Low Level Laser Therapy for Tinnitus
By Barry Keate
Low Level Laser Therapy (LLLT) for tinnitus has been practiced for about 20 years in Europe and is beginning to be recognized and practiced in the US. There are indications it is very helpful for tinnitus and other inner ear conditions. There are also many conflicting reports that show no benefit whatsoever. I will present both sides of this issue and we’ll see if we can make some sense of it.
LLLT was first developed for inner ear diseases by Uwe Witt, MD of Hamburg, Germany in the 1980’s. Lutz Wilden, MD, of the Center for Low Level Laser Therapy in Bad Fussing, Germany developed it further and brought it to a wide range of patients. Dr. Wilden’s central thesis is that laser energy in the red and near infrared light spectrum is capable of penetrating tissue. It stimulates mitochondria in the cells to produce energy through the production of ATP (adenosine triphosphate). Mitochondria are the power supplies of all cells; they metabolize (burn) fuel and produce energy for the cell in the form of ATP. In stimulating the mitochondria, laser therapy can repair damaged tissue and return cells to a healthy state, reversing many degenerative conditions.
We know the importance of cell mitochondria from our investigations of neurotoxins and what can be used to reverse their effects. A discussion of mitochondria occurs in the second half of a previous Quiet Times article about neurotoxins and how to prevent or reverse neuronal damage. In this article, Michael Seidman, MD discusses the effects of Acetyl-L-Carnitine (ALC) and Alpha Lipoic Acid (ALA) on hearing loss, stating that “ALC and ALA reduce age-associated deterioration in auditory sensitivity and improve cochlear function. This effect appears to be related to the mitochondrial metabolite ability to protect and repair age-induced cochlear damage, thereby unregulating mitochondrial function and improving energy producing capabilities.” This article can be seen by clicking here.
If Low Level Laser Therapy stimulates mitochondria to produce more energy, it could be exptrapolated that it might also help repair damage to the cochlea and restore some degree of hearing loss, thereby reducing tinnitus. Clearly further research is needed.
Dr. Wilden applies this therapy using multiple lasers which are used simultaneously on each patient. The lasers emit dual wavelength beams which are red and near infrared. These laser beams are cool to the touch and do not cause discomfort. They are aimed into the auditory canal and through the mastoid bone behind the ear. The wavelength nature of these lasers allows them to penetrate tissue. Although the laser beams loses intensity rapidly, these lasers can have an effect on tissues 2 to 5 cm inside the body.
The patient is in a comfortable position; the lasers are carefully aimed and turned on. Each treatment session lasts 60 minutes and typically there are 10 sessions conducted over a period of 10 to 14 days.
Since 1991, Dr. Wilden has treated 800 inner ear patients with LLLT. He claims a high level of success and states that “even serious impairments, such as the most excruciating cases of tinnitus and Meniere’s can be considerably alleviated and even healed with the aid of modern light technology and the corresponding medical management.”
Dr. Wilden has not provided convincing clinical trials that prove his thesis. I have searched the National Institute of Health database (PubMed), for clinical trials. There are quite a few available although none were authored by Dr. Wilden. There was an article by him published in the Journal of Clinical Laser Medical Surgery in June of 1998. It was concerned with therapeutic low-level laser and its effect on mitochondrial energy transfer. There was nothing in the article about hearing or tinnitus.
A clinical trial can be found on his website titled “Results of high dosage low level laser therapy by Dr. Wilden in children and young adults with defective hearing.” This paper was presented at the 25th Anniversary meeting of the American Society for Laser Medicine and Surgery (ASLMS) in Lake Buena Vista, FL in April, 2005. The trial was conducted on 19 patients with an average age of 12 years old who had defective hearing from a variety of causes. This is a very small number of patients and it may be difficult to provide sound statistical analysis of the study. The bulk of the material consists of audiograms conducted before and after treatment. The audiograms by and large show dramatic improvement in hearing thresholds. Despite the small size of the study, this is highly encouraging and demonstrates that there is a real change in hearing using LLLT.
There are also the negative studies, and these are quite numerous. I examined a total of nine other clinical studies of which 7 were negative and 2 were positive. I noticed one overriding fact about these studies: In all cases, the amount of time spent with the laser was far less than in those who received treatment from Dr. Wilden. In many instances the treatments were also spread out much longer. Remember that Dr. Wilden treats his patients for 60 minutes each session and conducts 10 sessions over 10 to 14 days. Typical of these negative studies, patients were treated for only 6 to 10 minutes per session and some were treated only once per week.
Dr. Wilden radiates his patients for a total of 600 minutes over 2 weeks. The other authors treat their patients for a total of perhaps 60 to 100 minutes and may spread this over a period of several months. An obvious disparity exists in chosen treatment times and dosages.
There are two clinical studies that show improvement in tinnitus using LLLT. In both of these studies the patients were also taking Ginkgo biloba extract. Ginkgo is one of the primary ingredients found in Arches Tinnitus Formula® (ATF). One study conducted in Sweden in 2001 and published in Acta Oto-Laryngologica, began treatment with Ginkgo biloba three weeks before LLLT. 120 patients underwent 10 sessions lasting 10 minutes each. This is the low end of session time. At the end of the study there was statistical improvement in 50.8% of the patients. It is quite possible the Ginkgo biloba extract had much to do with the improvement.
Another recent study was conducted by Miroslav Prochazka, MD, in Prague, Czechoslovakia. To my knowledge, this unique study has not been published in any medical journal and the translation is fairly difficult to understand. This study has not been peer-reviewed, a process whereby other physicians in the field review the work for accuracy, completeness and statistical relevance. One of the difficulties of this study is that it employs several treatment modalities simultaneously. Of the 200 patients enrolled, 73% were already using Ginkgo biloba extract. This is not unusual in Europe where most tinnitus sufferers use Ginkgo to reduce symptoms. Another 39% were using Betahistine, also known as Serc. Some 16% were using both, 13.5% used other medications and only 5.5% were not on any medication or supplement. The practice of using several treatment modalities is generally frowned on in clinical studies because it becomes virtually impossible to determine which one is effective.
In addition to this, Dr. Prochazka treated all patients with spinal manipulation and LLLT. He makes no mention of how long each LLLT session lasted but his results were seemingly very, very good. He conducted a placebo controlled study in one group of patients who received sham laser therapy. All participants continued with their medication and received spinal manipulation. In this way he does somewhat separate the effect of the laser treatment.
Dr. Prochazka reports that in the active laser group 16% had no effect at all, 15% had improvement of less than 50% relief, 43% had improvement exceeding 50% and 26% were cured. The total percent improved or cured was 84%. The total percent who received either more than 50% reduction or complete reduction was 69%. This is remarkable and is very favorable compared to the placebo group where 25.8% had no change, 48.4% had improvement less than 50%, 25.8% had improvement exceeding 50% and 0% were cured.
|Dr. Prochazka Findings|
|Less than 50%|
|More than 50%|
Did the LLLT increase the effectiveness of the ginkgo and other medications? There is no way to be certain and only further study will determine if this is the case.
This study is very significant because there is a US company treating tinnitus patients which was founded on this method and for which Dr. Prochazka serves on the board. The company is Advanced Energy Medicine of Daytona Beach in Daytona Beach, FL, and the basis of their treatment is based on thework conducted by Drs. Wilden and Prochazka. They claim to be successors of various European clinics which have treated upwards of 20,000 tinnitus patients with LLLT.
Individual treatment session at Advanced Energy Medicine range from 40 to 60 minutes each. They also say that in many cases the treatment is combined with zinc or B vitamin supplements. Zinc is a primary ingredient in TRF and Arches Tinnitus Stress Formula™ contains a high potency B vitamin complex
So there we have it. There has not been a thorough and rigorous undertaking to determine how effective this treatment can be and to determine parameters for therapy; such as how many treatments at what intervals, how long each treatment should last, and the effect of additional supplements.