Editor's Note: Contains updates and links to articles written after original publication date.

Alternative Medications and Other Treatments for Tinnitus:
Facts From Fiction
Part 2 of 3 Installments

MINERALS

by Michael D. Seidman, MD
and Seilesh Babu, MD

ZINC
Zinc is a component of over 100 enzymes. Among these are DNA polymerase, RNA polymerase, and tRNA synthetase. Mild deficiency causes growth retardation in children. More severe deficiency is associated with growth arrest, hypogonadism, infertility, poor wound healing, diarrhea, dermatitis, alopecia, behavioral changes, taste and smell disorders, and tinnitus. Zinc seems to function in certain areas to influence neurotransmission and to inhibit binding of peptides and other ligands to their neuroreceptors.

The RDI of zinc in adults is 15 mg. The majority of the zinc content in humans is bound to proteins in the tissues. In plasma, zinc is primarily bound to albumin; less than 2% of zinc is found free. The zinc level in serum is not the best parameter, but is the most reliable one for assessing zinc balance in the body. Nearly 99% of total-body zinc is inside the cells. The remainder is in plasma and extracellular fluids.25

Studies on rodents have shown a high content of zinc in the inner ear. Other studies have found that the human cochlea has the body's greatest concentration of zinc. These findings have given rise to speculation of the role of zinc in inner ear function. A correlation between hypozincemia and tinnitus has been reported.22 In an uncontrolled trial by Gersdorff et al., zinc was found to reduce tinnitus.9 Zinc given in doses ranging from 10 to 25mg has delivered good results in some patients shown to be hypozincemic based on blood tests. In a double-blind, randomized study, Paaske showed little correlation between hypozincemia and tinnitus; and no significant improvement in subjective tinnitus using zinc supplements.25

Ochi, et al. demonstrated a significant decrease in zinc levels in patients suffering from tinnitus, and that supplementation with doses of 34-68 mg of zinc over two weeks significantly decreased tinnitus. Excellent results have been found with the combination of niacin and 25 mg zinc gluconate twice a day.22 If tinnitus is of recent onset, complete resolution is possible. With longer duration, the tinnitus can be diminished with these nutrients in some people.

Supplementation of 90-150 mg per day has been shown to be beneficial in some cases. Zinc therapy when prescribed is often accompanied by frequent blood tests to monitor copper levels. Copper and zinc compete for intestinal absorption, so chronic ingestion of zinc may result in copper deficiency. Acute zinc toxicity can usually be induced by ingestion of greater than 200 mg of zinc in a single day and is manifested by epigastric pain, nausea, vomiting, and diarrhea.

Editors Note: A more recent clinical study conducted in Ankara, Turkey by Arda, et. al. showed that 50 mg of zinc daily reduced subjective tinnitus in 82% of patients. See complete clinical study on zinc. - Barry Keate

CALCIUM
By enhancing neural transmission, calcium supplementation has been shown to improve tinnitus symptoms in certain patients. Calcium is one of the most abundant minerals in the human body and accounts for between two to three pounds of total body mass. Adequate dietary sources are necessary for building and maintaining strong bones and teeth, as well as regulating muscle growth. In conjunction with magnesium, calcium also plays a pivotal role in the regulation of electrical impulses in the central nervous system and in the activation of various hormones and enzymes required for proper digestion and metabolism. This vital mineral is also necessary to support bodily functions such as blood clotting and maintaining blood pressure. There is also strong evidence that calcium plays a role in colon cancer, and those with low intake of calcium and Vitamin D are more prone to this disease.

Half of America's adults are not getting enough calcium according to a panel of experts assembled by the National Institutes of Health (NIH). The federal committee estimates that calcium deficiencies, resulting in brittle bones and fractures, are costing the U.S. health care system $10 billion annually. The report states that the recommended daily allowance for calcium is too low, leading to weak bones in children, adults, and especially, elderly women.37

Calcium absorption occurs primarily in the small intestines, and requires adequate amounts of Vitamin D. The current RDI of calcium is 800 mg for adults, 1,200 mg for premenopausal women, and 1,500 mg for postmenopausal women unless they are taking estrogen. Those with kidney disorders should not take calcium supplements unless directed to do so by their health care professionals. Key dietary sources of calcium include dairy foods, green leafy vegetables, and seafood. Absorption of dietary calcium can be drastically reduced by consuming large amounts of foods such as cocoa, spinach, kale, rhubarb, almonds, and whole wheat products which are high in oxalic acid, and are known to interfere with calcium absorption. Taking antibiotics such as tetracycline, or aluminum containing antacids can also result in lower absorption of calcium. Alcohol, sugar, and coffee can also affect the body's levels of this mineral.

Some patients have experienced improvement in their tinnitus after starting a regimen of vitamin and nutrient supplementation, which included calcium.16 Dosages ranged from 1000 to 1500 mg per day for several months.

MAGNESIUM
Magnesium is the fourth most abundant cation in the body after sodium, potassium, and calcium, and the second most prevalent intracellular cation. The normal body content is around 1000 mmol, 50-60% of which is in bone. Extracellular magnesium accounts for only 1% of total body magnesium. The normal serum concentration ranges between 0.75 and 0.95 mmol/L.40

Magnesium is essential for the function of important enzymes, including those related to the transfer of phosphate groups and every step related to the replication and transcription of DNA and the translation of mRNA. This cation is also required for cellular energy metabolism and has an important role in membrane stabilization, nerve conduction, ion transport. Deficiency can thus result in a variety of metabolic abnormalities and clinical consequences, including tinnitus.1

Magnesium has been shown to prevent hearing loss in a study by Attias et al. Three hundred healthy, young male military recruits undergoing two months of basic training were studied. The trainees were repeatedly exposed to high levels of impulse noise. 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. It can be inferred, therefore, that magnesium may have a positive role on tinnitus.1

Magnesium is a potent glutamate antagonist. There is evidence in the literature that antagonism of glutamate receptors has an effect on auditory sensitivity and on tinnitus.37 Furthermore, a highly motivated patient elected to have magnesium sulfate delivered to the inner ear for her severe unilateral cochlear tinnitus. While the MgSO4 was being delivered, her tinnitus ceased. Unfortunately, it recurred shortly after cessation of the perfusion.16

Animal studies have shown that noise exposure causes magnesium to be excreted from the body.40 Supplementation with magnesium might reduce the ototoxicity from this noise and thus reduce the likelihood of new onset tinnitus. Few studies have documented that magnesium supplementation improves tinnitus, but many patients have had relief with this method.

Editors Note: View a more complete look at Magnesium and its relation to health and tinnitus. - Barry Keate

MANGANESE
Manganese is a mineral that is required in small amounts to manufacture enzymes necessary for the metabolism of proteins and fats. It also supports the immune system, regulates blood sugar levels, and is involved in the production of cellular energy, reproduction, and bone growth. Manganese works with vitamin K to support blood clotting and aids in digestion. As an antioxidant, manganese is a vital component of Superoxide Dismutase, an enzyme that is the body's main front-line defense against damaging free-radicals.30 While there is no RDI for manganese, the average intake of manganese is between 2 to 9 milligrams per day. Foods high in manganese include avocados, blueberries, nuts and seeds, seaweed, egg yolks, whole grains, legumes, dried peas, and green leafy vegetables.

Along with the B-complex vitamins, manganese helps control the effects of stress while contributing to ones sense of well being and it is possible that this may have a stabilizing effect on patients suffering from tinnitus. A deficiency in intake can retard growth, cause seizures, lead to poor bone formation, impair fertility, cause birth defects, and lead to nervous symptoms, such as tinnitus. Investigators are also looking at new links between manganese deficiency and skin cancers. Anecdotal evidence has shown that manganese supplementation may reduce the symptom of tinnitus.16

SELENIUM
Selenium is a component of several enzymes, most notably glutathione peroxidase and superoxide dismutase. These enzymes prevent oxidative and free radical damage of various cell structures. Evidence suggests that the antioxidant protection conveyed by selenium operates in conjunction with vitamin E, since deficiency of one seems to enhance damage induced by a deficiency of the other. Selenium also participates in the conversion of thyroid hormone to its active form.

The RDI is 50 to 70 mcg/day.20 Deficiency is rare in North America. Such individuals have myalgias, cardiomyopathies, and nervous system abnormalities. Keshans disease, a fatal heart disease found in children living in certain sections of China, occurs where selenium intake is limited. Toxicity is associated with nausea, diarrhea, alterations in mental status, and peripheral neuropathy, observed in adults who inadvertently consumed between 1500-2700mg. One may check RBC glutathione peroxidase activity, or plasma selenium concentrations for deficiency, although neither are entirely accurate.23 Supplementation may take up to six months to show improvement in symptoms such as tinnitus.

HYPERBARIC OXYGEN THERAPY
Oxygen deprivation and/or reduced cochlear blood flow has been suggested as a potential cause of hearing loss and tinnitus in response to intense noise exposure or secondary to sudden sensorineural hearing loss. Hyperbaric oxygen therapy (HBO) may be considered in these situations. It may be more effective for recent onset rather than long-term cases. Since tinnitus and hearing loss are not approved indications for the use of HBO, insurance will not normally cover the treatments. HBO therapy is in common use in European countries for the management of sudden hearing loss and noise-induced hearing loss and their results have been positive.6

The theory behind HBO treatment is based on the assumption that tinnitus is caused by reduced oxygenation to the inner ear. 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 Russia this method reportedly has been used extremely successfully for many years. In Moscow alone, there are about 40 pressure chambers in use for this currently.14

Editors Note: Read an extended discussion of Hyperbaric Oxygen Therapy. - Barry Keate

VINPOCETINE and VINCAMINE
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. It is a vasodilator and increases blood flow to the brain and improves the brain's use of oxygen.33
These drugs have not yet been approved in the United States for treatment, however they are available in Europe and South America in over-the-counter preparations. Although it is not available in North America as a pharmaceutical, it is available in low doses in over-the-counter supplements. Only anecdotal evidence exists that these medications can suppress tinnitus.16

Vinpocetine is a derivative of vincamine and is three to four times more potent at improving cerebral circulation and is overall twice as potent as vincamine in humans. Vinpocetine has wide ranging effects and can be used to treat stroke and improve memory, menopausal symptoms, macular degeneration, impaired hearing, and tinnitus. The usual oral starting dose is 40mg 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.

In humans, the effect of vinpocetine on cerebral blood flow is uncertain, with some investigators reporting no change, and others reporting an increase. It has been reported that vinpocetine can be used safely to treat patients with "chronic cerebral dysfunction of vascular origin". Vinpocetine is also a powerful memory enhancer. It facilitates cerebral metabolism by improving cerebral microcirculation, enhancing brain cell ATP production, and increasing utilization of glucose and oxygen.33 Vincamine has also 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.5 Vincamine has also been used for improving memory defects and inability to concentrate. Vincamine has extremely low toxicity and is inexpensive.

HYDERGINE
Hydergine is reported to increase mental abilities, prevent damage to brain cells from hypoxia, and may even be able to reverse existing damage to brain cells. Hydergine is an extract of ergot, a fungus that grows on rye.38 Midwives in Europe traditionally used ergot with birthing mothers to lower their blood pressure. Scientists have analyzed ergot alkaloids since the late 1940s in search of blood-pressure medications. Studies in the elderly population uncovered cognition-enhancing effects of hydergine and it is now a popular treatment 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: increases blood supply and oxygen to the brain, enhances brain cell metabolism, protects the brain from free-radical damage during decreased or increased oxygen supply, and reduces symptoms of dizziness and tinnitus.10

Hydergine may cause mild nausea, gastric disturbance, and headache. There are no serious side effects reported with hydergine use. It is nontoxic even at very large doses. However, it is contraindicated for individuals with acute or chronic psychosis, or those with a known sensitivity to the medication. Overdosage may, paradoxically, cause an amnestic effect.

Hydergine is available in the United States with a doctor's prescription. Hydergine has not undergone rigorous scientific tests to prove its effectiveness for tinnitus reduction. However, in Europe many patients have been using Hydergine with good success in relieving their symptoms.

To Be Continued... In September. Dr. Seidman discusses herbal treatments.

REFERENCES

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