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

[attheedgeofscience]

Effect of low-level laser treatment on cochlea hair-cell recovery after ototoxic hearing loss.

Abstract

The primary cause of hearing loss includes damage to cochlear hair cells. Low-level laser therapy (LLLT) has become a popular treatment for damaged nervous systems. Based on the idea that cochlea hair cells and neural cells are from same developmental origin, the effect of LLLT on hearing loss in animal models is evaluated. Hearing loss animal models were established, and the animals were irradiated by 830-nm diode laser once a day for 10 days. Power density of the laser treatment was 900 mW/cm(2), and the fluence was 162 to 194 J. The tympanic membrane was evaluated after LLLT. Thresholds of auditory brainstem responses were evaluated before treatment, after gentamicin, and after 10 days of LLLT. Quantitative scanning electron microscopic (SEM) observations were done by counting remaining hair cells. Tympanic membranes were intact at the end of the experiment. No adverse tissue reaction was found. On SEM images, LLLT significantly increased the number of hair cells in middle and basal turns. Hearing was significantly improved by laser irradiation. After LLLT treatment, both the hearing threshold and hair-cell count significantly improved.

Source: http://www.ncbi.nlm.nih.gov/pubmed/24343446

 

[linearb]

You are free to say whatever you want to say. If you want to say that humans can regenerate hair cells, be my guest. This is an Internet tinnitus board, not a courtroom. Regrettably, accuracy here is irrelevant. The LLLT threads bear witness to that sad reality.

I was not taking about LLLT, I was speaking to the idea that hair cell regeneration has not been demonstrated. It has, at least in other animals, Novartis CGF166:
http://osp.od.nih.gov/sites/default/files/1_1260_CGF166_Klickstein.pdf
http://www.genvec.com/product-pipeline/cgf-166-hearing-loss

Human trials in the profoundly deaf are underway now: https://clinicaltrials.gov/ct2/show/NCT02132130

 

[Dr. Nagler]

I was not taking about LLLT, I was speaking to the idea that hair cell regeneration has not been demonstrated. It has, at least in other animals ...

In your earlier post you said it's been demonstrated in humans.

stephen nagler

 

[attheedgeofscience]

If I were a scam artist, I would find a few friends or relatives - perhaps employees - to assume various personalities and post on the most widely viewed tinnitus board of the day about the wonders of my therapy, all the while coming up with excuse after excuse for not publishing a legitimate study in a respected juried scientific journal. Do I want LLLT to be the magic bullet folks claim it to be? Yes, who wouldn't? Do I think that the handful of folks posting here about their personal LLLT successes are sockpuppets? Of course not. But is it remotely possible? Yes, it's remotely possible. In fact, that's exactly what happened some 15 years ago with another "miracle" therapy on another tinnitus board. And the guy made hundreds of thousands of dollars taking tinnitus sufferers to the cleaners.

Sock puppets? Scammers? Who knows, maybe there are.

But is it any worse than people who "cherry pick" their responses? Or is it any worse than people who have a conflict of interest?

 

[attheedgeofscience]

And by the way, ATEOS, I am not @KingRoanoke. I do not have any idea who KingRoanoke is. A number of folks might well be posting here under more than one nick, but I am not one of them.

That's comforting to know.

 

[dboy]

All I can say is that other LLLT thread is so hostile that I am afraid to post anything in there.
I am interested and yet sceptical , that does not seem to jive with that thread.

Hi RaZaH, did you mean this thread ("Efficacy Debate")? Speaking for myself I apologise if anything I have posted in any thread has made you feel that way. To explain, I have taken a fair bit of c**p from Dr Nagler in this thread and others for questioning what he says. While at first that bothered me, now I have toughened up a bit and learned to enjoy demonstrating what is wrong with his arguments. Because there is plenty. I also might disagree with other people if they say things that seem wrong to me. I've spent a fair bit of time researching LLLT so I sometimes have worthwhile information to contribute. But I'll do it respectfully eg.

I am happy for you to not believe in LLLT and I think your sceptical voice is valuable in this thread because what you say is measured and reasonable

Speaking generally there is a fair bit of defensiveness around LLLT from people who believe in it. This is because there is a long history of deliberate obtuseness and misrepresentation on the part of those who like to say it is a scam. It is a complex and long-running argument that goes back longer than the existence of Tinnitus Talk. Looking only superficially at what is said you might miss the complexities of what is going on. But I think if you want to ask questions or post your insights - and you do it with respect for the experiences and integrity of others - then you'll be surprised how reasonable most people are.

 

[marqualler]

I agree completely that some references in the text that Dr. Wilden gives away would be reassuring. Not everything he says in that book chimes with things I have read elsewhere and I am not 100% convinced by it at all. The overall feel of it does n
Iot inspire huge confidence (albeit it is given away free and seems not intended as a scientific text). I am no acolyte of Dr Wilden. I have said a few times that I am not arguing that LLLT is effective, only that Dr. Nagler's criticism of it is misleading, contradictory and hypocritical (since TRT is not proven to the same standard that he holds LLLT to and he offers TRT for sale).

I think the section about the dangers of TRT was included partly because Dr Wilden objects to some of the principles on which TRT is founded (I take that at face value) and partly because he believes that avoiding noise is important to the healing of ears and TRT involves using noise making devices. Hence, see this post today in the Dr.s Corner:

https://www.tinnitustalk.com/threads/trt-incompatible.8263/#post-95521

I am happy for you to not believe in LLLT and I think your sceptical voice is valuable in this thread because what you say is measured and reasonable (unlike our friend with the 'ignore' button and the short term memory loss). Regarding the hearing aid manufacturers I am on the fence, but did you see the post earlier where a link was established?

Hi RaZaH, did you mean this thread ("Efficacy Debate")? Speaking for myself I apologise if anything I have posted in any thread has made you feel that way. To explain, I have taken a fair bit of c**p from Dr Nagler in this thread and others for questioning what he says. While at first that bothered me, now I have toughened up a bit and learned to enjoy demonstrating what is wrong with his arguments. Because there is plenty. I also might disagree with other people if they say things that seem wrong to me. I've spent a fair bit of time researching LLLT so I sometimes have worthwhile information to contribute. But I'll do it respectfully eg.

Speaking generally there is a fair bit of defensiveness around LLLT from people who believe in it. This is because there is a long history of deliberate obtuseness and misrepresentation on the part of those who like to say it is a scam. It is a complex and long-running argument that goes back longer than the existence of Tinnitus Talk. Looking only superficially at what is said you might miss the complexities of what is going on. But I think if you want to ask questions or post your insights - and you do it with respect for the experiences and integrity of others - then you'll be surprised how reasonable most people are.

I agree with @RaZaH on this point--that these threads become needless sniping at each other. (E.g. ATEOS and Dr. N just a few posts above is a perfect example.) The post ATEOS was informative, but for skeptics (such as myself) I am not going to be convinced until intensive studies on humans get underway. (Not to say that your personal testimonies aren't valuable--they are.) If that is something those with more advanced connections in the research level can influence, then all the more power. Like Dr. N said--it's OK to take all of this with a giant grain of salt, but the general argumentative tone takes away from the information that users could have.

 

[dboy]

I agree with @RaZaH on this point--that these threads become needless sniping at each other

OK, I see why you guys feel the way you do. It is what it is I guess, although I do stick to what I said about why it is that way.

 

[Dr. Nagler]

Sock puppets? Scammers? Who knows, maybe there are.

Right, maybe there are. I'm glad we agree on something.

But is it any worse than people who "cherry pick" their responses?

Are scammers worse than regular posters who for one reason or another choose not to answer each and every question asked of them? Absolutely.

Or is it any worse than people who have a conflict of interest?

I suspect many who post here have conflicts of interest. I cannot speak for others, but in the interest of honesty and transparency I have taken care to thoroughly disclose mine.

stephen nagler

 

[dboy]

the general argumentative tone takes away from the information that users could have.

Just to address that point briefly... This 'debate' thread was split off from the 'user experiences' thread specifically so that the argumentative tone did not interfere with the sharing of information by users. As ATEOS showed, Dr Nagler has posted massively more than anyone else. As far as I can see Dr Nagler pretty much set the tone as well. He defended it here:

But what you should not do is read through the posts in a debate thread and expect to feel warm and fuzzy about everything you see there.

A few people have disagreed with what he says and over time have become as blunt and direct as him, and as lacking in the social graces that can make discussion into a collaborative effort rather than a battle. That is a shame, but better than allowing unbalanced information to go unchallenged.

Through all this everybody who wants to read can hopefully make up their own mind - as you are doing. And if they want to post then... well... I do hope your own experience was not too horrendous?

 

[linearb]

LLLT killed my dog and raped my cat.

 

[marqualler]

Just to address that point briefly... This 'debate' thread was split off from the 'user experiences' thread specifically so that the argumentative tone did not interfere with the sharing of information by users. As ATEOS showed, Dr Nagler has posted massively more than anyone else. As far as I can see Dr Nagler pretty much set the tone as well. He defended it here:

A few people have disagreed with what he says and over time have become as blunt and direct as him, and as lacking in the social graces that can make discussion into a collaborative effort rather than a battle. That is a shame, but better than allowing unbalanced information to go unchallenged.

Through all this everybody who wants to read can hopefully make up their own mind - as you are doing. And if they want to post then... well... I do hope your own experience was not too horrendous?

Fair enough! That is occasionally the nature of message boards--I agree with that. My experience has been totally fine--if anything I have learned more about LLLT as a potential treatment as I might have anywhere else on the web or otherwise. It just takes some discernment to come to one's own conclusion about this or anything else.

 

[RaZaH]

@dboy no, I was not referring to you . The other LLLT thread creeps me out as it does not seem to have any room for criticism and I see people throwing around all kinds of advice as fact. And even with such a religius belief in its efficiancy , when I go through the thread the actual results are super dubious , even from the hardcore LLLT fans .
Just seems weird and in fact turns me off the whole LLLT thing since in my experience belief is the biggest placebo.

And btw , I am not sure I would dare to post this in the other thread.

 

[dboy]

@RaZaH I think the defensiveness I mentioned is real, but people have posted criticism in that thread without any problem. (Eg. linearb in post #798 on Friday). I'm really intrigued to see what happens with bwspot's clinic treatment and with luka's high power home treatment in the thread below. These folks seem not currently to be convinced LLLT believers - their reports should be impartial and interesting.

https://www.tinnitustalk.com/thread...ice-for-reversing-hearing-loss-tinnitus.8277/

P.S. Just a thought though... phrases like 'creeps me out', 'religious belief', 'super dubious' and 'weird' could easily be read as insulting to the people you are talking about. Maybe we could all be more friendly.

 

[RaZaH]

True , I did not mean to be unfriendly , sorry about that .

 

[SoulStation]

I would love to see before and after DPOAE or TOAE reports of folks doing LLLT- since people are debating it's efficiency in both hearing regeneration and overall cilia health. I would figure the SNR and amplitude of emissions in a DPOAE would change for anyone having TRUE improvement to hearing cells. Audiograms are good but DPOAE/TOAE are way more subjective.

 

[marqualler]

Agree with @SoulStation here. If we accept the possibility that LLLT can have a similar effect on the cochlea in the way that AM-101 is theorized to have (but with presumably fewer side effects), it would be nice to be able to point to some "hard" improvement that shows the progression. Whether that is with DPOAE or TOAE reports or with more datapoints showing dosages, number of days using those dosages, subjective and objective improvements, etc. Basically something similar to how the Retigabine "User Information" thread is going. I really think there is something to what @attheedgeofscience is trying (see his Flupertine thread) in attacking both the cochlea and the potassium-channel openers--and I think this board has the potential to get more information and try new things about treating tinnitus this way.

 

[Dr. Nagler]

Effect of low-level laser treatment on cochlea hair-cell recovery after ototoxic hearing loss.

Abstract

The primary cause of hearing loss includes damage to cochlear hair cells. Low-level laser therapy (LLLT) has become a popular treatment for damaged nervous systems. Based on the idea that cochlea hair cells and neural cells are from same developmental origin, the effect of LLLT on hearing loss in animal models is evaluated. Hearing loss animal models were established, and the animals were irradiated by 830-nm diode laser once a day for 10 days. Power density of the laser treatment was 900 mW/cm(2), and the fluence was 162 to 194 J. The tympanic membrane was evaluated after LLLT. Thresholds of auditory brainstem responses were evaluated before treatment, after gentamicin, and after 10 days of LLLT. Quantitative scanning electron microscopic (SEM) observations were done by counting remaining hair cells. Tympanic membranes were intact at the end of the experiment. No adverse tissue reaction was found. On SEM images, LLLT significantly increased the number of hair cells in middle and basal turns. Hearing was significantly improved by laser irradiation. After LLLT treatment, both the hearing threshold and hair-cell count significantly improved.

Source: http://www.ncbi.nlm.nih.gov/pubmed/24343446

I found the above abstract to be of considerable interest and decided to read through the entire article. Turns out that the investigators only looked at eight rats. Moreover, there were no controls (i.e., they did not check to see if the same improvement would have been obtained without LLLT). Also, they started the LLLT a mere two days after the ototoxic insult, again speaking to the possibility that the same results might have occurred spontaneously in the absence of LLLT. In spite of those significant methodological shortcomings they drew some conclusions - but as is unfortunately all-too-often the case, those conclusions were not accurately reflected in the abstract. I will quote directly from the last paragraph in the study. My comments appear in brackets ...

"In this article we investigated the effect of LLLT on live hearing loss animals with cochleas artificially deranged by gentamicin and furosemide. We found that LLLT helps the recovery of hair cells after ototoxic damage; it promotes the survival of hair cells and improves hearing threshold." [In the absence of controls, such a conclusion cannot be drawn. smn] "But the effect may not be complete. That is, LLLT is effective only in a specific group of hair cells in which the damage is not too severe or too small. Also, it seems that LLLT cannot induce regeneration of the hair cells when they are completely lost." [So the abstract says that the hair cell count "significantly improved," while the study concluded the exact opposite! smn]​

I am in no way criticizing ATEOS for posting the abstract of this article. He did not have access to the entire study. If he did, he would surely have noted the significant methodological flaws and moreover would have discovered the unfortunate mismatch between the findings of the study and the wording of the abstract.

This was a terrible study. It appeared in a journal from the Society of Photo-Optical Instrumentation Engineers, where apparently the editors' primary concern is the quality of the photomicrographs rather than the integrity of the study.

stephen nagler

 

[attheedgeofscience]

Moreover, there were no controls (i.e., they did not check to see if the same improvement would have been obtained without LLLT).

No, but this study did have controls...

https://www.tinnitustalk.com/threads/low-level-laser-therapy-lllt-for-tinnitus-—-efficacy-debate.7650/page-16#post-95489

This was a terrible study. It appeared in a journal from the Society of Photo-Optical Instrumentation Engineers, where apparently the primary concern is the quality of the photomicrographs rather than the integrity of the study.

So was this one you posted, but that did not prevent you from posting it (nor from choosing not to comment on it, when I did a follow-up analysis):

https://www.tinnitustalk.com/threads/low-level-laser-therapy-lllt-for-tinnitus-—-efficacy-debate.7650/page-9#post-88136

That's what I consider "cherry picking"...

 

[Dr. Nagler]

The literature is replete with terrible LLLT studies.

It would be wonderful to see a good one! Based strictly on the literature, I really do not know how anybody can draw a conclusion on LLLT one way or the other.

stephen nagler

 

[attheedgeofscience]

Moreover, there were no controls (i.e., they did not check to see if the same improvement would have been obtained without LLLT).

Dr. Nagler, I don't have access to the full study text, but given that the abstract mentions the tympanic membranes were intact after the experiment, my guess is that they used left/right ear as controls (i.e. ototoxicity was induced locally via injection or something like that). So probably the study did have controls - something I will try to verify, shortly.

However, attached is another and complete study of LLLT (and with controls!)...

Tag: @Markku @Steve

 

[Dr. Nagler]

Dr. Nagler, I don't have access to the full study text, but given that the abstract mentions the tympanic membranes were intact after the experiment, my guess is that they used left/right ear as controls (i.e. ototoxicity was induced locally via injection or something like that). So probably the study did have controls - something I will try to verify, shortly.

The ototoxic agent was introduced intravenously, but I think you are correct in that it looks like they only applied the LLLT to one ear.

That said, the study concluded that LLLT is ineffective for dead hair cells and for all but slightly damaged hair cells limited to two specific locations on the basilar membrane.

stephen nagler

 

[attheedgeofscience]

The ototoxic agent was introduced intravenously, but I think you are correct in that they only applied the LLLT to one ear.

stephen nagler

But then they did have controls!?!

Tags: @Steve @Markku

 

[RaZaH]

@marqualler , Excellent idea , would make sense to make something like the Retagabine progress reports on LLLT.

 

[dboy]

Based strictly on the literature, I really do not know how anybody can draw a conclusion on LLLT one way or the other

Now that is a point that I can absolutely agree with. What puzzles me is that Dr Nagler has been drawing conclusions based on a selective ("cherry picked" as ATEOS points out) reading of the literature for years.

 

[Dr. Nagler]

But then they did have controls!?!

Yes, I was wrong about that.

stephen nagler

 

[attheedgeofscience]

Yes, I was wrong about that.

stephen nagler

How could you be wrong - and in relation to something so specific - when you just mentioned you had read the entire article?

I found the above abstract to be of considerable interest and decided to read through the entire article. Turns out that the investigators only looked at eight rats. Moreover, there were no controls (i.e., they did not check to see if the same improvement would have been obtained without LLLT).

 

[dboy]

I also have tremendous experience in critical analysis of scientific studies

 

[Dr. Nagler]

How could you be wrong ...

I missed it. Thank you for pointing it out.

stephen nagler

 

[Kevin08]

I have been following this debate for a while and I'm beginning to wonder if the improvement in hearing in the LLLT group might be from the positive affect lasers can have on inflammation. Could it be that by reducing the inflammation leads to better overall health and function of the inner ear? I truly believe that the LLLT group is getting some relief. Many of those who are skeptical are so due too the lack of proof that hair cells are regenerated. Maybe there's more at work here. Many people with Tinnitus feel it as a head sensation, maybe the lasers help reduce inflammation of the nerves thereby improving tinnitus and hearing. Just trying to think outside of the box. I'm still considering LLLT treatment as I've yet to hear of a single individual who has been harmed by this and in the long run it's probably cheaper than TRT .