Acupuncture for Post-traumatic Olfactory Dysfunction: A Randomized Controlled Trial

The treatment group includes two interventions: acupuncture and a steroid placebo (prednisone placebo).

Acupoint selection: Fengchi (GB20, bilateral, quick needling), Jingbailao (bilateral, quick needling), Dazhuipang (bilateral, quick needling); Shenting (DU24), Baihui (DU20), Yingxiang penetrating Bitong (bilateral), Quanliao penetrating Bitong (bilateral), Hegu (LI4, bilateral), Wailaogong (bilateral), Zusanli (ST36, bilateral), Taichong (LR3, bilateral).

Procedure: First, the patient sits upright. Quick needling (without retaining needles) is performed at Fengchi, Jingbailao, and Dazhuipang. Then, the patient assumes a supine position. Needles are inserted Shenting, Baihui, etc.while deep needling is performed at Yingxiang penetrating Bitong, Quanliao penetrating Bitong, Hegu, and Zusanli. After achieving deqi (needle sensation), the needles are retained for 20 minutes.

Course: 3×/week for 4 weeks (12 sessions). Oral prednisone placebo at same dose/duration as control group.

Acupoint selection:

Fengchi (GB20, bilateral, quick needling), Jingbailao (bilateral, quick needling), Dazhuipang (bilateral, quick needling); Shenting (DU24), Baihui (DU20), Yingxiang penetrating Bitong (bilateral), Quanliao penetrating Bitong (bilateral), Hegu (LI4, bilateral), Wailaogong (bilateral), Zusanli (ST36, bilateral), Taichong (LR3, bilateral).

Procedure:

The patient is first seated upright. Quick needling (without needle retention) is performed at Fengchi, Jingbailao, and Dazhuipang. Then the patient assumes a supine position. Needles are inserted at Shenting, Baihui, Wailaogong, and Taichong, while deep needling is applied at Yingxiang penetrating Bitong, Quanliao penetrating Bitong, Hegu, and Zusanli. After achieving deqi (needle sensation), the needles are retained for 20 minutes.

Course of treatment:

Acupuncture is given 3 times per week for 4 weeks (total 12 sessions)

The placebo tablets were manufactured to be identical in appearance (color, size, shape) and taste to the active prednisone tablets, ensuring effective blinding. Participants received the placebo orally according to the same tapering regimen as the control group: 30 mg/day (as equivalent tablet count) for week 1, 15 mg/day for week 2, 10 mg/day for week 3, and 5 mg/day for week 4, after which the medication was discontinued. The total course lasted 4 weeks, matching the duration of both the active prednisone therapy and the acupuncture sessions.

Medication: Oral prednisone given as a short-term course (4 weeks). Dosage and tapering schedule: Week 1: 30 mg/d; Week 2: 15 mg/d; Week 3: 10 mg/d; Week 4: 5 mg/d, then discontinued after 4 weeks.

Sham acupuncture: Park sham acupuncture device (placebo needle) is used. The acupoint selection and operation sites are the same as those in the treatment group. After routine disinfection, the needle holder is applied to the acupoint, and the needle is inserted into the holder without penetrating the skin, and retained for 20 minutes. The treatment course is the same as the treatment group (3 times per week for 4 weeks).

Oral prednisone given as a short-term course (4 weeks). Dosage and tapering schedule: Week 1: 30 mg/d; Week 2: 15 mg/d; Week 3: 10 mg/d; Week 4: 5 mg/d, then discontinued after 4 weeks.

Sham acupuncture: Park sham acupuncture device (placebo needle) is used. The acupoint selection and operation sites are the same as those in the treatment group. After routine disinfection, the needle holder is applied to the acupoint, and the needle is inserted into the holder without penetrating the skin, and retained for 20 minutes. The treatment course is the same as the treatment group (3 times per week for 4 weeks).

Improvement rate of the CSIT score at 4 weeks.The olfactory identification test is the Chinese Smell Identification Test (CSIT), developed by the Human Olfaction Laboratory, Institute of Psychology, Chinese Academy of Sciences, based on the Chinese population. It contains 40 odor items familiar to the Chinese population and has a 6-month test-retest reliability of 0.92.If the CSIT score improves by 4 points or more, this indicates an improvement in olfactory function.

Rate of improvement in olfactory identification test scores after 12 weeks,The olfactory identification test is the Chinese Smell Identification Test (CSIT), developed by the Human Olfaction Laboratory, Institute of Psychology, Chinese Academy of Sciences, based on the Chinese population. It contains 40 odor items familiar to the Chinese population and has a 6-month test-retest reliability of 0.92.If the CSIT score improves by 4 points or more, this indicates an improvement in olfactory function.

It measures the lowest concentration level that the patient can perceive, assessing sensitivity in detecting odors. It targets the peripheral olfactory nerves. It includes 20 concentration-graded odor sticks (of the same odor) and a baseline odor stick (nearly odorless). The patient smells one graded odor stick and one baseline odor stick sequentially and compares which odor is stronger.

The visual analogue scale (VAS, 0-100) in the olfactory disorder scale was used to rate the severity of olfactory loss, where 0 indicates normal olfaction and 100 indicates complete loss of smell. According to other published studies, the severity of olfactory loss was categorized as mild (0-30), moderate (31-70), and severe (>70).

Emotional and psychological assessment will be conducted using the Hamilton Anxiety Scale (HAMA), the 17-item Hamilton Depression Scale (HAMD17), the Generalized Anxiety Disorder 7-item scale (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9) to evaluate patients' emotional and psychological status.

Adverse events within 12 weeks after randomization, such as infection, pain, and other acupuncture-related complications in the Traditional Chinese Medicine Department; major adverse events will be reported until the end of the study.