Oral and Injected Medications Can Relieve Tinnitus

Q:  1. In a recent column, you discussed tinnitus and the drugs and treatment used. I am 89 years old and have had tinnitus for approximately 50 of those years. Do you believe my family doctor could give your suggestions a try using the medications and drugs mentioned?

2. I read your article on tinnitus retraining therapy with great interest. My mother, who is 78, has been suffering for several years with tinnitus. Her quality of life has deteriorated so much due to this condition that I grab any bit of information I can for her. Could you please tell me more?

3. Which drugs are used in the tinnitus retraining therapy you spoke about in your latest column? Are they SSRIs or a different drug?

A:  Tinnitus, or ear ringing, is a vexing problem that affects 25 million to 30 million people in the United States. Fortunately, only 10% of them have it bad enough to interfere with daily functioning, but that's still a few million people. Some of them evidently live in Milwaukee, because that column has generated some 200 calls to the office of Dr. David R. Friedland, Assistant Professor of Otolaryngology and Communication Sciences at the Medical College of Wisconsin, who came here via Johns Hopkins. Dr. Friedland has set up a program for tinnitus retraining and for balance disorders.

Because there are different reasons for tinnitus, the first step is a thorough evaluation that includes medical, neurologic and otologic exams.

There are many different treatments for tinnitus and no single therapy works for everyone. Anti-depressant medications, such as nortriptyline or amitriptyline, prescribed at low doses, may be helpful. Newer anti-depressant SSRIs (selective serotonin reuptake inhibitors) such as Prozac and Zoloft have not been used as much. Some people have reported herbs such as gingko biloba and echinacea effective, and even cholesterol-lowering medication has brought unexpected relief to others. Your primary care physician could prescribe these medications. For more specific treatment, you will need an ear, nose and throat specialist.

Friedland has had good results with oral steroids and with injecting steroids into the middle ear. Relief may last for several months before the tinnitus gradually returns. Steroids seem to work better with the low frequency "grinding" type of tinnitus. For high-tone tinnitus, research is being done in Iowa with a small stimulator that is implanted in the ear. This device may not be out for a couple of years. Sarah Holschuh, audiologist at the Koss Hearing & Balance Center at Froedtert Memorial Lutheran Hospital, also has attended a seminar given by Pawel Jastreboff of Emory University and can order the masking devices.

Dr. Friedland emphasized that tinnitus retraining is not a cure. It does not remove the sound, but trains the brain to consider it as background noise.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.