Tinnitus and Hearing Loss

Tinnitus is a condition in which a person hears a buzzing or ringing sound in their ear, even when there is no external source of the noise. The sound can vary greatly, from the sound of waves crashing on the shore to a high-pitched buzzing like the sound of a forest full of cicadas.

Hearing loss, on the other hand, is a decline in the ability to hear, and can be accompanied by tinnitus or not. The underlying causes and mechanisms of tinnitus and hearing loss are similar, although certain conditions are more likely to cause one or the other. Although tinnitus and hearing problems are traditionally associated with Kidney pathology, as the ear is the organ of the Kidney and its external orifice, they can also be caused by problems with the Liver, gallbladder, and spleen, as well as head and ear trauma.

Tinnitus and hearing loss can be symptoms of a wide range of medical conditions. Some of the patterns described in Chinese medicine can cause earache along with tinnitus. Children, who are particularly prone to wind in the ear, phlegm-fire, and spleen deficiency, may complain of earache, but rarely of tinnitus. Similarly, children may not be aware of hearing loss, and it may be detected by parents or teachers.

Causes

External Pathogens

In traditional Chinese medicine, wind is believed to enter the ears through the surrounding channels and collaterals, disrupting the flow of qi and blood and leading to reduced aural acuity. This invasion of wind is thought to primarily affect the Bladder and Small Intestine or Gallbladder and Triple Burner channels. The Triple Burner, Gallbladder, and Small Intestine are closely related to ear function due to their proximity to the ears and their relationship with the Kidneys. When there is preexisting Kidney deficiency, the ears may be more vulnerable to pathogenic invasion through the Bladder's external and internal connections.

Emotional Factors

In traditional Chinese medicine, prolonged anger, frustration, and resentment can constrain the Liver and impair the flow of its qi. This constraint on its own is not a common cause of hearing problems, but its common consequences - heat, fire, or ascendant yang, and damage to Liver blood - can lead to auditory problems.

As qi becomes constrained and the distribution of yang qi is impaired, pressure builds. At a certain point of intensity, the constrained yang qi can suddenly escape and rush towards the head, causing problems with hearing, vision, and balance. Similarly, the pressure can generate heat or fire that rises through the Gallbladder channel and affects the ears. A diet rich in sugar, fat, and alcohol can promote the generation of Liver fire, which, when chronic, can consume Liver and Kidney yin, leading to a deeper, more persistent form of tinnitus and hearing loss.

Liver blood can be depleted by chronic qi constraint, a natural consequence of the yin-yang balance within the Liver organ system. The pent-up excessive 'yangness' of the constrained qi means that the yin component (in this case, Liver blood) is in deficit by definition. The combination of qi constraint and blood deficiency can lead to a cyclical pattern of tinnitus and hearing loss as blood fails to reach the ears.

Diet, Medications

Diet can affect hearing by weakening the Spleen and depleting qi and blood, or by promoting the production of phlegm and dampness, which can accumulate in the ear. When phlegm-dampness becomes trapped in the ear, it can easily become heated or combine with external wind to create phlegm-heat. A chronically weak Spleen may rely on the Kidneys for support, leading to gradual depletion of Kidney energy. Additionally, certain medications are known to damage the ear and hearing acuity, such as cannabis, alcohol, tobacco, antibiotics, and quinine.

Age, Overwork, Constitutional Factors

These factors can lead to depletion of the Kidneys. Kidney deficiency, which is often due to aging, is commonly found in chronic tinnitus and hearing loss, and some degree of preexisting Kidney deficiency may be involved in excess patterns. The Kidneys are believed to "open into the ear", and intact Kidney qi is necessary for the processes of hearing and for protecting the ear from pathogenic influences. Factors such as stimulant drug use, which can deplete Kidney yin, overwork, and insufficient sleep can also contribute to Kidney deficiency. Excessive reproductive activity, congenital deficiency, and prolonged or serious illness can also deplete Kidney essence. Kidney yin deficiency may be more likely to cause tinnitus, while Kidney yang deficiency may be more likely to cause hearing loss.

Trauma

In traditional Chinese medicine, head injury or long-term stagnation of qi can lead to blood stasis, which can prevent adequate circulation of qi and blood to the ears. Prolonged or extreme exposure to loud noises can also disrupt the channels of the ear, leading to qi and blood stasis and damaging the structures of the inner ear.

Treatment

Tinnitus and hearing loss are common problems that can be difficult to treat successfully. Chronic cases are often more difficult to treat than acute or recent cases, and those caused by prolonged exposure to loud noises are typically the least responsive. Clinical experience suggests that prolonged therapy can sometimes be successful, and positive results are often noted by people being treated for other problems. This suggests that a minimum of several months of herbal treatment may be necessary.

In cases where there is no clear pattern or etiology (a situation that is not uncommon in relatively healthy individuals with tinnitus), a treatment strategy based on invigorating blood and strengthening the Kidneys may offer the most promise.