Wet Cupping Therapy as an Integrative Medicine Treatment for Subjective Tinnitus

Official title

Wet Cupping Therapy as an Integrative Medicine Treatment for Subjective Tinnitus: A Randomized Controlled Study

Overview

Cupping therapy is an ancient complementary medicine therapy. It was a cornerstone in many ancient healing systems, including Traditional Chinese Medicine, Unani Medicine, Traditional Korean Medicine, and Islamic Medicine. Previous pilot randomized controlled trials reported promising effects of adding cupping therapy in the management of tinnitus and hearing loss. This trial aims to evaluate the safety and efficacy of wet cupping as a complementary treatment in the management of chronic subjective tinnitus with or without hearing loss. Materials and Methods: The study participants will be 142 patients suffering from subjective and continuous tinnitus aged from 21 to 65 years. Participants will be randomly assigned into an interventional group (71) or a control group (71). This study is a randomized controlled study. All participants will read and sign the informed consent. Intention to treat and changes in the Tinnitus Handicap Inventory (THI) between groups will be the primary outcome. Hearing Level (HL) and adverse events related to wet cupping will be the secondary outcomes. Data will be collected on required forms. Statistical analysis will also be performed. Descriptive analysis will also be represented, showing the demographic information. This clinical trial is a large clinical trial which will be based on a previously conducted pilot trial at Hamad Medical Corporation (HMC).

Detailed description

Wet Cupping therapy (WCT): One of the complementary and integrative medicine healing practices, which uses cups with superficial scarifications of the selected points on the skin.

Tinnitus was defined as the perception of a sound without an associated known stimulus consciously.

In spite of several work and research studies, the pathophysiology of Tinnitus is still unclear. Tinnitus is one of the major audiological symptoms. Despite its huge personal and presumed economic impact, there are only limited therapeutic options available. The reason for this deficiency lies in the very nature of the disease as it is deeply connected to elementary plasticity of auditory processing in the central nervous system. Furthermore, tinnitus with unknown causes was classified as subjective tinnitus, and if tinnitus duration was more than six months, it was classified as chronic tinnitus. One of the major challenges in tinnitus is to explore the pathophysiological causes to find an appropriate effective treatment.

Cupping therapy is an integrative and complementary medicine practice. Cupping therapy types were numerous, and there was a published classification of cupping therapy types. Wet cupping therapy is one of the technical types of cupping therapy. Wet cupping was practiced by applying cups on selected body points. Superficial scarifications should be performed by using a sterile surgical blade after removing the cups. The cups should be re-applied again. Cupping therapy showed promising and significant effects in the management of various diseases such as: headache, migraine, neck pain, low back pain, and knee osteoarthritis. A previous case report and a pilot study were conducted to evaluate the safety and efficacy of cupping therapy in the management of tinnitus and dizziness. The promising effects and the wide safety profile of wet cupping therapy were reported in this study. Furthermore, wet cupping therapy reduced the discomfort of tinnitus and dizziness. Evidently, cupping therapy was reported to have a wide safety profile as shown in previous published systematic reviews.

Tinnitus Handicap Inventory (THI) uses validated tinnitus questionnaires, is a self-administered test that is used to help determine the degree of distress suffered by the tinnitus patient. It is widely used in medical offices and in clinical trials to determine the effectiveness of a given therapy. The purpose of this questionnaire is to identify difficulties that may be experienced because of tinnitus, focused instead on the impact of tinnitus on a person's activities of daily living. The THI is the most recent, most reliable, and most widely used of several questionnaires developed over the last 20 years.

Hearing Level shows the audible threshold for standardized frequencies as measured by an audiometer. It will measure the intensity in decibels at certain frequencies measured in hertz.

The hypothesis of this condition is that wet cupping therapy has a significant effect as a complementary therapy for the management of subjective and continuous tinnitus.

Cupping reported effects that can be of benefit for tinnitus patients include increasing microcirculation in the area treated, reducing pro-inflammatory cytokines (IL-6, TNF-α), increasing anti-inflammatory lipids, and a neuromodulation effect.

This clinical trial is a large clinical trial design which will be based on a previously conducted pilot trial at Hamad Medical Corporation (HMC). The previously published pilot trial was the first world pilot clinical trial in this field which was conducted IN HMC, and to continue our work, this trial is a leading clinical trial which will improve the knowledge regarding the use of integrative medicine in the field of ear pathologies. It will provide the first evidence about the effectiveness and safety of using cupping therapy as an integrative therapy for the management of chronic subjective tinnitus. It is the first step of a long way to collect and provide evidence regarding the use of cupping therapy for the management of tinnitus.

Study objectives

1. To examine the effect of wet cupping therapy as an integrative therapy on perceived tinnitus handicap severity among adults with subjective tinnitus. 2. To evaluate the safety of wet cupping therapy as an integrative therapy treatment for subjective tinnitus.

Interventions

• Other Wet Cupping Therapy plus Usual care
  wet cupping therapy will be done by a licensed cupping therapist on 2 points post-auricular and bilateral) plus usual care
• Other usual care only
  Usual medical care (Treatment includes (Patients with hearing loss: Hearing aid option with masker plus or minus Amitriptyline, while patients without hearing loss will receive Amitriptyline) according to ENT department at HMC guidelines.

Primary outcome measures

• Tinnitus Handicap Inventory (THI) [Time frame: The scale will be performed at baseline, and end of treatment at 8 weeks]

Secondary outcome measures (2)

• Hearing Level (HL) : [Time frame: The scale will be performed at baseline, and end of treatment at 8 weeks]
• Adverse events. [Time frame: Adverse events will be checked up to 8 weeks from baseline.]

Eligibility criteria

Inclusion criteria

• Adults aged 21 to 65 years old.
• Primary subjective tinnitus with or without hearing loss for more than 6 months.
• Tinnitus significantly impacting quality of life, as measured by the Tinnitus Handicap Inventory (THI).

Exclusion criteria

• Objective, acute or intermittent tinnitus.
• History of Ménière's disease.
• Tinnitus induced by cerebellopontine angle tumors.
• Cardiovascular disease, or a serious medical or mental illness.
• History of central nervous system disease.
• Patient with anemia or cardiovascular diseases.
• Current pregnancy or breast-feeding.
• Patients with a lack of willingness or availability.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

Center list to be confirmed — check the primary protocol.

Publications

• Al-Bedah, A. M., Shaban, T., Suhaibani, A., Gazzaffi, I., Khalil, M., & Qureshi, N. A. (2016). Safety of cupping therapy in studies conducted in twenty one century: a review of literature. British Journal of Medicine and Medical Research, 15(8), 1-12.
• Almusleh ZA, El Ansari W. Integrating Cupping Therapy in the Management of Sudden Sensorineural Hearing Loss: A Case Report. Cureus. 2020 Feb 20;12(2):e7063. doi: 10.7759/cureus.7063. PMID 32226665
• Kim, T. H., Kim, K. H., Choi, J. Y., & Lee, M. S. (2014). Adverse events related to cupping therapy in studies conducted in Korea: a systematic review. European Journal of Integrative Medicine, 6(4), 434-440
• Tunkel DE, Bauer CA, Sun GH, Rosenfeld RM, Chandrasekhar SS, Cunningham ER Jr, Archer SM, Blakley BW, Carter JM, Granieri EC, Henry JA, Hollingsworth D, Khan FA, Mitchell S, Monfared A, Newman CW, Omole FS, Phillips CD, Robinson SK, Taw MB, Tyler RS, Waguespack R, Whamond EJ. Clinical practice guideline: tinnitus. Otolaryngol Head Neck Surg. 2014 Oct;151(2 Suppl):S1-S40. doi: 10.1177/0194599814545 PMID 25273878
• Haider HF, Bojic T, Ribeiro SF, Paco J, Hall DA, Szczepek AJ. Pathophysiology of Subjective Tinnitus: Triggers and Maintenance. Front Neurosci. 2018 Nov 27;12:866. doi: 10.3389/fnins.2018.00866. eCollection 2018. PMID 30538616
• Aboushanab TS, AlSanad S. Cupping Therapy: An Overview from a Modern Medicine Perspective. J Acupunct Meridian Stud. 2018 Jun;11(3):83-87. doi: 10.1016/j.jams.2018.02.001. Epub 2018 Feb 7. PMID 29436369
• Al Bedah AM, Khalil MK, Posadzki P, Sohaibani I, Aboushanab TS, AlQaed M, Ali GI. Evaluation of Wet Cupping Therapy: Systematic Review of Randomized Clinical Trials. J Altern Complement Med. 2016 Oct;22(10):768-777. doi: 10.1089/acm.2016.0193. Epub 2016 Aug 24. PMID 27557333
• Almusleh Z, Sulaiteen MA, Hadi KA, Hassan E, Ali A, Charalil J. Integrating cupping therapy in the management of tinnitus and dizziness: a pilot study. TMR Non-Drug Ther. 2021;4(2):11. doi:10.53388/TMRND20210529032

Identifiers

NCT: NCT07685171 · MRC-01-25-546

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗