Visual abstract

Introduction

Sensorineural hearing loss (SNHL) is the most common form of permanent hearing loss, and impairment is caused by damage to the cochlea, auditory nerve, or central auditory pathways and it significantly affects communication, cognition, social integration, and quality of life. Unlike conductive hearing loss, which is often reversible, SNHL is typically irreversible and progressive, making it more difficult to manage [1]. Globally, over 1.5 billion people live with hearing loss, and around 430 million people need rehabilitation services [2]. SNHL accounts for more than 90% of permanent hearing loss cases [3]. Prevalence increases with age, impacting approximately a third of individuals over 65 and more than half of those over 75 [4]. Adult-onset SNHL affects 12%–25% of the population, with higher rates observed in low- and middle-income countries due to delayed diagnosis and limited access to care. SNHL has multiple causes, including aging (presbycusis), noise exposure, viral infections, autoimmune conditions, Ménière’s disease, ototoxic drugs, and genetics.

Sudden SNHL (SSNHL) is defined as ≥ 30 dB loss over 3 contiguous frequencies within 72 hours. While most clinical studies and randomized controlled trials of SSNHL focus on sudden unilateral hearing loss in adults, in this case, bilateral SSNHL was treated in an adolescent patient, a less commonly reported group. Findings from adult unilateral cases may not be directly generalizable to younger patients with bilateral involvement.

Treatment options for SNHL remain limited. In cases of SSNHL, corticosteroids administered orally or via intratympanic injection are commonly used to reduce inflammation [5]. For chronic SNHL, hearing aids and cochlear implants are standard interventions [6]. However, these devices do not restore natural hearing and are often associated with high cost, discomfort, reduced speech clarity, and other persistent auditory symptoms. Due to these challenges, interest has been growing in complementary therapies like acupuncture.

Acupuncture, a core treatment within Traditional Chinese Medicine (TCM), is believed to restore the flow of Qi (vital energy) and enhance blood circulation. In TCM theory, auditory disorders are frequently attributed to imbalances in the Kidney and Liver meridians [7]. Stimulating specific acupoints along the meridians related to these 2 organs, alongside local acupoints, may help regulate systemic function, and improve hearing outcomes [8]. Evidence supports the potential validity of integrative approaches, suggesting that acupuncture may improve cochlear blood flow, reduce neuroinflammation, regulate stress pathways, and enhance neuroplasticity when combined with heterogeneous conventional pharmacologic treatments reported in the literature, including vasodilators (e.g., flunarizine), neurotrophic agents (e.g., mecobalamin), and adjunctive therapies such as Ginkgo biloba preparations and intratympanic corticosteroid injections [9,10]. Functional magnetic resonance imaging studies have demonstrated activation in auditory regions of the brain following acupuncture treatment [11] and clinical research has shown improvements in hearing thresholds, tinnitus, and quality of life [12,13]. However, evidence is limited by small sample size and inconsistent non-standardized protocols which results in outcomes which may be unreliable.

Acupuncture shows promise as an adjunct therapy, especially for those unresponsive to standard treatments or seeking non-pharmacological options [14]. This case report describes an adolescent patient with bilateral SSNHL who received acupuncture treatment without corticosteroid or other pharmacologic therapy. Hearing changes were monitored longitudinally. This report contributes to the limited literature describing acupuncture as a standalone intervention in SSNHL.

Case Report

A 15-year-old male student presented to the Acupuncture Department, Blue Lotus Hospital, Kathmandu, Nepal, with dizziness and bilateral hearing loss. The patient reported that symptoms began on first week of January, 2025. He had experienced 3 weeks of hearing loss prior to the first audiogram on January 26. He did not have associated symptoms such as vertigo, tinnitus, nausea, vomiting, fatigue, or nystagmus. The patient's medical history was unremarkable, with no hypertension, diabetes, cardiovascular disease, viral infection, Ménière’s disease, ototoxic drug use, tympanitis, noise trauma, smoking, or alcohol use. His diet was low in fat, salt, and sugar. Based on the presentation, bilateral SSNHL of unknown etiology, accompanied by dizziness, was suspected. The absence of vestibular symptoms suggested a non-vestibular cause of dizziness, likely related to hearing loss.

Audiological and clinical evaluations were conducted across 3 sessions. Otoscopy revealed normal external and middle ear structures, no signs of obstruction, or otitis. Tympanometry was not performed, so middle-ear status could not be objectively confirmed. Pure Tone Audiometry (PTA) was used to assess air- and bone-conduction thresholds (250–8,000 Hz) and the patient consistently demonstrated bilateral SNHL without air-and bone-conduction gaps. Advanced audiological tests such as otoacoustic emissions and auditory brainstem response, as well as imaging, were not performed due to resource limitations. As a result, the precise etiology of the patient’s SNHL could not be definitively determined. This uncertainty is important to acknowledge, as several transient cochlear insults such as viral inflammation, noise exposure, or barotrauma may recover spontaneously without intervention.

Hearing thresholds were measured at 3 time points (Figures 1 and 2) to determine the frequency levels (250–8,000 Hz) and the hearing levels in decibels (dB). Pure tone averages for air- and bone-conduction in both ears were determined and consistently demonstrated bilateral SNHL.

Based on bilateral SNHL with dizziness, and an absence of vertigo, tinnitus, and systemic excess, was the most likely TCM pattern was Kidney Essence Deficiency (Shèn jīng kuī xū). In TCM, the Kidneys govern auditory function, and chronic bilateral hearing loss, without external pathogenic factors, often reflects Essence decline. Dizziness without vertigo further supported a deficiency pattern, as insufficient Essence which results in failure to nourish the brain and sensory orifices [15].

Acupuncture was performed by a licensed otolaryngo-logist (Ear, Nose, and Throat physician) with conventional medical training and additional expertise in otologic acupuncture. A semi-standardized protocol was used, and adjunct acupoints were individualized based on symptoms: Points included Tīnghuì (GB2), Tīnggōng (SI19), and Ěrmén (SJ21), supplemented by Yìfēng (SJ17), Jiăosûn (SJ20), Shàngguān (GB3), and Tàiyáng (EX-HN5), as shown in Figure 3. Sterile, single-use filiform needles (0.25 × 40 mm; Zhongyan Taihe, China) were inserted to a depth of 15–25 mm, and were angled towards the auditory canal. Standard lifting-thrusting manipulations were applied to elicit deQi, with periodic manual stimulation every 10 minutes. Sessions lasted about 40 minutes, were performed daily for 15 days, then twice-weekly for 6 weeks. No additional treatments were administered during the course of acupuncture treatment (Table 1).

The baseline audiogram, performed on January 26, 2025, showed mild SNHL in the right ear (25–40 dB) and moderate SNHL in the left (40–60 dB) revealing a greater severity of SNHL in the left ear. After 20 acupuncture sessions (February 9, 2025), the thresholds for the right ear either improved slightly or remained stable (20–30 dB), while the left ear improved to reach a level denoting mild SNHL (25–35 dB). By March 4, 2025, hearing was within normal limits bilaterally (10–20 dB). The patient reported progressive relief of auditory fullness (relief of sensation of pressure) and dizziness, with complete resolution after the first treatment week, and no recurrence thereafter. Audiometric and clinical outcomes are summarized in Table 2.

Audiometric progression from January to March 2025 is displayed in Figure 4. Initial testing revealed mild SNHL in the right ear and moderate loss in the left. By February, thresholds improved, and by March hearing in both ears was within the normal range.

Discussion

The most common form of permanent hearing loss is SNHL. This case report presents a favorable clinical course of transient bilateral SNHL in a young patient that received acupuncture treatment (without corticosteroid treatment). The patient's loss of hearing improved from moderate and mild loss to normal hearing within 6 weeks, and dizziness resolved within 1 week of acupuncture treatment and did not reoccur.

Spontaneous recovery can occur in idiopathic SNHL, particularly in youth. The timing of interventions may be relevant to clinical outcomes, and acupoint selection may have contributed to the observed hearing improvement. However, this possible temporal association may not be a reliable assumption.

Acupuncture has been investigated as an adjunct treatment to corticosteroids for sudden SNHL (SSNHL). Spontaneous recovery occurs in 32%–65% of SSNHL cases, especially when treated with corticosteroids within 2 weeks of onset; however, recovery is often incomplete, and full restoration of hearing is not consistently achieved[16]. Given the growing focus on the number and duration of acupuncture sessions (“dose”), a relatively intensive cumulative stimulation was chosen (40-minute sessions daily for 15 days, then twice weekly for 6 weeks). Although the optimal acupuncture dose for SNHL remains undetermined, published case reports have used similarly intensive or even longer retention times. For example, Chang and Chan [17] reported 60-minute electroacupuncture sessions delivered 1–3 times per week in a pediatric SSNHL case, and other studies have reported comparable acupuncture protocols in adult patients. These precedents support the plausibility of using a relatively intensive regimen. While the schedule may be intensive, it was feasible because the patient was in the hospital setting and it was well tolerated, with no adverse side effects reported. The early daily phase was chosen to maximize cumulative stimulation during the acute treatment period. However, the question of whether daily sessions are essential remains uncertain and warrants further investigation.

Consistent with these mechanisms, animal studies summarized in a review of reactive oxygen species-based therapeutic strategies for SNHL reported improved cochlear blood flow, reduced hair cell loss, and upregulation of brain-derived neurotrophic factor in the auditory cortex following acupuncture [14]. The treatment strategy in this case prioritized local otologic points due to the clinical urgency of sudden hearing loss, while still considering Kidney Essence Deficiency as the underlying constitutional pattern. According to the Huangdi Neijing, the meridians govern the regions they traverse, and dysfunction along these pathways may manifest as impairment of the corresponding sensory orifices. The acupoints selected in this case—Ermen (SJ21), Tinggong (SI19), and Tinghui (GB2)—are located on the San Jiao (Shaoyang), Small Intestine (Taiyang), and Gallbladder (Shaoyang) meridians, all of which pass through the ear and, within TCM theory, are associated with the regulation of Qi and blood in the auditory region. Modern clinical evidence supports this traditional framework: a meta-analysis on acupuncture for SSNHL reported that SJ17, SJ21, SI19, and GB2 were the primary acupoints used to improve hearing through local meridian regulation [14].

Thus, although the patient’s constitutional pattern reflected Kidney Essence Deficiency, the immediate therapeutic focus was on regulating local meridian dysfunction affecting the ear, consistent with commonly applied acupuncture protocols for SSNHL. Importantly, stimulation of local otologic acupoints may also influence central auditory processing through peripheral-central neural pathways. Neuroimaging studies suggest that acupuncture may exert central effects, with functional MRI showing altered activity in auditory-related cortical regions, including the superior temporal gyrus, following stimulation at acupoints such as SI19 [18]. Other points, including SJ21, are often discussed in clinical practice for auditory disorders. These findings support a potential neuromodulatory mechanism in conditions such as tinnitus and SSNHL [19]. Although changes in hearing-related outcomes were not formally assessed in the present case, a randomized controlled trial reported greater auditory recovery and reduced dizziness in patients with tinnitus-associated SSNHL who received acupuncture compared with no treatment, along with improvements in tinnitus severity and quality of life [15]. However, for idiopathic SNHL specifically, the existing evidence remains of low certainty, heterogeneous in treatment protocols, and often limited to the adjunctive use of acupuncture alongside corticosteroids. In the present case, although the etiology was idiopathic, recovery occurred without pharmacological therapy, which allows consideration of acupuncture as a potential non-pharmacological or adjunctive approach in younger patients. This case contributes to the limited body of literature exploring acupuncture as a treatment option for SNHL, while emphasizing the need for cautious interpretation and further well-designed controlled studies. The limitations of this case report include the single-case design which does not allow for a control or sham group, and the lack of tongue and pulse diagnosis, which limits the precise identification of the TCM pattern. In addition, formal vestibular evaluation was not performed. No positional tests, head-impulse / Vestibular Ocular Reflex assessments, Romberg or Fukuda testing, or validated symptom scores were performed. Therefore, the description of dizziness is based solely on patient-reported symptoms, and objective characterization of vestibular dysfunction or its resolution cannot be confirmed. Future studies should include formal vestibular testing to better assess the effects of acupuncture on balance and dizziness. Furthermore, the audiologist was not blinded to the treatment stage, which may introduce bias in threshold marking. Although air- and bone-conduction thresholds improved similarly and returned to normal limits suggesting cochlear recovery, these findings should be interpreted with caution. Moreover, the absence of a comprehensive audiological and etiological workup further limits the case findings, and so cautious interpretation of the idiopathic SNHL diagnosis is required. Further controlled studies are needed to validate these observations.

In conclusion, bilateral SNHL, hearing improvement in this adolescent patient may be temporally associated with acupuncture treatment. Although improvement occurred following acupuncture, spontaneous or fluctuating recovery cannot be excluded, and causality cannot be established. Dizziness was reported subjectively, by the patient, while tinnitus was not present in this case. These observations suggest a possible association between acupuncture and hearing recovery, and support the need for controlled studies.

Article information

Author Contribution

Conceived and designed the study: NL. Contributed to data collection and analysis: KS. Assisted with methodology and interpretation of results: IG. Provided critical revision of the manuscript: YY. Contributed to figure and table preparation and assisted in manuscript rewriting and editing: DPL. All authors read and approved the final manuscript.

Conflicts of Interest

Authors have no conflicts of interest to declare.

Author Use of AI Tools

During the preparation of this manuscript, the authors used ChatGPT (OpenAI) for the sole purpose of identifying and correcting grammar errors. All content was subsequently reviewed and revised by the authors, who accept full responsibility for the final version of the work.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article

Ethical Statement

Written informed consent for publication of the case details and associated images was obtained from the patient’s legal guardian. Ethical approval was not required for this single-patient case report, as our institution does not consider anonymized case reports to require ethics approval.

Data Availability

The datasets are available from the corresponding author upon request.

Figure 1

Pure Tone Audiometry (PTA) results displaying hearing thresholds: (A) first session; and (B) second session. Right ear (red symbols) and left ear (blue symbols).

Figure 2

Pure Tone Audiometry (PTA) results from the third session. Hearing thresholds are shown for the right ear (red symbols) and left ear (blue symbols) across standard audiometric frequencies. Overall, thresholds were similar between ears at mid- and high-frequencies, with slightly higher thresholds in the left ear at lower frequencies. The figure includes a box indicating the pure tone average (PTA) for each ear, summarizing overall hearing sensitivity without reporting individual numeric values.

Figure 3

The image shows the acupoints Ěrmén (SJ21), Tīnggōng (SI19), and Tīnghuì (GB2).

Figure 4

Audiometric thresholds over time with hearing loss zones.

Line chart showing right (red) and left (blue) ear thresholds from 3 audiograms (January 26th, February 9th, and March 4th, 2025). Colors on the left indicate hearing loss severity: normal (green), mild (yellow), and moderate (red). Hearing improved progressively and reached normal levels of bilateral hearing by the final test.

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