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Q: My 3 weeks old baby has been diagnosed with moderate hearing loss due to issues with inner ear. We found some articles talking about benefits of acupuncture treatment in such cases. Can you please advise if this is something that is proven to work and whether this can be done on babies?

A:  There are no age restrictions on treatment, and we have known people to have treated babies that are a day or two old. However, we do increasingly take the view that it requires slightly more specialist postgraduate training to approach treating the very young. However, in our specialist guidelines which are still under development treatment on children under the age of six months is not favoured because of the unreliability of many of the usual diagnostic signs at this age. We don't simply stick needles in where the problem is, and trying to work on the extremely young would be only undertaken if there was a very clear syndrome with some very specific treatments.

As far as the research itself is concerned, we have seen one or two studies which suggest that acupuncture may have a role to play in treating inner ear issues, but none which we would regard as robust enough to underpin a recommendation.

Indeed, this expert, if faced with a request like this, would almost invariably recommend that a parent took their child to a cranial osteopath. Many of the problems with neonates can arise from the pressures on the skull during delivery, and the treatment itself is extremely gentle as well as being effective for many birth problems. If you did decide to try acupuncture, however, we would recommend that you seek out someone who has attended a structured postgraduate training in the treatment of children. There are two or three course providers, whom we cannot unfortunately name, who are recognised by our community as the acknowledged experts in the field. Someone who has trained with them will know their limitations, and that is the most important thing to consider, whether it is appropriate to use acupuncture with a child so young.

Q.  Is accuputure any good for sinus problems?

A. For such a common problem it is surprising how infrequently we are asked about whether acupuncture can help. An answer which we have given and which still seems current was:

As our factsheet shows


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

the evidence from the few trials there have been of sinus problems have not been that encouraging. This reflects the clinical experience of many practitioners, that sinus problems can be intractable and defy all attempts to relieve them. It would be good to be able to conclude that surgical options like rhinoplasty and sinus washes were the best alternative, but many acupuncture patients who come to treatment with sinus problems find that surgery has only offered temporary relief.

A great deal depends on the wider backdrop of your health against which the problems can be seen. Chinese medicine looks at the whole picture of someone's health, and it would be unusual for someone to be troubled by a single, quite unpleasant problem without their being other health issues, even if these are not particularly troublesome in themselves. It is this whole complex picture which can give the practitioner a better idea of what is happening and by the same logic a better idea of how difficult or how straightforward it will be to treat a problem. The best advice is to visit a BAcC member local to you so that they can offer a better assessment based on a face to face chat.

What we often find, however, is that there is often a lifestyle factor such as diet which is at least contributory to the problem. Many people eat a great deal of dairy produce in the form of milk or cheese, and this can often have aa significant effect on the body's fluids, from a Chinese medicine perspective making them more thick and less free-flowing. Cutting out some of these foods can often have a profound effect. A practitioner would very quickly be able to assess whether this was the case, and also consider other common contributory factors.
We think that this still remains pretty good advice. Each person is unique and different from a Chinese medicine perspective, and there are occasions when it becomes clear very quickly that the sinus problems have an obvious cause which is responsive to treatment. More often, though, people usually come to acupuncture treatment when the problem has existed for some time, and by this stage it has actually become a more fixed problem in itself, whatever the original cause. Your best bet is, as we said in the earlier response, to visit a BAcC member local to you for a more informed assessment based on seeing what is actually going on.

We have checked the databases again, and there is nothing new of interest. However, this is not entirely surprising; sinus problems are usually multifactorial, i.e. involving a number of separate causes, and it is quite difficult to design trials which can compare like with like.

The advice which we pretty much always give in these situations is to visit a local BAcC member for a quick chat about what might be possible. Five minutes face to face is often enough to make an assessment on the run about whether someone has factors which point to the potential benefit of acupuncture treatment, and most members are quite happy to give up a few minutes without charge to help prospective patients to make an informed choice.

We have been asked this question a number of times, and our answer has always been:

Google is a massively powerful search facility, and if you google 'acupuncture anosmia' it looks as though there are a number of studies which give cause for hope. If you look carefully, however, you will see that there is but one studyhttp://aim.bmj.com/content/21/4/153.longwhich is frequently quoted, generating a number of secondary references. This study, what we call an n=1 case study because it is the report of a single case, is important because it suggests that there may be something worth looking at in the use of acupuncture treatment. The weakness of n=1 studies, of course, is that they are not designed to test acupuncture, and the positive outcome could have arisen for any number of reasons, especially since the case study can provide no evidence for the sudden onset of the problem.That is not to say that acupuncture treatment is not worth trying. The use of Traditional Chinese medicine involves a great deal of questioning and examination to determine the state and flow of the energies of the body, called 'qi', and the state of the organs which are responsible for all of the functional aspects of the body. Even where there is no obvious cause from a conventional medical point of view, it is rare for a symptom to stand alone in Chinese medicine other than where it derives from a blockage. In this case, if the blockage is removed, the function is restored. We strongly suspect that this is what happened in the case study, and blockages of this kind can sometimes occur for no obvious reason.Generally speaking, though, a pattern of disharmony will generate a number of symptoms or changes in function, not all of which are clinically significant from a conventional perspective, and these may point t specific imbalances affecting Organic function. Note that we capitalise the word 'Organ' - what we understand by this in Chinese medicine is a great deal more than a physical unit in the body. The Chinese understanding of an Organ embraced functions on all levels, body mind and spirit, and when practised properly Chinese medicine can legitimately claim to be holistic.The best advice we can give is that you visit a BAcC member local to you for advice on whether they think that acupuncture treatment may be of benefit, and to discuss briefly with you the other aspects of your health which may indicate wider patterns which in turn may link to your problem. That is not to say that there may not be as simple a treatment as the one described in the paper, and one of the points used has the Chinese name 'Welcome Fragrance' suggesting that it may have a direct bearing on the sense of smell. You would certainly not do any harm. However, we would be more likely to look at this as a functional disturbance and be looking at other factors in the system which might point to a treatable pattern.We have had a look through all of the databases again and found references to these four papers which give mixed outcomes for treatment
  1. Vent J, Wang DW, Damm M. Effects of traditional Chinese acupuncture in post-viral olfactory dysfunction. Otolaryngol Head Neck Surg. 2010;142:505–509. doi: 10.1016/j.otohns.2010.01.012.[PubMed] [Cross Ref]
  2. Silas J, Doty RL. No evidence for specific benefit of acupuncture over vitamin B complex in treating persons with olfactory dysfunction. Otolaryngol Head Neck Surg. 2010;143:603. [PubMed]
  3. Damm M, Vent J. Response to: no evidence for specific benefit of acupuncture over vitamin B complex in treating persons with olfactory dysfunction, by Jonathan Silas and Richard L. Doty. Otolaryngol Head Neck Surg. 2010;143:603–604. [PubMed]
  4. Anzinger A, Albrecht J, Kopietz R, Kleemann AM, Schöpf V, Demmel M, Schreder T, Eichhorn I, Wiesmann M. Effects of laserneedle acupuncture on olfactory sensitivity of healthy human subjects: a placebo-controlled, double-blinded, randomized trial. Rhinology. 2009;47:153–159. [PubMed]
and don't really give us much cause to be over-optimistic. However, what we said above about blockages and energetic weaknesses is probably a great deal more relevant than studies which are either too small to underpin any conclusions or too specific to one variant of anosmia. Chinese medicine was always and remains the treatment of the person, not the named condition, in the expectation that if the system is in good balance it will repair itself and function as it should. This seems to us a better statement of what we are trying to achieve than 'acupuncture treats x and y', and having used this kind of approach for many, many years we have seen enough problems resolve for which there was no evidence to suggest that a short course of treatment is always worth trying, and will certainly cause no harm.
We have been asked many times about tinnitus, and our most recent reply has been:

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 showshttp://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/tinnitus.htmland 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  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.
Invariably we check for more evidence when we are asked a question to which we have responded before, and the evidence trail for the fact sheet stops some time ago. We found a number of small studies like this onehttps://www.ncbi.nlm.nih.gov/pubmed/26747258which seem on the face of it to encourage the belief that there is a recognised connection between acupuncture treatment and symptom relief. There is also a systematic review, a 'trial of all trials' beloved of researchers because it aggregates to a much more powerful study than the individual ones.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3493359/This draws the usual sorts of conclusion about the need for more and better trials, but the authors do conclude that acupuncture is worth trying as a safe alternative which seemed to have shown some success in addressing the problem.The advice we gave before, though, holds good. Each case is unique and different, as is each treatment plan, and the best advice you can get will always come from someone who can see your problem in its overall context.So, in answer to your question, there is some evidence that acupuncture treatment may help tinnitus, but not yet enough for us to say with any certainty that a result is guaranteed.As far as specialists are concerned, by its very nature Chinese medicine is generalist. Indeed in ancient China specialists were regarded as decidedly inferior because they only treated single conditions. From the Chinese medicine perspective it is the patient who has the problem, not the problem which is the primary focus. Each manifestation of a problem is unique and different, and twenty people with the same named problem might be treated in twenty different ways.On this basis we are happy to recommend any of our members to offer the same exemplary level of care, and using the postcode search on our home page www.acupuncture.org.uk will direct you to the geographically closest.

We were asked a similar question a number of years ago, and our answer then contained the following paragraphs:

Chinese medicine is based on an entirely different theoretical basis from conventional medicine, what is often called a different paradigm. The essence of Chinese medicine is a belief that the body, mind, emotions and spirit are all manifestations of an energy called 'qi' whose proper flow and balance means that everything functions the way it is supposed to. If this flow becomes blocked or disturbed in any way, then functional disturbances appear, often affecting all 'levels' of the system and for which needles are used by the practitioner to restore flow.

When someone reports blockages it makes one question immediately whether the energy of that area is flowing as well as it might, and a skilled and experienced practitioner could determine quite quickly whether, from the Chinese medicine perspective, there was something which might be done. Even if there were no immediately obvious signs in the area itself, the principles of Chinese medicine are founded on a notion of overall balance which means that symptoms are less critical, being indicators of a wider imbalance in the system rather than the necessary focus of attention. It would be worth your while to visit a BAcC practitioner local to you for an informal assessment of whether they believe that acupuncture treatment may be of benefit to you.

That said, we have to say that the research evidence for the treatment of both conditions with acupuncture is a little bit thin. There are a few studies, but one of the key factors in undertaking research from a conventional perspective is trying to reduce the variables, and this means being able to define clearly what the problem is. Blocked tear ducts  have several possible causes, and this means that comparing like with like becomes more difficult, and the results less reliable. What research we have identified is of relatively poor quality, and if we were making recommendations based solely on that we would have to say that it would not be worth pursuing. However, our clinical experience is that where there are clear energetic blockages treatment can sometimes have a very direct effect, and it would certainly be worth seeking advice from a BAcC member local to you.  

There are, in fact, some quite useful studies of related problems like dry eye syndrome, and although it is rather technical this paper

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3355143/

is both realistic and encouraging.

This expert has to admit that it has not been the most successful area of his practice. While few patients have come specifically for this as a problem several have had it as a secondary problem, and even where the main problems have responded well this hasn't. That said, in the minority of cases where there has been a positive change the result has been welcomed with great joy.

Acupuncture treatment is always worth a try. There is very little chance of an adverse effect, and there are enough reports of treatment working for this problem to suggest that it is worth a go. The only issue for cases where there is less evidence is to make sure that a patient doesn't get tied into a long and potentially expensive course of treatment without any tangible benefit. In another context, Dr Johnson once described something as 'the triumph of hope over experience', and we always ask our members not to succumb to joining patients in a desperate hope for good outcomes. If there is nothing happening after four or five sessions it may well mean that nothing will happen.

If you do decide to go for treatment, we hope that your case is one of the ones which does respond.

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