Ren Wenqi, Tao Bo, Deng Haixia
School of Clinical Medicine, Jiangxi University of Chinese Medicine, Nanchang, China.
Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China.
Integr Med Res. 2024 Dec;13(4):101087. doi: 10.1016/j.imr.2024.101087. Epub 2024 Sep 21.
Despite numerous pharmacological and therapeutic options for sudden sensorineural hearing loss(SSNHL), treatment remains challenging due to various side effects and suboptimal efficacy. Acupuncture, as a complementary and alternative therapy, has achieved some success in this field. The objective of this study was to systematically evaluate the efficacy and safety of acupuncture for SSNHL, and to seek robust evidence-based medical evidence for the therapeutic effect of acupuncture.
The following databases were searched: PubMed, EMbase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, VIP Information Database, and China Biomedical Literature Database (SinoMed) up to September 1, 2024. The quality of the RCTs was evaluated utilizing the risk of bias assessment tool from the Cochrane Collaboration. Risk ratio (RR), risk difference (RD), mean differences (MD), and 95% confidence interval (CI) were used to estimate the effect. Data analysis was used RevMan 5.3.
A total of 28 randomized controlled trials involving 2,456 patients were included in this systematic review and meta-analysis. The meta-analysis results indicate that the integration of acupuncture with WMCT for SSNHL may enhance the total effective rate (RR=1.18, 95% CI: 1.14-1.23, <0.00001), change in hearing threshold (MD=-10.71, 95% CI: -12.52 to -8.89, <0.00001), and cure rate (RD=0.15, 95% CI: 0.11-0.19, <0.00001) compared to WMCT alone. Acupuncture as a monotherapy seems to be superior to WMCT in terms of total effective rate (RR=1.19, 95% CI: 1.07-1.32, =0.001) and cure rate (RD=0.11, 95% CI: 0.02-0.19, =0.01). There was no significant difference observed between acupuncture alone and WMCT in improving pure tone hearing thresholds (MD=-5.45, 95%CI: -20.75 to 9.85, =0.48). While the combination of acupuncture with WMCT may offer greater efficacy in reducing tinnitus symptoms (RR=1.12, 95% CI:1.01 to 1.24, =0.03), but the reliability of this outcome is contested upon sensitivity analysis (RR=1.07, 95% CI:0.87-1.31, =0.51).
The findings of the meta-analysis indicate that acupuncture, either as a standalone intervention or in conjunction with WMCT, may offer supplementary therapeutic advantages in certain respects. However, the results should be interpreted with caution due to the quality and potential bias of the included studies.
尽管针对突发性感音神经性听力损失（SSNHL）有众多药物和治疗选择，但由于各种副作用和疗效欠佳，治疗仍然具有挑战性。针灸作为一种补充和替代疗法，在该领域已取得了一些成效。本研究的目的是系统评价针灸治疗SSNHL的疗效和安全性，并为针灸的治疗效果寻找有力的循证医学证据。
检索了以下数据库：截至2024年9月1日的PubMed、EMbase、Cochrane图书馆、中国知网（CNKI）、万方数据知识服务平台、维普资讯数据库和中国生物医学文献数据库（SinoMed）。使用Cochrane协作网的偏倚风险评估工具对随机对照试验（RCT）的质量进行评估。采用风险比（RR）、风险差值（RD）、均数差值（MD）和95%置信区间（CI）来估计效应。使用RevMan 5.3进行数据分析。
本系统评价和Meta分析共纳入28项随机对照试验，涉及2456例患者。Meta分析结果表明，与单纯西医常规治疗（WMCT）相比，针灸联合WMCT治疗SSNHL可能提高总有效率（RR = 1.18，95%CI：1.14 - 1.23，P < 0.00001）、听力阈值变化（MD = -10.71，95%CI：-12.52至-8.89，P < 0.00001）和治愈率（RD = 0.15，95%CI：0.11 - 0.19，P < 0.00001）。针灸作为单一疗法在总有效率（RR = 1.19，95%CI：1.07 - 1.32，P = 0.001）和治愈率（RD = 0.11，95%CI：0.02 - 0.19，P = 0.01）方面似乎优于WMCT。在改善纯音听力阈值方面，单纯针灸与WMCT之间未观察到显著差异（MD = -5.45，95%CI：-20.75至9.85，P = 0.48）。虽然针灸联合WMCT在减轻耳鸣症状方面可能具有更高的疗效（RR = 1.12，95%CI：1.01至1.24，P = 0.03），但敏感性分析对该结果的可靠性提出了质疑（RR = 1.07，95%CI：0.87 - 1.31，P = 0.51）。
Meta分析结果表明，针灸无论是作为独立干预措施还是与WMCT联合使用，在某些方面可能具有补充治疗优势。然而，由于纳入研究的质量和潜在偏倚，对结果的解释应谨慎。
