Efficacy and safety of electroacupuncture and electroacupuncture combined with warm needling for subjective tinnitus: A multicenter, three-arm randomized controlled trial

To evaluate the clinical efficacy and safety of electroacupuncture (EA) and electroacupuncture combined with warm needling (EAWN) on reducing tinnitus loudness and tinnitus-related distress among older adults. This multicenter, assessor-blinded, parallel-group, randomized clinical trial was conducted from December 2022 to April 2024 at three out-patient clinics in Hong Kong. Ninety eligible participants aged 50-70 years with subjective tinnitus for 0.5-24 months were equally randomized to EA, EAWN, or waitlist groups. Both treatment groups received two standardized treatment sessions per week for 5 weeks. The waitlist group received no treatment during the study period. The outcome measures were numeric rating scale (NRS) scores for tinnitus loudness, Tinnitus Handicap Inventory (THI) scores, and safety outcomes. Assessments were conducted at baseline, weeks 5 and 10. Both EA and EAWN groups showed significantly greater reductions in NRS scores for tinnitus loudness than did the waitlist group at weeks 5 (mean difference [95% confidence interval]; EA: -1.91 [-2.79 to -1.03]; P < 0.001; EAWN: -1.81 [-2.68 to -0.94]; P < 0.001) and 10 (EA: -2.03 [-2.95 to -1.11]; P < 0.001; EAWN: -1.98 [-2.92 to -1.04]; P < 0.001). Improvements in total THI scores were also greater in the intervention groups at weeks 5 (P < 0.01) and 10 (P < 0.001). The two intervention groups showed no significant differences. No serious adverse events were reported. Both EA and EAWN therapies could be effective and safe treatments for subjective tinnitus in older adults.