It has been a long time since you addressed tinnitus. Are there any new alternative treatments? What about NAC? -- Janet Echon

Nearly 12 million Americans suffer from tinnitus, ringing in the ears that can stop and start or continue non-stop. In addition to ringing the sound can resemble a roar, squeal, whine, buzz, click, hiss, or hum and can affect one ear or both. In at least one million cases, tinnitus is severe enough to interfere with daily activities; the disorder is so distracting that people can't hear, work or even sleep.

Most tinnitus is due to damage to the microscopic endings of the hearing nerve in the inner ear, commonly from exposure to loud noise. Other causes include allergy, high or low blood pressure, a tumor, diabetes, thyroid problems, a head or neck injury. Some drugs including anti-inflammatories, antibiotics, sedatives, antidepressants and aspirin can cause tinnitus. If this is the case, changing drugs or lowering the dosage usually takes care of the problem.

Recent research also found that a specific area of the brain involved in tinnitus that affects only one ear. Using positron-emission tomograph (PET), researchers at the State University of New York in Buffalo were able to detect changes in the auditory cortex, the part of the brain that processes sound, on the opposite side of the brain from the tinnitus. The researchers said that this suggests that tinnitus may be initiated by brain activity rather than by the ear.

As far as treatment is concerned, I've seen no evidence suggesting that NAC (N-acetyl-L-cysteine) is effective for tinnitus. I recommend trying ginkgo, two tablets of standardized extract three times a day with meals. Ginkgo may help by increasing blood circulation in the head and neck. Give it at least a two months trial.

My colleague, naturopathic physician Judy Hutt, NMD sends her patients to an osteopathic physician experienced in craniosacral therapy, a gently manipulative technique for the bones in the head. She says this seems to take the pressure off the auditory nerves. She also has found that reducing blood pressure via weight loss can help.

In addition, you can try these self-help steps suggested by the American Academy of Otolaryngology-Head and Neck Surgery:

- Avoid exposure to loud sounds and noises.

- Lower your salt intake (salt impairs blood circulation).

- Avoid stimulants such as coffee, tea, cola and tobacco.

- Exercise daily.

- Get adequate rest; avoid fatigue.

To all of that, I would add that you try not to worry about your tinnitus. You might want to investigate tinnitus retraining therapy with otolaryngologists (ear, nose and throat specialists) or audiologists who can help you learn to cope better with the disorder. And because stress can worsen tinnitus, practice breathing exercises or other relaxation techniques.

Dr. Andrew Weil

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