Skip to main content

Low-level laser therapy for treatment of tinnitus in Red Sea scuba divers: a randomized clinical study

Abstract

Background

Scuba diving has become a popular hobby. However, diving puts the auditory system at the risk of a wide variety of complaints including tinnitus. Low-level laser therapy is a new modality in treatment of tinnitus. This study evaluates effect of laser therapy on tinnitus of scuba divers in Red Sea. This randomized study included 200 scuba diving patients with tinnitus without any other audiological symptoms. They were randomly divided into two groups: GI (n=100) patients were subjected to 60 sessions of laser therapy, and in the other group GII (n=100), the machine was off while doing the procedure. The Tinnitus Questionnaire (TQ) was done every 20 days to evaluate the severity of the tinnitus for both groups.

Results

Both groups were matched regarding age and sex distribution. GI group experienced significantly decreased tinnitus severity compared to GII after laser therapy. There was no relation between duration of diving and laser therapy effect in GI.

Conclusion

Laser therapy is effective in treatment of tinnitus of scuba divers and its effect is increased by number of laser sessions.

Background

Tinnitus is a common otological symptoms and is defined as conscious awareness of a sound in the absence of an external auditory stimulus [1]. In this context, it was suggested that pathophysiological mechanism may be a thalamocortical lesion with decreased auditory stimulation [2]. Central theories suggest an increased activity with tinnitus in the dorsal cochlear nucleus and the inferior colliculus of the brainstem [3].

The dysfunction theory concluded that the cochlea is damaged by loud noise, drug exposure, or viral infections [4]. The outer hair cells (OHC) are damaged first and then the inner hair cells (IHC). Cochlear damage occur after acoustic trauma changes the spontaneous firing rates of neurons in the dorsal cochlear nucleus (DCN) [2]. There is no treatment recommended for tinnitus but sedatives, antihistamines, anti-depressants, local anesthetics, and antipsychotics are prescribed for treatment with different outcomes [5]. Also, low-level laser radiation was introduced as alternative modality for cochlear dysfunction and tinnitus [6].

Possible mechanisms explaining the actions of laser therapy in treatment of tinnitus include growth factors secretion, increasing cell proliferation and improvement of blood flow to inner ear [7]. The present study aimed to detect laser effect of tinnitus in scuba divers in the Red Sea

Methods

The present randomized study was conducted at a private hospital in Kingdom of Saudi Arabia between 2017 and 2020. The study protocol was approved by the local ethical committee, and all patients gave informed consent before participation. The study is registered at clinicaltrials.gov (NCT04962750).

The study included 200 adult scuba divers. Patients had history of scuba diving for at least 5 years without history of hearing loss, vertigo, or other causes of tinnitus, The recruited patients comprised two groups: GI (n=100) treated with low-level light laser for 60 sessions. Each session is 20 min daily. In GII (n=100), the machine was off while doing the procedure.

Examination of the nose, throat, and ear by using fibro-optic endoscopy was done for all patients, audiological assessments were done including pure tone audiometry (sibelsound 400 audiometer) and tympanometry (Tympanometer 4000 Homoth GmbH&Co KG).

The laser light technical data were as follows: output power 5mW, wavelength: 650 m for 20 min pass to the cochlea through the meatus (the external auditory canal); the machine is made in Switzerland designed by COL company. Laser therapy is completely safe and painless [8].

This device consists of three parts in which laser source is placed; the tip is silicon. It was inserted inside the external ear canal, and laser ray was radiated to the inner ear and cochlea via tympanic membrane (Fig. 1). The device does not have any noise or particular vibration so the patients are not aware it is off or on, and the laser machine were off in GII group.

Fig. 1
figure 1

One of our patients during the session (picture published after his consent)

Randomization was performed using computer generated numbers and sealed envelope technique. Patients’ allocation was achieved by an independent researcher who was not aware of the nature of the study.

Outcome parameters

Outcome parameters included the effect of laser light in the treatment of scuba diving patients with tinnitus and the Tinnitus Questionnaire (TQ) which were done 1 week pre-treatment and every 20 days of treatment for each group [9].

We asked the patients place circle at the number that best describes your tinnitus on a scale of 1 to 5 with 1 representing less tinnitus and 5 high tinnitus, all of our patients understand the questionnaire without translation (Table 1).

Table 1 How much of a problem is your tinnitus?

Statistical analysis

Results of the present study were presented as number or mean and standard deviations. Numerical data were compared using t test while categorical data were compared using chi-square test. All statistical calculations were achieved using SPSS 25 (IBM, USA). P value less than 0.05 was considered statistically significant.

Results

The present study included 200 scuba divers, they included two groups: GI (n=100) was subjected to 60 sessions of laser therapy and GII (n=100) the machine was off while doing the test, they comprised 156 males and 44 females with an age range of 23–45 years. Both groups were matched regarding age and sex distribution (Table 2).

Table 2 Baseline characteristics of the studied groups

Comparison between the studied groups regarding mean of tinnitus severity pretreatment and after 20 sessions of laser therapy showed no significant difference GI 4.37±2.02 versus GII 4.39±2.05 with p >0.05, but there was significant difference between both groups after 40 and 60 sessions GI 4.99±2.11 versus GII 1.99 ±0.90 and GI 3.23±1.64 versus GII 1.93 ±0.64, p< 0.001 (Table 3).

Table 3 Comparison between GI and GII before and after laser therapy

Analysis implicated that in GI Laser therapy achieved more effect with increasing number of sessions with p < 0.001 (Fig. 2), but in the GI group, there was no difference regarding the laser therapy effect on duration of diving per years with p >0.05 (Fig. 3) and there was no difference regarding the laser therapy effect on male and females in both groups with p >0.05 (Fig. 4).

Fig. 2
figure 2

The mean of tinnitus severity in the GI group after laser therapy

Fig. 3
figure 3

The mean of tinnitus severity according to duration of diving in years in GI

Fig. 4
figure 4

The mean of tinnitus severity between males and females in both groups

Discussion

Scuba divers report chronic disability such as tinnitus and hearing loss [10, 11], and now low-level laser light is used in its treatment as it is safe and effective. Our study comparing the tinnitus severity by using the Tinnitus Questionnaire (TQ) after laser light output can affect tinnitus recovery particularly for long time, which agree with Hahn et al. [12], who studied 100 patients suffered from tinnitus and treated by low-level laser radiation with 200mw and 650 nm wave length for 50 sessions each session10 min and recovery was reported in 59.8% of the patients.

Our results as compared to other procedures in line with the conclusions of Gungor et al. [13] who used low-level laser radiation with 5mw and 650nm for 25 min per week on 45 patients (18 females and 27 years old (mean 55.8) with chronic tinnitus, recovery percentage was increased and tinnitus frequency had significant difference comparing both under studying groups, also agree with Cuda et al. [14] and Rilana et al. [15] who assessed before and after treatment, 62% of patients in the therapy group and 36% of patients in the control group recovered.

On the other hand, Tauber et al. [16] found no effect on duration of the laser therapy on recovery of tinnitus in scuba diving using criteria visual analog scaling (VAS) and tinnitus handicap inventory (THI) between patients of both groups, we suppose that the controversial results may be due to different treatment ways, our patients received therapy in the clinic, while other study done by Simoes et al. [17] who gave the participants their course of treatment at home.

In addition, our study noted no significant difference between GI and GII before laser therapy, while there was significant difference between GI and GII groups after laser therapy which agree with Okhovat et al. [18] who concluded the same results with most similar protocol to ours, we noticed some idiopathic improvement in GII but it was not statistically significant, also no difference in results of GI according to duration of diving in years which agree with Teggi et al. [19]

Conclusions

Scuba diving is an interesting sport and becomes more popular every day, but it has many audiological hazards. Now, laser therapy is easy and safe technique in treatment of tinnitus in scuba divers and its effect is increasing by number of sessions of laser therapy.

Availability of data and materials

All data are owned by the institution.

Abbreviations

TQ:

Tinnitus Questionnaire

OHC:

Outer hair cells

IHC:

Inner hair cells

DCN:

Dorsal cochlear nucleus

LLLT:

Low-level laser therapy

References

  1. 1.

    Livingstone DM, Smith KA, Lange B (2017) Scuba diving and otology: a systematic review with recommendations on diagnosis, treatment and post-operative care. Diving Hyperb Med 47(2):97–109. https://doi.org/10.28920/dhm47.2.97-109

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Kitajima N, Sugita-Kitajima A, Kitajima S (2014) Altered eustachian tube function in SCUBA divers with alternobaric vertigo. Otol Neurotol 35(5):850–856. https://doi.org/10.1097/MAO.0000000000000329

    Article  PubMed  Google Scholar 

  3. 3.

    Montazeri K, Mahmoudian S, Razaghi Z, Farhadi M (2017) Alterations in auditory electrophysiological responses associated with temporary suppression of tinnitus induced by low-level laser therapy: a before-after case series. J Lasers Med Sci 8(Suppl 1):S38–S45. https://doi.org/10.15171/jlms.2017.s8

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Carmichael ML, Boyev KP (2016) Middle ear barotrauma causing transient facial nerve paralysis after scuba diving. Diving Hyperb Med 46(4):260–261 PMID: 27966206

    PubMed  Google Scholar 

  5. 5.

    Fackrell K, Potgieter I, Shekhawat GS, Baguley DM, Sereda M, Hoare DJ (2017) Clinical interventions for hyperacusis in adults: a scoping review to assess the current position and determine priorities for research. Biomed Res Int 2017:2723715. https://doi.org/10.1155/2017/2723715

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Rozycki SW, Brown MJ, Camacho M (2018) Inner ear barotrauma in divers: an evidence-based tool for evaluation and treatment. Diving Hyperb Med 48(3):186–193. https://doi.org/10.28920/dhm48.3.186-193

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Doering A (2018) From He’e Nalu to olympic sport: a century of surfing evolution. In: Higham J, Hinch T (eds) Sport tourism development, 3rd edn. Channel View Publications, Bristol, pp 209–317

    Google Scholar 

  8. 8.

    Yeh CW, Tseng LH, Yang CH, Hwang CF (2019) Effects of oral zinc supplementation on patients with noise-induced hearing loss associated tinnitus: a clinical trial. Biomed J 42(1):46–52. https://doi.org/10.1016/j.bj.2018.10.009

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Baguley DM, Humphriss RL, Hodgson CA (2000) Convergent validity of the tinnitus handicap inventory and the tinnitus questionnaire. J Laryngol Otol 114(11):840–843. https://doi.org/10.1258/0022215001904392 PMID: 11144832

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Lechner M, Sutton L, Fishman JM, Kaylie DM, Moon RE, Masterson L, Klingmann C, Birchall MA, Lund VJ, Rubin JS (2018) Otorhinolaryngology and diving-part 1: otorhinolaryngological hazards related to compressed gas scuba diving: a review. JAMA Otolaryngol Head Neck Surg 144(3):252–258. https://doi.org/10.1001/jamaoto.2017.2617

    Article  PubMed  Google Scholar 

  11. 11.

    Hostler D (2015) Underwater RISKS. Recognizing & treating injuries caused by SCUBA diving. JEMS. 40(8):46–49 PMID: 26403045

    PubMed  Google Scholar 

  12. 12.

    Hahn A, Sejna I, Stolbova K, Cocek A (2001) Combined laser-EGb 761 tinnitus therapy. Acta Otolaryngol Suppl 545:92–93. https://doi.org/10.1080/000164801750388207

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Gungor A, Dogru S, Cincik H, Erkul E, Poyrazoglu E (2008) Effectiveness of transmeatal low power laser irradiation for chronic tinnitus. J Laryngol Otol 122(5):447–451. https://doi.org/10.1017/S0022215107009619

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Cuda D, De Caria A (2008) Effectiveness of combined counseling and low-level laser stimulation in the treatment of disturbing chronic tinnitus. Int Tinnitus J 14(2):175–180 PMID: 19205171

    PubMed  Google Scholar 

  15. 15.

    Cima RFF, Kikidis D, Mazurek B, Haider H, Cederroth CR, Norena A, Lapira A, Bibas A, Hoare DJ (2020) Tinnitus healthcare: a survey revealing extensive variation in opinion and practices across Europe. BMJ Open 10(1):e029346. https://doi.org/10.1136/bmjopen-2019-029346

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Tauber S, Schorn K, Beyer W, Baumgartner R (2003) Transmeatal cochlear laser (TCL) treatment of cochlear dysfunction: a feasibility study for chronic tinnitus. Lasers Med Sci 18(3):154–161. https://doi.org/10.1007/s10103-003-0274-6

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Simoes J, Neff P, Schoisswohl S, Bulla J, Schecklmann M, Harrison S, Vesala M, Langguth B, Schlee W (2019) Toward personalized tinnitus treatment: an exploratory study based on internet crowdsensing. Front Public Health 7:157. https://doi.org/10.3389/fpubh.2019.00157

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Okhovat A, Berjis N, Okhovat H, Malekpour A, Abtahi H (2011) Low-level laser for treatment of tinnitus: a self-controlled clinical trial. J Res Med Sci 16(1):33–38 PMID: 21448380; PMCID: PMC3063436

    PubMed  PubMed Central  Google Scholar 

  19. 19.

    Teggi R, Bellini C, Piccioni LO, Palonta F, Bussi M (2009) Transmeatal low-level laser therapy for chronic tinnitus with cochlear dysfunction. Audiol Neurootol 14(2):115–120. https://doi.org/10.1159/000161235

    CAS  Article  PubMed  Google Scholar 

Download references

Acknowledgements

None.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Affiliations

Authors

Contributions

Conceptualization: OE and BA; Methodology: OE and B ; Formal analysis and investigation: OE and BA; Writing—original draft preparation: OE and BA; Writing—review and editing: OE and BA; Resources: OE and BA; Supervision: OE and BA. The authors revised the manuscript and approved it for publications. The authors read and approved the final manuscript.

Corresponding author

Correspondence to Osama A. Elsayad.

Ethics declarations

Ethics approval and consent to participate

The study protocol was approved by the ethical committee of the Saudi German Hospital in Jeddah, Kingdom of Saudi Arabia, and all participants provided written informed consent before enrollment. Approval reference number is not available.

Consent for publication

Informed consent was obtained from all individuals included in this study.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Elsayad, O.A., Alsharif, B. Low-level laser therapy for treatment of tinnitus in Red Sea scuba divers: a randomized clinical study. Egypt J Otolaryngol 38, 4 (2022). https://doi.org/10.1186/s43163-021-00196-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s43163-021-00196-5

Keywords

  • Tinnitus-scuba divers
  • Laser therapy
  • Red Sea