Hi Guys,
I'm hoping to pick your larger brains. A little while ago I posted on my BadTinnitus blog about LLLT used as a treatment for Tinnitus. I don't want to repeat the entire post, that can be seen on my site but the difficulty I have is the laser aspect.
The central thesis of the LLLT merchants is that laser energy and 'wavelengths' can penetrate either through the mastoid process or ear canal to reach the soft tissue of the inner ear. Never mind the extremely spurious notion that it can 'energise' damaged inner or outer hair cells...
I understand that LLLT has some positive evidence in surface wound care and pain management, however it seems desperately unlikely to me that any of the laser energy can actually reach the Cochlear. Does laser have some unusual properties which might allow it to pass through the 'Petrous portion' of the mastoid bone? I'm giving a talk on CAM treatments for Tinnitus at this years British Tinnitus Association Conference in Sheffield and I'm really keen to have my science right.
Thanks,
Tim
Does this involve a single laser or multiple ones used together?
Where a laser dumps the bulk of its heat depends on which cells absorb it most. This, in turn, depends on the wavelength of the light. You'd need to know the absorption characteristics for each type of tissue at the proposed light wavelength to work out how far it would penetrate and where the heat would end up.
Last edited by Mulder; 12th August 2009 at 09:35 AM.
Hi Mulder,
Here's the main proponents explanation of the mechanism of action. As I mentioned before the method of application is either against the mastoid process or via the ear canal, in both cases there is obviously a lot of tissue that could be absorbing the energy...
The low level laser therapy of inner ear diseases has been made use of in Germany since the end of the eighties (for example by Dr. Uwe Witt, Hamburg) and is also to be found in quite a few other countries (Italy, France, Scandinavia, Switzerland, Hungary, the United States of America, Russia etc.).
Since 1991, about 800 inner ear patients have been treated with low level laser light under the medical and scientifical supervision of me. The therapy results have been (and still are) continuously documented and analyzed.
As the observation of healing processes has shown in the course of the years, even serious impairments such as the most excruciating cases of tinnitus, dysacusia, morbus Menière and bradyacusia can be considerably alleviated and even healed with the aid of modern light technology and the corresponding medical management. Inner ear diseases & the inner ear
The inner mitochondrial membrane mm is a large collector surface folded onto a small total volume. All nutritive molecules (fats, proteins and glucose) are oxidized within the cell to the last molecular nutritive component, that is, pyruvate. The pyruvate is then imported into the cellular power plant, where it disintegrates into carbon dioxide and water in the immediate proximity of the collector surface of the mitochondrion. The molecular bond energy thus released, which corresponds with visible, ultraviolet and infrared light as far as its wavelength and frequency is concerned, is utilized by the mitochondrion to produce the cellular fuel ATP.The collector surface of our cellular power plant is enlarged by the mushroom-shaped protrusions of the inner mitochondrial membrane mm. The molecular bond energy mb of the pyruvate is released in the form of light energy le.
The antennae pigments are capable of absorbing this light energy le and transmit it to our cellular power plant, which can now produce the cellular fuel ATP.
The natural solar radiation also stimulates the antennae pigments of the mitochondrion to produce ATP.Low level laser light lll is compressed light from the red spectrum of the visible part of electro-magnetic radiation (= light). It reaches the cellular power plants of low-lying cells as well and is absorbed by their collector surfaces as an additional source of energy. The cellular power plants can thus produce more ATP. The cellular energy is the fuel the inner ear cells strives after and needs. A sufficiently high supply of cellular energy enables our inner ear cell to work under optimum conditions and is the essential prerequisite to ensure a successful self-healing process.
Doubtless arguments will continue over this for years to come, however the initial data is not encouraging. Prior to 2003 all studies have used unfocused energy, the initial pilot study was not encouraging, the susbequent placebo controlled trial negative. Of course proponents will simply claim the wrong wavelength, wrong dose, wrong target etc. etc.
Audiol Neurootol. 2009;14(2):115-20. Epub 2008 Oct 9.
Links
Transmeatal low-level laser therapy for chronic tinnitus with cochlear dysfunction.
Teggi R, Bellini C, Piccioni LO, Palonta F, Bussi M.
ENT Department, San Raffaele Hospital, 'Vita e Salute' University, Milan, Italy. teggi.roberto@hsr.it
OBJECTIVES: To establish the efficacy of low-level laser therapy for tinnitus. METHODS: We performed a prospective, randomized double-blind study on 60 outpatients with tinnitus presenting sensorineural hearing loss in the affected ear. They were randomly divided into two groups, the first performing active laser therapy 20 min a day for 3 months with a 650-nm, 5-mW soft laser (group L), the second using a dummy device which duplicated all aspects of active laser therapy except for the activation of the laser beam (group C). One subject in both groups dropped out due to an increase in tinnitus loudness. Two more patients in each group ceased to comply with the protocol due to familiar problems. RESULTS: The Tinnitus Handicap Inventory (THI) was considered the main outcome measure; no statistical difference was detected between the 2 groups in the THI total score (p = 0.97), and its functional (p = 0.89), emotional (p = 0.89) and catastrophic (p = 0.89) subscales. Moreover, a visual analog scale for self-perceived loudness of the tinnitus showed no difference between the groups (p = 0.69). Regarding psychoacoustic parameters, the minimum masking level showed no difference (p = 0.42), while loudness expressed in sensation level exhibited lower values in group L (p = 0.0127). Group L subjects also presented a decreased rate of hyperacusis (p = 0.02). No changes were detected in the audiometric threshold in both groups. CONCLUSIONS: Soft laser therapy demonstrated no efficacy as a therapeutic measure for tinnitus. 2008 S. Karger AG, Basel.
Lasers Med Sci. 2003;18(3):154-61.
Links
Transmeatal cochlear laser (TCL) treatment of cochlear dysfunction: a feasibility study for chronic tinnitus.
Tauber S, Schorn K, Beyer W, Baumgartner R.
Department of Otolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University of Munich, D-81377 Munich, FRG. drtauber@yahoo.de
Low-level-laser-therapy (LLLT) targeting the inner ear has been discussed as a therapeutic procedure for cochlear dysfunction such as chronic cochlear tinnitus or sensorineural hearing loss. Former studies demonstrate dose-dependent biological and physiological effects of LLLT such as enhanced recovery of peripheral nerve injuries, which could be of therapeutic interest in cochlear dysfunction. To date, in patients with chronic tinnitus mastoidal and transmeatal irradiation has been performed without systematic dosimetric assessment. However, light-dosimetric studies on human temporal bones demonstrated that controlled application of laserlight to the human cochlea depends on defined radiator position within the external auditory meatus. This feasibility study first presents a laser application system enabling dose-controlled transmeatal cochlear laser-irradiation (TCL), as well as preliminary clinical results in patients with chronic cochlear tinnitus. The novel laser TCL-system, consisting of four diode lasers (lambda=635 nm-830 nm) and a new specific head-set applicator, was developed on the basis of dosimetric data from a former light-dosimetric study. In a preliminary clinical study, the TCL-system was applied to 35 patients with chronic tinnitus and sensorineural hearing loss. The chronic symptoms persisted after standard therapeutic procedures for at least six months, while retrocochlear or middle-ear pathologies have been ruled out. The patients were randomised and received five single diode laser treatments (lambda=635 nm, 7.8 mW cw, n=17 and lambda=830 nm, 20 mW cw, n=18) with a space irradiation of 4 J/cm2 site of maximal cochlear injury. For evaluation of laser-induced effects complete otolaryngologic examinations with audiometry, tinnitus masking and matching, and a tinnitus-self-assessment were performed before, during and after the laser-irradiation. The first clinical use of the TCL-system has been well tolerated without side-effects and produced no observable damage to the external, middle or inner ear. Changes of tinnitus loudness and tinnitus matching have been described. After a follow-up period of six months tinnitus loudness was attenuated in 13 of 35 irradiated patients, while two of 35 patients reported their tinnitus as totally absent. Hearing threshold levels and middle ear function remained unchanged. Further investigations by large double-blind placebo-controlled studies are mandatory for clinical evaluation of the presented TCL-system and its therapeutic effectiveness in acute and chronic cochlear dysfunction.
Thank you so much for taking the time to look at this. Your conclusions very much mirror those in my post, although more cogently and succinctly put.
In my experience both patients and practitioners of LLLT are 'True Believers' who are immune to any interpretations of the scientific record that fails to support their thesis.
What I'd also like to get my head around is the physics/biology of the laser energy traveling through epidermal tissue and then very dense bone. Is this feasible and if so how?
Regards,
Tim
Hi,
I'm new to this forum....I found it while searching for information on laser therapy and tinnitus. I'd never heard of laser therapy for tinnitus before, I found a thread about it on another board and while I found it intriguing I also saw that the mere suggestion of using lasers was met with incredulity and cynicism. I've had tinnitus for some time now and am always looking for new methods to combat the symptoms. Up until now, I'd been relying on a simple room fan, my tv or a few different white noise machines.
Anyways, thanks to all who've posted in this thread - very informative and just the kind of facts I was hoping to find. The poster on the other board didn't do a lot to back up or really quantify what he was talking about, he just mentioned that lasers were "really good" as a tinnitus therapy.
Cheers.
That's the power of a skeptical approach for you.Originally Posted by tmijs789
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