Needle Technique Research Articles

The role of a dry needling technique in pain reduction

Introduction: Dry needling is a therapeutic procedure using the insertion of thin needles through the skin into myofascial trigger points (MTrPs), muscular or connective tissue with the aim to reduce pain intensity. The objective of this systematic review is to analyze the literature for the efficacy of the dry needle technique in pain reduction in conditions of musculoskeletal pain caused by MTrPs.
 Reference Sources: Web of Science, Scopus and EBSCOhost database were searched for studies and e-books published from January 2010 to December 2018.
 Studies Selection: We included randomized controlled studies, prospective and longitudinal studies, and case studies which analyzed the efficacy of dry needling for musculoskeletal pain reduction.
 Data Extraction Method: The studies, which satisfied criteria for inclusion were further analyzed. The primary instrument of the evaluation was pain intensity analyses.
 Results: Dry needling treatment is efficient in pain intensity reduction in patients who suffer musculoskeletal pain and is more efficient compared to sham dry needling treatment. In addition, different techniques of dry needling are efficient in the treatment of myofascial pain syndrome.
 Conclusion: Based on systematic review of the literature, dry needling, independently or as an addition to other intervention, is recommended for treatment of musculoskeletal pain conditions caused by myofascial trigger points. Various techniques of dry needling treatment are almost equally efficient in myofascial pain intensity reduction.

Enhanced safety and aesthetic outcomes: cannula technique versus sharp needle technique

The popularity of dermal fillers continues to grow, and it is important that the aesthetic practitioner is aware of the safest and most effective techniques available in delivering this treatment. In this article, Jordan Garrett describes her experience of using cannula technique in the administration of injectables, as well as reviewing some of the relevant literature.

Leaf area index estimated by direct, semi-direct, and indirect methods in European beech and sycamore maple stands

Leaf area index (LAI) is one of the most important characteristics of forest stands that affects the fundamentals of tree physiological processes, biomass production, and mechanical stability. The LAI results obtained by the semi-direct and indirect methods (the needle technique and an LAI-2000 PCA) in three European beech (Fagus sylvatica L.) stands and one sycamore maple (Acer pseudoplatanus L.) stand were compared with LAI estimated by litter traps during the 2013 growing season. Seasonal LAI was estimated using an LAI-2000 PCA which showed similar trends among the stands and strongly corresponded to phenological phases of deciduous stands in Europe, with the fastest rate of leaf area increment occurring during the first month following bud break. During the growing season, maximum stand LAI value was on June 19th and reached 4.5–5.1, and 4.0 in the beech and maple stands, respectively. The needle technique significantly underestimated (p .05) LAI on average by 15.1% and 5.8% in the beech and maple stands, respectively. All methods for LAI estimation at the stand level could be applicable in deciduous forest stands (beech, maple) with similar site and stand characteristics. However, calibration by direct method is necessary to obtain the required precision.

A prospective pilot comparison of wet and dry heparinized suction for EUS-guided liver biopsy (with videos)

As EUS-guided liver biopsy sampling (EUS-LB) becomes more widely used, further studies have investigated ways to improve tissue yields. Use of a heparin-primed needle may lead to less clotting of blood within the needle, improve tissue recovery, and decrease fragmentation. The purpose of this study was to prospectively evaluate wet suction using a heparin-primed needle for EUS-LB. This was a prospective crossover study evaluating wet suction for EUS-LB in parenchymal liver disease. The primary outcome was specimen adequacy, defined by an aggregate specimen length≥15mm and≥5 complete portal tracts (CPTs). Secondary outcomes included number of CPTs, length of the longest piece, aggregate specimen length, and number of small (≤4mm), medium (5-8mm), and large (≥9mm) fragments. Adverse events were tracked at 7 and 30 days. One hundred twenty biopsy specimens were collected from 40 participants (3 specimens per patient). Specimen adequacy occurred in 39 wet heparin (98%), 37 dry heparin (93%), and 30 dry needle biopsy samples (80%; 95% confidence interval [CI], .14-.18; P= .01). There was no difference between dry needle techniques. Length of the longest piece was 8.9mm for wet heparin and 5.8mm for dry techniques (95% CI, .33-1.53; P=.003). Aggregate specimen length was 49.2mm for wet heparin and 23.9mm for dry heparin (95% CI, -46.34 to 44.94; P= .003). Mean CPT count was 7.0 for wet heparin versus 4.0 for dry (95% CI, .74-6.26; P= .01). There were more medium (2.0 vs 1.0; 95% CI, .06-1.24; P= .03) and large (1.0 versus 0.0; 95% CI, .33-1.53; P= .003) fragments with wet suction with no difference in small fragments between groups. The use of wet suction EUS-LB demonstrated improved tissue adequacy compared with dry needle techniques. (Clinical trial registration number: NCT03103997.).

Outcomes in thread lift for face and neck: A study performed with Silhouette Soft and Promo Happy Lift double needle, innovative and classic techniques.

Increased demand for rejuvenation of the aging face has led to the evolution of various plastic surgery techniques. This study was conducted to evaluate the surgical efficacy and outcomes of the absorbable suture suspension system related to eyebrow, midface, mandibular, and neck lifting. In this prospective review chart clinical study, a total of 193 patients were included in the study from January 2016 to May 2017. All participants underwent thread lifting using the Proma Happy Lift double needle and Silhouette Soft threads. The patients were followed up for first week and first, third, and sixth month after lifting surgery. Outcomes were assessed by two surgeons and patients based on the GAIS score. A total of 193 patients (mean age: 52.22±11.74year, range: 25-89), 23 (11.9%) men and 170 (88.1%) women, were included in the study. The most common sites for the face lifting surgery were the jawline (46.1%), midface (33.7%), eyebrows (12.4%), and neck (7.8%). The level of satisfaction increased from 94% in the first week after surgery to 99% in the sixth month after surgery for patients, increased from 94% to 99% for surgeon 1, and increased from 83% to 98% for surgeon 2. The results showed that the level of satisfaction of patients and surgeons increased over time. These results demonstrated that facial rejuvenation thread lift with Proma Happy Lift double needle and Silhouette Soft threads is a being cosmetically more acceptance, safe, and effective procedure associated with minor complications.

Technique to Facilitate Retrograde Puncture of Mid to Upper Calf Tibial Vessels

Purpose: To describe a simple maneuver to facilitate the retrograde puncture of challenging tibial vessels in the lower leg. Technique: Because of the depth of the tibial vessels at the mid to upper calf, especially in obese or muscular patients, a 7- or 9-cm, 21-G micropuncture needle is often needed to reach the artery. However, the low profile of the needle contributes to its flexibility and therefore the tendency to bend as it progresses through the deep tissues, hindering access to the target vessel. To overcome this obstacle, a 4- to 5-cm, 18-G needle is initially placed pointing to the artery. The 21-G needle is advanced through it to the target site. This simple maneuver increases the support to the 21-G needle, preventing its bending and facilitating arterial puncture in the presence of calcified vessels. Conclusion: The telescoping needle technique may be considered as a bailout procedure in the retrograde tibial approach after failed attempts secondary to needle bending or calcified vessels.

Comparison of the effects of superficial dry needling and sparrow pecking acupuncture on upper trapezius myofascial pain

Myofascial syndrome is a group of symptoms and signs at one or more trigger points and is characterized by chronic muscle pain with increased sensitivity to pressure. Manual acupuncture with several stimulation techniques can be used to treat this condition. The purpose of the present study was to compare the superficial needling technique with the sparrow pecking technique in terms of pain reduction and change in pain threshold in myofascial pain syndrome (MPS) of the upper trapezius. A sample of 36 individuals was divided into two equal groups. The first group underwent superficial dry needling acupuncture, whereas the second group underwent sparrow pecking acupuncture. The intensity of pain was measured using the visual analog scale (VAS), and the pain stimulus threshold was measured using a pressure threshold meter (PTM) before treatment and at 0, 30, and 60 min after treatment. At 0 min, there was no mean difference between the superficial dry needling and sparrow pecking acupuncture in terms of pain scores or pain stimulus threshold. Overall, dry needling acupuncture and sparrow pecking both reduced pain and increased the pain stimulus threshold of myofascial pain in the upper trapezius, with no statistically significant difference.

Ultrasound-guided, percutaneous, needle technique, A1-pulley release for trigger finger

Trigger finger is a common cause of hand pain and disability and an A1-pulley dividing, percutaneous release is a definitive treatment for advanced stage disease. High-resolution, musculoskeletal ultrasonography provides clear visualization of the A1-pulley and flexor tendon, however, the evidence to support ultrasonographic guidance of this procedure is scarce. This study aim to evaluate the results of ultrasound (US)-guided, percutaneous, needle technique, annular, A1-pulley release for trigger finger (TF); specifically identifying whether this minimally-invasive procedure had low complication rates and enables early functional recovery. Single center, prospective cohort study of consecutive patients who were > 20 years of age, had grade II TF or higher for at least 4 months, and were unresponsive to conservative treatment. Patients with chronic connective tissue disease, rheumatoid arthritis, previous TF surgery, pregnancy, or bleeding risks were excluded. The procedure was an US-guided percutaneous A1-pulley release using needle technique. Outcome measures at 1 week post-surgery included; recovery time, pain level and duration, use of analgesic medications, time to normal activity of affected TF, and subject satisfaction for cosmesis and overall results. Surgical complications were monitored for 6 months. Thirty-nine fingers from 33 patients who received US-guided, percutaneous, A1-pulley release using needle technique were included in the analysis. Mean operative time was 6.17 (SD = 1.70) minutes. Median postoperative pain duration, use of analgesic medications, and recovery time to normal activity were 1.0 (IQR = 0–2), 0.5 day (IQR = 0.5–1), and 2 days (IQR = 1–2), respectively. Mean subject satisfaction scores for wound appearance and overall treatment were 9.87 and 9.61, respectively. Only one patient had an incomplete release and no severe complication were observed. US-guided, percutaneous, A1-pulley release with needle technique was an effective treatment for TF, with high levels of overall satisfaction and no significant complications.

Platelet-rich plasma and corticosteroid injection in lateral epicondylitis: Who is great

Elbow epicondylar tendinitis is a common problem that usually resolves with nonoperative treatments. When these measures fail, there is a role of Platelet-rich plasma (PRP) for tissue repair. The trial was conducted in Bangabandhu Sheikh Mujib Medical University Hospital during the period August 2016 to February 2017. One hundred patients with chronic lateral epicondylitis were randomly assigned to a leukocyte-enriched PRP group ( n = 51) or the corticosteroid group ( n = 49). Patients received either a corticosteroid injection or an autologous PRP injection through a peppering needling technique. Outcome was measured in terms of Visual Analog Scale (VAS) and Disabilities of the Arm, Shoulder and Hand (DASH). Success was defined as a reduction of 25% on VAS or DASH scores without a re-intervention within 6 months. When baseline VAS and DASH scores were compared with the scores of 6 months follow-up, both groups significantly improving within this time (intention-to-treat principle). But the DASH scores of the corticosteroid group come back to baseline levels, while the PRP group is unchanged at the end of 6 months (as-treated principle). The PRP group shows better outcome than the corticosteroid group ( P < 0.0001). There were no complications shown in the use of PRP. Patients with chronic lateral epicondylitis treated with PRP reduces pain and increases function, exceeding the effect of corticosteroid injection.

Precise application of Traditional Chinese Medicine in minimally-invasive techniques

Precise application of Traditional Chinese Medicine in minimally-invasive techniques

Single puncture versus standard double needle arthrocentesis for the management of temporomandibular joint disorders: A systematic review

The aim of this systematic review was to investigate the current evidence in order to assess the efficacy of single puncture arthrocentesis vs standard double needle arthrocentesis in the management of temporomandibular joint(TMJ) disorders. An electronic search of the PubMed, Scopus, Cochrane CENTRAL and Google Scholar databases was performed to identify English studies published up until October 2017. Eligible studies were selected based on inclusion criteria and included randomised controlled trials(RCTs) comparing single puncture arthrocentesis and standard double needle arthrocentesis for the management TMJ disorders. The initial screening identified 984 records, of which only 5 fulfilled the inclusion criteria. A high degree of heterogeneity was found in the 5 studies with each reporting different sample selection and arthrocentesis protocol. All 5 studies reported no difference in reduction in pain intensity and improvement in maximal mouth opening between the single puncture technique and standard double needle technique. This review provides some evidence that single puncture arthrocentesis is clinically as efficacious as standard double needle arthrocentesis. There is a need of well-designed RCT with standard protocol of arthrocentesis comparing different single puncture techniques and standard double needle technique for the management of TMJ disorders.

JIN Bohua's experience in the clinical acupuncture treatment of trigeminal neuralgia with fire needle and filiform needle

To introduce the experience of JIN Bohua, the capital Chinese medicine master, in the differentiation of acupuncture and the treatment on trigeminal neuralgia with fire needle and filiform needle. Regarding the diagnosis of trigeminal neuralgia, Professor JIN focuses on the coordination of meridian differentiation and zangfu differentiation. For the treatment, the fire needling technique and common filiform needling technique are used in combination. According to meridian differentiation, the acupoints are selected and stimulated with fire needle. In reference to zangfu, qi and blood differentiation, the treatment with filiform needles is applied. "The holistic treatment" and "seeking for the root cause of disorder" are the basic principle to be complied. When treating with filiform needle, Professor JIN emphasizes the needling sequence, meaning stimulating the acupoints in the lower part of the body before those in the upper part of the body, aiming to eliminating the pathogens and strengthening the antipathogenic qi.

Xerophthalmia of qi and yin deficiency treated with jinhuobu needling technique

To explore the differences in the clinical therapeutic effects on xerophthalmia of qi and yin deficiency between the jinhuobu needling technique (the combined reinforcing technique to induce warm sensation) and the reinforcing needing technique achieved by rotating needle. A total of 54 patients of xerophthalmia were randomized into an observation group (28 cases) and a control group (26 cases). In both of the groups, the main acupoints included Cuanzu (BL 2), Sizhukong (TE 23), Taiyang (EX-HN 5) and Fengchi (GB 20); the combined acupoints were Danzhong (CV 17), Sanyinjiao (SP 6), Taixi (KI 3) and Taichong (LR 3). In the observation group, the jinhuobu needling technique was used and in the control group, the reinforcing needing technique achieved by rotating needle was adopted. The treatment was given once every day. 10 treatments made one course and 2 courses were required. Before and after treatment, the score of eye symptoms, tear secretion and the breakup time of tear film were observed in the two groups. The clinical therapeutic effects were compared between the two groups after treatment and in 4-week follow-up after treatment separately. After treatment, the total effective rate was 92.9% (26/28) in the observation group and was 80.8% (21/26) in the control group, without significant difference in comparison (P>0.05). In 4-week follow-up after treatment, the total effective rate was 85.7% (24/28) in the observation group and was 61.5% (16/26) in the control group, indicating the significant difference in comparison (P<0.05). After treatment, the differences were significant in the score of eye symptoms, tear secretion and the breakup time of tear film as compared with those before treatment in the two groups (all P<0.01). After treatment, the improvements of the score of eye symptoms, tear secretion and the breakup time of tear film in the observation group were better remarkably than those in the control group, indicating the significant differences (all P<0.05). The jinhuobu needling technique achieves the significant therapeutic effects on xerophthalmia of qi and yin deficiency and the recurrence rate of the disease is low.

Methods to Obtain Percutaneous Access to Difficult-to-Reach Masses and Collections in the Abdomen and Pelvis

AbstractImage-guided biopsy and drainage of collections in the abdomen and pelvis are frequently performed in interventional radiology practices. Many options are available to facilitate access to masses and collections in challenging locations. This review focuses on the technique and efficacy associated with the various options available, including out-of-plane access, patient positioning, needle techniques (i.e., blunt and curved needle tip), adjunctive use of electromagnetic tracking devices, organ displacement, and transorgan access.

Effect of warm joint needling plus rehabilitation on the balance function and quality of life of patients with spastic hemiplegia after ischemic cerebral stroke

To observe the effect of warm joint needling plus rehabilitation techniques on the balance function and quality of life (QOL) of patients with spastic hemiplegia after ischemic cerebral stroke. Ninety patients with spastic hemiplegia after ischemic cerebral stroke were randomized into a rehabilitation group, a warm joint needling group and an observation group, with 30 cases in each group. The rehabilitation group was intervened by Bobath therapy, the warm joint needling group was treated with joint needling on the affected side plus warm needling, and the observation group was given the same rehabilitation treatment as the rehabilitation group together with the same warm joint needling as the warm joint needling group. The three groups were treated once another day, 1 month as a treatment course for 6 months. Before the treatment, and respectively after 2-week, 1-month, 3-month, and 6-month treatment, the modified Ashworth scale (MAS) was used to measure the anti-spasm ability of the lower limb, the Berg balance scale (BBS) was adopted to evaluate the balance function, and the stroke-specific quality of life scale (SS-QOL) was employed to estimate the QOL. After 3-month and 6-month treatment, the lower-limb MAS scores in the observation group were significantly better than those in the rehabilitation group and the warm joint needling group (all P<0.05). After 1-month, 3-month and 6-month treatment, the BBS scores in the observation group were significantly better than those in the rehabilitation group and the warm joint needling group (all P<0.05). After 2-week, 1-month, 3-month and 6-month treatment, the SS-QOL scores in the observation group were markedly better than those in the rehabilitation group and the warm joint needling group (all P<0.05). Warm joint needling plus rehabilitation can effectively improve the lower‐limb spasticity state, balance function and QOL in patients with spastic hemiplegia after ischemic cerebral stroke.

Value of artisanal simulators to teach ultrasound-guided percutaneous biopsy using a tru-cut needle for veterinary and medical students.

The present study aimed to evaluate the applicability of artisanal simulators to teach veterinary and medical students the ultrasound-guided percutaneous biopsy using a tru-cut needle. The artisanal simulators consisted of bovine liver between two layers of commercially available grape gelatin. Students were paired, with one doing the biopsy and the other the ultrasound guidance. After performing the biopsies, each student answered a questionnaire with close-ended questions using a visual analog scale. The evaluated items were realism of the model, liver scanning, procedure instructions, biopsy feasibility, tru-cut needle handling, technique learning, and confidence to perform in vivo procedures. Items that received a score of 7 or higher were considered strong items; items with a score between 5 and 6.9 were classified as average items; and items with a score of 5 or lower were considered weak items. The answers to all questions had an average score of 7 or higher, suggesting that the simulator was classified as strong for all of the evaluated items. Answers to question 7 suggested that some of the students did not develop confidence to perform a tru-cut biopsy on a patient. Students evaluated the artisanal simulator as a strong method to be used in ultrasound-guided percutaneous biopsy with a tru-cut needle. Additionally, the model presented a low cost of production and was proven accurate to teach biopsy skills in health professional schools dealing with veterinary or human medicine.

Relevance of B3 lesions in breast diagnosis – frequency and therapeutic consequences

AbstractWith improvements in breast imaging and minimally invasive interventions, detection of early breast cancer has increased. However, with the improved diagnostic capabilities, the risk of false-positive benign lesions as well as lesions classified as B3 by histopathology has also increased. Varying rates of malignancies are associated with B3 lesions, raising the question of whether such lesions should always be surgically removed. The results of our retrospective analysis should assist in this decision-making process.307 core needle or vacuum-assisted needle biopsies in which B3 lesions were found were examined. The most common lesions were intraductal papillomas (44 %), atypical ductal hyperplasia (22.8 %), flat epithelial atypia (9.4 %), phyllodes tumours (6.5 %), radial scars (5.9 %), LIN 1 (4.9 %), complex fibroadenomas (3.3 %) and LIN 2 (1.6 %). The frequencies depended considerably on whether the tissue was obtained by core biopsy or vacuum biopsy. Stereotactic vacuum biopsy was generally performed in the case of microcalcification not apparent on sonography. Lesions visible on ultrasound had core needle biopsy.Surgery was performed in 254 cases and a malignancy was found in 27.2 % on the final histopathology. Malignancy was found in 24.6 % of 114 cases initially diagnosed as intraductal papilloma. Similarly, cancer was discovered in 48.4 % of the 62 cases of atypical ductal hyperplasia, in 2.4 % of the 41 cases of flat epithelial atypia, complex fibroadenoma and phyllodes tumour, in 20.7 % of the 29 cases of LIN 1 and radial scar as well as in 50 % of the 8 cases of LIN 2, adenomyoepithelioma and atypical apocrine metaplasia.These data indicate the necessity for complete surgical removal of a B3 lesion when it is discovered using the core needle or vacuum-assisted biopsy technique. The decision not to perform surgery can be made when the risk of associated malignancy is deemed low in the clinical pathology conference, but careful follow-up is essential.

Microanatomical Location of Hyaluronic Acid Gel Following Injection of the Upper Lip Vermillion Border: Comparison of Needle and Microcannula Injection Technique.

To compare needle and microcannula injection techniques in regards to the microanatomical location of hyaluronic acid (HA) gel injected in the upper lip vermillion border of cadaver specimens. The upper lip vermillion border was injected transcutaneously with HA gel in 8 fresh hemifaces of 4 female human cadavers. Each hemiface was injected by a single experienced injector, the right side using a 27-gauge microcannula and the left side using a 30-gauge needle. A 2-cm region of each lip was excised lateral to a point 1-cm lateral to the philtrum. Specimens were fixed in 95% alcohol, embedded in paraffin, and stained with hematoxylin-eosin for histologic examination. Most HA injected with either a needle or a microcannula was located within the orbicularis oris muscle, and the remaining HA resided within the subcutaneous fat. In 3/4 right (microcannula) hemifaces, 100% of the HA was located within the muscle. Only 2/4 left (needle) hemifaces had at least 95% of the HA located within the muscle. Overall, in right (microcannula) hemifaces, 93% of the filler was located within the muscle, and in left (needle) hemifaces, 79% of the filler was located within the muscle (p =0.14). Most HA filler injected into the vermillion border after either microcannula or needle injection resides within the orbicularis oris muscle rather than in a subcutaneous/submucosal location. Injection with a microcannula shows a trend for more uniform intramuscular location compared with needle injection.

F29. Recovery of sensory modalities after peripheral nerve lesions associated with mechanoreceptor and sensory nerve fiber function

Introduction Sensation is essential for recovery after peripheral nerve injury. However, the relationship between sensory modalities and function of regenerated fibers and reinnervated sensory receptors is uncertain. We have investigated the relationships between touch threshold, tactile gnosis and mechanoreceptor and sensory fiber function after nerve regeneration. Methods Twenty-one median or ulnar nerve lesions were repaired by a collagen nerve conduit or direct suture. Quantitative sensory hand function using a modified Rosen score and sensory conduction studies by near-nerve needle technique including tactile stimulation of mechanoreceptors were followed for 2 years, and results were compared to non-injured hands. Results At both repair methods, touch thresholds at the finger tips recovered to 81 ± 3% whereas tactile gnosis only recovered to 20 ± 4% (P Conclusion The recovered function of regenerated peripheral nerve fibers and reinnervated mechanoreceptors may differentially influence recovery of sensory modalities. Touch was affected by the number and function of regenerated fibers and mechanoreceptors. In contrast, tactile gnosis depends on the input and plasticity of the CNS, which may explain the absence of a direct relation between electrophysiological parameters and poor recovery. Dispersed maturation of sensory nerve fibers with desynchronized inputs to the CNS also contributes to the poor recovery of tactile gnosis.

Clinical observation on idiopathic tinnitus treated with acupuncture, buzhong yiqi tang and cizhu wan

To observe the differences in the clinical therapeutic effects on idiopathic tinnitus between the combined therapy with acupuncture and the modified formula of buzhong yiqi tang and cizhu wan and the simple administration of the modified formula of buzhong yiqi tang and cizhu wan. A total of 60 patients were randomized into a combined treatment group and an herbal medicine group, 30 cases in each one and 2 cases dropped out in the herbal medicine group. In the combined treatment group, acupuncture was given at the local acupoints for tinnitus, such as Yifeng (TE 17), penetrating needling technique from Ermen (TE 21) to Tinggong (SI 19) and Tinghui (GB 2) combined with the scalp acupuncture [the vertigo-auditory area, Baihui (GV 20)] and the oral administration of the modified formula of buzhong yiqi tang and cizhu wan. In the herbal medicine group, the oral administration of the modified formula of buzhong yiqi tang and cizhu wan was only applied. The treatment was given once a day in each group, 5 times a week for acupuncture and 7 times a week for the oral administration of herbal medicine. Totally, the treatment for 6 weeks was required in the two groups. Before and after treatment, the tinnitus severity score (TSS) and the score of tinnitus handicap inventory (THI) were observed and the clinical therapeutic effects were compared between the two groups. After treatment, the TSS and THI scores reduced as compared with those before treatment in the two groups (all P<0.05). The scores in the combined treatment group were lower than those in the herbal medicine group (both P<0.05). The total effective rate in the combined treatment group was 93.3% (28/30), better than 67.9% (19/28) in the herbal medicine group (P<0.05). The combined treatment with scalp acupuncture, acupuncture around the ear and the modified formula of buzhong yiqi tang and cizhu wan achieve the superior therapeutic effects on idiopathic tinnitus as compared with the simple oral administration of the modified formula of buzhong yiqi tang and cizhu wan.