Vertigo and Tinnitus with Dr. Benjamin Asher: Rational Wellness Podcast 206
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Dr. Benjamin Asher discusses Vertigo and Tinnitus with an Integrative Approach with Dr. Ben Weitz.
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5:35 Vertigo is the experience of motion when you’re not moving. You might either feel that you are spinning or that the room is spinning around you. Some people have a symptom that we call mal de debarquement, where you feel like you’re on a boat all the time. At least 80% of cases of vertigo are related to inner ear issues. There is part of the inner ear called the vestibular system that is responsible for balance. If you imagine what’s going on is is that the inner ear is giving the brain like a Morse code signal. When we’re sitting still both sides, the Morse code signal is the same. When you turn one way or the other, the fluid shifts, and then one Morse code on one side speeds up and the other one slows down. The brain reads that difference and it says, “Oh, I must be moving.” So, the brain gives you the experience of motion when you are moving. Now, it can also happen, let’s say there’s an injury to the inner ear, and then one side shuts down and isn’t giving any signal or speeds up, then the brain reads that and it says, “Oh, I must be moving,” and it gives you the sensation of motion and you’re not. That’s vertigo.
The most common cause of vertigo is benign paroxysmal positional vertigo (BPPV) where there is thought to be a loose crystal in the inner ear. When you move into a certain position, such as when you lay down on one side and then after a brief period you are hit with vertigo, which lasts for a few minutes. The solution to this type of vertigo is to perform the Epley maneuver, which is a type of manipulation to get the crystal back to where it belongs. You will probably need to perform this maneuver 2-3 times and about 50% of the time, the person is better. There’s another maneuver called the Semont maneuver, which is if the crystal is in a different canal. Another solution to BPPV is just get in that position to make you dizzy 10 times twice a day because what happens is the brain after a period of time figures out that you’re really not moving, and then it figures it out, and it shuts the experience down, and tells you you’re not moving and you realize you’re not and then it doesn’t give you the experience of vertigo. If you take medicine that suppresses the vestibular system, like Antivert or Dramamine, you will stay dizzy longer.
12:39 Meniere’s Disease is another common cause of vertigo. This is also known as idiopathic endolymphatic hydrops, and what it means is that there’s a mixture of inner ear fluids going on between two chambers of the inner ear, and it’s this rupture of a membrane, and it results in three main symptoms: 1. True, severe vertigo that lasts anywhere from 20 minutes to 18 hours. So, if it’s two minutes, it’s probably not Meniere’s disease. If it lasts for seven days, it’s not Meniere’s disease. 2. hearing loss, 3. Loud tinnitus that is described as a fullness and roaring in the ear. So, that’s the triad of Meniere’s. Nobody really knows what causes Meniere’s, except the conventional treatment is to put people on a low salt diet and a diuretic. Dr. Asher will test such patients for Lyme Disease with a Western blot test and he will also order a coinfection panel for babesia, bartonella, ehrlichia, and human granulocytic anaplasma.
20:57 Dr. Ken Bookler wrote a few papers linking abnormal glucose and insulin metabolism with Meniere’s disease. The inner ear is rich in insulin receptors. So he treated patients for insulin resistance and they got better. For some patients he was using bisphosponates because he found out that a lot of patients with vertigo and tinnitus had inner ear otosclerosis and he treated them with bisphosphonates. But nobody is following up on his work.
22:19 Natural treatments for vertigo include glutathione, used both orally and intravenously. Hyperbaric oxygen can help. Some patients find that lipo-flavinoids are helpful, but the research for this product is not that great. Certain antibiotics, esp. minocycline, some blood pressure medications, statins, and NSAIDs can all trigger vertigo.
23:58 Cervical manipulation can be of benefit in some cases of vertigo. There is a condition called cervical vertigo that is similar to BPPV. Proprioceptive fibers in the neck muscles play a role in balance and if you have inflammation in those muscles, those proprioceptor fibers can misfire and give the brain misinformation, and that can cause vertigo.
26:54 Tinnitus is the perception of a sound that isn’t an internal sound in the head or from the ear. Tinnitus is often associated with a hearing loss, so if a patient complains of tinnitus, you should get a hearing test. Aspiring and some medications can cause tinnitus and even herbs, esp. if they contain salicylates. Loud noises such as going to a rock concert can trigger tinnitus. Grinding your teeth and having a temporomandibular joint disorder can trigger tinnitus. So can heavy metals. There are a lot of cases of tinnitus that goes away after a short period of time.
32:13 10-15% of patients with tinnitus have somatic tinnitus, which means that something is going on in the proprioceptor fibers in the muscles in the neck and releasing the trigger points, esp. in the suboccipital region can help. Cervical manipulation or cranial manipulation may be of some benefit. Patients with tinnitus may be low in vitamin B12, D3, and CoQ10, so you can test for these or just supplement with them. 34:03 There is a natural compounded product called synapsin, which contains RG3 from ginseng, which reduces brain inflammation, was developed by pharmacist Jim Lavalle, that can help. It is used as a nasal spray. Nicotinamide riboside is a supplement that can also help. NAC may also be helpful. There is a high dose gingko product, Arches Tinnitus Relief Formula, that can be helpful.
Dr. Benjamin Asher is a board certified Otolaryngologist and a Head and Neck Surgeon and he has been at the forefront of applying an Integrative approach to ENT (ear, nose, and throat) disorders. He has a specialty in the area of Lyme and tick borne illnesses. Dr. Asher has served as the house physician for the New York City Opera and the New York City Ballet and has pioneered the use of IV glutathione for vocal cord polyps instead of steroids or surgery. His website is BenjaminAsherMD.com.
Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss and also athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111. Dr. Weitz is also available for video or phone consultations.
Dr. Weitz: Hey. This is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates, and to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast.
Hello, Rational Wellness Podcasters. Today, we’re going to delve in to a different topic that then we’ve covered in the past. As you know, our podcast is devoted to covering the full breadth of different topics in functional medicine, and that really means covering all the different conditions and health issues that people deal with. Today, for the first time, we’re going to cover an integrative approach to ear, nose, and throat specialties, and in particular today, we’re going to highlight a couple of conditions that are fairly common and are difficult to treat, vertigo and tinnitus or least I think they’re difficult to treat or they have been for a lot of people. Vertigo is the sensation that you or the environment around you is moving or spinning. Tinnitus is a ringing or a buzzing noise in one or both ears and maybe constant or come and go. Both of these are fairly common conditions. With tinnitus or tinnitus, I’m not really sure how to pronounce it, affecting about 15% to 20% of people, and it’s especially common in older adults. Here to give us some information about these topics is Dr. Benjamin Asher, who’s a board certified otolaryngolist.
Dr. Asher: Otolaryngologist.
Dr. Weitz: Thank you, a head and neck surgeon, and he’s been at the forefront of apply an integrative approach to ear, nose, and throat disorders. Prior to attending medical school, Dr. Asher worked as a full-time meditation teacher. Dr. Asher is focused on identifying the root cause of symptoms and has a specialty in the area of Lyme and tick-borne illnesses. Dr. Asher served as the house physician for the New York City Opera and the New York City Ballet, and he’s pioneered the use of IV glutathione for vocal cord polyps as an alternative to steroids or surgery. Dr. Asher, thank you so much for joining us today.
Dr. Asher: Thanks a lot, Dr. Weitz. I really appreciate you having me.
Dr. Weitz: Excellent. So, perhaps you can start by telling us a little bit about yourself and how you found your way to an integrative, functional approach to care.
Dr. Asher: Well, before I went to medical school, I was a meditation teacher. Really, the truth is is that I went to medical school because I thought if I became a doctor, people would listen to me and I would get more people to meditate.
Dr. Weitz: Were people meditating?
Dr. Asher: Not because of me, necessarily, but … So, everybody has their reasons, and when you’re young and naïve about how life goes. So, when I was in medical school, I actually never felt that Western medicine was particularly good at treating chronic illnesses. It was basically good if you had an acute problem or an immediate life-threatening issue. So, I was trying to decide actually between choosing going to a surgical specialty like ENT or going to psychiatry. My dad who was a psychiatrist at the time said, “Don’t go into psychiatry.” So, I listened to him. I chose ENT because it struck me as something that you could fix things. If something was broken, you could fix it. I didn’t realize at the time how many of the chronic ENT issues really have much deeper underlying things going on, and surgery is not the answer for many of them.
So, in any case, I over the years have studied and worked with all kinds of alternative healing modalities. Actually, when I was in medical school, there were some chiropractic students that were living right by me, and we used to get together and work on each other and do stuff, and they would teach me some of their chiropractic manipulation, although I don’t do that. I was very interested, and then later on in my career, I started working with an osteopath and learned cranial osteopathy, and that is a very big part of my practice for the last 26 years.
Dr. Weitz: Oh, interesting. So, there’s a lot of topics we could talk in the ENT area, but when we had a brief conversation, you mentioned vertigo and tinnitus, and I think these are two conditions that are fairly common. I know I had certainly seen a lot of patients in practice with these, and I think these would be good topics to highlight, though I’m okay with the discussion on any topic in ENT.
Dr. Asher: Sure.
Dr. Weitz: So, let’s start with vertigo. What is vertigo?
Dr. Asher: Okay. So, vertigo is the experience of motion when you’re not moving, basically. It can either be you spinning or it can be the room spinning, but there’s some-
Dr. Weitz: Do those two different distinctions can be-
Dr. Asher: Well, people will report it different ways. So, when a person comes to see me and they say, “I’m dizzy,” then I’m trying to determine whether it’s a problem with the inner ear, whether it’s some other reason. So, I always ask people the question, “Without using the word dizzy, what’s your experience?” Then the people will either say, “I’m moving.” If somebody says, “I feel like I’m going to faint or blackout,” then that’s not an inner ear issue, but there are many flavors of … You can disequilibrium or feeling like you don’t have balance, and it’s not vertigo, but that can be an inner ear symptom. One symptom is called mal de debarquement, where you feel like you’re on a boat all the time. So, vertigo can happen for … There are many causes of it.
Dr. Weitz: By the way, what percentage of cases of vertigo do you think are related to inner ear issues?
Dr. Asher: True vertigo, I’d say the largest percentage of them are an inner ear issue.
Dr. Weitz: 70%? 80%?
Dr. Asher: Yeah, something, at least that amount, some inner ear issue. So, basically, the way our balance organ works is the balance is related to the inner ear, and there are two functions of the inner ear. One is hearing, and one is balance. So, there is an organ called the vestibular system, and that is the balance part of the inner ear. If you imagine what’s going on is is that the inner ear is giving the brain like a Morse code signal. When we’re sitting still both sides, the Morse code signal is the same. When you turn one way or the other, the fluid shift, and then one Morse code on one side speeds up and the other one slows down. The brain reads that difference and it says, “Oh, I must be moving.” So, the brain gives you the experience of motion when you are moving. Now, it can also happen, let’s say there’s an injury to the inner ear, and then one side shuts down and isn’t giving any signal or speeds up, then the brain reads that and it says, “Oh, I must be moving,” and it gives you the sensation of motion and you’re not. That’s vertigo. Okay?
Now, there’s another part of the inner ear, which is involved in perception or gravity, too. In any case, the most common cause of vertigo is something called benign paroxysmal positional vertigo, and that’s where the understanding is, once again, nobody really knows because the inner ear is the hardest bone in the body, and it’s bone encased in bone. So, it’s the cochlea, vestibular system, the semicircular canals are encased in the temporal bone. The only way to look at it is person for them to be dead, and it’s a really big deal to get to it, anyhow. So, a lot of these things, people don’t really, there’s no way to know when on a live person exactly what’s going on. So, what happens in the benign paroxysmal positional vertigo, and this is the most common, the most common form of vertigo in adults is benign paroxysmal positional vertigo, is there’s thought to be a loose crystal in the inner ear. A loose crystal then when you move in a certain position, you lay down with your right ear down or your left ear down, all of a sudden, there’s a little period of latency, and then, boom, you’re hit with vertigo and it lasts for a few minutes, but it can be horrible. It freaks a lot of people out. It happens a lot to elderly people, but it can happen to anybody. So, the solution to that problem is not to take a medicine, right? That’s not what you want to do. The solution to the problem is, actually, you can either do what’s called an Epley maneuver, which you can actually look this up online. You can watching a video, but you can see a physical therapist or a-
Dr. Weitz: Yeah. I’ve performed that procedure on patients before.
Dr. Asher: Right. So, an Epley maneuver is a type of manipulation where you just basically get the crystal to go back to where it belongs and then the vertigo goes away. So, that’s the solution there. There’s another maneuver called the Semont maneuver, which is if the crystal is in a different canal and you can do both of them, and you can do it at home. You don’t have to go see somebody. The reason to go see somebody is that most people are so freaked out about the vertigo they think they’re having a stroke or they think that something terrible is happening. It’s not. That will often solve the problem.
Dr. Weitz: When you do that Epley’s maneuver on average, how many times have you … Do you see patients having to do it before it actually resolves?
Dr. Asher: Oh, that’s a good question.
Dr. Weitz: Personally, I haven’t seen it to be the magic cure.
Dr. Asher: Right. So, it depends. Usually, when I do it on somebody, I probably have to do it two or three times when I do it. Sometimes, I don’t know, maybe 50% or 60% of the time, the person is better. Then sometimes I’ll tell the person, “Look, you can do this at home, too.” The key thing is to get the positioning right, and then that makes a big difference, having the head extended to a proper degree. So, there’s a good animated video online that goes over it very carefully.
Dr. Weitz: Perhaps you can send me the link to that and I can put that in the show notes.
Dr. Asher: Okay. I’ll do that.
Dr. Weitz: Thank you.
Dr. Asher: So, another solution to BPPV is just get in that position to make you dizzy 10 times twice a day because what happens is the brain after a period of time figures out that you’re really not moving, and then it figures it out, and it shuts the experience down, and tells you you’re not moving and you realize you’re not and then it doesn’t give you the experience of vertigo. So, that’s not a functional medicine thing, but it is actually not taking a medication. If you take medication in this situation, you will actually prolong your symptoms because if you take Antivert or Dramamine or whatever, a medicine that suppresses the vestibular system, if you do that, you will stay dizzy longer. So, the best thing is to be dizzy to get over the dizziness.
Dr. Weitz: Okay, and then we have Meniere’s disease.
Dr. Asher: Right. So, let’s go into that because that’s actually, and once again, there was a homeopathic medicine and it was called Vertigoheel, and that company, Heel, can’t sell in the United States, and they … I’m trying to remember the name of what they converted it to. It’s Cocculus Compositum. It is a homeopathic remedy. Actually, if you have a lot of imbalance, it does actually help support equilibrium. So, that is a natural remedy that’s helpful.
So, regarding Meniere’s syndrome, the Meniere’s syndrome, the pathological term for that is something called idiopathic endolymphatic hydrops, and what it means is that there’s a mixture of inner ear fluids going on between two chambers of the inner ear, and it’s this rupture of a membrane, and it results in three main symptoms, true vertigo and it’s horrible vertigo, and it lasts anywhere from 20 minutes to 18 hours. So, if it’s two minutes, it’s probably not Meniere’s disease. If it lasts for seven days, it’s not Meniere’s disease. You have a fullness and roaring in the ear, hearing loss, and loud tinnitus. So, that’s the triad of Meniere’s. Nobody really knows what causes Meniere’s, except the treatment is to put people on a low salt diet and a diuretic is what conventionally is done. One of the things in my practice that I do in the area that I live is I test everybody for Lyme disease because late stage Lyme disease, Lyme is caused by a spirochete. Another organism that is a spirochete is syphilis and tertiary syphilis, late stage syphilis will give you endolymphatic hydrops. So, being in the New York area or New England where Lyme is so endemic, and you have the issue in Los Angeles, too-
Dr. Weitz: Yeah. I think Lyme is pretty much across the country now.
Dr. Asher: Right. So, people that are having these symptoms, I test everybody for Lyme disease.
Dr. Weitz: Now, testing for Lyme disease is somewhat problematic.
Dr. Asher: It is.
Dr. Weitz: So, which particular test do you find most effective?
Dr. Asher: So, I always order a Western blot for Lyme, and I order a coinfection panel. So, when the ticks bite people, the ticks are carrying more than one organism often. So, they carry borrelia. They also carry babesia, bartonella, ehrlichia, human granulocytic anaplasma. So, I test people with the Lyme Western blot, and then I do a coinfection panel.
Dr. Weitz: Is that enough because most of the companies that specialize in Lyme tend to include the Western blot and a series of other tests as well.
Dr. Asher: They do. So, one of the restrictions I have when I’m practicing in New York is a lot of tests aren’t available for New York State doctors, so we’re limited by what we can order.
Dr. Weitz: I see.
Dr. Asher: I also am cognizant of people’s pocketbooks, and some of the Lyme testing gets incredibly expensive. So, even though the commercial labs are not as good as the Lyme labs, if I can establish a diagnosis with a commercial lab where it’s covered under a person’s insurance, great, and if I still think they have Lyme disease, then I use one of the specialty labs because they do better. Some of the specialty labs do better PCR or other kinds of tests.
Dr. Weitz: Is there a specialty lab you like best?
Dr. Asher: I wouldn’t say that. There are several that I like. I mean, I like the IGeneX Lab in California. I like MDL. That’s the Medical Diagnostic Lab in New York State. I like the Stony Brook Lab in New York State. I like ArminLabs in Germany. They’re all good labs for Lyme, but I’d say the largest percent of the time I can use a commercial lab and figure out what I need to do. I got into the Lyme thing through the backdoor, like why would an ENT be doing Lyme, but I had a patient who had non-serviceable hearing and one ear is deaf. Basically, deaf in one ear. He had Meniere’s spells. He had Lyme disease, which had been inadequately treated. So, he came to see me. It had been 10 years down the line. He was so dizzy. Actually, he was having spells all the time. He couldn’t even find his way home from work. He told me he had this history of Lyme. So, I said, “Why don’t we just try treating the Lyme disease? Maybe it’s this persistent Lyme.” I treated him, and his deaf ear basically came back.
Dr. Weitz: Cool.
Dr. Asher: That’s really unheard of. That’s a miracle medicine.
Dr. Weitz: What kind of treatment did you use?
Dr. Asher: Actually, I just treated him with doxycycline. I mean, I do-
Dr. Weitz: For a short period of time or a long period of time?
Dr. Asher: I treated him for probably two, three months, but after about … It was about three or four weeks and his hearing just came back. His dizziness went away and that was it. I’ve had several people like that. So, if I have a patient who has typical Meniere’s spells, and if my index of suspicion is that they could have Lyme, whether they have a positive Lyme test or not, I will treat them for Lyme disease. Now, I may use herbs. I may use antibiotics. It just depends on what the person is interested in doing, but it can be a big game-changer. I think I’m the only ENT that does that, but-
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Dr. Weitz: I saw a few articles that link abnormal glucose and insulin metabolism with Meniere’s disease.
Dr. Asher: Oh, yeah, yeah. That’s Ken Brookler. Right. That’s Ken Brookler’s work.
Dr. Weitz: Apparently, the inner ear is rich in insulin receptors.
Dr. Asher: Right. Yes. So, Ken Brookler, who’s retired now, he’s just a really brilliant guy. Once again, he was a lone warrior out there treating people for insulin resistance. For some people, he was using bisphosphonates, actually, because he found a lot of people who had vertigo and tinnitus had what he called inner ear otosclerosis, which-
Dr. Weitz: A loss of bone in the inner ear?
Dr. Asher: Right, right, a bony overgrowth sort of. It’s a complicated condition, but in any case, he had a lot of success, but nobody has actually taken up that mantle. So, there’s not anybody out there doing that work anymore in my specialty.
Dr. Weitz: What about some of the natural treatments for vertigo and Meniere’s? I understand that glutathione may be effective.
Dr. Asher: That’s a good question. I mean, I used a lot of glutathione both orally and intravenously. When I first started using glutathione, I started using it in patients that had what’s called sudden sensorineural hearing loss, which can be Meniere’s or hydrops. You can just have the hearing loss portion of it, but not the vertigo portion of it. It’s complicated, but I started using intravenous glutathione on those people. Personally, I didn’t find people had much of a benefit from it. The one thing that you can do for the sudden hearing loss aspect is hyperbaric oxygen.
Dr. Weitz: Okay. You find that to be effective. I saw a few articles about vitamin D, CoQ10 and ginkgo.
Dr. Asher: Mostly, that’s for tinnitus. I’ve not seen that for … Well, there is this product called lipo-flavonoids that people use. You can get it at the regular pharmacy.
Dr. Weitz: Right. Yes. I’ve had patients get prescribed that.
Dr. Asher: People will use that for Meniere’s. They’ll use it for tinnitus. The research on it is not that great, but people try it and it does help some people. So, you take what you can get.
Dr. Weitz: Now, how often have you seen cervical manipulation be a benefit?
Dr. Asher: For vertigo?
Dr. Weitz: Yeah.
Dr. Asher: It can be. There is a condition called cervical vertigo, and the spells can be very similar to BPPV-like spells. So, why can the neck cause vertigo? There are three legs to the balance stool that keep it upright, okay? One of them is your inner ear, one of them is your eyes, and the other is your proprioceptor fibers. They are your proprioceptor fibers and your muscles. For people that aren’t familiar with that term, proprioceptor fibers are these small fibers that are in all of your muscles that inform the brain where it is in space. If you have inflammation in muscles, particularly in your neck, that are getting the proprioceptor fibers to miss-trigger, once again, they will misfire and give the brain misinformation, and that can cause vertigo. So, whether it’s directly a subluxation in the neck that’s causing the vertigo or whether it’s the fact that the nerve impulse to the muscle groups is what the issue is, it’s then developing these trigger points. I’m not sure, but it definitely can help. I’m sure in your experience you found it to be helpful.
Dr. Weitz: Yes, we have. When I was looking at some of the possible triggers would cause us a vertigo, I also saw that heavy metal toxicity can play a role, and it can also be a side effect of a whole series of prescribed medications.
Dr. Asher: Oh, yeah. I mean, yeah, many, many medications have some kind of toxicity to the inner ear, absolutely. Heavy metals are neurotoxic, and certainly if you have heavy metal issues, people can have balance disturbance. I will sometimes look for heavy metal issues in patients that are chronically dizzy.
Dr. Weitz: Which of the medications do you find are most at fault? I noticed antibiotics.
Dr. Asher: Right, minocycline, particularly. Of the tetracycline, doxycycline family, minocycline is the one that I find the most problematic for vertigo.
Dr. Weitz: I also saw blood pressure meds, statins, NSAIDs.
Dr. Asher: I mean, it’s everywhere. Listen, if you look at the side effects of every medication, vertigo is almost one of them.
Dr. Weitz: Right. Okay. So, let’s move on to tinnitus or tinnitus. Which is the correct pronunciation?
Dr. Asher: Both are correct, actually.
Dr. Weitz: Okay. So, what’s your definition of it?
Dr. Asher: It’s the perception of a sound that isn’t an internal sound in the head or from the ear.
Dr. Weitz: So, what do you think are some of the most common root causes, triggers for tinnitus?
Dr. Asher: It’s a very common problem, first of all. So, it’s actually sometimes hard to ascribe a cause because it is so common, and people have it for no apparent reason. One of the common causes tinnitus, of course, is hearing loss. So, if a person comes complaining of tinnitus or it’s new onset, I get a hearing test. It’s important to do that. Sometimes if it’s a hearing loss in one ear, then you should evaluate that in a certain kind of a way. So, a hearing test is always a good thing to get if tinnitus is bad or is concerning to somebody.
In the field of chronic issues, it’s one of the toughest nuts to crack quite frankly. Medications can cause tinnitus. Herbs and supplements can cause tinnitus, particularly many, many herbs have salicylates in them, like willow, feverfew. They have salicylates, and then if you’re taking them in higher dose, salicylates is a base of what? Aspirin. Aspirin can cause tinnitus. So, it’s important to note that even if you’re taking herbs, they can have side effects and you should be aware of that.
Dr. Weitz: Herbs other than ones that contain salicylates or base of-
Dr. Asher: No. Mostly, the ones that I know of are the salicylate family, and I don’t know all of them, but a lot of herbs who have salicylates in them.
Dr. Weitz: What are some of the other common triggers?
Dr. Asher: Well, noise. So, if you go to a loud rock concert or get exposed to loud noise, you can be left with tinnitus for a period of time. Usually, it’s a short period of time. So, tinnitus can happen in various ways. Sometimes you’ll just get a loud piercing sound in your ear. It happens for 10 seconds and it goes away, and that’s the end of it, right? That’s tinnitus, but it’s not the kind of tinnitus that people go see the doctor for. People go see the doctor because the sound is loud and it’s bothering them or they’re worried about something serious going on. I would say it is possible that any systemic inflammation in the body can support tinnitus happening, but I wouldn’t say that if you eliminate all the inflammation by going on all kinds of dietary restrictions, et cetera, et cetera, you will necessarily help the problem.
Dr. Weitz: Can food sensitivities, can they be triggers?
Dr. Asher: Like I said, anything could potentially be, but I would never … From my perspective, I see people who have come in to see me have tried a million things and their tinnitus doesn’t go away. So, the problem is is that tinnitus, and let’s say you have tinnitus today, it came on, and it can go away in two days. It can go away in one day. So, the natural history of tinnitus in many people is that it’s short-lived.
Dr. Weitz: What percentage of people who get tinnitus have short-lived?
Dr. Asher: I can’t answer because the people that have that probably I had never see, right?
Dr. Weitz: Okay. You think it’s 20%, 50%?
Dr. Asher: I think it’s a lot of people. Many, many, many, many people will have tinnitus and they may have it for a week and it goes away, and then they forget about it. They forgot they even had it.
Dr. Weitz: So, would you say if you ended up having tinnitus and you give it a couple of weeks and it’s not gone-
Dr. Asher: Yeah, and then I probably would look into it a little bit more, but even at two weeks, I wouldn’t rush into freaking out.
Dr. Weitz: Right. So, if you have a patient in your office with tinnitus, how would you work them up? Are there certain tests you would do or would you just try certain treatments?
Dr. Asher: I get a hearing test. Another thing that will cause tinnitus is TMD, by the way, temporomandibular joint disorder, people who grind.
Dr. Weitz: Interesting.
Dr. Asher: So, there is a small percentage. I’d say 10% to 10% of people have something called somatic tinnitus.
Dr. Weitz: Okay. What is that?
Dr. Asher: Somatic tinnitus is there is something going on once again in the proprioceptor fibers or some fibers in the neck, and there is this paper from Japan from many years ago, which actually explains the whole neural pathways of how it happens, but there is this path where muscles in the neck can generate tinnitus. So, I’d do some manual therapy releasing trigger points, and particularly paying very close attention to the suboccipital area. So, releasing, opening up the suboccipital, so many people because we’re in front of the computer all day long because of how we live-
Dr. Weitz: [inaudible 00:33:03] posture.
Dr. Asher: Right. The junction between the occiput and the cervical spine is compressed, and freeing that up can actually really make a big difference in some people with tinnitus. If you want to get blood work, you can and you can look for B12 levels, CoQ10 levels, vitamin D3 levels or you can just supplement with B12 and D3 and CoQ10.
Dr. Weitz: I saw several papers on the use of pine bark extract, also known pycnogenol, which was shown to increase cochlear blood flow and eliminate tinnitus in a percentage of patients.
Dr. Asher: I’m not familiar with that, actually. Maybe I was at one point, but I don’t use that on a regular basis. So, I don’t have any experience with it.
Dr. Weitz: What about other supplements?
Dr. Asher: So, one of the things that I’ve been using, there is a compound, a natural product called synapsin. It was developed by this pharmacist named Jim LaValle, who’s always-
Dr. Weitz: Oh, yeah. I had him on the podcast a month ago.
Dr. Asher: Right. So, he’s quite a brilliant guy.
Dr. Weitz: He is, yeah.
Dr. Asher: He came up with this product called synapsin, which is RG3 from ginseng, which is the most potent part of the ginseng plant, which reduces brain inflammation. Nicotinamide riboside and methylcobalamin. Now, nicotinamide riboside is a supplement. It has been shown to protect the inner ear from noise channel-
Dr. Weitz: Oh, interesting.
Dr. Asher: … and as has N-acetylcysteine, NAC. Both of those supplements will protect the ear from noise channel.
Dr. Weitz: Interesting.
Dr. Asher: So, I have in a number of tinnitus patients prescribed the synapsin nasal spray. It’s expensive. You have to prescribe it. It’s compounded from a compounding pharmacy, but it reduces brain inflammation. I’ve had some people where it helps, not everybody. Once again, not everybody is helped by any one thing in tinnitus, but you take what you can get. If it helps, great, and if it doesn’t, no harm, no foul.
Dr. Weitz: So, it’s a nasal spray?
Dr. Asher: It’s a nasal spray, right.
Dr. Weitz: So, is this something that would only be available through an MD prescription?
Dr. Asher: I’m not sure whether … It depends on what the prescribing laws are in the states that you’re in, but I know that there are a lot of integrative doctors and Lyme doctors that use synapsin all the time. It improve mental clarity. It’s great for brain fog. I use it in some people for anosmia. So, it’s a great product.
So, I will prescribe the other supplements, too. People ask me often about acupuncture, and acupuncture, there has never been a paper out there that show that acupuncture has done anything for tinnitus. So, I don’t generally recommend it, but I have a colleague who’s a neuro-otologist and he does a lot of complex inner ear surgery and middle ear surgery. He says that he believes that acupuncture helps 50% of his patients. So, if somebody wants to do it, I would never tell you not to, but I wouldn’t go with the expectation it would.
Dr. Weitz: I also saw at least one paper using zinc.
Dr. Asher: I’ve seen that. I’ve not seen that it’s been particularly helpful in my experience. Zinc has the side effect of nausea. A lot of people don’t tolerate it very well.
Dr. Weitz: Then ginkgo.
Dr. Asher: I’ve used ginkgo. There is this product called Arches Tinnitus Relief Formula, which is available online. It’s high-dosed ginkgo, and they say that it’s very, very helpful. For people that are really having a lot of problems, I will prescribe it. It’s not a prescription. You just go online and you order it. They have the Arches Tinnitus Relief Formula, then they have a zinc product, and they have something else. I just tell people to get the basic one with ginkgo in it.
Dr. Weitz: You know what would be interesting is since so many people, I don’t know what the number is, but I know all my patients, and I think quite a number of people are taking additional supplemental zinc as part of their immune-strengthening protocols in the last year. I wonder if that has affected rates of-
Dr. Asher: Tinnitus?
Dr. Weitz: … tinnitus.
Dr. Asher: Good question. Good question. So, I will recommend Arches Tinnitus Relief Formula for people. The people that are most struggling with tinnitus are people that have depression, actually. The natural course of tinnitus is that most people habituate to it. So, if you develop tinnitus and you have it for a little bit of time, over time, you will not notice it. When you’ve habituated to it and you’re not noticing it, the question is, do you even have it if you’re not even-
Dr. Weitz: [inaudible 00:39:02]
Dr. Asher: Right. Exactly. So, I mean, I have tinnitus, and it’s been surprisingly not annoying for a long time. Actually, of late, I’ve just been tuning in, and it’s hardly there. So, the question is, for the person that’s really struggling, what are the strategies to work with? Antidepressant medication does not really particularly work. So, I treat tinnitus like a pain syndrome. So, what do you do with somebody who’s got chronic pain? How can you manage that non-pharmacologically because, obviously, pain medications don’t do anything for tinnitus?
You can’t run away from it. The issue with tinnitus is that you’re living, it’s in you, and you can’t get it to go away, and you can’t run away from it. So, how can you embrace it? If you can embrace it and not run away from it, the strategy is to hold it with loving kindness and not push it out. That can actually make a really big difference in tolerability because the key for the person that’s really suffering with tinnitus is they’re experiencing something absolutely intolerable in their life. So, it’s how to hold space for what’s intolerable.
There is a really great book that I recommend to people. It’s called The Path is Everywhere by Matt Licata. It’s all about holding space for intolerable feelings, and tinnitus in that regard can be in that realm of feeling because it’s all the stuff that it brings up. What it brings up in people is idea of, “What if this never goes away? I’m never going to have quiet again in my life,” blah, blah, blah. You have all these stories that you tell yourself, and those are the things that make it more and more intolerable.
Dr. Weitz: Okay. Great. I think that’s a wrap, doc. You’ve provided us with some interesting useful information in the realm of ear, nose, and throat disorders, specifically vertigo and tinnitus. How can our listeners and viewers get a hold of you and-
Dr. Asher: They can call my office. My office number is 212-223-4225. I have a website. My website is asherent.com. I do do telemedicine, so if people want to get a consult from not in the New York, I do that all the time.
Dr. Weitz: That would be great. Thank you so much, doc.
Dr. Asher: Okay. Dr. Weitz, nice to meet you on virtually and thanks for your great questions.
Dr. Weitz: Excellent. Excellent. Thank you.
Thank you, listeners, for making it all the way through this episode of the Rational Wellness Podcast. Please take a few minutes and go to Apple Podcasts and give us a five-star ratings and review. That would really help us so more people can find us in their listing of health podcasts.
I’d also like to let everybody know that I now have a few openings for new clients for nutritional consultations. If you’re interested, please call my office in Santa Monica at 310-395-3111. That’s 310-395-3111, and take one of the few openings we have now for an individual consultation for nutrition with Dr. Ben Weitz. Thank you and see you next week.
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