Antioxidant therapy in idiopathic tinnitus: preliminary outcomes

http://www.ncbi.nlm.nih.gov/pubmed/17416295

Antioxidant therapy in idiopathic tinnitus: preliminary outcomes.

Abstract

BACKGROUND:
Reactive oxygen species (ROS) play an important role in several pathogenic processes, damaging various structural and functional cellular components. The endothelium is at major risk of radical-induced lesions and this damage is most manifest in microcirculation. It has been recently observed that ROS are implicated in the pathology of the inner ear and the peripheral and central pathways. In a previous study we detected high serum values of ROS in subjects with idiopathic tinnitus. The purpose of the present study was to evaluate the validity of antioxidant treatment in tinnitus sufferers with high ROS values.

METHODS:
The study considered 31 consecutive patients with unilateral idiopathic tinnitus. The mean pure tone audiometric threshold (PTA), tinnitus loudness, subjective disturbance level [visual analogue scale (VAS) determination], and the indirect ROS dosage 48 h before and after medical treatment were evaluated. Patients underwent an 18-week oral treatment with a mix of phospholipids and vitamins (glycerophosphorylcholine, glycerophosphorylethanolamine, beta-carotene, vitamin C, vitamin E).

RESULTS:
ROS levels were significantly reduced following antioxidant treatment (malonaldehyde: 2.10 vs. 1.98 mumol/dL, p = 0.003; 4-hydroxynonenal: 2.36 vs. 2.16 mumol/dL, p = 0.002) In addition, great improvement was observed in the reduction of tinnitus (VAS and tinnitus loudness evaluations). No significant changes in audiometric threshold occurred.

CONCLUSIONS:
Oral antioxidant therapy in patients with idiopathic tinnitus seems to reduce the subjective discomfort and tinnitus intensity and may be considered as an additional treatment modality.

 

Targeted Nutritional Therapies

Antioxidants

Antioxidants are compounds that have the ability to neutralize damaging reactive oxygen species (ROS). Since ROS are involved in the development and progression of tinnitus and hearing loss, antioxidants represent a promising therapeutic strategy (Sergi 2004; Savastano 2007; Joachims 2003).

N-acetyl cysteine. N-acetyl cysteine (NAC) is a naturally occurring antioxidant that has been used for years to treat acetaminophen overdose and break up mucus; it also increases the production of glutathione, one of the most prevalent antioxidants in the body (Kopke 2007). NAC has been studied as a potential therapeutic agent to protect hair cells from damage due to excessive noise as well. A 2011 study on military recruits found that NAC was able to protect the cochlea from damage due to noise from firing a gun in an enclosed space (Lindblad 2011). Animal studies have also found that NAC has a protective effect against continuous loud noises (Lorito 2006; Bielefeld 2007) as well as impulse noise (Kopke 2005). Another animal study showed that NAC may reduce noise-induced hearing loss even when administered after exposure to dangerous levels of noise (Coleman 2007). NAC has generated interest in the field of hearing loss because it is safe for human consumption and has already been approved for some uses in humans (e.g., treatment of acetaminophen toxicity) (Kopke 2007).

Acetyl-L-carnitine. Mitochondria are the energy powerplants of the cell. They are also the site of ROS production, especially when the cell is under stress. In cochlear hair cells, mutations in mitochondrial DNA and declining function of the mitochondria have been found to cause age-induced hearing loss (Yamasoba 2007). As a result, compounds that help maintain mitochondrial health, such as acetyl-L-carnitine, may help protect cells from damage. Animal studies have found that acetyl-L-carnitine is able to protect the cochlea from both continuous and impulse noise damage as well as prevent loss of hair cells (Kopke 2002; Kopke 2005). Acetyl-L-carnitine was also found to reduce mutations in mitochondrial DNA, suggesting that it could prevent not only noise-induced hearing loss, but also age-related hearing loss (Seidman 2000). Much like NAC, acetyl-L-carnitine appears to be effective even when administered after exposure to loud noise(s) (Coleman 2007; Du 2012). In one animal study, acetyl-L-carnitine was shown to protect against ototoxicity induced by the chemotherapeutic drug cisplatin (Gunes 2011).

Lipoic acid. Lipoic acid has been found to reduce age-related hearing loss (Seidman 2000). Preliminary animal studies have also found that lipoic acid can help protect against noise-induced hearing loss and preserve inner-ear mitochondrial function (Diao 2003; Peng 2010). This may be partly due to the effect it has on glutathione (i.e., a naturally occurring antioxidant in the body). Studies have found increasing glutathione levels help protect the cochlea from damage due to loud noises (Le Prell 2007). In one laboratory study, lipoic acid was shown to increase glutathione levels in nerve cells, protecting them from damage (Jia 2008). Lipoic acid may also be able to counteract the action of toxins (e.g., carbon monoxide) that aggravate the effects of noise and make normally safe levels of volume harmful to the ear (Pouyatos 2008). In a clinical trial among 46 elderly subjects with hearing loss, 8 weeks of treatment with lipoic acid (60 mg/day) combined with two other free radical scavengers (vitamin C [600 mg/day] and rebamipide [300 mg/day]) significantly improved hearing at all frequencies tested (Takumida 2009).

Vitamins. Dietary supplementation with vitamins that have antioxidant capabilities can help protect the hair cells of the cochlea. One animal study showed that a 35-day pretreatment regimen of vitamin C may be able to protect against noise-induced hearing loss (McFadden 2005). Similarly, supplementing animals with certain forms of vitamins A and E have shown significant protective effects (Hou 2003; Ahn 2005). The length of time vitamins need to be taken prior to noise exposure may vary depending on the vitamin. For example, vitamin E appears to be effective with three days of pretreatment, vitamin A may only require two days to be effective, and Vitamin C may require a longer pretreatment period. In addition, taking vitamins in combination may be more effective than any one of them alone (Le Prell 2007). For example, a combination of B-vitamins, vitamins C & E, and L-carnitine protected rodents from cisplatin ototoxicity (Tokgoz 2012).

Folate and Vitamin B12. Folate and vitamin B12 are important for the functioning of many cells in the body, including nerve cells. They also help reduce levels of homocysteine, a potentially toxic compound found in the body. Elevated homocysteine levels are linked to an increased risk of hearing problems (Gok 2004; Gopinath 2010). Vitamin B12 injections (1 mg for 7 days followed by 5 mg on day 8) protected against noise-induced hearing loss in healthy volunteers aged 20 to 30 years (Quaranta 2004). Researchers have found that patients with low levels of folate in their blood are more likely to develop hearing loss (Gok 2004; Lasisi 2010; Gopinath 2010), and that low vitamin B12 levels are associated with hearing loss (Gok 2004) and tinnitus (Shemesh 1993).

Magnesium. Because loud noise impairs blood flow to the cochlea, researchers have also examined compounds that could help improve circulation to the hair cells and prevent their death. Magnesium is known to help expand blood vessels and improve circulation; it also helps control the release of glutamate, one of the major contributors to noise-induced hearing loss (Le Prell 2011). Animal studies have found that magnesium deficiency increases the risk of noise-induced hearing loss (Sendowski 2006b; Schiebe 2002). A combination of magnesium and other antioxidants may synergistically prevent hearing loss, potentially because magnesium’s ability to increase blood flow also helps transport the protective antioxidants (Le Prell 2011). Other animal studies have determined that magnesium can protect against impulse noise damage (Sendowski 2006a; Haupt 2003). Magnesium’s benefits have been demonstrated in human trials as well; magnesium supplementation (122 mg daily for ten days) reduced noise-induced hearing loss in men aged 16-37 years (Attias 2004). Studies have also found that both intravenous magnesium and oral magnesium supplementation may be beneficial for other types of hearing loss, such as sudden sensorineural hearing loss (Gordin 2002; Coates 2010).

Melatonin. Melatonin, a hormone critical for healthy sleep (Wurtman 2012), has powerful antioxidant properties. Animal studies have found that it is effective at preventing hearing damage after exposure to loud noises (Karlidag 2002; Bas 2009). It is also effective at treating other types of hearing loss caused by ROS, such as due to the chemotherapy drug cisplatin (Lopez-Gonzalez 2000). Researchers have discussed the potential for melatonin to act as a protectant against age-related hearing loss (Martinez 2009). For example, it was noted in a study that low plasma levels of melatonin were associated with significant high-frequency hearing loss among elderly subjects (Lasisi 2011).
Additionally, melatonin has been tested as a treatment for tinnitus, both in combination with the medication sulpiride (an atypical antipsychotic) and on its own. On its own, melatonin provides relief from tinnitus, especially in people with significant sleep problems (Rosenberg 1998; Megwalu 2006; Reiter 2011).When combined with sulpiride, melatonin reduces the perception of tinnitus by diminishing the activity of dopamine, a chemical in the brain. In one study, sulpiride alone relieved tinnitus in 56% of subjects while melatonin alone reduced tinnitus in 40%. However, when used together, 81% of subjects reported relief from their tinnitus symptoms (Lopez-Gonzalez 2007).

Ginkgo Biloba. Ginkgo biloba, a commonly used herbal supplement, has attracted interest as a means of protecting against hearing loss as well as a treatment for tinnitus. Early animal studies found that when a standardized preparation of Ginkgo biloba extract was given as a supplement to animals, it reduced behavioral manifestations of tinnitus (Jastreboff 1997). This extract, at a dose of 160 mg daily over a 12 week period, was also effective at reducing symptoms in humans (Morgenstern 2002). However, other studies have found negligible or no effect (Hilton 2010; Canis 2011); therefore, more research is needed in this area. Ginkgo biloba may also be effective at preventing hearing loss that causes tinnitus; an animal study found that a Gingko biloba extract was able to reduce drug-induced oxidative damage to hair cells in the cochlea (Yang 2011).

Coenzyme Q10. Coenzyme Q10(CoQ10) supports mitochondrial function and has significant antioxidant properties (Quinzii 2010). Animal studies have found that supplementation with CoQ10 reduced noise-induced hearing loss and the death of hair cells (Hirose 2008; Fetoni 2009, 2012). Human studies have also yielded promising results, as 160-600 mg of CoQ10 daily was found to reduce hearing loss in people with sudden sensorineural hearing loss and presbycusis (Ahn 2010; Salami 2010; Guastini 2011). Also, a small preliminary trial found that CoQ10 supplementation alleviated tinnitus in those whose CoQ10 blood levels were initially low (Khan 2007). Another small trial found CoQ10 may slow progression of hearing loss associated with a mitochondrial genetic mutation (Angeli 2005).

Zinc. Zinc, a mineral involved in many physiological processes (including nervous system function), has antioxidant and anti-inflammatory properties (Frederickson 2000; Prasad 2008). Evidence suggests that inadequate zinc intake may be associated with impaired hearing (Kang 2012). Researchers have found that zinc supplementation may be helpful in treating some forms of hearing loss (Yang 2010). In addition, low levels of zinc correlate with perceived loudness of tinnitus in afflicted individuals (Arda 2003).

Omega-3 fatty acids. Long-chain omega-3 (n-3) polyunsaturated fatty acids, long recognized as important for health, may also affect hearing loss; a preliminary study found that participants with the highest blood levels of these beneficial fats suffered the least amount of hearing loss over time (Dullemeijer 2010). In another study, greater fish or fish oil consumption was associated with less hearing loss among nearly 3,000 subjects over 50 years of age. The authors remarked that “dietary intervention with n-3 PUFAs could prevent or delay the development of age-related hearing loss” (Gopinath 2010).

http://www.lef.org/protocols/eye_ear/tinnitus_07.htm

 

Hearing International did a 5 part series on: Homeopathic Medicine and Tinnitus Treatment

http://hearinghealthmatters.org/hea...athic-medicine-and-tinnitus-treatment-part-v/
"Based upon my research over these past five weeks, I have concluded that the only homeopathic remedy that has any REAL merit for tinnitus and other auditory symptoms is the use of antioxidants. If patients are experiencing tinnitus, I will recommend that they consider the use of antioxidants While the jury is still out, evidence suggests that when these antioxidants are received from natural foods and beverages, there are better results than when obtained from supplements. If an antioxidant supplement is used it should come from a reputable, known source to ensure that the substance is of high quality."

 

Thanks for all the great information. I have read much of this information since giving myself noise induced T. I think my good progression after almost 120 days with T can be attributed to the the antioxidants and supplements I started to take within three days of onset. I started NAC within three days of onset, and took for almost three months everyday. I have stopped taking daily, but take when pressure builds in my ears. Within an hour or so, it relieves the pressure.

I have good days and bad days as most of us do. But I believe I am still healing and getting better as a result of posts like this one. Newbies, pay attention and start the antioxidants as soon as possible. Acetyl l-carnitine and B12 made my ears buzz, but melatonin, magnesium, fish-oil with DHA, red wine, dark chocolate, I have consumed with no problems.

Thanks for continuing the search for such valuable information. Maybe one day we will find the magical concoction that will cure this infernal racquet! And by the way Calin, I am still wearing my far infrared cap as I type! Keep up the great work!

 

haha... that is so cool that you are still wearing the cap!

I noticed a bit of a change for the better since I started taking the salvestrol capsules. The change is that I used to have longer periods of the louder T states and less of the quieter T states. Now it is reversed. the whisper T lasts much much longer. And my night time T. has been quieter when that used to be my louder states. Salvestrols are antioxidants as well as cancer cell death mechanisms.

I sure hope to hear more of your good experiences!

 

Thanks for the response. Is this the only supplement you feel like has helped your T? Also, where did you purchase? I did not find a lot of available sources at reasonable prices. Keep us updated on your progress.

 

Ya know, I can't be absolutely sure about anything with tinnitus. I have done so many things to get it reduced to where I am over the last year. However, this new change in the volume and consistency has been since I started the salvestrol. If I had to live the rest of my life with the volume of T that I have now, I could manage. However, I expect the T to go to absolutely zero in time. I will find a way!!!

I have also been taking Ayurveda capsules for a case of urticaria I developed suddenly in December. I think it was the stress of my sister and her issues which includes lung cancer. She had personal issues that ended with the terminal status. She doesn't really have anyone but me left other than her daughters, so the support had to come from me. Major stress issues!

The herbal capsules came from India and there are 14 different ingredients in one dosage. They seem to be antioxidants, flavonoids, etc - plants from Himalayas, etc, which could all very well have salvestrols in them as well. I started those though long before the salvestrols. The doctor told me this treatment would take 3 months with the capsules. It is called Urtiplex which helps to purify the liver and body as well. I also take a child's dose of benedryl twice a day for the antihistamine property. Again, these were taken a couple of months or more before the salvestrol.

I also started taking quercetin and selenium over a month ago with my regimen of supplements which could also be a contributor. I increased my inositol powder to 12 grams a day for stress reduction recently too.

I switched to eating mostly organic as well as using body products that are natural or organic since the urticaria. I was trying to eliminate allergies and decided to go mostly organic for the health benefits.

I purchased the salvestrols from two places. One is kind of local which cost me more ($125) from a doctor that uses complimentary/alternative treatments. The other is from Canada - Salvestrols.ca.

My urticaria is diminishing significantly, but I still have a month to go with the capsules. When I stop taking that, I will have a better feel if it has something to do with the T volume. I doubt it though.

 

Karen, nope. The T is a pulse.

Yep! I agree! It is all about natural cures! Although, they often take longer.

 

Sworthi245, I read the information about your "cap", and it sounds interesting; might be worth a try! Let us know if that seems to be helping your tinnitus. I'm all about natural cures!![/quote]

I do like my far infrared cap. It seems to sooth my ears when they are really riled. When I sleep, I like to fold it over and hold it against my ears if one or the other is really ringing. If I hold it in between my hand and ear, it seems to get warmer than when I just wear it.

When I wear the cap, I think it helps, although it is hard to get it to fit tightly. I would like it much better if they made it with some spandex included with the other materials to make it grip my head. Body heat is supposedly what helps to generate the beneficial waves, but if it is loose, it does not warm up like it should.

For $37 US I would recommend that anyone try it. It is not expensive, and may benefit you in some way. I will continue to use mine, and getting closer to shelling out the $67 for the pillow case.