Scandinavian Audiology
ISSN: 0105-0397 (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/iaud20
Acupuncture for Tinnitus Management Sune Nilsson, Alf Axelsson & Gu Li De To cite this article: Sune Nilsson, Alf Axelsson & Gu Li De (1992) Acupuncture for Tinnitus Management, Scandinavian Audiology, 21:4, 245-251, DOI: 10.3109/01050399209046008 To link to this article: http://dx.doi.org/10.3109/01050399209046008
Published online: 12 Oct 2009.
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Citing articles: 3 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=iaud20 Download by: [Flinders University of South Australia]
Date: 17 February 2016, At: 11:07
Scand Audiol 1992; 2 1: 245-25 1
ACUPUNCTURE FOR TINNITUS MANAGEMENT Sune Nilsson, Alf Axelsson and G u Li De From the Department of Audiology. Sahlgrenska Hospital, Gothenburg. Sweden
ABSTRACT Acupuncture for tinnitus management. Nilsson, S., Axelsson, A. and Li De, G. (Department of Audiology, Sahlgrenska
Downloaded by [Flinders University of South Australia] at 11:07 17 February 2016
Hospital, Gothenburg, Sweden). Scand Audiol 1992; 2 1 : 245-25 1.
Fifty-sixpatients with continuous and severe tinnitus as their major complaint were treated with traditional Chinese acupuncture. 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 percent 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. Key words: acupuncture, tinnitus
INTRODUCTION Tinnitus is a symptom which frequently occurs in association with most cases of hearing disorders. We know very little about its pathophysiology but it has been suggested that tinnitus can be caused by several kinds of lesions at any level of the hearing organ. The majority of people with tinnitus seem to cope with their situation, but for a few, tinnitus becomes a serious problem. Patients who are seeking help are often simply told by their doctors that there is nothing that can be done about it and that they will have to learn t o live with it. Therefore it is not surprising that patients try to get help from other sources. Acupuncture is one such alternative. Chinese acupuncture has been introduced in the western world as a method of alleviating pain. The success is well documented. In China, acupuncture has
also been recommended for the treatment of tinnitus since very early times. Similarities between tinnitus and perception of pain have been discussed. Physiological similarities between the distal auditory and pain pathways have been demonstrated (Galambos, 1956; Fex, 1962; Melzac & Wall, 1965; Desmedt, 1975). Local anaesthetic agents such as lignocaine (lidocaine) can reduce tinnitus (Melding et al., 1978). Further, it has been postulated that the threshold to painful stimuli could be raised by suppressing the transmission of pain impulses in the dorsal horn. This is achieved by the activity of efferent pathways acting o n these synapses (Melzac & Wall, 1965). Masking may work in the auditory pathway in a similar way (Marks et al., 1984). Controlled trials have evaluated the effect of traditional Chinese acupuncture versus placebo acupuncture on chronic unilateral tinnitus. Placebo acupuncture was performed by subcutaneously inserting needles in the same regions of the skin as for ‘real’ acupuncture, but in areas with no acupoints and without any ‘needling sensation’ (Hansen et al., 1982). Marks et al. (1984) used non-penetrating acupuncture as placebo. Acupuncture points were chosen out of the patient’s line of vision. The needles were only used to prick the skin and were immediately removed. At the end of the session thisprocedure was repeated, giving the sensation of removal. None of the patients was aware of not having received acupuncture. N o significant differences were found between genuine acupuncture and placebo in either of the studies. However, Hansen et al. found a slight reduction in tinnitus during all periods which was significant in the group receiving placebo as the first treatment. Marks et al. noticed a subjective improvement as a result of genuine acupuncture. None of the patients reported changes for the worse but 35% described some benefit from active treatment. Neither tinnitus-matching nor assessments by visual analogue scales (VAS) could confirm these findings. Scand Audio/ 21
246 S. Nilsson et al. A n attempt to evaluate the effect of a n extended period of acupuncture treatment did n o t s h o w substantially different results f r o m previous studies (Thomas et al., 1988). F r o m o u r clinical experiences these findings seem somewhat puzzling. Patients frequently report effects f r o m acupuncture on tinnitus, some f o r the worse, some f o r the better. A large g r o u p ofpatients return to
Downloaded by [Flinders University of South Australia] at 11:07 17 February 2016
their acupuncturist regularly f o r repeated treatment despite sizeable costs. These facts encouraged us to search f o r other than purely physical effects. Increased levels of endorphine released by acupuncture needles
may have additional psychological effects. Tinnitus (and often additional hearing impairment) can affect the patient in a multifactorial way (Jakes et al., 1985). T h e r e a r e factors o f a n oto-neurological as well as of a psychological nature. Psychological factors might influence the perception of tinnitus (e.g. thresholds f o r annoyance, stress, awareness). Tinnitus assessments, so far, a r e purely subjective. A t t e m p t s have been m a d e to ‘objectify’ the methods.
The value of these psycho-acoustic methods has been questioned. M a j o r disadvantages haw; been d e m o n strated. Tinnitus-matching is n o t correlated with reports of annoyance and discomfort. Tinnitusmatching, expressed i n ‘personal loudness units’ ( P L U ) (Hinchcliffe & C h a m b e r s , 1983), is poorly correlated with self-recordings of tinnitus. Suggestions have been made that these assessments do not serve a n y clear clinical purpose (Lindberg et al., 1989). O u r choice was to use a V A S as a mode of continuous evaluation of tinnitus. Such a scale has proved t o be practical, reliable a n d valid (Aitken, 1969). T h e aim of this study w a s to investigate three commonly adopted p a r a m e t e r s of tinnitus (intensity, annoyance and awareness) f r o m a large patient p o p u lation, treated by a competent acupuncturist, a Chinese oto-laryngologist with 25 years o f a c u p u n c t u r e experience. F u r t h e r , w e wished to evaluate if intervention had a n y effects o n mood (decreased anxiety) or sleep.
MATERIAL AND METHODS Fifty-six consecutive patients with unilateral or bilateral tinnitus as their major complaint were enrolled in the study. The severity of their tinnitus was defined as grade 11-111 according to the following classification: grade I: intermittent tinnitus. When present: moderately annoying in quiet environments. May influence ability to fall asleep; grade 11: constant tinnitus. When listening for it, tinnitus is always present. Annoying in quiet surroundings, affects concentraScond Audio/ 21
tion and influences ability to fall asleep. Can be suppressed from the mind by other activities and masking noise; grade 111: constant, plaguing tinnitus. Always present and can hardly ever be suppressed. Influences concentration, work, sleep. It often awakens the sufferer during sleep. Influences quality of life. The cause of the patients’ tinnitus was established by a careful history-taking, including the onset of tinnitus, audiometry, a detaiIed questionnaire (eight pages), tinnitus analysis, blood testing, etc. After these investigations, a ‘best-guess diagnosis’ based on all the different examinations was established in each case. If, for example a patient with an extended history of occupational noise exposure reported gradual onset of tinnitus, the etiology of tinnitus was considered to be noise-induced hearing loss. Conversely, in a patient with a chronic symmetric noise-induced hearing loss but with sudden additional unilateral hearing loss and sudden onset of tinnitus, the tinnitus was regarded as due to sudden deafness rather than noise-induced hearing loss. The patients were informed about the most probable cause of their tinnitus and about the experimental procedure. They were also told that they were free to leave the treatment at any time. Careful instructions in the use of the VAS were given. Recordings were made twice a day, in the morning and at the end of the day. Three parameters were used: subjective ‘intensity’ of tinnitus, ‘annoyance’ and ‘awareness’. The patients were recommended to make the recordings at the same time every day. Horizontal scales, 0-100 mm, were used with extremes as follows: intensity: no tinnitus vs maximum intolerable tinnitus; annoyance: no annoyance vs maximum unbearable annoyance; awareness: not aware vs maximum awareness, constantly in the mind. Ten days of recordings preceded the treatment period. The pretreatment assessments served as baseline measurements of the patients’ tinnitus. Subjective recordings for the three criteria (intensity, annoyance, awareness) continued during the acupuncture period and the post-treatment period (10 days). By the end of the post-treatment period, a questionnaire was mailed to the patients including a retrospective multiple-choice question about the effects from treatment on tinnitus over time. A number of alternatives were available: ( I ) tinnitus became worse; (2) unchanged tinnitus; (3) temporary improvement of tinnitus; (4) improvement of tinnitus, lasting for hours; ( 5 ) improvement lasting for days; (6) improvement still valid at the time of evaluation. Two additional questions were included about effects on sleep and feelings of decreased anxiety. There was also an open-ended question asking if the patient had noticed any other positive or negative side effects from treatment. Five patients were excluded (four because they were unable to fill out the forms regularly and adequately; one left the treatment because tinnitus became considerably worse). Thus, the material consisted of 51 patients, 26 females and 25 males, aged 25-81 years (mean: 57.6 years). There were 15 normal ears (one with tinnitus), one ear with conductive hearing loss and tinnitus, five totally deaf ears (four with tinnitus), two ears with sensorineural hearing loss and tinnitus in one patient with Sjogren’s syndrome, and 79 ears with sensorineural hearing loss (69 with tinnitus).
Techniques Acupuncture was performed by one of the authors, a Chinese otolaryngologist trained in western medicine and with 25 years of experience in acupuncture. The selection of acupoints was based on an integration of western diagnostics and Chinese acupuncture. Three sets of
Acupuncture for tinnitus management
Table I. Acupoints used on each patient I New
‘Head acupuncture’, developed during the 1960s. On 4 cm wide horizontal line, 1.5 cm above ear top Hearing problems esp. tinnitus
General health
Downloaded by [Flinders University of South Australia] at 11:07 17 February 2016
Sj 3: Zhong Zhu Sj 17: Yi Feng Sj 21: Er Men Si 19: Ting Gong GB 20: Feng Chi Vertigo and hearing point’
S 36: Zu San Li Li 4: He Gu
Helping kidney function
K 3: Tai Xi
I New point 2 cm lateral to the processus spinosus of the sixth cervical vertebra ’Midpoint of medial ends of eyebrows ‘New point. Midpoint of Sj 17 and G b 20
H 7: Shen Men P 6: Nei Guan An Men3
Headaches Du 20: Bai Hui In Don’
Reliability of the scales The reliability of VAS evaluation was assessed using the testretest method. Individual repeated evaluations made during the first five days of the pre-treatment period were compared to evaluations made five days later. The test-retest productmoment correlations were as follows: intensity: 0.710; annoyance: 0.682; awareness: 0.553. The correlations were regarded as satisfactory, bearing in mind the existence of real short-time variations of the perception of tinnitus.
RESULTS
Table 11. Acupointsfor additional disorders
Sleeping problems
247
Blood pressure problems Blood pressure point1
acupoints were the same for each tinnitus patient, as shown in Table I. Three additional sets of points were selected and used only for a few subjects who had such problems (see Table 11). Bilateral acupuncture was used for bilateral tinnitus cases. In cases of unilateral tinnitus, ipsilateral acupuncture was used. One exception, though, was the point ‘Sj 3: Zhong Zhu’ which was used contralaterally according to the basic traditional theory. Chinesc-made stainless acupuncture needles were used. The diameter was 0.32 mm and the length 12.5,25, 50 and 75 mm, depending upon the thickness of the subcutaneous layer. The needles were inserted to a depth which varied between different points and persons until the characteristic needling sensation was experienced. The needles were retained for 20-30 min. Acupuncture was given to groups of patients, 5-6 at a time. During the treatment period (20 days) the patients received 10 treatments, once every other day. No other treatments were given simultaneously.
Group means O n the basis of the patients’ daily recordings, period means (pre-treatment, treatment, post-treatment) were calculated for intensity, annoyance and awareness. The parameters were examined by ‘one-factor repeated-measures ANOVAs’ (see Table 111). N o significant treatment effects were seen for any of the variables.
Individual analysis Differences were calculated between individual postand pre-treatment means. Looking at the whole group, these differences were approximately normally distributed around the mean value. The range between the extreme values was divided into five sub-groups of uniform range size. Negative difference values represent decreasing, and positive values indicate increasing complaints about tinnitus (see Table IV). Patients who considered themselves most improved in terms of tinnitus intensity also showed much improvement in terms of annoyance as well as awareness, while patients who considered that they had deteriorated in any of the three parameters evaluated, did not show the same consistency. Pre- and post-treatment mean differences between - 10 and 10 mm VAS were considered as ‘minor’ changes and differences exceeding - 10 or + 10 mm
+
Table 111. Period means for intensity, annoyance and awareness before treatment (Pre), during treatment (Treatment) and during 10 days immediately after treatment (Post). Measures ( m m ) obtained from VAS evaluations Pre
Treatment
Post
Variable
Mean
SD
Mean
SD
Mean
SD
F(2)
Intensity Annoyance Awareness
71 71
19.6 20.2 19.5
71 I0 73
22.7 24.1 23.3
72 71 13
23.7 25.2 24.5
0.18 0.29 0.37
I4
Scand Audio1 21
248 S. Nilsson et al. Table IV. Subjects distributed by individual diferences between post- andpre-treatment period means over the three parameters. Total number of subjects actually included in columns A-C. Range measures: VAS (mm) Range From
ISSN: 0105-0397 (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/iaud20
Acupuncture for Tinnitus Management Sune Nilsson, Alf Axelsson & Gu Li De To cite this article: Sune Nilsson, Alf Axelsson & Gu Li De (1992) Acupuncture for Tinnitus Management, Scandinavian Audiology, 21:4, 245-251, DOI: 10.3109/01050399209046008 To link to this article: http://dx.doi.org/10.3109/01050399209046008
Published online: 12 Oct 2009.
Submit your article to this journal
Article views: 25
View related articles
Citing articles: 3 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=iaud20 Download by: [Flinders University of South Australia]
Date: 17 February 2016, At: 11:07
Scand Audiol 1992; 2 1: 245-25 1
ACUPUNCTURE FOR TINNITUS MANAGEMENT Sune Nilsson, Alf Axelsson and G u Li De From the Department of Audiology. Sahlgrenska Hospital, Gothenburg. Sweden
ABSTRACT Acupuncture for tinnitus management. Nilsson, S., Axelsson, A. and Li De, G. (Department of Audiology, Sahlgrenska
Downloaded by [Flinders University of South Australia] at 11:07 17 February 2016
Hospital, Gothenburg, Sweden). Scand Audiol 1992; 2 1 : 245-25 1.
Fifty-sixpatients with continuous and severe tinnitus as their major complaint were treated with traditional Chinese acupuncture. 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 percent 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. Key words: acupuncture, tinnitus
INTRODUCTION Tinnitus is a symptom which frequently occurs in association with most cases of hearing disorders. We know very little about its pathophysiology but it has been suggested that tinnitus can be caused by several kinds of lesions at any level of the hearing organ. The majority of people with tinnitus seem to cope with their situation, but for a few, tinnitus becomes a serious problem. Patients who are seeking help are often simply told by their doctors that there is nothing that can be done about it and that they will have to learn t o live with it. Therefore it is not surprising that patients try to get help from other sources. Acupuncture is one such alternative. Chinese acupuncture has been introduced in the western world as a method of alleviating pain. The success is well documented. In China, acupuncture has
also been recommended for the treatment of tinnitus since very early times. Similarities between tinnitus and perception of pain have been discussed. Physiological similarities between the distal auditory and pain pathways have been demonstrated (Galambos, 1956; Fex, 1962; Melzac & Wall, 1965; Desmedt, 1975). Local anaesthetic agents such as lignocaine (lidocaine) can reduce tinnitus (Melding et al., 1978). Further, it has been postulated that the threshold to painful stimuli could be raised by suppressing the transmission of pain impulses in the dorsal horn. This is achieved by the activity of efferent pathways acting o n these synapses (Melzac & Wall, 1965). Masking may work in the auditory pathway in a similar way (Marks et al., 1984). Controlled trials have evaluated the effect of traditional Chinese acupuncture versus placebo acupuncture on chronic unilateral tinnitus. Placebo acupuncture was performed by subcutaneously inserting needles in the same regions of the skin as for ‘real’ acupuncture, but in areas with no acupoints and without any ‘needling sensation’ (Hansen et al., 1982). Marks et al. (1984) used non-penetrating acupuncture as placebo. Acupuncture points were chosen out of the patient’s line of vision. The needles were only used to prick the skin and were immediately removed. At the end of the session thisprocedure was repeated, giving the sensation of removal. None of the patients was aware of not having received acupuncture. N o significant differences were found between genuine acupuncture and placebo in either of the studies. However, Hansen et al. found a slight reduction in tinnitus during all periods which was significant in the group receiving placebo as the first treatment. Marks et al. noticed a subjective improvement as a result of genuine acupuncture. None of the patients reported changes for the worse but 35% described some benefit from active treatment. Neither tinnitus-matching nor assessments by visual analogue scales (VAS) could confirm these findings. Scand Audio/ 21
246 S. Nilsson et al. A n attempt to evaluate the effect of a n extended period of acupuncture treatment did n o t s h o w substantially different results f r o m previous studies (Thomas et al., 1988). F r o m o u r clinical experiences these findings seem somewhat puzzling. Patients frequently report effects f r o m acupuncture on tinnitus, some f o r the worse, some f o r the better. A large g r o u p ofpatients return to
Downloaded by [Flinders University of South Australia] at 11:07 17 February 2016
their acupuncturist regularly f o r repeated treatment despite sizeable costs. These facts encouraged us to search f o r other than purely physical effects. Increased levels of endorphine released by acupuncture needles
may have additional psychological effects. Tinnitus (and often additional hearing impairment) can affect the patient in a multifactorial way (Jakes et al., 1985). T h e r e a r e factors o f a n oto-neurological as well as of a psychological nature. Psychological factors might influence the perception of tinnitus (e.g. thresholds f o r annoyance, stress, awareness). Tinnitus assessments, so far, a r e purely subjective. A t t e m p t s have been m a d e to ‘objectify’ the methods.
The value of these psycho-acoustic methods has been questioned. M a j o r disadvantages haw; been d e m o n strated. Tinnitus-matching is n o t correlated with reports of annoyance and discomfort. Tinnitusmatching, expressed i n ‘personal loudness units’ ( P L U ) (Hinchcliffe & C h a m b e r s , 1983), is poorly correlated with self-recordings of tinnitus. Suggestions have been made that these assessments do not serve a n y clear clinical purpose (Lindberg et al., 1989). O u r choice was to use a V A S as a mode of continuous evaluation of tinnitus. Such a scale has proved t o be practical, reliable a n d valid (Aitken, 1969). T h e aim of this study w a s to investigate three commonly adopted p a r a m e t e r s of tinnitus (intensity, annoyance and awareness) f r o m a large patient p o p u lation, treated by a competent acupuncturist, a Chinese oto-laryngologist with 25 years o f a c u p u n c t u r e experience. F u r t h e r , w e wished to evaluate if intervention had a n y effects o n mood (decreased anxiety) or sleep.
MATERIAL AND METHODS Fifty-six consecutive patients with unilateral or bilateral tinnitus as their major complaint were enrolled in the study. The severity of their tinnitus was defined as grade 11-111 according to the following classification: grade I: intermittent tinnitus. When present: moderately annoying in quiet environments. May influence ability to fall asleep; grade 11: constant tinnitus. When listening for it, tinnitus is always present. Annoying in quiet surroundings, affects concentraScond Audio/ 21
tion and influences ability to fall asleep. Can be suppressed from the mind by other activities and masking noise; grade 111: constant, plaguing tinnitus. Always present and can hardly ever be suppressed. Influences concentration, work, sleep. It often awakens the sufferer during sleep. Influences quality of life. The cause of the patients’ tinnitus was established by a careful history-taking, including the onset of tinnitus, audiometry, a detaiIed questionnaire (eight pages), tinnitus analysis, blood testing, etc. After these investigations, a ‘best-guess diagnosis’ based on all the different examinations was established in each case. If, for example a patient with an extended history of occupational noise exposure reported gradual onset of tinnitus, the etiology of tinnitus was considered to be noise-induced hearing loss. Conversely, in a patient with a chronic symmetric noise-induced hearing loss but with sudden additional unilateral hearing loss and sudden onset of tinnitus, the tinnitus was regarded as due to sudden deafness rather than noise-induced hearing loss. The patients were informed about the most probable cause of their tinnitus and about the experimental procedure. They were also told that they were free to leave the treatment at any time. Careful instructions in the use of the VAS were given. Recordings were made twice a day, in the morning and at the end of the day. Three parameters were used: subjective ‘intensity’ of tinnitus, ‘annoyance’ and ‘awareness’. The patients were recommended to make the recordings at the same time every day. Horizontal scales, 0-100 mm, were used with extremes as follows: intensity: no tinnitus vs maximum intolerable tinnitus; annoyance: no annoyance vs maximum unbearable annoyance; awareness: not aware vs maximum awareness, constantly in the mind. Ten days of recordings preceded the treatment period. The pretreatment assessments served as baseline measurements of the patients’ tinnitus. Subjective recordings for the three criteria (intensity, annoyance, awareness) continued during the acupuncture period and the post-treatment period (10 days). By the end of the post-treatment period, a questionnaire was mailed to the patients including a retrospective multiple-choice question about the effects from treatment on tinnitus over time. A number of alternatives were available: ( I ) tinnitus became worse; (2) unchanged tinnitus; (3) temporary improvement of tinnitus; (4) improvement of tinnitus, lasting for hours; ( 5 ) improvement lasting for days; (6) improvement still valid at the time of evaluation. Two additional questions were included about effects on sleep and feelings of decreased anxiety. There was also an open-ended question asking if the patient had noticed any other positive or negative side effects from treatment. Five patients were excluded (four because they were unable to fill out the forms regularly and adequately; one left the treatment because tinnitus became considerably worse). Thus, the material consisted of 51 patients, 26 females and 25 males, aged 25-81 years (mean: 57.6 years). There were 15 normal ears (one with tinnitus), one ear with conductive hearing loss and tinnitus, five totally deaf ears (four with tinnitus), two ears with sensorineural hearing loss and tinnitus in one patient with Sjogren’s syndrome, and 79 ears with sensorineural hearing loss (69 with tinnitus).
Techniques Acupuncture was performed by one of the authors, a Chinese otolaryngologist trained in western medicine and with 25 years of experience in acupuncture. The selection of acupoints was based on an integration of western diagnostics and Chinese acupuncture. Three sets of
Acupuncture for tinnitus management
Table I. Acupoints used on each patient I New
‘Head acupuncture’, developed during the 1960s. On 4 cm wide horizontal line, 1.5 cm above ear top Hearing problems esp. tinnitus
General health
Downloaded by [Flinders University of South Australia] at 11:07 17 February 2016
Sj 3: Zhong Zhu Sj 17: Yi Feng Sj 21: Er Men Si 19: Ting Gong GB 20: Feng Chi Vertigo and hearing point’
S 36: Zu San Li Li 4: He Gu
Helping kidney function
K 3: Tai Xi
I New point 2 cm lateral to the processus spinosus of the sixth cervical vertebra ’Midpoint of medial ends of eyebrows ‘New point. Midpoint of Sj 17 and G b 20
H 7: Shen Men P 6: Nei Guan An Men3
Headaches Du 20: Bai Hui In Don’
Reliability of the scales The reliability of VAS evaluation was assessed using the testretest method. Individual repeated evaluations made during the first five days of the pre-treatment period were compared to evaluations made five days later. The test-retest productmoment correlations were as follows: intensity: 0.710; annoyance: 0.682; awareness: 0.553. The correlations were regarded as satisfactory, bearing in mind the existence of real short-time variations of the perception of tinnitus.
RESULTS
Table 11. Acupointsfor additional disorders
Sleeping problems
247
Blood pressure problems Blood pressure point1
acupoints were the same for each tinnitus patient, as shown in Table I. Three additional sets of points were selected and used only for a few subjects who had such problems (see Table 11). Bilateral acupuncture was used for bilateral tinnitus cases. In cases of unilateral tinnitus, ipsilateral acupuncture was used. One exception, though, was the point ‘Sj 3: Zhong Zhu’ which was used contralaterally according to the basic traditional theory. Chinesc-made stainless acupuncture needles were used. The diameter was 0.32 mm and the length 12.5,25, 50 and 75 mm, depending upon the thickness of the subcutaneous layer. The needles were inserted to a depth which varied between different points and persons until the characteristic needling sensation was experienced. The needles were retained for 20-30 min. Acupuncture was given to groups of patients, 5-6 at a time. During the treatment period (20 days) the patients received 10 treatments, once every other day. No other treatments were given simultaneously.
Group means O n the basis of the patients’ daily recordings, period means (pre-treatment, treatment, post-treatment) were calculated for intensity, annoyance and awareness. The parameters were examined by ‘one-factor repeated-measures ANOVAs’ (see Table 111). N o significant treatment effects were seen for any of the variables.
Individual analysis Differences were calculated between individual postand pre-treatment means. Looking at the whole group, these differences were approximately normally distributed around the mean value. The range between the extreme values was divided into five sub-groups of uniform range size. Negative difference values represent decreasing, and positive values indicate increasing complaints about tinnitus (see Table IV). Patients who considered themselves most improved in terms of tinnitus intensity also showed much improvement in terms of annoyance as well as awareness, while patients who considered that they had deteriorated in any of the three parameters evaluated, did not show the same consistency. Pre- and post-treatment mean differences between - 10 and 10 mm VAS were considered as ‘minor’ changes and differences exceeding - 10 or + 10 mm
+
Table 111. Period means for intensity, annoyance and awareness before treatment (Pre), during treatment (Treatment) and during 10 days immediately after treatment (Post). Measures ( m m ) obtained from VAS evaluations Pre
Treatment
Post
Variable
Mean
SD
Mean
SD
Mean
SD
F(2)
Intensity Annoyance Awareness
71 71
19.6 20.2 19.5
71 I0 73
22.7 24.1 23.3
72 71 13
23.7 25.2 24.5
0.18 0.29 0.37
I4
Scand Audio1 21
248 S. Nilsson et al. Table IV. Subjects distributed by individual diferences between post- andpre-treatment period means over the three parameters. Total number of subjects actually included in columns A-C. Range measures: VAS (mm) Range From
