Tinnitus Frequently Answered Questions v2.7
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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 --------------------------------------------------------------------------- What's New * A new FAQ maintainer has stepped forward. Stay tuned for a new and easier to use FAQ, coming soon. --------------------------------------------------------------------------- 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) --------------------------------------------------------------------------- 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. --------------------------------------------------------------------------- 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!) --------------------------------------------------------------------------- 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 --------------------------------------------------------------------------- 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? --------------------------------------------------------------------------- 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. --------------------------------------------------------------------------- 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. --------------------------------------------------------------------------- 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 --------------------------------------------------------------------------- 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. --------------------------------------------------------------------------- 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. --------------------------------------------------------------------------- 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". * 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? ... The length of time it takes to achieve results varies from twenty four hours to fourteen months. Usually more severe cases take longer, so it is advisable to persist with the therapy for at least six months. ... The initial results of a listener survey conducted by Sound Therapy Australia [Ed. note: not exactly unbiased] indicate that 96% of tinnitus sufferers who perservered with the listening felt they benefited from the therapy. Of these, 20% said the tinnitus stopped completely, and 36% experienced a reduction in the sound. The other 44% experienced other benefits such as improved sleep and reduced stress, which made the tinnitus easier to bear. * hypnotherapy Hypnotherapy has been reported by Dr. Kevin Hogan, who is a registered Clinical Hypnotherapyst, to be showing remarkable results for tinnitis sufferers . Dr. Hogan says, (in reguards to a April 95 release of a study by Mason, J, Rogerson, D, Derbyshire Royal Infirmary, UK., which stated, in part: ...."therapy for their tinnitus....68% showed some benefit for their tinnitus ...32% showed no evidence of improvement for their tinnitus"....) ..."This confirms previous research in the use of hy