Who is who in tinnitus?
Roughly 55 million Americans suffer from tinnitus, which renders mild to fierce irritation and is viewed as a considerable medical trouble in a multitude of cases. There are more or less 13 million cases who suffer from fierce tinnitus issues, which very likely have to be associated with underlying physiological disorders which are under certain circumstances critical or also life-threatening. In those cases, an experienced otolaryngologist requires to execute a detailed checkup of the patient’s condition and exclude these adverse conditions through diagnosis.
“Subjective” or “objective” tinnitus?
Tinnitus has an immense scope of potential causes, mainly determining its classification. Chiefly we can separate tinnitus as “subjective” and “objective” tinnitus. The “objective” tinnitus is defined by pathophysiological modifications in the middle-ear, which can be heard and assessed objectively. Depending on the cause of these changes, the doctor is required to determine if operation or medication can cure the problem.
Then again, only about 1% of all tinnitus cases are considered to be the “objective” type; the big rest of 99% belongs to the category of “subjective” tinnitus. Yet, subjective tinnitus has an extended list of potential causes, as there are: otologic and neurologic disorders, sensorineural hearing loss, analgesic and antibiotic medicinal drugs, diuretics, psychedelic drugs, chemotherapy, head injury, external ear infection, acoustic shock, middle ear effusion, superior canal dehiscence, excessive or loud noise, presbycusis, Ménière’s disease, acoustic neuroma, mercury or lead poisoning, metabolic disorders like vitamin B12 deficiency, hyperlipidemia, iron deficiency anemia, psychiatric disorders as there are depression and anxiety, just to name some of the most significant and most frequent causes for subjective tinnitus.
The secret causes for tinnitus
Little to nothing is known about tinnitus causing treatments and medicinal drugs. A good example is aspirin, which is being offered as pain medication with supplementary attributes, like blood thinning properties for high risk MI (myocardial infarction) patients. Furthermore it is used as antipyretic (fever) medication, and as antiinflammatory drug. Aspirin is being looked at as a safe drug with a reasonably long history in the market. Therefore only a small percentage of medical experts are aware that this drug can induce the outbreak of tinnitus. Other nonsteroidal antiinflammatory medications, like ibuprofen or naproxen, are also to be considered among those drugs that can induce tinnitus.
Some antibiotics are also known to induce tinnitus: Vibramycin (doxycycline), vancomycin, tetracycline, chloramphenicol, and aminoglycosides count into this list. Chemotherapy and antiviral drugs, like interferon, cisplatin, methotrexate, and vincristine, also have tinnitus stimulating potential.
Loop diuretics mark another class of drugs, which have some potential in including tinnitus. The most popular drug here is Lasix (furosemide), a fast acting diuretic, having as indication the treatment of edema and hypertension. Chloroquine and quinine are malaria medications, and some specific antidepressants and vaccines, which are all drug medications as well with some tinnitus inducing potential.
As of now, it is not entirely clear how these medications are able to trigger tinnitus. Therefore a certain chance always exists that patients, who are looking for relief from an entirely different illness, end up having tinnitus as an extra health problem (tinnitus as a pharmaceutical “give-away” disease, cheaper by the dozen) or having the old problem being substituted with the tinnitus problem. There is a list of drugs which are known to induce tinnitus, and this list contains more than 200 different substances from different classes.
A great part of western school medicine practice restricts itself merely to the management of symptoms instead of addressing the underlying causes; and tinnitus treatment is not exempted from this kind of procedure. Since its treatment is asking for a lot of time and effort and cannot be accomplished and resolved in just a few rounds of consultation, the average practitioner will most probably select the “way of least resistance“ and address those symptoms, which cause the most discomfort, simply by just prescribing e.g. antidepressants, since most tinnitus sufferers go through increased stress levels due to the never ending noise in their head and ears. But those antidepressants don’t do anything about tinnitus and its causes; they only assist the patient to get along with their problem and manage their condition, and nobody can exclude the possibility that the medication will cause more tinnitus, since antidepressants, as depicted earlier, have some potency to stimulate and exacerbate tinnitus.
What kind of cure do the experts offer?
Since we can refer to a long list of possible reasons and causes for the development of tinnitus, there also exists an even longer list of possible approaches in treating the disease.
The list of medical approaches to cure, yet with no guaranteed success, the “objective” tinnitus embraces the following:
- Gamma knife radiosurgery (glomus jugulare)
- Shielding of cochlea by teflon implant
- Botulinum toxin (palatal tremor)
- Propranolol and clonazepam (arterial anatomic variation)
- Clearing ear canal (in the case of earwax plug)
- Usage of a Neurostimulator.
For the “subjective” tinnitus I listed here the most important treatments, according to Entrez Pubmed (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&term=treatment%20tinnitus&linkpos=3&log$=related_query) and Wikipedia (http://en.wikipedia.org/wiki/Tinnitus)
Drugs and nutrients
- Lidocaine, injection into the inner ear found to suppress the tinnitus for 20 minutes, according to a Swedish study.
- Benzodiazepines (lorazepam, clonazepam) in small doses
- Tricyclics (amitriptyline, nortriptyline) in small doses
- Avoidance of caffeine, nicotine, salt
- The consumption of alcohol can both increase and decrease the severity of tinnitus. Therefore alcohol’s effect on the severity of tinnitus is dependent on the causes of the individual’s affliction and cannot be considered a treatment.
- Zinc supplementation ( with serum zinc deficiency)
- Etidronate or sodium fluoride (otosclerosis)
- Lignocaine or anticonvulsants ( in patients responsive to white noise masking)
- Carbamazepine ( anticonvulsive drug)
- Melatonin (especially for those with sleep disturbance)
- Sertraline ( oral antidepressant)
- Vitamin combinations (Lipoflavonoid)
Electrical stimulation
- Repetitive transcranial magnetic stimulation, a noninvasive method to excite neurons inside of the brain.
- Transcutaneous electrical nerve stimulation, also a noninvasive method to influence nervous potentials via electric current placed on the skin of the patient.
- Direct implantation of electrodes into the auditory cortex.
External sound
- Low-pitched sound treatment has shown some positive, encouraging results.
- Tinnitus masker (white noise, or better ’shaped’ or filtered noise).
- Tinnitus retraining therapy.
- Auditive stimulation therapy (music therapy).
- Auditive destimulation therapy (also called “notched music” therapy) uses individually designed music with the patients’ favorite music altered to remove the musical tones that match the aural frequencies associated with their tinnitus. The removal of these tones alleviates the tinnitus by destimulating brain activity for these specific frequencies.
- Compensation for lost frequencies by use of a hearing aid.
- Ultrasonic bone-conduction external acoustic stimulation.
- Avoidance of outside noise (exogenous tinnitus).
Psychological, cognitive behavioral therapy.
These procedures claim to be efficient in curing tinnitus to a certain degree, singular as well as in combination with two, three, or even more therapeutic approaches in combination. For bringing about some success in the treatment of tinnitus, a proper diagnosis is the Alpha and Omega for such an intervention. Most of those therapeutic approaches consume an extended amount of time and depend vastly on the compliance and patience of the patient.
Is the good old western school medicine the only solution?
As discussed earlier, the almost endless list of possible causes for the occurrence of tinnitus is calling for a more specified medical approach. Western medicine instead developed a specific treatment program for each possible cause, which is the reason for an even longer list of possible cures or, let’s better say, disease management. The “segmental” view of a patients body let’s the practitioner focus on that part of the body where the problems occur. Let’s take a patient, who is suffering from a nervous disease; he/she will be taken care of by a specialist for nervous diseases, a neurologist or brain doctor. A problem of the heart will be addressed by a heart specialist, a cardiologist etc. These examples show that the patient will be fragmented into anatomic parts, which fit into the specialization of the attending physician. The usual jargon of physicians gives even a clearer picture of the previous statements: Physicians usually, when talking to each other or other medical personnel, do not refer to a patient’s name, no, they talk of the liver, the heart or heart attack, the bladder etc. (“is the liver ready for OP?”; “new developments of the gallbladder?”; “can I have the x-ray of the colon cancer” etc.), referring to affected organs or their corresponding disease.
But in many cases, this kind of (exaggerated) fragmentation or segmentation does not entirely fit the true picture; the underlying cause of a disease can also occur in a completely different part of the body, but expresses itself by revealing symptoms in that particular organ, in the case of tinnitus the ears and head. So it becomes a somewhat bothersome task to find out what in the very end really caused the onset of tinnitus in a patient. In many cases, try and error will be the prevailing medical or curative approach, a not-so-funny affair for the patient, who’s patience (that’s why he/she is called “patient”!) will be tested, and many (un)patients develop the feeling to be a doctor’s Guinea pig or residual income guarantor. What remains is a patient who is frustrated, less patient, and stressed and felt left alone, and therefore willing to resort to alternative solutions, like traditional Chinese and Japanese herbal medicine, homeopathic medicine, tribal medications from tribes in America, India, Australia medicine, faith healers and other more or less trustworthy procedures.
Prevailing medical practice of those alternative solutions (faith healing not included) is the administration of herbal formulations, very much like the pharmaceutical products of the western school medicine. These preparations have been verified under various experimental or empirical conditions, from private experience and testimonials up to scientific evaluation. Gingko biloba is a characteristic model for the difficulty in evaluating the effectivity of a treatment with this herb. Scientific surveys brought out a wide scope of answers, starting from very efficient to no results altogether.
Michael D. Seidman, MD and Seilesh Babu, MD published regarding to this matter: “Opinions differ as to the efficacy of this herbal remedy (with Ginkgo biloba). While certain sufferers of tinnitus ‘swear by’ Ginkgo biloba, others claim that it has no effect on their symptoms. The results of the first large-scale double-blind randomized prospective study (1121 volunteers at Birmingham University in the U.K.) on the efficacy of Ginkgo in tinnitus treatment, was published in 2001. The patients in this study received either 150mg of Ginkgo or placebo in a randomized fashion for 12 weeks. The results did not show significant effect in treating tinnitus, however the dose employed was approximately 65% less than what has been shown to be of benefit.”
There are still other forms of alternative treatment, like supplementation of vitamins, enzymatic therapy, several sorts of laser therapy, vibration therapy, and “tinnitus retraining” therapy. But those approaches have also shown contradictive results when it comes to evaluate the effectivity in curative potential. Nonetheless the majority of these regimen have shown corresponding or still better results in comparison with those of the traditional western medicine, and at the same time with far less unwanted effects than the western school medicine intervention regimen.
And where is the difference between alternative and western medicine?
Common characteristic of most alternative regimen is the fact that they avoid the segmentation of the body as a whole. These medicinal approaches are well aware of the fact that our body is a unit, which is much more than the sum of its different parts.
Here the whole body system becomes the object of investigation, since, as mentioned before, a disease does not inevitably develop at that particular location where the patient’s troubles show up. All components of our physical structure are interrelated and regulate each other. The eruption of an illness is nothing but a warning signal that the total system is in distress and out of balance. Simply addressing that specific organ, where the problems take place, is not completely productive, because this pattern can boil down to a simple management of symptoms, not of causes.
As we have been evaluating before, tinnitus has a large number of potential causes, singular and multifactorial, so that a segmental setup very soon will reach its limits. This is also one cause why there are so many “assorted” treatments proposed by the western school medicine, and only few are entirely efficient for a few patients. A holistic setup anticipates to be more efficient, since from the very beginning the complete anatomy of the patient is required in the medicative program, and the treatment is not restricted only to the ears. Psychological and mental factors should also be taken into consideration in a holistic approach. For example, stress can be very frequently a potential cause for the pathogenesis of tinnitus. An examination of the ears of such a tinnitus patient will not disclose plenty of diagnostic and/or therapeutic evidence for his or her problem, as the phenomenon of stress occurs at another “department” of the body and translates in the end into tinnitus as an warning signal. Put differently, holistic medicine must take the undivided body or physiology and the psychology of the patient as well into consideration, and acknowledging thence the biological setup of our physical being as humans.
A holistic treatment for tinnitus has many other aspects and potential approaches. The following listing manifests how many-sided a holistic treatment is:
Acupuncture and Acupressure
Alexander Technique
Aromatherapy
Autosuggestion / Hypnosis
Ayurveda
Bach Flower Remedy
Biofeedback
Deep Breathing
Chiropractic
Color Therapy
Diet, Vitamin and Nutritional Supplements
Guided Imagery and Visualization
Herbal Medicine
Homeopathy
Lifestyle
Massage
Meditation
Mind/Body Medicine
Nutrition
Reflexology
Relaxation
Tissue Salts
Taking all these things into consideration, we must also recall that the western school medicine appears to be virtually lost when it has to deal with to those so called “civilization diseases.” Hypertension, diabetes, arthritis, and some more ailments are regarded to be incurable, and western school medicine renders only pain and disease management. Yet with a good prophylaxis and holistic treatment, chances increase that the therapy of all these diseases, including tinnitus, will be blessed with success.
The exotic way of curing tinnitus: Hypnotherapy
More Or Less 20% of all grownups are known to have tinnitus, but only about 25% of them is permanently affected to the point beyond tolerability, while the rest of 75% simply brushes off the “music” in their head. This gives reason for a question: Why is there a pool of 25% sound “martyrs” on the one hand and a pool of 75%, who hear, but don’t seem to listen? What are the factors which make people suffer from tinnitus and other people, also with tinnitus, handling the noise as if it is not existing? A feasible answer is, that the sufferers show the tendency of associating their tinnitus closely with adverse, negative emotions. Non-sufferers don’t establish this sort of associative linking. Unfavorable or distressing feelings and emotions are usually caused by stress, fright, anxiousness, frustration, defeat, wrath, depressive disorder etc., and the subconscious part of the brain plays a critical role in the genesis of these emotions.
Taking these points into consideration, it appears more than logic to apply hypnotherapy as a means of treating tinnitus. Hypnotherapy has access to the subconscious area of the brain and can influence therefore psychological roots of the expression of tinnitus. It could be shown that using hypnotherapy in combination with alternative regimen and/or with western school medicine, the success rate in tinnitus therapy reached more than 90%.
How can we explain such a huge figure in terms of therapeutic success? Neither our conscious nor our unconscious mind is permanently able to ignore negative emotional input, e.g. bad feelings, disappointment, fright, anger, etc. These feelings are part of a sort of basic psychological setup, set off in the limbic system, which cannot be influenced or even shut down by our conscious or unconscious mind. This setup is located in areas of the brain which belong to the older evolutionary areas. They are common in many animals, not only humans, and they are important agents for survival of the individual. Fear for example forces the individual to be more careful and avoid life-threatening situations, so its probability of survival increases. The same is true for anger and aggression. The faster the individual is able to decide whether to fight or run away, the bigger are its chances to survive. This “fight and flight” pattern is common throughout the animal kingdom and is not restricted only to us humans. This kind of behavior is not acquired or learned; it is inborn, inherited into all of us as part of a basic survival mechanism. In prehistoric times it was a kind of basic requirement for survival, since the learning capabilities of prehistoric animals were very limited, from what we know now. So it was important for the survival of the individual and the survival of the race to have a genetically predisposed setup which protected the individual animal from life-threatening behavior.
Today life-threatening situations do not often come from being attacked by wild beasts, unless you are in Africa or in the jungles of South America. Nevertheless our survival mechanism is still intact and functional. In our modern society this kind of behavior is not predominantly necessary for survival. Other factors play a more important role for social survival, since the physical threats are commonly eliminated. Or in other words: This biological setup has become biologically obsolete to a certain degree. But the feelings brought about with this setup remain and execute sometimes adverse effects. They seem to have become “irrational”, since the reason for them seems not to be existing. But the irrationality derives only from its logic of missing reasons, yet the rational reason lies in our evolutionary heritance, our biology.
What has this to do with our tinnitus problem? Tinnitus is a sound which cannot be ignored by the conscious mind, because of the inherited setup for fear or other negative sensations, which are associated with this emotion. We can put this into a kind of formula:
Sound of tinnitus + fear = conscious awareness which cannot be ignored by the tinnitus sufferer.
These adverse feelings initiate the genesis of tinnitus, which itself generates panic, fears, anxiety etc. only to end up in the creation of a perfect vicious circle.
Hypnotherapy seems to be able to break up this circle. But what exactly is hypnotherapy or hypnosis? The accepted medical definition of hypnosis is: “An altered state of consciousness in which the conscious mind is temporarily bypassed, so that the subconscious mind becomes highly receptive to selective, positive suggestions” (Charles Smithdeal, MD). In other words, being under hypnosis, we are enabled to have a far better and more profound access to those adverse emotions. This improved access enables us to correct them or even get rid of them in order to replace them with positive feelings and emotions.
Having accomplished the removal of negative emotions, the tinnitus sufferer will shift from the 25% bracket of sufferers to the 75% bracket of non-sufferers, who hear occasionally some noise, but meanwhile their brain understood to lose interest in these noises, since it knows that the noise is not associated with potentially life-threatening or other important issues, which normally cannot be ignored by the unconscious mind.
Cauda
Tinnitus seems to have a multitude of causes, which on the other hand results in a multitude of therapeutic approaches. Almost none of those therapeutic regimen alone is able to resolve the patient’s situation satisfactorily. Combining two or more therapies is a more promising approach. The holistic way of treatment seems to have the upper hand over western school medicine, since it considers the patient’s entire system and works on this entity. Therefore combination of therapies in holistic medicine is rather the rule but the exemption. Holistic medicine also more readily includes psychologic factors into the therapy. With hypnotherapy and the work-out of physical conditions, holistic medicine has a 90% proven track record in curing tinnitus.
