July 5, 2008: 8:30 am: Tinnitus

 by Neil Bauman, Ph.D.

A lady asked:

Can unilateral pulsatile tinnitus in my right ear only be the cause of hypertension/high blood pressure? What are the causes unilateral pulsatile tinnitus?

Its the other way around, but yes, high blood pressure can result in pulsatile tinnitus.

There are a good number of causes of pulsatile tinnitus. All of them are vascular—meaning having to do with blood flowing in the various blood vessels near your ears. This is because pulsatile tinnitus sounds are rhythmic, pulsing sounds that are synchronous with your heart beat.

The most common cause of pulsatile tinnitus is benign intracranial hypertension, followed by carotid artery disease, glomus tumors, turbulent blood flow, increased blood flow in different blood vessels, emissary veins, high blood pressure, twisted arteries, aneurysm in an artery, and a number of other things.

If you are interested, you can read more about pulsatile tinnitus (and all the other kinds of tinnitus) in my book, “When Your Ears Ring! Cope With Your Tinnitus—Here’s How“.

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May 6, 2008: 1:44 pm: Tinnitus

by Neil Bauman, Ph.D.

A man wrote:

Several years ago at a hearing clinic, I told the young lady that I had ringing in my ears. She asked me if I had ever taken Niacin, and I hadn’t. She said it helps some people. I took Niacin pills for a good while, and it seemed to rid me of the ringing in the ears. I did get a flushing from taking Niacin. She suggested Niacinamide, and that seemed to help the flushing.

For one reason or another, I have not had ringing in my ears for a lot of years, so I no longer take Niacin or Niacinamide.

I would like your thoughts about taking Niacin or Niacinamide for ringing in the ears. Do you know of a connection here, or was it helping me a fluke?

Niacin (Niacinamide) or Vitamin B3 helps some people with tinnitus because it increases blood flow to the peripherals which includes the inner ears (hence the flushing—it shows it is doing its job).

If your tinnitus was caused by a lack of blood to your inner ears, then taking Niacin really can work—its not a fluke. However, Niacin does not work for everyone—only for those with circulation problems to their inner ears. For example, nothing I’ve tried has helped my tinnitus because mine is probably the result of my severe hearing loss, not lack of blood flow to my inner ears.

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April 23, 2008: 11:34 am: Tinnitus

by Neil Bauman, Ph.D.

New research reveals that for some people with hearing loss, the tinnitus associated with hearing loss stems from over-active sensory nerves in the face and neck.(1) After hearing loss occurs, for some reason, touch-sensing nerves in the face and neck step up their activity in the brain. The result is that some neurons in the cochlear nucleus become hyperactive. This increased activity has been linked to tinnitus.

For these people, treatment for their tinnitus may be as simple as acupuncture targeted at the nerves in the head and neck.

These findings may also reveal why many people with temporomandibular joint dysfunction (TMD) also suffer from tinnitus.

(1) The Hearing Review, Vol 15, No. 2, February 2008. p. 60.

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April 14, 2008: 11:14 am: Ototoxic Drugs, Tinnitus

by Neil Bauman, Ph.D.

A lady explained:

In your book ‘When Your Ears Ring‘ you speak of black cohosh as a possible tinnitus treatment. I have tinnitus and I am trying to get off HRT [hormone replacement therapy drugs]. I looked at a lot of web sites and it seemed that black cohosh especially as the product Remifemin might be a help to a lot of my problems.

After four days on Remifemin it seemed my tinnitus was a lot louder. Today, I found a few web sites that say that black cohosh contains salicylates and should not be used by people who need to avoid aspirin. (I believe that aspirin worsened my tinnitus several months ago when I took some for back pain. At that time I took about six or seven 325 mg. pills over the course of one day to try to fight a disk problem in my back. I had had steady tinnitus for five years before this, then developed a second noise in my left ear four days after taking the aspirin. Since then both ears have become louder.) Do you think the Remifemin is causing this increase? I sure thought I did my homework on this one.

I think you are wise in getting off the HRT. HRT is pretty harmful to your whole body from everything I’ve read. I’d never consider it if I were a woman. It’s just not worth the risk. I think that Remifemin is a much safer alternative. And yes, I think you did your homework very well.

Remifemin contains an extract of black cohosh (roots and rhizomes) equivalent to 20mg that is standardized to contain 1 mg of the active ingredient—triterpene—so that leaves 19 mg for anything else in the black cohosh.

There are a LOT of chemical compounds in black cohosh apart from triterpene glycosides. These compounds include phenolic acids, flavonoids, volatile oils and tannins. In addition, there are several acids such as acetic, butyric, formic, oleic, palmitic, and salicylic acids. Thus the amount of salicylates in Remifemin must be a very small part of the remaining 19 mg.

I don’t think that Remifemin tablets even contain 1 mg of salicylic acid. But even if they were ALL salicylic acid—the dose would still be well below what is needed to cause tinnitus in the typical person.

Let’s compare the salicylate content in Remifemin to that of a typical aspirin. Standard adult aspirin contain 325 mg of acetylsalicylic acid. It is generally accepted that it takes about 6 aspirins a day to cause tinnitus in the typical person—that would be about 1950 mg.

Since the normal dose of Remifemin is 2 tablets a day, the most salicylic acid you would be getting is maybe 2 mg a day—a far cry from the 1950 mg needed to cause tinnitus in the typical person.

However, having said that, everyone is different, and for some people maybe even small doses of salicylic acid can cause tinnitus—but I wouldn’t think it would be very common.

The good thing about tinnitus from aspirin (and related salicylates) is that typically the tinnitus only occurs while you are taking the drug. Once you have stopped, in 3 or 4 days the tinnitus should disappear. (Unfortunately, for a few people this is not true and they are left with permanent tinnitus, but this is not the norm.)

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April 4, 2008: 10:36 am: Ototoxic Drugs, Tinnitus

by Neil Bauman, Ph.D.

A man wrote:

I have recently read a number of articles involving the use of Acamprosate (Campral) in treating tinnitus. One Brazilian study showed pretty positive results in giving tinnitus sufferers some relief using this drug.

I am going to see my ENT soon for my annual hearing test. While there, I am going to show him some articles I have printed to see if he would allow me to try this drug to see if I too can achieve some relief.

Prior to seeing him, I thought I would e-mail you to see if you have any thoughts or viewpoints regarding the use of this drug in the treatment of tinnitus. It seems as though the side effects are generally mild and well tolerated. After suffering with tinnitus for seven years, I would certainly welcome a trial with anything that may provide me some relief!

I hear you. There are millions of people in the same boat that would love to get rid of their tinnitus with a magic “tinnitus pill”, but that is not very likely in the near future.

First, be aware that at the present time there is not a single drug approved by the FDA for the treatment of tinnitus. To me this is a pretty strong indication that drugs are not the answer to curing tinnitus. Many drugs have been tried as possible tinnitus cures, but none has been very successful so far.

Now let’s look at Acamprosate (Campral). Acamprosate is approved for helping people overcome their alcohol addiction.

In the Brazilian study you mentioned, the figures sound impressive. After 90 days on Acamprosate there was a significant overall improvement rate of 87%. Nearly half stated their tinnitus had declined by at least 50%. Wow! Impressive results, right? But this was one small study involving only 25 people taking Acamprosate.

The results of this single study have been picked up and spread far and wide. What bothers me is that the research was done 4 years ago, and if the results of this study were so wonderful, why haven’t many other studies been done in the past 4 years verifying the results of this study? Why aren’t doctors prescribing this drug to help people with tinnitus? Why hasn’t the FDA moved to approve this drug for tinnitus treatment, and thus help the 50 million Americans that have tinnitus?

The truth is, Acamprosate is not without serious side effects including suicide and depression. In addition, it can be ototoxic. It has been implicated in hearing loss, tinnitus, dizziness and vertigo as well as [auditory] hallucinations.

When it comes to drugs, it is better to not be on the leading edge because most (about 51%) serious side effects are not discovered in the studies drug companies do—but only become apparent after the drug has been approved by the FDA and is released to the public. Do you really want to be the guinea pig?

One of the problems in finding a drug cure for tinnitus is that we so often think of tinnitus as a single condition—whereas it is really a number of different things that cause the annoying phantom sounds. Since there are a number of causes, it stands to reason that one treatment that not will work for everyone. The treatment has to fit the cause.

For example, some studies show that the herb, Ginkgo biloba, alleviates tinnitus, and other studies show it doesn’t. Who do you believe?

In actual fact, if your tinnitus was the result of lack of blood flow to your inner ears (cochlea), then Ginkgo may indeed “cure” your tinnitus. But, if your tinnitus was caused by ototoxic drugs, or wax in your ears, or a glomus tumor in your neck, then obviously Ginkgo is the wrong treatment.

Therefore, if and when Acamprosate has stood the test of time as an effective treatment for tinnitus, and if its benefits far outweigh its side effects, then, and only then, is it time to give it a try if you value your health.

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March 24, 2008: 10:24 am: Tinnitus

by Neil Bauman, Ph.D.

A lady asked:

I am forwarding this to ask your opinion. I don’t suffer with tinnitus but friends do and I would like to be able to recommend this product if it is something you might recommend.

The ad reads:

What is Tinnitus? Research shows almost 40 million adults suffer from tinnitus commonly referred to as “ringing in the ears”.

This problem may be caused by excess ear wax, nerve damage or dysfunction, or irritation from an unknown source. The constant ringing or noises in the ears can greatly interfere with the quality of life.

If this sounds familiar, you’ll be happy to hear Bronson’s Ring Eze formula may offer you the relief you’ve been searching for! This topical formula is an all-natural, high quality liquid containing a proprietary blend of Bio-Chelated concentrated herbal extracts in a synergistic combination shown to help relieve the ringing, buzzing and

noise in the ears. Though there is no cure for Tinnitus, this unique blend of natural ingredients helps by nourishing nerve endings in the ear and gently improving circulation.

So much for the hype. What is the truth? Will this formulation help people with tinnitus?

Let’s look carefully at the claims this ad makes and see what it is really saying—not what you thought it said based on a quick reading.

Here’s the first statement.

This problem may be caused by excess ear wax, nerve damage or dysfunction, or irritation from an unknown source. The constant ringing or noises in the ears can greatly interfere with the quality of life.

This is a true statement. There are many different causes of tinnitus. What they don’t say is that consequently you need specific treatments based on these causes. It is not a case of one treatment fits all. It continues:

If this sounds familiar, you’ll be happy to hear Bronson’s Ring Eze formula may offer you the relief you’ve been searching for!

Notice the “may offer you the relief”. It doesn’t say it will—but they are counting on you to believe it will—so that you will order it. Now comes the part—long on hype and lacking in any concrete evidence:

This topical formula is an all-natural, high quality liquid containing a proprietary blend of Bio-Chelated® concentrated herbal extracts in a synergistic combination shown to help relieve the ringing, buzzing and noise in the ears.

It sure sounds good, doesn’t it. It’s got all the right buzz-words. However, where are the studies showing that this particular formulation really works? They’ve got you believing you can say bye-bye to your tinnitus, but in the very next sentence they essentially contradict themselves. Notice:

Though there is no cure for Tinnitus…

If there is “no cure”, why should a person think their formula will work for them?

It then continues,

…this unique blend of natural ingredients helps by nourishing nerve endings in the ear and gently improving circulation.

Now they finally get to what their formulation can do—improve circulation. Thus, if your tinnitus is caused by a lack of blood flow to your inner ears—then this formulation may help you. I agree.

What they don’t say is that most people with tinnitus do not have this problem, so it helps a relatively small proportion of people with tinnitus.

As I’ve said in previous articles, if you have wax in your ears, or partially obstructed arteries in your head and neck, or have tinnitus from taking ototoxic drugs, or tinnitus from noise damage, this formulation is not going to help you much, if at all, because your tinnitus is not caused by a lack of circulation in your inner ears.

I once tested a whole case of a similar product—took it faithfully for 9 months—and at the end I couldn’t discern any difference in my tinnitus because, like most people, my tinnitus is not caused by poor circulation.

Do I recommend this product? Actually, I neither recommend nor not recommend it. It certainly won’t hurt your ears. It can help your tinnitus if your tinnitus is caused by lack of blood flow to your ears, but otherwise don’t expect any/much help from it. That’s my assessment based on my knowledge and experience.

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March 13, 2008: 11:38 am: Noise-induced Hearing Loss (NIHL), Tinnitus

by Neil Bauman, Ph.D.

A man wrote:

I do not expose myself to high noise levels either in my occupation or leisure. I do not listen to iPods etc. However, 5 days ago after a night out, when leaving a bar with loud music, my hearing felt dull. While my hearing appears normal, I now have a feeling of fullness and a constant ringing. I have scared myself silly reading all the forums and panicking that after 5 days, this may be permanent. Has tinnitus been known to go after 5 days?

I’d call going to nightclubs exposing your ears to loud sounds in your leisure time. You may have been exposing your ears to more loud sounds than you realize.

The feeling of fullness you are experiencing is actually indicative of a temporary threshold shift. In other words you do have a hearing loss significant enough that your brain notices it—thus you get this “blocked” feeling. The constant ringing (tinnitus) is another sign that the noise was far too loud, and you exposed your ears for far too long.

I’m glad you have “scared yourself silly”. Hopefully, you will now carefully protect your ears in the future. Too bad you hadn’t done that before. At the very least, have some foam ear protectors in your pocket, and put them in your ears before you go into noisy places, or leave as soon as the racket gets too loud.

Now to explain about tinnitus and whether it will go away. Typically the way it works is that the first few times you expose your ears to loud sounds the tinnitus goes away reasonably rapidly—hours or a day or so—but the more you expose your ears to loud sounds (and the louder the sounds are), the longer it takes for the tinnitus to go away. Finally, if you don’t wise up and protect your ears, it will never go away.

I doubt this was your first time in a night club, so I fear you have been exposing your ears to excessive noise for some time.

The main thing now is not to expose your ears to any louder sounds in order to give them time to “heal” if they will. After a month or so, re-evaluate your tinnitus and see whether it has gone away. In the meantime don’t dwell on your tinnitus or it will only appear to get worse. You need to totally ignore it by focusing on the loves of your life and let the tinnitus fade into the background.

In a month or so, it wouldn’t hurt to go to an audiologist and have a complete audiological evaluation to see the state of your hearing. That way you’d know if there was any permanent damage. I wouldn’t go now—give your ears time to recover, and hopefully the temporary threshold shift will go away.

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March 7, 2008: 11:30 am: Ototoxic Drugs, Tinnitus

by Neil Bauman, Ph.D.

A man explained:

I have had tinnitus now for 6 years. It was brought on by an inner ear infection. However I have suffered very little or no noticeable hearing loss. My tinnitus has been chronic and constant, never stopping. It is a hissing, whistling sort of pitch. Usually it is low, always noticeable to me but lately seems louder.

I was recently diagnosed with diverticulosis and my Dr. has prescribed Metronidazole and Levaquin. My question to you is, am I at risk for hearing damage or permanently making my tinnitus worse? I explained the situation to my Dr. but she affirmed that these are safe for my treatment. I am depressed because the tinnitus has been very hard for me to deal with over the past 6 years. I just want to make sure I am doing the right thing.

You are wise to check out the side effects of drugs before you take them. Metronidazole is mildly ototoxic and may cause tinnitus although I don’t think it very likely as only one source has reported tinnitus. It is not listed as causing hearing loss. I don’t think I’d worry about this drug.

However, Levofloxacin (Levaquin) is another matter. It is moderately ototoxic. In addition to my usual published sources indicating it can cause tinnitus, I’ve had a number of people tell me their stories, and for most of them it resulted in bad tinnitus. One person also reported hearing loss. So this isn’t a drug you’d really want to take since you already have enough tinnitus as it is—but of course, the choice is up to you in consultation with your doctor.

This man also asked, “If tinnitus is listed as a possible side effect to these medications, does one necessarily get tinnitus from taking them? Can I perhaps take them and not make my tinnitus worse and yet solve my other problem?”

Yes, you may take these drugs and not get tinnitus. Not everyone that takes these drugs gets tinnitus. In fact, it may be a reasonably small percentage that do get tinnitus from taking them. The real problem is knowing which group you are going to fit into—the small unfortunate tinnitus group, or the large non-tinnitus group. Since there is no way of knowing ahead of time, I warn people so they can decide for themselves whether they want to take this risk or not—especially as in your case, you already have bad tinnitus, and you don’t want to do anything to make it worse.

It looks like all the Quinolone family of which Levaquin is a member can cause tinnitus, but perhaps some of them are not as likely to cause tinnitus as are Levofloxacin and Ciprofloxacin (another common Quinolone)—I really can’t say.

Finally, this man asked:

Is there a safer medication or treatment to this?

Again, I can’t really say—remember I’m not a medical doctor—so I can’t prescribe or treat medical conditions. I just provide information to help people make more informed decisions.

However, I was looking in one of my books and it says that Cefadroxil (Duricef) is also used in treating diverticulosis—and this drug is not listed as causing tinnitus, nor have I heard any reports of people getting tinnitus from it. If your doctor agrees that this drug will do the job, it would almost certainly be much easier on your ears than any of the Quinolones. Its worth asking your doctor about it.

If you want to check out the ototoxic side effects of the Quinolones (or any other ototoxic drugs for that matter) look them up in “Ototoxic Drugs Exposed“. This book contains information on the ototoxicity of 763 drugs known to damage ears (and a number of chemicals too).

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February 16, 2008: 10:20 am: Coping Strategies, Tinnitus

by Neil Bauman, Ph.D.

A lady wrote:

I found a little dog and had him with me for one week before finding his grateful owners. Of course I had to walk him, and I fussed over him (a sheltie/Pomeranian mix—he is super cute). During that time, it seemed the ringing in my ears was much less. Perhaps it was only that I was occupied—but I think there is some healing effect beyond what we understand that pets have on us. I know it is a subject much talked about, but I never experienced it first hand (I have laid-back cats but they are different).

I think it was mostly that you had something to focus on—and when you do that, often you don’t notice your tinnitus as much. But who knows what loving a pet can do for your health in the broadest sense? Anything that helps you deal with your tinnitus is a good thing. Maybe you need to get yourself a little tinnitus-reducing dog of your own?

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February 7, 2008: 9:59 am: Tinnitus

by Neil Bauman, Ph.D.

Recently a woman explained,

I haven’t lost my hearing, but I hear my pulse as a “squeak” frequently. It is only on the left side, but it is very annoying and sounds like a heart murmur. Any suggestions?

When you hear your pulse in one or both ears, this is a type of tinnitus called pulsatile tinnitus. Interestingly enough, as you have found, typically you only hear pulsatile tinnitus in one ear.

I’ve never heard it described as a squeaking sound before, but it is consistent with what other people hear. One lady hears hers as a high-pitched ringing sound in time with her heartbeat, while a man explained he hears a “zing, zing, zing” sound in time with his heartbeat. Thus, your “squeak, squeak”, “squeak” fits right in.

Since you are writing to me now, I assume that this is a fairly new phenomenon—and not a tinnitus sound you’ve been hearing for years.

Typically pulsatile tinnitus is related to the blood flowing in the arteries in your neck and near your ears. Normally you don’t hear such sounds, but when something changes in the blood vessels near your ears, you sometimes hear these strange (and annoying) tinnitus sounds.

There are at least 25 different known causes of pulsatile tinnitus. The three most common causes of pulsatile tinnitus, accounting for 68% of the cases, are Benign Intracranial Hypertension (BIH) syndrome, Carotid Artery Disease (CAD) and Glomus Tumors (benign masses of blood vessels that grow near the ear). The good news is that this kind of tinnitus can often be fixed once the specific cause is identified.

Generally, pulsatile tinnitus occurs when the smooth flow of blood in the blood vessels in your neck or head is interrupted. Often this is caused by atherosclerotic build up of cholesterol on the walls of your arteries, or high blood pressure. These conditions cause your blood to flow faster and/or more turbulently—thus producing these strange sounds in step with each heartbeat.

The first step in treating pulsatile tinnitus is to go to a cardiovascular specialist and see if he can pinpoint the cause and go from there.

To learn more about pulsatile tinnitus, check out the section on “Pulsatile Tinnitus in “When Your Ears Ring! Cope with your Tinnitus—Here’s How“.

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