- Email: [email protected]
Clinical observation on the different frequency hearing damages in sudden deafness treated by electroacupuncture combined with western medicine comprehensive therapy
World Journal ofAcupuncture-Moxibustion (WJAM) Vol. 22, No.2, 30th Jun. 2012
·22·
ELSEVIER
Clinical Research
Clinical observation on the different frequency hearing damages in sudden deafness treated byelectroacupuncture combined with western medicine comprehensive therapy ~/~t~@J2f~~1Jr*X1~~tt1:J+~/Ffnj$!$PJTjJm~Ef{JIf{h*~~~ QIU Ling (~ J4-)r, ZHENG Xu (~ 1@.)r, XIE Fang OM- -*i, ZHANG Min (*- ~)r, ZHANG Ji (*- -g)r, YUAN Song-bai ($.t,t}-Ml)3, ZENG Guang-zhi (it j(.;t)4 1. Pain Department, Chengdu Hospital ofIntegrated Chinese and Western Medicine, Chengdu 610041, Sichuan Province, China; 2. Nanchong Hospital of rCM; 3. Acupuncture-Moxibustion School, Affiliated Hospital of Chengdu University of rCM; 4. Dechang County Hospital of rCM, Liangshan Autonomous Region, Sichuan QYJrl,ijl(;~ 610041, 9='00; 2.1¥I1tm9='~~; 3. ,ijl(;~9='~~* Province (1. ,ijl(;~m9='W~~~~~;J¥m*4, ~~~~~#~~~; 4. QYJrr1§'~J1r1IHWJ~.g.9='~~)
ARTICLE INFO
ABSTRACT
Firstauthor:QIULing (1963-),female,
Objective Tocompare the differenceinthe clinicalefficacy onthe different frequencyhearingdamages forthe patientswith suddendeafness between the comprehensivetherapy of electroacupunctureand western medicine and the simple western medicinecomprehensivetherapy. Methods Fiftyeight caseswere randomized into an acupunctureplus medicationgroup (28cases, 32damaged ears)and a western medicinegroup (30cases, 34 damagedears). Inthe acupunctureplusmedicationgroup,thecomprehensive therapy of electroacupunctureand western medicinewasused. Themain points were Ermen (1+1'1 TE21), TTngg6ng (1lJT,§ SI 19), TTnghul (1lJT ~ GB2), Ylfeng (It)5<\. TE 17),etc. Thewestern medicine therapywasthe comprehensivetreatmentwith vasodilators,the medicinesfor promoting nerve functionandreleasing inner earedema and hyperbaricoxygen.In the westernmedicine group,the westernmedicine comprehensivetherapywas adopted. 10-day treatment madeone session.Two sessionsof treatment were required. In1 or2 sessionsof treatment, the efficacywasobserved, the electricaudiometrywasevaluated. Additionally,t he blood routine and liverand kidneyfunctionsweredetected. ResultsThe total effectiverate was 50.0%(16/32) inthe acupuncture+ medicationgroup andwas 55.9%(19/34) inthe westernmedicine group.The efficacieswere similarbetweenthe two groups(P>0.05). In1 and2 sessionsoftreatment,at250 Hz,500 Hzand 1kHz, the electricaudiometryvaluesin either group wererecovered significantly ascompared with thosebefore treatment(all P0.05). Therewere no abnormalitiesinthe bloodroutine andliver andkidney functiondetectionsbeforeand after treatmentin either group.Conclusion Either the comprehensivetherapy of electroacupunctureand western medicineor thesimple westernmedicine comprehensivetherapyiseffective inthe treatmentoflow frequencyhearingdamageof suddendeafness.Either ofthem hasno effecton highfrequency hearingdamage. Butfor themiddle frequencyhearing damage, the efficacyof the comprehensivetherapy of electroacupunctureand western medicineis superiorto that of thesimple westernmedicine comprehensivetherapy.
chiefphysician. Researchfield:rehabilitationwith acupunctureand moxibustionforpain disordersandthedisorders ofnerve system. E-mail:[email protected] Acceptedon August8,2011
KEY WORDS: suddendeafness;nervedeafness; electroacupuncture;hearing; differentfrequencies
World Journal ofAcupuncture-Moxibustion (WJAM) ELSEVIER
Vol. 22, No.2, 30th Jun. 2012
·23 •
Sudden deafness (sudden hearing loss, SD or SHL) is sudden sensorineural hearing loss, in a period of several minutes, hours or 3 days, without definite causes, greater than 20 dB hearing reduction, over at least two contiguous frequencies!". The morbidity of SD is 5-20 per 100 000 persons each year'", It is the common disease in clinic and the acute disorder in the otology department. There are many therapeutic methods in clinic and the prognoses are very different. Recently, the authors adopted the comprehensive therapy of electroacpuncture (EA) and western medicine to treat this disease. The clinical therapeutic observation was focused on the hearing damages at different frequencies for the patients with SD. The report is as follows.
CLINICAL DATA General data All of 60 cases were the SD patients from the Pain Department and ENT Department of Chengdu Hospital of Integrated Chinese and Western Medicine from June 2007 to February 2011. According to the random number table, an acupuncture + medication group and a western medicine group were divided, 30 cases in each one. In the acupuncture + medication group, 2 cases were dropped off (2 right ears) due to breaking off the treatment and adopting the other therapies. In light of the treatment program, 58 cases (66 ears) were accomplished the observation totally. In the acupuncture + medication group, 28 cases were accomplished the observation, with 17 left ears, 15 right ears and 4 cases of bilateral ears involved. In the western medicine group, 30 cases were accomplished the observation, of them, there were 20 left ears, 14 right ears and 4 cases of bilateral ears involved. In the acupuncture + medication group, the age was in the range from 14 to 62 years and the duration of sickness was from 1 to 45 days. In the western medicine group, the age was in the range from 15 to 64 years and the duration of sickness was from 1 to 15 days. There were no statistically Table1
Diagnostic criteria The diagnostic evidences proposed by China Otorhinolaryngology Association in 1997: 1) sudden non-volatility hearing damage, moderate or severe damage; 2) unknown causes; 3) potentially associated with tinnitus; 4) associated with vertigo, nausea and vomiting, but without repeated attacks; 5) no damage symptoms of other cranial nerves except No. V pair cranial nerve affected.
Inclusive criteria 1) In accordance with the diagnostic criteria of SD; 2) aged from 14 to 65 years; 3) being accepted willingly, and having signed the Informed Consent Form.
Exclusive criteria 1) Disorders of inner auditory tract; 2) mental disorders; 3) combined with severe liver, kidney disorders, hematonosis, tumor, the disorders of the respiratory and cardiovascular systems, extremely weak constitution; 4) women in pregnancy or lactation; 5) being allergic or contraindicated to the research medicine; 6) younger than 14 years old or older than 65 years old.
METHODS Acupuncture + medication group (1) Acupuncture treatment Acupoint selection: main points: Ermen (If TE 21), Tinggong (1!Jf'§ SI 19), TInghui (1!Jf~ GB 2), Yireng (BR TE 17), Zhongzhu (9=lm TE 3) and Xiaxi (~m GB 43). For Ermen (lfn TE 21), Tinggong (1!Jf'§ SI 19) and TInghui (nJT~ GB 2), one or two points of them were selected according to the disease in each treatment.
n
Comparisonofthe generaldata forthe patientswithsudden deafnessbetweenthetwo groups Numbers of affected ear
Sex (cases)
Groups
Patients
Acupuncture + medication
28
32
6
Western medicine
30
34
10
Table2
significant differences between the two groups in sex, age, duration of sickness, tympanogram, electric audiometry, etc. (all P>0.05). See Table 1 and Table 2.
Male
Tympanogram (ears)
Mean age (X±s, years)
Mean sick duration (X±s, days)
22
42.6±13.5
4.5±19.5
28
4
20
42.8±13.4
7.0±5.2
27
7
Female
A type
Non-A type
Baselineanalysisof electricaudiometryvalues ofthe patientswith suddendeafnessbetweenthetwo groups (X±s, dB)
Groups
Patients
Numbers of affected ear
250Hz
500Hz
Acupuncture + medication
28
32
42.7±29.0
47.0±29.6
53.3±33.6
57.7±32.3
53.0±28.3
Western medicine
30
34
47.2±31.2
52.8±31.8
49.7±31.7
48.8±31.8
49.4±31.9
1 kHz
2kHz
4kHz
·24·
WorldJournal ofAcupuncture-Moxibustion (WJAM) Vol. 22, No.2, 30th Jun. 2012
Supplementary points: adding Fengchi ()5
ELSEVIER
10-day treatment made one session. Totally, 2 sessions of treatment were required.
Western medicine group The western medicine comprehensive therapy was adopted. The methods and treatment course were same as the acupuncture + medication group.
Observation indices (1) Electric audiometry detection The electric audiometry detection was performed by the professional of Electric Audiometry Room of ENT Department. The examination was done before treatment, at the end of 10 and 20 treatments separately. (2) Safety indicators Before and after treatment, all the patients were required to have the detection of blood routine (RBC, WBC, PLT) and liver and kidney functions (ALT, BUN, Cr) for the evaluation of the safety of medication and therapeutic methods.
Efficacy evaluation criteria The efficacy evaluation criteria of SD were implemented in reference to Chinese Medicine Industry Standards ofthe People's Republic of China: Diagnostic Criteria of Otorhinolaryngological Department (ZY/TOO1.6-94). Clinically cured: the hearing threshold was recovered to be normal at 0.254 kHz or the hearing of the affected ear was same as that of the healthy one or as the level before sickness. Remarkably effective: the hearing was improved by over 30 dB at the above frequencies. Effective: the hearing was improved by over 15-30 dB at the above frequencies. Failed: the hearing was less than 15 dB at the above frequencies.
Statistical management The statistical soft package of Chinese Medicine Encyclopedia: Medical Statistics (3rd edition) was adopted for all the statistical calculation. 'l test was applied for the enumeration data. Mean ± standard deviation (X±s) indicated the measurement data, t test was used. P<0.05 indicated the statistically significant difference.
RESULTS Comparison of the clinical efficacy for the patients between the two groups (Table 3) It was shown in Table 3 that the difference of the clinical efficacy was not significant statistically between the two groups (P>0.05), which suggested that the overall efficacy of these two therapies was
World Journal ofAcupuncture-Moxibustion (WJAM)
Vol. 22, No.2, 30th Jun. 2012
ELSEVIER
Table3
·25 • ears(%)
Comparisonofthe clinicalefficacyfor suddendeafnesspatientsbetween thetwo groups
Groups
Patients
Numbers of affected ear
Clinically cured
Remarkably effective
Effective
Failed
Total effective
Acupuncture + medication
28
32
7 (21.9)
5 (15.6)
4 (12.5)
16 (50.0)
16 (50.0)
Western medicine
30
34
9 (26.5)
8 (23.5)
2 (5.9)
15 (44.1)
19 (55.9)
similar.
at the middle frequency (2 kHz), the comprehensive therapy of EA and western medicine was effective, but the simple western medicine did not achieve the superior effect. At 4 kHz, there was no statistically significant difference before and after treatment (all P>0.05). It was suggested that either of the therapies did not achieve the superior effect on the hearing damages ofSD at the high frequency (4 kHz).
Comparison of the electric audiometry values of the patients before and after treatment between the two groups (Table 4) It was known in Table 4 that after 1 and 2 sessions of treatment, at 250 Hz, 500 Hz and 1 kHz, the electric audiometry values were improved significantly as compared with those before treatment (all P0.05), which explained that either of the therapies had the significant efficacy on the hearing damages of SD at the low frequencies (250 Hz, 500 Hz, 1 kHz). At 2 kHz, in the acupuncture + medication group, after 1 and 2 sessions of treatment, the electric audiometry values were improved significantly as compared with those before treatment (P<0.05, P
Safety analysis for the patients between the two groups (Table 5, Table 6) It was indicated in Table 5 and Table 6 that there were no any significant abnormal changes in the results of liver and kidney functions as well as blood routine examinations that were relevant with the experimental operation and medicines before and after treatment in either group (all P>0.05). It was suggested that the differences in liver and kidney functions as well as blood routine examinations were not significant statistically before and after treatment in the two groups. Either of the therapies was safe in
Comparisonofthe electricaudiometryvalues of suddendeafnesspatientsbetween thetwo groups Groups
Patients
Acupuncture + medication
28
Western medicine
30
Acupuncture + medication
28
Western medicine
30
Acupuncture + medication
28
Western medicine
30
Acupuncture + medication
28
Western medicine
30
Acupuncture + medication
28
Western medicine
30
Frequency
Before treatment
250Hz 500Hz 1 kHz 2kHz 4kHz
After 1 session treatment
(X±s,dB)
After 2 session treatments
42.7±29.0
24.8±18.5 1)
23.6±16.0 ')
47.2±31.2
23.7±14.5 1)
18.5±9.4 1)
47.0±29.6
31.1±20.81)
29.5±19.4 1)
52.8±31.8
32.1±17.3
1 )
26.5±11.1 1)
1 )
53.3±33.6
36.7±25.1
49.7±31.7
34.6±20.8 1)
37.3±24.0 ') 29.6±14.0 ')
57.7±32.3
37.5±26.8 2)
37.5±26.2 1)
48.8±31.8
36.5±25.1
35.7±18.9
53.0±28.3
48.1±30.8
48.1±28.9
49.4±32.0
37.7±25.1
38.1±25.5
Notes: compared with that before treatment in the same group, I) P
Table5
Comparisonofliver andkidney functionsofsudden deafnesspatientsbeforeand after treatment betweenthetwo groups ALT(lU/L)
BUN (mmol/L)
(X±s)
Cr (umol/L)
Groups
Patients
Acupuncture + medication
28
23.2±17.1
23.9±19.4
5.0±1.6
5.1±1.6
65.001.2
66.1±22.2
Western medicine
30
21.4±17.7
22.8±11.0
5.3±1.5
5.2±1.6
62.2±12.4
63.4±16.8
Table6
Before treatment After treatment Before treatment After treatment Before treatment After treatment
Comparisonofblood routineof sudden deafnesspatientsbefore andafter treatmentbetweenthe twogroups (X±s) Groups
Patients
RBC (xlO I2/L)
WBC (xl09/L)
PLT (x10 9/L)
Before treatment After treatment Before treatment After treatment Before treatment After treatment
Acupuncture + medication
28
4.75±0.22
4.29±0.24
7.08±1.88
6.69±1.54
210.0±33.7
195.2±36.3
Western medicine
30
4.66±0.45
4.52±0.58
6.59±1.09
5.54±1.32
189.1±37.3
190.1±23.2
World Journal ofAcupuncture-Moxibustion (WJAM)
·26·
Vol. 22, No.2, 30th Jun. 2012
operation.
DISCUSSION The etiology of SD is unknown currently. The common recognized etiology and pathogenesis is relevant with the inner ear circulatory disturbance, viral infection, autoimmunity reaction, autonomic nerve disturbance and membranous labyrinth rupture. Additionally, tumor, operation, traumatic injury or ototoxic drug may also induce SD. Of them, the inner ear circulatory disturbance and viral infection are acknowledged'", The main manifestations are hearing declining, tinnitus, vertigo, ear blockage feeling and others, which bring the very impacts on the patients physically and mentally, as well as the life activity. The treatment of the disease is very significant for dealing with the physical and mental issues of the patients and improving the life quality. The western medicine comprehensive therapy is commonly adopted at present. In this research, the integrated Chinese and western medicine was used. Through the random clinical observation, it was discovered that the comprehensive therapy of EA and western medicine achieved the best efficacy on the hearing damages of the middle frequency as compared with the simple western medicine comprehensive therapy. The disease is in the category of "Baolong" and "Tulong" (sudden deafness) of Chinese medicine. It
is commonly caused by the upward attack of wind heat to the clear yang; or dysfunction of the liver in maintaining the free flow of qi, the stagnation of liver qi transforming into fire, and the upward attack of the liver and gallbladder fire; or qi and blood stagnation and retarded qi and blood circulation in the ear collaterals. The pathogenesis is blockage in meridians and collaterals, blockage of the ear orifice and hearing damages. The treatment principle should be activating blood circulation, promoting the circulation in meridians and collaterals and opening the orifice. The Shaoyang meridians of hand and food run inside the ear from the posterior side of the ear and go to the anterior of the ear. The HandTaiyang Meridian enters the ear. Hence, acupuncture treatment should focus on these three meridians so as to clear away heat, improve hearing and open the orifice. Brmen (:E!=f1 TE 21), Ttnggong (1!Jf;§ SI 19), TInghui (1!Jf~ GB 2) are the key points of the Shaoyang meridians of hand and foot and the HandTaiyang Meridian separately and located near the ear. They were selected because of their local functions and indications'". Acupuncture at the acupoints can promote Shaoyang and Taiyang meridian qi and remove the stasis of the ear, promote the circulation
ELSEVIER
of qi and blood in the local meridians. Locally, the superficial temporal artery and vein, auriculotemporal nerve, facial nerve, great auricular nerve and the others are distributed. Acupuncture promotes the peripheral microcirculation of blood, relieves or prevents from the local ischemic and anaerobic conditions, boosts the local blood circulation and the histiocytic recovery!", It improves the nerve and auditory sensitivity of the inner ear. Zhongzhii TE 3) is the key acupoint in the treatment of ear disease and is the acupoint of Shaoyang Meridian. It acts on regulating Shaoyang meridian qi, removing the pathogenic heat of the triple energizer, opening the orifice and benefiting the hearing. In EA, the disperse-dense wave was adopted to prevent from the adaptability to the human body, in which, the disperse wave and dense wave were output alternatively. As a result, the strong and long-term stimulation could be induced to the human body. In treatment, the rhythmical contraction and relaxation of the muscles around the ear can promote the blood and lymph circulations of the local tissues, relieve rapidly vertigo and blockage feeling of the ear for the patients, improve the nutrient metabolism of the tissue, accelerate the ion operation inside and outside the membrane and enhance the excitability of the auditory nerve. Additionally, EA normalizes the stimulation of needling to the points, promotes and maintains the propagated sensation along the channel so as to enhance and prolong the post-acupuncture effectiveness.
u:rm
The research'f showed that the severity of hearing damage is the important factor of the prognosis. The hearing recovery is significant for deafness of the low frequency as compared with that of the high frequency. Concerning the improvement ofthe middlefrequency hearing, the results of this research showed that the treatment with EA supplemented achieved the better effect as compared with the simple western medicine comprehensive therapy. It may be related to that acupuncture contributes to the maintenance of hair cells. The regular and persistent stimulation of EA therapy at the acupoints bring the benefits to the damaged hair cells. The cochlear hair cells located in the basement membrane is the sound receptor cells of the inner ear. The synapses are constituted by their basements with the afferent nerve terminals and efferent nerve terminals separately, which directly participate in the afferent process of hearing. When damaged, the afferent fibers can be degraded. The recent research'" indicated that the new hair cells naturally generated in the embryo and the ear of adult birds and lower vertebrates. But so far there was no effective way to stimulate the regeneration of
World Journal ofAcupuncture-Moxibustion (WJAM)
ELSEVIER
Vol. 22, No.2, 30th Jun. 2012
·27·
the cochlear hair cells for the adult mammalian. The survival and maintenance of the function hair cells is very important for normal hearing. Hence, how to recover the damaged hair cells or maintain their function is the important issue at present to restore the patients hearing. Acupuncture can reduce the degeneration and necrosis of the hair cells of the inner ear for the deaf guinea pigs, promote the compensatory role of the undamaged cochlea hair cells and increase the cortical auditory central excitability'". Acupuncture probably promotes the stability of the residual function of the damaged hair cells and the originally recovered function: maintaining the cilia movement of the hair cells, maintaining the membrane potential of the hair cells, maintaining the activity of the neurotransmitter receptors of the afferent fibers of the hair cells and the auditory nerve and the normal material exchange and maintaining the biological activity and excitability of the afferent fibers, finally recovering the hearing level. This research proves that either the comprehensive therapy of EA and western medicine or the simple western medicine comprehensive therapy is effective on hearing damage of the low frequency for sudden deafness and has no effect on hearing damage of the high frequency. The comprehensive therapy of EA and western medicine is effective on hearing damage of the middle frequency, but the effect on it is not obvious in the treatment with the simple western medicine comprehensive therapy.
REFERENCES [1]
[2]
[3]
[4]
[5]
[6]
[7] [8]
Board of Editors of the Chinese Journal of Otorhinolaryngology Head and Neck Surgery, the Branch of Otorhinolaryngology Head and Neck Surgery, Chinese Medical Association. Guide of diagnosis and treatment of sudden deafness (2005, Jinan). Chin J Otorhinolaryngol Head Neck Surg (Chin) 2006; 541(5):325. Byl FM Jr. Sudden hearing loss: eight years' experience and suggested prognostic table. Laryngoscope 1984; 94 (5 Pt 1): 647-661. Tan J. New progression ofthe clinical treatment of sudden deafness. J Chin Tradit Chin Med Inform(Chin) 2011; 3(7):131-133. Shen LH, Luo KT, Bian XD, Lou ZY, Lu HJ. Thirty cases of sudden deafness treated with warm needling and point injection. Zhejiang J Tradit Chin Med (Chin) 2011; 46(3): 201. Wang CH, Wang W, Li JC, Wang ZR, Feng W, Ma SP, et al. Changes in the nail fold microcirculation of sudden deafness and impacts of acupuncture. J Fourth Mil Med Univ (Chin) 2003;24(5): 477--478. Lu YL, Zhao W. Correlative factor analysis of the treatment effect and prognosis of sudden deafuess. Mod Rehabil (Chin) 2001; 5(6):48,51. Sgone JS, Rubel EW. Deltal expression during avian hair cell regeneration. Development 1999; 126(5):961-973. Zhou QH, Zeng ZL, Li D. Brief introduction of the modem research of deafness treated with acupuncture and moxibustion. Chin Acup-Mox (Chin) 1999;19(3):185188. (Editor: YANG Li-li Translator: WANG Fang)
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·22·
ELSEVIER
Clinical Research
Clinical observation on the different frequency hearing damages in sudden deafness treated byelectroacupuncture combined with western medicine comprehensive therapy ~/~t~@J2f~~1Jr*X1~~tt1:J+~/Ffnj$!$PJTjJm~Ef{JIf{h*~~~ QIU Ling (~ J4-)r, ZHENG Xu (~ 1@.)r, XIE Fang OM- -*i, ZHANG Min (*- ~)r, ZHANG Ji (*- -g)r, YUAN Song-bai ($.t,t}-Ml)3, ZENG Guang-zhi (it j(.;t)4 1. Pain Department, Chengdu Hospital ofIntegrated Chinese and Western Medicine, Chengdu 610041, Sichuan Province, China; 2. Nanchong Hospital of rCM; 3. Acupuncture-Moxibustion School, Affiliated Hospital of Chengdu University of rCM; 4. Dechang County Hospital of rCM, Liangshan Autonomous Region, Sichuan QYJrl,ijl(;~ 610041, 9='00; 2.1¥I1tm9='~~; 3. ,ijl(;~9='~~* Province (1. ,ijl(;~m9='W~~~~~;J¥m*4, ~~~~~#~~~; 4. QYJrr1§'~J1r1IHWJ~.g.9='~~)
ARTICLE INFO
ABSTRACT
Firstauthor:QIULing (1963-),female,
Objective Tocompare the differenceinthe clinicalefficacy onthe different frequencyhearingdamages forthe patientswith suddendeafness between the comprehensivetherapy of electroacupunctureand western medicine and the simple western medicinecomprehensivetherapy. Methods Fiftyeight caseswere randomized into an acupunctureplus medicationgroup (28cases, 32damaged ears)and a western medicinegroup (30cases, 34 damagedears). Inthe acupunctureplusmedicationgroup,thecomprehensive therapy of electroacupunctureand western medicinewasused. Themain points were Ermen (1+1'1 TE21), TTngg6ng (1lJT,§ SI 19), TTnghul (1lJT ~ GB2), Ylfeng (It)5<\. TE 17),etc. Thewestern medicine therapywasthe comprehensivetreatmentwith vasodilators,the medicinesfor promoting nerve functionandreleasing inner earedema and hyperbaricoxygen.In the westernmedicine group,the westernmedicine comprehensivetherapywas adopted. 10-day treatment madeone session.Two sessionsof treatment were required. In1 or2 sessionsof treatment, the efficacywasobserved, the electricaudiometrywasevaluated. Additionally,t he blood routine and liverand kidneyfunctionsweredetected. ResultsThe total effectiverate was 50.0%(16/32) inthe acupuncture+ medicationgroup andwas 55.9%(19/34) inthe westernmedicine group.The efficacieswere similarbetweenthe two groups(P>0.05). In1 and2 sessionsoftreatment,at250 Hz,500 Hzand 1kHz, the electricaudiometryvaluesin either group wererecovered significantly ascompared with thosebefore treatment(all P
chiefphysician. Researchfield:rehabilitationwith acupunctureand moxibustionforpain disordersandthedisorders ofnerve system. E-mail:[email protected] Acceptedon August8,2011
KEY WORDS: suddendeafness;nervedeafness; electroacupuncture;hearing; differentfrequencies
World Journal ofAcupuncture-Moxibustion (WJAM) ELSEVIER
Vol. 22, No.2, 30th Jun. 2012
·23 •
Sudden deafness (sudden hearing loss, SD or SHL) is sudden sensorineural hearing loss, in a period of several minutes, hours or 3 days, without definite causes, greater than 20 dB hearing reduction, over at least two contiguous frequencies!". The morbidity of SD is 5-20 per 100 000 persons each year'", It is the common disease in clinic and the acute disorder in the otology department. There are many therapeutic methods in clinic and the prognoses are very different. Recently, the authors adopted the comprehensive therapy of electroacpuncture (EA) and western medicine to treat this disease. The clinical therapeutic observation was focused on the hearing damages at different frequencies for the patients with SD. The report is as follows.
CLINICAL DATA General data All of 60 cases were the SD patients from the Pain Department and ENT Department of Chengdu Hospital of Integrated Chinese and Western Medicine from June 2007 to February 2011. According to the random number table, an acupuncture + medication group and a western medicine group were divided, 30 cases in each one. In the acupuncture + medication group, 2 cases were dropped off (2 right ears) due to breaking off the treatment and adopting the other therapies. In light of the treatment program, 58 cases (66 ears) were accomplished the observation totally. In the acupuncture + medication group, 28 cases were accomplished the observation, with 17 left ears, 15 right ears and 4 cases of bilateral ears involved. In the western medicine group, 30 cases were accomplished the observation, of them, there were 20 left ears, 14 right ears and 4 cases of bilateral ears involved. In the acupuncture + medication group, the age was in the range from 14 to 62 years and the duration of sickness was from 1 to 45 days. In the western medicine group, the age was in the range from 15 to 64 years and the duration of sickness was from 1 to 15 days. There were no statistically Table1
Diagnostic criteria The diagnostic evidences proposed by China Otorhinolaryngology Association in 1997: 1) sudden non-volatility hearing damage, moderate or severe damage; 2) unknown causes; 3) potentially associated with tinnitus; 4) associated with vertigo, nausea and vomiting, but without repeated attacks; 5) no damage symptoms of other cranial nerves except No. V pair cranial nerve affected.
Inclusive criteria 1) In accordance with the diagnostic criteria of SD; 2) aged from 14 to 65 years; 3) being accepted willingly, and having signed the Informed Consent Form.
Exclusive criteria 1) Disorders of inner auditory tract; 2) mental disorders; 3) combined with severe liver, kidney disorders, hematonosis, tumor, the disorders of the respiratory and cardiovascular systems, extremely weak constitution; 4) women in pregnancy or lactation; 5) being allergic or contraindicated to the research medicine; 6) younger than 14 years old or older than 65 years old.
METHODS Acupuncture + medication group (1) Acupuncture treatment Acupoint selection: main points: Ermen (If TE 21), Tinggong (1!Jf'§ SI 19), TInghui (1!Jf~ GB 2), Yireng (BR TE 17), Zhongzhu (9=lm TE 3) and Xiaxi (~m GB 43). For Ermen (lfn TE 21), Tinggong (1!Jf'§ SI 19) and TInghui (nJT~ GB 2), one or two points of them were selected according to the disease in each treatment.
n
Comparisonofthe generaldata forthe patientswithsudden deafnessbetweenthetwo groups Numbers of affected ear
Sex (cases)
Groups
Patients
Acupuncture + medication
28
32
6
Western medicine
30
34
10
Table2
significant differences between the two groups in sex, age, duration of sickness, tympanogram, electric audiometry, etc. (all P>0.05). See Table 1 and Table 2.
Male
Tympanogram (ears)
Mean age (X±s, years)
Mean sick duration (X±s, days)
22
42.6±13.5
4.5±19.5
28
4
20
42.8±13.4
7.0±5.2
27
7
Female
A type
Non-A type
Baselineanalysisof electricaudiometryvalues ofthe patientswith suddendeafnessbetweenthetwo groups (X±s, dB)
Groups
Patients
Numbers of affected ear
250Hz
500Hz
Acupuncture + medication
28
32
42.7±29.0
47.0±29.6
53.3±33.6
57.7±32.3
53.0±28.3
Western medicine
30
34
47.2±31.2
52.8±31.8
49.7±31.7
48.8±31.8
49.4±31.9
1 kHz
2kHz
4kHz
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WorldJournal ofAcupuncture-Moxibustion (WJAM) Vol. 22, No.2, 30th Jun. 2012
Supplementary points: adding Fengchi ()5
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10-day treatment made one session. Totally, 2 sessions of treatment were required.
Western medicine group The western medicine comprehensive therapy was adopted. The methods and treatment course were same as the acupuncture + medication group.
Observation indices (1) Electric audiometry detection The electric audiometry detection was performed by the professional of Electric Audiometry Room of ENT Department. The examination was done before treatment, at the end of 10 and 20 treatments separately. (2) Safety indicators Before and after treatment, all the patients were required to have the detection of blood routine (RBC, WBC, PLT) and liver and kidney functions (ALT, BUN, Cr) for the evaluation of the safety of medication and therapeutic methods.
Efficacy evaluation criteria The efficacy evaluation criteria of SD were implemented in reference to Chinese Medicine Industry Standards ofthe People's Republic of China: Diagnostic Criteria of Otorhinolaryngological Department (ZY/TOO1.6-94). Clinically cured: the hearing threshold was recovered to be normal at 0.254 kHz or the hearing of the affected ear was same as that of the healthy one or as the level before sickness. Remarkably effective: the hearing was improved by over 30 dB at the above frequencies. Effective: the hearing was improved by over 15-30 dB at the above frequencies. Failed: the hearing was less than 15 dB at the above frequencies.
Statistical management The statistical soft package of Chinese Medicine Encyclopedia: Medical Statistics (3rd edition) was adopted for all the statistical calculation. 'l test was applied for the enumeration data. Mean ± standard deviation (X±s) indicated the measurement data, t test was used. P<0.05 indicated the statistically significant difference.
RESULTS Comparison of the clinical efficacy for the patients between the two groups (Table 3) It was shown in Table 3 that the difference of the clinical efficacy was not significant statistically between the two groups (P>0.05), which suggested that the overall efficacy of these two therapies was
World Journal ofAcupuncture-Moxibustion (WJAM)
Vol. 22, No.2, 30th Jun. 2012
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Table3
·25 • ears(%)
Comparisonofthe clinicalefficacyfor suddendeafnesspatientsbetween thetwo groups
Groups
Patients
Numbers of affected ear
Clinically cured
Remarkably effective
Effective
Failed
Total effective
Acupuncture + medication
28
32
7 (21.9)
5 (15.6)
4 (12.5)
16 (50.0)
16 (50.0)
Western medicine
30
34
9 (26.5)
8 (23.5)
2 (5.9)
15 (44.1)
19 (55.9)
similar.
at the middle frequency (2 kHz), the comprehensive therapy of EA and western medicine was effective, but the simple western medicine did not achieve the superior effect. At 4 kHz, there was no statistically significant difference before and after treatment (all P>0.05). It was suggested that either of the therapies did not achieve the superior effect on the hearing damages ofSD at the high frequency (4 kHz).
Comparison of the electric audiometry values of the patients before and after treatment between the two groups (Table 4) It was known in Table 4 that after 1 and 2 sessions of treatment, at 250 Hz, 500 Hz and 1 kHz, the electric audiometry values were improved significantly as compared with those before treatment (all P
Safety analysis for the patients between the two groups (Table 5, Table 6) It was indicated in Table 5 and Table 6 that there were no any significant abnormal changes in the results of liver and kidney functions as well as blood routine examinations that were relevant with the experimental operation and medicines before and after treatment in either group (all P>0.05). It was suggested that the differences in liver and kidney functions as well as blood routine examinations were not significant statistically before and after treatment in the two groups. Either of the therapies was safe in
Comparisonofthe electricaudiometryvalues of suddendeafnesspatientsbetween thetwo groups Groups
Patients
Acupuncture + medication
28
Western medicine
30
Acupuncture + medication
28
Western medicine
30
Acupuncture + medication
28
Western medicine
30
Acupuncture + medication
28
Western medicine
30
Acupuncture + medication
28
Western medicine
30
Frequency
Before treatment
250Hz 500Hz 1 kHz 2kHz 4kHz
After 1 session treatment
(X±s,dB)
After 2 session treatments
42.7±29.0
24.8±18.5 1)
23.6±16.0 ')
47.2±31.2
23.7±14.5 1)
18.5±9.4 1)
47.0±29.6
31.1±20.81)
29.5±19.4 1)
52.8±31.8
32.1±17.3
1 )
26.5±11.1 1)
1 )
53.3±33.6
36.7±25.1
49.7±31.7
34.6±20.8 1)
37.3±24.0 ') 29.6±14.0 ')
57.7±32.3
37.5±26.8 2)
37.5±26.2 1)
48.8±31.8
36.5±25.1
35.7±18.9
53.0±28.3
48.1±30.8
48.1±28.9
49.4±32.0
37.7±25.1
38.1±25.5
Notes: compared with that before treatment in the same group, I) P
Table5
Comparisonofliver andkidney functionsofsudden deafnesspatientsbeforeand after treatment betweenthetwo groups ALT(lU/L)
BUN (mmol/L)
(X±s)
Cr (umol/L)
Groups
Patients
Acupuncture + medication
28
23.2±17.1
23.9±19.4
5.0±1.6
5.1±1.6
65.001.2
66.1±22.2
Western medicine
30
21.4±17.7
22.8±11.0
5.3±1.5
5.2±1.6
62.2±12.4
63.4±16.8
Table6
Before treatment After treatment Before treatment After treatment Before treatment After treatment
Comparisonofblood routineof sudden deafnesspatientsbefore andafter treatmentbetweenthe twogroups (X±s) Groups
Patients
RBC (xlO I2/L)
WBC (xl09/L)
PLT (x10 9/L)
Before treatment After treatment Before treatment After treatment Before treatment After treatment
Acupuncture + medication
28
4.75±0.22
4.29±0.24
7.08±1.88
6.69±1.54
210.0±33.7
195.2±36.3
Western medicine
30
4.66±0.45
4.52±0.58
6.59±1.09
5.54±1.32
189.1±37.3
190.1±23.2
World Journal ofAcupuncture-Moxibustion (WJAM)
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Vol. 22, No.2, 30th Jun. 2012
operation.
DISCUSSION The etiology of SD is unknown currently. The common recognized etiology and pathogenesis is relevant with the inner ear circulatory disturbance, viral infection, autoimmunity reaction, autonomic nerve disturbance and membranous labyrinth rupture. Additionally, tumor, operation, traumatic injury or ototoxic drug may also induce SD. Of them, the inner ear circulatory disturbance and viral infection are acknowledged'", The main manifestations are hearing declining, tinnitus, vertigo, ear blockage feeling and others, which bring the very impacts on the patients physically and mentally, as well as the life activity. The treatment of the disease is very significant for dealing with the physical and mental issues of the patients and improving the life quality. The western medicine comprehensive therapy is commonly adopted at present. In this research, the integrated Chinese and western medicine was used. Through the random clinical observation, it was discovered that the comprehensive therapy of EA and western medicine achieved the best efficacy on the hearing damages of the middle frequency as compared with the simple western medicine comprehensive therapy. The disease is in the category of "Baolong" and "Tulong" (sudden deafness) of Chinese medicine. It
is commonly caused by the upward attack of wind heat to the clear yang; or dysfunction of the liver in maintaining the free flow of qi, the stagnation of liver qi transforming into fire, and the upward attack of the liver and gallbladder fire; or qi and blood stagnation and retarded qi and blood circulation in the ear collaterals. The pathogenesis is blockage in meridians and collaterals, blockage of the ear orifice and hearing damages. The treatment principle should be activating blood circulation, promoting the circulation in meridians and collaterals and opening the orifice. The Shaoyang meridians of hand and food run inside the ear from the posterior side of the ear and go to the anterior of the ear. The HandTaiyang Meridian enters the ear. Hence, acupuncture treatment should focus on these three meridians so as to clear away heat, improve hearing and open the orifice. Brmen (:E!=f1 TE 21), Ttnggong (1!Jf;§ SI 19), TInghui (1!Jf~ GB 2) are the key points of the Shaoyang meridians of hand and foot and the HandTaiyang Meridian separately and located near the ear. They were selected because of their local functions and indications'". Acupuncture at the acupoints can promote Shaoyang and Taiyang meridian qi and remove the stasis of the ear, promote the circulation
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of qi and blood in the local meridians. Locally, the superficial temporal artery and vein, auriculotemporal nerve, facial nerve, great auricular nerve and the others are distributed. Acupuncture promotes the peripheral microcirculation of blood, relieves or prevents from the local ischemic and anaerobic conditions, boosts the local blood circulation and the histiocytic recovery!", It improves the nerve and auditory sensitivity of the inner ear. Zhongzhii TE 3) is the key acupoint in the treatment of ear disease and is the acupoint of Shaoyang Meridian. It acts on regulating Shaoyang meridian qi, removing the pathogenic heat of the triple energizer, opening the orifice and benefiting the hearing. In EA, the disperse-dense wave was adopted to prevent from the adaptability to the human body, in which, the disperse wave and dense wave were output alternatively. As a result, the strong and long-term stimulation could be induced to the human body. In treatment, the rhythmical contraction and relaxation of the muscles around the ear can promote the blood and lymph circulations of the local tissues, relieve rapidly vertigo and blockage feeling of the ear for the patients, improve the nutrient metabolism of the tissue, accelerate the ion operation inside and outside the membrane and enhance the excitability of the auditory nerve. Additionally, EA normalizes the stimulation of needling to the points, promotes and maintains the propagated sensation along the channel so as to enhance and prolong the post-acupuncture effectiveness.
u:rm
The research'f showed that the severity of hearing damage is the important factor of the prognosis. The hearing recovery is significant for deafness of the low frequency as compared with that of the high frequency. Concerning the improvement ofthe middlefrequency hearing, the results of this research showed that the treatment with EA supplemented achieved the better effect as compared with the simple western medicine comprehensive therapy. It may be related to that acupuncture contributes to the maintenance of hair cells. The regular and persistent stimulation of EA therapy at the acupoints bring the benefits to the damaged hair cells. The cochlear hair cells located in the basement membrane is the sound receptor cells of the inner ear. The synapses are constituted by their basements with the afferent nerve terminals and efferent nerve terminals separately, which directly participate in the afferent process of hearing. When damaged, the afferent fibers can be degraded. The recent research'" indicated that the new hair cells naturally generated in the embryo and the ear of adult birds and lower vertebrates. But so far there was no effective way to stimulate the regeneration of
World Journal ofAcupuncture-Moxibustion (WJAM)
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Vol. 22, No.2, 30th Jun. 2012
·27·
the cochlear hair cells for the adult mammalian. The survival and maintenance of the function hair cells is very important for normal hearing. Hence, how to recover the damaged hair cells or maintain their function is the important issue at present to restore the patients hearing. Acupuncture can reduce the degeneration and necrosis of the hair cells of the inner ear for the deaf guinea pigs, promote the compensatory role of the undamaged cochlea hair cells and increase the cortical auditory central excitability'". Acupuncture probably promotes the stability of the residual function of the damaged hair cells and the originally recovered function: maintaining the cilia movement of the hair cells, maintaining the membrane potential of the hair cells, maintaining the activity of the neurotransmitter receptors of the afferent fibers of the hair cells and the auditory nerve and the normal material exchange and maintaining the biological activity and excitability of the afferent fibers, finally recovering the hearing level. This research proves that either the comprehensive therapy of EA and western medicine or the simple western medicine comprehensive therapy is effective on hearing damage of the low frequency for sudden deafness and has no effect on hearing damage of the high frequency. The comprehensive therapy of EA and western medicine is effective on hearing damage of the middle frequency, but the effect on it is not obvious in the treatment with the simple western medicine comprehensive therapy.
REFERENCES [1]
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Board of Editors of the Chinese Journal of Otorhinolaryngology Head and Neck Surgery, the Branch of Otorhinolaryngology Head and Neck Surgery, Chinese Medical Association. Guide of diagnosis and treatment of sudden deafness (2005, Jinan). Chin J Otorhinolaryngol Head Neck Surg (Chin) 2006; 541(5):325. Byl FM Jr. Sudden hearing loss: eight years' experience and suggested prognostic table. Laryngoscope 1984; 94 (5 Pt 1): 647-661. Tan J. New progression ofthe clinical treatment of sudden deafness. J Chin Tradit Chin Med Inform(Chin) 2011; 3(7):131-133. Shen LH, Luo KT, Bian XD, Lou ZY, Lu HJ. Thirty cases of sudden deafness treated with warm needling and point injection. Zhejiang J Tradit Chin Med (Chin) 2011; 46(3): 201. Wang CH, Wang W, Li JC, Wang ZR, Feng W, Ma SP, et al. Changes in the nail fold microcirculation of sudden deafness and impacts of acupuncture. J Fourth Mil Med Univ (Chin) 2003;24(5): 477--478. Lu YL, Zhao W. Correlative factor analysis of the treatment effect and prognosis of sudden deafuess. Mod Rehabil (Chin) 2001; 5(6):48,51. Sgone JS, Rubel EW. Deltal expression during avian hair cell regeneration. Development 1999; 126(5):961-973. Zhou QH, Zeng ZL, Li D. Brief introduction of the modem research of deafness treated with acupuncture and moxibustion. Chin Acup-Mox (Chin) 1999;19(3):185188. (Editor: YANG Li-li Translator: WANG Fang)
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