Current Research in Acupuncture Treatment for Sudden Sensorineural Hearing Loss
Shan-Hong Wu3 and Chen Jei Tai1,2,3,4*
1Graduate Institute of Clinical Medicine, Taipei Medical University, Taiwan
2Department of Obstetrics and Gynecology, Taipei Medical University, Taiwan
3Department of Traditional Chinese Medicine, Taipei Medical University Hospital, Taiwan
4Traditional Herbal Medicine Research Center, Taipei Medical University Hospital, Taiwan
Submission: May 23, 2017; Published: June 08, 2017
*Corresponding author: Chen Jei Tai, Department of Traditional Chinese Medicine, Taipei Medical University Hospital, No.252, Wuxing St., Xinyi Dist., Taipei City 110, Taiwan, Tel: +886-2-27372181-3102; Email: chenjtai@tmu.edu.tw
How to cite this article: Shan-Hong W, Chen J T. Current Research in Acupuncture Treatment for Sudden Sensorineural Hearing Loss. J Complement Med Alt Healthcare. 2017; 2(3): 555590. DOI: 10.19080/JCMAH.2017.02.555590
Abstract
Sudden sensorineural hearing loss (SSNHL) is defined as a sensorineural hypoacusis of at least 30 dB over 3 continuous speech frequencies within 3 days. The risk factors and the etiology for idiopathic SSNHL are still uncertain. Currently Steroids are the most commonly used treatment for SSNHL but the effectiveness of glucocorticoids remains conflicted. Previous research showed interventions combining acupuncture with western medicine comprehensive treatment (WMCT) had more efficacious results in the treatment of SSNHL than western medicine comprehensive treatment alone. The effective outcome of acupuncture may be the improvement of local blood circulation and promotion blood flow to the ear, enhancement of blood circulation and blood flow in the ear and the increasing of oxygen supply of the ear. Even though the mechanism of acupuncture is unclear, the combination of acupuncture and WMCT has better effectiveness than WMCT alone.
Keywords: Sudden sensorineural hearing loss; Acupuncture; Traditional chinese medicine; Qi stagnation; Acupoints
Abbreviations: SSNHL: Sudden Sensorineural Hearing Loss; WMCT: Western Medicine Comprehensive Treatment
Introduction
Sudden sensorineural hearing loss (SSNHL) is defined as a sensorineural hypoacusis of at least 30 dB over 3 continuous speech frequencies within 3 days [1] and affects 5 to 20 per 100,000 populations, with nearly 4000 new cases per year in the United States [2]. SSNHL can occur at any age, nevertheless most commonly affects patients 43 to 53 years of age [3] and similar numbers of men and women are affected [4]. Risk factors for idiopathic SSNHL are still uncertain [5]. The etiology of most cases of SSNHL is also unclear [6]. Assumptive causes for idiopathic SSNHL include viral cochleitis, microvascular events [7] and autoimmune disorders [8,9]. A research showed an association of genes related to prothrombotic states and promoted serum levels of fibrinogen and homocysteine in patients with SSNHL offered a multifactorial basis for microvascular events as a cause of SSNHL [9]. Strong evidence for the efficacy of any treatment option for the patients with SSNHL currently is not available.
Western Medicine Comprehensive Treatment
Steroids are the most commonly used treatment for SSNHL [10] and may be administered systemically or locally via intratympanic installation. Oral glucocorticoids have been considered standard therapy for SSNHL; however, the benefit of these drugs is unclear. Systematic reviews and meta-analyses conclude that the effectiveness of glucocorticoids remains conflicted [11,12]. Some retrospective series studies indicated about 40% patients do not provide a fully response to systemic steroids treatment [13]. Many therapies have been evaluated including intratympanic steroid [14], hyperbaric oxygen therapy [15], antiviral medication [16-18] and plasmapheresis [19].
But evidence for the efficacy of any treatment modality is not strong enough that no official guidelines or position statements from professional organizations concerning the evaluation and treatment of SSNHL [11,20]. The prognosis for SSNHL is reasonably well, especially if it is a high- or low-frequency hearing loss pattern; nevertheless the prognosis is poor in patients whose profound hearing loss across all frequencies [21]. Previous studies showed rates of hearing recovery following audiogram within the first few days of onset is 87%, with a week, 87%, 2 weeks 52% and 10% or less after 3 months [22-28].
Acupuncture Intervention
Previous research showed interventions combining acupuncture with western medicine comprehensive treatment (WMCT) had more efficacious results in the treatment of SSNHL than western medicine comprehensive treatment alone [29]. Some researchers also confirmed the good effects in the treatment of SSNHL based on placebo-controlled trials [30,31]. Thus, earlier acupuncture interventions may lead to better prognosis. For Cases of SSNHL who took corticosteroid as therapy for at least 21 days but didn't improve, acupuncture can provide effective result [32].
Discussion
According to traditional Chinese medicine theory, SSNHL is caused by wind-cold, wind-heat, hyperactivity of liver-fire, yin deficiency and yang excess, Qi stagnation and blood stasis and stagnation of phlegm-fire [33]. These factors are considered to disturb the Yin-Yang balance in humans' bodies, while acupuncture is a useful treatment to balance these imbalance conditions. The effective outcome of acupuncture may be the improvement of local blood circulation and promotion blood flow to the ear [34].
Previous research suggested that acupuncture performed by stimulating acupoints may enhance blood circulation and blood flow in the ear and simultaneously increase the oxygen supply of the ear. These could be the important factors which promote auditory recovery [29]. Besides, acupuncture can decrease blood viscosity, which might be a mechanism that acupuncture could treat SSNHL [35]. Some studies suggested that acupuncture at acupoints around the ear could reduce blood viscosity, improve lymph circulation, regulate the inflammatory response and promote the excitability and conductivity of the auditory nerve [29,30].
Conclusion
Even though the mechanism of acupuncture is unclear, the combination of acupuncture and WMCT has better effectiveness than WMCT alone. In order to confirm the current findings regarding acupuncture as an intervention to SSNHL patients more RCTs and clinical evidence are appreciated.
References
- Schreiber BE, Agrup C, Haskard DO, Luxon LM (2010) Sudden sensorineural hearing loss. Lancet 375(9721): 1203-1211.
- Stachler RJ, Chandrasekhar SS, Archer SM, Rosenfeld RM, Schwartz SR, et al. (2012) Clinical practice guideline: sudden hearing loss. Otolaryngol Head Neck Surg 146(3 Suppl): S1-35.
- Rauch SD (2008) Idiopathic Sudden Sensorineural Hearing Loss. New England Journal of Medicine 359(8): 833-840.
- Fetterman BL, Luxford WM, Saunders JE (1996) Sudden bilateral sensorineural hearing loss. Laryngoscope 106(11): 1347-1350.
- Nakashima T, Tanabe T, Yanagita N, Wakai K, Ohno Y (1997) Risk factors for sudden deafness: a case-control study. Auris Nasus Larynx 24(3): 265-270.
- Chau JK, Lin JR, Atashband S, Irvine RA, Westerberg BD (2010) Systematic review of the evidence for the etiology of adult sudden sensorineural hearing loss. Laryngoscope 120(5): 1011-1021.
- Yueh B, Shapiro N, MacLean CH, Shekelle PG (2003) Screening and management of adult hearing loss in primary care: scientific review. JAMA 289(15): 1976-1985.
- Toubi E, Kessel A, Halas K, Sabo E, Luntz M, et al. (2004) Immune- mediated disorders associated with idiopathic sudden sensorineural hearing loss. Ann Otol Rhinol Laryngol 113(6): 445-449.
- Baek MJ, Park HM, Johnson JM, Altuntas CZ, Jane-Wit D, et al. (2006) Increased frequencies of cochlin-specific T cells in patients with autoimmune sensorineural hearing loss. J Immunol 177(6): 42034210.
- Labus J, Breil J, Stutzer H, Michel O (2010) Meta-analysis for the effect of medical therapy vs. placebo on recovery of idiopathic sudden hearing loss. Laryngoscope 120(9): 1863-1871.
- Wei BP, Stathopoulos D, O'Leary S (2013) Steroids for idiopathic sudden sensorineural hearing loss. Cochrane Database Syst Rev (7): CD003998.
- Crane RA, Camilon M, Nguyen S, Meyer TA (2015) Steroids for treatment of sudden sensorineural hearing loss: a meta-analysis of randomized controlled trials. Laryngoscope 125(1): 209-217.
- Parnes LS, Sun AH, Freeman DJ (1999) Corticosteroid pharmacokinetics in the inner ear fluids: an animal study followed by clinical application. Laryngoscope 109(Pt 2): 1-17.
- Wu HP, Chou YF, Yu SH, Wang CP, Hsu CJ, et al. (2011) Intratympanic steroid injections as a salvage treatment for sudden sensorineural hearing loss: a randomized, double-blind, placebo-controlled study. Otol Neurotol 32(5): 774-779.
- Imsuwansri T, Poonsap P, Snidvongs K (2012) Hyperbaric oxygen therapy for sudden sensorineural hearing loss after failure from oral and intratympanic corticosteroid. Clin Exp Otorhinolaryngol 5 (Suppl 1): S99-S102.
- Stokroos RJ, Albers FW, Tenvergert EM (1998) Antiviral treatment of idiopathic sudden sensorineural hearing loss: a prospective, randomized, double-blind clinical trial. Acta Otolaryngol 118(4): 488495.
- Uri N, Doweck I, Cohen-Kerem R, Greenberg E (2003) Acyclovir in the treatment of idiopathic sudden sensorineural hearing loss. Otolaryngol Head Neck Surg 128(4): 544-549.
- Tucci DL, Farmer JC, Jr., Kitch RD, Witsell DL (2002) Treatment of sudden sensorineural hearing loss with systemic steroids and valacyclovir. Otol Neurotol 23(3): 301-308.
- Bianchin G, Russi G, Romano N, Fioravanti P (2010) Treatment with HELP-apheresis in patients suffering from sudden sensorineural hearing loss: a prospective, randomized, controlled study. Laryngoscope 120(4): 800-807.
- Conlin AE, Parnes LS (2007) Treatment of sudden sensorineural hearing loss: II. A Meta-analysis. Arch Otolaryngol Head Neck Surg 133(6): 582-586.
- Wen YH, Chen PR, Wu HP (2014) Prognostic factors of profound idiopathic sudden sensorineural hearing loss. Eur Arch Otorhinolaryngol 271(6):1423-1429.
- Byl FM (1984) Sudden hearing loss: eight years' experience and suggested prognostic table. Laryngoscope 94(Pt 1): 647-661.
- Fetterman BL, Saunders JE, Luxford WM (1996) Prognosis and treatment of sudden sensorineural hearing loss. Am J Otol 17(4): 529536.
- Nosrati-zarenoe R, Arlinger S, Hultcrantz E (2007) Idiopathic sudden sensorineural hearing loss: results drawn from the Swedish national database. Acta Oto-Laryngologica 127(11): 1168-1175.
- Shaia FT, Sheehy JL (1976) Sudden sensori-neural hearing impairment: a report of 1,220 cases. Laryngoscope 86(3): 389-398.
- Simmons FB (1973) Sudden idiopathic sensori-neural hearing loss: some observations. Laryngoscope 83(8): 1221-1227.
- Xenellis J, Karapatsas I, Papadimitriou N, Nikolopoulos T, Maragoudakis P, et al. (2006) Idiopathic sudden sensorineural hearing loss: prognostic factors. J Laryngol Otol 120(9): 718-724.
- Zadeh MH, Storper IS, Spitzer JB (2003) Diagnosis and treatment of sudden-onset sensorineural hearing loss: a study of 51 patients. Otolaryngol Head Neck Surg 128(1): 92-98.
- Zhang XC, Xu XP, Xu WT, Hou WZ, Cheng YY, et al. (2015) Acupuncture therapy for sudden sensorineural hearing loss: a systematic review and meta-analysis of randomized controlled trials. PLoS One 10(4): e0125240.
- Fan XH, Ding YN, Chang XH, Ouyang YL, Xie Q (2010) Comparative observation on acupuncture-moxibustion and western medication for treatment of sudden deafness. Zhongguo Zhen Jiu 30(8): 630-632.
- Ji J, Fang XL (2008) Clinical observation on warming-removing obstruction needling method for treatment of sudden tinnitus and deafness. Zhongguo Zhen Jiu 28(5): 353-355.
- Yin CS, Park HJ, Nam HJ (2010) Acupuncture for refractory cases of sudden sensorineural hearing loss. J Altern Complement Med 16(9): 973-978.
- Su CX, Yan LJ, Lewith G, Liu JP (2013) Chinese herbal medicine for idiopathic sudden sensorineural hearing loss: a systematic review of randomised clinical trials. Clin Otolaryngol 38(6): 455-473.
- Luo RH, Zhou J, Huang YS, Xu K (2009) Observation on therapeutic effect of electroacupuncture for treatment of sudden hearing loss. Zhongguo Zhen Jiu 29(3): 185-187.
- Changhai W, Lanwen Y, Hongcai W (2003) Effect of acupuncture treatment on hemorheology in the patient of sudden deafness. Chinese Acupuncture & Moxibustion 2: 012.