TINNITUS

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Tinnitus
Vitamin B-12 (Cobalamin)

Checklist for Tinnitus (Ringing in the Ears)

Rating	Nutritional Supplements	Herbs
	Melatonin (insomnia-associated) Zinc (for deficiency only)
	Vitamin B12 (injection)	Ginkgo biloba Periwinkle
See also:  Homeopathic Remedies for Tinnitus
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of tinnitus? Symptoms may include hearing buzzing, roaring, ringing, whistling, or hissing sounds. These sounds may be intermittent, continuous, or pulsing. Tinnitus may interfere with normal activities and sleep, and there may be an associated decrease in the ability to hear conversation or other sounds in the environment.

How is it treated? Conventional treatment is typically directed at any underlying medical condition. In some cases, doctors recommend the use of a tinnitus masker, which is a hearing device that produces a sound that is more tolerable than the tinnitus. In addition, doctors may suggest the use of earplugs in the presence of loud noises to prevent damage to the ear.

Dietary changes that may be helpful: Ménière’s disease (a condition characterized by tinnitus, vertigo, and hearing loss) is reportedly associated with various metabolic abnormalities, including elevations of serum cholesterol and/or triglycerides and abnormal regulation of blood sugar. In one trial, people with Ménière’s disease who replaced refined carbohydrates in their diet with foods high in fiber and complex carbohydrates frequently experienced an improvement or disappearance of their tinnitus.¹

Nutritional supplements that may be helpful: Zinc supplements have been used to treat people who had both tinnitus and hearing loss (usually age-related). Of those who had initially low blood levels of zinc, about 25% experienced an improvement in tinnitus after taking zinc (90–150 mg per day for three to six months).² Such large amounts of zinc should be monitored by a doctor. Two controlled clinical trials^{3 4} found no benefit from zinc supplementation (66 mg per day in one double-blind trial) in people with tinnitus. However, participants in these studies were not zinc deficient. Preliminary research suggests that zinc supplementation is only helpful for tinnitus in people who are zinc deficient.⁵ A doctor can measure blood levels of zinc.

In a double-blind trial, melatonin supplementation (3 mg taken nightly) improved the symptoms of tinnitus.⁶ Although improvement did not reach statistical significance for all participants, the results were significant in those who reported more severe symptoms (such as two-sided vs. one-sided tinnitus). Among participants who had difficulty sleeping due to tinnitus, 47% of those who took melatonin reported sleep improvement after one month, compared with only 20% of those who took placebo.

People exposed to loud noise on the job who develop tinnitus are commonly deficient in Vitamin B12.⁷ Intramuscular injections of vitamin B12 reduced the severity of tinnitus in some of these people. Injectable vitamin B12 is available only by prescription. The effect of oral vitamin B12 on tinnitus has not been studied.

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful: Lesser periwinkle (Vinca minor) contains a compound known as vincamine. Extracts containing vincamine have been used in Germany to help decrease tinnitus.⁸ Preliminary clinical trial data show that vinpocetine, a semi-synthetic version of vincamine, can help reduce symptoms in people whose tinnitus is due to poor blood flow.⁹ Because these extracts are not widely available outside of Germany, consult with a doctor knowledgeable in botanical medicine about obtaining them.

Ginkgo biloba has been used to treat tinnitus, with mixed results.¹⁰ The largest placebo-controlled trial to date failed to find any effect of 150 mg per day of ginkgo extract in people with tinnitus.¹¹ Two smaller, controlled trials have found that standardized ginkgo extract (120 mg per day, containing 24% flavone glycosides and 6% terpene lactones), was effective at relieving the symptoms of tinnitus.^{12 13} One trial failed to find ginkgo beneficial, but used less than 30 mg of ginkgo extract per day, an amount unlikely to have any therapeutic effect.¹⁴

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

Other integrative approaches that may be helpful: Acupuncture has been studied as a treatment for tinnitus in several controlled trials. Preliminary trials have reported improvement in symptoms of tinnitus following acupuncture treatment, but this relief was either not permanent or did not reach statistical significance.¹⁵ Most trials have shown no advantage of acupuncture treatment over placebo for the treatment of tinnitus.^{16 17 18 19 20 21 22} A review of clinical trials concluded that acupuncture is not an effective treatment for tinnitus.²³

1. Spencer JT Jr. Hyperlipoproteinemia, hyperinsulinism, and Meniere’s disease. South Med J 1981;74:1194–7.

2. Shambaugh GE. Zinc and presbycusis. Am J Otol 1985;6:116–7.

3. Paaske PB, Pedersen CB, Kjems G, Sam IL. Zinc in the management of tinnitus. Placebo-controlled trial. Ann Otol Rhinol Laryngol 1991;100:647–9.

4. Paaske PB, Kjems G, Pedersen CB, Sam ILK. Zinc in the management of tinnitus. Placebo-controlled trial. Ann Otol Rhinol Laryngol 1991;100:647–9.

5. Ochi K, Ohashi T, Kinoshita H, et al. The serum zinc level in patients with tinnitus and the effect of zinc treatment. Nippon Jibiinkoka Gakkai Kaiho 1997;100:915–9 [in Japanese].

6. Rosenberg SI, Silverstein H, Rowan PT, Olds MJ. Effect of melatonin on tinnitus. Laryngoscope 1998;108:305–10.

7. Shemesh Z, Attias J, Ornan M, et al. Vitamin B12 deficiency in patients with chronic tinnitus and noise-induced hearing loss. Am J Otolaryngol 1993;14:94–9.

8. Weiss RF. Herbal Medicine. Gothenburg, Sweden: Ab Arcanum and Beaconsfield, UK: Beaconsfield Publishers Ltd, 1988, 181.

9. Ribarti O, Zelen B, Kollar B. Ethyl apovincaminate in the treatment of sensorineural impairment of hearing. Arzneimittelforschung 1976;26:1977–80.

10. Ernst E, Stevinson C. Ginkgo biloba for tinnitus: a review. Clin Otolaryngol 1999;24:164–7.

11. Drew S, Davies E. Effectiveness of Ginkgo biloba in treating tinnitus: double blind, placebo-controlled trial. BMJ 2001;322:1–6.

12. Meyer B. A multicenter randomized double-blind study of Ginkgo biloba extract versus placebo in the treatment of tinnitus. In Rokan (Ginkgo biloba): Recent Results in Pharmacology and Clinic, ed. EW Funfgeld. New York: Springer-Verlag, 1988, 245–50.

13. Morgenstern C, Biermann E. Ginkgo biloba special extract EGb 761 in the treatment of tinnitus aurium: Results of a randomized, double-blind, placebo-controlled study. Fortschr Med 1997;115:7–11.

14. Holgers K, Axelsson A, Pringle I. Ginkgo biloba extract from the treatment of tinnitus. Audiol 1994;33:85–92.

15. Furugard S, Hedin PJ, Eggertz A, Laurent C. Acupuncture worth trying in severe tinnitus. Lakartidningen 1998;95:1922–8 [in Swedish].

16. Nielsen OJ, Moller K, Jorgensen KE. The effect of traditional Chinese acupuncture on severe tinnitus. A double-blind, placebo-controlled clinical study with an open therapeutic surveillance. Ugeskr Laeger 1999;161:424–9 [in Danish].

17. Vilholm OJ, Moller K, Jorgensen K. Effect of traditional Chinese acupuncture on severe tinnitus: a double-blind, placebo-controlled, clinical investigation with open therapeutic control. Br J Audiol 1998;32:197–204.

18. Axelsson A, Andersson S, Gu LD. Acupuncture in the management of tinnitus: a placebo-controlled study. Audiology 1994;33:351–60.

19. Nilsson S, Axelsson A, Li De G. Acupuncture for tinnitus management. Laryngoscope 1988;98:664–7.

20. Thomas M, Laurell G, Lundeberg T. Acupuncture for the alleviation of tinnitus. Scand Audiol 1992;21:245–51.

21. Marks NJ, Emery P, Onisiphorou C. A controlled trial of acupuncture in tinnitus. J Laryngol Otol 1984;98:1103–9.

22. Hansen PE, Hansen JH, Bentzen O. Acupuncture treatment of chronic unilateral tinnitus—a double-blind cross-over trial. Clin Otolaryngol 1982;7:325–9.

23. Park J, White AR, Ernst E. Efficacy of acupuncture as a treatment for tinnitus: a systematic review. Arch Otolaryngol Head Neck Surg 2000;126:489–92 [review].

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