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文獻一、新北市中醫臨床顯效案例彙編九─運用山元式新頭針療法治療突發性耳聾顯效醫案


運用山元式新頭針療法治療突發性耳聾顯效醫案

高資承醫師

台北醫學大學醫務管理學系碩士班
醫心堂中醫診所院長
日本山元式新頭針療法 2015, 2016年英文班結業
日本山元式新頭針療法 2017-2019年日文班結業
日本YNSA學會會員
台灣山元式學會 理事長

前言
突發性耳聾是耳鼻喉科的急症，俗稱耳中風，突發性耳聾的定義是72小時之內出現連續3個頻率大於30分貝的感音神經性聽力損失。發生率約為十萬分之5到20，發病的年齡大多在40歲到60歲，男女相當，多發生於單耳，很少雙耳同時發生。
發生突發性耳聾的真正原因不明，有許多可能的致病機轉被提出，最常被提到的原因為病毒感染、血管因子、病毒感染以及氣溫降低導致供應內耳血流的血液循環不足，造成聽力障礙，所以有些人稱為「耳中風」。
而目前不論是耳鼻喉科使用類固醇治療、高壓氧，或者中醫師使用傳統針灸搭配方劑治療，仍有少數病人聽力恢復有限，造成病人生活上的困擾與不適。
山元式新頭針療法(Yamamoto New Scalp Acupuncture, YNSA)，是由日本宮崎縣的山元敏勝醫師所研發，在世界各地已廣泛使用約30年，治療方式為針對頭皮與身體上的刺激點用針做刺激。然而針刺點並非穴位，而是Somatotope. 其治療特色為立即見效，對於疼痛與神經症狀有立即緩解的效果。

案例
王小姐 35歲 病歷號碼76*** 初診日期：106/9/15
主訴：左耳突發性耳聾已六年
現病史：六年前因不明原因導致左耳聽力突然降低，耳鼻喉科判斷為突發性耳聾，初期住院時有注射類固醇治療，出院後於中醫診所持續針灸治療合併傳統湯劑，但聽力並未明顯恢復。
過去病史/個人史：無系統性疾病、抽菸以及飲酒

治療經過
四診
望診：面色稍暗，有疲倦感
聞診：無明顯異常
問診：耳鳴，耳朵悶塞、有時帶有脹痛感，聽到噪音時覺得很不舒服、月經來時聽力較差等。
切診：左右脈均弦數
聽力測驗：
102/7/9: 左耳聽力平均50dB, 右耳聽力平均20dB
106/9/30: 左耳聽力平均56dB, 右耳聽力平均18dB, 其中500Hz為60dB, 1000Hz為60dB, 2000Hz為50dB.如圖一
診斷：左耳突發性耳聾
處方：
基本點：Right A point*2
感覺點：Right Tinnitus point*4
腦點：Right Cerebrum point, Cranial Nerve No.8 point
Y點：Right Kidney point
其他Somatotope：Right I-somatotope, Master key tinnitus point

追蹤報告
由於病患並非住在台北市，因此每一周前來診所就診，至撰寫文章日為止共就診13次。而本診所並沒有耳鼻喉科的專業聽力檢測儀器，因此每次針灸完之後只能利用手邊的iPad進行簡單的聽力測試。但治療期間病患自覺聽力逐漸恢復，耳鳴減緩，耳朵悶塞感與脹痛感消失，噪音造成的不舒適感也逐漸減緩。
病患於治療第11次時，至醫院耳鼻喉科進行聽力測試：
106/11/22: 左耳聽力平均46.25dB, 右耳聽力平均12.15dB, 其中500Hz為50dB, 1000Hz為45dB, 2000Hz為45dB.如圖二

診治思維
    筆者在治療病患當下，使用診斷點進行診斷，發現Tender point多出現在頸部點、腦點、腎點，因此在頭皮上使用山元老師所教導的A point, Cerebrum point, Kidney point. 此外，在頭皮上進行觸摸時，發現CN8, 耳感覺點、Tinnitus point有壓痛點，故再度進行施針。最後再使用I-somatotope, Master key tinnitus point進行最後補正。
    由於YNSA強調診斷方式為主，因此每次施針的刺激點並不完全一致，點的位置也並非每次都100%相同, 但可以預見的是，若下針位置正確，病患大多數都會有立即性的緩解，如耳鳴減輕，耳朵悶脹感緩解等。

圖一、病患治療前數據

圖二、病患治療第11次數據

 

 

 

 

文獻二、中醫藥研究論叢─山元式新頭針療法治療耳中風之病例報告
 

山元式新頭針療法治療耳中風之病例報告

高資承醫師

台北醫學大學醫務管理學系碩士班
醫心堂中醫診所院長
日本山元式新頭針療法 2015, 2016年英文班結業
日本山元式新頭針療法 2017-2019年日文班結業
日本YNSA學會會員
台灣山元式學會 理事長

摘要
耳中風，亦稱為突發性耳聾(SSHL), 是耳鼻喉科急症，其症狀為急速聽力減退，而嚴重影響病患的生活。山元式新頭針療法(YNSA)於西元1967年由日本山元敏勝所研發，其治療方法是採用身體上的刺激點(somatotope), 而非傳統針灸穴位治療。此外，目前對於突發性耳聾的論文多半屬於西醫的類固醇治療或中醫的傳統針灸，尚未有運用YNSA來治療突發性耳聾的研究文章，因此，本病歷報告為運用YNSA來治療耳中風之有效案例。
林先生，62歲男性，2018年6月中旬右耳罹患耳中風，經過耳鼻喉科注射類固醇治療後聽力未明顯恢復，左耳以前亦曾發作過突發性耳聾，前來就診時左耳耳鳴、右耳悶塞感。治療期間運用山元式新頭針療法，約治療18次後，聽力恢復約40分貝，目前持續治療當中。
結論：YNSA對於耳中風有顯著的療效，亦可改善耳鳴、耳朵悶塞感等症狀。若西醫與傳統針灸治療後無效，可採取本療法治療。

關鍵詞：耳中風、突發性耳聾、山元式新頭針療法、Yamamoto New Scalp Acupuncture, Somatotope

前言
耳中風，又名突發性耳聾(Sudden sensorineural hearing loss, SSHL)[1]為耳鼻喉科的急症，發生率約5-20人/每10萬人。其定義為在3天內連續3個頻率的聽力下降超過30分貝[2-4]。這種耳科急症會造成高危險性的永久聽力喪失，以及影響病患的社會與專業能力。突發性耳聾除了造成聽力減退以外，也會伴隨頭暈、噁心嘔吐等症狀。在中國、日本、歐洲、美國所進行的大型研究指出，突發性耳聾通常發生在40-55歲，占總人數的39.5%，男女發生機率均等。而18-30歲則占16%, 且有上升的趨勢[5-6]。
山元式新頭針療法(Yamamoto New Scalp Acupuncture, YNSA)由日本的山元敏勝醫師所發表，他發現了一個不同於傳統中醫針灸的系統，並在西元1973年的大阪良導絡學會首次發表。本方法不同於傳統針灸的穴位，而採用刺激點，山元醫師稱之為Somatotope.直到2018年為止，YNSA已在日本、歐洲、美國等地區盛行。
YNSA可以快速緩解骨骼肌肉系統的疼痛[7]，以及神經疾患。本療法含有四個主要的刺激點系統：基本點、感覺點、腦點、Y點，以及其餘刺激點，如圖1[8].
有關突發性耳聾有許多治療方法：類固醇治療，亦為耳鼻喉科的第一線治療方式、高壓氧治療[9]、電針[10]、傳統中醫針灸[11]
儘管上述四種治療方法有許多學術研究發表，但目前仍無運用YNSA治療突發性耳聾的文章。本病歷詳細描述了運用YNSA治療突發性耳聾，且取得顯著的聽力恢復。

病例報告
一、    基本資料
姓名：林○○
年齡：62歲
性別：男
初診日期：2017/7/16
二、    主訴
右耳聽力減退已一個月
三、現病史
62歲男性，2018年6月中旬右耳罹患耳中風，經過耳鼻喉科注射類固醇治療後聽力未明顯恢復。2018年7月前來就診時，左耳耳鳴、右耳幾乎無聽覺，伴隨著耳朵悶塞感。
右耳聽力：2018/7/5檢測
頻率250Hz=100分貝, 500Hz=105分貝, 1000Hz=105分貝, 2000Hz=110分貝, 4000Hz=110分貝, 8000 Hz=105分貝, 如圖4
四、過去病史
左耳突發性耳聾，病患自述聽力僅存50分貝
五、個人史
無慢性疾病
六、家族史
無家族遺傳疾病
七、中醫四診
望診：面色略疲倦、舌淡紅少苔
聞診：無明顯異常
問診：左耳耳鳴、右耳耳朵悶塞感，稍微疲倦、睡眠狀況稍差
切診：左右脈均弦數有力
八、診斷
右耳突發性耳聾
九、追蹤診療經過
病患從2018/7/16起，每周接受YNSA治療二次，如表1。治療過程，請參見表2. 

結果
病患從2018/7/16開始治療，截至撰稿為止，共治療了18次，期間
左耳因患病已久，聽力變化不大。但右耳從治療前平均110分貝，進步至95分貝，最後恢復到70分貝，詳見補充資料。且在治療期間，病患的耳鳴減輕，耳朵悶塞感症狀緩解。目前仍繼續治療當中。

討論

病因病機
突發性耳聾一般來說可以分成六種證型：風邪襲閉、肝陽上亢、痰火蘊結、氣滯血瘀、氣血虧虛、腎精虧損[12]。
病因方面，屬於肝陽上亢；病位為耳；病性方面，左耳耳鳴、右耳耳朵悶塞感，面色略疲倦、舌淡紅少苔，脈弦數有力；病勢方面，雖發病為不明原因，但症狀顯示病患氣機阻滯，導致肝臟陰不配陽以致肝陽不潛或肝氣升發太過，陽氣浮動於上而引起肝陽上亢，進而導致耳鳴、耳悶、聽力減退。因此，本病例屬於肝陽上亢型。
流行病學方面，根據德國在德勒斯登市的統計，耳中風發生率為160人/每10萬人[13]。發生原因無法確定，醫師們多半認定為病毒感染或不明原因。但突發性耳聾預後多半不錯，病患多可以感受到聽力逐漸進步[14]。如果病患在兩周內聽力無進步，而聽力減退持續2-3個月以上的話，很有可能變成永久性聽力喪失[15]。
以前對突發性耳聾所做的系統性研究，且可被證實有實際效果的，只有類固醇治療[13]。雖然口服皮質醇並非十分有效且無強力證據支持，但它仍是突發性耳聾的第一線治療方法[16]。若類固醇治療無效，也有醫師會採用耳內注射dexamethasone來治療。然而，這些療效依然受到質疑[18]。
目前已經有論文發表有關運用傳統針灸來改進晚期突發性耳聾的聽力。Yin與其團隊收集了17位病患, 其中8位病患聽力提升超過20分貝[17]. 另一篇論文則收集了63位罹患突發性耳聾超過1個月以上的病患，在1個月當中治療14次以後，平均聽力增加了17分貝[19]. 這兩個研究清楚地顯示傳統針灸對於晚期突發性耳聾可能有相當的療效。
    在其他的研究當中，針灸亦可以改善早期突發性耳聾。Nanbin Huang發表了兩位罹患突發性耳聾一周的病患，他們使用電針治療5天與7天，而病患的聽力有恢復[19]。
    綜上所述，傳統中醫針灸可以改善突發性耳聾的症狀，很可惜的是，目前仍然沒有針對YNSA治療突發性耳聾的論文發表。對於使用刺激點而非穴道來治療突發性耳聾是否有效是值得研究的。
    在本病例當中，病患在第三次檢查前已經治療了15次，純音聽力檢查表(PTA)顯示聽力明顯地進步了40分貝, 本病案之進步幅度遠超過之前使用傳統針灸治療突發性耳聾之20分貝與17分貝. 希望未來能夠比較YNSA與傳統中醫針灸在突發性耳聾的療效。
    YNSA治療神經疾患的機轉，目前仍然不明。即便山元敏勝醫師，亦尚未有相關研究。但根據山元老師於課堂所述，診斷後所觸摸到的tender point, 對應到的somatotope宛如開關，只要使用針刺就可以把這個開關關閉掉，進而治療somatotope所對應的疾病。筆者認為YNSA與傳統醫學中的全息率有高度相關性，但與傳統針灸、或是高麗手指針等連結，仍需要近一步的研究。
    由於病患均在中醫診所治療，我們無法為病患作聽力測驗，只能仰賴耳鼻喉科的聽力室來協助。若有可能的話，希望能夠做更多的臨床試驗。
結論
本病例為運用YNSA治療突發性耳聾的有效案例。此外，YNSA亦可改善耳鳴、耳朵悶塞感等症狀。若病患採取類固醇治療以及傳統中醫針灸治療後無效，可以再嘗試YNSA治療。此外，YNSA早期介入突發性耳聾效果佳，若能與西醫治療並行，有相當大的機率改善甚至治癒。
 
參考文獻
1.    高雄醫學大學附設醫院(民98年11月)，簡禎佑。取自http://www.kmuh.org.tw/www/kmcj/data/9811/5.htm
2.    Shemirani NL, Schmidt M, Friedland DR. Sudden sensorineural hearing loss: an evaluation of treatment and management approaches by referring physicians. Otolaryngol Head Neck Surg 2009;1401:86–91
3.    Byl FMJr. Sudden hearing loss: eight years’ experience and suggested prognostic table. Laryngoscope 1984; 94(5 Pt 1):647–61.
4.    Fetterman BL, Saunders JE, Luxford WM. Prognosis and treatment of sudden sensorineural hearing loss. Am J Otol 1996;17:529–36
5.    Lazarini PR, Camargo AC. Idiopathic sudden sensorineural hearing loss: etiopathogenic aspects. Braz J Otorhinolaryngol 2006; 724: 554–61.
6.    Zhang X, Xu X, Ma W, et al. A clinical study of sudden deafness. ActaOtolaryngol 2015; 13510:1030–5.
7.    Hemat Allam, and Nagwa Hassan Mohammed: The Role of Scalp Acupuncture for Relieving the Chronic Pain of Degenerative Osteoarthritis: A Pilot Study of Egyptian Women. MEDICAL ACUPUNCTURE Volume 25, Number 3, 2013.
8.    T. Yamamoto, Th. Schockert. Pain effectively treated by scalp acupuncture! https://www.ynsa.net/ynsa-other-languages/ynsa-in-english/
9.    Dorota Olex-Zarychta: Successful treatment of sudden sensorineural hearing loss by means of pharmacotherapy combined with early hyperbaric oxygen therapy. Olex-Zarychta Medicine 2017:96:51.
10.    Ya-Ching Chang, Kwok-Ying Chan: Treatment of sudden hearing loss using electro-acupuncture. SAGE Open Medical Case Reports Volume 5: 1–4, 2017.
11.    Yuanyuan Jin, Ming Lu: Acupuncture as a primary and independent treatment in the acute phases of sudden sensorineural hearing loss. Jin and Liu. Medicine (2016) 95:26.
12.    李雲英(民101)。突發性聾。中國中醫藥出版社
13.    Klemm E., Deutscher A. & Mosges R. A. Present Investigation of the Epidemiology in Idiopathic Sudden Sensorineural Hearing Loss. Laryngo. Rhino. Otologie. 88, 524–527 (2009).
14.    Wilson WR, Byl FM and Laird N.: The efficacy of steroids in the treatment of idiopathic sudden hearing loss. A double-blind clinical study. Arch Otolaryngol 1980; 106: 772–776.
15.    Moon IS, Kim J, Lee SY, et al.: How long the sudden hearing loss patients should be followed after early steroid combination therapy? Eur Arch Otorhinolaryngol 2009; 266: 1391–1395.
16.    Schreiber BE, Agrup C, Haskard DO, Luxon LM: Sudden sensorineural hearing loss. Lancet 2010; 375: 1203–1211.
17.    Hamid M, Trune D: Issues, indications, and controversies regarding intratympanic steroid perfusion. Curr Opin Otolaryngol Head Neck Surg 2008; 16: 434–440.
18.    Yin CS, Park HJ, Nam HJ: Acupuncture for refractory cases of sudden sensorineural hearing loss. J Altern Complement Med 2010;16:973–978.
19.    Zhao YZ: Observation on therapeutic effect of acupuncture on late sudden deafness (in Chinese). Zhongguo Zhen Jiu 2006;26:180–182.
20.    Nanbin Huang, Changwei Li: Acupuncture in Treating Sudden Sensorineural Hearing Loss: A Report of 2 Cases. Forsch Komplementmed 2014;21:246–249.

 
圖、表

圖1: YNSA之基本點、感覺點、腦點、Y點

 

YNSA診斷

右合谷(+)、右頸部、腦幹、大腦(+)

YNSA刺激點

 

基本點

右A點

感覺點

右tinnitus 1-4

腦點

右大腦點

腦神經點

左、右CN8, CN9

Y點

右腎點

其他

右Mastoid,

Master key point tinnitus, J-K somatotope

針刺方法

斜刺15度，深度約1-2mm, 刺到帽狀腱膜後停止進針，留針20分鐘

表1: YNSA治療刺激點

 

治療前

2018/7/5

左耳：250Hz=40分貝, 500Hz=50分貝, 1000Hz=50分貝, 2000Hz=50分貝, 4000Hz=70分貝, 8000 Hz=95分貝

平均50分貝

右耳：250Hz=100分貝, 500Hz=105分貝, 1000Hz=105分貝, 2000Hz=110分貝, 4000Hz=110分貝, 8000 Hz=105分貝

平均110分貝

治療第5次後檢查

2018/7/26

左耳：250Hz=45分貝, 500Hz=55分貝, 1000Hz=45分貝, 2000Hz=50分貝, 4000Hz=70分貝, 8000 Hz=90分貝

平均50分貝

右耳：250Hz=85B, 500Hz=100分貝, 1000Hz=95分貝, 2000Hz=90分貝, 4000Hz=90分貝, 8000 Hz=100分貝

平均95分貝

治療第15次後檢查

2018/8/21

左耳：250Hz=40分貝, 500Hz=50分貝, 1000Hz=55分貝, 2000Hz=50分貝, 4000Hz=65分貝, 8000 Hz=90分貝

平均52分貝

右耳：250Hz=55分貝, 500Hz=65分貝, 1000Hz=75分貝, 2000Hz=70分貝, 4000Hz=75分貝, 8000 Hz=90分貝

平均70分貝

表2: 治療過程

補充資料


2018/7/5之聽力測驗

 


2018/7/26之聽力測驗

 


2018/8/21之聽力測驗

 

Use of Yamamoto New Scalp Acupuncture to Treat Sudden Sensorineural Hearing Loss: A Case Study 

Tzu-Chen Kao, MD123
Abstract
Sudden sensorineural hearing loss (SSHL), also known as sudden deafness, is an acute otorhinolaryngological illness manifested as rapid hearing loss; this acute illness can have serious negative effects on patients’ lives. In 1967, Japanese physician Yamamoto Toshikatsu invented Yamamoto new scalp acupuncture (YNSA), a new acupuncture system that uses somatotopes instead of acupuncture points used in traditional Chinese acupuncture. To date, studies on SSHL have generally investigated treatments made using Western steroid therapy or traditional Chinese acupuncture, and those that investigated treatments involving YNSA remain to be seen. Accordingly, this study presented the use of YNSA to treat SSHL.
In this study, the patient was a 62-year-old man who experienced SSHL in his left ear and later developed right ear SSHL in June 2018. He received a steroid injection for his right ear in an otorhinolaryngology clinic, but his hearing was not satisfactorily recovered. When he visited the clinic, he experienced tinnitus in his left ear and blockage (plugged) in his right ear. He was subsequently given YNSA treatment. To date, he has received YNSA treatment 18 times, and his hearing has improved to 40 dB. He continues to receive such treatment.
Conclusion: YNSA has a significant and positive effect on SSHL, tinnitus, and ear blockage. Patients whose hearing does not improve after receiving Western treatment or traditional Chinese acupuncture may consider receiving this treatment.

Keywords: sudden sensorineural hearing loss, sudden deafness Yamamoto new scalp acupuncture, somatotope


1. Yi-Xin-Tang Chinese Medical Clinic
2. Master Degree, Graduate of Health Care Administration, Taipei Medical University, Taipei, Taiwan
3. Tzu-Chen, Kao, MD. 106 2F, No.267, XinYi Road, Daan District, Taipei, Taiwan. Yi-Xin-Tang Chinese Medical Clinic
E-mail: fd053193@hotmail.com Tel: +886983754060

 

 

文獻三、The role of Yamamoto new scalp acupuncture as an independent treatment for sudden sensorineural hearing loss: a case report Acupuncture in Medicine Vol 38, Issue 2, 2020


The role of Yamamoto New Scalp Acupuncture as an independent treatment of sudden sensorineural hearing loss: A Case Report 

Tzu-Chen Kao1234, MD, MBA Che-Ming Yang, MD, PhD5
1. Yi-Xin-Tang Chinese Medical Clinic
2. Master Degree, Graduate of Health Care Administration, Taipei Medical University, Taipei, Taiwan
3. Tzu-Chen, Kao, MD. 106 2F, No.267, XinYi Road, Daan District, Taipei, Taiwan. Yi-Xin-Tang Chinese Medical Clinic
4. Corresponding author
5. Che-Ming Yang, MD, PhD. 110 No.250, Wuxing Street, Xinyi District, Taipei, Taiwan. Taipei Medical University, Graduate of Health Care Administration
E-mail: fd053193@hotmail.com Tel: +886983754060 Fax: +886227840030

Key words: Acupuncture, Complementary medicine, Otolaryngology
Word count: 685 words
 
INTRODUCTION
Sudden sensorineural hearing loss (SSHL) is a disease with an annual incidence of 5 to 20 people per 100,000 people and is defined as a rapid hearing loss of at least 3 consecutive test frequencies in 3 days or less > 30dB (Shemirani et al. 2009). Yamamoto New Scalp Acupuncture (YNSA) was invented by Japanese doctor Toshikatsu Yamamoto as an independent acupuncture system. This system is based on somatotope rather than traditional Chinese acupuncture. YNSA is now widely known in Japan, Europe and the United States.
YNSA can quickly relieve pain in the locomotors system (Hemat et al. 2013) and neurological diseases. The therapy consists of 4 major sections (Figure 1).
    There are many methods of treating SSHL:
1.    Steroid therapy.
2.    Early hyperbaric oxygenation therapy.
3.    Traditional Chinese medicine acupuncture.
Although many studies have been conducted on the above three therapies for the treatment of SSHL, YNSA as the main therapy of SSHL has not been conducted. We would like to report the successful application of YNSA in an elderly patient with acute SSHL.
METHODS
The patient was a 28-year-old female and white-collar worker. Her symptoms started as left ear tinnitus and sudden monocular hearing loss. She had no symptoms of dizziness, vomiting, nausea and fatigue. After she went to the otolaryngology clinic near his home, the doctor diagnosed SSHL. She refused steroid treatment and hyperbaric oxygen therapy.
This case report is approved by Taipei Medical University - Joint Institutional Review Board. And the case number is N201907063. 
She was confirmed to have hearing loss through the pure tone audiometry (PTA). Her average hearing level was 78 dB when first diagnosed (Figure 2). Then she came to us to receive the YNSA treatment. YNSA was applied to the following acupuncture somatotopes:
Basic points: A points.
Sensory point: ear points.
Brain point: cerebrum point
Y point: kidney point
Each treatment session lasted 20 min.
The patient received two sessions of treatment per week. After the second treatment, the patient's hearing had improved significantly. She reported that she can hear high frequent voice. After the third treatment, the symptoms of tinnitus have improved. Moreover, her hearing ability has been greatly improved from 78dB to 45dB. After the fourth treatment, the patient received another PTA. Her average hearing level had improved to 13 dB at that time around 2 week after the onset of the disease (Figure 2). The otolaryngologist declared that she had fully recovered.

DISCUSSION
The causes of SSHL in the pediatric population are still not well understood. The cause is often not determined and is considered viral or idiopathic. Those with hearing loss for more than 2 to 3 months may experience permanent hearing loss.
Oral corticosteroids are the most commonly used treatment for SSHL, although it does not always work and there is currently little supporting evidence (Schreiber et al. 2010). 
    According to previous studies, acupuncture can also improve the hearing of late period SSHL. Yin and colleagues reported 17 cases of SSHL, who had gone through  3 weeks of conventional treatment and failed. After about 70 days of acupuncture treatment, 8 of them had hearing improvement of more than 20 decibels (Yin et al. 2010). 
    Chinese medicine acupuncture can indeed improve the symptoms of hearing loss. Unfortunately, there is no research on YNSA treatment of SSHL. It is therefore interesting to learn if the treatment of SSHL by somatotopes is effective.
In our case, the patient received YNSA treatment 4 times, and her PTA showed a hearing improvement of 65 dbs. This improvement is superior to previous studies. Comparing the efficacy of YNSA with Chinese acupuncture in the treatment of acute and chronic phases of SSHL reveals considerable significance.
Due to the limitation, we are equipped with PTA and there is no otolaryngologist to provide assistance. Further clinical trials are warranted to gain more insight in this area.
CONCLUSION
   This SSHL case responded well to YNSA. For those not responding to conventional medical treatment or traditional Chinese acupuncture, it may be worthwhile to try YNSA. Further clinical trials are needed to demonstrate the efficacy of YNSA in treating patients with SSHL.

REFERENCES
1.    Shemirani NL, Schmidt M, Friedland DR. Sudden sensorineural hearing loss: an evaluation of treatment and management approaches by referring physicians. Otolaryngol Head Neck Surg 2009;1401:86–91
2.    Hemat Allam, and Nagwa Hassan Mohammed: The Role of Scalp Acupuncture for Relieving the Chronic Pain of Degenerative Osteoarthritis: A Pilot Study of Egyptian Women. MEDICAL ACUPUNCTURE Volume 25, Number 3, 2013.
3.    Schreiber BE, Agrup C, Haskard DO, Luxon LM: Sudden sensorineural hearing loss. Lancet 2010; 375: 1203–1211.
4.    Yin CS, Park HJ, Nam HJ: Acupuncture for refractory cases of sudden sensorineural hearing loss. J Altern Complement Med 2010;16:973–978.
 

 

文獻四


 

 

文獻五

國內文獻：
1.    高資承（2020）。山元式新頭針療法治療耳中風之病例報告。中醫藥研究論叢，23(1)，237-244。doi:10.6516/TJTCM.202003_23(1).0019
2.    高資承（2020）。山元式新頭針療法的臨床運用。首都中醫報導，(48)，9-10。doi: 10.6971/TPCM

國外文獻(英文)：
Kao, T. C., & Yang, C. M. (2020). The role of Yamamoto new scalp acupuncture as an independent treatment for sudden sensorineural hearing loss: a case report. Acupuncture in medicine: journal of the British Medical Acupuncture Society, 38(2), 126–128. https://doi.org/10.1177/0964528419894594