The effectiveness of acupuncture as a treatment for tinnitus: a randomized controlled trial using 99mTc-ECD SPECT

Music therapy for tinnitus: A systematic review and meta-analysis

OBJECTIVE

To evaluate the clinical efficacy of music therapy in the treatment of tinnitus.

METHODS

Three English databases (PUBMED, Embase, Web of Science) and three Chinese databases (CNKI, VIP, and Wanfang) were searched, and eligible articles were selected according to the set inclusion criteria. Clinical efficacy was used as the primary outcome, and each score was used as the secondary outcome. Using RevMan5.3 software for statistical analysis.

RESULTS

A total of 14 studies involving 1239 tinnitus patients were included. The results of the meta-analysis showed that music therapy had a certain clinical efficacy in the treatment of tinnitus, but there was no significant difference compared with the control group (OR = 1.00, 95%CI =0.83-1.22; P = 1.00). However, music therapy significantly improved THI score (MD = -6.77, 95 % CI = -9.62 to -3.92; P < 0.00001), TSQ (MD = -2.80, 95 % CI = -3.23 to -2.36; P < 0.00001), tinnitus loudness (MD = -3.90, 95 % CI = -6.58 to -1.23; P = 0.004), VAS score (MD = -1.11, 95 % CI = -2.11 to -0.11; P = 0.03) and TQ score (MD = -8.36, 95 % CI = -11.10 to -5.62; P < 0.001).

CONCLUSION

Music therapy is an effective method for the treatment of tinnitus, which can improve the THI score, tinnitus severity, VAS score, and TQ score and reduce the loudness of tinnitus. Due to the low quality of the included literature, the current conclusions need to be further verified by more and higher-quality studies.

Advances in acupuncture treatment for tinnitus

Tinnitus is the abnormal perception of sound in the absence of a corresponding external acoustic stimulus, which seriously affects the patients' quality of life, physical and mental health, and the safety of life. There is almost no effective cure for tinnitus, primarily due to its complicated etiopathogenesis and unclear mechanisms. As a major and ancient physical therapy in Traditional Chinese Medicine, acupuncture has been widely used in tinnitus because of its simple operation, rapid effect, and low cost. This paper reviews the relevant literature on the treatment of different kinds of tinnitus by acupuncture, and summarizes the therapeutic efficacy and mechanism of acupuncture on tinnitus, which is expected to provide new ideas and research directions for the study of tinnitus treatment by acupuncture. Tinnitus is the abnormal perception of sound in the absence of a corresponding external acoustic stimulus, which seriously affects the patients' quality of life, physical and mental health, and the safety of life. There is almost no effective cure for tinnitus, primarily due to its complicated etiopathogenesis and unclear mechanisms. As a major and ancient physical therapy in Traditional Chinese Medicine, acupuncture has been widely used in tinnitus because of its simple operation, rapid effect, and low cost. This paper reviews the relevant literature on the treatment of different kinds of tinnitus by acupuncture, and summarizes the therapeutic efficacy and mechanism of acupuncture on tinnitus, which is expected to provide new ideas and research directions for the study of tinnitus treatment by acupuncture.

Reporting of Participant Demographics in Clinical Trials Published in General Radiology Journals

OBJECTIVES

The reporting of research participant demographics provides insights into study generalizability. Our study aimed to determine the frequency at which participant age, sex/gender, race/ethnicity, and socioeconomic status (SES) are reported and used for subgroup analyses in radiology randomized controlled trials (RCTs) and their secondary analyses; as well as the study characteristics associated with, and the classification systems used for demographics reporting.

METHODS

RCTs and their secondary analyses published in 8 leading radiology journals between 2013 and 2021 were included. Associations between study characteristics and demographic reporting were tested with the chi-square goodness of fit test for categorical variables, Wilcoxon-Mann-Whitney test for impact factor, and logistic regression for publication year.

RESULTS

Among 432 included articles, 89.4% (386) reported age, 90.3% (390) sex/gender, 5.6% (24) race/ethnicity, and 3.0% (13) SES. Among articles that reported these demographics and were not specific to a subgroup, results were analyzed by age in 14.2% (55/386), sex/gender in 19.4% (66/340), race/ethnicity in 13.6% (3/22), and SES in 46.2% (6/13). Journal, impact factor, and last author continent were predictors of race/ethnicity and SES reporting. Funding was associated with race/ethnicity reporting. No study reported sex and gender separately, or documented transgender, nonbinary gender spectrum or intersex participants. A single category for race/ethnicity was used in 37.5% (9/24) of studies, consisting of either "White" or "Caucasian."

CONCLUSION

The reporting of participant demographics in radiology trials is variable and not always representative of the population diversity. Editorial guidelines on the reporting and analysis of participant demographics could help standardize practices.

Network meta-analysis of acupuncture for tinnitus

OBJECTIVE

To provide evidence for medical management of tinnitus based on an assessment of the evidence concerning the effectiveness of acupuncture as a treatment for tinnitus using network meta-analysis (NMA).

METHODS

We conducted a systematic literature review by searching 8 national and international databases (inception to February 2023) for randomized controlled trials (RCTs) for tinnitus. Only RCTs that recruited participants aged over 18 and diagnosed with tinnitus, and that evaluated acupuncture or acupuncture in combination with conventional western medical therapy were included. We used response rate and tinnitus handicap inventory (THI) to examine efficacy. We conducted NMA with random effects, and the rate ratio or mean difference with its 95% credible interval was calculated. In addition, we ranked all treatments via their SUCRA and assessed the quality of evidence according to the GRADE criteria.

RESULTS

A total of 2575 patients were included in the study. The main findings of the current NMA were that acupoint injection combined with warm acupuncture was the most effective for response rate, followed by warm acupuncture and acupoint injection combined with western medical treatment. Acupuncture combined with western medical treatment was the most effective for THI, followed by electroacupuncture combined with warm acupuncture and acupuncture combined with moxibustion.

CONCLUSION

Acupuncture seems to be a better trend treatment for tinnitus. Further rigorous RCT studies that include direct comparisons for different acupuncture-related treatments are encouraged to provide the most promising evidence for patients with tinnitus.

PROTOCOL REGISTRATION

CRD42023398745.

Lipid Profile Response to Acupuncture in Obese Patients with Subjective Tinnitus: a Randomized Controlled Trial

Background

Blood lipid levels have been reported as novel biomarkers for chronic subjective tinnitus (CST), with their levels being higher in patients with CST.

Objectives

This trial aimed to determine the change in lipid profile and tinnitus-related quality of life (TR-QoL) responses to 8-week acupuncture treatment in patients with CST.

Methods

Sixty obese patients with CST were randomly assigned to group A (treatment group; n = 30; mean age = 44.10 ± 3.69 years) or group B (sham group; n = 30; mean age = 45.53 ± 3.62 years). Patients in group A (n = 30) received manual stimulation at the TE3, TE5, TE17, TE18, TE19, TE20, TE21, TE22, GB2, GB8, GB20, LI4, LI11, KI3, SP6, ST36, CV4, CV9, and CV12 acupoints through in-site acupuncture needles thrice weekly. Furthermore, the bilateral abdominal ST25 and GB28 acupoints were electrically stimulated through in-site acupuncture needles. Group B (n = 30) received the same acupuncture protocol as group A but the insertion of needles was a sham insertion. Anthropometrics such as body mass index (BMI) and waist circumference (WC), TR-QoL (assessed via tinnitus handicap inventory), blood lipid levels such as high-density lipoprotein (HDL_s), low-density lipoprotein (LDL_s), cholesterol (C), and triglycerides (TG_s), and the visual analogue scale (VAS) score for tinnitus severity, were assessed prospectively.

Results

Only group A showed significant within-group improvements. Except for HDL_s, BMI, and WC, unpaired between-group comparisons showed significantly greater improvements in other outcome measures of all patients with tinnitus (TR-QoL, LDL_s, TG_s, C, and VAS) in group A than in group B.

Conclusion

Safe acupuncture treatment not only improves anthropometrics and TR-QoL, but also helps resolve hyperlipidemia and reduces the severity of tinnitus in obese patients with CST.

Effects of Physical Interventions on Subjective Tinnitus, a Systematic Review and Meta-Analysis

Increasingly, patients suffering from subjective tinnitus seek help from physical therapists. Numerous randomised controlled trials (RCTs) have investigated the effect of physical interventions commonly used in physical therapy practice on subjective tinnitus. This systematic review and meta-analysis aimed to analyse the effects of physical interventions on tinnitus loudness, tinnitus annoyance, and scores on the Tinnitus Handicap Index (THI). Four databases were searched from inception up to March 2022. A total of 39 RCTs were included in the systematic review, and 23 studies were appropriate for meta-analyses. Risk of bias assessments were also performed. Interventions analysed in at least five studies were summarised, including transcutaneous electrical nerve stimulation (TENS), laser therapy, and acupuncture. Random-effects meta-analysis models were used, and effect sizes were expressed as Hedge's standardised mean differences (SMD) with 95%CI's. The quality of three-quarters of the studies was limited due to insufficient allocation concealment, lack of adequate blinding, and small sample sizes. Large, pooled effects sizes were found for acupuncture (SMD: 1.34; 95%CI: 0.79, 1.88) and TENS (SMD: 1.17; 95%CI: 0.48, 1.87) on THI as well as for acupuncture on tinnitus loudness (VAS Loudness (SMD: 0.84; 95%CI: 0.33, 1.36) and tinnitus annoyance (SMD: 1.18; 95%CI: 0.00, 2.35). There is some evidence that physical interventions (TENS and acupuncture, but not laser therapy) may be effective for tinnitus. However, the lack of high-quality studies and the risk of bias in many studies prohibits stronger conclusions.

Acupuncture Treatment Decreased Temporal Variability of Dynamic Functional Connectivity in Chronic Tinnitus

Acupuncture is recommended for the relief of chronic tinnitus in traditional Chinese medicine, but the underlying neural mechanism remains unclear. The human brain is a dynamic system, and it’s unclear about acupuncture’s effects on the dynamic functional connectivity (DFC) of chronic tinnitus. Therefore, this study based on resting-state functional magnetic resonance imaging (fMRI) investigates abnormal DFC in chronic tinnitus patients and the neural activity change evoked by acupuncture treatment for tinnitus. In this study, 17 chronic tinnitus patients and 22 age- and sex-matched normal subjects were recruited, and their tinnitus-related scales and hearing levels were collected. The fMRI data were measured before and after acupuncture, and then sliding-window and k-means clustering methods were used to calculate DFC and perform clustering analysis, respectively. We found that, compared with the normal subjects, chronic tinnitus patients had higher temporal variability of DFC between the supplementary motor area and medial part of the superior frontal gyrus, and it positively correlated with hearing loss. Clustering analysis showed higher transition probability (TP) between connection states in chronic tinnitus patients, and it was positively correlated with tinnitus severity. Furthermore, the findings showed that acupuncture treatment might improve tinnitus. DFC between the posterior cingulate gyrus and angular gyrus in chronic tinnitus patients after acupuncture showed significantly decreased, and it positively correlated with the improvement of tinnitus. Clustering analysis showed that acupuncture treatment might promote chronic tinnitus patients under lower DFC state, and it also positively correlated with the improvement of tinnitus. This study suggests that acupuncture as an alternative therapy method might decrease the tinnitus severity by decreasing the time variability of DFC in chronic tinnitus patients.

Altered Neurovascular Coupling in Unilateral Pulsatile Tinnitus

Objective

Altered cerebral blood flow (CBF) and regional homogeneity (ReHo) have been reported in pulsatile tinnitus (PT) patients. We aimed to explore regional neurovascular coupling changes in PT patients.

Materials and Methods

Twenty-four right PT patients and 25 sex- and age-matched normal controls were included in this study. All subjects received arterial spin labeling imaging to measure CBF and functional MRI to compute ReHo. CBF/ReHo ratio was used to assess regional neurovascular coupling between the two groups. We also analyzed the correlation between CBF/ReHo ratio and clinical data from the PT patients.

Results

PT patients exhibited increased CBF/ReHo ratio in left middle temporal gyrus and right angular gyrus than normal controls, and no decreased CBF/ReHo ratio was found. CBF/ReHo ratio in the left middle temporal gyrus of PT patients was positively correlated with Tinnitus Handicap Inventory score (r = 0.433, p = 0.035).

Conclusion

These findings indicated that patients with PT exhibit abnormal neurovascular coupling, which provides new information for understanding the neuropathological mechanisms underlying PT.

[Tinnitus: clinical and pathogenetic aspects]

The article discusses the pathogenetic and clinical features of tinnitus. It is emphasized that various causes contribute to the appearance of tinnitus, including somatic diseases, excess body weight, iatrogenies, otological diseases with an outcome in hearing loss. The anatomical and physiological features of the structure of the central part of the auditory system are considered. It is suggested that the occurrence of tinnitus is associated with the processes of maladaptive neuroplasticity caused by pathological changes in the neuronal activity of cortical structures of the CNS, and not with changes in the peripheral part of the auditory analyzer - the structures of the cochlea. The results of recent studies, including those using functional neuroimaging methods, indicate the significance of cortical connection disorders (human connectome) in patients with tinnitus. In patients with tinnitus, there are changes in regional neuronal activity and connections not only in the auditory cortex, but also in areas not directly related to the analysis of auditory afferentation. Thus, tinnitus can be considered as one of the variants of dysfunction of the human connectome, triggered primarily from the «auditory input».

Methodological Aspects of Randomized Controlled Trials for Tinnitus: A Systematic Review and How a Decision Support System Could Overcome Barriers

Although a wide range of tinnitus management interventions is currently under research and a variety of therapeutic interventions have already been applied in clinical practice, no optimal and universal tinnitus treatment has been reached yet. This fact is to some extent a consequence of the high heterogeneity of the methodologies used in tinnitus related clinical studies. In this manuscript, we have identified, summarized, and critically appraised tinnitus-related randomized clinical trials since 2010, aiming at systematically mapping the research conducted in this area. The results of our analysis of the 73 included randomized clinical trials provide important insight on the identification of limitations of previous works, methodological pitfalls or gaps in current knowledge, a prerequisite for the adequate interpretation of current literature and execution of future studies.

Efficacy of Electronic Acupuncture Shoes for Chronic Low Back Pain: Double-Blinded Randomized Controlled Trial

BACKGROUND

Chronic low back pain is a common problem and is associated with high costs, including those related to health care and indirect costs due to absence at work or reduced productivity. Previous studies have demonstrated that acupuncture or electroacupuncture can relieve low back pain. Electronic acupuncture shoes (EAS) are a novel device designed in this study. This device combines the properties of acupuncture and transcutaneous electrical nerve stimulation for clinical use.

OBJECTIVE

The aim of this study was to evaluate the efficacy of EAS in patients with chronic low back pain.

METHODS

In this prospective double-blinded randomized controlled study, the data of 83 patients who experienced chronic low back pain were analyzed. Patients came to our clinic for 20 visits and underwent assessment and treatment. Patients were randomly allocated to receive either EAS plus placebo nonsteroidal anti-inflammatory drugs (NSAIDs) (EAS group, n=42) or sham EAS plus NSAIDs (NSAID group, n=41). The visual analog scale (VAS) score and range of motion were assessed at baseline, before and after each EAS treatment, and 2 weeks after the last treatment. The time for achieving pain remission was recorded. Quality of life was assessed at the 2nd, 14th, and 20th visits.

RESULTS

After 6 weeks of treatment, the treatment success rate in each visit in the EAS group was higher than that in the NSAID group, as revealed by the intention-to-treat (ITT) and per-protocol (PP) analyses, but significant differences were observed only during the 16th visit in the ITT analysis (EAS group: 31/37, 84% and NSAID group: 21/34, 62%; P=.04). The change in the VAS score from baseline in each visit in the EAS group was greater than that in the NSAID group, as revealed by the ITT and PP analyses, and significant differences were observed in the 5th visit and 9th visit in the ITT analysis (P=.048 and P=.048, respectively). Significant differences were observed in the left rotation in the 2nd visit and 4th visit (P=.049 and P=.03, respectively). No significant differences were observed in the VAS score before and after treatment in each visit and in the quality of life in both groups.

CONCLUSIONS

EAS might serve as a reliable alternative therapeutic tool for patients with chronic low back pain who are contraindicated for oral NSAIDs.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02468297 https://clinicaltrials.gov/ct2/show/NCT02468297.

Acupuncture for tinnitus: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

To evaluate the efficacy/effectiveness of acupuncture for the treatment of tinnitus.

METHODS

Four English and four Chinese databases were searched for randomized controlled trials (RCTs) of acupuncture for tinnitus published before 30 September 2018. RCTs applying acupuncture alone compared with conventional treatments, sham acupuncture, or no treatment, as well as acupuncture plus conventional treatments compared with conventional treatments alone, were included. The primary outcome was the visual analogue scale (VAS). Secondary outcomes included tinnitus handicap inventory (THI) and tinnitus severity index (TSI) scores. Meta-analysis was conducted using RevMan V5.3 software. The protocol was registered in the PROSPERO database (ref. CRD42018108692).

RESULTS

Eight studies involving 504 participants were included. Meta-analysis showed no significant differences in the VAS score (mean difference (MD) = -1.81, 95% confidence interval (CI) = -3.69 to 0.07; p = 0.06) between the acupuncture and control groups. However, favorable effects of acupuncture on changes in THI score (MD = -10.11, 95% CI = -12.74 to -7.48; p < 0.001) and TSI score (MD = -8.36, 95% CI = -8.87 to -7.86; p < 0.001) were found.

CONCLUSION

Acupuncture had no significant effect on the primary outcome of VAS score compared with control treatment; however, positive effects on secondary outcomes (THI and TSI score) were observed in acupuncture versus control groups. Due to the low quality and small sample size of the included trials, the level of evidence was insufficient to draw any definitive conclusions. Further rigorous and high-quality studies with larger sample sizes should be conducted to confirm the efficacy/effectiveness of acupuncture for tinnitus.

Outcomes of Triple-Combination Therapy for Chronic Tinnitus

BACKGROUND/AIM

Patients with tinnitus suffer not only from auditory dysfunction but also physical, mental, and social difficulties. Our aim was to investigate the outcomes of our triple-combination therapy for chronic tinnitus, which includes narrow-band noise masking, auricular acupuncture and cognitive behavioral therapy.

PATIENTS AND METHODS

The tinnitus handicap inventory (THI) scores of 78 adults with chronic tinnitus who received triple-combination therapy for 12 weeks were analyzed retrospectively.

RESULTS

There were 39 females and 39 males in this study. The mean age was 60.5 years [standard deviation (SD)=13.0, range=27-88 years] for all subjects. Mean pure tone average=39.5 decibel hearing level (SD=23.09). Pre-treatment mean THI score was 41.4 (SD=21.13), functional (F) subscore was 17.9 (SD=10.69), emotional (E) subscore was 10.6 (SD=6.87), and catastrophic (C) subscore was 12.9 (SD=4.85). Post-treatment THI total score was significantly lower compared to pre-treatment THI total score. Also, post-treatment subscores were significantly lower compared to pre-treatment subscores in F and C subsocres, but not in E subscore. In addition, multivariate logistic regression analysis showed that coffee and tea consumption was significantly positively associated with a reduction of THI total score.

CONCLUSION

Triple-combination therapy could be helpful for chronic tinnitus patients. It seemed that coffee and tea consumption may elicit increased improvement in conjunction with combined therapy for chronic tinnitus.

Acupuncture Treatment in Patients with Chronic Subjective Tinnitus: A Prospective, Randomized Study

Objective: This study investigated the effect, onset, duration of action, and short-term outcomes of acupuncture therapy for treating patients with severe chronic subjective tinnitus. Materials and Methods: This randomized controlled trial evaluated patients with chronic, idiopathic, and severe tinnitus. A total of 105 participants were divided into 2 groups using a randomization method: a study group who received verum acupuncture therapy (n = 53) and a sham acupuncture group (n = 52). Ten acupuncture sessions were given over 5 weeks. After treatment, each participant was monitored for up to 3 months according to changes on a visual analogue Scale (VAS), and Tinnitus Handicap Inventory (THI), and Pure-Tone Audiometry and Speech Discrimination (Interacoustics AC-40, Denmark) scores. Results: The VAS and THI scores were evaluated. A statistically significant difference was noted between the sham and verum acupuncture groups at post-treatment follow-up (P < 0.001). Decreases in the THI and VAS scores became significant in the second week of treatment (P < 0.001 and P < 0.001, respectively), but these scores increased again in the third month post-treatment (P < 0.001 and P < 0.001, respectively). Conclusions: Acupuncture is an effective treatment for patients with severe chronic subjective tinnitus. Patient complaints, decreased beginning at the second treatment week; however, in the third post-treatment month, the complaints reappeared. Maintenance acupuncture therapy is necessary for patients with tinnitus; this approach should be investigated in future studies.

Tinnitus and sound intolerance: evidence and experience of a Brazilian group

Introduction

Tinnitus and sound intolerance are frequent and subjective complaints that may have an impact on a patient's quality of life.

Objective

To present a review of the salient points including concepts, pathophysiology, diagnosis and approach of the patient with tinnitus and sensitivity to sounds.

Methods

Literature review with bibliographic survey in LILACS, SciELO, Pubmed and MEDLINE database. Articles and book chapters on tinnitus and sound sensitivity were selected. The several topics were discussed by a group of Brazilian professionals and the conclusions were described.

Results

The prevalence of tinnitus has increased over the years, often associated with hearing loss, metabolic factors and inadequate diet. Medical evaluation should be performed carefully to guide the request of subsidiary exams. Currently available treatments range from medications to the use of sounds with specific characteristics and meditation techniques, with variable results.

Conclusion

A review on tinnitus and auditory sensitivity was presented, allowing the reader a broad view of the approach to these patients, based on scientific evidence and national experience.

BIBLIOMETRIC ANALYSIS OF ACUPUNCTURE RESEARCH FRONTS AND THEIR WORLDWIDE DISTRIBUTION OVER THREE DECADES

Background:

Considerable research has been conducted on acupuncture worldwide. This study chronologically examined the changing features and research fronts of acupuncture and elucidated the differences among the six most productive countries.

Methods:

Bibliographic coupling is a powerful tool for identifying the research fronts of a field. Acupuncture-related publications worldwide and from the six most productive countries during 1983-2012 were retrieved from the Science Citation Index Expanded and Social Science Citation Index. To form the research fronts, the 100 most highly cited papers (HCPs) were clustered in terms of references shared.

Results:

The United States had the highest proportion of HCPs. The effectiveness of acupuncture in areas such as relieving neck and back pain, migraines and headaches, and knee osteoarthritis symptoms was a predominant topic. Initially, the endogenous opioid peptide system was the primary research focus in the acupuncture mechanism research; however, during 1993-2012, researchers focused more on the functional magnetic resonance imaging of brain activity. In addition, acupuncture use and prevalence, the attitudes of health practitioners, and the effects of expectancy and belief were also major topics. Researches from Western countries, including the United States, England, and Germany, showed more interest in clinical trials and economic- and ethics-related studies, whereas those from East Asian countries including China, Japan, and South Korea focused more on mechanism research.

Conclusion:

Western countries dominated the research fronts of acupuncture. The patterns of the research fronts varied worldwide, indicating continuity and innovation in research in each country.