Acupuncture for Tinnitus

Timothy C. Hain, MD. Tinnitus Page Page last modified: October 9, 2011

Other links:

• Chicago Dizziness and Hearing Acupucture for Tinnitus
• Acupuncture for migraine
• Acupuncture for motion sickness

Acupuncture has been studied for treatment of tinnitus, and traditional chinese medicine has been used to treat it as early as 18th century BC (Yap et al, 2009).  Acupuncture is commonly used in treatment of many conditions, but for the majority of the indications no proof is available in the sense of medical studies of acceptable scientific level (Hakimi, 2009).

It seems somewhat reasonable that sensory stimulation of the head or neck could modulate tinnitus, as there is good evidence that tinnitus can often be modulated by somatosensory input (Levine et al, 2007). For example, many persons with tinnitus find that it increases after clenching their jaw. Many persons with TMJ dysfunction indicate that they also have tinnitus. It seems reasonable that acupuncture, which is generally accepted to be helpful in reducing pain, might temporarily affect tinnitus that is modulated by muscle tension.

Treatment trials from Pubmed.

• Hansen et al (1982) found no difference between traditional Chinese acupuncture and placebo, and also noted no correlation between tinnitus matching and patient subjective assessments of their tinnitus intensity.
• Marks et al (1984) reported no significant differences between placebo and acupuncture treatment.
• Thomas et al (1988) reported transient improvements in 6 of 12 patients treated at acupucture points recommended in TCM for tinnitus.
• Podoshin et al (1991) reported that biofeedback was superior to acupuncture, which in turn was superior to medication (cinnarizine) in alleviation to tinnitus.
• Axelsson et al (1994) reported that acupuncture was preferred due to effects on improved sleep, decreased muscle tension and improved blood circulation, but there was no effect on tinnitus annoyance or loudness.
• Furugard et al (1998) suggested that tinnitus was worth trying in severe tinnitus.
• Nielson et al (1999) found no statistically significant differences between the acupuncture group and the placebo group.
• Park et al (2000) examined 6 randomized controlled trials available in 2000. Two unblinded studies showed a positive result, whereas 4 blinded studies showed no significant effect of acupuncture. They concluded that acupuncture has not been demonstrated to be efficacious as a treatment for tinnitus on the evidence of rigorous randomized controlled trials.
• Okada et al (2006) reported a "significant reduction" between pre and post needling in a double-blinded study accomplished in Brazil.
• Tan et al (2007) reported a 73.3% response rate in acupuncture at cervical Jiaji (EX-N 2), 20 minutes per session, once a day, for 10 sessions.
• Wang et al (2010) reported that the frequency of tinnitus occurrence and the tinnitus loudness were significantly decreased after-treatment compared with baseline in the EA group (P<0.009). However, no significant differences were detected from placebo.

Conclusion:

Controlled studies have generally shown no significant effect of acupuncture, by itself, on idiopathic tinnitus.  Studies that break out response to tinnitus into subcategories such as tinnitus that modulates with muscle tension, tinnitus due to TMJ disturbances, tinnitus of different frequencies and other etiologies than simply idiopathic, are entirely lacking.  It seems likely to us that as is the case in other physical treatment disciplines, results could depend strongly on the individual delivering the treatment.  Even if acupuncture is a placebo, placebo relief is still relief.

References:

• Axelsson, A., S. Andersson, et al. (1994). "Acupuncture in the management of tinnitus: a placebo-controlled study." Audiology 33(6): 351-360.
• Furugard, S., P. J. Hedin, et al. (1998). "[Acupuncture worth trying in severe tinnitus]." Lakartidningen 95(17): 1922-1928.
• Hakimi, R. (2009). "[Acupuncture--propagated indications beyond pain-relief therapy]." Versicherungsmedizin 61(1): 19-24.
• Hansen, P. E., J. H. Hansen, et al. (1982). "Acupuncture treatment of chronic unilateral tinnitus--a double-blind cross-over trial." Clin Otolaryngol Allied Sci 7(5): 325-329.
• Levine, R. A., E. C. Nam, et al. (2007). "Evidence for a tinnitus subgroup responsive to somatosensory based treatment modalities." Prog Brain Res 166: 195-207.
• Marks, N. J., P. Emery, et al. (1984). "A controlled trial of acupuncture in tinnitus." J Laryngol Otol 98(11): 1103-1109.
• Nielsen, O. J., K. Moller, et al. (1999). "[The effect of traditional Chinese acupuncture on severe tinnitus. A double-blind, placebo-controlled clinical study with an open therapeutic surveillance]." Ugeskr Laeger 161(4): 424-429.
• Okada, D. M., E. T. Onishi, et al. (2006). "Acupuncture for tinnitus immediate relief." Braz J Otorhinolaryngol 72(2): 182-186.
• Park, J., A. R. White, et al. (2000). "Efficacy of acupuncture as a treatment for tinnitus: a systematic review." Arch Otolaryngol Head Neck Surg 126(4): 489-492.
• Podoshin, L., Y. Ben-David, et al. (1991). "Idiopathic subjective tinnitus treated by biofeedback, acupuncture and drug therapy." Ear Nose Throat J 70(5): 284-289.
• Tan, K. Q., C. Zhang, et al. (2007). "[Comparative study on therapeutic effects of acupuncture, Chinese herbs and Western medicine on nervous tinnitus]." Zhongguo Zhen Jiu 27(4): 249-251.
• Thomas, M., G. Laurell, et al. (1988). "Acupuncture for the alleviation of tinnitus." Laryngoscope 98(6 Pt 1): 664-667.
• Yap, L., V. B. Pothula, et al. (2009). "The root and development of otorhinolaryngology in traditional Chinese medicine." Eur Arch Otorhinolaryngol 266(9): 1353-1359.
• Wang, K., J. Bugge, et al. (2010). "A randomised, placebo-controlled trial of manual and electrical acupuncture for the treatment of tinnitus." Complement Ther Med 18(6): 249-255.