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The role of caffeine in otorhinolaryngology: guilty as charged?

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Caffeine is implicated as causing or aggravating numerous otorhinolaryngological conditions, including tinnitus, Ménière's disease, laryngopharyngeal reflux, globus pharyngeus and dysphonia. We address caffeine's effects in such conditions and to determine whether such implications are founded. The defined search limits of data sources included human trials and either randomised control trials, meta-analyses, editorials, letters, clinical trials, case reports, comments or journal articles over the last 40 years. MEDLINE, EMBASE and CINAHL databases were searched using 'otorhinolaryngological diseases' and 'caffeine' as a duplicate filter. PubMed databases were searched using 'caffeine' in combination with 'tinnitus', 'Ménière's', 'vertigo', 'motion sickness', 'imbalance', 'vestibular migraine', 'voice', 'vocal hygiene', 'reflux', 'ear', 'nose', 'throat' and 'head neck cancer', respectively. Searches were not limited to the English language. MEDLINE, EMBASE and CINAHL database searches identified 417 papers. Of these, 200 abstracts were chosen for further scrutiny, following which 30 full manuscripts were chosen for full review. The PubMed database search identified 275 abstracts of which 33 were reviewed. Of the total 692 studies searched, 63 studies were reviewed and 36 were finally used. At present, there is little evidence in the literature to support the notion that caffeine causes or aggravates otorhinolaryngological conditions. In tinnitus, its withdrawal may actually worsen symptoms whereas in motion sickness, there is some clinical evidence for its benefit. More research is needed into the role caffeine plays in otorhinolaryngological conditions to allow clinicians to give informed advice to their patients.
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REVIEW ARTICLE
The role of caffeine in otorhinolaryngology: guilty as charged?
A. Trinidade
T. Robinson
J. S. Phillips
Received: 8 May 2013 / Accepted: 23 July 2013 / Published online: 11 August 2013
Ó Springer-Verlag Berlin Heidelberg 2013
Abstract Caffeine is implicated as causing or aggravat-
ing numerous otorhinolaryngological conditions, including
tinnitus, Me
´
nie
`
re’s disease, laryngopharyngeal reflux, glo-
bus pharyngeus and dysphonia. We address caffeine’s
effects in such conditions and to determine whether such
implications are founded. The defined search limits of data
sources included human trials and either randomised con-
trol trials, meta-analyses, editorials, letters, clinical trials,
case reports, comments or journal articles over the last
40 years. MEDLINE, EMBASE and CINAHL databases
were searched using ‘otorhinolaryngological diseases’ and
‘caffeine’ as a duplicate filter. PubMed databases were
searched using ‘caffeine in combination with ‘tinnitus’,
‘Me
´
nie
`
re’s’, ‘vertigo’, ‘motion sickness’, ‘imbalance’,
‘vestibular migraine’, ‘voice’, ‘vocal hygiene’, ‘reflux’,
‘ear’, ‘nose’, ‘throat’ and ‘head neck cancer’, respectively.
Searches were not limited to the English language. MED-
LINE, EMBASE and CINAHL database searches identified
417 papers. Of these, 200 abstracts were chosen for further
scrutiny, following which 30 full manuscripts were chosen
for full review. The PubMed database search identified 275
abstracts of which 33 were reviewed. Of the total 692
studies searched, 63 studies were reviewed and 36 were
finally used. At present, there is little evidence in the lit-
erature to support the notion that caffeine causes or
aggravates otorhinolaryngological conditions. In tinnitus,
its withdrawal may actually worsen symptoms whereas in
motion sickness, there is some clinical evidence for its
benefit. More research is needed into the role caffeine plays
in otorhinolaryngological conditions to allow clinicians to
give informed advice to their patients.
Keywords Caffeine Ear Nose Throat
Balance Tinnitus Me
´
nie
`
re’s disease Globus
Dysphonia Voice
Introduction
Widespread caffeine use explains a lot about the twentieth
century—Greg Egan
Caffeine, a crystalline methylxanthine alkaloid stimu-
lant, is the world’s most widely consumed legal, unregu-
lated psychoactive drug [1, 2], due to its ubiquitous
presence in many of the beverages consumed globally,
including coffee, tea, soft drinks, energy drinks and, to a
lesser extent, in chocolate and chocolate-based products.
Its cited effects on health, both positive and negative, are
broad, and range from lowering the risk of Type 2 diabetes
mellitus to inducing psychomotor agitation [3]. The latter
is generally induced at levels of greater than 250 mg/day
(known as caffeinism) and the average adult European
caffeine consumption ranges from 280–490 mg/day, high-
est in Scandanavia [3]. In comparison, the average Amer-
ican coffee drinker consumes approximately three cups of
coffee a day (up to 525 mg/day in brewed coffee) and
represents 54 % of the population.
Within the speciality of otorhinolaryngology, it has been
implicated as the cause or aggravator of several common
ailments, including tinnitus, Me
´
nie
`
re’s disease, laryngo-
pharyngeal reflux and its associated symptoms, and globus
pharyngeus. However, despite such allegations, the evi-
dence to support its status as culprit to these conditions is
conflicting and sparse.
A. Trinidade (&) T. Robinson J. S. Phillips
ENT Department, Norfolk & Norwich University Hospital
NHS Trust, Colney Lane, Norwich NR4 7GJ, UK
e-mail: aarontrinidade@gmail.com
123
Eur Arch Otorhinolaryngol (2014) 271:2097–2102
DOI 10.1007/s00405-013-2648-0
This review considers the role of caffeine in ENT con-
ditions and reviews the available literature to support or
dispel such a role.
Methodology
The defined search limits of this review included human
trials and either randomised control trials, meta-analyses,
editorials, letters, clinical trials, case reports, comments or
journal articles. Additional articles received following
author correspondence were also included. MEDLINE,
EMBASE and CINAHL databases were searched using
both ‘otorhinolaryngological diseases’ and ‘caffeine’ as a
duplicate filter. The PubMed database was searched using
‘caffeine’ in combination with ‘tinnitus’, ‘Me
´
nie
`
re’s’,
‘vertigo’, ‘motion sickness’, ‘imbalance’, ‘voice’, ‘vocal
hygiene’, ‘reflux’, ‘ear’, ‘nose’, ‘throat’ and ‘head neck
cancer’, respectively. Searches were not limited to the
English language.
Results
MEDLINE, EMBASE and CINAHL database searches
identified 417 papers. Of these, 200 abstracts were chosen
for further scrutiny, following which 30 full manuscripts
were chosen for full review based on relevance to the topic
as determined by the authors. The PubMed database search
identified 275 abstracts of which 33 were reviewed, again
based on relevance as determined by the authors. Of the
total 692 studies that our search returned, 63 studies were
reviewed and 36 were finally used for this review. The
decision regarding which papers would be included in the
review was undertaken jointly by AT and JSP.
Table 1 shows the distribution of paper types analysed
either in abstract of full paper form and their levels of
evidence, based on the Oxford Centre for Evidence Based
Medicine classification.
Discussion
Coffee leads men to trifle away their time, scald their
chops, and spend their money, all for a little base, black,
thick, nasty, bitter, stinking nauseous puddle water—The
Women’s Petition Against Coffee, 1674.
Does caffeine really aggravate tinnitus?
It has been long thought that the excessive intake of caf-
feine can aggravate tinnitus, and many patients are given
advice on avoidance of caffeine as well as nicotine, salt,
and a variety of other substances. Medeiros et al. [4] found
that in 744 tinnitus sufferers with otherwise normal hear-
ing, caffeine abuse was found in 45.5 %; however, no basis
for this association was found. In 1988, Slepecky et al. [5]
showed that caffeine causes the shortening of cochlear
outer hair cells (OHCs) through a smooth-muscle like
mechanism (later postulated to be an osmotic process by
Skellett et al. in 1995 [6]) and suggested that this effect
may be responsible for an increase in tinnitus [7]. In a more
recent study by Bobbin, caffeine and ryanodine were used
to prove the role of Ca
2?
release from ryanodine receptors
in the OHCs and supporting cells of organ of Corti on the
function of the cochlear amplifier in guinea pig cochleae
[8]. The results show that caffeine does have a suppressive
effect on the compound action potential of the auditory
nerve and distortion product otoacoustic emissions. How-
ever, whether these described effects of caffeine on the
organ of Corti can themselves cause tinnitus remains
unknown.
Regardless of its effect on the auditory system, recent
research by Claire et al. [9] suggests that caffeine absti-
nence in the management of tinnitus is ineffective and may
indeed aggravate symptoms. In a pseudo-randomized,
double-blinded, placebo-controlled crossover trial of
30 days duration, 66 volunteers with tinnitus and who
usually consumed at least 150 mg/day of caffeine partici-
pated. Volunteers’ usual caffeinated tea/coffee was
replaced with double-blinded supplies under one of two
conditions: either maintenance followed by phased with-
drawal, or phased withdrawal followed by reintroduction
and maintenance. The outcome measure of tinnitus severity
was measured by the total score of the Tinnitus Ques-
tionnaire on Days 1, 15, and 30. Caffeine was found to
have no effect on tinnitus severity (p = 0.97), but signifi-
cant acute effects of caffeine withdrawal were observed,
potentially adding to the burden of the tinnitus [9]. This
latter aspect, however, was not further investigated with
quality of life assessment tools. It is therefore difficult to
draw a definitive conclusion on the effect of caffeine
withdrawal on tinnitus patients.
Overall, whilst there is some evidence of a biological
effect of caffeine on the cochlea, there is no evidence for
presumed association with tinnitus or for its cessation
during tinnitus management.
Caffeine and its role in endolymphatic hydrops
The traditional understanding of Me
´
nie
`
re’s disease is that it
is due to hydrops of the endolymphatic space leading to
rupture of the membranous structures that affect hearing
and balance. However, evolving research has shown that
hydrops is not always associated with Me
´
nie
`
re’s disease
and symptoms may represent a common endpoint of a
2098 Eur Arch Otorhinolaryngol (2014) 271:2097–2102
123
variety of anatomic or physiologic variables, including
ischemic or even autoimmune injuries. Hydrops could be
considered the ultimate cause of such symptoms [10]. It is
this concept of hydrops, however, that is the basis of the
advice given to sufferers of Me
´
nie
`
re’s disease to avoid
alcohol, high salt intake and caffeine. The postulation
underlying this advice is that they cause large fluid shifts
through physiologic fluid compartments and hence result in
inner ear instability [11]. With respect to caffeine, this
would be caused by the sympathomimetic and diuretic
actions of methylxanthine as it distributes into body fluid
compartments [12]. But in a cross-over study by Grandjean
et al. [13], caffeinated drinks were found to have no
significant effects on hydration status when body weight
and urinary output were measured and compared. Simi-
larly, in a recent randomised controlled trial, Ruxton et al.
[14] tested the effect of two different amounts of black tea
(providing 168 and 252 mg of caffeine, respectively)
against a control of boiled water on the physiology of 21
healthy resting, fasted males from the general population.
Interval blood and urine samples were tested over 24 h and
the outcome variables measured included whole blood cell
count, Na
?
,K
?
, bicarbonate, total protein, urea, creatinine
and osmolality for blood; and total volume, colour, Na
?
,
K
?
, creatinine and osmolality for urine. Statistical analysis
revealed no significant differences between tea and water
Table 1 Characteristics of studies used to review the role of caffeine in otorhinolaryngological disorders
Study type Author Location Year published Reference Level of evidence
Review articles Persad South Africa 2012 [2]3a
Wierzejska R Poland 2012 [3]3a
Berlinger USA 2011 [10]3a
Rauch USA 2010 [11]3a
Burgess et al. UK 2010 [15]1a
Estrada et al. USA 2007 [17]3a
Bhavsar UK 2009 [20]3a
Hopkins et al. UK/Denmark 2012 [33]1a
Kaltenbach et al. USA 2006 [34]3a
Galeone et al. Italy 2010 [36]3a
Randomised controlled trial Claire et al. UK 2010 [9]2b
Ruxton et al. UK 2011 [14]2b
Erickson-Levendoski et al. USA 2011 [19]2b
Cohort study
Retrospective Medeiros et al. Brazil 2004 [4]2b
Outcomes research Louis et al. Belgium 2009 [22]2c
Fritz et al. Luxembourg 2009 [23]2c
Case–control study Grandjean et al. USA 2000 [13]3b
Gudjonsson et al. Iceland 1995 [25]3b
Lohsiriwat et al. Thailand 2006 [26]3b
Van Nieuwenhoven et al. Netherlands 2000 [27]3b
Elam et al. USA 2010 [28]3b
Retrospective chart review Block et al. USA 2007 [30]4
Thomas et al. USA 2012 [32]4
Case series Eyeson-Annan et al. Australia 1996 [16]4
Akhtar et al. UK 1999 [18]4
Rouev et al. Bulgaria 2005 [21]4
van Deventer et al. USA 1992 [24]4
Zhou et al. China 2012 [29]4
Cross-sectional survey Cohen et al. USA 2012 [31]4
Laboratory research Slepecky et al. Sweden 1988 [5]5
Skellett et al. USA 1995 [6]5
Ulfendahl et al. Sweden 1987 [7]5
Bobbin USA 2002 [
8]5
Eur Arch Otorhinolaryngol (2014) 271:2097–2102 2099
123
for any of the mean blood or urine measurements. This
contradicts the hypothesis of caffeine causing physiologi-
cal fluid compartment shifts in Me
´
nie
`
re’s disease.
It is also this concept of hydrops that underlies the
administration of diuretics as a medical therapy strategy for
Me
´
nie
`
re’s disease. Diuretics are thought to work by influ-
encing inner ear fluid and electrolyte processing in a sim-
ilar way that it affects ion pumps and ionic gradients in the
kidney [11]. However, a recent systematic review by
Burgess et al. found an insufficient quantity of good evi-
dence to support the effect of diuretics on vertigo, hearing
loss, tinnitus or aural fullness in clearly defined Me
´
nie
`
re’s
disease [15].
In summary, the effect of caffeine on the endolymphatic
system in Me
´
nie
`
re’s disease remains unknown and it seems
unlikely that any effect is related to the direct precipitation
of endolymphatic hydrops.
Caffeine and motion sickness
Motion sickness is considered by some to represent a
mismatch between motion perceived by the visual and
vestibular systems [16]. Sympathomimetic drugs are
known to counteract motion sickness both individually and
in synergistic combination with anticholinergic drugs [17],
and caffeine possesses such an action in the form of
methylxanthine [12]. In a recent double-blinded
randomized controlled trial by Estrada et al. [17], 64 sub-
jects were randomly assigned promethazine 25 mg ? caf-
feine 200 mg, meclizine 25 mg, scopolamine 1.5 mg
transdermal patch or a stimulation wristband, subjected to a
30-min helicopter ride and then another similar ride 7 days
later after having been prescribed a placebo. After filling a
Motion Sickness Questionnaire, the promethazine/caffeine
combination produced the only statistically significant
improvement when compared to the placebo for nausea
(p = 0.019), symptom severity (p = 0.041) and reaction
time (p = 0.05). Given the robustness of the study, this
combination can be recommended for motion sickness.
Caffeine, the larynx and the pharynx
Caffeine is one of the putative causes of poor voice
hygiene, but the evidence for this is lacking. The most
commonly held theory is that the diuretic action of caffeine
leads to dehydration of the vocal fold mucosa. As previ-
ously discussed, there is no evidence that the diuretic
action of caffeine has an effect on hydration or the balance
of body fluid compartments [13, 14].
In 1999, Akthar et al. [18] investigated the more direct,
local effects of caffeine on vocal mucosa in a small pilot
study. Fundamental frequencies, taken as a measure of
disordered voice production, were measured in eight
subjects before and after ingestion of 200 mg of caffeine in
tablet form. Post-ingestion, irregularities of frequencies
during three vocal loading tasks (free speech, reading
passage and singing ‘Happy Birthday’) were analysed. In
all three areas, at least six of the subjects showed sub-
stantial changes in fundamental frequency irregularity
(approximately 8 % for free speech, and 2 % for the other
areas). However, despite this trend, there was considerable
inter-subject variability as evidenced by large standard
deviation values. Other weaknesses of the study include
their use of only one of several voice parameters, namely
fundamental frequency, the lack of subject matching for
age and sex and the absence of a control group. The study
did not, therefore, provide enough statistical support for the
avoidance of caffeine as a valid strategy in improving voice
hygiene. A more recent, robust, prospective, double-blin-
ded, randomized controlled trial by Erickson-Levendoski
et al. [19
] involved randomizing 16 healthy adults to two
sessions where they consumed beverages containing either
caffeine (caffeine concentration of 480 mg) or a sham
(caffeine concentration of 24 mg). Voice measures (pho-
nation threshold pressure and perceived phonatory effort)
were collected. Subjects then completed a vocal loading
challenge and voice measures were again recorded. No
significant differences in voice measures between the caf-
feine and sham conditions were reported (p [ 0.05 in both
parameters).
Other postulations regarding the effect of caffeine on
voice include biochemical interactions between it and the
vocal fold mucosa or possibly a central effect of caffeine
leading to alterations in breathing patterns and bronchial
smooth muscle relaxation indirectly affecting voice [20],
but there remains insufficient evidence for any of these
claims.
Another way in which caffeine is thought to affect the
voice is through its aggravation of laryngopharyngeal
reflux (LPR), a condition which is a direct consequence of
gastro-oesophageal reflux disease (GORD) and which on
its own accord may lead to presentation to the ENT clinic
for a myriad of symptoms, including hoarseness, postnasal
drip, sore throat, dysphagia, chronic cough, globus pha-
ryngeus and chronic throat clearing [21]. Two recent large
epidemiological studies have shown a high incidence of
caffeine ingestion in patients with GORD [22, 23], but the
evidence for the actual effect that caffeine has on the
aggravation on GORD is conflicting. Three recent studies
on the effect of caffeine on the lower oesophageal sphincter
show a relaxation following ingestion of coffee when
compared to a control, despite small numbers in all studies
(12, 12 and 8) [2426]. Yet in a study by van Nie-
uwenhoven et al. [27] in which 10 healthy subjects
underwent oesophageal motility, gastro-oesophageal
reflux, and intragastric pH measuring via transnasal
2100 Eur Arch Otorhinolaryngol (2014) 271:2097–2102
123
catheterization during exercise, no significant difference
could be found in any of the parameters when subjects
were supplemented with a carbohydrate-electrolyte solu-
tion sports drink with or without 150 mg/L of caffeine or
with water.
With respect to voice, there is evidence that LPR does
have an effect. In a case–control study of 119 patients,
Elam et al. [28] showed that patients with LPR had sig-
nificantly higher mean Voice Handicap Index (VHI) scores
for total, functional and physical domains (p = 0.002, 0.02
and 0.008, respectively). Similarly, in another case–control
study of 196 patients, Zhou et al. [29] showed that in
patients with diagnosed LPR, a significant perturbation of
fundamental frequency and amplitude and a significant
increase in normalization noise energy was present
(p \ 0.01). Similar findings have been found in paediatric
populations [30]. There are authors, however, who support
the notion that dysphonia secondary to LPR is an over-
diagnosed condition due to, amongst other things, the need
for a diagnosis in the absence of pathological findings or
the inability to appreciate the differences in findings on
stroboscopy and laryngoscopy [31, 32]. In addition, whilst
LPR may indeed cause dysphonia, there is no evidence that
initiating anti-reflux treatment is beneficial, as outlined in a
Cochrane review by Hopkins et al. [33].
Whilst there is evidence for the effect of LPR on voice,
the evidence for the effect of caffeine on GORD (and hence
LPR) is conflicting and weak. It can therefore be concluded
that the evidence for caffeine as an aggravator of LPR and
its associated symptoms, including dysphonia, is currently
lacking. Indeed, a systematic review of 2,039 papers by
Kaltenbach et al. [34] supports this statement by conclud-
ing that there is no evidence supporting an improvement in
GORD measures after dietary interventions including the
cessation of tobacco, alcohol or caffeine.
Head and neck cancer: is caffeine a risk factor?
Whilst tobacco and alcohol consumption are well-known
risk factors for the development of head and neck cancers,
other dietary and lifestyle factors, including caffeine-con-
taining beverages such as coffee and tea have also been
implicated [35]. In 1990, when the International Agency
for Research on Cancer evaluated the evidence for the
relationship between coffee intake and head and neck
cancers based on six case–control studies, they found the
evidence to be inadequate [35]. Since then, there have been
over 20 studies further investigating this relationship,
including prospective, case–control and cohort studies, but
all with inconsistent findings. However, an inverse asso-
ciation between coffee intake and the risk of cancer of the
oral cavity and pharynx exists [36]. In one of the most
recent pooled analyses of case-controlled studies of head
and neck cancers, 9 such studies were analysed by Galeone
et al. [36]. They concluded that whilst bias, confounding
factors and reverse causality could not be ruled out, their
results supported the hypothesis that such an inverse
association exists. Coffee ingestion was not found to be
associated with an increased risk of laryngeal cancer. They
stated, however, that as coffee use is so widespread, and
given that head and neck cancer has such a high incidence
and low survival, more research into a causal link between
head and neck cancer and coffee drinking is needed.
Conclusion
Caffeine has been labelled as a perpetrator of a variety of
otorhinolaryngological ailments, but perhaps without much
good evidence. Much of the advice that we prescribe to our
patients seems to be founded in hypotheses that lack sound,
supporting empirical evidence. Though it is tempting to
override such a statement with the claim that ‘‘whilst we do
not know with any certainty that caffeine abstinence can
improve the outlined ailments, what harm could it do?’
there is evidence that doing so may have a negative effect,
as in the case of tinnitus. More research is needed in all
areas where caffeine is implicated in the ailments pre-
senting to the ENT clinic to allow clinicians to give more
informed advice to their patients.
Conflict of interest None.
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... Few studies have investigated caffeine's role in vestibular disorders such as Menière's disease, vestibular migraines, and motion sickness. Caffeine restriction was commonly described as beneficial for treating Menière's disease [72,73]. It has also been suggested that limiting caffeine use to no more than a single dose per day keeps the inner ear stable and prevents attacks [73]. ...
... It has been suggested that caffeine and alcohol cause large fluid shifts through physiologic fluid compartments [73]. However, some studies have failed to confirm that caffeine causes physiological fluid compartment shifts in Ménière's disease patients, as caffeine consumption did not significantly affect patients' hydration status [72]. Caffeine could reduce blood supply to the inner ear and exacerbate the symptoms of Ménière's disease sufferers. ...
Article
Coffee, of which caffeine is a critical component, is probably the most frequently used psychoactive stimulant in the world. The effects of caffeine on the auditory and vestibular system have been investigated under normal and pathological conditions, such as acoustic trauma, ototoxicity, auditory neuropathy, and vestibular disorders, using various tests. Lower incidences of hearing loss and tinnitus have been reported in coffee consumers. The stimulatory effect of caffeine is represented by either a shorter latency or enhanced amplitude in electrophysiological tests of the auditory system. Furthermore, in the vestibular system, oculomotor testing revealed significant effects of caffeine, while other tests did not reveal any significant caffeine effects. It could be that caffeine improves transmission in the auditory and vestibular systems' central pathways. Importantly, the effects of caffeine seem to be dose-dependent. Also, inconsistent findings have been observed regarding caffeine's effects on the auditory and vestibular systems and related disorders. Overall, these findings suggest that caffeine does not strongly influence the peripheral auditory and vestibular systems. Instead, caffeine's effects seem to occur almost solely at the level of the central nervous system.
... For many years, people with tinnitus were advised to avoid caffeinecontaining drinks such as coffee, tea, soft drinks or energy drinks. 30,31 The main arguments are caffeine's stimulatory effects on the central nervous system and a potential interaction with central auditory processing (eg caffeine can cause a shortening of cochlear outer hair cells). 31,32 However, there is no supporting empirical scientific evidence for a caffeine restriction recommendation. ...
... 30,31 The main arguments are caffeine's stimulatory effects on the central nervous system and a potential interaction with central auditory processing (eg caffeine can cause a shortening of cochlear outer hair cells). 31,32 However, there is no supporting empirical scientific evidence for a caffeine restriction recommendation. The few published studies on the link between caffeine consumption and tinnitus are listed in Table 2. ...
Article
Background: Tinnitus is a common and multifactorial condition that requires careful medical assessment and management. Many people with tinnitus believe foods can exacerbate or reduce their perception of the condition, but the research on the relationship between diet and tinnitus is limited. Objective: The aim of this article is to review the available literature on the efficacy of a healthy diet, use of dietary supplements, caffeine restriction and salt restriction against tinnitus. Discussion: There is very weak evidence that dietary quality affects tinnitus symptoms, and further high-quality analytical studies are needed. On the other hand, the research is clear that dietary supplements are ineffective in reducing the symptoms of people with tinnitus and should therefore not be recommended by clinicians. There is also no supporting empirical scientific evidence for the commonly advocated restriction of caffeine and dietary salt for tinnitus patients.
... It is perhaps unsurprising, then, that respondents to the present survey reported these items as being among those items most likely to cause a worsening of tinnitus symptoms. The mechanisms through which caffeine, salt, and alcohol are proposed to worsen tinnitus include exacerbating effects on blood pressure, vasoconstriction within the cochlea, alteration of endolymph composition, and stimulatory effects on the central nervous system, which might interfere with central auditory processing [59,63,64]. Despite the widespread and persistent nature of these theories, high-quality studies have failed to identify the predicted effects. ...
Article
Full-text available
Optimization of dietary intake is an essential component in the multidimensional effort to prevent and manage chronic disease. Recently, demand has increased for nutrition-focused management strategies for chronic tinnitus. The primary aim of this study was to evaluate 10 dietary items for their association with changes in subjective tinnitus severity. A secondary aim was to develop an algorithm to better identify those individuals who might benefit from dietary modification strategies. A total of 5017 anonymous users of the TinnitusTalk forum completed an online survey regarding how various dietary items affected the severity of their tinnitus. Results suggest that, while intake of caffeine [positive effect (PE): 0.4%; negative effect (NE): 16.2%], alcohol (PE: 2.7%; NE: 13.3%, and salt (PE: 0.1%; NE: 9.9%) was most likely to influence tinnitus severity, it did so only for a small proportion of participants and reported effects were most commonly mild. Further, though a classification algorithm was able to leverage participant demographic, comorbidity, and tinnitus characteristics to identify those individuals most likely to benefit from dietary modification above chance levels, further efforts are required to achieve significant clinical utility. Taken together, these results do not support dietary modification as a primary treatment strategy for chronic tinnitus in the general population, though clinically meaningful effects might be observable in certain individuals.
... 8 The effect of excessive caffeine consumption on voice has been a topic of research since a very long time, however, the exact effect is yet unclear due to the absence of strong empirically valid studies in humans. 16,17 Avoiding throat clearing and ensuring a longer duration between dinner and bedtime to reduce or prevent laryngopharyngeal reflux are common recommendations in a vocal hygiene program especially for professional voice users. 18 On being asked to rate their knowledge about the larynx, 67% rated their knowledge to be basic while 20.2% rated it to be thorough. ...
Article
Objectives The objective of the present survey was to profile the knowledge, attitude, and practices towards vocal health care amongst Hindustani classical singers. Study Design Mixed-methods, cross-sectional questionnaire-based study. Methods A self-reported questionnaire was developed and used to gather data on the knowledge, attitude, and practices of Hindustani classical singers towards vocal health care. An online survey link was generated, and responses were collected from self-identified trained Hindustani classical singers. Descriptive statistics was carried out for the closed-ended questions and inductive approach was used to analyse the responses of open-ended questions. Results Ninety-four self-identified trained Hindustani classical singers participated in the study. The responses indicate good knowledge towards vocal health measures and positive attitudes towards vocal health care. The open-ended responses were analysed using an inductive approach. Although, 70% were aware about role of a speech language pathologist, only 9.7% reported of consulting one in the event of voice problem. Further, 70% singers reported of following precautions to avoid voice problems while 85.1% considered voice rest as necessary before a performance. The singers reported of using home remedies, vocal and non-vocal measures as a part of vocal health measures. Conclusions The present study helps to profile the knowledge, attitude, and practices towards vocal health care amongst Hindustani classical singers. It also helps to provide a basis for further studies to establish an empirical basis for the reported practices towards vocal health care.
... 14 In theory, caffeine is a CNS stimulant, and direct application of caffeine to the inner ear has been shown to reduce the outer hair cell size, and this mechanism may partially account for tinnitus development. 17 To date, it is unclear whether caffeine can cause or protect against tinnitus. Although tinnitus is subjective and its pathophysiology is unknown, mechanisms are likely to include either hyperactivity of ascending auditory pathways or a reduction in CNS suppression. ...
Article
Full-text available
Introduction Excessive caffeine intake has been thought to be a contributory factor for tinnitus. However, there has been no systematic review to elucidate the causal relationship between caffeine intake and the incidence of tinnitus. Objectives We performed the current review aiming at evaluating the evidence from the current literature for the relationship between caffeine intake and the incidence of tinnitus. Data Synthesis Databases including PubMed, Scopus, and Google scholar were searched for relevant articles. A total of 142 studies were screened for eligibility, of which four articles met our inclusion criteria: two were prospective cohorts and two were cross-sectional studies. Although one study found no association between caffeine consumption and the incidence of tinnitus, an inverse relationship was reported by two population-based studies. Concerning patients with preexisting tinnitus, reduction of caffeine intake in a subset who consumed 150 ml to 300 ml/day of coffee yielded a favorable outcome in tinnitus severity. However, those with higher dose intake were less prone to have improvement in the severity of tinnitus. Conclusion Although the current review was inconclusive, it appears that the incidence of tinnitus in previously unaffected individuals might be prevented by a high dose of caffeine intake. However, in preexisting tinnitus, a high dose of caffeine may adversely interfere with the efficacy of caffeine reduction.
... Further, over 95% of the singers consumed more than 2 cups of tea/coffee in a day. However, although caffeine is considered as a cause of poor voice hygiene, there is a weak evidence to support the effect of caffeine on voice [34]. ...
Article
Objective This study aimed to profile voice-related complaints, as well as vocal and nonvocal habits among Hindustani classical singers. Method Cross-sectional study design was used to profile voice-related complaints and vocal and nonvocal habits among Hindustani classical singers. Phase I involved developing a questionnaire for exploring vocal and nonvocal habits. Phase II involved the administration of the survey to 61 Hindustani classical singers. Results Based on the overall findings, 41% of singers reported of at least three vocal symptoms. The most common vocal symptoms included out of breath while singing, felling tired after singing and experiencing tension or tightness in neck/shoulder. The commonly reported vocal habits included excessive phone use, loud coughing/sneezing, throat clearing and excessive speaking. A high consumption of caffeinated beverages and spicy food were also reported. Conclusion This study helps to highlight the voice-related complaints and vocal and nonvocal habits of Hindustani classical singers. Further studies, need to explore the prevalence of voice problems incorporating other dimensions of voice evaluation such as acoustic, auditory perceptual, self-reported and laryngeal examination.
... A cafeína pode aumentar a eliminação de líquidos através da urina, levando a desidratação corporal, incluindo as pregas vocais, o que compromete a qualidade vocal. Alimentos que contém cafeína podem aumentar a acidez, provando refluxo gastroesofágico, que pode irritar a mucosa da laringe (KYRILLOS et al., 2003;BEHLAU;REHDER, 2008;FARIA et al., 2008).Entretanto, estudos recentes têm demonstrado que não há evidências da ação diurética intensa da cafeína na hidratação ou no balanço dos fluidos corporais (TRINIDADE et al., 2014). ...
Article
Full-text available
Objetivo: Verificar na literatura os alimentos que promovem efeitos benéficos e maléficos à saúde vocal. Fonte de dados: Foi realizada uma busca nas bases de dados MEDILINE, SCIELO, LILACS e periódicos da CAPES. Síntese dos dados: A alimentação apresenta a capacidade de proporcionar benefícios à saúde vocal, reduzindo o atrito entre as pregas vocais, melhorando a vibração da mucosa e estimulando a mastigação, e malefícios à saúde vocal, propiciando efeito anestésico, reduzindo a movimentação do diafragma e provocando refluxo gastroesofágico. Conclusões: Os cuidados com a voz perpassam por escolhas alimentares saudáveis. Portanto, torna-se essencial os conhecimentos nessa área para a melhora do desempenho vocal e da qualidade de vida. Palavras-chave: comunicação, alimento funcional, disfonia
Chapter
Beim M. Menière kann es schwerfallen, den Überblick im „Labyrinth“ des schwindelerregenden und höreinschränkenden Geschehens zu behalten, auch wenn sicherlich jeder Experte – auf seinem Gebiet und mit seinen Kenntnissen – sein Möglichstes gibt. So macht es einen Unterschied, wer bei wem in welchem Zustand und Stadium des Geschehens (akut oder chronisch) auf die Krankheit oder den Erkrankten schaut. Ebenfalls wird die Sichtweise eine spezielle sein, ob man eher konservativ oder chirurgisch orientiert ist, auf die Ohren oder das Nervensystem oder „die Psyche“ spezialisiert ist, selbst betroffenen ist oder war oder dem Krankheitsbild eher forschend gegenübersteht.
Chapter
In the case of Ménière’s disease, it can be difficult to keep an overview of the “labyrinth” of dizzying and hearing-restricting events, even if every expert – in his or her field and with his or her knowledge – certainly does his or her best. It makes a difference, who looks at whom in which course of the disease (acute or chronic). Also it makes a difference, if one looks primarily at the disease or the ill person. Likewise, the perspective is influenced from the fact, whether one is more conservatively or surgically oriented, or one is specialized in neurootology or neurology or in “psyche”, or is more research-oriented. At least, not at last, it matters, if one is or was affected with Menière’s disease himself or herself.
Article
Medications can have innumerable direct and indirect effects on laryngeal hydration, vocal fold mucosal integrity, laryngeal muscle function, and laryngeal sensation. Effects, therefore, can be subtle and slowly progressive over time. This article delineates the general classes of medications that are known to cause alterations of vocal function, highlights medical history symptoms that may help raise suspicion for medication-related vocal changes, and presents recommendations for approaches to treatment of these issues.
Article
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OBJECTIVE: To investigate the instruments used by general otolaryngologists to visualize the larynx, assess the perception of the instruments' capabilities, and understand their comfort diagnosing specific etiologies of dysphonia. STUDY DESIGN: Cross-sectional survey. METHODS: One thousand randomly chosen general otolaryngologists from American Academy of Otolaryngology-Head & Neck Surgery were mailed a survey. RESULTS: The response rate was 27.8%. Mean years in practice were 19.5. Mirror and fiberoptic laryngoscopy were most commonly used. Approximately 84.1% used stroboscopy and 33.7% reported laryngoscopy could assess vibration. Respondents were more comfortable diagnosing conditions with obvious laryngeal structural abnormalities compared with those without, such as central neurologic disorders (P≤0.001). Approximately 46.5% were concerned about overdiagnosing laryngopharyngeal reflux (LPR). CONCLUSIONS: Although 84.1% of general otolaryngologists use stroboscopy, one-third may not appreciate the differences between stroboscopy and laryngoscopy. General otolaryngologists are less comfortable diagnosing voice disorders without obvious laryngeal structural abnormalities, and nearly 50% are concerned that they overdiagnose LPR.
Article
Full-text available
Caffeine is the most widely used psychoactive stimulant with prevalent use across all age groups. It is a naturally occurring substance found in the coffee bean, tea leaf, the kola nut, cocoa bean. Recently there has been an increase in energy drink consumption leading to caffeine abuse, with aggressive marketing and poor awareness on the consequences of high caffeine use. With caffeine consumption being so common, it is vital to know the impact caffeine has on the body, as its effects can influence cardio-respiratory, endocrine, and perhaps most importantly neurological systems. Detrimental effects have being described especially since an over consumption of caffeine has being noted. This review focuses on the neurophysiological impact of caffeine and its biochemical pathways in the human body.
Article
This chapter reviews the epidemiology of cancers of the oral cavity, pharynx, lip, and salivary glands. In the United States (1996-2000), invasive cancers of the OCP/lip/salivary gland account for 2.7% of cancers among men and 1.5% of cancers among women. It is estimated that 27,700 cases will be diagnosed with these malignancies in the United States in 2003 and about 7,200 will die from these cancers. The lifetime risk of being diagnosed with OCP/lip/salivary gland cancers for a US male is 1.4% and 0.7% for a US female.
Article
Objectives: Tinnitus usually appears in patients with some degree of hearing loss. Just a few papers studied tinnitus in normal hearing patients, usually involving less than 20 cases. The objective of this study is to describe the main characteristics of a significant sample of tinnitus patients with normal pure tone audiometry.Methods: The files of 744 tinnitus patients following the same medical audiological protocol were reviewed, excluding those with hearing thresholds above 25dBHL in at least one frequency. Thus, 66 (8.8%) files belonging to patients with tinnitus and normal audiometry were enrolled in this study, analyzing their main characteristics (sex, gender, laterality, severity, laboratories alterations).Results: There was a high prevalence of female patients in 71.2% of the cases. The mean age was 42 ± 13 years (minimum 7, maximum 72). Tinnitus was a single tone in 71.2%. There were 11 patients with pulsatile tinnitus. Bilateral in 51.5% and constant in 66.7%. According to the visual analogue scale, the tinnitus severity was mild in 6 cases, moderate in 27 and severe in 32. Caffeine abuse was detected in 45.4%, sweet compulsion in 45.4%, and lipid disturbances in 36.3%. Blood glucose and thyroid hormones levels were altered in 27.3% and 13.6%, respectively.Conclusion: Tinnitus in normal hearing patients may also evoke an important annoyance and showed an association with metabolic disorders. Trying to find the main characteristics of these patients and other possible etiologies can be fundamental for therapeutic approach.
The objectives of this study were: (1) to determine the percentage of patients seen in a private laryngology clinic with voice-related disorders previously diagnosed with and treated for laryngopharyngeal reflux (LPR); (2) to determine how many of those patients are found to have disorders other than LPR as a cause for their voice disorder. A retrospective, chart-review analysis of new patients was conducted from January 2005 through December 2007 in a private laryngology clinic setting. Patients with a previous diagnosis of LPR as the cause of hoarseness, with or without anti-reflux treatment were included. Incomplete charts and patients with additional diagnoses besides LPR where excluded. Patient charts were analyzed in search of different variables including chief complaint, previous medications and final diagnosis among others. 784 consecutive charts were reviewed. Inclusion criteria were met in 105 charts. 82 % had no improvement or felt worse after previous anti-reflux treatment while 18 % had significant or mild improvement. However, all patients remained with some degree of hoarseness. Final diagnosis by the author was diverse though none of the patients had laryngopharyngeal reflux as a final diagnosis and none of them noted worsening of their voice after respective treatment. Only 6 % felt the same after treatment and 9 % could not be found for follow-up. LPR has become an over-diagnosed entity. With a thorough history, vocal capability testing and physical exam, an accurate diagnosis for hoarseness can be made in the vast majority of cases. LPR may not be the cause of voice disorders and should not be assigned as a de facto diagnosis just because the cause of hoarseness is not readily identifiable.
Article
Caffeine is widely consumed by people of all ages. In the last period a market of caffeine-containing products, particularly energy drinks and food supplements increased. Caffeine for years is under discussion, whether has positive whether adverse impact on health. Children are a group of special anxieties. Caffeine is a stimulant of central nervous system and therefore is probably the most commonly used psychoactive substance in the world. The physiological effect of caffeine and the lack of nutrition value causes a great interest its impact on health, especially with reference to the risk of cardiovascular diseases. Results of scientific research are not clear. The influence of caffeine on the human body is conditioned with the individual metabolism of caffeine which also depends on many endogenic and environmental factors. According to the current knowledge moderate caffeine intake by healthy adults at a dose level of 400 mg a day is not associated with adverse effects, but it also depends on other health determinants of a lifestyle. Excessive caffeine consumption can cause negative health consequences such as psychomotor agitation, insomnia, headache, gastrointestinal complaints. Adverse effect of caffeine intoxication is classified in World Health Organization's International Classification of Diseases (ICD-10). Metabolism of caffeine by pregnant woman is slowed down. Caffeine and its metabolites pass freely across the placenta into a fetus. For this reason pregnant women should limit caffeine intake. Children and adolescents should also limit daily caffeine consumption. It results from the influence of caffeine on the central nervous system in the period of rapid growth and the final stage of brain development, calcium balance and sleep duration. Average daily caffeine consumption in European countries ranging from 280-490 mg. The highest caffeine intake is in Scandinavian countries what results from the great consumption of the coffee. As far as caffeine consumption by Polish population is concerned there is very few data in this subject so far. In the nineties of the previous century it was 141 mg per day, whereas according to recent survey daily caffeine intake by women from the Warsaw region was 251 mg and 15% of examined women consumed an excessive quantity of caffeine (> or = 400 mg). Smokers consume more caffeine than nonsmokers, similarly to persons with mental illnesses. With reference to the caffeine consumption it should be underline that caffeine content in coffee and tea beverages varies greatly depending on the method of brewing whereas the content of caffeine in many brands of energy drinks can much vary. This should be taken into account in the daily caffeine intake.
Article
To investigate the voice features of laryngopharyngeal reflux (LPR), and analyze the effects of LPR to the life qualities of patients. To analyze the dependability between objective and subjective ways. One hundred and ninety-six of the patients who were suspected of LPR were received the surveys of general state, electronic nasopharyngolaryngoscope, evaluation of the reflux symptom index (RSI) and the reflux finding score (RFS). One hundred of patients whose RSI>13, RFS>7 were diagnosed as LPR and were received evaluation of voice handicap index (VHI), analysis of vocal acoustics and examination of glottogram. The funda mental frequency included male and female depressed,the perturbation of fundamental frequency, the perturbation of amplitude and normalization noise energy increased. Differences were statistically significant (P<0.01) compa ring with the normal control. The contiguity rate depressed, maximum phonation time shorten, the differences in which were statistically significant (P<0.01) comparing with the normal control. In the evaluation of VHI, the score of physiology was the highest, the function was second and the emotion was the lowest. The RSI and VHI had correlations (P<0.05), while RFS, RSI and VHI had not (P>0.05). Physiology, function and emotion had correlations in LPR. From the analysis of vocal acoustics and examination of glottogram,we knew that vocal function was effected because the vocal cord was injured by LPR. The fundamental frequency depressed and the vibrations of vocal cords were not instability, glottis wasn't closed up well and contact time was depressed. Patients who had the reflux symptoms uncertainty had the reflux findings.
Article
Our understanding of Meniere's disease is being revamped. For decades, the condition was thought to be caused by excessive fluid retention (hydrops) in the endolymphatic spaces of the inner ear, which led to tears or ruptures of the membranous structures that affect hearing and balance. More recently, research has shown that hydrops is not always associated with Meniere's and ought not to be considered the ultimate cause of its symptoms. New theories center on the fact that Meniere's disease may not have a single cause but may well be a common endpoint of a variety of anatomic or physiologic variables, including ischemic or even autoimmune injuries. This article describes the new thinking about Meniere's and explains why current treatment approaches, although they are based on outdated understanding, may still be valuable for alleviating symptoms in some patients.
Article
A core component of vocal hygiene programs is the avoidance of agents that may dry the vocal folds. Clinicians commonly recommend that individuals reduce caffeine intake because of its presumed dehydrating effects on the voice. However, there is little evidence that ingestion of caffeine is detrimental to voice production. The first objective of this study was to evaluate whether caffeine adversely affects voice production. The second objective was to evaluate if caffeine exacerbates the adverse phonatory effects of vocal loading. Prospective, double-blinded, sham-controlled study. Sixteen healthy adults participated in two sessions where they consumed caffeine (caffeine concentration=480 mg) or sham (caffeine concentration=24 mg) beverages. Voice measures (phonation threshold pressure and perceived phonatory effort) were collected. Subjects then completed a vocal loading challenge and voice measures were obtained again. There were no significant differences in voice measures between the caffeine and sham conditions. Ingestion of caffeine did not adversely affect voice production (P>0.05) or exacerbate the detrimental phonatory effects of vocal loading (P>0.05). Our findings contribute to emerging knowledge on the effects of caffeine on voice production. Recommendations to completely eliminate caffeine from the diet, as a component of a vocal hygiene program, should be evaluated on an individual basis.
Article
There is a belief that caffeinated drinks, such as tea, may adversely affect hydration. This was investigated in a randomised controlled trial. Healthy resting males (n 21) were recruited from the general population. Following 24 h of abstention from caffeine, alcohol and vigorous physical activity, including a 10 h overnight fast, all men underwent four separate test days in a counter-balanced order with a 5 d washout in between. The test beverages, provided at regular intervals, were 4 × 240 ml black (i.e. regular) tea and 6 × 240 ml black tea, providing 168 or 252 mg of caffeine. The controls were identical amounts of boiled water. The tea was prepared in a standardised way from tea bags and included 20 ml of semi-skimmed milk. All food taken during the 12 h intervention period was controlled, and subjects remained at rest. No other beverages were offered. Blood was sampled at 0, 1, 2, 4, 8 and 12 h, and a 24 h urine sample was collected. Outcome variables were whole blood cell count, Na, K, bicarbonate, total protein, urea, creatinine and osmolality for blood; and total volume, colour, Na, K, creatinine and osmolality for urine. Although data for all twenty-one participants were included in the analysis (mean age 36 years and mean BMI 25·8 kg/m(2)), nineteen men completed all conditions. Statistical analysis, using a factorial ANOVA approach within PROC MIXED, revealed no significant differences between tea and water for any of the mean blood or urine measurements. It was concluded that black tea, in the amounts studied, offered similar hydrating properties to water.