Tryptophan is a natural amino acid that safely increases seratonin levels in the brain. Selective seratonin re-uptake inhibitor medications (SSRI anti-depressants) are prescription drugs that concentrate existing levels of seratonin in the brain so they stay in the synapse between nerve endings. Tryptophan is the only compound that actually increases seratonin levels, however it has been banned by the FDA since 1989 due to an adulterated product from an unscrupulous Japanese manufacturer.

Despite intense lobbying efforts by the pharmaceutical industry, the FDA could no longer justify the ban on tryptophan.  Pharmaceutical-grade tryptophan can now be imported for use in dietary supplements. This means that many people using drugs such as Prozac, Paxil, Lexapro and Celexa will be able to discard these medications and once again treat their seratonin deficiency syndrome with natural tryptophan.

Barry Keate

We were interested to note that British researcher, Dr Lindsay St Claire and the Center for Hearing and Balance Studies at Bristol University have received a research grant for £55,000 or $110,000 to finally determine if caffeine does indeed affect tinnitus.

While we applaud further research into all aspects of tinnitus, we won’t hold our breath as to the outcome. For almost a decade we have written about the three major offenders of tinnitus: caffeine, salt, and alcohol. In fact certain "food" substances such as MSG and the sweetener Aspartame (think Equal and diet sodas) can be deleterious to tinnitus as well.

According to tinnitus authority and inner ear specialist, Michael Seidman, MD FACS, diet plays a major role in in affecting tinnitus levels. The old adage, "Your are what you eat" applies double to those living with tinnitus.

Brent Curtis - Editor

A recent news report discusses the possibility of Viagra and other erectile dysfunction (ED) medications causing sudden hearing loss in a small number of users. The FDA found 29 reports of sudden hearing loss, of which one third was temporary and the remainder was permanent. Most hearing loss involved one ear only.

This is an extremely small number considering the millions of prescriptions issued each year for Viagra, Cialis and Levitra. Nevertheless, the FDA has changed the labels of these drugs to include this new precaution and has issued an updated adverse reactions section.

Anyone using these medications should be aware of the potential for hearing loss. If this occurs, immediately discontinue the medication and contact an Ear, Nose and Throat physician. Many cases of hearing loss can be corrected if treated within a few days.

Barry Keate

A recent article by the Associated Press discussed the huge influx of hearing-related injuries connected to the wars in Iraq and Afghanistan by US military personnel. The most prevalent of these disabling injuries centered on acute hearing loss and tinnitus.

Hearing loss has always been a hazard associated with military service but the these injuries have seen an exponential increase since the war on terror. According to the Department on Veteran Affairs, hearing loss is now the number one disability of US servicemen. 70,000 military personnel are now collecting disability for tinnitus just from these current conflicts.

The marked increase of improvised explosive devices (IED) such as roadside bombs and the frequency of firefights and ambushes are blamed for the increase of hearing injuries. According to military officials these blasts can cause extreme changes in air pressure rupturing ear drums.

While the military provides hearing protection for its war fighters they often go unused, Many soldiers feel that wearing hearing protection on patrol limits their ability hear subtle changes is sound that may indicate an ambush.

Michael Hoffer, MD, an otolaryngologist (ENT) and Navy commander discussed aspects of hearing loss and tinnitus in the military at both the 24th International Tinnitus Forum in Toronto in 2006 and again in Washington, DC at the 25th International Tinnitus Forum.

Dr. Hoffer served in Iraq treating war fighters for a variety of hearing disorders. He concluded that he saw four types of tinnitus due to warfare: noise induced;blast induced (pressure); tinnitus without hearing loss; and post traumatic Meniere’s disease.

The Naval Medical Center San Diego has conducted studies on antioxidants such as such as N-Acetyl Cysteine and Acetyl-L-Carnitine, and their ability to prevent hearing loss and found they can be effective if taken within eight hours of hearing loss damage.

Ben Balough, MD is the Chief of Neurotology at the Naval Medical Center San Diego stated in a talk at the 23rd International Tinnitus Forum that Ginkgo biloba extract showed good indications that it could be a benefit to tinnitus patients but more studies are needed with standardized testing and large numbers of participants.

Brent Curtis - Editor

Oregon Health & Science University (OSHU), Oregon state’s only health and research university has received funding to conduct a study on a medication previously used for the treatment of alcoholism to see if it may be effective in reducing symptoms of tinnitus.

There has been previous evidence that suggests the drug, Acamprosate, used to treat alcoholism may indeed be viable for tinnitus. A small clinical trial in Brazil conducted on 25 tinnitus patients in Brazil showed that 87% had some degree of relief and nearly 48% had a reduction of more than 50%. 1

The study had the shortcoming of having a small number of participants and researchers speculated that those on the active medication were aware of it due to the marked drowsiness associated with the drug. They also say the drowsiness itself may have contributed to improvement as many tinnitus patients have trouble sleeping. The OSHU study plans on having over 150 participants.

Billy Martin, Ph.D., professor of otolaryngology/head and neck surgery, and director of the OHSU Tinnitus Clinic believes that since Acamprosate can restore balance between two competing neurotransmitters in the brain, it may also serve the same role in tinnitus suffers.

Neurotransmitters in the brain conduct information between brain cells. An imbalance of neurotransmitters occurs in alcoholics and scientists speculate that those suffering with ringing in the ears may have the same type of imbalance

Researchers hope to identify, by the close of the study, the common characteristics of people who respond to the medication, for example tinnitus pitch, degree of sleep problems and level of hearing loss.

We spoke with OSHU project coordinator Linda Howarth, who told us the study is now open for participants to apply. Each individual must first answer a series of questions to see if they qualify for participation. 150+ qualified individuals will be accepted to participate. Inquiries should be directed to Linda Howarth at (503) 494-0670.

1. Rev Bras Otorrinolaringol (Engl Ed). 2005 Sep-Oct; 71(5):618-23. Epub 2006 Mar 31. Tinnitus treatment with acamprosate: double-blind study. Azevedo AA, Figueiredo RR.

Brent Curtis - Editor

A large clinical study conducted by researchers from the Aarhus University Hospital, Denmark and the National Institute of Occupational Health, Copenhagen, Denmark seems to confirms that in average non-industrial work environments the chance of tinnitus is low for individuals with normal hearing but as might be expected, higher for those individuals with some type of hearing-related issue. The study’s assessment that ongoing noise exposure in offices, or perhaps large retail environments and other non-industrial settings, has statistically little chance of causing tinnitus in those with normal hearing seems obvious. Or is it?

The abstract of the study published in the International Journal of Audiology can be seen below. We welcome comments by qualified individuals who can help to explain the significance (if any) of this study.
Brent Curtis - Editor

Excerpted abstract from the International Journal of Audiology
The risk of tinnitus following occupational noise exposure in workers with hearing loss or normal hearing
"The purpose was to investigate the relationship between noise exposure and tinnitus among workers with normal hearing and hearing loss, respectively. We conducted a cross-sectional survey of 752 workers employed at 91 workplaces that were investigated by means of full work-shift noise levels, questionnaire data, and bilateral pure-tone audiometry. Tinnitus was not associated with the present noise level, the duration of noise exposure, or the cumulative noise exposure if participants had normal hearing. As expected, such trends were demonstrated if participants had a hearing handicap. Based on these data, we will be cautious in ascribing tinnitus to noise exposure in our patients’ workplaces if they have a normal audiogram. Furthermore our data indicates no risk of noise-induced tinnitus at exposure levels where no hearing loss would be expected, e.g. as usually encountered in non-industrial workplaces."

by Barry Keate

GABA (gamma-aminobutyric acid) is a brain neurotransmitter that inhibits electrical activity and reduces tinnitus and other conditions, such as anxiety, depression and epileptic seizure. We have discussed in previous articles the central role that GABA plays in many neurodegenerative conditions, including tinnitus. A new study shows that yoga practice can substantially increase GABA levels and, by extension, reduce tinnitus.

In 2002, Drs. Abraham Shulman, Arnold Strashun and Barbara Goldstein, from the Martha Entemann Tinnitus Research Center, published a paper describing the common central pathway through the brain through which all tinnitus symptoms must travel.1 This pathway, they determined, is the chemical receptor called gamma-aminobutyric acid-benzodiazepine-chloride receptor (GABA/BZ/Cl) in the medial temporal lobe system.

The researchers stated the function of the GABA receptor is to inhibit central nervous system synapse activity. Deficiency in the GABA receptor is directly related to the worsening of tinnitus, which is marked by increased emotional difficulty, anxiety, stress, depression and fear. Impairment of GABA function also leads to convulsions, which provides clinical support for the concept that tinnitus is an epileptic-like auditory phenomenon.

The authors of the paper went on to treat tinnitus patients with Neurontin (a common anti-seizure medication) and Klonopin (a benzodiazepine anti-anxiety medication). They reported significant reduction in tinnitus intensity and annoyance in most of their treated patients. Neurontin, however, caused significant side effects (including sleepiness, dizziness, nausea, and anxiety) and 30% of the patients dropped out of the study because they could not tolerate them. This treatment is discussed in greater detail in our article “Brain Receptors and Tinnitus.”

A recent study conducted at Harvard Medical School and Boston University School of Medicine showed that a 60-minute yoga session increased GABA levels 27% over that of the control group, who spent the time reading. The study was published in the Journal of Alternative and Complementary Medicine. 2

The researchers explain that GABA dysfunction is a factor in mood and anxiety disorders. Cerebrospinal fluid studies have demonstrated low GABA levels in depressed subjects compared to controls. Since yoga has shown promise in improving symptoms associated with depression, anxiety disorders and epilepsy, they hypothesized that the ability of yoga to decrease symptoms in these disorders is mediated through the GABA system and can be measured using magnetic resonance spectroscopy (MRS).

Yoga practitioners were instructed to spend a 60-minute time period that focused on the yoga postures, known as asana yoga. The study design focused on asana yoga because the postures are observable, as opposed to the internal state of meditation. The control group was instructed to read magazines or books for the same 60-minute time period.

The study demonstrated that a 60-minute asana yoga session in established yoga practitioners is directly associated with a 27% increase in GABA levels. The control group did not demonstrate an increase in GABA.

Dr. Chris Streeter, the lead researcher for the study, is a neurologist and a psychiatrist at Boston University. She is also a yoga practitioner. She stated in a newspaper interview “I’m quite sure this is the first study that’s shown there is measurable change in a major brain neurotransmitter with a behavioral intervention such as yoga. What’s really fabulous is this is hard science that is able to clearly document neurochemical changes in the brain.” 3

Dr. Streeter learned that the National Institutes of Health gave a high score to her research grant proposal for a larger yoga-GABA study and hopes to begin soon. “It will be a much bigger study,” she said. “We will use yoga-naïve people to gauge how regular practice can change GABA levels. It will also include more ability to gauge the positive effects of yoga over time.”

In a separate published study, researchers at the University of Rajasthan, India, found that yoga postures and breathing exercises can help reduce the frequency and intensity of migraine headaches.4 The study followed 72 migraine-troubled adults who were randomly assigned to take part in a yoga therapy program or a headache education group.

After five months of gentle yoga postures and breathing techniques, the yoga participants reported fewer attacks and much less intense pain.

In cases of acute anxiety and stress, doctors frequently prescribe medications such as Valium, Klonopin or Xanax to control symptoms. These medications can be effective but, unfortunately, they are addictive and the more you take of them the more you need to obtain the same effect. With this new research we now know that regular yoga practice can reduce these symptoms and tinnitus without medication.

1. Shulman A, Strashun A, Goldstein B. GABA-Benzodiazepine-Chloride Receptor-Targeted Therapy for Tinnitus Control. Int Tinnitus J. 2002;8(1):30-6.
2. Streeter C, Jensen E, et al. Yoga Asana Sessions Increase Brain GABA Levels: A Pilot Study. Journal of Alternative and Complementary Medicine. Volume 13, Number 4, 2007, pp. 419-426.
3. Seattle Post-Intelligencer, June 17, 2007, Health & Fitness.
4. John PJ, Sharma N, Sharma CN, Kankane A. Effectiveness of yoga therapy in the treatment of migraine without aura: a randomized controlled trial. Headache 2007 May;47(5):654-61.