Case Report · Falldarstellung Forsch Komplementmed 2014;21:246–249 DOI: 10.1159/000365982
Published online: August 15, 2014
Acupuncture in Treating Sudden Sensorineural Hearing Loss: A Report of 2 Cases Nanbin Huanga Changwei Lib b
Department of Acupuncture, Beijing Shijitan Hospital, Yang Fang Dian, Haidian District, Beijing, China Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
Keywords Sudden sensorineural hearing loss (SSHL) · Fullness in ear · Neck pain · Electroacupuncture
Schlüsselwörter Hörsturz · Druck auf den Ohren · Nackenschmerzen · Elektroakupunktur
Summary Background: Two cases of sudden sensorineural hearing loss (SSHL) in left ear diagnosed by an ear, nose, and throat specialist are presented. Case Report: The first patient was a 22-year-old male college student with moderately severe hearing loss, tinnitus, and a feeling of fullness in the ear for 5 days. The other patient was a 48-year-old male pilot with severe hearing loss, tinnitus, and fullness in the ear for 7 days. Both patients did not respond to medical treatment, and the hearing loss became even worse. The patients were then treated with acupuncture 5 and 7 days, respectively, after hearing loss had developed. Electroacupuncture was applied to ear and neck once per day for both patients. Results: Fullness in ear disappeared during the first treatment in both cases, and the first patient also felt great improvement in hearing during the first treatment. After 10 treatments, the first patient had recovered. In the other patient, hearing had greatly improved after 19 treatments. Conclusion: Acupuncture may be worth trying in patients with SSHL who do not respond to routine medical treatment.
Zusammenfassung Hintergrund: Der vorliegende Fallbericht stellt die Behandlung zweier Patienten mit Hörsturz im linken Ohr vor, der von einem Hals-, Nasen-, Ohrenspezialisten diagnostiziert worden war. Falldarstellung: Der erste Patient war ein 22-jähriger College-Student mit einem mittelgradig schweren Hörverlust und Tinnitus. Zudem plagte ihn seit 5 Tagen ein Gefühl von Druck auf dem betreffenden Ohr. Der andere Patient war ein 48-jähriger Pilot mit schwerem Hörverlust und Tinnitus, der seit 7 Tagen ebenfalls an einem Druckgefühl im Ohr litt. Beide Patienten reagierten nicht auf bisherige konventionelle Therapiemaßnahmen, und der Hörverlust verschlimmerte sich zunehmend. Schließlich wurden die Patienten 5 bzw. 7 Tage nach Auftreten des Hörsturzes mit Akupunktur behandelt. Die Elektroakupunktur wurde einmal täglich bei beiden Patienten am Ohr und am Nacken angewandt. Ergebnisse: Das Druckempfinden im Ohr verschwand bei beiden Patienten bereits während der ersten Behandlung. Beim ersten Patienten stellte sich zudem eine wesentliche Besserung des Hörvermögens ein, und nach 10 Behandlungen hatte er sich vollständig erholt. Beim anderen Patienten hatte sich das Hörvermögen nach 19 Behandlungen wesentlich gebessert. Schlussfolgerung: Die Anwendung von Akupunktur könnte eine erfolgreiche Alternative bei Patienten mit Hörsturz sein, bei denen Routinebehandlungen nicht anschlagen.
© 2014 S. Karger GmbH, Freiburg 1661-4119/14/0214-0246$39.50/0 Fax +49 761 4 52 07 14 [email protected] www.karger.com
Accessible online at: www.karger.com/fok
Changwei Li, MD Department of Epidemiology Tulane University School of Public Health and Tropical Medicine 1440 Canal Street Suite 2080, New Orleans 70112, LA, USA [email protected]
Downloaded by: NYU Medical Center Library 128.122.253.228 - 5/30/2015 4:14:46 PM
a
Introduction Sudden sensorineural hearing loss (SSHL) is an urgent condition, accompanied by a hearing loss of *30 decibels (dB) with a subjective sensation of hearing impairment occurring in one or both ears [1]. A variety of medical treatments have been used in clinical practice. However, the effectiveness of these treatments remains controversial [2]. 2 unusual cases of hearing loss are presented here, where the routine medical care was not effective. Both cases achieved good health outcomes after acupuncture treatment.
Case Report
Case 2 A 48-year-old male pilot came to our acupuncture department with severe hearing loss, tinnitus, and a feeling of fullness in the left ear for 7 days.
Acupuncture in Treating Sudden Sensorineural Hearing Loss: A Report of 2 Cases
Fig. 1. Pure tone audiometry tests of the first patient.
One week previously, the patient caught a cold and was very tired and stressed due to his high workload. He suddenly felt hearing loss, accompanied by tinnitus and a feeling of fullness. The patient went to see a specialist in ENT the next day, and was confirmed clinically deaf by PTA (fig. 2a). The ENT doctor diagnosed SSHL. Starting from the next day of the onset of hearing loss, the patient was given a transfusion of ligustrazine, oral administration of liu-wei tonic tablets (a traditional Chinese medication), and hyperbaric oxygen therapy for 3 days. Unfortunately, the patient’s hearing loss worsened (fig. 2b), so he decided to stop medical treatment and sought help from acupuncture. A physical examination showed that the patient had tenderness on the left side of the neck. We accepted the ENT doctor’s diagnosis. Electroacupuncture was applied to the following acupuncture points: GB20, GB8, GB2, TE18, TE17, DU14, and all the Jiaji points located along the last 5 cervical spinous processes. Each treatment session lasted 30 min. The frequency of the stimulation was 60 Hz, and the intensity was tolerated even at maximum stimulation. During the first treatment, the patient felt great relief in the feeling of fullness. After 4 treatments, the patient felt great improvement in hearing. However, the tinnitus had not improved. After 6 treatments, the patient received another PTA (fig. 2c) demonstrating an improvement from severe to moderately severe hearing loss, and there was greater improvement in low frequency range. After 10 treatments, the patient felt that his hearing returned to normal, and tinnitus became better during the day. The patient had another PTA (fig. 2d) after 11 treatments, and the PTA showed that the patient’s hearing was improved at low and high frequency range. The treatment continued, and the patient had the last PTA (fig. 2e) test after 19 treatments. The last PTA showed that the patient’s hearing improved to moderate hearing loss, and there was great improvement in low and high frequency hearing. At the same time, tinnitus decreased to a tolerable level.
Results In the presented 2 cases, conventional medical treatment was not effective in alleviating the symptoms, which became even worse. In contrast, acupuncture improved the patients’ health
Forsch Komplementmed 2014;21:246–249
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Case 1 A 22-year-old college student came to our acupuncture department with moderately severe hearing loss, tinnitus, and a feeling of fullness in the left ear for 5 days. The student had been busy preparing for the national exam for a long time. He stayed up late every day, and was very tired before the onset of hearing loss. 5 days before he came to the department, when getting up in the morning, he suddenly found that he could not hear anything in his left ear, accompanied by tinnitus and a feeling of fullness. He went to an ear, nose, and throat (ENT) hospital in Beijing immediately that day. He was confirmed to have moderately severe hearing loss by pure tone audiometry (PTA) (blue line in fig. 1). The ENT doctor diagnosed SSHL and admitted him to hospital. He was given prednisolone hydrochloride along with a transfusion of Ginkgo extract and an injection of mouse nerve growth factor for 3 days. However, the patient did not feel any improvement in hearing loss, tinnitus, or the feeling of fullness in the left ear. The PTA showed that his hearing loss became even worse and expanded to low-frequency segment (green line in fig. 1). Prednisolone hydrochloride and Ginkgo extract were then no longer administered to the patient. Instead, a transfusion of cinepazide maleate for 2 days along with mouse nerve growth factor injection was given to the patient. Again, the patient did not feel any improvement in any symptoms, so he decided to stop medical treatment and switch to acupuncture. A physical exam at our acupuncture department showed that the patient had tenderness in the left side of his neck, especially at the GB20 point. The patient mentioned that he suffered from stiff neck occasionally. The SSHL diagnosis made by the patient’s ENT doctor was considered. Electroacupuncture was applied to the following acupuncture points: GB20, GB8, GB2, TE18, TE17, and DU14. In addition, based on our previous experience, we also treated tenderness in the neck using all the Jiaji points located along the last 5 cervical spinous processes. Each treatment session lasted 30 min. The frequency of stimulation was 60 Hz, and the intensity was tolerated even at maximum stimulation. During the first treatment, the patient felt significant relief of the feeling of fullness and great improvement in hearing in his left ear. After 4 treatments, the patient felt great improvement in hearing. Another PTA showed that the patient’s hearing was much improved below the frequency of 3000 Hz. However, there was a slight hearing loss above 3000 Hz (black line in fig. 1). After the 5th.treatment, the patient reported that he felt his hearing became normal when he talked through telephone. After the 8th treatment, the patient’s tinnitus had resolved. After the 10th treatment, the patient’s symptoms disappeared. The last PTA (pink line in fig. 1) showed that the patient’s hearing returned to normal.
status right after treatment in both cases, especially in case of fullness feeling in the affected ear. Both cases experienced improvement in the feeling of fullness after first treatment, and hearing loss became much better within 4 treatments. Although the beneficial effect could be due to the carry-over effect of previous medical treatment or the natural course of SSHL, the recovery of symptoms was more likely due to acupuncture. If medical treatments had worked out in the 2 cases, it should have attenuated or even stopped the hearing loss and fullness feeling in the affected ear. However, in both cases, the symptoms became worse, so it is very unlikely that medical treatment had carry-over effect in the 2 cases. Moreover, the immediate relief or even disappearing of fullness feeling in the affected ear after applying acupuncture indicates that acupuncture was very likely beneficial in these 2 cases. Finally, in case 2, evidence suggested a poor prognosis of recovery (severe hearing loss; age 48 years); however, after applying acupuncture, hearing and fullness feeling were all recovered to a very good level.
Discussion SSHL affects as many as 160 per 100,000 people per year [3]. Only about 10% of cases have an identifiable cause [4]. Besides hearing loss, most patients have tinnitus and fullness of the ear [5]. The prognosis of SSHL is generally good, and it is common that patients experience hearing improvement within days [6]. Patients with no improvement in hearing within 2 weeks are unlikely to recover, and those having hearing loss for more than 2–3 months are likely to become permanently deaf [7]. Prognosis is also poor for those with severe
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Forsch Komplementmed 2014;21:246–249
hearing loss, down-sloping shape of loss on an audiogram, vertigo, and evidence of systemic infection [8]. Oral corticosteroids are the most commonly used treatment for SSHL, although there is little supporting evidence for their effectiveness [6]. Intratympanic dexamethasone has also been used in patients, who did not respond to systemic steroid therapy. However, the efficacy of this treatment is controversial [9]. Previous studies have documented that acupuncture could improve hearing in late SSHL. Yin and colleagues [10] reported a series of 17 SSHL cases, in which a 3-week conventional therapy failed. After about 70 days of treatment, 8 of them had an improvement of more than 20 dB in hearing. In another study by Zhao [11], 63 patients with SSHL for at least 1 month were recruited. After 14 treatments within about 30 days, the average hearing threshold increased by 17 dB, and 63.5% of the patients had an increment of at least 15 dB. These 2 studies clearly show that acupuncture may be effective in treating patient with late SSHL. So it is very likely that acupuncture is also effective in patients with early SSHL, as shown in the current 2 cases. Unfortunately, the 2 studies [10, 11] did not report the effect of acupuncture on tinnitus and fullness feeling, both being strong factors affecting the quality of life among SSHL patients [12]. The treatment of the current 2 cases shows that acupuncture may also be effective in eliminating accompanying symptoms, hence improving patients’ quality of life. Further, SSHL may be triggered by tiredness, as seen in previous cases at our department [13] and confirmed by those reported in this case study. Further, both patients felt also tenderness in the neck of the affected side. Our treatment to neck tenderness helped in improving SSHL symptoms. It is likely that the neck tenderness may be associated with SSHL.
Huang/Li
Downloaded by: NYU Medical Center Library 128.122.253.228 - 5/30/2015 4:14:46 PM
Fig. 2 a–e. Pure tone audiometry tests of the second patient.
Conclusion
Acknowledgments
Both cases of SSHL did not respond to medical treatment, but responded well to acupuncture. In addition, acupuncture seems to be very effective in eliminating the fullness in the affected ear. Acupuncture may be worth trying in patients with SSHL who do not respond to routine medical treatment. In line with previous studies on late SSHL, the current report indicates that future observational studies or even clinical trials are needed to prove the efficacy of acupuncture on hearing loss and the accompanying symptoms among SSHL patient who do not respond to routine medical treatment.
We would like to thank the patients, without whose cooperation and compliance with our medical advice, we could not have achieved such good clinical outcomes.
Disclosure Statement The authors declare that there is no conflict of interests concerning this paper.
References
Acupuncture in Treating Sudden Sensorineural Hearing Loss: A Report of 2 Cases
5 Nosrati-Zarenoe R, Arlinger S, Hultcrantz E: Idiopathic sudden sensorineural hearing loss: results drawn from the Swedish national database. Acta Otolaryngol 2007;127: 1168–1175. 6 Schreiber BE, Agrup C, Haskard DO, Luxon LM: Sudden sensorineural hearing loss. Lancet 2010;375: 1203–1211. 7 Moon IS, Kim J, Lee SY, Choi HS, Lee WS: How long should the sudden hearing loss patients be followed after early steroid combination therapy? Eur Arch Otorhinolaryngol 2009;266:1391–1395. 8 Xenellis J, Karapatsas I, Papadimitriou N, Nikolopoulos T, Maragoudakis P, Tzagkaroulakis M, Ferekidis E: Idiopathic sudden sensorineural hearing loss: prognostic factors. J Laryngol Otol 2006; 120:718–724.
9 Hamid M, Trune D: Issues, indications, and controversies regarding intratympanic steroid perfusion. Curr Opin Otolaryngol Head Neck Surg 2008;16: 434–440. 10 Yin CS, Park HJ, Nam HJ: Acupuncture for refractory cases of sudden sensorineural hearing loss. J Altern Complement Med 2010;16:973–978. 11 Zhao YZ: Observation on therapeutic effect of acupuncture on late sudden deafness (in Chinese). Zhongguo Zhen Jiu 2006;26:180–182. 12 Carlsson PI, Hall M, Lind KJ, Danermark B: Quality of life, psychosocial consequences, and audiological rehabilitation after sudden sensorineural hearing loss. Int J Audiol 2011;50:139–144. 13 Huang N, Li C: Recurrent sudden sensorineural hearing loss in a 58-year-old woman with severe dizziness: a case report. Acupunct Med 2012;30:56–59.
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1 Stachler RJ, Chandrasekhar SS, Archer SM, et al.: Clinical practice guideline: sudden hearing loss. Otolaryngol Head Neck Surg 2012;146(suppl 3): S1–35. 2 Kuhn, M, Heman-Ackah SE, Shaikh JA, Roehm PC: Sudden sensorineural hearing loss: a review of diagnosis, treatment, and prognosis. Trends Amplif 2011;15:91–105. 3 Klemm E, Deutscher A, Mosges R: A present investigation of the epidemiology in idiopathic sudden sensorineural hearing loss (in German). Laryngorhinootologie 2009;88:524–527. 4 Penido NO, Cruz OL, Zanoni A, Inoue DP: Classification and hearing evolution of patients with sudden sensorineural hearing loss. Braz J Med Biol Res 2009;42:712–716.
Published online: August 15, 2014
Acupuncture in Treating Sudden Sensorineural Hearing Loss: A Report of 2 Cases Nanbin Huanga Changwei Lib b
Department of Acupuncture, Beijing Shijitan Hospital, Yang Fang Dian, Haidian District, Beijing, China Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
Keywords Sudden sensorineural hearing loss (SSHL) · Fullness in ear · Neck pain · Electroacupuncture
Schlüsselwörter Hörsturz · Druck auf den Ohren · Nackenschmerzen · Elektroakupunktur
Summary Background: Two cases of sudden sensorineural hearing loss (SSHL) in left ear diagnosed by an ear, nose, and throat specialist are presented. Case Report: The first patient was a 22-year-old male college student with moderately severe hearing loss, tinnitus, and a feeling of fullness in the ear for 5 days. The other patient was a 48-year-old male pilot with severe hearing loss, tinnitus, and fullness in the ear for 7 days. Both patients did not respond to medical treatment, and the hearing loss became even worse. The patients were then treated with acupuncture 5 and 7 days, respectively, after hearing loss had developed. Electroacupuncture was applied to ear and neck once per day for both patients. Results: Fullness in ear disappeared during the first treatment in both cases, and the first patient also felt great improvement in hearing during the first treatment. After 10 treatments, the first patient had recovered. In the other patient, hearing had greatly improved after 19 treatments. Conclusion: Acupuncture may be worth trying in patients with SSHL who do not respond to routine medical treatment.
Zusammenfassung Hintergrund: Der vorliegende Fallbericht stellt die Behandlung zweier Patienten mit Hörsturz im linken Ohr vor, der von einem Hals-, Nasen-, Ohrenspezialisten diagnostiziert worden war. Falldarstellung: Der erste Patient war ein 22-jähriger College-Student mit einem mittelgradig schweren Hörverlust und Tinnitus. Zudem plagte ihn seit 5 Tagen ein Gefühl von Druck auf dem betreffenden Ohr. Der andere Patient war ein 48-jähriger Pilot mit schwerem Hörverlust und Tinnitus, der seit 7 Tagen ebenfalls an einem Druckgefühl im Ohr litt. Beide Patienten reagierten nicht auf bisherige konventionelle Therapiemaßnahmen, und der Hörverlust verschlimmerte sich zunehmend. Schließlich wurden die Patienten 5 bzw. 7 Tage nach Auftreten des Hörsturzes mit Akupunktur behandelt. Die Elektroakupunktur wurde einmal täglich bei beiden Patienten am Ohr und am Nacken angewandt. Ergebnisse: Das Druckempfinden im Ohr verschwand bei beiden Patienten bereits während der ersten Behandlung. Beim ersten Patienten stellte sich zudem eine wesentliche Besserung des Hörvermögens ein, und nach 10 Behandlungen hatte er sich vollständig erholt. Beim anderen Patienten hatte sich das Hörvermögen nach 19 Behandlungen wesentlich gebessert. Schlussfolgerung: Die Anwendung von Akupunktur könnte eine erfolgreiche Alternative bei Patienten mit Hörsturz sein, bei denen Routinebehandlungen nicht anschlagen.
© 2014 S. Karger GmbH, Freiburg 1661-4119/14/0214-0246$39.50/0 Fax +49 761 4 52 07 14 [email protected] www.karger.com
Accessible online at: www.karger.com/fok
Changwei Li, MD Department of Epidemiology Tulane University School of Public Health and Tropical Medicine 1440 Canal Street Suite 2080, New Orleans 70112, LA, USA [email protected]
Downloaded by: NYU Medical Center Library 128.122.253.228 - 5/30/2015 4:14:46 PM
a
Introduction Sudden sensorineural hearing loss (SSHL) is an urgent condition, accompanied by a hearing loss of *30 decibels (dB) with a subjective sensation of hearing impairment occurring in one or both ears [1]. A variety of medical treatments have been used in clinical practice. However, the effectiveness of these treatments remains controversial [2]. 2 unusual cases of hearing loss are presented here, where the routine medical care was not effective. Both cases achieved good health outcomes after acupuncture treatment.
Case Report
Case 2 A 48-year-old male pilot came to our acupuncture department with severe hearing loss, tinnitus, and a feeling of fullness in the left ear for 7 days.
Acupuncture in Treating Sudden Sensorineural Hearing Loss: A Report of 2 Cases
Fig. 1. Pure tone audiometry tests of the first patient.
One week previously, the patient caught a cold and was very tired and stressed due to his high workload. He suddenly felt hearing loss, accompanied by tinnitus and a feeling of fullness. The patient went to see a specialist in ENT the next day, and was confirmed clinically deaf by PTA (fig. 2a). The ENT doctor diagnosed SSHL. Starting from the next day of the onset of hearing loss, the patient was given a transfusion of ligustrazine, oral administration of liu-wei tonic tablets (a traditional Chinese medication), and hyperbaric oxygen therapy for 3 days. Unfortunately, the patient’s hearing loss worsened (fig. 2b), so he decided to stop medical treatment and sought help from acupuncture. A physical examination showed that the patient had tenderness on the left side of the neck. We accepted the ENT doctor’s diagnosis. Electroacupuncture was applied to the following acupuncture points: GB20, GB8, GB2, TE18, TE17, DU14, and all the Jiaji points located along the last 5 cervical spinous processes. Each treatment session lasted 30 min. The frequency of the stimulation was 60 Hz, and the intensity was tolerated even at maximum stimulation. During the first treatment, the patient felt great relief in the feeling of fullness. After 4 treatments, the patient felt great improvement in hearing. However, the tinnitus had not improved. After 6 treatments, the patient received another PTA (fig. 2c) demonstrating an improvement from severe to moderately severe hearing loss, and there was greater improvement in low frequency range. After 10 treatments, the patient felt that his hearing returned to normal, and tinnitus became better during the day. The patient had another PTA (fig. 2d) after 11 treatments, and the PTA showed that the patient’s hearing was improved at low and high frequency range. The treatment continued, and the patient had the last PTA (fig. 2e) test after 19 treatments. The last PTA showed that the patient’s hearing improved to moderate hearing loss, and there was great improvement in low and high frequency hearing. At the same time, tinnitus decreased to a tolerable level.
Results In the presented 2 cases, conventional medical treatment was not effective in alleviating the symptoms, which became even worse. In contrast, acupuncture improved the patients’ health
Forsch Komplementmed 2014;21:246–249
247
Downloaded by: NYU Medical Center Library 128.122.253.228 - 5/30/2015 4:14:46 PM
Case 1 A 22-year-old college student came to our acupuncture department with moderately severe hearing loss, tinnitus, and a feeling of fullness in the left ear for 5 days. The student had been busy preparing for the national exam for a long time. He stayed up late every day, and was very tired before the onset of hearing loss. 5 days before he came to the department, when getting up in the morning, he suddenly found that he could not hear anything in his left ear, accompanied by tinnitus and a feeling of fullness. He went to an ear, nose, and throat (ENT) hospital in Beijing immediately that day. He was confirmed to have moderately severe hearing loss by pure tone audiometry (PTA) (blue line in fig. 1). The ENT doctor diagnosed SSHL and admitted him to hospital. He was given prednisolone hydrochloride along with a transfusion of Ginkgo extract and an injection of mouse nerve growth factor for 3 days. However, the patient did not feel any improvement in hearing loss, tinnitus, or the feeling of fullness in the left ear. The PTA showed that his hearing loss became even worse and expanded to low-frequency segment (green line in fig. 1). Prednisolone hydrochloride and Ginkgo extract were then no longer administered to the patient. Instead, a transfusion of cinepazide maleate for 2 days along with mouse nerve growth factor injection was given to the patient. Again, the patient did not feel any improvement in any symptoms, so he decided to stop medical treatment and switch to acupuncture. A physical exam at our acupuncture department showed that the patient had tenderness in the left side of his neck, especially at the GB20 point. The patient mentioned that he suffered from stiff neck occasionally. The SSHL diagnosis made by the patient’s ENT doctor was considered. Electroacupuncture was applied to the following acupuncture points: GB20, GB8, GB2, TE18, TE17, and DU14. In addition, based on our previous experience, we also treated tenderness in the neck using all the Jiaji points located along the last 5 cervical spinous processes. Each treatment session lasted 30 min. The frequency of stimulation was 60 Hz, and the intensity was tolerated even at maximum stimulation. During the first treatment, the patient felt significant relief of the feeling of fullness and great improvement in hearing in his left ear. After 4 treatments, the patient felt great improvement in hearing. Another PTA showed that the patient’s hearing was much improved below the frequency of 3000 Hz. However, there was a slight hearing loss above 3000 Hz (black line in fig. 1). After the 5th.treatment, the patient reported that he felt his hearing became normal when he talked through telephone. After the 8th treatment, the patient’s tinnitus had resolved. After the 10th treatment, the patient’s symptoms disappeared. The last PTA (pink line in fig. 1) showed that the patient’s hearing returned to normal.
status right after treatment in both cases, especially in case of fullness feeling in the affected ear. Both cases experienced improvement in the feeling of fullness after first treatment, and hearing loss became much better within 4 treatments. Although the beneficial effect could be due to the carry-over effect of previous medical treatment or the natural course of SSHL, the recovery of symptoms was more likely due to acupuncture. If medical treatments had worked out in the 2 cases, it should have attenuated or even stopped the hearing loss and fullness feeling in the affected ear. However, in both cases, the symptoms became worse, so it is very unlikely that medical treatment had carry-over effect in the 2 cases. Moreover, the immediate relief or even disappearing of fullness feeling in the affected ear after applying acupuncture indicates that acupuncture was very likely beneficial in these 2 cases. Finally, in case 2, evidence suggested a poor prognosis of recovery (severe hearing loss; age 48 years); however, after applying acupuncture, hearing and fullness feeling were all recovered to a very good level.
Discussion SSHL affects as many as 160 per 100,000 people per year [3]. Only about 10% of cases have an identifiable cause [4]. Besides hearing loss, most patients have tinnitus and fullness of the ear [5]. The prognosis of SSHL is generally good, and it is common that patients experience hearing improvement within days [6]. Patients with no improvement in hearing within 2 weeks are unlikely to recover, and those having hearing loss for more than 2–3 months are likely to become permanently deaf [7]. Prognosis is also poor for those with severe
248
Forsch Komplementmed 2014;21:246–249
hearing loss, down-sloping shape of loss on an audiogram, vertigo, and evidence of systemic infection [8]. Oral corticosteroids are the most commonly used treatment for SSHL, although there is little supporting evidence for their effectiveness [6]. Intratympanic dexamethasone has also been used in patients, who did not respond to systemic steroid therapy. However, the efficacy of this treatment is controversial [9]. Previous studies have documented that acupuncture could improve hearing in late SSHL. Yin and colleagues [10] reported a series of 17 SSHL cases, in which a 3-week conventional therapy failed. After about 70 days of treatment, 8 of them had an improvement of more than 20 dB in hearing. In another study by Zhao [11], 63 patients with SSHL for at least 1 month were recruited. After 14 treatments within about 30 days, the average hearing threshold increased by 17 dB, and 63.5% of the patients had an increment of at least 15 dB. These 2 studies clearly show that acupuncture may be effective in treating patient with late SSHL. So it is very likely that acupuncture is also effective in patients with early SSHL, as shown in the current 2 cases. Unfortunately, the 2 studies [10, 11] did not report the effect of acupuncture on tinnitus and fullness feeling, both being strong factors affecting the quality of life among SSHL patients [12]. The treatment of the current 2 cases shows that acupuncture may also be effective in eliminating accompanying symptoms, hence improving patients’ quality of life. Further, SSHL may be triggered by tiredness, as seen in previous cases at our department [13] and confirmed by those reported in this case study. Further, both patients felt also tenderness in the neck of the affected side. Our treatment to neck tenderness helped in improving SSHL symptoms. It is likely that the neck tenderness may be associated with SSHL.
Huang/Li
Downloaded by: NYU Medical Center Library 128.122.253.228 - 5/30/2015 4:14:46 PM
Fig. 2 a–e. Pure tone audiometry tests of the second patient.
Conclusion
Acknowledgments
Both cases of SSHL did not respond to medical treatment, but responded well to acupuncture. In addition, acupuncture seems to be very effective in eliminating the fullness in the affected ear. Acupuncture may be worth trying in patients with SSHL who do not respond to routine medical treatment. In line with previous studies on late SSHL, the current report indicates that future observational studies or even clinical trials are needed to prove the efficacy of acupuncture on hearing loss and the accompanying symptoms among SSHL patient who do not respond to routine medical treatment.
We would like to thank the patients, without whose cooperation and compliance with our medical advice, we could not have achieved such good clinical outcomes.
Disclosure Statement The authors declare that there is no conflict of interests concerning this paper.
References
Acupuncture in Treating Sudden Sensorineural Hearing Loss: A Report of 2 Cases
5 Nosrati-Zarenoe R, Arlinger S, Hultcrantz E: Idiopathic sudden sensorineural hearing loss: results drawn from the Swedish national database. Acta Otolaryngol 2007;127: 1168–1175. 6 Schreiber BE, Agrup C, Haskard DO, Luxon LM: Sudden sensorineural hearing loss. Lancet 2010;375: 1203–1211. 7 Moon IS, Kim J, Lee SY, Choi HS, Lee WS: How long should the sudden hearing loss patients be followed after early steroid combination therapy? Eur Arch Otorhinolaryngol 2009;266:1391–1395. 8 Xenellis J, Karapatsas I, Papadimitriou N, Nikolopoulos T, Maragoudakis P, Tzagkaroulakis M, Ferekidis E: Idiopathic sudden sensorineural hearing loss: prognostic factors. J Laryngol Otol 2006; 120:718–724.
9 Hamid M, Trune D: Issues, indications, and controversies regarding intratympanic steroid perfusion. Curr Opin Otolaryngol Head Neck Surg 2008;16: 434–440. 10 Yin CS, Park HJ, Nam HJ: Acupuncture for refractory cases of sudden sensorineural hearing loss. J Altern Complement Med 2010;16:973–978. 11 Zhao YZ: Observation on therapeutic effect of acupuncture on late sudden deafness (in Chinese). Zhongguo Zhen Jiu 2006;26:180–182. 12 Carlsson PI, Hall M, Lind KJ, Danermark B: Quality of life, psychosocial consequences, and audiological rehabilitation after sudden sensorineural hearing loss. Int J Audiol 2011;50:139–144. 13 Huang N, Li C: Recurrent sudden sensorineural hearing loss in a 58-year-old woman with severe dizziness: a case report. Acupunct Med 2012;30:56–59.
Forsch Komplementmed 2014;21:246–249
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1 Stachler RJ, Chandrasekhar SS, Archer SM, et al.: Clinical practice guideline: sudden hearing loss. Otolaryngol Head Neck Surg 2012;146(suppl 3): S1–35. 2 Kuhn, M, Heman-Ackah SE, Shaikh JA, Roehm PC: Sudden sensorineural hearing loss: a review of diagnosis, treatment, and prognosis. Trends Amplif 2011;15:91–105. 3 Klemm E, Deutscher A, Mosges R: A present investigation of the epidemiology in idiopathic sudden sensorineural hearing loss (in German). Laryngorhinootologie 2009;88:524–527. 4 Penido NO, Cruz OL, Zanoni A, Inoue DP: Classification and hearing evolution of patients with sudden sensorineural hearing loss. Braz J Med Biol Res 2009;42:712–716.
