Complementary therapy for tinnitus - an opinion
Last updated on 13 April 2011
Many of you will at some time or other have tried at least one form of complementary therapy, or alternative medicine, as a way of helping your tinnitus. Your chosen therapy may have been recommended by a friend, by a newspaper or on the internet. Some will have found it quite effective, others will have found it utterly useless, and others still, may be unsure whether it really helped or not. All will have tried it in the sincere hope that it might make a difference.
Those with tinnitus are not alone in choosing to try complementary therapy. It has been used by at least 25% of the people in the Western world for all kinds of ailments, but in particular for conditions for which there is no definitive medical cure. Several reasons have been identified for turning to complementary therapy, which include patients’ dissatisfaction with the symptom- focussed approach often taken by their GPs (treating each headache for example, rather than the cause of the headaches in general) and patients’ desire to play a more active role in their own treatment. Unfortunately, the medical profession as a whole is not catching up with the demands of patients. We are still quite uninformed about the effectiveness of complementary therapy in general, and for tinnitus in particular. This information sheet is not intended to be a guide to complementary therapy for tinnitus, but more a comment on what we do, and don’t know about it, what there is left to learn and what conclusions we can draw from the work that has been done so far.
The form of complementary therapy I am most often asked about in my tinnitus clinic is Gingko Biloba, a herbal supplement available in health food shops which derives from the rather beautifully named Chinese Maidenhair tree. Quite a few studies have been carried out into the effects of Gingko on tinnitus. Three quite small studies carried out in the 1990’s did show that Gingko was fairly effective in reducing tinnitus, but the largest study carried out to date - which involved many BTA members - showed more disappointing results. Ewart Davies and his team at Birmingham University, concluded that Gingko was not an effective treatment for tinnitus for most people, although the possibility remains that certain individuals might benefit, so the book is not yet closed on this one.
Second in line to Gingko in terms of number of enquiries in my clinic, is acupuncture. This is a form of complementary therapy that many people have tried for all sorts of ailments, often with high levels of success. One study in 1998, which compared acupuncture to physiotherapy, showed some improvements in tinnitus for 45% of patients following acupuncture but sadly the improvements did not last long. Another six studies showed no positive effect, so I would hesitate to recommend acupuncture to anyone as a treatment for tinnitus.
Homeopathy is a tremendously popular form of complementary therapy which has whole hospitals dedicated to its use and a string of well known advocates, including Prince Charles. Its governing principle is that ‘like cures like, so for example hay fever is treated with pollen. However, it is most unusual as it works on the philosophy that the more a substance is diluted, the more potent it becomes. So far only one study has been carried out into tinnitus and homeopathy - once again by the ever busy Ewart Davies and others - and this showed that the homeopathic remedy had no effect. Whether homeopathy can possibly be an effective treatment for anything is a matter of hot debate within the scientific community, and beyond the scope of this article, but as far as tinnitus is concerned the outlook is not good so far.
A quick surf of the internet reveals many other forms of complementary therapy being recommended for tinnitus, amongst them zinc supplements, vitamin B and restricted diets. The most that can be said for these is that, as yet, not enough scientific evidence exists to make any judgements about whether they are effective or not - we simply do not know.
Plenty of anecdotal evidence does of course exist, and there are probably people reading this information sheet right now, who feel that their tinnitus has been helped significantly by some form of complementary therapy or other. So, does it matter that we do not yet have the evidence to prove that it works? If there’s a possibility that it might help, isn’t it worth a try?
Complementary therapy is often regarded as a ‘safe’ option and, indeed, compared to many forms of conventional medicine, most complementary therapies are very safe indeed. However, side effects from herbal medicines are possible - just because it can be bought over the counter does not mean that it carries no risks at all. People have reported headaches and stomach upsets after taking Gingko Biloba, and there can also be negative health effects caused by large doses of vitamin and mineral supplements.
These may be relatively small considerations and many people would argue that they would rather have an upset stomach than tinnitus. However, possible side effects are not the only reason why we should be wary of the advice: ‘why not try it- there’s nothing to lose’.
Many people with tinnitus go through a period of ‘cure seeking’, particularly in the early days, during which they try a whole range of treatments, perhaps things suggested by friends or recommended in the media, which fail to give them any relief. Often, people try a succession of treatments, one after the other, and as each one fails they become increasingly disheartened, and increasingly more despairing about their tinnitus.
It is fairly obvious that the more despairing a person feels, the more difficult it becomes to cope with tinnitus day-to-day. This idea is backed up by a Swedish study from 1997 which found that patients who had tried some form of complementary therapy for tinnitus, without success, prior to attending appointments at the tinnitus clinic started off with a more negative outlook than those who had not, and were less motivated to accept the specialist advice being offered there.
Another factor to consider, is that complementary therapy is generally expensive, and not normally available on the NHS. Paying out hard earned cash for treatments which do not work is again likely to increase feelings of despair and resentment, both of which stand in the way of coming to terms with tinnitus.
It is for these reasons that I feel uneasy about recommending any form of complementary therapy to my patients as a tinnitus treatment. I am unwilling to recommend anything that I feel might make matters worse for them.
Having said this, I think there are circumstances under which complementary therapy can have a very useful role to play. For many, having tinnitus means much more than hearing an internal noise. It means feeling anxious, or getting depressed, or not being able to get to sleep. Any tinnitus clinic worth its salt will try to address the co-symptoms of tinnitus rather than just the noise itself.
It is well proven that people feel more able to get on top of their tinnitus when they are feeling otherwise well in themselves. For some, complementary therapy may be a way of reaching a sense of improved well being. Things like anxiety, depression and insomnia tend to get more attention from the medical world than tinnitus, and a smallish number of clinical trials have been carried out into various complementary therapies for such problems.
In some cases the results are promising, and although alternative medicines are rarely shown to be more effective than conventional medicines, such as anti-depressants, they may be equally effective in some cases, and are often preferable to users. They may be an option worth considering for those who are struggling with other problems surrounding their tinnitus.
There are other ways, too, in which I believe the world of complementary therapy can improve the lives of people with tinnitus.
A criticism sometimes launched at complementary therapies is that their apparently high success rate for treating some ailments is due entirely to the placebo effect. This phenomenon has been recognised since ancient Greek times; a large number of patients who go for treatment will find themselves getting better even when they are in fact taking sugar pills, or some other inactive treatment. Nobody really understands how this works, but it does seem clear that believing you are being treated for your ailment has a positive effect on the ailment itself. Everybody is susceptible to the placebo effect, even rational, sceptical individuals. This is why, in order to be considered valid, any treatment being tested has to be shown not just to be effective but to be more effective than placebo. The placebo effect is strong in many complementary therapy trials, including those for tinnitus. This means that in many of the studies where treatment - Gingko Biloba, acupuncture or whatever - was shown to be ineffective, a number of people did actually experience improvements in their tinnitus. It was just that a similar number of people responded to the placebo treatment as responded to the actual one.
Does this mean that the whole thing is just a big con, and people are somehow deceived into thinking their treatment it working? I don’t think so. If people are feeling better, something is making them feel better, and we would do well to look at what the placebo effect is actually doing.
Britain’s only professor of complementary therapy, Edzard Ernst, identifies several factors which enhance the placebo effect. These include:
- Showing a high level of confidence in the treatment you are offering
- Showing empathy, warmth and understanding towards the patient
- Giving the patient plenty of information about their disorder
- Spending a long time over the consultation.
Complementary therapists tend to do all of these things, so it is perhaps not surprising that patients usually feel happy with the treatment they have received at their hands, even if clinical trials have shown it to be ineffective. Furthermore, even when a treatment is actually beneficial, its effect will still be further enhanced by these same factors.
So where does that leave you, if you are currently considering complementary therapy for tinnitus? My advice to you is this: be as well - informed as you can. Consider the potential dangers and be aware of the lack of real evidence so far. If you do decide to go for it, be aware also that a good, well-informed, caring therapist is probably worth any number of Gingko Biloba capsules.
British Tinnitus Association
Helpline: 0800 018 0527
Lucy Handscomb, Hearing Therapist, St Mary’s Hospital London
© British Tinnitus Association
Those with tinnitus are not alone in choosing to try complementary therapy.
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