In this blog, we discuss the causes of tinnitus, its diagnostic tests, types, and potential natural treatment options to support symptoms.

Today we will be talking about a condition that affects nearly 50 million Americans: Tinnitus. Tinnitus is defined as the perception of noise or ringing in the ears when no external sound is present. Tinnitus is often very difficult to treat because its causes are often multifaceted and thus a one-size-fits-all approach does not exist. It can often take a lot of trial and error and cannot be cured, but symptom management is possible with patience and a willingness to try different approaches. Unfortunately, severe tinnitus cannot be treated at all when permanent and irreversible damage to the ears or nerves has occurred. We will discuss the diagnosis of tinnitus, various types of tinnitus, some of its causes, as well as some treatment options that may assist you on your journey of managing your tinnitus.

Some of the people that have a high risk of developing tinnitus are older adults, men, people who smoke or use drugs, people with a history of ear infections or cardiovascular disease. 

Some conditions that can cause symptoms of tinnitus are ear canal obstructions, infections, injuries or surgeries. Other ear disorders tied to tinnitus include otosclerosis, which causes changes to the bones inside the ears, tympanic membrane perforation or labrynthitis. Inner ear damage is the most common type of ear disorder that causes tinnitus because it changes the way tiny hairs inside the ears move in relation to the pressure of sound waves, causing false electrical signals to be sent through the auditory nerves to your brain. 

Other things that could cause tinnitus are cranial nerve tumors that affect parts of the brain connected to sound and hearing, anemia, arteriosclerosis and hypertension, which cuts off normal blood flow and affects nerve signals leading to the ears. Cervical spondylosis is a degenerative disorder that compresses arteries leading to the neck and ears, sinus infections, labyrinthitis, earwax buildup, vertigo, muscle stress or physical fatigue, Eardrum rupture, Bell’s palsy, Temporomandibular joint arthralgia (TMJ), a rapid change in pressure in the environment, significant weight loss from malnutrition, Long-term holding of the head in a hyperextended position, Problems with the nerves, such as multiple sclerosis or with migraine headaches, Thyroid problems, Hormonal changes (in women), and Heart or blood vessel disease, including high blood pressure and preeclampsia.

Additional potential causes include Ménière’s disease, a rare and serious inner-ear disorder that develops after fluid accumulates in the inner ear abnormally, causing pressure levels to change within the ear, and Eustachian tube patency. Overdosing on certain prescription drugs, recreational drugs or alcohol can sometimes cause permanent damage to nerves that affect hearing. In some cases if a pregnant woman uses drugs during pregnancy, this can cause tinnitus to develop in her child. Common drugs that might contribute to tinnitus include ototoxics, psychotropic drugs, aminoglycosides, certain antibiotics and vancomycin.

The diagnostic testing for tinnitus is multifaceted just as the causes are. One type of testing is patient history and lifestyle factors: exposure to loud noises, ototoxic medications, head trauma, stress, anxiety, sleep patterns, diet, nutrient intake, and toxin exposure. Another type of testing is physical examination, which includes an ear exam, cervical spine assessment, and TMJ assessment. In the ear exam, the healthcare provider checks for ear wax buildup, infections, or structural issues. In the cervical spine and TMJ assessment, they identify misalignments that may be contributing to tinnitus. 

Next type of testing is hearing exams including a hearing test to identify hearing loss patterns, and tinnitus matching and masking tests to measure the frequency and intensity of the sounds heard. Another type of testing is blood testing and functional labs to identify underlying causes, including nutrient deficiencies of zinc, B12, and magnesium, inflammation markers of CRP and homocysteine, thyroid and hormonal panels to determine metabolic causes, and heavy metal testing for lead, mercury or other toxins. Finally, a Doppler ultrasound can be used if vascular tinnitus is suspected; this method evaluates blood circulation and possible issues in the arteries. 

Now let's discuss the different types of tinnitus which manifest differently according to their cause. Each type also has specific nutrients that may be helpful for treatment. After we discuss these types, we can review other general treatments for tinnitus that may be helpful. 

The first type of tinnitus is subjective tinnitus, which is the most common type. It is characterized by a sound heard only by the patient rather than an external source. Its causes include noise-induced hearing loss, age-related hearing decline, ototoxic medications such as NSAIDs, antibiotics and chemotherapy drugs, stress and anxiety, and neurological issues including multiple sclerosis and migraines. One supplement that may be useful for this type is Gingko Biloba. Gingko has been shown to improve blood flow to the inner ear. Gingko may also improve inflammation and alter the way nerve cells work. Some options for Gingko include Ginkgo Forte Medi Herb and Ginkgo Biloba Arcana. 

Magnesium may also be helpful for this type of tinnitus due to its ability to protect against noise induced damage to the ear. Some options for magnesium include: our Magnesium Glycinate, Magnesium Glycinate by Pure, and if you want to try a powder, Thorne has a Magnesium Bisglycinate powder. CoQ10 may also be helpful because it supports mitochondrial function in the ear cells and supports circulation. Some options for CoQ10 include:  CoQ10 Thorne, CoQ10 100 Arcana, CoQ10 200 Arcana, CoQ10 Ortho Molecular, and CoQ10 Power Researched Nutritionals. Lastly, N-Acetyl-Cysteine (NAC), is an antioxidant that may prevent damage from noise exposure. Some options for NAC include: NAC Thorne, NAC Pure, NAC Xymogen, and NAC Vital Nutrients. 

Next is a rare form of tinnitus known as objective tinnitus where the sound can be heard by a practitioner using a stethoscope. Some causes for this type of tinnitus are Vascular abnormalities such as carotid artery stenosis and aneurysms, and muscle spasms in the middle ear. Some prospective treatments for this type of tinnitus are magnesium, which helps with muscle relaxation and reduces spasms, calcium and Vitamin D, which support muscle and nerve function, and Ginkgo Biloba that supports blood circulation. To learn more about vitamin D and to view supplement options, check out our monographs on Vitamin D: Part 1 and Part 2. For calcium, you can try Reacted Calcium Ortho Molecular. 

The next type of tinnitus is called pulsatile tinnitus, which is categorized as a rhythmic sound in sync with the heartbeat. Some causes of this type of tinnitus are high blood pressure, atherosclerosis, arteriovenous malformations, and increased intracranial pressure. Some potential treatments for this type of tinnitus are omega-3 fatty acids, which support cardiovascular health, CoQ10, which improves circulation, hawthorn berry, which supports cardiovascular health and blood vessel function, and ginkgo biloba, which improves blood circulation. For omega-3 fatty acids, try Omega 900 TG Active Factors, Pro Omega Nordic Naturals, and Omegagenics Metagenics. For Hawthorn Berry try Hawthorn Mediherb or Hawthorne Max-V Douglas Laboratories. 

Another type is somatic (somatosensory) tinnitus, which is connected to physical movement or musculoskeletal issues. The sounds in this type change with jaw movement, neck position, or posture. Causes of this type include TMJ dysfunction, neck injuries or cervical spine misalignments, and dental issues or teeth grinding. Support for this type of tinnitus includes magnesium, which is a muscle relaxant that can help with tinnitus related to TMJ, Vitamin C, which supports joint and connective tissue, Curcumin reduces inflammation in muscles and joints, and B vitamins: B6,B12, and Folate that supports proper nerve function. For vitamin C, you can try Bio C Complete, featuring bioflavonoids, Vitamin C with Flavonoids Thorne, Buffered Vitamin C Powder Thorne, and Amla-C if you are looking for a food based Vitamin C. For Curcumin, try Curcumin Active Factors, Curcumin phytosome Thorne, or Curcuplex-95 Xymogen. For a B-complex that contains all the B vitamins try Basic B Complex Thorne, Activ B Xymogen, or Methyl B Complex Ortho Molecular. 

The next type is called neurological tinnitus, which is associated with nervous system disorders. Causes of this type include Meniere’s disease, an inner ear disorder with vertigo and hearing loss, an Acoustic neuroma, a benign tumor on the auditory nerve, and Multiple sclerosis. Support for neurological tinnitus includes omega-3 fatty acids for their neuro protective and antioxidant properties, Vitamin B12 to support nerve regeneration, NAC to reduce oxidative stress in the nerves, and Ginkgo biloba to support inner ear blood flow. For Vitamin B12 on its own, you can try Methylcobalamin Xymogen, Methylcobalamin Thorne, and B12 liquid Pure. It is good to supplement all of the B vitamins rather than just one on its own, so you can pair these with a B complex if you need the additional B12. 

Low frequency tinnitus is characterized by a deep humming, rumbling, or throbbing sound; it is often linked to Meniere’s disease or ear pressure imbalances. Support for this type includes potassium to support fluid balance in the inner ear, Ginkgo biloba to improve inner ear circulation, and omega-3 fatty acids to reduce inner ear inflammation. For potassium, make sure to include food sources of potassium in your diet such as dark leafy greens, avocado, beans, and fish. Also, it is good to check if you are taking any medications that are affecting your potassium levels. After that if you still need more potassium, you can supplement using Potassium Citrate Thorne or Potassium-HP Biotics. 

High-Frequency Tinnitus is characterized by a high-pitched ringing, buzzing, or whistling sound that is commonly caused by hearing loss, noise exposure, or ototoxic medications. Support for this type of tinnitus include magnesium, which protects against noise-induced nerve damage, zinc to help with age-related hearing decline, vitamin A and E offer antioxidant protection for inner ear cells, and B vitamins: B1, B6, and B12 to support nerve function. For Zinc supplement options and to learn more about Zinc, see our Zinc Monograph. For Vitamin A, check out our Vitamin A monograph; for vitamin E, you can try Delta-Fraction Tocotrienols Allergy Research Group or Annatto Tocotrienols Cardiovascular Research Group. For further antioxidant support, try Advanced Antioxidant Complex Arcana. 

The final types we will discuss today are tonal and non-tonal tinnitus. Tonal tinnitus is a constant sound at a single frequency and non-tonal tinnitus is characterized by fluctuating sounds like, whooshing, clicking, or chirping. Support for tonal tinnitus includes Ginkgo Biloba to improve tinnitus symptoms if linked to poor circulation, Vitamin B12 to support nerve health, and NAC to help with oxidative stress. Non-tonal tinnitus can be supported with Magnesium to help regulate nerve excitability, and Coenzyme Q10 (CoQ10) to support cellular energy in the auditory system.

Some other treatment options that can support tinnitus include biofeedback in order to control stress and the reaction to tinnitus sounds, seeing a counselor, or joining a support group. Learning coping strategies can be useful for managing side effects of tinnitus such as anxiety, insomnia, lack of focus and depression. There is also an option for “tinnitus retraining”, which includes wearing a device in the ears that provides soothing music or noise paired with counseling. This is supposed to help your body and brain become accustomed to the tinnitus noise to reduce negative reactions to unwanted sounds. There is also research on cognitive behavioral therapy interventions to help with distress associated with tinnitus; the research shows  that tolerance to tinnitus can be facilitated by “reducing levels of autonomic nervous system arousal, changing the emotional meaning of the tinnitus, and reducing other stresses.” 

To avoid making tinnitus worse, it is necessary to avoid medications, drugs, and over the counter painkillers that can make it worse. Recreational drugs, smoking, and alcohol are also associated with tinnitus. Medications that can contribute to ear damage and cause tinnitus include: antibiotics such as polymyxin B, erythromycin, vancomycin and neomycin, Cancer medications such as mechlorethamine and vincristine, Diuretics such as bumetanide, ethacrynic acid or furosemide, Quinine medications, some antidepressants, and Aspirin when taken in high doses (usually 12 or more a day). 

Another aspect to focus on is addressing stress and high levels of inflammation that can raise the risk for ear problems and can make tinnitus symptoms worse by changing how your brain reacts to the noises it hears. Additionally, poor diet, sedentary lifestyle, poor sleep, and chronic stress can all reduce immunity and make you more susceptible to nerve damage, allergies, and ear problems. Some ways to address stress include exercising, meditation, taking warm baths, using essential oils,  spending more time outdoors, and eating an anti-inflammatory diet. For supplement support for inflammation, try BCQ Vital Nutrients, Curcumin BCM-95 Active Factors, or Omega 900 TG Active Factors.

Other supplement options for supporting tinnitus include zinc, ginseng, taurine, and lion’s mane mushroom. 

Zinc is an essential mineral that helps nerve signals get to the brain, including signals involved in hearing. Some research has shown that zinc deficiency may interfere with hearing signals and thus could contribute to tinnitus. Some studies have shown that zinc shows no improvement in tinnitus sounds, while other research reports improvement with zinc supplementation; other research reveals that many people that suffer tinnitus have a zinc deficiency. As mentioned above, check out our zinc monograph for more on zinc and for supplement options. 

Ginseng may help with tinnitus symptoms. Studies have shown that tinnitus symptoms and general well being have improved with ginseng supplementation. However, more research is needed to further show the efficacy of ginseng for tinnitus. If you are interested in trying Ginseng, check out Arcana’s Panax Ginseng, which you can find by calling or coming into the store. 

Taurine has been studied in rat models to be helpful for tinnitus symptoms. At a higher dose taurine was able to attenuate tinnitus symptoms, while at a lower dose taurine did not help with tinnitus. For Taurine, try Taurine 500 Allergy Research Group or Taurine 1,000 Pure. 

Lion’s mane mushroom may also help with tinnitus. Lion's mane has been shown to help stimulate nerve growth and repair in the brain, spinal cord, and retina. One of the causes of tinnitus is a decline of the nerve fibers in the ear, thus lion's mane can be helpful for tinnitus because it may both slow down the decline of nerve fighters and may stimulate new nerve growth. For Lion’s mane, try Lion’s mane Host Defense in capsules or liquid tincture. 

This has been a discussion on the etiology of tinnitus, its diagnostic tests, types, and potential treatment options. Tinnitus is different for everyone and thus there is no one size fits all treatment plan; if you are willing to have the openness and patience to try different options, you should hopefully find relief to tinnitus symptoms.

References 

Brozoski, T. J., Caspary, D. M., Bauer, C. A., & Richardson, B. D. (2010). The effect of supplemental dietary taurine on tinnitus and auditory discrimination in an animal model. Hearing research, 270(1-2), 71–80. https://doi.org/10.1016/j.heares.2010.09.006

Levy, Jillian. (2016, Aug 5). Natural Tinnitus Treatment Methods to Stop Ringing in the Ears. Dr. Axe. https://draxe.com/health/tinnitus-treatment/ 

Samberkar, S., Gandhi, S., Naidu, M., Wong, K. H., Raman, J., & Sabaratnam, V. (2015). Lion's Mane, Hericium erinaceus and Tiger Milk, Lignosus rhinocerotis (Higher Basidiomycetes) Medicinal Mushrooms Stimulate Neurite Outgrowth in Dissociated Cells of Brain, Spinal Cord, and Retina: An In Vitro Study. International journal of medicinal mushrooms, 17(11), 1047–1054. https://doi.org/10.1615/intjmedmushrooms.v17.i11.40

Solely Practitioner. What’s up Doc? Newsletter. Solely Practitioner. https://www.solelypractitioner.com/resources 

Team VeryWell Health. (2023, Oct 24). Natural Remedies for Tinnitus. VeryWell Health. https://www.verywellhealth.com/natural-remedies-for-tinnitus-89317 

The Remeday Team. (2022, Sep 28). Can Lion’s Mane Help with Tinnitus: The Complete Guide. Remeday. https://www.remeday.com/mushrooms/lions-mane-tinnitus