Investigating acupoint selection and combinations of acupuncture for primary idiopathic tinnitus using data mining

This study represents an important milestone in the standardization of acupuncture treatment for idiopathic tinnitus, using advanced data mining techniques to analyze more than a decade of clinical research. Idiopathic tinnitus, also known as neurologic tinnitus, affects millions of people globally, causing not only auditory discomfort but also anxiety, depression, and a significant reduction in quality of life. Although acupuncture is widely used for this condition because of its safety and efficacy, the lack of standardized criteria for point selection has limited the optimization of therapeutic outcomes. The researchers carried out a systematic search across six major medical databases, including PubMed, Embase, and specialized Chinese databases, covering literature from database inception through September 2023.

After a rigorous selection process, 112 studies were included in the analysis, comprising 93 randomized controlled trials, 18 self-control studies, and 1 retrospective study. From this sample, 221 acupuncture prescriptions were extracted, involving 99 different points with a total frequency of use of 1,786. The methodology employed sophisticated statistical analysis tools, including SPSS for cluster analysis and IBM SPSS Modeler for association rule analysis. The results revealed a clear pattern in point selection.

The five most frequently used points were Tinggong (SI-19), Tinghui (GB-2), Yifeng (TE-17), Ermen (TE-21), and Zhongzhu (TE-3), accounting respectively for 10.81%, 10.58%, 10.47%, 7.33%, and 6.22% of total use. Notably, the first four are located near the ear, which aligns with anatomic and physiologic principles of tinnitus treatment. Meridian analysis showed predominance of the Sanjiao meridian (29%), followed by the Gallbladder (26.32%) and Small Intestine (11.70%) meridians — all of which pass through the auricular region. Association rule analysis identified the core combination 'Ermen (TE-21)-Tinggong (SI-19)-Tinghui (GB-2)-Yifeng (TE-17)' as the therapeutic nucleus, with confidence greater than 97% in the main associations.

Cluster analysis revealed three functional groups: Group 1 focused on local auricular points, Group 2 representing distal treatment through points on the limbs, and Group 3 addressing treatment based on syndrome differentiation. From a mechanistic standpoint, the main points are located near critical neural and vascular structures, including branches of the superficial temporal artery, the great auricular nerve, and the trunk of the facial nerve. Stimulation of these points may improve inner ear microcirculation, promote metabolic exchange in the labyrinth, and facilitate regeneration of auditory cells. Cited neuroimaging studies show that acupuncture at these points activates specific brain areas, reducing anxiety and improving sleep quality.

The clinical implications are substantial. The study provides, for the first time, data-driven evidence for standardized acupuncture protocols in idiopathic tinnitus. The identification of the core four-point combination offers a solid basis for initial treatment, while the cluster groups provide options for personalization based on individual patient presentation. The predominance of specific points such as crossing points, five-shu points, and yuan-primary points offers additional guidance on point selection based on traditional Chinese medicine theory.