Exploring the Evidence Base for Acupuncture in the Treatment of Ménière's Syndrome—A Systematic Review

Table 2

Evidence table (English and Chinese language studies).

Study, study type and country	Treatment, sample size and follow-up time	Confirmed diagnosis and time with Ménière's disease	Appropriateness of treatment	Key findings	Summary evaluative comments and overall quality
Randomized controlled trials
	Body acupuncture versus Western medicine 15-day treatment	MD patients attending hospital for acute attack	No TCM pattern diagnosis used; set acupoints; TCM rationale provided	Total effectiveness rate: 74% versus 49% (P < .05)	Strengths of the study include: confirmed MD, random allocation to treatment groups, detailed overview and rationale of the treatments, graded outcome measurements and audiometric testing. The short length of follow-up limits the generalization of the results.
Zhang et al. [9] China	(i) Acupuncture: once a day for 2-3 days; if symptom relief, then every other day;			69% versus 43% symptom control (P < .05)
	(ii) Western medicine: two drugs (Serc and Vitamin B3) and Vitamin B6
	(n = 76; I = 39; C = 37)	Unknown duration		Small, audiometrically confirmed, hearing change
					Follow-up: 15 days (end of treatment period)			Overall quality judgment: Good
	Scalp acupuncture and Western medicine versus Western medicine and vitamin B1 and B12	MD confirmed by two medical committees		Set prescription without individualized diagnosis and treatment	Total effectiveness rate: 98% versus 89% (P < .05)	Strengths of the study include: confirmed MD, random allocation to treatment groups, detailed overview of the treatments, and graded outcome measurement. The chosen treatment approach is experimental, rather than a traditional TCM one.
Gao and Ni [10] China	(i) Acupuncture (or injected vitamins) once a day for 10 days as one course, total of three courses		89% versus 27% symptom control (P < .001)
	(ii) Western medicine: once a day for 10 days, total of three courses	Up to 7 years
	(n = 132; I = 58; C = 74)		84% versus 49% hearing improvement (P < .001)
	Follow-up: 2 years				Overall quality judgment: Good
	Acupuncture and drug treatment versus drug treatment	Unclear if the MD cases confirmed MD	Individualized diagnosis and prescription	Total effectiveness rate for Ménière's group: 91% versus 50% (NS, P > .05)	Strengths of the study include: random allocation to treatment groups, individualized diagnosis, detailed overview of the treatments, and graded (and quantitative) outcome measurement. Weakness in very small number of MD sample size, non-confirmation of MD diagnosis and short follow-up time.
	(i) Acupuncture—key points; once daily (acute stage), once every 3 days (remission stage).
Fang [11]* China	(ii) Drug treatment (sibelium, 10 mg once daily for 30 days)
	(n = 65; I = 36; C = 29; of which Ménière's I = 11; C = 4)	1 day to 3 months (from dizziness)		7 out of 11 versus none of controls dizziness cured
	Follow-up: 30 days				Overall quality judgment: Fair
Non-randomized controlled trials
	Acupuncture versus Western medicine and vitamin	Unclear if confirmed MD	Treatment group has TCM diagnosis and individualized treatment; control group has set acupoints.	Total effectiveness rate: 100% versus 74% (P < .01)	Strengths include details over outcome measurement; length of follow-up; use of TCM pattern differentiation. Weaknesses include: lack of clarity over how patients are allocated to the two treatment groups; MD not confirmed; and limited detail over treatments (form or frequency).
	(i) Acupuncture—key and specific points.			60% versus 39% cured and no recurrence at 2 years (P < .01)
Yu and Shi [12] China	(ii) Western medicine (vitamin C and Luminal (an anti-convulsive drug) injection)	1–7 years		30% versus 8% outstanding improvement and no recurrence at 1 year
	No details given on daily frequency or number of sessions of acupuncture (n = 168; I = 86; C = 82)				Overall quality judgment: Fair
	Follow-up: 2 years
	Body acupuncture versus Chinese herbal medicine (for vertigo)	Patients with MD	No TCM pattern diagnosis used to choose acupoints	Total effectiveness rate: 99% versus 88% (P < .01)	Short report, but adequate details on MD confirmation, treatment points, appropriate 2:1 case: comparison subject ratio and explanation of set acupoint prescription. Lack of detail over how patients were allocated to the treatment and comparison group (non-random).
	(i) Acupuncture: Two courses of 15 sessions 1 p day, with 5 day rest			93% versus 60% “complete" response (P < .001)
Yan [13]* China	(ii) Chinese herbal medicine: Two courses of 15 sessions 1 p day, with 5 day rest	102 patients had MD for ≤1 year, 135 1–5 years and 20 > 5 years	Set acupoint prescription	99% versus 88% “complete" or “partial" response
	n = 257; Ac = 189; Hb = 68			11% versus 49% recurrence rate (P < .001) (when not indicated)
	Follow-up: 1 year
	Scalp and ear acupuncture versus body acupuncture	Confirmed MD by hospital	Set prescription without individualized diagnosis and treatment	Total effectiveness rate: 94% versus 73% (P < .01)	Strengths include details over acupuncture treatment and their rationales and outcome measurement.
Qin and Jia [14] China	(i) Scalp and ear acupuncture once per day for 10 days, plus patients (taught to) self-treat for 5 days.			53% versus 33% cured (P < .01)	Weaknesses include: lack of follow-up; and lack of clarity over how patients are allocated to the treatment groups.
	(ii) Body acupuncture once a day for 10 days	Duration—no information		27% versus 23% marked improvement
	(n = 102; I = 72; C = 30)
	Follow-up: none				Overall quality judgment: Fair
Pre-test, post-test design
	Acupuncture	Patients with MD in acute phase (all previously treated with Western medicine without effect)	Set prescription, needling one point (Gang Shen), based on clear rationale	Total effectiveness rate: 100%	Extensive details over treatment procedure and rationale are provided (Gang Shen is an experimental point for MD). But lack of detail over choice of participants and outcome measurement scale.
Li and Li [15] China	Once a day for 20 days			77% acute symptom control after one treatment; 16% after two.
	n = 56			Most patients needed only 7 sessions to experience benefit.	Overall quality judgment: Fair
	Follow-up: 1 year	Up to 8 years
Li [16] China	Herbal medicine and ear acupuncture, for 2-60 days	Patients with MD according to explicit criteria	Individualised treatment following TCM principles for herbal medicine; ear acupuncture points set in conjunction with herbal medicine	Total effectiveness rate: 90%	Strengths include: clear diagnostic criteria, appropriate TCM principles and outcome measurement in relation to these principles and descriptions. But lack of detail over treatment duration or choice of participants.
	n = 90	Up to 20 years		72% cured	Note: this is predominantly a herbal approach with ear acupuncture as an adjunct.
	Follow-up: 1 year			18% improved	Overall quality judgment: Good
	Scalp acupuncture plus herbal medicine Once daily acupuncture for 7 days; simple herbal tea (to continue tea for 1 year)	MD acute stage (hospitalized following acute attack)	TCM individualized diagnosis and treatment, with herbal remedy adjusted	Total effectiveness rate: 97% 18% outstanding effect	Strengths include: clarity over outcome measurement, TCM diagnosis and treatment and length of follow-up.
Dong and Zhou [17] China	n = 180			70% cured
	Follow-up: 1 year	Up to 10 years		8% improved	Overall quality judgment: Good
	Moxibustion at Du-20	Patients with clinically confirmed MD	TCM individualized diagnosis with set acupoint	Total effectiveness rate: 100%	Use of standard diagnosis criteria and outcome measurement criteria for MD, appropriate acupoint with TCM rationale. (Note: treatment also included advice on diet and emotion) Overall quality judgment: Good
Sun and Li [18] China	Twice a day for 15 days			75% cured
	n = 20	Up to 2 years		25% outstandingly improved
	Follow-up: 1 year		(Du-20)
Post-test design
	Electro-acupuncture, acupuncture and moxibustion	MD patients who had auditory vertigo symptoms	One set point for acupuncture, another for moxibustion; other points added according to TCM diagnosis	Total effectiveness rate: 100%	Targets only cases with auditory vertigo syndrome. Detailed description of other Ménière's symptoms of cases; full explanation of potential role of acupuncture in treating Ménière's.
Dai and Liang [19]* China	One treatment daily for up 6 days (30 min application)			70% “cured"
	n = 23			18% “excellent"
	Follow-up: 1 year		Up to 17 years
	Acupuncture	MD—query over criteria	Individualized treatment following TCM principles	Total effectiveness rate: 90%		Strengths include: appropriate TCM principles. But lack of detail over treatment duration, choice of participants and diagnostic criteria for MD.
	10 sessions for 1 month			22% cured
Liu [20] China	n = 51	Duration—no information		69% improved
	Follow-up: 2 year				Overall quality judgment: Poor
	Moxibustion at Du-20 (over 2 hours), for up to three sessions 32	Confirmed MD (Otol. Dept)	Du-20 is a good experiential point for dizziness.	Total effectiveness rate: 100% 100% symptom relief (8 from one session, 10 from two, and 14 after three).	Strengths include: MD confirmed by Otolaryngology Department, use of standard treatment duration, use of an appropriate (Du-20) treatment point and length of follow-up.
Chao [21] China	n = 32		Not diagnosed according to TCM theory.		Weaknesses include: unclear sampling criteria, sole focus on one MD symptom (dizziness) and lack of control group.
	Follow-up: 2 years	average 9 years	Note: moxibustion only	No recurrence after 2 years.	Overall quality judgment: Fair
	Electro-acupuncture	Patients with MD	Treatment according to TCM pattern diagnosis	Total effectiveness rate: 74%	Short article; in consequence, limited details on methods, except on acupuncture treatment.
Tian [22]* China	Two to three courses of 10 sessions daily, with 2 days rest between course (10–20 min application)	Fifty had MD for 1–5 years, 22 for >5 years		50% “marked improvement"
	n = 72			24% “improved"	Overall quality judgment: Fair
	Follow-up period: 1 year			Treatment more effective in cases of shorter duration
	Acupoint injection at Du-20	Patients with MD according to “book" of common diseases	Set, single point used, with TCM rationale	Total effectiveness rate: 100%	Clear diagnostic criteria with detailed treatment procedure. But duration of follow-up is not stated and lack of clarity over outcome measurement (causes of dizziness disappeared).
Bo [23] China	Once a day for 10 days, 1 day break, then another course of treatment (3–30 sessions in total)			75% cured
	n = 88				Overall quality judgment: Fair
	Follow-up: not stated	Up to 3 years		23% improved
Wang and Chen [24] China	Acupuncture points injection with Dansheng liquid on one side at one time plus scalp acupuncture	Patients with MD	Set prescription but based on good TCM treatment principles	Total effectiveness rate: 92%	Combined traditional and scalp needling plus points injection seems a potentially good treatment method, and based on TCM principles. While diagnosis is based on TCM principles, treatment is not individualized. Good detail on treatment procedures.
	Acupuncture with injection once a day, with scalp acupuncture every other day, for 10 days. 5-day break, second course of treatment	Up to 14 years		62% cured
	n = 50			30% outstandingly improved	Overall quality judgment: Fair
	Follow-up: 2 years
	Body acupuncture	Patients with MD	Treatment according to TCM pattern diagnosis	Total effectiveness rate: 94%	Study report is from an abstract, translated from the original Chinese paper. Brief detail on methods is provided, with extensive detail on needling and TCM rationale.
Zhang [25]* China	Courses of 10 sessions with a 2-day rest between (30 min application)			72% cured
	n = 18	Up to 6 years.
	Follow-up period: 2 years			22% marked effect	Overall quality judgment: Fair
	Acupuncture	MD—query over criteria	TCM pattern differentiation	Total effectiveness rate: 100%	Lack of detail over choice of participants or diagnostic criteria for MD. While diagnosis is individualized, the treatment points are only for one TCM diagnosis pattern. It is unclear if the treatment is individualized.
Zhou [26] China	3–15 sessions, once per day (average of 9)
	n = 20	Up to 8 years		80% cured	Overall quality judgment: Poor
	Follow-up: 1 year			20% improved
	Acupuncture	MD—query over criteria	Set acupoints based on explicit TCM rationale for point choice	Total effectiveness rate: 92%	Strengths include: explicit rationale for set acupoint prescription, based on TCM theory, and extensive details over treatment methods. Lack of clarity over how many courses were provided and diagnostic criteria.
Zhang [27] China	Once a day for 10 days, 5 day break, another course			60% cured
	n = 60	Up to 10 years		30% outstandingly improved	Overall quality judgment: Poor
	Follow-up: 2 years
Case series
	Body acupuncture, ear acupuncture and moxibustion (and, rarely, scalp acupuncture)	Patients with MD—with confirmed auditory tests	Treatment according to TCM pattern diagnosis	Total effectiveness rate: 100%	Very brief report on cases over 5-year period, with limited detail on outcome measurement (focus on vertigo). Strengths include: the use of audiometric tests (for auditory acuity) and extensive detail on needling and TCM treatment rationale.
Steinberger and Pansini [28]* ?Yugoslavia	Five treatments, once a day (30 min application)
	n = 34			100% success for vertigo after 3 treatments	Overall quality judgement: Poor
	Follow-up period: unclear
	Body acupuncture	Patients with MD according to clinical symptoms	Set acupoint prescription, with extra points if tinnitus and deafness were severe	Total effectiveness rate: 93%	Reporting on 18-year case series of clinically confirmed MD cases. Short report, with limited but adequate detail on the acupuncture treatment.
Xu and Ge [29]* China	Courses of 10 sessions, once a day (20–30 min application)			39% cured
				33% “marked" improvement
	n = 75	18 had had MD for <1 year, 57 for ≥1 year		21% improved
	Follow-up period: 1 year			On average, needed two treatment courses (range 1–5)	Overall quality judgment: Poor
	Body acupuncture	Patients with MD, with a “sudden onset" of symptoms	Treatment according to TCM pattern diagnosis	Total effectiveness rate: 100%	Brief report on cases treated since 1975 with very limited detail, except on rationale and approach to treatment (and ways to improve the treatment).
Tian [30]* China	10–15 treatments			100% “cured" (Eight had alleviation of symptoms after four treatments; 13 after 7)
	n = 21
	Follow-up period: unstated				Overall quality judgment: Poor
	Acupuncture	MD—query over criteria	Treatment following TCM principles, but only for the one symptom of dizziness	Total effectiveness rate: 99%	Strengths include: treatment based on appropriate TCM principles. But lack of detail over choice of participants or diagnostic criteria for MD, treatment not individualized, no standard course of treatment, and unclear length of follow-up
Song and Yi [31] China	Once a day until all symptoms disappear (mean n = 5; range 2 to >10)	Up to 15 years		91% cured over short term
	n = 152			8% improved	Overall quality judgment: Poor
	Follow-up: unclear
	Acupuncture	Patients with MD at an acute stage	No TCM diagnosis differentiation or individualized treatment	Total effectiveness rate: 98%	Following appropriate TCM principles for treating two symptoms (dizziness and vomiting) of MD, but limited detail and no explicit follow-up mentioned.
Zhu [32] China	n = 51	Up to 6 years		64% cured
	Follow-up: not indicated			32% outstanding effect	Overall quality judgment: Poor
	Acupuncture	Patients with MD	Appropriate acupuncture at single point. No TCM pattern differentiation	Total effectiveness rate: 90%	The study reports on a large group of patients; the treatment provided is an integrated treatment for MD, but there is a lack of detail over the number of courses given.
Zhang and Shang [33] China	Once a day for 3 days (as one course)			57% cured
	n = 286	Up to 24 years		28% outstanding effect
	Follow-up: 1 year				Overall quality judgment: Fair
	Body acupuncture and moxibustion	Patients with MD	Treatment according to TCM pattern diagnosis	Total effectiveness rate: 100%	Short report on cases treated over a number of years. Argues that Ménière's syndrome belongs to the category of “dizziness" in TCM. Strengths include one year follow-up and clear rationale for treatment.
Lu [34]* China	One treatment per day (30 min application); 2–14 daily treatments given (mean of 7.4)	Twenty-two patients had MD ≤10 years; eight for >10		87% cured
	n = 30			13% effective
	Follow-up: 1 year			30% symptom free after 1 year; 47% re-occurrence within 6 months	Overall quality judgment: Fair
	Acupuncture plus moxibustion at Du-20	MD—query over criteria	TCM pattern differentiation and treatment	Total effectiveness rate: 100%	Reporting on cases treated since 1988 for TCM diagnosis of dizziness.
Wang [35] China	Once a day for 7 days as one course of treatment
	n = 30	Up to 10 years		97% cured	Overall quality judgment: Fair
	Follow-up: 2 years

Asterisk indicated studies located from English language search. RCT: randomized controlled trial; CT: controlled trial; MD: Ménière's Disease; I: Intervention; C: Comparison/Control.