The efficacy and safety of acupuncture in the treatment of sudden sensorineural hearing loss: A systematic review and meta-analysis

Background: 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. Methods: 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. Results: 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, P < 0.00001), change in hearing threshold (MD =-10.71, 95% CI:-12.52 to-8.89, P < 0.00001), and cure rate (RD = 0.15, 95% CI: 0.11-0.19, P < 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, P = 0.001) and cure rate (RD = 0.11, 95% CI: 0.02-0.19, P = 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, P = 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, P = 0.03), but the reliability of this outcome is contested upon sensitivity analysis (RR = 1.07, 95% CI:0.87-1.31, P = 0.51). Conclusions: 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.