Effectiveness of acupuncture therapy as treatment for tinnitus: a randomized controlled trial

Braz J Otorhinolaryngol. 2016;82(4):458---465 Brazilian Journal of OTORHINOLARYNGOLOGY www.bjorl.org ORIGINAL ARTICLE Effectiveness of acupuncture therapy as treatment for tinnitus: a randomized controlled trial夽 Marcelo Yugi Doi a,b,∗ , Simone Sayomi Tano a,b , Adriane Rocha Schultz a,b , Ricardo Borges c,d , Luciana Lozza de Moraes Marchiori a,b a Rehabilitation Science Program Associate, Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil Universidade Norte do Parana (UNOPAR), Londrina, PR, Brazil c Faculdade de Medicina, Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil d Medical Residency Program Supervisor in Otolaryngology, Hospital Universitário de Londrina (UEL), Londrina, PR, Brazil b Received 31 March 2016; accepted 13 April 2016 Available online 30 April 2016 KEYWORDS Acupuncture therapy; Tinnitus; Quality of life; Randomized controlled trial; Rehabilitation Abstract Introduction: Tinnitus is a subjective sensation of hearing a sound in the absence of an external stimulus, which significantly worsens the quality of life in 15---25% of affected individuals. Objective: To assess the effectiveness of acupuncture therapy for tinnitus. Methods: Randomized clinical trial (REBEC: 2T9T7Q) with 50 participants with tinnitus, divided into two groups: 25 participants in the acupuncture group and 25 participants in the control group. The acupuncture group received acupuncture treatment and the control group received no treatment. After a period of 5 weeks, they were called to perform the final evaluation and the control group received acupuncture treatment for ethical reasons. Results: A statistically significant result was found for the primary outcome, reducing the intensity of tinnitus, with p = 0.0001 and the secondary endpoint, showing improvement in quality of life, with p = 0.0001. Conclusion: Chinese scalp acupuncture associated with bilateral electroacupuncture demonstrated, in the short term, a statistically significant improvement by reducing the level of tinnitus intensity, as well as improving the quality of life of individuals with tinnitus. © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/). 夽 Please cite this article as: Doi MY, Tano SS, Schultz AR, Borges R, Marchiori LLM. Effectiveness of acupuncture therapy as treatment for tinnitus: a randomized controlled trial. Braz J Otorhinolaryngol. 2016;82:458---65. ∗ Corresponding author. E-mail: (M.Y. Doi). http://dx.doi.org/10.1016/j.bjorl.2016.04.002 1808-8694/© 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). Acupuncture therapy as treatment for tinnitus PALAVRAS-CHAVE Terapia por acupuntura; Zumbido; Qualidade de vida; Ensaio clínico controlado aleatório; Reabilitação 459 Efetividade da terapia por acupuntura como tratamento para o zumbido: ensaio clínico aleatorizado Resumo Introdução: O zumbido é a sensação subjetiva de ouvir um som na ausência de um estímulo externo e piora significativamente a qualidade de vida de 15%---25% das pessoas afetadas. Objetivo: Verificar a efetividade da terapia por acupuntura em indivíduos com zumbido. Método: Ensaio clínico aleatorizado com 50 participantes com zumbido, divididos em dois grupos: 25 participantes no Grupo da Acupuntura (GA) e 25 participantes do Grupo de Controle (GC). O GA recebeu tratamento com a craniopuntura chinês e o GC não recebeu nenhum tratamento. Após o período de 5 semanas, eles foram chamados para realizar a avaliação final e o GC recebeu tratamento de acupuntura por questões éticas de pesquisa. Resultados: Foi encontrado resultado estatisticamente significativo para o desfecho primário, reduzindo a intensidade do zumbido, com p = 0,0001 e o desfecho secundário, apresentando melhora na qualidade de vida, com p = 0,0001. Conclusão: A craniopuntura chinesa associada à eletroacupuntura bilateral nos mostrou no curto prazo, uma melhora estatisticamente significativa, reduzindo o nível de intensidade do zumbido, bem como melhorando a qualidade de vida dos indivíduos com zumbido. © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Publicado por Elsevier Editora Ltda. Este é um artigo Open Access sob uma licença CC BY (http:// creativecommons.org/licenses/by/4.0/). Introduction Tinnitus is a symptom defined as the perception of sound without the presence of an external sound source.1 It is estimated that approximately 5---15% of the population has of some type of tinnitus and, although it can occur at any age, it is more prevalent among the elderly (mainly in those aged between 60 and 69 years) than in young adults.2 In a study on the incidence of tinnitus, Nondahl et al.3 followed a group of 2922 adult and elderly individuals, aged 48---92 years, for 10 years. During the first 5 years of followup in this same group, they observed that the incidence of tinnitus in the assessed population was 5.7%.4 After 10 years, the authors found that the incidence had more than doubled, reaching 12.7%.3 In Brazil, it is estimated that 17% of the population is affected by tinnitus, i.e., more than 28 million Brazilians.5 Santos et al.6 evaluated 406 patients in a 6 month period and found that 58% had a tinnitus complaint; of these, 68% were females and 32% males. In a study carried out by Gibrin et al.7 in 2012, the authors evaluated 519 individuals of both genders with a median age of 69 years and found a prevalence of 42.77% for tinnitus complaints. It is currently believed that tinnitus occurs as a result of the dynamic interaction of several centers of the nervous and the limbic system, and that cochlear alterations and/or lesions are the precursors of this process, causing imbalance in the lower auditory pathways, resulting in abnormal neuronal activity, further enhanced by the central nervous system, and finally perceived as tinnitus.8 Several etiologies have been proposed, including otologic, dental, neurological, psychiatric diseases, cervical spine and metabolic disorders, as well as others related to the intake of drugs, caffeine, alcohol, and tobacco.9 However, the physiopathological mechanisms of tinnitus are not well-defined, and therefore the treatment remains a major challenge to date. Symptom subjectivity and the wide etiological variety, often seen in the same patient, make it difficult to obtain good results.9 Moreover, currently, no one specific treatment, including drug therapy, is considered effective in treating the symptoms of tinnitus.10 Complementary and alternative medicine has often been used to treat tinnitus, and acupuncture is one of the most often-used options.10 Acupuncture is a therapeutic method that involves the insertion and manipulat (...truncated)