https://orcid.org/0000-0001-8759-5083
Sudden sensorineural hearing loss (SSNHL) and tinnitus are prevalent among Corona Virus Disease 2019 (COVID-19) patients and post-COVID-19 individuals, yet not all of these patients exhibit favorable responses to steroid therapy. Acupuncture may offer potential therapeutic benefits for SSNHL and tinnitus associated with COVID-19.
Case description
A 32-year-old man presented to the acupuncture clinic in our hospital, with complaints of severe hearing loss and tinnitus in the right ear for 18 days. According to the timeline, he was diagnosed with Corona Virus Disease 2019 (COVID-19) according to nucleic acid tests and typical symptoms such as fever, cough and fatigue. Six days after he was diagnosed with COVID-19, he noticed that he was unable to hear clearly, accompanied by ringing in the right ear. Immediately, he visited the otolaryngology department and received a 10-day course of steroid treatment. However, there was no symptom improvement, which seriously affected his life and sleep. Thus, he sought for acupuncture treatment.
At admission, pure tone audiometry revealed significant hearing loss across low frequencies (i.e. 125, 250, 500 and 1000 Hz) in the right ear (as shown in Figure 1b), while acoustic impedance test and inner ear magnetic resonance imaging results were normal. The electric auriscope also showed no ear infections or inflammation. Taken together, we diagnosed him as COVID-19-associated sudden sensorineural hearing loss (SSNHL) and tinnitus. Additionally, the emotional, functional and physical impact of tinnitus was measured using the validated tinnitus handicap inventory (THI) scale, in which a score of 0 represents no impact and a score of 100 represents maximum impact. The THI before acupuncture was 75.
(a) Schematic diagram for the locations of three periauricular acupoints; (b) pure tone audiometry before acupuncture treatment; (c) pure tone audiometry after nine acupuncture sessions.
Regarding acupuncture protocols, as shown in Figure 1a, three periauricular acupuncture points were needled due to their function in regulating the nervous system and cochlear blood circulation, including Tinggong (SI19), GB2 (Tinghui) and Yifeng (TE17). The acupuncturist inserted the acupuncture needles vertically, and then slowly rotated in a small range to the insertion depth of ∼20–25 mm. Successful manipulation was to ensure deqi sensations (distention, soreness and numbness) could be transmitted to the ear canal. Subsequently, the needles were left for 30 min. He received acupuncture three times per week. Throughout the acupuncture treatment course, he did not seek other therapies.
Following the first acupuncture session, the patient reported a prompt reduction in the tinnitus loudness. By the end of six acupuncture sessions, he reported a marked improvement in both hearing loss and tinnitus, resulting in a substantial decrease in THI score, from 75 to 32. After undergoing nine acupuncture sessions, he was able to communicate effectively, and re-examination via pure tone audiometry indicated that his hearing in the right ear within the normal range across all frequencies (Figure 1c). Additionally, THI score was significantly reduced to 4, and he reported no episodes of tinnitus in the preceding week, so acupuncture treatment was discontinued. Finally, follow-up at 1 month revealed no recurrence of either hearing loss or tinnitus.
Discussion
Previous studies1,2 revealed that SSNHL is prevalent in both COVID-19 patients, and it is often accompanied by tinnitus. Although the mechanisms regarding the relationship between COVID-19 and SSNHL/tinnitus have not been well established, the immune-mediated inflammation may be a contributing factor.3,4
To our knowledge, this is the first case report highlighting the efficacy of acupuncture on COVID-19-associated SSNHL and tinnitus. The key to successful acupuncture manipulation lies in ensuring the transmission of deqi sensation to the ear canal, which is achieved by slowly rotating the needles in a small range. It is believed that such sensation transmission can significantly increase cochlear blood flow5 and promote neuroplasticity in the auditory center.6 Additionally, acupuncture may mitigate the immune-mediated inflammation and regulate dysfunctions of the auditory afferent pathway. These effects may synergistically contribute to the favorable efficacy in this case. Nonetheless, further studies with rigorous design are needed to validate these findings.
Funding
The work was supported by Zhejiang Provincial Famous Traditional Chinese Medicine Experts Inheritance Studio Construction Project (grant number: GZS2021027); the Hospital Project of the Third Affiliated Hospital of Zhejiang Chinese Medical University (grant number: ZS21ZA01); and the Zhejiang Province Public Welfare Technology Application Research (grant number: LTGY23H270003).
Consent
Written consent was obtained from the patient prior to the submission of this report.
Conflict of interest: None declared.
Author contributions
Hantong Hu (Writing—original draft [equal]), Xiaoqi Lin (Writing—original draft [equal]), Lijuan Fan (Conceptualization [supporting], Writing—original draft [equal]), Lianqiang Fang (Conceptualization [supporting]), Jie Zhou (Writing—review & editing [supporting]), and Hong Gao (Writing—review & editing [equal]).
References
Author notes
H. Hu, X. Lin and L. Fan contributed equally to this work.
