הבטחתי ...קיימתי

http://www.itmonline.org/arts/tinmen.htm ACUPUNCTURE FOR TINNITUS MANAGEMENT By Nilsson S; Axelsson A; Li De G. [Acupuncture for tinnitus management] Scandinavian Audiology, 1992, 21(4):245-51. (UI: 93141943) AT: UCLA Biomed W1 SC131 (PE title: Scandinavian audiology.) AT: UCLA Biomed W1 SC131A (PE title: Scandinavian audiology. Supplementum.) http://acupuncture.com/research/tinnitus.htm מי שרוצה עוד מחקרים - שיבקש...יקבל

שלום רב אני מבינה שאתה עסוק כעת בהתנגחות קצת איתי, ובנסיון לחזק את נושא הדיקור והטיניטוס. אני גם יודעת שלא תמיד אדם רואה את התמונה המלאה, אבל בשביל זה יש מחקרים וספרות מקצועית ועיתונות רפואית. ואני רופאה, ומאמינה ברפואה ומחקר ולא עובדת בשיטה של נדמה לי. אז אולי אתה 15 שנים בנושאי רפואה סינית, אבל אני 30 שנה באודיולוגיה ו 20 שנה רופאה, אז בבקשה לא לספור לי שנים. התמונה המלאה של הדיקור מבחינתי היא שבמקרים מסוימים יש בו תועלת ואני ששה לשלוח חולים עם מחלות ספציפיות לטיפולים משלימים, ובמקרים אחרים - כמו למשל בנושא הטיניטוס, מדובר באפקט פלצבו. לא שאני מזלזלת בפלצבו אבל לפחות בוא נאמר את האמת לאנשים. אז ככה. אספתי כמה דוגמיות על קצה המזלג ככה מהצד שיהיה מעניין. כל מה שצריך הוא לפתוח ספרות רפואית. ביקשת שאפנה את החולים לעבודות = אז יאללה לעבודה, כל אחד יכול לקרוא ומי שיודע ומבין אנגלית ידע להבין את המשמעות של אין הבדל בהשוואה לפלצבו (כלומר אין הבדל בין כלום לבין דיקור בנושא הטיניטוס). בכנסים הכי רציניים שיש בעולם בנושא טיניטוס והטיפול בו מציינים במפורש את העדר ההשפעה של דיקור (ואפילו את האופציה שהוא עשוי לגרום להחמרה, אגב, ובכנסים אלה יושבים גדולי האנשים שדנים בטיניטוס בעולם הרפואה), אגב גם מוזכרים העדר ההשפעה של גינקו, הומיאופתיה, ועוד שונות ומשונות . ואני חותמת בזאת את הויכוח כי נמאס לי ויש עוד דברים נחמדים בחיים חוץ מאשר להתווכח מי יותר גיבור. 1. J Laryngol Otol. 1984 Nov;98(11):1103-9.Links A controlled trial of acupuncture in tinnitus.Marks NJ, Emery P, Onisiphorou C. The relationship of tinnitus to pain is examined and a theoretical case made out for the possible use of acupuncture in the treatment of tinnitus. A double-blind cross-over controlled trial is described. The use of Visual Analogue Scales (V.A.S.) is discussed in this context. 35 per cent of patients described some benefit from the active treatment only, although we were unable to demonstrate this objectively. Statistical analysis of the group as a whole revealed no significant differences between placebo and active acupuncture treatment. 2. 1: Ugeskr Laeger. 1999 Jan 25;161(4):424-9.Links [The effect of traditional Chinese acupuncture on severe tinnitus. A double-blind, placebo-controlled clinical study with an open therapeutic surveillance][Article in Danish] Nielsen OJ, Møller K, Jørgensen KE. Høreklinikken, Vejle Sygehus. The aim of the present study was to determine the effect of intensive acupuncture on severe tinnitus. The structure of the study was a randomized, double-blind, clinical investigation with open therapeutic surveillance and included 54 patients. All were subjected to 25 treatment sessions over a period of two months, each treatment lasting 30 minutes. Fifty-two patients completed the study. The variables used for self-registration were based on the Visual Analogue Scale, where annoyance, loudness and awareness of the tinnitus were assessed. These were recorded twice daily over a four month period starting one month before the first treatment and ending one month after the last treatment. Questionnaires, interviews and audiometry were carried out repeatedly. No statistically significant differences were found between the acupuncture group and the placebo group. 3. Audiology. 1994 Nov-Dec;33(6):351-60.Links Acupuncture in the management of tinnitus: a placebo-controlled study.Axelsson A, Andersson S, Gu LD. Department of Audiology, Sahlgrenska University Hospital, Gothenburg, Sweden. The present study was performed on 20 patients randomly selected from a large group with noise-induced tinnitus in order to investigate the effect of acupuncture on their tinnitus. The patients were divided into two groups. One group first received classical Chinese needle acupuncture for 5 weeks, and the other was given a placebo procedure; after a 2-week interval, the procedures were reversed. A single-blind cross-over design was used. Acupuncture was given by a Chinese otolaryngologist around the ear as well as at distal points on the extremities. Placebo consisted of mock electrical stimulation via surface electrodes connected to a Chinese electro-acupuncture stimulator which delivered a weak sound and a light flash at a frequency of 2 Hz but no current to the surface electrodes. The effect was evaluated by the use of visual analogue scales. No significant difference between acupuncture and placebo was found in annoyance, awareness or loudness of the tinnitus. Many patients indicated a preference for acupuncture due to unspecific effects such as improved sleep, decreased muscle tension and improved blood circulation. It is concluded that acupuncture has no specific alleviating effect on noise-induced tinnitus. 4. Br J Audiol. 1998 Jun;32(3):197-204.Links Effect of traditional Chinese acupuncture on severe tinnitus: a double-blind, placebo-controlled, clinical investigation with open therapeutic control.Vilholm OJ, Møller K, Jørgensen K. Department of Audiology, Vejle Hospital, Denmark. This study aims to determine the effect of intensive acupuncture on severe tinnitus. The structure of the study was a randomized, double-blind, clinical investigation with open therapeutic surveillance and included 54 patients. All were subjected to 25 treatment sessions over a period of two months, each treatment lasting 30 minutes. Fifty-two patients completed the study. The variables used for self-registration were based on the visual analogue scale (VAS), where annoyance, loudness and awareness of the tinnitus were assessed. These were recorded twice daily over a four-month period starting one month before the first treatment and ending one month after the last treatment. Questionnaires, interviews and audiometry were carried out repeatedly. No statistically significant differences were found between the acupuncture group and the placebo group. 5. Arch Otolaryngol Head Neck Surg. 2000 Apr;126(4):489-92. Links Efficacy of acupuncture as a treatment for tinnitus: a systematic review.Park J, White AR, Ernst E. Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter, England. [email protected] BACKGROUND: Tinnitus is a prevalent condition for which patients may seek treatment with acupuncture since no conventional treatment has been shown to be effective. OBJECTIVE: To summarize and critically review all randomized controlled trials on the efficacy of acupuncture as a treatment for tinnitus. DATA SOURCES: Four independent computerized literature searches (MEDLINE, Cochrane Controlled Trials Register, Embase, and CISCOM) were conducted in December 1998 using the key words acupuncture and tinnitus. STUDY SELECTION: All randomized controlled trials that compared any form of acupuncture with any control intervention in the treatment of tinnitus were included. DATA EXTRACTION: Data were extracted by 2 authors independently. The methodological quality of the included randomized controlled trials was assessed using the Jadad score. DATA SYNTHESIS: Six randomized controlled trials were included in the review, 4 of which used crossover design. Four studies used manual acupuncture and 2 used electroacupuncture. Five of 6 studies used inconsistent acupoints. Three studies scored 3 points or more on the Jadad scale. MAIN OUTCOME MEASURES: Outcome measurements were visual analog scale scores for loudness, annoyance, and awareness of tinnitus; subjective severity scale scores for tinnitus; or Nottingham Health Profile scores. RESULTS: Two unblinded studies showed a positive result, whereas 4 blinded studies showed no significant effect of acupuncture. CONCLUSION: Acupuncture has not been demonstrated to be efficacious as a treatment for tinnitus on the evidence of rigorous randomized controlled trials. 6. Clin Otolaryngol Allied Sci. 1982 Oct;7(5):325-9.Links Acupuncture treatment of chronic unilateral tinnitus--a double-blind cross-over trial.Hansen PE, Hansen JH, Bentzen O. In a double-blind controlled trial the effect of traditional Chinese acupuncture versus placebo acupuncture was evaluated among 17 patients (8 females and 9 males, mean age 45.7 years) with chronic (mean disease duration 5.3 years) unilateral tinnitus. None of the patients had any treatable otological disease. All patients suffered from daily tinnitus, the intensity of which was recorded by the patients themselves every day during a period of 15 weeks. Each patient was treated by traditional Chinese acupuncture as well as placebo acupuncture following randomization (Figure 1). Each period of treatment comprised 2 treatments a week for 3 weeks. Throughout the whole investigation a period effect was recorded, insignificant in the acupuncture-placebo group, but significant in the placebo-acupuncture group (Friedman analysis of variance) (Table 4). There was no significant difference between traditional Chinese acupuncture and placebo (Wilcoxon test, P greater than 0.05, one-tailed). There was no relation between the patients' subjective statements and the results of sound balance measurements as an objective standard of tinnitus (Spearman test). 7. From the 1Department of Special Needs Education, Faculty of Education, University of Oslo, Norway, 2North Trent Department of Medical Audiology, The Royal Hallamshire Hospital, Sheffield, UK, 3Briskeby School and Resource Centre for the Hearing Impaired, Lier, Norway Falkenberg E-S, Tungland OP, Skollerud S. Habituation therapy of chronic distressing tinnitus: a presentation of a treatment programme and an evaluation study of its effects. Audiological Medicine 2003; 2: 132–137 During the last 15 years, tinnitus suffering has been an increasing reason for patients to seek medical and audiological advice in Norway. In 1998–1999 we introduced Tinnitus Habituation Therapy (THT) to nearly 200 tinnitus sufferers. This paper presents the programme and the evaluation of the effects it had on the patients. Two treatment groups were presented and pre- and post-treatment analysis was used. Immediately after the treatment, 59% reported less annoyance and 72% reported increased ability to cope with tinnitus. A follow-up assessment 12 months after the end of treatment, involving 164 patients who completed the survey, indicates that these effects are maintained, and a considerable number even continued to improve. Key words: habituation, multidisciplinary team, neurophysiological based management, tinnitus, tinnitus-related activity in the nervous system (TRA), white noise generator. ___________ Tinnitus, also denoted “the perception of sound within the head in the absence of external auditory stimulation” (Hazell and Jastreboff, 1990), is an annoying condition that during the last two decades has been an increasing reason for patients to seek audiological and medical advice. A prevalence study of tinnitus as part of the National Study of Hearing in England, (Coles, 1984) dealt with different aspects of hearing and disorders associated with tinnitus. He found that the prevalence of tinnitus perception, lasting more than 5 minutes, in the adult population, was 17%. Fabijanska et al. (1999) suggested in the introduction to their paper “Epidemiology of tinnitus and hyperacusis in Poland” that tinnitus affects about 17% of the general population around the world. An epidemiological study performed by the Norwegian National Institute for Public Health in 1996 showed that 15% of the population are affected by tinnitus (Birkeland, 1998), and this corresponds with a study from Sweden, with a prevalence of 14% (Axelsson and Ringdahl, 1989). These authors also found tinnitus to be disabling in 2.4% of the people surveyed. In Coles’ study (1984), 1% reported a definite impairment in quality of life and about 8% complained of sleep disturbance in varying degrees. The occurrence of tinnitus seems to increase with age (Chung et al., 1984; Brown, 1990; Siwiec, 1999; Fabijanska et al., 1999), but there is no clear evidence that tinnitus becomes more of a health problem (Lindberg et al., 1984; Scott et al., 1990). Clinical data from first presentation at specialist tinnitus clinics consistently show that the majority of patients are 50–70 years of age (Sanchez et al., 1999). The effect of gender on the prevalence of tinnitus is inconstant. Many studies have shown females to be slightly more affected by tinnitus, but the results have not reached statistically significant values (Davis and Rafaie, 2000). Evidence referring to unpublished data from Sheffield has shown that approximately 60% of tinnitus sufferers relate their first awareness of tinnitus to changes in their life, small or substantial (Tungland, 2002, personal communication). These could include events such as being made redundant, retiring, sickness in the family, problems at work, accidents, surgery, or even having had their ears syringed. Such events can produce a change in the arousal of the brain or its homeostasis, resulting in a state of heightened brain arousal during which the tinnitus signal is registered cortically (Jastreboff, 2000). It is also likely that such events can weaken the normal mechanisms of defence against anxiety and other emotional reactions. A considerable number of treatments have been suggested and tested. Many of these, however, have been reported as having little or no long-term effect on tinnitus, e.g. Tan et al. (1999) who reported no effects from hyperbaric oxygenation treatment; Simpson et al. (1998) none from homeopathy; Nebeska et al. (1999) and Wilholm et al. (1998) none from acupuncture. A large study by Drew and Davies (2001) showed that 12 weeks treatment with Gingko biloba, was no more effective than placebo. 8. אז נגעתי בקצה התמונה. וברור שיש בינינו חילוקי דעות וטוב שכך כי החיים מעניינים יותר בדרך הזו. ושיהיה לך יום טוב, ד"ר טלי מרק

ד"ר נכבדה, אינני עוסק בהתנצחות וחילוקי דעות עשויים להפרות את הגולשים ואותנו.. פרסמת מאמרים ארוכים והדבר מבלבל את הגולשים. חבל. אינני אומר שדיקור הינו פיתרון קסם אך כדאי לנסות ובמיוחד לאור המחקרים מהשנים האחרונות. ולגופו של עניין : המחקר הראשון, ישן מאד ( מ 1984), מציין במפורש " we were unable to demonstrate this objectively" . וגם אז 35% " per cent of patients described some benefit from the active treatment" מחקר שלישי ישן מאד גם הוא ( 1994) ביצע את הטיפולים רק 5 שבועות ורק על 20 איש וגם כאן הפסיקו את המחקר כפול הסמיות והפכוהו למחקר חד סמיותי. הפרוטוקולים הטיפוליים של היום מדברים על מינימום של 12 שבועות טיפול !!. מחקר רביעי גם הוא ישן (1998) בדק רק 8 שבועות טיפול ואינו רלוונטי. ברצוני להדגיש כי בדור הטכנולוגי של היום שנתיים מהוות זמן ארוך ..... המחקרים ה"נחשבים " הינם בני שנתיים – שלוש כך שמחקרים מלפני עשור... ממש לא נחשבים. הטיפול המומלץ היום הינו בן 12 שבועות מינימום וכולל הוספת תערובות צמחים סיניות ה"נתפרות" על המטופל לאחר אבחנה מבדלת. "מחקר" חמישי אינו מחקר כלל אלא חיפוש ממוחשב באינטרנט ובסיפרות הכולל בתוכו גם את המחקרים הקודמים " DATA SOURCES: Four independent computerized literature searches" וגם אז " RESULTS: Two unblinded studies showed a positive result" מחקר שישי – ארכיאולוגי ממש 1982 !!, זה ממש מצחיק.....17 איש טופלו במשך 3 שבועות....אין סיכוי להצלחה !! מחקר שביעי, בכלל לא על רפואה סינית....אלא על שיטה אחרת : introduced Tinnitus Habituation Therapy (THT) " " " " This paper presents the programme and the evaluation of the effects" ובהערה בסוף כתוב " placebo " 12 weeks treatment with Gingko biloba, was no more effective than זה לא קשור בכלל.... לסיכום: אינני יודע מהיכן הסקת ש"דיקור מחמיר את המצב" לכך אין ולו רפרנס אחד. ואלו שציינת (למעט אחד ) לגמרי לא רלבנטיים בעוד שאלו שהצגתי – חדשים ומאד רלוונטיים. חושבני שכדאי מאד (בלשון המעטה) להפנות מיקרים מסויימים לדיקור במקום להשמיע את המשפט השגור "זה אולי יעבור לך עם הזמן" או "תאלץ לחיות עם זה".....

ושוב שלום. מה שהכי הכי הכי מצחיק זה המאמר שאתה ציטטת .... הנה האבסטרקט שלו. Nilsson S, Axelsson A, Li De G (1992) AP for tinnitus management. Scand Audiol 21(4):245-251. Department of Audiology, Sahlgrenska Hospital, Gothenburg, Sweden. Fifty-six patients with continuous and severe tinnitus as their major complaint were treated with traditional Chinese AP. After a pre-treatment period with baseline evaluation of tinnitus, 10 treatments were given during a period of 20 days, followed by a post-treatment period in order to obtain indications of prolonged treatment effects. Assessments were made using visual analogue scales (VAS) and a verbal retrospective rating scale. Three patients reported improvement which lasted for at least 10 days after the last treatment, indicating a possible long-term effect in some cases. Twenty-one% of the patients reported transient intensity reductions lasting for hours/days. Estimated 'substantial' improvement rate by VAS, consistent for all three parameters involved (intensity, annoyance, awareness), was 20%, while the corresponding deterioration rate was 25%. Statistical analysis of the whole group did not show any significant general treatment effects. Interactions between treatment evaluations by verbal rating and VAS are discussed as well as interactions with psychological components. PMID: 1488611, UI: 93141943 אז מה היה לנו ? אני אתרגם כדי שלא יהיה ספק. 3 חולים בלבד (מתוך 56 שהחלו את הטיפול) דווחו על שיפור למספר ימים. מספר ימים - כשאנחנו רוצים שיפור לאורך חודשים ושנים. 21% מהחולים דווחו על שיפור זמני בעוצמה למשך שעות-עד ימים, שיפור במדדי עוצמה מיטרד וערנות לטיניטוס היה ל 20%, והתדרדרות - ל 25%. אולי מכאן יצאה האזהרה בכנסים המקצועיים והרפואיים של טיניטוס .... עיבוד סטטיסטי של כל הקבוצה לא הראה השפעה טיפולית. אז אם מה שיש לך להתגאות בו הוא מאמר שבעצם מציין שאין בטיפול בדיקור שום עניין רציני, מה נותר לי לאמר ? אז אולי בזאת נסיים סופית את הדיון העקר ובא לציון גואל. לילה טוב ד"ר טלי מרק

ד"ר מרק הנכבדה, מעולם לא זילזלתי בכבודך ולא הכפשתי אותך, ירדת לרמות שאינני רוצה להגיע לשם..."נובח על העץ הלא נכון" "ומנסה לפרוק את התסכולים שלך עלי." התכוונתי ליצור דיון פורה וראי לאן ירדת...ישפטו הגולשים וכנראה יש ממש במה שכתב אחד מהם לגבי האמון שלו ....עד כאן. אני נשאר עם האמת שלי ואת ממשיכה להתבצר בעמדתך. חבל.