Abstract
Objective:
This retrospective analysis aimed to assess the effectiveness of auricular point acupressure therapy as an adjunct to conventional treatment for noise-induced tinnitus.
Methods:
The study retrospectively analyzed the data of patients with noise-induced tinnitus admitted to the Sandun branch of Zhejiang Hospital from June 2020 to June 2023 and included 100 patients for analysis. Based on the different treatments, the patients were divided into a conventional therapy group (methylcobalamin tablets for 4 weeks, n = 52) and an auricular point acupressure therapy group (methylcobalamin tablets and auricular point acupressure therapy for 4 weeks, n = 48). The baseline characteristics, tinnitus loudness, hearing thresholds, Tinnitus Handicap Inventory (THI), Tinnitus Evaluation Questionnaire (TEQ), and clinical efficacy were assessed before and after treatment.
Results:
After 4 weeks of treatment, compared with the patients in the conventional therapy group, those in the auricular point acupressure therapy group had an advantage in tinnitus loudness, hearing thresholds, and THI and TEQ scores, and the differences were statistically significant (P < 0.05). The clinical effectiveness in the auricular point acupressure therapy group was significantly higher than that in the conventional therapy group (P < 0.05).
Conclusion:
Auricular point acupressure therapy has a substantial effect on the treatment of noise-induced tinnitus. It is superior to conventional therapy in reducing tinnitus loudness and hearing thresholds. As a noninvasive therapy, auricular point acupressure has the potential to be an adjuvant therapy for noise-induced tinnitus.
Keywords: Tinnitus, Noise-induced, Acupuncture points, Retrospective study, Auricular
KEY MESSAGES
-
(1)
Auricular point acupressure therapy can reduce hearing thresholds and tinnitus loudness in patients with noise-induced tinnitus.
-
(2)
Compared with conventional therapy, auricular point acupressure therapy can improve the Tinnitus Handicap Inventory and Tinnitus Evaluation Questionnaire scores.
-
(3)
Auricular point acupressure therapy has better clinical efficacy than conventional therapy.
-
(4)
Auricular point acupressure therapy offers a noninvasive adjunctive treatment for noise-induced tinnitus.
INTRODUCTION
Tinnitus is usually defined as the perception of sound in the absence of the vibration of an elastic body.[1] It is a prevalent audiological symptom affecting a large portion of the general population, and it has an estimated prevalence of 10%–15% among adults; approximately 20% of these individuals experience bothersome tinnitus.[2,3] Noise-induced tinnitus is a form of tinnitus that arises from exposure to excessive noise, such as occupational or recreational noise, and accounts for a substantial portion of tinnitus cases.[4] The effect of noise-induced tinnitus extends beyond the auditory perception of sound and often results in functional impairment, emotional distress, and decreased quality of life among affected individuals.[5] Conventional treatments for noise-induced tinnitus include a combination of counseling, sound therapy, cognitive behavioral therapy (CBT), and even pharmacological care in some cases.[6] However, the effectiveness of these treatments can vary. Many patients may experience relief from these conventional therapies, but some may not obtain therapeutic effects. As a result, complementary and alternative treatments are being explored to augment the existing armamentarium for tinnitus management.
Auricular point acupressure therapy is a noninvasive technique derived from traditional Chinese medicine (TCM) that involves the application of acupressure to specific points on the ear to elicit therapeutic effects.[7] It is based on the principles of auricular acupuncture and acupressure, which postulate that the stimulation of specific points on the outer ear can influence the physiological and pathological processes of the body.[8] In the context of tinnitus, the proponents of auricular point acupressure posit that targeted pressure on auricular points can potentially mitigate tinnitus symptoms and improve overall well-being through regulatory effects on the nervous system, blood circulation, and energy balance.[9] Despite the theoretical underpinnings of auricular point acupressure in tinnitus, empirical evidence on its efficacy for noise-induced tinnitus remains limited and warrants further investigation. In this retrospective study, we conducted a series of tests in order to understand the effects of the treatment.
MATERIALS AND METHODS
Subject Selection and Grouping
This study was approved by the Institutional Review Board and Ethics Committee of The Sandun branch of Zhejiang Hospital (No. 2024LSD085K). All participants included in this study gave informed consent. The study retrospectively analyzed the data of noise-induced tinnitus patients admitted to the Sandun branch of Zhejiang Hospital from June 2020 to June 2023. Based on the different treatments, the patients were divided into conventional therapy (mecobalamin tablets alone, n = 52) and auricular point acupressure therapy (auricular point acupressure therapy combined with mecobalamin tablets, n = 48) groups. The subject selection and grouping process is shown in Figure 1.
Figure 1.
Flowchart of patient selection and grouping.
Inclusion and Exclusion Criteria
The inclusion criteria were as follows: clinical symptoms meeting the diagnostic requirements for noise-induced tinnitus;[10] normal cognitive function and consciousness; voluntary participation; suffering from noise-induced hearing loss, with hearing threshold ＞25 dB;[11] completed 4 weeks of treatment; complete medical records available; receiving auricular acupressure therapy for the first time.
The exclusion criteria were as follows: low compliance and cooperation, presence of other serious illnesses, history of mental illness, allergy to acupoint adhesive, and auditory or brain trauma.
Treatment Methods
The conventional therapy group was treated with 0.5 mg mecobalamin tablets (manufacturer: Eisai China Pharmaceutical Co., Ltd., Suzhou, Jiangsu, China) three times a day for 4 weeks. The auricular point acupressure therapy group received auricular pressure on the basis of methylcobalamin treatment. Auricular point acupressure patches made from Vaccaria seeds (manufacturer: Suzhou Acupuncture Products Co., Ltd., Suzhou, Jiangsu, China) were placed on the patients’ auricular points, including Shenmen, occiput, inner ear, external ear, and endocrine points [Figure 2]. Subsequently, the medical staff instructed the patients to use their thumbs and forefingers to press firmly and continuously on the abovementioned auricular points for 5 min at a time, 3–4 times a day. When the patients felt local swelling and pain in the auricular acupoints, they could reduce the intensity and frequency of pressing.
Figure 2.
Locations of auricular points. Note: The figure was plotted using WPS Office Excel 2021 (Jinshan Software Co., Ltd., Beijing, China).
Evaluation Indexes
General Information
The baseline data were obtained from the medical record system and mainly included age, gender, duration of tinnitus, duration of noise exposure, sleep quality, previous tinnitus treatments (hearing aids, CBT, sound therapy, and medication), occupational noise exposure levels, and hearing loss status. Sleep quality was assessed using the Chinese version of the Pittsburgh Sleep Quality Index (PSQI).[12] PSQI is the sum of seven components and range from 0 to 21 points in total, and a total score greater than 5 indicates poor sleep quality. The overall reliability coefficient for PSQI is reported to be between 0.82 and 0.83.
Tinnitus Loudness and Hearing Thresholds
Before and 4 weeks after the treatment, both groups underwent pure tone audiometry and tinnitus matching tests, which were implemented using the MADSEN SM950 audiometer (Copenhagen, Denmark) in a standard testing environment. The testing frequencies ranged from 125 Hz to 8000 Hz.
A psychological tinnitus test method was used for tinnitus loudness matching.[13] First, the patients were asked to adjust a pure tone in a frequency that matched the pitch of their tinnitus. Second, they were asked to adjust the loudness of the pure tone at the matched frequency starting from their hearing thresholds, with a 2–3 dB increment. The loudness of the pure tone perceived by the patient to be the same or close to the loudness of tinnitus is called tinnitus loudness, which is expressed in dBSL and marked on the audiogram.
In the hearing threshold test, a sufficiently intense auditory signal was initially presented to each subject. When a correct response was received from the subject, the intensity would decrease by 10 dB steps until no response was elicited. Subsequently, the intensity increased by 5 dB steps until a response was once again received. The criteria for assessing the average hearing threshold were as follows: normal hearing, ≤25 dB; mild hearing loss, 26–40 dB; moderate hearing loss, 41–60 dB; moderate-to-severe hearing loss, 56–70 dB; severe hearing loss, 61–80 dB; and profound hearing loss, ≥81 dB.[14]
Tinnitus Assessment Scales
The Tinnitus Handicap Inventory (THI) and Tinnitus Evaluation Questionnaire (TEQ) scores were collected from the hospital medical record system before and 4 weeks after treatment. THI reflects the degree of tinnitus-induced disability and consists of 25 questions covering multiple dimensions affected by tinnitus, such as hearing, emotions, sleep, social activities, and work. Each question is scored as follows: not affected, 0 point; occasionally affected, 2 points; often affected, 4 points. The total score range of THI is 0–100, and its Cronbach’s α coefficient ranges from 0.78 to 0.94.[15] Meanwhile, the TEQ score reflects tinnitus severity, and the total score ranges from 0 to 21 points. High scores indicate severe tinnitus. The Cronbach’s α coefficient of TEQ is 0.79.[16]
Clinical Efficacy
The patients’ treatment efficacy was assessed using tinnitus distress, which consists of six grades as follows: Grade 0: no tinnitus; Grade 1: occasional tinnitus that is not bothersome; Grade 2: persistent tinnitus that worsens in a quiet environment; Grade 3: persistent tinnitus even in noisy environments; Grade 4: persistent tinnitus with associated attention and sleep disturbances; Grade 5: severe, persistent tinnitus that makes the patient unable to work; and Grade 6: extreme tinnitus that causes suicidal tendencies.[17] Clinical efficacy was divided into three levels by comparing the grades of tinnitus distress before and 4 weeks after treatment. The three levels were as follows: significantly effective (tinnitus distress reduced by two grades or above), effective (tinnitus distress reduced by one grade), and ineffective (no change in the grades of tinnitus distress). The clinical effective rate was calculated using the following formula: (number of significantly effective + number of effective/total number of patients) × 100%.
Statistical Analysis
The data were analyzed using SPSS 29.0 software (SPSS Inc., Chicago, IL, the USA). Categorical variables were expressed as n (%). Pearson’s chi-square test was applied when the sample size was ≥40 and when the expected frequency (T) for each cell was ≥5. When the sample size was ≥40 but 1≤T<5, the chi-square test was adjusted using a correction formula. When the sample size was <40 or when the T value in one or more cells was <5, statistical analysis was conducted using Fisher’s exact test. The continuous variables were tested for the normal distribution by using the Shapiro–Wilk test. The continuous variables that conformed to the normal distribution were expressed as mean ± standard deviation. Independent t-test was used for comparison between groups, and paired t-test was employed for comparison within groups. The continuous variables that did not conform to the normal distribution were expressed as medians and quartiles (M [Q1, Q3] and assessed by the Mann–Whitney U test. P < 0.05 was considered statistically significant.
RESULTS
Baseline Data
No significant difference was found in the baseline data, such as age, gender, duration of tinnitus, duration of noise exposure, PSQI scores, previous tinnitus treatments, occupational noise exposure, and hearing loss, between the conventional and auricular point acupressure therapy groups (P > 0.05), as indicated in Table 1.
Table 1.
Comparison of the Baseline Data between the Two Groups.
| Parameters | Conventional Therapy Group (n = 52) | Auricular Point Acupressure Therapy Group (n = 48) | χ2/t/Z | P |
|---|---|---|---|---|
| Age (years) | 48.09±3.19 | 48.37±3.10 | 0.444 | 0.657 |
| Gender (male/female) | 29 (55.77%)/23 (44.23%) | 25 (52.08%)/23 (47.92%) | 0.137 | 0.712 |
| Duration of tinnitus (years) | 2.28±0.22 | 2.29±0.31 | 0.187 | 0.851 |
| Duration of noise exposure (years) | 3.11±0.27 | 3.12±0.31 | 0.172 | 0.863 |
| Sleep quality (PSQI scores) | 5.28±0.46 | 5.29±0.47 | 0.107 | 0.914 |
| Previous tinnitus treatments | 0.131 | 0.866 | ||
| Hearing aids | 12 (23.08%) | 10 (20.83%) | ||
| CBT | 12 (23.08%) | 10 (20.83%) | ||
| Sound therapy | 41 (78.85%) | 39 (81.25%) | ||
| Medication | 37 (71.75%) | 35 (72.92%) | ||
| Occupational noise exposure levels (dB) | 77.18±3.19 | 78.29±3.31 | 1.707 | 0.090 |
Notes: PSQI, Pittsburgh Sleep Quality Index; CBT, cognitive behavioral therapy.
Tinnitus Loudness and Hearing Threshold
After treatment, compared with the conventional therapy group, the auricular point acupressure therapy group exhibited statistically significantly reduced tinnitus loudness (P = 0.036) and hearing threshold (P = 0.027), as shown in Table 2.
Table 2.
Comparison of Tinnitus Loudness and Hearing Thresholds between the Two Groups before and after Treatment.
| Parameters | Time | Conventional Therapy Group (n = 52) | Auricular Point Acupressure Therapy Group (n = 48) | Z | P |
|---|---|---|---|---|---|
| Tinnitus loudness (dBSL) | Before treatment | 67.90 (64.82, 71.76) | 68.53 (63.63, 71.93) | −0.549 | 0.583 |
| After treatment | 52.88 (50.06, 56.33) | 48.58 (42.79, 48.73) | −2.096 | 0.036* | |
| Hearing thresholds (dB) | Before treatment | 45.04 (42.79, 48.73) | 45.48 (42.59, 47.89) | −0.125 | 0.923 |
| After treatment | 44.57 (42.59, 47.89) | 42.71 (40.41, 45.55) | −2.206 | 0.027* |
Note: *P < 0.05.
THI and TEQ Scores
Before treatment, no difference in THI and TEQ scores was observed between the two groups. After treatment, the THI and TEQ scores of the auricular point acupressure therapy group were significantly lower than those of the conventional therapy group (P < 0.001), as shown in Table 3.
Table 3.
Comparison of the THI and TEQ Scores between the Two Groups before and after Treatment.
| Parameters | Time | Conventional Therapy Group (n = 52) | Auricular Point Acupressure Therapy Group (n = 48) | t | P |
|---|---|---|---|---|---|
| THI | Before treatment | 44.98±3.19 | 45.01±3.36 | 0.045 | 0.963 |
| After treatment | 35.18±2.84 | 30.31±2.11 | 9.668 | <0.001* | |
| TEQ | Before treatment | 14.29±0.83 | 14.50±0.51 | 1.509 | 0.134 |
| After treatment | 12.12±0.29 | 9.32±0.23 | 53.201 | <0.001* |
Notes: THI, Tinnitus Handicap Inventory; TEQ, Tinnitus Evaluation Questionnaire; *P < 0.001.
Clinical Efficacy
According to the data shown in Table 4, the clinical effectiveness in the auricular acupressure point therapy group was significantly higher than that in the conventional therapy group (P = 0.035).
Table 4.
Clinical Efficacy Values of the Conventional and Auricular Point Acupressure Therapy Groups, n (%)
| Parameters | Significantly Effective | Effective | Ineffective | Clinical Effective Rate |
|---|---|---|---|---|
| Conventional Therapy Group (n = 52) | 13 (25.00%) | 25 (48.08%) | 14 (26.92%) | 38 (73.08%) |
| Auricular Point Acupressure Therapy Group (n = 48) | 23 (47.92%) | 20 (41.67%) | 5 (10.41%) | 43 (89.59%) |
| χ2 | 4.418 | |||
| P | 0.035* |
Note: * P < 0.05.
DISCUSSION
Effect of Auricular Acupressure Therapy
The effectiveness of auricular acupressure therapy in noise-induced tinnitus has elicited increasing interest in the field of otolaryngology.[18] The results of this study indicate that auricular acupressure therapy may considerably reduce the severity of tinnitus and the related emotional distress and suffering it causes to patients, compared with conventional pharmacological therapy alone. The use of standardized outcome measures strengthens the evidence supporting the efficacy of auricular acupressure therapy.
According to basic TCM theories, the occurrence of tinnitus is often related to impeded qi and blood circulation. Acupressure on auricular points can promote blood circulation in the ears and throughout the body, thereby improving conditions of qi and blood stagnation.[19] In a clinical study, Schlee et al.[20] evaluated the effectiveness of auricular massage therapy in alleviating tinnitus symptoms. Relief was achieved by massaging specific auricular points, which was consistent with the findings of this study.
This study applied pressure on the auricular points, including occiput, Shenmen, and endocrine points, of patients with noise-induced tinnitus. These auricular points are closely related to the functions of many viscera, including the heart, liver, gallbladder, and spleen, and exert an alleviating effect on tinnitus symptoms. According to TCM theories, the common cause of tinnitus is kidney disorder.[21] Applying acupressure on the inner and outer ear points clears and benefits the ears, dispels wind and heat, clears the head, nourishes yin, and suppresses yang. Additionally, auricular acupressure can accelerate the dilation of blood vessels in the ears, increase blood flow velocity, and thus promote blood circulation.[22] For instance, hormone levels can be regulated by pressing the endocrine point, which is the reflex area of the endocrine system, thereby relieving noise-induced tinnitus caused by endocrine disorders.
After 4-week treatment, the auricular acupressure therapy group experienced substantial reductions in THI and TEQ scores compared with the conventional therapy group. The THI score reflects the effect of tinnitus on patients’ daily life by assessing their concentration, hearing, emotions, work, and social activities.[23] TEQ consists of six questions about the characteristics of tinnitus and related emotional and mental health issues.[24] THI is a widely used tool internationally, and TEQ is a Mandarin tinnitus evaluation questionnaire that is closely aligned with the actual situation and clinical needs of Chinese patients with tinnitus. Both scales can be used as tools to evaluate the degree of tinnitus-related clinical symptoms and emotional distress.
The improvements observed in the auricular acupressure therapy group after treatment in this study indicated that auricular acupressure therapy can address the multifaceted burden of tinnitus. The harmonizing effect on qi and blood circulation helps alleviate tinnitus symptoms and enhances the nutritional supply and metabolic levels in the ears. These findings align with the broad goals of tinnitus management proposed by Grundfast and Jamil.[25] These goals aim to reduce the perceptual aspects of tinnitus and mitigate its related functional and psychological effects on individuals.
Limitations
The results of this study showed that auricular point acupressure therapy has a positive effect on patients with noise-induced tinnitus, but this effect and the underlying factors that influence clinical efficacy were not deeply explored. We plan to employ biomarkers and imaging methods in our future studies to evaluate the regulatory effects of auricular acupressure therapy on the nervous system and blood circulation. We will also conduct randomized controlled clinical trials and enlarge the sample size to improve the reliability and generalizability of the findings. Furthermore, the long-term efficacy of auricular acupressure therapy and its combination with other therapies should be examined to further optimize auricular acupressure therapy and provide a reliable basis for clinical practice.
CONCLUSION
In summary, this study proved that auricular point acupressure therapy has high clinical efficacy and can reduce the loudness of tinnitus and its effect on daily life and psycho-emotional symptoms. As a noninvasive therapy, auricular point acupressure therapy has the potential to be an adjuvant treatment for noise-induced tinnitus.
Ethics Approval and Consent to Participate
This study has been approved by the Ethics Review Committee of the Sandun branch of Zhejiang Hospital (Approval No.: 2024LSD085K). All participants included in this study gave informed consent.
Author Contributions
QC designed the study; all authors conducted the study; HL collected and analyzed the data; QC, HL, and JQ participated in drafting the manuscript, and all authors contributed to the critical revision of the manuscript for important intellectual content. All authors gave final approval of the version to be published. All authors participated fully in the work, take public responsibility for appropriate portions of the content, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or completeness of any part of the work are appropriately investigated and resolved.
Availability of Data and Materials
The datasets used and/or analyzed during the current study were available from the corresponding author upon reasonable request.
Conflicts of Interest
The authors declare no conflicts of interest.
Acknowledgment
Not applicable.
Funding Statement
This research received no external funding.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets used and/or analyzed during the current study were available from the corresponding author upon reasonable request.
