Dr.
Seidman’s Treatment Protocol for Tinnitus
by Barry Keate
 Michael
Seidman, MD, is considered by his peers to be one
of the preeminent Otolaryngologists (Ear, Nose &
Throat physicians) in the United States. He is an
active scientist and conducts research into all
facets of ENT practice.
He is an expert on tinnitus, noise
induced hearing loss, otologic/neurotologic-skull
base surgery, the molecular basis of aging, nutrition/antioxidants
and their relationship to health and aging, and
herbal therapies.
Dr. Seidman’s Curriculum Vitae.
Dr. Seidman is Medical Director of Arches Tinnitus
Formulas, formally endorses our products, and refers
many of his patients to Arches.
Read
Dr. Seidman’s complete endorsement.
Recently, a fellow ENT physician
asked Dr. Seidman, for his advice regarding a tinnitus
patient who did not respond to the treatment she
provided. Concerned for the patient’s welfare,
she asked Dr. Seidman how he progressed in his tinnitus
treatment protocol and what therapies he used.
Dr. Seidman gave a detailed answer
to her on his treatment progression and many of
the tools he uses. He also graciously copied me
in the reply. I thought this would be very interesting
to our readers and Dr. Seidman agreed to allow us
to publish it. I have used the third person narrative
and attempted to flesh out some of the “doctor
speak” so it will be more understandable to
the lay reader.
On days he is not performing surgery,
Dr. Seidman sees 3-4 tinnitus patients each day
that he spends in the office. He has two nurse practitioners
who he describes as “wonderful” and
who help him greatly with his tinnitus patients.
He asks several important questions
of his tinnitus patients:
1 – Does this affect your
activities of daily living (ADL)?
2 – Does it interfere with sleep?
3 – On a scale of 1-10, with 1 being so mild
you just wanted to make sure nothing was wrong and
10 being so severe you would ask for a brain operation,
what are you?
Not surprisingly many of his patients
respond that they are a 9-10.
Dr. Seidman produced a video that
he presents as the first stage of therapy. All tinnitus
patients see this. It essentially states that although
they have heard that they must learn to live with
it, he states, “My colleagues are correct
that there is no cure to date.” That being
said, there are MANY things that can be tried. Although,
what helps person A might not help person B. Generally
speaking he helps 90% of his patients but he cures,
or eliminates tinnitus, very rarely.
Dietary Concerns
 On
the video, he discusses causes of tinnitus and potential
treatments. He advises patients to reduce or eliminate
use of salt, caffeine, alcohol, simple sugar, aspartame
(NutraSweet), MSG, and food coloring/dye.
Patient response to these recommendations
runs from acceptance to resistance. For example,
he has some patients who drink up to 24 cups of
coffee per day. Some report back after 8 weeks upset
having gone through withdrawal but still experiencing
tinnitus. Other patients may drink as little as
½ cup per day and stop at his suggestion
but express skepticism that that this protocol has
the ability to reduce their tinnitus. His answer
is he does not know what their “poison”
is and it might not be any of these things but it
might contribute. He has had several people quit
their ½ cup per day and they tell him their
tinnitus went from an 8 to a 5 on a scale of 1-10.
Read
an article on Diet and Tinnitus.
Arches Tinnitus Formulas
 After
diet modifications, which are sometimes effective,
he recommends the Arches
Tinnitus Combo Pack. Along with Arches Tinnitus
Relief Formula, the Combo Pack includes the Stress
Formula (B-Complex vitamins) and a B-12 subliminal
tablet, for a 3-month supply. If possible he prefers
that patients take the Combo Pack for 4 months or
more. He discloses that he is a minor shareholder
in the company and if this doesn’t work, he
is truly sorry. He believes there is not a better
Ginkgo biloba product on the market than that found
in Arches Tinnitus Relief Formula. (The German
Commission E continues to recommend 240 mg of Ginkgo
biloba, twice daily for both tinnitus and balance
issues.)
Medical and Electronic Therapies
Next he discusses:
Tinnitus
Retraining Therapy (TRT), a form of habituation
therapy designed to help people who suffer from
tinnitus (ringing ears). TRT uses counseling to
explain to the patient how a combination of tinnitus
retraining and sound enrichment can end their negative
reaction to the tinnitus sound, and then reduce
and eventually end their perception of it. Frequently,
noise generators are used in TRT to provide a background
noise level. This therapy offers hope to sufferers
who are willing to take the time and make the effort
to learn and implement it. Patients travel to approved
TRT centers and the therapy takes up to two years.
Neuromonics, uses highly customized Baroque
and New Age music to try to retrain the brain to
ignore the tinnitus through a process called neuroplasticity.
The device costs an average of $4,000 and comes
with individual training from an audiologist or
ENT.
O ther sound therapies,
Hearing aids and tinnitus maskers.
Prescription Medication
 If
his patients have crossed his “magic line”
of either affecting activities of daily living or
interfering with sleep, and have not responded to
the previous therapies, he offers prescription medications.
1 – Xanax. He states that patients must use
the real medication, not generics. He generally
prescribes 0.5 mg, three times daily, for 4 months
then conducts a follow-up appointment. This treatment
helps, but does not cure, 78% of patients.
2 – Baclofen plus Klonopin. He prescribes
10 mg Baclofen, three times daily, plus 1 mg Klonopin
at bedtime. He finds that neither alone is as effective
as both together. Baclofen is a muscle relaxant
and an anti-spastic agent. It is also a selective
GABA receptor drug and has been used in tinnitus
trials with some success. Klonopin is a benzodiazepine
derived anti-convulsant and anti-anxiety medication.
3 – Neurontin or Lyrica. These are anti-epilepsy
medications that work by increasing GABA uptake
in the brain. GABA is the primary inhibitory neurotransmitter
in the brain and helps decrease electrical activity.
Increased electrical activity can lead to seizure,
tinnitus and many other neurodegenerative conditions.
An article on GABA
can be seen in our Tinnitus Library.
Dr. Seidman is not a big fan of prescribing Neurontin
and Lyrica because they require liver function tests
and so he frequently sends these patients to a neurologist.
When he does prescribe Neurontin, he starts with
a low dose of 300 mg, three times daily, and has
gone up to as high as 1200 mg, three times daily.
He has seen success at both the low doses and higher
dosage.
4 – Campral. This is a medication that has
recently been approved by the FDA for alcohol dependence.
A clinical study in Brazil showed it reduced tinnitus
in most patients. The study was very small and flawed
in many respects but it still holds promise. Researchers
surmise that it may act as a glutamate antagonist,
a potential contributor to tinnitus. A discussion
of glutamate
antagonists and excitotoxins can be seen in
our Tinnitus Library. .
Dr. Seidman has treated about 20 tinnitus patients
with Campral and it has helped 3-4. He will use
it if the patient requests it.
5 – Memantine. This is another glutamate antagonist.
Dr. Seidman says he has a 15% response rate.
These are his central therapies. From here, he has
referred some patients for repetitive Transcranial
Magnetic Stimulation (rTMS). It is based on the
principle that a varying magnetic field will cause
an electrical current within any volume where it
passes. Electromagnets with intense electric current
are pulsed on and off immediately outside the skull.
This is not an FDA approved procedure for tinnitus
but clinical trials are under way. An article on
rTMS can be seen here.
Surgery
Dr. Seidman has also conducted clinical trials using
an electrode stimulator implanted in the brain and
an Implantable Pulse Generator in the chest. We
published an article in our Tinnitus Library on
the first
two implanted patients and surgeries.
He has now conducted trials on 5 patients with the
following results:
1 – One patient was “cured”. The
patient turns on the stimulator and his tinnitus
goes from a 10 to a 0-1.
2 –One patient experienced no change. This
really bothers Dr. Seidman as he thinks of this
patient often.
3 – One patient has improved by 35%.
4 – One patient has improved by 50%.
5 – The most recent patient has improved by
80%.
It should be noted that this is a very preliminary
effort. In the case of cochlear implants, it took
many years of biomedical engineering to refine the
process and obtain consistently favorable results.
In this case, there is much work to be done in the
fields of tinnitus mapping, electrode development
and determining which patients will benefit most.
Medtronic is the company that manufactures the stimulator
and funded the earlier work. The company is no longer
funding this so anyone who wishes to be implanted
has to pay about $100,000 to have it done.
Dr. Seidman works with a person he describes as
a “wonderful” psychiatrist, Dr. Alan
Rosenbaum, who is one of the leading neuropsychopharmacologists
in the country. This means he is a combination of
neurologist, psychiatrist and pharmacologist. He
will take Dr. Seidman’s severely disable patients
and put them on one of 4 or 5 hard-core drugs. The
patients will come back to see Dr. Seidman and might
often note that their tinnitus is better.
He sends a fair amount of patients in the 7 -10
category to the Center for Integrative Medicine
at the hospital where he works. There are several
therapies offered there.
1 – Mind-body therapies that include hypnosis.
2 – Acupuncture. A National Institutes of
Health study shows this “helps” approximately
40% of tinnitus patients. They usually need 6 treatments
or more to determine effectiveness. An article on
Acupuncture
and Tinnitus by Beth Kohn, who works with Dr.
Seidman, can be seen in our Tinnitus Library.
3
– St. John’s Neuromuscular Therapy.
This is designed to realign the spine. It involves
a form of deep muscle, deep tissue massage to put
the muscles back where they belong so the spine
goes back where it belongs.
Dr.
Seidman has many patients who can change their tinnitus
by moving their jaw, putting their hand on their
temporal region, or looking left or right. These
patients have neuromuscular issues and are sometimes
able to ratchet down their tinnitus by 30-50% with
this therapy. |