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."

Did aspirin make her tinnitus worse?

Dear Barry,
I have had tinnitus for five years. Until recently, it was a steady sound in both ears, louder in the left. I was able to habituate to the sound over time. Recently, everything has changed. I had a bad bout of extreme back pain for which I took aspirin for one day. I took about 7 or 8 350 mg. tablets during that one day. Four days later, I noticed a second sound in my left ear. I experienced a lot of anxiety after this and my right ear has become louder than it was also. The doctor I saw thought it was probably not the aspirin but the long bout with back pain followed by stress and anxiety. I am trying hard to put it out of my mind and not be anxious but am finding it harder this time. Do you have any advice for me? Do you think your product would be helpful to my circumstance? I am new to your website and have just started to get your newsletter which I love and the articles are wonderful. Thank you for your time..

Sincerely,
Peggy Dale

Hi Peggy,
Thanks for your message. I agree with your doctor. You took a lot of aspirin and it may have made your tinnitus temporarily louder and created the new sound. However, this should subside in a few days. It takes a lot of aspirin for a very long time to make tinnitus permanently louder and one day won’t do that.

I know that I can take two aspirin of 325 mg each without fear. If I take a third one, my tinnitus will get louder and stay there for at least a day. But it always goes back down. I believe yours will also.

The stress and anxiety caused by the increase in tinnitus and also your back pain are the cause of the increase, I’m sure. Once you can reduce the stress, the tinnitus will improve. There are a lot of things you can do to reduce stress. A healthy diet, low on salt, sugar, caffeine and no diet drinks, and regular vigorous exercise are perhaps the best ways. There are articles on Diet and Tinnitus and Stress and Tinnitus in our Tinnitus Library that have important ideas for better health, lower stress and reduced tinnitus symptoms.

If all else fails, ask your doctor for a prescription for anti-anxiety medication such as Xanax or Klonopin. These cannot be taken indefinitely but are good for reducing stress short-term.

And yes, I think Arches Tinnitus Formulas can significantly help reduce the sound level. It takes time so please remember you must use Arches Tinnitus Relief Formula® for three months (4 bottles) before determining how effective it will be.

Wishing you quiet times,
Barry Keate

Sugar & Tinnitus

This is my second question for you on tinnitus and I appreciated your prompt response to my last question. This question is concerning sugar. I have been to several ENT doctors and they all tell me to watch my salt, but none seem to think that sugar will aggravate my tinnitus. Can you tell me what your studies have found out regarding sugar triggering tinnitus?

Thank you!
Joyce R.

Hi Joyce,
Salt seems to be the biggest problem for those with tinnitus but sugar definitely has an effect. Researchers in Brazil found the great majority of people with tinnitus also have hyperinsulinemia. This is a condition where the body becomes less sensitive to insulin and is the first step in the long, slippery slope towards Type II Diabetes. They placed these patients on a diet suitable for diabetics and the great majority improved. You can read an article about sugar metabolism and tinnitus in our Tinnitus Library.

There is a quandary regarding sugar intake for those with tinnitus. They should not consume large amounts of it due to the above mentioned relationship. However, sugar substitutes are, in many ways, worse. Aspartame (e.g. Equal), the sugar substitute used in diet colas, is very harmful and can cause many neurodegenerative conditions, including tinnitus. Xylitol and Stevia are good sugar substitutes. A discussion of this can be viewed in a previous Ask Barry - March of 2005.

Wishing you quiet times,
Barry Keate

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.