Neuropathy "The Painful Enigma"

Tinnitus is defined as the perception of sound without an external acoustic stimulus. It is a prevalent complaint in ENT offices, but the etiology of this condition has not yet been elucidated fully. However, it is believed that the root cause of the sound is perceived without any external stimulation is due to abnormal neural activity along the hearing path from the cochlear apparatus to the auditory cortex. In addition, tinnitus accompanies a wide array of conditions like sleep disturbances, stress, and reduced work efficiency. Furthermore, its treatment is complex, and 5-15% of those patients with tinnitus report that the symptoms are still present. Therefore, alternative therapies such as supplements and acupuncture have been proposed to reduce tinnitus symptoms positively.

Acupuncture Therapy as Tinnitus Treatment:

Acupuncture as tinnitus treatment has been extensively reported in books. Indeed, acupuncture’s effectiveness in treating tinnitus relies on the electric stimulations promoted by the needles, which initiates action potentials to rebalance the body’s systems. 

A study to determine acupuncture efficacy to reduce tinnitus symptoms was performed in 105 patients. This study compared the effects of two types of acupuncture, verum acupuncture and sham acupuncture, for five weeks, twice weekly. In addition, the study used the Tinnitus Handicap Inventory (THI) questionnaire and the visual analog scale to measure the treatment’s efficacy.

THI: 

The Tinnitus Handicap Inventory is a survey of 25 questions that are answered by the patient with a scoring system of 3 options:

Yes (4 points)

 

Sometimes (2 points) 

 

No (0 points)

 

After answering the 25 items, the points are added, and the result classifies the degree of tinnitus as grade 1 (0–16 points), grade 2 (18–36 points), grade 3 (38–56 points), grade 4 (58–76 points), or grade 5 (78–100 points). This survey is associated with the quality of life of the patient.

 

VSA

The Visual Analog Scale is a verbally administered scale to determine the degree of discomfort caused by tinnitus. It is ranged by scores starting with 0, indicating no discomfort, up to 10, which means an unbearable amount of pain.

 

Furthermore, this study reported that the group with the lowest THI and VAS scores was the one who received verum acupuncture. Additionally, this study reported a three-month follow-up, which determined that the tinnitus symptoms increased after stopping the acupuncture sessions.

 

One of the most exciting findings in tinnitus acupuncture treatment is that the VAS score decreases from 9.56 to 2.88. This same finding is reported by many authors who used the THI score in their studies. Nevertheless, this study concluded that acupuncture therapy is highly effective in reducing tinnitus symptoms, and it can potentially increase the patient’s quality of life. However, the changes promoted by this treatment are temporary and seem to diminish over time. 

Ginkgo biloba:

Over time pharmaceutical treatments have been used to diminish the severity of tinnitus. Indeed, medications like calcium channel blockers, vasodilators, muscle relaxants, anticonvulsants, antihistamines, anesthetics, and even barbiturates form part of the tinnitus treatment. However, these medications have shown little to no effects when compared with placebo. 

 

Once again, the lack of an etiology makes tinnitus hard to treat. However, new research has pointed to oxidative stress as one of the proposed mechanisms for the development of tinnitus. In addition, the increase of glutamate as an excitatory neurotransmitter in combination with neurotoxicity leads to the inflammation and necrosis of dendrites. Consequently, dendrite damage and inflammation of the afferent cochlear Corti organ cells is due to the production of free radicals.

 

The literature strongly supports the use of Gingko Biloba to treat tinnitus due to its varied bioactive constituents such as phytochemicals including alkanes, lipids, sterols, benzoids, carotenoids, phenylpropanoids, carbohydrates, flavonoids, and terpenoids. Furthermore, the Gingko Biloba acts like a monoamine-oxidase inhibitor (MAOI), improving tinnitus symptoms caused by ischemia. This mechanism of action is mainly due to myricetin, quercetin, ginkgolide, and bilobalide terpenoids. In conclusion, Gingko Biloba can reduce tinnitus symptoms by regulating vascular tone, and it acts as a scavenging agent of primary and secondary free radicals.

 

Despite all the medical research in tinnitus, no recommended treatment can reduce all the symptoms. Indeed, this is associated with tinnitus being a multifactorial disease and should be carefully evaluated to determine its treatment. The conclusion of many experts on this topic determines that the treatment should be a combination of sustainable and secure treatments. Therefore, Ginkgo Biloba and acupuncture studies can be used together to improve tinnitus outcomes in a conservative measure. – Ana Paola Rodríguez Arciniega, MS

 

References:

 

Mahmoudian Sani, M. R., Hashemzadeh-Chaleshtori, M., Asadi-Samani, M., & Yang, Q. (2017). Ginkgo biloba in the treatment of tinnitus: An updated literature review. International Tinnitus Journal, 21(1), 58-62.

 

Kuzucu, I., & Karaca, O. (2020). Acupuncture Treatment in Patients with Chronic Subjective Tinnitus: A Prospective, Randomized Study. Medical acupuncture, 32(1), 24–28. https://doi.org/10.1089/acu.2019.1367

 

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Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

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