By Barry Keate
Low-Level Laser Therapy (LLLT), sometimes referred to as Low Light Laser Therapy, has been studied as a treatment for tinnitus since 1993 but clinical studies have resulted in contradictory conclusions. Most conclude it’s not effective however some studies have shown positive results. We will review a recent study and the history of LLLT here in an attempt to reach some understanding as to efficacy of the therapy.
How LLLT Affects the Body
Mitochondria are the powerhouses of the cells of the human body. These organelles (parts of the cell) are responsible for taking in fatty acids from food and metabolizing them to produce energy for the cell. There may be 1,000 or more mitochondria in many cells. The energy produced by the mitochondria is in the form of ATP (adenosine triphosphate). Without mitochondria and ATP production, the cells, and eventually the person, will die.
It is believed that laser energy in the red and near-infrared light spectrum is capable of penetrating tissue. It stimulates mitochondria in the cells to produce more ATP and thereby more energy. Laser therapy can then repair damaged tissue and return cells to a healthy state, reversing many degenerative conditions.
Low-Level Laser Therapy has been shown to have positive effects on wound healing, tissue repair, musculoskeletal complications and pain control. One study showed positive results in treating rheumatoid arthritis with LLLT. (1)
Can LLLT Affect Tinnitus?
Uwe Witt, MD of Hamburg, Germany first introduced LLLT for inner ear diseases in the 1980’s. Lutz Wilden, MD of Bad Fussing, Germany, further developed the therapy. Dr. Wilden brought it to a wide range of patients and has treated 800 tinnitus patients since 1991. He claims a high level of success but has not published clinical studies that prove the case.
Dr. Wilden applies this therapy using multiple lasers, which are used simultaneously on each patient. The lasers emit dual wavelength beams in the deep red (650 nm) and near infrared (700-1,000 nm) frequencies. The beams are aimed into the auditory canal and through the mastoid bone behind the ear. Although the beams lose intensity quickly, they are able to penetrate 2 – 5 cm (0.8” – 2”) inside the body.
Each treatment session last 60 minutes and there are 10 sessions conducted over a period of 10 to 14 days. Each patient is exposed to the laser therapy for 600 total minutes.
While Dr. Wilden has not published in a peer-reviewed journal, he has made several presentations to the American Society for Laser Medicine and Surgery (ASLMS) in the United States. In one presentation in 2005 he described using LLLT on children and young adults with defective hearing. There were 19 patients with an average age of 12 who suffered impaired hearing from a variety of causes. Dr. Wilden presented audiograms conducted before and after treatment. The audiograms largely showed dramatic improvement in hearing levels. (2)
For those interested in a more detailed article about Dr. Wilden’s therapy and previous clinical studies, please read our article Low-Level Laser Therapy and Tinnitus.
Clinical Trial on LLLT for Tinnitus Therapy
A recent clinical study on LLLT for tinnitus was published in the ENT - Ear, Nose & Throat Journal in January 2015. (3) Researchers at the Islamic Azad University in Iran studied 66 patients; 33 who received active laser treatment and 33 who received inactive dummy treatment.
This was a double-blind placebo controlled study. They conducted a complete medical history to determine that the patients’ tinnitus was cochlear in nature and not attributable to other organic disease states. Patients’ age ranged from 19 to 88 years and all participants had subjective, non-pulsatile, idiopathic tinnitus for a minimum of two months.
Laser treatment was delivered to the cochlea through the auditory canal using a laser with an adapter for use in the ear. The laser beam is directed via an optical fiber into the ear. The device emits a deep red laser with a wavelength of 650 nm and a power output of 5 mV. Patients were treated for 20 minutes a day, 5 days a week, for 4 weeks.
At the study’s end, 1 patient in the active laser group and none in the control group had a complete cessation of their tinnitus. The Tinnitus Severity Index declined for 14 patients in the active group and 17 in the control group. Reductions in tinnitus loudness scores were seen in 7 patients in the active group and 9 in the control group. There was no significant effect in alleviating tinnitus-related vertigo.
LLLT for Tinnitus Clinical Discussion
The authors noted that although laser therapy did reduce tinnitus in some of the patients in this study, there was no significant difference between laser therapy and placebo overall. The same conclusions were found in three other studies of which all were double-blind, placebo controlled studies.
However, some studies have shown positive results. Two other studies of shorter duration showed significant improvements in some patients, enough to be clinically significant.
One study conducted by Hahn, et al reported an alleviation of tinnitus in 50.8% of their patients. However, this study used LLLT in combination with Ginkgo Biloba Extract. It is very possible the ginkgo was the active factor in the reduction. (4)
In conclusion, the authors noted they found that a 5 mV laser with a wavelength of 650 nm was no better than placebo in treating tinnitus. They suggested that more studies with different strengths of laser treatment be carried out.
Regarding Dr. Wilden’s previous work in Germany, it needs to be remembered he uses multiple lasers, each with dual frequency output, on each patient. He also treats each patient to 600 minutes of laser radiation. Subsequent trials have used one, single frequency laser. This trial exposed patients to 400 minutes of radiation and some use less. So Dr. Wilden exposes his patients to much more power than recent trails.
The data suggests that further clinical trials should be conducted exposing the patients to more power, equivalent to that used by Dr. Wilden. Only then will we truly know whether Low-Level Laser Therapy has beneficial effects on tinnitus.
1 – Walker JB, Akhanjee LK, Cooney MM, et al. Laser therapy for pain of rheumatoid arthritis. Clin J Pain 1987;3(1):54-9.
2 - http://www.dr-wilden.de/en_praxis/11.html
3 – Dehkordi MA, Einolghozati S, et al. Effect of low-level laser therapy in the treatment of cochlear tinnitus: A double-blind, placebo-controlled study. ENT – Ear, Nose & Throat Journal, January 2015; Volume 94, No. 1:32-36.
4 – Han A, Sejna I, Stolbova K, Cocek A. Combined Laser – EGb 761 Tinnitus Therapy. Acta Otolaryngol Suppl 2001;545:92-3.