Have you ever experienced a time when you had a ringing in your ear? If so, you are not alone. Approximately 25 million adults in the US will experience tinnitus in their lifetime.

Tinnitus is a symptom that has occurred due to dysregulation between the ear, the auditory nerve, and the parts of the brain that process sound (1,2). In going upstream and using a functional medicine lens, you can explore the root causes of this auditory or neurological process and work towards improving or relieving the symptoms or severity of tinnitus.

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What is Tinnitus?

Tinnitus is a subjective noise that the individual only hears. While it is commonly referred to as "ringing in the ears," tinnitus can manifest as many different perceptions of sound, including buzzing, hissing, whistling, swooshing, and clicking.

Sound is created through the conduction of sound waves from the outer to the inner ear. The cochlea is housed within the inner ear and contains fluid that creates waves when met with vibrations. These waves stimulate the hair cells along the cochlea's walls to move, resulting in an electrical impulse that travels along the auditory nerve to the brain, creating sound.

When there is a disruption in this system, the ability to process sound is impaired.

The exact pathophysiology of tinnitus is not well known. However, research suggests that the brain creates sound to accommodate missed sound frequencies (3).

Depending on the severity of the symptoms, tinnitus can contribute to impaired socialization, lost wages, and productivity, along with the development of mood disorders and insomnia (1,2,4).

Tinnitus Signs & Symptoms

The signs and symptoms of tinnitus vary with each individual and include (1,2,3):

• Ringing or other sounds heard (ex: buzzing, clicking, hissing, whooshing, music)
• Sounds in one or both ears
• Sounds may be intermittent or constant
• Sounds may ranging from low pitch to high pitch
• Maybe rhythmic or whooshing (in timing with your heartbeat)
• In very rare cases, pulsatile sounds are heard by the practitioner (i.e., objective tinnitus)

Individuals with chronic symptoms may experience more psychological distress and poor quality of life as their symptoms start interfering with their daily experiences. This can include insomnia and associated fatigue, poor concentration, memory impairments, anxiety, depression, and relationship strains (2,4).

Tinnitus Possible Causes

Tinnitus is most commonly associated with the development of hearing loss, which can occur for various reasons throughout one's lifespan. Understanding the root causes of hearing loss is helpful in working towards a solution. However, there may be other etiologies. Additional root causes of tinnitus include (2,3,5):  

Obstruction

Anything blocking the middle ear will affect how sound is perceived. This can include cerumen impaction, fluid from a viral or bacterial infection, or a foreign object.  

Medications

Over 200 drugs are ototoxic and can cause tinnitus. Commonly used medications include NSAIDS, anti-anxiety, antidepressants, and loop diuretics.  

Nutrient Deficiencies

Individuals with low or suboptimal Vitamin B12 and Zinc levels may have a higher risk of tinnitus.

Head or Neck Trauma

Nerves, muscles, and brain tissue damaged by head trauma can contribute to tinnitus. Members of the military are a particularly vulnerable population, as they have a high incidence of tinnitus as a result of traumatic brain injuries.

Age

Individuals over 40 are more likely to develop tinnitus. The increased risk in older age is multifactorial. It includes exposure to ototoxic meds, the development of other pathologies that may affect the auditory system, and oxidative damage to the auditory nerve.

Lifestyle

Certain occupations or hobbies, like those in the military, who work with loud machinery, musicians who are exposed to loud music, or individuals who use earpieces at a loud volume, are at higher risk of developing hearing loss and, subsequently, tinnitus. Moreover, highly stressed individuals have a greater incidence of tinnitus.

Medical Conditions

Several disease states have been associated with the development of tinnitus. These include:

• Viral or Bacterial ear Infections
• Osteosclerosis
• Thoracic outlet syndrome
• Meniere's disease
• Temporomandibular joint disorder (TMJ)
• Anxiety
• Depression
• High blood pressure
• Atherosclerosis‍
• Mold toxicity
• Tumors of the head
• Autoimmune conditions like rheumatoid arthritis, lupus, lyme disease, or fibromyalgia have been linked to individuals with tinnitus.

Functional Medicine Labs to Test for Root Causes of Tinnitus

Comprehensive assessments by an otolaryngologist, audiologist, and dentist are necessary to help identify the disease process at play that may contribute to tinnitus.

Moreover, although rare, tumors of the head and the auditory system can be associated with tinnitus, and a Head CT or MRI may be indicated at the discretion of a medical professional.

Having learned that there can be many root causes of tinnitus, specific lab tests can help to identify the root cause. These labs will explore associations with nutrient deficiencies, oxidative stress, methylation, and toxicity.  

• The NutraEval plasma test will inform you of nutritional deficiencies, like Vitamin B12 and Zinc, which could be associated with tinnitus or directly contribute to another disease process, like depression or anxiety. This test will also provide the status of antioxidants and methylation, which are essential when assessing one's risk of oxidative damage and cardiovascular disease.    

• Environmental toxins can be at the root of tinnitus symptoms. The MycoTOX urine test will provide a comprehensive assessment of the presence of mold.

• Given that tinnitus can develop due to an autoimmune disorder, exploring lab work that can confirm this is prudent. Depending on the presentation and other associated symptoms, these panels of autoimmune testing can be helpful.

6 Natural Treatment Options for Tinnitus

Treatment for tinnitus will depend on the underlying cause. For a general overview and the purpose of this article, we'll review all possible options to support an individual suffering from tinnitus.

1. Nutrition

Nutrition is the foundation of health, and, as with any symptom or disease you are working to prevent or improve, it is of utmost priority. Given that oxidative stress is often at play in those with tinnitus, focusing on nutrients that boost antioxidant function and methylation is key, as it has been shown to improve discomfort and intensity associated with the symptoms. This includes berries, colorful vegetables, fresh herbs, and spices. Focusing on organic and grass-fed produce and meats will help ensure you get the best nutrition quality in your diet.

By chewing correctly and eating slowly, you can ensure proper digestion and absorption of the nutrient-dense foods needed to improve tinnitus symptoms.

2. Herbs & Supplements

When not available in your diet, or if testing identifies deficiencies that require additional support, boosting antioxidants through supplementation is necessary. This includes CoQ10, melatonin, glutathione, Vitamin A, Vitamin C, and Vitamin E. Supplementing with other key nutrients like Zinc, Vitamin B12, Omega-3, and Gingko Biloba has been shown to be beneficial in those with tinnitus (7,8,10,11).

3. Complementary Alternative Medicine (CAM) Therapies

Neurofeedback, relaxation therapies (ex: Yoga, meditation, breathwork), hypnosis, sound therapy, and hyperbaric oxygen are the most widely used, and results vary by the individual.  

4. Acupuncture

Traditional Chinese Medicine has been diagnosing and treating ringing in the ears for centuries. They commonly diagnose low ringing as Kidney Essence Deficiency and Higher pitch ringing as Liver Yang Rising.

A current study observing the effects of acupuncture points alongside western treatments on kidney essence deficiency patients (low ringing tinnitus) showed that this acupuncture technique, combined with western medication, improved tinnitus severity, tinnitus volume, and hearing in patients. Its curative effect is better than simple western medication alone.

5. TMJ Treatment

Wear a mouthguard if TMJ or dental grinding has been determined to be contributing. Acupuncture and trigger point massage can help relax these muscles.

6. Hearing Aids

If hearing loss is contributing to tinnitus, it may be helpful to explore both sound-enhancing and sound reduction tools. The use of hearing aid has been shown in some to reduce symptoms of tinnitus and improve quality of life.

Summary

Tinnitus is a symptom experienced when the auditory system is not working correctly. Fortunately, through a functional medicine lens, there lies more options for the work-up and management of tinnitus. In exploring possible root causes of tinnitus, an individual can work towards improving their symptoms. In identifying the root causes of tinnitus symptoms, there is hope that the individual can have relief and improved quality of life.