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Chapter
Herbal Medicine in the
Management of Tinnitus
Mohammad HosseinKhosravi, MasoumehSaeedi,
JalehYousefi, AliBagherihagh and ElnazAhmadzadeh
Abstract
Tinnitus, which is commonly defined as “ringing in the ears” by the patients, is
a perception of an auditory sensation without any accompanying external stimula-
tion. It accounts for a notable part of visits in otolaryngology clinics and has been
estimated to involve about 5–15% of adult population making serious problems
in 3–5% of patients. Tinnitus causes a lot of problems for patients, their family,
and guardians and significantly decreases quality of life of patients. Many treat-
ment methods have been proposed and presented for Tinnitus since the first year
of diagnosis. These methods range from conservative management and chemical
medications to surgical methods. As the other diseases and conditions, herbal
medicine has been trying to treat Tinnitus and a variety of medications have been
proposed. In this chapter, we aimed to have a comprehensive review on the current
herbal medications of Tinnitus from all over the world.
Keywords: tinnitus, herbal medicine, treatment, epidemiology, Ginkgo biloba
1. Tinnitus: definition, etiology, and epidemiology
Tinnitus, which is commonly defined as “ringing in the ears” by the patients, is
a perception of an auditory sensation without any accompanying external stimula-
tion [1, 2]. It accounts for a notable part of visit in otolaryngology clinics and has
been estimated to involve about 5–15% of adult population making serious prob-
lems in 3–5% of patients [1–5].
Tinnitus causes a lot of problems for patients, their family, and guardians and
significantly decreases quality of life of patients. Most of the patients have com-
plaints with sleep disorders, depression, decreased self-confidence, and altered
social communications as well as difficulties in quotidian activities [2].
Tinnitus is generally categorized into two types: subjective and objective. A
majority of patients suffer from a subjective tinnitus, which means perception of an
auditory sensation without any evident stimulus. In some patients, a kind of organic
measurable stimulus such as glomus tumor, by making turbulence of blood flow, is
the cause for tinnitus, which is called objective tinnitus [1, 2]. This type of tinnitus
can be found by examiner using an ear-canal microphone or stethoscope [6].
A variety of risk factors have been reported for subjective tinnitus so far; hearing
loss, depression, head trauma, and medication-related ototoxicity [7–9]. Some other
conditions may have a role in predisposing patients to tinnitus such as acoustic trauma
and presbycusis, and it may be associated with temporomandibular joint (TMJ) or cer-
vical spine dysfunctions (somatic tinnitus) as well as depression and anxiety [10–14].
Management of Tinnitus - The Views of Various Disciplines
2
2. Current treatments
Currently, United States Food and Drug Administration (FDA) or the European
Medicine Agency has not approved any drug for the treatment of tinnitus [15].
The complex mechanism and innate diversity in etiology of tinnitus have made
its treatment a dilemma for physicians and specially otolaryngologists. Despite
considerable number of researches, none of the so far presented medications and
treatments has resulted in a sustained reduction in perception of tinnitus [16]. No
appropriately controlled clinical trials have been successful to prove efficacy of a
single drug. Thus, pharmacological treatment of tinnitus seems to be ineffective
[17, 18]. Antidepressants are more frequently prescribed for tinnitus and seem to
be effective but with a notable number of side effects. Anticonvulsants, benzo-
diazepines, lidocaine, and antispasmodics are also among commonly prescribed
medications [19]. Voice therapy, using hearing aids, adjuvant therapies as well as
environmental sound enrichment are the most common nonmedical approaches to
Tinnitus [20].
Regarding the abovementioned issues, there are varieties of complementary and
alternative medicine (CAM) treatments, which have been experimented in clinical
stage for tinnitus. Herbal medicine or acupuncture, as the most popular types of
CAMs therapy among people, have been shown to be effective in management of
tinnitus when prescribed solely or in combination [21, 22]. Most of the CAM studies
have a small sample size and few methodological pitfalls make it difficult to decide
firmly about these treatments.
Some of medicinal herbs and their derivates have been evaluated in vari-
ous phases of studies: invitro, invivo, and even in small to large scale clinical
trials [23–30]. In fact, people in different regions of the world have different
approaches to medicinal plants and use a variety of herbal medications for
treating different diseases and conditions, which have not yet been scientifically
assessed [31, 32]. In this chapter, we will discuss and review current traditional
and herbal medicine treatments with approved or possible effects on manage-
ment of Tinnitus.
3. Ginkgo biloba (Jinko)
Ginkgo biloba from the Ginkgoaceae family is a Chinese traditional medicine
herb, which is being used for the treatment of asthma and bronchitis for a long time
[22, 33]. It has gotten popular also in western countries as well as in Asian ones [34].
Ginkgo biloba is widely available as easily accessible, inexpensive, and relatively safe
leaf extracts with various reported therapeutic benefits such as improved cognition
and memory as well as sexual function [35, 36]. These improvements beside other
biological effects of Jinko extracts such as improvement of microcirculation and
neuroprotection are attributable to flavonoid glycosides and terpene lactones, active
pharmacologic gradients of Ginkgo biloba. It should be pointed that seeds play a
remarkable role in Chinese traditional medicine and they are the most commonly
used parts of plants for herbal medications, while Ginkgo biloba is processed from
the plants’ leaves.
Jinko has been proposed for management of various central nervous system
pathologies including tinnitus; however, some previous researches have reported no
beneficial effects for Ginkgo biloba in treatment of tinnitus [36–41]. Nevertheless,
no certain decide can be made regarding effects of Ginkgo biloba on management
of tinnitus according to its complex pharmacological profile, which shows need for
further accurate researches [42].
3
Herbal Medicine in the Management of Tinnitus
DOI: http://dx.doi.org/10.5772/intechopen.81320
4. Bojungikgitang and banhabaekchulchonmatang (traditional Korean
medicine)
Bojungikgitang and banhabaekchulchonmatang have been approved by Korea
Food and Drug Administration and are being widely used in Korea for treat-
ment of Tinnitus because of their very low rate of adverse effects [16]. These two
herbal medications have found their places among Korean people and physicians.
Traditional Korean medicine (TKM) believes that Tinnitus is mainly caused from
irregularities in bowel and visceral (zang-fu) functioning [16]. According to TKM,
gallbladder deficiency associated with tinnitus is managed by banhabaekchulcho-
nmatang, and bojungikgitang is used to manage the pattern of qi-deficiency [21].
Both of these drugs are now fully covered by Korean National Health Insurance
(KNHI).
5. Gushen Pianas
Gushen Pianas is a novel Chinese medicinal herb, which is being used in the
treatment of sensorineural hearing loss and Tinnitus. Phlegm-accumulation stasis
and splenonephric hypofunction are the two main proposed mechanisms of action
for Gushen Pianas in treatment of Tinnitus [43]. This medication has been devel-
oped by Institute of Otorhinolaryngology of Chinese PLA General Hospital and
Wuhan Kexing Biomedical Development Co.
Effectiveness of the drug was evaluated in a phase 2 double-blind randomized
clinical trial on 120 patients with sensorineural deafness associated with tinnitus.
Patients received five tablets of Gushen Pianas every 8hours and the effect was
assessed after 4weeks. The findings suggested Gushen Pianas as a suitable treat-
ment for hearing loss with no evident adverse effects [43].
6. Panax ginseng (Jinseng)
Root of the Panax ginseng, with local name of Jinseng, a Chinese medicinal
plant from the Araliaceae family has been being used for treatment of Tinnitus
since dawn of traditional medicine [44]. Korean red ginseng (KRG) is a tradi-
tional Korean herbal medication, which has been used for more than 2000years,
believed to have several benefits for human body [45]. It is considered that
oxidative stress is the cause for idiopathic tinnitus and patients may take benefits
from oral antioxidant therapy [46, 47]. So, KRG has been proposed for treatment
of tinnitus as it inhibits production of reactive oxygen species (ROS) and also
attenuates hydrogen peroxide-induced oxidative stress in human neuroblastoma
cells [48, 49]. The effect of KRG (3000mg/day) was evaluated in a randomized
clinical trial in which the patients showed a significant reduction in tinnitus
handicap inventory (THI) score and increased quality of life. Also some adverse
effects have been reported for Jinseng and specially KRG in literature. Deficiency
of vital energy (DE), known as qi-deficiency, is a traditional Chinese medicine
syndrome, which indicates the disease emerging identity. Some studies believe
that Ginseng, especially Korean Red Ginseng, might cause some adverse effects
if the patient’s body constitution does not match the qi-deficiency. However,
others have reported the Ginseng as the treatment of qi-deficiency caused by any
reasons [50].
Further researches are needed to assess beneficial and adverse effects of KRG
more accurately.
Management of Tinnitus - The Views of Various Disciplines
4
7. Garlic
Previous conducted researches have reported a lipid-lowering effect for garlic
and some others have counted fibrinolytic activity and lowering blood pressure as
therapeutic roles of garlic. Few studies have also reported garlic to be beneficial for
treatment of tinnitus [6]. Garlic’s effect on tinnitus is attributable to improve blood
flow of cochlea as a result of its antiplaque formation ability, stabilizing blood pres-
sure, and augmentation in antioxidant capability of the blood. No scientific studies
have been conducted for approving these effects and all of them are theoretical [51].
8. Yoku-kan-san
There are more than 120 plants approved by Japanese ministry of health, labor,
and welfare, which are now being used in practice as traditional medications [52].
Yoku-kan-san, a traditional Japanese herbal medication, is one of these approved
herbal medications composed from seven plants (Angelicae Radix, Atractylodis
Lanceae Rhizoma, Bupleuri Radix, Poria, Glycyrrhizae Radix, Cnidii Rhizoma, and
Uncariae Uncis Cum Ramlus). This combination is more frequently used as treat-
ment of psychological conditions such as irritability, insomnia, night terrors, and
hypnic myoclonia, especially in infant patients [53]. Although, there are not enough
clinical investigation and convincing data for beneficial effect of Yoku-kan-san on
tinnitus, but it has been shown to be effective for tinnitus resulted from undifferen-
tiated somatoform disorder in a 44-year-old woman [54]. There is an obvious need
for more clinical researches to support such kind of case reports.
Today’s world is going toward the use of medicinal plants and herbal medicines,
which are now finding their place among people. Conditions with no precise pharma-
cologic treatment, such as tinnitus, are more probable to be resolved by herbal medica-
tions. In this chapter, we tried to review current medicinal plants for treatment of
tinnitus; however, currently, there is a lack of clinical research in this issue. The effect of
herbal medications on tinnitus should be investigated in more future clinical researches.
5
© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms
of the Creative Commons Attribution License (http://creativecommons.org/licenses/
by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.
Herbal Medicine in the Management of Tinnitus
DOI: http://dx.doi.org/10.5772/intechopen.81320
Author details
Mohammad HosseinKhosravi1,2,3*, MasoumehSaeedi1,3, JalehYousefi3,
AliBagherihagh3 and ElnazAhmadzadeh1,4
1 International Otorhinolaryngology Research Association (IORA), Universal
Scientific Education and Research Network (USERN), Tehran, Iran
2 Student Research Committee, Baqiyatallah University of Medical Sciences,
Tehran, Iran
3 Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of
Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
4 Department of Audiology, School of Rehabilitation, Shahid Beheshti University
of Medical Sciences, Tehran, Iran
*Address all correspondence to: dr.mhkhosravi@gmail.com
6
Management of Tinnitus - The Views of Various Disciplines
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