• Lack Of Vitamin A May Be Overlooked Root Of Tinnitus And Hearing Loss

    Posted May 21, 2014: by Bill Sardi

    Nutritional supplementation may play a preventive, therapeutic or even regenerative role when hearing loss occurs. Frequently doctors are remiss in making nutritional recommendations. It is now a common practice for physicians to address every disease as if it were a drug deficiency in the face of published reports showing nutritional imbalances are at the root of most chronic diseases.

    For example, confronted with a case of sudden unexplained loss of hearing, physicians impulsively inject steroids that have been shown to work no better than an inactive placebo. [Archives Otolaryngology Head & Neck Surgery June 2007] Yet there are valid nutritional approaches to emergent cases of hearing loss, as explained below.

    An estimated 360 million people worldwide are hearing impaired. The most prevalent cause of hearing loss is advancing age. Presbycusis, the medical term for “hard of hearing,” originates from the Greek words presbys – “elder” + akousis – “hearing.”

    However, there are other issues outside of aging that increase the risk for hearing loss, namely anemia, toxic drugs (such as mycin antibiotics, aspirin, acetaminophen, diuretics and chemotherapy), loud noise, excessive alcohol and diabetes. Then there is sudden idiopathic hearing loss – a severe decline in hearing of unexplained origin.

    The way the age-related form typically emanates is better explained as Ménière’s disease, which affects the inner ear, usually between age 30 and 50. Ménière’s disease is comprised of ringing in the ears (tinnitus), sensitivity to loud sounds and hearing loss. It has no known cause, though this report suggests lack of nutrition may be its origin. [American Speech Language Hearing Assn.]

    Aside from some lame attempts to allay the symptoms of hearing loss, physicians have little to offer for the common form of this problem.

    Even a 10 decibel increase in hearing loss results in a 2.8% increase in physical “sickness” scores among elderly adults, so hearing impairment is no trivial matter, it is an important factor in the overall function of senior adults. [Journal American Geriatric Society Feb 1989]

    Dietary nutrients and hearing loss

    A number of recently published studies point to nutritional factors that are involved in hearing loss.

    A study of 1823 adults age 45-60 in France over 13 years showed hearing levels were better among those individuals who consumed the most vitamin A, vitamin B12 from foods and red meat (women). [British Journal Nutrition June 2013] This suggests women required iron to maintain hearing. Vitamin B12 is required for the myelin sheath that surrounds nerves and it makes sense that it would be beneficial for a nerve disorder. The connection with vitamin A is a bit surprising and requires further investigation, as provided below.

    Another study involving 2592 adults 20-69 years of age showed higher dietary intake of beta carotene (that converts to vitamin A), vitamin C and magnesium were associated with better hearing scores. [American Journal Clinical Nutrition 99: 148-55, 2014] However, this data was obtained from the NHANES database that has fallen into disrepute. [Medscape Oct 16, 2013]

    Hearing thresholds were tested among 1910 participants age 50-80 years in Korea and dietary intake of vitamin A, riboflavin (B2), niacin (b3) and vitamin C were associated with better hearing. Dietary supplement use was associated with better hearing at all frequencies tested. [American Journal Clinical Nutrition March 2014]

    The Blue Mountains Hearing Study conducted among 2956 age 50+ adults correlated dietary vitamin E intake with a 14% reduction in the likelihood of hearing loss. Again, the highest intake of vitamin A from foods produced a 47% reduction in risk for moderate or greater hearing loss. [Journal Nutrition Health & Aging Dec 2011]

    The Health Professionals Follow-Up Study conducted among 26,273 men age 40-74 years beginning in 1986 found 3559 cases of hearing loss with no association overall between hearing loss and dietary vitamin intake. However, among men over age 60 there was a relative 21% reduction in hearing loss attributed to folate in the diet. [Otolaryngology Head Neck Surgery Feb 2010]

    Take notice, all but one of the above dietary studies identified vitamin A as a preventive agent against hearing loss.

    Dietary supplements/ antioxidants

    The potential for dietary supplements to avert or treat hearing loss is very promising despite a paucity of studies. The most common genetic caused of hearing loss, a mutation in the Connexin26 gene, was ameliorated with the use of supplemental vitamin A, C, E and magnesium in a young child. [International Journal Pediatric Otorhinolaryngology March 2014] Dietary supplements can over-ride a progressive inherited disease!

    A drug used to provoke the secretion of Mucin (like vitamin A) along with supplemental lipoic acid and vitamin C reportedly improved hearing among 46 elderly patients with age-related hearing loss. [Acta Otolaryngology Jan 2009]

    The vitamin A connection

    It appears modern medicine has overlooked the most obvious remedy for hearing loss – vitamin A.

    The body of scientific reports involving vitamin A and hearing loss can be confusing. A three-decades-old report stated that cochleas (spiral-shaped snail shell-like structure of the inner ear) of vitamin A-deficient rats examined under an electron microscope concluded that “vitamin A does not have an important function in the inner ear.” [Archives Otorhinolarygology 1982] This study may have served as a giant misdirection.

    In that same year 50-percent of 59 chronic alcoholic patients without a history of ear infection, noise exposure, use of oto-toxic drugs or a family history of hereditary deafness were found to have a hearing deficit that correlated with low blood levels of vitamin A and zinc. [HNO Oct 1982]

    Another report said: “morphological (form and structure) experiments reveal different and in some ways contradictory results, but they showed that vitamin A seems to be essential for inner ear morphogenesis.” [Z Ernahrungswiss (European Journal Nutrition) June 1984]

    By 1985 European researchers were reporting a 5-15 decibel improvement in patients with age-related hearing loss when vitamins A + E were used. [Acta Vitaminologica et Enzymologica 1985]

    Another similar report by researchers in Italy in that same year reported that vitamins A + E resulted in improvement of symptoms among patients with presbycusis (age-related hearing loss). [Acta Vitaminologica Enzymologica 1985]

    Other researchers reported that a vitamin A deficiency results in a decline in sensory cells in the nose, tongue and inner ear. [Acta Vitaminologica Enzymologica 1985]

    By 1990 researchers fed two groups of guinea pigs a vitamin A-deficient and supplemented diet and reported that the vitamin A-fed group had greater sensitivity to sounds. [Journal Nutrition July 1990] The researchers puzzlingly concluded that vitamin A may increase the probability of noise-induced hearing loss without recognizing vitamin A must be regenerative in some manner.

    Then finally a breakthrough was reported in 1993 in none other than the prestigious journal SCIENCE. Hair cells are the nerve cells that reside within the spiral cochlea of the ear and respond to sound by converting vibrations into electrical signals that are sent to the brain. Hair cells are damaged in both acute toxic stress (drugs, loud noise) and in chronic slow-progressive age-related hearing loss.

    In the 1993 Science report researchers said: “sensorial hearing loss resulting from the loss of auditory hair cells is thought to be irreversible in mammals. This study provides evidence that retinoic acid (vitamin A) can stimulate the regeneration in vitro {in a lab dish} of mammalian auditory hair cells” in poisoned ear tissues of the lab rat. “These results provide hope for a recovery of hearing function in mammals after auditory hair cell damage,” said the report. [Science April 30, 1993]

    Sixteen years later researchers supplemented laboratory mice diets with vitamin A and then exposed them to loud noise for 3 days that resulted in a loss of some hair cells in the inner ear. These mice were compared with animals fed with sesame oil as a control group. The vitamin A-fed mice experienced less hearing loss and greater survival of hair cells. [Acta Otolaryngologica March 2009]

    In the same year researchers in Japan studied 762 adults age 65 years and older and found that those subjects with the highest blood serum levels of vitamin A and plant-food carotenoids that convert to vitamin A cut their risk for hearing loss in half. [Journal Gerontology A Biological Science Medical Science Aug 2009]

    In 2012 researchers at the University of Southern California reported on the use of vitamin A injections (200,000 international units) among poorly nourished school children in Nepal. It is assumed frequent childhood inner-ear infections would induce hearing loss. Among children who had experienced inner ear infections, the vitamin A-treated children were 42% less likely to have experienced hearing loss than non-vitamin-treated children. [British Medical Journal Jan 10, 2012]

    In 2013 it was reported that patients who undergo bariatric weight loss surgery that may induce malabsorption of nutrients can experience hearing loss. The case of a woman with severe vitamin A deficiency following bariatric surgery and experienced severe dry eyes, dry skin and hearing loss was presented. [Nutrition Hospital July-Aug 2013]

    Finally, to the present day, researchers finally got around to determining whether lack of vitamin A during pregnancy has any bearing on hearing loss. While it is known that middle ear infections during childhood can result in hearing loss, what was not known was whether vitamin A deficiency during gestation prevents hearing deficits. Based upon animal experiments, researchers concluded that vitamin A deficiency during pregnancy, especially during the early stages of fetal development, “may predispose offspring to inner ear malformations and sensorial hearing loss.” The researchers recommend vitamin A throughout pregnancy to promote inner ear development. [Medical Hypotheses Jan 2014]

    What we have learned so far is that vitamin A is involved in all forms of hearing loss, from the womb forward.

    The forgotten vitamin A report

    This report calls attention to another important paper published over a half century ago involving hearing loss and vitamin A.

    The important role of vitamin A in prevention and restoration of hearing loss was reviewed way back in 1951 by M Joseph Lobel MD, a practicing physician in New York.

    Dr. Lobel had published a preliminary report in 1949. [Eye Ear Nose & Throat Monthly May 1949] He followed that report with a longer discourse that presented his experience with injectable vitamin A among 300 patients with hearing loss. [AMA Archives Otolaryngology May 1951]

    Dr. Lobel’s work stood on the shoulders of those who had preceded him and his published paper recognized them. The idea that vitamin A resolved or prevented hearing loss had been circulating since the 1920s.

    Dr. Lobel noted a published study by Roy A. Barlow in 1927 noted that “deficiency of vitamin A causing changes in the mucus membrane of the respiratory tract might be considered a possible factor in the production of changes in the soft tissue of the middle ear, which might become permanent.” [Laryngoscope Sept 1927]

    Dr. Lobel refers to observational studies published by Drs. Anderson, Zoller and Alexander that “injectable vitamin A therapy in massive doses is a valuable therapeutic agent in patients with deafness not amenable to the usual methods of treatment.” [Eye Ear Nose Throat Monthly Feb 1950]

    However, Dr. Lobel wanders a bit in his enthusiasm for vitamin therapy and doesn’t stay focused on his own study involving vitamin A. He mentions the work of Dr. Charschak who reported in 1936 that the provision of vitamin B-rich dried yeast resulted in the disappearance of 12 of 15 cases of tinnitus. In that same year Dr. G Selfridge reported that vitamin B1 and B3 “most beneficial” in deafness. Other doctors report success with B vitamins and iron.

    Then Dr. Lobel returns to the topic of vitamin A and refers to other early inconsistent reports, some which showed that vitamin A-rich cod liver oil remedied some cases of tinnitus (ringing in the ears) without hearing improvement.

    Dr. Lobel also cites the work of Dr. W. Rosenfeld who used vitamin A-rich cod liver oil and calcium and reported markedly reduced or disappearance of tinnitus along with hearing improvement. The problem here was the ample amount of vitamin A or the small amount of vitamin D in cod liver oil responsible for such a beneficial effect?

    Dr. Lobel proceeded to cite the work of Sir Edward Mellanby, the discoverer of vitamin D, who experimentally induced deafness in young animals with vitamin A-deficient diet. [Journal Physiology Dec 14, 1938]

    Dr. Lobel noted the strongest argument against the theory that vitamins are important in nerve deafness that is that deafness is not a symptom of frank vitamin deficiency. Scurvy (vitamin C deficiency), pellagra (niacin B3 deficiency, beriberi (B1 deficiency) are not associated with nerve deafness. But certainly vitamins A & D are!

    Dr. Lobel went on to count 300 patients who experienced an average gain of 17.3 to 18.9% gain in hearing with the use of injectable vitamin A (249 patients benefited (83%), 51 did not (17%). Dr. Lobel concluded that: “clinical trials with a new injectable vitamin A preparation hold out promise of its therapeutic value in certain types of deafness.” [AMA Archives Otolaryngology May 1951]

    However, Dr. Lobel mixed positive reports about vitamin therapy involving B vitamins with his notations about vitamin A. So his enthusiasm for vitamin therapy becomes a bit muddy at this point.

    Dr. Lobel’s work was not to go unchallenged. Miles Atkinson MD, an obvious competitor of Dr. Lobel’s in New York City, wanted to determine whether Dr. Lobel’s results were produced by B vitamins from dried yeast or the injectable vitamin A, since both were used in some patients.

    Dr. Atkinson injected 50,000 units of vitamin A in ten patients with Ménière’s disease, tinnitus and vertigo as well as progressive hearing loss. None of the patients responded to treatment. However, all were under intensive B vitamin therapy, which may have clouded the results. [AMA Archives Otolaryngology Feb 1954]

    Give vitamin A an “A”

    But you can see by reading the above modern day reports that vitamin A still stands tall as a therapeutic agent for hearing loss of all forms.

    A strong piece of evidence of vitamin A’s ability to not only protect but regenerate or replace damage hair cells in the ear comes from modern work with stem cells, which are internally produced. Stem cells are unspecialized cells that can be converted to specialized cells such as muscle or nerve cells.

    Vitamin A helps maintain a stem cell’s ability to differentiate into another type of cell. [Stem Cells July 2008] Freshly published reports indicate Vitamin A (aka retinoic acid) supports self-renewal of stem cells. [Nutrients March 21, 2014]

    Endogenous (internally produced) stem cells produce new nerve cells throughout life [American Journal Physical Medical Rehabilitation May 5, 2014] Endogenous stem cells are capable of self-renewal, that is, they make copies of themselves. [Expert Opinion Biology Therapy Sept 2009]

    It is recognized that internally derived stem cells appear to retain their ability to replace damaged cells, though these stem cells are not easily recruited for repair of inner ear nerve cells and hair cells. [International Journal Developmental Biology 2007]

    Researchers are exploring the use of vitamin A to differentiate stem (progenitor) cells to differentiate into new hair cells to rescue hearing loss. [American Journal Physiology Cell Physiology March 2009]

    The possibility of cell regeneration in the ear by conversion of stems cells via vitamin A into fully functioning hair cells was mentioned at least a decade ago. [Proceedings Nutrition Society Feb 2000]

    A report published in 1997 showed that vitamin A could be used successfully in a lab dish to regenerate hair cells using vitamin A. [Acta Otorhinologica Belgium 1997] Experiments published in 1993 showed that vitamin A “may be able to induce a population of cells to become hair cells.” [Development Dec 1993]

    It becomes very clear now that vitamin A not only works to inhibit ear infection but also to provoke endogenously produced stem cells to differentiate into hair cells in the ear.

    The problem in today’s commercialized research environment, any natural remedies like vitamin A therapy will be cast aside until modern medicine can figure out to how produce more financially rewarding cures. Conventional medicine has had over eight decades to capitalize on the discovery vitamin A restores hearing. Over that time more Americans now live into their eighth and ninth decades of life and suffer from age-related tinnitus and hearing loss.

    In summary, there is lab dish, animal and human (dietary and supplemental) evidence that vitamin A prevents, treats and can even reverse hearing loss. While clinicians may demand more controlled studies, there is no reason not to recommend vitamin A to anyone who has experienced hearing decline of any origin.

    Balancing A with D

    A problem arises in this era of vitamin D awakening. Vitamins A and D compete for absorption in the liver. This author experienced two eye infections, his first ever, while taking daily vitamin D supplements. Apparently supplemental vitamin D was crowding out vitamin A and the mucin layer of my tear film was lacking. Supplemental vitamins A & D remedied the problem.

    This author’s suggestion is that individuals with hearing problems take a 50,000-unit dose of vitamin D once a week and take vitamin A, at least 10,000 IU daily.

    Overcoming nutriphobia-A

    Another problem is that modern medicine has frightened consumers away from vitamin A pills. Ask a doctor and he will quickly tell you supplemental vitamin A is potentially toxic.

    The published medical literature shows that vitamin A in multivitamins is not liver toxic. [Journal American College Nutrition Dec 1992]

    Acute vitamin A liver toxicity may occur after ingestion of 500,000 international units of vitamin A (100 times more than the Recommended Daily Allowance) by adults. Reported incidences of vitamin A toxicity are rare and have averaged fewer than 10 cases per year from 1976 to 1987. [American Journal Clinical Nutrition Feb 1989] Vitamin A liver toxicity generally occurs among alcoholics who already have liver disease.

    Even concerns about birth defects induced by excessive vitamin A are diminished by a report showing 30,000 units a day of vitamin A is not likely to induce birth defects. [International Journal Vitamin Nutrition Research 1998]

    Either cod liver oil that is rich in vitamin A or vitamin A acetate can be taken.

    Individuals with tinnitus (ringing in the ears) and hearing loss should probably initiate a trial regimen of vitamin A supplementation for six weeks to assess if there is any improvement. Combined use with low-dose resveratrol (50-100 mg) and once-weekly vitamin D may be advisable to encourage stem cell renewal of hair cells.

    Age-related hearing loss

    There is other evidence that nutrients can stave off age-related hearing loss.

    In a study of adults over 60 years of age, blood serum levels of folic acid were higher (412.3 nanomoles/liter) with normal hearing versus hearing loss (279.1 nanomoles/liter). Vitamin B12 was not correlated with hearing loss. [Otolaryngology Head Neck Surgery Dec 2010]

    A European study among 728 older men and women who were provided with 800 micrograms of daily folic acid over a period of 3 years resulted in a slowing of hearing loss in a country that does not fortify its foods with folic acid. [Annals Internal Medicine Jan 2, 2007]

    Some (but not all) studies associate hearing loss with poor vitamin B12 blood levels. While individuals with hearing loss show evidence of having low B12 blood levels (by elevated levels of methylmalonic acid), short-term B12 supplementation did not improve hearing status among older adults. [Journal Nutrition Elderly 2006]

    In a study of women age 60-71 years, women with impaired hearing had vitamin B12 and folate blood serum levels 38% and 31% lower than women with normal hearing. Among women who took no dietary supplements, women with impaired hearing had 48% lower blood serum vitamin B12 and 43% lower red cell folate than women with normal hearing. [American Journal Clinical Nutrition March 1999]

    Calorie restriction mimics/Sirtuin3 survival gene activation to save hearing

    Calorie restricted diets extend the lifespan and healthspan of laboratory mice and slow the progression of hearing loss. The genetic mechanism behind limited calorie diets slowing hearing loss has been identified as activation of the Sirtuin3 survival gene, which operates in the mitochondria (atomic power plants) within living cells. [Experimental Gerontology Oct 2013] Sirtuin3 gene protein increases glutathione, a naturally produced antioxidant, within mitochondria.

    Sirtuin3 is considered “an essential player in enhancing the glutathione antioxidant defense system during calorie restriction. [Cell Nov 24, 2010] In an animal study, a calorie-restricted diet maintained the most acute hearing sensitivity, produced the fewest mitochondria DNA deletions and the least amount of hair cell losses when compared to vitamin C and vitamin E therapy. [Laryngoscope May 2000]

    Resveratrol molecularly mimics a calorie restricted diet and a commercially available dietary supplement has been shown to activate Sirtuin3 gene 295% better than the red wine molecule resveratrol. [ResveratrolNews.com June 30, 2011]

    Vitamin D

    Doctors prescribe fluoride (to harden bone, boron can be used as substitute); calcium and vitamin D for patients with hearing loss associated with osteoarthritis. [Annals Otolaryngology Laryngology March-April 1984; Ear Nose & Throat Journal Aug 1995]

    Abnormal bone metabolism (osteoporosis) is suspected among patients with senile deafness. Twelve patients treated with senile deafness were treated with vitamin D and 4 patients (6 ears) experienced hearing improvement. [American Journal Otology Sept 1988]

    Vitamin D supplements may be helpful in resolving cases of demineralizing deafness caused by vitamin D deficiency. [British Medical Journal July 1981; Journal Laryngology Otology May 1983; American Journal Otology Jan 1989]

    Mice bred in the laboratory to be deficient in KLOTHO gene protein exhibit mild hearing loss. Vitamin D up-regulates the production of KLOTHO gene protein. [Hearing Research May 2011]

    Mice bred with an absent KLOTHO gene have little control over vitamin D and develop progressive loss of hearing and balance. [Journal Steroid Biochemistry Molecular Biology March 2009] On the other hand, mice bred without a vitamin D cell receptor develop accelerated age-related hearing loss. [Audiology Neurootology 2008]

    Sudden idiopathic (unexplained) hearing loss

    Sudden hearing loss is a perplexing problem. Modern medicine has few if any successful treatments for it. Physicians impulsively inject steroids that have been shown to work no better than an inactive placebo. [Archives Otolaryngology Head & Neck Surgery June 2007]

    Supplemental vitamin A (natural beta carotene, 26,000 IU vitamin A activity); vitamin C (200 mg), vitamin E (200 IU d-alpha tocopherol) and selenium (50 micrograms) twice daily for 30 days following sudden onset of hearing loss fared better than patients who received steroids (prednisone) alone. [European Archives Otorhinolaryngology Feb 2014]

    Patients treated with vitamin E after sudden onset of idiopathic hearing loss fared better than patients given magnesium, steroids, bed rest alone.  [Otology Neurotology July 2003]

    Intravenous magnesium improves recovery from sudden onset hearing loss.  [Otology Neurotology July 2002]

    When hyaluronic acid is added to injected steroids to treat sudden idiopathic hearing loss, treatment improves. [European Archives Otorhinolaryngology Feb 2005]

    The use of vitamin E (600 mg/day) and vitamin C (1200 mg/day) was far superior (29.4 decibel improvement versus drug therapy alone) for sudden idiopathic hearing loss.  [Acta Otolaryngology Feb 2008]

    The delivery of intravenous vitamin C (200 mg/kilogram body weight/day) for 10 days plus 2000 mg vitamin C orally for 30 days enhanced hearing recovery among patients with sudden idiopathic hearing loss.  [European Archives Otorhinolarynology Sept 2013]

    Zinc gluconate supplementation enhanced hearing recovery among patients with idiopathic sudden hearing loss.  [Laryngoscope March 2011]

    Tinnitus

    There is animal lab evidence that supplemental taurine (an amino acid) quells ringing in the ears. [Hearing Research Dec 2010; Journal Neuroscience Research Nov 2012]

    Ursolic acid, which is available in extracts of rosemary, has been identified as an agent that can calm tinnitus. [American Journal Chinese Medicine 2009]

    High insulin levels and diabetes are associated with tinnitus, vertigo and hearing loss. [International Tinnitus Journal 1998 and International Tinnitus Journal 2001] A low carbohydrate diet (no bread, no rice, no pasta, no refined sugars) may be in order. [PLos One April 9, 2014]

    Individuals with osteoarthritis (wear and tear arthritis) are far more likely to experience tinnitus. [Clinical Otolaryngology Apr 10, 2014] Oral hyaluronic acid may be helpful.

    References to nutrients and other origins of hearing loss

    Diabetes induced

    Noise-induced hearing loss

    Tinnitus

    Malnutrition

    • Thiamin B1, cobalamin B12, folate (B9, sulfur amino acids (cysteine) curbed an epidemic of sensorial hearing loss. [Journal Neurological Science Dec 1994]

    Megaloblastic anemia

    Alcohol induced

    • High intake of alcohol and low intake of B12 is associated with hearing loss. [Ear Hear Feb 2011]

    Drug induced

    hearing-loss-nutrients

    ©2014 Bill Sardi, Knowledge of Health, Inc.

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One Response to “Lack Of Vitamin A May Be Overlooked Root Of Tinnitus And Hearing Loss”

  1. Ed Says:
    May 21st, 2014 at 3:53 pm

    In 1981 I had a head cold that got into my sinuses. I was flying a lot and my hearing was severely affected. I was advised by a nutritionist to take 50,000 units of vitamin a per day for one week along with 1000 Mg of Vitamin C no drinking or smoking. At the end of the week my hearing had improved by at least 50% and in another two weeks was back to normal. Vitamin A did this when six months of prescription drugs did nothing. Ed

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