Magnesium The Magnificent
Beneficial effects were also found in the human studies. Using double-blind, placebo-controlled methods, Joachims et al. (1993) and Attias et al. (1994) studied military recruits (320 and 300 respectively) who had normal hearing.Here’s the study:
Nearly 16 million Americans are affected by hearing loss, ranging from temporary to permanent or from partial to complete (Bertoni et al. 2001). Hearing loss affects about 30% of all adults ages of 65-74. The percentage increases to 50% for adults by the time they reach age 75-79. Hearing loss is classified as conductive (external or middle ear disorders that block the transmission of sound); sensorineural (disorders of the inner ear or the eighth cranial nerve); mixed (a combination of conductive and sensorineural disorders); and functional (resulting from psychological factors and with no identifiable organic damage). Hearing loss may result from the dysfunction of any part of the auditory system. Possible causes of hearing loss include disease (genetic or infectious), allergies, exposure to noise (either chronic or a single event), ototoxic drugs, polyps, tumors, brain injury, and injury to the cochlear nerve. The most common type of hearing loss in elderly persons is called presbycusis, a term used to describe sensorineural hearing loss that affects people over the age of 50 (i.e., hearing loss generally attributed to the aging process). The specific cause of age-related hearing loss is unknown (Bertoni et al. 2001).
DETECTING HEARING LOSS
Screening for hearing loss is the first step in determining the type and degree of hearing loss. Today’s technology allows hearing screening in a physician’s office to be a quick procedure. In a matter of a few minutes, a screening audiometer can identify patients who need to be referred to an otolaryngologist or audiologist for further examination.
Many elderly patients are reluctant to admit a loss of hearing because of embarrassment or fear. Often, if the hearing loss does not affect speech frequencies, the patient may not be aware of it (Bertoni et al. 2001). It is extremely important that adults over the age of 65 be screened regularly. A study of elderly patients has shown that untreated hearing loss increases psychosocial difficulties and reduces functional health. These physical and psychological problems might be easily avoided by treating the problem of hearing loss properly (Anon. 2000).
Amplification provided by a hearing aid is the best rehabilitative strategy for some types of hearing loss that cannot be treated medically or surgically. Many hearing-impaired patients can be significantly helped through hearing aids, assistive listening devices, and rehabilitation. Hearing aids have evolved from cumbersome, highly visible devices to amazingly sophisticated, discreet minicomputers (AMA 1989). There are more than 1000 models of hearing aids available. An audiologist or hearing-instrument specialist can help with selection of the hearing aid that is right for you based on your preferences and degree of hearing loss.
For a minority of patients who have profound hearing loss, surgery is an indicated treatment. The cochlear implant is an option for those patients who derive no benefit from the most powerful hearing aids. A cochlear implant is a mechanical device implanted surgically on the inside or outside of the cochlea. The cochlea is the part of the inner ear that transforms sound vibrations into nerve impulses that will be transmitted to the brain. During the surgery, a tiny receiver is implanted under the skin, either behind the ear or in the chest, with a wire that connects it to the device on the cochlea. The patient will also need to wear an external transmitter that is connected to a sound processor and a microphone. A cochlear implant does not restore normal hearing, but it may improve the patient’s understanding of speech and facilitate lip-reading. Implantation of this device involves mastoid surgery and brief hospitalization (AMA 1989). Cochlear implants are only recommended to a limited number of patients who would be totally deaf otherwise. Because individual compliance in learning to use a cochlear implant is essential, the usefulness of the implant for any particular person cannot be reliably predicted, but for some patients, the cochlear implant makes a tremendous difference in hearing capacity.
There is evidence that agents such as alpha-lipoic acid, which reduce free-radical formation, play an important role in (1) reducing presbycusis and improving cochlear function (Seidman et al. 2000) and (2) reducing the auditory toxicity caused by aminoglycosides (Conlon et al. 1999), cisplatin (Rybak et al. 1999a; 1999b; 1999c), and noise (Armstrong et al. 1998). Studies show that alpha-lipoic acid, lessens nerve damage induced by ototoxic aminoglycoside antibiotics (Conlon et al. 1999). According to Conlon, the studies “highlight a potential clinical therapeutic use of alpha-lipoic acid in patients undergoing aminoglycoside treatment.” Alpha-lipoic acid has also been shown to provide very good protection against cisplatin auditory toxicity in several studies by Rybak et al. (1999a; 1999b; 1999c). Patients undergoing treatment with drugs that have ototoxic side effects may benefit from a dose of 500 mg of alpha-lipoic acid twice daily.
The drug Hydergine is considered to be an all-purpose “brain booster” and may help improve hearing (Jimenez-Cervantes et al. 1990). Although the FDA has approved doses of only 3 mg a day of Hydergine, doses of 12-20 mg a day may be required to help improve hearing. Hydergine is nontoxic and relatively safe. Its potential side effects include mild nausea and some gastric disturbance. It is not recommended for people with psychosis, low blood pressure, or an abnormally low heartbeat.
Hydergine was originally produced and distributed by Sandoz Pharmaceuticals. The original patent has since expired and generic versions are now available in various strengths by prescription. However, many people choose to obtain low-cost 5-mg Hydergine from overseas pharmacies.
Ginkgo biloba has helped some people with various hearing disorders, including tinnitus (ringing in the ears) (Dubreuil 1986; Hoffmann et al 1994; Holstein 2001). Ginkgo also provides a wide range of health benefits, including improved neurological function (Soholm 1998), and has been shown to have a protective effect against gentamicin-induced cochlear damage (Jung et al. 1998).
For many years, researchers have investigated the potential benefits of vitamin A for persons with hearing loss. As early as 25 years ago, hearing loss was observed in volunteers who participated in a study on the effects of hypovitaminosis A (low vitamin A) (Chole et al. 1976). Research results have sometimes been contradictory, but they did show that vitamin A is essential in inner-ear morphogenesis (Chole 1978; Lohle 1982; Biesalski 1984). According to Romeo (1985), several researchers reported an improvement of 5-15 decibels in the tone threshold of patients with presbycusis. Biesalski et al. (1990) studied the effects of vitamin A deficiency and noise-induced hearing loss. Although their study was conducted with guinea pigs, they concluded “that vitamin A deficiency increased the sensitivity of the inner ear to noise and that this increased sensitivity increases the probability of noise-induced hearing loss” (Biesalski et al. 1990).
Several of the B vitamins have been shown to have positive benefits for persons with hearing loss, including B1 (thiamine), B6 (pyridoxine), B12 (cyanocobalamin), biotin, and the vitamin B complex. In a study of 51 subjects with sudden deafness (hearing levels worse than 100 decibels) who were treated with vitamin B as part of their treatment regimen, hearing recovery began between days 2-28. Only seven subjects showed ultimate hearing levels worse than 100 decibels. Most were in the 55- to 80-decibel range. Two subjects achieved complete recovery (hearing levels better than 20 decibels).
- Note: A normal hearing level is 20 decibels; profound hearing loss is over 90 decibels.
The subjects who recovered hearing within the first 14 days had a better ultimate outcome (Sano et al. 1998). As part of their treatment regimen, another group of patients with tinnitus were given the vitamin B complex. After 5 weeks, 54% of them reported that the treatment had been effective. Long-term effectiveness was not investigated in this study (Ohsaki et al. 1998).
Vitamin B1 deficiency has been associated with delayed auditory brainstem responses. In a study on animals, the delayed response was corrected in 2-4 days after beginning vitamin B1 (Shigematsu et al. 1990). Biotin deficiency is also thought to affect development of the auditory nerves. Diagnosis and treatment of biotin deficiency is essential in the first year of life (Taitz et al. 1985; Wallace 1985; Bressman et al. 1986; Wastell et al. 1988). Vitamin B12 is often deficient in vegetarian diets. Deficiency has been associated with chronic tinnitus and noise-induced hearing loss (Shemesh et al. 1993). A study of 55 women conducted by Houston et al. (1999) examined the association of age-related auditory dysfunction and vitamin B12 deficiency. In both of these studies, subjects with hearing dysfunction exhibited low blood levels of vitamin B12. This led these researchers to recommend that serum levels of vitamin B12 be evaluated in persons with tinnitus, noise-induced hearing loss, or age-related hearing loss.
Although the studies were conducted with animals, researchers found beneficial effects of vitamin C, particularly in the areas of aiding overall nutritional status and protection from or lowering damage to cochlear hair cells and hearing caused by exposure to noise (Branis et al. 1988; Lautermann et al. 1995).
The possible role of vitamin D deficiency in otosclerosis (abnormal bone growth in the inner ear), unexplained cochlear deafness, presbycusis, bilateral cochlear deafness, and bilateral sensorineural hearing loss has been the subject of scientific studies (Brookes 1983, 1985a,b; Ikeda et al. 1989). These researchers concluded that vitamin D deficiency is likely one of the causal factors in some cases of otosclerosis, cochlear deafness, and presbycusis. According to Brookes (1983; 1985a,b) and Ikeda et al. (1989), vitamin D deficiency should be considered in persons with hearing loss. The studies by Brookes indicated that vitamin D replacement therapy resulted in significant hearing improvement in two of four patients (1983) and three of 16 patients (1985b). The encouraging conclusion was that cochlear deafness and progressive hearing loss may be partly reversible by replacement vitamin D therapy.
The relationship between zinc deficiency and tinnitus, cochlear damage, and hearing damage has been studied in both humans (Shambaugh 1989; Podoshin et al. 1997) and animals (Gunther et al. 1989; Rubio et al. 1998; McFadden et al. 1999b). Results in both of the human studies (Shambaugh 1989; Podoshin et al. 1997) and one animal study (McFadden et al. 1999b) indicated that zinc deficiencies increase the vulnerability of the cochlea to damage associated with normal aging. Shambaugh (1989) reported that zinc supplementation improved tinnitus and sensorineural hearing loss in a third of elderly patients who were marginally deficient in zinc and stated: “We believe zinc deficiency is one causation of presbycusis; by recognizing and correcting it, a progressive hearing loss can be arrested.” According to Podoshin et al. (1997), the incidence of tinnitus in presbycusis is 11% and not gender related, but it is correlated with exposure to noise. Interestingly, they stated that tinnitus occurred in 13% of children who passed audiometric screening texts, in 23 to 60% of children with hearing loss, and in 44% of children with secretory otitis media. Only 3% of children complain about tinnitus, because they do not consider it to be abnormal. According to Podoshin et al. (1997), tinnitus might be a factor in behavioral problems in children.
Magnesium deficiency and its possible role in noise-induced hearing loss has been the subject of numerous studies in both humans (Altura et al. 1992; Joachims et al. 1993; Attias et al. 1994;) and animals (Ising et al. 1982; Cevette et al. 1989; Gunther et al. 1989; Joachims et al. 1983, 1989; Spasov et al. 1999; Scheibe et al. 2000a; 2000b). In animals, magnesium had positive beneficial effects: faster recovery from hearing threshold shift (Scheibe et al. 2000a); significant reduction of trauma caused by high levels of noise exposure (Ising et al. 1982; Joachims et al. 1983; 1989; Scheibe et al. 2000 a); reduced ischemia-induced hearing loss (Spasov et al. 1999; Scheibe et al. 2000b); and a protective effect for ear hair cells (Gunther et al. 1989; Spasov et al. 1999).
Beneficial effects were also found in the human studies. Using double-blind, placebo-controlled methods, Joachims et al. (1993) and Attias et al. (1994) studied military recruits (320 and 300 respectively) who had normal hearing. The recruits were studied for 2 months during basic military training, which included repeated exposure to high levels of firearm noise. All of the recruits wore earplugs. Noise-induced hearing loss was significantly higher in the placebo group than in the group receiving magnesium in both studies. According to Attias et al. (1994), “This study may introduce a significant natural agent for the reduction of hearing damage in the noise-exposed population.”
Most people receive adequate amounts of copper from their diet. However, copper deficiency has been associated with auditory system disorders (Farms et al. 1993; Prohaska et al. 1996) and age-related hearing loss (McFadden et al. 1999). In one study in animals, McFadden et al. (1999a) concluded that “the results indicate that copper/zinc superoxide dismutase deficiency potentiates cochlear hair cell degeneration, presumably through metabolic pathways involving the superoxide radical.” In a case reported by Hamano et al. (1997), a female patient with copper deficiency as a result of gastrointestinal tract disturbance developed severe neurological symptoms, including hearing loss. Hamano et al. (1997) recommended treating gastrointestinal tract conditions that affect absorption and administration of copper to prevent progression of neurological disease.
Although iodine deficiency is most commonly associated with endemic goiter (overgrowth of the thyroid gland caused by lack of iodine in the diet), studies in animals and humans find that iodine deficiency also has a role in sensorineural hearing loss (Meyerhoff 1979; Wang et al. 1985; Delange et al. 1989; Valeix et al. 1992, 1994; DeLong 1993), including middle ear changes, cochlear lesions, congenital deaf-mutism and bilateral hearing deficits, and high hearing thresholds in children. Adequate maternal iodine status is critical for brain development of the fetus, beginning about the 14th week and continuing perhaps into the third trimester (DeLong 1993). Iodine is available from household salt. However, levels of iodine content are deliberately low in some types of table salt in an effort to compensate for the excessive use of table salt by many persons (Delange et al. 1989). Certain medical conditions also require strict limitation of dietary salt, further reducing intake of iodine.
Iron deficiency can result from too little dietary iron, poor absorption of iron, or chronic or acute bleeding. The effects of iron deficiency have been studied in animals (Sun et al. 1987; 1990; 1991). These studies indicated that iron deficiency resulted in several hearing abnormalities, including damage to the inner ear cells and sensorineural hearing loss, elevated auditory thresholds, and a basis for noise-induced hearing loss and cochlear deafness. Conversely, some of the research in animals has focused on the role of iron in gentamicin-induced ototoxicity. Gentamicin and other similar drugs are commonly used antibiotics worldwide, despite their known toxicity to the inner ear (Song et al. 1996; 1997; 1998; Sha et al. 1999; Conlon et al. 1998; Song et al. 1998). In these studies, gentamicin combined with iron actually produces free radicals and ototoxicity. Iron supplementation for anemia-related hearing loss should be discussed with your physician. The Life Extension Foundation does not recommend iron supplements unless blood testing reveals iron-deficiency anemia.
Arginine is one of the essential amino acids. In addition to the benefits often associated with arginine (e.g., in hypertension, age-related protein synthesis, and wound healing), studies indicate that arginine is also protective against sensorineural hearing loss and cochlear damage caused by the toxins that are produced by Streptococcus pneumoniae infections (Amaee et al. 1995). Pretreatment with arginine was found to provide marked protection to the cochlea.
- Diabetics and borderline diabetics should use arginine with care; children, teenagers, and pregnant and lactating women should not use arginine except under a physician’s supervision; persons who have had ocular or brain herpes should not use arginine; and persons with certain psychoses may experience worsened symptoms. Always take antioxidants with arginine.
Carnitine is an amino acid recognized as an effective antiaging therapy to maintain youthful cellular energy metabolism. However, the results of a study suggest that carnitine can have beneficial effects on the central neuropathy associated with diabetes (Yildiz et al. 1996). The diabetes-induced brain stem auditory evoked potentials (BAEP) deficits were improved after carnitine treatment. Acetyl-L-Carnitine is the preferential form of carnitine because of its superior absorption. A daily dose of 1000-2000 mg is suggested.
Methionine is an antioxidant amino acid found in meat and dairy products. It has been found to have important protective benefits from various types of ototoxic hearing loss:
- Aminoglycoside-induced hearing loss (Sha et al. 2000)
- Ionic platinum compounds, the therapy most commonly used to treat metastic tumors (Reser et al. 1999)
- Cisplatin, an effective agent used in the treatment of squamous cell cancer of the head and neck (Campbell et al. 1996; Gabaizadeh et al. 1997)
- An epidemic outbreak of peripheral neuropathy (Cuba 1992-1993), affecting over 50,000 people (Roman 1994), some with sensorineural deafness. The deafness produced high-frequency hearing loss. Obvious malnutrition was not present, but a deficit in micronutrients including methionine appeared to be a primary determinant of the epidemic (Roman 1994).
- Methionine is the precursor to homocysteine in the body. Always take folic acid and vitamins B12 and B6 supplements with methionine to protect against excess accumulation of homocysteine.
Glutathione is another amino acid that has been shown to have protective benefits against hearing loss caused by acoustic overstimulation (Yamasoba et al. 1998a). A depleted glutathione state increased noise-induced hearing loss, whereas replenishment of glutathione reduced the damage (Yamasoba et al. 1998a; 1998b). Another protective benefit of glutathione was protection from gentamicin ototoxicity, particularly when the diet was low in protein (Lautermann et al. 1995). More benefit was attained in subjects with the lower-protein diets. Alpha-lipoic acid, selenium, whey protein, and cysteine supplements boost glutathione levels in the cells.
Taurine is described as one of the “conditionally essential” amino acids. Absence of a conditionally essential nutrient may not produce an immediate deficiency disease, but deficiency can cause problems in the long term, particularly in preterm and term infants (Gaull 1989; Tyson et al. 1989; Chesney et al. 1998; Dhillon et al. 1998). Infants with inadequate dietary taurine had shorter auditory brain stem responses (Dhillon et al. 1998). In animal studies, taurine-supplemented diets resulted in earlier maturation of the brainstem auditory response, leading Vallecalle-Sandoval et al. (1991) to suggest that taurine plays “an important role in the anatomical and functional development of the auditory system.” Because taurine is defined as a “conditionally essential” amino acid, the clinical consequences that result from taurine deficiency are reversible with taurine supplementation, particularly in infants (Chesney et al. 1998).
Coenzyme Q10 (CoQ10)
CoQ10 is an antioxidant that has already received favorable evaluation in the clinical treatment of heart disease. However, animal studies by Sato (1988) have reported that CoQ10 is also effective in promoting recovery from acute sudden deafness resulting from hypoxia. Sato’s results also indicated that CoQ10 was effective in promoting the recovery of damaged auditory hairs and in preventing respiratory metabolic impairment of the hair cells caused by hypoxia. Another interesting study by Suzuki et al. (1998) investigated the effect of CoQ10 on neurosensory deafness resulting from maternally inherited diabetes mellitus and deafness (MIDD): 50 patients (29 with MIDD, 7 with impaired glucose tolerance, and 15 with normal glucose tolerance) were treated daily with 150 mg of CoQ10 for 3 years. The control group consisted of 28 patients (16 with MIDD, 5 with impaired glucose tolerance, and 5 with normal glucose tolerance). Each group received yearly examinations. Suzuki et al. (1998) found that CoQ10 prevented progressive hearing loss and improved blood lactate after exercise in patients with MIDD without affecting other diabetic complications or clinical symptoms. CoQ10 did not affect the insulin secretory capacity of the other subjects (those with impaired glucose tolerance or normal glucose tolerance), and there were no side effects during the therapy.
Hyperbaric oxygen treatment has been used as part of multistep therapy for sudden hearing loss of unknown cause (Wolf et al. 1991; Sano et al. 1999); acute noise trauma from a car airbag (Stankiewicz et al. 2000); Meniere’s disease (Fattori et al. 2001a); and rapid-onset hearing loss of unknown cause that can progress or severe deafness (Fattori et al. 2001b). The hyperbaric oxygen treatment varied: several short treatments, lasting 15 minutes (Wolf et al. 1991); daily treatment for 10 days in a row, with maintenance treatments for 5 days in a row each month in the first year and then treatments 5 days in a row every 3 months for the second, third, and fourth years (Fattori et al. 2001a); and daily treatment for 10 days in a row only (Fattori et al. 2001b).
Wolf et al. (1991) and Fattori et al. (2001a, b) reported positive results, leading Fattori et al. (2001b) to state: “Patients in the hyperbaric oxygen treatment group experienced a significantly greater response to treatment than did those in the vasodilator group, regardless of age and sex variables. Significantly more patients in the hyperbaric oxygen treatment group experience a good or significant response. Based on our finding, coupled with the fact that oxygen therapy is well tolerated and produces no side effect, we conclude that hyperbaric oxygen treatment should be considered the preferred treatment for patients with rapid onset hearing loss of unknown origin.” Hyperbaric oxygen treatment and vasodilator therapy were not effective in the case of hearing damage (tinnitus and hearing loss in one ear) caused by noise trauma from a car airbag. However, the patient was not treated for 5 months. The airbag mechanism was presented as the cause of the noise trauma (Stankiewicz et al. 2000).
Hearing loss is most common in adults over 65 years of age. To determine the degree of hearing loss and appropriate treatment, your physician will administer a hearing test and make the necessary referrals to an otolaryngologist or audiologist for further examination.
Many patients experiencing hearing loss can be treated effectively through use of a hearing aid. For others with more profound hearing loss, surgery involving cochlear implants may be an option. Cochlear implants may be recommended for patients with profound deafness who derive no benefit from hearing aids.
Alternative treatments that may help in preventing age-related hearing loss and provide protection from ototoxicity include:
- Alpha-lipoic acid, 500 mg twice daily, has been shown to reduce hearing loss from ototoxic drugs. After the ototoxic drugs are discontinued, the dose of alpha-lipoic acid can be reduced to 250 mg twice a day.
- Hydergine, 12-20 mg a day, may help improve hearing.
- People with hearing loss should consider taking 120 mg of Ginkgo biloba extract daily.
- Vitamin A deficiency has been shown to be a factor in hearing loss, including noise-induced hearing loss. A supplement supplying 10,000 IU daily of vitamin A is suggested.
- The B vitamins have shown positive benefits for persons with hearing loss. A high potency complete B complex is recommended. Alternatives are to take 500 mg of vitamin B1, 250 mg of B6, and 500 mcg of vitamin B12.
- Vitamin C is particularly beneficial in aiding overall nutritional status and protecting cochlear cells from damage caused by noise. About 2500 mg a day is suggested.
- Vitamin D deficiency has been shown to be a causal factor in several hearing disorders, including age-related hearing loss. Daily doses of 400-1400 IU are suggested.
- Zinc deficiency increases the vulnerability of the cochlea to hearing loss associated with normal aging; 30-80 mg of zinc are suggested. (If more than 50 mg of zinc is taken daily, also take 2 mg of copper.)
- Magnesium has been shown to have protective benefits against noise-induced hearing loss. Take 500-1000 mg of elemental magnesium a day.
- Copper plays an important role in overall neurological health, including hearing. Copper deficiency has been associated with hearing loss. One 2-mg copper capsule every other day is suggested. (If taking zinc, 1 capsule daily is recommended.)
- Ensure adequate dietary consumption of iodine.
- Ensure adequate dietary consumption of iron. If blood testing reveals iron deficiency anemia, Iron Protein Plus (15 mg a capsule) may be taken to restore normal iron levels.
- Arginine is an essential amino acid that is protective against sensorineural hearing loss and damage to the cochlea by toxins produced by infection. Take 2700 mg daily. Always take antioxidants with arginine.Methionine has protective benefits for aminoglycoside-induced hearing loss. A suggested dose is 700 mg daily or 1/4 tsp of L-methionine powder. Always take folic acid, B12, and B6 with methionine.
- Note: Diabetics, borderline diabetics, children, teenagers, pregnant women, lactating women, or persons who have had ocular or brain herpes or who have certain psychoses should not take arginine without the supervision of a physician.
- Taurine is a “conditionally essential” amino acid that plays a role in anatomical and functional development of the auditory system. A daily dose of 500-1000 mg is suggested.
- Coenzyme Q10 has been shown to be effective in preventing progressive hearing loss in diabetics, without affecting other diabetic complications or clinical symptoms. The daily dose is 100-200 mg of an oil-based CoQ10 supplement.
- Hyperbaric oxygen therapy has been shown to be an effective therapy. It is well-tolerated with no side effects.
- Note: Many of the nutrients recommended above can be obtained in a high-potency multinutrient supplement called Life Extension Mix. The nutrients found in Life Extension Mix are a high-potency vitamin B complex, taurine, vitamin C, vitamin D3, copper, zinc, iodine, and vitamin A.