Acupuncture for the Treatment of Tinnitus
Tinnitus, the perception of noise or ringing in the ears, is a prevalent problem in the United States, affecting approximately 45 million Americans each year.1,2 Though tinnitus is not considered a disease on its own, it is a significant symptom stemming from some kind of underlying condition.3 Root causes of tinnitus range from age-related hearing loss to ear injury or circulatory disorder.1 Further, tinnitus can appear in those with structural lesions or those with conditions such as Meniere’s disease and multiple sclerosis.3 Pulsatile and non-pulsatile tinnitus are two ways to classify the problem, though many subtypes are frequently identified in the literature (somatic, neurological, objective, subjective). Pulsatile tinnitus involves the sensation of a rhythmic sound that resembles a heartbeat, swooshing or whooshing not externally sourced.4,5 This form of tinnitus is often caused by sounds such as personal pulse, vascular problems or changes in the ear canal.5 By comparison, non-pulsatile tinnitus is attributed to problems with the nerves involved with hearing and may be experienced in one or both ears.5 This form of tinnitus is oftentimes described as originating inside the head.5
Determining the cause of tinnitus, regardless of type, is of key importance in the terms of treatment. Clearly, if the underlying problem can be addressed and rectified or improved, the associated symptoms may be alleviated or improved as well. However, finding effective treatments for tinnitus have been challenging to date.3
Acupuncture, originating in ancient China, has been used for thousands of years to treat a variety of conditions. Due to its efficacious outcomes in treating multiple maladies, it seems appropriate to examine its usefulness when applied to those suffering from tinnitus. Research surrounding this topic is abundant, yet simultaneously inconsistent with many studies demonstrating efficacy and some presenting its lack of usefulness.
In a review of 40 research studies, the efficacy of acupuncture as a treatment for tinnitus was examined.6 Eight different types of acupuncture were analyzed, some of which were tested in conjunction with additional interventions such as supplementary medicine.6 A total of 3657 subjects were included across the 40 studies.6 Researchers concluded that all eight methods of acupuncture were effective in the treatment of neurological tinnitus (tinnitus caused by disease such as Meniere's disease).6
Similarly, a 2019 study was performed to determine the usefulness of acupuncture as a treatment choice for patients suffering from tinnitus.7 One hundred seven tinnitus patients were examined over the course of 17-24 acupuncture treatments.7 Researchers concluded that patients experienced improvement in their tinnitus condition following the course of treatment.7
A clinical observation study was performed to determine the difference in outcome between acupuncture combined with the intake of an herbal formula compared with the intake of the same herbal formula alone.8 Sixty patients were randomized into two groups - a combined therapy group and an herbal formula only group and treatment was administered according to a specific regimen for a total of six weeks.8 Tinnitus severity score and tinnitus handicap inventory were used to determine clinical effects of the treatments over the course of the study.8 Results showed an efficacy rate of 93.3% in the combined therapy group when compared to the 67.9% efficacy rate in the herbal formula only group.8 Researchers concluded that acupuncture used in conjunction with an herbal formula provided improvement for tinnitus patients.8
A randomized clinical trial of 50 participants tested the effectiveness of acupuncture on tinnitus when compared to no treatment.9 Subjects were divided into equal groups and were evaluated for five weeks.9 Results showed a statistically significant effect between groups, leading researchers to conclude the efficacy of acupuncture to reduce tinnitus intensity and improve the quality of life of the tinnitus patients.9
In a systematic review of literature, tinnitus and the effect of acupuncture as a treatment modality was studied.10 Six randomized controlled studies were examined and results showed positive effect in two unblinded studies and no significant effect in four blinded studies.10 Researchers concluded: “The belief that acupuncture is a specifically effective treatment for chronic tinnitus is not based on the evidence of rigorous randomized controlled trials. Further research on this subject seems to be warranted but should be conducted according to the highest methodological standards.”10
An additional study demonstrated the ineffective nature of acupuncture on tinnitus patients.11 The randomized, single-blind, placebo-controlled study followed 50 patients suffering from the condition and divided participants into a manual acupuncture group, an electrical acupuncture group and a placebo group.11 Researchers studied frequency of tinnitus, tinnitus intensity, and reduction of life quality among patients over the course of the study.11 Patients were evaluated before treatment, following six sessions of treatment and one month following the completion of treatment.11 Results demonstrated no statistically significant effect of either form of acupuncture.11 Despite the lack of statistically significant improvements, researchers noted relative advantages of electrical acupuncture when compared to the other two groups.11
From the preponderance of the evidence, it appears that acupuncture holds a distinct amount of possibility in terms of an effective treatment modality for those suffering from tinnitus. There are several factors to acknowledge in regard to the studies reviewed, including small sample sizes and relatively brief treatment periods. However, it is important to note that though the evidence for the efficacy of acupuncture as a treatment option is perhaps not overwhelming, it does not include extensive risk. Therefore, it likely would be wise to consider acupuncture as a treatment option for those suffering from tinnitus, particularly if other therapies have not yielded results or have created negative side effects.
1.Mayo Clinic. Tinnitus. Available at: https://www.mayoclinic.org/diseases-conditions/tinnitus/symptoms-causes/syc-20350156. Accessibility verified November 24, 2019.
2.American Tinnitus Association. Understanding the Facts: Demographics. Available at: https://www.ata.org/understanding-facts/demographics. Accessibility verified November 24, 2019.
3.Naderinabi B, Soltanipour S, Nemati S, Saberi A, Parastesh S. Acupuncture for chronic nonpulsatile tinnitus: A randomized clinical trial. Caspian J Intern Med. 2018;9(1):38–45. doi:10.22088/cjim.9.1.38
4.Department of Radiology and Biomedical Imaging. Pulsatile Tinnitus Clinic. Available at: https://radiology.ucsf.edu/pulsatile-tinnitus. Accessibility verified November 24, 2019.
5.My Health Alberta. Ringing in the ears (tinnitus). Available at: https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=tinit. Accessibility verified November 24, 2019.
6. Pang P, Shi Y, Xu H, et al. Acupuncture methods put to the test for a tinnitus study: A Bayesian analysis. Complementary Therapies in Medicine. 2019; 42:205-213.
7. Lin TY, Yang SW, Lee YS, et al. Analysis of Factors Influencing the Efficiency of Acupuncture in Tinnitus Patients. Evid Based Complement Alternat Med. 2019;2019:1318639. Published 2019 May 26. doi:10.1155/2019/1318639.
8. Chen S, Tan X, Fei L, Xiang X. Clinical observation on idiopathic tinnitus treated with acupuncture, buzhong yiqi tang and cizhu wan. Zhongguo Zhen Jiu. 2018;38(4):369-73. doi: 10.13703/j.0255-2930.2018.04.007.
9. Doi MY, Tano SS, Schultz AR, Borges R, Marchiori LL. Effectiveness of acupuncture therapy as treatment for tinnitus: a randomized controlled trial. Braz J Otorhinolaryngol. 2016;82(4):458-65. doi: 10.1016/j.bjorl.2016.04.002.
10. Park J, White AR, Ernst E. Efficacy of Acupuncture as a Treatment for Tinnitus: A Systematic Review. Arch Otolaryngol Head Neck Surg. 2000;126(4):489–492. doi:https://doi.org/10.1001/archotol.126.4.489.
11.Wang K, Bugge J, Bugge S. A randomised, placebo-controlled trial of manual and electrical acupuncture for the treatment of tinnitus. Complement Ther Med. 2010;18(6):249-55. doi: 10.1016/j.ctim.2010.09.005.
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