The Gluten-Tinnitus Debate: What Is The Research Saying?

A gluten free diet has been hailed as a holy grail of sorts in some health circles, with proponents of gluten free eating suggesting that gluten can be responsible for everything from brain fog to skin issues. Some people legitimately have an allergy to the proteins that make up gluten; whereas others simply adopt the diet for the believed health benefits. However, there may not be adequate evidence to suggest that gluten is at the root of other health issues, such as severe tinnitus. So are tinnitus and gluten legitimately linked? We’ll take a closer look at the ways gluten and tinnitus may be tied together below. First, let’s take a closer look at what exactly gluten is, and the role of gluten in food and the body.

What Is Gluten?

Far from being a single, easy to define thing, gluten is actually a complex structured protein made up of hundreds of related but distinct proteins, with gliadin and glutenin being the most prominent. Gluten is the general term that has been given to the proteins found in common grains such as wheat, rye, barley, and triticale.

Gluten is a naturally occurring protein, but it can also be extracted from foods, concentrated, and subsequently added to food items and other materials to add protein, strengthen bonds, improve texture, and even add flavor. It is frequently used as a binding agent with which to hold processed foods together to maintain a certain shape.

Like many other convenience foods that have been discovered, gluten is frequently added to processed foods, and gluten exposure today may be significantly higher than it was 100 years ago, or prior to the advent and proliferation of highly processed foods.

What Happens To Gluten In The Body?

Humans have digestive enzymes used to break down food. Protease is the enzyme that helps us process proteins, but it can’t completely break down gluten. This can result in gas, bloating, and other symptoms that have come to be associated with Celiac Disease. Patients reporting gluten sensitivity is much higher than diagnosed cases of Celiac Disease.

Gliadin (a protein in gluten) contains peptide sequences that are highly resistant to gastric, pancreatic, and intestinal proteolytic digestion in the gastrointestinal tract. As a consequence, individuals may complain of discomfort in the digestive system, stress as a result of embarrassing reactions to foods, and general suffering related to diet, including insomnia, frequent infection, and more. Many individuals who claim to be affected by gluten experience discomfort on a daily basis until a gluten-free diet is introduced.

Gluten that has not been completely digested goes to the small intestine, which most people are able to tolerate. Gluten in and of itself, especially when it is found in whole grains, is not considered bad or harmful for healthy people whose bodies can tolerate it.

That being said, there are those for whom eating gluten can trigger a severe autoimmune response called Celiac Disease, which can be accompanied by other symptoms that can cause a significant degree of pain and discomfort. There are also those for whom gluten does not trigger autoimmunity, but still triggers bloating, diarrhea, headaches, or skin rashes after eating gluten rich foods.

What Is Celiac Disease?

Celiac disease is an autoimmune disease that occurs in genetically predisposed people that causes damage to the small intestine in people who consume gluten. A higher number of infections in early life and certain digestive system infections are other causes that have also been tied to the incidence of Celiac Disease. A diagnosis of Celiac comes after blood tests and small intestine biopsies.

Individuals with celiac disease need to follow a gluten free diet due to the gluten allergy; however, doctors don’t recommend starting a gluten-free diet before diagnostic testing because a gluten-free diet can affect test results and impair accurate reporting.

Symptoms of celiac disease can vary but most often are related to gastrointestinal symptoms. Some patients report bloating, chronic diarrhea, constipation, gas, lactose intolerance as a result of damage to the small intestine, nausea or vomiting, and abdominal pain.

Does Celiac Disease Cause Autoimmune Sensorineural Hearing Loss?

Some researchers believe that celiac disease could be a disease that causes autoimmune sensorineural hearing loss (SNHL), which is thought to share the same pathophysiologic mechanism as other autoimmune disorders and hearing disorders.

Many autoimmune diseases, such as Behçet’s Disease, systemic lupus erythematosus (SLE), and antiphospholipid antibody syndrome (APS) may cause hearing loss with thrombosis of labyrinthine vessels, which results in cochlear involvement and sensorineural hearing loss. Ultimately, this means that there is a risk of developing hearing loss and or tinnitus in those who have an autoimmune disease. 

Patients with celiac disease may be at an increased risk of developing venous thromboembolism (VTE) due to chronic inflammation and vitamin deficiency; a significantly increased risk of VTE among patients with celiac disease was demonstrated in a recent meta-analysis. However, the study found that the hearing levels of celiac disease patients do not seem to differ from that of the general population; autoimmune SNHL is not considered as a neurologic finding that is induced by celiac disease.

ENT Manifestations of Celiac Disease: A Scholarly Review

The objective of this scholarly review was to examine the ENT (ear, nose, and throat) manifestations of celiac disease and its pathophysiology and management, in order to highlight that some patients with celiac disease may present initially to the otolaryngologist (ENT physician).

There are some studies that support evidence of lower hearing levels in adults and children with celiac disease vs not, while other studies dispute the relationship between sensorineural hearing loss (SNHL) and celiac disease. The review sought to reconcile the different approaches to those with ear congestion and other hearing conditions with the disease, and those without.

Theories of the pathological mechanism behind SNHL and Celiac Disease is wide and include: immune-mediated neurological damage comprising of autoantibodies, autoreactive T cells and immune complex deposition, malnutrition, neutralizing autoantibodies against osteoprotegerin (loss of osteoprotegerin is shown to result in sensorineural and conductive hearing loss in animal studies), and others.

This topic needs more study and research, but despite the conflicting evidence, it should be noted that the study with the largest sample size (11) showed a statistically significant positive association between celiac disease and sensorineural hearing loss. A sample size of 11 individuals is quite small, so it is difficult to say if this would reflect findings in the general population. Nonetheless, this association is an important learning point for otolaryngologists to consider for treatment while further research is completed.

Limitations Of Current Studies

Although some research has been completed regarding celiac patients and how those patients’ senses are affected, there have not been any large, definitive studies to date that evaluate why or whether celiac patients might have ear problems or vision problems, or the exact role the disease may play in the degradation of senses. The following studies are some of the most significant sources of research that have been completed to date:

• Small study in Turkey: researchers concluded that subclinical (low-level) hearing loss may be present in children with celiac disease, and this “could presage more serious hearing impairments at older ages and later stages of the disease.”
• Small study at Catholic University of Rome: no statistical difference in hearing loss between the people who were newly diagnosed and those who had been gluten-free for some time. Those researchers hypothesized that celiac disease may be linked to some sort of immune system attack on the ears.
• Another study in Turkey: found the hearing functions of the children with celiac were similar to those in the non-celiac group.

Further research needed before concluding a true link between celiac disease and changes in our senses.

Gluten Sensitivity In Meniere’s disease

Meniere’s disease is a disorder of the inner ear that causes severe dizziness (vertigo), ringing in the ears (tinnitus), hearing loss, and a feeling of fullness or congestion in the ear. Typically, the disease affects only one ear.

Symptoms of Meniere’s disease are caused by the buildup of fluid in the compartments of the inner ear, called the labyrinth. The labyrinth contains the organs of balance (the semicircular canals and otolithic organs) and of hearing (the cochlea). When fluid builds up, there is a considerable decrease in auditory function, and people with the disease may begin to hear ringing and experience ongoing bouts of dizziness and discomfort.

Researchers found wheat to be one of the most common food allergens found in patients with Meniere’s Disease. In a prospective individual case-control study, a total of 33 Meniere’s patients (56.9%) proved to be sensitive to gliadin (a gluten protein). Certain hearing conditions like these may be linked to gluten in the diet.

Tinnitus is a known symptom of Meniere’s disease; an increase in wheat/gluten in these patients may cause increased symptoms. Further studies are needed to define the relationship between immune response to wheat proteins and Meniere’s disease symptoms, but some preliminary research has suggested the possibility of a link.

Gluten And Hearing Loss

Current research suggests that there could be a link between gluten and hearing loss. Gluten can cause the body to respond as if it were a threat, attacking the gluten protein with histamine and immunoglobulin E antibodies. Histamine levels that rise after the ingestion of gluten can affect the soft tissues in your ears, and this can lead to swelling, which impairs the body’s ability to function properly and can lead to symptoms of tinnitus, hearing loss, and other issues such as dizziness and discomfort in the ears and sinuses.

A valuable case report identified the effect of a gluten-free diet on a patient complaining of severe tinnitus. The report in question concluded that gluten sensitivity may have contributed to the pathogenesis of tinnitus in the patient; however, it is still unclear exactly how gluten could have affected their condition. 

Swelling in the ears can cause congestion, which can result in fluid buildup within the ear and can cause temporary hearing loss and tinnitus. Avoiding all foods that contain gluten may help, though a gluten free diet alone may not be enough to reverse or fully address symptoms.

If you have a gluten intolerance and often feel congested, or are experiencing hearing loss, consider removing this protein from your diet and consult with your physician and an audiologist for further evaluation and hearing loss, Celiac (or gluten sensitivity), and tinnitus treatment.

Conclusion

More research needs to be done to reach a definitive conclusion, but gluten may be related to temporary tinnitus in individuals that are sensitive to this series of proteins. If there is new ringing in the ears, or other symptoms of tinnitus in conjunction with gastrointestinal symptoms, it may be worth taking a look into both tinnitus and gluten sensitivity or allergy.