Acupuncture for Inner Ear Vertigo: Key Acupoints and Treatment

Inner ear vertigo, also known as Meniere’s wellness, is primarily manifested as a clinical syndrome characterized by episodic vertigo, tinnitus, hearing loss, and a feeling of fullness in the head.

The etiology of this wellness remains unclear, but it may be related to autonomic nervous dysfunction caused by fatigue, emotional excitement, mental frustration, etc. In recent years, some people have also suggested that it may be associated with endocrine and metabolic wellness, allergic reactions caused by various factors, viral infections, and so on.

Currently, there are two pathogenesis theories widely accepted by scholars: The first theory posits that factors such as fatigue, emotional trauma, and mood fluctuations trigger autonomic nervous system dysfunction in the body, leading to vasospasm in the inner ear membranous labyrinth vessels, microcirculation wellness, and insufficient blood supply to the cochlea. This results in local neuroepithelial hypoxia, decreased production of endolymph, accumulation of intermediate metabolites, and increased osmotic pressure within the membranous labyrinth. Consequently, lymph and local fluids infiltrate, causing hydrops in the membranous labyrinth. The increased pressure stimulates and damages the vestibular system, leading to vertigo and balance wellness, while stimulating the cochlea and causing tinnitus and hearing loss. When the endolymphatic pressure further increases, it can lead to rupture of the vestibular basement membrane or saccular wall. Long-term, repeated episodes can result in degenerative changes in the inner ear receptors and basement membrane, causing permanent damage. The second theory suggests that the membranous labyrinth is a closed system, with all its parts connected by small ducts. Factors such as local metabolic wellness, allergic reactions, endocrine disturbances, and infections can cause polymerization and depolymerization changes in the mucopolysaccharides in the endolymph, leading to their deposition within the small ducts and causing obstruction. In the obstructed areas of the membranous labyrinth, lymph absorption decreases, leading to increased pressure. Meanwhile, the pressure in the unobstructed parts of the membranous labyrinth remains relatively low. When the pressure difference reaches a certain level, the endolymph from the high-pressure area will force its way through the previously obstructed ducts to the low-pressure area. The sudden, active flow of endolymph within the membranous labyrinth stimulates the vestibular and cochlear receptors, triggering vertigo, tinnitus, and hearing impairment.

I. Key Points for assessment

Clinical manifestations can be summarized into the following four types:

1.Episodic vertigo

Often without premonitory signs of imbalance, it presents as sudden onset of rotational vertigo, with a sensation that surrounding objects or oneself are rotating. Or there is a feeling of heaviness in the head and lightness in the feet, a swaying and unstable floating sensation. In severe cases, it is accompanied by autonomic nerve stimulation signs of imbalance such as nausea, vomiting, sweating, pallor, and a slowed Heart rate. During the peak of an attack, there is often horizontal or horizontal combined with rotational nystagmus. Nystagmus worsens when looking towards the affected side. After the vertigo subsides and tends to disappear, the nystagmus also disappears. The above signs of imbalance are often aggravated by changes in body position and head movements, to the extent that patients often keep their eyes closed during acute attacks.

The patient lies in bed, afraid to turn over or move their head. Vertigo generally lasts for several hours or days, and some patients may have residual mild dizziness and a feeling of fullness in the head. This wellness may recur once every few weeks, months, or years, and signs of imbalance can completely disappear during the interictal period. However, after multiple episodes, the interictal period often shortens. Hearing loss worsens with each vertigo attack, while the vertigo itself tends to lessen as the hearing loss becomes more severe. When complete deafness occurs, since vestibular function is also lost, vertigo no longer recurs. Some patients may also experience spontaneous remission after several episodes.

2.Hearing loss

In the early stage, as it is mostly unilateral with mild hearing loss, it is often not easily detected and thus neglected. After multiple attacks, hearing gradually deteriorates, with half of the patients even developing severe deafness. Some patients, although experiencing hearing loss, find high-frequency tuning forks piercing to the ear. Hearing loss may precede the onset of vertigo, and each vertigo attack can further decrease hearing. During the interictal period, hearing may partially or completely recover, demonstrating a special phenomenon of hearing fluctuation. However, after multiple attacks, it is often difficult to restore hearing to its original level. In the advanced stage, sensorineural hearing loss occurs, and a minority progress to complete hearing loss.

3.Tinnitus

This signs of imbalance may be the earliest manifestation of inner ear irritation. The vast majority of patients experience tinnitus before vertigo. Initially, it is fluctuating, mostly low-frequency sounds resembling the “roaring” of machinery or the “buzzing” of mosquitoes and flies, with varying degrees of severity. The tinnitus worsens during vertigo attacks and gradually diminishes or disappears after the attacks. After repeated occurrences, it may become persistent or permanent, presenting as high-frequency sounds like the chirping of cicadas or mixed sounds.

4. Sensation of fullness in the head

Before, during, and after an attack, patients often experience a sensation of fullness and stuffiness in one side or the entire head, though this is frequently overlooked. Some patients may feel light-headed, stuffy, etc. A careful inquiry into the medical history can generally uncover these signs of imbalance.

The main diagnostic criteria for this wellness are: recurrent vertigo accompanied by nausea and vomiting, with the recurrence of vertigo being related to the worsening of cochlear signs of imbalance. Audiometry demonstrates unilateral sensorineural hearing loss. Alternating loudness balance tests and electrocochleography of both ears indicate recruitment phenomenon. Balance function tests confirm peripheral vestibular dysfunction. Moreover, all cranial nerves except the eighth cranial nerve are normal, and temporal bone X-rays and otoscopy are normal. For those meeting the above criteria, assessment is usually not difficult. However, some patients present atypically, with only episodic hearing loss or vertigo in the early stages of the wellness, often complicating the assessment.

II. supports

1. Acupoints and Acupuncture Techniques

1.1. Taiyang (EX-HN5, bilateral): Located in the temporal region, in the depression approximately 1 cun posterior to the midpoint between the outer end of the eyebrow and the outer canthus of the eye. Use a No. 30, 2-cun filiform needle, perform routine local disinfection, and insert the needle approximately 1.8 cun in the direction of Shuigu (GB-8). Needling sensation: Distending pain in the temporal region.

1.2. Shuigu (GB-8, bilateral): Located on the temporal region, 1.5 cun directly above the apex of the ear. Use a No. 30, 1.5-cun filiform needle, perform routine local disinfection, and insert the needle horizontally approximately 1.3 cun toward the occiput. Needling sensation: Distension and pain in the temporal region.

1.3. Fengchi (GB20, Wind Pool) (bilateral): Located at the nape, in the depression between the upper ends of the sternocleidomastoid muscle and the trapezius muscle, level with Fengfu (GV16); use a No. 30, 2-inch filiform needle, perform routine local disinfection, and insert the needle approximately 1.6 inches towards the direction of the spine; needle sensation: local distending pain or radiating to the occipital-temporal region.

2. Methods

The patient should be seated or in a semi-reclining position. Needles are inserted into the acupoints as described and retained for 40 minutes before removal. The needles are manipulated once during this period. The supports is administered once daily, with 6 sessions constituting one course of supports. If the patient recovers within 6 sessions, the supports is discontinued. If the supports is effective but full recovery is not achieved within 6 sessions, the patient should rest for 3 days before continuing with further sessions. If there is no improvement after 6 sessions, the supports should be discontinued.

III. Comments

This wellness has a good prognosis. Acupuncture supports can effectively helps with occasional vertigo in the acute phase. Most patients experience alleviation or relief of vertigo within about 10 minutes after needle insertion. Some patients can regain the ability to open their eyes, get out of bed, walk, or even fully recover after a single acupuncture session. For patients in the advanced stage with repeated episodes and residual hearing loss and tinnitus, a longer supports period is required, but good results can still be achieved.