sudden sensorineural hearing loss ( sshl ) with an annual incidence of 5 to 20 people per 100,000 populations has been defined as a rapid hearing loss of > 30  db in at least 3 contiguous test frequencies occurring 3 days or less . it has become an otological emergency as the high risk of permanent hearing damage and seriously affected patient 's social and professional life . the hearing loss in sshl is of accompanied with dizziness , vertigo , nausea , and vomiting . large - scale case studies performed in china , japan , europe , and the u.s . have shown that sshl typically occurs between 40 and 55 years of age , which is higher about 39.5% with equal sex distribution . the prevalence in the age group 18 to 30 is about 16% with a growth trends . with an unclear mechanism , a series of causative factors - including microcirculatory disorders , upper respiratory tract infections , autoimmune disorders , and barotrauma have been reported . different causative factors make different damage to the functioning of the cochlea or / and internal auditory meatus , and patients will have different levels of syndromes . many researchers have been aware of this and put forward the necessity to classify sshl into definite types initially . some clinical studies depending on the syndrome with or without dizziness or vertigo , divided sshl into 3 types ( simple - type , dizziness - type , and vertigo - type ) . some studies divided into 4 types based on hearing curve , which the hearing loss in ( low tone frequencies , high tone frequencies , all frequencies , and total deafness ) . prospective clinical multicenter studies indicated that sshl should be classified and different types should use different treatments . duration and dosage of efficacy of intravenously steroids base on the concentration in the inner ear and the improvement of the syndrome , given the uncertainty and variability in management of sshl . nevertheless evidence of the usefulness of steroids is mostly based on retrospective series and is not strong . moreover , retrospective series studies indicated approximately 40% patients do not provide a response fully to systemic steroids treatment , even in the early phases after onset , without consideration of steroids systemic effects . so , the use of secondary treatment modalities , like intratympanic steroids , hyperbaric oxygen therapy , and plasmapheresis , has been advocated . however , evidence for the efficacy of any treatment modality is not strong as no official guidelines or position statements from professional organizations concerning the evaluation and treatment of sshl . acupuncture as a traditional chinese therapy has been confirmed the good effects in the treatment of sshl based on placebo - controlled trials recently . ji and fang reported the effects of acupuncture therapy in sshl beyond 1 month after steroids treatment . despite many studies on acupuncture as an adjuvant therapy after western treatment , no study about acupuncture as a primary and salvage therapy without any other interventions and in the acute phases of sshl has been carried out . this case report details the successful use of acupuncture therapy without any additional treatment in a young patient in the acute phases of sshl . the patient was a 26-year - old young woman as a white - collar worker . her syndromes were just ear fullness and sudden monaural hearing loss ( right ear ) without dizziness , vertigo , vomiting , nausea , tired , tinnitus , or nystagmus . she was admitted in the department of acupuncture and moxibustion after diagnosed with sshl by an experienced ear , nose , and throat department specialist within 1 day after the onset . she had no past medical history like hypertension , coronary heart disease , diabetes , virus infection , hyperlipemia , meniere diseases , ototoxic drugs , tympanitis , and noise trauma . her previous individual history was recorded , including regular diet with low fat / salt / sugar , no smoking / drinking history , and no sexual intercourse prior to the onset . but she had undergone variable emotions ( e.g. , anger , anxiety , sadness , and depression ) for stressful overwork pressure and had a history of excessive noise exposure ( long - lasting telephone calls or listening to mp3 ) . according to her syndrome we divided her into simple - type ( hearing loss alone ) . laboratory determinations of her blood samples , computed tomography , and magnetic resonance imaging scans of brain / auditory nerves and acoustic immitance showed no obvious abnormality . mean hearing thresholds were expressed as the pure tone average ( pta ) of the 0.125- , 0.25- , 0.5- , 1.0- , 2.0- , 4.0- , and 8.0-khz hearing thresholds . hearing thresholds were calculated as the difference between pta prior and past the treatment weekly . the degree of the residual hearing loss after primary therapy was classified as mild ( 40  db ) , moderate ( 4170  db ) , severe ( 7190  db ) , or profound ( 91  db ) . the patient 's initial hearing loss thresholds were lesser than 40  db at the pta of the 0.125- , 0.25- , 0.5- , hearing thresholds , which were classified as mild - type . after the initial evaluation we believe that the intervention of acupuncture treatment alone was an effective therapeutic option . acupuncture and moxibustion therapy of excitation - focus transfer was adopted on yongquan(ki1 ) by stabbing 8 to 15  mm , 2 sides alternately with reducing and slightly heavy manipulation , and associated with suspending moxibustion for thermal sensitization ( which means the warm feeling of patient located on the adjacent or distal , the surface or deep induced by stimulating acupoints ) . ting hui(gb2 ) , ting gong(si19 ) , and er men(te21 ) were needled 15 to 25  mm only in the affected ear with mild stimulation . acupuncture treatment sessions were performed once a day for 1 month by a licensed acupuncturist . left in the figure shows the acupoints er men(te21 ) , ting gong(si19 ) , and ting hui(gb2 ) , right in the figure shows the main acupoint yong quan(ki1 ) . the intervention was carried out from october 1st , 2015 to october 30th , 2015 at zhejiang hospital . the patient was assessed with pure tone test weekly and instructed on keeping a diary of all her sshl - related symptoms . the 1st week , she presented with no improvement , fullness and hearing loss still troubled her . she was still asked keeping a diary of all her sshl - related symptoms , and stated sporadic symptoms of tinnitus that were  on and off  at night after the 4th acupuncture treatment . a week later , she reported feeling better with fullness and hearing loss with mild infrequent tinnitus 4 days a week . the 3rd week , she reported more improvements with mild symptoms . she reported sleeping better but still with mild infrequent tinnitus 2 days a week . the last week she reported total recovery from her fullness and hearing loss symptoms , and no further tinnitus symptoms since her last visit everything is going well .  at the current time , 3 months past treatment , the patient has not needed further treatment for sshl . the patient was a 26-year - old young woman as a white - collar worker . her syndromes were just ear fullness and sudden monaural hearing loss ( right ear ) without dizziness , vertigo , vomiting , nausea , tired , tinnitus , or nystagmus . she was admitted in the department of acupuncture and moxibustion after diagnosed with sshl by an experienced ear , nose , and throat department specialist within 1 day after the onset . she had no past medical history like hypertension , coronary heart disease , diabetes , virus infection , hyperlipemia , meniere diseases , ototoxic drugs , tympanitis , and noise trauma . her previous individual history was recorded , including regular diet with low fat / salt / sugar , no smoking / drinking history , and no sexual intercourse prior to the onset . but she had undergone variable emotions ( e.g. , anger , anxiety , sadness , and depression ) for stressful overwork pressure and had a history of excessive noise exposure ( long - lasting telephone calls or listening to mp3 ) . according to her syndrome we divided her into simple - type ( hearing loss alone ) . laboratory determinations of her blood samples , computed tomography , and magnetic resonance imaging scans of brain / auditory nerves and acoustic immitance showed no obvious abnormality . mean hearing thresholds were expressed as the pure tone average ( pta ) of the 0.125- , 0.25- , 0.5- , 1.0- , 2.0- , 4.0- , and 8.0-khz hearing thresholds . hearing thresholds were calculated as the difference between pta prior and past the treatment weekly . the degree of the residual hearing loss after primary therapy was classified as mild ( 40  db ) , moderate ( 4170  db ) , severe ( 7190  db ) , or profound ( 91  db ) . the patient 's initial hearing loss thresholds were lesser than 40  db at the pta of the 0.125- , 0.25- , 0.5- , hearing thresholds , which were classified as mild - type . after the initial evaluation we believe that the intervention of acupuncture treatment alone was an effective therapeutic option . acupuncture and moxibustion therapy of excitation - focus transfer was adopted on yongquan(ki1 ) by stabbing 8 to 15  mm , 2 sides alternately with reducing and slightly heavy manipulation , and associated with suspending moxibustion for thermal sensitization ( which means the warm feeling of patient located on the adjacent or distal , the surface or deep induced by stimulating acupoints ) . ting hui(gb2 ) , ting gong(si19 ) , and er men(te21 ) were needled 15 to 25  mm only in the affected ear with mild stimulation . acupuncture treatment sessions were performed once a day for 1 month by a licensed acupuncturist . left in the figure shows the acupoints er men(te21 ) , ting gong(si19 ) , and ting hui(gb2 ) , right in the figure shows the main acupoint yong quan(ki1 ) . the intervention was carried out from october 1st , 2015 to october 30th , 2015 at zhejiang hospital . the patient was assessed with pure tone test weekly and instructed on keeping a diary of all her sshl - related symptoms . the 1st week , she presented with no improvement , fullness and hearing loss still troubled her . she was still asked keeping a diary of all her sshl - related symptoms , and stated sporadic symptoms of tinnitus that were  on and off  at night after the 4th acupuncture treatment . a week later , she reported feeling better with fullness and hearing loss with mild infrequent tinnitus 4 days a week . the 3rd week , she reported more improvements with mild symptoms . she reported sleeping better but still with mild infrequent tinnitus 2 days a week . the last week she reported total recovery from her fullness and hearing loss symptoms , and no further tinnitus symptoms since her last visit everything is going well .  at the current time , 3 months past treatment , the patient has not needed further treatment for sshl . this article introduces the case of a young patient whose symptoms were effectively managed with acupuncture alone . our goals were to determine whether mild and simple hearing loss improved by acupuncture alone and whether the improvements were maintained after the intervention . our clinical results indicated that acupuncture as an alternative therapy has been a salient approach in sshl . in the reported case , our treatment plan calls acupuncture and moxibustion therapy of excitation - focus transfer , which has been presented with superior therapeutic effect on sshl after the western routine therapy . in traditional chinese medicine ( tcm ) , it is believed that sshl is caused by the yin - yang imbalance of internal organs . acupuncture is considered a useful treatment to balance this skewed condition as some channels originating from those organs flowing . numerous clinical studies indicated that acupuncture and moxibustion therapy of excitation - focus transfer was one of the most significant techniques of balancing the meridians . so , we believe that the acupuncture treatment has the potential to reduce the medical costs of sshl and avoid the side effects of oral or intravenously steroids . we suppose that the effects will be maintained for at least 3 months and other treatments are not necessary as the hearing loss or tinnitus never occurred during the observation periods . tinnitus might be the syndrome accompanied with hearing loss , also the possibility of an influence of the lymph fluid of the cochlea by acupuncture was the critical factor underlying the tinnitus occurring in the treatment . however , the observed changes in outcome measures may be attributed to several factors . the fullness or hearing loss could be enhanced by stopping excessive noise exposure and emotion - control for work pressure . the patient could be cured without any intervention as the spontaneous remission rate has been reported as 45% to 65% . first , we were unable to prove the efficacy of acupuncture alone only by a single case . multicenter studies with large samples and a long follow - up period are needed to confirm our observations . future studies should require a more rigorous design , such as a randomized controlled trial . although this article is based on self report , there are very clear trends on how patients with sshl responded to acupuncture treatments .
abstractsudden sensorineural hearing loss ( sshl ) is an otological emergency defined as a rapid hearing loss , seriously affects patient 's social life . to data , 
 no study has reported the treatment by acupuncture alone in the acute phase . in this report 
 , acupuncture and moxibustion therapy of excitation - focus transfer is outlined.the patient was a 26-year - old young woman who had an sshl coupled with ear fullness . 
 the patient had no past medical history , but she had undergone variable emotions and had a history of excessive noise exposure . 
 the patient refused to receive any medicine especially steroids and hyperbaric oxygen therapy . 
 she just only received acupuncture treatment.her symptoms and outcome measurements were improved every week and completely recovered after the last week.even though the article presents a single case and is based on self - reports , there are very clear trends on how patients with sshl responded to acupuncture treatments .