Deafness

=Tinnitus and Deafness (Ĕr Míng Ĕr Lóng)=

Er Ming: “ear ringing” (e.g., cicadas, ocean tides) Er Long: “deafness; decline or loss of hearing”

Clinically, tinnitus and deafness may or may not present simultaneously. Although they have different manifestations, their pathogenesis in TCM terms is virtually identical, which is why they are discussed together.

=Deafness= Hearing loss can be divided into 2 main categories: Conductive hearing loss (CHL): occurs because of some mechanical problem in the external or middle ear. The three tiny bones of the ear (ossicles) may fail to conduct sound to the cochlea or the eardrum may fail to vibrate in response to sound. Fluid in the middle ear can cause CHL. Sensorineural hearing loss (SNHL): results from a dysfunction of the inner ear. It most often occurs when the tiny hair cells (called cilia) that transmit sound through the ear are injured. This type of hearing loss is sometimes called "nerve damage," although this is not accurate.

[[image:deafness2.png align="right"]]General Etiology
-Occupational/Noise-induced -Age-related (a.k.a. presbycusis) -Infectious (e.g. otitis media) -Toxic (e.g., aminoglycoside antibiotics, aspirin, quinine) -Genetic (e.g., otosclerosis) -Congenital (e.g., otosclerosis) -Traumatic -Other (physical obstruction such as earwax, Meniere’s disease, acoustic neuroma, autoimmune)

-Obstruction of external ear canal (for example, with wax, a tumor, or pus from an infection) -Middle ear infection (otitis media) -Chronic middle ear fluid (otitis media with effusion) -Cholesteatoma (noncancerous tumor in the middle ear caused by an ear infection) -Otosclerosis (bony overgrowth of the ossicles from genetic or congenital factors) -Perforated eardrum
 * Conductive hearing loss**

-Aging (a.k.a. presbycusis) -Loud noise -Certain drugs (e.g., aminoglycoside antibiotics, aspirin) -Viral infection of the inner ear (labyrinthitis) -Childhood infections (mumps, meningitis) -Congenital infection (toxoplasmosis, rubella, cytomegalovirus, herpes, syphilis) -Genetic -Meniere's disease -Brain tumors -Congenital abnormality -Demyelinating diseases (diseases that destroy the myelin sheath covering nerves) -Sudden pressure changes from flying, diving, and strenuous exercise
 * Sensorineural hearing loss**

Statistics
-More than 28 million people in the United States are deaf or have hearing loss. -Older people are the most affected: 30 to 40% of people aged 65 and older have significant hearing loss. -Every year, about 1 out of 5,000 people develops sudden deafness. Sudden deafness is severe hearing loss, usually in only one ear, that develops over a period of a few hours or less.

Age-related hearing loss first affects the highest pitches (frequencies) and only later affects lower pitches. Loss of the ability to hear high-pitched sounds often makes it more difficult to understand speech. Although the loudness of speech appears normal to the person, certain consonant sounds—such as the sound of letters C, D, K, P, S, and T—become hard to distinguish, so that many people with hearing loss think the speaker is mumbling.
 * Age-related Hearing Loss (a.k.a. Presbycusis)**

-A screening test that helps distinguish between conductive from sensorineural hearing loss by comparing how well a person hears sounds conducted by air with how well the person hears sounds conducted by the skull bones. -To test hearing by air conduction, the tuning fork is placed near the ear. To test hearing by bone conduction, the base of a vibrating tuning fork is placed against the head so the sound bypasses the middle ear and goes directly to the nerve cells of the inner ear. -If hearing by air conduction is reduced but hearing by bone conduction is normal, the hearing loss is conductive. If both air and bone conduction hearing are reduced, the hearing loss is sensorineural or mixed. People with sensorineural hearing loss may need further evaluation to look for other conditions, such as Meniere's disease or brain tumors.
 * Rinne Tuning Fork Test**

Biomedical Tx
-Obstruction of the canal from debris or wax: a doctor can vacuum (wash) the canal or recommend over-the-counter drops that dissolve ear wax -Fluid in the middle ear: tympanostomy (a small tube placed in the eardrum to drain and prevent fluid accumulation) -Deafness: Biomedical Tx -Corticosteroids: for autoimmune causes or sudden hearing loss -Surgery: otosclerosis, tumors -Hearing Aids -Cochlear Implants

Prevention of Deafness
-Limiting exposure to loud noise (music played through headphones can be particularly damaging) -For occupational or firearm exposure, the use of hearing protectors, such as plastic or foam rubber plugs in the ear canals or glycerin-filled muffs over the ears, is essential

TCM Etiology and Pathogenesis
Tinnitus: Differentiating Repletion from Vacuity Repletion patterns characterized by sudden onset, loud and high-pitched ringing Vacuity patterns characterized by gradual onset and soft, low-pitched sounds Note: The pitch or loudness of tinnitus should not be taken as a sure indicator of repletion or excess; always corroborate these sx’s with patient’s other sx’s to determine the pathology and pattern.

Wind-Heat Invasion
Symptoms: common Wind-Heat symptoms including sore throat, fever, aversion to cold, headache, dry mouth, possible red tongue tip, thin, yellow tongue coating, floating and rapid pulse, with additional manifestation of distention and obstruction within the ears with possible earache leading to tinnitus and impairment of hearing Treatment Principles: Disperse Wind, clear Heat, open the orifices Herbal Treatment: Yin Qiao San Jin Yin Hua 10-30g Lian Qiao 10-30g Dan Dou Chi 10g Niu Bang Zi 10g Bo He 10g Jing Jie 10g Jie Geng 5g Lu Gen 10g Gan Cao 3g Note: children are less likely to complain of tinnitus or loss of hearing, but will complain of earache Wind-Heat Invasion

Liver and Gallbladder Fire
Main Symptoms: sudden onset of loud tinnitus or deafness with the tinnitus resembling ocean waves or claps of thunder; onset of symptoms or increase in severity of symptoms with anger or frustration; Additional Symptoms: headache, dizziness and vertigo, epistaxis, earache, distending sensation of the ears, flushed complexion, red eyes, dry mouth, bitter taste in mouth, irritability, irascibility, restlessness, insomnia, distention and pain of the chest and hypochondria, constipation, dark urine Tongue: red with yellow coating Pulse: rapid, wiry, forceful Liver and Gallbladder Fire Treatment Principles: Drain Liver and Gallbladder Fire, open the orifices Herbal Treatment for Liver and Gallbladder Fire: Long Dan Xie Gan Tang Long Dan Cao 10-15g Huang Qin 10g Shan Zhi Zi 10g Ze Xie 10g Mu Tong 6g Dang Gui 10g Che Qian Zi 10g Sheng Di Huang 10g Chai Hu 6g Gan Cao 6g Herbal Treatment for Liver Depression transforming to Heat (less pronounced Fire: Jia Wei Xiao Yao San Chai Hu 10g Bai Shao 10g Dang Gui 10g Bai Zu 10g Fu Ling 10g Zhi Gan Cao 6g Pao Jiang 6g Bo He 6g Zhi Zi 10g Mu Dan Pi 10g

Binding Depression of Phlegm-Fire
Main Symptoms: tinnitus and deafness accompanied by dizzy spells, sensation of heaviness of the head Additional Symptoms: oppression in the chest, profuse phlegm, bitter taste in the mouth, irregularity of urination and bowel movements Tongue: red with greasy, yellow coating Pulse: slippery, wiry or rapid, slippery pulse Treatment Principles: Drain Fire, transform Phlegm, open the orifices Herbal Treatment: Huang Lian Wen Dan Tang Jia Wei Zhu Ru 10g Zhi Shi 10g Ban Xia 10g Chen Pi 6g Fu Ling 10g Huang Lian 5g Gan Cao 6g Sheng Jiang 3pcs.

Blood Stasis
Main Symptoms: persistent tinnitus and/or hearing loss, possibly associated with black discharge from the ear or dark matter mixed with ear wax; possible earache Additional Symptoms: dark complexion; possible HA Tongue: purple or purple spots with thin coat Pulse: wiry or choppy and thready Treatment Principles: Quicken the Blood, eliminate stasis, open the orifice Herbal Treatment: Tong Qiao Huo Xue Tang (best when stasis confined to head) Tao Ren 10g Hong Hua 10g Chi Shao Yao 10g Chuan Xiong 9g She Xiang 0.15g Cong Bai 3g Sheng Jiang 3 pcs Da Zao 7 pcs

OR

Xue Fu Zhu Yu Tang (selected when Blood stasis is more systemic) Tao Ren 12g Hong Hua 10g Chuan Niu Xi 10g Dang Gui 10g Chi Shao Yao 6g Chuan Xiong 6g Zhi Ke 6g Jie Geng 6g Chai Hu 6g Gan Cao 3g

Note: this pattern usually follows upon some trauma to the head or injury to the ear, including exposure to loud noise or sudden pressure changes. It can also complicate other chronic patterns of tinnitus or hearing loss

Kidney Essence Depletion Main Symptoms: gradual onset of tinnitus or hearing loss/deafness associated with aging or chronic illness; tinnitus resembles the buzzing of cicadas, may be intermittent and is often worse at night Additional Symptoms: dizziness and vertigo, insomnia, weak, aching low back and knees, seminal emission Tongue: red with scanty coating Pulse: thin or rapid, thin pulse Treatment Principles: Supplement the Kidneys, secure the Essence Herbal Treatment: Er Long Zuo Ci Wan Shu Di Huang 24g Shan Zhu Yu 12g Shan Yao 12g Mu Dan Pi 9g Ze Xie 9g Fu Ling 9g Shi Chang Pu 6g Wu Wei Zi 6g Ci Shi 30g

SP and ST Qi Vacuity(Center Qi Fall)
Symptoms: tinnitus and deafness aggravated by overwork, sensation of emptiness and coolness within the ears, accompanied by tiredness, fatigue, poor appetite, loose stools, epigastric distention after eating and a sallow, withered complexion, pale tongue with white coating, weak pulse Treatment Principles: Strengthen the Spleen and Stomach, boost Qi Herbal Treatment: Bu Zhong Yi Qi Tang Huang Qi 10-60g Dang Shen 10g Bai Zhu 10g Dang Gui 10g Chen Pi 10g Sheng Ma 5-15g Chai Hu 5g Zhi Gan Cao 3g

Excess Patterns
Modification Based on Pattern:
 * Primary Points:** TE 3, TE 17, TE 21, SI 19, GB 2, GB43
 * Wind-Heat:** TE 5, LI 4, LI 11
 * LV/GB Fire:** LV 2, LV 3, GB 34, GB 41
 * LV depression Heat:** LV 3, LI 4, PC 6, GB 20
 * Phlegm-Fire:** ST 40, PC 8
 * Blood Stasis:** LV 3, LI 4, SP 10, SP 6, BL 17

Vacuity Patterns
Modification Based on Pattern:
 * Primary Points:** TE 3, TE 17, TE 21, SI 19, GB 2
 * Kidney Essence Depletion:** BL 23, KI 3, SP 6, CV 4, GV 4
 * SP/ST Qi Vacuity:** BL 20, BL 21, ST 36, SP 6, CV 6

Insert 3 needles along Jiao Auditory Line (a 4.0 cm horizontal line, with the midpoint 1.5 cun directly above the apex of the ear; at about GB8). Needle the two end points and the middle point obliquely downward, angled towards the apex. With a thin copper wire (it cannot be too thick), start at one of the end needles, encircle it once, then encircle the middle needle once, and do the same with the last needle, making sure the wire is efficiently wrapped without much slack. Attach the wire around the middle of the handle and not at the top.
 * Auricular Acupuncture:** Subcortex, Endocrine, Liver, Kidney, Inner Ear, Shen Men
 * Scalp and Electroacupuncture Tx of Tinnitus and Deafness:**

Attach the negative lead to SI19 and the positive lead to the middle needle on auditory line, above the wire. Use intermittent wave with 1/2 or 1/3 frequency. Use your best judgement as to how strong, but not so much as to cause the patient any discomfort. Use this technique on both ears for 25 minutes and add supplemental points according to the pattern. This treatment protocol comes from Shandong University of TCM. Note: GB12 is often used in this hospital for head disorders of all sorts.

Herbs For Ear Disorders
Ci Shi Dong Chong Xia Cao Ge Gen He Shou Wu Long Dan Cao Mu Li Nu Zhen Zi Shan Zhu Yu

Homeopathic Remedies for Tinnitus
Cimicifuga 6c: for people sensitive to noise who tend toward depression Carbo Vegetabilis 6c: for tinnitus accompanied by vertigo and nausea Graphites 6c: for tinnitus with associated hearing loss Chinium Sulfuricum 30c: for tinnitus resulting from ingestion of quinine tablets (common among elderly for nighttime leg cramps) Homeopathic Remedies for Tinnitus Salicylic Acid 30c: for tinnitus resulting from ingestion of high dosage of aspirin Natrum Salicylicum 30c: may be beneficial if tinnitus present as a low, dull hum; loss of hearing and vertigo may also be present Lycopodium 6c: may be beneficial to tinnitus present as humming and roaring along with impaired hearing Supplements for Tinnitus and Hearing Loss Cobalamin (vitamin B12): patients with tinnitus and noise-induced hearing loss have demonstrated significant vitamin B-12 deficiency

Shemesh, Z., Attias, J., Ornan, M., Shapira, N., Shahar, A. (1993). Vitamin B12 deficiency in patients with chronic-tinnitus and noise-induced hearing loss. American Journal of Otolaryngology, 14, 94-99. Magnesium: low levels of magnesium are associated with noise-induced hearing loss; supplementation with magnesium has been shown to prevent noise-induced hearing loss

Attias, J., Weisz, G., Almog, S., Shahar, A., Wiener, M., Joachims, Z., Netzer, A., Ising, H., Rebentisch, E., Guenther, T. (1994). Oral magnesium intake reduces permanent hearing loss induced by noise exposure. American Journal of Otolaryngology, 15, 26-32. Supplements for Tinnitus and Hearing Loss Determination of vitamin B12 status in individuals with tinnitus and noise-induced hearing loss is warranted. If low, supplement with 2,000 mcg daily for 1 month, followed by 1,000 mcg daily thereafter (sublingual methylcobalamin is preferred form). Take with folic acid. 200 mg of magnesium daily (as magnesium aspartate) is safe and effective in preventing noise-induced hearing loss. Supplements for Tinnitus and Hearing Loss Vinpocetine, an extract of the Periwinkle plant, has shown possible benefit in the treatment of tinnitus. For more info.: http://www.bixby.org/faq/tinnitus/treatmnt.html#vinpocetine http://www.vinpocetine.net/Articles/vin_aug2000. htm


 * Other Tx Alternatives for Tinnitus**

Use of low-pitch sound to mask high-pitch tinnitus: http://www.hearinglossweb.com/Medical/Tinnitus/ low.htm

Basic Gemmotherapeutic Treatment: Sorbus Domestica