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Tinnitus Frequently Answered Questions v2.7
From: markb@cccd.edu (Mark Bixby)
Newsgroups: alt.support.tinnitus
Subject: Tinnitus Frequently Answered Questions v2.7
Date: 8 Nov 1996 09:00:10 -0800
Sender: markb@spock.dis.cccd.edu
Message-ID: <medicine/tinnitus-faq-1-847472407@spock.dis.cccd.edu>
Reply-To: markb@cccd.edu (Mark Bixby)
Summary: Questions and answers regarding tinnitus - ringing ears and other head noises
Keywords: faq tinnitus ear ringing
Posted-By: auto-faq 3.3 beta (Perl 5.003)
Archive-name: medicine/tinnitus-faq
Posting-Frequency: monthly
Last-modified: 23 August 1996
Version: 2.7
Tinnitus Frequently Answered Questions
Last update v2.7, August 30, 1996
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What's New
* A new FAQ maintainer has stepped forward. Stay tuned for a new and
easier to use FAQ, coming soon.
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What Was New In Recent Updates
* In v.2.6-Updated German language Web Page URL. See: What online
resources are available?
* In v.2.5-What online resources are available?
o http://www.ohsu.edu/ohrc-otda/ Oregon Tinnitus Data Archive- A
reference source for those desiring quantitative information
about clinically-significant tinnitus.
o http://www.ucl.ac.uk/~rmjg101/tinnitus1.html "Tinnitus Retraining
Therapy"- ..."tinnitus management in our clinics is a result of
retraining and relearning"....
o http://www.cdc.gov/niosh/noise2a.html NIOSH- Occupational Noise
and Hearing Conservation page. Provides a basis for a recommended
standard to reduce permanent noise damage.
* In v.2.4-What online resources are available?
http://www.teleport.com/~ata The Home Page Site (under construction)
for the "American Tinnitus Association".
* In v.2.4-What organizations can I turn to for more information? A new
Tinnitus Organization in Spain: ASOCIACION DE PERSONAS AFECTADAS POR
TINITUS(Acúfenos)
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About the Tinnitus FAQ
Welcome to the Tinnitus FAQ. At the present time, there are many questions
about tinnitus, but few definitive answers that apply to all sufferers. If
you have any additional insights not covered in this document, please help
your fellow tinnitus sufferers by contacting the FAQ Maintainer, Lee
Leggore, at nomader@eskimo.com.
IMPORTANT DISCLAIMER: This document is not a substitute for advice from a
competent health care provider specializing in tinnitus. Many of the
underlying medical conditions can be serious, if not fatal, and several of
the listed treatments may have dangerous side-effects. Contact one of the
tinnitus organizations listed in this document if you are seeking a
referral to a skilled physician. The Tinnitus FAQ may contain material
contrary to opinions of the tinnitus research community.
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About the Tinnitus FAQ Maintainer
I (Lee Leggore) began maintaining this FAQ in September of 1995. I was born
8/2/51. I have had Tinnitus and Hyperacusis since 1982. In 1985 I became a
member and contact person with, "American Tinnitus Association".
In 1993, I became involved in computer science at, "Tacoma Community
College", where I previosly earned a diploma in Management. Other than,
"Basic First Aid and CPR", I am WITHOUT medical training. Everything in
this FAQ is the contribution of many, many people, who submitted via
private e-mail and indirectly via public postings to alt.support.tinnitus.
While I will always try to answer questions via private e-mail, you will
hopefully reach people with better expertise than I by posting publicly to
the newsgroup: alt.support.tinnitus (Be advised/warned that this newsgroup
has had obscene posting and you may be quite repulsed by them! Please! Do
not respond to them!)
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In addition to being posted monthly to the Usenet newsgroups
alt.support.tinnitus, news.answers, and alt.answers, this FAQ can also be
found at:
* http://www.cccd.edu/faq/tinnitus.html
* http://www.cccd.edu/faq/tinnitus.txt
* ftp://ftp.cccd.edu/pub/faq/
* ftp://ftp.cccd.edu/pub/faq/
* ftp://rtfm.mit.edu/pub/usenet/news.answers/medicine/
* And many other Usenet *.answers FAQ archive sites
To retrieve this FAQ in 150+K large, single message entirety via e-mail,
send a message to majordomo@cccd.edu, and in the body of the message use
one of the following commands:
get faq tinnitus.html
get faq tinnitus.txt
To retrieve this FAQ split into multiple smaller messages, send e-mail to
an ftp-by-mail server (there are many) such as ftpmail@census.gov, and in
the body of the message ask for either the plaintext (.txt) or HTML version
of the FAQ as follows (note that ftpmail servers are very popular and
response time may range from several hours to several days):
open ftp.cccd.edu
get /pub/faq/tinnitus.txt
quit
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Topics covered in this FAQ:
1) What is tinnitus?
2) What does tinnitus sound like?
3) How is tinnitus diagnosed?
4) What causes tinnitus?
5) How can I avoid getting tinnitus?
6) What are some ototoxic drugs?
7) What is Meniere's Disease?
8) What is hyperacusis?
9) What drugs, vitamins, and herbs are available for treating tinnitus?
10) What other treatments are available for tinnitus?
11) What is masking?
12) What types of ear plugs or other hearing protection are available?
13) What organizations can I turn to for more information?
14) What books can I turn to for more information?
15) What online resources are available?
16) What can I do when all else fails?
17) Where did the medical advice in the FAQ come from?
18) What clinics or physicians can I turn to for real medical advice?
19) Who are the contributors to this FAQ?
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1) What is tinnitus?
Tinnitus can be described as "ringing" ears and other head noises that are
perceived in the absence of any external noise source. It is estimated that
1 out of every 5 people experience some degree of tinnitus.
Tinnitus is classified into two forms: objective and subjective. Objective
tinnitus, the rarer form, consists of head noises audible to other people
in addition to the sufferer. The noises are usually caused by vascular
anomalies, repetitive muscle contractions, or inner ear structural defects.
Subjective tinnitus is much less understood, with the causes being many and
open to debate. Anything from the ear canal to the brain may be involved.
Hearing loss, hyperacusis, recruitment, and balance problems may or may not
be present in conjunction with tinnitus.
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2) What does tinnitus sound like?
Many sufferers in the online community report that their tinnitus sounds
like the high-pitched background squeal emitted by some computer monitors
or television sets. Others report noises like hissing steam, rushing water,
chirping crickets, bells, breaking glass, or even chainsaws. Some report
that their tinnitus temporarily spikes in volume with sudden head motions
during aerobic exercise, or with each footfall while jogging.
Objective tinnitus sufferers may hear a rhythmic rushing noise caused by
their own pulse. This form is known as pulsatile tinnitus.
In a database of 1544 tinnitus patients, 79% characterized the sound as
"tonal" with an average loudness of 7.5 (on a subjective scale of 1-10).
The other 21% characterized the sound as "noise" with an average loudness
of 5.5. When compared to an externally generated noise source, the average
loudness was 7.5dB above threshold. 68% of patients were able to have their
tinnitus masked by sounds 14dB or less above threshold. The internal
origination of the tinnitus sounds was perceived by 56% of the patients to
be in both ears, 24% from somewhere inside the head, 11% from the left ear,
and 9% from the right ear.
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3) How is tinnitus diagnosed?
The following flowchart from the Cecil Textbook of Medicine, 1992 (19th
ed.), W.B. Saunders, shows the logic for diagnosing the common causes of
tinnitus (note that this chart omits some causes such as TMJ disorders):
ear exam--->(audible sounds)-+-->sync w/respiration--->patent eustachian tube
| |
| +-->sync w/pulse--->aneurysm, vascular tumor,
v | vascular malformation,
(no audible sounds) | venous hum
| |
| +-->continuous--->venous hum, acoustic emissions
v
neurological exam-->(normal)-->audiogram
| |
| +-->normal--->idiopathic tinnitus
| |
| +-->conductive hearing loss
v | |
(brain stem signs) | v
| | impacted cerumen, chronic
| | otitis, otosclerosis
v |
multiple sclerosis, +-->sensorineural hearing loss
tumor, ischemic |
infarction v
BAER test
|
v
+---------+--------------+
| |
v v
abnormal (neural) normal cochlear
| |
v v
acoustic neuroma noise damage
other tumors ototoxic drugs
vascular compression labyrinthitis
Meniere's Disease
perilymph fistula
presbycusis
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4) What causes tinnitus?
In a database of 1687 tinnitus patients, no known cause was identified for
43% of the cases, and noise exposure was the cause for 24% of the cases.
* overexposure to loud noises
Repeated exposure to loud noises such as guns, artillery, aircraft,
lawn mowers, movie theaters, amplified music, heavy construction, etc,
can cause permanent hearing damage. Some people report auditory
fatigue from driving automobiles long distances with the windows down.
Anybody regularly exposed to these conditions should consider wearing
ear plugs or other hearing protection (see below).
* MRI, CAT, and other non-invasive scanning machines
These high-tech machines may take great images, but they are very,
very LOUD. Do not attempt this type of imaging without wearing
approved earplugs; any competent imaging facility should be able to
supply the earplugs. [Note: Mark Bixby reports that he had knee MRIs
done, and even with earplugs and his head outside the bulk of the
machine it was very loud.]
* wax/dirt build-up in the ear canal
If you're experiencing tinnitus, this is one of the first things you
should check for. NEVER try digging or suctioning the ear canal
yourself or allow a physician to do it as SERIOUS damage may result.
Numerous over-the-counter chemical washes are available from your
drugstore which will clean the ear canal in a safe and gentle manner.
* acoustic neuromas
Acoustic neuromas are small, slow growing benign tumors that press
against or invade the auditory nerves. If your tinnitus is only in one
ear, you should see your physician to rule this one out. An MRI will
probably be required for a definitive diagnosis, but one contributor's
ENT felt that an MRI wasn't warranted unless frequent dizziness was
present. Acoustic neuromas are removable by surgery but involve a risk
of hearing loss. Doing nothing should be considered an option by
elderly patients since these tumors grow so slowly.
* ototoxic drugs
Many prescription and over-the-counter drugs may cause tinnitus and/or
hearing loss that may be permanent or may disappear when the dosage is
reduced or eliminated. Before starting treatment with any prescription
drug, tinnitus sufferers should always ask their physician and/or
pharmacist about the potential for ototoxic side effects. See the next
section for more detail. These drugs include:
salicylate analgesics (higher doses of aspirin)
naproxen sodium (Naprosyn, Aleve)
ibuprofen
many other non-steroidal anti-inflammatories
aminoglycoside antibiotics
anti-depressants
loop-inhibiting diuretics
quinine/anti-malarials
oral contraceptives
chemotherapy
* severe ear infections
Many tinnitus cases onset after severe ear infections. But this may
also be related to the use of ototoxic antibiotics (see above).
* high blood cholesterol
High blood cholesterol clogs arteries that supply oxygen to the nerves
of the inner ear. Reducing your cholesterol level may reduce your
tinnitus.
* vascular abnormalities
Arteries may press too closely against the inner ear machinery or
nerves. This is sometimes correctable by delicate surgery.
* Temporo-Mandibular Joint (TMJ) syndrome
This jaw disorder may cause tinnitus and is characterized by many
symptoms, including headaches, earaches, tenderness of the jaw
muscles, dull facial pain, jaw noises, the jaw locking open, and pain
while chewing. For a good online document on TMJ, see:
http://www.uiuc.edu/departments/mckinley/health-info/dis-cond/misc/tmj-diso.html
One contributor has this to say about the TMJ/tinnitus connection:
The Sternocleidomastoideus muscle connects on your sternum
by the collar bone on both sides and goes back to the back
of the ear. It's about 6-10 inches long and when it gets
tight, it can pull on the TMJ area thereby creating a pull
on the muscles and ligaments around the inner ear area.
Almost certainly the final "pull" is the sphenomandibular
ligament which connects the ear drum and TMJ. An osteopath
can work with this. Xanax or other benzo's can provide
tension relief as well. The masseter and temporalis muscles
(those in front of the ear and above the ear can cause the
same TMJ/tinnitus problems. If a person wants to know if
their tinnitus is connected to their TMJ in some way, have
them 1) clench their teeth- does it change the tinnitus? 2)
push in hard on the jaw with your palm. Does the tinnitus
change? (Get louder/softer, pitch or tone change) 3) Push in
on the forehead with your hand hard. Resist with the head.
Any changes? In about half the people I talk to, they find a
TMJ correlation they never even dreamed of...
There is a highly recommended dentist knowledgable about TMJ/tinnitus
cases who has 30 years of experience and has authored/co-authored
several papers on the subject:
Doug Morgan, DDS
308 Foothill Boulevard
Glendale, CA USA 91214
+1 818 248-1283
For more information about TMJ, visit the TMJ Foundation (a California
public nonprofit corporation) WorldWideWeb site at
http://www.tmjfound.com/ , or contact them at:
TMJ Foundation
P.O. Box 28275
San Diego, CA USA 92128-0275
fax +1 619 592-9107
* traumatic head injuries
Some automobile crash victims have reported a sudden onset of
tinnitus.
* cochlear implant or other skull surgeries
Sometimes poking around inside the skull will accidentally damage the
hearing system. Tinnitus can result, or even profound deafness caused
by severe inner ear infections.
* stress
Stress is not a direct cause of tinnitus, but it will generally make
an already existing case worse.
* diet and other lifestyle choices
Like stress above, a poor diet can worsen an existing case of
tinnitus. Alcohol, tobacco, caffeine, quinine/tonic water, high fat,
high sodium can all make tinnitus worse in some people.
* food allergies
Specific foods may trigger tinnitus. Problem foods include red wine,
grain-based spirits, cheese, and chocolate. One contributor reported
hearing tones after consuming honey. Another contributor notes that
these same foods are on the list known to trigger migraine headaches;
additional migraine foods include soy and anything including soy, MSG,
very ripe bananas, avocados, and citrus fruits.
* foods rich in salicylates
There is a long list of foods that are supposed to be "rich" in
salicylates. See the Shulman book listed below for details. [Ed. note:
I'm not listing the foods here since no data is given on exactly how
rich the foods are, i.e. "13 mangoes = 1000mg aspirin" as a
hypothetical example.]
* glaumous tumors
These tumors can cause pulsatile tinnitus. They are confirmed with a
CAT scan or other imaging, and may be surgically removable by a
delicate procedure.
* mercury amalgam tooth fillings
Researchers June Rogers and Jacyntha Crawley (P.O. Box 413, London SW7
2PT, U.K.) have found a possible connection between mercury tooth
fillings and tinnitus. They publish a booklet on the subject available
for 6 International Reply Coupons, and they also have a questionnaire
that interested people can fill out. Their research suggests following
a vegetarian diet, plus eating 2 raw African green chillies one day,
followed by 1 chilli the next day for temporary relief.
But a prominent American tinnitus specialist says that no such link
has been established.
* marijuana
Marijuana usage may worsen pre-existing cases of tinnitus.
* Lyme Disease
Lyme is a parasitic, tick-borne disease, which in the United States is
most commonly seen in eastern states. In some cases, tinnitus has been
a side-effect of Lyme.
Lyme disease deserves special mention partly because it is so
difficult to diagnose objectively; the commonly available serological
tests have very high rates of false negatives. In the only study (by
McDonald) in the literature which used objective measures
(histopathology) to confirm test results, over 50% of currently
infected patients were negative by ELISA and/or Western Blot. False
positives are infrequent, occurring primarily in pts. exposed to other
nasties such as syphilis or rocky mountain spotted fever. So
serologies can be used to confirm but not to rule out diagnosis.
The Lyme Urine Antigen Test is a useful supplement test to serologies;
it tests for current infection, as opposed to a history of exposure.
It has some problems with low sensitivity; these can be improved by
the following regimen. Give amoxicillin 500mg tid q5d; on days 3,4,5
take and test first-in-the morning urine specimens. The LUAT can be
ordered by your MD from Immugenex, 1-415-424-1191. Other, better tests
(including PCR) are under development, expected to be available for
clinical use within the next few years.
For further online information about Lyme Disease, you may send the
following command in the body of an e-mail message to
listserv@lehigh.edu:
subscribe LymeNet-L yourfirstname yourlastname
A regular newsletter is published here, and patients & physicians may
exchange their stories.
* dental procedures
Certain dental procedures such as difficult tooth extractions and
ultrasonic cleaning can cause hearing damage via bone conduction of
loud sounds directly to the ear. Wearing ear plugs will not guard
against bone conduction.
* intracranial hypertension
Intracranial hypertension can cause pulsatile tinnitus. If you can
stop your tinnitus by slight pressure to the neck on the affected
side, that is an indication. The definite way to find out is if you
get a spinal tap and your Opening Pressure is higher than 200.
* otosclerosis
Otosclerosis is a bony growth around the footplate of the stapes (one
of the 3 middle ear bones). This footplate forms the seal that
separates the middle ear space from the inner ear. When the footplate
moves normally, the sound vibrations are passed from the middle ear
"chain" of bones into the fluid of the inner ear. If the footplate is
fixated, the vibrations cannot pass into the inner ear as well and
hence a resulting hearing loss. Tinnitus may also be involved.
Treatment is by surgery, as one poster to alt.support.tinnitus
explains:
When should surgery be performed? Well IMHO, it all depends
upon the amount of loss (or progression of the condition)
and the amount of difficulty that the patient experiences.
If the amount of loss caused by the otosclerosis is 40 dB or
more, then surgery may be an option that you may want to
think about. But remember that surgeries can be complicated
and can always end up with no real improvement.
Stapedectomy involves removal of the stapes, along with the
fixated footplate, and insertion of a prosthetic stapes into
the window that contains the oval window.
One "nice" thing about people with conductive hearing loss
(i.e. otosclerosis) is that they are excellent candidates
for hearing aids. They often do not experience the
overwelming loudness that people with sensorineural hearing
loss often report, and speech is not distorted.
If your condition involves a 40 dB loss *DIRECTLY* due to
otoscelerosis, you may want to thnik about surgery, but if
it is less than that, you may want to try a hearing aid, and
think about surgery in the future (if the condition develops
further).
* aspartame
Some people allege (quite controversially) that the artificial sugar
substitute aspartame is linked to tinnitus, vertigo, and many other
serious problems (I agree). To retrieve further information about the
allegations against aspartame, send e-mail to freeinfo@servint.com and
include the lowercase command "info mp" in the body (not the Subject:)
of the message.
* Arnold Chiari Malformation (ACM)
An *unscientific* response of 30 ACM patients revealed that 14 had
ringing in the ears (significant) and 9 had a whooshing sound in their
ears (also significant). The survey of patients was conducted by
Darlene Long-Thompson, RN, MHSc.
Essentially there is (in ACM) extra cerebellum crowding the outlet of
the brainstem/spinal cord from the skull on its way to the spinal
canal. This crowding will commonly lead to headaches, neck pain, funny
feelings in the arms and/or legs, stiffness, and less often will cause
difficulties with swallowing, or gagging . There are those that
believe it can cause tinnitus. Often the symptoms are made worse with
straining.
Untreated, the chronic crowding of the brainstem and spinal cord can
lead to very serious consequences including paralysis. There are many
ways to treat Chiari malformations, but all require surgery.
When the diagnosis is suspected the study of choice is an MRI scan.
These malformations are very difficult to see on CT scans and
impossible to see on plain x-rays.
If you are intending to have an MRI for another reason, e.g., Acustic
Neuroma, the MRI technicians should be alerted to the possibility of
ACM (if you are showing any symptoms listed above) since the "MRIing"
will have to concentrate on the brain stem/cerebellum area to detect
the problem.
Most of the preceding (ACM) information provided courtesy of: Bernard
H. Meyer
Arnold Chiari Malformation involves the herniation of the cerebellum
and/or brainstem through the foramen magnum. This can cause problems
in the areas of cerebellar compression and dysfunction, cranial and
spinal nerve (including trigeminal and acoustic nerve) compression and
inflammation, CSF blockages and increased intracranial pressure
(constant or intermittent), and brainstem compression and
inflammation. ANY of these components can cause symptomology
associated with tinnitus...(Think of the ringing in the ears or
buzzing sound associated with light headedness or fainting...many ACM
sufferers experience this either due to acoustic nerve involvement or
to fluid and pressure dynamics).
Because hard data on ACM is difficult to find (and often
contradictory) it is difficult to find a source that says specifically
any one symptom is related to ACM...but the symptoms are often
categorized as...cerebellar syndrome, brainstem deficits, CSF
obstruction, and cranial nerve deficits. Due to the close proximity of
the acoustic nerve to the hindbrain region it would be one of the
primary cranial nerves involved in the compression/inflammation
syndrom.[sic]
Two of my references on this are as follows...
Tinnitus and Neurosurgical Disease
Journal: Journal of Laryngology & Otology
Authors: WA Shucart
M. Tenner
Citation: (4): 166-8
ISSN0144-2945
Tinnitus from Intracranial Hypertension
Journal: Neurology
Authors: KJ Meador
TR Swift
Citation: 34(9): 1258-61
ISSN 0028-3878
Preceding (ACM) information provided courtesy of: Darlene
Long-Thompson, RN, MHSc.
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5) How can I avoid getting tinnitus?
Avoid the causes listed above. Really. The number one cause of tinnitus is
exposure to excessively loud noise. Either avoid these noisy situations, or
wear hearing protection as described below. Rock concerts, movie theaters,
nightclubs, construction sites, guns, power tools, stereo headphones and
musical instruments are just some of the things that can be hazardous to
your ears. Damage can result from either a single exposure or cumulative
trauma. There are "tough" ears, and there are "weak" ears; what may be safe
or dangerous for one individual may not be the same for you. If you ever
experience temporary ringing after a sound exposure, YOU ARE AT A SEVERE
RISK FOR TINNITUS AND/OR HEARING LOSS.
If you already have tinnitus, educate your family, friends, and neighbors
so that they can keep their ears healthy.
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6) What are some ototoxic drugs?
All tinnitus sufferers should ask their physician and/or pharmacist about
the potential for ototoxic side effects BEFORE starting a new prescription.
In her book _When the Hearing Gets Hard_ (Insight Books 1993, ISBN
0-306-44505-0), author Elaine Suss names several potentially ototoxic
substances. She lists them in three categories: (1) substances that most
physicians consider ototoxic; (2) substances that many physicians consider
potentially ototoxic; and (3) substances that may be ototoxic in rare
cases. The ototoxic effects of the substances in the third list are
considered to be reversible--the effects diminish when you stop taking the
drug. Ms. Suss does not list dosages.
The first group includes a few antibiotics and several diuretics. Not being
a physician, I don't recognize them all, though Capreomycin, Gentamicin ,
Kanamycin, Neomycin, Streptomycin, Tobramycin sulphate, Vancomycin, and
Viomycin are obviously antibiotics. Ms. Suss mentions that Streptomycin is
used only for certain cases of tuberculosis.
The first group also includes aspirin--ototoxic at higher doses and whose
effects are usually reversible--and other salicylates such as Oil of
Wintergreen (Ben Gay). The other substances in the first group are:
Amikacin, Amphotericin B (Fungizone), Bumetanide (Bumex), Carboplatin
(Paraplatin), Chloroquine (Aralen), Cisplatin (Platinol), Ethacrynic acid
(Edecrin), Furosemide (Lasix), and Hydroxychloroquine (Plaquenil).
The second group includes the analgesic Ibuprofen (Advil) and the tricyclic
anti-depressant Imipramine (Tofranil), along with Chloramphenicol
(Chloromycetin), lead, and quinine sulphate.
The third group includes alcohol, toluene, and trichloroethylene, as well
as Chlordiazepoxide (Librium), Chlorhexidene (Phisohex, Hexachlorophene),
Ampicillin, Iodoform, Clemastin fumarate (Tavist), Chlomipramine
hydrochloride (Anafranil), and Chorpheniramine Maleate (Chlor-trimeton and
several others).
Ms. Suss points out that the _Physicians Desk Reference_ (PDR) did not list
ototoxic drugs until the 1989 and later editions. She refers to a separate
document, _Drug Interactions and Side Effects Index_, which is keyed to the
PDR. She then points out that the Index is incomplete: several problem
drugs are not listed there.
Although the lists of ototoxic drugs are useful, I cannot recommend this
book to tinnitus sufferers in general because it is devoted almost entirely
to the problems of the hearing impaired and methods for ameliorating them.
The book mentions tinnitus primarily as a precursor to hearing loss. (I do
not believe that is the general case.)
The book _Tinnitus: Diagnosis/Treatment_ (Lea & Febiger, 1991, ISBN
0-8121-1121-4) adds that ototoxic symptoms may arise days or even weeks
after the termination of aminoglycoside antibiotics. Some of these
aminoglycosides not listed above are Netilmycin and Erythromycin. Other
trouble antibiotics include Colistimethate, Doxycycline and Minocycline.
The following is a list of drugs that have demonstrated Tinnitus side
effects as indicated in the 1995 "Physicians Desk Reference" and
distributed by the American Tinnitus Association:
Accutane [less than 1%] Mazicon [less than 1%]
Acromycin V Meclomen [greater than 1%]
Actifed with Codiene Cough Syrup Methergine [rare]
Adalat CC [less than 1%] Methotrexate [less common]
Alferon N [one patient] Mexitil [1.9% to 2.4%]
Altace [less than 1%] Midamor [less than or equel to 1%]
Ambien [infrequent] Minipress [less than 1%]
Amicar [occasional] Minizide [rare]
Anatranil [4-5%] Mintezol
Anaprox and Anaprox DS [3-9%] Moduretic
Anestacon [among most common] Mono-Cesac
Ansaid [1-3%] Monopril [0.2-1%]
Aralen Hydrochloride [one Patient] Monopril [0.2-1%]
Arithritis Strength BC Powder Motrin [less than 3%]
Asacol Mustargen [infrequent]
Ascriptin A/D Mykrox [less than 2%]
Ascriptin Nalfon [4.5%]
Asendin [less than 1%] Naprosyn [3-9%]
Asperin [among most frequent] Nebcin
Atretol Neptazane
Atrofen Nescaine
Atrohist Plus Netromycin
Azactam [less than 1%] Neurontin [infrequent]
Azo Gantanol Nicorette
Azo Gantrisin Nipent [less than 3%]
Azulfidine [rare] Nipride
BC Powder Noroxin
Bactrim DS Norpramin
Bactrim I.V. Norvasc [0.1-1%]
Bactrim Omnipaque [less than 0.1%]
Blocadren [less than 1%] Omniscan [less than 1%]
Buprenex [less than 1%] Ornade
BuSpar [frequent] Orthoclone OKT3
Cama Orudis [greater than 1%]
Capastat Sulfate Oruvail [greater than 1%]
Carbocaine Hydrochloride P-A-C Analgesic
Cardene [rare] PBZ
Cardioquin Pamelor
Cardizem [less than 1%] Parnate
'' CD [less than 1%] Paxil [infrequent]
'' SR [less than 1%] Pedia-Profen [greater than 1% less than 3%]
Cardura [1%] Pediazole
Cartrol [less common] Penetrex [less than 1%]
Cataflam [1-3%] Pepcid [infrequent]
Childrens Advil [less than 3%] Pepto-Bismol
Cibalith-S Periactin
Cinobac [less than 1 in 100] permax [infrequent]
Cipro [less than 1%] Phenergan
Claritin [2% or less] Phrenilin [infrequent]
Clinoril [greater than 1%] Piroxicam [1-3%]
Cognex Plaquenil
Corgard [1-5 of 1000 patients] Platinol
Corzide [ '' ] Plendil [0.5% or greater]
Cuprimine [greater than 1%] Pontocaine Hydrochloride
Cytotec [infrequent] Prilosec [less than 1%]
Dalgan [less than 1%] Primaxin [less than 2%]
Dapsone USP Prinvil [0.3-1%]
Daypro [greater than 1% less than 3%] Prinzide [0.3-1%]
Deconamine Procardia [1% or less]
Demadex ProSam [infrequent]
Depen Titratable Proventil [2%]
Desferal Vials Prozac [infrequent]
Desyrel & Desyrel Dividose [1.4%] Questran
Diamox Quinaglute
Dilacor XR Quinamm
Dipentum [rare] Quinidex
Diprivan [less than 1%] Q-vel Muscle Relaxant Pain Reliever
Disalcid Recombivax HB [less than 1%]
Dolobid [greater than 1% in 100] Relafen [3-9%]
Duranest Rheumatrex Methotrexate [less common]
Dyphenhydramine [Nytol, Benydrl, etc] Rifater
Dyclone Romazicon [less than 1%]
Dasprin Ru-Tuss
Easprin Rythmol
Ecotrin Salflex
Edecrin Sandimmune [2% or less]
Effexor [2%] Sedapap [infrequent]
Elavil Sensorcaine
Eldepryl Septra
Emcyt Sinequan [occasional]
Emla cream Soma Compound
Empirin with Codiene Sporanox [less than 1%]
Endep Stadol [3-9%]
Engerix-B Streptomycin Sulfate
Equagesic Sulfadiazine
Esgic-plus [infrequent Surmontil
Eskalith Talacen [rare]
Ethmozine [less than 2%] Talwin [rare]
Etrafon Tambocor [1% or less than 3%]
Fansidar Tavist and Tavist-D
Feidene [1-3%] Tegretol
Fioricat with Codeine [infrequent] Temaril
Flexeril [less than 1%] Tenex [3% or less]
Floxin [less than 1%] Thera-Besic
Foscavir [1-5%] Thiosulfil Forte
Fungijzone Ticlid [0.5-1%]
Ganite Timolide
Gantanol Timoptic
Gantrisin Tobramycin
Garamycin Tofranil
Glauctabs Tolectin [1-3%]
HIVID [less than 1%] Tonocard [0.4-1.5%]
Halcion [rare] Toprol XL
Hyperstat Toradol [1% or less]
Hytrin [at least 1%] Torecan
Ibuprofen [less than 3%] [Advil, etc.} Trexan
Ilosone Triaminic
Imdur [less than or equal to 5%] Triavil
Indocin [greater than 1%] Trilisate [less than 20%]
Intron A [up to 4%] Trinalin Repetabs
Kerione [less than 2%] Tympagesic Ear Drops
Lariam [among most frequent] Ursinus
Lasix Vancocin HCI [rare]
Legatrin Vantin [less than 1%]
Lncocin [occasional] Vascor [up to 6.52%]
Lioresal Vaseretic [0.5-2%]
lithane Vasotec [0.5-1%]
Lithium Carbonate Vivactil
Lithobid Voltqaren [1-3%]
Lithonate Wellbutrin
Lodine [greater than 1% less than 3%] Xanax [6.6%]
Lopressor Ampuis Xylocaine [among most common]
Lopressor DCT [1 in 100] Zestril '0.3-1%]
Lopressor Zestoretic [0.3-1%]
Loreico Ziac
Lotensin HCT [0.3-1%] Zoleft [1.4%]
Ludiomil [rare] Zosyn [less than 1%]
MZM [among most frequent] Zyloprim [less than 1%]
Magnevist [less than 1%]
Marinol (Dronabinol) [less than 1%] Risperdal [rare]
Marcaine Hydrochloride
Marcaine Spinal
Maxaquin [less than 1%]
Your physician should always be consulted about questions before any
changes are made in your medication.
The absence of incidence data means there was none given, and/or it is
unknown.
---------------------------------------------------------------------------
7) What is Meniere's Disease?
Meniere's is a very serious disease of the inner ear, resulting in extended
vertigo attacks, major hearing loss, and frequently tinnitus. Here is one
sufferer's (not myself) story:
What are the symptoms?
In my case it started with a constant fullness in my right ear
and the constant ringing. I also noticed I wasn't hearing very
well and I was having some vertigo attacks.
Originally I had my Allergist treat me. She thought it might just
be an inner ear infection or a sinus infection. It manifested
itself in the fall which is one of my worst allergy seasons.
By Spring she referred me to an ENT.
What tests would a physician do to diagnose it?
First was a hearing test. This was followed by an MRI to ensure
there wasn't a tumor to deal with. There was also the physical to
ensure there was no other underlying cause, including Diabetes.
Then being referred to a surgeon who specializes in this kind of
thing. He did further hearing tests and another test which I will
have to get the name for you. It consists of lights on the wall
that you follow with your eyes. They also insert warm and cold
water into each ear (ENG/AU test) to measure the response; a
short vertigo spell is the result for healthy ears. There is also
a special set of hearing tests that they do.
Are there any known environmental causes, or is it one of those things that
"just happens" to people?
One possible cause is Diabetes. Other than that no one that I
have spoken with knows. It may also be hereditary. Usually
doesn't show up until later in life 40 and beyond, and can burn
itself out in 3 - 5 years. Some have it earlier in life (me at
35) and could have it the rest of our lives.
What are the common treatments? Anti-vertigo drugs? Surgical operations on
the inner ear balance mechanisms?
The most common treatment for mild episodic Meniere's I guess
would be to rule out Diabetes and allergies. For the vertigo
attacks usually the prescription drug Antivert is used or the
over the counter drug Meclizine. Both tend to relive the vertigo.
For more chronic cases a low dosage of Valium can help. When
things get bad enough the next procedure is an Endolymphatic
Transmastoid Shunt. This helps to keep some of the pressure of
the inner ear. Changes in diet can help. Removal of sodium,
caffeine and alcohol can help. Usually a mild diuretic is
prescribed.
I know of several folks who keep it under control with allergy
shots and restricting their sodium intake.
If it progresses to a point where the patient can no longer
'live' with it an Eighth Nerve Section can be done. But according
to my surgeon this is an absolute last resort. It guarantees
deafness in the ear and some patients report balance problems at
night. He also claims the risks are high with this procedure
including partial face paralysis. [Ed. note: new surgical
techniques access the nerve via the posterior fossa, preserving
hearing and reducing the risk of facial paralysis. The vestibular
nerve alone can be sectioned, providing vertigo relief.]
In general, imagine yourself back when you first encountered Meniere's.
What kind of summary info would have been helpful to you?
Knowing that it can be treated with medication and there is the
hope that it will burn itself out keeps me going. There does seem
to be a connection with the tinnitus and the Meniere's. I have
noticed over the last two years that the tinnitus gets worse and
my hearing decreases prior to a vertigo episode or series of
vertigo episodes. 25mg of Meclizine usually has the vertigo under
control in 20 - 30 minutes for a mild attack. A severe attack can
leave you completely disoriented such that there is no real up or
down. An attack this severe usually has bouts of nausea and
vomiting with it. I find lying down in a quiet dark room helps
while the medicine kicks in. Anti-nausea drugs can help. In my
case when I have had a severe episode I usually feel
'out-of-sorts' for a couple of days.
If you experience pretty intense tinnitus coupled with vertigo
and the inability of hold your eyes steady on an object I would
suggest seeing an ENT who knows about Meniere's. I have found
that it is not well known or understood.
Meniere's, Tinnitus, & Gentamicin, as explained by Jim Chinnis
<jchinnis@interramp.com>:
Originally, streptomycin was tried as a treatment for medically
intractable Meniere's (before considering surgical approaches).
As best I can determine, the technique was developed at Tulane
Univ by Charles Norris in the US and first tested by Dr. John
Shea Jr. in Memphis, Tennessee, USA. Doctors knew that
streptomycin could destroy hearing and balance. Early interest
was in seeing if the vestibular system could be suppressed with
small doses during space travel in order to reduce motion
sickness experienced by NASA astronauts.
Shea and others soon recognized that streptomycin could be used
in two ways for Meniere's. Either a large dose could be used to
chemically destroy the neural hair cells of the inner ear (giving
a result similar to nerve section, but without surgery) or a
carefully monitored dose could be used so that treatment would
stop as soon as any hearing or vestibular damage could be
measured. The latter idea was based on the thought that either
the vestibular signal could be weakened or even that the cells in
the vestibular (balance) system in the ear that were misfiring
and causing vertigo might be selectively destroyed with
streptomycin. It was also known that aminoglycosides had complex
activity within the tissues of the inner ear and had a particular
affinity for tissue believed responsible for the production of
endolymph. (Overproduction of endolymph or failure of resorption
is believed to be the principal cause of Meniere's symptoms and
the symptoms of some other inner ear problems, as well.) Dr. Shea
was somewhat successful in developing this treatment. It has been
tried now around the USA, in Italy, Australia, Canada, and
elsewhere in numerous variations but is not generally known to
practicing ENTs.
The newer form of the treatment is to use gentamycin instead of
streptomycin because it is safer. The drug is administered either
into the middle ear and allowed to perfuse through the round
window into the inner ear or given by (systemic) injection.
Patient goes home same day. Results have been very good as far as
I can tell. One large unilateral study (people with Meniere's in
one ear) showed the following results: vertigo gone in over 90%
of cases, tinnitus GONE in more than 80% of cases. Another large
study found vertigo gone in 85.5% of cases, improvement of
hearing of at least 10 db in 26.7%, disappearance of pressure or
fullness in 78.4%, and the disappearance of tinnitus in 51.6% of
cases and its significant reduction in another 24.2%.
Researchers (e.g., T. Sala in Italy) think that the gentamicin
permanently affects the"vascular stria" and the "dark cells" so
that less endolymph is produced and causes changes in a number of
cellular biochemical processes in the inner ear.
Of major importance to those with Meniere's affecting both ears
is the finding that the Meniere's may be "cured" by either
parenteral injections or middle ear applications. Sala cites four
additional references that report on treatment/cure of bilateral
Meniere's using streptomycin or gentamicin. He argues for
gentamicin, due to its greater affinity for tissues believed
responsible for endolymph production and because of its lower
toxicity. He argues also that the topical administration of
gentamicin can be used even when little or no hearing loss is
present, since the dosing can be stopped before significant
hearing loss occurs. Because the drug then (allegedly) results in
reduction of endolymph pressure, no further hearing loss or
vertigo attacks are expected. Thus gentamicin perfusion therapy
appears to be a viable treatment at any stage of Meniere's
unilateral or bilateral, and may preserve hearing and balance if
used soon enough.
Sala also argues that treatment with aminoglycosides could be
expected to be effective against tinnitus or balance disorders
due to any of a wide variety of causes, not just Meniere's. I
have not seen any research done on this assertion.
A finding of major importance is that when the earliest patients
from about 15 years ago are examined today, the improvements made
by the streptomycin therapy are still there, suggesting that the
treatment may be permanent.
Please note that if you seek this treatment or ask your doctor to
consider it you will probably have difficulty. S/he will probably
never have heard of it. I have a list of about six doctors in the
US who perform the treatment in at least some versions. There is
obviously Sala in Italy (Venice), and I have a lead to a doctor
in Australia and Canada.
This information is just my take on some fairly technical journal
articles. The opinions are those of medical doctors who wrote the
journal articles but the words are mine. I am not a medical
doctor, just a Meniere's patient like many of you.
References:
Dickens, John R.E., M.D., and Graham, Sharon S. (Meniere's
Disease--1983-1989). The American Journal of Otology, Vol. 11,
Number 1. January 1990.
Sala, T. (Transtympanic administration of aminoglycosides in
patients with Meniere's disease). Archives of
Oto-Rhino-Laryngology, 245:293-296. 1988.
Pyykko, I., Ishizaki, H., Kaasinen, S., Aalto, H. (Intratympanic
gentamicin in bilateral Meniere's disease). Otolaryngology--Head
& Neck Surgery, 110(2):162-167. Feb 1994.
Shea, J.J. Jr., and Ge, X. (Streptomycin perfusion of the
labyrinth through the round window plus intravenous
streptomycin). Otolaryngologic Clinics of North America,
27(2):317-24. April 1994.
Endolymphatic hydrops (see http://lab9924.wustl.edu/Intro4.htm) is a
condition similar to Meniere's that involves vertigo without hearing loss,
as described by another contributor:
I have a problem with one ear that is called endolymphatic
hydrops, which is something like Meniere's without a severe
hearing loss. Apparently the fluid in the semicircular canals
responds to changes in body fluid levels - which it isn't
supposed to do- and sends messages to say you are dizzy. I have
spontaneous vertigo attacks and motion induced dizziness - all
lasting only a short time. Well, what does this have to do with
tinnitus? I also have tinnitus in that ear, which is helped by
some things I have been taught to do for dizziness. Eating small
meals several times a day keeps your body fluid levels fairly
consistent. Also avoid salt. That really makes a difference with
tinnitus and avoid too much sugar as well. Other things to be
careful of are fatigue and dehydration. All these things have
been helpful for me.
---------------------------------------------------------------------------
8) What is hyperacusis?
Hyperacusis is defined as a collapsed tolerance to normal environmental
sounds. It is a rare hearing disorder whereby a person becomes highly
sensitive to noise. Sometimes people think they have hyperacusis because
they are bothered by loud sounds like music, heavy equipment or sirens.
This is not hyperacusis because these sounds are loud to the normal ear.
Individuals with hyperacusis have difficulty tolerating sounds which do not
seem loud to others. The ears lose much of their normal dynamic range, and
everyday noises sound unbearably or painfully loud. Simply stated, it is
like the volume control on your hearing is stuck on HIGH! Hyperacusis can
affect people of all ages and is almost always accompanied by tinnitus, an
ailment that causes sufferers to hear constant ringing, buzzing or static.
Unlike hyperacusis, tinnitus is very common and is associated with many
hearing disorders. Hyperacusis and tinnitus can affect one or both ears.
Recruitment is a similar hearing disorder which is often confused with
hyperacusis. The difference is that an individual with hyperacusis is
highly sensitive to sound but has _no hearing loss_ whereas a person with
recruitment is highly sensitive to sound but also _has hearing loss_. This
is an important difference.
What causes hyperacusis?
Unfortunately, because hyperacusis is so rare, little research has been
done so little is known about it. The onset is usually caused by exposure
to loud noise (either prolonged or a single episode) or a head injury. Some
experts speculate that the cause is damage to the auditory nerves.
Currently, a popular theory is that there has been a breakdown or
dysfunction in the efferent portion of the auditory nerve. Efferent meaning
fibers that originate in the brain which serve to regulate or inhibit
incoming sounds. If the cause would be damage to the auditory nerve then
why does hyperacusis most often show up in patients who have little or no
discernable hearing loss? One possibility is that the efferent fibers of
the auditory nerve are selectively damaged even though the hair cells that
allow us to hear pure tones in an audiometry evaluation remain intact. The
real problem is that no one clearly understands how the brain interprets
sound. Medicine has much to learn about the auditory system before
hyperacusis and many other auditory problems can be fully understood. Other
contributing causes of hyperacusis are thought to be Temporomandibular
Syndrome (TMJ), Williams Syndrome, Bell's Palsy, Meniere's Disease and
Tay-Sachs Disease. Also as many as 40% of all autistic children are
sensitive to noise, however their condition is called hyperacute hearing.
Autistic children currently receive Auditory Integration Therapy (AIT) to
resolve their sound sensitivities. These treatments do not work on
hyperacusis and can actually worsen our condition - particularly the
tinnitus because it is administered at uncomfortably loud sound levels.
What can be done?
Currently all treatments for hyperacusis are experimental. The most
promising treatment comes from Dr. Pawel Jastreboff who have patients with
hyperacusis listen to static (white noise) from ear appliances called
maskers. The theory is that by listening to a specific kind of white noise
at a barely audible volume for a disciplined period of time each day that
the efferent system of the auditory nerve will be retrained through
desensitization to once again tolerate normal environmental sounds. The
treatment has been somewhat successful on a select number of patients but
usually no improvement is seen during the treatment period for at least the
first 3 months. Treatment may take as long as 2 years.
How rare is hyperacusis?
Although there may be as many as 1% of the population who are sound
sensitive, hyperacusis sufferers go well beyond the definition of sound
sensitive and often cannot tolerate their surroundings or even people's
voices. Because the media has not publicized this disorder it is hard to
get a handle on how rare hyperacusis is, however, it may be as little as
one in every 50,000 people. That is extremely rare!
Where can I turn to for help?
Because so little is known about it, doctors either have no idea what is
wrong with us or give us poor advice. Some even subject our ears to tests
which only make our ears worse. A person who comes down with hyperacusis
needs immediate counseling. No one can even imagine what this condition is
like unless they experience it first hand. Running water, rustling
newspaper pages, people talking, slamming doors, kitchen silverware and
driving in a car can all be intolerable particularly without ear
protection. Most hyperacusis patients wear ear protection - either foam ear
plugs or ear muffs when they are in areas which are not sound-friendly.
When ears suddenly become traumatized it is even difficult to sleep because
the sufferer's stress level is so high. To help individuals who are
experience the trauma of hyperacusis, an international support network has
been established called The Hyperacusis Network. See Organizations below
for details.
[The above information was provided courtesy of The Hyperacusis Network.]
---------------------------------------------------------------------------
9) What drugs, vitamins, and herbs are available for treating tinnitus?
* niacin
Niacin supplements produce a temporary flushing effect that is
supposed to pump more oxygen into the inner ear due to vasodilation.
Take niacin on an empty stomach for best results. You may experience a
flush ranging from a mild sunburn to wondering about spontaneous skin
combustion. ;-) You may also experience a "dry mouth" sensation.
MEGADOSES OF NIACIN CAN DESTROY YOUR LIVER AND KILL YOU. 50mg twice
per day is a common dose for tinnitus. If you experience the flush,
then you are getting the maximum benefit. Caution: niacin can provoke
migraine headache attacks in some people.
Some people report good results from niacin, other people gain
nothing. Your mileage may vary. One contributor advocates taking
niacin in combination with thiamine:
The 1994 text on Myofascial Pain: Trigger Points said that
Niacin without Thiamine will do no good for tinnitus. I
don't recall the reasoning. Nicotinic Acid (a form of
Niacin) if taken in over 500mg per day should only be done
so with Dr. approval. I take 100mg per day with a B-complex
vitamin that already is balanced properly. You want roughly
two parts niacinamide for each one part thiamine. Most
vitamins will come balanced in this proportion. To my
knowledge Nicotinic Acid in large doses like 2-5mg per day
over a year or so, could lead to liver damage. Niacinamide
shouldn't have any negative effects nor should thiamine. But
I suppose if someone swallows a bottle they'd have a side
effect!
There is no clinical proof for the effectiveness of niacin in treating
tinnitus. This is inherently difficult to prove due to a possible
"placebo effect" arising from the niacin flush sensation rather than
any therapeutic value of the underlying vasodilation. Additionally,
any vasodilation that occurs cannot benefit the cochlear hair cells,
because the blood vessel (vas spralie) that feeds these cells cannot
expand or contract.
* lecithin
The following anecdotal report advocates lecithin in combination with
niacin [Ed. note: my nutrition book does not cover lecithin, so I
cannot speculate as to toxicity and side-effects]:
After reading the tinnitus faq I emailed to my father, he
replied that he has helped a number of people cure their own
tinnitus by using Niacin and Lecithin. His theory is that
the lecithin, being an emulsifier, helps disperse the build
up of fats in the capillaries, and the niacin helps dilate
the capillaries to let the lecithin in.
He had meier's [sic - Meniere's?] syndrome in the 70's, and
cured it this way. Our neighbor, a police officer, retired
on disability for the same reason, and Dad practically cured
him that way.
I got tinnitus as a result of childhood ear infections, and
it has done nothing for me, but then, mine is not what I
would call irritating.
It does seem that after chelation, the noise is less.
CAUTION: Smart Drugs & Nutrients, Dean & Morgenthaler, 1991, Heath
Freedom Publications, ISBN 0-9627418-9-2, says that phosphatidyl
choline is the active ingredient of lecithin, and as a precursor of
acetylcholine should be avoided by people who are manic-depressive
because it can deepen the depressive phase.
* gingko biloba
Gingko biloba leaves have been used therapeutically by the Chinese for
centuries for the treatment of asthma and bronchitis. In western
countries a standardized 50:1 concentrate of 24% gingko
flavoglycosides is used, either in liquid or capsule form. Gingko has
been shown to increase circulation throughout the body and the brain.
The article "Ginkgo biloba", The Lancet, Vol 340, Nov 7, 1992, pp.
1136-1139, examines numerous studies on the efficacy of ginkgo on
intermittent claudication (pain while walking), and cerebral
insufficiency, a wide collection of vascular impairment symptoms
including tinnitus. Typical dosages range from 120-160mg per day,
divided equally at meal time.
Most studies showed that between 30-70% of subjects had reduced
symptoms over a 6-12 week period. No serious side effects were
observed, and any minor side effects were not statistically
significant compared to subjects treated only with placebo.
Other references on gingko biloba:
As to tinnitus, Hobbs in reference (1) says:
For example, in 1986 a study statistically proved the effectiveness of
treatment with ginkgo extract for tinnitus: the ringing completely
disappeared in 35% of the patients tested, with a distinct improvement
in as little as 70 days!(2)
Similarly, when 350 patients with hearing defects due to old age were
treated with ginkgo extract, the success rate was 82%. Furthermore, a
follow-up study of 137 of the original group of elderly patients 5
years later revealed that 67% still had better hearing(3).
References
1.) Ginkgo Elixir of Youth; Christopher Hobbs; Botanica Press, Box
742, Capitola, CA 95010; 1991; pages 50-51
2.) Tinnitus-multicenter study. A multicentric study of the ear;
Meyer, B.; 1980; Ann. Oto-Laryng. (Paris) 103:185-8
3.) Tebonin-therapy with old hard-of-hearing people. Koeppel, F. W.;
1980; Therapiewoche 30: 6443-46
Here's an abstract of a recent paper in Audiology:
Holgers KM; Axelsson A; Pringle I
Ginkgo biloba extract for the treatment of tinnitus.
Department of Audiology, Sahlgren's Hospital, Goteborg,
Sweden.
Language: Eng
Source: Audiology 1994 Mar-Apr;33(2):85-92
Unique Identifier: 94234927
Abstract:
Previous studies have shown contradictory results of Ginkgo
biloba extract (GBE) treatment of tinnitus. The present
study was divided into two parts: first an open part,
without placebo control (n = 80), followed by a double-blind
placebo-controlled study (n = 20). The patients included in
the open study were patients who had been referred to the
Department of Audiology, Sahlgren's Hospital, Goteborg,
Sweden, due to persistent severe tinnitus. Patients
reporting a positive effect on tinnitus in the open study
were included in the double-blind placebo-controlled study
(20 out of 21 patients participated). 7 patients preferred
GBE to placebo, 7 placebo to GBE and 6 patients had no
preference. Statistical group analysis gives no support to
the hypothesis that GBE has any effect on tinnitus, although
it is possible that GBE has an effect on some patients due
to several reasons, e.g. the diverse etiology of tinnitus.
Since there is no objective method to measure the symptom,
the search for an effective drug can only be made on an
individual basis.
And still another abstract:
I searched the medline for your using PHYSICIANS ON LINE
software, from 1988 to present obtained the following:
Remacle J, Houbion A, Alexandre I, Michiels C
[Behavior of human endothelial cells in hyperoxia and
hypoxia: effect of Ginkor Fort]
Laboratoire de Biochimie Cellulaire, Facultes Universitaires
N.D. de la Paix, Namur, Belgique.
Phlebologie 1990 Apr-Jun;43(2):375-86
Article Number: UI91046351
ABSTRACT:
Recent discoveries have shown that venous diseases have a
multifactorial etiology. One of the factors which is
definitely involved in this pathologic process is the change
in the concentration of oxygen. An increase in the
concentration of oxygen, hyperoxia, or reoxygenation
following hypoxia, damages the tissues by stepping up the
production of free radicals. In addition, a reduction in
oxygen concentration, or hypoxia, is also damaging, probably
through a reduction in ATP synthesis. From a therapeutic
standpoint, the veins, and more particularly the
endothelium, must be protected against the impact on the
tissue of these changes in oxygen concentration. In this
study, the effects of Ginkor Fort were tested on cultured
endothelial cells subjected to varying oxygen pressures. The
results show that Ginkor Fort can provide good protection of
endothelial cells against hyperoxia and
hypoxia-reoxygenation. These beneficial effects are probably
due to the presence of flavonoids in the **Ginko** biloba
extract; these flavonoids have an anti-oxidant effect. In
addition, this substance also protects the cells against
hypoxia, possibly by increasing the availability of oxygen
for ATP synthesis. This dual protective effect, which is
produced by two different mechanisms, may account for the
wide spectrum of Ginkor Fort in its use in venous diseases.
Despite the above quotes, one prominent American tinnitus specialist
says that gingko does no better in rigorous scientific studies than a
placebo effect of 5%.
* anti-depressants, tranquilizers, and muscle relaxants
Many tinnitus sufferers become depressed from having to deal with the
constant noise. Treating the depression may make the tinnitus seem
less severe. But beware that certain ototoxic anti-depressants may
_worsen_ tinnitus. SSRI anti-depressants may temporarily worsen
tinnitus for the first few weeks, but risk fewer side-effects as
compared to the older tricyclic drugs.
Tricyclic anti-depressants, such as Nortriptyline and benzodiazepines,
such as Alprazolam (Xanax) were used in one study in which some people
reported improvement.
Possible reasons:
(1) Patients just think they feel better (placebo effect).
(2) Since these drugs are central nervous system depressants, auditory
responsiveness diminishes.
(3) Tinnitus is stress-related - i.e. muscle tension in neck & jaw
restricts blood and lymph flow.
Alprazolam (Xanax)
A double-blind study with placebo control showed 76% of the subjects
benefited with tinnitus reductions of at least 40%, whereas only 5% of
the placebo subjects had an improvement. Try 0.5mg at bedtime. Can be
addicting, and may make you feel excessively mellow.
An abstract of an article describing the Xanax study:
Use of Alprazolam for Relief of Tinnitus
A Double-Blind Study
Robert M. Johnson, PhD; Robert Brummett, PhD; Alexander
Schleuning, MD
(Arch Otolaryngol Head Neck Surg. 1993:119:842-845)
OBJECTIVE: To systematically test the effectiveness of
alprazolam as a pharmacological agent for patients with
tinnitus.
DESIGN: Prospective, placebo-controlled, double-blind study.
PATIENTS: Forty adult patients with constant tinnitus who
had experienced their tinnitus for a minimum of 1 year and
who resided in the Portland, Oreg., metropolitan area.
Twenty patients were randomly assigned to the experimental
group and 20 to the control group.
RESULTS: Seventeen of 20 patients in the experimental
(alprazolam) group and 19 of the 20 in the placebo (lactose)
group completed the study. Of the 17 patients receiving
alprazolam, 13 (76%) had a reduction in the loudness of
their tinnitus when measurements were made using a tinnitus
synthesizer and a visual analog scale. Only one of the 19
who received the placebo showed any improvement in the
loudness of their tinnitus. No changes were observed in the
audiometric data or in tinnitus masking levels for either
group. Individuals differed in the dosages required to
achieve benefit from the alprazolam, and the side effects
were minimal for this 12-week study.
CONCLUSIONS: Alprazolam is a drug that will provide
therapeutic relief for some patients with tinnitus.
Regulation of the prescribed dosage of alprazolam is
important since individuals differ considerably in
sensitivity to this medication.
Reprint requests to 3515 SW Veterans Hospital Rd., Portland,
OR 97201 (Dr. Johnson).
Here's the Conclusion section of the article:
CONCLUSION. It appears that alprazolam is beneficial in
treating some patients with tinnitus. Because long-term use
of a benzodiazepine is not recommended, it probably should
be used as an option when the patient cannot benefit from
tinnitus maskers, hearing aids, or other therapy. Patients
who elect to continue taking the drug are prescribed it for
a maximum of 4 months. The dosage is then reduced by 0.25 mg
every 3 days before it is completely discontinued. Once the
drug therapy program has been terminated, it is not resumed
for at least 1 month. For some patients, the tinnitus
remained at a low level. Also, some patients are able to
continue the drug at daily dosages of 0.5 mg and 1.0 mg. It
is important to regulate the prescribed dosage of alprazolam
since individuals differ considerably with regard to
sensitivity to this medication.
Patients in the Portland study reported an average tinnitus loudness
of 7.5 dB before Xanax treatment, and 2.3 dB after.
Klonopin
Same class of drug as Xanax, but somewhat less effective and less
addictive. Klonopin has not been tested for tinnitus reduction in
rigorous scientific studies.
A word of warning:
Big-time antidepressants like the tricyclics and Prozac cannot be
expected to have an effect if the tinnitus sufferer does not suffer
from an affective disorder originating in brain chemistry. Minor
tranquilizers may help. But people should beware of trusting their
friendly local internist/GP to prescribe drugs of this type. Current
knowledge of psychopharmacology is essential. GP prescriptions of
these drugs have messed up more facets of people's lives than just
their hearing.
* anti-convulsants
Carbamazepine (Tegretol, a dangerous drug!), phenytoin (Dilantin),
primidone (Mysoline), valproic acid (Depakene) have all shown some
effectiveness in reducing tinnitus. But there is no standard dosage
for tinnitus applications, and some of these drugs may cause dangerous
side-effects that require careful monitoring via blood chemistry and
other tests. Anti-convulsants have not been studied in rigorous
scientific tests for reduction of tinnitus.
* intravenous lidocaine
An initial injection of lidocaine followed by an IV drip may provide
temporary relief to some sufferers. In one study, relief of up to 30
minutes after IV disconnection was reported by 23 out of 26 patients.
* tocainide hydrochloride
This is an oral relative of lidocaine thought to act in a similar
manner. Tocainide can have serious side-effects.
* histamine
On p.32 of Conn's Current Therapy, 1994, W.B. Saunders Co., MDs Jack
C. Clemis and Sally McDonald write "The authors' choice for
pharmacotherapy is histamine. In a study awaiting publication, nearly
70% of patients treated with histamine achieved complete or partial
resolution of their symptoms."
Anyone with more information about this Therapy, the study to be
published, MDs Jack C. Clemis and Sally McDonald, and/or anyone else
using this Therapy please contact me at: nomader@eskimo.com I have as
to date no other information than that is in the above paragraph.
* anti-histamine
[Ed. note: Yes, I realize this is in contradiction with the above
paragraph.] The theory is that the mild sedative effect eases anxiety,
and that mucous reduction allows the inner ear to dry out, thus
relieving cochlear pressure.
* meclizine
This is an over-the-counter (USA) anti-vertigo drug. While it is
obviously relevant to the severe vertigo that comes with Meniere's,
there was one anecdotal report submitted to this FAQ by a tinnitus
sufferer who did not _have_ vertigo but took meclizine to successfully
reduce his tinnitus.
* DMSO
The following appeared in a recent article in Alternatives regarding
tinnitus:
"Ask your doctor to review the following article, Annals of
the New York Academy of Sciences 75:243:468:74. 'In this
study,15 patients were suffering from tinnitus. Every four
days 2 milliliters of a medicated DMSO solution containing
anti-inflammatory and vasodilatory compounds were applied
locally to the external auditory canals of their ears. They
were also given an intramuscular injection of DMSO at the
same time.
'After one month, 9 of the 15 patients had a total cessation
of the tinnitus and it didn't return during the one year
observation period. It was diminished in two others and in
the remaining four it became only an occasional problem
instead of permanent (cold temperatures seemed to be the
main factor causing it to return).
'In addition, all of the five patients that were suffering
from vertigo noted significant improvement...'
* vinpocetine and vincamine
The following is an anecdotal report concerning vinpocetine, a drug
that is NOT registered in the United States. A search of the
Physician's Desk Reference and several CDROM databases turned up
nothing on the drug or its manufacturer. Be skeptical, but also
remember that some of today's wonder drugs were once new and
unregistered. A prominent American tinnitus researcher (Dr. Jack
Vernon) says, "Vinpocetine shows high promise." Judge for yourselves:
I started taking vinpocetine (a nootropic drug available
mail-order from Europe) a couple months ago, and my tinnitus
(due to listening to a walkman for the entire eighties) is
now almost gone. Occasionally the tinnitus will re-occur,
but I think that's due to what I happen to be eating (or not
eating) that day, as the FAQ states.
In short, vinpocetine cured what I thought was incurable,
and made me a whole-lot happier -- especially since I'm in
the music industry and depend on my ears.
From what I understand, vinpocetine repairs damaged nerve
cells, among other things. There are no side effects -- you
don't notice anything while taking it except that you may
remember things better, and your tinnitus may improve.
"VINPOCETINE: A side effect free synthetic derivative of
vincamine. Vinpocetine is three to four times as potent as
vincamine at improving cerebral circulation and overall is
OVER TWICE as potent as vincamine in humans. Vinpocetine has
wide ranging effects and can be used to improve memory,
treat stroke, menopausal symptoms, macular degeneration,
impaired hearing and tinnitus. The usual oral starting dose
is 1-2 tablets three times daily, to be followed by a
maintenance dose of 1 tablet three times daily for a longer
period of time. Vinpocetine has not been reported to
interact with other drugs and may be used in combination."
-- 'Recommended Dosages' sheet from Interlab.
You can order vinpocetine by sending a letter to Interlab
asking for an order form. Currently, vinpocetine is US$26
for 100 tablets. For Canadians, you can only order a three
month personal supply at a time. For Americans, you may need
a doctor's prescription, and can only order a three month
personal supply at a time. Call your government's "Customs"
agency, or "Food and Drug" administration to be sure.
Interlab
BCM box 5890
London
WC1N 3XX
England
A different contributor has this interjection to make about Interlab:
Interlab is not a reputable source. They are a "black"
organization that has shipped bogus drugs, and they
routinely ignore complaints. They use greeting cards to ship
drugs into the US (which is very reliable) and people either
love their service or hate it, depending on whether or not
they have had a problem that Interlab will not remedy.
How did you find out about vinpocetine? Did you explicitly try it for
tinnitus, or was it for some other condition and the tinnitus cure was
an unexpected side-effect? Did a doctor recommend it to you?
I read about it in a document regarding drugs that the FDA
won't approve because they don't consider the problem the
drug cures important enough (such as tinnitus.) It was on
the net somewhere -- I don't have it.
I got it specifically for tinnitus. A doctor didn't
recommend it -- I "prescribed" it to myself. I have a degree
is psychology, so I'm not completely in the dark as to its
effects.
The literature from the manufacturer almost has that "too good to be
true" ring to it. Have you ever seen any other literature on this drug
that didn't come from the manufacturer?
Nothing really substantial, except personal reports from
people who say it works with them.
Do you have any info regarding undesirable side-effects or toxicity
levels?
Non-toxic at any level, no side-effects. It's available OTC
(Over The Counter) in Europe and South America. It is not
available in North America because drug laws stipulate that
a drug has to cure an existing condition before it can be
approved. I guess tinnitus isn't a real problem to them. The
only way we can find out if it really works is if several
people try it and report back. I doubt tinnitus is something
that placebo response can overcome, and I'm sure that if
other peoples tinnitus was as annoying as mine, they'll jump
at the chance to try vinpocetine.
Another FAQ contributor reports:
In a quick review of the medline literature I did not find
any papers dealing with vinpocetine and tinnitus, but did
find some with information I will share....I found some
information in the merck index as well as in two articles on
vinpocetine-side effects in the Journal of the American
Geriatics Society ..JAGS 35:425(1987); 37:515(1989).....
VINPOCETINE
ethyl apovincaminate
3,16-eburnamenine-14-carboxylic acid ethyl ester
registered drug names...cavinton,ceractin,eusenium,finacilen
mode of action...cerebral vasodilator used to treat cerebral
dysfunction resulting from reduced blood flow....in addition
has other complex metabolic actions..."In humans, the effect
on cerebral blood flow is not certain, with some
investigators reporting no change, while others report an
increase". It has been reported that vinpocetine can be used
safely to treat patients with "chronic cerebral dysfunction
of vascular origin". The drug is not without some side
effects but these.. "were mild and not considered to be of a
serious nature". These papers also discussed the
concentration of drug administered to groups of patients in
controlled studies...There was mention made in the 1989
paper that vinpocetine was under investigation in the US
assessing its value in patients with multi-infarct
dementia...
The information that vinpocetine helps some people that have
tinnitus is at the moment anecdotal...as one with tinnitus,
I certainly would approach self treatment very
conservatively....I take niacin for my hypercholesteremia
and haven't noticed any change in the ringing...I would be
willing to take lecithin and ginko but I don't think I will
attempt vinpocetine until I am sure of its efficacy....most
of the people with tinnitus do not have cerebral
dysfunction!... I can also appreciate trying anything to
reduce the discomfort of tinnitus...please be cautious when
it comes to the use of drugs...as we know even niacin in
excess is potentially harmful....
Smart Drugs & Nutrients, Dean & Morgenthaler, 1991, Health Freedom
Publications, ISBN 0-9627418-9-2, has this to say about vinpocetine
and vincamine:
"Vinpocetine is a powerful memory enhancer. It facilitates
cerebral metabolism by improving cerebral microcirculation
(blood flow), stepping up brain cell ATP production (ATP is
the cellular energy molecule), and increasing utilization of
glucose and oxygen.
...
Vinpocetine is often used for the treatment of cerebral
circulatory disorders such as memory problems, acute stroke,
aphasia (loss of the power of expression), apraxia
(inability to coordinate movements), motor disorders,
dizziness and other cerebro-vestibular (inner-ear) problems,
and headache. Vinpocetine is also used to treat acute or
chronic ophthalmological diseases of various origin, with
visual acuity improving in 70% of the subjects.
Vinpocetine also is used in the treatment of sensorineural
hearing impairment.
...
Vinpocetine is a derivative of vincamine, which is an
extract of the periwinkle. Although they have many similar
effects vinpocetine has more benefits and fewer adverse
effects than vincamine.
Precautions: Adverse effects are rare, but include
hypotension, dry mouth, weakness, and tachycardia [Ed. note:
this is excessively rapid heartbeat, which can be FATAL. I
do not consider that to be "very safe"]. Vinpocetine has no
drug interactions, no toxicity, and is generally very safe.
...
Vincamine is an extract of the periwinkle. It is a
vasodilator and increases blood flow to the brain and
improves the brain's use of oxygen.
Vincamine has been used to treat a remarkable variety of
conditions related to insufficient blood flow to the brain,
including vertigo and Meniere's syndrome, difficulty in
sleeping, mood changes, depression, hearing problems, high
blood pressure and lack of blood flow to the eyes. Vincamine
has also been used for improving memory defects and
inability to concentrate. Vincamine has extremely low
toxicity and is very inexpensive.
...
Precautions: Rarely causes gastrointestinal distress, which
disappears when usage is stopped. Vincamine has not been
proven to be safe for pregnant women or children."
Like vinpocetine, vincamine is not directly available in the United
States. For a list of mail-order suppliers of these and other "smart
drugs", send US$2.00 to the address below and request the Smart Drug
Sources List:
Cognition Enhancement Research Institute
P.O. Box 4029
Menlo Park, CA 94026-4029
USA
Smart Drugs & Nutrients is also available from CERI:
It is now 5 years since SD&N was published and it is getting
hard to find in many bookstores in many areas of the
country. For those who can't find it locally, they can get
it from CERI for $12.95 plus $3 for Priority Mail shipping.
If they mention the Tinnitus FAQ, we will include the Smart
Drug Sources listing for free.
* hydergine
Another "smart drug", for which Dean & Morgethaler say:
"Hydergine is reported to increase mental abilities, prevent
damage to brain cells from insufficient oxygen (hypoxia),
and may even be able to reverse existing damage to brain
cells [Ed. note: Call me skeptical].
Hydergine is an extract of ergot, a fungus that grows on
rye. Midwives in Europe traditionally used ergot with
birthing mothers to lower their blood pressure. Researchers
at the pharmaceutical giant Sandoz analyzed ergot in the
late 1940s, looking for blood-pressure medications. Of the
thousands of compounds that researchers found in ergot,
three were combined and tested for their anti-hypertensive
properties. When studies with elderly people uncovered
cognition-enhancing effects, Sandoz began spending a great
deal of research money on Hydergine. It is now one of the
most popular treatments for all forms of senility in the
U.S., and is used to treat a plethora of problems elsewhere
in the world.
Hydergine probably has several modes of action for its
cognitive-enhancement properties. Its wide variety of
reported effects include the following:
o Increases blood supply and oxygen to the brain.
o Enhances brain cell metabolism.
o Protects the brain from free-radical damage during
decreased or increased oxygen supply.
o Speeds the elimination of age pigment (lipofuscin) in
the brain.
o Inhibits free-radical activity.
o Increases intelligence, memory, learning, and recall.
o Normalizes systolic blood pressure.
o Lower abnormally high cholesterol levels in some cases.
o Reduces symptoms of tiredness.
o Reduces symptoms of dizziness and tinnitus (ringing in
the ears).
...
Precautions: If too large a dose is used when first taking
Hydergine, it may cause slight nausea, gastric disturbance,
or headache. Overall, Hydergine does not produce any serious
side effects. It is nontoxic even at very large doses and it
is contraindicated only for individuals who have chronic or
acute psychosis, or who are allergic to it. Overdosage of
Hydergine may, paradoxically, cause an amnesic effect."
Hydergine is available in the United States with a doctor's
prescription. It is also available from overseas sources, as one
contributor explains:
Hydergine is widely used in France, and it is cheap there.
One person told me that you can get 5 mg Hydergine tablets
there for less than the price of 1 mg in the US. If contacts
can be made directly with French pharmacists sympathetic to
the use of the higher European dosages in the US, mail-order
access might be arrangeable for US tinnitus people.
Hydergine has not been proven in rigorous scientific tests to be
effective for tinnitus reduction.
* sodium fluoride
May be helpful when the tinnitus is due to cochlear otosclerosis.
* vasodilators
Vasodilators like niacin, gingko biloba, and prescription drugs for
hypertension increase blood flow inside the skull, raising the oxygen
available for good nerve health. But note that vasodilation cannot
benefit the cochlear hair cells, as the blood vessel (vas spralie)
which feeds these cells cannot expand or contract. Furthermore,
vasodilation may not always be helpful, as explains one FAQ
contributor:
A few years ago, physicians started treating some forms of
stroke, especially TIA's, with vasodilators. The theory was
that, with dilation, more blood could flow to the starved
areas. A later study showed that, in many cases, the
vasodilators made the condition worse. The reason was that
dilation increased flow to non-damaged areas and robbed
damaged areas of even more blood.
By extrapolation, one could conclude that tinnitus related
to vascular damage could be made worse with vasodilators. I
have no data to back this extrapolation up, but it does seem
reasonable.
* zinc
The cochlea has the body's greatest concentration of zinc. Supplements
of 90-150 mg per day may be beneficial in some cases. BUT BEWARE: high
levels of zinc interfere with the body's absorption of copper, leading
to anemia. Several studies have identified the 150mg dosage as leading
to toxicity problems. Zinc therapy when prescribed by physicians is
often accompanied by frequent blood tests to monitor copper levels.
Zinc has not been formally tested for the treatment of tinnitus.
* diuretics
Diuretics may be prescribed when Meniere's Disease is present. One
contributor reported tinnitus relief from Dyazide. But be aware that
some diuretics are ototoxic and can worsen or even cause tinnitus.
* homeopathic remedies
One contributor reports tinnitus relief from homeopathic cell salts:
I am a big believer in homeopathic cell salts. They have
help me tremendously in coping with the high input-output
life of a drummer. I perform approximately 12-15 hours a
week, full blast, which could take its toll (I'm 42) if I
wasn't taking care of myself.
For tinnitus, Kali Phos and Mag Phos for the nerves, Kali
Mur for any swelling in the inner ear. If I take the remedy
before retiring for the night, the symptoms are greatly
relieved by morning, and always within 48 hours.
These are generic names. There are several manufacturers,
notably Scheussler's Cell Salts (the guy who invented them
back in 1905), and Boiron out of France; Standard Homeopathy
here in the U.S.; all of which are usually available in most
health and nutrition stores.
You cannot overdose on homeopathic remedies, they are very
cheap ($5 for 150 doses), and extremely effective,
especially on acute conditions.
* betahistine hydrochloride (SERC)
The symptoms of Meniere's Disease can be ameliorated somewhat by
betahistine hydrochloride. It is sold, but alas, not in the United
States, under a host of names. It should NOT be taken by anyone
pregnant or lactating, by children, anyone with an adrenal tumor
(pheochromocytoma), bronchial asthma, or peptic ulcers. Possible side
effects are nausea, gastric distress, headache, rash.
It is not always effective, but if it is, relief is provided for 6 to
12 hours on the standard dosage of 24-48 mg per day. It is believed to
reduce pressure in the inner ear, and perhaps improve the blood flow
to the small blood vessels there.
Betahistine hydrochloride is sold in Canada under the trade name
"SERC", and is distributed by Solvay Kingswood, Inc, Scarborough,
Ontario, M1B 3L6 for Unimed, Inc.
Here is one sufferer's SERC experience:
I have suffered from Meniere's disease for 21 years. I've
had endolymphatic sac and 8th vestibular nerve surgeries on
my left ear during the last 5 years. Starting in September
'95, my right ear, which previously had been fine, began
ringing loudly. The hearing in the right ear declined
dramatically. My doctor tried a course of steroids to no
effect. It looked like I was going to be deaf within a year.
A friend of mine found your tinnitus FAQ file and mailed it
to me. I reviewed its contents with my doctor. He referred
me to another doctor who is more familiar with homeopathic
and other alternative treatments. This doctor encouraged me
to try SERC, which is not available in the US. I got an
appointment with a Canadian doctor in Windsor, Ontario. I
started using SERC (one 4mg pill three times per day) on
April 20, 1995. Seven days later, nothing had improved so I
increased the dosage to two 4mg pills three times per day
(as the doctor said I could). Two days later the right ear
ringing stopped completely and hasn't returned!!! I stayed
on that dosage for a month. I've now cut back to 2mg three
times a day and the ringing has not returned as of 7/30/95.
There were no side effects from the SERC at any of the
dosages I've tried.
I have my life back. My left ear works pretty well with a
hearing aid. My right ear has full normal hearing. I have no
side effects from the SERC. (By the way, SERC is cheap. 100
4mg pills cost me about $18.)
I'm happy to share my story with anyone. My name is Ken
Cornell. Phone is: 313-878-0809. E-mail: cordley@ismi.net
Please add this to your FAQ and keep up your good work. Your
efforts have saved my hearing. All my friends, family, work
associates and I thank you VERY much.
* magnesium
Magnesium Prevents Hearing Loss:
Three hundred young healthy male military recruits
undergoing two months of basic training were studied. The
trainees were repeatedly exposed to high levels of impulse
noises. Each recruit received daily either 167 mg of
magnesium (as magnesium aspartate) or a placebo (sodium
aspartate). Permanent hearing loss was significantly more
frequent and more severe in the placebo group than in the
magnesium group-
Attias J, Weisz G, Almog S, Shahar A, WienerM, et al. Oral magnesium
intake reduces permanent hearing loss induced by noise exposure. Am J
Otolaryngol 1994;15:26-32.
COMMENT: Hearing loss is a common problem, particularly
among older individuals. Although there are many causes,
repeated exposure to excessive noise is one key factor. Many
people do not realize how much noise pollution we are
subjected to on a daily basis, from the steady hum of home
appliances to the roar of trucks and autos. People who live
in large cities face a constant bombardment with potentially
damaging noise. Studies in animals have shown that noise
exposure causes magnesium to be lost from the body. Perhaps
supplementing with a little magnesium might prevent all of
that noise from damaging your hearing.
Nutrition and Healing, November 1994, p.8
* caroverine
Some research on caroverine is being done in Austria:
Dr. Doris Maria DEINK c/o
Universitiftsklinik flir Hals-Nasen-Ohrenkrankheiten
Vorstand: Univ.Prof.Dr. KEhrenberger
Allgemeines Krankenhaus der Stadt Wien
1090 Wien, Wahringer Gurtel 18-20
Telephone: 011-43-1-426355
September 9, 1994
Dear Mr. Berger,
Referring to your letter of August 1994, 1 am writing to
give you some informations, about our tinnitus treatment
with Caroverine. As you already know, the treatment with
Caroverine is indicated in cases of cochlearsynaptic
tinnitus. Therefore, a thorough ENT and audiological
examination is necessary before therapy to rule out other
tinnitus causes. If necessary, the diagnostic measurements
should also comprise brainstem audiometry. As far as I know,
Caroverine is not available as a registered drug in the
United States. Therefore, I do not know any collegue who
uses this substance in tinnitus treatment. Caroverine is a
commercially available drug in Austria (Spasmium-R),
Switzerland and Japan. In Austria, Spasmium-R has been used
as a spasmolytic drug for nearly 30 years. I am enclosing
some information about Spasmium-R. Caroverine is a
Quinoxaline - derivative. It is produced by
DONAU-PHARMAZIE-CEHASOL Ges.m.b.H., A-1230 VIENNA, AUSTRIA.
You can get further informations about the availability of
Spasmium-R from: PHAFAG AG, Im Bretscha 29,FL-9494, SCHAAN,
LIECHTENSTEIN FAX 05/075/232 19 93.
For tinnitus treatment, Caroverine is applied as slow
intravenous infusion (2 ml per minute). The dosage of
Caroverine differs from patient to patient and depends on
the tinnitus reduction achieved in the individual patient.
When the tinnitus is reduced, the infusion is stopped. At
maximum, 160mg Caroverine (4 ampules) are given in 100ml
physiologic saline solution. Until now, we have not observed
any severe side-effects. In some patients, a slight
transient headache or dizziness occured. I hope that our
informations will help you a little.
With best wishes for you,
Yours sincerely,
Dr. Doris-Maria Denk, MD
Dr. Doris Maria Denk
Allgemaines Krankenhaus der Stadt Wien
HALS-, NASEN- UND OHRENKLINIK
DER UNIVERSITAT WIEN
Vorstand: Prof. Dr. K. Ehrenberger
A-1090 Wien Lazarettgasse 14
tel. 40400/3305
FAX 43/222/4021722
Jan.23, 1993
The symptom tinnitus may be due to various causes.
Therefore, an exact audiological examination is absolutely
necessary. The tinnitus therapy with transmitter antagonists
can influence a special form of tinnitus - the so called
cochlear synaptic tinnitus. It is caused by functional
disturbances in the synapse between the inner hair cells and
the afferent dendrites of the auditory nerve. By intravenous
application of transmitter antagonists (e.g. GDEE,
Caroverine) the synaptic function can be improved and the
tinnitus reduced.
All other forms of tinnitus cannot be reduced by transmitter
antagonists. The substances we use for therapy of cochlear
synaptic tinnitus are GDEE (Glutamic acid diethyl ester) and
Caroverine. GDEE is not a registered drug and is only
available upon special request by the clinic. The substance
is produced by "FLUKA Biochemie, Industriegasse 25, CH-9479
BUCHS, Switzerland). GDEE has to be lyophilised in order to
be effectful. Now we are mainly using Caroverine. This
substance is a registered drug in Austria (SpasmiumR) and
known for its spasmolytic effect. At the Annual Meeting of
the American Academy of Otolaryngology Head and Neck Surgery
in Washington in September 1992 I reported about our
results. Now we are preparing a publication. I am enclosing
some information about our therapy (including papers about
the theoretical basis).
In your case the tinnitus etiology seems to be noise. If in
addition to the mechanical damage of the inner ear a
functional disturbance is present, there is a chance to
influence the tinnitus. If you like to come to Vienna for
therapy, please contact me to fix a date. I would propose a
date at the beginning of March. If I can be of any further
assistance, please let me know.
Yours sincerely,
Doris-Maria Denk, MD.
Head and Neck Surgery
Therapy of Cochlear Synaptic Tinnitus
DORIS MARIA DENK MD (presenters, R. BRIX PHD, D. FELIX PHD,
and K EHRENBERGER MD, Vienna, Austria
Tinnitus occurs in about 60% of inner ear diseases. A
tinnitus model that explains the pathophysiology of a
certain type of cochlear tinnitus, the so called cochlear
synaptic tinnitus, is presented. Cochlear synaptic tinnitus
is caused by functional disturbances of the synapse between
inner hair cells and afferent dendrites of the auditory
nerve. This may be the case in sudden hearing loss, hearing
loss in the elderly ("presbycusis") or noise-induced hearing
loss. The cochlear synapse has the following
characteristics: (1) glutamate is supposed to be the
transmitter substance, and (2) on the subsynaptic membrane,
two different receptor types work as a dual receptor system:
NMDA (N-methyl-D-aspartate) and non-NMDA-receptors
(Quisqualate, Kainate). This dual receptor system is
responsible for a typical pattern of depolarization, which
can be shown in microiontophoretic animal experiments. Under
pathological conditions, spontaneous receptor-dependent
depolarization patterns mimic sound-induced patterns, which
are perceived as tinnitus. On the basis of these
considerations, we use the specific Quisqualate antagonist
glutamic acid diethyl ester (GDEE) for therapy of cochlear
synaptic tinnitus to normalize the synaptic function. We
have treated 130 patients by intravenous application of
GDEE. In 77.2% of the patients, tinnitus was reduced by more
than 50% in absolute values of sound intensity. The
indications, diagnostic and therapeutic procedures, as well
as methods of subjective and objective evaluation of the
therapeutic effect, will be discussed.
CAROVERINE
Countries Where Available and Release Dates: Austria (1970);
Sp. synonyms: v TP 20 1 - I
Brand Names und Manufacturers:
Base: Espasmofibra-Faes (Spain), Spasmiurn-Donau Pharmazie
(Austria)
Hydrochloride: Espasmofibra-Faes (Spain), Spasmium-Donau
Pharmazie (Austria)
Drug Action: Spasmolytic.
Indications/Usage: Intestinal spasm; biliary spasm.
How Supplied: 20 mg capsules; 40 mg ampules; 40 mg
suppositories
Dosage: 40 mg up to 3 times daily.
Precautions/Warnings: Hyperthyroidism; cardiac
insufficiency; muscular weakness in the elderly and
disabled.
Contraindications: Glaucoma; prostate hypertrophy; duodenal
obstruction.
Interactions: Phenothiazines; anticholinergics;
antihistamines; tricyclic antidepressants; digoxin.
Adverse Effects: Dry mouth; blurred vision; urinary
retention; tachycardia.
US Treatments: Cicyclomine, L-hyoscyamine and propanthelin
are US anticholinergic drugs with similar pharmocologic
properties
* carbogen
From: govaerts@uia.ua.ac.be (Paul.Govaerts)
To: Sigeroo@aol.com
Dear Mr Segal
....The problem of acoustic trauma is completely different
from a large vestibular aqueduct or even a sudden deafness.
In acoustic trauma there is both physical lesion of the
hairs of the hair cells and biochemical lesion of the
auditory neurons because of toxicity of the excitatory
neurotransmittor that is involved. (Ref Prof Pujol,
Montpellier, France). The tinnitus and vertigo and I guess
also the hearing loss result from these lesions. It has been
shown that these cells may have a good potential for
recuperation and possibly also for regeneration (ref Van De
Water, Bronx, NY and Lefebvre, Liege, Belgium). By
administering vaso-active drugs and carbogen inhalation, a
massive peripheral vaso-dilation is triggered, bringing huge
amounts of oxygen and nutrients to these damaged cells.
Although one has not been able to demonstrate superior
effect of vasoactive drugs to placebo, carbogen has never
been really studied. And I have several cases with sudden
deafness (including after acoust or baro-trauma) who were
not responding to vasoactive drugs and who responded
spectacularly to carbogen, even when given several weeks
after the injury. Unfortunately this treatment has no
success when given too late, since there is no more
potential for regeneration....
Yours,
Paul Govaerts, MD, MS.
This information is courtesy of Dan Segal (sigeroo@aol.com).
---------------------------------------------------------------------------
10) What other treatments are available for tinnitus?
* surgery
For tinnitus caused by acoustic neuromas, vascular abnormalities, and
TMJ syndrome. But note above in the Causes section that tinnitus,
hyperacusis, or even profound deafness can _result_ from ear/skull
surgery.
* maintain a healthy diet & lifestyle
This means no tobacco, no alcohol, no caffeine, low fat, low sodium.
This may not cure your tinnitus, but there are other well-proven
health benefits. Other less obvious foods like quinine/tonic water
should also be avoided. If your dietary intake isn't sufficiently
diverse, consider supplements:
My research work during the past ten years has been on
health and nutrition, and I can see that use of some dietary
supplements would be a rational approach to ameliorating
tinnitus. More than half of our population is at least
slightly deficient in all of the B vitamins, magnesium,
zinc, and perhaps copper and iron. Since folate, vitamin B6,
vitamin B12 are critical for tissue repair and organ
regeneration, it would be a very good idea to consider
supplementing the daily diet with these. In addition, our
diets are deficient in essential elements, including
calcium, magnesium and zinc. Calcium is necessary for the
action of about 500 enzymes, while magnesium is required by
about 400 enzymes. All of these are interlinked in a system
that is active 24 hours a day. Just supplementing the diet
with one will not be completely effective if others are
lacking. I think that the first step for anyone who wants to
be really healthy, with ability to efficiently repair tissue
and organ damage, should examine the diet critically to find
deficiencies, then make sure that all of the essential
elements and vitamins are present in greater than minimal
amounts. Supplements make very good sense if approached this
way.
* biofeedback
Useful as a stress reduction tool, biofeedback may help some people.
*****[comments from someone who's been there?]*****
* accupuncture
May provide temporary relief to some people. One contributor reports
significant relief that enabled him to avoid the heavy-duty
anti-depressants that his Western physician had prescribed.
* stress reduction
Many people say their tinnitus is more active when they're tired and
stressed out. Get a good night's sleep and avoid unnecessary stress.
* hearing aids
Some people with severe tinnitus may benefit from hearing aids that
bring normal speech sounds above the background tinnitus sounds. In
addition to amplification, hearing aids may be useful as maskers when
they also introduce white noise into the sound stream.
* cranial sacral therapy
There is anecdotal evidence of help for tinnitus through cranial
sacral therapy by osteopaths and chiropractors.
* electrical stimulation
Various electrode placements with various voltages & frequencies may
provide some relief. External, ear canal, transtympanic, middle ear,
and cochlear electrodes have all been tried. Side effects may include
pain, and alterations to sense of taste & smell. In one study of
electrical stimulation on the round window, 3 out of 5 patients
experienced some relief when frequencies of 40 Hz or less were
applied.
* surgically severing the auditory nerves
An Eighth Nerve section is the treatment of last resort. You will be
totally deaf. But beware - if your tinnitus originates somewhere
inside the brain, you will be totally deaf AND still have tinnitus. A
prominent American tinnitus specialist says this surgery should never
be done for tinnitus, since he knows of patients whose tinnitus
INCREASED to suicidal levels afterward.
* hyperbaric oxygen therapy
This treatment is supposed to be beneficial when the tinnitus is
thought to be due to a lack of oxygen for the hearing mechanism. It
may be more effective for recent onset cases rather than long-term
ones. [Ed. note: this treatment is not without risk; at one such
center in my community that treats Alzheimer's patients, the door
seals on the chamber failed, resulting in an explosive decompression
that injured several patients.] One poster to alt.support.tinnitus has
this to say about the therapy:
Following is a summary (my own words) of an article which
recently appeared in the "MAINZER ALLGEMEINE ZEITUNG"
describing a new method treating T with pure oxygen under
high air pressure (hyperbaric oxygen treatment - in short
"HBO" treatment).
PLEASE NOTE: I cannot in any way guarantee the validity of
the information given in that article. The same is true for
my interpretation of the article's information and my
summarzing it (I tried to be as close as I could). Using
this info is at the reader's own risk.
SUMMARY starts:
A doctor's practice in Duesseldorf (no further details
mentioned) uses a submarine-like tube (6 meters in length)
which is a similar device as used for treating divers who
have suffered a diving accident or patients with carbon
monoxide poisoning or having had a "hearing infarct" (could
not find the right English word !). Such "Oxygen Therapy
Centers", mostly stationary ones, do exist at various other
locations in Germany, mainly hospitals.
Twelve tinnitus patients can be accomodated in Duesseldorf
at the same time. Treatment is comparable to a dive to 15
meters depth of water while breathing pure oxygen.
Consequently, treatment starts with air pressure in the tube
being raised slowly within 20 minutes. Pure oxygen is
supplied to each patient via oxygen mask. Treatment lasts
for two hours. Depressurization at the end lasts somewhat
longer than 20 minutes. An experienced professional diver is
accompanying the patients during treatment to assist them if
they have problems due to climbing or falling air pressure.
Newspapers and headphones are provided to help avoid boredom
during the two hours treatment.
Ten consecutive treatments are offered, one each day. Cost:
300 DMarks (about just below $ 200.-) per treatment.
HBO treatment is offered to patients who often have been
suffering from tinnitus for years with no other traditional
treatments having helped (like infusions, blood circulation
improving medicine, etc). -- Health insurance normally does
not cover the HBO treatments. They may consider taking part
of the bill, however, in specific cases, e.g. if classical
tinnitus treatment methods have been used unsuccessful.
Traditional medicine has not found a general treatment
method for tinnitus so far. The theory behind the new HBO
treatment is based on the assumption that tinnitus is caused
mainly by oxygen supply shortage in the inner ear organs.
Studies at Munich Technical University have shown that pure
oxygen treatment under high air pressure can increase oxygen
saturation in the inner ear up to 500 %. In the USA and in
the former Soviet Union this method reportedly has been used
extremely successfully for many years. Alone in Moscow are
about 40 pressure chambers in use. (No further details for
either country).
Cure from tinnitus through the new therapy cannot be
guaranteed, according to the doctors. The article closes
with a statement of one doctor: "I can hardly *promise*
anything."
SUMMARY end !
So much for the article. I hope I could understandably relay
what it said. No information has been supplied in the
article about success rates or the like. -- I hope this
information is of some help. If some co-sufferer has tried
the HBO treatment his comments would certainly be very
welcome.
* feedback therapy
A poster to alt.support tinnitus reports about a therapy involving
listening to a series of electronically-produced tinnitus noises:
This may be old news to some readers, but perhaps many
others might be interested. A very interesting paper by L.
P. Ince, et al appeared in the journal Health Psychology in
1987, "A matching-to-sample feedback technique for training
self-control of tinnitus." Here's a summary:
Ince and his colleagues worked with 30 individuals suffering
from tinnitus, and used a "matching-to-sample" feedback
procedure. Each subject's tinnitus sounds were reproduced
electronically and played into either one ear (for those
with single-side T) or both ears. The sound was then reduced
by 5 dB during each session. The subject was asked to
"think" their tinnitus sounds down to match the signal that
was supplied. No instructions were provided as to how to do
this...each subject just tried the best he or she could.
Each trial lasted 60 seconds, with 30 second rests between
trials. If the tinnitus was brought down to the lower level
during any one trial, the subject was then supplied with the
electronically-produced sound that was lowered by an
additional 5 dB, otherwise the same signal was provided. A
total of 15 trials were run each session (so, less than one
half hour overall for the session). Subjects went through 3
to 12 of these sessions.
Almost all of the 30 subjects experienced a reduction in
their tinnitus. One subject completely eliminated the
tinnitus in 3 sessions. By the end of the experiment, eight
subjects eliminated the tinnitus. One subject who had had
tinnitus for 30 years reduced the level from 40 to 10 dB.
The subjects' tinnitus at the start varied greatly in
quality and loudness and had varied greatly in the duration
since onset.
This experiment showed that many people could be trained to
"not hear" their tinnitus. This was not just a case of the
subjects' being less bothered by the sounds, but actually
reducing the sound levels. This was shown by playing random
sound levels for the subjects who indicated when the sound
level matched their tinnitus.
I wrote Dr. Ince in 1991. He replied that he was not a
tinnitus specialist and had ceased his studies. However, he
was very willing to aid professionals who wished to try to
replicate his results. He also informed me that it is not
possible to reproduce his study with standard household
electronic equipment (such as tapes), and only trained
audiologists should try to do such a study.
Dr. Ince's study reminded me of an interesting question I
once heard asked about tinnitus: Why doesn't *everyone* hear
wild noises? The blood going through the inner ear creates
vibrations that are FAR greater than even fairly loud sounds
outside the ear. Perhaps we all have trained our brains to
ignore such sounds.
A prominent American tinnitus specialist says that Ince's work was a
"misleading dead end".
http://www.vlasback.com
* Auditory Integration Training (AIT)
Auditory Integration Training (AIT) was originally developed by a
French doctor named Alfred Tomatis. Another French doctor who was
seeking a cure for his tinnitus (the crickets he kept hearing
everywhere he went) received Dr. Tomatis's training. Dr. Guy Berard
was so fascinated by the cure that he studied it and modified the
treatment. The original Tomatis auditory training is still available
today. It involves many hours of listening therapy, sometimes on the
magnitude of hundreds of hours of therapy. (See sound therapy, below.)
Dr. Berard's auditory training method is ten total hours of treatment.
The treatment involves listening to music that has been altered such
that the high frequencies and low frequencies are randomly shifted in
and out. The sessions are 30 minutes in length given twice a day
(treatments separated by four hours) for 10 days. Some practictioners
opt to run the program in two consecutive weekday blocks while others
run the program through the weekend. The music ranges from Gordon
Lightfoot to reggae. It sounds distorted.
The Berard method of AIT is described in Dr. Guy Berard's book,
_Hearing Equals Behavior_. The method was brought to the United States
in the early nineties by Annabel and Peter Stehli whose daughter
recovered from autism after receiving AIT in France. Their daughter's
story is documented in Annabel's book, _The Sound of a Miracle_.
Because of the Stehli's affiliation with autism, AIT is used heavily
by persons with autism and hyperacusis although Dr. Berard has used
AIT mostly for learning disabilities, tinnitus, and depression.
There are two different devices that are capable of delivering Berard
AIT: the audiokinetron, which was developed by Dr. Berard, and the BGC
which is designed and manufactured in the United States. Research has
not shown any difference in results according to which machine
delivers the AIT.
The preparation for AIT usually involves an audiogram to look for
hypersensitive hearing. A normal audiogram should be nearly flat (all
frequencies heard equally well) but sometimes a person may have an
audiogram that resembles a mountain range. If a person shows extreme
sensitivity to particular frequencies, then filters may be used during
AIT to eliminate those frequencies from the training. However there is
some feeling that by filtering out certain frequencies the
randomization of AIT is reduced and perhaps the effectiveness is
reduced.
There is no scientifically proven theory explaining why AIT works. It
may be that the stimulation of the middle ear acts and physical
therapy for the ear. Since each frequency stimulates a different area
of the cochlea, it may be that the broad range of frequencies evens
out the cochlear response to sound.
Once a person has undergone AIT, they should not listen to music
through headphones as it may undo the training. Other factors that
have been known to reverse the benefits of AIT have been high fevers
(meningitis), general anesthesia, exposure to loud sounds, and
headphone use for music. Listening to voices (story tapes or language
tapes) is acceptable.
AIT treatments do not work on those with hyperacusis and can actually
worsen the condition - particularly the tinnitus, because it is
administered at uncomfortably loud sound levels.
For further information on AIT:
o Hearing Equals Behavior, by Dr. Guy Berard (translated by Simone
Monnier-Clay & Catherine Dodge), 192 pages, 1993, paperback
US$17.95, ISBN 0-87983-600-8, Keats Publishing Inc., New Canaan,
CT USA, +1 800 858-7014.
o The Sound of a Miracle by Annabel Stehli
o Dancing in the Rain, edited by Annabel Stehli. This is a
collection of stories written about children with special needs
who have undergone AIT.
AIT organizations:
The Georgiana Organization
P.O. Box 2607
Westport, CT 06880 USA
+1 203 454-3788
A packet on AIT as well as a list of AIT practitioners trained by the
Georgiana Organization.
Autism Research Institute
4182 Adams Ave.
San Diego, CA USA
A packet on AIT which includes research papers published by Steve
Edelson, Ph.D.
Society for Auditory Integration Training
Center for the Study of Autism
Boardwalk Plaza, Suite 230
9725 SW Beaverton-Hillsdale Hwy
Beaverton, OR 97005 USA
+1 503 643-4121
SAIT (Society for Auditory Integration Training) is dedicated to the
enhancement of the quality of life for individuals with special needs
through auditory integration training. The purpose or goal of SAIT is
to establish policies, minimum training and equipment standards and
guidelines for _all_ AIT practitioners, and to promote a professional
image. SAIT's objectives are: Promote professional and ethical
standards for AIT; Set procedural standards; Promote networking and
sharing of information; Advise and evaluate research on the efficacy
of AIT.
SAIT does not promote any single method of AIT (Berard, BGC, or
other). They will provide you objective information about many issues
concerning Auditory Integration Training (research, age
recommendations, after-care, etc.) and answer frequently asked
questions. They maintain a list of persons trained in _both_ the
Berard and BGC methods of AIT.
The SAIT Newsletter is published quarterly and is full of information
on AIT. Associate membership ($30) is open to anyone interested in
AIT. Professional memberships (reserved for practitioners who had
passed the examination for SAIT certification and who had the
appropriate educational backgrounds) have been temporarily suspended
pending FDA approval of the Audiokinetron and other AIT devices.
Currently a Practitioner membership is open to practitioners who have
been trained by an "approved" instructor. No certification of these
members will take place.
The recent FDA investigation of AIT has interrupted SAIT's efforts to
certify practitioners and to insure the ethical and professional
practice of AIT. Once the Audiokinetron and other AIT devices receive
FDA approval, SAIT will recommence its original mission. Currently
SAIT's first priority is to provide practitioners and families with
information about the current status and pressing issues of AIT. The
newsletter will focus on research, legal advice and other noteworthy
news. A supplemental paper on a related topic will also be distributed
on a quarterly basis to its members; such topics will include sensory
integration, visual training, and hearing anomalies.
* sound therapy
Sound therapy originates from the work of Dr. Alfred Tomatis. The
following is quoted from a flyer entitled "Tinnitus, Vertigo, and
Sound Therapy", published by Sound Therapy Australia, P.O. Box E237,
St. James, N.S.W. 2000 (this organization sells books and cassette
tapes for this therapy):
How can Sound Therapy help?
The middle ear contains two tiny muscles, tensor tympani and
stapedius, which play an active role in the functioning of
the ear. Lack of tone in these muscles means that the ear
loses its ability to recognise certain frequencies of sound,
so these sounds never reach the inner ear. The ear's ability
to adjust and balance the fluid pressure in the inner
chambers is also impeded if the stapedius muscle is not
fully functional.
The electronic ear used in the recording of Sound Therapy
challenges the ear with constantly alternating sounds of
high and low tone. At the same time, low frequency sounds
are progressively removed from the music so the ear is
introduced to higher and higher frequencies. The result is a
complete rehabilitation of the ear, improving the tone and
responsiveness of the middle ear muscles. Once the ear is
able to recognise and admit high frequency sounds to the
inner ear, this creates the opportunity for the sensory
cells in the inner ear to be stimulated and restored to
their upright, receptive position.
...
Meniere's vertigo
Dr. Tomatis has proposed that Menieres vertigo which
produces attacks of dizziness is also due to an anomaly in
the tension of the stirrup muscle. This muscle may be
subject to involuntary twitches, like any other muscle in
the body. Such twitching would radically alter the fluid
pressure in the inner ear chambers, thus causing havoc with
the balance mechanism. The re-toning of the stirrup muscle
achieved by Sound Therapy frequently resolves this
condition.
Does it really work?
...
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