Ringing in your ears? Genetics, Tinnitus, and Meniere’s disease

Key Takeaways:
~ Symptoms of Meniere’s disease include vertigo, constant ringing (tinnitus), and nausea.
~ Meniere’s can also cause pressure in the ear and possible hearing loss, most often striking people in their 40s and 50s.
~Tinnitus, or ringing in your ears, can be a problem, even without Meniere’s.
~ Research-backed solutions exist for Meniere’s and tinnitus — and these can be personalized based on your genes.

Members will see their genotype report below, plus additional solutions in the Lifehacks section. Join today.  

Meniere’s, tinnitus, and how the ear works:

Many health websites claim Meniere’s is a chronic condition: with no cure and without an exact cause [article 1, Medline]

Recent research, though, paints a different picture, and genetics points to the root causes of Meniere’s and tinnitus.

Let’s start with some background information on how the ear works – and how this ties into balance and ringing.

Your balance is coordinated by the change in motion of the fluid in the inner ear. It is like a built-in accelerometer that knows when you are in motion.

Peripheral vertigo, or feeling dizzy and off-balance, is due to inner ear dysfunction. The sense of balance gets messed up by signals sent to the brain that don’t match reality.

Within the inner ear, a spiral-shaped cavity called the cochlea is dedicated to hearing. Also, the inner ear contains the vestibular system responsible for your balance.[ref]

As you can imagine, something disturbing and pressing on the vestibular system could cause vertigo and impact hearing.

Endolymph is the fluid inside the inner ear. This fluid moves and transmits sounds, movement, etc., to the brain. The makeup of the ions in that fluid is essential for transmitting signals to the brain. The endolymph within the cochlea has a very low calcium (Ca²⁺) concentration, which allows for better mechanoelectrical transduction with the little hair cells in the cochlea.[ref]

Here is a picture of the ear structure so you can visualize where the inner ear is – with the vestibular area and the cochlea. (Creative Commons License- Wikimedia commons.):

What is going wrong in Meniere’s disease?

Researchers think too much potassium (K⁺) in the inner ear causes too much endolymph in the vestibular organ. Any excess fluid is normally stored in an endolymphatic sac.

In Meniere’s, the storage sac is thought to fill up with too much fluid, ballooning and pressing on the hearing parts of the ear, causing hearing loss. A rupture of the membrane in this area can cause severe vertigo.

Often the symptoms in Meniere’s fluctuate, with the vertigo attacks suddenly becoming severe to the point of causing nausea and vomiting. The attacks sometimes may be preceded by changes in tinnitus, hearing, and the ear feeling full.[ref]

The membrane can heal up pretty quickly, leading to a cycle of increasing fluid and eventual rupture. Tinnitus and vertigo can fluctuate during the cycle when the fluid is building back up again.

Digging a little deeper:
So what do potassium and other ions have to do with fluid in the ear? Think back to osmosis experiments in high school science class… fluid can be drawn across a membrane to balance out ions.

The endolymph fluid has a different ion concentration and pH from the rest of the ear. The sodium concentration is higher, and the potassium and chloride concentrations are lower. Researchers think the ion gradient gets messed up (too much potassium), which is then balanced out with more fluid, causing swelling.

The cells surrounding the endolymphatic sac have receptors activated by cortisol and receptors sensitive to aldosterone.

Aldosterone is the hormone that controls the absorption of salt in the kidneys and is important in blood pressure.[ref] This ties Meniere’s to blood pressure and stress (cortisol).

This general explanation of Meniere’s disease may not be the whole story. Researchers note that some people have swelling within the endolymph system and don’t have the symptoms of Meniere’s. They also question whether the swelling can actually cause vertigo.[ref] Questions remain on what triggers Meniere’s.

Theories on the cause(s) of Meniere’s Disease:

The symptoms and progression of the disease vary a lot from person to person, making any single root cause of Meniere’s disease hard to pin down.

Some scientists postulate that Meniere’s is an autoimmune condition due to elevated antibody titers and higher levels of circulating immune complexes. People with autoimmune diseases are also more likely to have more severe Meniere’s disease.[ref][ref] Certain HLA serotypes are associated with an increased risk of Meniere’s disease, adding to the evidence that it is autoimmune related.[ref]

Other researchers point to Meniere’s being multifactorial, with causes including adrenal insufficiency, hypothyroidism, narrowing of the inner auditory canal, trauma, and allergies.[ref]

Genetic mutations and a familial aspect of Meniere’s disease are other lines of investigation.[ref] The genetic variants linked with Meniere’s point towards the body’s immune and inflammatory response as well as potassium regulation.

All of these, when taken together, point to a system that is out of balance.

Conditions that overlap with Meniere’s:

Meniere’s disease is linked to an increased risk of both migraines and motion sickness.[ref]

Migraine prevalence in Meniere’s is double that of the population in general.[ref]

People with rheumatoid arthritis have a (slightly) increased risk of Meniere’s disease.[ref]

One study found that Meniere’s patients who didn’t respond to diuretics were more likely to respond to medications used to prevent migraines.[ref]

A study of 35 patients with Meniere’s disease found that 12 were clinically hypothyroid. Treating them with thyroid medication improved Meniere’s symptoms in all of the hypothyroid patients.[ref]

Allergies and histamine intolerance are also linked to Meniere’s

What if it is ‘just’ tinnitus, not Meniere’s?

Tinnitus is a sensation described as ‘ringing in the ears’ or a constant buzzing pitch.

In addition to being a symptom of Meniere’s disease, tinnitus can also accompany other hearing loss diseases or can occur spontaneously.

It is thought to affect up to 15% of adults at some point in their lives, affecting both their quality of life and mental health.

Is tinnitus genetic?

Genetics is partly to blame. Genetic variants do play a role in susceptibility to tinnitus, but environmental factors – such as lifestyle factors that cause inflammation – also are important here.

Researchers often study twins, siblings, and adoptees to determine whether a condition, such as tinnitus, is ‘heritable’ or has a genetic component. In a large study in Sweden, researchers discovered that adoptees with a biological parent with tinnitus were over twice as likely to have tinnitus, showing the link to genetics. The researchers also noted no association between tinnitus in an adopted parent and the adoptee, thus making the environment a less likely factor.[ref]

What causes tinnitus?

Researchers think ion regulation – specifically potassium transport – could be at the root of tinnitus.[ref]

Other research points towards inflammation.

New studies using animal models of hearing impairment show that neuroinflammation may be a part of the picture for tinnitus and hearing loss. Blocking TNF-α prevents neuroinflammation and tinnitus in a mouse model.[ref]

Other studies point to IL-1B (interleukin 1 beta), a proinflammatory cytokine, as a risk factor.[ref]

Human studies show that inflammatory markers are important in tinnitus. A 2019 study in Portuguese adults found that IL10 was lower in tinnitus patients. IL-10 (interleukin 10) is an anti-inflammatory cytokine limiting your body’s inflammatory response. Thus, low IL-10 levels can lead to higher inflammation. Accordingly, the researchers found that IL-1a, an inflammatory cytokine, was higher in participants with tonal tinnitus.[ref]

People with periodontitis, inflammed gums, are statistically more likely to have tinnitus.[ref] Research shows that genetic variants linked to higher inflammatory cytokines are strongly linked to periodontitis and gingivitis.

Related article: Gum Disease, Inflammation, and Genetics

Salicylates and tinnitus:

In animal research, sodium salicylate, the sodium salt of salicylic acid (aspirin), is often given to animals to create tinnitus. Higher doses of aspirin can cause (or worsen) tinnitus in some people. Animal studies have shown that salicylate blocks a certain type of calcium channel in the inner ear. It could then cause decreased GABA, an inhibitory neurotransmitter, in the inner ear.[ref]

The thought here is that not enough inhibition = constant firing of the neurons and tinnitus. GABA inhibits excess firing, while glutamate can increase the neuron’s firing potential. Thus, alternatively, the salicylate could increase the neurons’ firing rate in the auditory nerve complex.[ref]

Brain involvement in tinnitus:

While tinnitus may be caused by changes in ion channels or neuron firing in the auditory canal, another possibility is that something is going wrong in the brain. GABA is the inhibitory neurotransmitter, including in the cortex in the brain. In mice, reducing GABA production in specific areas of the brain can induce tinnitus, and similarly, enhancing GABA can eliminate tinnitus. Thus, researchers think that loss of cortical GABA inhibition is a cause of tinnitus.[ref]

Lifehacks: Natural solutions for Meniere’s and Tinnitus:

Modulating NF-κB (NFKB1 variants):

NF-κB is a transcription factor that is responsible for activating and controlling the immune response.[ref] The genetic variants in the NFKB1 and the intergenic region show a definite link between NF-κB (nuclear factor – kappa beta) and Meniere’s disease for some people.

NF-κB is activated by cytokines such as TNFα and IL-1β. Thus, targeting chronic inflammation may help with Meniere’s.

Related Article: TNFα and inflammation lifehacks

Mold has been shown in one study to trigger “a significant release of TNF-α in [Meniere’s Disease] patients, which were not found in controls.”[ref] Consider testing your home and workplace for mold and getting mold remediation done if needed.

Related article: Mycotoxin and Mold Detoxification Genes

Heat therapy, such as sauna, increases heat shock proteins. This increase in heat shock proteins then helps modulate inflammatory stress by decreasing the activation of NF-κB.[ref] Specifically, repeatedly activating heat shock protein 70 (Hsp70) leads “to the inactivation of downstream of nuclear factor-κB (NF-κB) inflammation signaling pathway.”[ref]

You may be wondering if there is any clinical evidence that sauna decreases the symptoms of Meniere’s disease… This doesn’t seem to be well-studied. One case study from 1977 showed that sauna visits improved Meniere’s disease for the two participants.[ref]

Vitamin D deficiency and autoimmunity (everyone):

In people who are vitamin D deficient, increasing vitamin D through supplements or increased sun exposure may prove helpful for Meniere’s disease. Researchers theorize that improving vitamin D levels helps by modulating the immune response. Additionally, vitamin D deficiency doubles the risk for benign positional vertigo. For people who suspect that either inflammation or an autoimmune reaction is at the root of their Meniere’s disease, vitamin D is an easy solution to try, especially if you are deficient.[ref][ref][ref]

Cutting down on salt, caffeine, and alcohol – possibility for KCNE1, and KCNE3 variants:

Traditionally, patients have been encouraged to decrease or eliminate the consumption of salt, caffeine, and alcohol to improve Meniere’s symptoms. I think the idea here is that caffeine could cause vasoconstriction and that decreasing salt may decrease the fluid in the ear.[ref]

A recent Cochrane study concluded, though, that there is no evidence “from randomized controlled trials to support or refute the restriction of salt, caffeine or alcohol intake in patients with Ménière’s disease or syndrome.”[ref]

If you carry the genetic variants above in the KCNE1 and KCNE3 genes, these variants impact potassium transport across the cell membrane — sodium and chloride from table salt balance out the potassium ions. Even though there aren’t thorough randomized clinical trials to support restricting salt, this would be an easy lifestyle change to try.

Experiment with altering your salt consumption – keeping track of the amount of sodium you consume and your Meniere’s or tinnitus symptoms. Another experiment would be to track your potassium intake and see if it impacts symptoms.

The website and app cronometer.com are free and make it easy to measure sodium and potassium in foods. You can also add notes to track your symptoms.

Turkey Tail Mushrooms (NFKB1, IL1A genes):

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