Rédacteur : Johan Nguyen

Sommaire

deafness:

Surdité : évaluation de l'acupuncture

☆☆☆ Evidence for effectiveness and a specific effect of acupuncture
☆☆ Evidence for effectiveness of acupuncture
☆ Limited evidence for effectiveness of acupuncture
Ø No evidence or insufficient evidence

1. Systematic Reviews and Meta-Analysis

1.1. Chen 2019 ☆

Chen S, Zhao M, Qiu J. Acupuncture for the treatment of sudden sensorineural hearing loss: A systematic review and meta-analysis: Acupuncture for SSNHL. Complement Ther Med. 2019;42:381-388. [191422].

Background Acupuncture as an alternative treatment method is widely used in the treatment of sudden sensorineural hearing loss (SSNHL) in China. We performed a systematic review and meta-analysis to assess the clinical efficacy of acupuncture for the management of SSNHL patients.
Materials and Methods The PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure and WanFang databases were searched. Searches were performed on April 27, 2018 and without language and publication year restrictions. We collected and analyzed the randomized controlled trials (RCTs) of acupuncture for the treatment of SSNHL patients to assess its efficacy and safety. The RevMan5.3 software was used for analysis. The fixed-effects model can be applied to calculate the risk ratio (RR) or weighted mean difference (WMD) if the chi-square test shows there was no significance of heterogeneity (p > 0.10, I2<50%). Otherwise, the random effects mode was used.
Results Twenty randomized controlled trials met our inclusion criteria. The electroacupuncture(EA), manual acupuncture(MA) plus western medicine(WM) and EA plus WM groups lead to significantly better pure tone audiometry(PTA) than WM alone in cured rate (P = 0.01; P < 00, 001; P < 0.006, respectively). However, no significant differences were observed between MA and WM (p = 0.27). In terms of total effective rate, all of them showed significant improvement compared to WM alone (MA: P = 0.03; EA: P = 0.01; MA + WM: P < 0.00001; EA + WM: P = 0.04). In addition, no significant difference was found between the MA plus WM and WM alone groups in the improvement of tinnitus (P = 0.37). No trials reported serious adverse events.
ConclusionAcupuncture could be a valid treatment option for SSNHL, especially for patients who could not be cured by drugs alone. However, the outcome was limited temporarily due to the lack of high-quality research support. High-quality evidence is needed to clarify the future efficacy and safety of acupuncture for SSNHL.

1.2. Jiang 2015 ☆☆

Jiang Y, Shi X, Tang Y. Efficacy and safety of acupuncture therapy for nerve deafness: a meta-analysis of randomized controlled trials. Int J Clin Exp Med. 2015;8(2):2614-20. [179320]

BackgroundAcupuncture is one of the important parts of therapeutic methods in traditional Chinese medicine, and has been widely used for the treatment of nerve deafness in recent years. The current study was to evaluate the efficacy and safety of acupuncture therapy for nerve deafness compared with conventional medicine therapy.
MethodsPubMed, the Chinese National Knowledge Infrastructure Database, the Chinese Science and Technology Periodical Database, the Chinese Biomedical Database, the Wanfang Database were searched for articles published to identify randomized controlled trials evaluating efficacy and side effects between acupuncture and conventional medicine therapies up to 2013/06.
ResultsA total of 12 studies, including 527 patients assessed the efficacy and safety of acupuncture therapy for nerve deafness. Overall, the efficacy of acupuncture was significantly better than that of the conventional western medication (RR: 1.54, 95% CI: 1.36-1.74) or traditional Chinese medicines (RR: 1.51, 95% CI: 1.24-1.84), and the efficacy of acupuncture in combination with conventional western medication or traditional Chinese medicine was better than that of the conventional western medication alone (RR: 1.51, 95% CI: 1.29-1.77) or traditional Chinese medicine alone (RR: 1.59, 95% CI: 1.30-1.95). Based on the comparison of number of deafness patients who were completely cured, the efficacy of acupuncture in combination with traditional Chinese medicines was better than that of traditional Chinese medicine alone (RR: 4.62, 95% CI: 1.38-15.47).
ConclusionsAcupuncture therapy can significantly improve the hearing of patients with nerve deafness, and the efficacy of acupuncture in combination with medication is superior to medication alone.

1.3. Zhang 2015 ☆

Zhang XC, Xu XP, Xu WT, Hou WZ, Cheng YY, Li CX, Ni GX. Acupuncture therapy for sudden sensorineural hearing loss: a systematic review and meta-analysis of randomized controlled trials. Plos One. 2015;10(4). [179330]

Objective Acupuncture has commonly been used in China, either alone or in combination with Western medicine, to treat sudden sensorineural hearing loss (SSHL). The purpose of this systematic review is to assess the efficacy and safety of acupuncture therapy for patients with SSHL.
Methods We searched PubMed, the Cochrane Library, Embase, China National Knowledge Internet (CNKI), Database for Chinese Technical Periodicals (VIP), and Chinese Biomedical literature service system (SinoMed) to collect randomized controlled trials of acupuncture for SSHL published before July 2014. A meta-analysis was conducted according to the Cochrane systematic review method using RevMan 5.2 software. The evidence level for each outcome was assessed using the GRADE methodology.
ResultsTwelve trials involving 863 patients were included. A meta-analysis showed that the effect of manual acupuncture combined with Western medicine comprehensive treatment (WMCT) was better than WMCT alone (RR 1.33, 95%CI 1.19-1.49) and the same as the effect of electroacupuncture combined with WMCT (RR 1.33, 95%CI 1.19-1.50). One study showed a better effect of electroacupuncture than of WMCT (RR 1.34, 95%CI 1.24-1.45). For mean changes in hearing over all frequencies, the meta-analysis showed a better effect with the combination of acupuncture and WMCT than with WMCT alone (MD 10.85, 95%CI 6.84-14.86). However, the evidence levels for these interventions were low or very low due to a high risk of bias and small sample sizes in the included studies.
Conclusion There was not sufficient evidence showing that acupuncture therapy alone was beneficial for treating SSHL. However, interventions combining acupuncture with WMCT had more efficacious results in the treatment of SSHL than WMCT alone. Electroacupuncture alone might be a viable alternative treatment besides WMCT for SSHL. However, given that there were fewer eligible RCTs and limitations in the included trials, such as methodological drawbacks and small sample sizes, large-scale RCTs are required to confirm the current findings regarding acupuncture therapy for SSHL.