Supplementary file 1_Efficacy of acupuncture for tinnitus with anxiety: a systematic review and meta-analysis.docx

Outcomes evaluated included the total effective rate, Tinnitus Severity Questionnaire (TEQ), Tinnitus Handicap Inventory (THI), Traditional Chinese Medicine syndrome scores (TCM syndrome scores), Hamilton Anxiety Scale (HAMA), Self-Rating Anxiety Scale (SAS), Beck Anxiety Inventory (BAI), brain-derived neurotrophic factor (BDNF), serum 5-hydroxytryptamine (5-HT), and serum gamma-aminobutyric acid (GABA) levels as outcome measures.

Meta-analysis was performed using ReMan 5.3 software.</p>Results<p>Twelve studies involving 908 patients were included. Meta-analysis revealed that acupuncture demonstrated superiority in improving the total effective rate for tinnitus with anxiety (RR = 1.18, 95% CI: 1.10–1.26, P < 0.00001) and significantly reduced TEQ scores (MD = −1.96, 95% CI: −2.47 to −1.45, Z = 7.57, P < 0.00001), and THI (MD = −9.11, 95% CI: −12.89 to −5.34, Z = 4.73, P < 0.00001), TCM syndrome scores (MD = −0.59, 95% CI: −1.13 to −0.06, Z = 2.17, P = 0.03 < 0.05), HAMA (MD = −2.04, 95% CI: −3.08 to −1.00, Z = 3.84, P = 0.0001 < 0.05) scores, SAS (MD = −3.50, 95% CI: −6.22 to −0.77, Z = 2.52, P = 0.01 < 0.05), BAI (MD = −8.80, 95% CI: −13.48 to −4.12, Z = 3.68, P = 0.0002 < 0.05) scores, but not in improving BDNF (MD = −72.27, 95% CI: −312.41 to 167.87, Z = 0.59, P = 0.56 > 0.05), 5-HT (MD = −22.56, 95% CI: −56.12 to 10.99, Z = 1.32, P = 0.19 > 0.05), and GABA (MD = 56.23, 95% CI: −46.50 to 158.96, Z = 1.07, P = 0.28 > 0.05) levels.</p>Conclusions<p>Acupuncture treatment for tinnitus with anxiety demonstrated greater improvement than non-acupuncture approaches in enhancing the clinical total effective rate and reducing TEQ, THI, TCM syndrome scores, BAI, HAMA, and SAS scores, warranting clinical promotion.

However, evidence levels for certain outcome measures (BDNF, 5-HT, and GABA) remain low, necessitating further validation through well-designed, methodologically rigorous, high-quality, large-scale randomized controlled trials.</p>Systematic review registration<p>crd.york.ac.uk/PROSPERO/view/CRD42024596594; identifier: CRD42024596594.</p>