Journal of Anthroposophic Medicine D e r M e r k u r s ta b |  S o m m e r  |  W h at h e l p s w i t h Ti n n i t u s ?
Original paper „Was hilft bei Tinnitus?“. Der Merkurstab 1/08, 63-67. English by Margot M. Saar among unemployed and its lowest among self-em- ployed people shows that an unfulfilled soul life invites tinnitus whereas fulfilment keeps it at bay (2).
Unlike any other auditory perception (with the ex- Noises in the ear are a common complaint in general ception of rare vascular ear noises and vertebrogenic practice. It often seems that no adequate treatmentis available. The paper presents a treatment strategy tinnitus) tinnitus does not change when the sufferer using anthroposophical medi cines which has proved turns his head or moves around which means that he its value. Details are also given on differential diag- cannot locate the source of noise nor can he diminish nosis and treatment of tinnitus, and an attempt is or stop the noise by distancing himself from it or cover- made to gain insight into the question as to why this symptom is such a problem to many patients. The sufferer gradually realizes to his horror that “it The spiritual-scientific findings of Rudolf Steiner sounds in me”, that the sound has invaded his body and and historical sources are considered.
is depriving him of silence, an experience that can be ■ Keywords
particularly irritating when one is trying to meditate.
Martin Luther, who suffered from a number of ailments, saw his tinnitus as an attack by the devil (3). Babylonian medical writings suggest that spirits are capable of gen- erating noises in the ear. That tinnitus is not a phenom- enon of our time is shown by the facts that Hippocrates mentioned it at least six times, that Aristotle devoted time to it and that great physicians from Galen to Most people will, at some point, have experienced Paracelsus felt called upon to speculate about its origin.
a subjective noise in their ears that could notbe heard by others, usually following an ex- Differential diagnosis allows for effective therapy
treme acoustic impact (for example after attending a Tinnitus sufferers are often given the impression, rock concert or as the result of an actual blast trauma).
even by ENT specialists, that there is not much one can The resulting “ringing in the ears” often responds well do about noises in the ear and physicians don’t even car- to higher potencies of Arnica. As we get older, episodic ry out the most basic investigations. The first thing to be or ongoing noises in the ear can occur more frequently.
established is whether the tinnitus is objective or sub- They are signs of the general “wear and tear” and begin- jective (or as Jean Marie Itard, founder of scientific oti- ning self-perception of the sense organ1 similar to the atrics, put it in 1822 in his still outstanding book on ear “floaters” we experience visually as a result of the de- complaints (4), whether it is a “true” or “false” auditory generating vitreous body. We usually “overlook” these noise). A tinnitus is objective or “true” if the examiner floaters and only notice them when our awareness is heightened which is when they become a real nuisance.
can also hear it. The physician auscultates the patient’s head (and carotids) to discover any vascular murmur.
Likewise, a slight tinnitus remains unnoticed or is cov- ered up by similar noises in the environment. In both Most patients describe a hissing sound that is more or less pulsatile. I diagnosed this kind of tinnitus in several cases the affected person should consciously try to “blend out” the phenomena of self-perception, because instances and most could be cured with surgery. I rec- ommend inserting the tube of the stethoscope into the they get worse the more one focuses on them, just as a slight itch on the skin becomes worse when one concen- acoustic meatus to detect, for example, myoclonus of trates on it. Especially in chronic (but also in acute) cases the tensor tympani muscle which causes a clicking or of tinnitus conscious distraction is an essential part of beating sensation that is more or less rhythmical, but therapy. The fact that tinnitus has its highest incidence not pulsatile. Also ask the patient to do chewing move- D e r M e r k u r s ta b |  S o m m e r  |  W h at h e l p s w i t h Ti n n i t u s ?
ments, as irregularities of the jaw joint (which should al- Making a diagnosis in the case of a newly developed so be examined) can also cause tinnitus. tinnitus should definitely include blood pressure deter- One of the most severe cases of tinnitus I came across mination in both arms and the exclusion of vascular risk was also the most easily treated: a very frightened, cry- factors (cholesterol, possibly also fibrinogen, etc.), in- ing, 9-year old child was brought to my surgery because flammation and Borrelia infection as these conditions she suffered from a terrible, irregular clanging noise in can also, in rare cases, cause tinnitus. (An even rarer the right ear. The sound could be picked up—if only faint- cause is syphilis, which allegedly led to Robert Schu- ly—on auscultation. It was caused, as I found out, by a mann’s continuous hearing of the “horrible A”). We tiny, beautifully shiny and colourful rhododendron also have to exclude tinnitus that occurs as an adverse hopper2 which had somehow found its way into the effect of certain drugs (very frequent with aspirin, acoustic meatus. It was prevented from backing out non-steroidal anti-inflammatory drugs, anti-arrhythmic again by tiny hooks on its hind legs and was forced to drugs—esp. quinidine—, azythromycin, aminoglycoside penetrate deeper into the ear. Getting panicky itself it antibiotics, cytostatics—esp. platinum compounds and tried to escape from its trap by jumping against the taxanes—, beta-blockers, diuretics—esp. furosemide. The most common kind is a whistling, continuous Auscultation can also detect tinnitus caused by “idiopathic” tinnitus that often goes with hearing loss whistling air movements in the head, which can accom- and is assumed to be related to sudden deafness (the pany infections of the upper respiratory tract due to pathogenesis of which is still entirely unclear). It prima- pressure differences and swollen mucosa. rily affects people who suffer from excessive nervous Psychotic auditory hallucinations (which Itard de- strain and lack of exercise. Itard wrote in 1821: “most scribes as “fantastic ear sounds” and “symptoms of common in people with a sedentary lifestyle, hypochon- mental confusion”) must be differentiated against tin- driacs and hysterical women”. In the United States nitus which is not difficult as the sufferer experiences physicians prescribe a holiday in these cases, and no them in most cases as meaningful messages.
drugs; whereas in Germany, rheological treatment with Tinnitus—as Itard pointed out—can accompany any HES (hydroxyethyl starch) infusions and glucocorticoids processes of gradual hearing loss. The tinnitus frequency are considered necessary measures. It has happened usually lies within the audio frequency that is most af- that physicians were successfully sued for damages be- fected and therefore patients often (wrongly) assume cause they omitted to prescribe this treatment. One that they will be able to hear better again as soon as the should therefore inform patients that these therapies ear noises disappear. As far as possible, any acute ear are available, but one can also point out that there can’t complaint, such as otitis media, must be treated first. really be such a big difference between American and As the hearing loss progresses, more complex—non- European ears. In any case, one should save one’s pa- psychotic!—auditory hallucinations (of melodies, for tients from more than one week of HES infusions, be- example) occur quite frequently (5). They are equivalent cause once a threshold dose has been exceeded, the sub- to Charles Bonnet syndrome which occurs with deterio- stance is deposited in the skin and the outcome is a high- rating vision (cataract, for example). In this case the ly unpleasant pruritus. Sometimes only continuous “emptiness” of the visual field is filled with complex showering can alleviate this additional pathological self- visual hallucinations. Quite often these complex audito- perception. In one particularly tragic case a woman’s ry hallucinations, but simple tinnitus also, improve or complaint that she had a splitting headache after each disappear even with the use of hearing aids or a cochlear infusion was ignored with the result that during one implant. In individual cases the (mostly modern) anti- session an aneurism of her anterior communicating ar- convulsants help reduce local over-excitability in the tery ruptured and she has had to live for years now with brain (which arises because it is not sufficiently sup- the effects of severe frontal lobe syndrome. pressed by physiological sensory “input”).
There are many cases of patients who, after undergo- Tinnitus also occurs—alongside hearing loss and ing conventional infusions unsuccessfully, were cured dizziness—with Ménière’s disease. The underlying en- afterwards by the anthroposophical treatment de- dolymphatic fluid build-up sometimes responds well scribed below. In one case, however, the latter had only showed a short-term effect, while the patient was Tinnitus resulting from cervical spine disorder typi- effectively cured afterwards by corticoid treatment. cally changes when the head is moved and greatly im-proves with craniosacral therapy and osteopathy. Proven treatments in anthroposophical medicine
In rare cases an increasing tinnitus that is accompa- The infusions make sense, in so far as the patient, nied by gradual hearing loss can be caused by a growing whether admitted to hospital or at home on sick leave, acoustic neuroma. In this case, the acoustically evoked has a break from stressful life and can find a new and potentials (AEP or “BERA”) are delayed in the affected more independent relationship to it. I usually give 10 ml ear and a MRI scan is recommended. (Operating the Solum inject in 100 ml NaCl 0.9 %, a medicament which fannahi Young. I would like to thank Professor acoustic neuroma remains problematic, as it is statisti- has an obvious, mentally balancing and “shielding”, ef- cally more likely to make the tinnitus worse rather than fect. Peat moss naturally occurs in areas with stagnating Burmeister who iden -tified the insect.
water. Potentized or pharmaceutically rhythmicized it D e r M e r k u r s ta b |  S o m m e r  |  W h at h e l p s w i t h Ti n n i t u s ?
can dissolve similar conditions in the human being and, as streptomycin), severance of the cochlear nerve, for example, help clear swellings in the inner ear. The neurectomy or labyrinthectomy often do not (!) result in preparation also contains potentized Equisetum which lasting improvement. In some cases the Janetta proce- supports kidney activity and arterial blood flow and po- dure, which is also used for trigeminal neuralgia, seems tentized chestnut for the veins; both enhance the effect to do the trick (7). In this operation, a small piece of of the Solum (peat moss). Apis ex animale Gl 30x helps padding is interposed between the auditory (e. g.
with inflammations or swellings (as cortisone does in trigeminal) nerve and an aberrant arterial vessel that conventional medicine), for example of the intima or en- presses on it causing demyelination and, associated with dothelium of the small vessels that supply the cochlea; this, increased autogenous excitability. The implant Cochlea Gl 15x prevents this organ from becoming too dampens the “neurovascular conflict” or—anthropo- loud in the “organism’s orchestra”. Cuprum met praep sophically speaking—the blood-nerve conflict. 30 % of 6x, finally, relaxes and loosens possible muscular or vas- the operations resulted in definite improvement and even complete symptomatic relief (8); with small case In the first newsletter of the Medical Section at the numbers and strict pre-operative selection, the reported Goetheanum (6), Rudolf Steiner and Ita Wegman wrote success rate was 70 % (9). Traditional treatements using in answer to a question regarding the treatment of au- various anticonvulsant drugs such as pregabalin or car- ditory noises that the condition arose because “the as- bamazepine or local anaesthetics like lidocaine or fle- tral body is growing weaker than the ether body in the cainide are moderately successful. Itard, by the way, tried bladder area”. This might seem astonishing, but a sur- this method in his day by blowing ether vapours into the prising number of tinnitus sufferers have pathological ear canal. He often observed improvement afterwards, urinary conditions, often bacteriuria, while not experi- but complained that the effect did not last. What Jean encing any subjective discomfort. This could be an ex- Marie Itard described in 1821 still holds true today for pression of reduced development in the bladder area most cases of chronic tinnitus: “Nothing can be done which allows foreign life to develop that remains unno- apart from making it a little less unbearable”. The meth- ticed and does not give rise to inflammatory reactions.
ods he proposed are still in line with the most modern The astral body, which is then not active in the abdomen, medical principles, which suggest attenuating the un- has moved higher up where it causes pathological self- bearable “internal” sound by “an analogous and regular perception. Apart from treating the bladder if necessary, outer sound”. Itard suggested “noisy machines” that are one should try and enhance self-perception in the lower set off by clockwork or the sound of water streaming in- body, which we do in our clinic by placing a hot water to a copper basin. Physicians today recommend a radio bottle on the feet during the infusion. A eucalyptus oil with interference or even a tinnitus masker, a hearing compress or a camomile steam sitz bath can also be aid that imitates the frequency of the tinnitus and can used. In order to generate a sense of protection and calm be part of a complex retraining programme. An indoor we apply the infusion, if possible, in a quiet room where water fountain can also be useful. “It is remarkable that the patient can lie down, warmly wrapped up. The infu- this different sound, which necessarily has to be sion is usually applied three to five times on consecutive stronger than the pathological sensation, does not pre- vent sleep, as the noise in the ear does, but gently in- We often observe that patients for whom conven- duces it and soothes and calms.” It seems that a pur- tional treatment had not worked experience that the posely generated noise, which can also be switched off tinnitus disappears, or is at least considerably improved, at will, i. e. a sound over which the patient has control, is during the infusion. A musician who suffered from tin- well tolerated, while a quieter sound from which onecannot escape can drive the sufferer almost insane.
nitus, had to postpone conventional treatment because Rudolf Steiner’s indication in the newsletter mentioned of his busy schedule and when he finally had it, it above confirms this approach, but he went a step further showed no effect (causality is not certain here, the treat- and suggested that the patient should convince himself ment often remains without result even when given ear- that he is actually generating the tinnitus (which is— ly on). After only one of the infusions described above he from a patho-physiological point of view—the case).
was fully cured and has been symptom-free for some This also relies on the fact that a self-generated sound is years now. Many colleagues have found the treatment more easily bearable (which means it can then recede) successful, too, and I would say it works in 80 % of tinni- than a sound of which one is the victim. Another creative tus cases that are acute and have not persisted for more approach consists is music therapy where the tinnitus is copied as closely as possible and transformed into a What else can be done in chronic tinnitus cases?
more and more satisfying, surrounding and harmonious Chronic tinnitus that has been going on for more sound experience. Other (art) therapies can also be suc- than six months rarely responds to the treatment, al- cessful if they manage to keep the soul from turning though it does also happen. As with chronic pain syn- inward and closely observing the body, but help it turn dromes or phantom pain the cause has shifted from the outward in order to joyfully engage with the world.
periphery to the CNS. This is evident in the fact that, in Excessive auditory sensibility, hyperacusis, can some- these cases, destruction of the cochlea with drugs (such times prevent this turning outward, because the patient D e r M e r k u r s ta b |  S o m m e r  |  W h at h e l p s w i t h Ti n n i t u s ?
cannot bear noises such as children screaming and es- References
capes into isolation. In these cases potentized doses of 1 Steiner R. Wegman I. Extend-
ing Practical Medicine. Tr. Anna R.
China, Chininum sulfuricum or Chininum arsenicosum, but also Cerebrum comp. B can be helpful, even healing. As a general rule, the tinnitus sufferer should seek 2 MRC Institute of hearing re-
search: Epidemiology of tinnitus.
noises and liveliness in his environment, because with- drawing from the world is not good for him. Here is one of Itard’s case studies from 200 years ago: “29-year old 1987
3 Martin Luther in a letter to
Madame de Souvray, a very imaginative person with great agility of the nervous system” had experienced a severe shock because of an accident, in which her baby had nearly died, and developed tinnitus as a result. Itard, 4 Itard, J. M. G. Die Krankheiten
who took a careful history, noticed that the complaint became better when Madame drove through cobbled des Gr. H. S. priv. Landes-Indus-trie-Compoirs, Weimar 1922 streets in her carriage. This led him to prescribe, after she had suffered for almost two years, that she should play a musical instrument such as the clarinet or violin 5 Sacks O. Musicophilia. New
York. Toronto. Knopf 2007
… drive more often through cobbled streets in her car- 6 Steiner R, Wegman I. Newslet-
riage and … move to the liveliest part of town instead of shutting herself off in a little isolated house as she had Course for Young Doctors. Tr. rev. G. Karnow. Spring Valley: done up to then”. The obedient patient then moved to a watermill where she was cured from her tinnitus within 7 Lenarz T. Chirgurgische
a fortnight, but stayed on for another two months for Therapie. In: Feldmann H. Tinni-tus. Stuttgart, New York. Thieme, In any case, it is best to try and prevent tinnitus from 8 Janetta PJ. Microvascular
becoming chronic and Solum inject, Apis ex animale Gl decompression of the cochlearnerve as treatment of tinnitus.
30x, Cochlea Gl 15x and Cuprum met. praep. 7x can play In: Feldmann H. (ed.). Proc. III Int.
Tinnitus Seminar, Harsch, Karls-ruhe 1987 9 Brookes (1996), quoted from


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