6-month symptom changes and factors associated with treatment response following combined acupuncture, moxibustion, and cupping protocol in patients with primary tinnitus: a retrospective cohort study.

BACKGROUND

Primary tinnitus is a highly prevalent auditory disorder, affecting approximately 14.4% of adults globally. Conventional interventions yield limited efficacy. Although acupuncture-based TCM interventions is widely applied for tinnitus management, robust evidence regarding 6-month sustained symptom changes following combined TCM intervention and factors associated with treatment response remains scarce.

OBJECTIVE

To explore short- and long-term (6-month) symptom changes following standardized combined acupuncture, moxibustion, and cupping therapy in patients with primary tinnitus, and to analyze factors associated with treatment response.

METHODS

We conducted a single-center retrospective cohort study at the Third Affiliated Hospital of Zhejiang Chinese Medical University, enrolling 140 patients with primary tinnitus who received standardized combined acupuncture, moxibustion, and cupping therapy between January 2024 and August 2025 and completed 6-month follow-up. The primary outcome was a ≥30% reduction in Tinnitus Handicap Inventory (THI) score from baseline; the secondary outcome was a ≥1-grade reduction in THI severity grade. Univariate screening followed by binary logistic regression was used to identify factors associated with treatment response.

RESULTS

All 140 patients completed follow-up. The primary response rate was 57.1% (80/140) at treatment completion and increased to 81.4% (114/140) at the 6-month follow-up. The secondary response rate rose from 63.6% post-treatment to 82.9% at follow-up. Multivariate regression showed that younger age (OR = 0.577, P = 0.028) and higher baseline THI grade (OR = 1.662, P = 0.008) were associated with meeting response criteria in the short term. However, neither association remained significant in sensitivity analyses excluding acute tinnitus cases (age: OR = 0.683, 95% CI 0.378-1.236, P = 0.208; THI grade: OR = 1.486, 95% CI 0.927-2.380, P = 0.100). For long-term observed THI score changes, both age (OR = 0.326, P = 0.003) and baseline THI grade (OR = 2.699, p = 0.001) were associated with meeting the primary response criterion; baseline THI grade (OR = 4.455, p < 0.001) and age (OR = 0.266, P = 0.001) predicted the secondary outcome. Gender, tinnitus laterality, disease duration, and comorbid symptoms showed no significant effects.

CONCLUSION

Reductions in tinnitus-related handicap were observed over 6 months following combined acupuncture, moxibustion, and cupping therapy. Factors associated with treatment response varied by timepoint: for long-term changes, baseline THI severity and age were associated with greater observed score reductions; short-term associations for these factors were not robust in sensitivity analyses.