By Neil Bauman, Ph.D.
© August, 2018
In fiction, sidekicks often accompany the main character. For example, the Lone Ranger had his sidekick Tonto; Batman had Robin; Sherlock Holmes had Dr. Watson. In the same manner, many drugs also travel with an invisible, yet very vocal, sidekick named “Tinnitus.”
If you are unlucky, tinnitus is a stranger that one day suddenly invades your life—unwanted and unbidden to be sure—but there nevertheless—as a sidekick of a drug you took.
How you cope with this stranger is up to you. However, if you are like me, you want to prevent this stranger from invading your life in the first place. To do this, you need to put the odds in your favor in order to reduce your chances of getting tinnitus as a result of taking drugs—whether they are prescription or over-the-counter (OTC) drugs.
There are numerous drugs that have tinnitus as their sidekick. Currently, I know of at least 657 drugs (and still counting) that list tinnitus as a possible side effect. In addition, I know of 10 herbs and 31 chemicals that can do the same.
Two common drugs you may not realize that can cause tinnitus are the anti-inflammatory drug Ibuprofen (Advil, Motrin) and the selective serotonin reuptake inhibitor (SSRI) Citalopram (Celexa). In fact, more people complain to me (via email) about getting tinnitus from taking these two drugs than from taking any other drugs.
The Top 20 Tinnitus-Producing Drugs
Here is my list of the top 20 tinnitus-producing drugs based on the number of reports submitted to the FDA’s database. (Note: these data are incomplete as I have not yet finished compiling the voluminous data I have acquired, so the drugs and their positions on this list may change in the future as I finish this project.) Even so, it gives you a good idea of some of the drugs you should avoid if you want to reduce your risk of getting tinnitus from taking drugs.
These drugs are listed in descending order from most reports (highest risk) to fewest reports (lower risk). The drugs are listed by generic name followed by a common brand name in italics.
- Alendronate (Fosamax)
- Acetylsalicylic acid (Aspirin)
- Paroxetine (Paxil)
- Alprazolam (Xanax)
- Bupropion (Wellbutrin)
- Venlafaxine (Effexor)
- Metoprolol (Lopressor)
- Acetaminophen (Tylenol)
- Hydrocodone (Vicodin)
- Atorvastatin (Lipitor)
- Omeprazole (Prilosec)
- Duloxetine (Cymbalta)
- Clonazepam (Klonopin)
- Gabapentin (Neurontin)
- Amlodipine (Norvasc)
- Ibuprofen (Advil)
- Lisinopril (Zestril)
- Lorazepam (Ativan)
- Sertraline (Zoloft)
- Quetiapine (Seroquel)
Strategies for Avoiding Tinnitus
The following four strategies will put the odds in your favor and typically reduce your risk of getting tinnitus from taking drugs.
1. Only take drugs when they are absolutely necessary
Instead of popping pills, seek to fix your underlying health problems. Most drugs do not do that. Typically, they just mask symptoms. Thus, you end up taking the drug “forever” because when you stop, the symptoms reappear. Instead, by digging down to the root of your health problems and fixing them, chances are you won’t have much (or any) need to take drugs.
Unfortunately, Americans are a nation of pill poppers. I think the motto of many Americans is “A pill for every ill” and “A drug for every bug.” It is the rare person who doesn’t take any drugs at all.
Drugs are often prescribed unnecessarily, especially to older adults. I didn’t say that. Dr. Sidney Wolfe, the Health Research Group founder and senior advisor of Public Citizen’s Worst Pills, Best Pills News (www.citizen.org) said that. The result is that what might have been a minor problem now becomes a major problem.
Numbers of people have told me that the side effects of the drugs their doctors prescribed were worse than the conditions they were supposed to help.
For example, a man wrote,
Three years ago, after taking Bupropion (Wellbutrin) for 6 months for depression, I woke up with tinnitus. At that point, my tinnitus was a “static” sound—not fun—but bearable. I was told by my doctors that there was no connection between this drug and my tinnitus, but stopped anyway. I have had tinnitus ever since. A few weeks ago, I started taking Bupropion again, falsely believing it wasn’t related to my tinnitus. Now my tinnitus is a louder, shrieking sound. I will never take this drug again because it seems I have to listen to this terrible sound for the rest of my life. I would never have chosen this over my depression, if I had even the slightest idea this could be a side effect. That I took this drug for depression is so ironic.
Another man wrote,
I had an injury to my foot and took Ibuprofen (Advil) for the pain. Shortly thereafter, the ringing in my ears started. I had no idea this could happen and would never have taken the Ibuprofen if I had known this would happen.
Therefore, to reduce your risk of getting tinnitus, go easy on drugs! If you choose to take a drug, make sure you know that the benefits will clearly outweigh the potential side effects. Therefore, make your doctor justify that a given drug is really, really necessary—not the casual “let’s try this and see what happens,” because unfortunately, in some cases, one of the risks is that tinnitus (or other ototoxic side effects) can happen.
Instead of taking drugs, make the lifestyle and dietary changes that will improve your health. In addition, consider alternative and complementary medicine therapies. The goal is eliminate the condition so you don’t need drugs.
Some alternatives for improving and maintaining your health include:
- Change your diet. This is a biggie. Did you know that more than 80% of health problems can be traced back to poor diet. According to prolific author and natural health advocate Dr. Joseph Mercola, D.O., your diet should consist of mostly raw and lightly-steamed vegetables and fruits. Cut way down on all sugars. Ideally, reduce your sugar intake from all sources to less than 25 grams per day—that’s less than 2 tablespoons of sugar from all sources including drinks, processed foods, fruits, etc.
Did you know that you can eliminate Type II diabetes by dietary changes alone, according to Dr. Mercola? Therefore, before you take drugs for Type II diabetes, try the dietary route first. When done correctly, there is a high probability you won’t have to take any drugs. And if you don’t take drugs, you won’t get tinnitus from taking them. - Supplement your diet with vitamins. (Another biggie.) For example, most people are low in Vitamin D3 and this affects many areas of your body including your mental health. (Vitamin D affects more than 3,000 genes.) To be effective, your optimal blood vitamin D3 levels should be in the range of 60 – 80 nanograms per milliliter (ng/ml). Many people’s levels are down around the 20 ng/ml level—far below the optimal level, and your health suffers as a result. So, go outdoors and absorb the benefits of natural sunlight, which enables your body to make its own vitamin D.
- Use herbals rather than drugs. They are typically not ototoxic and do not have the harsh action on your body that many drugs have.
- Try Chiropractic—my choice is the specially-trained upper cervical spine chiropractors. I’m now realizing that many “ear” (and other) problems are actually the result of the top two vertebrae in your neck (C1 and C2) not being in proper alignment.
- Go to herbalists, naturopathic doctors (NDs), acupuncturists, massage therapists, etc. when appropriate.
- Exercise more. Just get moving. Don’t sit so much.
- Get adequate sleep. This typically means 7 to 9 hours per night. If you short yourself on sleep, both your physical and mental health suffer.
- Consider counseling rather than drugs for depression, anxiety and related issues. The drugs just hide the symptoms. Better to deal with the underlying issues and let them go. Then you won’t need drugs.
There are a number of other things you can also do, but just doing these few things will greatly reduce or eliminate your need for drugs and your risk of getting tinnitus.
My own philosophy is that I use drugs very sparingly. I’ve often said, “Drugs should be your last line of defense, not your first line of attack.” Only take them when all else fails. Unfortunately, too many people take drugs as their first, and only, choice because it is so much easier to “pop a pill” than to make the effort to do any of the above. As a result, their risk of getting tinnitus increases unnecessarily.
2. Choose the drug least likely to be ototoxic
If you choose to take a drug, talk to your healthcare provider about which drugs are least likely to aggravate or cause tinnitus. This may be a different drug in the same drug class, or a drug in a different class, or even a herbal instead of a drug. This, too, can reduce your risk.
For example, a lady asked me,
Do you have an opinion on which antidepressants are the safest for our ears—e.g. Pamelor, Zoloft, Lexapro, Celexa, etc. Is there one that is significantly less ototoxic than the others?
In my reply to her, I explained that personally I wouldn’t use any of the above drugs. Why? Because there is a much safer alternative—the herbal, St. John’s Wort.
You see, numerous studies have shown that St. John’s Wort is at least as effective as prescription drugs in treating mild to moderate cases of depression. Furthermore, St. John’s Wort is not known to be ototoxic in the least. Thus, you can take it for as long as you need to without fear of causing hearing loss or aggravating your tinnitus.
Note: If you are on other medications and choose to take herbals such as St. John’s Wort, you want to run it by your doctor or pharmacist to be sure the herbal doesn’t adversely interfere with any of your current medications.
3. Take the lowest effective dosage possible
Ask your doctor to prescribe the lowest dose of the drug that will treat your condition. This is because many drugs do not exhibit ototoxic side effects when taken in low doses. I often tell people they have a “magic threshold” below which ototoxic side effects do not appear. The trick is to keep your dose below this “magic threshold”. The problem is that you don’t know exactly where it is—it can be different for each person—that’s why I call it a “magic threshold”.
Side effects may become apparent at higher doses. Thus, by keeping your dose low, you can often “fly under the drug radar” and protect your ears from ototoxic side effects.
For example, one woman told me her existing tinnitus became noticeably louder when her doctor put her on a higher dose of Irbesartan to try to control her high blood pressure. When she complained to her doctor, he reduced the dose to its old level again, and her tinnitus dropped back to its old level.
4. Take medication for the shortest time possible
Ask your doctor to prescribe any drug for the shortest effective time possible because some ototoxic drugs do not damage your ears in the short term. However, the longer you take the drug, the more likely it is to damage your ears. Many doctors are quick to prescribe drugs unnecessarily, and conversely, are slow to take you off them. By taking a given drug for only two weeks, for example, you may avoid ototoxic side effects, whereas taking the same drug for several months may cause ear problems.
Can Foods and Herbal Medicines Cause Tinnitus?
A lady asked,
I wondered if you knew about the ototoxicity of various foods. I read that tea is high in salicylates, as are also a lot of fruits. Does this mean that drinking/eating these things can make my existing tinnitus worse?
That’s an excellent question. Yes, certain foods and herbals can cause tinnitus, but typically those you eat/take are not ototoxic, or only ototoxic if you take them in enormous quantities. So, as long as you don’t go off the deep end and consume far more than the recommended dose, you shouldn’t have to worry about getting tinnitus from foods or from taking herbal preparations.
For example, I’ve been asked whether you can get tinnitus from eating foods high in salicylates (the basic ingredient in Aspirin). The truth is, some foods are high in salicylates, but even so, the amount they contain is far less than what you’d need to get tinnitus.
Curry powder is a good example. It has the highest salicylate content of any known food—218 mg. per 100 g. If you wanted to consume the equivalent amount of salicylates contained in 6 adult Aspirin—the amount of Aspirin that you’d typically have to take to cause tinnitus—you’d have to choke down almost 4 pounds of pure curry powder—at one sitting. It’s just not going to happen!
The same applies to raisins. Raisins are relatively high in salicylates (6.62 mg. per 100 g.). To get the equivalent amount of salicylates contained in 6 adult Aspirin, you’d have to gorge yourself on 144 pounds of raisins at one time. By the time you did that, tinnitus would be the least of your worries!
Therefore, for all practical purposes, you don’t have to worry about foods or herbal preparations exacerbating your tinnitus. Herbals typically will not cause tinnitus or make your existing tinnitus worse unless you are supersensitive to salicylates (or other compounds)—but this is rare.
Drug Results Are Unique to Each Person
Each one of us is unique, and so is our response to taking drugs. This means that a drug that gives me tinnitus may not cause your tinnitus to increase and vice versa. As a result, it is hard to know which drugs you should stay away from and which you can safely take if you want to avoid tinnitus or other ototoxic side effects.
What you can do to reduce your risk of getting tinnitus is to look at reports of tinnitus occurrence for each drug. The more people who report getting tinnitus from taking a given drug, the greater your risk is if you take that drug. Thus, only taking drugs with minimal reports of tinnitus is an excellent risk-reduction strategy.
Unfortunately, there is no single source of this kind of information. You can do what I do and search through numerous drug books and on-line data bases to try to ferret out the risk of tinnitus (or other side effects) that are reported for any given drug. This can be extremely time consuming. That is why I have compiled this kind of information into a single source—the book Ototoxic Drugs Exposed—available on the Center’s website or Amazon.com.
You can also go by your past experiences. If you took a given drug in the past and got louder tinnitus, guess what? If you take it again in the future, don’t be surprised if you get even louder tinnitus this time. Furthermore, the resulting tinnitus may prove to be permanent.
Also, be aware that some people who have taken a given drug in the past without experiencing any tinnitus find that for whatever reason, when they take it again some years later, it gives them tinnitus. Thus, you always have to be vigilant.
Will Your Tinnitus be Temporary or Permanent?
People often ask me whether their tinnitus will be temporary or permanent. I tell them that if their tinnitus is secondary to drug-induced hearing loss, then they could expect it to last as long as the resulting hearing loss.
Thus, if you have temporary hearing loss from taking a certain drug (Aspirin is a good example), when you stop taking that drug and your hearing returns in a few days to a few weeks, as your hearing returns, you could expect your tinnitus to fade away. However, if your drug usage results in permanent hearing loss, then don’t be surprised if your tinnitus also proves to be permanent.
When tinnitus is a primary side effect, it is impossible to predict whether your tinnitus will be temporary or permanent. With the use of some drugs, tinnitus will be temporary for some people and permanent for others. It doesn’t seem fair, but that is the way it is.
This may have more to do with your emotional make-up than with the drug itself. Thus, according to Dr. Pawel Jastreboff, who developed the neurophysiological model of tinnitus and its practical application—Tinnitus Retraining Therapy (TRT), if you treat your tinnitus as a threat to your well-being in any way—whether physical, mental, emotional, social, financial, etc.—your tinnitus will tend to be loud, intrusive and permanent.
However, if you treat your tinnitus as an unimportant background sound and not as a threat to your well-being, it will tend to fade into the background in time and will not bother you. In fact, you may go for hours without even being aware you have tinnitus. Thus, even if your tinnitus proves to be permanent, it ceases to be an issue. It is just “there” and is no big deal. As a result, you are free to live a happy and successful life even if you are “stuck” with that “sidekick” of a drug you took.
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If your tinnitus bothers you, I recommend that you get and read my comprehensive book on tinnitus—”Take Control of Your Tinnitus“—either the printed book or the eBook version (the text is identical in both).
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This article, slightly revised, was published in the Summer 2018 (Vol. 43, No. 2) edition of Tinnitus Today, a publication of the American Tinnitus Association.
Pulsing/ thumping in ear. Ok google, what’s going on. See list, #5 wellbutrin. Well, I’d rather be dead then have to deal with this for the rest of my life.
This is the drug that caused my Tinnitus. Then my dr. put me on another antidepressant I’d taken with no problem in the past – it got worse! Then I got an eye infection, and had to make a choice between losing my eye or taking prescription eye drops. I fearfully took the eye drops. Then I had high-pitched screaming tinnitus! It is awful! So what do we do? I fear every single day that I may need a drug to treat a condition. And I’m young, so you know it’s coming. It’s not the tinnitus that’s ruining my life — it’s the fear of taking another drug that is ruining my life, I just couldn’t live with worsening tinnitus again.
Does ANYONE answer these questions we pose?!
Since my tinnitus was caused — and then worsened twice — by two others drugs, I have to live in fear every single day that I will have to take a drug. I’m young! This is ruining my life! What do people do who have experienced what I did?
Hi Debbie:
Are you following the principles laid out in this article, or are you blindly taking the drugs you doctor prescribes? One of the principles mentioned says to take the least ototoxic drug. Did you do that? You have to do your own due diligence and not rely on your doctor or you can end up with tinnitus again like you have in the past. My book, Ototoxic Drugs Exposed will help you to choose the least ototoxic drug. And if you still need help, you can email me.
Cordially,
Neil
I’ve had tinnitus since 2009 when my doctor increased my dose of amlodipine/banezaprill to 10/40. I’ve been reading hear and recently downloaded your special report. I will be working with an integrative medical Dr soon.
Hi Rick:
Great idea working with an integrative doctor. Hopefully your tinnitus will go away in time after you get off the Amlodipine.
Cordially,
Neil
Hi! I just read your article and I’m not sure if I have tinnitus from a drug I took or if it’s really tinnitus at all. I started taking Prilosec prescribed by my doctor for GERD about 2 1/2 weeks ago and a few days ago i woke up with this feeling of fullness and pressure in my ear. I can hear fine and there’s no pain but it’s that feeling of muffledness and hearing myself loudly when I talk that is annoying! I’m wondering if this could possibly be a result of this medication or possibly something different. I’m not hearing any whistling or crackling sounds so I’m not positive what’s going on.
I’ve also been having weird itchy skin rashes all over my body and this started happening at this same time. Weird but wondering if Prilosec is the culprit
Hi Jess:
Omeprazole (Prilosec) is quite ototoxic and can cause all sorts of ototoxic side effects including a blocked or muffled feeling in your ears.
This has to do with your Eustachian tubes not working properly now. That is one reason for the muffled and blocked feeling. It also explains why you hear your own voice so loud–in this case the Eustachian tube is open rather than closed. It is called Patulous Eustachian tube, and the whole set of side effects can be lumped under the general term of middle ear myoclonus.
The weird itchy skin rashes sounds like an allergic reaction to this drug. If it were me, I’d quit taking it and do the various things I suggest in my article for dealing with GERD.
Cordially,
Neil
I have tinnitus. When I have tinnitus spikes, I take prednisone, it usually seems to help. But this spike I took prednisone before the spike, because I felt like my ears were starting to bother me and it has not gotten better. I am wondering if prednisone is ototoxic and could it be causing the spike? And this new ringing seems to be reactive, as sound goes it goes up.
Thank you,
Josh
Hi Josh:
It is true that doctors use Prednisone for all sorts of ear problems. Sometimes it works and other times it doesn’t. However, hundreds of people have reported getting tinnitus from taking Prednisone so it works both ways. Personally, I’d not take Prednisone for tinnitus. I don’t think the risk is worth it.
If you now have reactive tinnitus where the tinnitus goes up when sounds levels go up, you also have hyperacusis. Just so you know, some people have reported getting hyperacusis from taking Prednisone. So that may be your problem. It’s hard to say for sure.
Cordially,
Neil
Hi Neil:
Another unfortunate person living with poisonous tinnitus, from Spain! Thanks for all your help, I have to say your 2016 edition of “List of ototoxic drugs and chemicals” is my new “bring-everywhere” PDF 🙂
I experience tinnitus in my left ear for about a year, after a trip. I can’t say the reason, I developed it after “serous otitis” but right treatment…
My problem now: I developped another tinnitus, since yesterday and in my right ear! But this time, no apparent reason at all: no nois-induced hearing loss, no hearing loss at all actually in my right ear! I was taking some sleep in the afternoon and suddenly started hearing a new sound in the right ear! I got sick a couple of days ago, but no specific ototoxic drugs that I took: only 1 spoon of anti-nausea Domperidone once 3 days ago, and a corticoide nasal spray (fluticasone).
Shall I do anything now? Please I’m seeking your advice. Is there any specific “quick” treatment I could take to make it disappear? Would it help taking some “acetilcisteine” e.g.?
Thanks for all your help!
André
Hi André:
Just be aware that that list of drugs that can cause tinnitus doesn’t tell you the probability of getting tinnitus from taking any given drug. For example, some drugs are high risk of tinnitus, and other are low risk–but they are all there in the same list.
If you had a virus, that could have caused the tinnitus. So could have the Domperidone–it causes tinnitus in a few people. However, the Fluticasone has been reported to cause tinnitus in hundreds and hundreds of people that take it, so that might be a good possibility.
Taking N-acetyl-cysteine may help, I can’t say. But it certainly won’t hurt to take it and see what happens.
You might also want to take magnesium and vitamin D3 supplements.
Cordially,
Neil
Thank you for your answers, much appreciated!
I’m a bit surprised and disappointed to see Fluticasone as a potential tinnitus-triggerer, as I made some research before and didn’t find any evidence…
Though, I have to admit I took it only twice (one spray for each nostril, once a day and for 2 days) and last time was a 4 days before my right-ear tinnitus appeared. During the “treatment”, I didn’t see any effects on my symptoms (apart from opening up my Eustachian tube, which was stuffed) and actually reduced my left-ear tinnitus…
Do you still believe it could be related? I’m so desperate now, as I think every thing can make tinnitus worse… There are just so many causes you can’t be sure, like… I’m now taking my usual morning coffee, as I do for 10+ years … could that trigger it?
Please understand I’m not blaming on anyone or discrediting your opinion, but I’m just desperate of tinnitus and it’s poisonous effect on life quality.
I feel so much sad, always having to hear a sound by night (because I only hear it by night).
There is a “tinnitus hospital” in Barcelona, where I live, they claim to relieve tinnitus by using “cochlear electrostimulation”. The website is https://www.ototech.es/, even though it’s in Spanish sorry.
What do you think about that? Is it pure marketing or could it help me?
Many thanks Neil again for your patience with all of us!
Cordially,
André
Hi Andre:
Most drugs have some ototoxic properties–but these are not often listed. So don’t feel bad you missed it. That is why I do all the research I do on drugs in order to help people. I’m not saying the Fluticasone gave you any ototoxic side effects–but it could have. That is why you have to be careful of drugs and only take them when really necessary.
Many thing can make tinnitus worse. Loud sounds and drugs are the main ones. But never discount the effects of depression and anxiety–then play a large role in how loud and intrusive your tinnitus seems to be.
Some people are sensitive to the caffeine in coffee and it makes their tinnitus worse. For others, it has no obvious effect, so you have to experiment and see whether it affects your ears.
If the tinnitus bothers you at night, play pink noise or fractal music or environmental sounds when it is quiet so your brain has something real to listen to instead of just your tinnitus. The sound doesn’t have to be loud–just loud enough to hear. One good environmental sound that helps many people is one of the various sounds of water–waves lapping on the beach, waterfalls, rain falling, creek running, etc. This can both help mask your tinnitus and also help calm you down which is also very important.
Cochlear electrostimulation works to a certain degree in some people. According to them, they have some reduction in tinnitus in 63% of the people taking this treatment. just be aware that 40% are not helped and the 60% that are helped may only be helped 10% or so–or could be helped 50% or 80%. So it is not the total answer. And yes, there is some “hype” associated with it.
If it worked for everyone 100%, everyone in the world with tinnitus would be using it–but in actual fact very few use it–so it may help you, or it may not. You’ll only know if you try it. It may or may not be worth the time and money to take this treatment. And since there is no way to know ahead of time whether it will cure your tinnitus, help you a lot, help you a little, or not help you at all, it is a gamble.
Cordially,
Neil
Thank you again for all these answers Neil, they make sense to me anyway!
One last quick question, sorry, regarding the use of white/pink noise (especially water-sounds) during night. I recently came upon some study saying it could, in the long-term, affect the neuroplasticity of the brain and worsen tinnitus.
This is where I read the article from:
https://www.sciencealert.com/white-noise-doing-something-bad-to-brain-study-suggests-tinnitus-hearing-loss-plasticity-neural
Could you please share your thoughts on the above “discoveries”?
Thanks,
André
Hi Andre:
That article only gives one side of the story–and makes everything it says seem logical and thus white noise is bad for your brain. However, it has some flaws in that what is not said is also important.
This article that came out 8 days after “your” article rebuts it and others like it.
https://audiology.org/news/turn-white-noise-immediately%E2%80%A6well-maybe-not
There may be a kernel of truth in your article, and thus I favor not white noise or pink noise, but rather fractal music or the various water sounds which are real nature sounds and thus are relaxing as well as providing help for your tinnitus.
Personally, I find white noise grating on the nerves. Pink noise is more natural and has the energy allocated the way our ears actually work so it is better in my opinion, but I’d still opt for fractal music (since it is semi-random and doesn’t repeat–you don’t actively listen to it) or real nature sounds which are also random yet pleasing to the ear. Any sound you use must not be annoying in any way or it will not help you with your tinnitus–so you want to select a pleasing sound that you don’t specifically focus on. That is why fractal music or nature sounds are probably the best all the way around.
Cordially,
Neil
Thanks a lot for your appreciation on this article. Indeed, I agree that “fractal music” and “random nature sounds” are quite the best.
Regarding my right-ear newly developed tinnitus, I’m now completely confused and it seems it’s gone, but sometimes appear very low volume, making me wondering if it’s coming from right or left ear…
I have an appointment with a tinnitus center today, so I’ll check with them. I wanted to say a big “thank you” again for your time.
I am also taking some magnesium supplements now, but they contain “nicotinamide” (seems like Vitamin B3). I’m seeing from your 2016 list of ototoxic drugs that “amino nicotinamide” is ototoxic, but it seems to me the formula is different and is a different chemical. Do you have any insights please?
Also, I was recommended by my pharmacist some “ginkgo biloba” supplements, which I’m taking now in the form of “tincture”. It’s basically Ethanol with plant extract. I know Ethanol is also ototoxic, but can it be dangerous to only take 5ml a day of tincture? (5ml of ethanol)
Thank you,
André
Hi Andre:
Niacin is the synthetic form of Vitamin B3. Nicotinic acid is the natural form. The information on ototoxicity I have refers to synthetic Niacin, not the Nicotinic acid form.
Ginkgo biloba can be a good supplement for tinnitus, but you have to take it at its effective dose. According to the German E committee, that dosage is 480 mg/day standardized to have 24% flavone glycosides, 5-7% terpene lactones and 2.6-3.2% bilobalide. Unfortunately, most formulations of Ginkgo do not meet this standard, or even anywhere near it, and are thus basically not effective. One that does, of which I know, is Arches Tinnitus Formula. There may be others.
I suspect your tincture does not meet this standard and thus is likely to be ineffective. Check with your pharmacist to find out.
Cordially,
Neil
Please add Mobic to this list. I suffered mightly for 2 years before the tinnitus came down to a level I could manage.
Hi SarahAnne:
Meloxicam (Mobic) is on the list of drugs that can cause tinnitus. Numbers of people have reported tinnitus as a side effect.
Cordially,
Neil
Sir I’m from India I’m really stressed these days I want to start from the beginning from where it started i was slapped in my Right ear and my eardrum got perforated but it was sealed itself in 7 days i think i took some antibiotics to prevent infection but after searching on net i was Scared of the tinnitus I’m not sure whether i got it or not but I. Took tinnex capsules 40mg a day And I started feeling better maybe placebo effect Also some ginkgo after that So In 2018 I think I started expierencing sound Sensitivity so again I took tinnex and ginkgo and everything got better But in 2019 I got Acoustic shock from a loud burst of Sound In my good ear I was depressed that I Destroyed my good ear also but only I got was a mild tinnitus Nothing else Life was again getting better and I think I forgot of it again and it was Mild also so I was enjoying my life With a faint Tinnitus in the background normal hearing and no Sensitivity but one day in August I started feeling That I’m having some hearing loss but I ignored but thn I got a dizzy feeling one day That remained For a week or so So I went to the ENT the EnT told me that I have 10-15 decibel Hearing But what they did on me was The dangerous acoustic reflex test at 100-105 db the next day in the morning i got this damn loud Tinnitus In my Right ear first I was Thinking what was the cause then I looked backed my reports After a week of depression then I came to know it was the Acoustic reflex test Who made a wave type Tinnitus in my left ear and a loud one in my Right symptoms start to get worse with increased hyperacusis And got to be worse But I took some escitalopram10mg and Etizolam 0.5 mg which helped me I started going out using Cotton now I stopped taking those medicine after a month And I’m okay now Sir could you tell me is tinnex safe and Will I ever get better this loud Tinnitus will ever go away ?
I have hyperacusis and tinnitus and from sometime i am getting crackling noise in ear when swallowing this never happened before started just 3-4 days ago and i think ear fullness stopped Although earfullness went away Crackling remained with the Tinnitus and hyperacusis the same
Hi Sachin:
As far as I know, Tinnex is safe to take. I don’t have any information on it being ototoxic or causing tinnitus.
Your tinnitus may be associated with your hearing loss. If so, it will be there as long as you have hearing loss. I’ve had tinnitus for over 70 years now from this cause.
The good news is that you don’t have to let your tinnitus bother you. If you habituate to your tinnitus then whether you hear it or not doesn’t make any difference. It is just there like any other normal constant background sound. And actually, hours will go by without your even being aware it is there. So it is a non-issue whether you have it once you are habituated to it.
Cordially,
Neil
I thought I read somewhere you are releasing a new ototoxic medication book? Is this correct? Am interested to see the latest findings on blood pressure medication as my doctor really wants me to take it and I have a very healthy lifestyle so can’t make improvements there.
Hi Tania:
Yes, I’m hoping to have it out sometime in 2022. Just depends how much time I have to work on completing it. I need to update my tinnitus book first, but hopefully that book will be out in the spring if not sooner. Then I can start working in earnest on updating the fourth edition of the drug book.
If you have some specific drugs you want me to look up for you I can do that as a lot of that information is already updated in the new version that is still on my computer.
Cordially,
Neil
Hello doctor i am from argentina , nerves trigger with pandemia, and by it i have high blood pressure , and my pscicologist derives me to psiquiatra, resume at my 2 day taking escitalopram 2 o clock in the morning i was woken up by zumbido in my ears,,,,,, i only took 2 montnhs and still have my tinnitus,,, my psiquiatra could believe me because she said is rare and none of her patients have,my cardiology told me to take bisoprolol,,, he said that this medication will make me calm, that i was nervous, not hipertensional person,, we speak spanish so i have to catch up my english, well i went to see an otorrinolaringologo and he took serum from my ear,,,, still have my tinnitus,,, but he told me as you said to one write ,,, dont listen to your tinnitus dont pay attention to it think about something else,,, well your words inspire me to write to you from the other part of the world, hope you are good and take care gratefullness cecilia
Hi Cecilia:
If the Escitalopram is causing you tinnitus, I’d get your doctor to change your prescription to in different drug, but I wouldn’t take the Bisoprolol as there are many times more reports of tinnitus from taking Bisoprolol than from taking Escitalopram.
Cordially,
Neil
Hi Dr,
I believe that I recently developed tinnitus in my right ear. A few weeks ago I noticed that my ears felt “full” and I felt off balance, so I made an appointment with an ENT. I underwent a hearing test (while “normal” my right ear did fall below my left in results. I was also very nervous) and he prescribed me a 2 week tapering of prednisone to see if it eases any inflammation. After researching the past few weeks, I have little hope that the prednisone will actually work.
In full disclosure, I am typically a bit high strung and my anxiety has been a bit high the past few months. My PCP prescribed Zoloft for my anxiety and I only made it 5 days on the stuff before quitting due to the horrid side effects. My question is: I took the Zoloft before seeing the ENT and starting the prednisone. Do you think 5 days of an SSRI could cause tinnitus and if so, is there any hope that it’ll go away since Ive stopped the SSRI? My right ear has gone from a low woosh sound to now a high pitch static sound in the past 3-4 days. Meanwhile, it’s my left ear that feels full and “clogged” but no tinnitus that I can tell. I am desperate for any advice as I feel my ENT rushed through my appointment. I do have to go back in a week for another hearing test as the prednisone will be done at that point. Thank you.
Hi Tris:
Taking Sertraline (Zoloft) can certainly cause tinnitus, as well as balance issues and your ears feeling blocked or full.
I think your tinnitus as well as your other ear issues could well be due to the Sertraline. Hundreds upon hundreds of people report these side effects from taking Sertraline to the FDA.
And yes, just 5 days of an SSRI can cause tinnitus that can prove to be permanent, or at least long term as some people have told me. Actually, only one pill can do that as one man explained to me. Sometimes the tinnitus goes away, or drops to a low level when you stop taking the drug. But this can take a long time for some people–like 3 years.
Since you have stopped taking it, I doubt that it will affect your hearing at this point.
Cordially,
Neil
I have been on 100 mg of metoprolol tartrat for about 10 years due to hbp. My doctor recently changed my prescription. I take 50mg in the morning and 50mg at night. After a month of doing this I now have tinnitus.
So she switched it to metoprolol Er 50 mg once a day. Do you think this will help my tinnitus or should I try a different drug?
Hi Rhonda:
I don’t see a clear reason for your tinnitus to begin after 10 years just because you split the dose into two parts, taking half morning and night, yet are still taking the same total dose per day.
What happens if you go back to the previous single dose?
The ideal thing would be to stop taking the Metoprolol completely and see whether your tinnitus goes away.
I really don’t think switching to Metoprolol ER is going to help matters. Perhaps you should consider a different drug.
Cordially,
Neil
Hello
I took 0.5mg of clonazepam for 1 year and 1mg of clonazepam for about 5 months. I started to feel the tinnitus gradually coming, so I stopped taking the drug completely over a month. The tinnitus lasted a month and I was able to tolerate it.
After that, after going to the oriental medicine hospital and receiving electric acupuncture treatment, the tinnitus sound got louder and louder, and when I lay down to sleep, the eardrum trembled in the opposite ear where the acupuncture was applied, so I couldn’t sleep.
So, it’s been about 2 weeks since I stopped taking clonazepam 0.5mg again a month after I stopped taking the drug again. I reduced it by 25% from 0.5mg and tapered it for 6 days, and my tinnitus got bigger. So I took 0.5mg again yesterday and my tinnitus got a little smaller. I was good
I want to stop taking the drug as soon as possible, but I am afraid my tinnitus will grow back
Since it is difficult to divide the drug, I would like to take a single drug while switching to diazepam. Will this help?
https://www.benzo.org.uk/manual/bzsched.htm#s5
How can I follow the instructions here?
I am only taking 0.5mg in the evening. Do I need to go back to 1mg?
Thank you
If I stop clonazepam, the tinnitus will increase again. As the teacher said, if I reduce it gradually, can I stop taking the medicine without the tinnitus?
In this case, wouldn’t it be recommended to reduce it by switching to diazepam?
Hi Rivotrill:
When coming off any of the Benzodiazepine drugs, once dependence is developed, you have to taper off VERY slowly if you want to avoid getting tinnitus as a side effect.
And yes, you first switch to the benzo with the longest half-life which happens to be Diazepam. This is the safe way to do it.
Cordially,
Neil
Hi Rivotrill:
As you know, in order to taper off a benzodiazepine, you first want to switch to the equivalent dose of a benzo with the longest half-life. According to the table in the link you give, the equivalent dose of Diazepam to Clonazepam is a 1 to 3 ratio. So since you are taking 0.5 mg of Clonazepam, this is equivalent to a 1.5 mg dose of Diazepam.
Using those figures as a starting point, you are now taking Clonazepam at 0.5 mg per day for a week. This is week 0.
On week 1 you reduce your dose of Clonazepam and at the same time start taking Diazepam. Here’s how it works.
Week Clonazepam (mg) Diazepam (mg)
1 0.42 1.7
2 0.33 3.3
3 0.25 5.0
4 0.17 6.7
5 0.08 8.3
Beginning week 6 you only take Diazepam until you are finally tapered off it. The suggested time is 2 weeks at each step (I’m showing them as sequential numbers now–not weeks. Each number is for 2 weeks.)
Seq. No. Diazepam (mg)
6 9.3
7 8.7
8 8.0
9 7.3
10 6.7
11 6.0
12 5.3
13 4.7
14 4.0
15 3.3
16 3.0
17 2.7
18 2.3
19 2.0
20 1.7
21 1.3
22 1.0
23 0.7
24 0.4
Then you can stop the Diazepam.
Note: this is a safe taper. You could go faster–for example 1 week intervals for the above–but only do that if NO side effects show up. If side effects show up, that means you are tapering too fast.
The above is how much of a tablet you need to take. Since you can’t accurately cut a tablet into these sizes, here’s how to do it. See below.
In order to take these precise amounts you will need to get yourself a mortar and pestle (at a drugstore) and a 100 ml tall skinny beaker marked off in 1 ml units.
What you do is each day you crush the tablet to a fine powder, put it in the beaker, then fill the beaker to the 100 ml mark with water, then stir/shake until it is totally dissolved. Then you pour out “x” ml of the dissolved solution and drink the rest.
Here is a table to show you the “x” amount you pour out (you drink the rest).
The sequence numbers are the same as the above table (1-24)
Seq. No. Pour out (ml)
Diazepam
1 66 (Sequences 1-3 based on using ONE 5 mg tablet Diazepam)
2 34
3 0
4 33 (Sequences 4-12 based on using TWO 5 mg tablets Diazepam)
5 17
6 7
7 13
8 20
9 27
10 33
11 40
12 47
13 6 (Sequences 13-24 based on using ONE 5 mg tablet Diazepam)
14 20
15 34
16 40
17 47
18 53
19 60
20 66
21 73
22 80
23 86
24 93
For Clonazepam follow the same procedure above for the first 5 sequences in ADDITION to the Diazepam sequences above.
Seq. No. Pour out (ml)
Clonazepam
1 16 (Sequences 1-5 based on using ONE 0.5 mg tablet Clonazepam)
2 34
3 50
4 66
5 84
After sequence 24 you are off the drug and hopefully with no withdrawal side effects.
Cordially,
Neil
Can you please tell me the ototixicity of Nortriptyline?
Thank you
Hi Dee Dee:
Like all antidepressants, Nortriptyline is ototoxic to some degree. I rate it as a 2 out of 5 (with 5 being the worst). It can cause hearing loss and tinnitus and various balance issues, etc. In the grand scheme of things it is certainly not the most ototoxic antidepressant drug, but at the same time keep a watch out for hearing loss, tinnitus or dizziness and if they begin to occur, you might want to stop taking this drug.
Cordially,
Neil
If you experience vertigo/imbalance and not tinnitus with a medication, is it still ototoxic? I took low dose remeron for about 10 days. I haven’t taken it for a couple weeks. I am experiencing this kind of dizziness. It happened in the past when taking remeron and it took 5 years to get better after discontinuing. Selective memory when you are desperate for a sleep med… but I also thought the dizziness could be a part of CFS, but now I am sure it is the drug.
Hi Sarah:
Yes, vertigo, dizziness and imbalance are three ototoxic side effects of many drugs. Anything that is injurious to the ear is an ototoxic side effect–so any hearing, tinnitus, balance, etc. side effects are all ototoxic.
Mirtazapine (Remeron) is indeed ototoxic and thousands of people have reported balance disorders including dizziness to the FDAs data base after taking this drug.
You’d probably be wise not to take this drug in the future. Find another way of getting a good night’s sleep. I’d suggest looking into the herbal Valerian to help you sleep. It works for numbers of people and is not ototoxic.
Cordially,
Neil
My blood pressure is a little high. I will see my doctor soon. He might put me on blood pressure medication. I have sensitive ears to medication. What is the least ototoxic medication (brand) for blood pressure (you would recommend)? I’m assuming I should get a low dosage. What should the dosage be for a low dosage? How many mg’s for example?
Note: I do not want tinnitus from the pills.
Hi Joe:
As far as I know, the least ototoxic BP medication is Lisinopril (Prinivil, Zestril), one of the angiotensin-converting enzyme (ACE) inhibitor class of drugs.
I’ve been taking it for some months without any effect on my ears or my tinnitus (as far as I know).
A low dosage would be 10 mg. (I’m on 20 mg myself.)
Note that all BP drugs can cause tinnitus, so you have to choose the one with the least risk and my information tells me it is Lisinopril.
Cordially,
Neil
Hi Joe:
You might want to try Lisinopril as it has a relatively low risk for causing tinnitus. A low dose could be 5 or 7.5 mg. Higher doses would be 10 or 20 mg. I’m taking Lisinopril at 20 mg with not tinnitus problems. My tinnitus is the same as it always is. See what you doctor thinks.
Cordially,
Neil
Hello,
I have tinnitus and take mirtazipine 30 mg, which has no effect on my tinnitus. Now I am heavily depressed and worry all day and my psychiatrist now recommends a low dose of quetiapine to reduce worrying and improve the operation of antidepressants. How big is the chance that it affects my tinnitus?
Hi AP:
In my estimation, Quetiapine has roughly twice as high a risk of causing tinnitus as Mirtazapine. These drugs are moderately ototoxic in my opinion.
In addition, it is unknown how taking these two drugs together will affect tinnitus.
So, if you choose to go ahead with it, be cautious and keep your eyes open for developing side effects.
Cordially,
Neil
Hi Neil,
Have a question about patient sensitivity to differing classes of antidepressant. In your experience if someone gets tinnitus with an antidepressant and switches out of class to a different antidepressant that works differently is it almost certain that the tinnitus would come back? I have had tinnitus develop on moclobemide. Stopped immediately and it’s now gone from very annoying to just mild. But I do feel I should be on an AD. Interestingly I have been on an ssri before without any tinnitus some years ago.
Hi Ed:
Everyone is different so there is no firm rule. For some people switching the class of antidepressants can solve the tinnitus problem. But for others, they can be sensitive to tinnitus from other classes of drugs.
Instead of taking a prescription drug with high risk of tinnitus, why not try the herbal St. John’s Wort? It helps many people with depression and has a low risk of tinnitus (and other side effects).
If you choose to try St. John’s Wort, make sure the bottle says three things. First, the word “standardized”, second the word “hypericin” and third, a percentage–typically 0.3%. You want to know that you are getting the right amount of the active ingredient (hypericin) so unless it says standardized to 0.3% hypericin, you don’t have a clue what you are getting. I’ve seen many bottles of St. John’s Wort that don’t mention any of these words–and I’d never suggest taking them as they may not have any (or little) of the active ingredient and thus won’t work. You’d just be wasting your money.
Cordially,
Neil
Hello Dr Neil. In another section you indicated I might have Global Hypersensitivity. Im currently on 200mg of Trazodone and Im wondering if it might be contributing to it, or on its own causing it. I read a post where you said that. To test this theory how would I taper to see if it was doing it?
It seems like it has a short half life. I dont want withdrawal as that can cause tinnitus too. I recently dropped Lamictal dose from 200mg to 150mg and seem to have a spike still going on. Thanks so much!
Hi Doug:
A “safe” taper is typically 10% per month on the descending balance. Dropping suddenly by 25% like you did can be much too fast depending on how long you have been taking the drug, the drugs half life, your body chemistry and whether you have built up a dependence on the drug.
Incidentally, the half life of Trazadone can be a fast as 5 hours and as long as 13 hours. So that would mean you need to take it 2 to 4 times a day to keep the level in your blood steady. Otherwise you are doing a 50% or faster taper every day–so taking it once a day would be like being a yo-yo–up and down twice a day.
Lamotrigine (Lamictal) certainly can cause tinnitus and does in hundreds of people.
Note, you should not try to taper off more than one drug at a time. So if you are trying to get off the Lamictal, do that before you start tapering off the Trazodone.
Cordially,
Neil
Thanks Dr Bauman.
Out of the Lamictal and the Trazadone which has the possibility of exacerbating/causing Tinnitus the most? Thank you.
Hi Doug:
Between Trazodone and Lamotrigine (Lamictal) for causing tinnitus, I’d say they are about the same overall. I have two methods of calculating risk and one way says Trazodone is less risk, and the other way Trazodone is the greater risk. Thus, overall, it seems to come out as a wash. So it really comes down to how each of these drugs actually affects your ears. Choose the one with the fewest and mildest side effects.
Cordially,
Neil
Hi Neil,
I was wondering if you could offer some guidance on treating an outer ear infection caused by a finger nail scratch.
I want to make sure that I don’t do more harm by taking an ototoxic antibiotic and I’m wondering if there was an option that was less ototoxic than others.
Is an external antibiotic spray/drop better or worse than internal treatments?
Thanks for being so helpful!
Matthew
Hi Michael:
Is this in your ear canal or just your outer ear? If in your ear canal, If the infection isn’t serious, I’d likely try two safe remedies–hydrogen peroxide or apple cider vinegar.
It’s harder to do this if it is on your outer ear. But in my opinion it is definitely safer to use a topical antibiotic rather than an oral (systemic) one. There are antiseptic ointments that are not very ototoxic and thus pretty safe to use. For example, Bacitracin is one such antibiotic. It is available OTC, but you want to follow the directions carefully as it can damage your kidneys.
There are other OTC preparations available. Ask your druggist about them, and if you have concerns let me know the active ingredient(s).
Cordially,
Neil
Dear Dr, I was put on Seloken ZOC (metoprolol succinate) 50 g a day on the suspicion that I might be experiencing atrial flutter. The first three weeks I felt some terrible side effects, such as cold extremities, pulsatile tinnitus, inner shakiness and nightmares. Even though I recovered from these, I developed fatigue, slow heart rate and dizziness two months later. In the meantime all tests, ecg, 24 holter monitor, blood test came back normal. The doctor told me to quit taking metoprolol since there is nothing wrong. However, I tapered off the drug slowly and kept taking 12 mg every night for another two months. This was due to my health anxiety and the drug seemed to give me some balance since it helps with stress. After these two months, and specifically during the last ten days I developed a ringing in my ears. One morning I woke up with a heavy head and ringing. It has not subsided since then though the loudness varies during the day. I was wondering whether the cumulative effect of the drug caused this. I asked a neurologist online and he seems to agree that tinnitus as a side effect can develop any time after starting the medication. I have now stopped taking the drug for 72 hours, and I understand that it can take some time for the tinnitus to subside. Having said that, I have experienced some tinnitus before taking metoprolol but it had always subsided fairly fast. I have also observed that the tinnitus increases in volume and changes pitch when I move my lower jaw backwards, and sometimes when moving the neck. It is also louder when I lay down and much weaker when standing (this does not have to do with stimulus during the day, I noticed it in a quiet environment). This certainly seems to be unrelated to metoprolol, but I guess that the drug might have exacerbated this. What is your take on all of this?
Hi Angelos:
Metoprolol certainly can cause all sorts of ototoxic ear problems including tinnitus. The good news is that for some people at least, their tinnitus goes away when they get off the Metoprolol so maybe that will be your experience now that you are finally off it. Give it at least two weeks and see if it is dropping in volume or gone away.
However, I suspect you have two kinds of tinnitus. The drug caused your neurophysiologic kind of tinnitus, but your current symptoms indicate you now have somatosensory tinnitus, probably due to your cervical vertebrae being out of proper alignment. This is why turning your head or moving your jaw causes a momentary increase in both your tinnitus pitch and volume. I find the same when my neck gets tight.
Your tinnitus getting louder when laying down and softer when standing is also almost certainly due to cervical misalignments. What happens in your case is when you lay down, it puts pressure on your vertebrae–pushing them “sideways” if you are a side sleeper. This “pinches” some of your somatosensory nerves and they become hyper and these excess signals get interpreted by your brain as tinnitus.
When you stand up and move around, your vertebrae realign themselves to some extent and as the nerve fibers are not pinched so much, your somatosensory tinnitus fades until you lay down the next time.
The reverse can also be true and some people find their tinnitus goes away when they lay down and gets worse when they stand up.
What I’d recommend is that you go to a chiropractor, preferably an upper cervical chiropractor (go to https://www.upcspine.com/ and click on “Practitioners” to find one) and have him precisely realign your cervical vertebrae and this should go away.
Massage therapy can also be profitable as it relaxes your cervical muscles so they don’t pull your vertebrae out of alignment again.
Cordially,
Neil
Dear Dr Neil, First of all, I would like to express my gratitude for the research work you do, it helps many people make informed decisions about risks to their hearing health that are difficult to find through other means. 2 and a half years ago I had tinnitus thanks to my total ignorance of taking Sertraline and Citalopram for 17 days. Since then I have not taken anything chemical again, not even for a headache. The only thing I have taken is the Arches formula with rest periods. My tinnitus has now gone from being a problem to a nuisance, many days of silence, and When I have it, it is very short. Now I have to go to the dentist and although it looks like I won’t have to take any antibiotics, I will need a local anesthetic. My question is about the least toxic anesthetic, it seems to be lidocaine. Am I right? Is there an alternative that I haven’t been able to find that is safer? Thank you very much for your expert advice.
Hi Mar:
Thanks for the kind words. I’m glad to help people this way, because as you said, few dig into the kind of information I search for to help people.
Of the two drugs that likely caused your tinnitus, Citalopram is the worse drug. I get more reports of ototoxicity from people taking Citalopram than for almost any other drug.
When it comes to painkillers for dentistry, in my opinion, Prilocaine (Citanest and Xylonest) and Procaine (Novocain) are both even better choices than Lidocaine (Xylocaine). Personally, I’d opt for Procaine if your dentist uses it.
Cordially,
Neil
Dear Dr. Bauman
Hope you doing good these days!
I am reaching out to you because I am on the search for the root cause of my Tinnitus, it’s complex 😉
After reading through your very valuable content on this side (big congratulation, will buy two of you books), I have the feeling you might have some inputs and maybe an idea concerning two specific questions on two potentially ototoxic substances.
Further down I wrote down my story for some context, maybe it’s interesting for you and you have some comments in general. However, my specific questions are the following:
-Do you have any experience with T coming from e-cigarettes/vaping (brand: Elfbar)? They contain highly ototoxic propylene glycol. I smoked tons of them during the last 12 month before the T onset and while I had my ear injury (see below). Is tinnitus coming from ototoxic chemicals always in combination with hearing loss or some measurably damage of the ear?
-I am currently undergoing a drainage of heavy metals in my body (led, aluminium etc.). It is done by DMPS (2,3-Dimercapto-1-propanesulfonic acid) (brand: Heyl from Dimaval) and EDTA (Ethylenediaminetetraacetic acid). Someone told me that especially DMPS could be an issue with Tinnitus. Do you have any knowledge about this?
Thank you very much! All the best from Switzerland.
—————————–
My tinnitus story
What do I have:
I got Tinnitus + Hyperacusis around 4 month ago. First on the left ear, couple of days later on the right one. Around 11.500 kHz left, 4.500 kHz right. Sounds are dynamically changing, flair-ups and spikes. Sometimes I hear it in the ears, sometimes more as a whitenoise in my head. It’s there all the time. Left ear sometimes feels physically strange and it is doing strange things. Mornings are normally more quite, it picks up towards the evenings. T got louder over time, H got far better.
What happened:
Someone shouted directly in my left ear during a concert. After that my left ear felt strange like there was water in it and it was hurting bit for around 3 weeks. I had strong H during this time, but no T and no noticeable hearing loss. The ear got better, but then I recognized a barely noticeable T one night (there was no T before, I am pretty sure), I needed to go to an absolute quite room and plug my ears to hear it (what I complete fool did of course…). After a week I smoked a joint and had a glass of wine, this night hell knocked on my door and didn’t leave anymore so far. I guess my brain made some connections due to the drugs which amplified the T.
What might be the cause:
After an odyssey of research, visits to doctors, tests and treatments I think it is multifactorial and so might be the cure, which I am still hoping for.
-Hearing loss: I got no conspicuous hearing loss according to 7 different ENTs (I am 37). Max minus 20 dB all the way up to 14K kHz. After 14 kHz it drops steap, but I guess high frequency hearing loss is normal in my age. Identically situation on both ears, left ear is even slightly better. They also did some other tests on top. I am kind of suspicious because my left ears still feels strange sometimes. If I plug it while walking it makes high pitched squeezing sounds in comparison to the right one. If I do meditation and do some humming, something starts to vibrate in it. When the T is strong, it’s feels almost something is tingeling in it. ENTs say there is nothing and it might be a muscle. -> Hearing loss seems not to be the reason, even though the T started 3 weaks after a noise trauma. I am not sure about these physical sensations in my left ear though.
-Stress: I am a manager and had a very demanding job. Also in my private life I do a lot of stuff and find it hard to relax. I did several blood, urin and saliva tests. Even I felt quite ok, the values show, that I had something like a burnout. In the first 3 weeks when my ear was injured (no T so far), I got extremely worried and had a panic attack. I guess the ear injury was just the cherry on top. I guess this is one major reason the T came up.
-Somatic: For years strong tensions in my shoulders and upper neck. Too less sport and to much screen time. C1 was not aligned. Beginning TMJ issues, cramped masseter muscle. In the first 3 weeks when my ear was injured I spend a lot of time looking on my phone and PC.
-Teath: Last week someone did an x-ray of my mouth. I have one rootcanal treated molar (3-6). The roots are infected. I guess this is also a strong T favoring factor in combination with the stress and somatic issues.
-Vaping: I smoked tons of e-cigarettes/vapes (brand: Elfbar) during the last 12 month before the T onset and while I had my ear injury. They contain highly ototoxic propylene glycol. The toxins might travel from the sinus to the ear and also the smoke might reach the ear canals through the air. I quit immediately of course. I have no hearing loss though.
-Heavy metals: Got quite high levels in my body, especially led and aluminium.
What treatments I started so far:
-Stress: Meditation and yoga. I also quit my job and will do a sabbatical. Mediation and calmness is bringing the T substantially down. Will go to Thailand next to do a meditation retreat for a couple of weeks in Dezember.
-Somatic: Did physiotherapy, osteopathy. Both therapists were working especially on the atlas C1 and my TMJ. On top I got a retainer, one for the day and one for the night. Unfortunately it didn’t help. And some acupuncture. The TCM lady gave me also some herbs, for some reason they seem to lower the T.
-Teath: Will get the root-canal-treated molar fixed in two weeks. I have great hope that this will be the solution. Not sure if I should redo the root-canal-treatment or pull the tooth completely out; any suggestions?
-Heavy metals: Drainage of heavy metals with chelate therapy (DMPS/EDTA). Got two infusions already, will get some more. No change so far.
-Supplements: I am taking a wide range of supplements. B vits, zink, magnesium, taurine, etc. Basically stuff thats good for the nervous system, recommended for T or missing in my boody due to my blood tests.
Hi Teo:
After reading through what you have told me here, there are a number of possible causes of your tinnitus, and likely your tinnitus is from more than one cause. This makes it harder to treat because you may treat one cause and nothing changes as far as you are concerned (but you have actually eliminated tinnitus from that cause). You still have to treat the other causes of tinnitus before it finally goes away or fades into the background and is not an issue anymore.
I don’t have any direct experience with vaping and tinnitus so can’t speak to that, but I can tell you that both nicotine and polyethylene glycol are ototoxic to some extent. Both can cause hearing loss and hearing loss can result in tinnitus as you already know.
Whether chemicals can cause tinnitus directly or the tinnitus arises from some degree of hearing loss caused by the chemicals is open to question. There are obviously two schools of thought on this. I tend to lean towards the idea of hearing loss as the precursor of tinnitus. This hearing loss may not be obvious on an audiogram for a couple of reasons. First, they typically don’t test the high frequencies above 8 kHz so you can have hearing loss up there and still be told you have perfectly normal hearing. The second is hidden hearing loss due to cochlear synaptopathy, although this is normally due to exposing your ears to loud sounds.
I also do not have any experience with DMPS. But I do know that if you are doing a detox and do it to fast and aggressively, you can cause tinnitus as the heavy metals get dumped into your bloodstream prior to being eliminated. So it is possible, but I don’t know how likely it is in your case.
The person yelling into your ear resulted in acoustic trauma resulting in loudness hyperacusis and no doubt some hidden cochlear synaptopathy so you heard things differently but nothing would show up via hearing testing. Fortunately your hyperacusis went away. But you still have some symptoms of acoustic shock disorder that have not yet gone away such as the vibrating sensation and strange tinnitus-like sounds.
I don’t see a strong connection between your vaping and drinking a glass of wine and your resulting loud tinnitus. As you and your doctors have said, it is probably due to several different factors.
Since you didn’t have a prior audiogram, you don’t know whether the yelling in your ear caused your high-frequency hearing loss above 14 kHz or not. It may have or it could be due to attending previous loud concerts and other loud venues.
As you already know, stress plays a big part in tinnitus and tinnitus severity. And if you took any medications for the stress/breakdown/panic attack those drugs can all add to your tinnitus.
The fact your C1 was out of proper alignment is another cause of tinnitus. You don’t mention, but C2 misalignment also affects tinnitus. So do misalignments (subluxations) further down your cervical spine such as around C5 which can also cause problems. So you want to be sure ALL your cervical vertebrae are properly aligned.
If you have an infected root canal tooth, it’s probably better to have it taken out, rather than just trying to kill the infection according to the latest information I’ve read. It may not help your tinnitus, but it is better for your overall health in any case.
The vaping and heavy metals in your body can affect your tinnitus, so stopping the vaping and detoxing is certainly a step in the right direction. You may have to wait until the detox is complete and your body adjusts before you notice a change in tinnitus IF your tinnitus is connected to the detoxing.
Learning how to reduce your stress and relax is very important and it is good to see that you are really working on that and that it is having an effect on lowering your tinnitus.
Taking your supplements is also a good step in the right direction such as zinc and magnesium. Also, be sure your Vitamin D3 is at the optimal level–around 70 ng/mL (175 nmol/L). Most people are way down around 20 to 30 ng/mL (75 nmol/L) which is too low for optimal health.
In order to habituate to your tinnitus so it no longer bothers you, be sure you don’t think of your tinnitus as a threat to your well-being. When you think of your tinnitus as a threat, your limbic system keeps bringing it to your attention. However, if you just think of it as a useless background sound that is safe to ignore, then you can slowly habituate to your tinnitus. This is another very important strategy in addition to other treatments you are doing.
Cordially,
Neil
Thx Neil!
Why is Lisinopril one of the least ototoxic drugs for BP if it appears as one of the worst offenders in your publication The Relative Ototoxicity of Anti-Hypertensive Drugs (page 11?
Hi Carlos:
That’s a good question. The simple answer is that I found a lot more information about the ototoxicity of anti-hypertensive drugs. So, if you read my Special Report on the relative ototoxicity of anti-hypertensive drugs you get one answer, and if you new material, you get another (and hopefully more-accurate) answer.
The basic reason for the changes is that in the former report, I used just the number of reports of ototoxic side effects, so the more popular drugs typically had consequent more reports than lesser used drugs. With the latest report, I had access to the number of prescriptions for some of the drugs. Thus I divided the number of number of prescriptions by the number of ototoxic reports in order to make a better comparison between the various drugs for which I had this information.
Thus, for example, a drug that had 1,000 reports of tinnitus, but that was based on 100,000,000 filled prescriptions is less ototoxic than a drug that had only 500 reports of tinnitus but that was based on just 10,000,000 prescriptions filled.
For your information, I have pulled the special report you have from the website. I’ve replaced it with a new one that reflects all the latest information I have currently available to me. The new special report is called “The Relative Ototoxicity of Selected Classes of Ototoxic Drugs” and includes tables not only for anti-hypertensive drugs, but tables for non-steroidal anti-inflammatory drugs (NSAIDs), selective serotonin reuptake inhibitor drugs (SSRIs), HMG-COA Reductase Inhibitor (Statin) drugs, some common classes of antibiotic drugs and Benzodiazepines.
If you are interested, you can get this special report at https://hearinglosshelp.com/shop/the-relative-ototoxicity-of-selected-classes-of-ototoxic-drugs/
Cordially,
Neil
I was on Lipitor years ago and struggled with tinnitus terrible for months after I went off of it. Fast forward to 3 years later I started taking crestor. Well once again my ears start fluttering and feeling clogged up. I went of the crestor but I am still struggling with crazy tinnitus. I was on this medicine two months and have been off for about two months. I just feel like it has to be the crestor. What is your opinion? What ear symptoms can crestor cause and can it last for a while after the medicine is stopped. Thank you for always being so gracious and answering all our questions.
Hi Pam:
Thousands of people have reported hearing loss and tinnitus from taking Atorvastatin (Lipitor) to the FDA’s data base no I’m not surprised that you got tinnitus from taking it.
Rosuvastatin (Crestor) is a similar drug to Lipitor and has much the same ototoxic side effects. Hundredn and hundreds of people have experienced hearing loss and tinnitus from taking this drug. I don’t have as many reports to the FDA from Crestor than for Lipitor, but that is likely because Crestor is a newer drug so not as many people have taken it at this point.
I have 25 different ototoxic side effects listed for Crestor–so just about any ear problem can be caused by this drug.
One man reported that his tinnitus went away a month after he stopped taking Crestor, so you may have a similar experience, but with a longer time-frame. So hopefully you tinnitus will fade away in time like the tinnitus from Lipitor did.
Cordially,
Neil
Just to add to my previous post. I do take Xanax when I fly. I took about 4 in a 10 day time frame. Could that cause a spike in my tinnitus. I definitely had it before but it did get worse after my travels.
I did go to an audiologist who said my hearing is amazing! He thought crestor could be the culprit but not much info on it. I didn’t ask him how long this should last. Will it go away if it was the crestor or Xanax? Thank you so much.
Hi Pam:
Whether your tinnitus goes away or not often depends largely on your emotional state towards your tinnitus. If you worry and obsess about your tinnitus, then it tends to stick around and often gets worse. In contrast, if you basically ignore your tinnitus and focus on the loves of your life, often your tinnitus fades into the background and may totally disappear. But you must not think of your tinnitus as a threat to your well-being in any way if you want this to happen as your brain is always alert to threats to your well-being which includes tinnitus if you worry about it.
Cordially,
Neil
Thank you so much. You are such a blessing to us all and so willing to answer our questions.
Thank you
Pam