Effect of acupuncture on tinnitus severity index in the elderly with non-pulsating tinnitus

This randomized controlled study investigated the efficacy of manual acupuncture as a complementary treatment for idiopathic non-pulsating subjective tinnitus in older adults. Idiopathic tinnitus represents a significant clinical challenge, especially in the geriatric population, where it affects about 33% of individuals and causes substantial negative impacts on quality of life, including frustration, anxiety, depression, concentration difficulties, insomnia, and interference in social interactions.

The study included 40 patients of both sexes, aged 65 years or older, who had non-pulsating tinnitus for more than three consecutive months. Participants were recruited from the otolaryngology outpatient clinic of Al-Iman Charitable Hospital in Benha City and randomized into two groups of 20 patients each. The exclusion criteria were rigorous, eliminating patients with objective pulsating tinnitus, Ménière's disease, ear tumors, otitis media, cochlear lesions, hearing loss, use of ototoxic medications, diabetes, hypertension, mental illness, or previous alternative treatment in the last three months.

The acupuncture protocol was based on previous studies and principles of traditional Chinese medicine. The intervention group received manual acupuncture for 30 minutes, three times a week for four weeks, using 14 specific points: TE-3, TE-5, TE-17, TE-18, TE-19, TE-20, TE-21, TE-22, GB-2, GB-8, GB-20, LI-4, KI-3, and ST-36. The selection of these points followed the theory of meridians, including periauricular, distal, and proximal points to maximize therapeutic response. Sterile stainless steel needles were inserted perpendicularly to a depth of 5-10 mm, except at the GB-20 point.

The protocol included manual manipulation with rapid counterclockwise rotations every five minutes to obtain de qi, a sensation considered essential for the efficacy of acupuncture.

The results were measured through two validated scales: the Visual Analog Scale of Tinnitus Intensity (VAS-T) and the Tinnitus Severity Index (TSI). The TSI contains 12 questions that evaluate the subjective impact of tinnitus on quality of life, with scores ranging from 12 to 60 points. Evaluations were performed before and after the four-week treatment period.

The results demonstrated significant efficacy of acupuncture. In the intervention group, the VAS-T decreased from 8.27 ± 1.45 to 3.20 ± 1.36 (p < 0.001), representing a 61.3% improvement. The TSI decreased from 44.30 ± 3.40 to 27.95 ± 4.18 (p < 0.001), indicating a 36.9% improvement. In contrast, the control group did not present statistically significant changes in any of the measures.

The comparative analysis between groups showed a highly significant difference favoring the acupuncture group (p = 0.0001).

The proposed mechanisms to explain these results include modulation of the autonomic nervous system, somatosensory stimulation, effects on the olivocochlear nucleus, serotonergic modulation in the limbic system, reduction of pericranial muscle tension, release of endogenous opioids, and improvement of local circulation. According to traditional Chinese medicine, tinnitus is related to yin-yang imbalance of the kidney and gallbladder meridians in the auricular region.

The clinical implications are relevant, considering that conventional pharmacological treatments for idiopathic tinnitus have limited efficacy. Acupuncture emerges as a safe and effective complementary therapy, especially valuable in the geriatric population. The study confirms results from previous research that demonstrated benefits of acupuncture in the treatment of chronic tinnitus.

Limitations include the small sample size and the absence of long-term follow-up to assess the durability of benefits. Future studies with larger samples, different age groups, and more extensive follow-up periods are necessary to consolidate this evidence and establish optimized treatment protocols.