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- Abrasions, anal fissure, autolytic debridement, bed sore, Clostridium sp., collagen, collagen matrix, cuts, debridement, decubitus ulcer, diabetic ulcers, electrotherapy, epithelial, epithelialization phase, extravasation, gangrene, gas gangrene, human growth factors, hydrocolloid, hyperbaric oxygen, incision wounds, incontinence, infected surgical wounds, infectious arthritis, inflammatory phase, injuries, laceration, macrophages, mechanical debridement, microvascular, minor injuries, myonecrosis, necrotizing fasciitis, pressure ulcers/wound care, proliferative phase, puncture wound, remodeling phase, scrapes, scratches, sepsis, septic arthritis, skin damage caused by incontinence, skin graft healing (split thickness), skin ulcer, surgical skin flap ischemia, skin wounds, squamous, stitches, superficial, suture, vulnerary, wound care, wound healing.
- A wound is a break in the outer layer of the skin, called the epidermis. Wounds are usually caused by cuts or scrapes. Different kinds of wounds may be treated differently from one another, depending upon how they happened and how serious they are. Other wounds include puncture wounds, lacerations (cuts), pressure sores, anal fissures, extravasations (a drug accidentally going outside of a vein causing tissue damage), skin damage caused by incontinence (lack of bladder control), skin graft healing (split thickness), diabetic ulcers, and surgical skin flap ischemia (lack of blood flow to surgically attached skin).
- Healing is a response to the injury that sets into motion a sequence of events. With the exception of bone, all tissues heal with some external scarring. The object of proper care is to minimize the possibility of infection and scarring.
- There are basically four phases to the healing process: the inflammatory phase, proliferative phase, remodeling phase, and epithelialization phase.
- The inflammatory phase begins with the injury itself. In the inflammatory phase, there is bleeding, immediate narrowing of the blood vessels, clot formation, and release of various chemical substances into the wound that will begin the healing process. Specialized cells (macrophages) clear the wound of debris over the course of several days.
- Next is the proliferative phase in which a matrix or latticework of cells forms. On this matrix, new skin cells and blood vessels will form. It is the new small blood vessels (known as capillaries) that give a healing wound its pink or purple-red appearance. These new blood vessels will supply the rebuilding cells with oxygen and nutrients to sustain the growth of the new cells and support the production of proteins (primarily collagen). The collagen acts as the framework upon which the new tissues build. Collagen is the dominant substance in the final scar.
- The remodeling phase begins after 2-3 weeks. The framework (collagen) becomes more organized making the tissue stronger. The blood vessel density becomes less, and the wound begins to lose its pinkish color. Over the course of six months, the area increases in strength, eventually reaching 70% of the strength of uninjured skin.
- Epithelialization is the process of laying down new skin, or epithelial, cells. The skin forms a protective barrier between the outer environment and the body. Its primary purpose is to protect against excessive water loss and bacteria. Reconstruction of this layer begins within a few hours of the injury and is complete within 24-48 hours in a clean, sutured (stitched) wound. Open wounds may take 7-10 days because the inflammatory process is prolonged, which contributes to scarring. Scarring occurs when the injury extends beyond the deep layer of the skin (into the dermis, which is the second layer of skin).
- Unclear or conflicting scientific evidence:
- Aloe: Transparent gel from the pulp of the meaty leaves of Aloe vera has been used topically for thousands of years to treat wounds, skin infections, burns, and numerous other dermatologic conditions. Study results of aloe on wound healing are mixed with some studies reporting positive results and others showing no benefit or potential worsening of the condition. Early studies suggest that aloe may help heal skin ulcers. High-quality studies comparing aloe alone with placebo are needed.
- Avoid if allergic to aloe or other plants of the Liliaceae family (garlic, onions, tulips). Avoid injecting aloe. Do not apply to open skin, surgical wounds or pressure ulcers. Avoid taking by mouth with diarrhea, bowel blockage, intestinal diseases, bloody stools or hepatitis. Avoid with a history of irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes, heart disease or kidney disease. Avoid taking by mouth if pregnant or breastfeeding.
- Alpha-lipoic acid: Alpha-lipoic acid (ALA) may reduce tissue damage that is often caused by long-term exposure to high levels of oxygen. While early studies are promising, more research is needed to fully understand how ALA might work for wound healing in patients undergoing hyperbaric oxygen therapy.
- Avoid if allergic to alpha-lipoic acid (ALA). Use cautiously with diabetes and thyroid diseases. Avoid with thiamine deficiency or alcoholism. Avoid if pregnant or breastfeeding.
- Arginine: Arginine, or L-arginine, is considered a semi-essential amino acid, because although it is normally synthesized in sufficient amounts by the body, supplementation is sometimes required (for example, due to inborn errors of urea synthesis, protein malnutrition, excess ammonia production, excessive lysine intake, burns, infection, peritoneal dialysis, rapid growth, or sepsis). Arginine has been suggested to improve the rate of wound healing in elderly individuals. A randomized, controlled clinical trial reported improved wound healing after surgery in head and neck cancer patients, following the use of an enteral diet supplemented with arginine and fiber. Arginine has also been used topically (on the skin) to attempt to improve wound healing. Early studies suggest that arginine may also help treat chronic anal fissures. Additional studies are needed.
- Avoid if allergic to arginine, or with a history of stroke, liver, or kidney disease. Avoid if pregnant or breastfeeding. Use caution if taking blood-thinning drugs (like warfarin or Coumadin®) and blood pressure drugs or herbs or supplements with similar effects. Blood potassium levels should be monitored. L-arginine may worsen symptoms of sickle cell disease. Caution is advised in patients taking prescription drugs to control sugar levels.
- Aromatherapy: Aromatherapy is a technique in which essential oils from plants are used with the intention of preventing or treating illness, reducing stress, or enhancing well-being. Preliminary data from one small study suggests aromatherapy may contribute to reduced pain intensity during dressing changes in wound care. Data are insufficient for forming any opinion for or against this application.
- Essential oils should only be used on the skin in areas without irritation. Essential oils should be administered in a carrier oil to avoid toxicity. Avoid with a history of allergic dermatitis. Use cautiously if driving or operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant.
- Ayurveda: There is some evidence that a traditional Ayurvedic treatment using specially prepared alkaline threads (ksharasutra or Ayurvedic setons) to achieve gradual cauterization may provide an effective alternative to surgery in patients being treated for anal fissures. Further research is needed to confirm these results.
- Ayurvedic herbs should be used cautiously. Some herbs imported from India have been reported to contain high levels of toxic metals. Ayurvedic herbs can interact with other herbs, foods and drugs. A qualified healthcare professional should be consulted before taking. Use guggul cautiously with peptic ulcer disease. User should avoid sour food, alcohol and heavy exercise. Mahayograj guggul should not be taken for long periods of time. Pippali (Piper longum) should be taken with milk and avoided with asthma. Avoid sweet flag, and avoid amlaki (Emblica officinalis) at bedtime. Avoid Terminalia hebula (harda) if pregnant. Avoid Ayurveda with traumatic injuries, acute pain, advanced disease stages and medical conditions that require surgery.
- Bovine cartilage: Reduction in inflammation and edema (swelling) and enhancement of the healing of wounds were effects that appeared in the medical literature of bovine cartilage during the 1950s and 1960s. In a preliminary comparison of potential wound healing effects with a commercially available ointment of 10% powdered bovine cartilage (Catrix® 10 Ointment) or Aquaphor® original formula in post-operative facial skin care with a laser resurfacing agent, Catrix® 10 Ointment was better. However, this study was a pilot study so its results need confirmation by follow-up clinical studies that clearly have the appropriate randomization and are double-blinded, given that such were in absence in this study. Also lacking in this study was a definition of primary outcome that therapeutically differentiated Catrix® 10 Ointment.
- Avoid if allergic or hypersensitive to bovine cartilage or any of its constituents. Use cautiously with cancer, renal (kidney) failure, or hepatic (liver) failure. Avoid if pregnant or breastfeeding.
- Calendula: Calendula (Calendula officinalis), also known as pot marigold, has been widely used on the skin to treat minor wounds, skin infections, burns, bee stings, sunburn, warts, and cancer. Calendula is commonly used topically (on the skin) to treat minor skin wounds. Reliable human research is necessary before a firm conclusion can be drawn regarding the use of calendula for wound healing.
- Avoid if allergic to plants in the Aster/Compositae family, such as ragweed, chrysanthemums, marigolds, and daisies. Use cautiously in patients taking sedatives, blood pressure medications, cholesterol medications, blood sugar-altering agents, and immunomodulators. Use cautiously with diabetes and in children. Avoid if pregnant or breastfeeding.
- Chamomile: Chamomile (Matricaria recutita, Chamaemelum nobile) has been used medicinally for thousands of years, and is widely used in Europe. There is promising preliminary evidence supporting the topical use of chamomile for wound healing. However, the available literature is not adequate to support the use of chamomile for this indication.
- Avoid if allergic to chamomile. Anaphylaxis, throat swelling, skin allergic reactions and shortness of breath have been reported. Chamomile eyewash can cause allergic conjunctivitis (pinkeye). Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding.
- Chitosan: There is limited evidence on the effects of chitosan in wound healing. Better studies are needed.
- Avoid if allergic or sensitive to chitosan or shellfish. Use cautiously with diabetes or bleeding disorders. Use cautiously if taking drugs, herbs, or supplements that lower blood sugar or increase the risk of bleeding. Chitosan may decrease absorption of fat and fat-soluble vitamins from foods. Chitosan is not recommended during pregnancy or breastfeeding.
- Dimethylsulfoxide (DMSO): Dimethylsulfoxide (DMSO) is a sulfur-containing organic compound. DMSO occurs naturally in vegetables, fruits, grains, and animal products. DMSO applied to the skin may prevent tissue death after extravasation of anticancer agents. It can be applied alone or with steroids. Limited available study also suggests that DSMO improves lack of blood flow in surgical skin flap ischemia. Currently, there is not enough scientific evidence available for the use of topical DMSO for diabetic ulcers.
- Avoid if allergic or hypersensitive to DMSO. Use caution with urinary tract cancer or liver and kidney dysfunction. Avoid if pregnant or breastfeeding.
- Eucalyptus oil: Eucalyptus (Eucalyptus globulus) oil contains 70-85% 1,8-cineole (eucalyptol), which is also present in other plant oils. Limited evidence suggests that eucalyptus essential oil may be beneficial for patients with skin ulcers when combined with antibiotics. More studies are needed to confirm these early findings.
- Case reports describe allergic rash after exposure to eucalyptus oil, either alone or as an ingredient in creams. Avoid if allergic to eucalyptus oil or with a history of seizure, diabetes, asthma, heart disease, abnormal heart rhythms, intestinal disorders, liver disease, kidney disease, or lung disease. Use caution if driving or operating machinery. Avoid with a history of acute intermittent porphyria. Avoid if pregnant or breastfeeding. A strain of bacteria found on eucalyptus may cause infection. Toxicity has been reported with oral and inhaled use.
- Gotu kola: Gotu kola, Centella asiatica (formerly known as Hydrocotyle asiatica), has a long history of use, dating back to ancient Chinese and Ayurvedic medicine. Preliminary study has demonstrated the ability of Centella asiatica extracts to promote wound healing, possibly through the stimulation of collagen synthesis. However, additional human study is needed in this area.
- Avoid if allergic to gotu kola, asiaticoside, asiatic acid, or madecassic acid. Avoid with a history of high cholesterol, cancer, or diabetes. Avoid if pregnant or breastfeeding.
- Honey: Honey is a sweet, viscid fluid produced by honeybees (Apis melliflera) from the nectar of flowers. The primary studied use of honey is for wound management, particularly in promoting rapid wound healing, deodorizing, and debriding necrotic tissue. The types of wounds studied are varied; most are non-healing wounds such as chronic ulcers, postoperative wounds, and burns. Currently, there is insufficient human evidence to support the use of honey for skin graft healing. Although honey has apparent antibacterial effects, more human study is needed in this area.
- Avoid if allergic or hypersensitive to honey, pollen, celery, or bees. Honey is generally considered safe in recommended doses. Avoid honey from the genus Rhododendron because it may cause a toxic reaction. Avoid in infants younger than 12 months of age. Use cautiously with antibiotics. Potentially harmful contaminants (like C. botulinum or grayanotoxins) can be found in some types of honey and should be used cautiously in pregnant or breastfeeding women.
- Hydrotherapy: Hydrotherapy is broadly defined as the external application of water in any form or temperature (hot, cold, steam, liquid, ice) for healing purposes. It may include immersion in a bath or body of water (such as the ocean or a pool), use of water jets, douches, application of wet towels to the skin, or water birth. These approaches have been used for the relief of various diseases and injuries, or for general well being. Hydrotherapy has been used in patients with pressure ulcers, and preliminary research suggests that daily whirlpool baths may reduce the time for wound healing. Better research is necessary in this area before a firm conclusion can be drawn.
- There is a risk of infection from contaminated water if sanitary conditions are not maintained. Avoid sudden or prolonged exposure to extreme temperatures in baths, wraps, saunas, or other forms of hydrotherapy, particularly with heart disease, lung disease, or if pregnant. Avoid with implanted medical devices like pacemakers, defibrillators, or hepatic (liver) infusion pumps. Vigorous use of water jets should be avoided with fractures, known blood clots, bleeding disorders, severe osteoporosis, open wounds, or during pregnancy. Use cautiously with Raynaud's disease, chilblains, acrocyanosis, erythrocyanosis, and impaired temperature sensitivity, such as neuropathy. Use cautiously if pregnant or breastfeeding. Hydrotherapy should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses. Patients with known illnesses should consult their physician(s) before starting hydrotherapy.
- Iodine: It is not clear if healing of wounds or skin ulcers is improved with the application of topical iodine solutions. Iodine solutions may assist with sterilization as a part of a larger approach to the wound healing process.
- Reactions can be severe, and deaths have occurred with exposure to iodine. Avoid iodine-based products if allergic or hypersensitive to iodine. Do no use for more than 14 days. Avoid Lugol solution and saturated solution of potassium iodide (SSKI, PIMA) with hyperkalemia (high amounts of potassium in the blood), pulmonary edema (fluid in the lungs), bronchitis, or tuberculosis. Use cautiously when applying to the skin because it may irritate/burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction. Iodine is safe in recommended doses for pregnant or breastfeeding women. Avoid povidone-iodine for perianal preparation during delivery or postpartum antisepsis.
- Magnet therapy: The use of magnets to treat illness has been described historically in many civilizations. In modern times, magnetic fields play an important role in Western medicine, including use for magnetic resonance imaging (MRI), pulsed electromagnetic fields, and experimental magnetic stimulatory techniques. Early scientific evidence suggests that the time to heal wounds, including ulcers, may decrease with the use of static magnets. Better quality studies are needed before a firm recommendation can be made for wound healing.
- Avoid with implantable medical devices, such as heart pacemakers, defibrillators, insulin pumps, or hepatic artery infusion pumps. Avoid with myasthenia gravis or bleeding disorders. Avoid if pregnant or breastfeeding. Magnet therapy is not advised as the sole treatment for potentially serious medical conditions, and it should not delay the time to diagnosis or treatment with more proven methods. Patients are advised to discuss magnet therapy with a qualified healthcare provider before starting treatment.
- Pantothenic acid (vitamin B5): Pantothenic acid (vitamin B5) is essential to all life and is a component of Coenzyme A (CoA), a molecule that is necessary for numerous vital chemical reactions to occur in cells. Pantothenic acid is essential to the metabolism of carbohydrates, proteins, and fats, as well as for the synthesis of hormones and cholesterol. In animal research, oral and topical pantothenic acid has been associated with accelerated skin wound healing. However early human study results conflict. Additional evidence is necessary before a clear conclusion can be reached regarding this use of pantothenic acid or dexpanthenol.
- Avoid if allergic or hypersensitive to pantothenic acid or dexpanthenol. Avoid with gastrointestinal blockage. Pantothenic acid is generally considered safe in pregnant and breastfeeding women when taken at recommended doses.
- Papain: Papain is an enzyme that breaks protein bonds and has been used in Africa for treating burns. In standard western medical care, papain-containing debridement agents are commonly used to remove necrotic tissue and slough in burns, postoperative wounds, pilonidal cyst wounds, carbuncles, trauma wounds, infected wounds, and chronic lesions, such as pressure ulcers, and varicose and diabetic ulcers. According to reviews and clinical trials, papain may be very useful for wound debridement and for stimulating wound healing. More high-quality research is needed in this area.
- Use cautiously in patients sensitive to papain. Use cautiously in patients being treated for prostatitis. Use Wobenzym®, which contains papain, cautiously, especially in those with bleeding disorders or taking anticoagulants or antiplatelets. Use cautiously as an adjuvant to radiation therapy. Avoid in patients with gastroesophageal reflux disease. Avoid in patients using immunosuppressive therapy.
- Physical therapy: Physical therapy techniques, such as laser treatment, have been used to clean and heal wounds. Early evidence also suggests that high voltage stimulation or pulsed electrical stimulation may speed the healing of some types of skin ulcers. More research with similar outcome measures is needed to better understand the role of physical therapy for wound care.
- Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with a qualified healthcare professional before beginning any treatments. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the literature although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used in pregnancy and although reports of major adverse effects are lacking in the available literature, caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
- Psyllium: Psyllium, also referred to as ispaghula, is derived from the husks of the seeds of Plantago ovata. Psyllium contains a high level of soluble dietary fiber, and is the chief ingredient in many commonly used bulk laxatives. Results from human study suggest that psyllium may reduce the number of surgeries necessary to heal anal fissures. Further evidence is necessary.
- Avoid if allergic or hypersensitive to psyllium, ispaghula, or English plantains (Plantago lanceolata). Avoid in patients with esophageal disorders, gastrointestinal atony, fecal impaction, gastrointestinal tract narrowing, swallowing difficulties, and previous bowel surgery. Avoid ingestion of psyllium-containing products in individuals with repeated or prolonged psyllium exposure who have not manifested allergic or hypersensitive symptoms. Prescription drugs should be taken one hour before or two hours after psyllium. Adequate fluid intake is required when taking psyllium-containing products. Use cautiously with blood thinners, antidiabetic agents, carbamazepine, lithium, potassium-sparing diuretics, salicylates, tetracyclines, nitrofurantoin, calcium, iron, vitamin B12, other laxatives, tricyclic antidepressants (amitriptyline, doxepin, and imipramine), antigout agents, anti-inflammatory agents, hydrophilic agents, and chitosan. Use cautiously with diabetes and kidney dysfunction. Use cautiously if pregnant or breastfeeding.
- Rose hip: Rose hips are the fruits that develop from the blossoms of the wild rose (Rosa spp.). They are typically orange to red in color, but some species may be purple or black. When applied topically, the volatile oils of aromatic plants may have physiological effects that will facilitate wound healing. Rose hips contain several vitamins and minerals, including vitamin C, vitamin B1, vitamin E, calcium, zinc, and carotenoids, which could potentially promote wound healing when applied to the skin. Much larger and high quality clinical trials are needed to establish the therapeutic efficacy of rose hip and rose oil preparations in the topical treatment of surgical wounds and ulcers.
- Use cautiously in patients who are avoiding immune system stimulants. Use cautiously in patients who are taking anticoagulant or anti-platelet aggregating agents, antibiotics, antineoplastics, antiretrovirals, anti-inflammatory agents, "Long-Life CiLi", antilipemics, aluminum-containing antacids, salicylates, or laxatives. Avoid in patients who are allergic to rose hips, rose pollen, its constituents, or members of the Rosaceae family.
- TENS: Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Electrodes are temporarily attached with paste in various patterns, depending on the specific condition and treatment goals. TENS is often used to treat pain, as an alternative or addition to pain medications. Therapy sessions may last from minutes to hours. TENS is often used in conjunction with acupuncture therapy. TENS has been tested for its effects on blood flow to skin flaps used in plastic surgery procedures such as breast reconstruction. TENS has also been evaluated in patients with skin ulcers, diabetic foot ulcers, and chronic ulcers of various causes. More research is needed in this area.
- Avoid with implantable devices, like defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation, like neuropathy, and with seizure disorders. Avoid if pregnant or breastfeeding.
- Therapeutic touch: Although some studies report an improvement in wound healing with therapeutic touch, others show no benefits.
- Therapeutic touch is believed to be safe for most people. Therapeutic touch should not be used for potentially serious conditions in place of more proven therapies. Avoid with fever or inflammation, and on body areas with cancer.
- Vitamin A: In preliminary study, retinol palmitate significantly reduced rectal symptoms of radiation proctopathy, perhaps because of wound healing effects. Further research is needed to confirm these results.
- Avoid if allergic or hypersensitive to vitamin A. Vitamin A toxicity can occur if taken at high dosages. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may be at an increased risk for lung cancer or heart disease. Vitamin A appears to be safe in pregnant women if taken at recommended doses; however, vitamin A excess, as well as deficiency, has been associated with birth defects. Excessive doses of vitamin A have been associated with central nervous system malformations. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.
- Zinc: Although zinc is frequently cited as having beneficial effects on healing of incision wounds, few studies have investigated this use. Further research is needed. There are conflicting findings regarding the potential benefit of zinc for healing leg ulcers. Available studies reported no or few adverse effects.
- Preliminary evidence suggests that topical zinc oxide oil may help manage perianal and buttock skin damage in incontinent patients. Further research is needed to better understand the role of zinc for treatment of skin damage caused by incontinence.
- Zinc is generally considered to be safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.
- Fair negative scientific evidence:
- Aloe: A well-designed human trial found no benefit of topical acemannan hydrogel (a component of aloe gel) in the treatment of pressure ulcers.
- Avoid if allergic to aloe or other plants of the Liliaceae family (garlic, onions, tulips). Avoid injecting aloe. Do not apply to open skin, surgical wounds or pressure ulcers. Avoid taking by mouth with diarrhea, bowel blockage, intestinal diseases, bloody stools or hepatitis. Avoid with a history of irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes, heart disease or kidney disease. Avoid taking by mouth if pregnant or breastfeeding.
- This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
- American Academy of Family Physicians. .
- American Academy of Pediatrics. .
- Arnold M, Barbul A. Nutrition and wound healing. Plast Reconstr Surg. 2006;117(7 Suppl):42S-58S.
- Centers for Disease Control and Prevention. .
- Dini V, Bertone M, Romanelli M. Prevention and management of pressure ulcers. Dermatol Ther. 2006;19(6):356-64.
- Langemo D, Anderson J, Hanson D, et al. Nutritional considerations in wound care. Adv Skin Wound Care. 2006;19(6):297-8, 300, 303.
- de Laat EH, Schoonhoven L, Pickkers P, et al. Epidemiology, risk and prevention of pressure ulcers in critically ill patients: a literature review. J Wound Care. 2006;15(6):269-75.
- Natural Standard: The Authority on Integrative Medicine. .
- National Institute of Allergy and Infectious Diseases. .
- Pieper B, Sieggreen M, Nordstrom CK, et al. Discharge knowledge and concerns of patients going home with a wound. J Wound Ostomy Continence Nurs. 2007;34(3):245-53; quiz 254-5.
- Wu SC, Driver VR, Wrobel JS, et al. Foot ulcers in the diabetic patient, prevention and treatment. Vasc Health Risk Manag. 2007;3(1):65-76.
- Overview: An ear infection occurs when a cold, allergy, or upper respiratory infection leads to the accumulation of pus, inflammation, and mucus behind the eardrum, blocking the Eustachian tube. This tube connects the middle ear to the back of the nose.
- More fluid may collect and push against the eardrum, causing pain and sometimes a temporary or, in severe cases, a permanent loss of hearing.
- Acute ear infections usually clear up after one to two weeks of treatment. Sometimes, ear infections last longer and become chronic (long-term). After an infection, fluid may stay in the middle ear. This may lead to more infections and hearing loss.
- Although ear infections are most common in young children, they may also affect adults.
- Causes: Ear infections can start with a bacterial or viral infection. In such cases,
the middle and/or outer structures of the ear become inflamed from the infection. Fluid may also build up behind the eardrum.
Bacteria cause about 65-75% of all ear infections. The most common types of these bacteria are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Viruses that may lead to ear infections include the respiratory syncytial virus (RSV), the most frequent type found, followed by influenza (flu) viruses.
- Ear infections also may be associated with problems, such as swelling in the Eustachian tubes, the narrow passageways that connect the middle ear to the throat. Normally, these tubes equalize pressure inside and outside the ear. A child's Eustachian tubes are narrower and shorter than an adult's. This makes it easier for fluid to get trapped in the middle ear when the Eustachian tubes dysfunction or become blocked during a cold. It also provides a perfect breeding ground for infections. Also, just as the mucus in the nose becomes thicker and harder to expel, fluid inside the ear may also become thick and difficult to drain.
- Another factor that contributes to ear infections is swelling of the small clumps of glandular tissue at the back of the nose (called adenoids). These are tissues located in the upper throat near where the Eustachian tubes connect. Adenoids contain lymphocytes, white blood cells that normally fight against infections. Sometimes the adenoids become infected or enlarged, blocking the Eustachian tubes. Infection in the adenoids may also spread to the Eustachian tubes, causing ear infections.
- Children also do not have fully developed immune systems, so it is easier for them to develop many illnesses, including ear infections.
- Symptoms: Ear infections are often difficult to detect in children because many children affected by this disorder do not yet have sufficient speech and language skills to tell someone what is bothering them. Common signs to look for include unusual irritability, difficulty sleeping, tugging or pulling at one or both ears, earache, fever, fluid draining from the ear, loss of balance, and unresponsiveness to quiet sounds or other signs of hearing difficulty. These signs may include sitting too close to the television or being inattentive. Fluid buildup in the middle ear also blocks sound, which can lead to temporary hearing loss.
- If the pressure from the fluid buildup is high enough, it may cause the eardrum to rupture, resulting in drainage of fluid from the ear, which may include blood and thick, yellow pus. This releases the pressure behind the eardrum, usually relieving pain.
- If there is fluid in the middle ear, it may feel similar to a sensation of ear fullness or "popping." The fluid behind the eardrum may block sound, so mild temporary hearing loss can happen, although it may not be obvious.
- Possible complications include short- or long-term hearing loss, ruptured ear drum, and inflammation of the rounded protrusion of bone just behind the ear, called the mastoid bone. When the mastoid bone swells, it is commonly called mastoiditis.
- Diagnosis: Ear infections are usually diagnosed after a medical history, physical exam, and ear exam. If a middle ear infection is suspected, a healthcare provider will use an instrument, called a pneumatic otoscope, to look at the eardrum for signs of redness, bulging, or fluid behind the eardrum.
- Reflectometry is used if the ear exam with a pneumatic otoscope does not indicate that fluid is behind the eardrum. The tip of a small handheld instrument is placed in the ear canal. This instrument sends off a sound. How the eardrum reacts to the sound tells the doctor if fluid is present.
- Tympanocentesis is performed when fluid stays behind the eardrum (chronic otitis media with effusion) or if an infection continues despite treatment with antibiotics. Tympanocentesis can remove the fluid. The doctor uses a needle to pierce the eardrum and suck out the fluid. A sample is usually tested for bacterial or viral growth. These tests reveal what kind of bacteria or virus is causing the infection and what medication is best for treatment. Patients may receive pain relievers or sedatives before the procedure.
- Treatment: Ear infections can be treated several ways. The best treatment option for a patient depends on several factors, including the person's age, medical history, level of pain, and the type of ear infection. Most ear infections go away without treatment in just a few days, and antibiotics will not help an infection caused by a virus. About 80% of children with acute otitis media recover without antibiotics, according to the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP).
- If a patient (adult or child) is uncomfortable, the doctor may recommend an over-the-counter (OTC) pain reliever, such as acetaminophen (Tylenol® or Tempra®) or ibuprofen (Advil® or Motrin®). It is important to read the labels closely on these medications and give the proper dosage, especially in children and infants.
- Ear drops are commonly used in both adults and children to relieve pain and inflammation. If fluid is not draining from the ear or ear tubes, prescription eardrops containing a local anesthetic (numbing agents) and anti-inflammatory drugs may be an option. Examples include benzocaine (Americaine Otic® or Otocain®) and antipyrine/benzocaine (Auralgan®, Auroto®, or Otocalm®). Ear drops containing neomycin and polymixin B (both antibiotics) are available for infections. These medications are also available as solutions and suspensions to treat a rupture.
- If the individual is younger than six months or has two or more ear infections within 30 days or fluid remains behind the eardrum (chronic otitis media with effusion), the doctor may recommend an antibiotic. The AAP and the AAFP recommend the use of high doses and short courses of amoxicillin (Amoxil®, Trimox®) or amoxicillin combined with clavulanate potassium (Augmentin®) in individuals (including children) with otitis media. Erythromycin antibiotics (Eryped® or Erytab®) may also be used.
- If fluid in the individual's ear is affecting his or her hearing or recurrent ear infections do not respond to antibiotics, surgery may be needed. The most common surgery for ear infections is a myringotomy. During this procedure, which requires general anesthesia, a surgeon inserts a small drainage tube through the eardrum. This helps drain the fluid and equalize the pressure between the middle ear and outer ear. Hearing should improve immediately. If the ear infections continue after age four, the surgeon may recommend removing the adenoids.
- Prevention: Ear infections are more common in children who are exposed to cigarette smoke in the home. Even fumes from tobacco smoke on the hair and clothes may affect the child.
- Breastfeeding a baby helps improve immunity and resistance to infections. This is because a mother's breast milk contains important proteins that improve a baby's developing immune system. The baby should be breastfed in an upright position to prevent the possibility of acquiring infections.
- Individuals should talk to their doctors about recommended vaccinations. Although there is currently no vaccine for infections, many immunizations can prevent illnesses that may progress to ear infections.
- Practicing good hygiene may also help reduce the risk of acquiring infections.
- Overview: Glue ear occurs when the middle ear fills with a thick fluid that resembles glue. Different kinds of fluid may build up behind the eardrum, which ranges from yellow to white in color. The fluid weakens the vibrations of the eardrum, which may cause a patient to hear sounds quieter than they really are. One or both ears may be affected.
- Although glue ear can affect anyone, it is most common in young children.
- This condition usually goes away without treatment, and hearing returns to normal after several weeks to months. In some cases, the condition may come back in the future. However, as children grow older, glue ear becomes less common. It is considered rare in children who are older than eight years old. This is because the Eustachian tube widens with age, allowing the middle ear to drain properly.
- Causes: The cause of glue ear is poorly understood. Experts believe it occurs when the Eustachian tube does not work properly. For instance, if the tube is blocked, does not open properly, or is too narrow, the amount of fluid and air in the middle ear is not regulated. Air in the middle ear may pass into the nearby cells if it is not replaced by air coming up the Eustachian tube. This may result in a vacuum-like effect in the middle ear, causing fluid to enter the middle ear from the nearby cells.
- Some cases of glue ear develop after a child has a cold, illness, or ear infection that causes the body to make extra mucus. In such cases, the mucus builds up inside the middle ear and does not drain down the Eustachian tubes.
- Symptoms: Symptoms typically last a few weeks, although sometimes they may persist for a few months. The main symptom of glue ear is dulled hearing. This temporary hearing loss is usually mild, but the severity can vary from day to day in the same person. Hearing loss is generally worst when the fluid is very thick. Older children may be able to communicate that they are having trouble hearing, while younger children may be unresponsive to normal sounds. Some children may experience a mild earache from time to time.
- Because the thick fluid in the ear provides a good environment for bacteria to grow, children with glue ear have an increased risk of developing ear infections. Therefore, if a child experiences any of these symptoms, he/she should be taken to a doctor for a checkup.
- Diagnosis: If glue ear is suspected, the child's doctor may recommend an ear, nose, and throat (ENT) specialist. A procedure called an otoscopy may be performed to determine if the child has glue ear. During the procedure, a doctor uses an instrument called an otoscope to look inside the ear drum. The doctor may see signs of trapped fluid and poor movement of the eardrum, which indicate glue ear.
- A hearing test may also be performed. There are many different types of hearing tests available. During most tests, a child wears headphones and responds to different sounds.
- Treatment: When a patient is diagnosed with glue ear, doctors typically wait to see if the condition improves on its own before starting treatment. The length of time a doctor might advise a patient to wait varies from weeks to several months.
- If the condition does not improve on its own, a balloon treatment may be recommended. During the procedure, a child uses the nose to blow up a special type of balloon. This process, called autoinflation, increases the pressure in the nose, which may help open up the Eustachian tube and allows the fluid to drain. This procedure is repeated several times until the fluid is drained. Although this procedure does not cause any side effects, it is not effective in all cases.
- If glue ear is persistent or severe, a minor operation may be recommended. During surgery, a small cut is made in the eardrum and fluid is drained. Then a ventilation tube is inserted into the ear. This tube (called a grommet) allows air to enter the middle ear. Hearing improves immediately. Grommets fall out of the ear as the eardrum grows (usually six to 12 months after surgery). Once the grommet falls out, the small hole in the eardrum heals quickly. In some cases, the small clumps of glandular tissue at the back of nose (called adenoids) may be removed.
- Prevention: Because the cause of glue ear remains unclear, there is no way to prevent the condition. However, children who are breastfed and live in homes free of cigarette smoke may have a decreased risk of developing glue ear.
Hearing loss and deafness
- Overview: Hearing problems may be present at birth or may occur later in life. Hearing loss may be mild, resulting in difficulties with conversation, or as severe as complete hearing loss (deafness). Depending on the cause, one or both ears may be affected.
- Causes: Experts believe that a person's biological makeup and long-term exposure to loud noises are the main factors that contribute to hearing loss. Frequent exposure to loud noises may damage the cochlea (ear organ), which can ultimately result in hearing loss. If hearing loss is caused by damage to the ears, the condition cannot be reversed. Sudden hearing loss might be caused by trauma to the ears or problems with blood circulation. If hearing loss occurs gradually, it may be caused by factors, such as aging, infections, tumors, or other diseases. It is normal for hearing, especially the ability to hear high-pitched tones, to decline with age.
- Earwax buildup is a common cause of temporary hearing loss. Once the earwax is removed, hearing returns to normal.
- Symptoms: The severity of symptoms varies among patients. Some patients may hear dulled sounds, while others may not be able to hear at all. Common symptoms include hearing muffled qualities of sounds, difficulty understanding people when they talk (especially when there is background noise), frequently asking others to repeat things and speak louder, needing to turn up the volume of the television or radio, and withdrawal from conversations. Babies with hearing loss may be unresponsive or less responsive than normal to sounds.
- Diagnosis: If hearing loss is suspected, a doctor may recommend a specialized doctor, called an audiologist. The audiologists will ask questions about the patient's medical history and perform a hearing test called an audiogram to determine the severity of hearing loss. During an audiogram, the patient wears headphones and is exposed to various sounds that have different pitches and frequencies. The patient is asked to identify each time a sound is heard. The audiologist may also say various words to evaluate the patient's hearing ability.
- Treatment: If earwax buildup is causing symptoms, a doctor will remove the extra earwax. First, the doctor places a few drops of baby oil, glycerin, or mineral oil into the patient's ears to loosen the wax. Warm water is then squirted into the ear. The patient then tilts the head and the water and wax drains out. This process may need to be repeated several times. Alternatively, a doctor may scoop out the wax with a small instrument called a curette. A suction device may also be used to remove loosened wax from the ears.
- Individuals who experience hearing loss due to aging may benefit from hearing aids. These battery-operated devices are available in three basic styles: behind-the-ear aids, in-the-ear aids, and canal hearing aids. Patients should talk to their healthcare providers to determine the type of hearing aid that is best for them. A behind-the-ear device is used for mild to profound hearing loss. The device has a hard plastic case that is worn behind the ear and connected to a plastic ear mold that fits inside the outer ear. In-the-ear hearing aids fit completely inside the outer ear, and they are used for mild to severe hearing loss. Canal hearing aids are smaller hearing aids that fit inside the patient's hearing canal. They are used for mild to moderately severe hearing loss.
- If hearing loss is severe, patients may benefit from cochlear implants. These electronic devices are surgically implanted inside of the ears. Unlike a hearing aid, which amplifies sound, a cochlear implant makes up for damaged parts of the inner ear.
- Individuals who are deaf are often able to communicate with others by using sign language. It is best to begin teaching signs at a young age. A child's pediatrician can recommend programs that teach sign language.
- Prevention: Some types of hearing loss can be prevented. People who are exposed to loud noises on a regular basis, such as construction workers, should wear protective ear muffs or earplugs. This helps prevent the eardrums from becoming damaged. Do not listen to loud music, especially when wearing headphones. Regularly remove earwax buildup to prevent temporary hearing loss. Do not use cotton balls or Q-tips to clean the ears because they may damage the ear. Regular hearing tests are also recommended. If hearing loss is diagnosed early, people can take steps to prevent further damage.
- Overview: Meniere's disease occurs when the fluid pressure in the inner ear increases for unknown reasons. This disrupts a person's hearing and balance. People with Meniere's disease typically experience sudden and sometimes severe attacks of dizziness (called vertigo). Individuals may feel like their surroundings are moving or spinning.
- Most cases of Meniere's disease affect one ear. However, in rare cases, both ears may be affected.
- Although the attacks associated with Meniere's disease may be disturbing, it is not considered a life-threatening condition. Treatment and lifestyle changes can help mange symptoms.
- Causes: The inner ear contains fluid and hair-like sensors that control a person's sense of balance and allow a person to hear sounds. When the fluid pressure in the inner ear increases, it signals the brain that the body is moving, even if it is not. It is unclear what causes the fluid pressure to increase in people with Meniere's disease.
- Symptoms: People with Meniere's disease typically experience attacks that last anywhere from 20 minutes to an hour or longer. People typically experience sudden episodes of extreme dizziness that are often accompanied by nausea and vomiting, hearing loss, feeling of fullness or pressure in the affected ear, and a ringing or abnormal sound in the affected hear (called tinnitus). Without treatment to manage symptoms, attacks may occur more frequent and may be more severe. Some people may eventually become deaf in the affected ear. However, with proper treatment, most people are able to maintain their normal daily activities.
- Diagnosis: The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) has proposed diagnosis criteria for Meniere's disease. According to these guidelines, a person must meet the following three criteria to be diagnosed with the condition. 1) The person has had at least two spontaneous attacks of vertigo that each lasted 20 minutes or longer. 2) The person hears abnormal or ringing sounds in the ear(s) (tinnitus) or experiences a feeling of fullness in the ear. 3) The person has experienced hearing loss.
- Treatment: There is currently no cure for Meniere's disease. Instead, treatment focuses on reducing the frequency and severity of attacks.
- A doctor may suggest diet changes to help reduce fluid retention and fluid buildup in the inner ear. Eating about the same amount for each meal at the same time each day is often recommended to regulate the amount of fluids throughout the body, including the ears. Limiting salt intake to 1,000 milligrams of sodium or less each day may also help reduce fluid retention. Avoiding or limiting caffeine may reduce fluid retention and lessen symptoms of tinnitus. Smoking should be avoided because it may worsen symptoms.
- Mediations may also help reduce the severity of symptoms. For instance, anti-vertigo medications, such as meclizine (Antivert®), may help reduce feelings of dizziness, nausea, and vomiting. Anti-nausea drugs, such as prochlorperazine (Compazine®), may help reduce nausea and vomiting. Diuretics, such as hydrochlorothiazide (Dyazide® or Maxzide®), may also be prescribed to reduce fluid retention.
- Medications may also be injected into a patient's middle ear. For instance, an antibiotic called gentamicin (Garamycin®) may be injected through the eardrum and into the inner ear. This antibiotic is toxic to the inner ear, so it reduces the ear's ability to sense a person's balance. The person is able to maintain his/her balance because the unaffected ear is still functional. This procedure has been shown to reduce the severity and frequency of attacks. However, since it damages the ear, it may worsen hearing loss.
- A steroid medication, called dexamethasone, may also be injected into the patient's inner ear. This treatment is generally less effective than gentamicin injections. However, it is less likely to worsen hearing loss.
- If the above treatment options are unable to manage symptoms of Meniere's disease, a doctor may recommend surgery. For instance, an endolymphatic sac decompression procedure may be performed to remove some of the bone that surrounds the inner ear. This may help relieve some swelling. Another procedure, called a sacculotomy, may be performed. During this procedure, a permanent tack-like device is surgically implanted inside the ear to automatically drain out the inner ear when pressure builds up. A labyrinthectomy may also be performed to remove the entire ear sense organ (called the vestibular labyrinth). This is usually only performed if other treatment options fail and the patient already has severe or complete hearing loss in the affected ear. When hearing loss is severe or causes intense dizziness, a vestibular neurectomy may be performed to eliminate function of the entire inner ear. It involves cutting the nerve that controls balance.
- Prevention: Because the cause of Meniere's disease is unknown, there is currently no known method of prevention.
- Overview: Sometimes hearing loss may lead to articulation disorders. Articulation disorders occur when an individual has difficulty pronouncing certain consonants or vowels correctly (such as the letters "s" and "r"). As a result, certain words are mispronounced. Patients with these disorders will omit, replace, or distort the sounds of vowels or consonants that they have difficulty pronouncing. A common type of phonological disorder is a lisp.
- Causes: In many cases, the cause for phonological disorders is unknown. However, most of the time phonological disorders are not an immediate cause for concern. Phonological disorders are common in young children, but most of these children are able to pronounce words correctly by the age of five. Patients with phonological disorders who are older than five years old should visit their doctors. Sometimes phonological disorders are caused by hearing loss. Other potential causes include brain damage, brain disorders, or physical handicaps (such as a cleft palate or cerebral palsy). In other cases, the condition may be caused by poor coordination of muscles in the mouth or dental problems.
- Symptoms: Patients with phonological disorders have difficulty pronouncing certain vowels or consonants. Patients may leave out certain sounds in words. For instance, they may say "at" instead of "hat." Patients may replace sounds that are difficult to pronounce with others. For instance, the letter "r" is often replaced with the letter "w." These patients may say "wunning" instead of "running." Finally, some patients may make distorted sounds when they try to pronounce certain words. A distorted sound may whistle, the air may come out the sides of the mouth causing a "slushy" sound or lateral lisp, or the tongue may thrust between the teeth causing a frontal lisp. Most children with phonological disorders are able to overcome this disorder without treatment by the age of five.
- Diagnosis: Phonological disorders are common among young children. However, patients who are older than five years of age and have symptoms of the condition should visit their doctors. A speech pathologist will evaluate the patient for characteristic symptoms of phonological disorders. If hearing loss is the suspected cause of an articulation disorder, an audiogram (hearing test) will be performed.
- Treatment: If hearing loss is causing articulation disorders, a doctor may recommend hearing aids or cochlear implants. Improving the person's hearing increases the effectiveness of speech-language therapy, which is considered the primary treatment for articulation disorders.
- Speech-language pathologists, also called speech therapists or speech-language professionals (SLPs), evaluate, diagnose, treat, and help to prevent speech, language, communication, swallowing, and other related disorders. These professionals have been educated in the study of human communication. SLPs have earned Master's degrees and state certification/licensure in the field. They are also certified in clinical competency from the American Speech-Hearing Association.
- During speech-language therapy, a qualified SLP works with the patient on a one-to-one basis, in a small group, or directly in a classroom to overcome speech disorders. Programs are tailored to the patient's individual needs. On average, patients receive five or more hours of therapy per week for three months to several years.
- Speech pathologists use a variety of exercises to improve the patient's communication skills. Exercises typically start off simple and become more complex as therapy continues. For instance, the therapist may ask the patient to name objects, tell stories, or explain the purpose of an object.
- The therapist may also help patients learn how to cope with some of their symptoms. For instance, the therapist may teach the patient to over-articulate words that are hard to pronounce or to pause before saying big words.
- Speech pathologists help patients improve their stronger communication skills in order to enhance those that are weaker. For instance, the therapist may teach the patient how to improve their skills with gestures or body language.
- Oftentimes, family members participate in therapy, serving as communication partners. This allows patients to practice their communication skills in a comfortable and supportive environment. This type of group therapy may include role playing, which allows patients to practice their language in social situations.
- Prevention: Hearing loss increases an individual's risk of developing phonological disorders. Therefore, infants who are at risk of developing hearing loss should have their hearing tested. It is important that patients with speech disorders receive immediate treatment. Early diagnosis and treatment has been shown to increase an individual's long-term prognosis.
Tinnitus (ringing in the ears)
- Overview: Tinnitus is a medical term for ringing in the ears. Tinnitus is a common condition that affects millions of people. For some, symptoms may occur intermittently and they may only be mildly annoying. Others may have more serious symptoms that are persistent and cause people to seek medical help.
- Tinnitus can affect anyone, but it is most common among elderly people. However, it is becoming increasingly common among young people who are frequently exposed to loud noises, such as music.
- Tinnitus is a symptom of an underlying condition, such as age-related hearing loss or ear injury. Although the noise may be irritating, it is rarely a sign of a serious health problem.
- Causes: Tinnitus occurs when the delicate hairs inside the ears (called cilia) become damaged. Normally, these hairs vibrate, which triggers nerve cells to send signals to the brain. These signals are then interpreted as sound. In patients with tinnitus, these hairs are bent or broken, and they move randomly because they are irritated. As a result, the person hears a ringing sound.
- In most cases, the hairs become damaged as a result of age-related hearing loss (also called presbycusis), a condition that usually begins around the age of 60.
- Long-term exposure to loud noises, such as chain saws, portable music devices, or construction equipment, may also damage the hairs.
- Sometimes a medication may cause tinnitus. For instance, high doses of aspirin and some antibiotics have been shown to cause tinnitus. In such cases, symptoms of tinnitus often go away once the medication is stopped.
- A head or neck injury may also damage the inner ear and cause tinnitus.
- Some types of blood vessel disorders may cause a type of tinnitus, called pulsatile tinnitus. For instance, atherosclerosis (hardening of the blood vessels), high blood pressure, and narrowing of a carotid artery or jugular vein may lead to tinnitus.
- Less commonly, tinnitus may be a symptom of a tumor in the neck or head.
- Symptoms: People with tinnitus hear sounds, such as ringing, whistling, or buzzing, when no external sound is present. The pitch and volume of the sound varies among patients. For some, the noise may be subtle. However, for others, the noise may make it difficult to concentrate or hear properly. The sound may occur temporarily and last for a few days to weeks. In other cases, the sound may be permanent and continuous. One or both ears may be affected.
- Diagnosis: A doctor first takes a detailed medical history and performs a physical examination. It is important for patients to tell their doctors if they are taking any medications, herbs, or supplements because these could be the cause the condition. If tinnitus is suspected, a doctor may recommend an ear, nose, and throat (ENT) specialist.
- An ENT specialist will examine the inside of the ear to determine if the inner ear is damaged. The doctor will also put a stethoscope up to the patient's ear to see if he/she can hear the abnormal noise as well. If only the patient can hear the noise, it is called subjective tinnitus. If the doctor is able to hear the noise as well, the condition is caused by a vascular disorder, and it is called pulsatile tinnitus. In such cases, the noise that the patient (and doctor) hears is turbulent blood flow in the patient's blood vessels.
- Treatment: Treatment of tinnitus depends on the cause. If a medication is the suspected cause of symptoms, a doctor may recommend a different dose or type of medicine. However, patients should not stop taking their medications or change dosages without first talking with their doctors.
- If tinnitus is caused by an underlying medical condition, symptoms may improve once treatment is started. For instance, patients with tinnitus that is caused by high blood pressure may experience an improvement in symptoms after they start taking blood pressure-lowering drugs.
- If tinnitus is caused by age-related hearing loss, there are no treatment options to reduce the noise. Instead, a doctor may recommend lifestyle changes to help manage the symptoms. For instance, nicotine, caffeine, tonic water, alcohol, or high doses of aspirin should be avoided or limited because they may worsen symptoms of tinnitus. These substances reduce blood flow to the structures of the ear, which may aggravate symptoms. Listening to a quiet background noise, such as a fan or low-volume music, may help mask the noise in the ears. Patients are encouraged to manage their stress because stress may constrict blood vessels and reduce blood circulation, which may subsequently worsen symptoms of tinnitus. Simple relaxation techniques may help reduce stress. Because fatigue may also worsen symptoms, patients are encouraged to get plenty of rest.
- Several medications have been suggested as possible treatment options for patients with tinnitus, but their effectiveness is unclear. Some doctors have prescribed tricyclic antidepressants, such as nortriptyline or amitriptyline, but they have had varying affects. For some patients, side effects of these medications may not be worth the potential benefit. Side effects may include dry mouth, blurred vision, and constipation.
- New evidence suggests that the migraine medication gabapentin (Neurontin®) and acamprosate (Campral®), a drug used to treat alcoholism, may help relieve symptoms of tinnitus. However, until additional studies are performed, it is unclear if these are effective treatment options.
- Prevention: People who are exposed to loud noises on a regular basis, such as construction workers, should wear protective ear muffs or earplugs. This helps prevent the inner ear from becoming damaged. Do not listen to loud music, especially when wearing headphones.
Copyright © 2011 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.