Tinnitus, a ringing or buzzing sound in the ears, is a common condition that affects about 15% to 20% of people. While tinnitus itself is not dangerous, it can significantly impact quality of life. Understanding the potential causes of tinnitus can help identify ways to prevent or manage it.
One potential cause of tinnitus that has been investigated is vitamin B12 deficiency. Vitamin B12 plays an important role in the health of the nervous system, which includes the auditory system responsible for hearing. This has led to speculation that a lack of B12 could contribute to auditory problems like tinnitus.
What causes tinnitus?
Tinnitus can arise from problems anywhere along the auditory pathway, from the outer ear to the brain’s auditory cortex where sounds are processed and interpreted. Some of the most common causes include:
- Noise-induced hearing loss – Exposure to loud noises can damage the delicate sensory hair cells in the inner ear that convert sound waves into neural signals. Tinnitus is a very common initial symptom of this type of hearing loss.
- Age-related hearing loss – As we age, the hearing system naturally degenerates, resulting in impaired hearing and sometimes tinnitus.
- Earwax blockages – Excessive earwax buildup can physically obstruct the ear canal and interfere with sound transmission, sometimes causing temporary tinnitus.
- Ear bone changes – Stiffening of the bones in the middle ear can affect vibration and cause conductive hearing loss and tinnitus.
- Malformation of capillaries – Abnormal capillaries near the inner ear can become widened and twisted, resulting in turbulent blood flow that produces pulsatile tinnitus.
- Muscle spasms – Spasms affecting the muscles of the middle ear may cause clicking or buzzing tinnitus.
- Inner ear disorders – Conditions like Meniere’s disease that affect the delicate fluids and nerves of the inner ear can lead to tinnitus.
In many cases, the root cause of tinnitus is unknown. However, it often results from damage to the hearing system. Anything that disturbs the delicate mechanics of hearing can potentially produce tinnitus.
What is vitamin B12 and what does it do in the body?
Vitamin B12, also known as cobalamin, is a water-soluble vitamin that plays essential roles in red blood cell formation, cell metabolism, nerve function, and DNA synthesis and regulation. As a complex vitamin, it contains a cobalt ion surrounded by a tetrapyrrole ring.
The main functions of vitamin B12 in the body include:
- Red blood cell production – B12 is necessary for synthesis of the red blood cell precursor hemoglobin.
- DNA synthesis – B12 is involved in the production and regulation of DNA.
- Fatty acid metabolism – B12 helps convert fatty acids into energy.
- Nerve health – B12 helps insulate and protect nerve fibers and facilitate neuronal signaling.
- Psychological health – B12 deficiency can lead to mental disturbances like depression, confusion, and memory loss.
As a crucial player in cellular metabolism and neurological function, vitamin B12 is essential for life. A severe deficiency can lead to anemia, nerve damage, psychiatric problems, and impaired development in children.
What causes vitamin B12 deficiency?
There are several potential causes of vitamin B12 deficiency:
- Pernicious anemia – An autoimmune condition where the body destroys its own stomach cells that produce intrinsic factor needed for B12 absorption.
- Gastrointestinal disorders – Conditions affecting the stomach, intestines, or pancreas can interfere with B12 digestion and absorption.
- Medications – Drugs like metformin and proton pump inhibitors can impair B12 uptake.
- Poor nutrition – Vegans and vegetarians may not get enough B12, as it is naturally found in foods of animal origin.
- Alcohol abuse – Heavy alcohol use impedes absorption and increases excretion of B12.
B12 deficiency is also more common in the elderly, possibly due to decreased stomach acid secretion and intestinal absorption that occurs with aging.
What are the symptoms of B12 deficiency?
There is a wide range of possible signs and symptoms of vitamin B12 deficiency, which may include:
- Weakness and fatigue
- Lightheadedness or dizziness
- Rapid heartbeat or shortness of breath
- Pale skin
- Sore tongue or mouth ulcers
- Loss of appetite and weight loss
- Nausea or vomiting
- Constipation or diarrhea
- Confusion, depression, or memory problems
- Numbness or tingling in hands and feet
- Difficulty walking or decreased reflexes
- Vision changes like blurred or double vision
Neurological symptoms like numbness, weakness, and balance problems indicate severe B12 deficiency that has progressed to nerve damage.
How is B12 deficiency diagnosed and treated?
B12 deficiency is diagnosed through blood tests measuring total serum B12 levels. A deficiency is generally defined as a blood B12 level below 200 pg/mL. The following tests help confirm B12 deficiency:
- Complete blood count – Checks for macrocytic anemia.
- Peripheral blood smear – Large, oval red blood cells indicate megaloblastic anemia.
- Serum homocysteine – Elevated homocysteine occurs with B12 deficiency.
- Serum methylmalonic acid – Increased MMA levels are a metabolic marker of B12 deficiency.
- Schilling test – Helps identify impaired B12 absorption.
Treatment for B12 deficiency involves B12 supplementation, usually via injection for faster absorption, especially if deficiency symptoms are severe. Improving diet through nutritional counseling may also help manage causes of deficiency related to poor intake.
Is there evidence linking B12 deficiency and tinnitus?
So is there evidence from research studies to support a relationship between vitamin B12 deficiency and tinnitus?
While findings are mixed, some studies suggest an association may exist:
- A 2016 study of 125 tinnitus patients found that those with B12 deficiency were more likely to have severe and unilateral tinnitus.
- A 2013 study reported greater hearing loss and tinnitus scores in noise-exposed workers with lower B12 levels.
- A 2012 study saw more severe tinnitus in B12 deficient patients that improved after B12 therapy.
- An older 1991 study found tinnitus in over half of 31 patients with low B12 levels.
The mechanism behind a potential link is unclear but may relate to the effects of B12 deficiency on the myelin sheath that insulates neurons. Deterioration of myelin in the auditory system could expose nerves to damage resulting in tinnitus.
However, not all studies demonstrate a correlation. A 2018 meta-analysis did not find an overall significant association between B12 deficiency and tinnitus severity, although it called for more rigorous controlled studies.
Are there risks associated with B12 supplements?
Vitamin B12 supplements are considered very safe, with little risk for toxicity or side effects at standard doses of 1-2 mg per day. Since B12 is a water-soluble vitamin, excess is generally excreted in urine.
Potential side effects may include:
- Allergic reactions – Symptoms like hives, rash, chest tightness.
- Acne – B12 may promote skin oil production.
- Rapid heartbeat – Uncommon and generally only with extremely high doses.
Interactions with medications or other supplements are rare. Those with Leber’s disease, a hereditary optic nerve disorder, should avoid B12 supplements due to potential vision damage.
As with any supplement, the ideal approach is to correct any deficiencies through diet first before resorting to pills.
Should people with tinnitus take B12?
There is currently insufficient evidence to recommend B12 supplementation solely for treating tinnitus. However, patients with tinnitus should have B12 levels tested, especially if other deficiency symptoms are present.
Those with confirmed B12 deficiency may want to carefully try supplementation and monitor if tinnitus improves. But supplements should not replace medical workup and management guided by an audiologist or ENT doctor.
While B12 deficiency may potentially contribute to some cases of tinnitus, it is rarely the sole cause. Tinnitus is complex condition that may result from multiple overlapping factors.
What dietary sources provide B12?
Natural food sources of vitamin B12 include:
- Meat – Beef, lamb, turkey, chicken livers
- Fish – Salmon, tuna, trout, sardines
- Eggs and dairy – Milk, cheese, yogurt
- Shellfish – Clams, oysters, crab
- Fortified foods – Cereals, plant milks, nutritional yeast
A balanced diet containing lean meats, seafood, eggs, and dairy should provide adequate B12. Those following strict vegan or vegetarian diets may require a supplement or foods fortified with B12.
What other nutrients may help with tinnitus?
While B12 has been investigated, other vitamins and minerals may also play a role in tinnitus. Some additional nutrients that may help include:
- Zinc – An essential mineral important for cellular metabolism and neural function. Deficiency has been linked to inner ear dysfunction.
- Folate – Vitamin B9, often taken with B12. Deficiency can lead to neural tube defects and neurological disorders.
- Vitamin A – Fat soluble vitamin important for vision, gene regulation, immunity. May have protective effects on the inner ear.
- Magnesium – Mineral involved in nerve transmission and muscle function. Insufficient levels associated with hearing loss.
- Coenzyme Q10 – Powerful antioxidant concentrated in the inner ear. May counter damage causing tinnitus.
A varied, nutrient-dense diet and lifestyle approach may help reduce tinnitus from multiple angles. Work with a doctor or nutritionist to identify any nutritional deficiencies.
What are some other ways to manage tinnitus?
In addition to diet, other strategies can help make tinnitus more bearable and minimize its impact on quality of life. Some tips include:
- Using background sounds or noise generators to mask tinnitus
- Cognitive behavioral therapy to develop coping skills
- Stress reduction through relaxation techniques
- Hearing aids to amplify ambient sounds
- Sound therapy customized for tinnitus pitch
- Medications like antidepressants, anticonvulsants, local anesthetics
- Alternative therapies like acupuncture, massage, hypnosis
Holistic management combining several approaches tailored to the individual often produces the best results. See an audiologist or ENT specialist for guidance.
Conclusion
In some cases, vitamin B12 deficiency may be a potential contributing factor to tinnitus, likely due to its effects on the nervous system. However, research overall does not firmly establish B12 deficiency as a clear direct cause of tinnitus.
Testing B12 levels in tinnitus patients, especially those with risk factors for deficiency like inadequate diet or gastrointestinal conditions, can identify needs for supplementation. But B12 on its own is unlikely to be a cure-all and should be just one part of a multifaceted management strategy overseen by medical professionals.
While results are variable, some patients may experience an improvement in their tinnitus from correcting any B12 deficiency. Given the safety of standard doses, it may be reasonable to carefully try B12 along with other lifestyle approaches that reduce the impacts of tinnitus.