Welcome to TLC - Tinnitus Laser Centre
TLC is a Swedish non-profit association with the aim of promoting
the knowledge about Laser Therapy of tinnitus. Tinnitus is a very
seriuos, debilitating and widespread phenomenon. Medicine has so far
tried many therapies and they seem to have only one trait in common
- they are not very successful. Laser therapy is not yet an established
therapy for tinnitus, but taking the positive anecdotal reports into
account, coupled with a number of positive clinical studies, we feel
this is an area well worth of further exploration.
The cause of tinnitus is controversial, indicating that there is no
absolute knowledge. In our experience there are three typical situations:
- The tinnitus is caused by a brain damage
- The tinnitus is caused by an acute or chronic acoustic trauma
to the inner ear
- The tinnitus is caused by stress and consequent muscular spasm
For no 1 there is no therapy known to us
For no 2 irradiadiation directed towards the innear ear can be performed,
in order to stimulate the "tired" cells in this region.
Acute injuries respond well.
For no 3 relaxation therapy, physiotherapy, adjustment of the teeth
(occlusion), bite splints and laser therapy to the involved muscles
TLC in itself does not treat patients, nor does it give advice to
patients. On our web site there are links to clinics performing Tinnitus
Laser Therapy, but these clinics are not TLC operations.
Low level laser therapy (LLLT) has been suggested as a possible therapy
for tinnitus. Several studies have used Ginkgo biloba infusions in
combination with LLLT, the former being a widespread but not well
documented therapy for tinnitus. The number of studies are few and
they will be briefly described in the following.
Witt  is one of the pioneers in this field, but to the knowledge
of the author his results have not been published in any peer-review
journal. Witt combines infusion of Gingko biloba (Egb 761, 17.5 mg
dry extract per 5 ml amouple)) and laser. This may be a favourable
combination but an evaluation of the contribution of the laser is
not possible. More than 500 patients have been treated since 1989
and Witt claims that more than 60% of the patients have reached a
considerable or total relief . The laser used is a combination of
HeNe 12 mW/GaAs 5 x 10 mW. Treatment technique not stated.
Swoboda  did not find any significant effect of Gingo/laser.
However, the ginkgo infusion used was at a homeopathic level (D3 =
1:1000 dilution), acc. to Witt.
Partheniadis-Stumpf  also failed to find any effect from the combined
ginkgo (6 ml Tebonin) infusion and laser. However, the laser was applied
at a distance of one cm above the mastoid. The non-contact mode reduces
penetration considerably and the mastoid is not ideal for reaching
the inner ear.
Plath  treated 40 tinnitus patients with 50 mg Ginkgo biloba.
20 patients received sham laser irradiation, 20 real laser. A HeNe
12 mW/GaAs 5 x 15 mW GaAs laser was used, irradiation procedure approximately
the same as for Partheniadis-Stumpf. In this study, 50% of the patients
reported a reduction of the tinnitus of more than 10 dB, compared
with 5% in the control group, in both self-assessment and audiometric
A similar study has been performed by von Wedel . 155 patients
were treated with Ginkgo infusion (5 ml Syxyl D3) and laser. The outcome
was negative. No information about the type of laser, treatment technique
or dosage is given, making an evaluation impossible.
Shiomi  has investigated the effect of infrared laser applied
directly into the meatus acusticus, 21 J, once a week for 10 weeks.
The result of this non-controlled study is as follows: 26% of the
patients reported improved duration, 58% reduced loudness and 55%
reported a general reduction in annoyance.
The same author  has also examined the effect of light on the
cochlea, using guinea pigs. Direct laser irradiation was administred
to the cochlea through the round window and the amplitude of CAP was
reduced to 53-83% immediately after the onset of irradiation. The
amplitude then returned to the original level. The results of this
investigation suggest that LLLT might lessen tinnitus by suppressing
the abnormal excitation of the 8th nerve or the organ of Corti.
More or less the same parameters were used in a controled study by
Mirtz  but in this case there was no significant effect.
Wilden   has applied a different method where the dose has
been increased considerably. A set consisting of one HeNe laser and
three powerful GaAlAs lasers is used, covering a large area over and
around the ear, in the non-contact mode. Doses between 3.000 and 5.000
J are given each session. Laser is applied as a monotherapy. More
than 800 patients have been treated with this concept and positive
effects are reported, even for vertigo. Recent injuries in "the
disco generation" are more easily treated than long-term chronic
conditions. In a separate study  Wilden reports improvment of
the hearing capacity of these patients, as evaluated by audiometry.
Beyer  has performed a very exact ex-vivo laser penetration study.
Based on these findings it was possible to calculate the energy needed
to obtain a dose of 4 J/cm2 in the cochlea itself. 30 patient were
treated five times within 2 weeks. One group was irradiated with 635
nm diode laser, the other with 830 nm diode laser. By self-assessment
around 40% of the patients reported a slight to significant attenuation
of the tinnitus loudness of the irradiated ear. This study has been
followed by a double blind study.
Prochazka  has evaluated the effect of combined Egb 761 Ginkgo
infusion and laser in a double blind study. 37 patients were divided
into three groups. One group had Egb 761 only, one Egb761 and placebo
laser, one Egb761 and real laser, 830 nm. The results in the three
groups were as follows: no effect 29/26/19, less than 50% relief 44/48/29,
more than 50% relief 18/26/36, no more tinnitus 9/0/26. Irradiation
was performed over the mastoid and over the meatus acusticus, twice
a week, 8-10 sessions, total 175 J.
Rogowski  divided a group of 32 tinnitus patients into one group
receiving LLLT and one receiving a placebo procedure. Dose, wavelength
and treatment technique not stated in the available English abstract.
The effect was evaluated through VAS. Within the patient group transiently
evoked otoacoustic emissions (TEOAE) were measured before, during
and after therapy. No significant difference between laser and placebo
was found in annoyance or loudness of the tinnitus and in changes
of TEOAE amplitude. These results indicate that there is no relationship
between the effect of low-power laser and changes in cochlear micromechanics.
A few other indications in otorhinolaryngology have been treated
with low level lasers, even with intravenous irradiation. [17-20]
It is obvious that the available literature on laser therapy of tinnitus
is scarse and ambiguous. Some studies have used a combination of Ginkgo
and laser, others laser as monotherapy. Differences in wavelengths,
pulsing, dosage and treatment technique makes a firm evaluation impossible.
However, the positive results reported in some studies do merit attention
and further research. Recent clinical experience also suggests that
the doses necessary for successful outcome of the therapy have to
be increased considerably. Tinnitus is a grave condition, sometimes
leading to suicide. It is also an increasing problem and the existing
treatment modalities offered to tinnitus patients are not very effective.
Young persons suffering from acoustic chocks (concerts, discos) can
be more successfully treated with laser therapy. Understandably enough,
a long standing condition in elderly persons is a severe condition
taking 10-20 sessions to influence.
 Witt U, Felix C. Selektive photo-Biochemotherapie in der Kombination
Laser und Ginkgo-Pflanzenextrakt nach der Methode Witt. Neue Möglichkeiten
bei Innerohrstörungen. [Selective photo-biochemotherapy in the
combination of laser and gingkoplan extracts acc. to the Witt method]
(1989). Unpublished material.
 Swoboda R, Schott a. Behandlung neurotologischer Erkrankungen
mit Gingko biloba Hevert, Hyperforat und Low-Power-Laser-Therapie.
[Treatment of neurotologic diseases with Gingko biloba and low level
laser therapy] Medizinische Akademie Erfurt. (1992)
 Partheniadis-Stumpf M, Maurer J, Mann W. Titel: Soft laser therapy
in combination with tebonin i.v. in tinnitus. [in German)] Laryngorhinootologie
 Plath P, Olivier J. Results of combined low-power laser therapy
and extracts of Ginkgo biloba in cases of sensorineural hearing loss
and tinnitus. Adv Otorhinolaryngol.1995;49:101-4
 von Wedel H, Calero L, Walger M et al. Soft-laser/Ginkgo therapy
in chronic tinnitus. A placebo-controlled study. Adv Otorhinolaryngol.1995;49:105-8
 Shiomi Y, Takahashi H, Honjo I, Kojima H, Naito Y, Fujiki N: Efficacy
of transmeatal low power laser irradiation on tinnitus: a preliminary
report. Auris Nasus Larynx 1997;24(1):39-42.
 Shiomi Y et al. [Effect of low power laser irradiation on inner
ear] [in Japanese]. Pract Otol (Kyoto). 1994; 87: 1135-1140.
 Mirz F, Zachariae R, Andersen S E et al. The low-power laser
in the treatment of tinnitus. Clin Otolaryngol 1999; 24: 346-354.
 Wilden L. The effect of low level laser light on innear ear diseases.
In: Low Level Laser Therapy, Clinical Practice and Scientific Background.
Jan Tunér and Lars Hode. Prima Books in Sweden AB (1999). ISBN
 Wilden L, Dindinger D. Treatment of chronic diseases of the inner
ear with low level laser therapy (LLLT): pilot project. Laser Therapy.
1996; 8: 209-21210
 Wilden L, Ellerbrock D. Verbesserung der Hörkapazität
durch Low-Level-Laser-Licht (LLLL). [Amelioration of the hearing capacity
by low-level-laser-light (LLL)]. Lasermedizin. 1999; 14: 129-138.
 Beyer W et al. Light dosimetry and preliminary clinical results
for low level laser therapy in cochlear dysfunction. Proc. Laser Florence
 Prochazka M, Tejnska R. Comprehensive therapy of patients suffering
from tinnitus. Proc. Laser Florence '99.
 Rogowski-M, Mnich-S, Gindzienska-E, Lazarczyk-B. [Low-power laser
in the treatment of tinnitus - a placebo-controlled study] . Laser
niskoenergetyczny w leczeniu szumow usznych-badania porownawcze z
placebo. Otolaryngologia polska. [Otolaryngol-Pol]. 1999; 53 (3):
 Mishenkin N V et al. [Effects of helium-neon laser energy on
the tissues of the middle ear in the presence of biological fluids
and drug solutions]. [in Russian] Vest Otorinolaringol. 1990; 5: 18-21
 Bogomilskii M R et al. [Effect of low-energy laser irradiation
on the functional state of the acoustic analyzer]. [in Russian] Vest
Otorinolaryngol. 1989; 2: 29-34.
 Palchun V T et al. [Low-energy laser irradiation in the combined
treatment of sensorineural hearing loss and Ménière's
disease]. [in Russian] Vestnik Otorinolaryngol. 1996; 1: 23-25.
 Ribari O et al. [Closure of tympanic perforations with low-energy
HeNe laser irradiation]. [in German] Acta Chir Academ Scient Hungariacae.
1980; 3: 229-238.
Medical therapies of tinnitus have one thing in common: their effect
is very limited (a survey in Swedish about various therapies is found
under the link "Detta har provats"). With the positive anecdotal
reports in mind and with the inspiration of the few positive studies,
we feel that Laser Therapy for tinnitus is well worth investigating
without prejudice. The following is a summary of TLC initiated research:
- Stockholm, private hospital. Finished. 15 consecutive tinnitus
patients were given 200 mW 820 nm laser via a thin optical cord,
very close to the ear drum and under visual control, total 24 J
and 10-15 sessions. The idea was to check the studies  and 
but with higher degree of dosage control. Through the small fiber
the energy density was higher and the visual control close to the
ear drum actually made the dosage inside the inner ear higher than
in the other studies. The laser was a custom made Irradia Mid Laser,
Stokholm. The outcome was negative, one reason probably the fact
that no differential diagnosis of the patients were made.
- Stockholm, private hospital. The LEnergy 275co (Laser Evolution,
Germany) is a stetoscope-like laser with red 780 nm laser light
being directed into both ears simultaneously, 45 mW each. 20 patients
will be treated. All patients have suspected aocustic trauma and
no history of clenching or sore masticatory muscles. The idea is
to pinpoint patients where the problem is likely to be centred in
the inner ear, not in the muscles or in the spine. Patients will
use the LEnergy 60 minutes daily, except Sundays, for one month.
Study started in September 2000 and will take one year.
- Stockholm, Department of Odontology, Karolinska Institutet, Huddinge.
Clincal examination of patients with tinnitus and temporo-mandibular-disorders.
These patients have been treated rather successfully in this department
through occlusal adjustment and in some cases bite splints. Laser
Therapy has proved to improve and speed up the outcome of this therapy
considerably. The laser used is a LASOTRONIC MED700, 820 nm, 300
mW. Ongoing for one year. Controlled study planned.
- Ystad, governmental dental clinic. Patients with Ménière´s
disease have successfully been treated in this clinic, through TMD
therapies. When the laser is used on an involved muscle, the tone
of the tinnitus will change character in many cases. A "Tinnitus
simulator" has been invented. The patient will adjust this
"tinnitus generator" until it emits the same sound as
the sound in the patient´s ear/ears. The laser will then be
applied and the patient will again adjust the "TinSim"
to the new sound. Theory: the TinSim will show: 1) the condition
in the muscle affects the tinnutus sensation and 2) the laser affects
the muscle. Start: February 2001. The laser used is a LASOTRONIC
MED700, 820 nm, 300 mW.
TLC is interested in sharing its experiences with other researchers.