Tinnitus Soft Laser Pen 6

4. Technicalexamination(audiogram,x-ray of neck vertebra,ENG,tinnitometry)
5. Laboratorytesting Audiogramswere taken in all the patients prior to the therapy.
After the therapyaudiogramswere taken in 62.5 per cent, i. e. 45 patients,showinga slight
improvement.
Audiogramprovidesonly for numeric range of perceptionof frequencyof sounds, howeverit
does not give us an objective evaluationof quality of hearing. Furthermore,the patients do
not see the main improvementin a wider rangeof frequencyof sounds,this remainsusually
on a similar level, but the main benefit is the absenceof the additionalburdeningsound
caused by tinnitus. Therefore the patients can better analyze sounds in general, their
hearing is "refreshed"as they usuallydescribethe result of the therapy. Typicalaudiograms
of patientswith tinnitus before and after therapy.
for
Laserdevice with an infrared laser probe (830 nm) and power output 300 mW was used
on the
the study. The followingapplicationdosagesand frequencymodulationswere applied
following points:
1. meatus acusticusexternus - in the direction of the axis of the auditory duct continuous
beam 50 J/cmtr followed by 25 J/cm[, frequencymodulationof 5 Hz'
the directionof
2, processusmastoideus- directedon the center, the vector of the beam in
5 Hz pulse
counter lateral orbit, continuousbeam 90 J/cmD , followedby 45 l/cmD with
frequency.
- in fact the
we strictly appeal to maintain the direction of the vector of aiming the beam
target structure of the helix is a shape of severalsquare millimetres'
a week' Having
At the beginning,attendancewas scheduledto 10 proceduresin total, twice
two series,each
completedthe first series, patients returned after 2 3 months for another
consistingof 5 - 6 therapies' once a week'
Evaluation
Levelof subjectivecomplaintswas evaluat€daccordingto three scales:
of therapy
1- Percentage scale - complaintsevaluated 100 per cent at the beginning
per cent, possible
(Blue), accordingto the level of relief decreased(Green) to 80, 70 etc'
accelerationof Problems( R e d ) g o e s u p t o l l 0 , l 2 0 e t c . p e r c e n t , n o t i n n i t u s e q u a | s 0 p e r
cent.
2- Five-grade scale - analogous to pain scales;
Reachingfrom Gr. I = No tinnitusto Gr. 5 = tinnitusinterferingall activities;
- Grade I
- Grade II
= No tinnitus
= No interfering sound perceived during the day, only in evenings,
causingno discomfort
- Grade III = Interfering sound perceivedduring the day, interruptingdrowse only
= Interrupting drowse and sleep, interfering sound causing discomfort
- Grade IV
during the day
- Grade V
= Unbearablediscomfort,interferingall activities
3- Graphic scale - Patientmarking 0 to 10, accompaniedby a simple graphicsshowing
face grimaces accordingto his/her amount of subjective hardship. In order to simplify the
effect of therapy as much as possiblethe resultswere divided in four groups:
1. Patientswith no effect of comprehensivetherapy
2. Lessthan 50 Per cent relief
3. More than 50 Per cent relief
4. No more tinnitus, patient free of the disease.
This evaluationis identicalwith our previousstudy, and it enabled us to compare easily the
resultsof both studies.
Table 2. The Role of LLLT in Tinnitus Treatment: Result
Result
# Patients
Percent
No effect
15
olo20,B
Less than 5O olo relief
19
0/o26,4
More than 5A olorelief
22
o/o34,6
No more tinnitus
16
o/o22,2
TOTAL
72
o/o100r0
Diagram 2. Thc Role of LLLT in Tinnitus Treatment: Result
tr No eftct
I Less fran 50% relief
tr ilorcthan 50% relief
tr No rrtre tinnihrs
It was interestingto compare our latest results (LLLT only) with those of our previous
studies,i. e. our study made in 1998, long-termstudy between1999 - 2OOt,and the initial
study aimed at LLLTonly.
Table 3. Comparative Results
Result
1994
1999-2001
LLLT only
No effect
o/o19,4
o/o16,0
olo2o,B
Lessthan 5O o/orelief
o/o!9,4
o/o15,0
0/o26,4
More than 5O o/orelief
o/o35,5
o/o43,O
o/o30,6
No more tinnitus
o/o25,8
0/o26,O
o/o22,2
Diagram 3. Comparative Results
$(fr
&46
4,4$
$ffi
4W
rlE8
25,4r,
-1999-2Wt
ILLTonly
ffit{oeffect
tesslhrt
*%rcli'ef
Mdedgt
5O%relief
Discussion
and ability' Since
Hippocratic Oath orders us to treat patients to the best of our knowledge
been based on the triad
our longterm experience in comprehensivetreatment of tinnitus has
at a loss whether we
of physiotherapeutic manipulation, medication, and LLLT, we were
treatment' mere LLLT'
would not harm our patients in a way, giving them only a part of the
introductory examination'
We have to declare, that we have selected patients during the
caused by vertebral
sorting out patients whose x-ray indicated a possibility of tinnitus
pure evaluation of the role of
blockades. On the other hand, this selection led to a more
possible cause and a corresponding
LLLT in the treatment of tinnitus, leaving out both a
the ratio of individual four
treatment. we have been positively surprised that in Eeneral
slightly increased
groups remained similar. The number of patients with no effect of LLLT
per cent in comparison to
(by 4.8 per cent when compared to the long-term study, by t'4
the absence of medication and
the original study of 1993). This is obviously caused by
improvement as less
physiotherapy, showing their supportive effect. In the group evatuating
best. More than one-fourth of all
than 50 per cent the leading role of LLLTcan be evidenced
LLLT only, which is a
patients (26,4) report improvement after therapy performed with
15.0) - Impressive results have
result better than those in both previous studies (19.4 and
more than one half of all
also been obtained in the last two groups , when we imagine
+ 22'2 = 52'8 per cent)'
patients reporting significant and/or total relief of tinnitus (30'6
Conclusion
22.2 per cent patients suffering from tinnitus never more after treatment with therapeutic
laser is a great success of LLLT. It only confirms the leading role of LLLT within
comprehensivelaser rehabilitationtherapy of tinnitus. On the other hand we must stress
the necessity to apply the two remaining parts of our therapeutic triad as well, since
medicationand physiotherapeuticmanipulationare integral parts of the general care of our
patients, and we should not deprive the suffering of the means and methods capable of
bringingthem more relief,which we are awareof.
comprehensive therapy of patients suffering frorn tinnitus
Prochazka M, Teinska R'
37 patientssufferingfrom tinnitus (age 18-86 years) were treated in three ways:
: mobilisation,physicaltraining,physiotherapy'
1. Rehabilitation
2. Same as 1 but with placebolaseradded'
3. Sameas 1 but with functionallaseradded'
given, total 10 treatments.
Laserused was 830 nm 300 mw. 2-3 treatments per week were
Treatment Protocol:
- 90 J/cmil CW on mastoideus,45 3/cmtr 5 Hz on mastoideus'
- 50 J/cmtr cw On acousticduct, 25 llcmn 5 Hz on acousticduct,
-Tebokan EgbT6:-ginko medicationwas added to treatment.
than 50o/orelief/no more
Results were classifiedas no effect/less than 50o/orelief/more
tinnitus.
groups
Table 4. The percent wise outcome for the three
Lessthan 5A o/orelief
More than 50 9o relief
Auris lVasus Larynx- 7997; 2a fi): 39-42
Diagram 4, The percent wise outcome for the three groups
5O,O%
4sp6
40p%
35,4%
35,5
top96
.. l6roup
"l
25,4%
20fr6
tspa
25,8
l2,group
3grouP
top96
s,o%
o.p96
l{o effect
Itlbre than
5O% relief
Lesthan
5O% relbf
No more
tinnitus
the effect of laser in a group
In an extended study over 3 years Prochazkat12631 evaluated
preparations (73o/o) or
of 200 pataents. These patients were taking gingko biloba
at the neck vertebrae'
Betahistadine(39olo)and also had physical therapy, mainty directed
75 Ucmfr into the ear and 135
Laser therapy was performed with a 300 mw GaAlAslaser,
J/cmtr behindthe ear.
The outcome can be examinedfrom Table 5'
Table 5. Results of Extended StudY
Result
No more tinnitus
percent
alo26
More than 5O o/orelief
o/o43
Less than 50 olo relief
o/oL5
No effect
o/oLG
Diagram 5. Results of Extended Study
50%
459d
M
ts%
to%
25%
2J0%
t5%
10%
5%
w
l{o nDr€
tinnit|s
lesst'pn
5O%rclief
tVlorethan
50%relief
No effect
In
where the same therapy as
addition a group of 31 patients were selected for a double blind study
months the outcome was as
above was performed, but one group received placebo laser. At 6
follows;
Table 6. Results of the Double-Blind Study
Result
Ufith Laser
No Laser
No more tinnitus
o/o25.8
o/o0.O
More than 5O olo relief
o/a35,5
o/a25,8
Less than 50 olo relief
o/oL9.4
o/o48.4
o/o79.4
o/o25,8
filo effect
Diagram 6, Results of the Double-Blind Study
il,w6
50.,n6
4',J'x
30pt6
2Ap%
''With La6er
I Nolset
Lsg}6
g,M
ap%
t{o more
tirmitts
iilore thnt
5096 reref
L€ssthtl
lloeffed
S{'%rcW
Official paper of the Czeeh Society for the Use of Laser in Medieine
Laser Association)
Edited under official scientific suprort of EIrII-A(European l.tedical
Long-Term Double Blind
comprehensive Laser Rehabilitation Therapy of Tinnitus:
Study in a Group of 2OOPatients in 3 Years (26'7'2AOZ)
M. Prochazka, M.D., RehabCtinic "Jarov", Prague, CZ
Ass'prof.A,Hahn,ENTClinic,FNKVFacultyHospital,Prague,CZ
Abstract
which there is no objective
Definitionof tinnitus recordsthat it is an auditory perceptionfor
publishedin Laser Partner
sonic source from the outer environment.our original study,
work' It unambiguously
clinixperienceNo. 4/2OOO,has been regardedas a classicaltinnitus
a high amount of personal
confirmedclinicalexperienceof our predecessors,presentedwith
on statistics' However'
enthusiasm (Shiomi, Wilden) but, unfortunately, not much based
slightly sceptical medical
recently our study has gained corroboration by originally
authoritiesobtaining statisticallyalmost identicalresults. Our study has been published
more than two years ago. With the time passingby we have been under the impressionthat
the results might be even better than those obtained during several-monthstherapy in the
original cohort of patients.This impressionled to a decisslonthat a new comparisonwith a
largergroup of patients,than the originalforty in our basicstudy, and followedin a longer
time horizon, might be of a certain interest. We were wondering whether our clinical
observations,confirmedby personalexperienceof other clinics,would also find an adequate
correlate in statisticalexpression.A model protocol as well as instruction photographsare
attachedto the paper.
Introduction
For our New Study the patients registeredin our clinic due to tinnitus for more than three
years were chosen. With regard to maximum objectiveness,the patients who had finished
attendancedue to unknown reasonswere includedin the "no-effect"group, althoughwe are
well aware that a part of them finished the treatment becauseof various other reasons
(such as time cunsumingengagements,problematictransport,family reasons).In a small
group of 5 patientswe tried to check the objective reasonsby a phone Qu€rY,and indeed, 2
patients gave other reasonswhilst 3 patients had finished attendancedue to unsatisfactory
or no result of procedures.Even though it is interestingfor us to have another little group of
6 patients visiting our cllnic for check ups and for a series of therapiesdespite (after a year
and more) zero effect of procedures.In a part of this group (in 3 patients) a certain
subjective improvement (up to less than 50 per cent relief) can be noticed after a long
attendance (Z - 3 years). There iS certainly a point at issue, to what an extent this
subjective improvementcan be regardedas an objective one, whether these patients have
not settled down to their complaint...It is a problem of little numbers,definitely not having
any influenceover the total figure, however, from a clinical point of view we considerthis
observationinteresting...It should be also mentioned that, in general, complianceof
patients suffering from tinnitus is excellent, which may be caused by the level of their
subjectivetribulationsleadingto a craving to get rid of it'
Materials and Methods
We have evaluated in total 200 patients visiting our clinic since 1997 till now for tinnitus,
followed till 2001, i.e. at least for 3 years. With our approval B patients, who were totally
free of tinnitus after a short period of treatment, were crossedoff and finished attendance
earlier. In this respectwe have an odd case history of a female patient, who was relievedof
her several years lasting lateralizedtinnitus after a single mobilizationof distal C vertebra
(note that entire B.B per cent of patientsin our originalstudy were relievedof tinnitusonly
by mere physiotherapyproceduresaimed at axial skeleton there really exists an often
patients'
disputed diagnosisof vertebrally conditionedtinnitus). As it can be seen above,
who finished the therapy due to reasons unknown, have been incorporatedin the group
"therapy with no effect".
Evaluatedgroup of patients was chosen at random from the whole number of our patients
with tinnitus, the main condition being particularlyregular attendanceduring the period of
the last three and more years. In all the patients a subjectivetinnitus had been diagnosed,
i.e. an organic cause of this condition could not be straightly determined by examinations
(meaning that especiallypatients with dg. neurinomus statoacusticusor another organic
cause, such as a tumor or a head injury with a positive finding by NMR, CT or EEG,were
possible
excluded).In this respectwe are well aware that some dubitation could be seen in
might
atheroscleroticchangesof veins, especiallyof carotid veins and a. vertebrales,which
also be regardedas an organic cause of tinnitus. However,with almost a hundred-per-cent
these
level of incidencein population of higher age categoriesit is rather difficult to call
changesa PathologY.
Table 7. Distribution of sex and Age among the Patients
Age
o-15
llale
2
r5-25 25-35 35-45
45-55
s5-65
65-75
75+
Total
3
9
11
23
28
32
4
tL2
Female
0
4
7
16
L9
25
16
1
88
Total
2
7
16
27
42
53
48
5
200
Diagram 7, Distribution of sex and Age among the Patients
B liale
gFemale
35-+F
ffi
(in comparison
Our group (New Group) of patientsconsistedof 112 males and 88 females
of males,
with our previous study there was an interesting shift towards higher share
of tinnitus
accordingto our opinion this more correspondswith the level of distribution
was 64 years,
within populationin relationto work anamnesisand hobbies).Averageage
higer categoriesof
rangingwithin the limits of 15 and 98 years.This meant a shift towards
with the incidenceof tinnituswithin the population,and maybe
age, probablycorresponding
media, mainly by those
also due to the fact that our activities have been covered by
on the basis of media
focussed on seniors, and thus new patients could have appeared
influence.
almost classical'three
Level of subjectivecomplaintswas evaluatedaccordingto, nowadays
scales:
per cent at the beginning of therapy'
1. Percentage scale (complaints evaluated 100
per cen, possible accelerationof
according to the level of relief decreased to 80, 70
problemsgoesUptoll0,l20percent,notinnitusequa|s0percent),
2.Five.gradesca|e.ana|ogoustopainscales(I=notinnitus,V=tinnituslimitinga|l
activities,II, III and IV = clearly definedcomplaints)
= No tinnitus
- Grade I
- Grade II
in evenings'
= No interfering sound perceived during the day' only
causingno discomfort
=
- Grade III
Interfering sound perceived during the
day'
interruPtingdrowseonlY
.GradeIV=InterruPtingdrowseands|eep,interferingsoundcausingdiscomfort
duringthe daY
- Grade v
= unbearablediscomfort,interferingall activities
face
accompaniedby a simplegraphicsshowing
3. Graphic scale (patientmarking0 to 10,
hardship)'
grimacesaccordingto his/her amount of subjective