I have had severe tinnitus in both ears for ten years. Is there any evidence that acupuncture might help?
John Carlton, Folkestone
Dr. Scurr replies: Living with tinnitus for ten years must have been painful, and I understand your desire to find a solution.
For those who haven’t experienced it yet, tinnitus is characterized by a constant ringing or noise in the ears that is not caused by an external source. Although we don’t understand exactly what causes this, there are a number of risk factors, including age-related hearing loss, damage to the inner ear from repeated exposure to loud noise, ear infections and conditions such as Meniere’s disease (which causes dizziness, dizziness and hearing loss).
Certain medications – including some chemotherapy drugs, antibiotics, nonsteroidal anti-inflammatories and aspirin – can also cause this, although this is rare and often temporary.
In about a third of cases there is no clear trigger. One theory is that tinnitus is often related to hearing problems; the sounds are the result of the brain ‘making up’ for the lack of sound input by creating its own sound input.
Acupuncture 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 using needles.
Treatment aims to reduce symptoms and usually involves some 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 these are about learning to live with the condition, rather than actually getting rid of it.
You’re not the only one wondering whether acupuncture is a better alternative. It has been practiced in China for over 2,000 years and is said to treat health conditions by stimulating certain pressure points on the body using needles.
The National Institute for Health and Care Excellence recommends its use for chronic pain, migraines, and the discomfort caused by prostatitis (inflammation of the prostate), but I am not aware of any good studies supporting its effectiveness for tinnitus.
In fact, a 2022 review in the journal Frontiers in Neurology found that while numerous studies pointed to some benefits in using acupuncture for tinnitus, most of the research was of poor quality and that any positive results “should be taken with caution.” Viewed’.
Still, my experience is that acupuncture is sometimes effective for some things, for some people.
Despite a lack of strong evidence for its use for tinnitus, I wouldn’t discourage you from trying it through an appropriate 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 prescribed steroids. But I don’t want to use them long term; are there alternatives?
Jill Conrad, by email
Dr. Scurr replies: Polymyalgia rheumatica (PMR), its full name, causes muscle pain and stiffness around the shoulders, neck and hips. Typically, people with the condition have symmetrical patterns of pain and stiffness in their shoulders, hips, neck, and trunk. The pain is worse in the morning and PMR normally affects people over 50, and usually women (it’s unclear why).
The main treatment is steroid tablets to reduce the inflammation causing the symptoms. In most cases, a small dose of a steroid (for example prednisolone) for a few days will resolve the symptoms, but this is not a cure. Longer-term treatment, usually with lower doses, is needed to control symptoms.
We used to think that PMR would resolve after about two years of treatment, yet several of my patients required prednisolone for ten years or more.
Recent research in the New England Journal of Medicine found that more than half of patients with PMR relapse once steroids are gradually reduced.
About a third of patients require 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 using steroids after one to two years.
In your longer letter, you question whether your diagnosis is correct. If you don’t have typical PMR symptoms 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 your treatment.
In my opinion: repeat prescriptions can be harmful
The mood at the NHS Transformation Directorate – the body that oversees digital change in healthcare – has seemed high lately, with great pride expressed in a radio interview with its head, Dr Timothy Ferris, about a new use from the NHS app. With this app, patients can order repeat prescriptions, saving a GP on average three minutes per prescription.
But I have my doubts. The three minutes a doctor spends approving a repeat prescription can be critical to a patient’s health and safety; is the medicine still necessary? Is the patient at risk for long-term side effects? Or, if they have recently had surgery, have they fully recovered?
Creating a smart technological shortcut to save three minutes seems smart, but it’s just another step toward the depersonalization of healthcare, another widening of the doctor-patient gap – and another opportunity for something to go wrong .