Abstract
Background:
Sudden sensorineural hearing loss (SSNHL) is commonly characterized by severe hearing loss of 30 dB or greater over at least three consecutive frequencies occurring within a 72-h period. Current treatments, depending on the cause, include decompression of tumor-related pressure, administration of anti-infection agents, cessation of ototoxic drugs, neuronutrition, administration of prednisone, and hyperbaric oxygen. Some patients may recover spontaneously, usually within 2 weeks of onset. Here, we present a case that the patient’s symptoms improved significantly after treatment with electroacupuncture.
Objective:
To report a case of SSNHL treated with electroacupuncture (EA) and to discuss its potential effects on hearing recovery of SSNHL.
Design:
A single case report.
Setting:
Department of Acupuncture and Moxibustion, Shaanxi Provincial Hospital of Traditional Chinese Medicine, Xi’an, China.
Patients:
A patient with SSNHL who experienced a significant decrease in left ear hearing.
Intervention:
EA treatment on the affected ear of an SSNHL patient; eight acupoints were divided into four groups (SJ21(Ermen)-GB10(Fubai), SJ19(Tinggong)-GB11(Touqiaoyin), GB2(Tinghui)-SJ17(Yifeng), and GV20(Baihui)- EX-HN3 (Yintang), with each group receiving 30 min of electrical stimulation (2 Hz, continuous wave, alternating current, 2 mA). This treatment was administered five times a week for 2 weeks.
Main Outcome Measures:
Pure-Tone Audiometry.
Results:
After 2 weeks of EA treatment, the patient’s hearing has improved from severe hearing loss to moderate hearing loss, with a significant improvement in daily communication ability.
Conclusions:
Electroacupuncture may be a promising complementary treatment for SSNHL.
Registration and Funding:
The study was not registered, and no funding was received.
Keywords: electroacupuncture, traditional Chinese medicine, complementary and alternative medicine
BACKGROUND
Sudden sensorineural hearing loss (SSNHL) is an abrupt-onset ear disease that results in a significant reduction in hearing ability within 72 h and is characterized by continuous impairment of three consecutive frequencies amounting to 30 decibels or greater.1 The prevalence of SSNHL has risen steadily in recent years. Current data indicates that the incidence of SSNHL in the United States stands at 27 cases per 100,000 individuals, which is significantly higher than the 5–20 cases per 100,000 individuals recorded in 1996.2 According to epidemiological surveys conducted in China, there has been a steady increase in the number of patients hospitalized for SSNHL in recent years.3 The current discourse surrounding the etiology of SSNHL primarily centers on the hypothesis of vascular and nerve damage.4 Clinical physicians use multiple combination therapies to treat SSNHL, such as decompression of tumor-related pressure, administration of anti-infection agents, cessation of ototoxic drugs, neuronutrition, administration of prednisone, and hyperbaric oxygen.4 Some researchers have also shown that SSNHL has the possibility of spontaneous recovery, but 40% of untreated patients do not recover their hearing, and active treatment is recommended to improve symptoms and prevent complications.5 In China, electroacupuncture (EA) in the treatment of SSNHL is considered effective, and some clinical trials support this claim.6–8 Here, we introduce a clinical case of SSNHL in which we treated the patient with EA, and her hearing loss improved.
Case Presentation
The patient, a 63-year-old female, boarded a plane on May 12, 2023, and had a pleasant flight without experiencing any abnormally loud sounds or barotrauma. On May 17th, 2023, the patient noticed a significant decrease in left ear hearing and urgently came to our hospital for treatment. We inquired about the patient’s medical history and found that she had been in good health with no major medical issues and had not taken any potentially ototoxic drugs. In the past week, there have been no symptoms such as fever, ear pain, tinnitus, dizziness, or eye pain. The patient now has mild communication barriers and no other obvious discomfort except for hearing loss. Physical examination also showed no obvious neurological symptoms. Otoscopy revealed that the left external ear canal was not obstructed and the left tympanic membrane was intact. No obvious abnormalities were found in the inner ear MRI examination. Acoustic impedance examination indicates that the tympanogram is of type A. Pure-Tone Audiometry report ruled out conductive hearing loss. Overall, we thought the patient had SSNHL. The patient refused prednisone and other pharmacologic treatments. She had a high acceptance of acupuncture. Therefore, on the morning of March 18th, 2023, we administered EA treatment to the patient.
Electroacupuncture Treatment
The patient was instructed to lie on their left side while a doctor disinfected the acupoints twice at the center point using a 75% ethanol-soaked cotton ball in an outward circular motion. Stainless steel needles (size: 0.25 mm × 40 mm, Suzhou Medical Supplies Factory Ltd., China) were inserted to a depth of 10–15 mm at the following acupoints: SJ21(Ermen), SJ19(Tinggong), GB2(Tinghui) and SJ17(Yifeng), then inserted acupoints horizontally to a depth of 5–8 mm into GV20(Baihui), EX-HN3 (Yintang), GB10(Fubai), GB11(Touqiaoyin). Subsequently, the doctor utilized acupuncture techniques, such as rotation and lifting, to generate a feeling of swelling, numbness, or burning at the acupoints. Then eight acupoints were divided into four groups (SJ21(Ermen)-GB10(Fubai), SJ19(Tinggong)-GB11(Touqiaoyin), GB2(Tinghui)-SJ17(Yifeng), and GV20(Baihui)- EX-HN3 (Yintang)), with each group receiving 30 min of electrical stimulation (2 Hz, continuous wave, alternating current, 0.5 mA). This treatment was administered five times a week for 2 weeks without other treatments. (The acupoints for EA stimulation mentioned above are all selected on the left side, which is the affected side).
Clinical Outcome
After two weeks of EA treatment, we compared the patient’s Pure-Tone Audiometry results before and after treatment. Conductive hearing loss was again ruled out. Prior to treatment, the left ear’s air conduction measured between 45 dB and 65 dB and bone conduction between 65 dB and 75 dB. We calculated the average hearing thresholds for bone conduction and auditory conduction separately, ranging from 65 dB to 70 dB, which is consistent with the diagnosis of severe hearing loss. After electroacupuncture for two weeks of treatment, the left ear’s air conduction measured between 35 dB and 60 dB and bone conduction between 15 dB and 45 dB. We calculated the average hearing thresholds for bone conduction and auditory conduction separately, ranging from 36.25 dB to 42.5 dB, which is consistent with the diagnosis of moderate hearing loss. Due to air conduction thresholds decreasing from 75 dB to 30 dB at 500 Hz and from 65 dB to 25 dB at 1000 Hz, the patient’s daily communication is no longer significantly impaired. Overall, after EA for 2 weeks of treatment, the audiologic results (and the patient’s hearing) improved from a baseline level of severe hearing loss to moderate hearing loss. The results of this inspection are shown in Figure 1.
FIG. 1.
Pure-Tone Audiometry diagram of the patient’s left ear prior to and following electroacupuncture treatment. (A) Patient’s initial audiogram before electroacupuncture treatment; (B) Audiogram after electroacupuncture treatment five times a week for 2 weeks. AC, Air conduction pathway; BC, Bone conduction pathway: The level of bone conduction in the left ear under masking; No bone conduction value has been measured here; The level of air conduction in the left ear under masking; The level of bone conduction in the left ear without masking; The level of air conduction in the left ear without masking.
Comment
This case suggests that electroacupuncture might be beneficial in the treatment of SSNHL, which may be due to its ability to enhance local blood circulation and reduce blood coagulation, improving local microcirculation and promoting the clearance of inflammatory substances.9 In addition, other studies suggest that EA can regulate the nervous system by stimulating the auditory cortex and enhancing its excitability.10,11 Due to the complex etiology, difficult diagnosis, and individual differences in self-healing of SSNHL, a single treatment method often fails to achieve ideal results. EA treatment can have multidimensional regulatory effects on the body, which may be the reason why EA can improve the hearing of SSNHL patients in this case.
Summary
Although this study is limited to an uncontrolled case report and 60% of SSNHL patients have the possibility of spontaneous recovery, we cannot draw a clear conclusion that EA has a significant therapeutic effect on SSNHL. However, this case may demonstrate the potential of EA treatment for SSNHL, so clinical research that will answer the question as to whether EA is beneficial in the treatment of SSNHL is valuable. Moving forward, it will be essential to conduct high-quality, multicenter, randomized, controlled clinical trials to further explore the effectiveness and underlying mechanisms of EA in the treatment of SSNHL.
ACKNOWLEDGMENTS
The authors would like to thank the patient for providing permission to publish this case report.
AUTHORS’ CONTRIBUTIONS
Y.L.: Writing—original draft, data curation; W.-x.Q.: Writing—review and editing, supervision; C.-j.Q.: Methodology; L.-j.Z.: Treatment; G.-q.Y.: Treatment.
AUTHOR DISCLOSURE STATEMENT
The authors declare no potential conflicts of interest related to the research, authorship, and/or publication of this article.
FUNDING INFORMATION
The authors received no financial support for the research, authorship, or publication of this article.
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