Research Progress on Pathogenesis, Modern Interventions and Neuromodulatory Mechanisms of Acupuncture for Tinnitus.

Tinnitus refers to the subjective abnormal auditory perception occurring without external sound stimuli, characterized by prominent clinical heterogeneity and complicated pathophysiological mechanisms, which severely impair patients' mental health and quality of life. Adopting a standardized literature retrieval procedure, this paper systematically sorts out the epidemiological characteristics, clinical classifications and diagnostic criteria of tinnitus, and deeply analyzes its dual pathological mechanisms involving peripheral auditory damage (hair cell injury, auditory nerve lesions) and abnormal central nervous system plasticity (auditory cortex remodeling, neurotransmitter imbalance, abnormal activation of the limbic system). It systematically summarizes mainstream Western medical interventions and critically evaluates the clinical efficacy and inherent research limitations of pharmacotherapy, sound therapy, cognitive behavioral therapy, repetitive transcranial magnetic stimulation and other neuromodulation techniques. Meanwhile, it integrates the traditional theories, neuromodulatory mechanisms and available clinical trial evidence of acupuncture for tinnitus treatment. Existing basic and clinical studies indicate that acupuncture can alleviate tinnitus symptoms and regulate autonomic nervous disorders to a certain extent by improving cochlear microcirculation, upregulating the expression of inhibitory GABA neurotransmitters, and remodeling functional connectivity of the brain's default mode network. Nevertheless, clinical trials on acupuncture are plagued by remarkable methodological flaws: acupoint prescriptions and acupuncture manipulation protocols are highly heterogeneous, outcome assessment indicators are inconsistent, most studies adopt single-center small-sample designs, long-term follow-up data exceeding one year are scarce, psychological placebo effects cannot be fully isolated, and efficacy reports vary widely across studies. At present, unified high-quality evidence is still lacking to confirm its stable clinical efficacy. As a narrative review, this paper abandons one-sided positive narratives and applies consistent evaluation criteria to balance the comparison of merits and drawbacks of all Chinese and Western therapeutic interventions. It fully discloses the procedures of literature retrieval, screening and synthesis, aiming to provide objective and reproducible theoretical and clinical references for standardized comprehensive diagnosis and treatment of tinnitus as well as interdisciplinary basic mechanistic research.