耳穴按壓治療耳鳴之有效性：系統性回顧與統合分析

Effectiveness of Auricular Acupressure in Treating Tinnitus: Systematic Review and Meta-Analysis

背景：耳鳴是一種無外部聲學刺激而產生的聲音感知，因尚未有全面且明確的有效治療策略，故非侵入性且易於居家進行的耳穴按壓治療是臨床患者可能會接受的替代治療，本研究旨在透過系統性回顧與統合分析探討耳穴按壓治療耳鳴的臨床效果。方法：經由搜尋Cochrane Library、MEDLINE、PubMed、EMBASE、中文電子期刊資料庫（CEPS）、中國期刊全文數據庫（CNKI）、ClinicalTrials.gov及ProQuest，檢索2025年6月前的文獻，使用Cochrane偏差風險評估工具評估文獻品質，並進行統計分析，用GRADE實證等級系統評估結果可信度，同時繪製網絡圖分析所使用的耳穴。結果：總共納入6篇隨機對照試驗，整體風險偏中度至高度，耳穴按壓組之總有效率顯著高於對照組（RR=1.44, 95%CI [1.09, 1.89], random effects model）。匹茲堡睡眠質量指數亦優於對照組（MD=-0.90, 95% CI [-1.42, -0.38], random effects model），且未見明顯副作用增加。透過對研究中使用的耳穴進行穴位網絡分析，則顯示耳神門及內耳穴是最常用之核心穴位。結論：耳穴按壓對耳鳴患者的耳鳴症狀及睡眠品質具有潛力，且安全性高，可作為輔助治療之選擇。

Background: Tinnitus is usually defined as the perception of sound in the absence of a corresponding external acoustic stimulus. Due to the lack of universally effective treatment, non-invasive and home-manageable auricular acupressure may offer a suitable alternative therapy. This study aimed to evaluate the clinical effectiveness of auricular acupressure in treating tinnitus through systematic review and meta-analysis. Methods: Databases including Cochrane Library, MEDLINE, PubMed, EMBASE, CEPS, CNKI, ClinicalTrials.gov and ProQuest were systematically searched up to June 2025. We assessed the quality of included studies with the Cochrane risk of bias tool, performed statistical analyses with Review Manager 5.4 and evaluated the certainty of pooled results of each meta-analysis using the GRADE system. We performed network analysis on the auricular acupoints identified across studies using NodeXL Pro. Results: Six randomized controlled trials were included, revealing moderate to high overall risk of bias. Auricular acupressure combined with conventional treatment significantly improved the total effective rate compared with conventional treatment alone (RR=1.44, 95% CI [1.09, 1.89], random effects model). Auricular acupressure also significantly improved Pittsburgh Sleep Quality Index scores (MD=-0.90, 95% CI [-1.42, -0.38], random effects model) without adverse effects being reported. Network analysis revealed that the Ear Shenmen and Inner Ear points were the most frequently utilized core acupoints. Conclusion: Auricular acupressure is significantly effective in alleviating tinnitus symptoms and improving sleep quality, with high safety. It can be considered as an effective adjunctive therapy for tinnitus.