Tinnitus and Complementary Medicine

Paul Reller, L.Ac.

Tinnitus, the perception of noise without external cause, can be a persistent and extremely annoying and problematic symptom, affecting sleep, nervous agitation, ability to focus, and quality of life. It is often linked to hearing loss, dizziness, vertigo, imbalance, or discomfort. Symptoms of sensitivity to loud or high pitch sound (hyperacusis) are reported in about 30% of chronic cases, and dislike of certain sounds (misophonia) are reported in 60%. It is estimated that 17% of the population suffers from the symptoms of tinnitus, and 4% suffer from a more severe form. Clinically, the U.S. government reports that 5.7% of the population seeks serious treatment for tinnitus. Tinnitus noise may be perceived as high pitch or low pitch constant ringing, pulsing sound, wind noise, electric static, or other noise that is perceived in the abscence of an external source of the sound. Scientists believe that we all perceive intrinsic noise, but that most of us have the ability to ignore it perceptually. For those of us that acquire a problematic perception of noise, the problem signifies that there is both something wrong that has started this noise perception, as well as something wrong that perpetuates the perception of noise. Treatment cannot focus on just one area, and must be designed around an accurate diagnosis.

The frustrating problem with tinnitus is the broad array of health problems that can cause this symptom. Often, to fully diagnose the problem, a number of expensive tests and exams must be completed, and even then, a majority of patients will end up with no diagnosis (idiopathic), or a diagnosis of exclusion (measurable and testable problems are not apparent and so we will make an educated guess). Since the tinnitus is very annoying and agitating, the last thing that the patient wants to hear is that we don't know what is wrong with you and we don't know what to do exactly to fix it. The patient is often told that they just have to live with the tinnitus and hope that it goes away. At this point, the patient must come to the conclusion that there are therapies that will work, but that it is up to the patient to persist with diagnosis and treatment. The patient should be reassured that the tests administered so far did not come up with answers, since the first diagnostic tests administered are performed to rule out serious health problems, such as cancerous tumors, cardiovascular threat, etc. The array of problems that are left untested usually point to a more subtle, complicated and chronic underlying imbalance, and often involve both chronic tissue problems, and a problem with the regulatory centers in the brain, sometimes with a neurohormonal aspect.

Complementary Medicine may help patients with a mild problem, an acute problem, or a serious chronic problem. Complementary Medicine offers a variety of treatment protocols and addresses the underlying causes as well as the manifestation of the symptom of tinnitus. Acupuncture, herbal and nutrient medicine, and even physiotherapies, may be effective, but the positive effects may occur after one treatment or many, and often depend on narrowing the diagnostic possibilities and spending the time to solve the health puzzle. The choice of physicians by the patient is thus very important, and choosing physicians that are knowledgeable and spend the time to solve this often difficult health problem is the key.

“The key to relief from tinnitus is the understanding that tinnitus is a symptom, not a diagnosis, and that often diagnosis is problematic, but that both the symptom relief and improvement of relevant diagnosed conditions are important. Experts agree that attention to dietary, nutritional, chemical, hormonal, immunological, and stress factors may all be involved directly and must be evaluated and considered in a treatment regimen that is individualized and persistent.”

The patient must understand that tinnitus is a symptom, and the term tinnitus is not a diagnosis. Modern medicine lists 128 potential causes, or diagnoses, of this symptom called tinnitus, and often offers no effective treatment. The patient must understand that to effectively treat persistent severe tinnitus, narrowing the diagnosis, or cause, and persistence with therapy is the key. Secondly, the patient must understand that not only must the cause, or origin, of the tinnitus be revealed and treated, but also the manifestation of the health problem, or underlying dysfunction in the central nervous system. Allopathic medicine offers a number of therapeutic choices, and if a tumor or cardiovascular problem, or an infection, can be solved with these treatments, they may be effective. If not, adaptive therapies may also be effective. Often, none of this turns out to be effective, and this is where Complementary Medicine offers a variety of treatment opportunities that are not available from standard allopathic medicine.

Tinnitus and the health problems underlying tinnitus have been treated successfully for many centuries in China, and over the whole world, with acupuncture, herbal medicine, nutrient medicine, and even physiotherapies where applicable. Complementary Medicine offers a number of effective therapies and a thorough diagnostic assessement. Therapies from the California Licensed Acupuncturist may include acupuncture, herbal medicine, nutrient medicine, physiotherapy, therapeutic instruction, and focused cognitive training, combined in a package of care. Because the diagnostic presentation can be so varied, and the treatment choices of the Licensed Acupuncturist broad, success with these therapies may be quick or take some time to produce results. The patient must keep in mind that tinnitus is a symptom, and not the disease mechanism itself, and noticeable improvement may only come after the disease mechanism, or cause of the tinnitus, is resolved, and then sometimes only after the problems with the central nervous system are also set straight.

The standard scenario of diagnosis and assessment

When the patient goes to their medical doctor to assess tinnitus, the M.D. will perform a number of tests to rule out the most obvious and the most threatening of the 128 potential causes of tinnitus. If nothing is uncovered from these initial tests and exams, the patient is sent to a specialist, called an otolaryngologist, or ears, nose and throat specialist. More tests and exams are performed to rule out more of the obvious or threatening potential causes. The specialist will determine first if the tinnitus is objective or subjective by listening at the ear with a stethoscope or other device. If the tinnitus is objective, or heard by the specialist, there is a mechanical tissue problem at the ear causing the perception of noise. This type of tinnitus is rare. To rule out threatening causes, CT scans, blood tests, etc. will be performed. Expert diagnosis with modern medicine may be only the first step to restoring health, and the emphasis may be on ruling out serious causes. Since there are no FDA approved drugs found effective to treat tinnitus, standard medicine may not pursue the actual diagnosis thoroughly.

Often, with tinnitus, not only is the patient tested, but the patience of the patient is also tested. If the tinnitus sufferer steps back and looks objectively at the situation, he or she realizes that patience and persistence may be the key to alleviating the symptoms, as well as finding and correcting the underlying cause, when there are so many potential causes. Complementary Medicine is always focused both on the symptom and the correction of the cause. Careful discussion and assessment of the possiblities of underlying cause takes time and is important in Complementary Medicine. Scientific study has confirmed that significant relief may be obtained in 3 weeks with the right acupuncture course, but a more thorough course of treatment incorporating a variety of treatment strategies is a better guarantee of success. The evidence for acupuncture and other strategies is found on this website below, under additional information. If the symptoms are not relieved quickly with therapy, often a more prolonged course of therapy is needed to address the underlying causes. Even if the tinnitus is relieved, the smart patient will still continue to treat the underlying cause if it is a serious threat to future health.

One important early step that the patient needs to consider is to try to stop potential causes, such as medication side effects, and perpetuating factors, such as nervous and emotional stress. There are a large number of medications that could cause or contribute to tinnitus, some acutely, and some via chronic use. Some of these medications could cause ototoxicity, and often the tinnitus could cease within a relatively short time after stopping these medications if underlying problems are also addressed. Hallmarks of ototoxicity are tinnitus in both ears, feeling of pressure in the ears, and awareness of a hearing loss in an unaffected ear. The patient should discusss these possibilities with the prescribing M.D. and come to a mutual decision as to the benefits and risks of temporarily stopping certain medications. It is well documented in medical texts that high doses of salicylates (e.g. aspirin), furosemide (Lasix, a diuretic), and other loop diuretics can cause intense, sometimes bilateral, acute tinnitus (Cecil's Essentials of Medicine), and aminoglycoside antibiotics (e.g. streptomycin), as well as other antibiotics (erythromycin and vancomycin), can destroy cochlear hair cells in direct relation to dosage or blood serum accumulation. Some chemotherapies (e.g. cysplatin) have also been documented to produce similar damage. Non-steroidal anti-inflammatory medicines are regarded as common causes, and there is rising concern of tinnitus caused by or aggravated by SSRI anti-depressants. Chronic use of hormonal therapies and other medications may contribute to underlying conditions often related to tinnitus. If this is suspect, the patient should discuss the possibility with the prescribing medical doctor.

If the specialist exams and tests reveal the cause, Complementary Medicine may offer specific treatment protocol that will complement, or aid, the standard treatment, if it is offered. If these exams do not reveal a cause, Complementary Medicine may offer a time-intensive diagnostic approach and perspective that helps the patient uncover the probable disease mechanisms, and again, may offer specific courses of therapy to help resolve the problems. Unless the standard tests and exams reveal a cause that can be treated allopathically, such as surgical removal of a growth, cleaning of the outer ear and eardrum, etc., modern medicine often offers no effective therapy for persistent tinnitus. Often, the modern medical approach is to wait and see if the tinnitus resolves spontaneously without treatment. Treatment with acupuncture and herbal medicine may be effective if the problem is acute and related to ear infection, trauma, or other acute problem. If the tinnitus is chronic and the cause is difficult to determine, of course the treatment will be more difficult and quick results are seldom expected.

With standard medicine, if the tinnitus symptoms do not resolve in time on their own, specialty clinics may be suggested to perform adaptive therapy, although this is often not covered on standard insurance plans. Tinnitus Retraining Therapy, or Neuromonics Tinnitus Treatment, is one example of an adaptive treatment, and cognitively retrains the patient to adapt change in conscious and subconscious reflexes that may be responsible for evoking inappropriate connections between the limbic system and the auditory system in the brain. Changes in cognitive focus, and often autonomic nerve reflexes, are stimulated by cognitive therapy combined with behavioral exercises and devices such as sound generators. With the subclass of chronic severe tinnitus sufferers, claims of success of these therapies for those that persist with the treatment is reported to vary from 32 to 92%, but varies with the type of patient and underlying presentation. The underlying mechanisms here may relate to neuroendocrine imbalance, such as chronic hypothyroid conditions, side effects of chronic medication use, adrenal stress syndrome, chronic exposure to high decibel industrial noise, Meniere's disease, or apparent psychologic disturbance. These therapies are based upon research that shows that chronic tinnitus is often related to deeper neurological pathology that is related to the limbic system, a portion of the brain that is involved in both emotional responses and memory, as well as hormonal or endocrine function. What does this tell us? It reveals that chronic tinnitus may be related to a broader neuroendocrine health problem, and may thus benefit from a more holistic approach to restore healthy balance and relieve the symptoms.

The various therapeutic approaches that may be needed to relieve the patient that is afflicted with serious tinnitus include treatment strategies addressing dietary, nutritional, chemical, hormonal, immunological, and stress factors. Acupuncture, herbal medicine, nutrient medicine, and physiotherapy, may all address these various contributing factors. Effective choice of therapeutic protocols is thus very important, and the choice of a competent Licensed Acupuncturist may be the key for the patient.

With a symptom like tinnitus, which could be related to as many as 128 underlying diagnoses, the patient benefits from increased understanding of the possible diagnoses so that he or she may present the most pertinent diagnostic facts to the physician. Complementary Medicine and acupuncture can provide dramatic relief of this symptom, but often only when the physician and patient arrive at a logical assessment of possible underlying causes.

Potential underlying causes of Tinnitus

Modern TCM physicians have divided the potential causes, or diagnoses, underlying the symptom of tinnitus into three main categories. This classification mirrors the system of differential diagnoses used for centuries in China with the practice of Traditional Chinese Medicine. Tinnitus has been treated successfully, and these treatment strategies documented, by TCM physicians for thousands of years, but the types of treatments used, from selection of acupuncture points to selection of herbal formulas, depends on the correctness of diagnosis. The three categories of diagnoses are 1) congestive accumulation of cerumen or endolymph, usually associated with inflammatory heat or emotional agitation; 2) nerve occlusion, perhaps associated with transitory ischemic attack, carotid or vertebrobasilar artery pathology affecting adjacent auditory nerves, or looping of small arteries around acoustic nerves, as well as neuroma or tumor; and 3) kidney/adrenal or thyroid deficiency, which are believed to be causative of tinnitus due to poor regulation of metabolism and tissue maintenance. Of course, the first category, which includes aftereffects of ear infection as well as Meniere's disease, would be easiest to treat, involving a more focal ear pathology. The second category involves treatment of both the vascular health and tissues of the central nervous system, a more difficult problem. The third category involves treatment of the endocrine system as well as potential chronic kidney dysfunction, and involves attention to overall health and regulation in the body. This third type of cause is typical with chronic tinnitus, and usually involves a prolonged course of therapy.

The most prevalent causes of tinnitus are related to congestion or swelling of the inner ear tissues. Allergies, deep viral infections, overgrowth of fungi, yeasts, etc. such as aspergillus niger or candida albicans, or even psoriatic and eczamatous conditions can all cause swelling and congestion. Sometimes the congestion causing tinnitus occurs well after the viral infection, causing the cerumen (ear wax), or endolymph (lymphatic drainage), to accumulate in the inner ear due to improper flow or drainage. An exam of the outer ear and eardrum may be unremarkable, and yet this congestive problem may still be present. Meniere's disease is an example of congestive accumulation of endolymphatic drainage that may occur well after a causative event, and cause sensorineural hearing loss rather than the conductive hearing loss seen in middle ear swelling.

Nerve occlusion, or pressure on the auditory nerve, may occur with swelling, trauma, or various vascular problems. Adjacent blood vessels may become enlarged with inflammation or atherosclerosis, twisted or looped, or a transient ischemic attack may cause vessel abnormalities that occlude the auditory nerve. Generally, CT scans will detect these problems and the right therapies prescribed. Besides acute care and standard therapy, Complementary medicine offers a variety of therapeutic options for cardiovascular health. These options should be discussed with a professional, such as a Licensed Acupuncturist.

Tinnitus is a problem with 7-29% of chronic hypothyroid patients. The causes of this problem are still unclear, but relate to potential metabolic problems, poor tissue repair, or even chronic use of thyroid medication. Many endocrine problems could result in these type of scenarios, or even neurohormonal problems that cause perpetuation of tinnitus by affecting regulatory centers in the brain. Kidney deficiency is another known association, creating a variety of metabolic problems, including electrolyte imbalance and acid-base imbalance. There is also a strong relationship between glomerular flow rate in chronic kidney dysfunction and atherosclerotic hypertrophy of the carotid arteries, which could present problems at the auditory nerve.

Ototoxicity is a fairly common cause of tinnitus, with various drugs and environmental toxins shown to affect tissues of either the inner ear or nervous system, and often creating an eventual damage from free radical oxidant accumulation and tissue degeneration. This became a serious concern with the use of high dose streptomycin antibiotic for tuberculosis in 1944. This antibiotic caused dysfunction at glutamate receptors in the inner ear that led to both degeneration in the cochlear hair cells, as well as eventual oxidant excess and damage. Since this time, research has found a number of mechanisms of ototoxicity, with both acute damage and eventual damage, occurring well after discontinuing the drug. Early treatment and discontinuance of the ototoxic drug, or avoidance of the environmental toxin is important, as well as immediate and persistent use of antioxidants.

The array of diagnostic possibilities is broad, and so, a patient is advised to choose their physicians wisely and stick with assessment and therapy until success is found.

The end result of this variety of causes, and some surmise that it is often a combination of causes creating this confusing pathology, is the hyperexcitability of the auditory cortex in the brain. Both a mild, or subclinical, endocrine deficiency, and an overstimulation of the auditory pathway, may result in a perpetuation of the perception of tinnitus, as well as other symptoms and hearing loss. Studies involving indirect stimulation of the auditory cortex in Germany with transcranial stimulation have proven that this may increase the metabolic activity of the cortex, and result in sustained improvement of tinnitus (see study cited below). Complementary medicine and acupuncture/TCM has long offered an array of therapies that work together to address these issues and to stimulate the auditory cortex via electroacupuncture.

Understanding the pathophysiology of tinnitus in order to better treat the symptom as well as the underlying cause

Several important studies in the last 20 years have localized the area in the brain responsible for the increased neurological signal that the patient perceives as subjective tinnitus. In the past, it was assumed that the abnormal neurological signal that is perceived as tinnitus originated in the ear, or in the auditory nerve as it emerges from the ear. While the primary problem may have been with the ear, the actual source of the abnormal neurological input into auditory centers, or nuclei, in the brain, that cause the perception of tinnitus, have been traced to the limbic system. We know that this is correct because patients who are deaf, and patients who have had the auditory nerve resected with trauma or surgery, still are afflicted with tinnitus. Thus, the perception of tinnitus must extend to causes beyond the ear and local auditory nerve. PET scans have also been utilized in study and confirmed that isolation of the nervous hyperactivity is located centrally in the brain, in the limbic system. Once again, the patient must understand that the causative problem, or origin of the tinnitus, may exist in the ear and auditory nerve, and should be addressed therapeutically, but also the perpetuation of the tinnitus signal, which is related to the central nuclei, especially the limbic system.

Aminoglycoside antibiotics are a cause of induced tinnitus that has been studied since 1944, when introduction of the widespread use of this class of antibiotics utilizing high dosage caused many documented cases of tinnitus. Since this time, modern medicine has of course limited the dosage, and altered the aminoglycosides, to achieve less incidence of tinnitus. Nevertheless, many experts still see the potential for aminoglycoside antibiotics as a cause of a significant percentage of tinnitus sufferers, even long after the antibiotic is discontinued. Exactly how this damage occurs is still a subject of debate, though, but understanding the pathway of damage could point to improved therapeutic understanding. Aminoglycosides are molecules that combine a complex sugar and amino acid, and work by disrupting bacterial functions, often inhibiting key protein synthesis. While the exact mechanisms are still poorly understood, these aminoglycosides cause errors in genetic synthesis with DNA and RNA, cause premature cell death, and disrupt the integrity of the bacterial membranes. Even low doses of aminoglycoside antibiotics continue to cause bacterial death after discontinuing use by irreversible binding to the RNA and degradation of the bacterial lipoprotein membrane. We see the potential for harm to the delicate mebranes of the inner ear, as well as disruption of protein receptors, and the possiblity that excess tissue damage could result in accumulation of free radical oxidants in tissue that is difficult to clear, because of the poor blood supply. In fact, disruption of the glutamate metabolism and receptors, has been well studied in this regard.

Glutamate receptors are located on the nerve synapses, or connections. Glutatmate is an amino acid that also serves as a neurotransmitter and is particularly abundant in the brain. Glutamate receptors are implicated in a number of neurodegenerative diseases. Dysfunction and imbalance of the glutamate metabolism in the brain leads to problems with the calcium channels, and overexcitation of nerve cells. Since the glutamate metabolism is a regulated metabolic state in the brain, affected by glutamic acid and L-Glutamate in the blood, problems with this metabolism may have a variety of negative effects, and can be helped with the proper prescription of nutrient medicines, particularly, Vitamin B6 (or the active P5P), niacinamide B3, and L-Glutamine.

Effective treatment strategies as of 2009 for tinnitus

Current treatment protocol for tinnitus is based upon recent research findings as described above. Currently, the perception of tinnitus, mobility of the neck and posture, and anxiety and depression are all important aspects of standard therapeutic protocol. The department of Otorhinolaryngology of the School of Medicine at Louisiana State University published a review of tinnitus and biochemistry in 1999, and concluded that “Dietary, nutritional, chemical, hormonal, immunological, and stress factors are involved in neurootological problems and must be evaluated and considered in designing the treatment regimen for patients complaining of tinnitus.” A variety of scientific studies meeting rigorous standards, and published in medical journals, as well as in PubMed, the database of the National Institute of Health in the United States, has found that various types of acupuncture therapy have significant success. Some of these studies are accessed below under information resources, and have been conducted throughout the world. Success with herbal and nutrient therapy has also been well studied in recent years in the West, and for a long time in hospitals in China. Of course, the herbal and nutrient therapies are based upon individual diagnostic needs and correct differential diagnosis. There are no one-size-fits-all herbal remedies, despite what some advertising claims. Proper prescription by a professional herbalist and nutrient physician is very important to insure success. A combination of therapies that is tailored individually and treats according to objective diagnosis is vitally important. Since the objective diagnosis is often unclear, and a diagnosis of exclusion is often the only diagnosis, treatment strategy may incorporate knowledgeable prescription, and some trial and error in these cases.

Nutritional deficiencies and metabolic causes and contributors from nutrient deficiencies have been well documented for many years in the treatment of tinnitus. This does not mean that the patient necessarily has a poor diet, and the nutrient deficiency often occurs because of some chronic disease process and either increased metabolic needs or decreased absorption and assimilation of the nutrient chemicals. This subject can be quite complicated and knowledgeable assessment is important. Testing of nutritional deficiency is problematic, as mere circulating blood values may not reveal actual deficiencies. Common nutrient deficiencies found to be associated with tinnitus are Vitamin B12, zinc methionine, coenzyme Q10, niacin, magnesium, Vitamin B6, folic acid, and various minerals.

Because tinnitus is a symptom of various disease mechanisms, and involves various types of tissue pathologies as well as a central nervous system hyperexcitability and perceptual dysfunction, finding the single therapy that will work for all patients, or that will even work by itself on a patient, is problematic. More and more scientific studies are revealing how various treatments could contribute significantly to the overall treatment protocol, though. Researchers in 1998 in Torino, Italy, found that a significant percentage of patients with tinnitus of a vascular origin benefitted from a combination of Gingko biloba, L-Arginine, and magnesium. For patients with ototoxicity induced by antibiotic use, which creates excess free radical oxidant accumulation and glutamate receptor dysfunction that leads to auditory hair cell damage in the inner ear, various antioxidants seem to have significant effect. Alpha-lipoic acid as studied at Duke University Medical Center and found to significantly attenuate the damage induced in laboratory animals from an aminoglycoside antibiotic. Researchers at the University of Michigan found that glutathione deficiency increased the susceptability of laboratory animals to inner ear damage. A reasonable conclusion would be that improved glutathione metabolism, as well as various antioxidant therapeutics, should be included in a comprehensive treatment strategy, but that it may take more that this in many patients with a chronic history of tinnitus to achieve success. This is why a more complex and multifactored therapeutic protocol, combined with acupuncture stimulation, is a reasonable choice for patients and physicians.

An effective treatment strategy in Complementary Medicine for patients suffering from tinnitus involves individualized diagnosis and treatment plan, treatment of both the symptoms and the underlying causes, or diagnoses, and a combination of therapies. Treatment must address issues of nutrient imbalance, metabolic and hormonal imbalance, immunological issues, and stress factors. Stress factors include physiological stress from underlying disease mechanisms, immunological stress, and emotional and physical stress. A thorough approach may be essential to success. Various acupuncture strategies, herbal strategies, nutrient strategies, and even physiotherapies, may be needed in the individual treatment protocol.

Information Resources

1. There are currently no drugs approved by the FDA as effective in the treatment of tinnitus symptoms: http://journals.prous.com/journals/
2. Experts agree that the exact causal mechanism of tinnitus is still elusive, and that an individualised treatment regimen and strong therapeutic relationship between the physician and patient are the keys to success: http://www.ncbi.nlm.nih.gov/pubmed/15040757
3. Information on Tinnitus Retraining Therapy is presented at this website from the audiologist Pawel J. Jasteboff PhD: http://www.tinnitus-pjj.com/
4. A 2009 study of acupuncture in the treatment of tinnitus at Lund University in Sweden produced significant decrease in symptoms from a short course of auricular acupuncture that persisted at a 3 month follow-up: http://www.tinnitus-pjj.com/
5. A 2009 historical study published in the European Archives of Otorhinolaryngolgoy found archeological evidence that tinnitus was treated by specialists in China as far back as the 5th century BC with acupuncture, moxibustion, herbal therapy and physiotherapy: http://www.ncbi.nlm.nih.gov/pubmed/
6. A 2007 placebo controlled double blind study on human subjects found that acupuncture performed on just one point on the temporoparietal scalp had a significant effect relieving tinnitus: http://www.ncbi.nlm.nih.gov/pubmed/18094800
7. A 2007 study in China that compared standard medical protocol to both acupuncture and herbal therapies found that acupuncture performed at the cervical spine jiaji points was the most effective, with a 73.3% effective rate. This treatment was performed daily for 10 days: http://www.ncbi.nlm.nih.gov/pubmed/
8. A 2006 study in China of standard acupuncture therapy for tinnitus, using a point prescription of SJ21, SI19, GB2, SJ17, DU24, DU20, and Cong-er 1-3, had a cure rat of about 15% and effective rate of 76.5% for aver a third of the cases, utilizing stimulation 3 times per week for 3 weeks: http://www.ncbi.nlm.nih.gov/pubmed/
9. In the United States, published reports of herbal therapy success are still rare, as the medical industry is dominated by money from pharmaceutical concerns. Still, general practice medical journals such as American Family Physician tout such herbal products as Gingko Biloba for treatment of tinnitus with vascular pathology in recent years: http://www.ncbi.nlm.nih.gov/sites/entrez
10. In 2005, at the University of Regensburg, Germany, studies showed that indirect stimulation, similar to the electroacupuncture approach, significantly improved the tinnitus symptoms by stimulation of the auditory cortex: http://www.sciencedirect.com/science
11. Antioxidant therapy was studied and proven to be a significant adjunct therapy in the overall treatment protocol: http://findarticles.com/p/articles/mi_m0FDN/is_2_12/ai_n19393460/
12. A long list of medications that could cause tinnitus, listed in the Physicians Desk Reference, is located on this website: http://www.tinnitusformula.com/infocenter/articles/conditions/drugs.aspx

The information on this website is not intended to be used as a specific medical advice or cure. Please consult with the practitioner or an appropriate physician, such as a licensed acupuncturist, naturopath, or medical doctor, to discuss the proper application of the information contained on this website.