Tinnitus FAQ
www.bixby.org/faq/tinnitus.html
a resource for understanding tinnitus,
not a substitute for a health care provider
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Tinnitus FAQ |
www.bixby.org/faq/tinnitus.html
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| Quick Directory |
How Can I Avoid Getting Tinnitus?
What About Hearing Protection?
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| What Are Some Ototoxic Drugs? |
All tinnitus sufferers should ask their physician and/or pharmacist about the potential for ototoxic side effects BEFORE starting a new prescription. [Ed. Note: Before starting any prescription, I suggest only getting a few days ' amount of the prescription. If you have any adverse side effects, at least you will not have spent unnecessary money on a full prescription.]
In her book When the Hearing Gets Hard (Insight Books 1993, ISBN
0-306-44505-0), author Elaine Suss names several potentially ototoxic substances.
She lists them in three categories:
(1) substances that most physicians consider ototoxic;
(2) substances that many physicians consider potentially ototoxic; and
(3) substances that may be ototoxic in rare cases.
The ototoxic effects of the substances in the third group are considered to be reversible--the effects diminish when you stop taking the drug. Ms. Suss does not list dosages.
First Group
The first group includes a few antibiotics and several diuretics. Not being a physician, I don't recognize them all, though Capreomycin, Gentamicin , Kanamycin, Neomycin, Streptomycin, Tobramycin sulphate, Vancomycin, and Viomycin are obviously antibiotics. Ms. Suss mentions that Streptomycin is used only for certain cases of tuberculosis.
The first group also includes aspirin--ototoxic at higher doses and whose effects are usually reversible--and other salicylates such as Oil of Wintergreen (Ben Gay). The other substances in the first group are: Amikacin, Amphotericin B (Fungizone), Bumetanide (Bumex), Carboplatin (Paraplatin), Chloroquine (Aralen), Cisplatin (Platinol), Ethacrynic acid (Edecrin), Furosemide (Lasix), and Hydroxychloroquine (Plaquenil).
Second Group
The second group includes the analgesic Ibuprofen (Advil) and the tricyclic anti-depressant Imipramine (Tofranil), along with Chloramphenicol (Chloromycetin), lead, and quinine sulphate.
Third Group
The third group includes alcohol, toluene, and trichloroethylene, as well as Chlordiazepoxide (Librium), Chlorhexidene (Phisohex, Hexachlorophene), Ampicillin, Iodoform, Clemastin fumarate (Tavist), Chlomipramine hydrochloride (Anafranil), and Chorpheniramine Maleate (Chlor-trimeton and several others).
Physicians Desk Reference
Ms. Suss points out that the Physicians Desk Reference (PDR) did not list ototoxic drugs until the 1989 and later editions. She refers to a separate document, Drug Interactions and Side Effects Index, which is keyed to the PDR. She then points out that the Index is incomplete: several problem drugs are not listed there.
Although the lists of ototoxic drugs are useful, I cannot recommend this book to tinnitus sufferers in general because it is devoted almost entirely to the problems of the hearing impaired and methods for ameliorating them. The book mentions tinnitus primarily as a precursor to hearing loss. (I do not believe that is the general case.)
The book Tinnitus: Diagnosis/Treatment (Lea & Febiger, 1991, ISBN 0-8121-1121-4) adds that ototoxic symptoms may arise days or even weeks after the termination of aminoglycoside antibiotics. Some of the aminoglycosides not listed above are Netilmycin and Erythromycin. Other trouble antibiotics include Colistimethate, Doxycycline and Minocycline.
Drugs with Tinnitus Side Effects
The following is a list of drugs that have demonstrated Tinnitus side effects as indicated in the 1995 Physicians Desk Reference and distributed by the American Tinnitus Association:
Accutane [less than 1%] Mazicon [less than 1%] Acromycin V Meclomen [greater than 1%] Actifed with Codiene Cough Syrup Methergine [rare] Adalat CC [less than 1%] Methotrexate [less common] Alferon N [one patient] Mexitil [1.9% to 2.4%] Altace [less than 1%] Midamor [less than or equel to 1%] Ambien [infrequent] Minipress [less than 1%] Amicar [occasional] Minizide [rare] Anatranil [4-5%] Mintezol Anaprox and Anaprox DS [3-9%] Moduretic Anestacon [among most common] Mono-Cesac Ansaid [1-3%] Monopril [0.2-1%] Aralen Hydrochloride [one Patient] Monopril [0.2-1%] Arithritis Strength BC Powder Motrin [less than 3%] Asacol Mustargen [infrequent] Ascriptin A/D Mykrox [less than 2%] Ascriptin Nalfon [4.5%] Asendin [less than 1%] Naprosyn [3-9%] Asperin [among most frequent] Nebcin Atretol Neptazane Atrofen Nescaine Atrohist Plus Netromycin Azactam [less than 1%] Neurontin [infrequent] Azo Gantanol Nicorette Azo Gantrisin Nipent [less than 3%] Azulfidine [rare] Nipride BC Powder Noroxin Bactrim DS Norpramin Bactrim I.V. Norvasc [0.1-1%] Bactrim Omnipaque [less than 0.1%] Blocadren [less than 1%] Omniscan [less than 1%] Buprenex [less than 1%] Ornade BuSpar [frequent] Orthoclone OKT3 Cama Orudis [greater than 1%] Capastat Sulfate Oruvail [greater than 1%] Carbocaine Hydrochloride P-A-C Analgesic Cardene [rare] PBZ Cardioquin Pamelor Cardizem [less than 1%] Parnate '' CD [less than 1%] Paxil [infrequent] '' SR [less than 1%] Pedia-Profen [greater than 1% less than 3%] Cardura [1%] Pediazole Cartrol [less common] Penetrex [less than 1%] Cataflam [1-3%] Pepcid [infrequent] Childrens Advil [less than 3%] Pepto-Bismol Cibalith-S Periactin Cinobac [less than 1 in 100] permax [infrequent] Cipro [less than 1%] Phenergan Claritin [2% or less] Phrenilin [infrequent] Clinoril [greater than 1%] Piroxicam [1-3%] Cognex Plaquenil Corgard [1-5 of 1000 patients] Platinol Corzide [ '' ] Plendil [0.5% or greater] Cuprimine [greater than 1%] Pontocaine Hydrochloride Cytotec [infrequent] Prilosec [less than 1%] Dalgan [less than 1%] Primaxin [less than 2%] Dapsone USP Prinvil [0.3-1%] Daypro [greater than 1% less than 3%] Prinzide [0.3-1%] Deconamine Procardia [1% or less] Demadex ProSam [infrequent] Depen Titratable Proventil [2%] Desferal Vials Prozac [infrequent] Desyrel & Desyrel Dividose [1.4%] Questran Diamox Quinaglute Dilacor XR Quinamm Dipentum [rare] Quinidex Diprivan [less than 1%] Q-vel Muscle Relaxant Pain Reliever Disalcid Recombivax HB [less than 1%] Dolobid [greater than 1% in 100] Relafen [3-9%] Duranest Rheumatrex Methotrexate [less common] Dyphenhydramine [Nytol, Benydrl, etc] Rifater Dyclone Romazicon [less than 1%] Dasprin Ru-Tuss Easprin Rythmol Ecotrin Salflex Edecrin Sandimmune [2% or less] Effexor [2%] Sedapap [infrequent] Elavil Sensorcaine Eldepryl Septra Emcyt Sinequan [occasional] Emla cream Soma Compound Empirin with Codiene Sporanox [less than 1%] Endep Stadol [3-9%] Engerix-B Streptomycin Sulfate Equagesic Sulfadiazine Esgic-plus [infrequent Surmontil Eskalith Talacen [rare] Ethmozine [less than 2%] Talwin [rare] Etrafon Tambocor [1% or less than 3%] Fansidar Tavist and Tavist-D Feidene [1-3%] Tegretol Fioricat with Codeine [infrequent] Temaril Flexeril [less than 1%] Tenex [3% or less] Floxin [less than 1%] Thera-Besic Foscavir [1-5%] Thiosulfil Forte Fungijzone Ticlid [0.5-1%] Ganite Timolide Gantanol Timoptic Gantrisin Tobramycin Garamycin Tofranil Glauctabs Tolectin [1-3%] HIVID [less than 1%] Tonocard [0.4-1.5%] Halcion [rare] Toprol XL Hyperstat Toradol [1% or less] Hytrin [at least 1%] Torecan Ibuprofen [less than 3%] [Advil, etc.} Trexan Ilosone Triaminic Imdur [less than or equal to 5%] Triavil Indocin [greater than 1%] Trilisate [less than 20%] Intron A [up to 4%] Trinalin Repetabs Kerione [less than 2%] Tympagesic Ear Drops Lariam [among most frequent] Ursinus Lasix Vancocin HCI [rare] Legatrin Vantin [less than 1%] Lncocin [occasional] Vascor [up to 6.52%] Lioresal Vaseretic [0.5-2%] lithane Vasotec [0.5-1%] Lithium Carbonate Vivactil Lithobid Voltqaren [1-3%] Lithonate Wellbutrin Lodine [greater than 1% less than 3%] Xanax [6.6%] Lopressor Ampuis Xylocaine [among most common] Lopressor DCT [1 in 100] Zestril '0.3-1%] Lopressor Zestoretic [0.3-1%] Loreico Ziac Lotensin HCT [0.3-1%] Zoleft [1.4%] Ludiomil [rare] Zosyn [less than 1%] MZM [among most frequent] Zyloprim [less than 1%] Magnevist [less than 1%] Marinol (Dronabinol) [less than 1%] Risperdal [rare] Marcaine Hydrochloride Marcaine Spinal Maxaquin [less than 1%]
Your physician should always be consulted about questions before any changes are made in your medication.
The absence of incidence data means there was none given, and/or it is unknown.
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| How Can I Avoid Getting Tinnitus? |
Avoid the causes listed above. Really. The number one cause of tinnitus is exposure to excessively loud noise. Either avoid these noisy situations, or wear hearing protection as described below. Rock concerts, movie theaters, nightclubs, construction sites, guns, power tools, stereo headphones and musical instruments are just some of the things that can be hazardous to your ears. Damage can result from either a single exposure or cumulative trauma. There are "tough" ears, and there are "weak" ears; what may be safe or dangerous for one individual may not be the same for you. If you ever experience temporary ringing after a sound exposure, YOU ARE AT A SEVERE RISK FOR TINNITUS AND/OR HEARING LOSS.
If you already have tinnitus, educate your family, friends, and neighbors so that they can keep their ears healthy.
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| What About Hearing Protection? |
Wearing ear plugs protects your ears from new damage as well as allowing them to rest without external stimuli. Noise attenuation may vary by frequency, so if you're a musician you may want to shop around for ear protection with fairly flat frequency response. Hearing protection devices are assigned Noise Reduction Ratings (NRRs) by their manufacturers under laboratory conditions and may not reflect Real World performance. Most plugs average around 20dB of noise reduction. Maximal noise reduction (about 50dB NRR) can be achieved by wearing canal plugs in combination with muffs, but *some* noise will still be perceived via bone conduction of the skull in extremely loud situations. The following classes of hearing protection devices are available:
Antecdotal Report Concerning Musician's Ear Plugs |
| Now for my 2 cents worth. I am an acoustic engineer working for the British
Broadcasting Corporation (BBC). Although my main job is designing studios,
I also act as a consultant on noise at work legislation. In that capacity
I work on the safety of people listening professionally on earphones and
loudspeakers, and also musicians in the several orchestras which the BBC
maintains. So I am interested in such items as musicians earplugs.
We intend to conduct, in the near future, a trial of the filtered musicians' earplugs that you refer to, and I can therefore fill out a bit of information on these. The ones we intend to use are type ER15 from Etymotic Research. These have an attenuation of 15dB, largely independent of frequency. (As far as I can find out, these are the only plugs claiming "flat attenuation" for which independent lab reports of attenuation are available. Of course you must have such a report if you're going to use the plugs for industrial safety purposes.) Etymotic Research (they like to pronounce the "o" long, as in rose, by the way, and print it with a line over the top, but I think they're fighting a losing battle on this one) also make a non-individually moulded "constant attenuation" plug, the ER20. However a close examination of its attenuation vs. frequency characteristic shows that it is really not all that different from more ordinary plugs. Despite this, some musicians report finding it useful. Its overwhelming advantage is that it comes at about 10UKP per pair! I can confirm the address you give for Etymotic Research. They are probably the best people to approach for details of suppliers in the American continent, as they will be up to date with changes.In the UK, the distributor is:
MBS Medical Ltd
The main distributor for Europe is in Holland: A large scale research programme on the use of flat attenuation earplugs with the Dutch Philharmonic Orchestra has recently been carried out by Dr Van Hees of Amsterdam University. I believe the findings will be made public soon, and I will post you if they are relevant. I have had a pair of these ER15 plugs moulded for myself, to see what it's like both having the moulds made and wearing them. The ears must first be checked for wax, which must be dissolved out in the usual way if excessive. Soft putty-like material is then put in the ears to make the mould. This is slightly uncomfortable, but certainly not painful. The moulds are then sent away to have the plugs made. For Europe, the plug manufacture is done by Elcea in Holland, who have a special apparatus for determining when the hole is the correct diameter. The filters are small flat devices which clip on to the outside of the plugs. The plugs are reasonably comfortable in use, although my own ear canals are very narrow and most earplugs don't fit me well. To give the flattest attenuation characteristic, the plugs go somewhat deeper into the ear than an ordinary hearing-aid earpiece. Early reports indicate that although their attenuation is less than that of other plugs, it is still too much for some musicians. It is possible that a lower attenuation plug will be available in future. Although my own work with musicians mainly involves symphony orchestras, musicians who work on stage in shows and rock concerts are probably at higher risk, due to high levels of sound from "foldback" loudspeakers. Listening using small in-ear earphones (which may possibly be individually moulded) can reduce the required foldback sound level, as the earphones keep out a lot of the external sound. Systems: Etymotic Research make high quality (but expensive) earphones which may be used for this purpose - type ER4. A well known system of this type, usually using a radio link to the performer, is The Radio Station. Manufacturer:
Garwood Communications No doubt I have gone on about some of my pet subjects at excessive length, but I hope you may find something useful here. I must, of course, say that my views are entirely my own and must not be quoted as the BBC's. |
Ear Muffs
These over the ear devices are more comfortable than canal plugs, and have NRRs that range from 23-29dB. But they are very bulky and obviously can't be worn discretely.
Active Sportsman's Ear Muffs
These are active (possibly amplifying), powered devices that pass normal levels of sound, but will attenuate extremely loud impulse-type noises similar to gunshots, etc. They are typically sold through gun catalogs and sporting goods stores, and when used in combination with plugs can achieve near-maximal NRRs of about 50dB. Note that amplified muffs actually have a negative NRR, which is one indication that the NRR doesn't tell the whole story for "impulse" noise such as gunshots. These muffs detect impulse noise and turn off the amplification in time to keep that noise from reaching the ear through the electronics.
The following is a first-hand account of active muff performance:
Antecdotal Report Concerning Electronic Muffs |
| Date: 16 Apr 1992 8:36 EDT Subject: Re: electronic muffs Having just purchased a set of Peltor Tactical 7-S active muffs from Dillon Precision, I'll add my two cents to the conversation. The T7-S's are stereo electronic muffs with a microphone on the front of each ear cup. They seem to be pretty sturdy in construction. One cup contains a circuit board covered with surface-mount parts and some trim pots. The other contains a nine-volt battery accessible from an outside door (there may also be a small circuit board in there, too). Each contains a small speaker, and the two are connected via a cable that crosses through the headband. There is a single gain control that is switched to provide the on/off function. Side-to-side balance is adjustable by one of the trim pots. A small concern I have is that the foam mic covers may come to harm while being jostled around in my range bag. I had originally thought (from where, I don't know) that the circuit amplified sound according to the gain control, and shut off completely noises above 85dB. In fact, the unit never actually shuts down, or if it does the switching is so quick and quiet that it gets lost in the muffled sounds coming through the muff's cups. There is constant compression, so that soft sounds are boosted, and loud sounds are limited to 85dB or less. The effect is strange at first, because you don't think there's much muffling being done, but believe me, you can find out real quick that the things work very well indeed. I used the muffs at an outdoor .22 silhouette match, then later in the day at a large indoor range where we were shooting .45 ACP and light .44 mag loads. At the match, they worked great. I could hear the spotters, the range officer, and all the others. I really didn't have a problem with distractions as another poster stated. The only "problem" I had was that at high gain I could easily hear the road noise of cars and trucks passing by about a quarter-mile away. The muffs seem to preserve directional information, since I don't remember having any problems locating sounds (like the CLANK when a ram fell over 100 yards away). The indoor range seemed a little different. Gunshots sounded a bit more veiled, whereas outdoors they just sounded lower in intensity. Voices were still easy to hear, but also sounded funny, so it was probably the echo in the large room. For grins, I tried the T7-S's at the indoor range without turning the active circuitry on, and swapped back and forth between them and some Silencio Magnum CDS-80 passive muffs (rated at -29dB -- my previous regular muffs). In an inactive state, the TS-7's were at least as effective as the Silencios. Further, the sound of the shots was perceived as being about an octave lower through the inactive T7-S's than through the Silencios. This was much more pleasant over the long run. In fact, my buddy, who was also wearing CDS-80's, said that his ears were starting to hurt by the end of our indoor range time. Mine were fine. (BTW, said buddy tried the T7-S's for a few minutes at each place -- he's ordering his today.) I tried sitting in a very quiet room with the muffs turned way up. I could hear my dog breathing in another room, and ripples on the surface of a small, nearby aquarium sounded like a set of river rapids. I could hear my own breathing quite clearly, and the cloth of my shirt rustling as it rose and fell. At really high gain, there was some whitish noise that was either the residual noise of the amplifiers, or the movement of air in the room. The muffs are very comfortable. I wore them most of the day with no problem. The ear seals are soft yet firm, and are probably more comfortable than the Magnum CDS-80's. The seals and inner foam pads are easily removable and replaceable. The rather sparse instruction manual suggests replacing them once or twice a year for hygienic reasons. All in all, I really like these muffs. It would be difficult to go back to passive protection after being able to hear "normally" while shooting. Dillon currently has the T7-S's on sale for $129.95. Regular price is $170. I have no connection with Dillon or Peltor save being a satisfied customer. |
Addendum to Above Antecdotal Report |
| Date: 5 Jul 1994 13:39 EDT Subject: Re: muffs review The battery should be a nine-volt alkaline, and it will probably last 10-30 hours (depending on gain setting used) before you'll notice a drop in volume. I have used the muffs while mowing (with a gasoline-powered mower), and with noisy power tools (like a circular saw), and they really help. Your ears do get a bit warm and sweaty on a hot day, however. Finally, I have seen pictures of new(?) Peltor muffs on which the foam mic covers were replaced by hard plastic grids. These might be an improvement. |
Some Hearing Protection Vendors
Westone Labs
P.O. Box 15100
Colorado Springs, CO 80935
USA
+1 800 525 5071 URL-
http://www.earmold.com/
Sells custom plugs.
Praised on rec.guns have been the "Max" earplugs and Peltor Ultimate 10 muffs. Dillon's "stealth" catalog, The Blue Press is available at no charge.
Sells musician's earplugs offering about 15dB of flat attenuation.
*****[product #, price, manufacturer, phone number, NRRs?]*****
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