Ayurvedic Management of Tinnitus*

*REFERENCES to herbs used in the following text should not be viewed as recommendations or suggestions for the treatment of any disease or condition. Each individual’s therapeutic needs are unique and what may be of benefit to one individual could be harmful for another. For specific information please consult an Ayurvedic practitioner or other health care provider.

Tinnitus, a persistent, unwelcome sensation of “ringing” in the ears, causes the perception of sound in one or both ears or in the head in the absence of any external cause or stimuli. Although often referred to as "ringing in the ears", some affected 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.

It is estimated that in U.S. alone, over 50 million experience tinnitus to some degree. Of these, nearly 25% have severe enough tinnitus and about 5% are so seriously debilitated that they cannot function on a "normal," day-to-day basis. The population of affected appears to contain a larger number of individuals involved in sedentary occupations, as opposed to manual workers.

Causes of Tinnitus: Medical Perspective

The exact physiological causes of tinnitus are not known. There are, however, several likely sources, all of which are thought 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.
• Ear or sinus infections.
• Temporomandibular joint/jaw misalignment.
• 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.
• Certain types of tumors on the auditory, vestibular, or facial nerves.
• Certain medications (such as aspirin, quinine and some antibiotics).
• Head and neck trauma.

Often, medical practitioners caution their patients that "you just have to learn to live with it." Far from being helpful, this phrase increases the isolation and frustration of the tinnitus patient. They are alone, they are without hope, an depending upon the intensity of the problem they suffer greatly: severely-affected patients often complain that they are going mad at the continuous noise.

Causes of Tinnitus: Ayurvedic Perspective

The Ayurvedic term for Tinnitus is "Karnanada". According to Ayurveda, tinnitus is not a disease but a symptom of a disturbance of prana vayu, a subdosha of vata which resides in the head and upper torso and governs all higher cerebral functions as well as the inhalation phase of respiration and the action of swallowing.

The same set of reasons which cause a vitiation of vata dosha can also cause Karnanada. Thus, lack of adequate sleep, nervous tension to increased stress, incessant talking, excessive fasting, excessive exercise, the sudden experience of shock, grief, or fear, excessive consumption of difficult-to-digest cereals in the diet, excessive use of medicines or consumption of foods of bitter taste are some of the reasons for tinnitus. Depletion of dhatus as a result of excess indulgence in sexual contact is also another possible etiology.

Samprapti (Pathogenesis) of Tinnitus

Ayurveda holds that when errant vata overflows its accustomed container in the colon, circulates throughout the body and find its site of deposition (khavaigunya) in the sound carrying channels of the head, the client perceives various types of sound; this condition is termed Pranada or Karnanada. As we know, vata dosha governs all movements within the body such as circulation, respiration, peristalsis, and sensory impulse movement, etc. and is comprised of the air (vayu) and space (akasha) elements. When vata is vitiated, the air and space elements increase in quantity and in the intensity of their physiological activity and disturb some or all the bodily functions of that dosha, i.e., movement. This leads to variations in pressure in the cavernosities of the body (particularly the cranial sinuses), sensations of pressure in the head, disruption of the nervous system, dryness of the mucous membranes, dysregulation of the senses – specifically, tinnitus - loss of sleep, anxiousness, and irritability, etc.

In tinnitus the sound is experienced only by the client. It is not external. It is not, however, the affected person’s imagination but is result of and internal vata imbalance which actually generates sound, albeit only audible to the sufferer.

According to Ayurveda, vata constitutions are prone to suffer with high frequency tinnitus sounds, pitta types with moderate (mid-range) frequency and kapha types have the tendency to suffer with low frequency sounds.

A similar albeit distinct condition is karnasveda (sound in ears). Here vata is aggravated by exertion, emaciation, the over-abundant intake of roughly-textured and astringent-tasting foods and also after excessive exposure to cold. In this state, pitta, kapha and vata become abnormally concentrated in the ear canal and produce the sounds sensed only by the sufferer. The difference between karnanada and karnaksveda is that the former is caused by pran vayu with the possible perception of various sounds while the latter is produced by pitta, kapha and vata acting in concert to produce a single distinctive sound which has been compared to that of a flute.

Complications

Tinnitus (karnanada) may lead to hearing loss (karna baadhirya) but this is in a relatively small number of cases. People with a high vata imbalance or a profoundly vata body type are more prone to certain have other disorders, like hearing loss follow in Tinnitus’ wake. Such individuals are also prone to a condition called hyperacusis wherein high-frequency sounds can evoke intense pain. Concentration problems, sleeping problems, irritability and a tendency toward annoyance, hypersensitivity to sounds, or increased sensitivity to other sensorial stimuli can appear as well. The chronicity of this problem can often lead to despair, frustration and depression in many sufferers.

Ayurvedic Treatments for Tinnitus

As tinnitus is a vata disorder, the vata balancing therapies and herbs are beneficial.

Vata influences the movement of thoughts, feelings, prana, nerve impulses, and gasses and fluids in the body. Hence a vata-pacifying diet is recommended consisting of warm food, moderately heavy in texture, with added butter. The sweet, salty and sour tastes are desirable. Reduce dry foods and bitter tastes. Use warm or hot water and drinks. Emphasize raw nuts and nut butters in the diet. Useful spices include cinnamon, cardamom, cumin, ginger, cloves in moderation.

Consumption of caffeine, alcohol, marijuana, nicotine, or cocaine can disturb prana vayu seriously, and are hence to be avoided.

Apart from dietary interventions, other modalities such as the following may prove helpful:

• Nasya: Vacha (Acorus calamus) oil nasya, has a powerful effect in calming and balancing the Prana vayu. A preparation of sesame oil medicated with calamus root is taken nasally, five drops per nostril, at night and in the morning. The nasya should be warmed to blood heat before administration. Nasya helps to nourish the senses to eliminate excess vata from 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.
• Karnapooran: (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 client 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.

Herbs and Formulations useful for Tinnitus

Ashwagandha, Jatamansi, and Dashmool (the last a multiherbal formulation) are among the most useful of medicinal plants.

Ashwagandha herbal preparations can be used to great effect. The simplest way is to take 1 to 2 tablets (250mg to 350mg) of Aswagandha along with 1 cup of warm milk at bedtime along with a little sugar and cardamom powder mixed, so that resulting sound sleep will reduce vata dosha. Aswagandha phytochemical constituents increase serotonin, a sleep inducing hormone. Aswagandharishtam, of which 15 ml can be taken with water after dinner. This will relax the cranial nerves, reducing the ringing caused by Tinnitus. (As a further aid to sleep the evening meal should consist of a greater portion of carbohydrates which also will cause an increase in serotonin to aid the onset of sleep.)

Vata is always pacified by oils. There are various oils of which the most useful for this problem are "Bilva Tailam", "Amrut Bindu" and "Kshar Tailam", to be dropped (2 drops in the affected ear) at bedtime and in the early morning. They can also be applied to the external portion of the ear canal by using a cotton swab. Garlic oil is also often effective.

For severe cases of chronic tinnitus, 'Brihad Vata Chintamani Ras' is available. This is a bhasma made from silver and gold oxides that acts on nerves quite rapidly, calming vata. Being a gold oxide based medicine, this should be taken in a low dose tablet twice a day, mixed well with cow ghee and honey. The dose can be halved after the reduction of ringing as a prophylactic measure. The administration of "Sarasvati churna" can be of great help also, as can the anti-inflammatory Yogaraj Guggulu (200 mg. 2 - 3 times a day) with warm water, after food.

The drinking of teas made from Fenugreek (Methi) and from equal amounts of comfrey, cinnamon, and chamomile are said to be useful.

Lifestyle Changes for Tinnitus management

• Perform a daily scalp message with an appropriate oil.
• Use 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.
• So far as practical, observe total 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. The radiation emitted by monitor is hitting the user all the time. A number of cases having auditory or vision nerve problems are coming to light.
• Do not travel or walk in an extremely or windy cold climate and do not bath excessively if the weather is cold.
• Do not suppress natural urges (sneezing, coughing, seeping, elimination, etc.).
• To increase blood circulation, use a loofah or other coarse sponge when showering which provides much the same benefits as massage. In addition, it cleanses the blood to a modest extent.
• Peace of mind and vata vitiation are inversely proportional. Hence, in case of tinnitus and in fact nearly 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 as they involve hearing - avoid too much exposure to loud noises, music, speakers, and professional activities which involve high frequency sounds.

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

Article provided by William Courson, BVSA, Dpl. Ayur., C.H. an Ayurvedic Practitioner, faculty member and the College Dean of Institutional Development at Sai Ayurvedic College & Ayurvedic Wellness Center.

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