Need help?

800-5315-2751 Hours: 8am-5pm PST M-Th;  8am-4pm PST Fri
Medicine Lakex

Low-level laser therapy for tinnitus

Low-level laser therapy for tinnitus (Protocol)
Peng Z, Chen XQ, Gong SS, Chen CF
This is a reprint of a Cochrane protocol, prepared and maintained by The Cochrane Collaboration and published in The CochraneLibrary 2012, Issue 4 Low-level laser therapy for tinnitus (Protocol)
Copyright 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

CONTRIBUTIONS OF AUTHORS Low-level laser therapy for tinnitus (Protocol)
Copyright 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Low-level laser therapy for tinnitus
Zhe Peng1, Xiu-Qi Chen2, Shu-Sheng Gong1, Cheng-Fang Chen1 1Department of Otorhinolaryngology - Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
2Department of Pediatrics, First Affiliated Hospital, Guangxi Medical University, Nanning, China Contact address: Shu-Sheng Gong, Department of Otorhinolaryngology - Head and Neck Surgery, Beijing Tongren Hospital, CapitalMedical University, Beijing, 100730, China.
Editorial group: Cochrane Ear, Nose and Throat Disorders Group.
Publication status and date: New, published in Issue 4, 2012.
Citation: Peng Z, Chen XQ, Gong SS, Chen CF. Low-level laser therapy for tinnitus. Cochrane Database of Systematic Reviews 2012,
Issue 4. Art. No.: CD009811. DOI: 10.1002/14651858.CD009811.
Copyright 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effectiveness of low-level laser therapy for the treatment of subjective idiopathic tinnitus.
Low-level laser therapy for tinnitus (Protocol)
Copyright 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
). This suggests the fundamental importance of the This is one of a number of tinnitus reviews produced by the central auditory pathways in the maintenance of the symptom, Cochrane Ear, Nose & Throat Disorders Group, which use a stan- irrespective of trigger.
dard Background. The following paragraphs ('Description of the Many environmental factors can also cause tinnitus. The most condition') are based on earlier work in the following reviews and relevant and frequently reported are: reproduced with permission: ; • acute acoustic trauma (AAT) (for example, explosions or • airbag inflation (toy-pistols ( Description of the condition
• exposure to occupational noise; 'urban noise pollution' Tinnitus can be described as the perception of sound in the absence of external acoustic stimulation. For the patient it may be trivial or it may be a debilitating condition The quality of the perceived sound can vary enormously from simple sounds such • exposure to recreational and amplified music ( as whistling or humming to complex sounds such as music. The patient may hear a single sound or multiple sounds. Tinnitus maybe perceived in one or both ears, within the head or outside thebody. The symptom may be continuous or intermittent. Tinnitus is described in most cases as subjective - meaning that it cannot beheard by anyone other than the patient. While, for the patient, this Over 50 years ago, Heller and Bergman demonstrated that if 'nor- perception of noise is very real, because there is no corresponding mal' people (with no known cochlear disease) were placed in a external sound it can be considered a phantom, or false, perception.
quiet enough environment, the vast majority of them would ex- Objective tinnitus is a form of tinnitus which can be detected perience sounds inside their head. They concluded that tinnitus- by an examiner, either unaided or using a listening aid such as like activity is a natural phenomenon perceived by many in a quiet a stethoscope or microphone in the ear canal. This is much less enough environment ( common and usually has a definable cause such as sound generated Mazurek has shown that pathologic changes in the cochlear neuro- by blood flow in or around the ear or unusual activity of the tiny transmission, e.g. as a result of intensive noise exposure or ototoxic muscles within the middle ear. Tinnitus may be associated with drugs, can be a factor in the development of tinnitus normal hearing or any degree of hearing loss and can occur at any In the 'neurophysiological model' of tinnitus ( It is important to distinguish between clinically significant and it is proposed that tinnitus results from the ab- non-significant tinnitus (and several different classi- normal processing of a signal generated in the auditory system.
fications have been proposed (; ; This abnormal processing occurs before the signal is perceived ). Dauman, for example, makes a distinction be- centrally. This may result in 'feedback', whereby the annoyance tween 'normal' (lasting less than five minutes, occurring less than created by the tinnitus causes the individual to focus increasingly once a week and experienced by most people) and 'pathological' on the noise, which in turn exacerbates the annoyance and so a tinnitus (lasting more than five minutes, occurring more than once 'vicious cycle' develops. In this model tinnitus could therefore re- a week and usually experienced by people with hearing loss).
sult from continuous firing of cochlear fibres to the brain, fromhyperactivity of cochlear hair cells or from permanent damage tothese cells being translated neuronally into a 'phantom' sound- like signal that the brain 'believes' it is hearing. For this reason Almost any form of disorder involving the outer, middle or in- tinnitus may be compared to chronic pain of central origin - a sort ner ear or the auditory nerve may be associated with tinnitus of 'auditory pain' (; ).
(). However, it is possible to have se- The relationship between the symptom of tinnitus and the activ- vere tinnitus with no evidence of any aural pathology. Conversely, ity of the prefrontal cortex and limbic system has been empha- tinnitus can even exist without a peripheral auditory system: uni- sised. The limbic system mediates emotions. It can be of great lateral tinnitus is a common presenting symptom of vestibular importance in understanding why the sensation of tinnitus is in schwannomas (acoustic neuromas), which are rare benign tumours many cases so distressing for the patient. It also suggests why, when of the vestibulo-cochlear nerve. When these neuromas are removed symptoms are severe, tinnitus can be associated with major depres- by a translabyrinthine route, the cochlear nerve can be severed.
sion, anxiety and other psychosomatic and/or psychological dis- Despite the effective removal of their peripheral auditory mecha- turbances, leading to a progressive deterioration of quality of life nisms, 60% of these patients retain their tinnitus postoperatively Low-level laser therapy for tinnitus (Protocol)
Copyright 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
and spasmolytic drugs. The use of anticonvulsants in treating tin- Epidemiological data reports are few. The largest single study was nitus is the subject of a Cochrane review ). An- undertaken in the UK by the Medical Research Council Institute tidepressants are commonly prescribed for tinnitus. However, two of Hearing Research and was published in 2000 (). This reviews (; ) showed that there is no in- longitudinal study of hearing questioned 48,313 people; 10.1% dication that tricyclic antidepressants have a beneficial effect.
described tinnitus arising spontaneously and lasting for five or Although a number of studies have suggested that Ginkgo biloba more minutes at a time and 5% described it as moderately or may be of benefit in the treatment of tinnitus severely annoying. However, only 0.5% reported tinnitus having a Cochrane review showed that there was a severe effect on their life. This is another of the paradoxes of no evidence that it is effective where tinnitus was the primary tinnitus: the symptom is very common but the majority of peo- ple who experience it are not particularly concerned by it. These Hyperbaric oxygen therapy (HBOT) can improve oxygen supply figures from the UK are broadly consistent with data collected to the inner ear which it is suggested may result in an improvement by the American Tinnitus Association (ATA) which suggests that in tinnitus, however a Cochrane review found insufficient evidence tinnitus may be experienced by around 50 million Americans, or 17% of the US population ). Data also exist for Japan, Studies have been carried out into the effect of cognitive be- Europe and Australia ), and estimates suggest havioural therapy (CBT) on tinnitus ). Another that tinnitus affects a similar percentage of these populations, with Cochrane review has shown that CBT can have an effect on the 1% to 2% experiencing debilitating tinnitus (). The qualitative aspects of tinnitus and can improve patients' ability to Oregon Tinnitus Data Archive ) contains data on manage the condition ).
the characteristics of tinnitus drawn from a sample of 1630 tinni- Other options for the management of patients with tinnitus in- tus patients. The age groups with the greater prevalence are those clude transcranial magnetic stimulation (), tinnitus between 40 and 49 years (23.9%) and between 50 and 59 years masking (use of 'white noise' generators) (mu- sic therapy reflexology, hypnotherapy and tra- Olszewski showed in his study that the risk of tinnitus increases in ditional Chinese medicine (TCM), including acupuncture patients over 55 years old who suffer from metabolic conditions and cervical spondylosis ().
Description of the intervention
Firstly a patient with tinnitus may undergo a basic clinical assess- Laser was discovered in the 1960s. Laser is light that is generated ment. This will include the relevant otological, general and family by high-intensity electrical stimulation of a medium, which can history, and an examination focusing on the ears, teeth and neck be a gas, liquid, crystal, dye or semiconductor (). The and scalp musculature. Referral to a specialist is likely to involve light produced consists of coherent beams of single wavelengths a variety of other investigations including audiological tests and in the visible to infrared spectrum, which can be emitted in a radiology. Persistent, unilateral tinnitus may be due to a specific continuous wave or pulsed mode disorder of the auditory pathway and imaging of the cerebello- Mester first reported the earliest clinical application of the low-level pontine angle is important to exclude, for example, a vestibular laser in 1972 (Since then, low-level laser therapy schwannoma (acoustic neuroma) - a rare benign tumour of the (LLLT) has come to the forefront of clinical research. Hundreds cochleo-vestibular nerve. Other lesions, such as glomus tumours, of randomised, double-blind, placebo-controlled phase III clinical meningiomas, adenomas, vascular lesions or neuro-vascular con- trials have been published from over a dozen countries flicts may also be detected by imaging ( Low-level laser therapy (LLLT) uses low-powered laser light in therange of 1 to 1000 mW, at wavelengths from 632 to 1064 nm, tostimulate a biological response. LLLT uses laser to aid tissue repair relieve pain and stimulate At present no specific therapy for tinnitus is acknowledged to be acupuncture points ). Surgical applications of satisfactory in all patients. Many patients who complain of tinni- laser ablate tissue by intense heat and are different from LLLT, tus, and also have a significant hearing impairment, will benefit which uses light energy to modulate cell and tissue physiology to from a hearing aid. Not only will this help their hearing disability achieve therapeutic benefit without a macroscopic thermal effect but the severity of their tinnitus may be reduced.
(sometimes termed cold laser). LLLT is non-invasive, painless and A wide range of therapies have been proposed for the treatment of can be easily administered in primary care settings.
tinnitus symptoms. Pharmacological interventions used include LLLT acts by inducing a photochemical reaction in the cell, a pro- cortisone (vasodilators, benzodiazepines, lidocaine cess referred to as biostimulation or photobiomodulation ( Low-level laser therapy for tinnitus (Protocol)
Copyright 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
). It is an irradiation technique that has the ability to in- ;), promotes local blood duce biological processes using photon energy. There are studies flow in the inner ear associated with suppression of the sympa- showing proliferation and angiogenesis after irradiation in skeletal thetic nerve action potential, and activates repair mechanisms in muscle tissue cells post-myocardial infarction. Most evidence of the inner ear through photochemical and photophysical stimula- efficacy is based on the increase in energy state and the activation tion of the hair cell mitochondria of mitochondrial pathways. It has been reasonably well established Additionally, studies have shown that laser leads to activation of that mitochondria are a principal intracellular target of red and related cortical areas in healthy subjects. The mechanism leading near infrared light Cytochrome C oxidase (unit IV to the observed activated neuronal network by means of trans- of the mitochondrial respiratory chain) is a chromophore that ab- meatal cochlear laser (TCL) is vague (). It can- sorbs light as far into the infrared as 1000 nm ().
not be explained by a supra-sensory stimulation of the tympanic In recent years, LLLT has been widely used in the treatment of membrane, since subjects are not able to differentiate between real tinnitus. The laser emits dual wavelength beams which are red and placebo stimulation.
and near infrared. These laser beams are cool to the touch and Different low-level laser therapy studies have focused on the deter- do not cause discomfort. They are aimed into the auditory canal mination and the modulation of irradiation parameters that seem and through the mastoid bone behind the ear. The patients are to play a pivotal role in its effectiveness awake during the period of therapy. The wavelength nature of these lasers allows them to penetrate tissue. Although the laser beams The biological effects of low-level laser ther- lose intensity rapidly, they can have an effect on tissues 2 to 5 cm apy are supposed to depend largely on well-controlled parameters, inside the body. The mechanism of action of low-level laser on the e.g. wavelength, waveform, power, dosage per site, duration of ir- inner ear and on tinnitus is not well understood. Previous studies radiation, type of irradiated cell and time interval between injury evaluating low-level laser for the treatment of tinnitus have been and irradiation.
equivocal, with both positive ; ; ; and negative effects (; ; ) reported.
Why it is important to do this review
The incidence of adverse effects of LLLT is low and similar to that The effects of low-level laser directed at the auditory canal or the of placebo, with no reports of serious events ).
mastoid bone behind the ear are not known (; ; ; ; ). Therefore this Cochrane review will How the intervention might work
provide an up-to-date, detailed analysis of the current evidence Several hypotheses have been proposed for the mechanism of ac- tion of LLLT. The prevailing opinion is that the respiratory chainplays a central role in the effect induced by laser therapy (). Laser energy in the red and near infrared light spectrumis capable of penetrating tissue. It stimulates mitochondria in O B J E C T I V E S
the cells to produce energy through the production of adenosinetriphosphate (ATP) (). Mitochondria are the power To assess the effectiveness of low-level laser therapy for the treat- supplies of all cells; they metabolise fuel and produce energy for ment of subjective idiopathic tinnitus.
the cell in the form of ATP. It has been reported that LLLT irra-diation increases the production of ATP IncreasedATP production may lead to enhanced cell metabolism, promot- ing the damage recovery process, returning cells to a healthy stateand reversing many degenerative conditions.
For ear disorders, low-level laser has been reported to alter the col- Criteria for considering studies for this review
lagen organisation within the cochlea, especially within the basilarmembrane. This should increase the stiffness of the basilar mem-brane (). Also, LLLT has a beneficial Types of studies
effect on the recovery of cochlear hair cells after acute hair cell loss Randomised controlled trials.
(), increases cell proliferation (), syn-thesis of ATP (and collagen ), releaseof growth factors (including nerve growth factor (NGF), brain- Types of participants
derived neurotrophic factor (BDNF), glial cell line-derived neu- Adults in whom there is a complaint of persistent, distressing, rotrophic factor (GDNF) and ciliary neurotrophic factor (CNTF)) subjective tinnitus of any aetiology.
Low-level laser therapy for tinnitus (Protocol)
Copyright 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Types of interventions
Searching other resources
Studies where the patients received low-level laser therapy. Com- We will scan the reference lists of identified publications for ad- parisons will include the following.
ditional trials and contact trial authors if necessary. In addition, • Low-level laser therapy versus placebo we will search PubMed, TRIPdatabase, The Cochrane Library and • Low-level laser therapy versus drug/other therapy Google to retrieve existing systematic reviews relevant to this sys-tematic review, so that we can scan their reference lists for ad-ditional trials. We will search for conference abstracts using the Types of outcome measures
Cochrane Ear, Nose and Throat Disorders Group Trials Register.
Data collection and analysis
• Improvement in tinnitus severity and disability, measured by a validated tinnitus-specific questionnaire. Commonly usedtinnitus questionnaires are listed in ( Selection of studies
Two authors (Zhe Peng, Xiu Qi Chen) will independently reviewthe titles, abstracts and keywords of all records retrieved to identify studies which meet the inclusion criteria outlined above. We will • Improvement of quality of life resolve disagreements by consensus.
• Change in socio-economic impact associated with work • Change in anxiety and depression disorders Data extraction and management
• Change in psychoacoustic parameters • Change in tinnitus loudness The same two review authors will carry out data extraction inde- • Change in overall severity of tinnitus pendently. Each review author will review approximately the same • Change in thresholds on pure-tone audiometry number of studies. We will use a standardised extraction form for • Adverse effects of treatment data collection. Unresolved disagreement on inclusion, 'Risk ofbias' assessment and data collection will be referred to the othertwo authors (Shusheng Gong, Chengfang Chen). Extracted datawill include the following.
Search methods for identification of studies
1. Study details: first author; year of publication; country of We will conduct systematic searches for randomised controlled publication; publication type.
trials. There will be no language, publication year or publication 2. Study eligibility: type of study; participants; types of status restrictions. We may contact original authors for clarification intervention; types of outcomes/measures.
and further data if trial reports are unclear, and we will arrange 3. Methods: study inclusion criteria; study exclusion criteria; translations of papers where necessary.
detail of participants (age, sex, aetiology, hearing level, durationof tinnitus, severity of tinnitus); setting; study intervention(wave, session, frequency); study control; matching of interventions; compliance; similarity between groups; duration We will identify published, unpublished and ongoing studies of follow-up.
by searching the following databases from their inception: the 4. Information on methods for 'Risk of bias' assessment.
Cochrane Ear, Nose and Throat Disorders Group Trials Register; 5. Outcome: primary outcomes, secondary outcomes and the Cochrane Central Register of Controlled Trials (CENTRAL, other outcomes at the end of treatment and/or the end of follow- The Cochrane Library); PubMed; EMBASE; CINAHL; LILACS; up. We will also extract the number and type of adverse events.
KoreaMed; IndMed; PakMediNet; CAB Abstracts; Web of Sci- 6. Conclusions.
ence; BIOSIS Previews; ISRCTN;; ICTRP and We will contact authors for clarification and missing data infor- We will model subject strategies for databases on the search strategydesigned for CENTRAL (see ). Where appropriate,we will combine subject strategies with adaptations of the highly Assessment of risk of bias in included studies
sensitive search strategy designed by the Cochrane Collaboration Zhe Peng and Xiu Qi Chen will independently undertake assess- for identifying randomised controlled trials and controlled clinical ment of the risk of bias of the included trials, with the following trials (as described in the Cochrane Handbook for Systematic Reviews taken into consideration, as guided by the Cochrane Handbook for of Interventions Version 5.1.0, Box 6.4.b. ( Systematic Reviews of Interventions Low-level laser therapy for tinnitus (Protocol)
Copyright 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
• sequence generation; • 0% to 40%: might not be important; • allocation concealment; • 30% to 60%: may represent moderate heterogeneity; • 50% to 90%: may represent substantial heterogeneity; • incomplete outcome data; • 75% to 100%: considerable heterogeneity.
• selective outcome reporting; and The importance of the observed value of the I² statistic depends • other sources of bias.
on (i) the magnitude and direction of effects and (ii) the strength We will use the Cochrane ‘Risk of bias' tool in Review Manager of evidence for heterogeneity (e.g. P value from the Chi² test or a (RevMan) 5 which involves describing each of confidence interval for I²) ( these domains as reported in the trial and then assigning a judge-ment about the adequacy of each entry: 'low', 'high' or 'unclear' Assessment of reporting biases
risk of bias.
We will test for potential publication bias using a funnel plot orother corrective analytical methods, depending on the number of Measures of treatment effect
clinical trials included in the systematic review. We will attempt We will analyse the data using Review Manager 5. We will assess to reduce any effects of reporting bias by obtaining and including the treatment effect for dichotomous data outcome measures using missing trial data and data from unpublished trials where possible.
the risk ratio (RR) and for continuous data we will use the meandifference (MD), with 95% confidence intervals. We will combine data statistically if they are available and of sufficient quality and A pooled statistical analysis of treatment effects will proceed only in the absence of significant heterogeneity.
in the absence of significant clinical or statistical heterogeneity.
Where it is appropriate to pool data and heterogeneity is detected, Unit of analysis issues
we will use the random-effects model. We will analyse the clinicalheterogeneity of the included trials to determine whether it is To protect the accuracy of the results, we will only include ran- appropriate to carry out the meta-analysis.
domised controlled trials. We will not include other non-standard If the trial data cannot be pooled, we will describe the outcomes designs such as cross-over trials and cluster-randomised trials.
in the text of the review.
Dealing with missing data
Subgroup analysis and investigation of heterogeneity
We will contact authors for missing data information. If the data No subgroup analyses are planned.
are missing at random, analyses based on the available data willtend to be unbiased; if the data are said to be 'not missing atrandom', publication bias and selective reporting bias may exist.
The principal options for dealing with missing data are based on We will perform sensitivity analyses by repeating the analysis ex- the recommendations in the Cochrane Handbook for Systematic cluding internal reports and conference abstracts. We will use study Reviews of interventions, Chapter 16 ).
quality in a sensitivity analysis.
Assessment of heterogeneity
We will assess clinical heterogeneity by examining types of par- ticipants (e.g. cause of tinnitus), interventions and outcomes ineach study. We will assess statistical heterogeneity among trials by We are grateful to Paolo Baldo, John Phillips, Malcolm Hilton, inspecting the forest plots and using the Chi² test and the I² statis- Jonathan Hobson and Michael Bennett for their previous tic. When interpreting the I² statistic, we will use the following Cochrane reviews on which the Background to this protocol is Low-level laser therapy for tinnitus (Protocol)
Copyright 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Bjordal 2007
Bjordal J, Johnson MI, Lopes-Martins RA, Bogen B, Alberti 1987
Chow R, Ljunggren AE. Short-term efficacy of physical Alberti PW. Tinnitus in occupational hearing loss: interventions in osteoarthritic knee pain. A systematic nosological aspects. Journal of Otolaryngology 1987;16(1):
review and meta-analysis of randomised placebo-controlled trials. BMC Musculoskeletal Disorders 2007;8:51.
Amaral 2001
Bjordal 2008
Amaral AC, Parizotti NA, Salvini TF. Dose-dependency Bjordal JM, Lopes-Martins RA, Joensen J, Couppe C, of low-energy HeNe laser effect in regeneration of skeletal Ljunggren AE, Stergioulas A, et al.A systematic review with muscle in mice. Lasers in Medical Science 2001;16:44–51.
procedural assessments and meta-analysis of low level lasertherapy in lateral elbow tendinopathy (tennis elbow). BMC Andersson G, Lyttkens L. A meta-analytic review ofpsychological treatments for tinnitus. British Journal of Briner 1995
Briner W. A behavioural nosology for tinnitus. Psychological
Argstatter H, Krick C, Bolay HV. Music therapy in chronic tonal tinnitus. Heidelberg model of evidence-based music Brummett RE. Drug-induced ototoxicity. Drugs 1980;19
Budd 1995
Budd RJ, Pugh R. The relationship between locus of American Tinnitus Association. 2004.
control, tinnitus severity, and emotional distress in a group of tinnitus sufferers. Journal of Psychosomatic Research 1995; Axelsson A, Sandh A. Tinnitus in noise-induced hearing loss. British Journal of Audiology 1985;19(4):271–6.
Chouard 2001
Baguley 1992
Chouard CH. Urban noise pollution. Comptes Rendus de Baguley DM, Moffat DA, Hardy DG. What is the effect l'Académie des Sciences. Série III, Sciences de la vie 2001;324
of translabyrinthine acoustic schwannoma removal upon tinnitus?. Journal of Laryngology and Otology 1992;106:
Christiansson BA, Wintzell KA. An audiological survey of Baldo 2006
officers at an infantry regiment. Scandinavian Audiology Baldo P, Doree C, Lazzarini R, Molin P, McFerran DJ.
Antidepressants for patients with tinnitus. Cochrane Chung 1980
Database of Systematic Reviews 2006, Issue 4. [DOI: Chung DY, Gannon RP. Hearing loss due to noise trauma.
Journal of Laryngology and Otology 1980;9(4):419–23.
Basford 1995
Daniell 1998
Basford JR. Low intensity laser therapy: still not an Daniell WE, Fulton-Kehoe D, Smith-Weller T, Franklin established clinical tool. Lasers in Surgery and Medicine GM. Occupational hearing loss in Washington state, 1984- 1991: II. Morbidity and associated costs. American Journal Becher 1996
of Industrial Medicine 1998;33(6):529–36.
Becher S, Struwe F, Schwenzer C, Weber K. Risk of Dauman 1992
hearing loss caused by high volume music - presenting Dauman R, Tyler RS. Some considerations on the an educational concept for preventing hearing loss in classification of tinnitus. Proceedings of the Fourth International Tinnitus Seminar, Bordeaux. 1992:225–9.
Belkin 1994
Davis 2000
Belkin M, Schwartz M. Evidence for the existence of low- Davis A, El Rafaie A. Epidemiology of tinnitus. In: Richard energy laser bioeffects on the nervous system. Neurosurgical Tyler editor(s). Tinnitus Handbook. San Diego: Singular Publishing Group, 2000.
Bennett 2007
Bennett MH, Kertesz T, Yeung P. Hyperbaric oxygen for Enwemeka CS, Parker JC, Dowdy DC, Harkness EE, idiopathic sudden sensorineural hearing loss and tinnitus.
Sanford LE, Woodruff LD. The efficacy of low-power lasers Cochrane Database of Systematic Reviews 2007, Issue 1.
in tissue repair and pain control: a meta-analysis study.
Photomedicine and Laser Surgery 2004;22:323–9.
Low-level laser therapy for tinnitus (Protocol)
Copyright 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Hilton 2004
Erlandsson SI, Hallberg LRM, Axelsson A. Psychological Hilton MP, Stuart EL. Ginkgo biloba for tinnitus. Cochrane and audiological correlates of perceived tinnitus severity.
Database of Systematic Reviews 2004, Issue 2. [DOI: Ernst 1999
Hobson 2010
Ernst E, Stevinson C. Ginkgo biloba for tinnitus: a review.
Hobson J, Chisholm E, Loveland M. Sound therapy (masking) in the management of tinnitus in adults.
Cochrane Database of Systematic Reviews 2010, Issue 12.
Fleischer G, Hoffmann E, Lang R, Muller R.
Documentation of the effects of child cap pistols. HNO Hoekstra CEL, Rynja SP, van Zanten GA, Rovers M.
Anticonvulsants for tinnitus. Cochrane Database of Griest 1998
Systematic Reviews 2011, Issue 7. [DOI: 10.1002/ Griest SE, Bishop PM. Tinnitus as an early indicator of permanent hearing loss. A 15 year longitudinal study of Holger 1994
noise exposed workers. AAOHN Journal: Official Journal Holger KM, Axelsson A, Pringle I. Ginkgo biloba extract of the American Association of Occupational Health Nurses for the treatment of tinnitus. Audiology 1994;33:85–92.
Gungor 2008
Jastreboff PJ. Phantom auditory perception (tinnitus): Gungor A, Dogru S, Cincik H, Erkul E, Poyrazoglu E.
mechanisms of generation and perception. Neuroscience Effectiveness of transmeatal low power laser irradiation for chronic tinnitus. Journal of Laryngology and Otology 2008;
Jastreboff PJ, Hazell JWP. Tinnitus Retraining Therapy. Hahn 2001
Implementing the Neurophysiological Model. Cambridge: Hahn A, Sejna I, Stolbova K, Cocek A. Combined laser-Egb Cambridge University Press, 2004.
761 tinnitus therapy. Acta Oto-Laryngologica. Supplement
Karu 1986
Karu TI. Molecular mechanism of the therapeutic effect Halford 1991
of low-intensity laser irradiation. Doklady Akademii Nauk Halford JBS, Anderson SD. Tinnitus severity measured by a subjective scale, audiometry and clinical judgement. Journal Karu 1989
of Laryngology and Otology 1991;105:89–93.
Karu T. Photobiology of low-power laser effects. Health Hallam 1996
Hallam RS. Manual of the Tinnitus Questionnaire. London: Karu 1995
The Psychological Corporation, 1996.
Karu T, Pyatibrat L, Kalendo G. Irradiation with He-Ne laser increases ATP level in cells cultivated in vitro. Journal Higgins JPT, Green S (editors). Cochrane Handbook of Photochemistry and Photobiology. B, Biology 1995;27(3):
for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, Kaviani 2011
2011. Available from
Kaviani A, Djavid GE, Ataie-Fashtami L, Fateh M, GhodsiM, Salami M, et al.A randomized clinical trial on the effect Hashmi 2010
of low-level laser therapy on chronic diabetic foot wound Hashmi JT, Huang YY, Osmani BZ, Sharma SK, Naeser healing: a preliminary report. Photomedicine and Laser MA, Hamblin MR. Role of low-level laser therapy in neurorehabilitation. PM & R: The Journal of Injury,
Function, and Rehabilitation
2010;2(12 Suppl 2):S292–305.
Kipshidze N, Nikolaychik V, Keelan MH, Shankar LR, Heller 1953
Khanna A, Kornowski R, et al.Low-power helium: neon Heller MF, Bergman M. Tinnitus aurium in normally laser irradiation enhances production of vascular endothelial hearing persons. Annals of Otology, Rhinology and growth factor and promotes growth of endothelial cells in vitro. Lasers in Surgery and Medicine 2001;28(4):355–64.
Henry 1995
Koester 2004
Henry JL, Wilson PH. Coping with tinnitus: two studies Koester M, Storck C, Zorowka P. Tinnitus - classification, of psychological and audiological characteristics of patients causes, diagnosis, treatment and prognosis. MMW with high and low tinnitus-related distress. International Fortschritte der Medizin 2004;146(1-2):23-4, 26-8; quiz 29-
Low-level laser therapy for tinnitus (Protocol)
Copyright 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Mester 1972
Kowalska S, Sulkowski W. Tinnitus in noise-induced Mester E, Szende B, Spiry T, Scher A. Stimulation of wound hearing impairment. Medycyna Pracy 2001;52(5):305–13.
healing by laser rays. Acta Chirurgica Academiae Scientiarum Kuk FK, Tyler RS, Russell D, Jordan H. The psychometric properties of a tinnitus handicap questionnaire. Ear and Metternich FU, Brusis T. Acute hearing loss and tinnitus caused by amplified recreational music. Laryngorhinootologie Lee LT. A study of the noise hazard to employees in local Mirz 1999
discotheques. Singapore Medical Journal 1999;40(9):571–4.
Mirz F, Zachariae R, Andersen SE, Nielsen AG, Johansen LV, Bjerring P. The low-power laser in the treatment of Li Y, Zeng RF, Zheng D. Acupuncture for tinnitus.
tinnitus. Clinical Otolaryngology and Allied Sciences 1999; Cochrane Database of Systematic Reviews 2009, Issue 4.
Mrena 2002
Mrena R, Savolainen S, Kuokkanen JT, Ylikoski J.
Lockwood AH, Alvi RJ, Burkard RF, Galantowicz PJ, Coad Characteristics of tinnitus induced by acute acoustic trauma: ML, Wack DS. Neuroanatomy of tinnitus. Scandinavian a long-term follow-up. Audiology and Neuro-otology 2002;7
Luxon 1993
Luxon LM. Tinnitus: its causes, diagnosis and treatment.
Nakashima T, Ueda H, Misawa H, Suzuki T, Tominaga M, Ito A, et al. Transmeatal low-power laser irradiation for
tinnitus. Otology and Neurotology 2002;23(3):296–300.
Martinez-Devesa P, Waddell A, Perera R, Theodoulou M. Cognitive behavioural therapy for tinnitus. Cochrane Neuberger M, Korpert K, Raber A, Schwetz F, Bauer Database of Systematic Reviews 2010, Issue 9. [DOI: P. Hearing loss from industrial noise, head injury and ear disease. A multivariate analysis on audiometric
examinations of 110,647 workers. Audiology 1992;31(1):
Marx 1999
Marx SV, Langman AW, Crane RC. Accuracy of the fastspin echo magnetic resonance imaging in the diagnosis of Newman 1996
vestibular schwannoma. American Journal of Otolaryngology Newman C, Jacobson G, Spitzer B. Development of the tinnitus handicap inventory. Archives of Otolaryngology -
Head & Neck Surgery
Mazurek 2007
Mazurek B, Stöver T, Haupt H, Gross J, Szczepek A. The role of cochlear neurotransmitters in tinnitus. HNO 2007; Olszewski J, Kowalska S, Ku mierczyk K. Tinnitus diagnosis and treatment on the basis of our experiences.
McCombe 2001
McCombe A, Baguley D, Coles R, McKenna L, McKinney Oregon 1995
C, Windle-Taylor P. Guidelines for the grading of tinnitus Oregon Tinnitus Archive. severity: the results of a working group commissioned by the British Association of Otolaryngologists - Head and Oron 2007
Neck Surgeons. Clinical Otolaryngology 2001;26:388–93.
Oron U, IIic S, De Taboada L, Streeter J. Ga-As (808nm) McShane 1988
laser irradiation enhances ATP production in human McShane DP, Hyde ML, Alberti PW. Tinnitus prevalence neuronal cells in culture. Photomedicine and Laser Surgery in industrial hearing loss compensation claimants. Clinical Melinek 1976
Passarella S, Casamassima E, Molinari S, Pastore D, Melinek M, Naggan L, Altman M. Acute acoustic trauma - Quagliariello E, Catalano IM, et al.Increase of proton a clinical investigation and prognosis in 433 symptomatic electrochemical potential and ATP synthesis in rat liver soldiers. Israel Journal of Medical Sciences 1976;12(6):
mitochondria irradiated in vitro by helium-neon laser.
Meng 2011
Meng Z, Liu S, Zheng Y. Repetitive transcranial Phillips JS, McFerran D. Tinnitus Retraining magnetic stimulation for tinnitus. Cochrane Database Therapy (TRT) for tinnitus. Cochrane Database of of Systematic Reviews 2011, Issue 10. [DOI: 10.1002/ Systematic Reviews 2010, Issue 3. [DOI: 10.1002/ Low-level laser therapy for tinnitus (Protocol)
Copyright 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Phoon 1993
tinnitus and the use of an inner ear drug delivery system.
Phoon WH, Lee HS, Chia SE. Tinnitus in noise-exposed International Tinnitus Journal 1998;4(2):148–54.
workers. Occupational Medicine 1993;43(1):35–8.
Shea 1981
Plath 1995
Shea A. Otosclerosis and tinnitus. Journal of Laryngology Plath P, Olivier J. Results of combined low-power laser and Otology Supplement 1981;4:149–50.
therapy and extracts of Ginkgo biloba in causes of Shiomi 1997
sensorineural hearing loss and tinnitus. Advances in Oto- Shiomi Y, Takahashi H, Honjo I, Kojima H, Naito Y, Fujiki N. Efficacy of transmeatal low power laser irradiation on Reddy 1998
tinnitus: a preliminary report. Auris Nasus Larynx 1997;24
Reddy GK, Stehno-Bittel L, Enwemeka CS. Laser photostimulation of collagen production in healing rabbit Achilles tendons. Lasers in Surgery and Medicine 1998;22
Siedentopf CM, Ischebeck A, Haala IA, Mottaghy FM, Schikora D, Verius M, et al.Neural correlates of transmeatal Rejali 2004
cochlear laser (TCL) stimulation in healthy human subjects.
Rejali D, Sivakumar A, Balaji N. Ginkgo biloba does not benefit patients with tinnitus: a randomized placebo- controlled double-blind trial and meta-analysis of Siendentopf C, Golaszewski SM, Mottaghy FM, Ru randomized trials. Clinical Otolaryngology 2004;29(3):
CC, Felber S, Schlager A. Functional magnetic resonance imaging detects activation of the visual association RevMan 2011
cortex during laser acupuncture of the foot in humans.
The Nordic Cochrane Centre, The Cochrane Collaboration.
Review Manager (RevMan). 5.1. Copenhagen: The NordicCochrane Centre, The Cochrane Collaboration, 2011.
Silva 2011
Silva GB, Mendonça EF, Bariani C, Antunes HS, Silva MA.
Rhee 2011
The prevention of induced oral mucositis with low-level Rhee CK, He P, Jung JY, Ahn JC, Chung PS, Suh MW.
laser therapy in bone marrow transplantation patients: a Effect of low-level laser therapy on cochlear hair cell randomized clinical trial. Photomedicine and Laser Surgery recovery after gentamicin-induced ototoxicity. Lasers inMedical Science 2011;4:[Epub ahead of print].
Sindhusake D, Mitchell P, Newall P, Golding M, Rochtchina Robinson S. Antidepressants for treatment of tinnitus.
E, Rubin G. Prevalence and characteristics of tinnitus Progress in Brain Research 2007;166:263–71.
in older adults: the Blue Mountains Hearing Study.
International Journal of Audiology 2003;42(5):289–94.
Rochkind S, Barrnea L, Razon N, Bartal A, Schwartz M.
Stimulatory effect of He-Ne low dose laser on injured sciatic nerves of rats. Neurosurgery 1987;20:843–47.
Stephens D, Hetu R. Impairment, disability and handicap
in audiology: towards a consensus. Audiology 1991;20:
Rochkind S, Ouaknine GE. New trend in neuroscience: low power laser effect on peripheral and central nervous system Sullivan MD, Dobie RA, Saki CS, Katon WJ. Treatment (basic science, preclinical, and clinical studies). Neurological of depressed tinnitus patients with nortriptyline. Annals of Otology, Rhinology and Laryngology 1989;98(11):867–72.
Saayman 2011
Saayman L, Hay C, Abrahames H. Chiropractic manipulative therapy and low-level laser therapy in the Sullivan M, Katon WJ, Russo J, Dobie R, Saki C.
management of cervical facet dysfunction: a randomized Somatization, comorbidity, and the quality of life: controlled study. Journal of Manipulative and Physiological measuring the effect of depression upon chronic mental illness. Psychiatric Medicine 1992;10:61–76.
Saunders JE, Slattery WH, Luxford WM. Automobile Sullivan M, Katon W, Russo J, Dobie R, Sakai C. A airbag impulse noise: otologic symptoms in six patients.
randomized trial of nortriptyline for severe chronic tinnitus.
Otolaryngology - Head and Neck Surgery 1998;118(2):
Archives of Internal Medicine 1993;153:2251–9.
Seidman 1998
Sullivan M, Katon W, Russo J, Dobie R, Sakai C. Coping Seidman MD. Glutamate antagonists, steroids and and marital support as correlates of tinnitus disability.
antioxidants as therapeutic options for hearing loss and General Hospital Psychiatry 1994;16:259–66.
Low-level laser therapy for tinnitus (Protocol)
Copyright 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Sweetow 1990
Wenzel 2004
Sweetow RW, Levy MC. Tinnitus severity scaling for Wenzel GI, Pikkula B, Choi CH, Anvari B, Oghalai JS.
diagnostic/therapeutic usage. Hearing Instruments 1990;41
Laser irradiation of the guinea pig basilar membrane. Lasers in Surgery and Medicine 2004;35(3):174–80.
Szundi 2001
Wenzel 2007
Szundi I, Liao GL, Einarsdóttir O. Near-infrared time- Wenzel GI, Anvari B, Mazhar A, Pikkula B, Oghalai JS.
resolved optical absorption studies of the reaction of fully Laser-induced collagen remodeling and deposition within reduced cytochrome c oxidase with dioxygen. Biochemistry the basilar membrane of the mouse cochlea. Journal of Tauber 2003
Wilden 1996
Tauber S, Schorn K, Beyer W, Baumgartner R. Transmeatal Wilden L, Dindinger D. Treatment of chronic diseases of cochlear laser (TCL) treatment of cochlear dysfunction: the inner ear with low level laser therapy (LLLT): pilot a feasibility study for chronic tinnitus. Lasers in Medical project. Laser Therapy 1996;8:209–12.
Wilson 1998
Teggi 2009
Wilson PH, Henry JL. Development and psychometric Teggi R, Bellini C, Piccioni L, Palonta F, Bussi M.
properties of a measure of dysfunctional cognitions Transmeatal low-level laser therapy for chronic tinnitus with associated with tinnitus. International Tinnitus Journal cochlear dysfunction. Audiology and Neuro-Otology 2009; Temmel 1999
Woodruff LD, Bounkeo JM, Brannon WM, Dawes KS, Temmel AF, Kierner AC, Steurer M, Riedl S, Innitzer J.
Barham CD, Waddell DL, et al.The efficacy of laser Hearing loss and tinnitus in acute acoustic trauma. Wiener therapy in wound repair: a meta-analysis of the literature.
Photomedicine and Laser Surgery 2004;22(3):241–7.
Tunér 1999
Yazdani 2012
Tunér J, Hode L (eds). Low level laser therapy - clinical Yazdani SO, Golestaneh AF, Shafiee A, Hafizi M, Omrani practice and scientific background. Grängesberg, Sweden: HA, Soleimani M. Effects of low level laser therapy on Prima Books AB, 1999.
proliferation and neurotrophic factor gene expression of van Breugel 1992
human schwann cells in vitro. Journal of Photochemistry and van Breugel HH, Bär PR. Power density and exposure time Photobiology. B, Biology 2012;6(107):9–13.
of He-Ne laser irradiation are more important than total energy dose in photobiomodulation of human fibroblast in Yu W, Naim J, Lanzafame RJ. The effects of photoirradiation vitro. Lasers in Surgery and Medicine 1992;12(5):528-37.
on the secretion of TGF-β, PDGF and bFGF from fibroblasts in vitro. Photochemistry and Photobiology 1994; Weissman JL, Hirsch BE. Imaging of tinnitus: a review.
Indicates the major publication for the study Table 1. Tinnitus questionnaires
No. of items/factors
Tinnitus Questionnaire () 52 items, 5 factors a = 0.91 for total scale; for subscales a = 0.76 to a = 0.94 Tinnitus Handicap Questionnaire (27 items, 3 factors a = 0.93 for total scale Tinnitus Severity Scale Alpha not reported Subjective Tinnitus Severity Scale (16 items Low-level laser therapy for tinnitus (Protocol)
Copyright 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Table 1. Tinnitus questionnaires
Scale 28 items, 3 factors Alpha not reported Tinnitus Handicap Inventory 25 items, 3 scales a = 0.93 for total scale Tinnitus coping strategy questionnaire ( 33 Tinnitus coping style questionnaire 40 Tinnitus cognitions questionnaire - A P P E N D I C E S
Appendix 1. CENTRAL search strategy
#1 MeSH descriptor Tinnitus explode all trees#2 tinnit*#3 (#1 OR #2)#4 MeSH descriptor Laser Therapy explode all trees#5 MeSH descriptor Lasers explode all trees#6 laser* OR lllt#7 #4 OR #5 OR #6#8 #3 AND #7 Protocol first published: Issue 4, 2012 Low-level laser therapy for tinnitus (Protocol)
Copyright 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Zhe Peng: lead author, searching, selection of studies, data extraction, drafting and co-drafting of the protocol/review, assistance withstatistics, data analysis and data presentation, update of the review.
Xiu-Qi Chen: selection of studies, data extraction, assistance with statistics, data analysis, update of the review.
Shu-Sheng Gong: selection of studies, assistance with statistics.
Cheng-Fang Chen: searching, assistance with data extraction.
• None, Not specified.
• None, Not specified.
Low-level laser therapy for tinnitus (Protocol)
Copyright 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.



P000 - ESAMI DI STATO CONCLUSIVI DEI CORSI DI STUDIO DI ISTRUZIONE SECONDARIA SUPERIORE PROVA DI ITALIANO (per tutti gli indirizzi: di ordinamento e sperimentali) Svolgi la prova, scegliendo una delle quattro tipologie qui proposte. TIPOLOGIA A - ANALISI DEL TESTO L. PIRANDELLO, Il piacere dell'onestà

Microsoft word - 157-164-palynology - pragnya.docx

VISTAS IN GEOLOGICAL RESEARCH (ISBN: 81-900907-0-4) Special Publication in Geology (14), January 2016, pp.157 - 164 A Palynological Investigation of Quaternary Sediment Core from Cauvery Delta, Tamilnadu, India MOHAPATRA , A. KRISHNAMURTHY , P. SRINIVASAN , P. SINGH , P. P. DAS *1Department of Geology, Raveneshaw University, Cuttack - 753003, India