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Effect of local irradiation with 630 and 860 nm low-level lasers on tympanic membrane perforation repair in guinea pigs.
Otolaryngology – Head and Neck Surgery Research Center, Rasool Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran. Objective: In this study, we evaluated the effect of low-level lasers on the healing of tympanic membrane perforation, one of the most common otological pathologies. Methods and materials: Twenty-four guinea pigs were randomly assigned to either the experimental or control group. Conclusion: The results show that the combined application of 630 and 860 nm lasers had a significant effect on the healing of tympanic membrane perforation, and on the prevention of thick fibrotic or atelectatic neomembrane formation.
Effect of low-level laser treatment on cochlea hair-cell recovery after acute acoustic trauma.
We investigated the effect of low-level laser radiation on rescuing hair cells of the cochlea after acute acoustic trauma and hearing loss. Moderate and severe sudden deafness treated with low-energy laser irradiation combined with auricular acupoint sticking. Department of Rehabilitation Medicine, The First Affiliated Hospital of Xinxiang Medical College, Weihui 453100, Henan Province, China. To test the therapeutic effect on moderate and severe sudden deafness treated with low-energy laser irradiation on acupoint and external auditory canal combined with auricular point sticking (APS) and as compared with electroacupuncture.
Two hundred and fifty-eight cases of moderate and severe sudden hearing loss were randomly divided into an observation group 1, an observation group 2 and a control group, 86 cases in each group. Both of low-energy laser irradiation on acupoint and external auditory canal combined with APS and electroacupuncture are able to decrease frequency audiometry, improve auditory function, and the therapeutic effects are better with prolongation of treatment time. Effect of low-level laser therapy on cochlear hair cell recovery after gentamicin-induced ototoxicity. Department of Otolaryngology-Head & Neck Surgery, Dankook University College of Medicine, Cheonan, Korea. Intravenous laser irradiation of blood for the combined treatment of patients presenting with chronic sensorineural hearing loss.
A method for the treatment of chronic sensorineural hearing loss (CSNHL) is proposed that includes administration of trental followed by intravenous laser irradiation of blood (IVLBI). The application of supravascular laser irradiation of blood for the treatment of cochleovestibular disorders. A total of 165 patients presenting with neurosensory impairement of hearing and Meniere’s disease were treated by supravascular (extracorporeal) laser irradiation of blood. Department of Otorhinolaryngology, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran. BACKGROUND: Despite the high prevalence and morbidity, tinnitus still remains an obscure symptom.
METHODS: It was a self controlled clinical trial study on 61 outpatients with subjective tinnitus.
CONCLUSIONS: Transmeatal low-level laser irradiation is effective for the treatment of tinnitus and some variables like age and job can affect the treatment outcome. Ear, Nose, and Throat Department, IRRCS San Raffaele Hospital, Vita-Salute University, Milan, Italy.
OBJECTIVE: To assess the efficacy of low-level laser therapy (LLLT) for Meniere’s disease (MD). CONCLUSIONS: In our experience, LLLT seems to prevent vertigo spells in MD, although results indicate that it has a slower action than betahistine. OBJECTIVE: To evaluate effectiveness of 5 mW laser irradiation in the treatment of chronic tinnitus. CONCLUSION: Transmeatal, low power (5 mW) laser irradiation was found to be useful for the treatment of chronic tinnitus.
The treatment of patients with chronic tinnitus is very problematic and therefore otologists are trying to discover more suitable courses of therapy. Transmeatal cochlear laser (TCL) treatment of cochlear dysfunction: a feasibility study for chronic tinnitus. Department of Otolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University of Munich, D-81377 Munich, FRG.
Low-level-laser-therapy (LLLT) targeting the inner ear has been discussed as a therapeutic procedure for cochlear dysfunction such as chronic cochlear tinnitus or sensorineural hearing loss. Hyperacusis treatment with a combination of laser therapy, pulsed electromagnetic field therapy and reactive oxygen speciment control. Patients with grave hyperacusis seem to have the largest dB-improvements from this therapy. The IXX Annual Meeting of The American Society for Laser Medicine and Surgery, Lake Buena Vista, Florida. A) The objective of the study was the documentation of the biostimulative effects of LLLL in high energetical dosages (measured in j) by audiometry changes of a statistically relevant number of patients.
According to a study of the university of Cologne1) by 2030 every second German will be suffering from impairments of the inner ear. The audiometry belongs to the diagnostical standard equipment of medical offices and acousticians and is universally being used as a basic diagnostic by trade operative associations and industrial medicine for the purpose of examinations and appraisements. The energy was transmitted by 3 laser diodes with a wave length of 830 nm und 3 diodes with a wave length of 635 nm; it was administered via meatus and mastoid.
In the case of the initial audiometrical results (pretherapeutical findings) the evaluation of the mean value of all readings reveals a clearly reduced average course of the hearing curves of the air and bone conductions over all frequencies, with low points in the frequency sector around 6 kc and the frequency sector around 12 kc (sensorineural hardness of hearing, oblique descension).As expected, the bone conduction is situated above the air conduction in all frequencies. The comparison of all pre- and posttherapeutical readings over all frequencies reveals statistically highly significant results in the case of the air and bone conductions.The values of the air conduction, which are slightly higher as those of the bone conduction, indicate that the LLLL has additional positive therapeutical effects on the sound conducting structures of the middle ear.
The grouping of the readings according to age groups and 3 frequency intervals results in findings that are biologically plausible as far as both the air and the bone conductions is concerned. As to the grouping of the readings according to the duration of the disease and 3 frequency intervals, the patient group with the shortest duration of the disease (0.6 years) has the best initial values and obtains the best final results with the smallest quantity of transfered energy.
The grouping of the readings according to energy quantities reveals a clear correlation between the total quantity of the transfered energy and the therapeutical results that were obtained. In this respect, the results of the study at hand not only refer to the fundamental working model of the cellular energy transfer6) from 1998, which was based on quantum mechanics, but confirm its conclusions as well, namely, that cellular regeneration processes do take place, if the mitochondria in question are stimulated to an increased production of adenosine triphosphate (ATP) by sufficiently large quantities of LLLL. Patients suffering from hyperacusis were treated twice a week with a combination of therapeutic laser, pulsed electromagnetic field and the control and adjustment of Reactive Oxygen Species (ROS).
59 patients with neurosensory hypoacusis and 45 with Meniere’s disease underwent helium-neon laser intra- or supravascular radiation of blood. Lightdosimetric quantitative analysis of the human petrous bone: experimental study for laser irradiation of the cochlea.
BACKGROUND AND OBJECTIVE: Application of laser irradiation targeting the inner ear has to be investigated for therapeutic effectiveness in cochlear injury and dysfunction. RESULTS: The transmission of light across the tympanic cavity and the promontory depends strongly on wave-length of the laser and the position of the radiator. CONCLUSION: The strong dependence of the cochlear light distribution on various irradiation parameters demonstrates the impact of preclinical lightdosimetric investigations for effective individual laser irradiation of the human cochlea.
The light distribution inside the cochlear windings produced by irradiation of the tympanic membrane was quantitatively measured ex vivo for wavelengths of 593, 612, 635, 690, 780 and 805 nm by means of video dosimetry. Comprehensive laser rehabilitation therapy of tinnitus has proven successfull and beneficial for treatment of this widespread civilization disease. Tinnitus is an auditory perception apearing without an objective sonic source from the outer environment.
Our last study on a group of 200 patients in the course of three years was finalized in February 2002 and published in June 2002. Our group consisted of 72 patients, 49 males, 23 females, age ranging between 16 to 92 years.
We strictly appeal to maintain the direction of the vector of aiming the beam – in fact the target structure of the helix is a shape of several square milimeters.
Percentage scale – complaints evaluated 100 per cent at the beginning of therapy (Blue), according to the level of relief decreased (Green) to 80, 70 etc.
This evaluation is identical with our previous study, and it enabled us to compare easily the results of both studies. It was interesting to compare our latest results (LLLT only) with those of our previous studies, i. We have been positively surprised that in general the ratio of individual four groups remained similar. In the group evaluating improvement as less than 50 per cent the leading role of LLLT can be evidenced best. 22.2 per cent patients suffering from tinnitus never more after treatment with therapeutic laser is a great success of LLLT. There's a reason these delicate and interconnected areas have doctors that specialize in ear-nose-and-throat health. One day after the induction of a 2 mm diameter, centred myringotomy in all animals, the tympanic membranes in the experimental group were irradiated with 630 and 860 nm lasers for 10 days.
The distance from the external auditory canal wall to the malleus tip did not differ significantly between the two groups (p = 0.42).


The clinical efficacy of above two the rapies on moderate and severe sudden deafness is superior remarkably to that of conventional treatment. It is well established that antibiotic drugs such as gentamicin can damage hair cells and cause hearing loss. The study included 81 patients at the age from 20 to more than 60 years presenting with CSNHL. The study undertaken to evaluate the efficacy of this treatment confirmed its beneficial effect in patients with acute hearing disorders.
The patients were irradiated with a 650-nm, 5-mW soft laser for twenty days and twenty minutes per day. The patients were randomly divided into two groups: group 1 patients received LLLT 20 min a day with a 5-mW soft laser for 6 mo, while group 2 received betahistine 16 mg twice a day for 6 mo.
Betahistine seems to have a faster action in spell reduction (p 0.05 comparing the 3-mo results between the two groups).
A 5 mW laser with a wavelength of 650 nm, or placebo laser, was applied transmeatally for 15 minutes, once daily for a week. In this study we wanted to evaluate the outcome of using a combination of EGb 761 and soft laser therapy. The patients underwent pure-tone audiometry, speech audiometry and objective audiometry tests.
Former studies demonstrate dose-dependent biological and physiological effects of LLLT such as enhanced recovery of peripheral nerve injuries, which could be of therapeutic interest in cochlear dysfunction. The combined set of therapies in this study should be a first choice therapy for all hyperacusis patients. B) The energy was transmitted with 3 laser diodes with a wave length of 830 nm and 3 diodes with a wave length of 635 nm; it was administered via meatus and mastoid. Even at the present time, the number of people all over the world, who are inflicted with long-standing impairments or acute diseases of the inner ear, amounts to millions.
The patients all received an out-patient treatment, which consisted exclusively of a monotherapy. The patient group with the longest duration of the disease (14.5 years) has the poorest initial values and furthermore needs the largest quantity of transfered energy. The larger the quantitity of transfered energy, the higher the db-reductions that could be observed.
6b clearly shows the correlative (parallel) connection between the total quantity of transfered energy and the total reduction.
The same applies for an augmentation of the total quantity of the transfered energy in the course of the treatment phases or per unit; in the latter case further technological developements on the part of the laser industry are indispensable, though.
Dosinetric analysis for low-level-lasertherapy (LLLT) of the human inner ear at 593nm and 633nm. Import of Radiation Phenomena of Electrons and Therapeutic Low-Level Laser in Regard to the Mitochondrial Energy Transfer.
245 observations in 42 ears on 26 patients were measured before therapy and after 10-20 therapeutic sessions. The treatment proved effective in acute neurosensory hypoacusis and Meniere’s disease. In vitro data demonstrate low-level laser-induced photochemical and photobiologic cell response, depending on cell type and irradiation parameters such as light dose.
The external auditory meatus, the tympanic membrane (quadrants), and the mastoid bone were illuminated by a helium-neon laser (lambda = 593 nm) and diode lasers of different wavelengths (lambda = 635, 690, 780, and 830 nm). Transtympanal irradiation results in spatial intensity variations of a factor 4 to 10 within the cochlear windings. Because of the observed spatial intensity variations, the optimal external light dose has to be chosen with regard to the tonotopy of the human cochlea.
It is not natural for the dentist to ask, nor for the patient to inform the dentist about such a situation since it does not appear to be a dental indication. The transmission of light across the tympanic cavity and the promontory depends strongly on the wavelength. Tinnitus can be subjective (heard only by the patient) and objective (sound can be even heard also by others). We have published three studies on this particular issue, and we are of the opinion that our results are being followed in several countries (Brasil, Cyprus, Sweden, Switzerland, Slovakia, Turkey, Japan, Germany etc.) and implemented in numerous clinics with significant results.
Since there have always been efforts to evaluate an exact role of LLLT in treatment of tinnitus, apart from medication and physiotherapeutic manipulation of neck vertebra as an integral part of the comprehensive therapy, we have decided to create a separate group of patients to be treated only with laser. Since our long-term experience in comprehensive treatment of tinnitus has been based on the triad of physiotherapeutic manipulation, medication, and LLLT, we were at a loss whether we would not harm our patients in a way, giving them only a part of the treatrment, mere LLLT.
It only confirms the leading role of LLLT within comprehensive laser rehabilitation therapy of tinnitus. Based on the above treatment, the observation group 1 was treated with low-energy laser irradiation on acupoint and external auditory canal (such as Ermen (TE 21), Tinggong (SI 19) and Tinghui (GB 2)), combined with APS at Gan (liver), Shen (kidney) and Neifenmi (endorine), etc.
The therapy of low-energy laser irradiation on acupoint and external auditory canal combined with APS can replace the electroacupuncture therapy in treating moderate and severe sudden deafness. It was equally effective as regards elimination of labyrinthine hydropsis in patients presenting with Meniere’s disease. The sensation of tinnitus was measured on a Visual Analog Scale (VAS) before and two weeks after treatment and they were compared by means of Wilcoxon signed ranktest.
According to American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines, the main outcome for vertigo control was considered to be the number of spells per month in the 6 mo before treatment compared with the same parameter in the 6 mo of therapy. Audiometric examination did not show a statistically significant difference between the two groups.
In our opinion, increased blood flow in the inner ear is the main mechanism leading to the therapeutic results.
A questionnaire was administered which asked patients to score their symptoms on a five-point scale, before and two weeks after laser irradiation. To date, in patients with chronic tinnitus mastoidal and transmeatal irradiation has been performed without systematic dosimetric assessment.
Pulsed Electromagnetic Field Therapy was also used and Reactive Oxygen Specimen were measured and controlled by an additional intake of antioxidants per os.
This study, however, only reports on the objective outcome of the audiometry, taken before and after therapy. The examination and therapy included 348 patients and 215 right and 187 left inner ear organs (cochlea). The basic diagnostic for the documentation of the functional quality of the cochlea is the audiometry.
They were advised to take reasonable prophylactic measures against noise during (and after) the therapy.
As expected, the bone conduction is once again situated above the air conduction in all frequencies; the intersection phenomena in the frequency sector between 6 and 8 kc show a downward tendency. One group was evaluated in short-term follow-up (immediately after therapy), another group was evaluated in long-term follow-up (4-6 months after therapy).
The aim of the presented study was to determine the light dose received by the cochlear hair cells by using different irradiation modalities for the human petrous bone. The spatial distribution of transmitted light in the cochlear windings was measured by means of a retrocochlearly positioned endoscopic CCD camera for image processing and was assigned to acoustic frequencies according to the tonotopic organization of the cochlea.
The obtained results are enabling us to apply defined laser light doses to different cochlear winding areas. Spatial intensity variations of a factor of 10 and more inside the cochlear windings have been measured. This investigation included 68 ears in 45 patients with disabling unilateral or bilateral tinnitus. Studies published by these clinics show results which are almost identical with our experience. This was only possible thanks to our vast experience and long involvement in tinnitus treatments.
We have to declare, that we have selected patients during the introductory examination, sorting out patients whose x-ray indicated a possibility of tinnitus caused by vertebral blockades. This is obviously caused by the absence of medication and physiotherapy, showing their supportive efect. On the other hand we must stress the necessity to apply the two remaining parts of our therapeutic triad as well, since medication and physiotherapeutic manipulation are integral parts of the general care of our patients, and we should not deprive the suffering of the means and methods capable of bringing them more relief, which we are aware of. The observation group 2 was treated with electroacupuncture at the same acupoints as those point irradiation in observation group 1.
Although many studies have indicated a positive effect of low-level laser therapy (LLLT) on neural cell survival, there has been no study on the effects of LLLT on cochlear hair cells.
The method proved less efficacious for the management of long-standing hearing impairement and chronic loss of hearing, but it can be used to prevent the development of these conditions.
A decrease of one scale point, regarding the loudness, duration and degree of annoyance of tinnitus, was accepted to represent an improvement. However, light-dosimetric studies on human temporal bones demonstrated that controlled application of laserlight to the human cochlea depends on defined radiator position within the external auditory meatus.


The hearing capacity of the patients was improved in all frequency sectors (average value = 20.6%).
This holds good for both the air and the bone conduction.If one takes into consideration the energy quantity (j) transmitted in order to reach these results, it is obvious that the eldest age group needs the largest quantity of transfered energy. For an estimation of the corresponding space irradiance in an intact cochlea, correction factors have been calculated by a Monte Carlo procedure on the basis of experimentally determined optical properties of skull bone.
For an irradiation of the mastoid, the light transmission within the cochlea is 10(3) to 10(5) times smaller compared with an irradiation of the tympanic membrane and is extremely variable for different specimens. Mastoidal irradiation leads to therapeutically insufficient light doses within reasonable treatment times, whereas transmeatal irradiation is recommendable.
Low level lasers have been used to treat tinnitus patients with reasonable success, if sufficient energy and suitable treatment technique is used.
The clinical study was performed with 30 patients suffering from chronic permanent tinnitus. The active or placebo laser treatment was administered trans-meatally once a week for 6 minutes. According to literature, fifteen per cent of entire population have experienced at least a tinitus episode some time, its incidence and severity rising with age up to approx.
On the other hand, this selection led to a more pure evaluation of the role of LLLT in the treatment of tinnitus, leaving out both a possible cause and a corresponding treatment.
Frequency-specific hearing levels were measured before the noise exposure and also after the 1st, 3rd to 5th, 8th to 10th and 12th irradiations. Therefore, the aim of this study was to elucidate the effects of LLLT on hair cell survival following gentamicin exposure in organotypic cultures of the cochlea of rats. The mean VAS score reduction was not statistically significant between male and female patients (p = 0.23).
Moreover, a hearing test was performed before and after therapy and results were reported as the pure tone average of 500-, 1000-, 2000-, and 3000-Hz frequencies.
This feasibility study first presents a laser application system enabling dose-controlled transmeatal cochlear laser-irradiation (TCL), as well as preliminary clinical results in patients with chronic cochlear tinnitus.
Patients with hearing aids were advised to reduce the adjustments according to their improving hearing quality.
It has to be emphasized, though, that once again the most difficult patient group (average duration of the disease 14.5 years) needed the largest quantity of transfered energy. Further studies are mandatory for development of clinical devices for transmeatal irradiation of the cochlea. Only 26% of the patients reported improved duration, but 58% had  reductiont of loudness and 55% reduced annoyance. This study brings an additional overview of the role of LLLT (Low Level Laser Therapy) in the treatment. Audiogram provides only for numeric range of perception of frequency of sounds, however it does not give us an objective evaluation of quality of hearing. The cochlea cultures were then divided into a control group (n=8), a laser-only group (n=8), a gentamicin-only group (n=8) and a gentamicin plus laser group (n=7).
The improvement of rheoencephalographic characteristics was documented in the patients of all groups but was especially pronounced in group 1.
The novel laser TCL-system, consisting of four diode lasers (lambda=635 nm-830 nm) and a new specific head-set applicator, was developed on the basis of dosimetric data from a former light-dosimetric study. The average improvement was 22.84 dB for 74 long time follow up observations (4-6 months after therapy). There was a close correlation between the improvement of the hearing capacity and the age of the patients and the duration of their disease. The authors conclude: ”Laser therapy seemed to be worth trying on patients with intractable tinnitus”. A questionnaire was administered to evaluate the loudness, duration, quality, and annoyance of tinnitus before and after irradiation. Our results enable us to pinpoint laser as the leading element in the overall therapy of tinnitus. Furthermore, the patients do not see the main improvement in a wider range of frequency of sounds, this remains usually on a similar level, but the main benefit is the absence of the additional burdening sound caused by tinnitus. Compared to initial hearing levels at all frequencies, thresholds increased markedly after noise exposure. It is concluded that the proposed method significantly increases the efficiency of treatment of chronic sensorineural hearing loss. In a preliminary clinical study, the TCL-system was applied to 35 patients with chronic tinnitus and sensorineural hearing loss.
Until now there hasn’t been any known potent therapeutic method improving hyperacusis. In conclusion it can be stated that if LLLT is administered in sufficiently high dosages to the inner ear (cochlea), it is possible to obtain and document significant biostimulative effects. Therefore the patients can better analyze sounds in general, their hearing is “refreshed” as they usually describe the result of the therapy. After the 12th irradiation, hearing threshold was significantly lower for the NL ears compared to the N ears. The chronic symptoms persisted after standard therapeutic procedures for at least six months, while retrocochlear or middle-ear pathologies have been ruled out. In some cases laser therapy alone will produce astonishing results, in others it has to be combined with traditional occlusal stabilisation procedures. However, 40% of the patients reported a slight to significant attenuation of the tinnitus loudness of the treated ear. In one patient who received active laser treatment, acute hearing deterioration occurred after the third irradiation. When observed using an electron microscope, the number of hair cells in the middle turn of the NL ears was significantly larger than that of the N ears. The gentamicin groups were exposed to 1 mM gentamicin for 48 h and allowed to recover (gentamicin-only group) or allowed to recover with daily irradiation (gentamicin plus laser group). The pulsed electromagnetic field applicator generated a magnetic field of a maximum of 100 µT and it was placed behind the ear, over the area of the mastoid bone.
Lutz Wilden of Bad Fussing, Germany reported on his 6 years of experience at a recent lecture before the members of the Swedish Laser Medical Society (Stockholm, May 1998). It is important for doctors to be aware of this subgroup of tinnitus patients since traditional therapies, and even laser therapy of the inner ears, will be ineffective if the CMD is not diagnosed and treated. Transmeatal low-power laser irradiation with 60 mW is not effective for the treatment of tinnitus. Our findings suggest that low-level laser irradiation promotes recovery of hearing thresholds after acute acoustic trauma. For evaluation of laser-induced effects complete otolaryngologic examinations with audiometry, tinnitus masking and matching, and a tinnitus-self-assessment were performed before, during and after the laser-irradiation. Before every therapy series with LLLL the patients actual hearing capacity (air and bone conductions) was examined by audiometry.
ROS were measured and controlled by administrating different sorts of antioxidants such as Ginkgo biloba. The number of hair cells was significantly larger in the gentamicin plus laser group than in the gentamicin-only group.
The first clinical use of the TCL-system has been well tolerated without side-effects and produced no observable damage to the external, middle or inner ear.
At the end of each therapy series their hearing capacity was examined by the same method for a second time. The number of hair cells was larger in the laser-only group than in the control group, but the difference did not reach statistical significance.
These results suggest that LLLT may promote hair cell survival following gentamicin damage in the cochlea.
After a follow-up period of six months tinnitus loudness was attenuated in 13 of 35 irradiated patients, while two of 35 patients reported their tinnitus as totally absent. Total dosage 2000-4000 (sic) joules per treatment (60 minutes per session, 30 minutes per ear). This is the first study in the literature that has demonstrated the beneficial effect of LLLT on the recovery of cochlear hair cells.
C) The hearing capacity of the patients was ameliorated in all frequency sectors (average value = 20.6 %). Doses may seem very high, but the thick bone behind the ear absorbs about 95% of the energy before reaching the inner ear. Further investigations by large double-blind placebo-controlled studies are mandatory for clinical evaluation of the presented TCL-system and its therapeutic effectiveness in acute and chronic cochlear dysfunction. There was a close (and biologically plausible) correlation as far as the amelioration of the hearing capacity and the age of the patients and the duration of their disease were concerned; this correlation was the higher, the more energy was transfered on the whole.



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