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92 questions

Q:  I have recently recovered from endocarditis, and having been treated with gentamicin have been left with bilateral vestibulopathy. I am wondering whether acupuncture would be effective in this case.

A:  From a western medical perspective we would have to say that the damage caused by the effects of gentamicin can lead to permanent problems, although the website of one of the major American organisations for hearing loss offers a rather more encouraging picture than most:

This is a condition that realistically often causes some permanent disability. In patients with gentamicin-induced ototoxicity, the symptoms generally peak at three months
from the last dose of gentamicin. In the long run however, (five years), most patients become substantially better. There are multiple reasons why people get
better. First, there is evidence that the damaged vestibular hair cells in the inner ear can regenerate, although the extent to which this occurs and the degree to which they are functional is not presently clear (Staecker et al., 2011; Forge et al, 1993)). Some recovery presumably occurs because marginal hair cells recover, because the brain rewires itself to adapt to the new situation (plasticity), and because people change the way they do things to adjust to their situation.

The majority of websites, however, are not usually as optimistic, and there is more often than not a touch of 'when it's gone, it's gone' about their prognostications.

From a Chinese medicine perspective we have to be careful not to engender a sense of false optimism. If there has been proven physical damage to the nerve structures of the inner ear there is not a great deal that acupuncture can achieve. The evidence for the regeneration of nerves with the help of acupuncture is not good except for a few trials with experimental animals (what our colleagues call 'ratpuncture'), and we have to be realistic. However, there are a number of ways in which balance can be affected in Chinese medicine terms, and if there has been a pathological change in the flow of energy in the area, whether brought about by a change in the area or by a
functional change in the whole system which has generated this particular symptom, then there may be some cause for cautious optimism that acupuncture
treatment might have a small impact on the problem. If there is a feasibility that some of the vestibular apparatus can regenerate, then anything which encourages the system as a whole to work better may help in this process.

On that basis there would be no reason not to visit a BAcC member local to you for a slightly more considered view than we can offer from a distance, and they may well be able to identify areas or patterns of weakness, the correction of which may help you to recover to a degree. What we would say, though, is that we would be surprised if the recovery was complete, and our own understanding is that positive change might take a considerable amount of time. This always makes it difficult because it is very difficult to set down good outcome measures which can take into account 5% change. One of our esteemed Japanese colleagues once memorably said that if a patient tells
you they are 10% better they are just saying 'you're a nice person, keep trying.' Her view was that anything less than 25% was difficult to judge. We would recommend, therefore, that if you did see a BAcC member who thought that treatment might help, it would be really important to set regular review periods and to try very hard to find a clearly defined outcome marker to get a sense of what progress, if any, was being made. Can acupunctu

A:  We publish a factsheet on vertigo http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/vertigo.html which summarises the position for a number of conditions, and in it the authors refer to a study which seem well worth reading http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136456/ which provides a review of the evidence from western and eastern studies. We note this because it is often quite difficult to get hold of studies in Chinese, and even having got hold of them getting them translated is a major obstacle. There are literally thousands every year, of which only a fraction make it to western journals or into translation. The upshot of the
review is positive but cautious, as is often the case. Acupuncture treatment appears to help, but larger and more methodologically sound trials are needed.

As you can see from the number of conditions grouped under the general banner of vertigo, though, this is a great illustration of where the Chinese medicine perspective and western medicine perspective don't translate exactly. There are a number of clearly defined syndromes and organic disturbances as understood in Chinese medicine where the group of symptoms which they can cause could lead to one of several definitions in western medicine, so two people with the same diagnosis in Chinese medicine might be labelled as having vertigo, Meniere's, or labyrinthitis in the West. By the same token each of these conditions, whose symptoms are very similar. might
lead to an entirely different diagnosis in Chinese medicine. This is more likely, insofar as from a Chinese medicine perspective each patient is unique and different. Having the same symptom tells you very little; what you need is to establish how the loss of balance in the system as a whole led this symptom to appear in this person.

The best advice is to visit a BAcC member local to you and seek their opinion based on an face to face assessment. We are confident that treatment will be able to reduce the severity of your symptoms, and also perhaps make you better able to deal with the secondary problems of confidence and stress which often arise after a while. Our clinical experience is that there is usually an effect, but how much of an effect and how sustainable it may be are unknowns. We are always very keen to set regular
review periods when we treat people with any of the balance or inner ear problems to avoid a long term 'treatment habit' developing when the results are neither large or sustainable enough to warrant continuing. The practitioner can then discuss other possible options, based on an understanding in both eastern and western terms of what is going on.

Q:  I have lost my sense of smell after a car accident years ago, but I can still taste foods and such. How come? Smell and taste are connected, doctors have told me if you lose one, you lose both, so why can I still taste?

A:  As the NHS website on anosmia (loss of sense of smell) says http://www.nhs.uk/conditions/anosmia/Pages/Introduction.aspx around 80% of the taste of food depends on the sense of smell, but this does leave a residual 20% which does mean that food does have a taste. As we understand it, the sense of taste is largely confined to much more basic distinctions between sweet, salty, etc, but there are cases where people with no sense of smell appear to be able to make finer distinctions. The NHS
website mentions a number of potential causes for loss of the sense of smell, and one of them, physical damage or obstruction, may be relevant if there has been some damage to your nasal passages which means that the smells are being diverted by an unusual route. However, it is more likely that there has been some neurological damage, although without knowing the detail of the accident that is hard for us to say.

As far as the use of acupuncture to treat anosmia is concerned, 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 study http://aim.bmj.com/content/21/4/153.long which 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 whenpractised 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.

There is not much more that we can say than this. From a Chinese medicine perspective, however, the functions of taste and smell are assigned to specific, and different, parts of the system, and if there has been a functional disturbance in one it may not necessarily mean a loss of function in the other. It may be interesting to see what a practitioner can find, because if either function has been disturbed there will be other confirming evidence.

Another treatment option, if acupuncture treatment does not present itself as a good choice, is cranial osteopathy. There is a very close association between good neurological function and a healthy structure in the head and spine, and accidental damage some distance away from a faculty can nonetheless affect it.

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: I have a condition called anosmia which is loss of my sense of smell which happened for no known reason 2 years ago. Scans have shown nothing abnormal and steroid
treatment did not work. Would acupuncture help me?

A:   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 study

http://aim.bmj.com/content/21/4/153.long

which 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 whenpractised 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.

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