Caffeine intake and Menière's disease: Is there relationship?

A comprehensive review of the effects of caffeine on the auditory and vestibular systems

Coffee, of which caffeine is a critical component, is probably the most frequently used psychoactive stimulant in the world. The effects of caffeine on the auditory and vestibular system have been investigated under normal and pathological conditions, such as acoustic trauma, ototoxicity, auditory neuropathy, and vestibular disorders, using various tests. Lower incidences of hearing loss and tinnitus have been reported in coffee consumers. The stimulatory effect of caffeine is represented by either a shorter latency or enhanced amplitude in electrophysiological tests of the auditory system. Furthermore, in the vestibular system, oculomotor testing revealed significant effects of caffeine, while other tests did not reveal any significant caffeine effects. It could be that caffeine improves transmission in the auditory and vestibular systems' central pathways. Importantly, the effects of caffeine seem to be dose-dependent. Also, inconsistent findings have been observed regarding caffeine's effects on the auditory and vestibular systems and related disorders. Overall, these findings suggest that caffeine does not strongly influence the peripheral auditory and vestibular systems. Instead, caffeine's effects seem to occur almost solely at the level of the central nervous system.

The relationship between nutrition and Ménière's disease

Ménière's disease is an inner ear disease with attacks characterized by ear fullness, tinnitus, fluctuant sensorineural hearing loss and vertigo. Although pathophysiology of the disease is not fully known, endolymphatic hydrops are believed to play a role. Although there is no certain treatment procedure for Ménière's disease, some treatments are applied to prevent attacks, to treat the symptoms that occur during the attacks, and to prevent the permanent effects of the symptoms on the hearing and balance system. Lifestyle changes, dietary modifications, diuretics, vasodilator corticosteroids, intratympanic steroids, surgical methods are some of these treatment methods. Dietary modification includes a low sodium diet, a reduction in daily alcohol and caffeine intake, a gluten-free diet, and a new dietary approach to specially processed grains, all of which are first-line treatments. The goal of this review article is to examine the relationship between MD and dietary intervention, which is frequently used in the prevention and treatment of MD attacks.

Tinnitus features according to caffeine consumption

INTRODUCTION

Consumption of high amounts of caffeine has been historically associated with tinnitus worsening. However, recent studies demonstrated that this seems not to be true, and caffeine may even improve tinnitus distress.

AIM

To analyze tinnitus features according to caffeine consumption levels.

STUDY DESIGN

Case-control study.

METHOD

Tinnitus patients were compared with patients without tinnitus concerning caffeine consumption. Tinnitus characteristics were correlated to the amount of caffeine consumption among the tinnitus patients.

RESULTS

One hundred and forty two patients with and 140 patients without tinnitus were enrolled. Patients without tinnitus consumed more caffeine than patients with tinnitus (300mL/day versus 100mL/day, P=0.0001). Among the patients with tinnitus, no differences concerning age, gender, tinnitus laterality, periodicity, quality, type of onset, tinnitus matching, hearing loss, THI scores and VAS (volume) according to the amount of caffeine consumed have been found. Concerning VAS (distress), the subgroup that consumed less than 150mL of caffeine daily had greater scores (6 versus 5, P=0.048).

DISCUSSION

Data from this study are on line with more recent studies that were not able to demonstrate any kind of association between high consume of caffeine and tinnitus distress. Moreover, this study was not able to point any possible tinnitus subtype affected by high amounts of caffeine consumption. The higher VAS distress score in the low caffeine consumption subgroup may represent a protective effect of caffeine, which is also on line with other studies.

CONCLUSION

High amounts of caffeine consumption is not associated with tinnitus and with no tinnitus subgroup, according to tinnitus characteristics. An eventual protective effect of caffeine should be evaluated in further prospective studies.

Clinical Practice Guideline: Ménière's Disease

OBJECTIVE

Ménière's disease (MD) is a clinical condition defined by spontaneous vertigo attacks (each lasting 20 minutes to 12 hours) with documented low- to midfrequency sensorineural hearing loss in the affected ear before, during, or after one of the episodes of vertigo. It also presents with fluctuating aural symptoms (hearing loss, tinnitus, or ear fullness) in the affected ear. The underlying etiology of MD is not completely clear, yet it has been associated with inner ear fluid (endolymph) volume increases, culminating in episodic ear symptoms (vertigo, fluctuating hearing loss, tinnitus, and aural fullness). Physical examination findings are often unremarkable, and audiometric testing may or may not show low- to midfrequency sensorineural hearing loss. Conventional imaging, if performed, is also typically normal. The goals of MD treatment are to prevent or reduce vertigo severity and frequency; relieve or prevent hearing loss, tinnitus, and aural fullness; and improve quality of life. Treatment approaches to MD are many and typically include modifications of lifestyle factors (eg, diet) and medical, surgical, or a combination of therapies.

PURPOSE

The primary purpose of this clinical practice guideline is to improve the quality of the diagnostic workup and treatment outcomes of MD. To achieve this purpose, the goals of this guideline are to use the best available published scientific and/or clinical evidence to enhance diagnostic accuracy and appropriate therapeutic interventions (medical and surgical) while reducing unindicated diagnostic testing and/or imaging.

European Position Statement on Diagnosis, and Treatment of Meniere's Disease

Meniere Disease keeps challenges in its diagnosis and treatment since was defined by Prosper Meniere at the beginning of 19th Century. Several classifications and definition were made until now and speculations still exist on its etiology. As the etiology remains speculative the treatment models remain in discussion also. The European Academy of Otology and Neurotology Vertigo Guidelines Study Group intended to work on the diagnosis and treatment of Meniere's disease and created the European Positional Statement Document also by resuming the consensus studies on it. The new techniques on diagnosis are emphasized as well as the treatment models for each stage of the disease are clarified by disregarding the dilemmas on its treatment. The conservative, noninvasive and invasive therapeutic models are highlighted.

A hypothetical proposal for association between migraine and Meniere's disease

Meniere's disease (MD) is a chronic condition affecting the inner ear whose precise etiology is currently unknown. We propose the hypothesis that MD is a migraine-related phenomenon which may have implications for future treatment options for both diseases. The association between MD and migraine is both an epidemiological and a mechanistic one, with up to 51% of individuals with MD experiencing migraine compared to 12% in the general population. The presence of endolymphatic hydrops in those with MD may be the factor that unites the two conditions, as hydropic inner ears have an impaired ability to maintain homeostasis. Migraine headaches are theorized to cause aura and symptoms via spreading cortical depression that ultimately results in substance P release, alterations in blood flow, and neurogenic inflammation. Chronically hydropic inner ears are less able to auto-regulate against the changes induced by active migraine attacks and may ultimately manifest as MD. This same vulnerability to derangements in homeostasis may also explain the common triggering factors of both MD attacks and migraine headaches, including stress, weather, and diet. Similarly, it may explain the efficacy of common treatments for both diseases: current migraine treatments such as anti-hypertensives and anti-convulsants have shown promise in managing MD. Though the etiology of both MD and migraine is likely multifactorial, further exploration of the association between the two conditions may illuminate how to best manage them in the future. MD is likely a manifestation of cochleovestibular migraine, which occurs as a result of migraine related changes in both the cochlea and vestibule.

Association of Coffee Consumption with Hearing and Tinnitus Based on a National Population-Based Survey

Coffee is the one of the most common beverages worldwide and has received considerable attention for its beneficial health effects. However, the association of coffee with hearing and tinnitus has not been well studied. The aim of this study was to investigate the association of coffee with hearing and tinnitus based on a national population-based survey. We evaluated hearing and tinnitus data from the 2009–2012 Korean National Health and Nutrition Examination Survey and their relationship with a coffee consumption survey. All patients underwent a medical interview, physical examination, hearing test, tinnitus questionnaire and nutrition examination. Multivariable logistic regression models were used to examine the associations between coffee and hearing loss or tinnitus. We evaluated 13,448 participants (≥19 years) participants. The frequency of coffee consumption had a statistically significant inverse correlation with bilateral hearing loss in the 40–64 years age group. Daily coffee consumers had 50–70% less hearing loss than rare coffee consumers, which tended to be a dose-dependent relationship. In addition, the frequency of coffee consumption had an inverse correlation with tinnitus in the 19–64 years age group but its association was related with hearing. Brewed coffee had more of an association than instant or canned coffee in the 40–64 years age group. These results suggest a protective effect of coffee on hearing loss and tinnitus.