Acupuncture provides tinnitus relief. Luoding City Hospital of Traditional Chinese Medicine (Guangdong, China) researchers determined that acupuncture combined with the herbal formula Liu Wei Di Huang Wan relieves symptoms and improves quality of life for tinnitus sufferers. The study compared acupuncture and herbs with hyperbaric oxygen treatment. Acupuncture plus herbs produced a 77.5% effective rate compared with 50% in the hyperbaric oxygen control group. [1] Study outcome measures included symptom severity, duration, and the impact of tinnitus on sleep, mood, and attention.

A total of 80 patients with tinnitus and a TCM (Traditional Chinese Medicine) diagnosis of liver and kidney yin deficiency were recruited for the study and were randomly assigned to receive either acupuncture and herbs or hyperbaric oxygen treatment. The acupuncture group was comprised of 23 male and 17 female patients, ages 45–67 years (mean age 54.3 years), with a disease duration of 1–12 years (mean duration 3.8 years). The control group was comprised of 24 male and 16 female patients, ages 46–70 years (mean age 55.4 years), with a disease duration of 2–13 years (mean duration 4.1 years). There were no statistically significant differences in baseline characteristics between the two groups at the initiation of the investigation (p>0.05).

Biomedical diagnostic criteria included tinnitus or hearing loss without obvious pathological changes to the tympanic membrane or external auditory canal and a reduced sense of hearing. TCM diagnostic criteria included: a TCM diagnosis of liver and kidney yin deficiency, tinnitus which is present day and night with a worsening of symptoms during the night, heat in the five palms, headaches, dizziness, dream-disturbed sleep, pain and weakness of the knees and lumbar region, night sweats, dryness of the mouth and throat, nocturia, red tongue body with sparse coating, and a fine-wiry pulse.

Further inclusion criteria were a disease duration of >12 months, the ability to communicate clearly, and informed consent. Exclusion criteria were concurrent cardiac, cerebral, hepatic, renal, hemopoietic, or immune disorders, other auditory disorders, and poor treatment compliance.

 

Treatment
Patients assigned to the control group received hyperbaric oxygen treatment administered at 0.2 MPa. Sessions were conducted daily and lasted 80 minutes with two five-minute breaks each time. Each course was comprised of 10 treatments and a total of 30 treatments were administered.

Patients assigned to the acupuncture group were prescribed Liu Wei Di Huang Wan (Shu Di Huang, Shan Zhu Yu, Shan Yao, Fu Ling, Mu Dan Pi, Ze Xie) at a dosage of 6 grams twice daily. Acupuncture was administered on the affected side at the following acupoints:

  • Tinggong (SI19)
  • Tinghui (GB2)
  • Ermen (TB21)
  • Wangu (SI4)
  • Fengchi (GB20)
  • Taichong (LV3)
  • Hegu (LI4)
  • Zusanli (ST36)
  • Shenshu (BL23)

Treatment was administered using number 28 filiform needles with a balanced reducing-reinforcing technique. For patients with patterns of excess, a lifting-thrusting, twisting-rotating reducing method was employed. For patients with patterns of deficiency, this was substituted with a lifting-thrusting, twisting-rotating reinforcing method. Treatment was administered daily with one course comprising 10 treatments. A total of 30 treatments were administered.

 

Results
The primary outcome measure for the study was the total effective rate which was calculated as follows. Each patient’s symptom severity was graded according to the subcategories of: tinnitus severity, tinnitus duration, impact on sleep, impact on attention, and impact on mood. Each subcategory was classified as absent, mild, moderate, or severe, and awarded 0, 2, 4, or 6 points respectively.

Patients with an overall score of <6 were classified as grade 1. Patients with an overall score of 7–10 were classified as grade 2. Patients with an overall score of 11–14 were classified as grade 3. Patients with an overall score of 15–18 were classified as grade 4. Patients with an overall score of 19–21 were classified as grade 5.

To calculate the total effective rate, patients with a total resolution of symptoms were classified as recovered. For patients who experienced a reduction in severity of two grades and a significant improvement in symptoms, the treatment was classified as markedly effective. For patients who experienced a reduction in severity of one grade and some improvement in symptoms, the treatment was classified as effective. For patients who experienced no change in grade and no improvement in symptoms, the treatment was classified as ineffective. The recovered, markedly effective, and effective rates were then added together to provide the total effective rate.

In the acupuncture group, mean pre-treatment scores were 2.00 for tinnitus severity, 2.86 for tinnitus duration, 1.32 for impact on sleep, 1.77 for impact on attention, and 0.82 for impact on mood. Following treatment, these scores improved to 0.85, 1.38, 0.80, 1.20, and 0.41 respectively. In the control group, mean pre-treatment scores were 2.01 for tinnitus severity, 2.83 for tinnitus duration, 1.30 for impact on sleep, 1.86 for impact on attention, and 0.83 for impact on mood. Following treatment, these scores reduced to 1.65, 2.00, 0.85, 1.31, and 0.64 respectively. Both groups experienced significant improvements across all subcategories (p<0.05). Improvements were significantly greater in the acupuncture group (p<0.05).

In the acupuncture group, there were 3 recovered, 10 markedly effective, 18 effective, and 9 ineffective cases, giving a total effective rate of 77.5%. In the control group, there were 4 markedly effective, 16 effective, and 20 ineffective cases, giving a total effective rate of just 50%.

The results of this study indicate that acupuncture combined with Liu Wei Di Huang Wan herbal formula may provide an effective treatment for tinnitus due to liver and kidney yin deficiency. This combined treatment offers superior results when compared with hyperbaric oxygen treatment. Overall, the high ineffective rate indicates that patients need to be advised that results vary significantly.

 

Reference:
Gan Mei (2019) “Clinical Observation on Treatment of Tinnitus with Liver and Kidney Yin Deficiency by Acupuncture Combined with Liu Wei Di Huang Pill,” Journal of Practical Traditional Chinese Medicine Vol.35 (2) p. 160.

 

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