Small Acupuncture Graphic The Treatment of Meniére's Disease by Acupuncture
Keith Chell B.App.Sc. (Acupuncture), Cert.Adv.Ac. (Guangzhou)

Abstract

The structure and function of the inner ear is defined and the disorder known as Meniére's Disease is described from the point of view of Western medicine and Traditional Chinese medicine. These perspectives are compared, with the aim of finding rationalisations of the two theoretical viewpoints. Using a single case study of a female patient the of validity of the medical examination and Traditional Chinese examination are discussed. Changes to her condition are described, listed and charted. Conclusions are drawn with reference to both strengths and weaknesses of the findings, and suggestions are made regarding further appropriate research.

Introduction

In the condition known as Meniére's Disease, the fluid volume in the semicircular canals is increased, leading to elevated pressure. Typically, this causes attacks of dizziness (or vertigo), creating a feeling of violent spinning or rotation, whirling and falling. This is usually the most disabling and distressing symptom of Meniére's Disease.

During these attacks of dizziness in the early stages of the disorder, hearing in the low ranges usually deteriorates and returns to normal or near normal after an attack. While the frequency and duration of attacks vary between individuals, these episodes usually re-occur over a few years. Once the disease is established however, hearing loss may fail to recover fully after an attack. In the later stages of the disease, hearing loss is relatively constant and irreversible, and affects hearing in all ranges.

Another distressing symptom which often manifests from Meniére's Disease is tinnitus. This ringing in the ears will not be noticed during the attacks and by the later stages may become constant. Nausea, vomiting and sensation of fullness or pressure in the affected ear are commonly experienced.

The pattern and incidence of the symptoms may vary from case to case, but the general indications are the same, vertigo, tinnitus, nausea, sensation of pressure in the ear and progressive deafness in the affected ear, often leading to permanent hearing disability or total hearing loss, usually unilaterally.

This disorder is quite common, occurring in approximately one in a thousand of the population. It is equally common in both sexes, and most commonly occurs in the age range of 30 to 60 years, with 65% of cases occurring before the age of 50. In the majority of cases (about 85%) only one ear is affected, however the longer the condition lasts the more chance there is that the other ear will also become affected (Victorian Deaf Society, 1992).

One of the important points about Meniére's Disease is that medically, there is very little knowledge of it's aetiology. It is believed that there may either be an overproduction or underabsorbtion of endolymph in the cochlear duct. However, it is still not clear what factors lead to this condition. Medical therapy available for this condition is limited. In many cases sufferers are advised to be patient and wait for spontaneous recovery (which does occur in many cases).

In contrast, the aetiology of Meniére's according to traditional Chinese medicine is very clear. In theory at least, it can offer an effective acupuncture treatment program for the disorder.

The Treatment of Meniére's Disease by Acupuncture

Meniére's Disease is believed to result from the dilation of the lymphatic channels in the cochlea. The usual symptoms are tinnitus, heightened sensitivity to loud sounds, progressive loss of hearing, headache and vertigo. In the acute stage there may be severe nausea with vomiting, profuse sweating, disabling dizziness and nystagmus. Frequency of attacks is highly variable and the disease usually lasts a few years, with progressive loss of hearing in the affected ear (Miller & Keane, 1983, p.686).

Meniére's Syndrome ... is characterized by an increased amount of endolymph that enlarges the labyrinth. Among the symptoms are fluctuating hearing loss, attacks of vertigo, and roaring tinnitus. Etiology of Meniére's Syndrome is unknown. It is now thought that there is either an overproduction or underabsorbtion of endolymph in the cochlear duct. The hearing loss is caused by distortions in the basilar membrane of the cochlea (Tortora et al, 1990, p.491).

Meniére's Syndrome is essentially a disease of medically unknown origin. It is characterised by a variety of symptoms, all related to inner ear dysfunction, and seems to entail a retention of endolymph in the affected ear. There is also no known hereditary link in the onset of Meniére's Disease.

The syndrome of recurrent paroxysmal vertigo with associated feeling of fullness in the ear, tinnitus, and depression of hearing on a background of progressive hearing loss, and depression of labyrinthine function has been shown to be due to an intermittent elevation of endolymphatic pressure. When this occurs idiopathically, this is known as Meniére's Disease (Ell, 1991, p.30,32).

While no actual medical cause is known, several factors have been linked with Meniére's Disease.

Medical treatments utilised include diet, medication and surgery.

Dietary measures involve reducing cholesterol, reducing fluid intake, stopping alcohol, and eliminating added salt from the diet. This reduction in salt intake is most important, as salt increases fluid retention. Stopping coffee and cigarettes is also important because they constrict the blood vessels (Victorian Deaf Society, 1991, p.2).

Drug therapy centres around vasodilation to increase cochlear and labyrinthine blood flow, diuretics to remove water from the body with the aim of decreasing the supposed elevated intralabyrinthine fluid pressure, symptomatic antivertiginous antihistamines, and psychotherapeutic drugs to offset attacks which may be precipitated autonomically (Avery, 1980, p.354).

Some clinicians have used diuretics alone, while others prefer to combine a salt restricted diet with a diuretic. These therapies are aimed at reducing intralabyrinthine pressure.

Endolymphatic hydrops can be treated with the combination of a sodium depleting diuretic and a low salt diet. Acute attacks may respond to 20 to 30 g of urea taken and dissolved freshly in water. This causes a rapid osmotic shift which can acutely lower endolymphatic pressure (Ell, 1991, p.30).

At present, 5% of people suffering from Meniére's Disease require surgery of the inner ear. With each operation, hearing is at risk and the symptoms of vertigo and tinnitus may actually worsen rather than improve.

Conservative surgery is mainly designed to control vertigo but, in some cases, also seeks to improve hearing. The patient should have useful hearing in the non-operable ear as loss of hearing may be a caused to the ear (which is subject to surgery). Conservative surgery usually involves decompression and drainage of the fluid system in the balance mechanism, often using a drainage shunt to relieve the pressure in the inner ear. These operations require considerable skill and are not always successful (Victorian Deaf Society, 1991, p.3).

Destructive surgery is designed to destroy the inner ear completely. Vertigo is usually relieved and tinnitus sometimes relieved, but the procedure obviously entails complete and permanent hearing loss from the affected ear. For this reason, destructive surgery will only be employed when there is severe hearing loss in the affected ear and useable hearing in the other ear (Victorian Deaf Society, 1991, p.3).

The eventual outcome of Meniére's Disease is unpredictable. In many cases the symptoms spontaneously disappear, in others however, "... the natural course of Meniére's Syndrome may stretch out over a period of years, with the end result being almost total destruction of hearing" (Tortora et al, 1990, p.491).

According to Traditional Chinese Medicine there are four traditional pathologies which relate to the group of symptoms which make up Meniére's Disease. Of these, the first two are generally considered the most significant and will be discussed in detail in this section. The pathologies are:

Traditional medicine attributes aural vertigo to Phlegm and Dampness obstructing the Middle Heater and suppressing the "cleansing" Yang Qi (ie., the Qi of respiration which is said to rise to the eyes, ears, nose and mouth so as to maintain the clarity of the senses). Alternatively, this condition may arise from depletion of Kidney Yin which causes the Liver Yang, in the form of Wind, to ascend.

Symptoms associated with Phlegm and Dampness include nausea and vomiting. Vertigo induced by depleted Kidney Yin and ascendant Liver Yang is evidenced by dizziness, headache, blurred vision and tinnitus. Treatment is directed toward clearing and draining the Wind, while spreading and regulating the Qi in the channels (O'Connor & Bensky, 1985, p.684-5).

Deficiency of Blood and Qi (failing to supply the brain with nutrients) may also cause vertigo (Chen & Nissi, 1988, p.141).

Lu Shou Kang (1990, p.183) also adds the possibility of deficient Kidney Essence to these pathologies. "Acupuncture is indicated for both true vertigo and pseudo-vertigo. The former is chiefly Meniére's Syndrome ..."

The pathology of Phlegm and Dampness obstructing the middle burner, as defined by its name, is located in the area of the body known as the "middle burner" or "middle heater" which is the area of the body below the diaphragm and above the navel. Dampness, when generated internally, is usually a direct result of Spleen Qi deficiency, or its more chronic sequela, Spleen Yang deficiency.

Dampness may be of either internal or external origin, but "... Phlegm can only originate from an interior dysfunction" (Maciocia, 1989, p.299).

... the main cause for the formation of Phlegm is Spleen deficiency. If the Spleen fails to transform and transport Body Fluids, these will accumulate into Phlegm ... the Spleen is always the primary factor in the formation of Phlegm (Maciocia, 1989, p.195).

So, as the Spleen becomes Damp and cannot control the fluid metabolism (due to it's inability to transform and transport fluids) a condition known as "Turbid Mucus Disturbing the Head" can eventuate. "This is a development of Damp Spleen patterns. The patient suffers from severe dizziness ... In Western terms, this pattern is often part of disorders such as hypertension and Meniére's Disease" (Kaptchuk, 1983, p.225).

For this pathology the treatment principle is to tonify Spleen Qi and resolve Phlegm. Spread and regulate Qi in the channels of the affected ear.

The following points may be used.

ST 36 - reinforces the Spleen, regulates ascent of the Clear and descent of the Turbid (Flaws, 1989, p.44).
SP 3 - tonifies the Spleen and its functions (Rogers & Rogers, 1989, p.49).
ST 40 - transforms Phlegm, eliminates Damp (Flaws, 1989, p.44).
SP 9 - strengthens the Spleen and eliminates Phlegm-Damp (Flaws, 1989, p.44).
PC 6 - regulates the middle heater (Rogers et al, 1989, p.49).
GB 20 - dissipates internal Wind, clears the head, opens the orifices, benefits the hearing and vision (Flaws, 1989, p.59).

TH 17, SI 19 and "Anmian" are all important points to "... restore circulation of the Qi in the channels surrounding the ear" (O'Connor et al, 1985, p.685).

The pathology of depletion of Kidney Yin leading to Liver Yang rising combines features of both Kidney and Liver Yin deficiency. Symptoms may include dizziness, tinnitus, vertigo, poor memory, deafness, night sweating, dry mouth at night, hot palms and soles, thirst, sore back, aches in the bones, constipation and dark scanty urine. The tongue is likely to be red with no coating and cracked, and the pulse will be floating-empty and rapid (Maciocia, 1989, p.252). Most of these signs are due to Empty Heat which may lead to internal Wind which can create Liver Yang Rising.

The treatment principle for Kidney Yin depletion leading to Liver Yang Rising, is to "Subdue Liver Yang, tonify Yin" (Maciocia, 1989, p.226), regulate the Qi in the channels of the ear (O'Connor et al, 1985, p.685).

The following acupuncture points may be employed.

LV 3 - smooths the Liver, descends rebellious Qi.
SP 6 - nourishes Yin suppresses Liver Heat (Flaws, 1989, p.54).
KD 3 - strengthens Kidney Yin, pacifies empty Fire caused by deficiency of Yin (Rogers et al, 1989, p.117)
LV 8 - tonifies Liver Yin (Maciocia, 1989, p.226).
GB 20, TH 17, SI 19 and "Anmian" as for previous pathology.

Practioners of Western medicine observe structural changes in the physiology of the inner ear and the resulting symptoms. Much of this information is unseen from the point of view of traditional Chinese medical theory, which has no intrinsic knowledge of the semicircular canals, endolymph and so on.

Likewise, traditional Chinese medical theory describes factors which are considered insignificant by western medicine. For instance, the functional aspect of the Spleen, which in the pathology known as "Spleen Qi deficiency" may result in a condition known as "Dampness" and the resultant formation of Phlegm is (from the point of view of modern western medicine) both unknown, irrelevant and even bordering on the esoteric.

Is it possible to draw parallels between the apparently dissimilar western and Chinese medical observations of Meniére's Disease?

One of the most common pathologies of Meniére's Disease, according to the Chinese medical model, is that of Phlegm and Dampness obstructing the Middle Burner. Abnormal distribution of body fluid "condenses" into Phlegm.

"When phlegm is formed, it may stay in different parts of the body and result in different syndromes ... Phlegm blocking channels and collaterals: hemiplegia, deviation of the eyes and mouth and numbness of the limbs" (Essentials, 1980, p.47).

"Meniére's Syndrome is one type of labyrinthine disorder that is characterized by an increased amount of endolymph that enlarges the labyrinth" (Tortora et al, 1992, p.491).

It seems an unlikely coincidence that both medical models seem to be describing the same condition. "... Phlegm blocking channels and collaterals ..." "... increased amount of endolymph that enlarges the labyrinth." Both conditions display similar symptoms, dizziness or vertigo, nausea, tinnitus and loss of hearing. An essential part of the treatment principle, according to both medical models, is to quite literally unblock the ear. In some cases, a medical practitioner may decide that surgical drainage of the inner ear is appropriate to relieve the pressure. The acupuncturist seeks the same result by "moving and clearing the channels and collaterals of the ear".

At present only the Chinese medical model suggests any significant understanding of the aetiology of Meniére's Disease. However, it is interesting to note that in a western medical study of 300 people diagnosed as having Meniére's Disease, 86% presented indications of obesity (Spencer, 1983, p.639-78). The signs and symptoms of obesity correspond very closely with those of Dampness. It would seem that both systems are describing the same disorder.

These examples present the most obvious correlations of western and Chinese medical theory in relation to the aetiology. It seems that there are at least some areas of Meniére's Disease where the observations and deductions of the two paradigms overlap sufficiently to believe that they may both have something to offer. Insights into this condition may lead to western medical practitioners including precise dietary and lifestyle advice to patients, to alleviate aetiological factors. The acupuncturist can only be aided by a better understanding of the structure and function of the inner ear, especially in relation to the selection of appropriate local acupuncture points.

Method

The research design selected aimed to show by empirical evidence the outcome of intervention by acupuncture therapy in the treatment of Meniére's Disease.

Four dependent variables were measured, in this case the symptoms of Meniére's Disease : tinnitus, vertigo, nausea (a secondary symptom) and hearing loss.

Other possible independent variables are accounted for, as it is not enough to merely show relationship between the application of acupuncture and a reduction of symptoms. It is desirable to show these other factors are unlikely to have effected a change in the dependent variables. These include, "history" (any non-test treatment, dietary changes or other variants), and "maturation" (which may be any spontaneous remission of the condition). The method selected for this study is a Single Case exprimental, ABAB Design, N = 1 (Polgar & Thomas, 1991, p.90).

The condition of the patient is measured during an initial period of no treatment. This is to establish a "baseline" and is known as the "A" period. Following this baseline period, the independent variable to be investigated, in this case acupuncture treatment, is applied for the same length of time as the original baseline interval, and is known as the "B" period.

A significant difference in symptoms between the A and B periods may indicate that there is a relationship between treatment and any change in symptoms.

"The basic feature of ABAB designs is the introduction of a reversal condition. That is, the researcher attempts to re-introduce the conditions pertaining under A" (Polgar & Thomas, 1991, p.89). This design allows examination of measured changes in symptoms when the treatment variable is withdrawn, and therefore controls for the threats of maturation and history, which can make the AB design unreliable.

"It is essential that the observations should be valid and reliable" (Polgar et al, 1991, p.92). The measurement criteria of the dependent variable should be as straightforward as possible. For this reason the symptoms of Meniére's Disease are measured as the number of waking hours during which the patient suffers significantly from tinnitus, vertigo and nausea. These can all be measured on a daily basis, unlike hearing, which is impractical to measure as frequently. The advantage of daily measurements is the comparatively short period of time required to establish a reliable baseline. However, hearing tests from before and after the entire ABAB phase are compared for interest.

In a single case design, it is not practical to comprehensively control for any placebo effect. In this case there are, however, some factors relevant to this possibility. This patient has been suffering from Meniére's Disease for a considerable period of time but despite extensive medical testing has received little or no medical treatment. The fact that acupuncture is the first real treatment she has received may predispose her towards a placebo effect. However, the withdrawal of treatment in the second "A" period partially controls for the placebo factor, depending on the patient's expectations of the withdrawal phase.

O'Connor & Bensky (1985, p.685) prescribe ten to fifteen daily treatments as a course of therapy.

Therefore the volunteer patient is treated five days per week for two weeks (B1) and again for five days per week over a two week period (B2) after the first withdrawal phase (A2).

Results

Case History (N = 1) Age: 34.
Occupation: Clothing Manufacturer.
Mother of two children.
The patient was selected when she attended a private acupuncture practise, seeking acupuncture therapy for her symptoms of Meniére's Disease.

The patient's right ear has been blocked for the last four years. She has seen an Ear, Nose and Throat (E.N.T.) specialist who has diagnosed her condition as cochlear blockage. The hearing in her right ear is impaired, especially in the low range and she also suffers from chronic tinnitus, vertigo and nausea.

The current symptoms appeared after a bad bout of influenza in August 1989. Initially the hearing of both ears was affected, the condition in the left ear resolved itself, but the right ear did not recover. Since early 1992 she has had episodes of acute vertigo and tinnitus accompanied by nausea and unsteadiness. The E.N.T. specialist has diagnosed her condition as Meniére's Syndrome.

The patient has been taking Stemetil for symptoms of nausea and vertigo. This has been providing slight relief for the nausea but not for the unsteadiness. She has been taking Thyroxine (150 micrograms/day) since 1982.

At 15 years of age, the patient suffered from excessive perspiration from both armpits. She was medically diagnosed as having too many sweat glands and surgery was performed to sever the axillary sweat glands.

At 16 years of age she was unconscious for a week, from no known cause. Post coma symptoms included intense pruritus of the palms of the hands and the soles of the feet. Two weeks later the itching disappeared and the subcutaneous layers of these areas of skin became necrotic. A medical diagnosis was not found despite extensive testing.

Pelvic Inflammatory Disease (P.I.D.) was diagnosed in 1980.

The patient had appendicitis at 19 years of age.

In addition, the patient was diagnosed as suffering from Thyroiditis with related goitres in March 1981 (23 years of age) but had not noticed any significant symptoms. The condition was discovered during a routine medical checkup. A thyroidectomy (90%) was performed immediately. She suffered severe symptoms post-surgically as the remaining Thyroid atrophied. Since this time, June 1981, she has been taking Thyroxine.

The patient has always suffered from occasional bouts of motion sickness.

No known family history, parents and siblings are healthy, with no significant medical disorders.

Blood pressure 113/71
Pulse rate 57.

The symptoms of Meniére's Disease and their aetiology are significant. The patient suffers related tinnitus, vertigo and nausea. She feels that her hearing is impaired in the right ear, and she experiences a sensation of "pressure" in the same ear. Cochlear blockage of medically unknown origin seems to be responsible for her condition. It should be noted that the patient suffers from a hypothyroid condition which has been identified as a possible causative factor (Victorian Deaf Society, 1991, p.2). This patient may, however, have had a predisposition to this type of disorder, since she has always suffered from occasional bouts of motion sickness.

All signs and symptoms indicate that the patient is suffering from Meniére's Disease. "...I am sure she does have the usual convincing features of Meniére's Syndrome..." (Corlette, 1993).

Audiometry performed on 24/3/89 indicated that the hearing in the right ear was significantly below normal in the low to mid range.

At 250 Hertz - 50 decibels.
At 500 Hertz - 30 decibels.
At 1,000 Hertz - 10 decibels.
At 2,000 Hertz - 10 decibels.
At 4,000 Hertz - 2 decibels.
At 8,000 Hertz - 10 decibels.

Audiometry performed on 8/4/92 showed a further decline in ranges of hearing in the right ear.

At 250 Hertz - 55 decibels.
At 500 Hertz - 55 decibels.
At 1,000 Hertz - 25 decibels.
At 2,000 Hertz - 20 decibels.
At 4,000 Hertz - 20 decibels.

Traditional Chinese medical examination revealed the following: Presenting symptoms as shown above.

No chills or fevers, but feels the cold easily.

Perspiration currently normal. Had excessive perspiration from both armpits at approximately 15 years of age.

Appetite is normal. The patient doesn't drink very much, only drinking when she remembers to, not due to thirst. She has no abnormal tastes in the mouth.

No pain.

Normal stools and urine.

Feels tired on waking, has difficulty waking up. Often feels like sleeping in the daytime.

Two healthy pregnancies despite a history of P.I.D. Births were in 1985 and 1986, both boys.
Periods are regular, "like clockwork", every 28 days.
Duration of menstruation is 3-4 days.
Periods alternate - one period is light with pain two days before onset and the first two days of the period. The other is normal flow with no pain. Colour of flow is normal in both cases.

Body build is endomorphic. That is to say Angela has a tendency towards having a heavy build and she puts on fat easily. Her face colour is a normal healthy pink.

Deep, slippery and slightly slow pulse.

Tongue is slightly swollen, the body is a normal colour. There is a thin greasy yellow coating in the middle and at the rear.

The patient shows surprisingly few signs other than the main symptoms of tinnitus, vertigo, nausea and hearing loss.

The patient feels the cold easily and has a deficient thirst which may indicate a Cold condition. She is also tired on waking and finds it difficult to wake up which may show that her condition is Empty. Deficient thirst and being overweight can also be indicators of Middle Heater Dampness, as can nausea, a slippery pulse and a greasy tongue coating. These factors tend to indicate an underlying Qi and Yang deficiency condition, which may relate to the years of thyroid deficiency. The control of this condition by Thyroxine may explain why she has so few other symptoms.

The onset of the current disease state may possibly have been a "Pathogenic Factor Remaining" after a bad attack of the flu (Wind-Heat or Wind-Cold turning to Heat) combined with her predisposition to Phlegm.

The Yang deficiency is also significant, in that the symptoms of the ear indicate an obstruction of the regional channels and collaterals. As Yang Qi is responsible for movement, or "transportation", any local obstruction will be adversely affected by a deficiency of the Yang function of movement.

The diagnosis in this case is Phlegm and Dampness in the Middle Heater causing local obstruction of the channels and collaterals of the ear.

Treatment principle is to resolve Phlegm and Damp of the Middle Heater, tonify Spleen Yang and clear the channels and collaterals of the ear.

Point formula selected as follows.

ST 36, ST 40, PC 6 (all bilateral).
TH 17, SI 19, GB 20, An Mian (all right side only).
All needles to be manipulated with tonifying technique.

ST 36 tonifies Spleen Yang and eliminates Dampness.

ST 40 is to resolve Phlegm and Dampness. This point is indicated for all types of Phlegm, including Phlegm which is said to "mist the mind" or cause dizziness of the head (Maciocia, 1989, p.390).

PC 6 "... is a major point to affect the Stomach ... it subdues rebellious Stomach-Qi and is the point of choice to treat nausea ..." (Maciocia, 1989, p.436).

TH 17, SI 19, GB 20 and "An Mian" - are all to be used on the right side, as local points to move the Qi of the channels and collaterals in the affected inner ear.

The variables to be measured over the ABAB are the incidence of vertigo, nausea and tinnitus, to be measured in the number of waking hours each symptom is experienced daily.

The patient is supplied with blank charts to fill in each day. She is asked to record how many waking hours per day she experiences the symptoms of tinnitus, vertigo and nausea respectively. That is to say, Angela is instructed to estimate how many hours a day each symptom causes some level of distress or debility.
In addition to these measurements, audiometry tests are studied from before treatment and after the final course of treatment.

For a full record of the measured incidence of symptoms during the five periods measured, ABABA, see the table in Appendix A and the chart in Appendix B.

A post treatment hearing test was performed on 1/7/93.

At 500 Hertz - -5 decibels.
At 1,000 Hertz - 0 decibels.
At 2,000 Hertz - 0 decibels.
At 4,000 Hertz - -5 decibels.

A further hearing test was performed on 21/9/93 which also indicated near normal hearing three months after the course of therapy.

Conclusions

Meniére's Disease is, quite literally, an obstruction of the inner ear. From this point of view, acupuncture is theoretically an ideal modality. It is concerned to a large degree with the movement of Qi, in that the insertion of acupuncture needles is essentially the manipulation of energy in the channels and collaterals. "The meridians, channels, or jing-luo of TCM are the main channels of communication and energy distribution in the body" (Legge, 1990, p.6). Acupuncture treatment is an ideal approach for a problem such as Meniére's Disease.

On examination of the data from this single case experiment, there are positive indications that acupuncture treatment was effective in treating this patient's Meniére's Disease. The data, as shown by the table and chart of symptomatic changes in Appendix 1 and 2, clearly shows a reduction in symptoms within a short time of commencing treatment. The condition continued to improve until the withdrawal period, when the patient's symptoms began to return. The frequency of the patient's indications continued to increase over the first two week withdrawal phase. When treatment was re-introduced, the patient's symptoms reduced dramatically until the last five days of this phase when the tinnitus, vertigo and nausea had disappeared completely.

Acupuncture treatment seems to have produced a significant reduction in the patient's symptoms. This is supported by the results of her hearing tests. Before acupuncture treatment she had notably reduced hearing levels. After therapy however, her hearing had returned to near normal. In fact the right ear now showed better audiometry readings than the previously unaffected left ear.

Although results indicate that acupuncture was successful in reducing the patient's symptoms of Meniére's Disease, it must be remembered that it is only relevant for this one case. The findings of experiments of this design (N = 1) may not be extrapolated to other cases of Meniére's Disease, although the data is encouraging.

In relation to further research, the findings of this project indicate that acupuncture is worthwhile considering as an effective means for treating disorders such as Meniére's Disease. A controlled study should provide significant data.

It may also be of value to perform research into other common aural disorders such as Otitis Media and "Glue Ear" to determine whether acupuncture may be an effective form of therapy for them.

APPENDIX 1 - Table of Symptoms

Date Tinnitus* Vertigo* Nausea* Date Tinnitus* Vertigo* Nausea*
26/4/93 16 13 13 31/5/93 0 7 7
27/4/93 16 15 15 1/6/93 2 8 8
28/4/93 16 15 15 2/6/93 2 4 4
29/4/93 16 14 14 3/6/93 1 8 8
30/4/93 16 15 14 4/6/93 1 7 5
1/5/93 16 16 16 5/6/93 8 10 10
2/5/93 16 16 16 6/6/93 14 14 14
3/5/93 16 14 14 7/6/93 6 8 8
4/5/93 16 12 12 8/6/93 0 3 3
5/5/93 16 16 15 9/6/93 0 5 5
6/5/93 16 16 16 10/6/93 0 2 0
7/5/93 16 14 14 11/6/93 5 4 1
8/5/93 16 14 13 12/6/93 3 2 0
9/5/93 16 14 13 13/6/93 4 6 0
10/5/93 16 15 15 14/6/93 6 6 0
11/5/93 16 14 14 15/6/93 5 2 0
12/5/93 2 11 10 16/6/93 6 0 0
13/5/93 0 14 14 17/6/93 0 0 0
14/5/93 4 10 10 18/6/93 0 0 0
15/5/93 4 10 10 19/6/93 0 0 0
16/5/93 6 12 12 20/6/93 0 0 0
17/5/93 6 10 9 21/6/93 0 0 0
18/5/93 2 6 6 22/6/93 0 0 0
19/5/93 0 6 4 23/6/93 0 0 0
20/5/93 0 4 4 24/6/93 0 0 0
21/5/93 0 5 5 25/6/93 0 0 0
22/5/93 0 3 0 26/6/93 4 0 0
23/5/93 0 4 3 27/6/93 4 0 0
24/5/93 1 4 4 28/6/93 3 0 0
25/5/93 1 2 2 29/6/93 1 0 0
26/5/93 0 6 6 30/6/93 0 0 0
27/5/93 2 4 4 1/7/93 0 0 0
28/5/93 2 6 6 2/7/93 0 0 0
29/5/93 3 8 8 3/7/93 0 0 0
30/5/93 1 6 6 4/7/93 0 0 0
* = number of waking hours this symptom is significantly experienced.
Un-bolded text areas are periods A1, A2 and A3.
Bold text areas are periods B1 and B2.

BIBLIOGRAPHY


Keith Chell B.App.Sc. (Acupuncture), Cert.Adv.Ac. (Guangzhou)
Goulburn Acupuncture
19 Beppo Street
Goulburn, NSW 2580
Telephone/Fax: (048) 223 223
e-mail:
juke@goulburn.net.au

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