Common Outer Ear Problems

Earwax Blockage
Skin lining the outer portion of the ear canal contains glands that produce a waxy substance called cerumen which is more commonly known as earwax. Cerumen is a normal protectant of the ear. Its job is to defend against harm, trapping dust and other foreign objects before they can reach the more delicate tympanic membrane (eardrum). Wax also helps inhibits the growth of bacteria.

Normally, earwax migrates to the external edge of the ear canal and falls away or is wiped off. However, sometimes more wax is produced than the ear can expel, causing it to accumulate in the ear canal. Generally, excessive earwax does not lead to hearing loss because it does not completely block the passageway. But many people insist on inserting a variety of objects into the ear canal on the assumption that they are cleaning the ear when in fact, they are introducing more potentially harmful microorganisms as well as risking damage to the delicate tissues and membrane. This action also pushes the wax farther into the passageway and impacting it. Impacted wax can reduce hearing by blocking airborne sound vibrations in the ear canal. Blockage can also induce earaches and tinnitus (noise like ringing, buzzing, or roaring in the ear).

Home Treatment: If necessary, earwax removal can be done at home or may require a physician. The easiest step in home care is to purchase an ear-cleaning kit and follow the instructions. However, softening the earwax with a few drops of vegetable oil twice a day for several days will also work. When the wax is softened, fill a bowl with water heated to body temperature. (Water any hotter or colder may cause dizziness during the procedure.) Hold the head upright and grasp the top of the ear, pulling upward. With the other hand, squirt water gently into the ear canal using a three-ounce rubber bulb syringe. Tilt the head to the side and allow the water to drain into another bowl. This may need to be repeated several times before all the wax falls out. Dry the outer ear carefully and, using an eyedropper, insert a few drops of alcohol-vinegar preparation (half rubbing alcohol, half white vinegar) to help dry out the middle ear. A few drops of hemp seed oil also works well since it has natural antimicrobial properties.

CAUTION: If there is a history of a ruptured eardrum or ear surgery, do not flush the ears unless your doctor has given permission to do so.

Foreign Objects
Occasionally, an object or an insect can become stuck in the ear. It may tickle, hurt, or give a feeling that the ear is plugged. Most can be removed without medical intervention; but if something is pushed too far into the ear, it may rupture the eardrum. If the object is clearly visible to an observer, it may be grasped with a pair of sterilized tweezers; but, if not, medical help should be contacted. If an insect is involved, it will instinctively crawl up rather than down. Therefore, if it is still alive, tilt the ear upward and place a few drops of oil into the ear. The oil will suffocate the critter so it can be washed out. Sometimes shining a flashlight into the ear will cause the insect to instinctively crawl towards the light, where it can be removed.

Swimmer’s Ear
Otitis externa (swimmer’s ear) is an infection of the ear canal and the result of persistent moisture in the ear. As its name suggests, it most commonly occurs after frequent swimming, but it can result in combination with a mild injury to the skin in the ear canal. Such an injury can also occur from scraping the ear canal when trying to remove ear wax. Hair spray and dyes may also cause similar ear infections.

Treatment: Pain or itching in the ear, a swollen ear canal, and pus draining from the ear are all symptoms of an outer ear infection. Temporary hearing loss may occur if swelling or pus blocks the canal.

For mild pain without drainage, do the following:

• Place a warm heating pad on the ear �?but not lying on it.
• Keep the ear canal as dry as possible by placing a few drops of 50% rubbing alcohol-vinegar solution in the ear after showering or swimming. The alcohol will help dry the skin while the vinegar helps prevent bacterial or fungal growth.
• Use over-the-counter drying drops.
• If the pain does not subside, medical help should be sought.

WARNING: In a few people, particularly those with diabetes or a weakened immune system, swimmer’s ear may lead to infections of the bones and cartilage at the base of the skull (malignant otitis externa). Such a complication is life-threatening and usually requires prolonged care under a team of specialists including an otologist, endocrinologist, and an infectious disease specialist.

Common Middle Ear Problems

Middle Ear Infections
An inflammation or infection of the middle ear is known as otitis media. This condition is often associated with a cold, sore throat, or other respiratory infection that blocks the eustachian tube. A blocked tube prevents the middle ear from being properly ventilated, causing the inflammation and an accumulation of fluids such as pus and mucus. Bacteria from the nose and throat may travel through the lining of the Eustachian tube and infect the middle ear.

Otitis media can occur at any age but is more common in children, partly because of the shape of the Eustachian tube, which is shorter and more horizontal than that of an adult. A more horizontal orientation means fluid is less likely to drain and more likely to accumulate. While fluid accumulation is not necessarily a problem, it is an ideal breeding ground for microorganisms that cause infections. Although the accepted course of treatment has been repeated doses of antibiotics, this is now proving not to be the best course of action.

Sometimes fluid accumulation in the middle ear can reach a point where it obstructs the movement of the eardrum and the ossicles, causing conductive hearing loss. Too much fluid can also cause the eardrum to rupture. Pain results as the infection worsens, and is just one of several symptoms. Others include dizziness, loss of balance, nausea, vomiting, ear drainage, and fever. At times, pus and mucus may persist even after the infection has passed, causing recurring episodes of infection and persistent hearing loss.

Food allergies, especially to wheat and dairy products, can be the cause of recurring middle ear infections.

Chronic Ear Infection
Persistent middle ear infection is known as chronic otitis media and may occur as a complication of an acute case of otitis media. Sometimes a low-level infection will continue long after an acute episode, leaving the ear more vulnerable to future infections. The signs and symptoms of a chronic ear infection are often milder than those of an acute episode, but they can be more dangerous than an acute episode.

If the Eustachian tube is consistently blocked, the tissues of the middle ear gradually thicken and become inflamed. The mucus that is normally secreted also thickens. A vacuum created in the middle ear by the blocked tube can deform or rupture the eardrum. As these changes occur, the structures of the middle and inner ear slowly deteriorate, causing permanent damage and hearing impairment. Infection can also spread to the bone behind the ear (mastoid process) and even to the brain.

Usually medication is given which will clear up the problem. However, when this fails to work, an incision may be made in the eardrum to relieve pressure and help drain the fluid. Healing should occur in about a week and sometimes before all the fluid has drained out. To prevent this, the doctor may temporarily place a tiny ventilation tube into the incision.

If significant damage has been done to the eardrum and ossicles, more extensive surgery may be required to remove infection tissue and repair these structures. This procedure is known as tympanomastoidectomy.

Eardrum Problems
The tympanic membrane is a resilient, yet fragile structure subject to constant use and abuse. Two common problems are a ruptured eardrum and barotrauma. Both can result in hearing loss mostly caused by a disruption or distortion of the eardrum and prevents it from vibrating properly. Usually the loss is temporary.

• Ruptured Eardrum
  This means that a tear or a perforation has occurred in the membrane as a result of an infection or a trauma. Chronic infections can also wear down the eardrum, creating a perforation on the surface. A blow to the head can also cause a perforation. Symptoms include an earache, partial hearing loss, tinnitus, and slight bleeding or discharge from the ear. In some cases, the ossicles in the middle ear may be damaged, resulting in more severe hearing loss. Usually, a ruptured eardrum heals by itself but larger ruptures may cause recurring infections.
• Barotrauma
  It is also known as “airplane ear�?because it results from a disparity between air pressure in the atmosphere and the air pressure in the middle ear. As the name suggests, this disparity of atmospheric pressure can occur during air flights or deep-sea dives. It can also happen when the Eustachian tube becomes blocked or fails to deliver air properly to the middle ear. An example of this would be when there is nasal congestion from an allergy or infection.

  Normally, the Eustachian tube that connects the middle ear to the back of the nose and upper throat allows air to flow in and out of the middle ear during swallowing or yawning. This type of movement helps maintain equal air pressure on both sides of the eardrum. A more serious problem may occur if the air pressure change is extreme or blocked, causing the small blood vessels in the middle ear to rupture and bleed.

  Generally, barotrauma is not a serious condition and requires no treatment. There are little techniques to help avoid the problem or relieve it as soon as it happens. Taking a decongestant before flying or scuba diving is sometimes helpful (but be aware of the side effects of such medications, especially drowsiness if scuba diving). Sucking on a lozenge or chewing gum during a flight is a well-known remedy. Pilots have a method that works well for them: pinch the nostrils shut, inhale, and swallow. The pop in the ears is a sign that the air has gone through the eustachian tube to the middle ear. On occasion, if the condition persists, a physician may have to make a tiny incision in the eardrum to equalize air pressure and remove fluid from the middle ear. This procedure is known as myringotomy.

Common Inner Ear Problems

Presbycusis
The most common form of sensorineural hearing loss is that associated with aging. This is known as presbycusis. As a person ages, the hair cells within the cochlea gradually wear out, causing a sensitivity loss to sound. Some adults may lose very little hearing as they age while others lose considerably more because of hair cell loss.

Viral Infections
Such infections as measles and mumps are the major causes of hearing loss in children. The measles virus usually attacks cells lining the lungs and back of the throat. The mumps virus typically affects the parotid glands �?one of three types of salivary glands �?between the ear and the jaw. From these areas in the head, either infection can easily spread to the inner ear and destroy hair cells and nerve endings in the cochlea. Viruses may also travel through the bloodstream to the cochlea. Such other viral infections, as influenza, chickenpox, and mononucleosis, may also lead to hearing loss.

Labyrinthitis
This is an inflammation of the inner ear that affects the cochlea and the vestibular labyrinth. The cochlea is vital to hearing and the vestibular labyrinth plays a role in balance and eye movement. If an inflammation affects only the vestibular labyrinth, it is known as vestibular neuronitis. The exact cause is unknown but often follows a bacterial ear infection or an upper respiratory viral illness. It may also occur after a blow to the head or it may occur with no associated illness or trauma.

Signs and symptoms of labyrinthitis include dizziness, hearing loss, tinnitus, nausea, vomiting, and involuntary movements of the eyes. All of the hearing in the affected ear may be lost. To keep the condition from becoming worse, it is sometimes helpful to sit as still as possible and avoid sudden changes in position. Most of the time, the inflammation goes away on its own in a few weeks. If the underlying problem is bacterial, antibiotics may be prescribed.

Presbycusis
This refers to age-related hearing loss. According to a survey conducted for the Centers for Disease Control and Prevention and the National Center for Health Statistics, about 30% of Americans 65 or older have hearing loss, whereas only about 3% under the age of 45 have hearing loss.

Because there is much variation in how people age, its effects on the human body cannot be precise. Typically, some of the hair cells in the cochlea may be lost during the aging process. In addition, nerves may become a little slower at transmitting messages to and from the brain and the brain may not be as quick to interpret sounds.

Initially, there is a loss of sensitivity to sounds with a higher frequency or pitch. This is because damage to the hair cells often occurs first at a location where high-frequency sounds are generally processed. At the same time, the ability to hear sounds with a low frequency may remain intact. Some sounds may even seem too loud.

Presbycusis is sometimes accompanied by a ringing or buzzing in the ears, a condition known as tinnitus. The condition also makes it hard to hold a conversation in an area with background noise, as a busy store. Presbycusis tends to run in families, which means genetics may be involved and the onset of hearing loss can be earlier in some families than in others.

Noise
This is another cause of sensorineural hearing loss because it can damage the inner ear. For many older adults, hearing loss is the result of a combination of aging and noise exposure over a period of years. The cumulative effect of a lifetime of noise can gradually affect the ability to hear. Noise-induced hearing loss may come as a result of a sudden explosion of sound or through gradual, prolonged exposure. If a sudden explosion of noise happens, hearing loss is noticed right away and may last a short or long time. However, with prolonged exposure, hearing loss may be so gradual and painless that it is hardly noticed until too late. Although noise-induced hearing loss cannot be restored, it can be prevented through the use of hearing protection devices.

Other Factors
Some drugs known to be harmful to the hearing mechanism are said to be ototoxic. Other causes include disease, trauma, and genetic disorders.

Nutrients Good for Hearing

• A: Although vitamin A is known to play a significant part in many bodily functions, as far as hearing is concerned, a deficiency increases noise susceptibility and a decrease in sensory function. As far back as 1978, research showed that vitamin A is essential in inner-ear morphogenesis (development of the structure). Benefits have been seen in the hearing-impaired who have taken vitamin A supplements, including those with noise-induced hearing loss. The best form for the body is Beta-Carotene since the retinol forms can create toxic levels if too much is taken. The beta-carotene form will not do this no matter how much is taken. The only side effect if too much is taken is the skin will turn an orangey colour.
• B Complex: While B complex is well known to be vital for the health of nerves, it is equally so in helping to prevent hearing loss. A good B complex supplement can help reduce ear pressure and has been used to treat sudden deafness with profound hearing loss. In one study, subjects with sudden deafness were treated with vitamin B complex. Some recovered completely while others improved their hearing substantially. Tinnitus has also been studied. After several weeks, treatment was deemed to be successful.
  The following is a break-down of how individual B vitamins can affect hearing.
  NOTE: Do not take only one of the B vitamins without adding all the others since doing so will create deficiencies in one or more of the others, which can lead to other health problems. In other words, if you take niacin, for example, also include a B complex supplement.
  • Biotin: A deficiency produces many health-related disorders, including hearing loss. It has also been associated with long-term hearing and visual complications.
  • Folacin: Although folacin is the official term, it can be quite confusing since other words are more commonly used, includingfolate and folic acid. Folate is used to encompass the entire group of folate vitamin forms: the natural folypolyglutamates found in food, and folic acid, the synthetic form added to dietary supplements and fortified foods. In any event, it is one nutrient commonly found deficient in those with hearing loss, especially the elderly who are often deficient in folacin as well as B12. When this happens, high levels of the toxin homocysteine form. This causes cholesterol deposits to build up on artery walls, reducing blood flow, nutrients, and oxygen to the heart and other organs, including the ears. Folacin supports energy production in hearing cells as well as increases circulation to the ears and elsewhere in the body. This deficiency is one of the main reasons people equate hearing loss with aging. Obviously, this need not happen.
  • B1 (Thiamine): Thiamine not only enhances circulation but it also optimizes brain and hearing function. A deficiency is known to produce a delayed auditory brainstem response. A biotin deficiency is also thought to affect development of the auditory nerves. Therefore, it is essential that a diagnosis and treatment of a biotin deficiency is carried out in the first year of life.
  • B2 (Riboflavin): B2 is thought to help the hearing cells use needed oxygen. To illustrate how important B2 is as far as the transportation of oxygen is concerned, hyperbaric oxygen treatments are now being recommended as the preferred treatment for sudden hearing loss, acute noise trauma from a car airbag, and Meniere's disease.
  • B3 (Niacin): In the body, niacin is converted into two active forms: NAD (nicotinamide adenine dinucleotide) and NADP (nicotinamide adenine dinucleotide phosphate), which are vital in the transfer of energy in cells. They are two of the most important coenzymes in the human cell involved in more than 50 different metabolic reactions. Niacin and its derivatives help nerve and hearing function cells operate at optimal levels by increasing circulation to the ears, as well as other parts of the body. It has been particularly helpful for those suffering from Meniere's syndrome, associated with hearing loss and vertigo.
  • B5 (Pantothenic acid): Pantothenic acid has been helpful to those suffering from tinnitus where it is thought to “coat�?nerve endings in the ear, thereby creating less of the agitating noise.
  • B6 (Pyridoxine): According to PubMed, a B6 deficiency can affect peripheral and brainstem auditory pathways. B6 is also thought to be able to help regulate fluid levels in the ears.
  • B12 (Cobalamin): B12 comes in various forms, but the methyl form is the one best used by the body, especially the central nervous system. Cyanocobalamin is the one most often found in nutritional supplements but then has to be converted by the liver. The conversion produces a significantly lesser amount. Therefore, it is best to use the methyl form. A Houston studypublished in the American Journal of Clinical Nutrition found that deficiencies in both B12 and folate, ones particularly common in the elderly, were likely associated with age-related auditory dysfunction. Deficiencies of these two B vitamins could affect both the nervous and vascular systems associated with hearing. A deficiency has also been associated with chronic tinnitus and noise-induced hearing loss. This led researchers to recommend that serum levels of vitamin B12 be evaluated in persons with tinnitus, noise-induced hearing loss, or age-related hearing loss. A deficiency of B12 may also inhibit myelination (outer covering) of the neurons in the cochlear nerve.
• C: In studies, vitamin C proved to be a highly beneficial antioxidant, particularly when combining it with glutathione as a protection against gentamycin ototoxicity. As much as two or three times the normal dosage was recommended during the drug treatment. Vitamin C was also found to help protect or lower the damage to cochlear hair cells and hearing caused by noise exposure. Vitamin C with bioflavonoids has long been used for proper immune function and, as a result, helps in preventing infections, including those in the ears.
• D: As far as hearing is concerned, a deficiency in this vitamin has serious consequences and has been associated with otosclerosis (abnormal bone growth in the middle ear), unexplained and bilateral cochlear deafness, presbycusis, and sensorineural hearing loss. Researchers had to conclude that vitamin D deficiency is likely one of the causes and supplementation should be considered in persons with hearing loss. Vitamin D can be inhibited if there is also a magnesium deficiency. If there is a magnesium deficiency, this will also affect calcium intakes. As you can see, not just one nutrient can be isolated as being a cause or cure of something.
• E: Vitamin E is a powerful antioxidant that increases circulation, beneficial to all parts of the body including the ear. A deficiency has also been associated with such neurological dysfunctions as abetalipoproteinaemia (also known as Bassen-Kornzweig syndrome) and other fat absorption disorders. Fats, especially alpha-linolenic acid (ALA an Omega-3 essential fatty acid) are vital for the auditory brainstem responses. Furthermore, if the body has problems with fats, there will also be deficiencies in the vitamins stored in fats: vitamin A, vitamin E, and vitamin K, which will cause a domino-effect in health that can also affect hearing. Good circulation depends on a rich supply of essential fatty acids. Excess saturated fat in the diet can interfere with this, as has been shown in children with hearing fluctuations which varied according to their fat intake. Essential fatty acids also helps reduce the tendency to produce excessive amounts of earwax.

Minerals

• Copper: Most people receive adequate amounts of copper from their diet. However, a copper-deficient diet has proven to have a detrimental effect on the auditory structures as well as the auditory startle response. Age-related cochlear hair cell loss is also enhanced when the diet is lacking in copper as well as zinc. Copper plays an important role in overall neurological health, including hearing; and a deficiency has been associated with hearing loss.
• Iodine: Although iodine deficiency is most commonly associated with goiter (an overgrowth of the thyroid gland), studies in animals and humans have found that an iodine deficiency also plays a role in sensorineural hearing loss, including middle ear changes, cochlear lesions, congenital deaf-mutism and bilateral hearing deficits, as well as high hearing thresholds in children. Having an adequate dietary intake of iodine during pregnancy is critical for fetal brain development, beginning about the 14th week and continuing perhaps into the third trimester. In Guizhou, China noted improvements in hearing were seen in otherwise normal school children in iodine-deficient areas following use of iodized salt. There has also been a noted relationship between urinary iodine concentration and hearing capacity in children. Although iodine is available in ordinary salt, some iodine contents are deliberately lowered in some types of table salt in an effort to compensate for the excessive use of table salt by many persons. Certain medical conditions also require strict limitation of dietary salt, further reducing intake of iodine. However, it should be noted that not much is usually needed by the average person.
• Iron: Iron deficiency is fairly common and can result from several causes including too little dietary iron, poor absorption of iron, or chronic or acute bleeding. (See more here.) Several studies have been conducted where results showed an association with iron deficiency and several hearing abnormalities, including damage to the inner ear cells and sensorineural hearing loss, elevated auditory thresholds, as well as noise-induced hearing loss and cochlear deafness.
  Caution: On the other hand, some research focused on the role of iron in gentamicin-induced ototoxicity. Gentamicin, and similar drugs, is a commonly used antibiotic worldwide, despite its known toxicity to the inner ear. In these studies, gentamicin combined with iron actually produced free radicals and ototoxicity. Therefore, any iron supplementation for anemia-related hearing loss should be done only under the supervision of a physician.
• Magnesium: Magnesium helps support healthy nerve function in the auditory system, prevents damage to the inner ear hair cells, and protects the arterial linings from physical stress. Studies have shown that this mineral has some protective benefits against noise-induced hearing loss with faster recovery from hearing threshold shift and a significant reduction of trauma caused by high levels of noise exposure, as well as a reduction in ischemia-induced hearing loss. A deficiency did show a significant decrease in these protective benefits.
• Manganese: Some nutritionists have noted a relationship between a deficiency in manganese and that of ear noises and diminished hearing.
• Potassium: A healthy nervous system and proper transmission of nerve impulses to all parts of the body, including the ear, is dependent upon potassium.
• Zinc: This essential mineral is vital for many functions that occur in the body including the support of the immune system, but research is finding that it also protects hair cells in the inner ear. The relationship between zinc deficiency and tinnitus, cochlear damage, and hearing damage has been studied in both humans and animals. Zinc deficiency increases the vulnerability of the cochlea to hearing loss associated with normal aging. Research results indicate that zinc deficiencies increase the vulnerability of the cochlea to damage associated with normal aging. When a zinc supplement was given, one-third of the elderly patients showed marked improvement in tinnitus caused by presbycusis and sensorineural hearing loss. One interesting finding was that researchers found that tinnitus occurred in 13% of children who passed audiometric screening texts, in 23% to 60% of children with hearing loss, and in 44% of children with secretory otitis media. Only 3% of children complain about tinnitus because they do not consider it to be abnormal. According to at least one researcher, tinnitus might be a factor in behavioral problems in children.

Amino Acids

• Arginine: Many health-related functions are attributed to this essential amino acid, including protection against sensorineural hearing loss and cochlear damage caused by the toxins produced by Streptococcus pneumoniae infections. A deficiency does have an effect on the inner ear in Reye’s syndrome. However, not everyone should take arginine supplements, which is why supplementation needs to have professional medical supervision. But if it is used as a supplement, it is advised to take antioxidants as well.
• Carnitine: Acetyl-L-carnitine is a favorite anti-aging amino acid and closely related to the B vitamins. However, it is also being recognized as having a beneficial effect on diabetes-induced brain stem auditory deficits. Acetyl-L-carnitine is the preferential form because of its superior absorption and because it plays a key role in the transport of fatty acids from inside to cell to the mitochondria in the inner ear, a crucial step for energy production. Studies have shown that it also improved hearing in aged subjects.
• Cysteine: N-acetyl-cysteine is the amino acid form best utilized by the body. It helps protect critical hearing cells in the inner ear. As an antioxidant and glutathione precursor, it has many important functions including the preservation of hearing. Studies have shown that noise levels normally causing severe and permanent hearing loss will result in little or no damage when n-acetyl-cysteine is taken. It is also known to protect various parts of the body, including the sense of hearing, from certain medical and cancer treatments as well as the ototoxic effects of cisplatin. (See The Laryngoscope 2001.)
• Glutathione: A deficiency of this amino acid can increase the risk of noise-induced hearing loss. Replenishing it reduces the damage. Another protective benefit is that it protects against gentamicin ototoxicity, which often induces damage to the cochlear. Studies have shown that aging causes a severe reduction in glutathione levels, especially in the auditory nerve.
• Histidine: An essential amino acid, histidine is vital in the maintenance of the myelin sheaths surrounding nerves, including the auditory nerve and used to treat some forms of hearing disability. Consequently, where there is a deficiency of histidine, nerve deafness is likely. A deficiency is also associated with overall hearing loss.
• Methionine: An amino acid with antioxidant properties, methionine has been found to have important protective benefits to both auditory hair cells and auditory neurons from various types of ototoxic hearing loss, especially from aminoglycosides, ionic platinum compounds, and cisplatin. Since methionine is the precursor to homocysteine in the body, folic acid and vitamins B12 and B6 should also be taken to protect against an excess accumulation of homocysteine. High homocysteine levels coupled with low B vitamin levels interfere with blood flow to the inner ear.
• Taurine: Taurine is a semi-essential amino acid, meaning that it is only essential under certain circumstances. A deficiency does take time to develop but can cause lasting effects, especially in infants who are not able to obtain the nutrient from their diets. Infants with inadequate dietary taurine have shorter auditory brain stem responses, but those who received a diet rich in the nutrient, showed earlier maturation of the brainstem auditory response.

Co-Enzymes

• Alpha lipoic acid: It is a powerful antioxidant which protects against free-radical damage, supports nerve system function, and plays an essential role in generating mitochondrea in the hair cells of the inner ear. It has also been shown to improve overall energy and age-related hearing losses. Presently its primary therapeutic use is for the treatment of diabetic induced nerve dysfunction (neuropathy). Alpha lipoic acid converts to DHLA (dihydrolipoic acid) which is known to recycle glutathione which, in turn, recycles vitamin E. Because it has such powerful action against free-radicals, there is also evidence that it plays an important role in reducing presbycusis and improving cochlear function, as well as providing protection against noise and auditory toxicity caused by ototoxic drug therapies.
• Co-enzyme Q10: It is another powerful antioxidant similar to vitamin E which helps to maintain circulation to the ears as well as supporting energy production in hearing cells, and protecting against free-radical damage. Known for improving function to heart patients, CoQ10 is also showing promise as a component necessary for preventing progressive hearing loss in diabetics without affecting other diabetic complications or clinical symptoms. Studies are showing that CoQ10 is also effective in promoting recovery from acute sudden deafness resulting from hypoxia (insufficient oxygen) as well as in the recovery of damaged auditory hairs and in preventing respiratory metabolic impairment of the hair cells caused by hypoxia. Other studies showed that CoQ10 had an effect on neurosensory deafness resulting from maternally inherited diabetes mellitus and deafness.
• NAD (nicotinamide adenine dinucleotide): This important coenzyme is formed from niacin (vitamin B3), which provides the nicotinamide in NAD (nicotinamide adenine dinucleotide). NAD, and its derivatives, are all vital in the transfer of energy in cells. It helps nerve and hearing function cells perform at optimal levels.
• Pregnenolone: Although its functions are not well known, it has been suggested that pregnenolone serves as a precursor or “mother steroid�?to other hormones, including DHEA (dehydroepiandrosterone) and progesterone. Pregnenolone is synthesized in both the adrenal glands and in cells of the central nervous system as well as in the liver, skin, testes and ovaries. Since pregnenolone, like other hormones, diminishes during the aging process, it is understandable why supplementation would improve overall health, including visual and hearing acuity in many people.
  Caution: Technically, pregnenolone can cause disturbances in the endocrine system. This may appear as changes in the menstrual cycle or the development or aggravation of such hormone sensitive diseases as breast or prostate cancer. The side effects and interactions with other therapies are currently unknown. Therefore, relying on this substance solely for the purpose of improving one’s hearing may not be the best idea.

Herbs

Herbs are meant to be used as medicines and should not be routinely consumed for long periods of time.

• Butchers broom: This herb can help support circulation to the ears and control fluid levels.
• Ginkgo biloba: This herb is better known for enhancing the memory, as well as a wide range of other health benefits. This may be because it helps promote blood flow, which works well for the circulation to the ears. It also seems to help to maintain balance in addition to other hearing disorders, including tinnitus, and has been shown to have a protective effect against gentamicin-induced cochlear damage and cisplatin-induced toxicity.

Medical experts have long grappled with a precise definition of the condition �?that is, whether it is a syndrome or a disorder. A syndrome is a set of symptoms that accompanies another separate disorder while a disorder is a culmination of definitive symptoms. Whatever the technical term, it can be a debilitating condition.

Although persistent tinnitus is a common condition, it is usually benign but very annoying. It is estimated that up to 50 million American adults are bothered by it in some form or another. Sometimes the condition interferes with sleep. Tinnitus is frequently associated with most other ear disorders as well as other diseases, including cardiovascular disease, allergies, and anemia.

Tinnitus has been described since the time of the ancient Pharaohs and still remains a mystery as to how mechanisms trigger the sounds within the ear. Several theories have been proposed. One is that something happens within the central nervous system, similar to the phantom-like sensations experienced after an amputation. In similar fashion, the CNS is somehow responding to hair cells that have been lost by stimulating electric signals to the brain.

Another theory suggests that it is centered in the brain, based on evidence from PET (positron emission tomography) scans. PET scans reveal information about which part of the brain is being used to process information or to accomplish a specific task. Careful study of PET imagery of people with tinnitus suggests that tinnitus sounds stimulate a part of the brain different from that stimulated by external sounds.

Some researchers also speculate that tinnitus arises in the cochlea, specifically from disorganized activity of the hair cells. Others think the cause may lie with the activity of chemicals in the auditory nerve, which carries messages between the inner ear and the brain. Evidence also suggests that spontaneous nerve activity in the auditory pathway may be the culprit.

Turbulent blood flow through veins and arteries may also produce a sound sensation. Such blood vessels as the carotid artery and the jugular vein lie close to the inner ear. And still another thought is that tinnitus may also result from a misalignment of the jaw joint (temporomandibular joint) which can produce a clicking or grating sound.

Most scientists agree, however, that the condition most likely stems from multiple causes and mechanisms. Since a definitive cause has not been found, neither has a cure. Therfore, most people have to live with the condition and develop ways to minimize its effect on their daily lives.

Classifications of Tinnitus
Some experts have placed tinnitus into two broad categories: objective and subjective.

• Objective tinnitus is sometimes referred to as pulsatile; that is, a sound sensation that can be heard within the body as that from a turbulent blood flow. Atherosclerosis, for example, is a buildup of cholesterol and other fatty deposits that can cause the blood vessels to narrow, requiring a more forceful blood flow. This causes the heart to work harder, to a point where the ears can detect each heartbeat. The malformation of small blood vessels (capillaries) connecting the arteries and veins can also produce an audible pulse sound. Other possible sources of objective tinnitus include muscle spasms, movement of the eustachian tube, and spontaneous vibrations of the hair cells in the inner ear. About 4% of individuals with tinnitus have the objective type, and treating the vascular conditions may help reduce or even eliminate the sounds.

• Subjective tinnitus involves sounds that only the individual can detect, differing from the objective type where the doctor may also hear the sounds through a stethoscope. As a result, scientists must rely on how well people describe what they are hearing. In fact, some experts have compared the effort of defining subjective tinnitus to the popular fable of the blind mice attempting to describe an elephant. The consensus may in fact turn out to be quite different from the reality. Many believe the problem originates somewhere within the structures of the inner ear, as the cochlea and the auditory nerve, or within the auditory centers of the brain.

  Although the precise nature of subjective tinnitus is unclear, several factors are known to trigger the condition or make it worse:

  • Loud noises can damage hair cells in the cochlea causing a permanent condition. About 90% of people with tinnitus have some form of noise-induced hearing loss. Age-related hearing loss may also precipitate tinnitus as will a wax buildup or an ear infection.
  • Medications, described as ototoxic, are associated with producing tinnitus as one of the side effects.
  • Jaw disorders may result in noises in the ear. A dentist who specializes in the treatment of this joint may be able to correct the alignment and eliminate the associated noises.

  Other factors associated with tinnitus include:

  • Schwannomas (benign tumors that grow on nerve fibers of the brain)
  • trauma or injury to the head or neck
  • perilymph fistula (a rupture in the membrane covering the oval window)
  • otosclerosis (stiffening of the middle ear bones)
  • Meniere’s disease (causes excess fluid in the inner ear)
  • excessive sodium intake
  • stress (emotional or physical)

• Hyperacusis is another condition often associated with tinnitus and involves an extreme sensitivity to sound. Such everyday noise as traffic, conversation, and ringing telephone may seem uncomfortably loud. The cause of this is unclear and can be more debilitating than tinnitus. A person with severe hyperacusis may avoid social situations for fear of exposure to painful noise (phonophobia). Although some form of hyperacusis may occur in people with hearing loss, those reporting hyperacusis usually have normal hearing.

Treatments
Treatments consist only of managing the symptoms.

• Option One: Attend a program that gradually increases the tolerance of normal sounds. This may involve a white noise generator, an electronic device that generates a hissing sound similar to that when a radio is turned between stations. Initially the device is turned to barely audible levels and then gradually increased to higher levels for regularly set periods of time.
• Option Two: Using a hearing aid that will attempt to include enough background noise so as to mask the tinnitus sounds. Hearing aids can amplify external sounds so that the sounds of tinnitus are less noticeable. However, if there is no hearing loss or the tinnitus is at a different frequency from any hearing loss, a hearing aid may not be helpful.
• Option Three: In cases where option two cannot help, an alternative might be to wear a simple masking device that fits behind the ear. This device resembles a hearing aid; but, instead of amplifying sounds, it produces low-level background noise that is supposed to be easier to tolerate than tinnitus. There are controls on the masker to raise or lower the loudness. Its frequency is usually programmed by the manufacturer. An audiologist will help with the necessary choice.
• Option Four: Using a combination hearing aid and masker. This device amplifies environmental sounds and speech but can also provide background noise to mask the tinnitus.
• Option Five: Using a bedside masker or loudspeaker. Since tinnitus is often more noticeable at night because everything else is so quiet, using a bedside masker or loudspeaker allows select sounds, as ocean waves, falling rain, or white noise to override the tinnitus sounds. This type of masker can help relax and obscure the noise of tinnitus during periods of rest or sleep.
• Option Six: Others find short periods of relief in a form called residual inhibition. This is a time when perception of tinnitus is partially or completely reduced after removing the masker. These episodes may last from less than 30 seconds to two or three hours.
• Option Seven: Cochlear implants. In certain cases, as in those with total or near total hearing loss, the use of a cochlear implant may help decrease tinnitus. A cochlear implant is a hearing device implanted behind the ear that picks up external sounds and sends them to the brain as electrical signals. These signals help the wearer hear speech and environmental sounds. However, cochlear implants have also been known to induce symptoms of tinnitus. (See more information separately.)
• Other treatments include drugs to mask symptoms of depression or dizziness, cognitive therapy, biofeedback, and a retraining program where the person is taught to refocus attention from the problem to something else. Still others have found relief through acupuncture, acupressure, yoga, hypnosis, and joint and muscle manipulation. Vitamin and mineral supplements, dietary controls, and herbal medicines have also improved overall health to the point where tinnitus has disappeared.