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Questions Asked by the Tinnitus Community - Answers Provided by Arches President, Barry Keate

Note: Ask Barry is pleased to be able to answer your questions based upon the information we have available. Our answers to inquiries are not substitutes for a physician’s advice nor are they reviewed by a physician. We encourage you to share any suggestions you have received from Ask Barry with your doctor.
Dementia, Memory Loss and Tinnitus

Hi Barry,

I have been reading things about damage to the brain causing memory lost. I have tinnitus in my left ear for several years. I am 72 years old, and I am experiencing some memory loss. Is there some truth in this diagnosis, and if so what can I do to stop this damage to the brain?

Frank S.

Dear Frank,

Yes, there is some truth to this. Tinnitus does not specifically cause dementia or memory loss,  hearing loss can cause cognitive decline. Since hearing loss is the primary cause of tinnitus it can also affect memory loss and dementia.

This happens because the brain needs input from all senses. If the auditory cortex doesn’t have enough sound input it begins to shrink.

Ways to prevent or slow the progression of cognitive decline are to increase the auditory environment to keep brain cells healthy. Hearing aids will be helpful as well as Arches Tinnitus Formula.  The ingredients in ATF has been shown in clinical studies to prevent hearing loss and even restore some degree of loss over time.

Wishing you quiet times,
Barry Keate

Can Napping Increase Tinnitus?

Hi Barry,

I’ve found controlling my diet and watching sodium levels has provided perhaps the best results over my tinnitus. I read that many tinnitus sufferers can have stable and low noise days and then after a short nap of 10-30 minutes, their tinnitus goes through the roof, taking days to recover.

Barry, what are your thoughts regarding after-nap affects?

Mike F.

Dear Mike,

Those who wake from a nap with worsened tinnitus may have a somatic component to their tinnitus. That is, there may be signals coming from the muscles or skeleton that are aggravated by the position the person sleeps in. These signals interfere with acoustic signals and can worsen tinnitus.

Temporomandibular joint disorder (TMJ) is a common cause of tinnitus. It occurs when the jaw is out of alignment with the skull. Sleeping on the side may aggravate this and cause TMJ to worsen. A specially trained craniofacial pain dentist can diagnose this. If TMJ is a problem, a simple mouth guard used when sleeping will keep the jaw in line and reduce symptoms.

Other somatic conditions can occur with a spasm of the SCM. That is the sternocleidomastoid muscle that is located below the ears and helps in turning the head.

Other causes can be misalignment of the upper cervical vertebrae or other muscular or skeletal abnormalities. Pressure from these conditions can affect the nerves that feed into the auditory cortex.

To learn more about this condition, please see our article on Somatic Tinnitus.

Wishing you quiet times,
Barry Keate

Hearing Aids for Tinnitus

Hi Barry,

I have tinnitus and have for many years, in both ears, different tones in both. It’s a constant high pitched sound, in two different tones, one being higher pitched then the other. I have hearing loss after wearing an in-ear headset for work for more then 20 years.

The tinnitus causes additional hearing loss, I can’t hear a lot over these sounds and have to ask people to repeat themselves, have the tv turned up. I had a hearing test, the doctor blew me off and said I have decent hearing for someone my age. Is there a hearing aid type device that can help this? Maybe dull the tones enough that I can hear normally again?

Thank you,
Karen P.

Dear Karen,

There are hearing aids and other hearing instruments that can help with tinnitus. It is important to note that the effectiveness of hearing aids will depend on the frequency of the tinnitus. Hearing aids amplify ambient sounds and may block out tinnitus if it is in the mid range, where there is a lot of background sounds. They may not be as effective for those with higher frequency tinnitus, like you and me, because there is not enough background sounds at those frequencies to mask the tinnitus. My tinnitus is at 4,000 Hz. I have a pair of quite expensive hearing aids that don’t do a thing to reduce my tinnitus.

There are other devices that can help to reduce tinnitus. Bedside sound generators can be helpful in reducing tinnitus while trying to sleep. A simple test for this is to step into the shower with the water running. If it significantly reduces or completely masks your tinnitus, This may work for you. Sound generators can be switched between different sounds such as running brook, seaside surf, gentle rain, etc.

There are  numerous tinnitus sound apps for masking that you can download on your smart phone(many are free). One good example is the Resound Tinnitus Relief App. It offers numerous soundscapes that you can listen to in the background, and even mix and match multiple sounds at once depending on own tinnitus sounds. A basic search in you App store will show many others.

There are hearing aids that combine a masking sound to take attention away from the tinnitus sound. A good Audiologist should have access to several brands however they can be quite expensive. Widex, a hearing aid manufacturer has developed a device called the Widex Zen that does this.

There are also notched music devices and programs. These involve notching out the frequency of tinnitus from music clips. The result is the auditory nerves responding to the tinnitus frequency are not stimulated but are dampened.

Arches Tinnitus Formula (ATF) is very successful in reducing tinnitus sounds, especially for those whose tinnitus is caused by hearing loss, which is the most common cause. One prominent ENT states ATF is successful in reducing tinnitus in 75% to 80% of his patients who use it. It must be taken for 100 days before the full effect is seen so we recommend Arches Tinnitus Formula Starter Kit, a 100 day supply and has the probability of quieting your tinnitus significantly.

Wishing you quiet times,
Barry Keate

How Glutamate and Glutamine affect Tinnitus

HI Barry,

I have read articles that say glutamate is the most abundant neurotransmitter in the human body and is believed to be heavily involved in memory and learning processes. glutamine is also believed to remove metabolic residue in the brain acting as a detox and improving brain function.

What is the difference between glutamine and glutamate? Is it safe to take glutamine if you have tinnitus? If glutamate is bad for tinnitus and Arches Tinnitus Formula blocks glutamate how does this affect GABA in the brain? Will taking GABA inhibit glutamate?

Darrel W.

Dear Darrell,

Glutamine and glutamate are both extremely important for human health. Both are amino acids (building blocks of protein) that humans derive from eating protein.

Glutamine is the most abundant amino acid in the body. The body can make enough glutamine for its regular needs. But during times of extreme stress (the kind you experience after heavy exercise or an injury), your body may need more glutamine than it can make. The best time to take a glutamine supplement is post-workout, usually 30 minutes within the workout. So yes, you can take glutamine. But since it is derived from protein, you don’t need supplements unless you are either protein deprived as some vegetarians can be or are do intense workouts and want to do body building.

Glutamate is responsible for carrying messages through the nervous system. It facilitates the flow of information to the brain. Glutamate is excitatory; it arouses nerve cell firing.

Gamma-aminobutyric acid (GABA) is also an amino acid that functions as the primary inhibitory neurotransmitter for the central nervous system (CNS). It functions to reduce neuronal excitability by inhibiting nerve transmission. GABA is inhibitory so it slows down nerve firing and communication. Both glutamate and GABA must be in balance for a healthy nervous system.

The problem arises when nerve cells in the cochlea are damaged, such as by loud noise or toxic medications. These nerve cells release a flood of glutamate that overwhelms the GABA in the nervous system and causes nerve cells to continuously fire until they become depleted and die. This is called excitotoxicity.

Arches Tinnitus Formula inhibits excess glutamate and helps keep it in balance with GABA. This is one of the primary ways it reduces tinnitus sounds. Taking GABA supplements will also inhibit glutamate. This is also what benzodiazepine medications do, they prolong the use of existing GABA in the nervous system. Unfortunately they are very addictive and don’t work for long.

Wishing you quiet times,
Barry Keate

Tinnitus Got Worse after COVID

Hi Barry

I contracted COVID on 1/23/21. Symptoms are gone, but my tinnitus has become a real problem. Is there any hope (even anecdotal) that a COVID induced flare-up will subside over time?

I realize there is not much I can do otherwise except stick it out. I’m about 75% thru the Starter Kit of your tinnitus formula. If there are suggestions you have to address the impact on tinnitus from COVID, I’d be interested in your thoughts.

Lee M.

Dear Lee,

The most recent study I am aware of was published March 2021, in the International Journal of Audiology, estimated that almost 15 percent of those with COVID-19 said they had tinnitus, often early in the course of the virus.

Thankfully many people with long COVID do eventually recover and most of them return to normal or near normal. I hope this is the case with your COVID-related tinnitus.

There is new research that shows that melatonin, also reduces the incidence of COVID-19 infection and may be therapeutic for those who already have the disease.

Melatonin has been shown to reduce tinnitus, especially in those with severe tinnitus and difficulty sleeping. There is new research that shows that Melatonin reduces the incidence of COVID-19 infection and may be therapeutic for those who already have the disease.

At the worst, you should sleep better. Start with maybe 5 mg an hour before bed. You can work up to 20 mg if needed, which is what I take every evening.

Hopefully, this will be helpful.

Wishing you quiet times,
Barry Keate

Sound Sensitivity with Tinnitus

Hi Barry,

I have had tinnitus and hyperacusis for 4 months. I think it came from ototoxicity and then the hyperacusis came a couple weeks later. My mom had tinnitus too. Will this tinnitus formula possibly help me? It is a high shrill 24/7.

Deborah W.

Dear Deborah,

I’m sorry to hear about your tinnitus and hyperacusis. Hyperacusis is a condition of extreme sensitivity to sound. Ordinary sounds are experienced as being unbearably loud. Arches Tinnitus Formula should be helpful for both your tinnitus and hyperacusis.

We have published an article on Hyperacusis and Tinnitus. Our article is based primarily on Dr. Jack Vernon’s work with Hyperacusis. He developed a treatment for hyperacusis that is still being used at the Oregon Health Sciences University. He advises people to not try to protect their ears by avoiding unpleasant sounds as that will increase and reinforce the hyperacusis. He states that short-term hyperacusis can be resolved fairly quickly and recommends people with the condition join Dan Molcore’s Hyperacusis Network in Green Bay, WI.

I hope this information is helpful for you.

Wishing you quiet times,
Barry Keate

Which COVID Vaccine is better for Tinnitus?

Hi Barry,

I regularly read your newsletter so wondered if you could give me some advice. As a tinnitus sufferer for many years, I’m concerned about taking any of the COVID vaccines as I think it may make my tinnitus worse. Is there anything I can do in order to reduce the risk of my tinnitus getting worse if I agree to the COVID jab?

Kind regards,
Loretta P.

Dear Loretta,

First, all indications are that getting tinnitus from any vaccine is very rare. There have been several reports that COVID-19 may cause tinnitus and the vaccine might also cause it. Since the disease and the vaccination are so new, there haven’t been any clinical trials on this and the incidence at which it may occur.

There are some indications however, that give us a rough idea of the very low incidence rate of the vaccine causing tinnitus.

The US Vaccine Adverse Event Reporting database cites 152 reports of tinnitus among 25,072 recipients of vaccines from Pfizer and Moderna. This represents about 0.6% of this adverse event occurring. A UK database of Astrazeneca and Pfizer vaccines reports for 54,180 recipients, there were 320 tinnitus reports. This represents a 0.59% incidence of tinnitus in this database.

These are self-reported cases of tinnitus so it may be somewhat underreported. However, even if it is only half of the cases occurring with the vaccines, the incidence would still be about 1.2%.

The vaccine is safe and should be taken as quickly as possible to protect you from the highly infectious Delta variant. The consequences of coming down with COVID-19 are very serious and can be life-threatening.

To reduce the chances of worsening your tinnitus you can take N-Acetyl Cysteine (NAC) and Ginkgo Max 26/7®, the special Ginkgo biloba, found in Arches Tinnitus Formula. Take 1,000 mg of NAC daily and 480 mg of Ginkgo daily starting a couple of weeks before the vaccination and continuing for at least a month after.

Wishing you quiet times,
Barry Keate

Will ringing in ear from COVID vaccine go away?

Hi Barry,

After taking my 2nd shot of the Pfizer vaccine, I am experiencing an increase in the ringing in my left ear. I have tinnitus only in my left ear; my right ear is OK, no ringing. I just finished reading a site where about 100 entries complained about the vaccines and the increase of ringing, fullness in the ear and ear pressure.

So what is your prediction, will it go away or is it permanent? The site I referenced had a couple of people state that in 4 to 6 weeks the ringing got better.

Robert H.

Dear Robert,

I think this is quite rare and it should resolve. I had my second vaccination two weeks ago and I got sick the day after. That cleared up within another day and I have no other side effects.

Dr. Steven Rauch, Vice Chair for Clinical Research at Harvard Medical School says he has seen some episodes of hearing loss after vaccination. But, he says, they are always seeing hearing loss and it is impossible to discern if there is any change above the normal occurrence.

Said Dr. Rauch: “These effects seem to occur within the first two weeks post-injection and sometimes within just a few days. They appear to be temporary. The actual likelihood of this phenomenon and its clinical course are not well-defined — it’s just too soon to know.”

I hope your condition resolves and returns to its previous level. You can read our recent article based on Fall 2020 research on the COVID virus, hearing loss and tinnitus.

Wishing you quiet times,
Barry Keate

Inner Ear Spasm or Pulsatile Tinnitus?

Hi Barry,

A physical therapist gave me the following information. Is this true?

“Muscle spasms in the inner ear can tense up (spasm) which can result in tinnitus, hearing loss and a feeling of fullness in the ear.” And “ In rare cases, tinnitus is caused by a blood vessel disorder. This type of tinnitus is called pulsatile tinnitus.”

This physical therapist wants me to see another therapist who specializes in helping to relieve ear ringing. I don’t know what to do, and I don’t someone hurting me further.

Your thoughts please.
Teresa M.

Dear Teresa,

Thanks you for sending these questions.

Both statements you quoted are mostly correct but they refer to two different types of tinnitus.

Muscle spasm in the middle ear can result in tinnitus, hearing loss and fullness. Please note these are muscles in the middle ear between the eardrum and cochlea. There are no muscles in the inner ear, which is the cochlea. These muscles connect to the eardrum and as they spasm a doctor can actually observe the eardrum moving.

This is called Middle Ear Myoclonus and usually produces thumping, clicking or buzzing sounds. Sometimes it can sound like a typewriter. Treatment options include acupuncture, biofeedback and sometimes the use of anti-anxiety medication.

In the case of pulsatile tinnitus, a blood vessel disorder, such as blockage or twisting can cause the problem. The blood becomes turbulent and causes a whooshing or pulsing sound in synch with the heartbeat. There are several possible causes of this but the result is always turbulent blood flow.

In most cases a vascular surgeon can identify the cause of the turbulence and successfully treat it. Please see our article on Pulsatile Tinnitus.

It should be fairly easy to determine if you have one of these conditions. In one the doctor can observe the eardrum moving. In the other the sound corresponds to your heartbeat.

Both of these conditions are fairly rare. The majority of tinnitus cases are due to hearing loss. In this case Arches Tinnitus Formula can be helpful in reducing the sound level and aggravation of tinnitus.

Wishing you quiet times,
Barry Keate

Did ED Meds help his Tinnitus?

Hi Barry

I have had tinnitus since 2010. In 2014 I was in Colombia with my wife. My wife bought a Cialis tablet. I took the tablet and as a side effect the hissing sound almost completely disappeared.

I thought I discovered a treatment for this hissing sound, and after 2 – 3 days slowly the hissing sound came back. When I got home in Amsterdam and checked the internet for Cialis in relation to tinnitus. Much to my horror I only find negative stories about Viagra and tinnitus.

Since then I am scared to try again and still hear the hissing sound. Have you ever heard an equal story about Cialis in relation to tinnitus?

I am a former user of your product. Is it recommendable to use your product lifelong? Do you think it can prevent tinnitus?


Dear Bas,

Yes, it is true that Cialis and Viagra can cause tinnitus. However, this is fairly rare, occurring in 0.1 to 1% of people. Most do not get tinnitus from these drugs. I have used them fairly often in the past with no problem.

However, what they do to all people is lower blood pressure. In fact, Viagra was initially developed as a drug to lower blood pressure before they found this other side effect, better erections.

It appears that lowering your blood pressure has the effect of also lowering your tinnitus. This makes sense as high blood pressure worsens tinnitus.

I would not worry too much and would continue with the Cialis. If your tinnitus does worsen, stop using it immediately and the tinnitus should recede. You can also combine it with NAC and/or Arches Tinnitus Formula, which protect the neurons in the inner ear and help prevent tinnitus.

People who achieve tinnitus reduction with Arches Tinnitus Formula usually continue using it consistently over many years. It is possible to reduce the dosage and still get the desired effect. We do not recommend reducing the dosage below 1/2 the recommended dosage on the label.

Wishing you quiet times,
Barry Keate

The COVID Vaccine and Tinnitus

Hi Barry,

I was wondering if you can comment on the possible ototoxicity of the COVID vaccine or is it too soon to tell? If those of us have had problems with hearing loss and increase in tinnitus from the flu shot in the past, would you recommend that we did NOT get the COVID vaccine? Are there similarities?

I realize COVID itself can possibly cause hearing loss, tinnitus and dizziness as can the medicine used to treat it. It’s a real dilemma.

Thank you,

Dear Jory,

I cannot comment on this because I don’t know. There has not been any research I’m aware of that indicates whether or not the vaccine causes tinnitus. I believe it acts a lot like the flu vaccine. I’m surprised you have had a problem with the flu vaccine. It’s the first I’ve heard.

I would not advise you to avoid the COVID vaccine(s). You can prepare yourself by taking antioxidants before and after the vaccine. I recommend 1,000 mg NAC, taken twice daily. Magnesium is also been shown to prevent hearing loss and tinnitus. Take a good quality product, not magnesium oxide but one chelated for easier absorption. Magnesium aspartate or magnesium citrate are good products. Take about 400 mg twice daily. Start two weeks before the vaccination and continue for a month afterward.

Wishing you quiet times,
Barry Keate

Cortisone Injections and Tinnitus

Hi Barry,

In early September, I had a Cortisone injection in my shoulder for arthritis damage that had destroyed some, but not all of the cartilage. The good news is that within 24 hours there was a marked improvement with my range of motion. The bad news is that within 12 hours my normal blood sugar early morning readings of 110 had spiked to 198 along with higher blood pressure. And to make matters worse I had a big spike in my tinnitus.

The blood sugar and blood pressure has resolved, but the tinnitus is still elevated after 2 1/2 weeks. Are you aware of other cases of these adverse effects on tinnitus?

Douglas C.

Dear Douglas,

This is a very unfortunate occurrence. Steroid shots can elevate blood pressure, blood glucose levels and tinnitus. It is not terribly common but does happen in up to 10% of people who receive cortisone shots.

I had osteoarthritis in my knee and took cortisones shots every six months until I had knee replacement therapy this August. I didn’t have any of the side effects that you mention. I would consider forgoing any further cortisones shots.

Hopefully the tinnitus spike will also resolve over time. If not, Arches Tinnitus Formula can be helpful.

Wishing you quiet times,
Barry Keate

VNG Test for Recent Tinnitus Sufferer?

Hi Barry,

I recently just suffered from what they usually called tinnitus for 5 days. I went to an ENT doctor who did a lot of tests to me. My doctor said everything turned out normal and I could clearly hear things. She referred me to take a VNG test. I don’t know if this can get rid of the sound I’ve been hearing.

Also, my ENT told me about your product that supposedly helps to get rid of the ringing thing or ease it at least. Is it possible that this could just go away?

Thanks in advance,
Gilbert A.

Dear Gilbert,

A VNG is a test called a Videonystagmography. It is used for testing inner ear and central motor functions, a process known as vestibular assessment. It involves the use of infrared goggles to trace eye movements during visual stimulation and positional changes.

This is used to determine if you have Meniere’s disease, which is characterized by periods of extreme dizziness and a low frequency buzzing or ringing in the ears. If you do not have any dizziness, the chances are you do not have Meniere’s.

It is possible the ringing could go away on its own. Many cases of short duration, within a couple of months, resolve by themselves. If it does not resolve, I recommend trying Arches Tinnitus Starter Kit, a full three-month supply of Arches Tinnitus Formula. This should reduce the sound and aggravation of the tinnitus.

Wishing you quiet times,
Barry Keate

Persistent Tinnitus after Getting COVID

Hi Barry,

In mid-July I contracted the Corona Virus. I only noticed the loss of taste/smell and had an array of headaches and mild fever for approximately 7 days.

On August 11th I took another Covid test, and as it was being administered, felt a significant discomfort and feared as to how deep that swab went into what I thought was my brain. Post the test, on the way home I played music in my car and as I arrived at home got a huge headache. When I arrived home, I took a short nap, and woke up with this ringing in my ears. It was so sudden and scary, it felt similar to the sound in your ears when you return from a concert and are about to go to sleep.

Ever since the ringing has not subsided. Sometimes the volume increases and it feels as if it travels from one ear to the other. I’ve had a very hard time accepting this, sleeping and insomnia have taken a toll on me.

I would like to know, given the fact that Corona Virus is so new, if there are other people experiencing a similar situation as mine – Did Corona weaken my hearing canals as well?

With high regards,

Dear Fernando,

I’m very sorry this happened to you. The COVID-19 is very new. There are billions of dollars being spent trying to find a vaccine but there hasn’t been enough time or money to study all the possible effects post-COVID-19.

There is a very new study conducted in the UK on the number of people who survived COVID-19 hospitalization and who reported hearing loss and/or tinnitus. About 13% of those people reported new or increased rate of hearing loss or new or increased tinnitus.

The researchers stated there was no way at this point to determine exactly what caused the hearing loss and tinnitus. It could have been the increased stress caused by being hospitalized or it could have been the ototoxic effects of the primary medicines used to treat the virus. All of the most popular treatments cause damage to hearing and tinnitus. Further studies are needed to determine cause and effect.

I hope this condition resolves itself, and it may, but we don’t know. In the meantime, it would be wise to use Arches Tinnitus Formula for your tinnitus. It takes a full three months to get the full benefit so we recommend Arches Tinnitus Starter Kit, a full three-month supply of four bottles.

Wishing you quiet time,
Barry Keate

Fear of MRI noise affecting Tinnitus

Hi Barry,

I am age 70 and have had tinnitus since age 20 from exposure to live music. I also developed hyperacusis. I need a brain MRI.

Any advice? I’m really petrified. Also, does doing an MRI under anesthesia prevent worsening tinnitus?

Thank you so much,

Dear Robert,

I’m sorry you developed tinnitus and hyperacusis (extreme sensitivity to sounds). The reason for an MRI is to rule out acoustic neuroma, a very rare occurrence of a non-malignant growth on the hearing nerve. The great majority of these tests turn out negative.

An MRI is fairly loud so you should take precautions. Use earplugs and ask for hearing protection during the procedure. If they have protective headphones, put them on over the earplugs. That should reduce the noise to a level that won’t be harmful.

I doubt they will provide anesthesia for this. But if you have something that can help calm you down, like a Valium or Klonopin, you may want to take one before the procedure. That should make the whole process much more relaxing.

You can also take Arches Tinnitus Formula to reduce the tinnitus sound level. It takes 3 months to get the full benefit so we recommend Arches Tinnitus Starter Kit, a complete 3-month supply of four bottles.

Wishing you quiet times,
Barry Keate

Inflammation, Infection & Antibiotics and Tinnitus

Dear Barry,

I`m a twenty nine year old woman, and I have problem with tinnitus. I`ve heard about your company and your remedies, so I would like to ask you some questions. By the way I will try to explain you the beginning of my tinnitus.

In 1999 I suffered from a severe inflammation of the middle ear (bilateral) which lasted for about fifteen days. After taking antibiotics, the inflammation disappeared, but soon after that I started hearing a pulsating noise, in the rhythm of my heartbeats. The lower my head was, the louder was this noise. A few days later the intensity of the noise decreased, but it remains even today; and it still gets stronger if my head is in the lower position, or if I perform any physically intensive activity.

Also, at that time I noticed faint buzzing sound in my right ear, but it was so faint that I could only hear it if I was in a very quiet, soundless room. A year later this buzz got slightly louder, and I went to see my physician again, but I was told then that it would be best to wait and see how it develops, without any medication, but under my physician`s supervision. Unfortunately, a few months later, the buzz got even louder. If I remember well, just before it I had some viral infection, but I am not quite sure. That is when I started taking Trental 400, and after about six months of using it, the condition stabilized. Even the tonal diagram showed a stable state; actually my hearing was not damaged.

About a year ago I had a strong throat inflammation, and tinnitus increased again. I received intramuscular injections of vitamin B12, I took zinc, but not Trental. This state continued for almost a year, but about two months ago I had some urological problems and I used strong antibiotics (Ofloxacin). I think that after that my tinnitus mildly worsened. Also, I was using Trental 400 as intravenous infusions, and I using Gingko biloba extract, vitamin E, and zinc (per os).

Since my tinnitus appeared I’ve had no acoustic traumas, or heavier stress. I think that the beginning of my tinnitus is connected to infections and inflammations of the ear, which is something I am quite prone to. I don`t suffer from vertigo, and my tympanogramme is OK. Sometimes, when I get up quickly, the buzz increases. It lasts for about one to two minutes, and then it goes back to usual level. I have low blood pressure and according to my physician`s opinion it contributes to my bad blood circulation and tinnitus.

When I recently checked my hearing again, the results showed that there was no damage at all. So I believe that my tinnitus is connected with inflammations in ear and throat, and I suppose that my low blood pressure and my bad peripheral circulation also contribute to it significantly.

I need to inform you that I finished with using homeopathy remedies two weeks ago, but it didn`t have any improvement in my occasions.

Please Barry, can you tell me, what sort of remedies will you recommend to me (combo pack or something else), and what will you generally recommend to me?

Yours sincerely,
Dalibor M.

Dear Dalibor,

Thank you for your message. Everything you mention, inflammation, infection and antibiotics, are known to cause tinnitus. Ofloxacin is an antibiotic that can cause or increase tinnitus, however in only about 1% of people who use it.

It seems to me, as you suggest, the infections and antibiotics in combination with poor circulation are the cause of your tinnitus. Trental (pentoxifylline) is helpful for this as it increases circulation in much the same way as Ginkgo biloba. It decreases blood viscosity and allows the blood to flow easier into the microcapillaries that feed the eyes, ears and brain. Many European doctors use this treatment for tinnitus but not so many here in the US.

Ginkgo has the added advantages of being a powerful antioxidant and glutamate inhibitor. When the cochlea is damaged, as in most cases of tinnitus, it produces an excess of glutamate which becomes toxic to the neuro-receptors in the auditory nerve. These receptors begin to die and produce large amounts of free radicals, which cause most of the damage. Ginkgo helps reduce the amount of glutamate produced and also fights the ensuing free radicals. Trental does not have this capability. There have been clinical studies which show the superiority of Ginkgo over prescription medications that reduce blood viscosity.

We published an article earlier this year on Antioxidants, Health and Tinnitus which explains the role of free radicals in the creation of tinnitus in more detail.

The basic problem is the frequency of inflammation and infections that seems to plague you. Modern allopathic medicine is very good at treating the symptoms and ignoring the causes of problems such as this. If you can increase the effectiveness of your immune system, your body will fight off these infections before it becomes necessary for medical intervention. This is much easier said than done as the immune system is a complex mystery to even the best minds. The basics, of course, are good diet, plenty of exercise and high quality supplements, such as multivitamins and antioxidants, to provide the nutrients we don’t receive in our diet.

There has never been a single clinical study conducted on the effects of homeopathy on tinnitus. This is because there have never been any anecdotal stories of success. Clinical trials are very expensive and time consuming. Doctors and researchers are only interested in conducting clinical trials if they have a reason to believe it will be successful. I believe the main benefit of selling homeopathic remedies is that they are extremely inexpensive to manufacture. I have never heard of a single person with tinnitus who has been helped by homeopathy. They certainly sell a lot of their products though.

I recommend primarily Arches Tinnitus Formula and trying antioxidant vitamins (see article link above).  ATF provides therapeutic doses of our pharmaceutical-grade Ginkgo extract, Ginkgo Max 26/7, zinc picolinate and deodorized garlic. It must be used for three months (4 bottles) before it can be determined how effective it will be for tinnitus. We recommend Arches Tinnitus Starter Kit, which is a 100 day supply.

Wishing you quiet times,
Barry Keate

Tinnitus caused by medication?

Hi Barry,

I started taking Ultram last year due to a herniated disk at L5/S1. It really helps the pain but, since last January, I’ve been experiencing the hissing sound of tinnitus in my right ear. My left ear has only had a touch of this but I wonder if it will get worse over time.

My pharmacist said that the medicine that I’ve been prescribed could very well have caused or, at least, contributed greatly to the tinnitus. Do you have any information connecting this particular medication to tinnitus?

I appreciate your newsletter and I want you to know that you’re doing a good thing by bringing this information to the masses. It lets all of us that have this problem know that we’re not “crazy” or imagining things. Thank you so much.

Warm Regards,
Stacy P.

Dear Stacy,

Thank you for your kind words. This job brings a lot of satisfaction to me, especially when I receive feedback like yours.

Ultram can cause or worsen tinnitus in less than 1% of people. This sounds small, but if you’re in that 1%, you don’t care that the other 99% didn’t get it. I recommend you discuss with your doctor whether there’s another, equally effective, painkiller without the possible side effect of tinnitus. You can view a list of prescription drugs that cause tinnitus .

Studies show that those people who have tinnitus primarily in one ear and who have had it for less than one year respond much better to Ginkgo biloba. One researcher stated that not only should all people with tinnitus use Ginkgo but they should begin as soon as symptoms are present. Our proprietary ginkgo, Ginkgo Max 26/7 is one of the primary ingredients in Arches Tinnitus Formula.

Wishing you quiet times,
Barry Keate

Phantom pressure in the ear?

Hi Barry,

I have been loyal to Arches Tinnitus Formula since the onset of my tinnitus. For 2 years now I am a tinnitus patient. My question is in two parts:

I have had bad fullness/pressure in my ears for 2 months now. After an appointment with an ENT, he examined me and said there was no indication of infection, blockage, or irritation in my ears, nose and throat. He said that he didn’t know what was causing the pressure in my Eustachian tubes. Do you know of any remedies to relieve this? I have not been in any altitude or pressure changes for 7 months.

He said I had quite a bit of ear wax in my ear. He attempted to remove it with a long, metal stick that really hurt my ear canal. I actually screamed and pulled away. I have heard many horror stories of people getting tinnitus from sticking things in their ears. Do you think he exacerbated my tinnitus from this? How do people get tinnitus from sticking objects into their ear canal when tinnitus is a disorder of the middle ear?

Always thanking you,

Dear Luana,

To answer your first question, you probably have some inflammation in your Eustachian tube. Inflammation can be caused by many things including infection, blockage and allergies.

It’s possible the fullness is simply generic inflammation. Inflammation is rampant in our society and causes many diseases. You may have seen the article we published on Omega-3 fatty acids and fish oil. I have determined to use fish oil forever.

Fish oil will take quite a while to reduce inflammation. In the short term, pain relievers may work. They relieve pain by reducing inflammation and are called NSAID for Non-Steroidal Anti-Inflammation Drugs. Such medications as aspirin, ibuprofen and acetaminophen fall into this category. Be careful of ibuprofen; when I take it my tinnitus goes through the roof.

To your second question, I don’t believe he exacerbated your tinnitus. If he did, you would have known it by now. I have also heard many horror stories about removing ear wax. It is possible but highly unlikely that this procedure would cause or worsen tinnitus. Generally speaking, it doesn’t unless you perforate an ear drum, which usually does not cause tinnitus anyway.

Wishing you quiet times,
Barry Keate

Rockin’ a full ear with Tinnitus

Hi Barry,

I was a rock musician for many years, and am suffering with a “hssssssss” in my left ear. Yes, I do do have substantial hearing loss in that ear (the right one is normal). The thing that’s causing me the most suffering is a stuffed up “fullness” in the affected ear. Is this another symptom of tinnitus?

I have seen an ear doctor, and he couldn’t find any obstructions (wax) in the ear. He said I should have an MRI examination to rule out the possibility of a tumor! First, I have no health insurance and can’t afford this procedure. Needless to say I’m scared stiff! I just want to know if ear “fullness” can be another symptom of tinnitus.

Thank you,
Fred W.

Dear Fred,

Ear fullness is not a symptom of tinnitus but tinnitus can be a symptom of ear fullness. It’s quite possible your Eustachian tubes are plugged which will cause or add to tinnitus.

MRIs are used to rule out tumors on the auditory nerve, which are extremely rare. When they do occur, they are always benign and slow growing. I would not suggest that you not get one but it’s not something I would worry about too much.

Ask your doctor if he will treat the fullness. Many typically prescribe a steroid-based nasal spray, such as Flonase or Rhinocort, and possibly an anti-histamine. This takes care of most ear fullness problems and should help the tinnitus. Also since you report having both hearing loss and tinnitus, I suggest trying Arches Tinnitus Formula which was developed specifically for these conditions and should help reduce sound levels.

Wishing you quiet times,
Barry Keate

Can cotton swabs affect tinnitus?

Hi Barry,

I have had tinnitus for as long as I can remember. I recently read that using cotton swabs to remove ear wax can damage the cochlea and cause tinnitus. I use cotton swabs almost daily as it seems as if my ear canals itch a lot, especially after a shower. Could I be actively making my tinnitus worse on a daily basis? If so, is there a fix?


Christopher P.
San Diego, CA

Hi Christopher,

In general most physicians will tell you not to stick anything in your ears… That said, using cotton swabs doesn’t actually damage the cochlea, which is pretty far removed from the ear drum. There is the danger you can damage your ear drum though and that can worsen the tinnitus. If you damage your ear drum, you’ll know it, it will be very painful. Ear wax build-up is a possible cause for tinnitus.

The American Academy of Otolaryngology suggests using mineral oil, baby oil or glycerin to remove wax. They have a complete “plain language” description of the ear wax problem and how to handle it at:  You can also read our article on 10 causes of ear fullness.

Wishing you quiet times,
Barry Keate

Anesthesia and Tinnitus

Dear Barry,

Thank you for taking my question. I think it is great what you are doing for those of us with tinnitus – offering a sense of hope and community.

My question has to with the connection between tinnitus and anesthesia. I am going into surgery in January, and I was told I would be put under general anesthesia, “out cold!” I already suffer from tinnitus, and I am curious if anesthesia exacerbates tinnitus or if it is a side effect. If so, what precautions can I take beforehand? I also read about the connection between tinnitus and antibiotics. I will surely be receiving high doses of antibiotics. Is there something I can do for this, to?

Thank you,

Hi Luana,

Thanks for submitting this question.  You didn’t mention which drug you were given but a few can cause an increase. I had an endoscopy last year and the doctor used propofol, which is very popular. My tinnitus increased for a few months and it was very scary. However it eventually returned to its lower level after I used N-acetyl cysteine (NAC) and Arches Tinnitus Formula. Other anesthetics will not cause this.

There is a very rare occurrence of a certain low frequency tinnitus that can occur after spinal anesthesia but it does not occur with general anesthesia.

You will need to discontinue the Arches Tinnitus Formula (ATF) for at least a week before the surgery to minimize the possibility of excess bleeding. You can resume ATF shortly after surgical bleeding stops.

Antibiotics can present a problem. Some antibiotics are more ototoxic than others and you should discuss with your doctor which medication you will be using and the occurrence of tinnitus with the specific antibiotic. Several years back, I had an injection of an extremely potent antibiotic in response to a skin infection I developed. I discussed this with my doctor and he told me the specific antibiotic used did not cause or increase tinnitus. He seemed pretty knowledgeable about it and I had no increase. If your doctor is not knowledgeable about this, ask him to look it up in his Physicians Desk Reference (PDR).

To be on the safe side, you should begin taking antioxidants along with the antibiotic. You can begin the ATF again at the same time. It is a powerful antioxidant and should greatly reduce the chances of any damage to your hearing.

You can also take N-Acetyl-Cysteine (NAC), which has been shown to reduce effects from ototoxic medications and sound trauma provided it is taken simultaneously. Popularly known as NAC, it is very inexpensive.

In July of 2022, the FDA had announced that NAC should not be sold without a prescription from a doctor, although it has been sold over-the-counter and used safely for more than 30 years. While Amazon has taken it off their site, it can still be found at many reputable online stores and many health food stores.The Natural Products Association has sued the FDA to repeal their edict calling it “a reckless misuse of government resources and will do nothing to protect public health.”

I have taken NAC for decades and recommend 500 mg, taken two or three times daily. Continue using it for two weeks after the antibiotic is stopped. I’m certain that with these precautions you will be fine.

Wishing you quiet times,
Barry Keate

Luana’s responds:

Oh, my, you are a plethora of info! I didn’t even think about asking the doctor about any ototoxic antibiotics. I will, indeed! Thanks for the info on the NAC. Would you mind posting your response to my question in your next newsletter for others to read? I think it may be helpful.

Thank you so very very very much…. Arches–and you–rock!!


Hormone Cream and Tinnitus

Hi Barry,

I am thinking about starting your formula for tinnitus. Before I start I need to know two things. My doctor put me on Premarin cream for a stage one prolapsed bladder and shortly afterward I got tinnitus. Could the hormone cream have started it and will your tinnitus formula still help me if I am on the hormone cream? By the way, I don’t approve of and have never taken hormone prescriptions before. I am 77 years of age.

Thank you so much,
Martha C.

Dear Martha,

A review posted at (Feb. 2021) compiled the details on side effects from 69,299 Premarin users, of whom 0.5% have reported tinnitus as a side effect. The incidence increases dramatically with the number of years on Premarin, and no one reported a recovery. Also, hormone changes are a known cause of tinnitus and it may well have brought yours about. It’s impossible for me to know. If your tinnitus started at the same time, Premarin should be suspected.

Whatever the cause, you might want to check out bio-identical hormones over Premarin and the like. The very name Premarin comes from Pregnant Mare’s Urine. It is a horse hormone and not intended for human consumption. Bio-identical hormones are plant based, they are identical to human hormones, and there are no side-effects. You can ask a compounding pharmacist how to obtain a prescription.

Arches Tinnitus Formula Starter Kit should be very helpful for you, especially since your tinnitus is early onset. All the clinical evidence shows that our products are helpful for most people but even more so for those who have experienced tinnitus for less than one year.

Wishing you quiet times,
Barry Keate

Breast Cancer Treatment and Tinnitus

Dear Barry,

I’ve had constant ringing, buzzing, hissing in my ears for at least six years, which really drives me crazy sometimes because the pitch of the ringing changes a lot. This happened around the time I was treated for breast cancer. I had four treatments of chemotherapy and radiation. I was told from my ear doctor that the ringing could be caused from the treatment. What is your opinion about Neuromonics? I can’t believe I have to deal with this for the rest of my life. I’m only 51. Do you have any hopeful advice for me?

Thank you,

Dear Lynne,

I’m sorry this happened to you. Many chemotherapy drugs are ototoxic and cause damage to the cochlea and a person’s hearing. I think I have some hopeful advice for you.

No single tinnitus therapy works for everyone. According to the company, Neuromonics works in reducing tinnitus in about 70% of a “select” group of patients. The word “select” is very important because it does not work for 70% of all patients. Neuromonics costs $3,500 – $5,000 for the device and the full treatment of 6 months. The goal of this treatment is not to reduce tinnitus but to desensitize the brain to the sounds of tinnitus and to reduce the patient’s annoyance with the sound.

Darius Kohan MD, a specialist in otologic surgery in New York, and a faculty member at several major medical centers, states regarding his patients with tinnitus due to sensorineural hearing loss: “Arches Tinnitus Formula doesn’t work with everybody, but works with about 75% to 80% of these patients. Arches Tinnitus Formula is a safe and benign treatment that we initiate for patients.” The total cost to find out how much of a reduction you will achieve will be $165 for a three month supply of our Tinnitus Combo Pack. This may be a good place to start.

There are other treatment options available. Please visit our Tinnitus Library which has over 150 articles on tinnitus treatments. Hopefully there should be a therapy that can help reduce your tinnitus.

Wishing you quiet times,
Barry Keate

Musical Ear Syndrome

Dear Barry,

I have Musical Ear Syndrome and want to know does your product work for this condition. If not can you give me any information on how to help my condition.

Thank you,
Rose M.

Dear Rose,

Musical Ear Syndrome usually arises in those who are hard of hearing and are not in an audio enriched environment. When the brain is deprived of sounds, it will often fill the void with sounds it has remembered. Many people do not find this bothersome and it can be quite pleasant for some.

Arches Tinnitus Formulas do not help Musical Ear Syndrome. Treatment therapies include maximizing hearing with a hearing aid and enriching the environment with sound. This provides the brain with much needed input so it won’t generate its own sound.

Wishing you quiet times,
Barry Keate

Will general anesthesia worsen Tinnitus?

Hi Mr. Barry,

I hope your well. Recently I went under a minor surgery for a muscle biopsy and was put under general anesthesia for about an hour or so. It’s been more than two weeks now and my tinnitus has become progressively louder. I’m not sure whether anesthesia has the effect to do this and I am very concerned as living with tinnitus in this volume is unbearable I tried to tell my doctor about this he said there’s no connection between the two. I’m very frightened if you have any experience about this matter please help me out.

Thank you,
Mohsin A.

Dear Mohsin,

Yes, anesthesia can cause an increase in tinnitus. You didn’t mention which drug you were given but many of them can cause an increase. I had an endoscopy last year and the doctor used propofol, which is very popular. My tinnitus increased for a few months and it was very scary. However it eventually returned to its lower level after I used N-acetyl cysteine (NAC) and Arches Tinnitus Formula. Other anesthetics will not cause this.

I’ve been recommending NAC for years as a way to prevent increased tinnitus due to noise exposure or ototoxic medications. I recommend you take NAC at the dosage of 2,000 mg per day, 1,000 in the morning and 1,000 in the evening. NAC can be found in most health food stores or online. It helps protect the ear from ototoxic medications.

I also recommend taking Arches Tinnitus Formula, 2 capsules in the morning and 2 in the evening. You must continue both of these for three months to determine efficacy. They are both very healthy and can be continued indefinitely if you like. Arches Tinnitus Formula should lower your tinnitus levels.

Wishing you quiet times,
Barry Keate

Over-the-counter Pain Meds and Tinnitus

Dear Barry,

Is there anything else to take besides ibuprofen for inflammation of the joints? When I take this it makes my tinnitus louder.

Thank you,
Esther B.

Dear Esther,

Over-the-counter pain medications present a real problem for those of us with tinnitus. Most of them will cause an increase in tinnitus. Aspirin in small amounts is probably OK but may not provide enough relief. Acetaminophen, found in Tylenol, will not increase tinnitus but can be poisonous and hard on the liver if too much is taken. You have to carefully read the label and make absolutely certain you are not taking too much.

Something that may reduce the need for painkillers is fish oil containing omega 3. This fights inflammation naturally. I don’t know if you can completely stop taking pain medication but you can probably reduce the need for it.

Wishing you quiet times,
Barry Keate

Treating Tinnitus with Klonopin (clonazepam)


I was recently prescribed clonazepam as a treatment for anxiety which my doc felt led to my depression and IBS. After venlafaxine seemed to cause my tinnitus back in 2019, I’m scared to death of these drugs – a fear not shared by doctors for some reason.

Anyway, in trying to find out if this drug could further cause exacerbation of my tinnitus problem, I’ve come across a study that shows significant broad based improvement in tinnitus from using clonazepam (2mgs for 180 days). My docs appear to be wholly unaware of the study and not interested. What gives? Not crazy about playing Russian roulette with another drug – but if this can treat tinnitus, IBS (irritable bowel syndrome) and depression, it seems like it is worth the risk. What would you do in my shoes and what’s your read on this study (which I’m sure you are of from 2012)?

Lee W.

Dear Lee,

Thanks for your question. The short answer is, yes, clonazepam (trade name Klonopin) can be very helpful for reducing the sound level of tinnitus and alleviate depression and other anxiety induced conditions.

Unfortunately, it’s not all that simple. Klonopin and the other benzodiazepine medications, Xanax, Valium, etc., are very addicting. They were originally intended to be used for only a short duration, a few weeks. There is a hidden time bomb in these medications. They are so addicting that the dosage needs to be increased at regular intervals to achieve the same effect. If the dosage is not increased, the same symptoms the drug was prescribed for in the first place can come back and can be even worse than in the beginning. Withdrawal from these drugs can be a nightmare of withdrawal symptoms that some people cannot live with. The success rate of a medically supervised withdrawal, after long-term use, is only 65%.

Having given you the bad news I need to say that not all people will become this addicted. When I was first diagnosed with tinnitus I spent three years on and off again with Valium. When it came time to stop, I didn’t have a problem. My sister also spent several years on one of the benzos and came off fairly easily. You should be aware of the danger, though, and try to not use any of these for longer periods than absolutely necessary.

So what would I do? I have some personal knowledge of anxiety and what it can do to you and I do have some suggestions. If you read the article you will see the benzo medications act on GABA (gamma-aminobutyric acid) which is a calming neurotransmitter in the brain. GABA is available as an over-the-counter medication and is quite inexpensive. You can begin taking this at the dosage suggested in the article and it should be helpful. Don’t expect it to work like the prescription drug as it is a supplement. However, it can calm you down and even make you drowsy so you should be careful driving until you know how it affects you.

I am also a huge fan of hypnotherapy for tinnitus. I tried quitting smoking for years before I finally visited a hypnotherapist. I have not had a single cigarette since though it did take a couple of follow-up visits to really get it fixed in my brain. More recently I was in a situation that generated high levels of stress in my life. Once again, hypnotherapy calmed me down and helped me to deal with the situation.

Another avenue to try is acupuncture for tinnitus. This ancient Chinese tradition offers a variety of therapies that help put the body back in balance and positively affect anxiety and tinnitus.

Not to be left out of the discussion is the use of biofeedback and neurofeedback for tinnitus. This feedback system helps the person learn to control basic bodily functions. People who become adept at this can actually reduce their blood pressure and heart rate. They can also reduce skin temperature and enter a state of perfect calm. It takes time and work but is very effective.

Last but certainly not least is the use of Arches Tinnitus Formulas. These will not directly work as an anti-anxiety medication but they can be very helpful in reducing tinnitus. I’ll bet if your tinnitus was improved your nervous system would be very happy.

All of these complementary therapies I’ve mentioned can be used alone or in conjunction with each other. You should begin working with some and see which ones resonate with you. You won’t have immediate relief in one hour, as with a prescription drug, but these therapies can give you a long and much happier life and are much healthier than the alternative.

Wishing you quiet times,
Barry Keate

Mother-daughter Hyperacusis… with Tinnitus

Hello Barry,

Both my daughter and I have tinnitus and hyperacusis, and the latter is the big worry. We are both sensitive to noise and this has curbed our daily lives. My daughter has been unemployed for 15 months because of her hyperacusis.

Is there any medication that might help?

Thanking you.
Jenny W.

Dear Jenny,

Hyperacusis is the collapse of loudness tolerance so that almost any sound creates loudness discomfort even if it is below the threshold that others deem uncomfortable. Most people with hyperacusis try to protect their ears from all sounds by staying in quiet environments, wearing ear plugs, etc. This is not the way to treat this and it increases the loudness intolerance. Instead, treatment options consist of gradually retraining the ear to accommodate sounds better. There are two ways to accomplish this and both have overlapping techniques.

The first is Tinnitus Retraining Therapy, which works with both tinnitus and hyperacusis. The second utilizes some of the same procedures but also involves wearing a hearing device that equalizes all sounds to similar loudness that is controlled by the patient. Either one of these therapies can be very helpful for hyperacusis patients over time.

Arches Tinnitus Formulas can also be helpful in reducing the tinnitus sound and stabilizing hearing.

Wishing you quiet times,
Barry Keate

Aspirin for Pulsatile Tinnitus?

Hi Barry,

Can taking low dose aspirin, (75 mg gastro-resistant tablets) help against pulsatile tinnitus? I have tinnitus constantly, and on top of this, I experience pulsatile tinnitus usually at night.

I also take one 50 mg doxycycline daily to manage rosacea, would this medication, which I have been taking for three years, have an effect on my tinnitus? I am 66 years of age. I have seen an ENT specialist, had a CT scan and have been told that nothing can be done, and the pulsatile tinnitus is most likely due to hardening of an artery near the ears.

I would be grateful for any advice you could give me.

Kind regards,
Graham H.
Dorset, UK.

Dear Graham,

Low dose aspirin could be helpful for pulsatile tinnitus. The mechanism of action would be to thin the blood and make the pulsing less noticeable. Another product that does this is Arches Tinnitus Formula, which we produce. We have heard numerous accounts that it has helped pulsatile tinnitus. It is also helpful for continuous tinnitus.

Doxycycline can cause hearing loss and tinnitus. It doesn’t do this to everyone but does have the capacity to do so. If you feel it is worsening yours, you should contact your doctor.

It sounds as though your ENT is guessing. Arteriosclerosis is certainly one possibility but there are many others. Essentially, pulsatile tinnitus is caused by turbulent blood flow in the artery close to the cochlea. Please read our article on Pulsatile Tinnitus. The specialist to see for this condition is a vascular surgeon. Once the direct cause of the pulsing can be determined, it is frequently very treatable.

Wishing you quiet times,
Barry Keate

Crying uncle… after a bad night’s sleep?

Dear Barry,

I have bought the Tinnitus Combo Pack for my uncle. But after 10 days he had a very bad night, he could not sleep because of the noise he had inside his head.

What do you recommend in this case?

Thank you in advance,
Maria R.

Hi Maria,

Sleeping can become very difficult for those with tinnitus. It used to wake me up from a dead sleep in the middle of the night so I can sympathize with your uncle.

He should continue the Tinnitus Combo Pack until finished before he can determine how helpful it will be for him. In the meantime there are several strategies to use to help him sleep better. One of the best for tinnitus sufferers is the use of an ambient sound generator or download an app on your smart phone. Stand alone sound generators are inexpensive, and generate several different sounds of moving water, from crashing surf to bubbling creek to falling rain. It has been known for a couple of decades that the sound of moving water is the best way to mask tinnitus. It helps cover the tinnitus sounds and is also very relaxing. Ask your uncle if he notices his tinnitus when he’s in the shower. If the answer is no, it will be effective for him.

Getting a good night’s sleep is important for all of us but more so for those with tinnitus. If they don’t sleep well they end up exhausted, with reduced energy reserves and worse tinnitus. I recommend ensuring a good night’s sleep using almost whatever method works. Vigorous exercise is very helpful and will also help reduce stress and tinnitus. Even a walk in the evening can make the difference.

Melatonin has been shown in clinical studies to be very helpful for people with tinnitus. I use a 10 mg timed-release melatonin. When taken an hour before bed it can make falling asleep easier and then allow one to maintain that sleep throughout the night without feeling groggy the next day. In cases where this doesn’t help, I recommend a sleeping pill or even a prescription medication like Klonopin or Xanax. These are benzodiazepine drugs that many doctors prescribe for tinnitus but are addicting to varying degrees and cannot be used continuously for a long period of time. They are helpful in reducing tinnitus symptoms and aid in sleeping short term. Try the other methods first but if they’re not effective, get your uncle to a doctor for help.

Hopefully our tinnitus products along with melatonin will reduce his tinnitus and his sleeplessness will be a thing of the past.

Wishing you quiet times,
Barry Keate

Tinnitus without Hearing Loss

Hello Barry,

I was diagnosed with tinnitus over one year ago and have taken at least four bottles of the Tinnitus Formula without success. My left ear has frying/hissing noise with “bom-bom” sounds and my right ear has light frying/hissing noise in it. Also, on occasions, in my left ear there is a loud screeching sound and when I pop my ear the noise goes away.

According to my doctor, I should be experiencing hearing problems if I have tinnitus; however, I have had two hearing tests and my hearing is quite good – I can hear a pin drop. The doctor has also stated that I probably have TMJ dysfunction because of the tenderness in my jaw bone areas. Since tinnitus has become your lifetime work, what suggestions do you have? I really need some serious help.

Please help!
Martha D.

Dear Martha,

The majority of people with tinnitus have it due to a degree of hearing loss. However, not everyone with tinnitus has hearing loss. There are many conditions that contribute to tinnitus. Your mention of screeching sounds that stop when you pop your ears indicates you may have Eustachian Tube Dysfunction (ETD). This occurs when the Eustachian tube is not functioning properly. It can be caused by sinus problems, colds and flu, allergies and other conditions that cause the Eustachian tube to become blocked.

I recommend you consult an Ear, Nose & Throat physician about this. Typical treatments involve a prescription nasal spray and an antihistamine. The great majority of cases are cleared up.

TMJ dysfunction is the other possibility here. This occurs when the temporomandibular joint (TMJ), which hinges the jaw into the skull, is knocked out of place. Tenderness in the jaw areas is one symptom of this as is tinnitus. The good news is TMJ can be treated and tinnitus caused by it is almost always improved. Treatment therapies are all painless and non-invasive. I recommend you see a TMJ specialist in your area. To find a TMJ specialist in your area go to: American Academy of Craniofacial Pain.

Please investigate both of these conditions. I feel you have a high degree of improving your condition with treatment for one or both of these.

Wishing you quiet times,
Barry Keate

Sounds like Somatic Tinnitus… But is it?

Dear Barry,

I have read your online column regarding tinnitus for many years. I have had tinnitus for 12 years. The tinnitus I experience changes every 2-3 days and it changes in my sleep. The volume goes up and down and when it is at its lowest it is very tolerable, but when it’s at its loudest it is drives me nuts. I believe you have described this as somatic tinnitus. Also, when I move my jaw in certain ways it will get louder.

Currently I am seeing a neurologist and he prescribed Neurontin (Gabapentin) 100 mg, two times a day. He also wants me to do a MRI, MRA, and a brain stem response test. I understand that these tests are quite noisy. I am very concerned and reluctant, that the noise from these tests could make my tinnitus permanently worse. I value your opinion, and I would like to hear your thoughts about my concerns, and any other thoughts you might have.

Very sincerely,
Dennis W.

Dear Dennis,

This does sound like somatic tinnitus to me. When tinnitus has wide fluctuations, somatic tinnitus is one of the first things to look for. The fact that moving your jaw increases your tinnitus indicates you may have some TMJ dysfunction, one of the primary causes of somatic tinnitus. TMJ dysfunction is when the jaw is out of alignment with the skull. Treatments for this condition are painless and non-invasive. Many ear doctors are not attuned to TMJ because it is in the domain of dentistry. At the end of the article is a link to the academy for TMJ specialists and a way to find one in your area.

Gabapentin is often used for tinnitus and 200 mg is a fairly low dose. However, if your tinnitus is due to TMJ, gabapentin won’t help. It is used to treat hyperactive neuronal connections due to hearing loss, which you don’t have.

MRI’s can be very noisy. The people that operate them know this and generally offer headsets for those who take the scan. I recommend taking along good quality ear plugs and making sure you have a headset over the plugs. This should be adequate to protect your hearing.

My advice is to check out the simplest possibility first. If this is indeed TMJ dysfunction, you can have that treated and should have considerable relief. I hope this is the case.

Wishing you quiet times,
Barry Keate

Trying Trileptal for Tinnitus

Hi Barry,

I spoke to my ENT doctor yesterday to discuss ways to help me cope with the loud tinnitus I am experiencing. He indicated that while medications will not get rid of the tinnitus it could make it much easier to cope. One medication that he mentioned was Trileptal and wanted me to try it for a month to see if there was any benefit. Have you ever heard of Trileptal for tinnitus? Any reply, if possible, is appreciated. Thanks Barry.

Ed S.

Dear Ed,

Trileptal is an anti-seizure medication and may have a positive influence on tinnitus. It has long been known that tinnitus is an epileptic-like condition of the auditory pathway and anti-seizure medications can help. We published an article on brain receptors and tinnitus that discusses this.

The problem with some of these medications is the side effects. Most people taking Trileptal will not experience strong side effects, but significant numbers will. Up to 31% of people using it will have headaches, 28% will have dizziness, 22% nausea.

I hope you have good success using Trileptal and do not have serious side effects. Please let me know how it works for you.

Wishing you quiet times,
Barry Keate

Clicking and Snapping Sounds in Ear

Dear Barry,

I’ve been struggling with a form of Middle Ear Myoclonus that produces a clicking, snapping sound in my right ear. It’s been going on every day for four months. Some days it clicks every few minutes, some days every couple of hours. It’s most anxiety provoking.

I struggled with “subjective tinnitus” (hissing sound in the same ear for five years). I have high-frequency hearing loss in that ear as well. Do you think it’s all related? I had an MRI withcontrast, EEG and VEP all are normal. I’ve seen two ENTs, a neuro-otologist and a neurologist (who gave me Valium, which didn’t help). I’m despondent and desperate that this will never end. Any help, tips, suggestions would be greatly appreciated.


Dear Steve,

Thanks for sending this question to me. I hope I can help you to manage or eliminate this condition.

Middle Ear Myoclonus (MEM) is a form of objective tinnitus that can be heard by others listening closely to your ear. Myoclonus refers to a brief twitching of a muscle or group of muscles. In the middle ear it is usually the tensor tympani muscle which connects to the ear drum and/or the stapedius muscle which attaches to the stapes bone. In the illustration below the tensor tympani is the longer black muscle running up to the back of the eardrum and the stapedius is the short red muscle attaching to the horseshoe shaped stapes bone.

The tensor tympani and stapedius muscles are protective. Their role is to reduce the amount of sound that gets into the inner ear. They can be triggered by loud noise, stress or other conditions. If the tensor tympani muscle is in spasm, an observer can see the twitching of the ear drum. If the stapedius is in spasm twitching is not visible. Spasm in the tensor tympani usually results in a “thumping” noise like a tympani drum. It can also be heard as a clicking sound. Spasm in the stapedius muscle is usually heard as a buzzing, rumbling or crackling sound. Descriptions of the sound can vary widely among patients.

Stress can be an important part of MEM and controlling this can be very helpful. In that sense this may be related to your subjective tinnitus. That is why your neurologist gave you Valium. Many therapies have been tried and they seem to work with some people. Hypnosis, sedatives, acupuncture and biofeedback have all been attempted with varying degrees of success. When benzodiazepine anti-anxiety medications are used they generally start at a low dosage and are gradually increased until the patient improves or side effects become harmful. This may be why your dosage didn’t work; it was the beginning dose. On the negative side there is the issue of becoming dependent on “benzo” medications. They can be very dangerous this way.

My personal favorites in the class of treatments are acupuncture and biofeedback. I have seen people after an acupuncture session being so totally relaxed they can barely move. Biofeedback teaches people how to control the involuntary actions of the nervous system.

Another type of clicking tinnitus is known as typewriter tinnitus. This is attributed to irritability of the 8th cranial nerve. It is intermittent and has a staccato quality like a typewriter, popping corn or Morse code. This type is responsive to carbamazepine (brand name Tegretol). This medication is an anti-convulsant and mood stabilizing drug commonly used for epilepsy and some other conditions.

I suggest you try these therapies for a few months and give them a good chance to work. If they don’t there are other therapies to try. Botox injections have frequently been used for MEM. Botox will paralyze the muscles and stop the MEM. It can be injected into the wall of the Eustachian tube. This treatment is reasonable but needs an individual who is very good at understanding the anatomy of the tensor tympani muscle to administer the injection. Also, Botox wears off in three months.

The final therapy, if nothing else works, is surgery. Surgical sectioning (cutting) of the tensor tympani and/or stapedial muscle tendons is a straightforward and effective procedure. This is called tympanotomy and refers to a tiny incision in the ear drum through which the surgery is accomplished. The procedure immediately cures the condition and those who have had it become symptom free even after a follow-up one year later.

I hope this is helpful for you.

Wishing you quiet times,
Barry Keate

Face and Ear Disorders with Tinnitus

Hi Barry,

How do you account for tinnitus occurring with and Myofascial Pain Syndrome and Eustachian Tube Dysfunction?

John B.

Dear John,

Thank you for this excellent question. Myofascial pain is often referred to as Myofascial Dysfunction (MFD). This is a muscular disorder that is characterized by tight bands of contracted muscle, extremely sensitive trigger points, limited range of motions and sensory abnormalities such as tinnitus. It is closely related to somatic tinnitus, which we have discussed previously.

Trigger points in the sternocleidomastoid muscle (SCM) are commonly the cause for tinnitus. The SCM is the large muscle under the ear on both sides of the neck that acts to rotate the head. These trigger points can be treated through physical therapy, biofeedback, the use of a TENS unit for electrical stimulation, or injection with xylocaine. An Ear, Nose and Throat physician can administer the injections.

Another common trigger point is TMJ dysfunction. This occurs when the temporomandibular joint (TMJ) that connects the jaw with the skull is out of alignment. Typical treatment for this begins with a mouth guard which slowly realigns the jaw and the skull.

Eustachian Tube Dysfunction (EDT) is a common cause of tinnitus and should be investigated by an ENT physician. Common treatments include a prescription nasal spray such as Flonase and an antihistamine.

The good news about these conditions is they do not represent damage to the cochlea. When the underlying conditions are treated, the tinnitus should improve dramatically or completely resolve.

Wishing you quiet times,
Barry Keate

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