Low-Level Laser Therapy (LLLT) for Tinnitus — Efficacy Debate

[dboy]

Maybe my lengthy post last night was too personal. I guess the rudeness got to me.

This topic is unhealthy and not a good use of anybody's time. Tinnitus Talk should be a supportive and positive place, not a stomping ground for competing egos. I'm gonna take a break from the forum.

Best wishes all.

 

[amandine]

Maybe my lengthy post last night was too personal. I guess the rudeness got to me.

This topic is unhealthy and not a good use of anybody's time. Tinnitus Talk should be a supportive and positive place, not a stomping ground for competing egos. I'm gonna take a break from the forum.

Please dont back off from this forum. I personally find your comments educated informing and enriching.
Perhaps the best thing to do is to accept that there are people who always want the last word (even yourself?) and sometimes it is better to let the last word not be yours or let the last word be another persons. It doesnt matter does it really who has the last word so long as you feel you have stated your case.
So please stay with us....
thanks

 

[Dr. Nagler]

The LLLT "User Experience" thread really frightens me:

https://www.tinnitustalk.com/threads/low-level-laser-therapy-lllt-for-tinnitus-—-experiences-dr-wilden-etc.295/

There is such a wealth of poor information there that is posted totally unchecked. I consider the thread to be dangerous.

stephen nagler

 

[RichL]

On the contrary, your opinions are not of great importance to me and I have no problem whatsoever with you having them. But I think what you are really asking me (neglecting the tone of the offended party) is why I have felt compelled to argue with you in this thread. That is a complicated question, but I'll take a shot at it since you asked.

First, I'm going to state my formal qualifications to offer an opinion since you apparently make much of such things. I started my university education in science subjects, so I know a little about how that works. But I then moved into humanistic psychology and psychotherapy, critical theory and philosophy. I am a doctor too in those worlds. I have taught on university courses and have been published in the field of ethics. In those areas of inquiry, intellectual rigour tends to be evidenced by how you argue. So while your field might involve looking at scientific studies, mine involves looking at how texts and arguments work and understanding what goes on behind them (assumptions, psychology, etc.).

So let me say that there are ways of conducting a discussion that respect the intelligence and the decency of the person or persons that you are discussing with. And, of course, there are other ways – ways that I have seen used repeatedly by yourself (and occasionally others) in debating against LLLT both on this forum and to an even greater extent on the Yuku forum. They involve bluff, bluster and belligerence. They involve subtly twisting the things that people say to turn those things against them and score points – without a care for how this makes them feel. They are ugly and callous: the arts of the political spin doctor rather than the seeker after truth. Having spent many hours reading through these threads when researching LLLT I began to become personally offended on behalf of the people who did not share your opinion, and who were treated as idiots. Just one relatively minor example: the ridiculous Nobel Prize argument that you now claim was 'tongue-in-cheek' but which was used repeatedly to obstruct meaningful discussion.

For a short while this lapsed. Some new contributors came along who had tried the treatment and experienced benefits. They shared their experiences and points of view in a generous fashion. They were not sycophantic to Dr Wilden since some doubts and some criticism of him was offered alongside the reports of benefits. The thread became more interesting and interest in the thread picked up… which inevitably meant that the battles had to begin again.

I suggested splitting this debate thread off from the support thread because of the fear that your voice would intimidate or drown out those who were reporting their experiences and that they would drift away. Ask yourself why a newish member to the forum (someone who came here to share and to help people) would write things like this:




I never intended to get involved in the 'debate' at all. But I saw holes in what you were saying and I asked you a simple question. And it must have touched a nerve because you proceeded to throw your toys out of the pram in much the same fashion as you did yesterday.

So by then I was involved – and like you I find it hard to walk away. I tried my best to argue rationally and respectfully. Indeed, I made very real efforts to be friendly about it so as not to upset your ego again. I really don't want to spoil anyone's day. But you made no such efforts, so of course my frustration grew. Look at the effort and thought that ATEOS must have put into this post:

Now look at how you responded. You effectively told him that his time was worthless to you. How do you think that makes him feel? Imagine it again and again.

After a while all this gets too much. It gets under a person's skin. Yesterday I was weak and I was tempted to the dark side. I settled for scoring cheap points the way that you do instead of aiming for rational discussion. By then I saw that rational discussion was futile. I am not proud of what I did (slightly ashamed if I am honest) since I reduced myself in the process. But you know what? I showed you how it feels.

Here is the punchline: I don't even have a strong opinion about how well LLLT works. My best guess is that it helps a few folks quite a lot and most folks a bit or not at all. Much like TRT probably does. Only a guess. But there's one thing that I know for sure doesn't work – and that is how you argue. It proves nothing and it makes people feel like s***.

You do some great work in the doctor's corner and are an asset to the forum in many ways. This post took me some time to write. Please do not lose any sleep over it, but please do think about it rather than just giving me a trite come back and feeling pleased with yourself. I took this trouble because I've been an a**hole many times in my own life, and because I trust and I hope that (like I try to be) you are a man who has the capacity to care about others and to grow.

Dr. dboy.

I just wanted to agree x10, but TT's rating doesn't allow it so I had to comment it!

 

[RichL]

Thank you for your concern. But no, I actually do not feel offended at all by the limited response from @Dr. Nagler.

The lack of content...

...simply means I won the debate.

If ever there was one. A debate, that is...

attheedgeofscience
20/JAN/2015.

I've won a couple of debates with the good doc too!

 

[dboy]

Please dont back off from this forum. I personally find your comments educated informing and enriching.
Perhaps the best thing to do is to accept that there are people who always want the last word (even yourself?) and sometimes it is better to let the last word not be yours or let the last word be another persons. It doesnt matter does it really who has the last word so long as you feel you have stated your case.
So please stay with us....
thanks

Amandine, your post is very kind and very much appreciated. Rest assured that I was definitely including myself in what I said about competing egos. That was why I felt it would be good to take a break and cool off. But (if it is not too inappropriate to quote Arnie)... "I'll be back."

& Thanks also @RichL.

 

[attheedgeofscience]

There is such a wealth of poor information there that is posted totally unchecked. I consider the thread to be dangerous.

Could you be more specific Dr. Nagler? What exactly is it that "frightens" you? TinnitusTalk is not a place where the posts are supposed to live up to the same high standards of academia that professors of recognized institutions operate by, for example.

The best way to address concerns in a forum such as this is via debate. Any reasonable point of concern is more than welcome. Here or elsewhere...

 

[Dr. Nagler]

Could you be more specific Dr. Nagler? What exactly is it that "frightens" you? TinnitusTalk is not a place where the posts are supposed to live up to the same high standards of academia that professors of recognized institutions operate by, for example.

This has nothing to do with standards of academia.

I am not going to go through the posts that disturb me one-by-one, but for example playing with various laser wavelengths and technologies on your own in an attempt to achieve tinnitus relief is one cause for concern. Same with recommendations for the use of hormonal agents. I fully realize that Tinnitus Talk has disclaimers and such, with warnings to always check with your own doctor. But all that does is protect the owners of the board from lawsuit; it doesn't do a thing for somebody who reads something here and follows the suggestion purely on its face value in spite of recommendations to the contrary.

The best way to address concerns in a forum such as this is via debate.

I'm not interested in debating. I simply expressed a concern.

stephen nagler

 

[bwspot]

but for example playing with various laser wavelengths and technologies on your own in an attempt to achieve tinnitus relief is one cause for concern

This I agree with. I believe that if one is planning to give it a try, it needs directions from somebody who understands the treatment. I believe those who practice laser therapy, understand what they do and just don't play with frequencies.

 

[Dr. Nagler]

I believe those who practice laser therapy, understand what they do and just don't play with frequencies.

Well, that would be another thing that bothers me. Are laser therapists credentialed in some way? If so, what legitimate organization does the credentialing? Is there any standardization? Any checks and balances? How is the public protected in that regard?

You of course know that I think LLLT for tinnitus is totally worthless - but what if I'm wrong? And what if the effects are somehow dose-related. More to the point, what if too much can actually cause some serious irreversible damage?

I just think those promoting LLLT on this board are being way too cavalier about it and are not considering the consequences. And that frightens me.

It also frightens me that this point cannot be raised in the thread where all the LLLT promoting is taking place.

stephen nagler

 

[Vincent R]

Let us assume that there's a suggested cure for a medical problem that turns peoples lives into hell, which is expensive and so far not scientificly verified. Let us also assume that it's debated on an Internet message board. Would it be reasonable to suspect it to be heavily questioned or not?

I'm interested in the experiences of people who try out LLLT, and I'm more than just a little excited about the possibility of regnerated inner ear cells. But I have no problem of what so ever to understand where the sceptics are coming from.

My humble point is this: If you read this your on the Internet. Don't take anything personal, don't share your credit card number, and if you watch porn erase your browsing history before you let your kids visiting friend lend your computer to check his e-mail. People who try LLLT should keep telling us how it works out, and those who think it's a scam should keep pointing out why. There's no guarantee this will make us any wiser but as long as we don't get dumber it's all good.

 

[bwspot]

Well, that would be another thing that bothers me. Are laser therapists credentialed in some way? If so, what legitimate organization does the credentialing? Is there any standardization? Any checks and balances? How is the public protected in that regard?

You of course know that I think LLLT for tinnitus is totally worthless - but what if I'm wrong? And what if the effects are somehow dose-related. More to the point, what if too much can actually cause some serious irreversible damage?

I just think those promoting LLLT on this board are being way too cavalier about it and are not considering the consequences. And that frightens me.

It also frightens me that this point cannot be raised in the thread where all the LLLT promoting is taking place.

stephen nagler

I had two root canals in USA performed by professionals. I asked them many times if I needed it as I did not have any pain. Both dentist were professionals with credentials and expertise performed the procedure just to make money. Since then I always had problems with both teeth. I went through nightmare with insurance companies. I had to pay out of packet for the retreatments. The dentist who performed the procedure and incorrectly diagnosed me are not liable and all they say is that they performed the procedure and the fact I proved to them that it was done incorrectly does not mean anything. So those so called credentials means nothing to me. I have seen so much harm done to poor people and my dear friends so many times that I have more belief in natural medicine then the cut and drug approach. It is very sad and frustrating.

 

[Dr. Nagler]

It is very sad and frustrating.

Sad and frustrating, no doubt.

But to condemn the entire credentialing process because you had an awful experience in the hands of a couple of credentialed dentists is to my way of thinking just a tad bit illogical.

Say you need to have open heart surgery tomorrow. Behind Door #1 is a Board-Certified cardiac surgeon and behind Door #2 is a rodeo clown who claims to be a cardiac surgeon. Please don't tell me that you'll just flip a coin to choose.

All I am saying here is that the credentialing process protects the public. Is it perfect? If course not. You can have a horrible outcome in anybody's hands.

So who credentials these LLLT gurus? Can anybody buy a machine and open a clinic?

stephen nagler

 

[bwspot]

Say you need to have open heart surgery tomorrow. Behind Door #1 is a Board-Certified cardiac surgeon and behind Door #2 is a rodeo clown who claims to be a cardiac surgeon. Please don't tell me that you'll just flip a coin to choose.

Both dentist were professional and acted like rodeo clowns.
I have tons of experiences like that, not just with dentists.

So who credentials these LLLT gurus? Can anybody buy a machine and open a clinic?

It seems like in Europe they can.

 

[Kevin08]

I've been following this thread for a long time and have really enjoyed reading the ongoing debate. When people are desperate they will take desperate measures. I've had first hand experience with cold laser therapy to aid in the healing of nerve damage and I felt it helped. That being said, I don't think I'd buy one of these and start messing around and after reading the last few messages I did a quick Google search and came up with this http://www.ctvnews.ca/w5-investigation-the-painful-side-to-laser-skin-treatments-1.759779 not sure if this is the case everywhere but it does give cause for concern. All of the Laser companies are selling franchises to anyone with the money. I was considering trying this for my ears but now I think I'll move on to some other less risky methods. I was thinking of training to be a rodeo clown as when I'm hiding it that barrel or running from a bull I bet my tinnitus would be hard to notice.

 

[attheedgeofscience]

That being said, I don't think I'd buy one of these and start messing around and after reading the last few messages I did a quick Google search and came up with this http://www.ctvnews.ca/w5-investigation-the-painful-side-to-laser-skin-treatments-1.759779 not sure if this is the case everywhere but it does give cause for concern.

The lasers mentioned in the article - and which are responsible for scarring amongst other things - are not cold lasers (or LLLT as this thread is about).

 

[Dr. Nagler]

The lasers mentioned in the article - and which are responsible for scarring amongst other things - are not cold lasers (or LLLT as this thread is about).

I agree.

So do you believe that LLLT lasers can be used with impunity (i.e., that they present no risk whatsoever to the patient)?

stephen nagler

 

[attheedgeofscience]

So do you believe that LLLT lasers can be used with impunity (i.e., that they present no risk whatsoever to the patient)?

No. As with most medical interventions - pharmaceutical or otherwise - dosage plays role. As long as a person is treated with the correct dosage levels, I would easily rate LLLT as one of the safest therapies available in medicine. For instance, when I was a kid suffering from semi-severe eczema on the feet, the standard treatment was topical steroids (still is some 30 years later). A "dose or two" of LLLT and it would have been gone with no side-effects (something I know today). Instead, back then, I would manage to finish several 50 gram-tubes of a level-III steroid called Diproderm. Just an example to put things into perspective...

As for dosage and LLLT, I mentioned this in the following post of mine:

https://www.tinnitustalk.com/threads/low-level-laser-therapy-lllt-for-tinnitus-—-experiences-dr-wilden-etc.295/page-17#post-86565

As I have already pointed out in another post, this forum only requires members to adhere to the netiquette of the forum - which essentially means that anyone can post incorrect information (as informational correctness per se is not part of the netiquette rules). One way to counter that "problem" and keep the thread on topic is via "debate" (as opposed to having a netiquette allowing posts with incorrect information to be removed).

 

[Dr. Nagler]

So, @attheedgeofscience, since you feel that dosage plays a role in safety, do you think credentialing would be important for the public to have some sort of reasonable assurance that the LLLT guru knows what the hell he or she is doing? And where does that leave all the doses for self-LLLT touted so authoritatively in the other LLLT threads, where such concerns cannot be raised? Ya can't "debate" issues like this in a thread that doesn't permit the other side to offer an opinion. I mentioned that this sort of thing caused me great concern ... and my post was immediately moved from there to here.

stephen nagler

 

[attheedgeofscience]

So since you feel that dosage plays a role in safety, do you think credentialing would be important for the public to have some sort of reasonable assurance that the LLLT guru knows what the hell he or she is doing?

I would highly appreciate that whoever carries out the therapy (i.e. LLLT) has the necessary credentials - which is also why I personally chose to go see Dr. Wilden (as opposed to his son or some other therapist who does not have an MD-background). I would also highly appreciate that the therapy comes with a certain degree of efficacy (so that patients don't waste their money).

And where does that leave all the doses touted so authoritatively in the other LLLT threads?

I don't know Dr. Nagler - and as such, I do not know why you ask me that. I am not the referee here. And I am not affiliated with LLLT in any way, either. Yes, I am generally pro-treatment as opposed to pro-habituation (that's no secret). I would love to have a proper double blind study done on LLLT. The reason I appear - to some - to be favouring LLLT is because tinnitus is a heterogeneous condition and consequently we should not expect all therapies to work equally well (as an example, you yourself reviewed the phase-II results of AM-101 and found that it only appeared to help with a subset of cases i.e. the medical investigators had to dissect the data in order to find something of clinical relevance). Because LLLT affects hearing thresholds, I therefore suspect that a similar weak overall correlation may be found between LLLT and tinnitus - a correlation which would become more evident if enough participants were to be subject of a clinical trial with the right dosage levels and treatment duration. You have several times said of LLLT and tinnitus that "either it works or it does not" (or words to that effect*). That is unlikely to be the right mindset when approaching conditions such as tinnitus (for the reason already mentioned). And it is a matter that I have already discussed with TRI in relation to the study of Trobalt, for instance.

I leave the following quote as a source of inspiration (and knowledge) from one of the pioneers of science - and as a reminder that all results in medicine are potentially significant.

"I have been trying to point out that in our lives chance may have an astonishing influence and, if I may offer advice to the young laboratory worker, it would be this - never to neglect an extraordinary appearance or happening."
--Alexander Fleming, biologist, discoverer of penicillin, and Nobel Prize winner

*

I try to keep things simple. If LLLT worked for tinnitus (after all, that's what we're talking about here), then by now there ought to be at least one reliable and independently verifiable double-blind randomized prospective placebo-controlled study attesting to its efficacy published in juried scientific journal. Such a study would be incredibly simple to design. And if legitimate, the major journals would be crawling over each other to publish it.

 

[attheedgeofscience]

Ya can't "debate" issues like this in a thread that doesn't permit the other side to offer an opinion. I mentioned that this sort of thing caused me great concern ... and my post was immediately moved from there to here.

I cannot answer your question; it was not my decision to split the threads.

 

[Dr. Nagler]

Yes, I am generally pro-treatment ...

So am I. But I am not at all pro-scam.

Which just about brings us full circle on this topic ... so I'll leave it with you.

stephen nagler

 

[bwspot]

@Dr. Nagler
Let's say somebody from this forum tries lllt and after some time gets relief from tinnitus meaning going completely away and at the same time gets improved hearing proved by audiograms. Would you still call it a scam or would you give credit to lllt or would you just call it pure coincidence or anecdotal evidence?

 

[Dr. Nagler]

@Dr. Nagler
Let's say somebody from this forum tries lllt and after some time gets relief from tinnitus meaning going completely away and at the same time gets improved hearing proved by audiograms. Would you still call it a scam or would you give credit to lllt or would you just call it pure coincidence or anecdotal evidence?

What you describe is a classic example of anecdotal evidence. It's not a question of where the "credit" goes. Anecdotal evidence is a real event, not a fairy tail. All the term means is that it does not in-and-of-itself have predictive value. In order to have predictive value, what you need is a study. The higher the quality of the study, the greater the predictive value.

stephen nagler

 

[bwspot]

What you describe is a classic example of anecdotal evidence. It's not a question of where the "credit" goes. Anecdotal evidence is a real event, not a fairy tail. All the term means is that it does not in-and-of-itself have predictive value. In order to have predictive value, what you need is a study. The higher the quality of the study, the greater the predictive value.

stephen nagler

thx, now I understand better the meaning of anecdotal evidence, which can be good but not necessary good evidence for a specific treatment.

 

[Dr. Nagler]

thx, now I understand better the meaning of anecdotal evidence, which can be good but not necessary good evidence for a specific treatment.

Right. The word "anecdotal" in science does not carry the same implications as "anecdote" does in general usage.

But for a moment, let's get back to the issue of credentialing. You posted that based on your experience, credentialing means nothing to you. So I asked you if you needed heart surgery and had the choice between a Board-Certified cardiac surgeon and a rodeo clown claiming to be a heart surgeon, which would you choose.

Well, in spite of your flippant response, I think it's obvious that you would choose the Board-Certified surgeon. At least I hope you would. So credentialing does mean something to you.

The real concern here is the lack of legitimate credentialing of LLLT practitioners. I found a place on the Internet where an LLLT practitioner can "buy" credentials - but that does not offer the public any assurances. Point is - in contradistinction to cardiac surgeons (where there is a formal rigorous credentialing process designed to protect the public), with LLLT the process (where it exists at all) is designed to churn the system at the expense of the public.

As your own expedience has shown, no credentialing process can offer absolute 100% guarantees of quality work and perfect outcomes, but the fact that the LLLT practitioner community pays little more than lip service to credentialing is very telling.

The lack of a legitimate LLLT credentialing process is yet another reason that the LLLT "Experiences" thread frightens me - because statements critical of LLLT are not permitted in that thread. Interesting, because I myself happen to have extensive experience in the use of laser technology in medicine. But my laser experience apparently does not count. One has to wonder ...

So I'll leave it at this. I think LLLT for tinnitus is pure shadows and mirrors - a scam. But on the chance I might be wrong, the fact that there is no legitimate credentialing in LLLT frightens me. And the fact that we have people here on Tinnitus Talk who in spite of having no medical or LLLT training whatsoever are recommending various protocols, technologies, and doses in an authoritative voice in threads on this board wherein no objections can be raised frightens me even more.

As I have already pointed out in another post, this forum only requires members to adhere to the netiquette of the forum - which essentially means that anyone can post incorrect information (as informational correctness per se is not part of the netiquette rules).

Right. But in my opinion there ought to be frequent prominently displayed reminders to that effect ... because the volume of incorrect information on Internet tinnitus boards is truly astounding. And in the case of LLLT doses, etc. we are talking not only about incorrect information, we are talking about potentially dangerous information.

stephen nagler

 

[attheedgeofscience]

Interesting, because I myself happen to have extensive experience in the use of laser technology in medicine.

Really? You have previously posted the following comment about LLLT...

They aim a "healing light" into your ear canal with the idea that it is supposed to make sick (or dead) hair cells healthy again. Problem is ... the ear canal has twists and turns, the hair cells are in the cochlea which is located at the other end of the ear canal, and the cochlea is encased in bone. So there's no way that the "healing light" can reach its intended target without burning a hole in your temporal bone!

...a comment you have recently retracted (I realize that):

I believe that @attheedgeofscience has offered some rather compelling photographic evidence to the effect that LLLT light can, indeed, reach the cochlea. So it seems that my initial impression based upon some studies in the literature may have been wrong.

But still, it means that you for the past many years could not have appreciated the correct capabilities of LLLT - and without knowing such basics (i.e. laser light penetration of body tissue), I do not see how you could have been able to objectively evaluate LLLT during your period as chairman of the ATA, for instance. As an example, if I had been left with the assumption that laser light is stopped by a thin layer of skin, then, I too would have (incorrectly) dismissed LLLT without further consideration. No question about it.

 

[attheedgeofscience]

And the fact that we have people here on Tinnitus Talk who in spite of having no medical or LLLT training whatsoever are recommending various protocols, technologies, and doses in an authoritative voice in threads on this board wherein no objections can be raised frightens me even more.

I realize that you may not be speaking of me specifically, but in any event, I would like to mention that I generally do not recommend anything (even when people ask me directly). What I have done is share my experience and audiograms. People can then take that information and do with it what they want. All that matters (to me) is that my experience is true and accurately reflected.

I do not see any of the posts within the LLLT thread as being any worse than what is being posted in - say - the thread about Trobalt on this board.

 

[Dr. Nagler]

Really?

Yes, really. I do have extensive experience in the use of laser technology in medicine, specifically in the treatment of malignant and premalignant diseases of the gastrointestinal tract as well as cancer metastatic to the liver. I hope you do not have a problem with the fact that I have first-hand experience using laser technology to save lives.

I'm really getting tired of this bull spit. I think LLLT for tinnitus is a scam. I have explained in detail why I feel that way. You actually think there may be some legitimate efficacy there, which is just fine with me. But if you are right, then surely its efficacy - as well as its potential permanent damage - are dose-related. It is LLLT's dose-related potential permanent damage that make all the authoritatively written pronouncements from tinnitus sufferers about various doses they recommend on the LLLT "Experience" thread highly irresponsible and moreover frightening. Which is precisely what I said in Post #393 above.

So if you want to quote me, you can quote me on that.

stephen nagler

 

[dboy]

According to the argument presented, there would only be something to be 'frightened' about if there were a chance that LLLT were effective. If Dr Nagler is genuinely 'frightened' then he must consider that there is a chance that LLLT is effective - something that he consistently and emphatically denies.

So simple logic applied to his statements suggests that either Dr Nagler is not genuinely frightened or he is not genuinely convinced that LLLT is ineffective.

I'm really getting tired of this bull spit. I think LLLT for tinnitus is a scam. I have explained in detail why I feel that way. You actually think there may be some legitimate efficacy there, which is just fine with me. But if you are right, then surely its efficacy - as well as its potential permanent damage - are dose-related. It is LLLT's dose-related potential permanent damage that make all the authoritatively written pronouncements from tinnitus sufferers about various doses they recommend on the LLLT "Experience" thread highly irresponsible and moreover frightening.