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Ask an expert - body - head - ear - tinnitus

7 questions

Q:  Do you know of doctors in Las Vegas, Nevada, USA, who use acupuncture to treat severe tinnitus? Also has seizure-like events been known to accompany tinnitus or has been caused by it? My daughter, born with a profound hearing loss in 1969, has lived with chronic pain since 1999 and tinnitus since 2012 with little relief. Any information you can provide will be helpful and appreciated. We are at a loss as to how to help her.

A:  We are sorry to say that we are not really aware of who works in Las Vegas, our reach being somewhat limited, and we certainly have not heard of any dramatic breakthroughs in the treatment of tinnitus. We are absolutely sure that had there been a serious development in the treatment of this chronic debilitating condition news would have travelled very quickly. When some acupuncture practitioners claimed to have a treatment for macular degeneration it sparked a whole host of questions across the globe.

We tend to be very conservative in the advice we give about tinnitus. One recent response said:

We used to be a great deal more downbeat about the treatment of tinnitus than we are now because our experience in practice was that it could prove intractable to treatment. However, as our factsheet shows

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

and as some recent personal experience in clinic has shown too, there may be some hope. 

The problem with measuring the success of treatment for tinnitus is that its appearance and disappearance can be entirely random. If you read the tinnitus association's magazine you will see stories along the lines of 'I tried everything and then x worked' and an equal number of stories which say 'I had tinnitus for five years and then one day it just went.'  Research trials tend to be quite reliable - it would be a remarkable coincidence if half the trial participants experienced a spontaneous improvement - but one-off cases could be a coincidence, with acupuncture just happening to be the therapy of choice when the change happened.

The available evidence, however, suggests that it might be worth a try with the proviso that progress is reviewed at regular intervals, and some kind of objective measure can be found, i.e. how much it interferes with a radio set at a particular level. It might also repay investigation of what makes it worse and what makes it better. A long n-1 case study this expert conducted had very little impact on the condition but did increase the sufferer's ability to deal with it.

The best advice is to visit a BAcC member local to you and your wife for an informal face to face assessment of what may be possible. There are one or two clearly recognisable syndromes within Chinese medicine which might offer considerable confidence that muting the problem may be possible, but even a general balancing of the system may bear fruit.

As for links between epileptic seizures and tinnitus there are a number of scientific studies which speak of a patho-physiological similarity in the two problems, and there is well document evidence of epilepsy affecting the vestibular apparatus which may well have an impact on the auditory ability of the body. We are acupuncturists first and foremost, though, not medical practitioners in the conventional sense, so we would have to say that we are not the best placed to answer your questions on this.

There is no doubt, though, that acupuncture has a long history of being used for pain relief, much of which was provoked by interest after Nixon's visit to China in the 1970s. That acupuncture treatment can have an effect on the release of the body's natural painkillers like endorphins and enkephalins is not in doubt. The main concern is how much pain relief and how sustainable it is. This can often be a delicate balance between outcome and cost, but it is always worth trying.

That's about the best that we can say. Our members tend to offer people brief face to face assessments which enable them to give a slightly better insight into what might be possible, and this seems to us the best way forward. Looking at things through the perspective of Chinese medicine can sometimes open up new lines of treatment which can in some cases provide unexpected relief.

Q:  My wife has a ringing in her ears which is said to be tinnitus, I recently read of a lady who after many years of suffering this affliction was cured by acupuncture. Could this be true ? 

A:  We used to be a great deal more downbeat about the treatment of tinnitus than we are now because our experience in practice was that it could prove intractable to treatment. However, as our factsheet shows

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

and as some recent personal experience in clinic has shown too, there may be some hope. 

The problem with measuring the success of treatment for tinnitus is that its appearance and disappearance can be entirely random. If you read the tinnitus association's magazine you will see stories along the lines of 'I tried everything and then x worked' and an equal number of stories which say 'I had tinnitus for five years and then one day it just went.'  Research trials tend to be quite reliable - it would be a remarkable coincidence if half the trial participants experienced a spontaneous improvement - but one-off cases could be a coincidence, with acupuncture just happening to be the therapy of choice when the change happened.

The available evidence, however, suggests that it might be worth a try with the proviso that progress is reviewed at regular intervals, and some kind of objective measure can be found, i.e. how much it interferes with a radio set at a particular level. It might also repay investigation of what makes it worse and what makes it better. A long n-1 case study this expert conducted had very little impact on the condition but did increase the sufferer's ability to deal with it.

The best advice is to visit a BAcC member local to you and your wife for an informal face to face assessment of what may be possible. There are one or two clearly recognisable syndromes within Chinese medicine which might offer considerable confidence that muting the problem may be possible, but even a general balancing of the system may bear fruit.


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

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.

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