Ear disorders

Note
: Below is a list of integrative therapies that have been studied or used traditionally or theoretically to treat a variety of ear disorders.

B

Good scientific evidence

• Iodine
  : Iodine is an element that the human body needs to make thyroid hormones. Chronic iodine deficiency can cause many health problems such as thyroid gland dysfunction and many neurologic, gastrointestinal, and skin problems. Hearing loss may occur in people who have iodine deficiencies. Continuous supplementation with iodine may help improve hearing loss.
• Reactions to iodine can be severe, and deaths have occurred after exposure to the element. Avoid iodine-based products if allergic or hypersensitive to iodine. Do no use for longer than 14 days. Avoid Lugol solution and saturated solution of potassium iodide (SSKI, PIMA) with high amounts of potassium in the blood, pulmonary edema (fluid in the lungs), bronchitis, or tuberculosis. Use cautiously when applying to the skin because it may irritate or burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction. Iodine is safe in recommended doses for pregnant or breastfeeding women. Avoid povidone-iodine for perianal preparation during delivery or postpartum antisepsis.

C

Unclear or conflicting scientific evidence

• Acupuncture
  : It is unclear if acupuncture can help treat patients with hearing loss. Early evidence suggests that deep needling acupuncture may be more effective in treating sudden deafness than shallow needling. However, better-designed trials are needed to reach a firm conclusion.
• Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, medical conditions of unknown origin, or infections. Acupuncture should not be applied to the chest in patients with lung diseases or on any area that may rely on muscle tone to provide stability. Avoid use in infants, young children, or in patients with needle phobias. Use cautiously with bleeding disorders, neurological disorders, seizure disorders, or diabetes. Use cautiously in the elderly or medically compromised patients. Use cautiously in patients who will drive or operate heavy machinery after acupuncture. Use cautiously if taking blood thinners. Avoid if pregnant.
• Applied kinesiology
  : Applied kinesiology (AK) uses muscle strength testing to identify nutritional deficiencies and health problems. Those that practice applied kinesiology believe that weakness in certain muscles corresponds to specific diseases or body imbalances. Early research suggests that symptoms of vertigo associated with Meniere's disease may improve with rotational exercises. Further evidence is needed before a conclusion can be made.
• Applied kinesiology techniques in themselves are harmless. However, medical conditions should not be treated with applied kinesiology alone. Applied kinesiology should not delay appropriate medical treatment.
• Art therapy
  : Art therapy involves many forms of art to treat anxiety, depression, and other mental and emotional problems. An art therapist helps a patient use many different types of artistic expression during art therapy. Drawing, painting, and sculpting are just a few examples of techniques that are used. Art therapy is practiced in hospitals, clinics, public and community agencies, wellness centers, educational institutions, businesses, and private practices. There is limited evidence suggesting that art therapy may be a beneficial treatment for phonological disorders in children. However, more studies are needed to determine the meaning of these findings.
• Because art therapy may stir up distressing thoughts or feelings, it should be used under the guidance of a qualified art therapist or mental health professional. Related materials, such as turpentine or mineral spirits, should be used in areas with good ventilation because they release potentially toxic fumes.
• Belladonna
  : Belladonna has been used for centuries to treat many medical conditions. Little reliable research is available on the use of belladonna for otitis media. Until additional studies are performed, it remains unknown if this is an effective treatment.
• Avoid if allergic to belladonna or plants of the Solanaceae
  (nightshade) family (such as bell peppers, potatoes, or eggplants). Avoid with a history of heart disease, high blood pressure, heart attack, abnormal heartbeat, congestive heart failure, stomach ulcer, constipation, stomach acid reflux, hiatal hernia, gastrointestinal disease, ileostomy, colostomy, fever, bowel obstruction, benign prostatic hypertrophy (enlarged prostate), urinary retention, glaucoma (narrow angle), psychotic illness, Sjögren's syndrome, dry mouth, neuromuscular disorders (such as myasthenia gravis), or Down's syndrome. Avoid if pregnant or breastfeeding.
• Calendula
  : Calendula, also known as marigold, has been widely used on the skin to treat minor wounds, skin infections, burns, bee stings, sunburn, warts, and cancer. Calendula has been studied for reducing pain caused by otitis media. Some human studies suggest that calendula may possess mild anesthetic (pain-relieving) properties equal to those of similar non-herbal eardrop preparations. Further studies are needed before a recommendation can be made in this area.
• Use cautiously if allergic to plants in the Aster/Compositae family (such as ragweed, chrysanthemums, marigolds, or daisies). Use cautiously while driving or operating machinery. Avoid if pregnant or breastfeeding.
• Chiropractic, Spinal Manipulative Therapy, Spinal Manipulation
  : Chiropractic care focuses on how the relationship between musculoskeletal structure (mainly the spine) and bodily function (mainly nervous system) affects health. Chiropractors use many techniques, including spinal manipulative therapy, diet, exercise, X-rays, and other techniques. Although ear infections are treated with chiropractic manipulation with some success, well-designed clinical trials have not yet been conducted. Presently, there is insufficient evidence to support the use of chiropractic manipulation for the treatment of otitis media in children.
• Avoid with vertebrobasilar vascular insufficiency, aneurysms, arteritis, or unstable spondylolisthesis. Avoid use on post-surgical areas of para-spinal tissue. Use cautiously with acute arthritis, brittle bone disease, conditions that cause decreased bone mineralization, bleeding disorders, migraines, or if at risk of tumors or metastasis of the spine. Use extra caution during cervical adjustments. Avoid if pregnant or breastfeeding due to a lack of scientific data.
• Coenzyme Q10
  : More research is needed in patients with tinnitus with low levels of CoQ10 before a conclusion can be made.
• Allergy associated with coenzyme Q10 supplements has not been reported in the available literature, although rash and itching have been reported rarely. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk and do not use immediately after these procedures. Use caution with a history of blood clots, diabetes, high blood pressure, heart attack, or stroke, or with anticoagulants (blood thinners), antiplatelet drugs (like aspirin, warfarin, clopidogrel (like Plavix®), or blood pressure, blood sugar, cholesterol or thyroid drugs. Avoid if pregnant or breastfeeding.
• Danshen
  : Danshen (Salvia miltiorrhiza) is widely used in traditional Chinese medicine (TCM), often in combination with other herbs. Limited evidence suggests that danshen in combination with other herbs and supplements may be a less effective treatment for tinnitus than acupuncture. Additional research is needed to fully understand danshen's effects on tinnitus.
• Avoid if allergic or hypersensitive to danshen. Use cautiously with altered immune states, arrhythmia, compromised liver function or a history of glaucoma, stroke, or ulcers. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Use cautiously if driving or operating heavy machinery. Avoid if taking blood thinners (anticoagulants), digoxin, or hypotensives including ACE inhibitors such as captopri, or Sophora subprostrata root or herba serissae. Avoid with bleeding disorders, low blood pressure, and following cerebal ischemia. Avoid if pregnant or breastfeeding.
• Folate
  : Folate and folic acid are forms of a water-soluble B vitamin. Folate occurs naturally in food and folic acid is the synthetic form of this vitamin. Folic acid supplementation was shown to slow the decline in hearing of speech frequencies associated with aging in a population from a country without folic acid fortification of food. The effect of folate on age-associated hearing decline requires confirmation, especially in populations from countries with folic acid fortification programs.
• Avoid if allergic or hypersensitive to folate or any folate product ingredients. Use cautiously if receiving coronary stents and with anemia and seizure disorders. It is recommended that pregnant women consume 400 micrograms of folate daily in order to reduce the risk of fetal defects. Folate is likely safe if breastfeeding.
• Ginkgo
  :
  Ginkgo biloba has been used medicinally for thousands of years. Early research has been conducted on the effect of ginkgo in chronic cochleovestibular (relating to parts of the ear) disorders. Further research is needed before a conclusion can be made on the effectiveness of ginkgo for cochlear deafness. Ginkgo has also been studied as a possible treatment for tinnitus. However,
  results are conflicting. Additional well-designed research is needed to make a conclusion.
• Avoid if allergic or hypersensitive to members of the Ginkgoaceae
  family.
  If allergic to mango rind, poison sumac, poison ivy, poison oak, or cashews, then allergy to ginkgo is possible. Avoid if taking anticoagulants due to an increased risk of bleeding. Ginkgo should be stopped two to three weeks before surgical procedures. Use cautiously with seizures or in children. Ginkgo seeds are dangerous and should be avoided. Skin irritation and itching may also occur due to ginkgo allergies. Do not use ginkgo in supplemental doses if pregnant or breastfeeding. There is conflicting research regarding the use of ginkgo for tinnitus. Additional well-designed research is needed in order to resolve this controversy.
• Hypnotherapy, hypnosis
  : Hypnosis is a trance-like state in which a person becomes more aware and focused and is more open to suggestion. Hypnotherapy has been used to treat health conditions and to change behaviors. It remains unknown if hypnotherapy can effectively treat tinnitus. Study results are conflicting and additional well-designed research is needed.
• Use cautiously with mental illnesses (e.g. psychosis/schizophrenia, manic depression, multiple personality disorder, or dissociative disorders) or seizure disorders.
• Kudzu
  : Kudzu has been traditionally used in China to treat alcoholism, diabetes, gastroenteritis, and deafness. Kudzu was used in clinical study to treat sudden nerve deafness. Additional evidence is needed to confirm these results.
• Avoid if allergic to kudzu, its constituents, or members of the Fabaceae/Leguminosae family. Avoid if taking methotrexate. Use cautiously if taking blood thinners, drugs that treat diabetes, benzodiazepines, bisphosphonates, mecamylamine, neurologic agents, drugs that have estrogenic activity, drugs that lower blood pressure, or drugs that are broken down by the liver. Avoid if pregnant or breastfeeding, due to a lack of safety evidence.
• Lavender
  : Oils from lavender flowers are used in aromatherapy, baked goods, candles, cosmetics, detergents, jellies, massage oils, perfumes, powders, shampoo, soaps, and teas. A small clinical trial used a naturopathic eardrop called NHED (containing Allium sativum, Verbascum thapsus, Calendula flores, Hypericum perfoliatum, lavender, and vitamin E in olive oil) with and without an antibiotic and topical anesthetic. It was found that ear pain was self-limiting and resolved after a few days with or without antibiotics. This evidence is early, and further research is needed before any conclusion about this treatment can be made.
• Avoid if allergic or hypersensitive to lavender. Avoid with a history of seizures, bleeding disorders, eating disorders (such as anorexia or bulimia), or anemia (low levels of iron). Avoid if pregnant or breastfeeding.
• Magnet therapy
  : The use of magnets to treat illness has been described historically in many civilizations. In modern times, magnetic fields play an important role in Western medicine, including use for magnetic resonance imaging (MRI), pulsed electromagnetic fields, and experimental magnetic stimulatory techniques. There are several small studies that have investigated the use of electromagnetic stimulation for tinnitus. Some trials reported no benefits, while other study reported significant improvements in symptom severity. Most research in this area has not been well designed or reported, and it remains unclear if magnet therapy is useful for this condition.
• Avoid with implantable medical devices, such as heart pacemakers, defibrillators, insulin pumps, or hepatic artery infusion pumps. Avoid with myasthenia gravis or bleeding disorders. Avoid if pregnant or breastfeeding. Magnet therapy is not advised as the sole treatment for potentially serious medical conditions, and it should not delay the time to diagnosis or treatment with more proven methods. Patients are advised to discuss magnet therapy with a qualified healthcare provider before starting treatment.
• Mullein
  : Mullein (Verbascum thapsus) has been used in natural medicine for centuries and is among the oldest known medicinal plants. There are some clinical studies using mullein in combination with other herbal products as an eardrop to treat earaches caused by ear infections. It is not clear what the effects of mullein alone are on ear infections because the product studied was a combination of different herbal products. Additional study is needed before a conclusion can be made regarding use of mullein for earache associated with acute otitis media.
• Avoid if allergic/hypersensitive to mullein (Verbascum thapsus), its constituents, or any of the Scrophulariaceae (figwort) family. Use cautiously if taking anticoagulants (bloodthinners). There are reports that mullein may contain a toxin called rotenone, which is an insecticide. Avoid if pregnant or breastfeeding.
• Music therapy
  : Specially designed music therapy may help improve symptoms of tinnitus. More research is needed. Music therapy is generally known to be safe.
• Noni
  : Noni (Morinda citrifolia) is a traditional folk medicinal plant that has been used for more than 2,000 years in Polynesia. Noni juice has been used for many years for a wide variety of indications in Southeast Asia, and noni juice may improve hearing in patients with hearing loss. Although results are promising, additional research is warranted in this area.
• Avoid if allergic to noni, its constituents, or any plants in the Rubiaceae family. Use cautiously if taking oral agents, anticoagulants (blood thinners), antivirals, blood pressure-lowering drugs, or immunosuppressants. Use cautiously with injuries, low blood pressure, HIV/AIDS, liver problems, gastrointestinal disorders and obstructions, or kidney problems. Use cautiously after surgery. Avoid if pregnant or breastfeeding.
• Physical therapy
  : The goal of physical therapy is to improve mobility, restore function, reduce pain, and prevent further injury. A variety of techniques, including exercises, stretches, traction, electrical stimulation, and massage, are used during physical therapy sessions. There is limited study on the effects of physical therapy in tinnitus. Limited available study found that acupuncture showed more benefit on reducing the severity of tinnitus and improving quality of life than physical therapy. More study is needed in this area.
• Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with their qualified healthcare professionals before beginning any treatments. Based on the available literature, physical therapy appears generally safe when practiced by a qualified physical therapist. However, physical therapy may aggravate some pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
• Probiotics
  : Probiotic capsules (containing Lactobacillus rhamnosus GG and LC705, Bifidobacterium breve 99, and Propionibacterium freudenreichii JS) were not shown to protect against ear infections in children. More research is needed to confirm these findings.
• Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiency.
• Relaxation therapy
  : Relaxation techniques include behavioral therapeutic approaches that differ widely in philosophy, methodology, and practice. The primary goal is usually non-directed relaxation. In preliminary studies, relaxation therapy has been associated with benefits for patients with tinnitus. Further research is needed to confirm these results.
• Avoid with psychiatric disorders such as schizophrenia/psychosis. Jacobson relaxation (flexing specific muscles, holding that position, and then relaxing the muscles) should be used cautiously with illnesses such as heart disease, high blood pressure, or musculoskeletal injury. Relaxation therapy is not recommended as the sole treatment approach for potentially serious medical conditions, and it should not delay the time to diagnosis or treatment with more proven techniques.
• Rutin
  : Rutin is a yellow crystalline flavonol glycoside (C27H30O16) that is found in various plants, especially the buckwheat plant, black tea, apple peels, onions, and citrus. Early study results support the use of O-(beta-hydroxyethyl)-rutosides for reduction of symptoms associated with Meniere's syndrome. Additional study is warranted in this area.
• Avoid if allergic/hypersensitive to O-(beta-hydroxyethyl)-rutosides or plants that rutin is commonly found in, such as rue, tobacco, or buckwheat. Use cautiously in elderly patients. Use cautiously with skin conditions. Use cautiously if taking diuretics, anti-coagulants, or medications used to treat edema. Use cautiously if pregnant or breastfeeding.
• Sanicle
  : Sanicle has been studied as a treatment for recurrent otitis media. More evidence is needed before a conclusion can be made.
• Avoid if allergic or sensitive to sanicle. Use cautiously with stomach problems. Use cautiously if taking blood pressure-lowering or diuretic drugs. Avoid if pregnant or breastfeeding.
• Tai chi
  : Early scientific evidence suggests that tai chi may be helpful as an adjunct treatment to regular vestibular rehabilitation programs. Tai chi may improve body stability and footfall stability. More studies are needed on the effects of tai chi for vestibulopathy.
• Avoid with severe osteoporosis or joint problems, acute back pain, sprains, or fractures. Avoid during active infections, right after a meal, or when very tired. Some believe that visualization of energy flow below the waist during menstruation may increase menstrual bleeding. Straining downwards or holding low postures should be avoided during pregnancy, and by people with inguinal hernias. Some tai chi practitioners believe that practicing for too long or using too much intention may direct the flow of chi (qi) inappropriately, possibly resulting in physical or emotional illness. Tai chi should not be used as a substitute for more proven therapies for potentially serious conditions. Advancing too quickly while practicing tai chi may increase the risk of injury.
• Yoga
  : Yoga is an ancient system of relaxation, exercise, and healing with origins in Indian philosophy. It is unclear whether yoga therapy may improve tinnitus. Although relaxation may theoretically benefit this condition, additional research is needed before a recommendation can be made.
• Yoga is generally considered to be safe in healthy individuals when practiced appropriately. Avoid some inverted poses with disc disease of the spine, fragile or atherosclerotic neck arteries, extremely high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, cervical spondylitis, or if at risk for blood clots. Certain yoga breathing techniques should be avoided with heart or lung disease. Use cautiously with a history of psychotic disorders. Yoga techniques are believed to be safe during pregnancy and breastfeeding when practiced under the guidance of expert instruction. However, poses that put pressure on the uterus, such as abdominal twists, should be avoided in pregnancy.
• zinc
  : Zinc formulations have been used since ancient Egyptian times to enhance wound healing. Studies on the efficacy of zinc in treating tinnitus have produced conflicting results. Further research is necessary before a conclusion can be drawn.
• Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride because studies have not evaluated its safety or effectiveness. While zinc appears safe during pregnancy in amounts lower than the established upper intake level, caution should be used because studies cannot rule out the possibility of harm to the fetus.

D

Fair negative scientific evidence

• Acupuncture
  : Scientific evidence suggests that acupuncture is not an effective treatment for tinnitus. Small trials have been conducted and found no benefits over placebo for the treatment of chronic unilateral or bilateral tinnitus. However, non-controlled case series have found possible benefit. Larger studies are needed before a conclusion can be made. Early evidence suggests that deep needling may be more effective in treating sudden deafness than shallow needling. Better-designed trials are needed on the effects of acupuncture for hearing loss.
• Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, medical conditions of unknown origins, or infections. Acupuncture should not be applied to the chest in patients with lung diseases or on any area that may rely on muscle tone to provide stability. Avoid use in infants, young children, or in patients with needle phobias. Use cautiously with bleeding disorders, neurological disorders, seizure disorders, or diabetes. Use cautiously in elderly or medically compromised patients. Use cautiously in patients who will drive or operate heavy machinery after acupuncture. Use cautiously if taking anticoagulants. Avoid if pregnant.
• Reflexology
  : Limited available study suggests that treatment given by a reflexologist is less effective (in terms of number of ear disorders, number of antibiotic treatments, number of sickness days, and duration of ear disorders) than treatment given by a general practitioner for ear infections.
• Avoid with recent or healing foot fractures, unhealed wounds, or active gout flares affecting the foot. Use cautiously and seek prior medical consultation with osteoarthritis affecting the foot or ankle, or severe vascular disease of the legs or feet. Use cautiously with diabetes, heart disease, or the presence of a pacemaker, unstable blood pressure, cancer, active infections, past episodes of fainting (syncope), mental illness, gallstones, or kidney stones. Use cautiously if pregnant or breastfeeding. Reflexology should not delay diagnosis or treatment with more proven techniques or therapies.