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

@cullenbohannon -

Perhaps they think if they want it to work badly enough, then maybe it will. That's just human nature.

And by the same faulty human nature logic, my pointing out that it does not work serves to somehow decrease the chance that it will.

Stephen Nagler

 

I think sometimes people just want to take action. They want to do _something_. Anything. And they do this knowing the only results could really just be cooincidental or a placebo effect. Or maybe they will be the one out of 100 it actually works for. God knows we don't know enough about T or the inner ear to say anything with absolute certainty. In my bad days, any placebo effect would have suited me just fine! As long as I felt better, so what?!

 

100% correct. All the more reason that no punishment is too severe for the pond scum who would take advantage of their misery and desperation.

Stephen Nagler

 

I believe the burden of proof in on the person making the claim. It is very easy to prove that something is not 100% anything. All one has to do is show one exception or one bit of doubt, and that is what I see myself as having done. Its very hard to prove something to a probabilty of 1, and unless you are talking about a case of deductive logic (A=B and B=C, therefore A=C), it is actually impossible to prove that. So it is easy for me to say with certainty, that it not 100% certain that LLLT is ineffective. There is somewhere a mathematical proof for that that uses deductive reasoning.

Also, I did not say that people who argue against LLLT do not have a leg to stand on. I said that people who say with certainty that LLLT absolutely does not work do not have a leg to stand on. As I think about those words now, I can see how they may not convey well what I meant depending on how you view that saying. Perhaps what I should have said is they do not have a fully stable leg to stand on (meaning they don't have a case for saying that LLLT is absolutely, 100% ineffective against tinnitus - the evidence simple does not support that).

The fact that some tinnitus suffers say they have received benefit from it is enough evidence for me to cast doubt on the hardline naysayers. Who am I to step on someone's first hand positive experience and judgement. They know what they experienced - no one else does. It might be that in 1 of a gazillion instances LLLT works, and if things are not exactly as they were in that particular instance, it doesn't work. If a person says it was effective for them I believe them (unless I have some reason to think they are lying and trying to manipulate me), and that is evidence that the treatment is not 100% ineffective. And if someone says that it did not help them, that is evidence that the treatment is not 100% effective. At the same time, the fact that there is little scientific evidence that it works makes me not want to spend my money on the treatment because I believe the probability that it will help me is low. The naysayers certainly have great evidence that their assertion is true, but it is not 100% certain. It is arrogant to to step on someone's sincere first hand experience claims that the treatment helped them. To squash their claim with opposing statements of certainty is equivalent to saying, "You're obviously a dunce", or maybe more mildly "you're mislead, you poor thing."

I think it is perfectly fine and correct to say, "There is not sufficient evidence to convince me to spend money on LLLT for tinnitus." Or to say, "I think the people who are selling LLLT treaments are frauds". I think it is wrong and insensitive to others values to say, "LLLT absolutely does not do anything for T" unless you have verifiable proof. Aside from what it says about what you think of that person, it is also damaging to constructive science. Such an attitude casts LLLT into the dungeon and makes it taboo to even study it. This certainly leaves room for scammers. There is not anything anyone can do about the fact that it is very difficult (actually impossible) to prove something like the effectiveness of a medical treatment with 100% certainty. That is simply the nature of infinity (you cannot perform a test an infinite number of times which is what is necessary to demonstrate a probability of one in an inductive logic argument). That scammers can exploit that is an unforunate circumstance.

The issue I've been trying to address has nothing to do with whether there a scammers in the world. It is only with the statement that LLLT is absolutely ineffective for tinnitus. Just because someone scams someone with a treatment does not mean the teatment should be wholly, completely, and forever eschewed. Treating it that way inhibits the free flow of information and knocks it out of the realm of worthwhile scientific study.

The fact that there is a study that shows LLLT may stimulate stem cells lends credance to the claim that LLLT may be helpful for T. If LLLT can stimulate stem cells, and stem cells can cause the regrowth of fine hairs in our ears that are used for hearing, then it stands to reason that LLLT might help tinnitus since there is a relationship between T and hearing loss. That does not say you should therefore go to Dr. Wilden for LLLT, or that you should run out and buy a laser. It only says what it says - its a possible avenue still and it should be investigated - not ignored because there are scammers in the world who have used LLLT to fraudulently make money.

 

I made the statement that LLLT is ineffective in the treatment of tinnitus, and in considerable detail I explained the basis for my coming to that conclusion. I'll stand by that statement, and given that I have explained its basis, I cannot see how it can be considered "insensitive to others' values."

Carry on.

Stephen Nagler

 

I had a physics professor in college who addressed this 100% business very well, I think. I'm a tad older now, but I still remember the class, word for word:

"Say that we line up the men in this class against one wall and the women [there were only a few] against the opposite wall. And then we have the men walk half the distance to the women. And then we do that over and over. Logic tells us that the men will never reach the women.

"However, for all practical purposes... "

I think the same applies to the probability that LLLT is effective for anyone's tinnitus. It may not be zero, but for all practical purposes, it is.

 

Anyone who is seeking hope in LLLT and the like might want to consider participating in an actual clinical trial of (other) tinnitus treatments, or maybe contributing to the ATA's Walk fundraiser. There are good research proposals that go unfunded for lack of money.

 

Unfortunately those are often unavailable to a majority of people for one reason or another (location, timing, or other exclusion criteria).

If there was something like that around me I would gladly participate.

 

Michael, you yourself posted:

"I think sometimes people just want to take action. They want to do _something_. Anything."

If you really want to take action, donate to ATA-funded tinnitus research. It will accomplish so much more than a visit to your local LLLT clinic.

Stephen Nagler

 

Sending in a financial donation and then sitting around waiting wasn't what I had in mind when I said take action. It's all well and good to do that, but it won't help a person who is struggling _now_.

 

I think it does help a person who is struggling now. It can have a powerful effect.

 

Sure, but it isn't, IMO, going to get them a whole lot closer to coming to terms with their T. It would be like spending time on a hobby, or better yet, spending time helping people less fortunate so that you can take your mind off T. That's a good way to take action and break out of the anxiety loop. Sure, I could send a check to the local food pantry instead, but it won't have near the same effect as physically being involved.

Btw, I am not an LLLT advocate. I just understand why someone might choose to do it anyway, despite the fact they know it has a very low chance of eliminating their T. I agree with the notion that we can't say with absolute certainty that it would never work for anyone. Anytime people speak in absolutes about T or the inner ear, I see red flags. There are far too many unknowns. Your analogy earlier doesn't consider the fact that a small number of people actually felt there was an improvement with LLLT and reached the women so to speak.

The idea that LLLT might affect your T seems to be equally as far fetched as having dramatic spikes only when you eat Thai food.

 

Founded in 1971, the ATA's greatest achievement:

TONY RANDALL and JERRY STILLER (I Say You Say)...

 

Not taking sides here, I think it's great that there's been such heated debate over this treatment and whether or not it's actually legit or a scam.

Personally however, from the very brief research I've done on LLLT and Dr. Wilden's take on auditory disorders, I would definitely think very carefully before putting any sort of money to something that has been around for so long but has very little solid evidence behind it. A great deal of the material I've seen in relation to LLLT (youtube videos, research documents, etc) mostly seems super shady too.

Even if the big hearing aid companies were in on some big conspiracy to keep this treatment from becoming more widely accepted (which isn't too far fetched given how corrupt big pharma is), it's hard to believe that this would not be wildly more popular just through word of mouth alone. You'd have wealthy musicians flying in from all over the world on the regular if they could regain any sort of hearing or improve their tinnitus/hyperacusis.

I think it's also important to note that while there have been a couple people here that have claimed that LLLT improved whatever symptoms they were experiencing in this thread; I remember there was another member on here that claimed his tinnitus was actually made worse undergoing LLLT with Dr. Wilden. So, while it's great to see others have possibly benefited from this treatment, it's important to realize and remember the risks involved in undertaking experimental treatments. I don't remember the guys username off the top of my head, but I can find the post if anyone is interested enough.

Anyway, I mostly just wanted to point out the stuff I mentioned in the last paragraph. Personally, I think the whole LLLT thing is shady, but I'd be very open to it if there was enough mounting evidence behind it.

 

You are so focused on trying to be right that you completely missed the point of Dr. Chinnis's analogy. For all practical purposes, everybody reaches the women (i.e., for all practical purposes, LLLT does not work.)

But that aside, a person's donating to tinnitus research and/or getting involved in some phase of tinnitus advocacy can, indeed, have a positive effect on that person - as he said. And even the smallest positive effect will be greater than the "benefit" to be derived from LLLT.

Stephen Nagler

 

LOL! Now that's funny coming from you!

It doesn't matter, you win! It appears you have no interest in understanding why people might try LLLT. You can even have the last word as you so often try to do.

-Mike

 

Michael, I focus on being right because people quite often consider my words when making important decisions about their healthcare. There's a difference. Part of the way I focus on being right is to make sure that I understand others' points of view. That's how I learn. That's how I correct myself when I am wrong. It's not the same as being right for the sake of being right. Perhaps now would be a good time for you to go back to Dr. Chinnis's "For all practical purposes ..." analogy to see what he is really saying there.

And I absolutely do understand why people might try scams like LLLT. I was scammed myself twice to the tune some $8,000 in my own search for relief twenty years ago (more than $15,000 in today's dollars) for the same reasons. That's why I feel so strongly about providing accurate information here about LLLT and other tinnitus rip-offs in the hopes that others will not make the same mistake.

Best to all.

Stephen Nagler

 

I've thought of a better and shorter way to say what I have been trying to say. "Condemn the fraudsters, not the the technology." I think the number of people who read this thread who are going to be sucked in by LLLT fraud is very, very small at this point. If they are vulnerable to LLLT frauds they are vulnerable to any fraud. If the issue is that concern, then the warning should be "be wary of fraud associated with tinnitus treatments; be wary of all T treatments. It is an ailment that is ripe for exploitation by scammers." I would extend the warning to not just fraudsters. There are a lot of well meaning healthcare providers that you need to be wary of. You also need to be wary of even an FDA approved treatment for anything. It's all about probabilities (an FDA approved drug is likely to be safe and effective, but it is not a 100% proposition), and I think if you think that way, you will make the best decision for yourself. The basic tenant that we have all heard at some point in our lives still applies: "if it sounds too good to be true, then it probably is." EDIT: I also subscribe to "Trust but verify."

I'll try one more truism to make my point. The difference between warning people of fraud by saying "LLLT absolutely does not have an effect on tinnitus" and "think about probabilities" (which is what I am saying), is analogous to the difference between "giving a man a fish" and "teaching a man to fish". Teaching the man to fish gives him the tools to be in charge of his own destiny, and he may even become a better fisherman than the teacher .

I'll add that I think it is perfectly okay for someone to seek out LLLT treatment for tinnitus after reading this thread, after doing their own research, and after weighing the probabilities even though that is not the course of action I have chosen after doing the same. I try to not make no assumptions about my intelligence compared to theirs, or my ability to analyze things being better than theirs. I post my comments on this forum because I find the act is helpful to me in clarifying my thoughts and because I find hearing what others think to be helpful. So I hope my posts leave people feeling like they can freely post their thoughts as well and those thoughts will be welcome.

 

Mick, I think we might be in agreement, at least in part.

I worked a lot in my career thinking about and researching probabilities. There is a field of mathematics known as Bayesian inference. It uses probabilities to represent the strength of belief in a proposition. Sometimes frequentist probabilities just don't exist and classical statistics is of no use in addressing the actual issue at hand.

I have worked to do things like calculate the probability that a buried storage tank contains certain dangerous chemicals. Records were partially lost, sampling from the tank was deemed too dangerous, and the tank was susceptible to leaking or even explosive detonation. In such a case, you use everything you can bring to bear on the probability you are seeking.

In the case of LLLT and similar treatments, there is the lack of an actual scientific test, so a classical statistician would have no comment regarding its efficacy. Yet, we have to decide whether there is a benefit or not, despite the lack of proper "objective" data. Do we go for the treatment or not?

And in this case there is a smoking gun out there, once we look at the broader context. The lack of a proper test despite all the LLLT treatments that have been done, the ease with which such a test could have been done, and the enormous value of such a test, leads one to conclude that such a test has not been done (or has not been reported or published) because the data observed by the practitioner(s) do not support the treatment's efficacy.

To actually work up a probability based on this kind of "dog in the night" data, one would need to examine each point I just made and quantify it. And one would need to look at the broader context in much more detail. But we all infer how likely things are all the time. It's at the core of what we are. Most of our decisions take place without classical-type probabilities.

And I'm perfectly comfortable assigning a near-zero probability to the efficacy of LLLT for tinnitus.

(I will let others address the probabilities re "fraudsters.")

 

We are in agreement with respect to our assessment of the probability of LLLT as practiced so far being helpful for tinnitus. I don't want people to accept my assessment without thinking about it on their own, I don't want people with opposing views to mine to not express them because they feel intimidated, and I don't want the door on LLLT to be closed such that it is not fully investigated in a scientific way. Most of all, I don't want people to not think on their own; that makes for one less brain focused on the matter. Thinking about the fraud aspect, that is what makes it possible for scammers to exist - people not thinking for themselves; people thinking that the expert or authority, real or fraudulent, always knows best. It's okay to challenge them and that is the best way to protect one's self. There are times when people do have to just say "For me the the best thing is to just follow the advice of another person that I trust", and that is okay, too.

 

In order for a researcher to decide to do a test of LLLT, he/she has to have some reason to think it might work.

We haven't had a randomized trial of Fruit Loops, for instance.

Same reason.

 

Was there once a reason to think that ginkgo biloba would have worked?

 

Just so I don't create a world of rebels with my comments...

There are times where you have to suppress challenges for the greater good of a community. If you 're in the military, which is an organization where the community good almost always take precedence over the individual, I advise you to follow orders without challenge unless you are extremely sure of yourself.

 

A point well made. However, in light of the study that suggests LLLT can stimulate stem cells, do you think LLLT or Fruit Loops is more worthy of research funds?

mick

 

I almost mentioned that in my post, but it was already way too long.

There was some evidence that ginkgo increased blood flow in some cerebral tissues, as I recall. So it was felt to be "active" and "natural." There was also quite a lot of hype both by those trying to sell more of it and by a few doctors who thought they saw signs that it worked in their patients.

In the case of ginkgo, a large number of tinnitus patients were trying it (much like acupuncture). So it seemed worthy of scientific test (again like acupuncture).

So, yes, there is sometimes the argument that if everyone is gulping down Fruit Loops hoping their tinnitus will go away, someone should study the question scientifically to resolve it.

 

If we get down to where we have funded a study of every feasible treatment of tinnitus save LLLT and Fruit Loops, I would support a study of LLLT over one of Fruit Loops.

 

I see this debate has died down, i am not looking to reignite it I just want to add, and this is not aimed at this in particular but i see that sometimes when people disagree on this site it becomes a whole big thing. Maybe im just used it from classes, organizations and events ive been involved in that it doesnt bother me when argue, debate with people. Anyway @mick I dont think this was aimed at me but i truly and deeply disagree with this, (The naysayers certainly have great evidence that their assertion is true, but it is not 100% certain. It is arrogant to to step on someone's sincere first hand experience claims that the treatment helped them. To squash their claim with opposing statements of certainty is equivalent to saying, "You're obviously a dunce", or maybe more mildly "you're mislead, you poor thing.") I don't see how that is so. Again maybe its just the way i am but i love when we have these debates on here and i cant imagine anyone taking these things personally, I hold my self from commenting on a lot of these discussions because im always afraid someone is going to take something the wrong way which seems to happen often. The points you make are true but because someone brings up another viewpoint which not to make someone look stupid but broaden there horizons, and learn new things if they are open enough is a good thing imo.

As for this, its a possible avenue still and it should be investigated - not ignored because there are scammers in the world who have used LLLT to fraudulently make money. I agree and the only way i know of that medicines are explored to show if they are an effective treatment, is the through properly controlled studies. Again everyone is free to make there decisions, for the most part i actually enjoyed reading all of these comments and what everyone had to say. I like hearing everyone view and I hope we continue to have these types of conversations on TT.

 

Ah Tinnitool. They have a page of evidence.

The first evidence is a customer satisfaction survey, so not exactly robust.

@HelmutK. The second study, that you reference, from the Italian ENT Department: Both groups showed a significant improvement, placebo and actual treatment, treatment more so. The study was randomised but not double blind so very much open to influence from the Doctor, plus the difference of over 14 years average age in each grow may have played a part. The study was directly funded by the device manufacturer and no peer review or registration of the trial is evident, again leaving it very open to bias.

The third study is a meaningless collection of tables, no methodology or real text.

The fourth is a prospective study, not controlled at all. Only to be used as maybe a grounding that drives a proper study to be carried out.

The fifth is beyond my level of functional spanish.

The sixth study, from University of Padua, seemed to ignore the statistical significance in the control group. They claim LLLT is effective but the placebo group had greater improvements. They bury this within the language of the paper.
----------------

I could go further through their list but in all honesty I don't expect it to get any better. Unfortunately I don't see anything there that does anything to shift the argument for or against - which is the crux of this pretty circular discussion that's taken up several pages.

I mentioned in another thread about ANM. The distributor in the UK (Tinnitus Clinic) are conducting a study, not much different to the principle of the referenced Tinnitool study. The difference is a properly controlled, independent, peer reviewed, registered trial. It can be done and it doesn't have to cost the earth to make it happen.

 

Hi to all.
Can someone tell me if all that in this link is false or faKe ?
http://www.tinnituspatient.de/bagp4anlage.pdf

All the best to everyone.

 

I found this as well:
Dr. Naglers valuation of the Low-Level-Laser-study Nakashima.
This information is from the Yuku social communities forum "Starting-self-administered-laser-treatment" of December 2010.

Mansi wrote:
To understand the real situation, we only need to have a look at the Nakashima Study, following at the bottom.
This study is in the arguments of the opponents of LLLT at position 1 and defined as a very good science and as to show that LLLT is not effective for the treatment of tinnitus.
We have not to be a medical to understand, that 6 minutes 60 mw LLLT once a week over total 4 times cannot change a T. This study is a bad joke.
Here has to come the first correction to get more clearance around the LLLT.
Mansi

Transmeatal low-power laser irradiation for tinnitus.
akashima T, Ueda H, Misawa H, Suzuki T, Tominaga M, Ito A, Numata S, Kasai S, Asahi K, Vernon JA, Meikle MB.
Department of Otorhinolaryngology, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
Abstract
OBJECTIVE: To evaluate effectiveness of 60-mW laser irradiation in the treatment of tinnitus.
STUDY DESIGN: Prospective, randomized double-blind study.
METHODS: This investigation included 68 ears in 45 patients with disabling unilateral or bilateral tinnitus. The active or placebo laser treatment was administered transmeatally once a week for 6 minutes. Laser irradiation was performed four times during a 4-week period. A questionnaire was administered to evaluate the loudness, duration, quality, and annoyance of tinnitus before and after irradiation. The loudness and pitch match for tinnitus were obtained, and distortion product otoacoustic emissions were also examined.
RESULTS: No significant difference was observed between the active and placebo laser groups with regard to outcome of loudness, duration, quality, and annoyance of tinnitus. In one patient who received active laser treatment, acute hearing deterioration occurred after the third irradiation.
CONCLUSION: Transmeatal low-power laser irradiation with 60 mW is not effective for the treatment of tinnitus.
PMID: 11981384 [PubMed - indexed for MEDLINE]

The answer of Dr. Nagler was the following:
Jack Vernon and Mary Meikle were co-investigators in that study. You can be sure that the doses were checked out carefully. You can be sure that the study was scientifically valid. And you can be sure that the study did not claim to demonstrate more than the data reveal.

We say to that:
How can someone say to 6 minutes LLLT a week: "the doses were checked out carefully"?
This doses are less than 1 % of the doses that Dr. Wilden uses.