Acupuncture improves outcomes for patients with Meniere’s disease. Researchers find that acupuncture, when added to a standard treatment regimen, significantly reduces symptoms of vertigo, tinnitus, and hearing loss for patients with Meniere’s disease. The researchers conclude that the combination of acupuncture with medication therapy is significantly more effective than drug monotherapy. 
Researchers from the China Academy of Chinese Medical Sciences and Tongren Hospital (Beijing) published the results. The investigators observed significant improvements in measures such as the dizziness handicap index (DHI), tinnitus handicap index (THI), and pure tone audiometry hearing tests for patients receiving biweekly acupuncture treatments.
A total of 96 participants with a clinical diagnosis of Meniere’s disease were recruited to the study and were assigned to receive either acupuncture plus standard medications or standard medication monotherapy. Throughout the study, 12 patients dropped out from the acupuncture group, and nine patients dropped out from the control group due to work and other commitments.
Of the remaining participants in the acupuncture group, there were 18 males and 18 females, ages 27–59 years (mean age 46 years). The minimum duration of disease in this group was two years, and the maximum was 20.5 years (mean duration of 6.9 years). Of the remaining participants in the drug monotherapy control group, there were 16 males and 23 females, ages 23–60 years (mean age 44 years). The minimum duration of disease was 1.5 years, and the maximum was 20 years (mean duration of 7.7 years).
Inclusion criteria for the study were the following: clinical diagnosis of Meniere’s disease, ages 18–60 years, no treatment with acupuncture or medications in the previous three months, and voluntary consent given to take part in the study. Patients were excluded that had vertigo due to other conditions, psychiatric disorders, heart, liver, or kidney dysfunction, malignant tumors, diseases of the hematopoietic system, or pacemakers. Pregnant or lactating women and those that had taken part in other clinical trials or treatments in the previous three months were also excluded.
Standard Medications The participants in both groups were treated with standard medications for Meniere’s disease. This was betahistine mesylate (12mg, three times a day) and mecobalamin (0.5mg, three times a day). Betahistine mesylate is a histamine analog and an H1 receptor agonist. It is a vasodilator used for the treatment of headaches and Meniere’s disease. Mecobalamin is vitamin B12. The researchers note that these substances act by enhancing cerebral circulation, reducing the build-up of pressure due to fluids in the inner ear, and promoting the repair of damaged nerves to relieve symptoms such as vertigo and tinnitus. Both medications were administered continuously for a total of 12 weeks.
Acupuncture Protocol In addition to standard medications, participants assigned to the acupuncture group also received acupuncture treatments. According to traditional Chinese medicine theory, Meniere’s disease stems from a deficiency of the zang organs, especially the liver and kidneys. This leads to the generation of interior wind or phlegm, causing the classic Meniere’s symptoms of vertigo and tinnitus. According to these principles, treatment was administered at the following acupoints:
Treatments were administered with patients in a supine position, and the acupoints were disinfected before use with 75% ethanol. Baihui was needled at a 45-degree angle, directed towards the back of the head, using 0.25 × 25mm needles, inserted to a depth of approximately 20mm. Fengchi was needled at a 45-degree angle, directed towards the tip of the nose, using 0.25 × 25mm needles, inserted to a depth of approximately 20mm.
Tinggong, Hegu, Taichong, and Taixi were needled perpendicularly using 0.25 × 25mm needles, inserted to a depth of approximately 20mm. The remaining points were needled perpendicularly using 0.30 × 40mm needles, inserted to a depth of approximately 30mm. All needles were stimulated using a balanced reinforcing and reducing method and were retained for 20 minutes. Treatment was administered every Tuesday and Friday for 12 weeks, yielding a total of 24 treatments throughout the study.
Outcomes and Discussion The four main outcomes measured by the study were the dizziness handicap inventory (DHI), tinnitus disability handicap (DHI), pure tone audiometry hearing test (PTA), and a visual analog scale (VAS) for sensations of congestion in the ears.
Vertigo The DHI is a scale from 0–100, with higher scores indicating increasingly severe dizziness. Mean baseline DHI scores were 27.00 in the acupuncture group and 25.05 in the control group. Following treatment, these scores fell to 10.61 and 12.36 respectively, indicating that improvements were significantly greater in the acupuncture group.
Improvements in vertigo symptoms were also measured. Those assigned to group A showed full control of vertigo symptoms, those assigned to group B showed good control, and those assigned to group C showed partial control. Participants assigned to group D showed no improvement in vertigo symptoms, and those assigned to group E experienced aggravation of symptoms. The number of participants in groups A–C were added together to determine the total effective rate. The total effective rate was significantly higher in the acupuncture group at 97.2%, compared with 71.8% in the drug monotherapy control group.
Tinnitus The THI is rated on a 0–100 scale, with higher scores indicating increasingly severe tinnitus symptoms. Mean baseline THI scores were 26.42 in the acupuncture group and 26.38 in the control group. Following treatment, these scores fell to 12.28 and 14.67, showing significantly greater improvements in the acupuncture group.
Hearing The PTA is a standard hearing test measuring the quietest sound (in decibels) that can be heard at different frequencies by the patient, 50% of the time. Mean baseline scores were 46.23dB in the acupuncture group and 45.60dB in the control group. Following treatment, these scores fell to 30.53dB and 37.54dB respectively, indicating significantly greater improvements in hearing for patients in the acupuncture group.
PTA improvements were categorized into several tiers. Participants showing improvements of over 30dB (or were able to hear sounds of 20dB or less across all frequencies) were assigned to group A. Participants showing improvements of 15 –30dB were assigned to group B, those showing improvements of 0 –14dB were assigned to group C, and those showing no improvement were assigned to group D. The number of participants in groups A and B were added together to give the total effective rate, which was 91.7% in the acupuncture group, compared with 74.4% in the control group.
Congestion The symptoms of ear congestion and pressure were measured by VAS on a 0–10 scale, with higher scores indicating increasing severity of symptoms. Mean baseline VAS scores were 6.00 in the acupuncture group and 4.00 in the control group. Following treatment, these fell to 0.00 and 2.00 respectively with acupuncture performing significantly better.
Quality of Life The participants’ quality of life was measured by quantifying the number of days of dysfunction due to the disorder. Participants were assigned to one of five groups. Those assigned to group A scored 0 points, indicating a full recovery, those assigned to group B scored 0–40 points, those assigned to group C scored 41–80 points, those assigned to group D scored 81–120 points, and those assigned to group E scored over 120 points. The number of participants in groups A–C were added together to calculate the total effective rate. The total effective rate was significantly higher in the acupuncture group at 88.9%, compare