Tinnitus: The Eastern Medical Approach
Tinnitus is a subjective sensation of hearing a sound in the absence of an external stimulus, and can be severe enough to significantly affect a patient’s quality of life with other symptoms such as sleep disturbances, depression and distress. It is a common condition that affects 5-15% of the population, more often occurring in the elderly but can occur at any age. It is believed that tinnitus occurs as a result of an interaction between the nervous and limbic system, and involves “cochlear alterations and/or lesions” that cause an imbalance in the lower auditory pathways, which results in abnormal neuronal activity that is further enhanced by the central nervous system. The result is the perception of sound created internally and is known as tinnitus.
However, little is known about the etiology of this condition. Proposed theories range from otologic, dental, neurological, psychiatric diseases, cervical spine and metabolic disorders, or related to drug intake. Because the physiopathological mechanism is not known, can vary widely and may involve a complex interaction of systems, pharmacological drug therapy has proven unsuccessful and the treatment of tinnitus to date has been a challenge with no known effective treatment.
In the absence of treatment solutions using Western biomedical interventions, many are turning to complementary and alternative medicine (CAM), with acupuncture and herbal medicine as the most popular choice of therapy. The randomized clinical trial below provides evidence for the efficacy and safety of acupuncture in the treatment of tinnitus, indicating a reduction in the intensity of the tinnitus and an improvement in quality of life.
A Case Report
As a case in point, an 80 year old male patient presented in my office complaining of severe tinnitus for over one year. He described an intermittent ringing in the ears that changed in pitch from low to high, with a frequent change in quality that was described to sound like loud sirens, buzzing noises, and often a loud “wind” that sounded like a “tornado was inside his head.” The sounds were reported to significantly affect his quality of life resulting in sleep disturbances, fatigue, irritability and depression. In addition, a review of systems revealed recurrent epistaxis and frequent headaches, dizziness, the sensation of heat in his head, and bilateral hearing loss. He had also been diagnosed with hypertension and diabetes mellitus type 2 for over 15 years.
After evaluating all of this patient’s symptoms and assessing from an Eastern medical perspective, it was determined that his condition was caused by a complex combination of diagnoses including long term Liver and Kidney Yin deficiency along with a combination of Wind, Liver Fire and Phlegm flaring upwards. In Chinese medicine, the aging process depletes Liver and Kidney Yin, eventually resulting in excess heat drying up the fluids, including those of the auditory canals. Long term deficiency heat can transform into Liver Fire with Wind manifesting in the channels due to the depletion of fluids. For the patient, this excess heat can be seen with his recurrent epistaxis and the Wind rising is evident not only with his frequent headaches, but with the patient’s own subjective description of hearing wind in his head. The diabetes mellitus presents in this patient with a corresponding Chinese medical diagnosis of Stomach Yin deficiency, which has contributed to the accumulation of Phlegm rising to combine with all other factors aforementioned to further create an imbalance that has resulted in the manifestation of severe tinnitus for this patient.
After 3 months of acupuncture and herbal medicine, the patient reported that the intensity of his tinnitus was significantly reduced from 9 to 4, out of 10. He reports that his sleep is no longer disrupted, and that the level of subjective noise is at a much more tolerable level. He also reported that the headaches, dizziness and sensation of heat in his head had subsided and were not nearly as frequent. With continued treatment, I believe there to be a favorable prognosis for recovery and management.
Possible Prevention of Stroke
The underlying TCM diagnoses of Liver and Kidney Yin deficiency, Wind, Liver Fire and Phlegm which led to the manifestation of severe tinnitus in this patient are also the common pathogenic factors that can lead to stroke. Head symptoms such as headaches and dizziness are especially important in the elderly when accompanied by hypertension and tinnitus, as it may indicate a symptom of Liver-Wind, Phlegm or both. These symptoms are considered to be prodromal signs of Wind-Stroke (Maciocia, 2004).
By assessing this patient with a holistic, macroscopic view and aiming to correct imbalances within the body as a whole rather than focusing microscopically on the auditory system, Chinese medicine was used in this case to effectively treat a condition that otherwise has no known solution. TCM seeks to identify and treat the root cause of symptoms rather than solely treating the symptom itself, and recognizes that the same pathological states within different people can lead to the manifestation of different symptoms, whether it be tinnitus or stroke.
For this patient with severe tinnitus, all of the necessary components were present to progress to stroke. By recognizing the common pathogenic factors and correcting the imbalance before it worsens and progresses, a Chinese medicine practitioner is in a unique position to be able to identify key symptoms that may seemingly be unrelated to stroke, but are in fact caused by the same pathogenic factors according to Eastern medical theory. By catching and treating it in its earlier stages and changing the internal conditions that may lead to stroke, it may be possible to prevent its occurrence.
Dr. Erin Lee, DACM, L.Ac. is a doctor of Acupuncture & Chinese Medicine, licensed acupuncturist and board certified Chinese herbalist. She obtained her Doctoral degree and Master of Science degree in Traditional Oriental Medicine from the Pacific College of Oriental Medicine in New York. Previous experience includes working with cancer patients at Mount Sinai Beth Israel Integrative Oncology Center, acute stroke and long-term rehabilitative care at NYU Lutheran Neurological & Orthopedic Rehabilitation, Housing Works (HIV/AIDS), Columbia Health Medical Center and Bronx Lebanon Hospital Center. She resides and practices in New York City.
Doi, M. Y., Tano, S. S., Schultz, A. R., Borges, R., & Marchiori, L. L. (2016, April 30). Effectiveness of acupuncture therapy as treatment for tinnitus: A randomized controlled trial. Retrieved from https://www.sciencedirect.com/science/article/pii/S1808869416300660?via=ihub
Maciocia, G. (2004). Diagnosis in Chinese medicine: A comprehensive guide. Edinburgh: Churchill Livingstone.