411 November 2
Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.
John, a sixty-seven-year-old man, recently retired from teaching high school, then went back to work as a security guard at the school gate. Whenever he begins to read, he starts to experiences sound within his ear, though there is no corresponding external sound. The off-and-on sound can be a strong ringing noise in his right ear, a high-pitched whining noise, buzzing, or hissing. If he pays attention to something else, he does not experience the tinnitus, but if he is idle or preparing to go to sleep, the sound recurs and can interfere with his ability to either concentrate or hear, which is very frustrating. He consulted several doctors, including an ENT specialist and a neurologist. The ENT doctor checked his outer, middle, and inner ears, and found no infection or allergies, and no edema in the ear. The neurologist ordered a CT scan and an MRI, which did not show a tumor or any problem with the brain. He was prescribed such medications as Xanax and tricyclic antidepressants, as well as niacin, all to no avail. At this point he was referred to me for evaluation.
I determined that John probably had tinnitus, the symptoms of which are hearing phantom sounds in the ear, including buzzing, clicking, hissing, ringing, or whistling, when there is no external noise. The sounds may vary in pitch from a low roar to a high squeal, and the person may hear it in one or both ears. The sound is sometimes continuous, sometimes intermittent, and it may interfere with the ability to concentrate. When the person is nervous or experiences stress, the tinnitus becomes worse.
Types of Tinnitus
There are two types of tinnitus.
Causes of Tinnitus
There are many causes of tinnitus, but the most common is hearing loss. As people age, they lose hearing because of tremors to the ear through noise, drugs, or chemicals, which damage the portion of the ear that allows them to hear. Examples include acoustic shock, external ear infection, ear-wax impaction, lead or mercury poisoning, Menière’s disease, or such toxic medications as aspirin, erythromycin, or tetracycline. There are also neurological disorders, such as head injuries, psychiatric disorders, such as depression and anxiety, sclerosis, or metabolic disorders, such as thyroid problems, hyperlipidemia, and vitamin B12 deficiency.
A common cause of tinnitus is inner ear cell damage. Tiny, delicate hairs in your inner ear move in relation to the pressure of sound waves. This triggers ear cells to release an electrical signal through a nerve from your ear (auditory nerve) to your brain. Your brain interprets these signals as sound. If the hairs inside your inner ear are bent or broken, they can “leak” random electrical impulses to your brain, causing tinnitus.
The above depicts the organ of corti of inner ear, there are about 15,000 micorscopic sensory hair cells, which are very fragile and easily damaged. The hair cells detect any tiny movement of the body in any direction, after activation of the hair cells by the wave of the body movement, the hair cells send signals to the underlining tectorial membrane generating an electrical impulse which the brian interprets as sound. If the hair cells constant send out the signals after damage, the patients usually feel contant noise, called tinnutis.
Treatments in Western Medicine
For this type of tinnitus, the obvious cause needs to be treated. If there is an acoustic tumor or an infection, the tumor should be removed, or the infection alleviated. These might make the tinnitus disappear or decrease in intensity. While there are many different treatments for tinnitus, none has proven to be entirely reliable. Western medicine treats this condition with gamma knife radiosurgery, cochlear implants, Botox, or medications, such as propanol and clonazepam.
For this type of tinnitus, the treatment might be lidocaine injections to the inner ear, and benzodiazepine to calm the person and decrease his or her anxiety, tricyclic antidepressants to decrease depression, or carbamazepine and melatonin to help decrease the tinnitus. None of these treatments show any statistical difference in the cure of tinnitus. Other methods include electrical stimulation, such as transcranial direct current stimulation, or direct stimulation to the auditory cortex by implanting electrodes.
Treatments in Traditional Chinese Medicine
Traditional Chinese medicine believes there are two main causes for tinnitus.
John underwent TCM treatment for reducing excessive heat with SI 19 Ting Gong and GB 2 Ting Hui points on both sides, and Liv 3 Tai Chong and St 36 Zu San Li, all of which were utilized to decrease excessive heat in the kidney and to improve his kidney and stomach function. After one month, John reported that he began to experience a decrease in the pitch of the tinnitus, and after two months, he reported that he heard no sounds about 70 percent of the time. He was advised to do some exercises and learn to deal with stress, and after three months of treatment his condition was much improved.
In my personal experience, the Ting Gong, Ting Hui, and Er Meng are the most important points, and by using this acupuncture treatment plus electrical stimulation each session for 30 minutes three times a week for one to two months, the tinnitus symptoms will most likely greatly decrease.
Tips for Acupuncturists and Patients
This content was originally published here.