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 refers many of his patients to Arches.
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.
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 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 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.
Other sound therapies, Hearing aids and tinnitus maskers.
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.
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.
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.