[Introduction]The patulous eustachian tube is an intractable disorder for rational symptoms such as a blocked ear, hearing breath sounds and autophony. Most of the causes are unclear. Therefore, we report a rare case of acupuncture on the patulous eustachian tube.
[Case]K. X., 43years old, male, Occupation:staff of an association.
Chief Complaint:Auto phony. Self breath sound listening.
Clinical history:In Oct 20xx, he was aware of suddenly hearing breath sounds and autophony.
The same year Oct, the "Y"Otolaryngology Clinic diagnosed it as normal hearing ability and patulous eustachian tube. It was not improved by pharmacotherapy.
In the same month, an otoscope examination was taken at the "Z"Medical College of Otolaryngology and it was diagnosed as a patulous eustachian tube again. Acupuncture treatment was started from Dec. of the same year.
Present illness:Weber test (-), hearing ability (normal), hypertonus of splenius capitis muscle
[Acupuncture treatment]Selection of acupoints was considered where the patient said "symptoms decreased with mandibular exercise". Therefore, the trigeminal nerve regional acupoints that influence the masseter and posterior region of the neck were chosen.
[Progress]In total, 25 acupuncture treatments were performed once a week from the onset.
The patulous eustachian tube symptoms were evaluated by Numerical Rating Scale (NRS) from the first treatment.
Barometric change and psychological stress exacerbated symptoms repeatedly, but the NRS of symptoms was relieved to about 50%by acupuncture at the first hospital visit.
[Discussion and conclusions]It was suggested that the symptoms of patulous eustachian tube were relieved by stimulation of acupoints on the splenius capitis muscle and trigeminal nerve region.

Objective : To determine the effectiveness of acupuncture therapy on hiesho in maturate stage females.
Design : Multicenter, randomized, prospective, open blind, waiting list-controlled trial.
Setting : A clinical center attached to three universities and one vocational school.
Participants : Twenty two females between 18-39 years of age and with a level of more than four points on the “hiesho sensation scale” proposed by Kusumi et al for hiesho. Interventions : Participants were randomly assigned to receive therapies of either acupuncture or no therapy (waiting list controls). Acupuncture therapy was provided by needle retention to SP 6 and electro-acupuncture therapy to BL 32 at a frequency of 1 Hz for 20 minutes. One session per week of this therapy was provided for a total of four sessions. Method of Measurement : The primary outcome of change in hiesho intensity was measured using the visual analogue scale (VAS). Secondary changes were measured by an eight heading score and three component summaries of the standard edition SF-36 v 2.
Results : The statistical analyses used an intent-to-treat analysis that included two participants who dropped out, and the mixture of one participant targeted for exclusion who was censored from the analyses. As a result, 21 participants were classified as either in the acupuncture group (n = 12) or the control group (n = 9). Efficacy with acupuncture therapy was not found for effect size (Cohen d, point-biserial correlation r) for VAS and the scores of SF-36 between the two groups.
Conclusions : Effectiveness of the acupuncture therapy was not found, which suggests that it may be due to the smaller sample size, frequency of intervention, and symptoms associated with autonomic dysfunction.

[Objective] We report a case in which we unexpectedly encountered a patient with a transient ischemic attack (TIA) caused by severe stenosis of the left middle cerebral artery (MCA) during the course of acupuncture treatment.Patient: A 79-year-old man suffered from bilateral shoulder pain. He was diagnosed with a frozen shoulder at the orthopedic department and was referred to the acupuncture department.[Results] During the course of acupuncture treatment, the subject occasionally exhibited subtle behavioral features, such as difficulty in speech, holding incoherent conversations, and forgetting where he put things. The symptoms were observed repeatedly during treatment, so the acupuncturist referred the patient to the neurosurgical department for a consultation. Magnetic resonance imaging (MRI) of the brain showed an old cerebral infarction in the watershed area in the left paraventricular region, and MR angiography (MRA) revealed left middle cerebral artery stenosis. Single photon emission computed tomography showed decreased blood flow in the left MCA area. The symptoms could be considered TIA with motor and sensory aphasia. The administration of aspirin was started, and the symptoms disappeared.[Discussion and Conclusion] The acupuncturist has more opportunities to obtain information about the patient due to the longer time spent in acupuncture therapy compared to general outpatient treatment. Acupuncture can play an important role in medical partnership. It is also important that the acupuncturist has sufficient medical knowledge.

  We report here on the current situation, regulations by law, and education of spa therapy and massage in France, as determined through a survey study on massage conducted by our university in France between March 19 and 28, 2012. Spa therapy is one of France natural therapies and means‘health through water’in Latin. It includes balneotherapy (le thermalisme) using thermal spring water, thalassotherapy (la thalassothérapie) using sea water, and hydrotherapy (la balnéothérapie) using water. At present in France, there are 105 balneotherapy centers (Thermés) at 89 sites with thermal spring water, located mainly in mountainous regions. National medical insurance can be used for 18-day balneotherapy treatment of 12 symptoms, provided as a 3-week stay (excluding Sundays) in sites with thermal spring water. Thalassotherapy, on the other hand, is currently regarded as a form of relaxation. Balneotherapy and thalassotherapy both include bathing with jets, showers (douche), exercise in the pool, mud therapy (mud pack and wrapping), and massage among other treatments, but there are differences between the two: balneotherapy uses thermal spring water while thalassotherapy uses sea water; the aim of balneotherapy is to treat or prevent disease while that of thalassotherapy is to promote well-being (relaxation); subjects for balneotherapy are patients, whereas those for thalassotherapy are generally healthy people.   The term‘massage’in France refers only to massage provided in medical practice, by massage therapists (masseur-kinesithérapeute) who hold a national massage therapy license. The treatment they provide is covered by national medical insurance. They work in hospitals, clinics, rehabilitation centers, and balneotherapy centers and can run their own massage clinics. In contrast, the term‘relaxation massage’(praticien bien-être), which refers to massage for well-being and is never called “massage” in order to distinguish it from medical massage, is not regulated by law. There is a self-regulatory body, that issues licenses for aestheticians, Certificat d’Aptitude Professionnelle (CAP). Their practice is known as modelage. The balneotherapy centers we visited employed licensed masseur-kinesithérapeutes, hydrotherapists who received 600 hours of training, and assistants with no licenses. The thalassotherapy centers mainly employed estheticians with CAP.