Tinnitus: An Integrated Approach

Tinnitus, or acufene, is a hearing condition characterized by the perception of sounds in the absence of an external acoustic source. This phenomenon, defined as a subjective experience not sustained by ambient stimuli, manifests as noises such as whistles, hisses, buzzing, or rustling, whose intensity, pitch, and frequency can vary considerably. “The noise may be heard in one or in both ears or, more generally, inside the head.”

It can disappear and then reappear (intermittent) or be constant; it can resemble a single noise or several sounds overlapped, and its volume can vary from barely audible to extremely loud.”(ISSalute) In some cases, the perceived sound is pulsatile and synchronized with the heartbeat and can amplify the disturbing component of the symptom.

Causes and Symptoms

The epidemiology of tinnitus shows a significant prevalence in the adult population. In 4% of cases it takes on a particularly severe character (2,400,000 people) and can be so bothersome as to cause a decrease in quality of life (sleep disturbances, depression, and anxiety). According to the Italian National Institute of Health (ISSalute), it is “a fairly common and widespread disorder; many people have at least once experienced it, even if only for a short period. In Italy about 15% of the population reports having suffered from tinnitus at least once.”

Tinnitus is not a standalone disease but a symptom that can accompany numerous clinical conditions. Among otologic causes are otitis, otosclerosis, labyrinthitis, Ménière’s disease, and injuries to the auditory nerve. Systemic conditions that may contribute to onset include hypertension, hypotension, anemia, hypothyroidism, and arteriosclerosis. Prolonged exposure to loud noises, cranial or acoustic trauma, and the use of ototoxic medications (salicylates, quinine and derivatives, aminoglycoside antibiotics, some diuretics, alcohol, heavy metals) are also known risk factors.

Therapeutic Management

The reaction to tinnitus varies greatly from person to person. Some manage it with minimal disruption, while others are deeply troubled. When the symptom is continuous and intense, it can seriously affect psychophysical well‑being by causing insomnia, irritability, and depression. For this reason it is essential to consider tinnitus not only as an isolated symptom, but as a possible signal of broader imbalances to explore and treat with an integrated approach.

The therapeutic management of tinnitus is based on a multidisciplinarian approach. The first phase consists in identifying and treating the underlying pathology, when present. In cases of tinnitus secondary to otitis, otosclerosis, Paget’s disease, Ménière’s disease, etc., targeted intervention can lead to a significant reduction of the symptom. Similarly, controlling systemic conditions such as hypertension, mood disorders, or chronic stress through targeted pharmacotherapy can contribute to clinical improvement. Pharmacologic agents such as baclofen, cinnarizine, vasodilators, and benzodiazepines are used. However, adverse effects often outweigh benefits and require careful, personalized assessment.

Prevention

In addition to medical therapies, preventive measures play a fundamental role: avoiding exposure to loud noises, limiting the use of personal audio devices, maintaining proper ear hygiene to prevent the formation of earwax plugs, and monitoring the intake of potentially ototoxic drugs are recommended measures. Stress management, through relaxation techniques, psychotherapy, or cognitive-behavioral therapy, can attenuate the emotional component of the disorder. Among non-pharmacological approaches, the Tinnitus Retraining Therapy (TRT) has shown effectiveness in retraining the central nervous system to ignore the perceived acoustic signal, progressively reducing its prominence.

Multidisciplinary Approach

In conclusion, although there is no definitive cure, tinnitus can be successfully addressed with an integrated multidisciplinary approach that combines otologic, neurologic, and psychological expertise. Personalizing treatment and paying attention to the patient’s subjective experience are key elements to improving quality of life and reducing the impact of a symptom that is as invisible as it is debilitating. In treating tinnitus, the integrative medicine approach — which includes phytotherapy, gemmotherapy, and homeopathy — can offer solid support in containing symptoms and fostering the restoration of balance in the individual’s terrain. The aim is to support self-regulation and adaptation mechanisms, promoting a more harmonious response to stress- and inflammatory stimuli that can contribute to the onset or worsening of tinnitus.

Herbal Remedies

“In phytotherapy, medicinal plants can be used to achieve an effective and safe action aimed at rebalancing the immune system and counteracting symptoms related to stress and depression (Rhodiola rosea), to address vascular and inflammatory disturbances (Ruscus aculeatus, Ginkgo biloba), and to exhibit antioxidant action (Rhodiola rosea). It is now established, for example, that medicines aimed at controlling stress or depression and anxiety can positively influence tinnitus intensity, just as antioxidant therapy appears to reduce subjective discomfort and tinnitus intensity. Homeopathic therapy involves medicines with symptomatic and constitutional actions” (Campanini, 2017).

In particular:

• Ginkgo biloba L. (Ginkgo): The standardized leaf extract is recognized by the German Commission E of the German Health Authority and by the World Health Organization as useful for alleviating tinnitus and vasogenic vertigo. Although a Cochrane review (2009) noted limited evidence for its effectiveness in treating tinnitus “when this is the primary indication,” a subsequent study conducted in patients with mild or moderate dementia—some of whom also had tinnitus—showed a small but significant reduction in tinnitus symptoms in those who took G. biloba. The plant has been shown to influence vascular permeability and neuronal metabolism, and thus there is a rational basis for its prescription (Edwards S., et al., 2015). Warnings: safety data in the literature suggest the plant is well tolerated at recommended doses. However, it can interfere with coagulation processes and may interact with anticoagulant and antiplatelet drugs. Dosage: the Commission E recommends a daily administration of 120–160 mg of standardized Ginkgo biloba extract, with the recommendation to discontinue treatment after 6–8 weeks if no improvement occurs.
• Rhodiola rosea L. (Rhodiola): preparations based on Rhodiola are advised in cases of tinnitus to reduce symptoms and improve hearing. The mechanism of action is not fully clarified, but it seems to depend on its serotoninergic properties. Thanks to these properties, its prescription can help reduce tinnitus intensity by acting directly on the neural conduction of the auditory stimulus, particularly on central auditory pathways rich in serotonin receptors. Serotonin is involved in modulating sensory processes of the primary auditory cortex, and dysfunction of the serotonergic system may increase the awareness of tinnitus; consequently, tolerance may improve. Antioxidant, anti-stress, immunomodulatory and anti-inflammatory properties are also present. In idiopathic tinnitus, an antioxidant therapy appears to reduce the intensity of tinnitus and subjective distress and is therefore considered as a supplementary treatment. The prescription of Rhodiola rosea ultimately can be indicated thanks to its documented anti-stress action. Warnings: Rhodiola rosea is considered a safe drug; clinical studies have not shown significant adverse effects. Only for inappropriate dosages (overdosage) can agitation or overexcitement occur: in that case, reduce the dose or discontinue therapy. It is advisable to avoid evening intake during the first weeks of therapy as it could disturb sleep in susceptible individuals. A possible interaction (potentiation) with ACE inhibitors and with stimulating substances or medications has been reported. Dosage: Dry extract (rosavin 3% and salidroside 1%): 100–300 mg, twice daily, before breakfast and before lunch; TM: 30–50 drops, diluted in water, twice daily (before breakfast and before lunch).
• Ruscus aculeatus L. (Pungitopo or butcher’s broom): its use can accompany the preceding medicinal plants, reinforcing their activity, thanks to venoconstrictive, venotonic, anti-inflammatory and anti-edematous properties. Numerous clinical observations highlight these properties and their effectiveness in treating microcirculation disorders in general, in improving the symptoms related to venous insufficiency (heavy legs, paresthesias, cramps, edema, etc.) and hemorrhoidal crises (burning, itching, congestion). Venoconstrictive action is attributed to the steroidal saponins (ruscogenin and neoruscogenin) which, through direct interaction with alpha-1 and alpha-2 adrenoceptors on smooth muscle cells of venous walls and through norepinephrine release, exert an effective venous vasoconstriction and help venous return. This activity is accompanied by anti-inflammatory and anti-edemigen effects supported by the saponosides. Warnings: only at high dosages can vomiting and diarrhea occur (Commission E). At present, no known pharmacological interactions are reported. Dosage: Dry extract (titled in saponins expressed as ruscogenin min. 10%, French Pharmacopoeia): 1–3 tablets per day, preferably away from meals; TM 40 drops, diluted in water, 1–3 times per day.