Acupuncture for Vestibular Disorders: A Comprehensive Review

Vestibular disorders, which include vertigo and dizziness, have a profound impact on individuals’ quality of life. While conventional medication has long been the primary approach for managing these conditions, there is a growing interest in exploring alternative therapies that provide effective and safe treatment options.

Acupuncture in Atlanta has emerged as a potential intervention, attracting scientific attention due to its potential efficacy in alleviating symptoms associated with vestibular disorders. Rigorous scientific methodologies such as randomized controlled trials, systematic reviews, and meta-analyses have been employed to investigate the effectiveness of acupuncture in managing vestibular disorders. These studies have contributed to our understanding of the potential benefits of acupuncture for individuals experiencing vertigo, dizziness, and related symptoms.

By examining the findings of these studies, we can gain insights into the effectiveness of acupuncture and the underlying mechanisms through which it exerts its therapeutic effects. This comprehensive review aims to assess the scientific evidence supporting the use of acupuncture as a treatment modality for vestibular disorders, with a specific focus on its effectiveness compared to conventional medication.

What are vestibular disorders and what causes them?

Vestibular disorders encompass a group of conditions that disrupt the body’s balance system, resulting in the predominant symptoms of vertigo or dizziness. The underlying causes of these disorders are diverse, with Benign Paroxysmal Positional Vertigo (BPPV), vestibular migraines and Ménière’s disease being the most common (1). Other causes include vestibular neuritis, labyrinthitis, and various structural abnormalities. Although vestibular disorders are frequently associated with older age, they can also occur in individuals of younger age groups(2).

The mechanisms underlying vestibular disorders involve dysfunction or disruption of the vestibular system, which comprises the inner ear structures and their connections to the brain. The inner ear plays a vital role in detecting and transmitting information about head position, movement, and spatial orientation to the brain. Abnormalities or disturbances in these structures and mechanisms can lead to the clinical presentation of vestibular disorders(1).

In the case of BPPV, otoconia, small calcium carbonate crystals normally located within the inner ear, become dislodged and migrate into the semicircular canals (3). This displacement interferes with the normal flow of fluid and disrupts the perception of head movement, resulting in episodes of vertigo. On the other hand, Ménière’s disease involves an excess accumulation of fluid in the inner ear, leading to disruptions in its normal functioning and the occurrence of recurrent vertigo, hearing loss, tinnitus, and a feeling of fullness in the ear (3). Vestibular neuritis and labyrinthitis are often caused by viral infections that induce inflammation and damage to the vestibular nerves or the inner ear structures, respectively (1, 3). These inflammatory processes disrupt the transmission of signals between the inner ear and the brain, resulting in vertigo, dizziness, and associated symptoms.

On the other hand, we also have vestibular migraines which are a specific subtype of vestibular disorders that involve recurrent episodes of vertigo or dizziness, accompanied by typical migraine symptoms such as headache, nausea, and sensitivity to light and sound. The underlying mechanisms of vestibular migraines are not fully understood, but they are believed to involve a combination of genetic predisposition, hormonal changes, and abnormalities in brain neurotransmitters and blood flow regulation. During a vestibular migraine episode, individuals may experience a spinning or swaying sensation, lightheadedness, and difficulties with balance and coordination. These symptoms can be debilitating and significantly impact an individual’s quality of life. Vestibular migraines can occur with or without an accompanying headache, and the duration and frequency of episodes can vary among individuals(4).

The clinical presentation of vestibular disorders arises from the disrupted signals sent to the brain about head movement, leading to a mismatch between sensory inputs from the vestibular system and other sensory systems, such as vision and proprioception. This discrepancy gives rise to the characteristic symptoms of vertigo and dizziness, often accompanied by imbalance, nausea, and difficulties with coordination and spatial orientation (3).

In summary, vestibular disorders stem from dysfunctions within the vestibular system, leading to the disruption of accurate information transmission about head position and movement to the brain. Factors such as dislodged otoconia, excess fluid accumulation, and inflammatory processes contribute to these disruptions. These disturbances manifest as symptoms such as vertigo and dizziness, significantly impacting an individual’s balance and spatial orientation.

Vertigo treatment: conventional vs acupuncture

Traditionally, the management of vestibular disorders has been primarily focused on alleviating symptoms and addressing underlying causes. However, some disorders, such as Ménière’s disease, do not have a definitive cure. This challenge highlights the limitations of current approaches in effectively managing associated symptoms and emphasizes the need for more effective treatment modalities.

A case study conducted by Djaali et al. demonstrated the superior efficacy of acupuncture in managing vertigo compared to conventional approaches. The study described the successful treatment of a 66-year-old female patient who had been experiencing episodic spinning dizziness for 18 months. After six sessions of manual acupuncture therapy, the patient reported complete resolution of spinning dizziness, and her Vertigo Symptom Scale–Short Form (VSS-SF) score significantly reduced from 22 to 4. These findings suggest that acupuncture could offer a promising alternative in the management of vestibular disorders, providing a more holistic approach to symptom relief(5).

In another study conducted by Chiu et al., acupuncture was evaluated as a treatment for dizziness and vertigo in the Emergency Department (ED). The results showed a significant reduction in discomfort and subjective ratings of dizziness and vertigo among those who received acupuncture compared to the control group. Importantly, no adverse events were reported, highlighting the safety profile of acupuncture in the ED. These findings provide clinical evidence supporting the effectiveness of acupuncture in managing dizziness and vertigo in emergency settings(6).

In a study by Jaroshevskyi et al., the effectiveness of a multimodal approach to managing cervical vertigo was assessed in 109 patients with vertigo and myofascial pain syndrome. The patients were divided into three groups and underwent various examinations, including neurological assessments and imaging tests. Results showed that all three groups experienced improvements in biomechanical patterns, reduction in musculo-tonic disorders, and relief from pain, dizziness, and postural instability.

However, the groups that received manual therapy combined with acupuncture showed additional positive outcomes, with significant improvements in pain scores and dizziness-related disability. Notably, patients who underwent a comprehensive approach that included manual therapy, acupuncture, and vestibular rehabilitation experienced a remarkable regression of vertigo and postural instability. These findings suggest that a multimodal approach involving manual therapy, acupuncture, and vestibular rehabilitation may offer maximum therapeutic benefits for managing cervical vertigo(7).

Furthermore, a comprehensive systematic review and meta-analysis conducted by Hou et al. examined the efficacy and safety of acupuncture for the treatment of Cervical Vertigo (CV). The analysis included 10 studies involving 914 participants and demonstrated that acupuncture was more effective than Conventional Medicine Therapy (CMT) in terms of effectiveness, improvement rate of vertigo and headache, and increased average blood flow velocity of the vertebral-basilar artery. Subgroup analysis further supported the consistent favorable outcomes of acupuncture across different acupuncture methods and drug categories(8).

In summary, these studies provide scientific evidence supporting the efficacy and safety of acupuncture in managing vestibular disorders, including vertigo and dizziness. The findings highlight the potential of acupuncture as a valuable alternative treatment option for these conditions, offering a holistic approach to symptom relief.

Mechanism of action of acupuncture in vertigo treatment

The mechanism of action of acupuncture in treating vestibular disorders, such as vertigo and dizziness, remains an area of ongoing research. While specific details are yet to be fully understood, several theories and hypotheses have been proposed in the field.

Acupuncture is believed to modulate various physiological processes within the body, including pain perception, neuroendocrine function, and inflammation. It is thought that acupuncture stimulates nerve fibers, leading to the release of neurotransmitters and modulation of neuronal activity, thus influencing the nervous system(9).

In the context of vestibular disorders, acupuncture may potentially impact the balance and function of the vestibular system. One hypothesis suggests that acupuncture may regulate the autonomic nervous system and modulate the balance of neurotransmitters involved in vestibular function. Changes in Heart Rate Variability (HRV) observed in some studies indicate the potential influence of acupuncture on the autonomic nervous system(6).

Additionally, acupuncture has been proposed to possess anti-inflammatory effects that could be beneficial for individuals with vestibular disorders. Inflammation and immune system dysfunction have been implicated in certain conditions like Ménière’s disease and vestibular migraine. The anti-inflammatory properties of acupuncture may help reduce inflammation and alleviate symptoms associated with these disorders(9).

It is important to acknowledge that the specific mechanisms by which acupuncture treats vestibular disorders require further investigation. While acupuncture has shown promise in reducing vertigo and dizziness symptoms, the precise neurophysiological and biochemical processes involved are still being elucidated. More extensive research, including well-designed randomized controlled trials and mechanistic studies, is necessary to gain a comprehensive understanding of how acupuncture exerts its effects in the context of vestibular disorders.

Long-term impacts of using acupuncture therapy to treat vestibular disorders

The effectiveness and long-term impacts of acupuncture therapy in treating vestibular disorders, such as vertigo and dizziness, are still under investigation, and further research is required to establish definitive conclusions. Nonetheless, current studies offer valuable insights into the potential effects of acupuncture on these conditions.

Clinical studies have demonstrated the immediate effectiveness of acupuncture in reducing discomfort and alleviating symptoms associated with dizziness and vertigo (6). Objective measures, such as the Dizziness Handicap Inventory (DHI) and Visual Analog Scale (VAS), have been utilized to evaluate the outcomes of acupuncture therapy for vestibular disorders, providing quantifiable evidence of its efficacy (6). Furthermore, the analysis of Heart Rate Variability (HRV) has shed light on the impact of acupuncture on balance function and related conditions, bolstering its clinical applicability (6).
In the specific context of Vestibular Migraine (VM), acupuncture has shown promise as a non-pharmaceutical therapy for reducing VM symptoms and associated comorbidities (10). However, the existing evidence regarding the long-term efficacy and safety of acupuncture for VM prophylaxis remains inconclusive, underscoring the need for comprehensive research in the form of systematic reviews and meta-analyses (10).

Moreover, acupuncture has been explored as a potential therapeutic approach for various neurological diseases, including those that may affect the vestibular system. Studies have provided evidence of the neuroprotective effects of acupuncture, as well as its ability to stimulate peripheral nerves for neural recovery and repair (11). These mechanisms may contribute to long-term improvements in symptoms and overall neurological function.

Adverse effects of acupuncture for vestibular disorders

Understanding the potential adverse effects of acupuncture is crucial for patient safety and informed decision-making. The side effects can vary depending on the technique used and may differ between individual patients.

In studies examining short-term reactions and adverse events following acupuncture, researchers found that negative reactions such as pain, tiredness, and dizziness were relatively rare. The study concluded that adverse events were infrequent, and no significant adverse events were associated with acupuncture treatment(12, 13). Another study aimed to assess adverse effects during routine acupuncture treatment. It involved 409 patients who received a total of 3535 acupuncture treatments.

Adverse effects were observed in 11.4% of the treatments and included slight bleeding, hematoma, dizziness, and other systemic symptoms. The study highlighted that acupuncture can be considered a safe treatment method when practitioners follow established safety guidelines(14). In a separate study, researchers investigated the incidence of adverse reactions associated with acupuncture. The study included 391 patients who underwent 1441 acupuncture sessions. The recorded adverse reactions were generally mild and transient. Systemic reactions included tiredness, drowsiness, aggravation of preexisting symptoms, and localized reactions such as minor bleeding and pain on insertion. Severe adverse events were rare in standard practice(15).

Overall, the reported adverse events were generally mild, transient, and infrequent. The most commonly reported side effects included minor bleeding, hematoma, tiredness, dizziness, and localized discomfort. Severe adverse events, such as pneumothorax or infection, were rare in the reviewed studies. It is important to note that these studies were conducted by trained practitioners following safety guidelines, which contributed to minimizing adverse events.

These findings underscore the significance of practitioners adhering to safety guidelines and receiving appropriate training. By doing so, the risk of adverse events associated with acupuncture can be further minimized. Acupuncture can be considered a safe therapeutic option when administered by well-trained practitioners who follow established safety guidelines.

Individualized Approach of Acupuncture in Treating vestibular disorders: Personalized Treatment for Optimal Results

The individualized approach of acupuncture in treating vestibular disorders involves tailoring the treatment to each patient’s specific condition and needs, aiming for optimal results. Acupuncture has shown effectiveness in alleviating symptoms of dizziness and vertigo associated with vestibular disorders, such as vestibular migraine (VM), through its potential effects on migraines, vertigo, and emotional disorders (10).

In the context of VM, an ongoing study is evaluating the efficacy and safety of acupuncture as a prophylactic treatment. The study follows a randomized controlled trial design and includes outcome measures such as changes in vertigo/migraine days, vertigo severity, migraine intensity, rescue medication doses, anxiety level, depression level, and quality of life (16). This personalized treatment approach recognizes the unique characteristics and symptoms of each patient, allowing for tailored acupuncture interventions that address their specific needs.

The personalized treatment of acupuncture involves a thorough assessment and diagnosis of the vestibular disorder, taking into account factors such as the patient’s medical history, symptom profile, and individual response to acupuncture therapy. The treatment plan may involve selecting specific acupoints based on the patient’s symptoms and employing various acupuncture techniques, such as manual acupuncture or electroacupuncture, to optimize the therapeutic effect. The frequency and duration of acupuncture sessions can also be adjusted based on the patient’s response and progress (6).

While acupuncture has shown potential as a complementary therapy for vestibular disorders, including VM, it is important to note that the current evidence on its efficacy is still inconclusive(10). Further research, including well-designed randomized controlled trials and systematic reviews, is necessary to provide more robust evidence and establish guidelines for the personalized use of acupuncture in treating vestibular disorders.

In conclusion, the individualized approach of acupuncture in treating vestibular disorders acknowledges the unique characteristics and symptoms of each patient, tailoring the treatment to optimize results. Acupuncture shows promise in alleviating symptoms of vestibular disorders, but further research is needed to establish its efficacy and safety and provide evidence-based guidelines for its personalized use.

Conclusion

In conclusion, the scientific evidence supports the potential benefits of acupuncture as a treatment modality for vestibular disorders, including vertigo and dizziness. Acupuncture has demonstrated immediate effectiveness in reducing discomfort and alleviating symptoms associated with these conditions. Studies have explored its efficacy in various contexts, such as cervical vertigo, vestibular migraine, and emergency department settings, highlighting its potential as an alternative or complementary approach to conventional therapies. However, the mechanisms of action underlying acupuncture’s effects on vestibular disorders are not fully understood and require further investigation.

While acupuncture shows promise, more rigorous research, including randomized controlled trials and mechanistic studies, is needed to establish its long-term impacts, optimal treatment protocols, and safety profile. Acupuncture’s individualized approach, involving personalized assessments, tailored treatment plans, and a holistic perspective, offers a comprehensive and patient-centered approach to managing vestibular disorders. By continuing to advance our understanding of acupuncture’s efficacy and mechanisms of action, we can enhance its integration into evidence-based treatment strategies for individuals suffering from vestibular disorders in Atlanta. Set up an appointment.

References

1. Strupp M, Dlugaiczyk J, Ertl-Wagner BB, Rujescu D, Westhofen M, Dieterich M. Vestibular Disorders. Deutsches Arzteblatt international. 2020;117(17):300-10.
2. Neuhauser HK. The epidemiology of dizziness and vertigo. Handbook of clinical neurology. 2016;137:67-82.
3. Dougherty JM, Carney M, Hohman MH, Emmady PD. Vestibular Dysfunction. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Michael Carney declares no relevant financial relationships with ineligible companies. Disclosure: Marc Hohman declares no relevant financial relationships with ineligible companies. Disclosure: Prabhu Emmady declares no relevant financial relationships with ineligible companies.: StatPearls Publishing
   Copyright © 2023, StatPearls Publishing LLC.; 2023.
4. Huang TC, Wang SJ, Kheradmand A. Vestibular migraine: An update on current understanding and future directions. Cephalalgia : an international journal of headache. 2020;40(1):107-21.
5. Djaali W, Simadibrata CL, Nareswari I, Djaali NA. Acupuncture Therapy for Peripheral Vestibular Vertigo (with Suspected Ménière’s Disease). Medical acupuncture. 2023;35(2):89-93.
6. Chiu CW, Lee TC, Hsu PC, Chen CY, Chang SC, Chiang JY, et al. Efficacy and safety of acupuncture for dizziness and vertigo in the emergency department: a pilot cohort study. BMC complementary and alternative medicine. 2015;15:173.
7. Jaroshevskyi OA, Payenok OS, Logvinenko AV. Evaluation of the effectiveness of multimodal approach to the management of cervical vertigo. Wiadomosci lekarskie (Warsaw, Poland : 1960). 2017;70(3 pt 2):571-3.
8. Hou Z, Xu S, Li Q, Cai L, Wu W, Yu H, et al. The Efficacy of Acupuncture for the Treatment of Cervical Vertigo: A Systematic Review and Meta-Analysis. Evidence-based complementary and alternative medicine: eCAM. 2017;2017:7597363.
9. Kawakita K, Okada K. Acupuncture therapy: mechanism of action, efficacy, and safety: a potential intervention for psychogenic disorders? BioPsychoSocial medicine. 2014;8(1):4.
10. Hu T, Zhang A, Jiang B, Shen F, Hu J. Is acupuncture effective and safe for prophylaxis of vestibular migraine?: A protocol for systematic review and meta-analysis. 2020;99(51):e23533.
11. Guo X, Ma T. Effects of Acupuncture on Neurological Disease in Clinical- and Animal-Based Research. Frontiers in integrative neuroscience. 2019;13:47.
12. Enblom A, Johnsson A. Type and frequency of side effects during PC6 acupuncture: observations from therapists and patients participating in clinical efficacy trials of acupuncture. Acupuncture in medicine: journal of the British Medical Acupuncture Society. 2017;35(6):421-9.
13. Park SU, Ko CN, Bae HS, Jung WS, Moon SK, Cho KH, et al. Short-term reactions to acupuncture treatment and adverse events following acupuncture: a cross-sectional survey of patient reports in Korea. Journal of Alternative and complementary medicine (New York, NY). 2009;15(12):1275-83.
14. Ernst G, Strzyz H, Hagmeister H. Incidence of adverse effects during acupuncture therapy-a multicentre survey. Complementary therapies in medicine. 2003;11(2):93-7.
15. Yamashita H, Tsukayama H, Hori N, Kimura T, Tanno Y. Incidence of adverse reactions associated with acupuncture. Journal of Alternative and complementary medicine (New York, NY). 2000;6(4):345-50.
16. Hu T, Hu H, Chen F, Jiang B, Shen F, Su Y, et al. The Efficacy and Safety of Acupuncture for Prophylaxis of Vestibular Migraine: A Study Protocol for a Randomized Controlled Trial. 2021;12.