Peripheral vestibular vertigo — including syndromes such as Ménière’s disease, vestibular neuritis, and BPPV post-resolution with residual symptoms — represents one of the most disabling complaints in otolaryngology. Conventional treatment includes sodium restriction (Ménière’s), diuretics, betahistine, repositioning maneuvers (BPPV), vestibular rehabilitation, and, in refractory cases, intratympanic injection of gentamicin or surgery. In parallel, acupuncture has been investigated as adjuvant therapy, especially for modulation of chronic dizziness perception and reduction of episode frequency.
What the Literature Shows
The meta-analyses converge on a moderate benefit of acupuncture as an adjuvant to conventional treatment, with reduction in DHI scales and self-reported episode frequency. The effect is more consistent when acupuncture is combined with betahistine or vestibular rehabilitation than as monotherapy. In patients with residual chronic dizziness after resolution of the acute vestibular component, acupuncture may contribute to reducing the subjective perception of instability — possibly via modulation of the multisensory processing network.
POOLED EFFECT SIZES (TANG ET AL. 2024, FRONT MED — 6 RCTS)
MANAGEMENT OF PERIPHERAL VESTIBULAR VERTIGO
| CAUSE | 1ST-LINE TREATMENT | ADJUVANTS |
|---|---|---|
| BPPV (canalithiasis) | Repositioning maneuver (Epley, Semont) | Vestibular rehabilitation |
| Ménière’s disease | Sodium restriction, diuretics, betahistine | Rehabilitation; adjuvant acupuncture |
| Vestibular neuritis | Short-course corticosteroid, early vestibular rehabilitation | Acupuncture for residual chronic dizziness |
| Subjective chronic dizziness | Vestibular rehabilitation + anxiety management | CBT; adjuvant acupuncture |
| Refractory | Specialized otolaryngologic assessment | Consider intratympanic gentamicin/surgery |
Mandatory investigation
Rule out active BPPV, vestibular schwannoma, and central causes before chronic treatment.
Rehabilitation as the pillar
Vestibular rehabilitation remains the intervention with the highest level of evidence.
Anatomic care
High cervical needling requires adequate technique to avoid sensitive vascular zones.
Limitations of the Evidence
Heterogeneity of the trials is high — diagnostic criteria vary (definite vs. probable Ménière’s, generic peripheral vestibular vertigo), as do modalities and point protocols. Few studies have follow-up > 6 months, and objective audiologic outcomes (audiometry, electrocochleography, VEMP) are rarely included. The separation between peripheral vestibular component and central processing of chronic dizziness is not always clear in the trials.
Fonte Original
Frontiers in Medicine(em inglês)Founded in 1989 by physicians trained at the University of São Paulo (USP) and specialized in China, CEIMEC is a Brazilian national reference in the teaching and practice of medical acupuncture. With more than 3,000 physicians trained over 35 years, it collaborates with HC-FMUSP and is recognized by the Brazilian Medical College of Acupuncture (CMBA/AMB).
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