I have had severe tinnitus in both ears for ten years. Is there any evidence that acupuncture can help?
John Carlton, Folkestone
Dr. Scurr responds: Living with tinnitus for ten years must have been distressing and I understand your desire to find a solution.
For those who haven’t experienced it, tinnitus is characterized by a constant ringing or noise in the ears that is not due to any external source. While we don’t understand exactly what causes it, there are a number of risk factors, including age-related hearing loss, damage to the inner ear from repeated exposure to loud noises, ear infections, and conditions such as Meniere’s disease (which can cause vertigo, dizziness, and hearing loss).
Certain medications, including some chemotherapy drugs, antibiotics, nonsteroidal anti-inflammatory drugs, and aspirin, can also cause it, although this is rare and often temporary.
In about a third of cases there is no obvious trigger. One theory is that tinnitus is often related to hearing problems; The noises are the result of the brain “compensating” for the lack of sound input by creating its own.
Acupuncture has been practiced in China for more than 2,000 years and is said to treat health problems by stimulating certain pressure points on the body using needles.
Treatment focuses on reducing symptoms and usually involves a form of cognitive behavioral therapy (where the patient is taught techniques to avoid focusing on the tinnitus) or biofeedback (where relaxation techniques are used to achieve this). .
But it’s about learning to live with the disease, rather than getting rid of it.
You’re not the only one wondering if acupuncture might be a better alternative. It has been practiced in China for over 2,000 years and is said to treat health problems by stimulating certain pressure points on the body with needles.
The National Institute for Health and Care Excellence recommends its use for chronic pain, migraine and discomfort caused by prostatitis (inflammation of the prostate), but I am not aware of any good studies that support its effectiveness in tinnitus.
In fact, a 2022 review in the journal Frontiers in Neurology found that although numerous studies pointed to some benefits in using acupuncture for tinnitus, most of the research was of poor quality and any positive results should be “viewed with caution.” caution”.
However, in my experience, acupuncture is effective for some things, on some people, and on some occasions.
Despite the lack of solid evidence for its use in tinnitus, I would not advise against trying it through a suitable therapist with a history of training and experience.
Are there alternatives to steroids in the treatment of polymyalgia?
My doctor recently diagnosed me with polymyalgia and put me on steroids. But I don’t want to take them long term; Are there alternatives?
Jill Conrad, via email
Dr. Scurr responds: Polymyalgia rheumatica (PMR), its full name, causes muscle pain and stiffness around the shoulders, neck, and hips. Typically, people with this condition have symmetrical patterns of pain and stiffness in the shoulders, hips, neck, and trunk. The pain is worse in the morning and PMR usually affects people over 50 and usually women (it is not clear why).
The main treatment is steroid tablets to reduce the inflammation that triggers the symptoms. In most cases, a few days on a small dose of a steroid (for example, prednisolone) resolves the symptoms, but this is not a cure. Longer-term treatment, usually at lower doses, is needed to control symptoms.
We used to think that PMR would go away after about two years of treatment, but several of my patients needed prednisolone for ten years or more.
In fact, recent research in the New England Journal of Medicine found that more than half of PMR patients relapse once steroids are tapered.
About a third of patients need steroids for six years or more; In these cases, the benefits of treatment must be weighed against the risk of drug-induced side effects, such as weight gain and high blood pressure. But half of all patients can stop taking steroids after one or two years.
In his longest letter he questions whether his diagnosis is correct. If you don’t have the typical symptoms of PMR and the blood tests are clear, you may not have it and you should discuss this with your GP. If your diagnosis is correct, my advice would be to continue with your treatment.
In my opinion: repeating prescriptions can be harmful
Spirits appeared to be high recently at the NHS Transformation Directorate – the body overseeing digital change in the health service – and great pride was expressed in a radio interview with its director, Dr Timothy Ferris, about a new use of the NHS app. This app allows patients to request repeat prescriptions, saving the GP an average of three minutes per prescription.
But I have my doubts. The three minutes a doctor spends approving a new prescription can be critical in terms of patient health and safety; Is the medication still necessary? Is the patient at risk for long-term side effects? Or, if they recently had surgery, have they fully recovered?
Creating a clever technological shortcut to save three minutes sounds smart, but it’s just another step toward the depersonalization of healthcare, another widening of the chasm between doctor and patient… and another opportunity for something to go wrong.