Acupuncture For Tinnitus In Glasgow

Acupuncture For Tinnitus | Glasgow

About Tinnitus

Tinnitus is the perception of sound in the ear or head that does not arise from the external environment, from within the body (e.g., vascular sounds), or from auditory hallucinations related to mental illness. Up to 18% of the general population in industrialised countries are mildly affected by chronic tinnitus and, for 0.5%, tinnitus has a severe effect on their ability to lead a normal life (Coles 1984).

The condition can occur as an isolated idiopathic symptom, or in association with any type of hearing loss - age-related hearing loss, noise-induced hearing loss, Menière's
disease, or an acoustic neuroma. It can also occur in people with normal hearing thresholds due to aspirin or quinine toxicity. Tinnitus is also associated with depression, but it is not always clear whether it is a cause of the depression or a manifestation of the condition (Sullivan 1988). It can also occur with chronic otitis media, head injury and barotraumas. Tinnitus can have an insidious onset, with a long delay before clinical presentation. It can persist for many years, particularly when associated with a sensorineural hearing loss. Tinnitus can cause insomnia, an inability to concentrate, and depression (Zoger 2001). Treatment is aimed at reducing the loudness and intrusiveness of the tinnitus, and minimising its impact on daily life.

References

• Coles RR. Epidemiology of tinnitus: (1) prevalence. J Laryngol Otol 1984; 9: 7–15.
• Sullivan MD et al. Disabling tinnitus: association with affective disorder. Gen Hosp Psychiatry 1988; 10: 285–91.
• Zoger S et al. Psychiatric disorders in tinnitus patients without severe hearing impairment: 24 month follow-up of
patients at an audiological clinic. Audiology 2001; 40: 133–40.

How acupuncture can help

A systematic review in 2000 concluded that research had not demonstrated acupuncture to be efficacious as a treatment for tinnitus (Park 2000); however, some of the studies used inadequate acupuncture, some used sham controls of questionable validity and most were a cross-over design that it is generally considered inappropriate for acupuncture evaluation (Jackson, 2006). Controlled trials conducted more recently than this review (Tan 2007, Okada 2006, Azevedo 2007, Jackson 2006) have all found acupuncture to provide effective relief from tinnitus, with one finding it more effective than western medicine (Tan 2007). However, they were very small, and larger, high-quality studies are required to confirm these findings. (See Table below)

Acupuncture may help relieve tinnitus by:

  • acting on the cochlea, specifically on the contractile activity of outer hair cells (Azevedo 2007);

  • acting on the function of the efferent olivocochlear system to suppress otoacoustic emissions (Azevedo 2007);
  • altering the brain’s chemistry, increasing neuropeptide Y levels (Lee 2009; Cheng 2009), and reducing serotonin levels (Zhou 2008);
  • reducing inflammation, by promoting release of vascular and immunomodulatory actors (Kavoussi 2007, Zijlstra 2003);
  • increasing local microcirculation (Komori 2009), which aids dispersal of swelling.

About traditional acupuncture

Acupuncture is a tried and tested system of traditional medicine, which has been used in China and other eastern cultures for thousands of years to restore, promote
and maintain good health. Its benefits are now widely acknowledged all over the world and in the past decade traditional acupuncture has begun to feature more
prominently in mainstream healthcare in the UK. In conjunction with needling, the practitioner may use techniques such as moxibustion, cupping, massage or lectroacupuncture. They may also suggest dietary or lifestyle changes.

Traditional acupuncture takes a holistic approach to health and regards illness as a sign that the body is out of balance. The exact pattern and degree of imbalance is
unique to each individual. The traditional acupuncturist’s skill lies in identifying the precise nature of the underlying disharmony and selecting the most effective
treatment. The choice of acupuncture points will be specific to each patient’s needs. Traditional acupuncture can also be used as a preventive measure to strengthen the
constitution and promote general well-being. An increasing weight of evidence from Western scientific research (see overleaf) is demonstrating the effectiveness of acupuncture for treating a wide variety of conditions. From a biomedical viewpoint, acupuncture is believed to stimulate the nervous system, influencing the production of the body’s communication substances - hormones and neurotransmitters. The resulting biochemical changes activate the body's self-regulating homeostatic systems, stimulating its natural healing abilities and promoting physical and emotional well-being.

About the British Acupuncture Council

With over 3000 members, the British Acupuncture Council (BAcC) is the UK’s largest professional body for traditional acupuncturists. Membership of the BAcC guarantees
excellence in training, safe practice and professional conduct. To find a qualified traditional acupuncturist, contact the BAcC on 020 8735 0400 or visit www.acupuncture.org.uk

Acupuncture For Tinnitus

The evidence

Research Conclusion
Systematic Reviews
Park J et al. Efficacy of
acupuncture as a treatment for
tinnitus: a systematic review. Arch
Otolaryngol Head Neck Surg 2000;
126: 489-92.
A systematic review of randomised controlled trials that looked
at the efficacy of acupuncture as a treatment for tinnitus
compared with any control intervention. Six randomized
controlled trials were included, four of which used manual
acupuncture and 2 electroacupuncture. Five of 6 studies used
inconsistent acupoints. Three studies scored 3 points or more on
the Jadad scale. Outcome measurements were visual analogue
scale scores for loudness, annoyance, and awareness of
tinnitus; subjective severity scale scores for tinnitus; or
Nottingham Health Profile scores. Two unblinded studies showed
a positive result, whereas 4 blinded studies showed no
significant effect of acupuncture. The reviewers concluded that
acupuncture had not been demonstrated to be efficacious as a
treatment for tinnitus on the evidence of rigorous randomised
controlled trials.
Controlled trials
Tan KQ et al. Comparative study on
therapeutic effects of acupuncture,
Chinese herbs and Western
medicine on nervous tinnitus
[Chinese]. Zhongguo Zhenjiu 2007.
27: 249-51.
A randomised controlled trial that compared the clinical
therapeutic effects of acupuncture, Chinese herbs and western
medicine in 90 patients with nervous tinnitus. The effectiveness
rates in the 3 groups were 73.3%, 40.0% and 33.3%,
respectively, with significant differences among the 3 groups
(p<0.05). The researchers concluded that acupuncture has
obvious therapeutic effect on nervous tinnitus, and that its
therapeutic effect is better than that of Chinese herbs and
western medicine.
Okada DM et al. Acupuncture for
tinnitus immediate relief
[Portuguese]. Revista Brasileira de
Otorrinolaringologia 2006. 72: 182-6.
A double-blind randomised study in 76 patients with tinnitus to
assess the effects of acupuncture. A Visual Analogue Scale
(VAS, 0 to 10 points) was used to assess the humming sensation
experienced by the patients at baseline. The patients were then
divided into a ‘real’ acupuncture group and a sham acupuncture
group. After treatment, the humming sensation was assessed
again. There was a significant difference (p<0,001) between the
VAS scores pre and post needling in the real acupuncture group
(p=0.0127). There was also a difference between the real and
sham groups (p=0.017). The researchers concluded that there
was significant reduction in tinnitus with acupuncture.
Azevedo RF et al. Impact of
acupuncture on otoacoustic
emissions in patients with tinnitus.
Revista Brasileira de
Otorrinolaringologia 2007; 73: 599-
607.
A study that assessed the effect of acupuncture on the cochlear
function in 38 patients with tinnitus by analysing otoacoustic
emissions. Measures of transitory otoacoustic emissions and
suppression of otoacoustic emissions were obtained from all
subjects before and after acupuncture. Patients were assigned to
‘real’ or sham acupuncture. There was a significant difference
between the amplitude of otoacoustic emissions assessed before
and after treatment in the real acupuncture group. No difference
was observed with sham acupuncture. The researchers
concluded that acupuncture had a significant effect on
otoacoustic emissions in patients with tinnitus.
Jackson A et al. Acupuncture for
tinnitus: a series of six n = 1
controlled trials. Complementary
Therapies in Medicine 2006; 14: 39-
46.
Controlled n=1 trials that explored patient perceived benefits of
acupuncture for tinnitus. Six patients with tinnitus were included.
Primary outcome was Daily Diary records related to four tinnitus
symptoms: loudness of tinnitus; pitch of tinnitus; waking hours
affected with tinnitus; quality of sleep. Secondary outcomes were
the Tinnitus Handicap Inventory (THI) and Measure Your Medical
Outcome Profile (MYMOP). Outcomes were measured during a
course of 10 acupuncture treatments over a 2-week period, and
also during a 14 day pre-treatment (phase A) and 14 days posttreatment (phase B). For the symptoms of loudness and pitch,
there were variable treatment effects between patients. There
was a trend (not statistically significant) to an overall reduction of
loudness and pitch. For waking hours affected and quality of
sleep, patients' responses were more consistent and there was a
significant overall median reduction. The THI and MYMOP
measures showed a trend towards improvement after treatment.
The researchers concluded that the results of their study suggest
that acupuncture may have a beneficial role in the treatment of
tinnitus.
Case series
Shaladi AM et al. Auricular
acupuncture plus antioxidants in the
treatment of subjective tinnitus: A
case series. Medical Acupuncture
2009; 21: 131-4.
A case series that assessed the benefit of auricular acupuncture
and antioxidants on subjective tinnitus. A prospective
questionnaire including an 11-point scale of the subjective
volume, an 11-point scale of the severity of tinnitus, and the
Zung Self-Rating Anxiety Scale were used to assess the
response to acupuncture. In all, 13 patients who had had
symptoms of tinnitus for 3 to 5 years were evaluated at baseline,
1 month, and 4 months. Patients were given oral antioxidants
and auricular acupuncture 2 times a week, for 4 weeks. From
baseline to 1 month, there was a nonsignificant reduction in the
subjective volume of the tinnitus and severity of the tinnitus; and
also a nonsignificant reduction on the anxiety scale. No variation
was registered between months 1 and 4, but patients reported
improved sleep. The researchers concluded that auricular
acupuncture plus oral antioxidants nonsignificantly reduced the
noise and the intensity of subjective tinnitus.
Research on mechanisms for acupuncture
Cheng CH et al. Endogenous
Opiates in the Nucleus Tractus
Solitarius Mediate
Electroacupuncture-induced Sleep
Activities in Rats. Evid Based
Complement Alternat Med 2009 Sep
3. [Epub ahead of print]
An animal study that investigated the involvement of the nucleus
tractus soliatarius opioidergic system in electroacupunctureinduced alterations in sleep, the findings of which suggested that
mechanisms of sleep enhancement may be mediated, in part,
by cholinergic activation, stimulation of the opiodergic neurons to
increase the concentrations of beta-endorphin and the
involvement of the µ-opioid receptors.
Lee B et al. Effects of acupuncture
on chronic corticosterone-induceddepression-like behavior and
expression of neuropeptide Y in the
rats. Neuroscience Letters 2009;
453: 151-6.
In animal studies, acupuncture has been found to significantly
reduce anxiety-like behaviour, and increase brain levels of
neuropeptide Y, the brain levels of which appear to correlate with
reported anxiety.
Komori M et al. Microcirculatory
responses to acupuncture
stimulation and phototherapy.
Anesth Analg 2009; 108: 635-40.
Experimental study on rabbits in which acupuncture stimulation
was directly observed to increase diameter and blood flow
velocity of peripheral arterioles, enhancing local microcirculation.
Zhou Q et al. The effect of electroacupuncture on the imbalance
between monoamine
neurotransmitters and GABA in the
CNS of rats with chronic emotional
stress-induced anxiety. Int J Clin
Acupunct 2008 ;17: 79-84.
A study of the regulatory effect of electro-acupuncture on the
imbalance between monoamine neurotransmitters and GABA in
the central nervous system of rats with chronic emotional stressinduced anxiety. The levels of serotonin, noradrenaline and
dopamine fell significantly, while GABA levels were significantly
higher in the rats given acupuncture (P<0.05, or P<0.0). The
researchers concluded that the anti-anxiety effect of electroacupuncture may relate to its regulation of the imbalance of
neurotransmitters.
Kavoussi B, Ross BE. The
neuroimmune basis of antiinflammatory acupuncture. Integr
Cancer Ther 2007; 6: 251-7.
Review article that suggests the anti-inflammatory actions of
traditional and electro-acupuncture are mediated by efferent
vagus nerve activation and inflammatory macrophage
deactivation.
Zijlstra FJ et al. Anti-inflammatory
actions of acupuncture. Mediators
Inflamm 2003; 12: 59-69.
An article that suggests a hypothesis for anti-inflammatory
action of acupuncture: Insertion of acupuncture needles initially
stimulates production of beta-endorphins, CGRP and substance
P, leading to further stimulation of cytokines and NO. While high
levels of CGRP have been shown to be pro-inflammatory,
CGRP in low concentrations exerts potent anti-inflammatory
actions. Therefore, a frequently applied 'low-dose' treatment of
acupuncture could provoke a sustained release of CGRP with
anti-inflammatory activity, without stimulation of proinflammatory cells.


Terms and conditions
The use of this fact sheet is for the use of British Acupuncture Council members and is subject to the strict conditions imposed by the British Acupuncture Council details of which can be found in the members area of its website www.acupuncture.org.uk.

For more information about acupuncture and how it can help sound in the ear that does not arise from external environment, contact Elaine Collins at 0141 585 7904 or fill in our Contact form, and we will get back to you.