TINNITUS
TINNITUS
6 Test drive a hearing aid/masking device ***
• Take melatonin at bedtime **
• Ask your doctor about misoprostol (Cytotec)
Can you imagine anything more annoying than hearing a mosquito buzzing around your head and not being able to catch it? A dentist’s drill might be a close match. Now imagine what it would be like to have crickets chirping in your ear 24 hours a day, 7 days a week.
Experts estimate that more than 30 million Americans hear a constant noise in their ears.807′Roughly one in eight men between the ages of 65 and 74 experiences some form of tinnitus (pronounced TIN-a-tus or tin-EYE-tus).808 Women and children are not spared the unwanted sound effects, which some describe as hissing, humming, chirping, whooshing, whistling, squeaking, or roaring.
Many tinnitus sufferers hear a high-pitched ringing, while others say it sounds more like steam escaping. Others complain of radio static or an electronic whine inside their head. One person described it this way: “I have aff ocean between my ears every day, 24-7.” Whatever the sound, it never lets up—but nobody else can hear it, either.
My husband has a constant buzz in his ears andalso hears a sound he likens to a dishwasher running. This particular sound bothers him most when he goes to bed or wakes up at night, and it wakes him frequently. The doctor says lots of people have tinnitus and the problem isn’t serious, but it has my husband on the ropes.
According to the medical establishment, “Many patients with tinnitus believe that they have a serious medical prob- lem. This is rarely the case.” 8(3) We beg to differ. People with tinnitus look normal, but the affliction can be as crippling as arthritis. Some individuals are so distressed by the sounds they hear that they become severely depressed and contemplate suicide. A study has found that even moderate tinnitus can interfere with cognitive ability, making it harder to focus and achieve peak performance while working on demanding tasks-810
Tinnitus can be caused by many things, including very loud noises. More than 15 years ago, Joe was preparing to cohost a radio show when a student engineer made an error and created a feedback loop through Joe’s headphones (the kind of screech you sometimes hear through speakers in an auditorium). The sound was so loud and so close to his ears that from that day to this, Joe has heard a ringing and hissing sound. Some days the noise is so overpowering that it is hard for him to concentrate. For people who cannot imagine what you are going through, it is difficult to describe how disconcerting it is to have a fieldful of crickets inside your head all the time.
We fear that millions of teenagers and young adults may be setting themselves up for tinnitus and other forms of hearing loss by exposing themselves to high volume levels while listening to iPods and other music devices. There are so many loud noises in our environment that the cumulative effect can damage our ears and increase our risk of tinnitus. We’re talking about everyday things in our lives like blenders, vacuum cleaners, motorcycles, leaf blowers, and lawn mowers. All of them are loud and can contribute to hearing problems.
G. I have just developed a hissing sound in my ears. The onset was very rapid!
The doctor diagnosed it as tinnitus but would give me no reason for the problem. He said there wasn’t anything I could do. I’ve noticed some days it is less disturbing than others, but some nights it awakens me because it has become so loud.
I was drinking large quantities of tonic water, which contains quinine, when this started. Do you have any suggestions to help me?
A. Stop the tonic water! Quinine gives tonic its distinctive bitter flavor, but it can cause tinnitus, especially at high doses. Hopefully the hissing sound will gradually go away once the quinine is out of your system.
Drugs are another common cause of tinnitus. An amazing number of prescription and over-the-counter medications can cause ringing in the ears. Aspirin is one of the most common culprits, but many other arthritis drugs can also contribute to the problem. If you suspect that a medicine is causing ringing, hissing, or whooshing, please discuss this with your physician promptly.
Drug-Induced Tinnitus
A. 1 am desperate to find some way to alleviate my arthritis pain without experiencing unbearable tinnitus. I have taken aspirin for some time, and it has been quite effective. If a joint flares up, l increase the dose for a few days. Then I heard your radio show where you mentioned that aspirin can contribute to tinnitus.
The noises in my head had been getting worse. I was resigned to this, but after listening to your program I stopped the aspirin. The result for my ears was dramatic! But then the joint pain came back. I feel I am walking a very thin line between arthritis and tinnitus.
A. Sadly, you are caught between a rock and a hard place. Aspirin and other arthritis drugs (nonsteroidal anti-inflammatory drugs, or NSAIDs, like naproxen and ibuprofen) can cause ringing in the ears. Some people are susceptible to even low doses. You may need to investigate other options for arthritis pain. (See page 102 for some nondrug approaches.)
In addition to sound-induced injury (like Joe experienced) and drugs, many other things can cause tinnitus. Impacted earwax is probably the most benign and easiest to correct. Some other contributors include head injury, multiple sclerosis, hypertension, infections (otitis media, Lyme disease), and tumors (acoustic neuroma). That’s why it is important-to be seen by a specialist (an otorhinolaryngologist, or ear, nose, and throat doctor) to rule out any treatable condition. Sometimes there is no obvious reason for the ringing or whooshing.
A few months ago I suddenly developed a case of tinnitus in my left ear It sounds like the high-pitched noise the computer makes when logging onto the Internet I am 36 years old and in extremely good health. I have not experienced any head trauma and am not exposed to loud noises.
I had an MRI to rule out a brain tumor Neither my family physician nor an ear, nose, and throat doctor could find anything wrong
DRUGS THAT CAN CAUSE TINNITUS*
GENERIC BRAND NAME
Aspirin Alka Seltzer, Ascriptin, Bayer
Bleomycin Blenoxane
Bumetanide Bumex
Bupropion Wellbutrin SR and XL
Cetirizine Zyrtec
Chloroquine Aralen
Cisplatin Platinol
Diclofenac Cataflam, Voltdren
Erythromycin E-Mycin, Ery-Tab, Eryc
Furosemide Lasix
Ibuprofen Advil, Motrin
Meloxicam Mobic
Methotrexate Rheumatrex
Nabumetone Relafen
Naproxen Aleve, Anaprox, Naprosyn
Quinine Quinamm, Quinerva, QM-260
Risedronate Actonel
Tetracycline Sumycin
Valproic acid DepakeRe,
Vancomycin Vancocin
Vincristine Oncovir
*This is just a partial list. Hundreds of drugs can contribute to tinnitus.
with me and they have not suggested any remedies. I currentlyiust barely manage it with white noise (a fan) at night
Treatments for Tinnitus
When everything else has been ruled out and you are left with ringing in the ears, what can be done? First and foremost, do not expose yourself to noise pollution. Chances are good you already have some hearing loss. Be cautious around all appliances (blenders and vacuum cleaners, for example) and power tools. When flying, take along hearing protectors (you can buy earplugs that fit in your ears unobtrusively) to block out some of the jet engine sounds at airports or on loud commuter airplanes. Do the same when attending concerts or sports events. Protect your ears from any further damage.
The official word from the medical establishment is that “most treatments [for tinnitus] are unsuccessful.”811 A review of 69 randomized clinical trials published in 1999 concluded that there was no proof that any therapy provides long-term improvement.812 Investigators have experimented with powerful medications that control irregular heart rhythms (intravenous lidocaine, and oral flecainide and tocainide), but the results were disappointing and the side effects scary. Anti-anxiety agents (benzodiazepines) such as alprazolam (Xanax) may help ease the psychological impact of tinnitus, but when the drug is discontinued, the problem can return with a vengeance. The antidepressant nortriptyline has shown more promise than many other approaches, but the benefits still are not overwhelming.813 Acupuncture, biofeedback, hypnosis, and “tinnitus retraining therapy” have all been disappointing and do not make the ringing go away.
Most physicians will say that the primary goal of treatment for tinnitus is “management.” Usually this means things like masking devices. In its crudest and cheapest form, a masking device is an FM radio tuned so that you do not get a signal, just static. The theory is that this “white noise” will mask the sound of the tinnitus. Some people find this helpful, whereas others report that it just intensifies the annoying sounds.
There are also white noise generators or masking devices that can be “tuned” to an individual’s general noise frequency. There are also sophisticated new hearing aids that both amplify sound in the hearing range that is impaired and Hearing Aid/Masking Device
High-tech hearing aids that combine frequency-specific amplification and masking in one device may be worth consideration. Some folks report both improved hearing and reduced tinnitus with such equipment. Sometimes the tinnitus relief lasts for some time after the device is turned off or removed .814
Downside: These special hearing aids are pricey, costing several thousand dollars. Insurance is not likely to cover the cost. They require professional fitting. Do not expect them to solve the problem, but they may make it more tolerable.
Cost: Approximately $1,000 to $3,000 per ear. Try to work out a “test drive” to make sure they work well and adequately relieve your tinnitus discomfort. Another option: Lease with an option to buy. If they do not solve your problem, you can at least give them back when the lease is up.
use a masking signal that is adjusted to the specific range of the patient.
My husband has suffered for years from tinnitus and hearing loss (due to his time in Vietnam). He recently found great relief with the new technology in hearing aids. Since getting his hearing aids, the ringing, buzzing, etc., has completely gone away and his hearing is now very acute.
Many folks have tried hearing aids in the past without success. know my husband did. He said they just made the ringing louder! He is thrilled with this new technology. I believe this might help many who haven’t tried the devices.
No one should buy these pricey instruments unless they ac-
tually work. That means you should be able to either test the device for a short while or lease it for somewhat longer before shelling out thousands of dollars to purchase it.
Ginkgo Biloba
There has been some interesting research on this ancient Chinese herbal medicine. From the more than 100 clinical
trials that have been published, there seems to be a reasonable amount of data suggesting that standardized ginkgo extracts (Ginkgold, Ginkoba, and Ginkai) improve circulation throughout the body, in general, and may modestly improve symptoms of dementia.’”‘ A 1999 review of clinical studies of ginkgo concluded that “overall, the results of these trials are favorable to ginkgo biloba as a treatment for tinnitus, but a firm conclusion about efficacy is not possible … the body of evidence is small.„816
Since then, there have been two studies that have not found ginkgo to be an better than placebo for relieving symptoms of tinnitus.”11,81′ At this time it would be fair to say that the evidence is mixed at best and probably not very promising. On the other hand, ginkgo does seem to improve circulation and may be worth a try. Do not expect any miracles, though.
Adding a little zinc to the mix (50 milligrams) might be worth consideration since a small study suggested that this mineral produced some modest clinical improvement.”’ If after several weeks there is no improvement, we would give up on this approach.
Melatonin
One of the least studied but most promising new approaches for the treatment of tinnitus may be melatonin. This natural compound is inexpensive and safe. Melatonin is a hormone that is made primarily by the pineal gland in the brain in response to darkness. During the daytime, the blood level is low, but at night melatonin climbs until it reaches its peak between
** Melatonin
Melatonin is natural, safe, and not very expensive. Although there is some controversy about its effectiveness for insornni8, two preliminary studies suggest that it may help people with tinnitus and sleeping problems associated with ear ringing. The dose that has been tested is 3 milligrams.
Downside: The data are not yet strong enough to elicit a ringing endorsement.
Cost: Approximately $2 to $4 per month when purchased in bulk
2:00 and 4:00 a.m. It is crucial for regulating sleep and wake
cycles.
Some extraordinary claims have been made for melatonin. Some proponents say that it can reverse aging, improve immune function, reduce the risk of cancer, control blood pressure, and lower cholesterol. The best-known use of melatonin is as a sleep aid. An extensive review of the existing studies published in the Cochrane Database concluded, “Melatonin is remarkably effective in preventing or reducing jet lag, and occasional short-term use appears to be safe. It should be recommended to adult travelers flying across five or more time zones, particularly in an easterly direction, and especially if they have experienced jet lag on previous journeys
Despite this good news, two reviews of melatonin’s use for easing insomnia were less glowing. They concluded that melatonin does not work for sleep disorders’ 1,822 Nevertheless, a small preliminary study carried out by the Ear Research Foundation in Sarasota, Florida, in 1998 revealed that a dose of 3 milligrams of melatonin was helpful for patients with tinnitus that interfered with their sleep. 823 Following up on this research, investigators at Washington University in St. Louis also found that a dose of 3 milligrams was beneficial for people with tinnitus: “In summary, our study demonstrates that melatonin use is associated with improvement of tinnitus and Sleep.”824 Although the research to date is preliminary, melatonin seems to be worth a try because of its safety and affordability.
Misoprostol (Cytotec)
Sometimes doctors teach old drugs new tricks.’Tbat might be the case with misoprostol (Cytotec), a medication approved more than a decade ago to help prevent stomach ulcers. It was hoped that Cytotec would be especially beneficial for people taking aspirin or other NSAVDs like ibuprofen or naproxen. This medication has become controversial in recent years because some obstetricians have used it to induce labor. Others have combined misoprostol with mifepristone to induce abortion.
An entirely different use for misoprostol is treating tinnitus. We first stumbled across a pilot study that was published in 1993 in the Archives of Otolaryngology—Head & Neck Surgery.wL’ One of the most prestigious ear clinics in the world (House Ear Institute in Los Angeles) enrolled 24 subjects. These volunteers were given either misoprostol or placebo. Not surprisingly, the placebo did not work. Misoprostol, on the other hand, provided improvement for eight (33 percent) of the subjects. According to the investigators, “Responders reported improvement in tinnitus severity, sleep, and concentration:
More than a decade later, Turkish investigators noted that 13 of 28 patients (46 percent) who were given misoprostol reported a decline in the volume of their tinnitus, compared to only 2 of 14 subjects (14 percent) in the control group. 827 A
Misoprostol (Cytotec)
This prescription medication has FDA approval for the prevention of stomach ulcers. An “off-label” use may ultimately turn out to be for tinnitus. Preliminary studies have found that misoprostol may help roughly one-third to two-thirds ofrr tinnitus sufferers, with those who experienced a sudden onset of tinnitus or who had a history of acoustic trauma getting the most benefit. The dose used by the researchers was “200 micrograms per day for the first week, increased by 200 micrograms every 5 days” to reach a maintenance dose of 800 micrograms per day. This latter amount is also the dosage commonly used in gastroenterology.”828
Downside: Very expensive! Misoprostol must never be taken by a woman who is pregnant or might become pregnant. It can induce premature labor and cause other serious complications. Patients with heart or inflammatory bowel problems should also avoid misoprostol.
Side effects: Common adverse reactions include abdominal pain, indigestion, diarrhea, nausea, vomiting, flatulence, constipation, headache, and menstrual changes. Rare but potentially serious side effects include allergic reaction, irregular heart rhythm, heart attack, high blood pressure, low blood pressure, breathing difficulty, and blood clots.
Cost: Approximately $160 to $300 for a 2-month supply (depending on whether you purchase from a Canadian or US pharmacy)
follow-up study found that 18 of 28 patients “showed improvement in tinnitus loudness, representing an improvement rate of 64 percent. These are all small studies, and larger, more comprehensive, and longer follow-up research is required to prove that misoprostol represents a true advance in the treatment of tinnitus.
Conclusions
Compared to heart disease, diabetes, and cancer, tinnitus seems like a trivial complaint. But ask anyone who suffers from it and you will discover that it can have devastating consequences on the person’s quality of life. The constant ringing or hissing not only affects concentration, it also can interfere with sleep. Many people with tinnitus are depressed, and some even contemplate suicide. There is no cure and no perfect treatment. Nevertheless, there are some options worth considering.
• Avoid loud noise, including common household appliances like blenders, hair dryers, vacuum cleaners, and power tools. Concerts, sporting events, and airports call for ear protection. Noise can make tinnitus worse.
• Beware of prescription medicines and over-the-counter remedies that can trigger tinnitus or make it worsee. Even the quinine in tonic water can be a problem for some people.
• Some people benefit from antianxiety agents like alprazolam (Xanax) or antidepressants such as nortriptyline. These drugs are not without side effects, however.
• Seek professional advice about new technology that combines a hearing aid with a masking device. This equipment may help improve hearing and reduce the ringing. Try to negotiate for a trial period to test the hearing aid so you can make sure you are satisfied before shelling out thousands of dollars to purchase it.
• Give ginkgo biloba a try. Although the research is not very supportive, ginkgo may help and it is relatively inexpensive. Make sure that it won’t interact with any other medicine you are taking.
• Consider melatonin. This natural compound appears to be quite safe and may help tinnitus sufferers get some much-needed sleep.
• If all else fails, your physician might prescribe misoprostol. A few small studies have found it useful for about one-third to two-thirds of tinnitus patients. Its price and side effects are daunting, however.