- Articulation disorders, auditory dysfunction, chronic cochleovestibular disorders, cochlear, deaf, deafness, ear infection, earache, ENT specialist, Eustachian tube, Eustachian tubes, glue ear, hearing loss, iodine deficiency, phonological disorders, presbycusis, tinnitus, ringing in the ears, sign language.
- Ear disorders are characterized by improper function of a person’s ear. The ear is important because it sends messages to the brain that allow a person to hear sounds and sense their balance. As a result, patients with ear disorders may be unable to hear sounds properly, or they may feel dizzy.
- The ear is divided into three parts: the outer, middle, and inner ear. Sound waves enter the outer ear and hit the eardrum. This causes the eardrum to vibrate. Behind the eardrum, in the middle ear, are three tiny bones: the malleus, incus, and stapes. When the eardrum vibrates, it signals these bones to transmit the vibrations to the hearing organ, called the cochlea, in the inner ear. Inside the cochlea, there are thousands of hair-like nerve endings, called cilia. When the cochlea vibrates, it causes the tiny cilia to move. The auditory nerves translate the vibrations and send them to the brain, where they are interpreted as sound.
- The middle ear is normally filled with air. It is connected to the back of the nose by the Eustachian tube. This tube is normally closed. However, sometimes (e.g. when a person yawns or swallows) it opens to let air into the middle ear and drain out any fluid. These tubes equalize pressure on either side of the middle ear.
- If any part of the ear is damaged, infected, or not properly developed, it may result in an ear disorder. Some of the most common types of ear disorders include ear infections, glue ear, hearing loss and deafness, Meniere’s disease, phonological disorders, and tinnitus (ringing in the ears).
Note: Below is a list of integrative therapies that have been studied or used traditionally or theoretically to treat a variety of ear disorders.
Good scientific evidence:
- Iodine: Iodine is an element that the human body needs to make thyroid hormones. Chronic iodine deficiency can cause many health problems such as thyroid gland dysfunction and many neurologic, gastrointestinal, and skin problems. Hearing loss may occur in people who have iodine deficiencies. Continuous supplementation with iodine may help improve hearing loss.
- Reactions to iodine can be severe, and deaths have occurred after exposure to the element. Avoid iodine-based products if allergic or hypersensitive to iodine. Do no use for longer than 14 days. Avoid Lugol solution and saturated solution of potassium iodide (SSKI, PIMA) with high amounts of potassium in the blood, pulmonary edema (fluid in the lungs), bronchitis, or tuberculosis. Use cautiously when applying to the skin because it may irritate or burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction. Iodine is safe in recommended doses for pregnant or breastfeeding women. Avoid povidone-iodine for perianal preparation during delivery or postpartum antisepsis.
Unclear or conflicting scientific evidence:
- Acupuncture: It is unclear if acupuncture can help treat patients with hearing loss. Early evidence suggests that deep needling acupuncture may be more effective in treating sudden deafness than shallow needling. However, better-designed trials are needed to reach a firm conclusion.
- Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, medical conditions of unknown origin, or infections. Acupuncture should not be applied to the chest in patients with lung diseases or on any area that may rely on muscle tone to provide stability. Avoid use in infants, young children, or in patients with needle phobias. Use cautiously with bleeding disorders, neurological disorders, seizure disorders, or diabetes. Use cautiously in the elderly or medically compromised patients. Use cautiously in patients who will drive or operate heavy machinery after acupuncture. Use cautiously if taking blood thinners. Avoid if pregnant.
- Applied kinesiology: Applied kinesiology (AK) uses muscle strength testing to identify nutritional deficiencies and health problems. Those that practice applied kinesiology believe that weakness in certain muscles corresponds to specific diseases or body imbalances. Early research suggests that symptoms of vertigo associated with Meniere’s disease may improve with rotational exercises. Further evidence is needed before a conclusion can be made.
- Applied kinesiology techniques in themselves are harmless. However, medical conditions should not be treated with applied kinesiology alone. Applied kinesiology should not delay appropriate medical treatment.
- Art therapy: Art therapy involves many forms of art to treat anxiety, depression, and other mental and emotional problems. An art therapist helps a patient use many different types of artistic expression during art therapy. Drawing, painting, and sculpting are just a few examples of techniques that are used. Art therapy is practiced in hospitals, clinics, public and community agencies, wellness centers, educational institutions, businesses, and private practices. There is limited evidence suggesting that art therapy may be a beneficial treatment for phonological disorders in children. However, more studies are needed to determine the meaning of these findings.
- Because art therapy may stir up distressing thoughts or feelings, it should be used under the guidance of a qualified art therapist or mental health professional. Related materials, such as turpentine or mineral spirits, should be used in areas with good ventilation because they release potentially toxic fumes.
- Belladonna: Belladonna has been used for centuries to treat many medical conditions. Little reliable research is available on the use of belladonna for otitis media. Until additional studies are performed, it remains unknown if this is an effective treatment.
- Avoid if allergic to belladonna or plants of the Solanaceae(nightshade) family (such as bell peppers, potatoes, or eggplants). Avoid with a history of heart disease, high blood pressure, heart attack, abnormal heartbeat, congestive heart failure, stomach ulcer, constipation, stomach acid reflux, hiatal hernia, gastrointestinal disease, ileostomy, colostomy, fever, bowel obstruction, benign prostatic hypertrophy (enlarged prostate), urinary retention, glaucoma (narrow angle), psychotic illness, Sjögren’s syndrome, dry mouth, neuromuscular disorders (such as myasthenia gravis), or Down’s syndrome. Avoid if pregnant or breastfeeding.
- Calendula: Calendula, also known as marigold, has been widely used on the skin to treat minor wounds, skin infections, burns, bee stings, sunburn, warts, and cancer. Calendula has been studied for reducing pain caused by otitis media. Some human studies suggest that calendula may possess mild anesthetic (pain-relieving) properties equal to those of similar non-herbal eardrop preparations. Further studies are needed before a recommendation can be made in this area.
- Use cautiously if allergic to plants in the Aster/Compositae family (such as ragweed, chrysanthemums, marigolds, or daisies). Use cautiously while driving or operating machinery. Avoid if pregnant or breastfeeding.
- Chiropractic, Spinal Manipulative Therapy, Spinal Manipulation: Chiropractic care focuses on how the relationship between musculoskeletal structure (mainly the spine) and bodily function (mainly nervous system) affects health. Chiropractors use many techniques, including spinal manipulative therapy, diet, exercise, X-rays, and other techniques. Although ear infections are treated with chiropractic manipulation with some success, well-designed clinical trials have not yet been conducted. Presently, there is insufficient evidence to support the use of chiropractic manipulation for the treatment of otitis media in children.
- Avoid with vertebrobasilar vascular insufficiency, aneurysms, arteritis, or unstable spondylolisthesis. Avoid use on post-surgical areas of para-spinal tissue. Use cautiously with acute arthritis, brittle bone disease, conditions that cause decreased bone mineralization, bleeding disorders, migraines, or if at risk of tumors or metastasis of the spine. Use extra caution during cervical adjustments. Avoid if pregnant or breastfeeding due to a lack of scientific data.
- Coenzyme Q10: More research is needed in patients with tinnitus with low levels of CoQ10 before a conclusion can be made.
- Allergy associated with coenzyme Q10 supplements has not been reported in the available literature, although rash and itching have been reported rarely. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk and do not use immediately after these procedures. Use caution with a history of blood clots, diabetes, high blood pressure, heart attack, or stroke, or with anticoagulants (blood thinners), antiplatelet drugs (like aspirin, warfarin, clopidogrel (like Plavix®), or blood pressure, blood sugar, cholesterol or thyroid drugs. Avoid if pregnant or breastfeeding.
- Danshen: Danshen (Salvia miltiorrhiza) is widely used in traditional Chinese medicine (TCM), often in combination with other herbs. Limited evidence suggests that danshen in combination with other herbs and supplements may be a less effective treatment for tinnitus than acupuncture. Additional research is needed to fully understand danshen’s effects on tinnitus.
- Avoid if allergic or hypersensitive to danshen. Use cautiously with altered immune states, arrhythmia, compromised liver function or a history of glaucoma, stroke, or ulcers. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Use cautiously if driving or operating heavy machinery. Avoid if taking blood thinners (anticoagulants), digoxin, or hypotensives including ACE inhibitors such as captopri, or Sophora subprostrata root or herba serissae. Avoid with bleeding disorders, low blood pressure, and following cerebal ischemia. Avoid if pregnant or breastfeeding.
- Folate: Folate and folic acid are forms of a water-soluble B vitamin. Folate occurs naturally in food and folic acid is the synthetic form of this vitamin. Folic acid supplementation was shown to slow the decline in hearing of speech frequencies associated with aging in a population from a country without folic acid fortification of food. The effect of folate on age-associated hearing decline requires confirmation, especially in populations from countries with folic acid fortification programs.
- Avoid if allergic or hypersensitive to folate or any folate product ingredients. Use cautiously if receiving coronary stents and with anemia and seizure disorders. It is recommended that pregnant women consume 400 micrograms of folate daily in order to reduce the risk of fetal defects. Folate is likely safe if breastfeeding.
- Ginkgo: Ginkgo biloba has been used medicinally for thousands of years. Early research has been conducted on the effect of ginkgo in chronic cochleovestibular (relating to parts of the ear) disorders. Further research is needed before a conclusion can be made on the effectiveness of ginkgo for cochlear deafness. Ginkgo has also been studied as a possible treatment for tinnitus. However, results are conflicting. Additional well-designed research is needed to make a conclusion.
- Avoid if allergic or hypersensitive to members of the Ginkgoaceaefamily. If allergic to mango rind, poison sumac, poison ivy, poison oak, or cashews, then allergy to ginkgo is possible. Avoid if taking anticoagulants due to an increased risk of bleeding. Ginkgo should be stopped two to three weeks before surgical procedures. Use cautiously with seizures or in children. Ginkgo seeds are dangerous and should be avoided. Skin irritation and itching may also occur due to ginkgo allergies. Do not use ginkgo in supplemental doses if pregnant or breastfeeding. There is conflicting research regarding the use of ginkgo for tinnitus. Additional well-designed research is needed in order to resolve this controversy.
- Hypnotherapy, hypnosis: Hypnosis is a trance-like state in which a person becomes more aware and focused and is more open to suggestion. Hypnotherapy has been used to treat health conditions and to change behaviors. It remains unknown if hypnotherapy can effectively treat tinnitus. Study results are conflicting and additional well-designed research is needed.
- Use cautiously with mental illnesses (e.g. psychosis/schizophrenia, manic depression, multiple personality disorder, or dissociative disorders) or seizure disorders.
- Kudzu: Kudzu has been traditionally used in China to treat alcoholism, diabetes, gastroenteritis, and deafness. Kudzu was used in clinical study to treat sudden nerve deafness. Additional evidence is needed to confirm these results.
- Avoid if allergic to kudzu, its constituents, or members of the Fabaceae/Leguminosae family. Avoid if taking methotrexate. Use cautiously if taking blood thinners, drugs that treat diabetes, benzodiazepines, bisphosphonates, mecamylamine, neurologic agents, drugs that have estrogenic activity, drugs that lower blood pressure, or drugs that are broken down by the liver. Avoid if pregnant or breastfeeding, due to a lack of safety evidence.
- Lavender: Oils from lavender flowers are used in aromatherapy, baked goods, candles, cosmetics, detergents, jellies, massage oils, perfumes, powders, shampoo, soaps, and teas. A small clinical trial used a naturopathic eardrop called NHED (containing Allium sativum, Verbascum thapsus, Calendula flores, Hypericum perfoliatum, lavender, and vitamin E in olive oil) with and without an antibiotic and topical anesthetic. It was found that ear pain was self-limiting and resolved after a few days with or without antibiotics. This evidence is early, and further research is needed before any conclusion about this treatment can be made.
- Avoid if allergic or hypersensitive to lavender. Avoid with a history of seizures, bleeding disorders, eating disorders (such as anorexia or bulimia), or anemia (low levels of iron). Avoid if pregnant or breastfeeding.
- Magnet therapy: The use of magnets to treat illness has been described historically in many civilizations. In modern times, magnetic fields play an important role in Western medicine, including use for magnetic resonance imaging (MRI), pulsed electromagnetic fields, and experimental magnetic stimulatory techniques. There are several small studies that have investigated the use of electromagnetic stimulation for tinnitus. Some trials reported no benefits, while other study reported significant improvements in symptom severity. Most research in this area has not been well designed or reported, and it remains unclear if magnet therapy is useful for this condition.
- Avoid with implantable medical devices, such as heart pacemakers, defibrillators, insulin pumps, or hepatic artery infusion pumps. Avoid with myasthenia gravis or bleeding disorders. Avoid if pregnant or breastfeeding. Magnet therapy is not advised as the sole treatment for potentially serious medical conditions, and it should not delay the time to diagnosis or treatment with more proven methods. Patients are advised to discuss magnet therapy with a qualified healthcare provider before starting treatment.
- Mullein: Mullein (Verbascum thapsus) has been used in natural medicine for centuries and is among the oldest known medicinal plants. There are some clinical studies using mullein in combination with other herbal products as an eardrop to treat earaches caused by ear infections. It is not clear what the effects of mullein alone are on ear infections because the product studied was a combination of different herbal products. Additional study is needed before a conclusion can be made regarding use of mullein for earache associated with acute otitis media.
- Avoid if allergic/hypersensitive to mullein (Verbascum thapsus), its constituents, or any of the Scrophulariaceae (figwort) family. Use cautiously if taking anticoagulants (bloodthinners). There are reports that mullein may contain a toxin called rotenone, which is an insecticide. Avoid if pregnant or breastfeeding.
- Music therapy: Specially designed music therapy may help improve symptoms of tinnitus. More research is needed. Music therapy is generally known to be safe.
- Noni: Noni (Morinda citrifolia) is a traditional folk medicinal plant that has been used for more than 2,000 years in Polynesia. Noni juice has been used for many years for a wide variety of indications in Southeast Asia, and noni juice may improve hearing in patients with hearing loss. Although results are promising, additional research is warranted in this area.
- Avoid if allergic to noni, its constituents, or any plants in the Rubiaceae family. Use cautiously if taking oral agents, anticoagulants (blood thinners), antivirals, blood pressure-lowering drugs, or immunosuppressants. Use cautiously with injuries, low blood pressure, HIV/AIDS, liver problems, gastrointestinal disorders and obstructions, or kidney problems. Use cautiously after surgery. Avoid if pregnant or breastfeeding.
- Physical therapy: The goal of physical therapy is to improve mobility, restore function, reduce pain, and prevent further injury. A variety of techniques, including exercises, stretches, traction, electrical stimulation, and massage, are used during physical therapy sessions. There is limited study on the effects of physical therapy in tinnitus. Limited available study found that acupuncture showed more benefit on reducing the severity of tinnitus and improving quality of life than physical therapy. More study is needed in this area.
- Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with their qualified healthcare professionals before beginning any treatments. Based on the available literature, physical therapy appears generally safe when practiced by a qualified physical therapist. However, physical therapy may aggravate some pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
- Probiotics: Probiotic capsules (containing Lactobacillus rhamnosus GG and LC705, Bifidobacterium breve 99, and Propionibacterium freudenreichii JS) were not shown to protect against ear infections in children. More research is needed to confirm these findings.
- Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
- Relaxation therapy: Relaxation techniques include behavioral therapeutic approaches that differ widely in philosophy, methodology, and practice. The primary goal is usually non-directed relaxation. In preliminary studies, relaxation therapy has been associated with benefits for patients with tinnitus. Further research is needed to confirm these results.
- Avoid with psychiatric disorders such as schizophrenia/psychosis. Jacobson relaxation (flexing specific muscles, holding that position, and then relaxing the muscles) should be used cautiously with illnesses such as heart disease, high blood pressure, or musculoskeletal injury. Relaxation therapy is not recommended as the sole treatment approach for potentially serious medical conditions, and it should not delay the time to diagnosis or treatment with more proven techniques.
- Rutin: Rutin is a yellow crystalline flavonol glycoside (C27H30O16) that is found in various plants, especially the buckwheat plant, black tea, apple peels, onions, and citrus. Early study results support the use of O-(beta-hydroxyethyl)-rutosides for reduction of symptoms associated with Meniere’s syndrome. Additional study is warranted in this area.
- Avoid if allergic/hypersensitive to O-(beta-hydroxyethyl)-rutosides or plants that rutin is commonly found in, such as rue, tobacco, or buckwheat. Use cautiously in elderly patients. Use cautiously with skin conditions. Use cautiously if taking diuretics, anti-coagulants, or medications used to treat edema. Use cautiously if pregnant or breastfeeding.
- Sanicle: Sanicle has been studied as a treatment for recurrent otitis media. More evidence is needed before a conclusion can be made.
- Avoid if allergic or sensitive to sanicle. Use cautiously with stomach problems. Use cautiously if taking blood pressure-lowering or diuretic drugs. Avoid if pregnant or breastfeeding.
- Tai chi: Early scientific evidence suggests that tai chi may be helpful as an adjunct treatment to regular vestibular rehabilitation programs. Tai chi may improve body stability and footfall stability. More studies are needed on the effects of tai chi for vestibulopathy.
- Avoid with severe osteoporosis or joint problems, acute back pain, sprains, or fractures. Avoid during active infections, right after a meal, or when very tired. Some believe that visualization of energy flow below the waist during menstruation may increase menstrual bleeding. Straining downwards or holding low postures should be avoided during pregnancy, and by people with inguinal hernias. Some tai chi practitioners believe that practicing for too long or using too much intention may direct the flow of chi (qi) inappropriately, possibly resulting in physical or emotional illness. Tai chi should not be used as a substitute for more proven therapies for potentially serious conditions. Advancing too quickly while practicing tai chi may increase the risk of injury.
- Yoga: Yoga is an ancient system of relaxation, exercise, and healing with origins in Indian philosophy. It is unclear whether yoga therapy may improve tinnitus. Although relaxation may theoretically benefit this condition, additional research is needed before a recommendation can be made.
- Yoga is generally considered to be safe in healthy individuals when practiced appropriately. Avoid some inverted poses with disc disease of the spine, fragile or atherosclerotic neck arteries, extremely high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, cervical spondylitis, or if at risk for blood clots. Certain yoga breathing techniques should be avoided with heart or lung disease. Use cautiously with a history of psychotic disorders. Yoga techniques are believed to be safe during pregnancy and breastfeeding when practiced under the guidance of expert instruction. However, poses that put pressure on the uterus, such as abdominal twists, should be avoided in pregnancy.
- Zinc: Zinc formulations have been used since ancient Egyptian times to enhance wound healing. Studies on the efficacy of zinc in treating tinnitus have produced conflicting results. Further research is necessary before a conclusion can be drawn.
- Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride because studies have not evaluated its safety or effectiveness. While zinc appears safe during pregnancy in amounts lower than the established upper intake level, caution should be used because studies cannot rule out the possibility of harm to the fetus.
Fair negative scientific evidence:
- Acupuncture: Scientific evidence suggests that acupuncture is not an effective treatment for tinnitus. Small trials have been conducted and found no benefits over placebo for the treatment of chronic unilateral or bilateral tinnitus. However, non-controlled case series have found possible benefit. Larger studies are needed before a conclusion can be made. Early evidence suggests that deep needling may be more effective in treating sudden deafness than shallow needling. Better-designed trials are needed on the effects of acupuncture for hearing loss.
- Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, medical conditions of unknown origins, or infections. Acupuncture should not be applied to the chest in patients with lung diseases or on any area that may rely on muscle tone to provide stability. Avoid use in infants, young children, or in patients with needle phobias. Use cautiously with bleeding disorders, neurological disorders, seizure disorders, or diabetes. Use cautiously in elderly or medically compromised patients. Use cautiously in patients who will drive or operate heavy machinery after acupuncture. Use cautiously if taking anticoagulants. Avoid if pregnant.
- Reflexology: Limited available study suggests that treatment given by a reflexologist is less effective (in terms of number of ear disorders, number of antibiotic treatments, number of sickness days, and duration of ear disorders) than treatment given by a general practitioner for ear infections.
- Avoid with recent or healing foot fractures, unhealed wounds, or active gout flares affecting the foot. Use cautiously and seek prior medical consultation with osteoarthritis affecting the foot or ankle, or severe vascular disease of the legs or feet. Use cautiously with diabetes, heart disease, or the presence of a pacemaker, unstable blood pressure, cancer, active infections, past episodes of fainting (syncope), mental illness, gallstones, or kidney stones. Use cautiously if pregnant or breastfeeding. Reflexology should not delay diagnosis or treatment with more proven techniques or therapies.
Traditional or theoretical uses lacking sufficient evidence:
- Aconite: The aconite plant grows in rocky areas. It is often found in the mountainous woodlands of many parts of Europe, especially France, Austria, Germany, and Denmark. It has been proposed that aconite may help treat otitis media. However, a firm conclusion cannot be made until human studies are performed in this area.
- Aconite is highly toxic and is not safe for human consumption. Avoid with heart disease, irregular heartbeat, hemodynamic instability (abnormal blood flow), and gastrointestinal disorders (such as ulcers, reflux esophagitis, ulcerative colitis, spastic colitis, or diverticulosis). Use cautiously with diabetes or suicidal tendencies. Avoid if younger than 18 years old due to a lack of safety evidence. Avoid if pregnant or breastfeeding.
- Chamomile: Chamomile is an herb that has an apple-like smell and taste. It is commonly taken as a tea. Although it has been suggested that chamomile may help treat ear infections, studies are currently lacking. It remains unknown if this is a safe and effective treatment for humans.
- Avoid if allergic to chamomile or any related plants, such as aster, chrysanthemum, mugwort, ragweed, or ragwort. Avoid with heart disease, breathing disorders, hormone-sensitive conditions, or central nervous system disorders. Avoid if taking cardiac depressive agents, central nervous system depressants, respiratory depressive agents, or anticoagulants. Use cautiously if taking benzodiazepine, anti-arrhythmic medications, calcium channel blockers, alcohol, sedative agents, anxiolytic medications, spasmolytic drugs, oral medications, or agents that are broken down by the liver. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding.
- Garlic (Allium sativum): Garlic has been used traditionally for ear infections. It is crushed and diluted in a carrier oil, such as olive oil, which is then applied topically. A small clinical trial used a naturopathic eardrop mixture containing garlic,mullein,calendula,St. Johns wort, lavender, and vitamin E in olive oil, with and without an antibiotic and topical anesthetic. It was found that ear pain was self-limiting and resolved after a few days with or without antibiotics. Additional research is needed to make a conclusion.
- Avoid if allergic or hypersensitive to garlic or other members of the Lilaceae(lily) family (like hyacinth, tulip, onion, leek, chive). Avoid with a history of bleeding problems, asthma, diabetes, low blood pressure, or thyroid disorders. Stop using supplemental garlic two weeks before dental/surgical/diagnostic procedures and avoid using immediately after such procedures to avoid bleeding problems. Avoid in supplemental doses if pregnant or breastfeeding.
- St. John’s wort (Hypericum perfoliatum): St. John’s wort has been used traditionally for various kinds of pain, however, reliable evidence indicating effectiveness is currently lacking. In clinical study, a naturopathic eardrop mixture containing garlic,mullein,calendula, St. Johns wort, lavender, and vitamin E in olive oil, was used with and without an antibiotic and topical anesthetic. It was found that ear pain was self-limiting and resolved after a few days with or without antibiotics. This evidence is preliminary and further research is needed before any conclusion about this treatment can be made. It is currently unclear if St. John’s wort is effective for chronic ear infections.
- Avoid if allergic or hypersensitive to plants in the Hypericaceae family. Rare allergic skin reactions like itchy rash have been reported. Avoid with HIV/AIDS drugs (protease inhibitors) like indinavir (Crixivan®), or non-nucleoside reverse transcriptase inhibitors, like nevirapine (Viramune®). Avoid with immunosuppressant drugs (like cyclosporine, tacrolimus or myophenic acid). Avoid with organ transplants, suicidal symptoms or before surgery. Use cautiously with history of thyroid disorders. Use cautiously with drugs that are broken down by the liver, with monoamine oxidase inhibitors (MAOI) or selective serotonin reuptake inhibitors (SSRIS), digoxin, or birth control pills. Use cautiously with diabetes or with history of mania, hypomania (as in Bipolar Disorder), or affective illness. Avoid if pregnant or breastfeeding.
- Taurine: Taurine, or 2-aminoethanesulfonic acid, was originally discovered in ox (Bos taurus) bile and was named after taurus, or bull. In the diet, taurine is considered to be a non-essential amino acid, although it is not a true amino acid. Taurine is found in high abundance in the tissues of many animals, especially sea animals, and in much lower concentrations in plants, fungi, and some bacteria. It has been suggested, but not scientifically proven, that taurine may help treat tinnitus.
- Taurine is an amino acid-like compound, and it is unlikely that there are allergies related to this constituent. However, allergies may occur from multi-ingredient products that contain taurine. Use cautiously with increased levels of very low density lipoprotein (VLDL) cholesterol, high triglycerides, potential for mania, or with a history of low blood pressure, bleeding disorders, or epilepsy. Use cautiously if taking lipid-lowering medications, blood pressure-lowering agents, drugs that affect blood sugar, or blood-thinners (anticoagulants or anti-platelet agents). Do not consume with energy drinks containing taurine, caffeine, glucuronolactone, or B vitamins. Do not consume taurine before drinking alcohol or exercising. Use cautiously if pregnant or breastfeeding; taurine is a natural component of breast milk.
- This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
- American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). .
- American Academy of Pediatrics. .
- Blakley BW, Blakley JE. Smoking and middle ear disease: are they related? A review article. Otolaryngol Head Neck Surg. 1995 Mar;112(3):441-6.
- Browning G. Evidence-based advice for glue ear. Practitioner. 2003 Aug;247(1649):626-7, 630-1, 634-5.
- Ilicali OC, Keles N, Deqer K, et al. Relationship of passive cigarette smoking to otitis media. Arch Otolaryngol Head Neck Surg. 1999 Jul;125(7):758-62.
- National Institute on Deafness and Other Communication Disorders. .
- Natural Standard: The Authority on Integrative Medicine. .
- [No authors listed]. Grommets for glue ear. Br J Perioper Nurs. 2005 Sep;15(9):352-3.
- Noble W, Tyler R. Physiology and phenomenology of tinnitus: Implications for treatment. Int J Audiol. 2007 Oct;46(10):569-74.
- Seydel C, Reisshauer A, Haupt H, et al. [The role of stress in the pathogenesis of tinnitus and in the ability to cope with it] [Article in German] HNO. 2006 Sep;54(9):709-14.
Overview: An ear infection occurs when a cold, allergy, or upper respiratory infection leads to the accumulation of pus, inflammation, and mucus behind the eardrum, blocking the Eustachian tube. This tube connects the middle ear to the back of the nose.
- More fluid may collect and push against the eardrum, causing pain and sometimes a temporary or, in severe cases, a permanent loss of hearing.
- Acute ear infections usually clear up after one to two weeks of treatment. Sometimes, ear infections last longer and become chronic (long-term). After an infection, fluid may stay in the middle ear. This may lead to more infections and hearing loss.
- Although ear infections are most common in young children, they may also affect adults.
Causes: Ear infections can start with a bacterial or viral infection. In such cases, the middle and/or outer structures of the ear become inflamed from the infection. Fluid may also build up behind the eardrum. Bacteria cause about 65-75% of all ear infections. The most common types of these bacteria are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Viruses that may lead to ear infections include the respiratory syncytial virus (RSV), the most frequent type found, followed by influenza (flu) viruses.
- Ear infections also may be associated with problems, such as swelling in the Eustachian tubes, the narrow passageways that connect the middle ear to the throat. Normally, these tubes equalize pressure inside and outside the ear. A child’s Eustachian tubes are narrower and shorter than an adult’s. This makes it easier for fluid to get trapped in the middle ear when the Eustachian tubes dysfunction or become blocked during a cold. It also provides a perfect breeding ground for infections. Also, just as the mucus in the nose becomes thicker and harder to expel, fluid inside the ear may also become thick and difficult to drain.
- Another factor that contributes to ear infections is swelling of the small clumps of glandular tissue at the back of the nose (called adenoids). These are tissues located in the upper throat near where the Eustachian tubes connect. Adenoids contain lymphocytes, white blood cells that normally fight against infections. Sometimes the adenoids become infected or enlarged, blocking the Eustachian tubes. Infection in the adenoids may also spread to the Eustachian tubes, causing ear infections.
- Children also do not have fully developed immune systems, so it is easier for them to develop many illnesses, including ear infections.
Symptoms: Ear infections are often difficult to detect in children because many children affected by this disorder do not yet have sufficient speech and language skills to tell someone what is bothering them. Common signs to look for include unusual irritability, difficulty sleeping, tugging or pulling at one or both ears, earache, fever, fluid draining from the ear, loss of balance, and unresponsiveness to quiet sounds or other signs of hearing difficulty. These signs may include sitting too close to the television or being inattentive. Fluid buildup in the middle ear also blocks sound, which can lead to temporary hearing loss.
- If the pressure from the fluid buildup is high enough, it may cause the eardrum to rupture, resulting in drainage of fluid from the ear, which may include blood and thick, yellow pus. This releases the pressure behind the eardrum, usually relieving pain.
- If there is fluid in the middle ear, it may feel similar to a sensation of ear fullness or “popping.” The fluid behind the eardrum may block sound, so mild temporary hearing loss can happen, although it may not be obvious.
- Possible complications include short- or long-term hearing loss, ruptured ear drum, and inflammation of the rounded protrusion of bone just behind the ear, called the mastoid bone. When the mastoid bone swells, it is commonly called mastoiditis.
Diagnosis: Ear infections are usually diagnosed after a medical history, physical exam, and ear exam. If a middle ear infection is suspected, a healthcare provider will use an instrument, called a pneumatic otoscope, to look at the eardrum for signs of redness, bulging, or fluid behind the eardrum.
- Reflectometry is used if the ear exam with a pneumatic otoscope does not indicate that fluid is behind the eardrum. The tip of a small handheld instrument is placed in the ear canal. This instrument sends off a sound. How the eardrum reacts to the sound tells the doctor if fluid is present.
- Tympanocentesis is performed when fluid stays behind the eardrum (chronic otitis media with effusion) or if an infection continues despite treatment with antibiotics. Tympanocentesis can remove the fluid. The doctor uses a needle to pierce the eardrum and suck out the fluid. A sample is usually tested for bacterial or viral growth. These tests reveal what kind of bacteria or virus is causing the infection and what medication is best for treatment. Patients may receive pain relievers or sedatives before the procedure.
Treatment: Ear infections can be treated several ways. The best treatment option for a patient depends on several factors, including the person’s age, medical history, level of pain, and the type of ear infection. Most ear infections go away without treatment in just a few days, and antibiotics will not help an infection caused by a virus. About 80% of children with acute otitis media recover without antibiotics, according to the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP).
- If a patient (adult or child) is uncomfortable, the doctor may recommend an over-the-counter (OTC) pain reliever, such as acetaminophen (Tylenol® or Tempra®) or ibuprofen (Advil® or Motrin®). It is important to read the labels closely on these medications and give the proper dosage, especially in children and infants.
- Ear drops are commonly used in both adults and children to relieve pain and inflammation. If fluid is not draining from the ear or ear tubes, prescription eardrops containing a local anesthetic (numbing agents) and anti-inflammatory drugs may be an option. Examples include benzocaine (Americaine Otic® or Otocain®) and antipyrine/benzocaine (Auralgan®, Auroto®, or Otocalm®). Ear drops containing neomycin and polymixin B (both antibiotics) are available for infections. These medications are also available as solutions and suspensions to treat a rupture.
- If the individual is younger than six months or has two or more ear infections within 30 days or fluid remains behind the eardrum (chronic otitis media with effusion), the doctor may recommend an antibiotic. The AAP and the AAFP recommend the use of high doses and short courses of amoxicillin (Amoxil®, Trimox®) or amoxicillin combined with clavulanate potassium (Augmentin®) in individuals (including children) with otitis media. Erythromycin antibiotics (Eryped® or Erytab®) may also be used.
- If fluid in the individual’s ear is affecting his or her hearing or recurrent ear infections do not respond to antibiotics, surgery may be needed. The most common surgery for ear infections is a myringotomy. During this procedure, which requires general anesthesia, a surgeon inserts a small drainage tube through the eardrum. This helps drain the fluid and equalize the pressure between the middle ear and outer ear. Hearing should improve immediately. If the ear infections continue after age four, the surgeon may recommend removing the adenoids.
Prevention: Ear infections are more common in children who are exposed to cigarette smoke in the home. Even fumes from tobacco smoke on the hair and clothes may affect the child.
- Breastfeeding a baby helps improve immunity and resistance to infections. This is because a mother’s breast milk contains important proteins that improve a baby’s developing immune system. The baby should be breastfed in an upright position to prevent the possibility of acquiring infections.
- Individuals should talk to their doctors about recommended vaccinations. Although there is currently no vaccine for infections, many immunizations can prevent illnesses that may progress to ear infections.
- Practicing good hygiene may also help reduce the risk of acquiring infections.
Overview: Glue ear occurs when the middle ear fills with a thick fluid that resembles glue. Different kinds of fluid may build up behind the eardrum, which ranges from yellow to white in color. The fluid weakens the vibrations of the eardrum, which may cause a patient to hear sounds quieter than they really are. One or both ears may be affected.
- Although glue ear can affect anyone, it is most common in young children.
- This condition usually goes away without treatment, and hearing returns to normal after several weeks to months. In some cases, the condition may come back in the future. However, as children grow older, glue ear becomes less common. It is considered rare in children who are older than eight years old. This is because the Eustachian tube widens with age, allowing the middle ear to drain properly.
Causes: The cause of glue ear is poorly understood. Experts believe it occurs when the Eustachian tube does not work properly. For instance, if the tube is blocked, does not open properly, or is too narrow, the amount of fluid and air in the middle ear is not regulated. Air in the middle ear may pass into the nearby cells if it is not replaced by air coming up the Eustachian tube. This may result in a vacuum-like effect in the middle ear, causing fluid to enter the middle ear from the nearby cells.
- Some cases of glue ear develop after a child has a cold, illness, or ear infection that causes the body to make extra mucus. In such cases, the mucus builds up inside the middle ear and does not drain down the Eustachian tubes.
Symptoms: Symptoms typically last a few weeks, although sometimes they may persist for a few months. The main symptom of glue ear is dulled hearing. This temporary hearing loss is usually mild, but the severity can vary from day to day in the same person. Hearing loss is generally worst when the fluid is very thick. Older children may be able to communicate that they are having trouble hearing, while younger children may be unresponsive to normal sounds. Some children may experience a mild earache from time to time.
- Because the thick fluid in the ear provides a good environment for bacteria to grow, children with glue ear have an increased risk of developing ear infections. Therefore, if a child experiences any of these symptoms, he/she should be taken to a doctor for a checkup.
Diagnosis: If glue ear is suspected, the child’s doctor may recommend an ear, nose, and throat (ENT) specialist. A procedure called an otoscopy may be performed to determine if the child has glue ear. During the procedure, a doctor uses an instrument called an otoscope to look inside the ear drum. The doctor may see signs of trapped fluid and poor movement of the eardrum, which indicate glue ear.
- A hearing test may also be performed. There are many different types of hearing tests available. During most tests, a child wears headphones and responds to different sounds.
Treatment: When a patient is diagnosed with glue ear, doctors typically wait to see if the condition improves on its own before starting treatment. The length of time a doctor might advise a patient to wait varies from weeks to several months.
- If the condition does not improve on its own, a balloon treatment may be recommended. During the procedure, a child uses the nose to blow up a special type of balloon. This process, called autoinflation, increases the pressure in the nose, which may help open up the Eustachian tube and allows the fluid to drain. This procedure is repeated several times until the fluid is drained. Although this procedure does not cause any side effects, it is not effective in all cases.
- If glue ear is persistent or severe, a minor operation may be recommended. During surgery, a small cut is made in the eardrum and fluid is drained. Then a ventilation tube is inserted into the ear. This tube (called a grommet) allows air to enter the middle ear. Hearing improves immediately. Grommets fall out of the ear as the eardrum grows (usually six to 12 months after surgery). Once the grommet falls out, the small hole in the eardrum heals quickly. In some cases, the small clumps of glandular tissue at the back of nose (called adenoids) may be removed.
Prevention: Because the cause of glue ear remains unclear, there is no way to prevent the condition. However, children who are breastfed and live in homes free of cigarette smoke may have a decreased risk of developing glue ear.
Hearing loss and deafness
Overview: Hearing problems may be present at birth or may occur later in life. Hearing loss may be mild, resulting in difficulties with conversation, or as severe as complete hearing loss (deafness). Depending on the cause, one or both ears may be affected.
Causes: Experts believe that a person’s biological makeup and long-term exposure to loud noises are the main factors that contribute to hearing loss. Frequent exposure to loud noises may damage the cochlea (ear organ), which can ultimately result in hearing loss. If hearing loss is caused by damage to the ears, the condition cannot be reversed. Sudden hearing loss might be caused by trauma to the ears or problems with blood circulation. If hearing loss occurs gradually, it may be caused by factors, such as aging, infections, tumors, or other diseases. It is normal for hearing, especially the ability to hear high-pitched tones, to decline with age.
- Earwax buildup is a common cause of temporary hearing loss. Once the earwax is removed, hearing returns to normal.
Symptoms: The severity of symptoms varies among patients. Some patients may hear dulled sounds, while others may not be able to hear at all. Common symptoms include hearing muffled qualities of sounds, difficulty understanding people when they talk (especially when there is background noise), frequently asking others to repeat things and speak louder, needing to turn up the volume of the television or radio, and withdrawal from conversations. Babies with hearing loss may be unresponsive or less responsive than normal to sounds.
Diagnosis: If hearing loss is suspected, a doctor may recommend a specialized doctor, called an audiologist. The audiologists will ask questions about the patient’s medical history and perform a hearing test called an audiogram to determine the severity of hearing loss. During an audiogram, the patient wears headphones and is exposed to various sounds that have different pitches and frequencies. The patient is asked to identify each time a sound is heard. The audiologist may also say various words to evaluate the patient’s hearing ability.
Treatment: If earwax buildup is causing symptoms, a doctor will remove the extra earwax. First, the doctor places a few drops of baby oil, glycerin, or mineral oil into the patient’s ears to loosen the wax. Warm water is then squirted into the ear. The patient then tilts the head and the water and wax drains out. This process may need to be repeated several times. Alternatively, a doctor may scoop out the wax with a small instrument called a curette. A suction device may also be used to remove loosened wax from the ears.
- Individuals who experience hearing loss due to aging may benefit from hearing aids. These battery-operated devices are available in three basic styles: behind-the-ear aids, in-the-ear aids, and canal hearing aids. Patients should talk to their healthcare providers to determine the type of hearing aid that is best for them. A behind-the-ear device is used for mild to profound hearing loss. The device has a hard plastic case that is worn behind the ear and connected to a plastic ear mold that fits inside the outer ear. In-the-ear hearing aids fit completely inside the outer ear, and they are used for mild to severe hearing loss. Canal hearing aids are smaller hearing aids that fit inside the patient’s hearing canal. They are used for mild to moderately severe hearing loss.
- If hearing loss is severe, patients may benefit from cochlear implants. These electronic devices are surgically implanted inside of the ears. Unlike a hearing aid, which amplifies sound, a cochlear implant makes up for damaged parts of the inner ear.
- Individuals who are deaf are often able to communicate with others by using sign language. It is best to begin teaching signs at a young age. A child’s pediatrician can recommend programs that teach sign language.
Prevention: Some types of hearing loss can be prevented. People who are exposed to loud noises on a regular basis, such as construction workers, should wear protective ear muffs or earplugs. This helps prevent the eardrums from becoming damaged. Do not listen to loud music, especially when wearing headphones. Regularly remove earwax buildup to prevent temporary hearing loss. Do not use cotton balls or Q-tips to clean the ears because they may damage the ear. Regular hearing tests are also recommended. If hearing loss is diagnosed early, people can take steps to prevent further damage.
Overview: Meniere’s disease occurs when the fluid pressure in the inner ear increases for unknown reasons. This disrupts a person’s hearing and balance. People with Meniere’s disease typically experience sudden and sometimes severe attacks of dizziness (called vertigo). Individuals may feel like their surroundings are moving or spinning.
- Most cases of Meniere’s disease affect one ear. However, in rare cases, both ears may be affected.
- Although the attacks associated with Meniere’s disease may be disturbing, it is not considered a life-threatening condition. Treatment and lifestyle changes can help mange symptoms.
Causes: The inner ear contains fluid and hair-like sensors that control a person’s sense of balance and allow a person to hear sounds. When the fluid pressure in the inner ear increases, it signals the brain that the body is moving, even if it is not. It is unclear what causes the fluid pressure to increase in people with Meniere’s disease.
Symptoms: People with Meniere’s disease typically experience attacks that last anywhere from 20 minutes to an hour or longer. People typically experience sudden episodes of extreme dizziness that are often accompanied by nausea and vomiting, hearing loss, feeling of fullness or pressure in the affected ear, and a ringing or abnormal sound in the affected hear (called tinnitus). Without treatment to manage symptoms, attacks may occur more frequent and may be more severe. Some people may eventually become deaf in the affected ear. However, with proper treatment, most people are able to maintain their normal daily activities.
Diagnosis: The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) has proposed diagnosis criteria for Meniere’s disease. According to these guidelines, a person must meet the following three criteria to be diagnosed with the condition. 1) The person has had at least two spontaneous attacks of vertigo that each lasted 20 minutes or longer. 2) The person hears abnormal or ringing sounds in the ear(s) (tinnitus) or experiences a feeling of fullness in the ear. 3) The person has experienced hearing loss.
Treatment: There is currently no cure for Meniere’s disease. Instead, treatment focuses on reducing the frequency and severity of attacks.
- A doctor may suggest diet changes to help reduce fluid retention and fluid buildup in the inner ear. Eating about the same amount for each meal at the same time each day is often recommended to regulate the amount of fluids throughout the body, including the ears. Limiting salt intake to 1,000 milligrams of sodium or less each day may also help reduce fluid retention. Avoiding or limiting caffeine may reduce fluid retention and lessen symptoms of tinnitus. Smoking should be avoided because it may worsen symptoms.
- Mediations may also help reduce the severity of symptoms. For instance, anti-vertigo medications, such as meclizine (Antivert®), may help reduce feelings of dizziness, nausea, and vomiting. Anti-nausea drugs, such as prochlorperazine (Compazine®), may help reduce nausea and vomiting. Diuretics, such as hydrochlorothiazide (Dyazide® or Maxzide®), may also be prescribed to reduce fluid retention.
- Medications may also be injected into a patient’s middle ear. For instance, an antibiotic called gentamicin (Garamycin®) may be injected through the eardrum and into the inner ear. This antibiotic is toxic to the inner ear, so it reduces the ear’s ability to sense a person’s balance. The person is able to maintain his/her balance because the unaffected ear is still functional. This procedure has been shown to reduce the severity and frequency of attacks. However, since it damages the ear, it may worsen hearing loss.
- A steroid medication, called dexamethasone, may also be injected into the patient’s inner ear. This treatment is generally less effective than gentamicin injections. However, it is less likely to worsen hearing loss.
- If the above treatment options are unable to manage symptoms of Meniere’s disease, a doctor may recommend surgery. For instance, an endolymphatic sac decompression procedure may be performed to remove some of the bone that surrounds the inner ear. This may help relieve some swelling. Another procedure, called a sacculotomy, may be performed. During this procedure, a permanent tack-like device is surgically implanted inside the ear to automatically drain out the inner ear when pressure builds up. A labyrinthectomy may also be performed to remove the entire ear sense organ (called the vestibular labyrinth). This is usually only performed if other treatment options fail and the patient already has severe or complete hearing loss in the affected ear. When hearing loss is severe or causes intense dizziness, a vestibular neurectomy may be performed to eliminate function of the entire inner ear. It involves cutting the nerve that controls balance.
Prevention: Because the cause of Meniere’s disease is unknown, there is currently no known method of prevention.
Overview: Sometimes hearing loss may lead to articulation disorders. Articulation disorders occur when an individual has difficulty pronouncing certain consonants or vowels correctly (such as the letters “s” and “r”). As a result, certain words are mispronounced. Patients with these disorders will omit, replace, or distort the sounds of vowels or consonants that they have difficulty pronouncing. A common type of phonological disorder is a lisp.
Causes: In many cases, the cause for phonological disorders is unknown. However, most of the time phonological disorders are not an immediate cause for concern. Phonological disorders are common in young children, but most of these children are able to pronounce words correctly by the age of five. Patients with phonological disorders who are older than five years old should visit their doctors. Sometimes phonological disorders are caused by hearing loss. Other potential causes include brain damage, brain disorders, or physical handicaps (such as a cleft palate or cerebral palsy). In other cases, the condition may be caused by poor coordination of muscles in the mouth or dental problems.
Symptoms: Patients with phonological disorders have difficulty pronouncing certain vowels or consonants. Patients may leave out certain sounds in words. For instance, they may say “at” instead of “hat.” Patients may replace sounds that are difficult to pronounce with others. For instance, the letter “r” is often replaced with the letter “w.” These patients may say “wunning” instead of “running.” Finally, some patients may make distorted sounds when they try to pronounce certain words. A distorted sound may whistle, the air may come out the sides of the mouth causing a “slushy” sound or lateral lisp, or the tongue may thrust between the teeth causing a frontal lisp. Most children with phonological disorders are able to overcome this disorder without treatment by the age of five.
Diagnosis: Phonological disorders are common among young children. However, patients who are older than five years of age and have symptoms of the condition should visit their doctors. A speech pathologist will evaluate the patient for characteristic symptoms of phonological disorders. If hearing loss is the suspected cause of an articulation disorder, an audiogram (hearing test) will be performed.
Treatment: If hearing loss is causing articulation disorders, a doctor may recommend hearing aids or cochlear implants. Improving the person’s hearing increases the effectiveness of speech-language therapy, which is considered the primary treatment for articulation disorders.
- Speech-language pathologists, also called speech therapists or speech-language professionals (SLPs), evaluate, diagnose, treat, and help to prevent speech, language, communication, swallowing, and other related disorders. These professionals have been educated in the study of human communication. SLPs have earned Master’s degrees and state certification/licensure in the field. They are also certified in clinical competency from the American Speech-Hearing Association.
- During speech-language therapy, a qualified SLP works with the patient on a one-to-one basis, in a small group, or directly in a classroom to overcome speech disorders. Programs are tailored to the patient’s individual needs. On average, patients receive five or more hours of therapy per week for three months to several years.
- Speech pathologists use a variety of exercises to improve the patient’s communication skills. Exercises typically start off simple and become more complex as therapy continues. For instance, the therapist may ask the patient to name objects, tell stories, or explain the purpose of an object.
- The therapist may also help patients learn how to cope with some of their symptoms. For instance, the therapist may teach the patient to over-articulate words that are hard to pronounce or to pause before saying big words.
- Speech pathologists help patients improve their stronger communication skills in order to enhance those that are weaker. For instance, the therapist may teach the patient how to improve their skills with gestures or body language.
- Oftentimes, family members participate in therapy, serving as communication partners. This allows patients to practice their communication skills in a comfortable and supportive environment. This type of group therapy may include role playing, which allows patients to practice their language in social situations.
Prevention: Hearing loss increases an individual’s risk of developing phonological disorders. Therefore, infants who are at risk of developing hearing loss should have their hearing tested. It is important that patients with speech disorders receive immediate treatment. Early diagnosis and treatment has been shown to increase an individual’s long-term prognosis.
Tinnitus (ringing in the ears)
Overview: Tinnitus is a medical term for ringing in the ears. Tinnitus is a common condition that affects millions of people. For some, symptoms may occur intermittently and they may only be mildly annoying. Others may have more serious symptoms that are persistent and cause people to seek medical help.
- Tinnitus can affect anyone, but it is most common among elderly people. However, it is becoming increasingly common among young people who are frequently exposed to loud noises, such as music.
- Tinnitus is a symptom of an underlying condition, such as age-related hearing loss or ear injury. Although the noise may be irritating, it is rarely a sign of a serious health problem.
Causes: Tinnitus occurs when the delicate hairs inside the ears (called cilia) become damaged. Normally, these hairs vibrate, which triggers nerve cells to send signals to the brain. These signals are then interpreted as sound. In patients with tinnitus, these hairs are bent or broken, and they move randomly because they are irritated. As a result, the person hears a ringing sound.
- In most cases, the hairs become damaged as a result of age-related hearing loss (also called presbycusis), a condition that usually begins around the age of 60.
- Long-term exposure to loud noises, such as chain saws, portable music devices, or construction equipment, may also damage the hairs.
- Sometimes a medication may cause tinnitus. For instance, high doses of aspirin and some antibiotics have been shown to cause tinnitus. In such cases, symptoms of tinnitus often go away once the medication is stopped.
- A head or neck injury may also damage the inner ear and cause tinnitus.
- Some types of blood vessel disorders may cause a type of tinnitus, called pulsatile tinnitus. For instance, atherosclerosis (hardening of the blood vessels), high blood pressure, and narrowing of a carotid artery or jugular vein may lead to tinnitus.
- Less commonly, tinnitus may be a symptom of a tumor in the neck or head.
Symptoms: People with tinnitus hear sounds, such as ringing, whistling, or buzzing, when no external sound is present. The pitch and volume of the sound varies among patients. For some, the noise may be subtle. However, for others, the noise may make it difficult to concentrate or hear properly. The sound may occur temporarily and last for a few days to weeks. In other cases, the sound may be permanent and continuous. One or both ears may be affected.
Diagnosis: A doctor first takes a detailed medical history and performs a physical examination. It is important for patients to tell their doctors if they are taking any medications, herbs, or supplements because these could be the cause the condition. If tinnitus is suspected, a doctor may recommend an ear, nose, and throat (ENT) specialist.
- An ENT specialist will examine the inside of the ear to determine if the inner ear is damaged. The doctor will also put a stethoscope up to the patient’s ear to see if he/she can hear the abnormal noise as well. If only the patient can hear the noise, it is called subjective tinnitus. If the doctor is able to hear the noise as well, the condition is caused by a vascular disorder, and it is called pulsatile tinnitus. In such cases, the noise that the patient (and doctor) hears is turbulent blood flow in the patient’s blood vessels.
Treatment: Treatment of tinnitus depends on the cause. If a medication is the suspected cause of symptoms, a doctor may recommend a different dose or type of medicine. However, patients should not stop taking their medications or change dosages without first talking with their doctors.
- If tinnitus is caused by an underlying medical condition, symptoms may improve once treatment is started. For instance, patients with tinnitus that is caused by high blood pressure may experience an improvement in symptoms after they start taking blood pressure-lowering drugs.
- If tinnitus is caused by age-related hearing loss, there are no treatment options to reduce the noise. Instead, a doctor may recommend lifestyle changes to help manage the symptoms. For instance, nicotine, caffeine, tonic water, alcohol, or high doses of aspirin should be avoided or limited because they may worsen symptoms of tinnitus. These substances reduce blood flow to the structures of the ear, which may aggravate symptoms. Listening to a quiet background noise, such as a fan or low-volume music, may help mask the noise in the ears. Patients are encouraged to manage their stress because stress may constrict blood vessels and reduce blood circulation, which may subsequently worsen symptoms of tinnitus. Simple relaxation techniques may help reduce stress. Because fatigue may also worsen symptoms, patients are encouraged to get plenty of rest.
- Several medications have been suggested as possible treatment options for patients with tinnitus, but their effectiveness is unclear. Some doctors have prescribed tricyclic antidepressants, such as nortriptyline or amitriptyline, but they have had varying affects. For some patients, side effects of these medications may not be worth the potential benefit. Side effects may include dry mouth, blurred vision, and constipation.
- New evidence suggests that the migraine medication gabapentin (Neurontin®) and acamprosate (Campral®), a drug used to treat alcoholism, may help relieve symptoms of tinnitus. However, until additional studies are performed, it is unclear if these are effective treatment options.
Prevention: People who are exposed to loud noises on a regular basis, such as construction workers, should wear protective ear muffs or earplugs. This helps prevent the inner ear from becoming damaged. Do not listen to loud music, especially when wearing headphones.
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.