tinnitus
Behavioral Therapies
Treatment for tinnitus includes behavioral therapies (ie, therapeutic behavior modification). One specialized therapy, known as tinnitus retraining therapy, aims to train the brain to ignore symptoms of tinnitus unless specifically focusing on ringing in the ears. Cognitive-behavioral therapy and biofeedback can also be used to help learn to manage responses of the mind and body to tinnitus, thus allowing people to minimize its effects on their daily lives (Andersson 1995; Dinces 2012; Pantev 2012).
Masking and Electrical Stimulation
Sound-masking devices are commonly used to treat tinnitus. These devices emit low levels of noise designed to help reduce the perception of tinnitus (Vernon 2003). However, it has been seen that masking by itself is not as effective in reducing the severity of tinnitus as some other treatment options, such as relaxation techniques, counseling, and tinnitus retraining (Hobson 2010).
Electrical stimulation of the cochlea, via electrodes placed on parts of the ear, can also provide relief from tinnitus in people who also have hearing loss (Konopka 2001; Dinces 2012).
Neuromodulation
One emerging treatment for tinnitus is neuromodulation, a process that helps correct the “misfiring” or continuous “firing” of neurons in the brain leading to tinnitus. Different methods and devices for this purpose are being researched (University of Nottingham 2012). One of them, called repetitive transcranial magnetic stimulation (rTMS), uses magnetic pulses to modulate brain activity; preliminary results show that it is effective for reducing tinnitus symptoms (De Ridder 2007). Deep brain stimulation, a technique in which electrodes are carefully placed in certain areas of the brain to deliver therapeutic electrical signals, has also been researched as a potential treatment for tinnitus (Cheung 2010). One of the most novel therapies to treat tinnitus is acoustic stimulation. A device used for this treatment has been found to be both safe and effective (Tass 2012) and has the added advantage of being relatively small and portable (University of Nottingham 2012).
Medications
Some drugs have been shown to partially relieve tinnitus or ease emotional distress associated with tinnitus or hearing loss; these include antidepressants, sleep aids, and antipsychotics (Salvi 2009; Belli 2012). However, efficacy has proven inconsistent in trials and more evidence is needed before the best drug strategy can be determined (Darlington 2007; Hoare 2011).
4 Nutrients
Antioxidants
Antioxidants are compounds that have the ability to neutralize damaging reactive oxygen species (ROS). Since ROS are involved in the development and progression of tinnitus, antioxidants represent a promising therapeutic strategy (Sergi 2004; Savastano 2007; Joachims 2003).
Melatonin
Melatonin, a hormone critical for healthy sleep (Wurtman 2012), has powerful antioxidant properties. Melatonin has been tested as a treatment for tinnitus, both in combination with the medication sulpiride (an atypical antipsychotic) and on its own. On its own, melatonin provides relief from tinnitus, especially in people with significant sleep problems (Rosenberg 1998; Megwalu 2006; Reiter 2011). When combined with sulpiride, melatonin reduces the perception of tinnitus by diminishing the activity of dopamine, a chemical in the brain. In one study, sulpiride alone relieved tinnitus in 56% of subjects while melatonin alone reduced tinnitus in 40%. However, when used together, 81% of subjects reported relief from their tinnitus symptoms (Lopez-Gonzalez 2007).
Ginkgo Biloba
Ginkgo biloba, a commonly used herbal supplement, has attracted interest as a means of protecting against hearing loss as well as a treatment for tinnitus. Early animal studies found that when a standardized preparation of Ginkgo biloba extract was given as a supplement to animals, it reduced behavioral manifestations of tinnitus (Jastreboff 1997). This extract, at a dose of 160 mg daily over a 12-week period, was also effective at reducing symptoms in humans (Morgenstern 2002). However, other studies have found negligible or no effect (Hilton 2010; Canis 2011); therefore, more research is needed in this area. Ginkgo biloba may also be effective at preventing hearing loss that causes tinnitus; an animal study found that a Gingko biloba extract was able to reduce drug-induced oxidative damage to hair cells in the cochlea (Yang 2011).
Zinc
Zinc, a mineral involved in many physiological processes (including nervous system function), has antioxidant and anti-inflammatory properties (Frederickson 2000; Prasad 2008). Evidence suggests that inadequate zinc intake may be associated with impaired hearing (Kang 2012). In addition, low levels of zinc correlate with perceived loudness of tinnitus in afflicted individuals (Arda 2003).
Taurine
Studies have found that in some cases, taurine can reverse the biochemical processes behind hearing loss (Liu 2006; Liu 2008a). Other studies have demonstrated that taurine can almost completely eliminate the ringing in the ears associated with tinnitus (Brozoski 2010).
Much of the damage to hearing occurs not in the mechanical parts of the ear, but rather in the nerve cells that convert sound waves into the electrical energy that is perceived in our brains. Like other nerve cells, these so-called “hair cells” depend on the flow of calcium ions into and out of the cell. Taurine helps restore and control normal calcium ion flow in auditory cells (Liu 2006; Liu 2008b).
Taurine improves the hearing ability in animals exposed to drugs like the antibiotic gentamicin, which is notoriously toxic to hearing (Liu 2008a). And in a boon for the 17% of us troubled by chronic tinnitus, taurine may help quiet the noise (Galazyuk 2012). Animal studies using human equivalent doses of 700 mg to 3.2 grams per day of taurine over the course of several weeks demonstrate near-complete resolution of tinnitus with taurine supplementation (the animals had been trained in tasks that are sensitive to distraction by tinnitus) (Brozoski 2010). And a human pilot study has shown encouraging results, with 12% of people responding to taurine supplementation (Davies 1988).
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