Editor's note: Part 3 of this three part series first ran in Quiet Times, August of 2001. You can view part 1 here and view part 2 here.

 

Alternative Medications
and Other Treatments for Tinnitus:

Facts From Fiction
Part 3 of 3 InstallmentS

Herbal Remedies
and other treatments

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

HERBAL REMEDIES
Patients who suffer from the condition of tinnitus have the opportunity to explore the horizon of complementary/integrative medicine (CIM) in pursuit of a treatment regimen that may relieve many of their agonizing symptoms. As is the case in the treatment of other chronic diseases, conventional pharmacotherapy represents only one avenue upon which the physician may venture. In an attempt to relieve the symptoms which plague the common tinnitus patient, the patient may want to explore non-conventional treatment options.

For more than 2000 years, herbal regimens have been employed in the treatment of medical conditions.10 Combinations of Chinese herbs, exotic fruits, plant roots, and seed oils have proven to be effective in the treatment of many medical disorders, where conventional medical therapy has failed. What many of these herbal treatment regimens lack, is solid medical evidence, in the form of double-blind research experiments, which would legitimize the utilization of these non-conventional treatments. However to the suffering patient, whose treatment regimens have been met with failure, perhaps anecdotal accounts of effective treatments are proof enough to justify an alternative approach.

GINGKO BILOBA
Gingko biloba, or maidenhair, is the oldest living tree on earth. Gingko biloba leaves have been used therapeutically by the Chinese for centuries for the treatment of asthma and bronchitis. Ginkgo biloba was believed at one time to have magical powers. Today, Ginkgo is felt by many to have a legitimate medicinal role. The important components of Ginkgo are flavonoids and terpenoids. These have been shown to inhibit the action of Platelet Activating Factor (PAF). The putative active ingredient has been isolated as EGB761 and there have been many studies related to its effectiveness in a variety of medical disorders.11 It has been shown to increase circulation throughout the body. Numerous studies have shown the efficacy of ginkgo on intermittent claudication, cerebral insufficiency, and tinnitus.12

Typical dosages range from 120-480mg per day, divided equally at mealtime. In western countries a standardized 50:1 concentrate of 24% gingko flavonoids is used, either in liquid or capsule form. Most studies showed that between 30-70% of subjects had improved cognitive abilities over a 6-12 weekperiod.11 No serious side effects were observed, and any minor side effects were not statistically significant compared to subjects treated only with placebo.

In terms of tinnitus, a study by Hobbs in 1986 provided statistical significance for 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.11 Similarly, when 350 patients with hearing defects due to advanced 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.12

Opinions differ as to the efficacy of this herbal remedy. While certain sufferers of tinnitus "swear by" Ginkgo biloba, others claim that it has no effect on their symptoms. The results of the first large-scale double-blind randomized prospective study (1121 volunteers at Birmingham University in the U.K.) on the efficacy of Ginkgo in tinnitus treatment, was published in 2001. The patients in this study received either 150mg of Ginkgo or placebo in a randomized fashion for 12 weeks. The results did not show significant effect in treating tinnitus, however the dose employed was approximately 65% less than what has been shown to be of benefit.8

Published studies have shown that 120 to 240mg twice per day of pharmaceutical-grade ginkgo extract can alleviate tinnitus.19 A controlled study showed that ginkgo extract caused a statistically significant decrease in behavioral manifestation in the animal model of tinnitus. Another human study showed that in patients suffering from cerebrovascular insufficiency, gingko extract produced a significant improvement in symptoms of vertigo, tinnitus, headache, and forgetfulness.11,5

One of the appealing aspects of Ginkgo biloba with regard to the treatment of tinnitus, has been the fact that it is relatively inexpensive, and has negligible side effects, such as increase risk for epistaxis. There has been one report of a woman who used Ginkgo for approximately 2 years who developed a subdural hemorrhage.16 However,this substance has been used for more than 2000 years without severe side effects. As with any medication, the physician should take a careful history before recommending Gingko as it may potentiate hemorrhage in people taking coumadin or heparin. The German Commission E, which is considered an excellent reference for the medicinal use of therapeutic herbs, rates Ginkgo as positive and recommends 240 mg twice per day for tinnitus and vertigo.5 The response to Ginkgo can occur within weeks, but is most noticeable within 3 to 4 months.

Combined application of soft-laser irradiation of the cochlea and intravenous supply of Ginkgo extract for 4 weeks was found to be beneficial in 20-50% of patients in one study.26 The mechanism of the soft laser is unknown, but it is known to cause an athermic stimulation of biochemical processes induced by light. Increased ATP production occurs in yeast fungus cultures irradiated with the soft laser, yet it is unclear if it is this same mechanism in human inner ear cells. Soft-laser/Ginkgo therapy promised to be very effective in chronic tinnitus. Ginkgo provides a better oxygen supply and the laser acts directly on the flavo proteins to activate "repair mechanisms." Plath and Olivier showed that in single cases, tinnitus reduction can be attained and they deduced that combined soft laser and Gingko application can be helpful in some patients suffering from severe tinnitus. However, Wedel et al showed no significant improvement with these treatments compared to placebo.39

The variable response to herbs including Gingko raises the concern of whether all preparations are the same. In the senior author's experience, it is clear that some of the less expensive brands were ineffective and had a higher rate of gastrointestinal upset. When these patients were then changed to a more respected or well-known brand, these side effects were ameliorated and the patients’ response was typically better. Over the past several years, we have been recommending Arches Tinnitus Relief Formula, as their formulation is highly standardized and appears to be effective for some patients. Ginkgo is not effective in every patient with tinnitus, but the risk to benefit ratio would suggest that a trial with Ginkgo is reasonable.

Editor’s note: A retrospective overview of 19 clinical trials published in Germany provides conclusive proof of the effectiveness of Ginkgo biloba for tinnitus. The complete overview can be seen here.  

Read about Why Some Ginkgo Products Don't Work for Tinnitus - What you need to know before starting. - Barry Keate

Black Cohosh (Cimicifuga Racemosa)
The popular herb Black cohosh comes from the root of the North American forest plant Cimicifuga racemosa. It derives its name from a description of the rhizome, which is black and rough. Also known as black snakeroot, bugbane, bugwort and squawroot, Black cohosh has an extensive history of safe use by Native Americans who revered it as a remedy for a host of common ailments.5 Native Americans employed Black cohosh as an effective treatment for fatigue, neuralgia, rheumatism, sore throat, asthma, bronchial spasms, bronchitis, and whooping cough. Mixed with chamomile, ginger, and raspberry leaf, Black cohosh has been used for centuries by women to stimulate menstrual flow, ease the strains of childbirth, and confer relief from the symptoms of menopause.

Contemporary herbalists also hold Black cohosh in high regard as an antispasmodic for relief from cramps, muscle pains, and menstrual pains. With its mildly sedative and relaxing effect, Black cohosh is also used to treat anxiety, nervousness, and chronic tinnitus. Some patients have reported improvement in their tinnitus while using this herbal preparation.

The active ingredients in Black cohosh appear to be chemical derivatives mimicking some of the effects of estrogen. It was also found to contain the glycoside acetein, a steroidal derivative that is effective in lowering blood pressure in animals.21 Black cohosh also contains compounds that support its use as a sedative and as an anti-inflammatory agent.

There are few known health concerns regarding Black cohosh, but consuming large amounts are known to cause nausea, dizziness and vomiting. Expectant mothers should only use black cohosh under the supervision of a health professional, since it has a reputation of stimulating the uterus to contract, and large doses could lead to premature birth. Black Cohosh has traditionally been used to calm the nervous system by nourishing blood vessels28 and it is theorized that it may improve cerebral blood flow, providing relief from tinnitus in some patients. Dosages range from 20 to 40 mg per day in liquid form for this ailment.

Mullein (Verbascum Densiflorum)
Mullein is ubiquitous, and its velvety leaves, rod like stem and brilliant yellow flowers are its striking characteristics. Mullein has a long history of use in herbal medicine. Its botanical family name -- Scrophulariaceae -- is derived from scrofula, an old term for chronically swollen lymph glands, later identified as a form of tuberculosis. Initially, this herb gained a favorable reputation as a respiratory remedy. Physicians from India to England touted it as a treatment for coughs and chest congestion, alleviating irritation, earaches, and tinnitus.24

In a 1986 survey of folk medicine in Indiana, researchers discovered that this herb remains "very popular" for respiratory complaints.24 There has been little research on mullein itself, and even less research into its treatment of tinnitus. However, some herbalists have shown benefit in patients suffering from severe tinnitus, claiming it to be very valuable. Mullein seems to have a slight diuretic effect and may alleviate inflammation. To brew a medicinal tea, use 1 to 2 teaspoons of dried leaves per cup of boiling water. Boil for ten minutes and strain leaves. 1 teaspoon contains approximately 0.5g of the drug. The dosage reported to provide relief from tinnitus seems to be 3 to 4g per day. There have been no reports of mullein causing adverse effects, except for mild irritation of the skin when in contact with the living plant.21

CORNUS
Cornus, which is also known as Asiatic cornelian cherry fruit and Asiatic dogwood, is grown in several parts of China. The fruit is harvested in October and November when it becomes purplish red, and is fat, thick, soft and seedless. Available at Chinese pharmacies, Asian food markets, and some Western health food stores, cornus is taken internally for excessive urination, incontinence, impotence, lightheadedness, excessive sweating, and excessive menstrual bleeding. Formerly, it was in use as a replacement for quinine.28 Preparation of the combination formula alluded to above, which is used in the treatment of tinnitus, requires the consultation of an herbalist. Chinese herbalists advise against the usage of cornus in combination with several other herbs, including platycodon, siler, and stephania.

Cornus (Cornus officinalis) alone does not seem to relieve the symptoms of tinnitus, but when used in combination with Chinese foxglove root and Chinese yam proves to be effective in the treatment of tinnitus, low-back pain, and urinary frequency.21

OTHER THERAPIES

Wobenzym
Wobenzym is a group of proteolytic enzymes including Pancreatin, Trypsin, Chymotrypsin, Bromelain, Papain, and Rutosid. It was initially developed by Dr. Ransberger in 1959 with MUCOS Pharma to fight cancer. Dr. Ransberger brought the formula to Germany and since then has pioneered the medical use of the systemic enzymes. This remedy has shown effectiveness for arthritis, throbbing pains, and tinnitus. It seems to be an “alternative” to aspirin and has shown some benefit to recovering from a myocardial infarction.27

Studies in Europe have been conducted on Wobenzym, backing the findings of Dr. Ransberger. Studies show Wobenzym as safe with none of the adverse side effects of aspirin, ibuprofen and other NSAIDs (Non-Steroidal Anti-Inflammatory Drugs).36 It has also been shown to improve red blood cell viscosity, improve circulation to damaged areas, and have anti-inflammatory properties.36 Whether or not Wobenzym can positively influence the symptom of tinnitus has not been adequately studied, but some patients have noted relief.

Laser Therapy
In the cochlea, all of the auditory processes require energy in the form of ATP. It takes place in the auditory cells of the cochlea and is connected with movements of hair-like receptors on the cellular membrane and other processes within the cells of the inner ear. ATP is produced by the mitochondria inside each cell. If the cochlea is acutely or chronically over strained, its sensory cells and their various cellular organs are affected as well, and they inevitably lose part of their functional capacity. The cells are suffering from a lack of ATP. This continuous lack of ATP within the inner ear cells of the cochlea leads to either a gradual or sudden impairment of the entire hearing organ.

Using low-level laser therapy, Dr. Lutz Wilden in Germany, has been able to produce a positive biological reaction regardless of the dysfunction involved in the inner ear. The electromagnetic energy released by the oxidation of nutrients is utilized as a source of primary energy for the production of the cellular fuel ATP.

The mitochondria can - in addition to the absorption of the released metabolic energy - utilize both the photons of the natural solar radiation (apparent bio-stimulative effect of sunlight on human cells) and the photons of low-level laser light (clinically proven bio-stimulative effect of low level laser light on human cells) as a source of primary energy. Dr. Wilden uses two separate beams on the mastoid bone and one beam down the ear canal simultaneously. This delivers a calculated 4 j/cm2 to the cochlea.42 The additional ATP triggered by the light may have some healing value for the damaged inner ear hair cells. This therapy may be more beneficial in patients in the early stages of tinnitus as it may have more benefit in damaged cells than dead ones.

Editor’s note: For an in-depth article on laser therapy, click here - Barry Keate

Beta Histine Hydorchloride (SERC)
Beta histine hydrochloride, also known as Serc, is not approved for use in the USA. This drug has been used in Canada and Europe for patients with severe vertigo from Meniere’s disease and in some patients suffering from tinnitus. Betahistine was found to have a histamine-like action in animals.

The usual starting dose is 4mg three times per day and may increase up to 48mg per day. Side effects include headaches (usually in the first 1-3 days of treatment and it is relatively contraindicated in patients with ulcer disease. Some studies in the past have shown efficacy in treating vertigo and tinnitus. An abstract titled "The Therapy of Tinnitus Resulting from Blast Injury," written by Jakobs P. Martin (Germany), compares betahistine, pentoxifyllin and xantinol-nicotinate in the treatment of tinnitus. Using 172 patients, the results showed that those receiving betahistine produced significantly better therapeutic results in eliminating their tinnitus.17

Vibrational Therapy
Tinnitus may arise from damage to the microscopic endings of the hearing nerve in the inner ear. The health of these nerve endings is important for acute hearing, and injury to them brings on hearing loss and tinnitus. Advancing age is generally accompanied by a certain amount of hearing nerve impairment and often tinnitus.

A device has been developed in Europe by Dr. Alfonso DiMino. He suffered from tinnitus and pioneered the Aurex-3, which stimulates the damaged nerve endings in a broadband frequency surrounding the frequency of the tinnitus. Eventually the brain is retrained to not reproduce the original tinnitus sound at the same intensity.

Mechanical vibrations are generated in the applicator and transmitted into the cochlea by placing the probe in front of the mastoid bone just behind the ear. A primary vibration is applied and its frequency tuned until it best matches or masks the tinnitus sound. As different parts of the cochlea operate at different frequencies it is important to ensure that the treatment is targeting the damaged area within the ear. The amplitude of vibration is then raised to a tolerable level for the patient, increasing energy applied to the damaged area.

The manufacturers of Aurex-3 recommend initial treatments of 3 to 5 minutes duration, 3 to 4 times a day. Immediate relief is rarely experienced but after regular use of 4 to 6 weeks, period relief should be sufficient to reduce the frequency of ongoing treatments. For those people who experience unilateral tinnitus, treatment in just one ear is appropriate. However for those who experience bilateral tinnitus or tinnitus inside their head, it is recommended that both ears are treated.

The Aurex-3 represents a new breakthrough in the search for relief from tinnitus. Experience from use of this device has shown unprecedented results and on the basis of subjective evidence amassed from around the world the Aurex-3 is being regarded as a major new development in the treatment of tinnitus.

Clinical trials are now underway to more substantiate evidence of these results and to determine precisely how effective Aurex-3 is. Trials are being conducted in the United States and in Europe.41

Tinnitus Retraining Therapy
Dr. Pawel Jastreboff's has developed a therapy technique called Tinnitus Retraining Therapy (TRT), which has provided significant improvement for at least 80% of tinnitus sufferers. Tinnitus Retraining Therapy is based on strong neurophysiological evidence that any person can habituate to acoustic, or acoustic like, sensations in their environment.13

TRT has two key elements: directive counseling and sound therapy. The counseling session is critical to the success of the program, and patients may actually achieve relief through counseling alone. The counseling process involves an in-depth discussion of the hearing physiology, which helps the patient understand why tinnitus occurs. Hearing only starts at the ear; from there, sound signals travel to the lowest levels of the brain (brain stem) and pass upward to eventually arrive at the highest level of the brain, the auditory cortex. Random signals in these areas may be responsible for the perception of tinnitus. A strong negative emotional reaction to the tinnitus causes it to be a problem. An expanded discussion about the auditory process enlightens patients and helps relieve their fears.

In addition to counseling, most patients are fitted with ear-level white noise devices. These look like small hearing aids and are comfortably worn during the day. The sound is set to a very low level, which never interferes with normal hearing, and after several weeks most patients do not hear the sound unless they really try to hear it. These devices help your brain to ignore the random signals of tinnitus, thus achieving auditory habituation.

The initial evaluation and counseling process is quite extensive, usually lasting four-and-a-half to five hours. Regular follow-up visits or telephone communication for out-of-town patients are absolutely necessary. Within six to 24 months most patients have eliminated or are no longer bothered by their tinnitus.

Editor’s note: A review of Tinnitus Retraining Therapy can be seen here.- Barry Keate

CONCLUSION
Tinnitus is a significant medical problem affecting approximately 50 million Americans, 12 million of them severely. Once a thorough evaluation has been performed by a qualified otolaryngologist, and no life threatening pathology has been identified, the opportunity for treatment exists. Treatment options are extensive and range form approved protocols to anecdotal remedies. While tinnitus may not miraculously disappear, many therapeutic options exist which may help to make the tinnitus more manageable.

SYNOPSIS
Tinnitus is an example of an often uncontrollable, disturbing medical condition which frequently fails to be adequately managed by conventional western medicine. The alternative therapies discussed herein suggest that the suffering patient is not without hope. While these nutritional and herbal therapies are representative of complementary medical treatment regimens, they do represent additional avenues of therapy upon which to venture in pursuit of relief of the intolerable symptoms of tinnitus.

REFERENCES