Tinnitus—the perception of ringing, buzzing, hissing, or

other sounds without an external source—can be more

than an auditory symptom. For many people, persistent

tinnitus is closely associated with sleep disturbance,

anxiety, emotional distress, difficulty concentrating, and

reduced quality of life.

A 2026 randomized controlled clinical trial published in

Complementary Therapies in Medicine investigated

whether electroacupuncture could improve subjective

tinnitus and whether those clinical changes could be

associated with measurable changes in brain function.

The researchers compared electroacupuncture with sham acupuncture and used both clinical outcome measures and resting-state functional magnetic resonance imaging (rs-fMRI) to examine the results.

The findings provide an interesting new perspective on acupuncture for tinnitus: electroacupuncture was associated not only with greater improvement in tinnitus severity, but also with changes in sleep, emotional status, hearing measures, and activity within a brain region involved in sensory and emotional processing.

​

Research & Insights | Balance Art Acupuncture
Published: August 2026

Key Takeaways

• The randomized clinical trial enrolled 90 adults with subjective tinnitus.

• Participants received either electroacupuncture or sham acupuncture.

• Treatment consisted of 20 sessions over 7 weeks.

• Electroacupuncture produced substantially greater improvement in Tinnitus Handicap Inventory (THI) scores than sham acupuncture.

• Improvements in tinnitus severity remained evident at the 3-month follow-up.

• Electroacupuncture was also associated with greater improvements in sleep quality and emotional status.

• Brain imaging identified changes in the right insula, a region involved in integrating sensory and emotional information.

• Changes in insular brain activity correlated with improvement in HADS emotional-status scores.

• No serious adverse events were reported in either group.

What Is Subjective Tinnitus?

Subjective tinnitus refers to hearing a sound that does not originate from an external acoustic source.

Patients may describe tinnitus as:

• ringing

• buzzing

• humming

• hissing

• whistling

• clicking

• high-pitched tones

Tinnitus can occur in one ear, both ears, or sometimes seem to originate inside the head.

Importantly, tinnitus is not always an isolated hearing complaint.

Persistent tinnitus can interact with sleep and emotional health, and patients with bothersome tinnitus frequently experience sleep disturbance and psychological distress. The researchers specifically highlighted relationships between tinnitus and conditions such as sleep disturbance, anxiety and depression when explaining the clinical importance of the study.

This is one reason modern tinnitus research increasingly examines not only the ear, but also how the brain processes and responds to persistent auditory signals.

The 2026 Randomized Controlled Trial

The study was conducted at the First Affiliated Hospital of Anhui University of Chinese Medicine.

Researchers enrolled 90 adults between 18 and 65 years of age with subjective tinnitus.

Participants were randomized at a 2:1 ratio:

Electroacupuncture group: 60 patients
Sham acupuncture group: 30 patients

Both groups received treatment over approximately seven weeks, for a total of 20 treatment sessions.

The sham treatment used non-penetrating needles, while the electroacupuncture group received actual acupuncture with electrical stimulation.

The researchers evaluated several outcomes, including:

Tinnitus Handicap Inventory (THI)
Measures the functional and emotional impact of tinnitus.

Pittsburgh Sleep Quality Index (PSQI)
Measures sleep quality and sleep-related difficulties.

Hospital Anxiety and Depression Scale (HADS)
Measures symptoms related to anxiety and depression.

Audiometry
Evaluates hearing function.

Researchers also performed resting-state fMRI to investigate whether treatment was associated with measurable changes in brain activity.

How Much Did Tinnitus Improve?

The primary outcome of the trial was the Tinnitus Handicap Inventory (THI).

This is particularly important because THI does not simply ask whether tinnitus exists. It measures how much tinnitus affects a person's daily functioning and emotional well-being.

After the first treatment course, THI scores decreased by an average of approximately:

14.5 points with electroacupuncture

compared with:

4.5 points with sham acupuncture

The between-group difference was statistically significant.

After completion of the second treatment course, the difference became substantially larger.

The electroacupuncture group showed an average THI reduction of approximately:

26.1 points

compared with approximately:

4.3 points

in the sham acupuncture group.

The between-group difference was approximately 22.4 points, with P < 0.001.

Did the Improvement Last?

This is one of the more interesting findings.

Researchers followed participants for three months after treatment.

At follow-up, the average reduction from baseline in THI remained approximately:

24.3 points in the electroacupuncture group

versus:

4.3 points in the sham acupuncture group.

The between-group difference remained statistically significant.

This suggests that, within this particular study population, the improvement observed after electroacupuncture was not limited to the immediate treatment period.

What About Tinnitus, Anxiety and Emotional Distress?

This part of the study is especially relevant because tinnitus and emotional distress can reinforce one another.

Persistent tinnitus may contribute to anxiety, frustration, stress and depressed mood, while increased emotional arousal can make tinnitus more intrusive or difficult to ignore.

The researchers therefore measured emotional symptoms using the Hospital Anxiety and Depression Scale (HADS).

After the complete treatment course, HADS scores improved by approximately:

6.6 points in the electroacupuncture group

compared with:

3.4 points in the sham acupuncture group.

The between-group difference was statistically significant (P = 0.003).

At the three-month follow-up, the advantage remained statistically significant (P = 0.019).

What About Tinnitus and Sleep or Insomnia?

Sleep disturbance is another common problem associated with bothersome tinnitus.

For some patients, tinnitus becomes especially noticeable in a quiet bedroom. Difficulty falling asleep may increase attention to tinnitus, while poor sleep can increase fatigue, stress and sensitivity to symptoms.

The researchers measured sleep using the Pittsburgh Sleep Quality Index (PSQI).

After the second treatment course, PSQI scores improved by approximately:

4.3 points with electroacupuncture

versus:

2.5 points with sham acupuncture.

The between-group difference was statistically significant (P = 0.009).

At three-month follow-up, the difference remained statistically significant (P < 0.001).

What Did the Brain Imaging Show?

Perhaps the most scientifically interesting part of this study involved resting-state functional MRI (rs-fMRI).

Researchers analyzed a measurement known as Regional Homogeneity (ReHo), which reflects the synchronization of local brain activity.

After treatment, the electroacupuncture group demonstrated a significant reduction in ReHo within the right insula compared with the sham acupuncture group.

Why Is the Insula Important?

The insula is a brain region involved in integrating multiple types of information, including:

• sensory perception

• auditory processing

• emotional processing

• attention

• internal bodily sensations

This is particularly interesting in tinnitus because the distress caused by tinnitus may involve more than abnormal auditory perception alone.

The brain also determines how much attention and emotional significance is assigned to that sound.

Previous research discussed by the study authors suggests that insular activity may be altered in people with tinnitus and may relate to tinnitus severity.

In this trial, the researchers found that changes in right-insula ReHo were positively correlated with changes in HADS scores in the electroacupuncture group (r = 0.365, P = 0.005).

In simpler terms:

The measurable brain changes associated with electroacupuncture were also related to changes in patients' emotional symptoms.

That does not prove that the insula is the sole mechanism through which electroacupuncture affects tinnitus. But it provides a potential neurobiological clue worth investigating further.

Is Electroacupuncture Different From Regular Acupuncture?

Yes.

Traditional acupuncture involves inserting fine needles into selected acupuncture points.

Electroacupuncture (EA) adds a controlled, low-level electrical current between selected needles.

In this study, researchers used seven standardized acupuncture points. Electrical stimulation was applied between selected points using a 2/10 Hz dense-disperse waveform.

Participants received three sessions per week for a total of 20 sessions.

The protocol used in a research study should not be interpreted as a universal treatment protocol for every patient with tinnitus. Clinical acupuncture treatment may vary according to the patient's symptoms, medical history and individual presentation.

What About Hearing?

The study also measured hearing thresholds.

After the complete treatment course, the electroacupuncture group demonstrated greater improvement in the study's audiometric measure than the sham acupuncture group, and the between-group difference remained statistically significant at the three-month follow-up.

Was Electroacupuncture Safe in This Study?

No serious adverse events were reported in either treatment group.

In the electroacupuncture group, one participant experienced a vasovagal episode associated with anxiety that resolved after needle removal and rest.

Two participants developed mild local hematomas, which resolved with compression.

As with any medical procedure, acupuncture should be performed by appropriately trained and licensed professionals.

What Does This Research Mean for Patients With Tinnitus?

This study provides evidence from a randomized controlled clinical trial that electroacupuncture may have clinically meaningful effects on several dimensions of subjective tinnitus.

The findings suggest potential effects involving:

Tinnitus severity
Patients receiving electroacupuncture experienced substantially greater improvement in THI scores than patients receiving sham acupuncture.

Sleep quality
Sleep scores improved more after electroacupuncture.

Emotional distress
Measures related to anxiety and depression improved more in the electroacupuncture group.

Hearing measures
Audiometric outcomes also favored electroacupuncture in this study.

Brain function
rs-fMRI demonstrated measurable changes in the right insula that were associated with changes in emotional status.

Taken together, these findings support the idea that tinnitus may involve an interaction among auditory processing, sleep, emotion and brain-network activity, rather than functioning purely as an isolated ear symptom.

Tinnitus Often Exists Alongside Other Symptoms

In clinical practice, people seeking care for tinnitus may also report concerns such as:

Difficulty sleeping or insomnia
The sound may become more noticeable in quiet environments and interfere with falling or staying asleep.

Anxiety and emotional distress
Persistent tinnitus can become frustrating or distressing and may increase attention toward the perceived sound.

Stress
Periods of increased stress may affect how intrusive tinnitus feels.

Difficulty concentrating
Persistent auditory perception can compete for attention and interfere with work or daily activities.

These relationships are clinically important because successful tinnitus management may require looking beyond the perceived sound itself.

The present trial is particularly relevant to sleep and emotional symptoms, because these outcomes were directly measured in the study.

The Bigger Picture: Acupuncture and Modern Neuroscience

For many years, acupuncture research focused mainly on whether patients reported feeling better after treatment.

Modern research is increasingly asking a deeper question:

What measurable biological changes occur when acupuncture is applied?

This tinnitus study is notable because it combines a randomized clinical trial with functional brain imaging.

The researchers did not simply measure whether patients reported less tinnitus.

They simultaneously examined:

clinical symptoms + sleep + emotional status + hearing + brain activity.

The observed change in insular function provides one potential window into how electroacupuncture may interact with neural systems involved in sensory and emotional processing.

It does illustrate how modern imaging technology is allowing researchers to investigate acupuncture using increasingly objective biological measurements.

Our Perspective

At Balance Art Acupuncture, we believe acupuncture should be discussed using both clinical experience and appropriately interpreted scientific evidence.

Research should neither be exaggerated nor ignored.

A single study rarely provides a final answer. Instead, each well-designed clinical trial adds another piece to our understanding of where acupuncture may be useful, how large its effects may be, and what biological mechanisms might be involved.

This 2026 randomized controlled trial is particularly interesting because it connects improvement in subjective tinnitus with changes in sleep, emotional status and measurable brain activity.

As additional studies replicate—or challenge—these findings, our understanding of electroacupuncture and tinnitus will continue to evolve.

Original Research

Zhang Y, Liu W, Ye Z, Huang Z, Zha B, Yang J.

Effects of electroacupuncture on brain functional connectivity in patients with subjective tinnitus: A randomized controlled clinical trial.

Complementary Therapies in Medicine. 2026;100:103391.

DOI: 10.1016/j.ctim.2026.103391

Read the original peer-reviewed study on ScienceDirect

View the study record on PubMed

 

About the Author

Run Guo, L.Ac., DAOM

Licensed Acupuncturist | Clinician & Educator
Balance Art Acupuncture | Vienna, Virginia

Run Guo, L.Ac., DAOM, is a licensed acupuncturist with more than 15 years of clinical practice and university-level teaching experience in acupuncture and traditional Chinese medicine. His clinical practice provides more than 10,000 patient visits annually, giving him extensive experience in the real-world application of acupuncture across a broad range of patient needs.

Alongside his clinical work, Run Guo has been involved in university-level education in acupuncture and traditional Chinese medicine for more than a decade, combining hands-on clinical experience with an academic perspective on the field.

Through Balance Art Acupuncture's Research & Insights series, he reviews emerging peer-reviewed research in acupuncture, electroacupuncture, neuroscience, immunology and modern biomedical science and translates scientific findings into clear, balanced information for patients and the general public.