Tinnitus natural treatment, vitamins, herbs, and supplements (ringing in the ears) by Ray Sahelian, M.D.

Tinnitus is a perception of sound in the absence of an acoustic stimulus. The sound may be a buzzing, ringing, roaring, whistling, or hissing, or it may involve more complex sounds that vary over time. Tinnitus may be intermittent, continuous, or pulsatile (synchronous with the heartbeat). An associated hearing loss with tinnitus is usually present.

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Natural options for Tinnitus
As of October 2009, I am not aware of  natural therapies that cure or significantly improve tinnitus. Before treatment of tinnitus is begun, a doctor has to determine the cause of the tinnitus and to make sure there are no significant medical conditions that are responsible. There are a few natural options that are worth trying.

Caffeine intake does not seem to make a difference one way or the other.
Cognitive Behavioral Therapy may be helpful in reducing tinnitus. Several studies have confirmed an association between psychological factors, such as anxiety and depression, and severe tinnitus. Assessment strategies used in CBT for tinnitus include structured interviews, daily diary ratings, and validated self-report questionnaires. The treatment approach includes applied relaxation, imagery and distraction techniques, advice regarding environmental sounds, management of sleep, cognitive restructuring of thoughts and beliefs associated with tinnitus, and relapse prevention.
Ginkgo biloba may be tried for up to four months to see if there is any improvement in tinnitus symptoms.
Since the serotonergic system is involved, 5-HTP may be tried for a couple of weeks to see if it provides tinnitus relief. 
Acupuncture has not been demonstrated to be efficacious as a treatment for tinnitus on the evidence of rigorous randomized controlled trials.
Rehmannia is a Chinese herb to consider.
CoQ10 may be beneficial in patients with tinnitus with low CoQ10-50mg levels.

Protective effect of Rehmannia glutinosa on the cisplatin-induced damage of HEI-OC1 auditory cells through scavenging free radicals.
J Ethnopharmacol. 2006 Oct 11;107(3):383-8. Epub 2006 Apr 6. Department of Food and Nutrition, Kunsan National University, Kunsan, South Korea.
The steamed root of Rehmannia glutinosa has been used in traditional Oriental Medicine for treatment of inner ear diseases, such as tinnitus and hearing loss. In the present study, we showed that the ethanol extract of steamed roots of rehmannia glutinosa protected HEI-OC1 auditory cells from cisplatin cytotoxicity in a dose-dependent fashion. These results indicate that rehmannia glutinosa protects cisplatin-induced HEI-OC1 cell damage through inhibition of lipid peroxidation and scavenging activities of free radials.

A pilot clinical trial of the effects of coenzyme Q10 on chronic tinnitus aurium.
Otolaryngol Head Neck Surg. 2007 Jan;136(1):72-7. Department of Otorhinolaryngology, Charité-University Medicine Berlin, Berlin, Germany.
To determine the effects of coenzyme Q10 (CoQ10) for 16 week period on the antioxidative status and tinnitus expression in patients with chronic tinnitus aurium. In a subgroup of 7 patients with low initial plasma CoQ10 concentration and significant increase in the plasma CoQ10 level, a clear decrease in the tinnitus score was observed. In patients with a low plasma CoQ10 concentration, CoQ10 supply may decrease the tinnitus expression.

Role of caffeine
Dr. Lindsay St. Claire of the Centre for Hearing and Balance Studies at the University of Bristol recruited 66 tinnitus sufferers who consumed at least 150 milligrams of caffeine daily, or the equivalent of about three 12-ounce servings of soda. Coffee can contain anywhere from around 50 to 160 milligrams caffeine per 5-ounce serving, while tea's caffeine content can range from 25 to 110 milligrams per 5-ounce serving. Over a 30-day period, half of the study participants kept up their normal caffeine consumption, and then went through a "phased withdrawal" in which the researchers gradually reduced the caffeine content of the beverages study participants drank. The other half went through this withdrawal first, and then went back to their normal intake. Dr. Lindsay St. Claire found that the amount of caffeine a person consumed had no effect on the severity of tinnitus. But people did experience significant caffeine withdrawal symptoms, including headache and nausea. International Journal of Audiology, January 2010.

Tinnitus workup
Evaluation of a patient with chronic tinnitus requires the minimum comprehensive audiologic assessment as well as CT of the temporal bone and MRI of the head. Pulsatile tinnitus requires investigation of the vascular system with carotid and vertebral arteriograms to exclude arterial obstruction, aneurysms, and vascular neoplasms.

Tinnitus Research Update
The role of zinc in the treatment of tinnitus.
Ankara Numune Research andf Education Hospital, Turkey.
This study was designed to investigate the role of zinc administration in treatment of tinnitus. Patients with tinnitus were admitted to the ear, nose, and throat clinic of the authors' hospital. Patients with tinnitus with no know pathologic conditions of the ear, nose, and throat; the mean age of 28 patients receiving zinc was 51.2 years, and that of 13 patients given placebo was 55 years. Blood zinc levels were measured. Frequency was detected by audiometry, and loudness of tinnitus was screened by tinnitus match test. A questionnaire that scored tinnitus subjectively between 0 and 7 was given to patients before zinc treatment. After 2 months of treatment (zinc 50 mg daily to zinc group, placebo pill containing starch to placebo group), all of the tests were performed again. There was no difference in age, sex, duration of tinnitus, and affected ears between the patients treated with zinc and those treated with placebo. Blood zinc levels were lower than normal in 31% of patients before treatment. A decrease in tinnitus loudness by at least 10 dB was accepted as clinically favorable progress. A decrease of more than 1 point in subjective tinnitus scoring was accepted as valid. Clinically favorable progress was detected in 46.4% of patients given zinc. Although this decrease was not statistically significant, the severity of subjective tinnitus decreased in 82% of the patients receiving zinc. The mean of subjective tinnitus decreased from 5 to 2.8. However, the decrease in severity of the tinnitus was not significant in patients receiving placebo. It can be concluded that patients with tinnitus may have low blood zinc levels (31%) and clinical and subjective improvement can be achieved by oral zinc medication. However, it remains to be seen whether the longer duration of treatment has more significant results.

People troubled by persistent ringing in the ears known as tinnitus may find relief with therapy aimed at changing the way they think about the problem. Tinnitus is a common disorder, estimated to affect 36 million Americans. It can arise from a number of causes, from ear wax build-up to medication side effects to hearing loss. For some people, the noise is persistent and bothersome enough to interfere with daily life. Treatment depends on the underlying problem, but one strategy--known as tinnitus retraining therapy (Tinnitus RT)--involves counseling to change the way patients perceive and react to the ear noise. In addition, small "noise generators" that can be worn in the ear are used to provide a low-level sound that competes with the tinnitus and makes it less noticeable. In the new study, 6 months of Tinnitus RT improved both physical and emotional well-being among 32 patients with tinnitus. The patients had been living with the ear ringing for more than 7 years, on average. Dr. Julie A. Berry and colleagues at the University of Maryland Medical System in Baltimore evaluated patients' scores on a standard test of daily functioning and emotional well-being before and after 6 months of Tinnitus RT. After therapy there was an improvement in test scores -- in practical measures such as job performance and concentration, and in the way patients reacted emotionally to their tinnitus. Evidence suggests that the brain can be retrained to remove the negative emotional association given to the tinnitus signal. For its part, the sound-generating ear device may blur the contrast between a patient's tinnitus and everyday noises in the environment, helping to change the way the tinnitus is perceived.  Archives of Otolaryngology--Head and Neck Surgery 2002;128:1153-1157. Tinnitus treatment cause of tinnitus pulsatile tinnitus tinnitus relief clear tinnitus acupuncture tinnitus remedy.

Tinnitus Acupuncture
Tinnitus has been treated with acupuncture with little success.

Tinnitus emails
Q. I found that flax oil and fish oil along with vinpocetine in a small dosage and as well ginkgo biloba, again in a small amounts eliminates the symptoms of Meniere's disease. I had all the symptoms for about a yr and a half. and finally i decided i would do something myself as i could not function and was offered no solution other than a lot of very expensive tests and procedures. "yep, you got a problem!" or expensive words to that effect.

Q. Just thought I would mention that I have found ginkgo biloba to be a wonderful supplement for the treatment of tinnitus (ringing in the ears) that was do to exposure to loud noise as a teenager. I would notice a significant improvement a day or two after taking the supplements (60mg 2x daily 24% standardization) and the ringing would gradually return after I would stop taking them. After using it on and off for several years the problem has faded into the background and they are now unnecessary. I observed no improvement in memory or concentration, though I might have been taking too little.
   A. Thanks for your feedback. Some studies do show ginkgo biloba helpful for tinnitus, although my clinical experience with this herb for tinnitus has not shown a consistent beneficial response.

Q. Do you think carnosine could be helpful for tinnitus?
   A. I have not seen studies regarding carnosine and tinnitus.

Q. I have taken quercetin and after a couple of days the tinnitus in my ear increases in volume. I also understand that tinnitus can also be a sign of hearing loss. Can quercetin cause hearing loss? or worsen one's tinnitus ?
    A. We have come across no such research regarding quercetin and tinnitus or hearing loss, so we can't really say.

Q. Both my wife and me, are suffering from Tinnitus (age 61 resp. 66). No trauma, no visible anatomic disorders / changes. We since years take 300 mg Ubiquinone a day and high dosage of Vitamin C and alpha lipoic acid and a lot of other food supplements. Please, what would you eat if you'd suffer from tinnitus ? We live in Istambul, Turkey.
     A. I'm not sure diet has a major role to play, except I would eat lots more fresh vegetables and perhaps more vegetable juices.

Q. I would like to know what I can take for tinnitus with mild depression. My tinnitus is bad, especially my left ear now
(for the last 4 months) I have tinnitus for 18 months, MRI taken everything is fine, blood work fine too, cardiogram fine, I exercise twice or three times a week, I get very tired and do not like to do the thing I used to enjoy doing. Psychologically I think I have been handle this just OK, I have family and I don't want them to be too affected. I am 44 years of age.
   A. Unfortunately we can't give any specific advice, just the general information on tinnitus listed on this page.

Q. As you may know there are millions of people who suffer from a condition called tinnitus (ringing in the ears) due to any number of causes from noise trauma (the cause of my tinnitus), certain drugs, acoustic neuroma, etc. Over the past year I have tried the following: Ginkgo Balboa, B-12, Zinc, melatonin, various sound therapy treatments, Tinnitus Retraining Therapy, a magnetic device called Ti-Ex, and cognitive behavior training. I had an ENT evaluation to rule out any medical conditions and had a hearing test in which shows I have a hearing loss in the left ear in the 6900-7100hz range which is where my tinnitus sound is matched to. What is your view on tinnitus and other possible treatments, holistic, nutritional, etc? I am glad that I found your website again because back in the 1990's I corresponded with you a number of times when melatonin first hit the market and purchased your book "The Melatonin L Nature's Sleeping Pill ". You are one of the VERY few Doctors that I trust on medical information. Keep up the good work!
   A. Thank you. We will update our site on tinnitus as more research is published.

I live in London and went in for a MRI on my shoulder several months ago. After the test, I noticed some hissing in my ears. Since then I think I have had some hearing loss or ringing in the ears. An ENT doctor prescribed some Prednisone. Have there been any reports of MRI testing causing tinnitus?
    This is not an area I have studied in any depth. I hope you recover fully.

I have occasional tinnitus, which manifests very quickly when I take NSAIDs - especially Vioxx, but also Ibuprophen or naproxin sodium. After being dormant for a couple years, my ringing in the ears is back. I have for many years taken a variety of supplements, and many of them have a mild anti-platelet aggregation effect. Is there evidence to suggest that the tinnitus-inducing effect of NSAIDs is linked to either the platelet aggregation inhibition effect, COX-2 inhibition, or OCX-3 inhibition? Is there evidence to suggest that other supplements that have an anti-platelet aggregation effect ex: quercetin, bromelain, curcumin, vitamin E, resveratrol, tend to induce tinnitis?
    There is no evidence that quercetin, bromelain, curcumin, vitamin E, resveratrol induce ringing in the ears. I have not studied in great detail the exact physiological mechanism that involves auditory nerve damage induced by NSAIDs.

For stress-induced tinnitus, mainly due to low ojas/yin deficiency, is there evidence that supplements such as GABA, NAC and Passionflower can exert a corrective action? What would be long-term approaches to fully reversing such a condition?
    I will provide more research on the treatment of this condition as more studies are published.

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