Acupuncture (AP) Treatment of Tinnitus
A Bibliography from MEDLINE Abstracts (Aug 27, 1998)
Philip AM Rogers MRCVS
1 Esker Lawns
Lucan, Dublin, Ireland
1 Esker Lawns
Lucan, Dublin, Ireland
PubMed MEDLINE (http://www.ncbi.nlm.nih.gov/PubMed/medline.html) was searched on Aug 27 1998 for data on acupuncture and allied methods in the treatment of people with tinnitus.
The search profile was: "tinnitus AND (acupuncture OR TENS OR moxibustion)". The search yielded 45 relevant hits.
The bibliography, sorted by author into two sections. Section A (30 abstracts) had data directly relevant to the main search. Section B (15 titles, but no abstracts) is included as useful background for researchers who may want to pursue these titles.
Conclusions: Only 24 abstracts reported the clinical results. 11/24 papers reported no significant effect of AP-like therapy on the severity of tinnitus. 13/24 papers reported a significant effect, or a possible benefit in tinnitus. Of those papers that reported some positive clinical effect in 20-40% of patients. This (in comparison to clinical success rates for AP in other conditions) is a disappointingly low success rate. Also, most of the positive papers reported only a partial, or transient, improvement in the tinnitus, with poor long-term improvement. Many patients, however, reported subjective improvement and also improvements in general well-being, such as better sleep, better circulatory function etc.
In summary, from a perusal of the Medline data, the clinical efficacy of AP or TENS-like stimulation in the treatment of tinnitus is controversial and of limited value.
SECTION A: RELEVANT ABSTRACTS
Andersson G (1997) Prior treatments in a group of tinnitus sufferers seeking treatment. Psychother Psychosom 66(2):107-110. Department of Clinical Psychology, Uppsala University, Sweden. Tinnitus is a common problem for which many treatments have been proposed and implemented. Patients tend to seek renewed treatment after treatment failure. The aim of this descriptive study was to describe a group of consecutive tinnitus patients in terms of prior treatments received. Sixty-nine tinnitus patients seeking treatment were asked about prior treatments and completed the short Tinnitus Effect Questionnaire (TEQ). Four groups were obtained: No treatment (n=24), AP (n=19), relaxation (n=13), and other treatments (n=13). Six subscales were derived from the TEQ measuring helplessness, capacity for rest, acceptability of change, emotional effects, hearing speech and sounds, and ability to ignore. The groups were compared with multivariate analyses of covariance and Tukey's post-hoc tests. Results showed minor differences between the groups, the exception being that the untreated group showed more acceptability for change. Clinicians should be aware of the fact that patients may have tried at least one treatment when entering the audiology clinic. Controlled studies are needed in order to avoid the spread of nonspecific and non-effective treatments in the management of tinnitus. PMID: 9097339, UI: 97251661
Axelsson A, Andersson S, Gu LD (1994) AP in the management of tinnitus: a placebo-controlled study. Audiology Nov;33(6):351-360. Department of Audiology, Sahlgrenska University Hospital, Gothenburg, Sweden. The present study was performed on 20 patients randomly selected from a large group with noise-induced tinnitus in order to investigate the effect of AP on their tinnitus. The patients were divided into two groups. One group first received classical Chinese needle AP for 5 weeks, and the other was given a placebo procedure; after a 2-week interval, the procedures were reversed. A single-blind cross-over design was used. AP was given by a Chinese otolaryngologist around the ear as well as at distal points on the extremities. Placebo consisted of mock electrical stimulation via surface electrodes connected to a Chinese EAP stimulator which delivered a weak sound and a light flash at a frequency of 2 Hz but no current to the surface electrodes. The effect was evaluated by the use of visual analogue scales. No significant difference between AP and placebo was found in annoyance, awareness or loudness of the tinnitus. Many patients indicated a preference for AP due to unspecific effects such as improved sleep, decreased muscle tension and improved blood circulation. It is concluded that AP has no specific alleviating effect on noise-induced tinnitus. PMID: 7741667, UI: 95260250
Brand H (19999983) [Neural therapy in tinnitus - Article in German]. Wien Med Wochenschr Nov 15;133(21):545-547. After the examination by ENT-specialists in 96 cases of tinnitus a conventional medical therapy with vasodilators and vitamin A has been tried. This therapy showed unsatisfactory results. Then neural therapy as defined by segmental therapy with a preparation containing lidocaine (Xyloneural) has been applied. The results have been so encouraging, that this method can be advised as basical therapy in tinnitus. PMID: 6659522, UI: 84099798
Collet L, Moussu MF, Dubreuil C, Disant F, Chanal JM, Morgon A (1987) Psychological factors affecting outcome of treatment after transcutaneous electrotherapy for persistent tinnitus. Arch Otorhinolaryngol 244(1):20-22. We used transcutaneous electrotherapy to treat 27 patients with persistent tinnitus. Each patient was tested with the short form of the Minnesota Multiphasic Personality Index test (MMPI) prior to the commencement of treatment. The "unimproved" group of patients (n=15) showed higher pretreatment scores for depression (p<.05), psychasthenia (p<.05) and schizophrenia (p<.02). Our findings indicate that patients having significantly pathological scores on at least one of these three scales will fail to benefit from treatment. These findings also show that there appear to be psychological prognostic factors that can be used to evaluate patients receiving transcutaneous electrotherapy for persistent tinnitus. PMID: 3497623, UI: 87298100
de Lavernhe-Lemaire MC, Garand G, Beutter P (1987) [Study by auditory evoked potentials of the efficacy of transcutaneous electric stimulation in the treatment of tinnitus - Article in French]. Arch Int Physiol Biochim Sep;95(3):173-181. Service d'O.R.L., C.H.U. Bretonneau, Tours, France. Thirty patients complaining about tinnitus were treated by transcutaneous tragal electrical stimulation. The effect of this treatment has been evaluated by BASR recordings before and after treatment. Taking into account the subjective results three groups are described. The first one (10 patients) is relieved of tinnitus. In second and third group the symptoms still exist, whatever the electrode's position (anode or cathode in tragal position). When BASR are studied before the electrical stimulation no inter-subjects difference can be found. After stimulation, the left delta I-V latency is significatively lengthened, and the wave I latency is shortened in the first group. The study of the two other groups do not reveal any difference between the pre- and the post- stimulation evaluation. So the BASR appears to be a good predictive tool for tinnitus suppression by electrical stimulation. PMID: 2446579, UI: 88076288
Dobie RA, Hoberg KE, Rees TS (1986) Electrical tinnitus suppression: a double-blind crossover study. Otolaryngol Head Neck Surg Oct;95(3 Pt 1):319-323. A wearable device for transcutaneous electrical tinnitus suppression (ETS) has recently been reported to be effective for relief of tinnitus. Twenty patients with sensorineural hearing loss and tinnitus participated in a double-blind crossover study. Both active devices and internally disconnected placebo devices, supplied by the manufacturer, were used. Reduction in severity of tinnitus was reported by 2 of 20 patients (10%) with the active device and by 4 of 20 (20%) with the placebo device. Fifteen of 20 (75%) had no relief with either device. Those who preferred the placebo device, however, reported only minimal relief, while one of the two who preferred the active device stated it had reduced tinnitus severity by 70% to 80%. This patient was recalled for a series of one-hour test sessions, during which either an active or placebo device was used, according to a random schedule. On each of four on trials, the score for severity of tinnitus for each ear decreased by at least 50% (median = 70%), while in three off trials, the severity of tinnitus was unchanged or decreased by up to 30% (median=16%). We conclude that the Theraband headset is effective for a small proportion of patients with sensorineural hearing loss and tinnitus. PMID: 3108780, UI: 87230361
Engelberg M, Bauer W (1985) Transcutaneous electrical stimulation for tinnitus. Laryngoscope Oct;95(10):1167-1173. The use of electrical stimulation to treat tinnitus was evaluated in a two-experiment study. The stimulus was a low amperage, low frequency variable square wave applied to 13 sites on the auricle of the ear with tinnitus. The sites were selected for their increased electrical conductivity as measured by low electrical resistance readings. Experiment 1 results defined improvement as either a complete remission of the tinnitus or a decrease in the frequency of the tinnitus. Experiment 2 utilized a single blind protocol with 20 subjects comprising 33 ears with tinnitus. 82% of the 33 ears showed improvement by either of the two criteria. The permanence of the improvement ranged from 20 minutes to at least six months. The variables associated with this procedure were discussed. The adverse effects from the stimulation were minimal. PMID: 3900611, UI: 86013274
Fischer MV (1982) [AP therapy in the outpatients-department of the University Clinic Heidelberg - Article in German]. Anaesthesist Jan;31(1):25-32. Encouraged by the good results obtained using AP anaesthesia, we started therapeutic AP in our institute of anaesthesiology four years ago. In the meantime AP is as important a therapeutic method in our out-patients department as are therapeutic local anaesthesia, transcutaneous electrical nerve stimulation and biofeedback. The results in 520 patients who have been treated with AP for different diseases are reported. The success of treatment, the number of sessions and the recurrence-rate within one and a half years are discussed for the different diseases. AP treatment was regarded successful when 1, the patient had no complaints at all without medication, and 2, when there was significant improvement (no long term medication, only mild complaints with unusual strain, which were responsive to minimal medication). Thus treatment in cephalgia was successful in 83% with no recurrences (NR) in 84%. In cervical pain syndromes the respective results6 were 80% (NR=74%) in constipation 80% (NR=72%), sinusitis 86% (NR=100%), insomnia 100% (NR=100%). Good results, albeit with high recurrence rate were achieved in cases of trigeminal neuralgia in 90% (NR=23%), colitis ulcerosa in 100% (NR=0%), in bronchial asthma 70% (NR=50%) and in tumour pain 61% (NR=0%). Treatment in patients suffering from parathymic conditions were unsatisfactory and results in cases of tinnitus were negative. PMID: 6978622, UI: 82179981
Fischer MV, Behr A, von Reumont J (1984) AP: a therapeutic concept in the treatment of painful conditions and functional disorders: Report on 971 cases. Acupunct Electrother Res 9(1):11-29. The results in 971 outpatients who have been treated with AP for different diseases are reported. The outcome of treatments and number of sessions are discussed in relation to the different diseases. AP treatment was regarded as successful when 1. the patients had no pain at all without medication and 2. there was a significant improvement (no long-term medication, only mild pain under unusual strain, minimal medication under such circumstances). We obtained positive results in cephalalgias , sinusitis, cervical spine syndrome, shoulder-arm syndrome, ischialgias , back pain, constipation, herpes zoster, allergic rhinitis and disturbances of peripheral blood flow. For the following ailments, in order to reduce the medication, we recommend AP despite a high rate of recurrence: Trigeminal neuralgia, colitis ulcerosa, bronchial asthma and cancer pain. Results in the treatment of mental disturbances were unsatisfactory, and in cases of tinnitus results were negative. PMID: 6145308, UI: 84227544
Furugard S, Hedin PJ, Eggertz A, Laurent C (1998) [AP worth trying in severe tinnitus - Article in Swedish]. Lakartidningen Apr 22;95(17):1922-1928. Norrlands Universitetssjukhus, Umea. The article consists in a report of a study of 22 patients with disabling tinnitus, performed to elucidate the effects of a 3-month course of AP (15 treatments) on the severity of tinnitus and on quality of life (QOL), as compared with those of individualised physiotherapy. The study was designed as a prospective, randomised, cross-over study with a follow-up period of one year after the final treatment. Treatment effects were evaluated in terms of the patients' VAS (visual analogue scale) ratings and answers to questionnaires, including the NHP (Nottingham Health Profile), regarding the impact of tinnitus on different aspects of QOL. Baseline NHP scores showed tinnitus patients to manifest pronounced depressive characteristics. AP was found to yield immediate relief, both in terms of loudness and disturbance of the tinnitus, and significant improvement in QOL (NHP) for three months after the conclusion of treatment. Although many patients in the subgroup with concurrent muscle tension reported beneficial effects of individualised physiotherapy, such treatment yielded no significant reduction of tinnitus loudness or disturbance due to tinnitus, and no improvement in NHP scores. In both treatment groups, however, both annoyance due to tinnitus and QOL scores had returned to pretreatment levels at one-year follow-up. Thus, the results suggest tinnitus patients to manifest depressive characteristics, and that AP may yield temporary improvement in terms of tinnitus relief and QOL. Comment in: Lakartidningen 1998 Jun 10;95(24):2799. PMID: 9604636, UI: 98267995
Gelb H, Gelb ML, Wagner ML (1997) The relationship of tinnitus to craniocervical mandibular disorders. Cranio Apr;15(2):136-143. Department of General Dentistry, Tufts University of College of Dental Medicine, USA. Patients with craniocervical mandibular (TMD) disorders can present with tinnitus as a primary or secondary complaint. The embryology and functional anatomy of the middle ear, temporomandibular joint, muscles of mastication and associated tendons, ligaments, blood vessels, nerves and lymphatics was found to be helpful in establishing etiologic concepts which relate tinnitus to these temporomandibular disorders. In addition to etiologic concepts, treatment modalities are described. The authors relate their experiences as well as those of others with different patient populations. PMID: 9586516, UI: 98247663
Giordano C, Bona Galvagno M, Brosio R, Schieroni MP, Revello MP (1987) [Treatment of tinnitus with the TENS stimulator in cervico-arthrosis patients: Preliminary results - Article in Italian]. Minerva Med Jun 30;78(12):861-864. The combination of ear buzzing and cervical arthrosis is frequently encountered in both ENT practice and physiatry. A group of 16 patients presenting this combination was therefore selected. After a series of ENT and physiatric tests the patients were subjected to audiological and radiographic examination in order to exclude any pathologies different from the two under study. Each patients was then subjected to a cycle of 12 periauricular TENS sessions and was examined at the end of the cycle and one month later. Brief bibliographical notes on this subjects are presented and the results obtained are reported and discussed. PMID: 3496560, UI: 87258866
Hansen JE (1975) AP in otolaryngology. Am J Chin Med Jul;3(3):281-284. The enthusiastic acceptance of AP by the people of the United States is partly indicative of the limitations of Western medicine. This paper is the result of a two year study using AP in the field of otolaryngolgy to treat those patients whose illnesses have not responded to conventional Western medicine approaches. PMID: 1190117, UI: 76059098
Hansen PE, Hansen JH, Bentzen O (1982) AP treatment of chronic unilateral tinnitus: a double-blind cross-over trial. Clin Otolaryngol Oct;7(5):325-329. In a double-blind controlled trial the effect of traditional Chinese AP versus placebo AP was evaluated among 17 patients (8 females and 9 males, mean age 45.7 years) with chronic (mean disease duration 5.3 years) unilateral tinnitus. None of the patients had any treatable otological disease. All patients suffered from daily tinnitus, the intensity of which was recorded by the patients themselves every day during a period of 15 weeks. Each patient was treated by traditional Chinese AP as well as placebo AP following randomization (Figure 1). Each period of treatment comprised 2 treatments a week for 3 weeks. Throughout the whole investigation a period effect was recorded, insignificant in the AP-placebo group, but significant in the placebo-AP group (Friedman analysis of variance) (Table 4). There was no significant difference between traditional Chinese AP and placebo (Wilcoxon test, p>.05, one-tailed). There was no relation between the patients' subjective statements and the results of sound balance measurements as an objective standard of tinnitus (Spearman test). PMID: 6756709, UI: 83077722
Kaada B, Hognestad S, Havstad J (1989) Transcutaneous nerve stimulation (TNS) in tinnitus. Scand Audiol 18(4):211-217. Clinical Neurophysiological Laboratory, Rogaland Central Hospital, Stavanger, Norway. Low-frequency (2 Hz) TNS applied distally to peripheral nerves of the upper extremity is known to induce a wide-spread, non-segmental and prolonged relief of pain and an increased microcirculation due to sympatho-inhibition in a number of vascular beds. Such stimulation was administered in 29 tinnitus patients of various etiology. Reduction of tinnitus was encountered in 9 subjects in response to a 45-min TNS-session. The improvement was mainly seen in tinnitus characterized by lower frequencies (125-500 Hz). In 7 of the 9 patients, the tinnitus reduction was associated with improvement of hearing, predominantly in the low-frequency band. The effects were still present after one week following daily stimulation at home. On continued treatment, the effects were found to be transitory in 4 of the patients, whereas the remaining 5 patients are still using the stimulator after 2 to 5 years. It is suggested that the mechanism behind the beneficial effects is increased microcirculation in part of the auditory pathways. PMID: 2609098, UI: 90117007
Marks NJ, Emery P, Onisiphorou C (1984) A controlled trial of AP in tinnitus. J Laryngol Otol Nov;98(11):1103-1109. The relationship of tinnitus to pain is examined and a theoretical case made out for the possible use of AP in the treatment of tinnitus. A double-blind cross-over controlled trial is described. The use of Visual Analogue Scales (VAS) is discussed in this context. 35% of patients described some benefit from the active treatment only, although we were unable to demonstrate this objectively. Statistical analysis of the group as a whole revealed no significant differences between placebo and active AP treatment. PMID: 6387018, UI: 85032251
Naujoks J, Lotter E (1981) [Conservative therapy of tinnitus - Article in German]. Laryngol Rhinol Otol (Stuttg) Apr;60(4):220-223. Conservative therapy of tinnitus presents a theme that is controversial, since the usefulness of almost all the proposed treatments is rarely based on scientific-experimental evidence. The blocking of the stellate ganglion, electric stimulation of the cochlea and the anaesthesia of the plexus tympanicus belong to the domain of surgical treatment methods of tinnitus. Drug therapy is the mainstay of treatment; our own measures are demonstrated. We attempt to give a hypothetic pharmacological interpretation of the efficacy of some drugs that derive essentially from diethylaminoethanol and the group of methylexanthines. We also mention the physical treatment methods such as tinnitus masker, ultrasound and physiotherapy as well as AP. Finally, the more recent psychotherapeutic treatment-modalities, for example biofeedback, hypnosis and medical sleep are mentioned. PMID: 6112647, UI: 81196519
Nilsson S, Axelsson A, Li De G (1992) AP for tinnitus management. Scand Audiol 21(4):245-251. Department of Audiology, Sahlgrenska Hospital, Gothenburg, Sweden. Fifty-six patients with continuous and severe tinnitus as their major complaint were treated with traditional Chinese AP. After a pre-treatment period with baseline evaluation of tinnitus, 10 treatments were given during a period of 20 days, followed by a post-treatment period in order to obtain indications of prolonged treatment effects. Assessments were made using visual analogue scales (VAS) and a verbal retrospective rating scale. Three patients reported improvement which lasted for at least 10 days after the last treatment, indicating a possible long-term effect in some cases. Twenty-one% of the patients reported transient intensity reductions lasting for hours/days. Estimated 'substantial' improvement rate by VAS, consistent for all three parameters involved (intensity, annoyance, awareness), was 20%, while the corresponding deterioration rate was 25%. Statistical analysis of the whole group did not show any significant general treatment effects. Interactions between treatment evaluations by verbal rating and VAS are discussed as well as interactions with psychological components. PMID: 1488611, UI: 93141943
Omura Y, Losco BM, Omura AK, Takeshige C, Hisamitsu T, Shimotsuura Y, Yamamoto S, Ishikawa H, Muteki T, Nakajima H, et al (1992) Common factors contributing to intractable pain and medical problems with insufficient drug uptake in areas to be treated, and their pathogenesis and treatment: Part I. Combined use of medication with AP, (+) Qi gong energy-stored material, soft laser or electrical stimulation. Acupunct Electrother Res 17(2):107-148. Heart Disease Research Foundation, New York. Most frequently encountered causes of intractable pain and intractable medical problems, including headache, post-herpetic neuralgia, tinnitus with hearing difficulty, brachial essential hypertension, cephalic hypertension and hypotension, arrhythmia, stroke, osteo-arthritis, Minamata disease, Alzheimer's disease and neuromuscular problems, such as Amyotrophic Lateral Sclerosis, and cancer are often found to be due to co-existence of 1) viral or bacterial infection, 2) localized microcirculatory disturbances, 3) localized deposits of heavy metals, such as lead or mercury, in affected areas of the body, 4) with or without additional harmful environmental electromagnetic or electric fields from household electrical devices in close vicinity, which create microcirculatory disturbances and reduced acetylcholine. The main reason why medications known to be effective prove ineffective with intractable medical problems, the authors found, is that even effective medications often cannot reach these affected areas in sufficient therapeutic doses, even though the medications can reach the normal parts of the body and result in side effects when doses are excessive. These conditions are often difficult to treat or may be considered incurable in both Western and Oriental medicine. As solutions to these problems, the authors found some of the following methods can improve circulation and selectively enhance drug uptake: 1) AP, 2) Low pulse repetition rate electrical stimulation (1-2 pulses/second), 3) (+) Qi Gong energy, 4) Soft lasers using Ga-As diode laser or He-Ne gas laser, 5) Certain electromagnetic fields or rapidly changing or moving electric or magnetic fields, 6) Heat or moxibustion, 7) Individually selected Calcium Channel Blockers, 8) Individually selected Oriental herb medicines known to reduce or eliminate circulatory disturbances. Each method has advantages and limitations and therefore the individually optimal method has to be selected. Applications of (+) Qi Gong energy stored paper or cloth every 4 hours, along with effective medications, were often found to be effective, as Qigongnized materials can often be used repeatedly, as long as they are not exposed to rapidly changing electric, magnetic or electromagnetic fields. Application of (+) Qi Gong energy-stored paper or cloth, soft laser or changing electric field for 30-60 seconds on the area above the medulla oblongata, vertebral arteries or endocrine representation area at the tail of pancreas reduced or eliminated microcirculatory disturbances and enhanced drug uptake. PMID: 1353650, UI: 92351823
Podoshin L, Ben-David Y, Fradis M, Gerstel R, Felner H (1991) Idiopathic subjective tinnitus treated by biofeedback, AP and drug therapy. Ear Nose Throat J May;70(5):284-289. Department of Otolaryngology, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa. The effect of three treatment modalities of idiopathic-subjective tinnitus (IST): AP (AP), biofeedback (BF) and Cinnarizine (Cin), was investigated in 58 randomly selected subjects. The findings show that at the end of treatment, 50% of the patients in the biofeedback group reported some amelioration in the level of the tinnitus, while 30% of the AP group and only 10% of the group receiving Cinnarizine reported an amelioration of the tinnitus. Treatment by biofeedback caused a significant easing in the degree of discomfort caused by the tinnitus to patients during rest. Within the limitations of the sample study, our results indicate that the biofeedback method is more effective in comparison with AP and Cinnarizine in the treatment of those suffering from tinnitus. PMID: 1914952, UI: 92007323
Podoshin L, Fradis M, David YB (1992) Treatment of tinnitus by intratympanic instillation of lignocaine (lidocaine) 2 per cent through ventilation tubes. J Laryngol Otol Jul;106(7):603-606. Dept of Otolaryngology, Bnai Zion Medical Centre, Haifa, Israel. Idiopathic subjective tinnitus (IST) is one of the most obscure otological pathologies. This paper presents the results of treating IST by intratympanic instillation of lignocaine (lidocaine) 2% through a grommet, for five weekly courses. Fifty-two patients suffering from intractable tinnitus entered this therapeutic trial, but only nine finished all five courses. In one patient, the tinnitus was almost completely abolished, but in all the nine patients the decompensated tinnitus changed to a compensated one. We suggest this mode of treatment for patients that were previously treated by drugs, AP and biofeedback, with disappointing results. Patients should be warned about the side effects of vertigo and vomiting, which subsides gradually with every new instillation, and that the tinnitus may not disappear but will be alleviated, enabling them to cope more easily with the disease and lead a more normal life. PMID: 1527456, UI: 92407442
Rahko T, Kotti V (1997) Tinnitus treatment by transcutaneous nerve stimulation (TNS). Acta Otolaryngol Suppl (Stockh) 1997;529:88-89. Department of Otolaryngology, Tampere University Hospital, Finland. Twenty-six patients were treated with transcutaneous nerve stimulation (TNS) for tinnitus. Except for 3 normal hearing patients, all had cochlear hearing losses. Tinnitus disappeared in none, but diminished in 7/26 cases against 3/24 nontreated controls. In the controls there were no reliefs in low-frequency tinnitus cases. One of these 7, who reported benefit initially, used the TNS system for several months. It seems that TNS is not as good as expected, but probably in cases where the tinnitus frequency is low and it disappears with TNS totally, the patients may use it. PMID: 9288279, UI: 97434393
Rostovtsev VN, Kofanov RV (1992) [Indirect electric stimulation of the auditory neural structures in the complex treatment of sensorineural hearing loss and subjective noise in the ears- Article in Russian]. Vestn Otorinolaringol 1992 May;3:13-14. Indirect or transdermal electrostimulation (ES) was used in 62 patients suffering from neurosensory hypoacusis stage II-III. The procedure was conducted with the help of an +electric stimulator made on the country and a device providing an automatic change of the polarity. Disappearance of noise in the ears, better hearing, 10-15 dB shifts in auditory thresholds were achieved in 20 patients (32.3%). Noise in the ears declined, hearing improved subjectively in 25 (40.3%) of the patients. 17 (27.4%) of the patients did not respond. ES is recommended as a method of choice in combined treatment of neurosensory hypoacusis and subjective noise in the ears. PMID: 1523763, UI: 92397457
Scott B, Larsen HC, Lyttkens L, Melin L (1994) An experimental evaluation of the effects of transcutaneous nerve stimulation (TNS) and applied relaxation (AR) on hearing ability, tinnitus and dizziness in patients with Meniere's disease. Br J Audiol Jun;28(3):131-140. Department of Clinical Psychology, University of Uppsala, Sweden. In 20 patients diagnosed with Meniere's disease, transcutaneous nerve stimulation (TNS) and applied relaxation (AR) were used as a treatment aimed at reducing tinnitus and dizziness and increasing hearing ability. The main aim of the study was to examine whether TNS could be regarded as a more beneficial treatment regimen than AR. An experimental between-group cross-over design was used. The results from the experimental phase (group comparisons) showed a significantly increased ability to hear for the TNS group when measured on visual analogue scales. During the same period, the AR-group showed a significant hearing improvement for the ear not primarily affected by Meniere's disease as measured with pure tone audiometry. The vestibular tests did not reveal any significant changes either after TNS or AR intervention. Tinnitus matching showed changes of pitch and loudness before and after both TNS and AR intervention. However, no statistically significant changes between treatment regimes were found on these measures. The results from this study did not show TNS to be superior to AR in reducing tinnitus, dizziness or increasing hearing ability.PMID: 7841897, UI: 95144049
Shulman A (1987) External electrical tinnitus suppression: a review. Am J Otol Nov;8(6):479-484. Division of Otolaryngology, State University of New York, Brooklyn 11203. Our experience with transcutaneous electrical stimulation for tinnitus suppression has been with the Theraband Headset from Audimax Inc. The purpose of this article is to review the highlights of the patients who exhibited tinnitus suppression and/or tinnitus control, and to provide an update of our results and techniques using external electrical stimulation with prolonged stimulation (stage IV). Patient selection is considered critical to the success of external electrical stimulation for tinnitus suppression. The key elements include the clinical finding of a peripheral site of lesion of the tinnitus; positive maskability of the symptom of tinnitus; absence of active ear disease; absence of a vestibular asymmetry; and absence or minimal evidence of dysfunction of the central auditory system. The protocol described for patient selection allows for tinnitus identification, the differentiation of clinical tinnitus types, and the clinical application of the concept of the dynamic range of electrical tinnitus suppression. External electrical tinnitus suppression is believed effective in a limited number of patients clinically identified as having a tinnitus site of lesion primarily peripheral in location and cochlear in type. The present device is not commercially available at this time. Both specific and general suggestions are proposed for the standardization of methods of reporting results of electrical tinnitus suppression and tinnitus control. PMID: 3324768, UI: 88131270
Steinberger A, Pansini M (1983) The treatment of Meniere's disease by AP. Am J Chin Med 11(1-4):102-105. 34 patients suffering from Meniere's disease were treated by AP. Prior to AP most of them had been treated with various other medical means without satisfactory results. After AP treatment their condition greatly improved. The classic symptoms of Meniere's disease are vertigo, tinnitus and deafness, but for all the treated patients vertigo was the most uncomfortable and distressing symptom. In all our cases vertigo stopped after a few AP courses; but in our opinion it is more important to follow and control hearing threshold, since if it remains stable the other symptoms of Meniere's disease also do not persist. All our patients were regularly followed by careful audiometric studies several years after AP treatment. In most cases hearing level had not greatly varied, so the other symptoms of Meniere's disease were not present in any large degree. PMID: 6660197, UI: 84101349
Tachibana M, Kiyoshita Y, Senuma H, Nakanishi H, Sasaki K (1992) Effect of transcutaneous electrostimulation on noise-induced temporary threshold shift. Acta Otolaryngol (Stockh) 112(4):595-598. Department of Otolaryngology, Meiji College of Oriental Medicine, Kyoto, Japan. The effect of transcutaneous electrostimulation around the ear before and during noise exposure on noise-induced temporary threshold shift (TTS) was examined in 26 volunteers. Electrostimulation reduced TTS in the majority of cases and the reduction was statistically significant. Two possible mechanisms for this reduction are proposed: stimulation of the olivocochlear bundle and alteration of cochlear blood flow. Transcutaneous electrostimulation may be useful for prevention or treatment of noise induced hearing damage and for treatment of tinnitus. PMID: 1442003, UI: 93071012
Thomas M, Laurell G, Lundeberg T (1988) AP for the alleviation of tinnitus. Laryngoscope Jun;98(6, Pt 1):664-667. Department of ENT, Karolinska sjukhuset, Stockholm, Sweden. The present study describes the effect of AP in 12 patients with tinnitus. The patients were referred from the Department of Audiology, Karolinska Hospital, where their hearing and tinnitus were assessed. None of the patients had benefited from previous treatment for tinnitus. The selection of AP points depended on the individual and was, to a limited extent, based on traditional Chinese medicine (TCM). Local points such as Si 19, Sj 17, and Sj 21 were fairly standard; distal points took into account associated problems of the patient, but were also points recommended in TCM for tinnitus. Ten treatments were attempted within a 6- to 12-week period. The treatments were carried out weekly or biweekly depending on the availability of patient and acupuncturist. Six patients had transient effects and noise reduction. However, no positive long-term results were obtained. Similarities between the experience of tinnitus and of pain are discussed in light of these findings. PMID: 3374243, UI: 88232105
Vernon JA, Fenwick JA (1985) Attempts to suppress tinnitus with transcutaneous electrical stimulation. Otolaryngol Head Neck Surg Jun;93(3):385-389. Various electrical stimuli were tested for their ability to suppress or relieve severe tinnitus. Stimulation was applied transdermally by electrodes placed on the preauricular and postauricular regions and on the two mastoids. Of the 50 patients tested, only 14 (28%) obtained relief that met the criterion of a reduction in the tinnitus by 40% or more. When relief was obtained, it usually extended for several hours into the poststimulation period. There was only one positive response (2%) in the placebo trial, which was administered to all patients. It was concluded that transdermal electrical stimulation such as that used in this research is not a practical therapeutic procedure for the relief of tinnitus. PMID: 3927235, UI: 85269382
Vilholm OJ, Moller K, Jorgensen K (1998) Effect of traditional Chinese AP on severe tinnitus: a double-blind, placebo-controlled, clinical investigation with open therapeutic control. Br J Audiol Jun;32(3):197-204. Department of Audiology, Vejle Hospital, Denmark. This study aims to determine the effect of intensive AP on severe tinnitus. The structure of the study was a randomized, double-blind, clinical investigation with open therapeutic surveillance and included 54 patients. All were subjected to 25 treatment sessions over a period of two months, each treatment lasting 30 minutes. Fifty-two patients completed the study. The variables used for self-registration were based on the visual analogue scale (VAS), where annoyance, loudness and awareness of the tinnitus were assessed. These were recorded twice daily over a four-month period starting one month before the first treatment and ending one month after the last treatment. Questionnaires, interviews and audiometry were carried out repeatedly. No statistically significant differences were found between the AP group and the placebo group. PMID: 9710337, UI: 98374111
SECTION B: RELEVANT TITLES, WITHOUT ABSTRACTS
Andersson G, Lyttkens L (1996) AP for tinnitus: time to stop? Scand Audiol 25(4):273-275. Department of Clinical Psychology, University Hospital, Uppsala, Sweden. No Abstract available. PMID: 8976001, UI: 97130169
Anon (1974) [Diagnosis and therapy of tinnitus - Article in Japanese]. Nippon Jibiinkoka Gakkai Kaiho Oct 20;77(10):820-829. No Abstract available. PMID: 4474365, UI: 75061598
Bentzen O (1986) Treatment of tinnitus with alternative therapy. Acta Otorhinolaryngol Belg 40(3):487-491. No Abstract available. PMID: 3788551, UI: 87072622
Cazals Y, Bourdin M, Negrevergne M, Dauman R (1986) [Transcutaneous electric stimulation in the treatment of tinnitus - Article in French]. Rev Laryngol Otol Rhinol (Bord) 107(5):433-436. No Abstract available. PMID: 3494285, UI: 87177173
Durko T, Daniel T, Wielka J (1984) [AP in the treatment of various otorhinolaryngologic diseases - Article in Polish]. Otolaryngol Pol 38(4):303-306. No Abstract available. PMID: 6522053, UI: 85112137
Gersdorff M, Robillard T (1986) [Electric stimulation in the treatment of tinnitus]. [Article in French]. Rev Laryngol Otol Rhinol (Bord) 107(5):439-446. No Abstract available. PMID: 3494286, UI: 87177174
Hansen PE, Hansen JH, Bentzen O (1981) [AP therapy of chronic unilateral tinnitus: A double-blind cross-over study - Article in Danish]. Ugeskr Laeger 1981 Oct 26;143(44):2888-2890. No Abstract available. PMID: 7034339, UI: 82108857
House JW (1984) Tinnitus: evaluation and treatment. Am J Otol Oct;5(6):472-475. No Abstract available. PMID: 6334995, UI: 85094519
Lindberg P, Scott B (1991) [Methodological shortages of the evaluation of AP therapy in tinnitus - Article in Swedish]. Lakartidningen Mar 13;88(11):940. Bada vid audiologiska avdelningen, Akademiska sjukhuset, Uppsala. No Abstract available. PMID: 2008140, UI: 91179266
Lindholm S, Berg S, Larsson B, Hybbinette JC (1991) [AP is a valuable therapeutic alternative in tinnitus - Article in Swedish]. Lakartidningen Mar 6;88(10):847-849. No Abstract available. Avdelningslakare, lanssjukhuset i Kalmar. PMID: 2008129, UI: 91179254
Marcus RE, Goldenberg RA (1974) Cochleoneural hearing loss treated with AP. Arch Otolaryngol 1974 Jun;99(6):451-453. No Abstract available. PMID: 4829765, UI: 74168175
Omura Y (1981) Simple custom-made disposable surface electrode system for non-invasive EAP or TNS and its clinical applications including treatment of cephalic hypertension and hypotension syndromes as well as temporo-mandibular joint problems, tinnitus, shoulder and lower back pain, etc. Acupunct Electrother Res 6(2-3):109-134. No Abstract available. PMID: 6120617, UI: 82132244
Popovici D, Gheorghiu C, Ionescu-Tirgoviste C (1985) [Treatment of tinnitus aurium by AP - Article in Romanian]. Rev Chir Oncol Radiol O R L Oftalmol Stomatol Otorinolaringol Jul;30(3):183-188. No Abstract available. PMID: 2937098, UI: 86150598
Sauer H (1990) [Adjuvant alternative therapy procedures in idiopathic tinnitus aurium]. [Article in German]. Laryngorhinootologie Feb;69(2):114-116. Hals-Nasen-Ohren-Arzt, Allergologie-Naturheilverfahren, Munchen. No Abstract available. PMID: 2322357, UI: 90211473
Schonweiler R (1986) Tinnitus: causes, diagnosis and therapy - Article in German]. Dtsch Med Wochenschr Sep 26;111(39):1489-1494. No Abstract available. PMID: 3757811, UI: 87004088
The search profile was: "tinnitus AND (acupuncture OR TENS OR moxibustion)". The search yielded 45 relevant hits.
The bibliography, sorted by author into two sections. Section A (30 abstracts) had data directly relevant to the main search. Section B (15 titles, but no abstracts) is included as useful background for researchers who may want to pursue these titles.
Conclusions: Only 24 abstracts reported the clinical results. 11/24 papers reported no significant effect of AP-like therapy on the severity of tinnitus. 13/24 papers reported a significant effect, or a possible benefit in tinnitus. Of those papers that reported some positive clinical effect in 20-40% of patients. This (in comparison to clinical success rates for AP in other conditions) is a disappointingly low success rate. Also, most of the positive papers reported only a partial, or transient, improvement in the tinnitus, with poor long-term improvement. Many patients, however, reported subjective improvement and also improvements in general well-being, such as better sleep, better circulatory function etc.
In summary, from a perusal of the Medline data, the clinical efficacy of AP or TENS-like stimulation in the treatment of tinnitus is controversial and of limited value.
SECTION A: RELEVANT ABSTRACTS
Andersson G (1997) Prior treatments in a group of tinnitus sufferers seeking treatment. Psychother Psychosom 66(2):107-110. Department of Clinical Psychology, Uppsala University, Sweden. Tinnitus is a common problem for which many treatments have been proposed and implemented. Patients tend to seek renewed treatment after treatment failure. The aim of this descriptive study was to describe a group of consecutive tinnitus patients in terms of prior treatments received. Sixty-nine tinnitus patients seeking treatment were asked about prior treatments and completed the short Tinnitus Effect Questionnaire (TEQ). Four groups were obtained: No treatment (n=24), AP (n=19), relaxation (n=13), and other treatments (n=13). Six subscales were derived from the TEQ measuring helplessness, capacity for rest, acceptability of change, emotional effects, hearing speech and sounds, and ability to ignore. The groups were compared with multivariate analyses of covariance and Tukey's post-hoc tests. Results showed minor differences between the groups, the exception being that the untreated group showed more acceptability for change. Clinicians should be aware of the fact that patients may have tried at least one treatment when entering the audiology clinic. Controlled studies are needed in order to avoid the spread of nonspecific and non-effective treatments in the management of tinnitus. PMID: 9097339, UI: 97251661
Axelsson A, Andersson S, Gu LD (1994) AP in the management of tinnitus: a placebo-controlled study. Audiology Nov;33(6):351-360. Department of Audiology, Sahlgrenska University Hospital, Gothenburg, Sweden. The present study was performed on 20 patients randomly selected from a large group with noise-induced tinnitus in order to investigate the effect of AP on their tinnitus. The patients were divided into two groups. One group first received classical Chinese needle AP for 5 weeks, and the other was given a placebo procedure; after a 2-week interval, the procedures were reversed. A single-blind cross-over design was used. AP was given by a Chinese otolaryngologist around the ear as well as at distal points on the extremities. Placebo consisted of mock electrical stimulation via surface electrodes connected to a Chinese EAP stimulator which delivered a weak sound and a light flash at a frequency of 2 Hz but no current to the surface electrodes. The effect was evaluated by the use of visual analogue scales. No significant difference between AP and placebo was found in annoyance, awareness or loudness of the tinnitus. Many patients indicated a preference for AP due to unspecific effects such as improved sleep, decreased muscle tension and improved blood circulation. It is concluded that AP has no specific alleviating effect on noise-induced tinnitus. PMID: 7741667, UI: 95260250
Brand H (19999983) [Neural therapy in tinnitus - Article in German]. Wien Med Wochenschr Nov 15;133(21):545-547. After the examination by ENT-specialists in 96 cases of tinnitus a conventional medical therapy with vasodilators and vitamin A has been tried. This therapy showed unsatisfactory results. Then neural therapy as defined by segmental therapy with a preparation containing lidocaine (Xyloneural) has been applied. The results have been so encouraging, that this method can be advised as basical therapy in tinnitus. PMID: 6659522, UI: 84099798
Collet L, Moussu MF, Dubreuil C, Disant F, Chanal JM, Morgon A (1987) Psychological factors affecting outcome of treatment after transcutaneous electrotherapy for persistent tinnitus. Arch Otorhinolaryngol 244(1):20-22. We used transcutaneous electrotherapy to treat 27 patients with persistent tinnitus. Each patient was tested with the short form of the Minnesota Multiphasic Personality Index test (MMPI) prior to the commencement of treatment. The "unimproved" group of patients (n=15) showed higher pretreatment scores for depression (p<.05), psychasthenia (p<.05) and schizophrenia (p<.02). Our findings indicate that patients having significantly pathological scores on at least one of these three scales will fail to benefit from treatment. These findings also show that there appear to be psychological prognostic factors that can be used to evaluate patients receiving transcutaneous electrotherapy for persistent tinnitus. PMID: 3497623, UI: 87298100
de Lavernhe-Lemaire MC, Garand G, Beutter P (1987) [Study by auditory evoked potentials of the efficacy of transcutaneous electric stimulation in the treatment of tinnitus - Article in French]. Arch Int Physiol Biochim Sep;95(3):173-181. Service d'O.R.L., C.H.U. Bretonneau, Tours, France. Thirty patients complaining about tinnitus were treated by transcutaneous tragal electrical stimulation. The effect of this treatment has been evaluated by BASR recordings before and after treatment. Taking into account the subjective results three groups are described. The first one (10 patients) is relieved of tinnitus. In second and third group the symptoms still exist, whatever the electrode's position (anode or cathode in tragal position). When BASR are studied before the electrical stimulation no inter-subjects difference can be found. After stimulation, the left delta I-V latency is significatively lengthened, and the wave I latency is shortened in the first group. The study of the two other groups do not reveal any difference between the pre- and the post- stimulation evaluation. So the BASR appears to be a good predictive tool for tinnitus suppression by electrical stimulation. PMID: 2446579, UI: 88076288
Dobie RA, Hoberg KE, Rees TS (1986) Electrical tinnitus suppression: a double-blind crossover study. Otolaryngol Head Neck Surg Oct;95(3 Pt 1):319-323. A wearable device for transcutaneous electrical tinnitus suppression (ETS) has recently been reported to be effective for relief of tinnitus. Twenty patients with sensorineural hearing loss and tinnitus participated in a double-blind crossover study. Both active devices and internally disconnected placebo devices, supplied by the manufacturer, were used. Reduction in severity of tinnitus was reported by 2 of 20 patients (10%) with the active device and by 4 of 20 (20%) with the placebo device. Fifteen of 20 (75%) had no relief with either device. Those who preferred the placebo device, however, reported only minimal relief, while one of the two who preferred the active device stated it had reduced tinnitus severity by 70% to 80%. This patient was recalled for a series of one-hour test sessions, during which either an active or placebo device was used, according to a random schedule. On each of four on trials, the score for severity of tinnitus for each ear decreased by at least 50% (median = 70%), while in three off trials, the severity of tinnitus was unchanged or decreased by up to 30% (median=16%). We conclude that the Theraband headset is effective for a small proportion of patients with sensorineural hearing loss and tinnitus. PMID: 3108780, UI: 87230361
Engelberg M, Bauer W (1985) Transcutaneous electrical stimulation for tinnitus. Laryngoscope Oct;95(10):1167-1173. The use of electrical stimulation to treat tinnitus was evaluated in a two-experiment study. The stimulus was a low amperage, low frequency variable square wave applied to 13 sites on the auricle of the ear with tinnitus. The sites were selected for their increased electrical conductivity as measured by low electrical resistance readings. Experiment 1 results defined improvement as either a complete remission of the tinnitus or a decrease in the frequency of the tinnitus. Experiment 2 utilized a single blind protocol with 20 subjects comprising 33 ears with tinnitus. 82% of the 33 ears showed improvement by either of the two criteria. The permanence of the improvement ranged from 20 minutes to at least six months. The variables associated with this procedure were discussed. The adverse effects from the stimulation were minimal. PMID: 3900611, UI: 86013274
Fischer MV (1982) [AP therapy in the outpatients-department of the University Clinic Heidelberg - Article in German]. Anaesthesist Jan;31(1):25-32. Encouraged by the good results obtained using AP anaesthesia, we started therapeutic AP in our institute of anaesthesiology four years ago. In the meantime AP is as important a therapeutic method in our out-patients department as are therapeutic local anaesthesia, transcutaneous electrical nerve stimulation and biofeedback. The results in 520 patients who have been treated with AP for different diseases are reported. The success of treatment, the number of sessions and the recurrence-rate within one and a half years are discussed for the different diseases. AP treatment was regarded successful when 1, the patient had no complaints at all without medication, and 2, when there was significant improvement (no long term medication, only mild complaints with unusual strain, which were responsive to minimal medication). Thus treatment in cephalgia was successful in 83% with no recurrences (NR) in 84%. In cervical pain syndromes the respective results6 were 80% (NR=74%) in constipation 80% (NR=72%), sinusitis 86% (NR=100%), insomnia 100% (NR=100%). Good results, albeit with high recurrence rate were achieved in cases of trigeminal neuralgia in 90% (NR=23%), colitis ulcerosa in 100% (NR=0%), in bronchial asthma 70% (NR=50%) and in tumour pain 61% (NR=0%). Treatment in patients suffering from parathymic conditions were unsatisfactory and results in cases of tinnitus were negative. PMID: 6978622, UI: 82179981
Fischer MV, Behr A, von Reumont J (1984) AP: a therapeutic concept in the treatment of painful conditions and functional disorders: Report on 971 cases. Acupunct Electrother Res 9(1):11-29. The results in 971 outpatients who have been treated with AP for different diseases are reported. The outcome of treatments and number of sessions are discussed in relation to the different diseases. AP treatment was regarded as successful when 1. the patients had no pain at all without medication and 2. there was a significant improvement (no long-term medication, only mild pain under unusual strain, minimal medication under such circumstances). We obtained positive results in cephalalgias , sinusitis, cervical spine syndrome, shoulder-arm syndrome, ischialgias , back pain, constipation, herpes zoster, allergic rhinitis and disturbances of peripheral blood flow. For the following ailments, in order to reduce the medication, we recommend AP despite a high rate of recurrence: Trigeminal neuralgia, colitis ulcerosa, bronchial asthma and cancer pain. Results in the treatment of mental disturbances were unsatisfactory, and in cases of tinnitus results were negative. PMID: 6145308, UI: 84227544
Furugard S, Hedin PJ, Eggertz A, Laurent C (1998) [AP worth trying in severe tinnitus - Article in Swedish]. Lakartidningen Apr 22;95(17):1922-1928. Norrlands Universitetssjukhus, Umea. The article consists in a report of a study of 22 patients with disabling tinnitus, performed to elucidate the effects of a 3-month course of AP (15 treatments) on the severity of tinnitus and on quality of life (QOL), as compared with those of individualised physiotherapy. The study was designed as a prospective, randomised, cross-over study with a follow-up period of one year after the final treatment. Treatment effects were evaluated in terms of the patients' VAS (visual analogue scale) ratings and answers to questionnaires, including the NHP (Nottingham Health Profile), regarding the impact of tinnitus on different aspects of QOL. Baseline NHP scores showed tinnitus patients to manifest pronounced depressive characteristics. AP was found to yield immediate relief, both in terms of loudness and disturbance of the tinnitus, and significant improvement in QOL (NHP) for three months after the conclusion of treatment. Although many patients in the subgroup with concurrent muscle tension reported beneficial effects of individualised physiotherapy, such treatment yielded no significant reduction of tinnitus loudness or disturbance due to tinnitus, and no improvement in NHP scores. In both treatment groups, however, both annoyance due to tinnitus and QOL scores had returned to pretreatment levels at one-year follow-up. Thus, the results suggest tinnitus patients to manifest depressive characteristics, and that AP may yield temporary improvement in terms of tinnitus relief and QOL. Comment in: Lakartidningen 1998 Jun 10;95(24):2799. PMID: 9604636, UI: 98267995
Gelb H, Gelb ML, Wagner ML (1997) The relationship of tinnitus to craniocervical mandibular disorders. Cranio Apr;15(2):136-143. Department of General Dentistry, Tufts University of College of Dental Medicine, USA. Patients with craniocervical mandibular (TMD) disorders can present with tinnitus as a primary or secondary complaint. The embryology and functional anatomy of the middle ear, temporomandibular joint, muscles of mastication and associated tendons, ligaments, blood vessels, nerves and lymphatics was found to be helpful in establishing etiologic concepts which relate tinnitus to these temporomandibular disorders. In addition to etiologic concepts, treatment modalities are described. The authors relate their experiences as well as those of others with different patient populations. PMID: 9586516, UI: 98247663
Giordano C, Bona Galvagno M, Brosio R, Schieroni MP, Revello MP (1987) [Treatment of tinnitus with the TENS stimulator in cervico-arthrosis patients: Preliminary results - Article in Italian]. Minerva Med Jun 30;78(12):861-864. The combination of ear buzzing and cervical arthrosis is frequently encountered in both ENT practice and physiatry. A group of 16 patients presenting this combination was therefore selected. After a series of ENT and physiatric tests the patients were subjected to audiological and radiographic examination in order to exclude any pathologies different from the two under study. Each patients was then subjected to a cycle of 12 periauricular TENS sessions and was examined at the end of the cycle and one month later. Brief bibliographical notes on this subjects are presented and the results obtained are reported and discussed. PMID: 3496560, UI: 87258866
Hansen JE (1975) AP in otolaryngology. Am J Chin Med Jul;3(3):281-284. The enthusiastic acceptance of AP by the people of the United States is partly indicative of the limitations of Western medicine. This paper is the result of a two year study using AP in the field of otolaryngolgy to treat those patients whose illnesses have not responded to conventional Western medicine approaches. PMID: 1190117, UI: 76059098
Hansen PE, Hansen JH, Bentzen O (1982) AP treatment of chronic unilateral tinnitus: a double-blind cross-over trial. Clin Otolaryngol Oct;7(5):325-329. In a double-blind controlled trial the effect of traditional Chinese AP versus placebo AP was evaluated among 17 patients (8 females and 9 males, mean age 45.7 years) with chronic (mean disease duration 5.3 years) unilateral tinnitus. None of the patients had any treatable otological disease. All patients suffered from daily tinnitus, the intensity of which was recorded by the patients themselves every day during a period of 15 weeks. Each patient was treated by traditional Chinese AP as well as placebo AP following randomization (Figure 1). Each period of treatment comprised 2 treatments a week for 3 weeks. Throughout the whole investigation a period effect was recorded, insignificant in the AP-placebo group, but significant in the placebo-AP group (Friedman analysis of variance) (Table 4). There was no significant difference between traditional Chinese AP and placebo (Wilcoxon test, p>.05, one-tailed). There was no relation between the patients' subjective statements and the results of sound balance measurements as an objective standard of tinnitus (Spearman test). PMID: 6756709, UI: 83077722
Kaada B, Hognestad S, Havstad J (1989) Transcutaneous nerve stimulation (TNS) in tinnitus. Scand Audiol 18(4):211-217. Clinical Neurophysiological Laboratory, Rogaland Central Hospital, Stavanger, Norway. Low-frequency (2 Hz) TNS applied distally to peripheral nerves of the upper extremity is known to induce a wide-spread, non-segmental and prolonged relief of pain and an increased microcirculation due to sympatho-inhibition in a number of vascular beds. Such stimulation was administered in 29 tinnitus patients of various etiology. Reduction of tinnitus was encountered in 9 subjects in response to a 45-min TNS-session. The improvement was mainly seen in tinnitus characterized by lower frequencies (125-500 Hz). In 7 of the 9 patients, the tinnitus reduction was associated with improvement of hearing, predominantly in the low-frequency band. The effects were still present after one week following daily stimulation at home. On continued treatment, the effects were found to be transitory in 4 of the patients, whereas the remaining 5 patients are still using the stimulator after 2 to 5 years. It is suggested that the mechanism behind the beneficial effects is increased microcirculation in part of the auditory pathways. PMID: 2609098, UI: 90117007
Marks NJ, Emery P, Onisiphorou C (1984) A controlled trial of AP in tinnitus. J Laryngol Otol Nov;98(11):1103-1109. The relationship of tinnitus to pain is examined and a theoretical case made out for the possible use of AP in the treatment of tinnitus. A double-blind cross-over controlled trial is described. The use of Visual Analogue Scales (VAS) is discussed in this context. 35% of patients described some benefit from the active treatment only, although we were unable to demonstrate this objectively. Statistical analysis of the group as a whole revealed no significant differences between placebo and active AP treatment. PMID: 6387018, UI: 85032251
Naujoks J, Lotter E (1981) [Conservative therapy of tinnitus - Article in German]. Laryngol Rhinol Otol (Stuttg) Apr;60(4):220-223. Conservative therapy of tinnitus presents a theme that is controversial, since the usefulness of almost all the proposed treatments is rarely based on scientific-experimental evidence. The blocking of the stellate ganglion, electric stimulation of the cochlea and the anaesthesia of the plexus tympanicus belong to the domain of surgical treatment methods of tinnitus. Drug therapy is the mainstay of treatment; our own measures are demonstrated. We attempt to give a hypothetic pharmacological interpretation of the efficacy of some drugs that derive essentially from diethylaminoethanol and the group of methylexanthines. We also mention the physical treatment methods such as tinnitus masker, ultrasound and physiotherapy as well as AP. Finally, the more recent psychotherapeutic treatment-modalities, for example biofeedback, hypnosis and medical sleep are mentioned. PMID: 6112647, UI: 81196519
Nilsson S, Axelsson A, Li De G (1992) AP for tinnitus management. Scand Audiol 21(4):245-251. Department of Audiology, Sahlgrenska Hospital, Gothenburg, Sweden. Fifty-six patients with continuous and severe tinnitus as their major complaint were treated with traditional Chinese AP. After a pre-treatment period with baseline evaluation of tinnitus, 10 treatments were given during a period of 20 days, followed by a post-treatment period in order to obtain indications of prolonged treatment effects. Assessments were made using visual analogue scales (VAS) and a verbal retrospective rating scale. Three patients reported improvement which lasted for at least 10 days after the last treatment, indicating a possible long-term effect in some cases. Twenty-one% of the patients reported transient intensity reductions lasting for hours/days. Estimated 'substantial' improvement rate by VAS, consistent for all three parameters involved (intensity, annoyance, awareness), was 20%, while the corresponding deterioration rate was 25%. Statistical analysis of the whole group did not show any significant general treatment effects. Interactions between treatment evaluations by verbal rating and VAS are discussed as well as interactions with psychological components. PMID: 1488611, UI: 93141943
Omura Y, Losco BM, Omura AK, Takeshige C, Hisamitsu T, Shimotsuura Y, Yamamoto S, Ishikawa H, Muteki T, Nakajima H, et al (1992) Common factors contributing to intractable pain and medical problems with insufficient drug uptake in areas to be treated, and their pathogenesis and treatment: Part I. Combined use of medication with AP, (+) Qi gong energy-stored material, soft laser or electrical stimulation. Acupunct Electrother Res 17(2):107-148. Heart Disease Research Foundation, New York. Most frequently encountered causes of intractable pain and intractable medical problems, including headache, post-herpetic neuralgia, tinnitus with hearing difficulty, brachial essential hypertension, cephalic hypertension and hypotension, arrhythmia, stroke, osteo-arthritis, Minamata disease, Alzheimer's disease and neuromuscular problems, such as Amyotrophic Lateral Sclerosis, and cancer are often found to be due to co-existence of 1) viral or bacterial infection, 2) localized microcirculatory disturbances, 3) localized deposits of heavy metals, such as lead or mercury, in affected areas of the body, 4) with or without additional harmful environmental electromagnetic or electric fields from household electrical devices in close vicinity, which create microcirculatory disturbances and reduced acetylcholine. The main reason why medications known to be effective prove ineffective with intractable medical problems, the authors found, is that even effective medications often cannot reach these affected areas in sufficient therapeutic doses, even though the medications can reach the normal parts of the body and result in side effects when doses are excessive. These conditions are often difficult to treat or may be considered incurable in both Western and Oriental medicine. As solutions to these problems, the authors found some of the following methods can improve circulation and selectively enhance drug uptake: 1) AP, 2) Low pulse repetition rate electrical stimulation (1-2 pulses/second), 3) (+) Qi Gong energy, 4) Soft lasers using Ga-As diode laser or He-Ne gas laser, 5) Certain electromagnetic fields or rapidly changing or moving electric or magnetic fields, 6) Heat or moxibustion, 7) Individually selected Calcium Channel Blockers, 8) Individually selected Oriental herb medicines known to reduce or eliminate circulatory disturbances. Each method has advantages and limitations and therefore the individually optimal method has to be selected. Applications of (+) Qi Gong energy stored paper or cloth every 4 hours, along with effective medications, were often found to be effective, as Qigongnized materials can often be used repeatedly, as long as they are not exposed to rapidly changing electric, magnetic or electromagnetic fields. Application of (+) Qi Gong energy-stored paper or cloth, soft laser or changing electric field for 30-60 seconds on the area above the medulla oblongata, vertebral arteries or endocrine representation area at the tail of pancreas reduced or eliminated microcirculatory disturbances and enhanced drug uptake. PMID: 1353650, UI: 92351823
Podoshin L, Ben-David Y, Fradis M, Gerstel R, Felner H (1991) Idiopathic subjective tinnitus treated by biofeedback, AP and drug therapy. Ear Nose Throat J May;70(5):284-289. Department of Otolaryngology, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa. The effect of three treatment modalities of idiopathic-subjective tinnitus (IST): AP (AP), biofeedback (BF) and Cinnarizine (Cin), was investigated in 58 randomly selected subjects. The findings show that at the end of treatment, 50% of the patients in the biofeedback group reported some amelioration in the level of the tinnitus, while 30% of the AP group and only 10% of the group receiving Cinnarizine reported an amelioration of the tinnitus. Treatment by biofeedback caused a significant easing in the degree of discomfort caused by the tinnitus to patients during rest. Within the limitations of the sample study, our results indicate that the biofeedback method is more effective in comparison with AP and Cinnarizine in the treatment of those suffering from tinnitus. PMID: 1914952, UI: 92007323
Podoshin L, Fradis M, David YB (1992) Treatment of tinnitus by intratympanic instillation of lignocaine (lidocaine) 2 per cent through ventilation tubes. J Laryngol Otol Jul;106(7):603-606. Dept of Otolaryngology, Bnai Zion Medical Centre, Haifa, Israel. Idiopathic subjective tinnitus (IST) is one of the most obscure otological pathologies. This paper presents the results of treating IST by intratympanic instillation of lignocaine (lidocaine) 2% through a grommet, for five weekly courses. Fifty-two patients suffering from intractable tinnitus entered this therapeutic trial, but only nine finished all five courses. In one patient, the tinnitus was almost completely abolished, but in all the nine patients the decompensated tinnitus changed to a compensated one. We suggest this mode of treatment for patients that were previously treated by drugs, AP and biofeedback, with disappointing results. Patients should be warned about the side effects of vertigo and vomiting, which subsides gradually with every new instillation, and that the tinnitus may not disappear but will be alleviated, enabling them to cope more easily with the disease and lead a more normal life. PMID: 1527456, UI: 92407442
Rahko T, Kotti V (1997) Tinnitus treatment by transcutaneous nerve stimulation (TNS). Acta Otolaryngol Suppl (Stockh) 1997;529:88-89. Department of Otolaryngology, Tampere University Hospital, Finland. Twenty-six patients were treated with transcutaneous nerve stimulation (TNS) for tinnitus. Except for 3 normal hearing patients, all had cochlear hearing losses. Tinnitus disappeared in none, but diminished in 7/26 cases against 3/24 nontreated controls. In the controls there were no reliefs in low-frequency tinnitus cases. One of these 7, who reported benefit initially, used the TNS system for several months. It seems that TNS is not as good as expected, but probably in cases where the tinnitus frequency is low and it disappears with TNS totally, the patients may use it. PMID: 9288279, UI: 97434393
Rostovtsev VN, Kofanov RV (1992) [Indirect electric stimulation of the auditory neural structures in the complex treatment of sensorineural hearing loss and subjective noise in the ears- Article in Russian]. Vestn Otorinolaringol 1992 May;3:13-14. Indirect or transdermal electrostimulation (ES) was used in 62 patients suffering from neurosensory hypoacusis stage II-III. The procedure was conducted with the help of an +electric stimulator made on the country and a device providing an automatic change of the polarity. Disappearance of noise in the ears, better hearing, 10-15 dB shifts in auditory thresholds were achieved in 20 patients (32.3%). Noise in the ears declined, hearing improved subjectively in 25 (40.3%) of the patients. 17 (27.4%) of the patients did not respond. ES is recommended as a method of choice in combined treatment of neurosensory hypoacusis and subjective noise in the ears. PMID: 1523763, UI: 92397457
Scott B, Larsen HC, Lyttkens L, Melin L (1994) An experimental evaluation of the effects of transcutaneous nerve stimulation (TNS) and applied relaxation (AR) on hearing ability, tinnitus and dizziness in patients with Meniere's disease. Br J Audiol Jun;28(3):131-140. Department of Clinical Psychology, University of Uppsala, Sweden. In 20 patients diagnosed with Meniere's disease, transcutaneous nerve stimulation (TNS) and applied relaxation (AR) were used as a treatment aimed at reducing tinnitus and dizziness and increasing hearing ability. The main aim of the study was to examine whether TNS could be regarded as a more beneficial treatment regimen than AR. An experimental between-group cross-over design was used. The results from the experimental phase (group comparisons) showed a significantly increased ability to hear for the TNS group when measured on visual analogue scales. During the same period, the AR-group showed a significant hearing improvement for the ear not primarily affected by Meniere's disease as measured with pure tone audiometry. The vestibular tests did not reveal any significant changes either after TNS or AR intervention. Tinnitus matching showed changes of pitch and loudness before and after both TNS and AR intervention. However, no statistically significant changes between treatment regimes were found on these measures. The results from this study did not show TNS to be superior to AR in reducing tinnitus, dizziness or increasing hearing ability.PMID: 7841897, UI: 95144049
Shulman A (1987) External electrical tinnitus suppression: a review. Am J Otol Nov;8(6):479-484. Division of Otolaryngology, State University of New York, Brooklyn 11203. Our experience with transcutaneous electrical stimulation for tinnitus suppression has been with the Theraband Headset from Audimax Inc. The purpose of this article is to review the highlights of the patients who exhibited tinnitus suppression and/or tinnitus control, and to provide an update of our results and techniques using external electrical stimulation with prolonged stimulation (stage IV). Patient selection is considered critical to the success of external electrical stimulation for tinnitus suppression. The key elements include the clinical finding of a peripheral site of lesion of the tinnitus; positive maskability of the symptom of tinnitus; absence of active ear disease; absence of a vestibular asymmetry; and absence or minimal evidence of dysfunction of the central auditory system. The protocol described for patient selection allows for tinnitus identification, the differentiation of clinical tinnitus types, and the clinical application of the concept of the dynamic range of electrical tinnitus suppression. External electrical tinnitus suppression is believed effective in a limited number of patients clinically identified as having a tinnitus site of lesion primarily peripheral in location and cochlear in type. The present device is not commercially available at this time. Both specific and general suggestions are proposed for the standardization of methods of reporting results of electrical tinnitus suppression and tinnitus control. PMID: 3324768, UI: 88131270
Steinberger A, Pansini M (1983) The treatment of Meniere's disease by AP. Am J Chin Med 11(1-4):102-105. 34 patients suffering from Meniere's disease were treated by AP. Prior to AP most of them had been treated with various other medical means without satisfactory results. After AP treatment their condition greatly improved. The classic symptoms of Meniere's disease are vertigo, tinnitus and deafness, but for all the treated patients vertigo was the most uncomfortable and distressing symptom. In all our cases vertigo stopped after a few AP courses; but in our opinion it is more important to follow and control hearing threshold, since if it remains stable the other symptoms of Meniere's disease also do not persist. All our patients were regularly followed by careful audiometric studies several years after AP treatment. In most cases hearing level had not greatly varied, so the other symptoms of Meniere's disease were not present in any large degree. PMID: 6660197, UI: 84101349
Tachibana M, Kiyoshita Y, Senuma H, Nakanishi H, Sasaki K (1992) Effect of transcutaneous electrostimulation on noise-induced temporary threshold shift. Acta Otolaryngol (Stockh) 112(4):595-598. Department of Otolaryngology, Meiji College of Oriental Medicine, Kyoto, Japan. The effect of transcutaneous electrostimulation around the ear before and during noise exposure on noise-induced temporary threshold shift (TTS) was examined in 26 volunteers. Electrostimulation reduced TTS in the majority of cases and the reduction was statistically significant. Two possible mechanisms for this reduction are proposed: stimulation of the olivocochlear bundle and alteration of cochlear blood flow. Transcutaneous electrostimulation may be useful for prevention or treatment of noise induced hearing damage and for treatment of tinnitus. PMID: 1442003, UI: 93071012
Thomas M, Laurell G, Lundeberg T (1988) AP for the alleviation of tinnitus. Laryngoscope Jun;98(6, Pt 1):664-667. Department of ENT, Karolinska sjukhuset, Stockholm, Sweden. The present study describes the effect of AP in 12 patients with tinnitus. The patients were referred from the Department of Audiology, Karolinska Hospital, where their hearing and tinnitus were assessed. None of the patients had benefited from previous treatment for tinnitus. The selection of AP points depended on the individual and was, to a limited extent, based on traditional Chinese medicine (TCM). Local points such as Si 19, Sj 17, and Sj 21 were fairly standard; distal points took into account associated problems of the patient, but were also points recommended in TCM for tinnitus. Ten treatments were attempted within a 6- to 12-week period. The treatments were carried out weekly or biweekly depending on the availability of patient and acupuncturist. Six patients had transient effects and noise reduction. However, no positive long-term results were obtained. Similarities between the experience of tinnitus and of pain are discussed in light of these findings. PMID: 3374243, UI: 88232105
Vernon JA, Fenwick JA (1985) Attempts to suppress tinnitus with transcutaneous electrical stimulation. Otolaryngol Head Neck Surg Jun;93(3):385-389. Various electrical stimuli were tested for their ability to suppress or relieve severe tinnitus. Stimulation was applied transdermally by electrodes placed on the preauricular and postauricular regions and on the two mastoids. Of the 50 patients tested, only 14 (28%) obtained relief that met the criterion of a reduction in the tinnitus by 40% or more. When relief was obtained, it usually extended for several hours into the poststimulation period. There was only one positive response (2%) in the placebo trial, which was administered to all patients. It was concluded that transdermal electrical stimulation such as that used in this research is not a practical therapeutic procedure for the relief of tinnitus. PMID: 3927235, UI: 85269382
Vilholm OJ, Moller K, Jorgensen K (1998) Effect of traditional Chinese AP on severe tinnitus: a double-blind, placebo-controlled, clinical investigation with open therapeutic control. Br J Audiol Jun;32(3):197-204. Department of Audiology, Vejle Hospital, Denmark. This study aims to determine the effect of intensive AP on severe tinnitus. The structure of the study was a randomized, double-blind, clinical investigation with open therapeutic surveillance and included 54 patients. All were subjected to 25 treatment sessions over a period of two months, each treatment lasting 30 minutes. Fifty-two patients completed the study. The variables used for self-registration were based on the visual analogue scale (VAS), where annoyance, loudness and awareness of the tinnitus were assessed. These were recorded twice daily over a four-month period starting one month before the first treatment and ending one month after the last treatment. Questionnaires, interviews and audiometry were carried out repeatedly. No statistically significant differences were found between the AP group and the placebo group. PMID: 9710337, UI: 98374111
SECTION B: RELEVANT TITLES, WITHOUT ABSTRACTS
Andersson G, Lyttkens L (1996) AP for tinnitus: time to stop? Scand Audiol 25(4):273-275. Department of Clinical Psychology, University Hospital, Uppsala, Sweden. No Abstract available. PMID: 8976001, UI: 97130169
Anon (1974) [Diagnosis and therapy of tinnitus - Article in Japanese]. Nippon Jibiinkoka Gakkai Kaiho Oct 20;77(10):820-829. No Abstract available. PMID: 4474365, UI: 75061598
Bentzen O (1986) Treatment of tinnitus with alternative therapy. Acta Otorhinolaryngol Belg 40(3):487-491. No Abstract available. PMID: 3788551, UI: 87072622
Cazals Y, Bourdin M, Negrevergne M, Dauman R (1986) [Transcutaneous electric stimulation in the treatment of tinnitus - Article in French]. Rev Laryngol Otol Rhinol (Bord) 107(5):433-436. No Abstract available. PMID: 3494285, UI: 87177173
Durko T, Daniel T, Wielka J (1984) [AP in the treatment of various otorhinolaryngologic diseases - Article in Polish]. Otolaryngol Pol 38(4):303-306. No Abstract available. PMID: 6522053, UI: 85112137
Gersdorff M, Robillard T (1986) [Electric stimulation in the treatment of tinnitus]. [Article in French]. Rev Laryngol Otol Rhinol (Bord) 107(5):439-446. No Abstract available. PMID: 3494286, UI: 87177174
Hansen PE, Hansen JH, Bentzen O (1981) [AP therapy of chronic unilateral tinnitus: A double-blind cross-over study - Article in Danish]. Ugeskr Laeger 1981 Oct 26;143(44):2888-2890. No Abstract available. PMID: 7034339, UI: 82108857
House JW (1984) Tinnitus: evaluation and treatment. Am J Otol Oct;5(6):472-475. No Abstract available. PMID: 6334995, UI: 85094519
Lindberg P, Scott B (1991) [Methodological shortages of the evaluation of AP therapy in tinnitus - Article in Swedish]. Lakartidningen Mar 13;88(11):940. Bada vid audiologiska avdelningen, Akademiska sjukhuset, Uppsala. No Abstract available. PMID: 2008140, UI: 91179266
Lindholm S, Berg S, Larsson B, Hybbinette JC (1991) [AP is a valuable therapeutic alternative in tinnitus - Article in Swedish]. Lakartidningen Mar 6;88(10):847-849. No Abstract available. Avdelningslakare, lanssjukhuset i Kalmar. PMID: 2008129, UI: 91179254
Marcus RE, Goldenberg RA (1974) Cochleoneural hearing loss treated with AP. Arch Otolaryngol 1974 Jun;99(6):451-453. No Abstract available. PMID: 4829765, UI: 74168175
Omura Y (1981) Simple custom-made disposable surface electrode system for non-invasive EAP or TNS and its clinical applications including treatment of cephalic hypertension and hypotension syndromes as well as temporo-mandibular joint problems, tinnitus, shoulder and lower back pain, etc. Acupunct Electrother Res 6(2-3):109-134. No Abstract available. PMID: 6120617, UI: 82132244
Popovici D, Gheorghiu C, Ionescu-Tirgoviste C (1985) [Treatment of tinnitus aurium by AP - Article in Romanian]. Rev Chir Oncol Radiol O R L Oftalmol Stomatol Otorinolaringol Jul;30(3):183-188. No Abstract available. PMID: 2937098, UI: 86150598
Sauer H (1990) [Adjuvant alternative therapy procedures in idiopathic tinnitus aurium]. [Article in German]. Laryngorhinootologie Feb;69(2):114-116. Hals-Nasen-Ohren-Arzt, Allergologie-Naturheilverfahren, Munchen. No Abstract available. PMID: 2322357, UI: 90211473
Schonweiler R (1986) Tinnitus: causes, diagnosis and therapy - Article in German]. Dtsch Med Wochenschr Sep 26;111(39):1489-1494. No Abstract available. PMID: 3757811, UI: 87004088
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