The Gerson Institute of Ayurvedic Medicine

Scott Gerson, M.D., Ph.D. (Ayurveda) Medical Director, Jupiter Medical Center Dept. of Integrative Medicine Division of Education and Research

Jupiter Medical Center at The Calcagnini Center for Mindfulness
1210 S. Old Dixie Highway, Jupiter, Florida 33458, Suite M-117.2

 

Lake Mary Clinic and Panchakarma Facility: at 635 Primera Blvd. Lake Mary, Florida 32746

 

 Telephone: (561) 263-MIND (6463); option #2 or (561) 510-3833

The Ayurvedic Approach to Tinnitus (Karnanada)

Tinnitus is the perception of sound in one or both ears or in the head, in the absence of any external sound. The term “tinnitus” derives from the Latin word tinnire, meaning to ring. It is often referred to as "ringing in the ears", although some people hear hissing, roaring, whistling, chirping, or clicking. The ringing can be intermittent or constant-with single or multiple tones-and its perceived volume can range from subtle to shattering. Tinnitus is a symptom (not a disease) and therefore reflects an underlying abnormality. As you shall see in this article the nature of that “underlying abnormality” is very different in the conventional and Ayurvedic viewpoints.

It is estimated that in U.S. alone, over 50 million people (10-18% of the population) experience tinnitus to some degree. Of these, nearly 25% have severe tinnitus and about 5% are so seriously debilitated that they cannot function on a "normal," day-to-day basis. The affected individuals are commonly academics, business people, and "intellectuals,” in sedentary occupations although it can affect anyone of either sex and of any age. Most commonly, tinnitus is associated with a sensorineural hearing loss, but other rarer tinnitus types including pulsatile tinnitus, tinnitus with vertigo, fluctuating tinnitus, or unilateral tinnitus also occur.

Causes                                                                                                                                                                       
The exact physiological causes of tinnitus are not known to science. There are, however, several likely sources all of which are known to trigger or worsen tinnitus.

  • Noise-induced hearing loss - Exposure to loud noises can damage and even destroy hair cells, called cilia, in the inner ear. Once damaged, these hair cells cannot be renewed or replaced.
  • Wax build-up in the ear canal - The amount of wax ears produce varies by individual. Sometimes, people produce enough wax that their hearing can be compromised or their tinnitus can seem louder.
  • Ear or sinus infections - Many people, including children, experience tinnitus along with an ear or sinus infection. Generally, the tinnitus will lessen and gradually go away once the infection is healed.
  • Jaw misalignment - Some people have misaligned jaw joints or jaw muscles, which can not only induce tinnitus, but also affect cranial muscles and nerves and shock absorbers in the jaw joint. Many dentists specialize in this temporomandibular jaw misalignment and can provide assistance with treatment. On the other hand, tinnitus can start by removal of wisdom teeth, (last molars) if cranial nerves in the neighborhood get damaged.
  • Cardiovascular disease - Approximately 3 percent of tinnitus patients experience pulsatile tinnitus; they typically hear a rhythmic pulsing, often in time with a heartbeat. Pulsatile tinnitus can indicate the presence of a vascular condition-where the blood flow through veins and arteries is compromised-like a heart murmur, hypertension, or hardening of the arteries.
  • Specific types of tumors - Very rarely, people have a benign and slow-growing tumor on their auditory, vestibular, or facial nerves (e.g. acoustic neuroma). These tumors can cause tinnitus, deafness, facial paralysis, and loss of balance.
  • Medications - Some medications are ototoxic-that is, toxic to the ear. Other medications will produce tinnitus as a side effect without damaging the inner ear Examples:  aspirin, quinine and some antibiotics. Effects can depend on the dosage of the medication, can be temporary or permanent.
  • Head and neck trauma - Physical trauma to the head and neck can induce tinnitus. Other symptoms include headaches, vertigo, and memory loss.

Often after steroids, antibiotics, and anti-inflammatories fail, conventional physicians eventually tell patients "you just have to learn to live with it." Far from being helpful, this phrase communicates a subliminal message of despair and increases the isolation and frustration of the tinnitus patients. They are alone, and they are without hope. Often, patients say that their entire life becomes negatively affected due to the continuous noise.

Western Conventional View

The conventional understanding of tinnitus centers around the concepts of neurophysiology and the brain. The brain is designed to acquire data from the external world through the sensory organs and to analyze, store, and process this information. The brain also generates outputs—actions and behaviors—to optimize our chances for survival and reproduction. The function of the auditory system is to represent and communicate to other brain regions information about sounds that are present in the environment. Tinnitus can be described as the conscious perception of a sound that is not generated by any source in the environment. Phantom sound could be generated by (1) abnormal spontaneous activity in the auditory system or (2) by malfunction of an inhibitory mechanism that normally prevents such activity to be audible or (3) both these factors. 

In neurophysiological terms, tinnitus is the brain’s response to input deprivation from the cochlea in the inner ear. The cochlea is where sound vibrations are initially converted into neural messages. In the normal auditory system, the cochlea organizes sounds according to their frequencies and this organization (tonotropic frequency mapping) remains intact as sound data is transmitted through the various nerve pathways of the midbrain all the way to the auditory cortex in the brain’s superior temporal lobe.

The auditory pathway begins with the tiny hair cells lining the cochlea (shown above) form the cochlear branch of the vestibulocochlear nerve (not shown) which leads to: the cochlear nucleus, the superior olivary nucleus, the inferior colliculus, the medial geniculate nucleus, and finally to the auditory cortex in the superior temporal lobe of the brain. Significant numbers of nerve fibers from one ear cross over and connect to the auditory cortex on the opposite side of the brain.

But, when a region of the cochlea is damaged, the subcortical and cortical projections adjust to this chronic lack of output (neuroplasticity), and the tonotopic organization is altered. Neuroplasticity is generally beneficial as it is the basis for learning new skills and recovery from nervous system trauma, but “misdirected” plasticity (maladaptive plasticity), as we see in tinnitus, can be harmful. Upon reaching the brain’s auditory cortex, the region that corresponds to the area of cochlear damage show two important changes: (1) an increase in the spontaneous firing rate and (2) an increase in firing of the neurons that border the region of damage.

So why does damage to the cochlea result in an increase and not a decrease of nervous activity? Scientists explain this as due to (a) the loss of central inhibition on the regions that are damaged and (b) cortical neuroplasticity of the neighboring regions of the cortex that are still active. Hence, tinnitus neurophysiology is related to detrimental cortical adaptation to input deprivation from the cochlea.

Additional studies have suggested that tinnitus may be associated with neuronal hyperactivity not only in the brain’s auditory cortex (temporal lobe) but at other levels of the auditory pathways, including the dorsal cochlear nucleus, the inferior colliculus, auditory cortex, and the striatum.

Ayurvedic View

Ayurvedic name for Tinnitus is "Karnanada". According to Ayurveda, tinnitus in not a disease but a symptom of prana vayu disturbance. Prana vayu is a subdosha of Vata which resides in the head and governs all higher cerebral functions.

Causes

The same lifestyle factors and behaviors which cause vitiation of Vata dosha anywhere in the mind-body also cause this condition. Thus lack of adequate sleep, nervous exhaustion due to increased worries, excessive workload, insufficient mental and physical recreation, incessant talking, excess fasting, excess exercise, sudden shock/grief/fear, excess and difficult to digest cereals in the food, excess bitter- or astringent-tasting  medicines/vegetables etc. are some of the reasons for tinnitus. Depletion of dhatus as a result of excess indulgence in sex is also another reason.

Samprapti ( Pathogenesis)

Sushruta says when Vata dosha covered with doshas taking faulty passage get located in sound carrying channels then the patient perceives various types of sound; this disease is known as pranada (phantom sounds) or karnanada (ringing in the ears).

The Vata principle governs movements in the body on the gross and subtle levels including respiration, circulation, and digestive movements, sensory movements, ionic flow through membranes, synaptic neurotransmitter release, etc. The Vata dosha is composed of of air and space mahabhutas. If Vata becomes vitiated, air and space elements increase in the physiology and disturb the finely orchestrated movements required for all the normal bodily and mental functions. This can lead to a variety of manifestations including but not limited to tension headache, insomnia, dryness in the external sense organs (dry eyes, ears, nasal passages, mouth, etc), tinnitus, dry scalp, dry skin, constipation, tendency to feel unstable, forgetful, disorganized, anxiousness, nervousness etc.

In agreement with the conventional medical viewpoint, Ayurveda regards tinnitus as a condition wherein the sound is experienced only by the patient; it is not external it is internal; it is not the persons imagination. In the Ayurvedic understanding, it is result of an internal Vata imbalance.

Furthermore, throughout time it has been observed that individuals with a dominant Vata prakriti (constitutional type) are prone to experience higher frequency sounds, Pitta prakriti individuals moderate frequency and Kapha body types have the tendency to experience tinnitus of low frequency sounds. In addition, Ayurveda meticulously notes the patients report of the quality of the sound; flute-like, continuous, pulsating, variegated, volume changes, time of day differences, food associations, and other factors play an important diagnostic role and help determine treatment protocols.

Complications:

Tinnitus (karnanada) may lead to hearing loss (karna baadhirya) although not all tinnitus cases lead to hearing loss. People with a severe Vata imbalance and/or a strongly Vata-dominant body type are more prone to reach the stage where hearing loss occurs either temporarily or permanently. These people are also prone to a condition called hyperacusis (certain high-frequency sounds which can be very painful), concentration problems, sleeping problems, irritation and annoyance, hypersensitivity to sounds, or increased sensitivity in silence. Chronicity of this problem causes despair, frustration and depression in many people.                                                                                 

Ayurvedic Management

As tinnitus is a Vata disorder, Vata-balancing lifestyle therapies, including Panchakarma chikitsa, and vyadipratnika type herbs are beneficial.

Diet

Vata influences the movement of thoughts, feelings, prana flows, nerve impulses, and fluids in the body. Hence a balanced Vata pacifying dietary plan is recommended.
While often prescribed as optional, in tinnitus breakfast is usually recommended as mandatory. Healthy Vata-decreasing foods such as cream of rice or wheat or any other breakfast that is warm, milky, and sweet. Lunch and dinner should adhere to principle of Vata-pacification.

Food should be primarily cooked (not raw), warm, moderately heavy in texture, with judicious amounts of added oil and or ghee. The sweet and sour tastes are desirable; moderate amounts of salt are permitted unless for other reasons medically contraindicated. Reduce, but do not completely eliminate, dry and raw foods and bitter tastes. Use warm or hot water and drinks. Raw nuts and nut butters can be eaten.
Useful Spices: cinnamon, coriander, nutmeg, cardamom, cumin, ginger, cloves.
Split yellow mung dal or green gram kitchari is the best balanced food during dinner, and has easily digestible proteins in addition carbohydrates and fibers. This will also remedy indigestion and constipation.
Consumption of caffeine, nicotine, or cocaine can disturb the prana vayu aggravating tinnitus--hence avoid all of these.

Panchakarma

  • Nasya (Errhine medications). Vacha (Acorus calamus) oil nose drops, have a powerful effect in calming and balancing the Prana vayu. A preparation of sesame oil medicated with calamus root is taken nasally, 3-6 drops per nostril, at night and in the morning. The nasya should be warmed to body temperature before administration. Nasya helps to nourish the senses to eliminate excess Vata from head, neck, and senses.
  • Abhyanga (Massage). Shiroabhyanga (head massage) and padabhyanga (foot massage), wherein the soles of the feet are massaged with warm sesame oil, has a specific effect in calming the prana vayu. At bedtime, warm sesame oil should be applied to the soles of the feet and also to the scalp. This treatment rapidly normalizes the prana vayu.
  • Karnapoorna (Ear drops). To calm the Vata in the ears, ten drops of warm sesame oil is applied daily to each ear. The oil is allowed to remain in the first ear for five or ten minutes, then that ear is cleaned, and the same procedure is followed with the other ear, with the patient lying on the other side. Typically, this treatment should alleviate tinnitus, and most other symptoms of prana vayu disturbance, within eight to ten days.Bilwadi tail,Apamargkshar tail,Dashmool tail can be used for Karnpooran.
  • Kawala & Gandush. Gargling of medicated oils or certain liquids/Kwath is Kawala.It strengthens the nerves of eyes and ears and also pacifies aggravated Vata.Gandush is Withholding medicated oils or certain liquids in the mouth for a certain period of time.
  • Shirobasti (Head Bath).

Herbs and Formulations
Ashwagandha, Jatamansi, Dashmoola, Rasna are the useful herbs.

Ashwagandha herbal preparations can be used. Simplest way is to take Ashwagandha churna ¼-1 tsp 2x daily. along with 4-5 oz. of warm milk preferably taken at bed time along with a little jaggery and cardamom powder mixed, so that resulting sound sleep will reduce Vata dosha. Ashwagandha has certain chemicals which induce an increase of serotonin, a sleep inducing hormone. Dinner should consist of a greater proportion of carbohydrates which also cause increase of serotonin. Ashwagandharishtam also can be taken instead, 15-30 ml with equal water. Being an arishtam, take it after dinner rather than at bedtime. This relaxation to cranial nerves reduces the ringing caused by Tinnitus.

Vata is always alleviated by warm oils. There are various oils directed at ringing and some other problems of the ear. Useful oils are "Bilva Tailam", "Amrut Bindu" and "Kshar Tailam", to be dropped 2 drops in ear at bed time and early morning. They can be applied to insides by using cotton bud. Another oil recipe which can be prepared at home consists of ginger powder, saindhava (salt) and honey mixed to a fine paste and boiled in sesame oil and water (4:1) on low heat till all moisture vaporizes. After cooling and straining the oil, it can be applied to insides of ear by using a cotton ear-bud. Garlic oil is sometimes effective. Place 3 drops into your ear at night before going to bed.

For those who have chronic tinnitus, meaning it has not resolved in three months, 'Brihad Vata Chintamani' is available. This is relatively expensive medicine as it is made from silver and gold oxides. It acts on nerves fairly rapidly calming Vata fast. Being a gold oxide based medicine, should be taken only under physician supervision at a dose of a single tablet once or twice a day, with cow’s ghee or honey.

Oral administration of "Sarasvati choorna" can be given in doses of a quarter teaspoon twice daily after meals.

You can take yogaraj guggulu (200 mg. 2 or 3 times a day) with warm water, after food; it will reduce inflammation in the ear.

Drinking a cup of fenugreek seed tea each morning, noon, and night is reported to abolish disturbing ear noises.

To alleviate this root cause-aggravation of Vata in the nervous system-prepare a tea made from equal amounts of nutmeg, cinnamon, and chamomile. Steep up to 1 teaspoon of this mixture per cup, and drink 2 or 3 times a day.

Lifestyle Changes

  • - Use amla or sesame hair oil daily
  • - Perform oil massage using Sesame oil or Mahanarayan Tailam for about 20 minutes to whole body and take hot water bath thereafter. The massage and bath just before bedtime will aid the sleep also. Oil massage calms down the Vata. Skin is an important seat of Vata, since it is widely distributed over the body.
  • - Observe silence for a few days and note the change in ringing.
  • - Tinnitus appears to have some connection with the number of hours one spends daily in front of computer monitor/cellphone. The radiation emitted by the screen is Vata-aggravating. A number of cases having auditory or vision nerve problems are coming to light.
  • - Do not travel or walk in an extreme cold climate. Do not take baths more frequently than once daily.
  • - Do not restrain natural urges when body wants to eliminate any wastes.
  • - To increase blood circulation, rub by a multani mitti (similar to Fuller’s mud) at bath time also gives the effect of massage. In addition, it cleanses the blood to some extent.
  • - In addition, there are certain breathing techniques which have to be learnt from an experienced Vaidya or Guru. These are known to help in most Vatic ailments affecting the body-mind.
  • - Peace of mind and Vata vitiation are inversely proportional. In fact Vata dosha imbalance causes a vacillation and constantly thinking mind. Hence, in case of all Vata disorders meditation appears to help.
  • - excess television watching, excess use of computers, or sleeping near an electrical outlet should be avoided.
  • - Moderation in sensory activities, especially the ear sense. Thus avoid too much exposure to loud noises, music, headphones, speakers, and professional activities which involve high frequency sounds.

Lifestyle adjustments are thus an essential part of the effective treatment of tinnitus.

References:

Charaka Samhita : Chikitsa Sthana, chapter 26, Shlokas 127,128.

Sushruta Samhita : Uttara Tantram chapter 21, Shlokas 1-61.