LASER LIGHT - SCIENTIFIC EVIDENCE
AND HEARING IMPAIRMENT RESEARCH WITH LASER THERAPY
2002, Michael Zazzio started a global academy for specialists
in the field of LASER treatment of
hearing and balance disorders and neurological abnormalities. The aim
of the academy is to connect specialists so that they can share knowledge
and clinical experiences. Neurological & Audiological Laser Medicine
Consensus Academy, NALMCA, is the
name of the academy, which consists of medical researchers, specialist
doctors, and many more categories of medical staff with experience and
knowledge in LASER therapy with medical LASER. Another aim of the academy
is to speed up the development of new diagnostic and therapeutic methods
so that better results can be achieved in treatment and research.
A. GUNGOR, S. DOGRU, H. CINCIK, E. ERKUL,
the department of otorhinolaryngologi at the Haydarpasa Military Hospital
in Turkey the researchers used a 650 nm LASER. The LASER light was administrated
daily for a week. The patients evaluated their tinnitus symptoms on
a 5 point scale. The study included 66 ears on 45 patients on
patients suffering from chronic unilateral or bilateral tinnitus. Evaluation
was made before and two weeks after finished therapy. The improvements
were in the functional LASER group as follows: 48.8 % had less
loudness, 57.5 % had less duration, 55.5 % had
a lower degree of annoyance. No significant improvement was obtained
in the placebo group. The research team concludes that the LASER method
is useful for the treatment of chronic tinnitus.
CUDA & A. De CARIA
the department of otorhinolaryngologi and tinnitus at the
Guglielmo da Saliceto hospital in Piacenza in Italy the doctors and
researchers used a similar 650 nm LASER for the treatment of tinnitus
as used in the study conducted by Gungor et al in Turkey year 2007.
In Cuda's and De Caria's study LASER therapy was combined with counseling
according to the TRT method. The treatment at the hospital in Piacenza
went on for three months and 61.5 % of the patients in the functional
LASER group got an improvement of their tinnitus. In the same LASER
group 3.8 % experienced a worsened tinnitus. The patients in
the study had at least for three months been suffering from chronic
continuous tinnitus related to cochlear pathology. Patients with psychiatric
diseases were excluded and so were patients who were on medications
that could be suspected to cause the tinnitus symptoms. The study was
prospective, controlled, randomized and double blind. The control group
consisted of patients receiving counseling according to the TRT model
and placebo LASER (non functional LASER). In the placebo
group 35 % had improvements on their tinnitus symptoms while
20 % experienced a worsened tinnitus. The difference between
the groups is significant, p<0.01.
M. ZAZZIO - SCIENTIFIC
ARTICLE THE TREATMENT
Michael Zazzio at the Audio Laser-Kliniken has conducted a clinical study on hyperacusis where the pain thresholds were measured using audiometry before and after the treatment. After completed therapy the pain thresholds were improved for all of the 48 patients in the group. In this second group 83 ears were treated and all of them (100%) displayed improvements. The largest measured average improvement for one ear was 40 dB including all frequencies regarded as hyperacusick before the treatment. An average improvement of 10 dB or more was found in 83.13% of the ears. 444 observations were made and 417 of them improved with up to a maximum of 65 dB. The average hyperacusis improvement (pain threshold improvement) per ear was 15.37 dB, and per observation it was 15.26 dB with a median per ear of 15.00 dB.
Long term follow up 4-6 months after finished therapy consisted of an audiometric hyperacusis test. 13 ears were randomly measured. The 80 observations that were hyperacusick before therapy had been improved for 79 (98.75%) of the observations. The average improvement per observation was 23.19 dB. Every ear improved at least 10 dB on average and the best average improvement was 40 dB.
This study did not include any control group, but the expectation for the spontaneous changes among chronic patients suffering from hyperacusis due to sound trauma could be based upon placebo group results from tinnitus studies. It was assumed that up to 40 % of the observations in a tinnitus treatment placebo group can sense an improvement. Based upon that, three chi square tests on the three different groups in this study display that for all observations, p=5.83·10 exp-120. For short term improvements, p=4.1·10 exp-95. For the long term improvements, p=7.67·10 exp-27. The differences are significant.
Audiometric follow up has shown great improvements for all audiometrically examined patients half a year after therapy. The largest improvement for a single hyperacusis observation is 65 dB.
Zazzio has been lecturing about his hyperacusis study at
above displays audiometrically measured results on 83 ears.
M. ZAZZIO - ADMINISTRATING LASER LIGHT TO THE INNER EAR
In November 2006 Michael Zazzio at the Audio Laser-Kliniken in Sweden irradiated a pig's ear from the outside after dividing the skull of the pig. The tissue sample measured 36 millimeters from the tympanic membrane to the inner incision of the skull. The LASER light passing through the tissue was photo documented. Through the results of the study, it is beyond doubt that LASER light in inner ear therapy gets into the inner ear cochlea through the ear canal, via the tympanic membrane, passing the hearing bones and getting through the shell of the cochlea if the LASER probe is placed correctly and in an optimal position, and if the LASER light is administrated in the right direction.
The LASER used in the scientific LASER light penetration study conducted by Michael Zazzio on the 11th of November 2006 was a collimated 35 mW InGaAlP LASER of 650 nm wavelength. LASER light with a wavelength of just above 800 nm has better penetration ability in tissue than the 650 nm LASER, but the 800 nm LASER light is not as visible to the human eye as shorter wavelengths.
J. OLIVER & P. PLATH - RESEARCH ABOUT TINNITUS TREATMENT
single blind study was conducted in 1991-1992 and published in 1993
by J. Oliver and Prof. P. Plath. The study showed that
LASER therapy in combination with Ginkgo Biloba can have a positive
effect on tinnitus symptoms. The study is one of several studies with
positive effects using LASER. Ginkgo Biloba (EGb 761) was given to 40
patients, 20 in the LASER
treated group and 20 in a placebo LASER group. After
therapy 50% of the patients in the LASER group had their tinnitus diminished
while only 5% among those in the control group had any relief. The
study was published in the medical journal Laser Therapy, 1993, no 5,
table above displays the results from the study by Oliver & Plath.
M. PROCHÁZKA & R. TEJNSKA - RESEARCH ABOUT TINNITUS TREATMENT
Another controlled, randomized, double blind study with even better results was a study conducted in 1999 and presented the same year at the Florence LASER congress. The study was carried through in Prague by Med. Dr. Miroslav Procházka and Renata Tejnska. The study displays that Ginkgo Biloba in combination with LASER reduced tinnitus completely among 26% of the patients in the study. 36% had their tinnitus reduced by more than half, 19% had their tinnitus reduced by up to 50% and only 19% had no effect at all. In total it means that 81% had a noticeable improvement in their tinnitus and 62% of the treated patients had considerable relief of their tinnitus. In the control group where placebo LASER was used, not one single patient was relieved of tinnitus. In the treatment there were much larger doses administrated towards the inner ear than in any recent blind study. The patients were treated during six months. The patients in the LASER group were treated in three treatment series with ten treatments per series. The randomization was based upon coincidence, which in this case meant that what group the patients would be part of depended on which LASER device was free when they arrived for their first treatment. The patients didn't know if they received true LASER or placebo LASER, and neither did the therapists. The LASER manufacturer Medicom revealed what was LASER and what was placebo LASER after finishing the study and breaking the code. The study has been published on the Internet together with many other controlled LASER studies.
results of the controlled,
double blind LASER therapy
study conducted by Miroslav
Procházka & Renata Tejnska.
M. PROCHÁZKA & A. HAHN - RESEARCH ABOUT TINNITUS TREATMENT
Laser Rehabilitation Therapy of Tinnitus: Long-Term Double Blind Study
in a Group of 200 Patients in 3 Years
Miroslav Procházka, Med. Dr., Private Rehab Clinic Jarov,
Prague, CZ and PhD, Med. Dr. Ale Hahn, Head of the ENT Clinic,
FNKV Faculty Hospital, Prague, CZ present even better results than in
Procházka and Tejnska's first tinnitus study. Procházka
and Hahn's study is carried through over a longer period of time and
also includes many more patients than the first study. The second study
also displays that patients getting a small but obvious positive treatment
effect after one treatment period in many cases get an improved treatment
effect after repeated therapy. These therapeutic experiences are shared
by all doctors who are today using the LASER therapy method on inner
ear patients. Ale Hahn has also conducted a LASER treatment study on
tinnitus symptoms. A link to this extended tinnitus study by Miroslav
Procházka and PhD Ale Hahn is found at Laser
The table above displays the results of the controlled, double blind LASER therapy study on tinnitus symptoms conducted by Miroslav Procházka & Ale Hahn.
Miroslav Procházka is lecturing about the LASER therapy
method for the treatment of tinnitus. He is also reporting his observations
in tinnitus treatment in Case Histories of Patients Suffering from
Tinnitus Treated by Comprehensive Rehabilitation Therapy Including LLLT.
M. QUITTNER - RESEARCH ABOUT TINNITUS TREATMENT
Mark Quittner, in a clinical study during the summer of 2004, treated 32 patients whose tinnitus symptoms were evaluated before and after therapy. In the study 29 (91%) of the 32 patients had diminished tinnitus symptoms after repeated LASER treatment sessions. The best results were found among the patients who received 240-480 J. The article describing the study was published in 2004 by the Swedish Laser Medical Society in Laser World as Guest Editorial.
Zazzio has together with Bill Verran and Mark Quittner
been planning a double blind, controlled, randomized study with a control
group. If and when the study will be carried through has not been decided.
Permission to start the study has not been received.
Y. SHIOMI - RESEARCH ABOUT TINNITUS TREATMENT
study, carried through at an otolaryngology department at a medical
institute in Kyoto in Japan in 1997 by the researchers Yosaku Shiomi,
Takahashi, Honjo, Kojima, Naito and Fujiki, displayed that tinnitus
therapy with LASER had a positive effect on more than half of the patients
in the study. The LASER light was administrated towards the cochlea
via the hearing canal, and the conclusion was that LASER is worth trying
on patients suffering from tinnitus symptoms. 55% of the patient population
in the study had a diminished effect from the LASER treatment and no
permanent or serious complications were observed. In the study, 26%
of the LASER-treated patients had a permanent improvement in their tinnitus
despite the low LASER doses administrated (21 Joule).
Y. SHIOMI - RESEARCH ABOUT COMPOUND ACTION POTENTIAL
study measuring CAP (Compound Action Potential) was also carried through
in Kyoto, Japan in 1995 by Yosaku Shiomi. The study was made
on ears from a guinea pig and displayed that LASER exposure of the cochlear
hair cells had an immediate effect on the impulse flow in the nerve
cells. When the LASER light was turned off the impulse flow went back
to normal levels. The
changing in impulse flow proves that immediate processes take place
in the inner ear when it is irradiated by LASER light.
RESPONS IN LASER THERAPY
ON THE INNER EAR
Siedentopf and his colleagues at the Department of Radiology II, Division
of Neuroradiology, University Hospital of Innsbruck in Austria investigated
using a using functional MRI whether LASER therapy for inner ear therapy
has any influence on the central nervous system. The laser stimulation
device was placed on the tympanic membrane of both ears. A LASER stimulation
run and a placebo run were performed in random order. The LASER run
had a clinically measurable effect on the central nervous system. The
placebo run didn't have that effect. The result in the study was significant.
This could very well explain why many patients experience effects from
LASER therapy already after the first treatment sesion.
The aim of the study was to investigate the presence of
symptoms and signs of temporomandibular disorders (TMD) in patients
with tinnitus and to evaluate the effect of TMD treatment on tinnitus
in a long term perspective in comparison with a control group of patients
on a waiting list. 43% of the patients reported that their tinnitus
was improved at the 2-year follow up, 39% that it was unchanged, and
17% that it was impaired compared to before the treatment. 12%
of the subjects in the control group reported that their tinnitus was
improved compared to 2 years previously, 32% that it was unchanged,
and 56% that it was impaired.
table above displays how common it is that
tinnitus symptoms are worsened and how rarely tinnitus symptoms improve.
The study was conducted at the Department of Clinical Oral Physiology,
Institute of Odontology, Karolinska Institutet, Huddinge, Sweden.
A. IZZO - LASER STIMULATION OF THE AUDITORY NERVE
hearing nerve was stimulated with LASER with a dose of only 0,015- 0,021
J/cm². The compound action potential (CAP) was affected by LASER
light. The researchers demonstrated that the auditory nerve can be stimulated
by optical radiation. One potential clinical use of this technology
would be for cochlear implants. In
a following study the research team has verified optical parameters
such as pulse duration, repetition rate and wavelength to be important
factors for tissue penetration depth and for the positive effects in
cochlear nerve cells.
S. TAUBER - RESEARCH ABOUT TINNITUS TREATMENT
In a controlled,
double blind study published in 2001 by Stefan Tauber, A. De
Nigris, K Schorn, R Baumgartner, and W Beyer at the institution of otolaryngology
at the Ludwig-Maximillian University in Münich, LASER therapy using
630 nm, 690 nm and 830 nm wavelengths had a positive effect on tinnitus
symptoms. In the study every patient received LASER light during
only three treatment sessions. Despite that, between 20 % and 40 % of
the patient population had a diminished tinnitus in the groups receiving
LASER from these wavelengths. Not one single patient of the 125 patients
in the study was negatively affected by the treatment. The study also
included a light dosimetric analysis measuring how much of the administrated
LASER light is reaching the cochlea when the LASER light is administrated
via the ear canal. Different LASER light frequencies were absorbed differently
on their way to the sensory cells of the cochlea.
S. TAUBER - RESEARCH ABOUT TINNITUS TREATMENT
In 2003 Stefan
Tauber, K Schorn, R Baumgartner, and W Beyer presented another positive
study on the positive effects of LASER light on tinnitus symptoms. In
this study the patients received LASER therapy on five occasions, and
after six months a follow up procedure was made on the tinnitus symptoms
of the patients. 13 out of 35 patients (37%) still had improvements
in their tinnitus symptoms six months after the treatment. 2 patients
got rid of their tinnitus symptoms. These results were measured despite
the few treatment sessions and despite the fact that the evaluation
was made six months after finished therapy.
T. KARU - RESEARCH ABOUT LASER THERAPY
A combination of 635 nm and 820-830 nm LASER light is, according to studies conducted by Prof. Tiina Karu, in a positive way affecting both RNA synthesis, DNA synthesis and the cell contact between cells. The cell repair work is stimulated by LASER light. If 820-830 nm LASER light is excluded in therapy, the effects in the RNA synthesis in the cells brings along that the transport function via the cell membranes is not as much stimulated as if they are used. If 635 nm LASER light is excluded, the positive effects in DNA synthesis affect the dividing rate of the cells. The cell contact between cells is stimulated by both wavelengths. Also, the ATP production is affected positively by LASER light. These effects have a major importance for cell respiration and for many processes in the cells and their ability to function normally. Apart from the work of Tiina Karu there are hundreds of LASER studies describing processes that support cell repair.
A. HAHN - RESEARCH ABOUT TINNITUS TREATMENT
A tinnitus study conducted by PhD. Med. Dr. Ale Hahn, I Sejna, K Stolbova, A Cocek at the Karlovy University Hospital in Prague, the Czech Republic showed an improvement of tinnitus symptoms for 50,8% of the LASER treated chronic patients, suffering from tinnitus for more than 10 years. The study was published in Acta Otolaryngol 2001.
Hahn's study was
divided into three groups. A comparison was made between LASER
and Ginkgo Biloba. The study was based upon the Lurias scale. Each patient
had a start value of their symptoms of the value 10. The evaluation
was made after both three and six weeks after starting the treatment
and the results are displayed in the table below.
The controlled study of Ale Hahn where tinnitus symptoms were treated with LASER and Ginkgo Biloba. All groups in the study were improved. In the combined Ginkgo Biloba / LASER group the improvements were found to be the greatest. Every group consisted of 35 patients.
Zazzio has together with Ale
Hahn been discussing and planning several
L. WILDEN - RESEARCH ABOUT HEARING TREATMENT
Wilden is the pioneer in LASER therapy on inner ear diseases who
showed that large doses of LASER light were more beneficial than low
doses administrated in earlier LASER studies. Lutz Wilden has
shown that larger doses have a positive effect on a larger number of
patients suffering from hearing impairment than smaller LASER light
doses. Lutz Wilden has together with Dirk Ellerbrock conducted
a study on patients with impaired hearing. The study was carried through
with large doses of LASER light and displayed good results. The hearing
capacity was improved for patients suffering from hearing impairment
with an average of 7,8 dB after twelve treatment sessions
on the approximately 400 ears that were treated in the study. The studies
of Lutz Wilden also display that tinnitus symptoms are diminished or
disappear for many patients who are treated with LASER light. Lutz
Wilden has together with D. Dindinger conducted a positive
clinical study on LASER treatment of tinnitus symptoms. Lutz Wilden
has in research also been pointing out processes in the mitochondria,
processes related to the increase of cell energy production when
LASER light is administrated. In
another study, Lutz Wilden has together with R. Karthein
been studying LASER
therapy on tinnitus symptoms. 67%
of the patients got better in their tinnitus symptoms.
P. MARTI - RESEARCH ABOUT TINNITUS TREATMENT
In 2001 Peter
Marti made a pilot study with the combined method including LASER
therapy, electromagnetic therapy and negatively ionized oxygen ions.
The study was conducted on 18 patients suffering from tinnitus symptoms.
In the study 61% got rid of their tinnitus symptoms, another 33%
had an obvious improvement in their tinnitus and 6% had a minor improvement.
94% of the patients had a major improvement or got rid
of the symptoms. All patients in this pilot study had improvements.
The study included 16 treatments per patient. Every treatment
session lasted approximately 40 minutes. The LASERs emitted 830 nm and
635 nm wavelengths of LASER light and were administrated via the ear
J. HUBACEK - RESEARCH ABOUT TINNITUS TREATMENT
Hubacek has been reporting his LASER medical experiences from
otorhinolaryngology in "Experience with the use of LLLT in ENT
Medicine". In the report there are two groups consisting of
60 tinnitus patients, 30 in each group. The patients were treated
with LASER from 10 to 30 sessions. 35% of the treated patients got rid
of their tinnitus, and 40% had their tinnitus symptoms reduced. There
were no treatment effects on tinnitus for 25% of the treated patients.
R. JUBERG - RESEARCH ABOUT TINNITUS TREATMENT
been treating patients
in Molde in Norway in cooperation with Ingunn Rogne at "Tinnituskontakt"
Møre og Romsdal and Harald Søbstad, the leader of "Kristiansund
og Omegn Hørselsforening".
The study shows that 87% of the treated patients had a noticeable
change in their tinnitus and 60% of the patients had a great reduction
(more than 40% reduction) of their tinnitus. 13% didn't receive any
U. WITT - RESEARCH ABOUT TINNITUS TREATMENT
are many studies supporting positive effects after using LASER therapy
on inner ear disorders and ear-nose-throat-dysfunctions, and there are
many reports from doctors in private practice. Med.
Dr. Uwe Witt has collected the following results for a report:
Med. Dr. Uwe Witt, Hamburg
G. WENZEL - HEARING IMPROVEMENT WITH LASER THERAPY
In Texas, U.S.A., a group of researchers have shown that collagen structures in the cochlea and the basilar membrane correct their birefringence instantly after LASER light exposure. The researchers believe that this is a very possible reason for hearing improvement in the higher frequencies. In another study it is concluded that LASER light doses of 180 J/cm² has a better treatment effect than LASER light doses of 15 J/cm².
F. ANDERSEN & C. DETERVILLE, IHA-GfK AG - LASER THERAPY ON TINNITUS
an investigation on 79 LASER treated patients in Switzerland, treated
for their tinnitus, 94
that they had become better from LASER therapy. The investigation
was conducted year 2005.
A. FLOCK - LASER THERAPY DOES NOT DAMAGE THE INNER EAR HAIR CELLS
At the Karolinska institutet in Solna / Stockholm in Sweden professor Åke Flock, Brita Flock and Eric Scarfone displayed that extremely high doses of LASER-light didn't damage the inner ear cells despite the fact that the shell (the cochlear bone) of the inner ear, constituting a somewhat protective barrier, had been removed and the inner ear hair cells therefore were directly exposed to the intense LASER-light.