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Ask an expert - body - head - ear

16 questions

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:  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.

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