Sudden hearing loss

Sudden sensorineural hearing loss is hearing loss in the inner ear or the hearing nerve that comes on within hours or days, usually in one ear and often with tinnitus or vertigo. The US otolaryngology guideline defines it as a loss of at least 30 decibels (dB) at three consecutive frequencies on a hearing test, occurring within 72 hours, and notes that in more than 90% of cases no cause is found. Every review of acupuncture for hearing loss found here concerns this sudden form; AcuiQ found none for age-related or noise-induced hearing loss. Almost all the trials those reviews pooled add acupuncture to drug treatment and compare it with drug treatment alone, without a sham procedure or blinding, and the two reviews that report where their trials were run found them all in China. The guideline adds a fact that bears on every such comparison: much of the literature reports that 32% to 65% of cases recover on their own, with the greatest spontaneous improvement in the first two weeks.

No Cochrane review

Cochrane registered a review titled Acupuncture for sudden idiopathic sensorineural hearing loss, by Zheng-jie Li, Fan-rong Liang and colleagues, and published its protocol in January 2012. It withdrew the protocol in February 2016 because the authors could not complete the review. The evidence therefore comes from reviews published elsewhere.

Systematic reviews

The 2015 review by Zhang and colleagues at Yangzhou University and Nanjing University of Chinese Medicine admitted manual acupuncture and electroacupuncture, which passes a small current through the needles, and accepted sham or no-treatment controls, but none of the 12 trials it found used either. Eleven added acupuncture to what the review calls Western medicine comprehensive treatment: combinations of steroids, drugs meant to improve blood flow, vitamins and, in six trials, hyperbaric oxygen. Against that treatment alone, more people improved by at least 15 dB with acupuncture added (risk ratio 1.33), and hearing thresholds were 10.9 dB better on average. One trial compared electroacupuncture alone with drug treatment and reported a similar risk ratio. No trial blinded participants, therapists or assessors, only three concealed which group a participant would join, and none followed people up after treatment ended. Three trials mentioned adverse events, one of them a skin infection after repeated needling. The authors concluded there was not enough evidence that acupuncture alone helps, and the 2019 US guideline cites this review.

The 2019 review by Chen, Zhao and Qiu at Anhui Medical University in Hefei found 20 randomised trials. Electroacupuncture alone, and manual or electroacupuncture added to drugs, left more people with hearing fully recovered on testing than drugs alone; manual acupuncture alone did not differ from drugs (P = 0.27), and tinnitus did not improve more when manual acupuncture was added. No trial reported a serious adverse event. The authors called acupuncture a possible option for people whose hearing drugs did not restore, and said high-quality research was lacking.

The 2024 review by Ren, Tao and Deng at Jiangxi University of Chinese Medicine widened the methods to include ear acupuncture and press needles, small needles taped in place. Added to drug treatment, acupuncture raised the share of people whose hearing improved by at least 15 dB (risk ratio 1.18) and lowered hearing thresholds by 10.7 dB. In five trials of acupuncture alone, acupuncture raised the shares of people who improved and who recovered fully, against drugs, but did not change hearing thresholds (mean difference −5.45 dB, 95% CI −20.75 to 9.85). A tinnitus benefit of adding acupuncture disappeared when the analysis was repeated leaving out one trial at a time. Two trials described double blinding and one blinded its assessors. Only one trial recorded adverse events, so the review could not judge safety, and its funnel plot, a check for missing small negative trials, was asymmetrical. The included trials diagnosed sudden hearing loss by the Chinese criteria of 2005 or 2015, which the review summarises as at least 20 dB at two adjacent frequencies, a lower threshold than the US definition.

The trials needled points around the ear. The 2024 review counted 38 points across its 28 trials and named the five used most: TB17 (Yifeng), GB02 (Tinghui), SI19 (Tinggong), TB21 (Ermen) and TB03 (Zhongzhu) on the back of the hand. The reviews write the triple burner points as SJ17 or TE17, which AcuiQ writes as TB; Reading a point code explains the difference.

A protocol by Hu and colleagues at Zhejiang Chinese Medical University, published in 2025, sets out a network meta-analysis to compare acupuncture methods with one another, with change in hearing thresholds as its main outcome, risk of bias assessed with the Cochrane RoB 2 tool and certainty with GRADE. Its results had not been published by October 2026.

Trials

Against sham

• With steroid injections into the ear, 2026. At the Eye and ENT Hospital of Fudan University in Shanghai, Yang and colleagues randomised 84 adults to real or sham acupuncture four times a week for one to two weeks, both added to dexamethasone injected through the eardrum, with six weeks of follow-up. Of the 77 analysed, the real acupuncture group's average hearing threshold on a pure tone test had improved 9.0 dB more at week 2 (95% CI 2.1 to 15.9). The abstract does not report the result at follow-up. Sham acupuncture sets out the kinds of control procedure in use.

Added to drug treatment

• Electroacupuncture settings, 2021. At Nanjing University of Chinese Medicine, Jiang and colleagues randomised 118 people to drug treatment alone or with electroacupuncture at one of three current settings, for two courses of 10 days. All three acupuncture groups had higher overall improvement rates than drugs alone, and the group given alternating 2 Hz and 50 Hz current had more people recover fully than the drug group and the 50 Hz group.
• With anxiety or depression, 2026. At a hospital in Hangzhou, Lou and colleagues randomised 78 people with sudden hearing loss and anxiety or depression to drugs alone or with seven days of electroacupuncture. Hearing gain was greater at every frequency tested with electroacupuncture, and depression and anxiety scores fell in that group only.

Planned and observational studies

• After steroids had failed, protocol 2018. At the Beijing Hospital of Traditional Chinese Medicine, Shang and colleagues planned to randomise 124 people whose hearing had improved little two to four weeks after steroid treatment, split by the shape of their hearing loss, to mecobalamin, a form of vitamin B12, with or without four weeks of acupuncture, with follow-up at 28 weeks. AcuiQ found no published report of its results.
• Chart review in Taiwan, 2021. At the Tri-Service General Hospital in Taipei, Lee and colleagues reviewed the records of 154 people with severe sudden hearing loss. The 37 treated with steroids, hyperbaric oxygen and acupuncture gained more hearing than those given steroids alone or steroids with hyperbaric oxygen. The groups were not randomised.

What guidelines say

The American Academy of Otolaryngology–Head and Neck Surgery Foundation published its clinical practice guideline on sudden hearing loss, by Chandrasekhar and colleagues, in August 2019, updating the 2012 version for adults. In its discussion under statement 11, on other drug treatments, it lists acupuncture among complementary therapies, alongside vitamins, minerals, supplements and Chinese herbal medicines, and states that the evidence is insufficient to make recommendations, so it makes no comment on their use; it cites the 2015 review for acupuncture. Of the treatments it does rate, it offers steroids within two weeks of onset and hyperbaric oxygen combined with steroids as options, recommends steroid injection into the ear when recovery is incomplete two to six weeks after onset, and describes even the data on steroids as “somewhat equivocal”. The guideline planned a review five years after publication. AcuiQ found no later version of it in the journal by October 2026. Clinical guidelines compares how other guideline bodies treat acupuncture.

What the reviews could not settle

The pooled trials added acupuncture to drug treatment that both groups received, and the people in them knew whether they were being needled. The 2024 review could not rule out bias from the audiometers and the assessors who measured hearing. Because a large share of sudden hearing loss recovers on its own, small unblinded trials of a few weeks cannot separate the needles from recovery, attention and expectation. One sham-controlled trial has been published, with 77 people analysed and a result reported at two weeks. The 2015 review found no trial that followed people after treatment ended, adverse events went unrecorded in most trials, and the Cochrane review that would have applied one method across the trials was withdrawn before it was written. Tinnitus reports the trials for a symptom the US guideline notes may persist after sudden hearing loss, and Dizziness and vertigo those in Ménière disease.

AcuiQ's symptom pages for sudden hearing loss, hearing loss and deafness list the protocols individual studies prescribed, each with its citation.