Ask an expert - body - head - throat

5 questions

Q:  I am suffering with vocal chord strain, after having a conversation with friends my voice box hurts, I have had all the tests done via ENT and nothing is showing up. This started after I had a trip in India and got larangyeal tonsillitis and at the same time I got vocal strain 4 months ago. Can acupuncture help me?

AThere are a relatively small number of studies which report successes in treating vocal cord paralysis, two examples of which are

http://www.ncbi.nlm.nih.gov/pubmed/2741280

http://www.ncbi.nlm.nih.gov/pubmed/848460

The abstracts of the papers do not cite the exact treatments used, and both speak of acupuncture being used in conjunction with other forms of treatment. In one paper, as is commonly found to be the case, the use of acupuncture alongside the conventional treatment appears to speed up the patient's recovery. However, it is best to consider these papers as indicative rather than conclusive; there are no large scale studies which make a confident prediction possible. A great deal will also depend on the extent of
the cordotomy. The operation is not supposed to interfere with a patient's vocal capacity if they recover naturally, but as with all surgical procedures there is an inherent risk that some of the changes are not reversible.

We suspect that some of the treatment offered in the studies was local, i.e. in the area near the problem, and this can often be very effectively in stimulating a return to good function. However, a practitioner may well want to establish whether this is simply a local problem or whether this is the tip of a much larger iceberg - this would have implications for how much treatment may be required and whether it is worthwhile attempting to address this as a local issue if there is a backdrop of much more extensive imbalance.

If we were being brutally honest we would say that treatment may be more in hope than in expectation, but acupuncture treatment has a reputation for occasionally achieving unexpected but significant results,. so we would be happy to advise you to seek a face to face assessment with a BAcC member local to you who can give you a much better assessment by looking at the problem and your father's health in the round.

Your situation is not quite so drastic as this case, and there may be some greater hope that treatment may encourage a return of some of the lost function.
Acupuncture treatment will certainly not do any harm, and since there are a number of functional disturbances seen from a Chinese medicine perspective which impinge directly on the effective use of the voice, it may be that an experienced practitioner can see a direct intervention which may help. Even in the absence of a direct connection, the underlying premise of Chinese medicine, the treatment of the patient rather than the illnss, may offer some possibility of a speedier recovery.

It is best to talk to a BAcC member face to face, though, to get a more accurate assessment of whether acupuncture treatment may be of benefit, and we
are confident that you will receive honest and impartial advice.

Although your problem is not quite as advanced as this, we believe that the same advice holds good. There may well be local treatments which can help to improve the
energy flow in the affected areas and reinstate better function. There may well also have been functional disturbances in the system as a whole brought on by the tonsillitis and which treatment may be able to help. However, in both of these cases you would need to have a better qualified view from someone who sees you face to face to determine whether there is something in the energetic patterns which they believe would indicate that improvement would be likely. At this distance it is difficult to say and without solid research to go on, even of the anecdotal and less formal type, it is hard for us to say more. If you did find a practitioner who felt it was worth a try we would advise that you set regular review periods to ensure that you do not invest a great deal of time and money in something which isn't achieving very much.

Q: Please could you tell me if acupuncture can definitely help with muscle tension dysphonia which affects the voice box, excessive mucus production and choking due to constriction of the entrance to the trachea. A: None of us could say that acupuncture can definitely help with anything. From a Chinese medicine perspective each individual has a unique balance of energies, and even where several people have the same visible symptom they could nonetheless each be treated differently depending on the patterns of disharmony in their general energy flow. We were asked earlier this year about spasmodic dysphonia which has overlaps with the MTD you describe and we replied: A: There are a very small number of studies such as these http://www.ncbi.nlm.nih.gov/pubmed/14513964 and http://www.ncbi.nlm.nih.gov/pubmed/9181547 which provide a basis for arguing that a larger scale trial would be useful. However, small scale trials are always problematic when being used in evidence for a form of treatment. Although we are not great fans of the randomised double blind control trial which is often taken as the gold standard for research, the need to take individual and unique variations out of the equation is important, and case studies on this scale can often owe a great deal to extraneous factors. However, that said, Chinese medicine has a very different way of looking at the functioning of the human body, one which rests on a theory of energy called 'qi' and its flow and circulation around the body. When blockages or deficiencies occur, this can lead to aggravation and symptoms. The Organs of the body as understood by Chinese medicine (always capitalised to differentiate them from a western understanding of organs) have a variety of functions on all levels - body, mind and emotions - some of which may have an impact on the ability to speak. One of the great strengths of Chinese medicine is that each patient is seen as unique and different, and the practitioner will look at all of the systems of the body, as well as all of the circumstances surrounding the onset of the problem, to try to understand the patterns of causation. Although symptoms can suddenly appear out of nowhere, there are often underlying issues which predispose someone to develop these symptoms. If this were to be the case with your problems, then there may be something in the overall presentation to encourage a practitioner to feel that they may be able to help to sort things out. Given that each case is unique and that research on this condition is sparse, your best bet would be to visit a BAcC member local to you for a brief face to face assessment of whether in their view acupuncture treatment might be of benefit. Even when there isn't a clear 'audit trail', the premise of the very old traditional systems was that treating the person and re-establishing balance would surely remove symptoms. This can cause problems in modern practice; it is possible to get rid of a symptom without anyone ever establishing what caused it, which some people find perplexing! The standard options, such as botulin injections, remain available to you, we imagine, but these offer only temporary relief from the problem. It would be nice to think that acupuncture treatment might offer a more lasting solution, but we have to be realistic and say that if you do choose to have some acupuncture sessions, you should set a very clear review date to make sure that acupuncture doesn't become a habit process. We have known patients to clock up a dozen sessions or more without much change because weekly bookings become a weekly pattern which easily stacks up to a large-ish sum of money. This is basically the same advice we would give now for your problem. The one factor which you mention, the excessive mucus production, is a factor in the condition anyway, but would certainly be of particular interest to a Chinese medicine practitioner because there may be other aspects of the system which are contributing to the problems you have.

Q:  I have recently been diagnosed with a condition called spasmodic dysphonia which means that my vocal cords go into spasm when trying to speak. Has anyone come across this and is this something you could help with?

A: There are a very small number of studies such as these
 
http://www.ncbi.nlm.nih.gov/pubmed/14513964
 
and
 
http://www.ncbi.nlm.nih.gov/pubmed/9181547
 
which provide a basis for arguing that a larger scale trial would be useful. However, small scale trials are always problematic when being used in evidence for a form of treatment. Although we are not great fans of the randomised double blind control trial which is often taken as the gold standard for research, the need to take individual and unique variations out of the equation is important, and case studies on this scale can often owe a great deal to extraneous factors.
 
However, that said, Chinese medicine has a very different way of looking at the functioning of the human body, one which rests on a theory of energy called 'qi' and its flow and circulation around the body. When blockages or deficiencies occur, this can lead to aggravation and symptoms. The Organs of the body as understood by Chinese medicine (always capitalised to differentiate them from a western understanding of organs) have a variety of functions on all levels - body, mind and emotions - some of which may have an impact on the ability to speak. One of the great strengths of Chinese medicine is that each patient is seen as unique and different, and the practitioner will look at all of the systems of the body, as well as all of the circumstances surrounding the onset of the problem, to try to understand the patterns of causation.

 

Although symptoms can suddenly appear out of nowhere, there are often underlying issues which predispose someone to develop these symptoms. If this were to be the case with your problems, then there may be something in the overall presentation to encourage a practitioner to feel that they may be able to help to sort things out. Given that each case is unique and that research on this condition is sparse, your best bet would be to visit a BAcC member local to you for a brief face to face assessment of whether in their view acupuncture treatment might be of benefit. Even when there isn't a clear 'audit trail', the premise of the very old traditional systems was that treating the person and re-establishing balance would surely remove symptoms. This can cause problems in modern practice; it is possible to get rid of a symptom without anyone ever establishing what caused it, which some people find perplexing!

 

The standard options, such as botulin injections, remain available to you, we imagine, but these offer only temporary relief from the problem. It would be nice to think that acupuncture treatment might offer a more lasting solution, but we have to be realistic and say that if you do choose to have some acupuncture sessions, you should set a very clear review date to make sure that acupuncture doesn't become a habit process. We have known patients to clock up a dozen sessions or more without much change because weekly bookings become a weekly pattern which easily stacks up to a large-ish sum of money.  

 



 

Q: I have had a cough now for about 7 months. I've been to the doctor several times, have taken antibiotics and had blood tests and xrays - nothing showed up.

A:  We are assuming that you have had all of the investigations which are available. The one you have not mentioned, and which is another quite frequent cause of a persistent cough, is a hiatus hernia or other stomach-related problem which leads to acid reflux. This can also be a cause of a persistent cough, along with a post-nasal drip and asthma.
 
If none of these has been identified as a cause, or even if they have, there may be some merit in looking at acupuncture treatment. There is not a great deal of evidence for the treatment of coughing, but this is mainly a reflection of the many different causes of coughing and the difficulties of designing a trial which generates meaningful results. Persisitent coughing has certainly be a symptom recognised within traditional Chinese medicine, and if it appears alongside other symptoms and alongside the diagnostic evidence which a trained practitioner will find using Chinese medicine techniques, there are a number of clearly defined syndromes which offer treatment protocols to address the underlying patterns.
 
Even where there is no recognised syndrome, it is important to remember that in its earliest forms Chinese medicine was asymptomatic, i.e it treated the patient as a whole based on the diagnostic evidence and not necessarily with regard to what they reported. In this way the treatment could truly be said to be unique. The underlying premise was symptoms only appear when the system as a whole is out of balance, and because of the internal patterns of energy flow, a symptom may not necessarily arise where the actual problem lies. The skill and art of the practitioner is to go to the root of the problem and once this is treated, there should be an improvement in the symptoms.
 
We would recommend that you get the stomach checked first, however, to see if this is the cause because this may offer rapid treatment solutions in conventional medicine. However, we still believe it would be worth your while talking to a BAcC member local to you to see if they feel they could offer you help, because most of the conventional solutions suppress the symptoms rather than clear them, and if there is an option which aims for a restoration of normal function this may be worth trying.  
 
 

Q:  My husband has just been diagnosed with unilateral vocal chord paralysis caused by a virus. His voice is vey weak and hoarse and surgery is not an option for at least a year.  Does acupuncture work for this condition?

A: There are a relatively small number of studies which report successed in treating vocal cord paralysis, two examples of which are
 
Please click here:
 
Please click here: 
 
The abstracts of the papers do not cite the exact treatments used, and both speak of acupuncture being used in conjunction with other forms of treatment. In one paper, as is commonly found to be the case, the use of acupuncture alongside the conventional treatment appears to speed up the patient's recovery.  However, it is best to consider these papers as indicative rather than conclusive; there are no large scale studies which make a confident prediction possible. A great deal will also depend on the extent of the cordotomy. The operation is not supposed to interfere with a patient's vocal capacity if they recover naturally, but as with all surgical procedures there is an inherent risk that some of the changes are not reversible.
 
We suspect that some of the treatment offered in the studies was local, i.e. in the area near the problem, and this can often be very effectively in stimulating a return to good function. However, a practitioner may well want to establish whether this is simply a local problem or whether this is the tip of a much larger iceberg - this would have implications for how much treatment may be required and whether it is worthwhile attempting to address this as a local issue if there is a backdrop of much more extensive imbalance.
 
If we were being brutally honest we would say that treatment may be more in hope than in expectation, but acupuncture treatment has a reputation for occasionally achieving unexpected but significant results,. so we would be happy to advise you to seek a face to face assessment with a BAcC member local to you who can give you a much better assessment by looking at the problem and your father's health in the round. 
 

Your husband's situation is not quite so drastic as this case, and there may be some greater hope that treatment may encourage a return of some of the lost function. Acupuncture treatment will certainly not do any harm, and since there are a number of functional disturbances seen from a Chinese medicine perspective which impionge directly on the effective use of the voice, it may be that an experienced practitioner can see a direct intervention which may help. Even in the absence of a direct connection, the underlying premise of Chinese medicine, the treatment of the patient rather than the illnss, may offer some possibility of a speedier recovery.
 
It is best to talk to a BAcC member face to face, though, to get a more accurate assessment of whether acupuncture treatment may be of benefit, and we are confident that you will receive honest and impartial advice.
 


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