Acupuncture as a Treatment for Tinnitus
Condition: Tinnitus
MeSH terms: Tinnitus
Study type: Interventional

Summary: 
      This trial was a randomized, single-blinded, sham-controlled study, in which the patients
      were blinded to treatment assignment. First, all candidates underwent audiological testing of
      hearing thresholds, tympanometry and stapedius reflex tests. The patients who were selected
      for the study were interviewed to assess and evaluate their condition and then underwent a
      detailed physical examination that included a complete otorhinolaryngologic examination and a
      complete blood test. Then, the subjects were randomized to undergo true or sham ACP. Seven
      days before (baseline) and seven days after twelve acupuncture (ACP) sessions (up to six
      weeks), which were performed twice a week, all participants underwent 99mTc-ECD SPECT
      scanning and completed the Portuguese version of the Tinnitus Handicap Inventory (THI), the
      Visual Analogue Scale (VAS), Hamilton Anxiety Scale (HAS) and the Beck Depression Inventory
      (BDI). The purpose of this study was to integrate the neuroscience research findings with the
      clinical research on tinnitus. Thus, a randomized, single-blinded, placebo-controlled trial
      was implemented to investigate the effect of ACP as a treatment for tinnitus using
      ethylcysteine dimer single-photon emission computer tomography (99mTc-ECD SPECT).
    

Detailed description: 
      Acupuncture (ACP) is frequently used to treat tinnitus, the condition defined as the
      perception of sound in the absence of an external auditory stimulus. However, no information
      is available regarding the consequences of ACP on the neural architecture and functionality
      of the brain in tinnitus patients. The aim of this study was to investigate changes in brain
      activity using ethylcysteine dimer single-photon emission computer tomography (99mTc-ECD
      SPECT) in patients with tinnitus and normal hearing who underwent ACP treatment. Methods and
      Findings: This was a randomized, single-blinded, sham-controlled study. The participants were
      adults (18-60 years old) with either normal hearing or chronic, idiopathic and continuous (+
      3 months) tinnitus. Fifty-seven (57) subjects were randomized to receive true (n=30) or sham
      (n=27) ACP, and 99mTc-ECD SPECT exams were performed seven days before (baseline) and seven
      days after twelve ACP sessions (up to six weeks), which were performed twice a week.
      Secondary outcomes included changes in the Tinnitus Handicap Inventory (THI), the Visual
      Analog Scale (VAS), the Hamilton Anxiety Scale (HAS) and the Beck Depression Inventory (BDI).
      Data regarding imaging outcomes were analyzed with Statistical Parametric Mapping (SPM8)
      software using a factorial design. For secondary outcomes, regression models were built
      considering two different analytical paradigms: intention-to-treat (ITT; where multiple
      imputations were conducted due to loss to follow-up) and complete cases. No significant
      differences in brain perfusion were observed between patients who underwent true versus sham
      ACP treatment. However, a significant improvement in THI scores at the end of true ACP
      treatment was observed for all domains (all p < 0.001), with the exception of the
      catastrophic field. For the other outcome measurements (VAS, BDI and HAS), no significant
      differences were observed between groups. The small sample size represents a potential
      limitation of this study. Conclusions: These findings suggest that ACP may improve the impact
      of tinnitus on daily life, although additional studies are needed to verify the consequences
      of ACP on the neural architecture and functionality of the brain in tinnitus patients.
    

Intervention name(s): Acupuncture
Intervention type(s): Other
Intervention description(s): All treatments were performed by the same acupuncturist, who is a medical doctor with more than eight years of clinical and research experience in ACP for tinnitus. Acupoints described as being effective for tinnitus were selected according to TCM theory. Basic points that are manipulated in ACP include GV 20 (Baihui), TE 17 (Yifeng), GB 8 (Shuaigu), SI 19 (Tinggong), GB 2 (Tinghui), TE 21 (Ermen), VC 23 (Lianquan), GB 20 (Fengchi), TE 2 (Yemen), TE 5 (Waiguan), SI 2 (Qiangu), GB 43 (Xiaxi) and GB 41 (Zulinqi). However, several secondary (accessory) acupoints were also added according to TCM and the etiological diagnosis of tinnitus: GV 4 (Mingmen), KI 3 (Taixi), BL 23 (Shenshu), BL 19 (Danshu), BL 18 (Ganshu) and CV 4 (Guanyuan).
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Single Photon Emission Computed Tomography; Acupuncture