Tinnitus natural treatment, vitamins, herbs, and supplements (ringing in the ears) by Ray Sahelian, M.D.
October 12 2016

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 is usually present. Unfortunately this stubborn condition is often difficult to treat effectively.

Lancet Neurol. 2013 Sep. Tinnitus: causes and clinical management. Tinnitus is the perception of sound in the absence of a corresponding external acoustic stimulus. With prevalence ranging from 10% to 15%, it is a common disorder. Many people habituate to the phantom sound, but it severely impairs quality of life of about 1-2% of all people. Tinnitus has traditionally been regarded as an otological disorder, but advances in neuroimaging methods and development of animal models have increasingly shifted the perspective towards its neuronal correlates. Increased neuronal firing rate, enhanced neuronal synchrony, and changes in the tonotopic organisation are recorded in central auditory pathways in reaction to deprived auditory input and represent--together with changes in non-auditory brain areas--the neuronal correlate of tinnitus. Assessment of patients includes a detailed case history, measurement of hearing function, quantification of severity, and identification of causal factors, associated symptoms, and comorbidities. Most widely used treatments involve counselling, and best evidence is available for cognitive behavioural therapy. New pathophysiological insights have prompted the development of innovative brain-based treatment approaches to directly target the neuronal correlates.

Cause of tinnitus
The mechanisms that cause tinnitus are obscure. Risk factors include aging, significant noise exposure, drug therapy (e.g. aminoglycosides, NSAIDs, diuretics), or disorders of the outer, middle or inner ear or auditory nerve (e.g. ear wax, infections, vestibular schwannoma, otosclerosis). It may be due to excessive spontaneous activity in the auditory system and brain; if the signal (normally suppressed by the subconscious) becomes noticed it becomes more intrusive and annoying in a vicious cycle. It may occur as a symptom of nearly all ear disorders, including:

Obstruction of the ear canal by wax or a foreign body,
Infections (external otitis, myringitis, otitis media, labyrinthitis, meningitis),
Eustachian tube obstruction,
Loud music exposure, and it becomes worse over time if the exposure continues. One in five high schoolers has permanent ringing in the ears, and few take measures to protect their ears from loud music.
Caffeine ingestion could make it worse.
     Braz J Otorhinolaryngol. 2014. Effects of the reduction of caffeine consumption on tinnitus perception. For many years, excessive caffeine consumption has been touted as an aggravating factor for tinnitus. The pathophysiology behind this effect is probably related to the blockage of adenosine receptors by the action of caffeine on the central nervous system. Patients under 60 years of age with bilateral tinnitus and daily coffee consumption between 150 and 300 ml are prone to benefit from consumption reduction.
Middle ear tumors
Meniere's disease
Ototoxicity (often drug induced due to aspirin, quinine and its synthetic analogs, aminoglycoside antibiotics, certain diuretics, carbon monoxide, heavy metals, alcohol).
    Email received 2013 - I took Wellbutrin drug for a few months and the very faint tinnitus I had increased a lot. That was 3 years ago and it's still increased. I now take Zoloft or Cymbalta which doesn't seem to bother me that way. The tinnitus is unusual in that I can have 3 days off and 3 days on. It's like this most of the time with variation, for instance if I take a drug it can keep the tinnitus going on for a week or two without the 3 days off. I'm considering taking Sam-e or 5 HTP because I don't want to be on prescription meds for this anymore. I have to be careful as some meds will aggravate the condition, it usually goes back down after I stop them. Too bad it didn't go back down after I quit the Wellbutrin!
Cardiovascular diseases (hypertension, arteriosclerosis, aneurysms)
Medical conditions such as anemia and hypothyroidism
Hereditary sensorineural or noise-induced hearing loss
Acoustic trauma (blast injury), and head trauma all are possible causes of tinnitus.
You may also visit the vertigo page for additional information since some people who have tinnitus also have vertigo.

The U.S. National Library of Medicine says possible causes of tinnitus include:
Having an ear infection.
Having an object or wax build-up in the ear.
Having damage to the ear from exposure to loud noise.
Having an inner-ear condition called Meniere's disease, which affects balance and hearing.
Consuming alcohol, caffeine or medication such as aspirin or certain antibiotics.

Natural treatment for tinnitus
As of 2016, I am not aware of  natural therapies that cure this condition. Before treatment of tinnitus is begun, a doctor has to determine the cause 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, if no benefit then it is reasonable to stop its use.

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.
   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.

Ghana Med J. 2012. The role of plasma melatonin and vitamins C and B12 in the development of idiopathic tinnitus in the elderly. Departments of Otorhinolaryngology, University of Ibadan, Ibadan, Nigeria. To determine the correlation between plasma levels of melatonin, vitamin C and vitamin B12 and the presence of tinnitus among elderly subjects with unexplained subjective tinnitus. Comparing the plasma levels of the markers between elderly with and those without tinnitus, the plasma levels of melatonin and vitamin B12 were significantly lower among the elderly with tinnitus compared to those without, while the difference in the plasma level of vitamin C was not. Low plasma melatonin and vitamin B12 have significant correlation with the development of subjective idiopathic tinnitus among the elderly.

Pine bark extract may be an option to try at a dose of about 30 to 50 mg twice daily.

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 mostly not been demonstrated to be efficacious as a treatment for tinnitus on the evidence of rigorous randomized controlled trials. However, a few studies have shown some mild benefit.

Rehmannia is a Chinese herb to consider.

Protective effect of Rehmannia glutinosa on the cisplatin-induced damage of HEI-OC1 auditory cells through scavenging free radicals.
J Ethnopharmacol. 2006. 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.

CoQ10 may be beneficial in patients with tinnitus with low
CoQ10 levels.
A pilot clinical trial of the effects of coenzyme Q10 on chronic tinnitus aurium.
Otolaryngol Head Neck Surg. 2007.
To determine the effects of coenzyme Q10 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.

Taurine amino acid has been studied in animals.

Vitamin B12
Noise Health. 2016. Therapeutic role of Vitamin B12 in patients of chronic tinnitus: A pilot study. A total 40 patients were enrolled, of which 20 in Group A (cases) received intramuscular therapy of 1 ml Vitamin B12 (2500 mcg) weekly for a period of 6 weeks and Group B (20) patients received placebo isotonic saline 01 ml intramuscular. The patients were subjected to Vitamin B12 assay and audiometry pre- and post-therapy. Of the total patients of tinnitus, 17 were Vitamin B12 deficient that is 42% showed deficiency when the normal levels were considered to be 250 pg/ml. A paired t-test showed that in Group A, patients with Vitamin B12 deficiency showed significant improvement in mean tinnitus severity index score and visual analog scale (VAS) after Vitamin B12 therapy. This pilot study highlights the significant prevalence of Vitamin B12 deficiency in North Indian population and improvement in tinnitus severity scores and VAS in cobalamin-deficient patients receiving intramuscular Vitamin B12 weekly for 6 weeks further provides a link between cobalamin deficiency and tinnitus thereby suggestive of a therapeutic role of B12 in cobalamin-deficient patients of tinnitus.

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: 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 as more research is published.

Q. Could you offer an opinion or refer me to studies that deal with the possible effectiveness of carnosine in treating tinnitus. A nutritional counselor told me that it can reduce glycation of the hairs in the inner ear which might be the cause of my tinnitus. I am 71 years old and have been told by my ENT physician that I have lost some hearing for higher frequency sounds.
   A. I have not, as of 2016, seen studies with carnosine for the natural treatment of tinnitus.

Medical Tinnitus treatment
Tinnitus is the perception of phantom sound in the absence of a corresponding external source. It is a highly prevalent disorder, and most cases are caused by cochlear injury that leads to peripheral deafferentation, which results in adaptive changes in the CNS.

For those with severe tinnitus who have failed other treatments, such as dietary modification, herbs and nutrients, sound therapies (tinnitus retraining, Neuromonics, masking, and others), or centrally acting medications, transcranial magnetic stimulation may be an option.

The ability to tolerate tinnitus varies among patients. Treatment of tinnitus should be directed toward the underlying disease, because its amelioration may lessen the tinnitus. Correcting the associated hearing loss usually relieves the tinnitus; a hearing aid often suppresses the tinnitus. Although there is no specific medical or surgical therapy for tinnitus, many patients find relief by playing background music to mask the tinnitus and may go to sleep with the radio playing. Some patients benefit from using a tinnitus masker, a device worn like a hearing aid that presents a sound more pleasant than the tinnitus. Electrical stimulation of the inner ear, as with a cochlear implant, occasionally reduces the tinnitus but is appropriate only for the profoundly deaf.

People suffering from chronic ringing in the ears may find some relief by spraying the hormone oxytocin in their nose, a small initial study by Brazilian researchers suggests.

Loud noise, acoustic neuroma
Prolonged exposure to loud noise increases the risk of acoustic neuroma, a benign tumor that grows in the nerve connecting the ear to the brain that is associated with hearing loss, tinnitus (ringing in the ears) and disequilibrium.

Tinnitus Research study
The role of zinc in the treatment of tinnitus.
Ankara Numune Research and 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.

Using a magnet to generate an electrical current in areas of the brain that control hearing does not seem to improve ringing in the ears.

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

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 ?
   We have come across no such research regarding quercetin and tinnitus or hearing loss, so we can't really say.

Both my wife and me, are suffering from tinnitus (age 61 and 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.
   I'm not sure diet has a major role to play, except I would eat lots more fresh vegetables and perhaps more vegetable juices.

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 tinnitis, 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.

I have read your articles on DHEA and Pregnenolone which I had prescribed by a Prolotherapist due to connective tissue deficiency in the treatment of a strained sacroiliac joint. The doses were DHEA 5mg x 2 and Pregnenolone 10mg x 2 a day. Unfortunately, this has greatly exacerbated my tinnitus.
   These two hormones enhance nerve sensation and perhaps this is the cause? I am not sure.

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