Efficacy of acupuncture for tinnitus with anxiety: a systematic review and meta-analysis.

BACKGROUND

Evidence suggests that acupuncture can alleviate tinnitus symptoms and improve the anxiety associated with tinnitus, but the relationship between these outcomes is unclear.

OBJECTIVES

To evaluate the efficacy of acupuncture for tinnitus with anxiety using a meta-analysis.

METHODS

Computerized searches were conducted in nine databases: China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP Chinese Science and Technology Journal Full-text Database, SinoMed, Chinese Medical Journal Full-text Database (CMAJD), PubMed, Embase, the Cochrane Library, and Web of Science. The search covered the period from the establishment of each database to January 15, 2026. Relevant randomized controlled trials meeting the inclusion and exclusion criteria were selected. The Cochrane Collaboration's recommended methods were used to assess the quality of included studies. Outcomes evaluated included the total effective rate, Tinnitus Severity Questionnaire (TEQ), Tinnitus Handicap Inventory (THI), Traditional Chinese Medicine syndrome scores (TCM syndrome scores), Hamilton Anxiety Scale (HAMA), Self-Rating Anxiety Scale (SAS), Beck Anxiety Inventory (BAI), brain-derived neurotrophic factor (BDNF), serum 5-hydroxytryptamine (5-HT), and serum gamma-aminobutyric acid (GABA) levels as outcome measures. Meta-analysis was performed using ReMan 5.3 software.

RESULTS

Twelve studies involving 908 patients were included. Meta-analysis revealed that acupuncture demonstrated superiority in improving the total effective rate for tinnitus with anxiety (RR = 1.18, 95% CI: 1.10-1.26, P < 0.00001) and significantly reduced TEQ scores (MD = -1.96, 95% CI: -2.47 to -1.45, Z = 7.57, P < 0.00001), and THI (MD = -9.11, 95% CI: -12.89 to -5.34, Z = 4.73, P < 0.00001), TCM syndrome scores (MD = -0.59, 95% CI: -1.13 to -0.06, Z = 2.17, P = 0.03 < 0.05), HAMA (MD = -2.04, 95% CI: -3.08 to -1.00, Z = 3.84, P = 0.0001 < 0.05) scores, SAS (MD = -3.50, 95% CI: -6.22 to -0.77, Z = 2.52, P = 0.01 < 0.05), BAI (MD = -8.80, 95% CI: -13.48 to -4.12, Z = 3.68, P = 0.0002 < 0.05) scores, but not in improving BDNF (MD = -72.27, 95% CI: -312.41 to 167.87, Z = 0.59, P = 0.56 > 0.05), 5-HT (MD = -22.56, 95% CI: -56.12 to 10.99, Z = 1.32, P = 0.19 > 0.05), and GABA (MD = 56.23, 95% CI: -46.50 to 158.96, Z = 1.07, P = 0.28 > 0.05) levels.

CONCLUSIONS

Acupuncture treatment for tinnitus with anxiety demonstrated greater improvement than non-acupuncture approaches in enhancing the clinical total effective rate and reducing TEQ, THI, TCM syndrome scores, BAI, HAMA, and SAS scores, warranting clinical promotion. However, evidence levels for certain outcome measures (BDNF, 5-HT, and GABA) remain low, necessitating further validation through well-designed, methodologically rigorous, high-quality, large-scale randomized controlled trials.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024596594; identifier: CRD42024596594.