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Ask an expert - body - head - ear

14 questions

Q:  My mother aged 88 years old has balance problems. The hairs in her ears have flattened and I was wondering if acupuncture could help.

A: A great deal depends on whether the 'flattened hairs' is a specific clinical description in layman's terms or whether it is a broad brush definition being offered by your mother's GP. There are a number of situations where the minute hair-like structures in the inner ear which are responsible for our sense of balance are thought to become obstructed by crystalline deposits, so the person affected does not have a clear sense of their position. A second set of fluid-filled tubes gives us a sense of acceleration and movement. If there are major physical changes in either of these structures, or serious deposits affecting the movement of fluids, then there is less chance that a course of acupuncture treatment will have a significant effect. That said, the structures themselves are microscopic, so clinical investigations are not as precise as one might wish.
 
There are a number of small studies of  balance which provide some encouraging evidence that acupuncture may be of benefit, but these are mainly associated with balance problems after strokes or specific neurological damage. However, there are a great many studies of vertigo as a part of a number of named western conditions, such as benign paroxysmal positional vertigo or Meniere's Disease, where the evidence for the benefits of acupuncture treatment is much stronger. Our factsheet

 

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/vertigo.html

 

summarises some of the better research.
 
Therefore, if the diagnosis is not based on CT scans or MRI evidence, or in some cases even if it has, there are many ways in Chinese medical understanding of the body to explain why someone's balance can be affected. The Chinese medicine view of the body is that everything is a manifestation of an energy called 'qi' whose flow, balance and rhythms determine our overall state of health and well-being. If there are local blockages in the flow, these can result in disturbances in the workings of the body where the blockage is. If there are functional disturbances, i.e. deeper imbalances in the system where whole body functions are disturbed, these too can lead to symptoms such as loss of balance. In cases like this, though, the loss of balance will be just one of a number of symptoms which the practitioner will identify as evidence of this loss of function, and the diagnosis will be confirmed by a number of specific Chinese medicine diganostic techniques such as taking the pulse at the wrist or looking at the tongue.
 
Essentially a properly qualified and trained practitioner, such as all BAcC members are, should be able to tell you on the basis of a brief face to face assessment whether there is anything from a Chinese medicine perspective which encourages them to believe that acupuncture treatment may be able to offer some benefit. Our advice is very often that someone should see a BAcC practitioner local to them for face to face advice. It has to be remembered also that some of the more traditional forms of Chinese medicine always treated the person as opposed to the symptoms with which people presented, and applied the simple premise that if the system as a whole was in balance then symptoms would necessarily disappear. This could mean that even in the absence of a direct correlation between symptom and named syndrome treatment may still be of benefit.

 

Q:  I am a muscian and DJ, looking for safe and effective treatment for tinnitus and long term hearing damage from working in loud venues. I do a little acupressure, and would like to learn acupuncture too as a self treatment. How much training do I need in order to perform self treatment safely and effectively?

A:  There are two issues here. The first is whether acupuncture is really an effective treatment for tinnitus. As you might imagine, we have been asked several times about tinnitus, and most recently we replied:

The fact sheet which we have on the website

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/tinnitus.html

is quite upbeat about a number of small studies, but our clinical experience is not as good, with tinnitus among the more intractable conditions with which patients present. In a recent answer, to which we can probably not add a great deal more, we said:

A. Tinnitus is one of the more intractable conditions which people seek acupuncture treatment for. Our Tinnitus fact sheet, found at lists a small amount of research which suggests that acupuncture may help, but there have been no significant trials which provide solid evidence. It is also fair to say that many practitioners are very cautious about taking on patients for whom tinnitus is the primary problem. 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.

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 identifable 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.

As far as self treatment is concerned, opinion in the profession is divided. There was a paper published some years ago

http://aim.bmj.com/content/22/3/141.full.pdf+html

which summarised the arguments for and against self treatment, although the last few years have seen an increase in the use of self-treatment for people who need regular top-ups after chemotherapy and the like. We believe that while the risk of an adverse event is very low, as indeed it is for any treatment with acupuncture, it is asking quite a lot of a patient to observe the rigorous conditions which we ourselves have to follow when we are needling. Disposal of the needles and any clinical waste is just one major headache among several. The fact that someone has agreed to accept the risk is all very well, but our experience is that this perception changes very quickly if something does go wrong. We have seen this when people treat friends; hell hath no fury like a friend with a bruise.

It is also fair to day that we do not necessarily think that formula treatments for named conditions are the best way to perform acupuncture. Our work is evolutionary and dynamic, the very thing which makes it so difficult to fit with the so-called 'gold standard' research model. Formula treatments tend not to work for everyone, and lack that very thing which makes acupuncture such a powerful intervention, the fact that the treatment plan and treatment is unique to the individual patient.

That said, we hate to discourage someone from using acupuncture because although the likelihood of making a big difference with acupuncture for tinnitus is low, it can and does happen. Your best bet is to try to find a practitioner local to you who uses ear acupuncture and uses stud needles or ear seeds which can be left in place and manipulated regularly to achieve the necessary effect. They can also review your treatment on a fairly regular basis to ensure that everything is going to plan. This is probably better, in our view, than self-needling.

Q:  I have been diagnosed with an inner ear problem that is causing pressure and discomfort. Can acupuncture help?

A:  A great deal depends on what is causing the pressure. Although we work with a system of medicine which rests on an entirely different basis from conventional medicine, we have the advantage of an understanding of the inner workings of the body which the ancient Chinese would have loved to have. If there are gross physical reasons for the pressure being in your ear, like narrowing or stenosis of some of the fluid conduits, then acupuncture treatment isn't going to be any use at all. If, however, the flow of fluids in the area is in any way compromised because they are becoming more viscous, then this is the sort of territory where Chinese medicine may make a difference. There are, for instance, a number of protocols for dealing with local blockages and with the systemic thickening of fluids which may offer some hope.

As far as research is concerned, there is nothing which we have identified which relates directly to this kind of problem. You will find a number of studies on Meniere's disease and vertigo where there may be an overlap, but nothing which relates to 'pressure' in an of itself.

We suspect that the only way you are going to get an informed answer to your question is to visit a BAcC member local to you and explain to them the exact nature of the problem. This will enable them to give you a much more informed view than we can here. Most members are happy to give up a small amount of time without charge to enable prospective patients to check whether this is the therapy, and sometimes the therapist, for them.

 

We are also aware that people also use cranial osteopathy to good effect with problems like this, especially where someone has a history of major dental treatment. This can sometimes cause subtle displacements of some of the joints in the area, and while acupuncture treatment can encourage a reinstatement of proper energy flow which might help the body to reassert its proper shape, a more direct method may work more quickly. Your local BAcC member will undoubtedly be able to give you a trustworthy referral for this option.

A:  This is not easy for us to answer. Although some of our members use auricular acupuncture, it is not a part of the mainstream traditional acupuncture tradition, having really developed in thelast half century in Europe, although based on Chinese understanding of inter-relationships between parts of the body. This American site:
 
http://www.auriculotherapy.com/faqs.html#prc11
 
provides an answer to your specific question, as well as offering a great deal more information about the tradition and the way that it is practised in the  US.
 
There are a number of UK organisations which offer auricular acupuncture, many of which have grouped together to form an umbrella body called the Microsystems Acupuncture Regulatory Working Group. Further details of its work, and the contact numbers for its members can be found on
 
http://www.macrwg.org/
 
This may be able to provide you with more information, should you need it.
 

Q:   I developed sudden hearing loss 18 days ago and went to ENT in Grays Inn this week. They tried a steroid injection into the inner ear which did not work. I have heard that electro acupuncture worked for this in China.  I am looking for someone who preferably has had experience in this.

A:  This is clearly an area which modern Chinese acupuncturists are studying with great gusto, and the there are several trials with electro acupuncture, of which these are a gew examples, which give promising results, and which also assess whether electroacupuncture is as, or more, effective than ordinary manual acupuncture. 
 
http://www.ncbi.nlm.nih.gov/pubmed/22650126
 
http://www.ncbi.nlm.nih.gov/pubmed/19358498
 
http://www.ncbi.nlm.nih.gov/pubmed/19835117
 
There are also studies like this one
 
http://www.ncbi.nlm.nih.gov/pubmed/23213981
 
which look at the effect of 'ordinary' acupuncture treatment.
 
 
While these trials all fall a long way short of what we are required to cite to be able to claim that acupuncture treatment may be of benefit (the bar is set very high, but that's another story!) they certainly seem indicative of something very positive, and woith the range of conventional options being somewhat limited, it could well be worth your while to give acupuncture treatment a go.
 
Unfortunately electroacupuncture is not a part of our core training, although a great many members do use EA, sometimes having attended courses, others following well-designed protocols and using trhe equipment exactly as instructed. We do not keep records of who does and who does not - that would mean setting standards, which would be difficult to create, or allowing people to self-certify, which as a registering body we would be relucantant to do. If you speak to a BAcC member local to you, however, and in N22 there are many, they will almost certainly be able to direct you to a colleague who uses EA regularly and may be able to help.
 
The subset of people using EA is also wider than simply BAcC members with an interest in extending their skills. There is a whole EA community which includes many conventional scientists and medics, although no single professional association to which you could go for a referral. Again, our members also 'know a man who does' and we are sure that they would be able to help you track down what you need in your locale.
 
As a final remark, you may also want to keep in mind as a fallback cranial osteopathy. We have heard interesting reports that this may also help, although we would always advise the use of EA first. Indeed, we would usually point out that EA does no more than conventional  acupuncture treatment but has the advantage of persistent stimulation over time which is difficult to replicate manually. That is not to say that a competent practitioner may not be able to achieve the same results using manual acupuncture, and you have the advantage of several highly experienced practitioners in your patch. Using our 'find a practitioner' function
 
http://www.acupuncture.org.uk/baccsearch.html
 
will generate a number of useful hits.       

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