I've been using a Chihiros doctor nano -unconventionally- for several months. I have several small heavily planted tanks - too many to invest in one unit per tank so thought I would experiment.
I started using it as a couple of my Betta's developed fin rot despite all my w/c efforts, so I thought I'd give it a try.
The fish definitely seem to have a tolerance level which oddly varies from fish to fish. At first they seem to enjoy it even actively seeking out the bubbles, but at a certain point they start acting a bit stressed. I have learned to use it appropriately to prevent them getting stressed.
All I can say is that after using it I see rapid fin repair. Before, even with ocd cleaning/filter cleaning & w/c, the fish would sometimes get fin deterioration and rot. Not any more.
I use the device for a short while ( less than an hour) in any tank I feel needs it. One of my fish can only tolerate 20 mins of it before getting anxious. My tanks are too small for even nano size recommendations, so there is no way I would use it non stop in any of them.
I don't use it everyday - usually less than an hour for 3 days in a row if a fish has a raggy fin - otherwise once week - works well for my needs.
One of the things I notice is a very fast clarity to the water during use - it does seem to make it noticeably sparkle and the water looks really good for a good few days after.
Algae - I don't get anything other than brown diatom outbreaks and sometimes a little green algae on the glass. I had a minor outbreak of cyno on some moss some weeks ago. I tried it on this - it seemed to help, but I really can't be sure as I also manually removed the stuff from my tank. It never came back though - so maybe it did help.
I put it in a jug of conditioned water and blast it in that a few turns, before it goes into another tank. One thing that puzzles me is that I gave the water in the jug a sniff and it smelt strongly of hydrogen peroxide or maybe chlorine??? - despite being dechlorinated. Not sure what that's about?! Any ideas?
I'd not advise anyone to use it as I do, without very careful observation of their fish. For fighters it seems to be a fine line - I do think if it was left in too long it would be detrimental to the fish and some other types of fish might react badly, I don't know. I'm breaking manufacturers instructions here, but in my defense, I was desperate.
So far it has been around 6 months of this intermittent use and my fish look happy/healthy. If I even think a fin rot episode might break out, or a fish seems below par, I use it preventatively. I feel it helped me get on top of an issue that was very troubling and for me it's a relief to not be subjecting my fish to medications and risking upsetting the bio balance of my tanks in the process.
The only pain is the scale build up. It would do my head in if it was in full time operation in my tanks.
I have a spare diffuser on standby - and I probably get more use out of the diffuser anyway, than if I was using it conventionally.