Long-standing, or chronic tinnitus, of longer than 6 months duration, is difficult to treat. The very best approach to tinnitus, as with any medical problem, is prevention. If you are beyond prevention, do consider the following list of possible causes and what to avoid, because it will help your tinnitus from worsening. Prescription drugs — even OTC drugs — are a major culprit. The primary offenders are aspartame (NutraSweet), aspirin, steroids, anti-depressants, anti-anxiety medications, antihistamines, anti-seizure drugs, antibiotics (especially cephalosporins) and pain killers. If drug initiation corresponds with onset of tinnitus — bingo! Avoid the drug. Some tinnitus is due to circulatory problems, including low blood volume. Make sure you are not anemic, especially if also being tired, pale and having heavy menses. With that symptom picture you could also be hypothyroid. Make sure you don’t have high blood pressure, which often goes undetected without periodic check-ups. Is your cholesterol or triglyceride level too high? Do you have food allergies? Are you diabetic? Do you have an ear infection? Do you suffer from “TMJ” (temporomandibular joint dysfunction syndrome)? There may be a structural problem. Have you had a head injury? Is your eardrum perforated? Have the tiny bones behind the eardrum fused (otosclerosis)? Is there a cyst (cholesteatoma) anywhere in the ear or canal? Do you use nicotine or caffeine? And, last but not least, do you now or have you ever listened to loud music? Using those Walkman-type devices with little earphones that go into the canal are particularly dangerous. And please don’t stand right under the speakers at aerobics class! Keep the volume low in your car, and at home including the TV. Damage to the tiny hair cells in the inner ear is irreversible. Protect your ears!

If the onset of your tinnitus is more recent, and none of the above is a possible cause, an inner ear virus is the likely culprit. Some of the treatment suggestions below will be helpful, and your tinnitus will probably resolve.

Top Five Treatment Approaches

1. Acupuncture
   Several controlled studies have shown acupuncture to improve tinnitus; just as many claim no benefit from acupuncture. Choose a licensed acupuncturist who has studied in China or Japan as part of their clinical training. Generally an MD acupuncturist has much less training. Traditional Chinese Medicine (TCM) distinguishes chronic or intermittent tinnitus from an acute, or sudden onset. The chronic form usually presents with a low, buzzing sound and is associated with general weakness, and thought to be a “deficiency” condition. Thus, “tonifying” is indicated. The sudden onset tinnitus is thought to be due to “excess” and the ringing is low, like screaming or thunder, and is not relieved by pressure on the ear. This presentation is treated by removing the “obstruction” in the channels (meridians) around the ears. A basic acupuncture prescription for tinnitus, which may take 10 to 15 sessions for improvement, is San Jao 3 and 17, Gallbladder 2 and 43, with Kidney 3 and 6 for the chronic type. Scalp or ear points are also useful. TCM has been around for many centuries; acupuncture often works, and it doesn’t hurt.

2. Gingko
   Gingko biloba is one of the most studied herbal medicines. It is well established that Gingko enhances blood flow to the periphery (edges of the body), in particular to the head and brain. If your tinnitus is due to circulatory problems, Gingko is likely to help, otherwise it will merely improve your memory. Take 240 mg of a standardized Gingko (in capsule form) daily, ideally in divided doses. The product should claim to contain 24% gingkolisides or gingko heterosides. You will notice your thinking is sharper within 3 to 10 days. Relief from tinnitus will take longer; give it 6 weeks. Once relief is achieved, you can lower the dose maintenance levels of 40-60 mg daily.

3. Eustachian Tube Drainage
   What? This is a naturopathic technique used to relief congestion in the tube behind the eardrum by draining fluid away from the ear. Ideally you can find your local naturopath to show you this technique; if not, you can give it a whirl on your own. This practice will help your tinnitus if it’s due to congestion of the ear, nose or throat. It’s also a good technique to expedite curing a simple ear infection, or unblocking your ears after diving or flying. First, make sure your hands are clean. With your mouth not too wide open, gently find your back molars on one side with your index finger. Beyond the molars is the curve of flesh-covered bone that creates the hinge between the upper and lower jaw. Gently go beyond the hinge, towards the back of the throat until you find a stringy vertical tendon. This is called the “tonsillar pillar”. Touch here will make most people gag, so go softly and carefully. Just behind the tonsillar pillar, down low near the root of the tongue, is the Eustachian tube, which feels like a small “mole tunnel” under the flesh. It may be impossible to feel, but if you got the tonsillar pillar you’re in the right area. Gently stroke the Eustachian tube from the ear side of the back of the throat towards the middle (towards the tongue) several times until you can’t stand it. Same thing on the other side if the tinnitus is bilateral. Do this daily and consistently for up to a week. Repeat as needed.

4. Supplements
   (Zinc and B12)Zinc, ideally in the picolinate form, 90-150 mg daily for 3-6 months may help, especially if zinc is low. If zinc lozenges taste really yucky, you probably don’t need zinc. If zinc seems to have little or no taste, you are deficient. Studies on zinc and tinnitus generally indicate that zinc is helpful in age-related tinnitus and hearing loss. Zinc can also help with age-related loss of taste.Vitamin B12 deficiency has been reported to be common in people exposed to loud noises, and who have developed occupational tinnitus and hearing loss. Intramuscular injections of B12 (1000 mcg weekly) reduced tinnitus severity; this is usually only available in the doctor’s office. You might find a doctor who will teach you to do this at home, and give you a prescription for the syringes and injectible hydroxycobalamin, which hurts less than cyano or methylcobalamin. No formal studies have been conducted using oral forms of B12, but many websites and anecdotal reports claim as little as 100 mcg daily by mouth can be effective after several weeks. Look for a B complex with emphasis on the B12.

5. Other Modalities
   (Cranio-Sacral Therapy, Neural Therapy, Tinnitus Retraining Therapy, Biofeedback, Homeopathy)

   Cranio-Sacral Therapy

   A quiet, non-force, hands-on therapy designed to improve the flow of fluid (cerebral spinal fluid) around the brain and along the spinal column. In the hands of a skilled therapist, symptoms may resolve in a single treatment.

   Neural Therapy

   An injection technique pioneered in Germany about 30 years ago, mostly for pain control. A very safe analgesic, usually 1 or 2% Procaine, is placed in specific “trigger points”. In the case of tinnitus, the trigger points will be similar to the acupuncture points, mostly around the ears. The idea is to “reset” and correct the nerve impulses which convey information from the outside world to the brain. Most doctors in the U.S. skilled in this technique were trained by Dr. Dietrich Klinghardt, MD.

   Tinnitus Retraining Therapy (TRT)

   TRT aims to teach the tinnitus patient to reduce or eliminate negative emotional reactions and to learn to live with the tinnitus. The intensive time commitment (18 months to 2 years) and financial investment required by TRT may make it unfeasible for most, but check it out on the Internet.

   Biofeedback

   A therapy that employs mild electrical stimulation to help you become more aware of physical changes resulting from stressors, and provides guidance for reducing those physical stress responses. In a nutshell, you learn to put mind over matter. Which is why using background music or mechanical noise like that of a fan is helpful, especially at night and during quiet periods, since silence can intensify the perception of tinnitus, which creates stress, which makes everything worse. If your tinnitus is severe, and nothing else has helped, broad-band tinnitus maskers or sound generators are a reasonable option. These devices can be fitted in or behind the ear by an audiologist, and provide a “white noise” distraction so the tinnitus is less noticeable.

   Homeopathy

   A 250-year-old medical science with German origins which uses plant, mineral and even animal material in minute doses to help the patient’s innate “healing force” to overcome the disease or symptom obstructing health. While better results are to be expected when working with a trained homeopath, the following remedies (with key symptoms in parentheses) have been useful in tinnitus:

   • Calc carb: chilly, craves sweets, anxious
   • Carbo veg: tinnitus after an illness
   • Cinchona officinalis: fluid loss, bleeding
   • Cimicifuga: head and neck tension, hypersensitive, menstrual headaches
   • Coffea cruda: buzzing in back of head, insomnia
   • Graphites: tinnitus and deafness, cracking skin, constipation
   • Kali carb: roaring noises with itchy ears; queasy stomach
   • Lycopodium: echoing sound, chronic digestive or urinary tract problems
   • Nat salicylicum: low, dull hum. Helpful in Meniere’s disease
   • Salicylicum acidum: loud roaring, may present with vertigo or deafness.
     Especially helpful if tinnitus is due to excessive aspirin use.