Trip Answers

Question answered:29/01/07 Warning! this question is over two years old.

We searched the NLH Specialist Library for ENT, TRIP and Medline databases but found little information on an association between food intolerance or lactose intolerance and the development or worsening of tinnitus symptoms per se however there is conflicting evidence concerning food allergies in Meniere’s disease.

 

The Tinnitus Association published and information sheet on drugs food and drink in which they state:

 

“A number of people with tinnitus associate fluctuations of their tinnitus with taking certain foods or drinks. Thus some people find that alcohol, drinks containing caffeine, or foods such as cheese may worsen their tinnitus. However, an equivalent number of people find that these same substances will actually improve their tinnitus! There does not seem to be any food or drink that definitely causes or exacerbates tinnitus in every person. Whatever reaction someone with tinnitus might notice is likely to be a personal idiosyncratic reaction. Unfortunately there is no simple test for such reactions.

 

The only way of determining if a foodstuff does affect the tinnitus is to remove it from the diet and then reintroduce it as a challenge. Sometimes it is difficult to identify the likely culprit. In these circumstances it may help to keep a diary of what is eaten and drunk and see if there is any relationship between bad periods of tinnitus and individual foods and drinks. The diary may have to be detailed, specifying what type of meat, vegetable, cheese, fish, wine, and so on, as one particular type of vegetable, for example, may aggravate the tinnitus, where others have no effect. If the diary suggests a particular food or drink, that food or drink should be avoided for a period of seven days. Then the system should be challenged by reintroducing that food or drink, withdrawing it, re-challenging, and withdrawing again. Tinnitus can fluctuate so much that the tests should be repeated several times. Relying on a single trial withdrawal may end up denying a person some item of food or drink that they would otherwise enjoy and in fact has no adverse effect on the tinnitus anyway. Similarly, well meaning but unjustifiable generalised advice is often repeated in books and articles on tinnitus, suggesting that people should give up tea, coffee, red wine, etc. Removing such items from the diet often brings no benefit and the lack of enjoyment of that food or drink then merely adds to the burden of tinnitus. It is important to issue a further word of warning at this point: keeping diaries and going on exclusion diets can sometimes be counterproductive as it encourages people to monitor their tinnitus, which can in turn make it seem louder.” [1]

 

Several articles question the pathogenic role of food allergies in Meniere’s disease.

 

Derebery and Berliner examined the prevalence of allergy in Meniere’s disease and reported:

 

“METHODS: A survey was mailed to all patients with Meniere's disease seen at our institution from 1994 to July 1998 (n = 1490). As a control group, 172 patients with otologic problems other than Meniere's disease completed the same survey. RESULTS: Of 734 respondents with Meniere's disease, 59.2% reported possible airborne allergy, 40.3% had or suspected food allergies, and 37% had had confirmatory skin or in vitro tests for allergy. These prevalence rates were significantly higher than those found in the control group, of which 42.7% reported having or suspecting airborne allergies and 25% had or suspected food allergies (differences all significant at P< or =0.005).” [2]

 

Derebery also outlined the methods and results of an outcome study of food allergy in Meniere’s disease:

 

“A total of 137 patients with Meniere's disease for whom allergy treatment had been recommended were identified and were mailed and returned a symptoms questionnaire. One hundred thirteen had received allergy treatment; 24 did not have treatment and served as a control group. Information regarding history, signs and symptoms, allergy test results, and audiologic data were obtained by chart review. The 113 patients treated with desensitization and diet showed a significant improvement from pretreatment to posttreatment in both allergy and Meniere's symptoms. Ratings of frequency, severity, and interference with everyday activities of their Meniere's symptoms also appeared better after allergy treatment than ratings from the control group of untreated patients. Vertigo control results, by use of the American Academy of Otolaryngology-Head and Neck Surgery classification, categorized 47.9% as class A or B. Hearing was stable or improved in 61.4%. Patients with Meniere's disease can show improvement in their symptoms of tinnitus and vertigo when receiving specific allergy therapy. The inner ear may be the target, directly or indirectly, of an allergic reaction.” [3]

 

However,Boulassel et al conclude serum levels of antifood antibodies are not increased in patients with Meniere’s disease:

 

“Antifood allergens as well as anti-baker's yeast antibodies are humoral factors that may be linked with allergenic disorders and other autoimmune conditions. To determine their possible role in MD activity, we investigated 29 MD sera for the presence of antibodies against gliadin, beta-lactoglobulin, albumin, ovalbumin, soya, and Dermatophagoides pteronyssinus and Saccharomyces cerevisiae strains using an ELISA technique. The patients were compared with 29 healthy individuals matched for sex and age. A serum was regarded as positive if the absorbance was two standard deviations higher than values obtained with sera from healthy subjects. Historical data, including factors which the patients believed to provoke their Meniere's symptoms, were obtained from patients' questionnaires. MD patients showed no significant symptoms of allergenic disorders suggesting allergies when compared to controls (p > 0.05). IgG and IgA antibody levels were not significantly raised in MD patients as compared with healthy controls (p > 0.05) for gliadin, beta-lactoglobulin, soya, albumin, ovalbumin, and D. pteronyssinus and S. cerevisiae strains.

 

These data do not convincingly support a hypothesis of increased serum levels of antifood antibodies in patients with MD, as very few patients were antibody positive.” [4]

 

References
1. British Tinnitus Association. Drugs, food and drink. February 2005. (http://www.tinnitus.org.uk/information/info%20sheets/front%20page/drugsfoodanddrink.htm).
2. Derebery MJ and Berliner KI. Prevalence of allergy in Meniere's disease. : Otolaryngol Head Neck Surg. 2000 Jul;123(1 Pt 1):69-75. (http://www.hubmed.org/display.cgi?uids=10889484).
3. Derebery MJ. Allergic management of Meniere's disease: an outcome study. Otolaryngol Head Neck Surg. 2000 Feb;122(2):174-82. (http://www.hubmed.org/display.cgi?uids=10652386).
4. Boulassel MR, Alost M, Tomasi JP et al. No increased serum levels of antifood antibodies in patients with Meniere's disease. ORL J Otorhinolaryngol Relat Spec. 2001 Jan-Feb;63(1):19-24. (http://www.hubmed.org/display.cgi?uids=11174058).

---

DISCLAIMER: TRIPanswers is a collection of clinical questions and answers.  Each provider will have their own methodology in answering questions and these are likely not to be as rigorous as systematic review.  If you have any doubt as to the implications of this contact the Q&A Service Provider for further information. This document is presented for information purposes only. This document cannot and should not be used as a basis of diagnosis or choice of treatment, and is in no way intended to replace professional medical care or attention by a qualified practitioner. TRIPanswers and TRIP Database Ltd are not responsible or liable for, directly or indirectly, ANY form of damage whatsoever resulting from the use/misuse of information contained in or implied by this document.  Also, ensure you have read the terms and conditions for using the site.