Evaluating foot reflexology as a proposed treatment for sensorineural hearing loss: A critical review

Abstract

This editorial critically evaluates the application of foot reflexology as a treatment for sensorineural hearing loss (SNHL) in infants, as proposed in a case report published in the World of Clinical Cases. SNHL is a condition characterized by damage to the cochlea or the neural pathways that transmit auditory information to the brain. The etiology of SNHL is often complex, involving genetic mutations, prenatal factors, or perinatal insults. Reflexology, an alternative therapy involving the application of pressure to specific points on the feet, is based on the hypothesis that these points correspond to different organs and systems in the body, including the auditory system. However, the biological plausibility and clinical efficacy of foot reflexology in addressing SNHL lack empirical support. This editorial examines the pathophysiology of SNHL, assesses the clinical claims of reflexology practitioners, and emphasizes the necessity of evidence-based approaches in treating infant hearing loss. While complementary therapies may provide ancillary benefits, they should not supplant validated medical treatments in managing SNHL in infants. Further research is needed to evaluate the safety and efficacy of foot reflexology and other alternative therapies in pediatric audiology.

Key Words: Sensorineural hearing loss; Reflexology; Congenital hearing loss; Alternative medicine; Audiology

Core Tip: Untreated sensorineural hearing loss (SNHL) in infants can lead to significant language delays, social-emotional difficulties, and academic challenges. While conventional treatments exist, alternative approaches like foot reflexology are gaining attention despite limited scientific evidence. Some claim that stimulating certain foot areas can influence hearing, but these claims lack support from the scientific community. While some patients may report benefits, these could be attributed to the placebo effect rather than the treatment itself. The medical community should remain cautious, emphasizing the need for rigorous research before considering reflexology as a viable option for treating SNHL in infants.

INTRODUCTION

Sensorineural hearing loss (SNHL) is a usually permanent hearing impairment that is caused by damage to the inner ear structures or auditory nerve pathways from the inner ear to the brain[1-3]. According to the Centers for Disease Control and Prevention, the prevalence of hearing loss in the United States was 1.8 per 1000 babies screened in 2020. SNHL in infants can arise from a variety of genetic and environmental factors. Genetic causes are responsible for more than 50% of cases, with mutations in GJB2, SLC26A4, and MT-RNR1 being among the most common genetic contributors[4]. Environmental factors, including prenatal infections, ototoxic medications, and complications during birth, can also play a significant role in the development of SNHL[5].

The impact of untreated SNHL on a child's development is profound. Research has shown that children with undiagnosed or late-diagnosed hearing loss are at a higher risk of language delays, social-emotional difficulties, and academic challenges compared to their peers with normal hearing[6]. Early identification of SNHL has been greatly improved by the widespread implementation of newborn hearing screening programs, which have become a standard practice in many countries. These programs have enabled healthcare providers to detect hearing loss soon after birth, allowing for timely intervention strategies, including hearing aids, cochlear implants, and early auditory-verbal therapy[7]. Such advancements have provided new opportunities for early diagnosis and personalized treatment approaches for infants with SNHL[7].

Amidst conventional treatments and therapies, alternative approaches such as foot reflexology are gaining attention for anecdotal evidence that points to potential benefits for a variety of health conditions[8]. The practice of foot reflexology dates to ancient civilizations, where similar practices were believed to be employed in ancient Egypt, China, and India[2]. The modern practice of reflexology was influenced by William H. Fitzgerald and Eunice D. Ingham in the early 20^th century[2]. Fitzgerald was an American physician who developed the concept of “zone therapy”, which proposed that the body could be divided into ten vertical zones, each corresponding to different parts of the body[2]. By applying pressure to specific points within these zones, he believed that it could relieve pain and improve health[2]. Ingham, expanded on Fitzgerald’s work focusing primarily on the feet and laid the foundation for the reflexology charts used today[2]. In this editorial, we delve into the concept of foot reflexology and its possible effects on infants with SNHL.

PLAUSIBILITY OF FOOT REFLEXOLOGY AS A TREATMENT FOR INFANTILE SNHL

SNHL results from damage to the inner ear or the nerve pathways from the inner ear to the brain. It is commonly caused by aging, exposure to loud noise, or genetic factors, and unfortunately, there are limited treatment options. While hearing aids and cochlear implants provide some aid, they do not restore normal hearing. Foot reflexology is a practice rooted in the belief that different points on the feet correspond to specific organs, glands, and body systems[9]. By applying pressure to these reflex points, practitioners aim to stimulate the body’s natural healing processes and restore balance. Proponents argue that stimulating these points can promote healing and improve function. Reflexologists claim that certain areas on the feet are connected to the ears and auditory pathways, suggesting that manipulating these areas could potentially influence hearing and serve as a feasible treatment modality for infants with SNHL. However, the existing literature has not yielded strong enough evidence to convince the scientific community of its efficacy[10].

Medicine is a field grounded in evidence-based science that guides clinical practice. Therefore, the notion that foot reflexology, a practice rooted in alternative medicine, could have a significant impact on SNHL naturally invites skepticism. The physiological mechanisms proposed by reflexology do not align with our current understanding of neuroanatomy and neurophysiology. There is no direct anatomical pathway from the feet to the auditory system that would suggest a straightforward mechanism for reflexology to improve hearing. However, it is paramount that the medical community remain open to exploring all avenues that may facilitate improved outcomes, particularly when conventional treatments have limited success. It is also important to consider the broader context of patient care, and some cultures hold that reflexology can improve their symptoms. Additionally, the placebo effect is a powerful phenomenon, and patients who believe in the efficacy of a treatment may experience real improvements in their symptoms indirectly benefiting overall health and well-being[11].

CLINICAL IMPLICATIONS

While reflexology is often proposed to elicit health benefits in adults, infants may respond differently to tactile stimulation due to the distinct physiological and developmental characteristics of their sensory systems. Moreover, the literature lacks robust evidence supporting the efficacy of foot reflexology in treating SNHL in infants. In recent years, advancements in genetic research and audiological technologies have provided new opportunities for early diagnosis and personalized treatment approaches for infants with SNHL[12]. Recommending foot reflexology as the sole treatment for infants with SNHL may delay access to evidence-based treatments, compromising the child’s developmental trajectory and quality of life.

CONCLUSION

While the idea of using foot reflexology to support infants with SNHL is intriguing, further research is essential to validate its effectiveness. Most existing research on reflexology is limited by small sample sizes, lack of control groups, and methodological weaknesses[10]. High-quality randomized controlled trials are essential to determine whether any observed benefits are due to the treatment itself or other factors such as the placebo effect or improved patient morale. Parents and healthcare providers should approach alternative therapies like foot reflexology with caution.