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Ask an expert - body - head - ear

19 questions

Q:  I have recently recovered from endocarditis, and having been treated with gentamicin have been left with bilateral vestibulopathy. I am wondering whether acupuncture would be effective in this case.

A:  From a western medical perspective we would have to say that the damage caused by the effects of gentamicin can lead to permanent problems, although the website of one of the major American organisations for hearing loss offers a rather more encouraging picture than most:

This is a condition that realistically often causes some permanent disability. In patients with gentamicin-induced ototoxicity, the symptoms generally peak at three months
from the last dose of gentamicin. In the long run however, (five years), most patients become substantially better. There are multiple reasons why people get
better. First, there is evidence that the damaged vestibular hair cells in the inner ear can regenerate, although the extent to which this occurs and the degree to which they are functional is not presently clear (Staecker et al., 2011; Forge et al, 1993)). Some recovery presumably occurs because marginal hair cells recover, because the brain rewires itself to adapt to the new situation (plasticity), and because people change the way they do things to adjust to their situation.

The majority of websites, however, are not usually as optimistic, and there is more often than not a touch of 'when it's gone, it's gone' about their prognostications.

From a Chinese medicine perspective we have to be careful not to engender a sense of false optimism. If there has been proven physical damage to the nerve structures of the inner ear there is not a great deal that acupuncture can achieve. The evidence for the regeneration of nerves with the help of acupuncture is not good except for a few trials with experimental animals (what our colleagues call 'ratpuncture'), and we have to be realistic. However, there are a number of ways in which balance can be affected in Chinese medicine terms, and if there has been a pathological change in the flow of energy in the area, whether brought about by a change in the area or by a
functional change in the whole system which has generated this particular symptom, then there may be some cause for cautious optimism that acupuncture
treatment might have a small impact on the problem. If there is a feasibility that some of the vestibular apparatus can regenerate, then anything which encourages the system as a whole to work better may help in this process.

On that basis there would be no reason not to visit a BAcC member local to you for a slightly more considered view than we can offer from a distance, and they may well be able to identify areas or patterns of weakness, the correction of which may help you to recover to a degree. What we would say, though, is that we would be surprised if the recovery was complete, and our own understanding is that positive change might take a considerable amount of time. This always makes it difficult because it is very difficult to set down good outcome measures which can take into account 5% change. One of our esteemed Japanese colleagues once memorably said that if a patient tells
you they are 10% better they are just saying 'you're a nice person, keep trying.' Her view was that anything less than 25% was difficult to judge. We would recommend, therefore, that if you did see a BAcC member who thought that treatment might help, it would be really important to set regular review periods and to try very hard to find a clearly defined outcome marker to get a sense of what progress, if any, was being made. Can acupunctu

A:  We tend to be a little downbeat about the possibility for success in treating tinnitus. One regularly used answer, for example, reads:

Tinnitus is one of the more intractable conditions which people seek acupuncture treatment for. Our Tinnitus fact sheet http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/tinnitus.html lists a small amount of research which suggests that acupuncture may help, but there have been no significant trials which provide solid evidence. There has also been a recent systematic review which concludes that there may be some subjective benefits but no positive conclusions sufficiently robust to be able to make firm recommendations.

It is fair to say that many practitioners are very cautious about taking on patients for whom tinnitus is the primary problem. As we can see from your husband's history of
treatment, it is quite easy to spend considerable time and money and be no better off than when you started, and the individual case reports in the tinnitus sufferers' magazines often have the same shape.

We are not aware of any member who specialises in the treatment of tinnitus. However, what many practitioners do find when treating people with tinnitus is that while the noise remains largely unchanged their ability to cope with it seems to improve. Evidence for this is largely anecdotal, though, and it would be wise to discuss carefully with any future practitioner whether they think that they might be able to help. In all events we would recommend that frequent and regular reviews of outcomes and progress are essential.

We don't think you can say more than this. There are two or three clearly identifiable patterns in Chinese medicine, described as syndromes, where tinnitus is a specific named symptom which frequently appears, and it is possible, if your tinnitus has arisen as a part of the syndrome, that there may be some help which acupuncture treatment may offer. An experienced practitioner should be able to make a very straightforward determination on whether this is the case. Overall, however, there is not a great deal of cause for optimism about getting rid of the unwanted noise.

We don't think there's a great deal more than can be said. We have come across cases where people have persevered for dozens of sessions in order to try to get on top of the problem, but without success, and there is always a danger that after investing a four figure sum for treatment which hasn't worked some patients may feel a little aggrieved. If someone really wants to give it a go we always advise members to set regular review periods and remind patients of where they are and that it is a freely made choice to continue.

A:  Difficult to answer without knowing exactly how the ear and throat are annoying you. Chinese medicine has addressed for over two thousand years all of the health problems from which modern people still suffer, and a traditional acupuncturist will always take a very full case history which covers the main problems you have, any other niggling chronic problems which you may have, your medical history and family medical history and lifestyle questions about sleeping, eating and eliminatory patterns. From all of this material the practitioner can assess whether this is a short term problem or whether it is the tip of a much larger iceberg. This in turn will determine how the treatment is undertaken.

Generally speaking, even with short term problems in the ear and throat the  treatment may not be entirely local. There may be some needles near the head and ears, but it is equally possible that needles could be applied anywhere. The internal connections or pathways are such that points on the foot will affect the head, and vice versa, and there is a very strong likelihood that if constitutional points are used for a systemic problem, the needles will be applied in the first instance to points on the arm below the elbow or on the leg below the knee. These are often the 'starter for ten' needles to assess what strength and frequency of treatment may be necessary, and often are sufficient in themselves.

Does it hurt? Not really. The needles are very fine, much thinner than sewing needles, and they are usually inserted through a plastic guide tube which both guarantees sterility and also applies a light pressure to the skin which masks the sense of the needle going in. Sometimes people can feel the slight prick as the needle penetrates the skin, but a much more common sensation is a dull ache, either on or shortly after insertion of the needle. The Chinese call this sensation 'deqi', pronounced 'derchee', and regard it as essential for a good result. the Japanese, however, are exactly the opposite, and try very hard to make sure that the needles are not felt on entry. Whichever approach a practitioner uses it is highly unlikely to hurt very much at all. let's face it, men have acupuncture treatment, so it can't be that bad.

The best advice we can give, without more information to go on, is that you visit a BAcC member local to you for a brief chat and face to face assessment of how, or if, they think acupuncture treatment might help you. Most are happy to give up a little time without charge and equally happy to refer on to other forms of healthcare practice if they think that it may be more effective for you.

Q: I have pulsatile tinnitus, it is extrely distracting as I can hear my heartbeat in my ear constantly. The only thing that eases it is putting pressure on my neck near my ear. Would acupuncture be of any help to me?

A:  Although our factsheet on tinnitus is relatively upbeat
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/tinnitus.html
 
our own clinical experience of treating the condition is that unless it relates to one or two very specific syndromes, tinnitus can be one of the more intractable conditions. There is no doubt in our minds that acupuncture treatment can often make the tinnitus sufferer better able to handle the problem, but shifting the problem itself is a more difficult problem. As the various support group magazines ably demonstrate, there is always something which works for some people but nothing that works for all people, so you will often read articles that suggest that almost anything you may name can work. Cynics tend to take the view that tinnitus can often disappear of its own accord, and like pass the parcel, whatever someone happened to be doing as a treatment at the time is given the credit. This may not always be far of the mark.
 
However, pulsatile tinnitus is a much more specific presentation, and although tracing which blood vessels may be causally related to the condition is difficult, from a Chinese medicine perspective the sense that there is blockage and constriction in an area is one with which a practitioner could work from a Chinese medicine perspective. One of the strengths of Chinese medicine is being able to take the symptoms which a patient experiences together with some of the signs with which they present and make a diagnosis of patterns of imbalance within the system which treatment may be able to adjust or correct. This can result in improvement.
 
To make this assessment, however, someone would have to see you face to face, and the best option is to use our find a practitioner option on the home page www.acupuncture,org.uk and arrange to see a BAcC member local to you for a brief assessment. We also think that you might want to hold in reserve a possible referral to a cranial osteopath. If there has been some change in the subtle structure of the skull this may be affecting blood vessels locally and causing the condition. Cranial osteopathy may be another possible modality for trying to address this problem.
 
 

Q: I have just been diagnosed with an acoustic neuroma and they have decided to wait to see if the tumour grows.  A symptom  of this is deafness and tinnitus in my left ear.  I have read that acupuncture  can help. How would I go about finding a suitable therapist?

A:  As far as finding a suitable practitioner is concerned, that couldn't be easier. If you go to our homepage www.acupuncture.org.uk you will see a search facility called 'find a practitioner' which can be used with postcodes or with area names to find someone close to where you would prefer to have treatment. All BAcC members are fully trained and qualified, and all are covered by the BAcC's bloc professional indemnity insurance cover.

As far as the acoustic neuroma is concerned, there are very few reliable studies which would enable us to venture an opinion based on evidence. Some of the support websites cite a number of case studies, and there are one or two accounts of auricular acupuncture being used to help deal with the problem, but nothing which meets the standards of evidence which we have to meet to be able to recommend acupuncture.

Tinnitus and deafness are, in our view, quite difficult to treat. In TCM, one of the styles of acupuncture used frequently in the UK, there are a couple of specific syndromes where tinnitus forms a part of a collection of symptoms, and in these cases one could say that there is a chance that the problem will be helped. In cases where tinnitus is caused by a physical obstruction or locally situated problem, as in a neuroma, or where it is idiopathic (medical speak for 'it just happens') we are not very convinced of its efficacy, and this particular expert will only venture four or five sessions before drawing a line in the sand.

However, while it has become more commonplace over the last decade to discuss the named conditions which acupuncture can or can't treat, we must not forget that in ancient times and in authentic modern versions acupuncture treats the person, not the disease or condition. Chinese medicine is based on an understanding of the body mind and emotions as a system of energy, called 'qi', whose flow, rhythms and balance determine health. Symptoms are simply signs that the system as a whole is out of kilter, and addressing the overall balance should, in theory, help to resolve all symptoms. One has to be careful because this can get mistranslated as 'acupuncture can treat anything' and give unreasonable and false expectations, but to the extent that it treats people, not things, it does give some hope in nearly all examples of imbalance, even if this is simply a matter of getting worse slower.

The best advice, as we always say, is to visit a BAcC member local to you and seek a brief face to face assessment of whether they think acupuncture treatment may be of benefit. Most members are happy to give up a few minutes without charge so that they can offer a realistic assessment, and from a prospective patient's perspective it is always good to be able to meet the person and see where they work before committing to treatment

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