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

I have been following this thread and I do not see @Dr Nagler being disrespectful at all--if this treatment is to be effective, it is important to determine what makes it effective, especially because LLLT is at this point largely unproven as a tinnitus treatment and could set a lot of people back a lot in $ for a treatment that is unproven. I do also think that if this worked, people would be jumping all over it--I do not believe there is a conspiracy of hearing aid manufacturers to slow this down.

 

Well, Dr Nagler wrote that @FERNANDO GIL believed that LLLT could

Fernando did not say this. To me that means that Fernando was misrepresented, which I consider disrespectful not only to him, but to those who might be misled by believing the misrepresentation.

If you are happy to be misled then that is fine. I merely stated how I find it.

 

What can I say?

 

Whatever you like. I was concerned it may seem I was speaking for you, and I did not want to put words in your mouth.

 

That's fair--I didn't interpret what Dr Nagler was doing to be misrepresentation but more clarification. To me there is a huge difference between the meaning behind resurrecting dead cells and regenerating cells that are not working as well as they could. If the research shows that LLLT can regenerate inactive hair cells or something to that effect, that is something that should be researched more.

 

Absolutely - that was the distinction I tried to make in my earlier posts today. It is absolutely crucial to the credibility of the therapy and Dr Nagler's earlier posts fudged it. But if he has me on 'ignore' (because he does not like me pointing out his errors) then he has deliberately chosen to remain in the dark.

 

http://www.dr-wilden.de/pdf/dgo_en.pdf
Page 40 explains what dr.Wilden means by regeneration.

 

I just read from pages 40-42 and am more confused than I am understanding now. It seems that he is truly talking about "regeneration" with regards to bringing dead cells back to life. Admittedly I just scanned through the document and paged to the end of the document but I do not see a single source outside the scope of his own webpage. I do see a section about the "dangers of TRT" near the end. And I do see that this document is dated from 2007. Why is there no advancement in this potentially very vital idea of regeneration of inner ear cells since 2007? I'm sorry, but from this chair, it is hard to buy into what this has to say.

 

From Page 40:

"The cellular nucleus “starts“ the process of regeneration (repair) at any lessening of its optimum health, such that this optimum health is restored as quickly as possible. For this purpose the cell requires sufficient energy at hand (ATP)."

Regeneration and repair are not synonymous as Wilden implies. All cells, including cochlear hair cells. have the ability to repair themselves when damaged. But when a human hair cell is dead, it's dead. A dead hair cell has no functioning nucleus. Regenerating human hair cells (i.e., regrowing them once they are dead) has long been a major focus of auditory research. And to date nobody has been able to accomplish that extraordinary feat.

Here is an accurate fact sheet from NIH:

http://report.nih.gov/nihfactsheets/viewfactsheet.aspx?csid=94

So I can see why somebody might fall under the false impression that LLLT can regenerate hair cells - all you have to do is totally redefine the word "regenerate" to suit your purpose, which is precisely what Wilden has done. Nauseating.

stephen nagler

 

I am no biologist, but lets look at Wikipedia (for example), where the word "regenerate" does not seem to mean that a cell has to come back from death:

"In biology, regeneration is the process of renewal, restoration, and growth that makes genomes, cells, organisms, and ecosystems resilient to natural fluctuations or events that cause disturbance or damage."

So Wikipedia does not seem to agree with Dr Nagler when he says

So if Dr Wilden's use of the word "regeneration" is compatible with that on Wikipedia then is it really "nauseating"? Or is Dr Nagler stretching things again?

Really? It is worth acknowledging that Dr. Wilden's website and free publications are available in several languages and it is unfortunate that the English is a little shaky. If it were my website/free pdf book then I would probably pay for a better translation. Nevertheless...

From the pdf:

"Only when our natural ability to repair and regenerate is either fully exhausted ( the cells ), or overstressed, perhaps by an accident, will cellular death occur and therewith also our ability to regenerate and repair." (Page 40)

From the webpage I linked yesterday:

"...the sense cells did not die however even in a so damaged inner ear and therefore, can be regenerated."

And:

"As a result, the exhausted (died however not) hearing cell has the possibility to become healthy again."

 

http://dx.doi.org/10.3342/kjorl-hns.2009.52.1.19

Copyright © 2009 Korean Society of Otorhinolaryngology-Head and Neck Surgery

Preventive and Therapeutic Effects of Low Level Laser Irradiation on Gentamicin-Induced Vestibulotoxicity in Rat Utricles

Jeong-Beom Kim, MD,1 Jae Yun Jung, MD, 1 Jin-Chul Ahn, PhD,2 Chung Ku Rhee, MD,1,2 and Yang-Hee Oh, MD3
1Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Dankook University, Cheonan, Korea.
2Medical Laser Research Center, College of Medicine, Dankook University, Cheonan, Korea.
3Sangquehan ENT Clinic, Namyangju, Korea.


Address for correspondence: Email: jjking@dankook.ac.kr


Received June 27, 2008; Accepted October 13, 2008.

Abstract

Background and Objectives

The purpose of this study was to investigate the effects of low level laser for the prevention and treatment of aminoglycoside-induced vestibular ototoxicity.

Materials and Method

An organotypic culture of 2 to 4 days old rat utricular maculae was established. Rats were divided into 6 groups according to the treadtment of the utricles: G (gentamicin-treated), L (laser-irradiated), LG (laser-irradiated and gentamicin-treated), GL (gentamicin-treated and laser-irradiated), LGL (gentamicin-treated during laser-irradiated) and C (control). After organotypic culture, the utricles of 6 groups were examined by confocal laser scanning electron microscope and scanning electron microscope. The results of each group were compared with each other by statistical methods.

Results

The number of vestibular hair cells of the group G was smaller compared to that of the group C. The group L had no difference compared with the group C. The groups LG and GL showed more vestibular hair cells compared with the group G. The group LG showed more vestibular hair cells than the group GL. The group LGL showed most vestibular hair cells compared to that of the groups G, LG, and GL.

Conclusion

The most effective treatment of aminoglycoside-induced vestibular otoxicity is the irradiation of low level laser before and after the insult of the aminoglycoside. Further clinical studies using low level laser were needed to prevent aminoglycoside-induced ototoxicity and to promote the regeneration of vestibular hair cells.

Keywords: Gentamicin, Ototoxicity, Low level laser.



Source: http://synapse.koreamed.org/DOIx.php?id=10.3342/kjorl-hns.2009.52.1.19&vmode=PUBREADER

 

I suspect that this is really what Dr Nagler finds "nauseating". And possibly what drives his input to this thread.

 

I guess my question would be, what is the motivation for including a long section about the "dangers of TRT" in the first place? Shouldn't his own research on LLLT be enough that he doesn't need to "bring the competition down" so to speak? From a purely rhetorical viewpoint (my wife is getting her Ph.D. in Rhetoric which makes me an armchair rhetorician so bear with me ) I scan through his document and find a lot of text with not a lot of references to outside sources. It doesn't help that the document itself just has a look similar to the "Tinnitus Gone" type websites.

As for the efficacy of LLLT on inner ear hair cells, I'm more inclined to believe Dr. Nagler's NIH source that discusses a variety of different potential methodologies that have the potential to work than I am convinced by Dr. Wilden's document which, again, is from 2007. Since then, we have seen a lot of new potential therapies, including the one highlighted in the NYTimes article that was circulated around here in January 2015 and is currently undergoing clinical trials in the US.

My overall point being--I think there ARE potential treatments for inner ear cells but I am not convinced by what Dr. Wilden has provided that his LLLT therapy is one with a lot of promise right now. Whether or not LLLT research has been blocked or the like by the existing hearing aid industry, well, I am not enough of a conspiracy theorist to buy into that.

 

I'm apparently missing a few posts from this thread - but if there is concern about the "Dangers of TRT" section of Wilden's 108 page tome, one really should consider the source of all that misinformation before lending any credence to it.

stephen nagler

 

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 not inspire huge confidence (albeit it is given away free and seems not intended as a scientific text). But 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?

 

I one that had been with Dr Widen

I know, so as I had nothing to ad, that´s why my post. Dr Wilden told me that LLLT will never get back to life dead cells, so I have to presume that when he says regeneration it means, restoring the ar cells.


Just to let you know, that i´m felling better everyday, Times to times it happens. since last weekend when I had two days with high T, it´s been coming down everyday. Funny how it´ the same T volume for some time and then sudenly in a few days the T sound just drop. And you notice day to day. For this last 5/6 days everyday I wake up I note is lower than the day before. Yesterday I could say my T was almost gone, during big part of the day it was really low. This mornning was low as well, it is up now at the end of the day. Just doing 15 minuts of LLLT and not everyday, actualy it´s been 3 days i din´t make. I will give time till end of the week, see how it goes, and then get back in full force during next week.


Sheers all.

 

More and more I´m so happy I went to make the SC tretament and made the Anne Harilla tretaments. As ATEOS say. REGENERETIVE MEDICE ROCKS. I´m all in.

 

@marqualler Just to clarify what I wrote above, I do believe the accounts of those who have written about getting benefit from LLLT. The words of Hansi Cross, Fernando, Nick J, ATEOS (hearing gain only) definitely ring true to me in the detail and conviction they display.

But that does not mean I am convinced it works for everybody. I suspect that big investments of money and time during the acute stage probably see the best results but am unclear beyond that. I was willing to spend $900 USD of my money on a device to try it. I do agree that we need more good quality information and analysis about this. Several interesting looking studies have been posted, but because we never seem to get into discussing these the discussion never really advances. Which is frustrating, but my skills are not in science (more in pedantic analysis of texts and ideas).

@FERNANDO GIL Really glad to hear that! Thanks for continuing to post!

 

For what I see from this video, and is not from Dr Wilden, the term regenerative is a term used on the LLLT treatments, as well reperative (wich I think is more apropriate) . Please see minute 1,44.

Hope this helps to clarify why Dr Wilden uses the term regenerative. It´s not him only.

Lasers Therapy - Basic Information of How...

Sheers

 

OK. So they're all a bunch of crooks.

Look, Fernando, a live human hair cell cannot regenerate. It can repair itself, but it cannot regenerate.

The term regenerate - as used in the auditory science literature - refers only to dead hair cells. And up to this point in time, research has not revealed a way for human hair cells to regenerate. Shark hair cells can do it. Parrot hair cells can do it. But human hair cells cannot. And all the LLLT in the world is not going to change that.

stephen nagler

 

As already pointed out, there are language issues in the translation of Dr Wilden's material. Using that fact to insist that a word can only mean one thing - and must be held to mean that thing even when it is clearly not intended that way! - is a pretty low tactic.

Fernando has already clarified his meaning.

 

I don't understand why Dr Wilden is given such a vast amount of benefit for the doubt on this forum. And the doubt is huge considering the transparency of the medical research. I mean, come on.

 

Hi KingRoanoke - not sure if you were addressing your post to me particularly. If you were then I'd answer with the following three points:

- I think most people who have posted here are sceptical or undecided, so in general terms I do not see any vast amount of benefit of the doubt. However some have actually experienced a benefit themselves and so they defend the therapy for that reason. And me... I just like a fight to be fair, and in this thread that means pointing out the underhand ways of arguing that are employed by one dominant poster. Because I suspect that not everyone can see these tactics for what they are.

- Transparency? You've got to be kidding. Have you looked at the range of studies?

- You might find some criticism of Dr Wilden by those who also defend LLLT if you look hard enough. I have made critical comments about his book. But that does not mean I think it is OK to twist what he actually says in it and claim it says things that it does not. If we don't strive for fairness and clarity then how can we get at the truth?

 

He doesn't. People report their experiences with the therapy. No more; no less.

Transparency? I see. Well, the lead poster in this thread (who has 100 posts more than me in this thread alone), happens to be in a situation where there is a potential conflict-of-interest (because of past affiliations). It is standard practice to excuse oneself from commenting under such circumstances.

Transparency, my ass.

 

I mean transparency in general. It just seems that if something like this really worked, it would be acknowledged as a working treatment and venerated universally in the medical community. Tinnitus is so common, after all.

 

It is not standard practice to withhold comments under such circumstances.

It is standard practice to reveal all potential conflicts of interest prior to commenting. The lead poster has done that. IN SPADES.

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.

stephen nagler

 

Transparency in the medical community in general. I mean, if something works - it will get adopted immediately. I don't really know the board members that well but I do keep up with the "Treatment and Research" part of the forum. I am just saying this as an outsider looking in, really. And perhaps I'm tired of family members telling me this and that works for tinnitus, when in reality we have nothing right now. I am just exhausted with all the hype regarding tinnitus treatment. This doesn't seem any different.

 

You're aware of the Novartis technology, right? I think it's still fair to say "no one has done it in humans, yet, though there is a trial underway". But, it's been done in animals and higher primates already -- so I'd say it's been done and is being done in humans now...

 

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.

 

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.

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.

Which is why healthy skepticism is a good thing. And which is why everything you read on Internet boards (yes, including what I write) should be taken with a grain of salt, a large grain of salt.

stephen nagler