Sudden deafness (SD), also known as sudden sensorineural hearing loss, has a complex and multifactorial etiology, and its underlying pathogenesis remains not fully elucidated. Restricted by anatomical structures such as the blood-labyrinth barrier, Western medical treatments still lack efficient and reliable therapeutic strategies for SD. As a characteristic therapy of traditional Chinese medicine, acupuncture boasts advantages including diverse treatment modalities, favorable clinical efficacy, and high safety profile. Accumulating studies have indicated that acupuncture may improve the inner ear microenvironment by regulating multiple pathways, such as enhancing inner ear blood perfusion, modulating vascular endothelial cell function, and inhibiting neuronal and cochlear hair cell apoptosis. Meanwhile, it can regulate neural activities in the auditory cortex and associated brain regions, promote the remodeling of auditory neural networks, and thereby facilitate hearing recovery. However, high-quality clinical studies on acupuncture for SD remain relatively scarce, with limitations such as small sample sizes and inconsistent acupuncture protocols. In the future, large-sample, rigorously designed randomized controlled trials should be conducted, and the multi-dimensional mechanisms of acupuncture should be further explored systematically and in-depth. This work aims to provide more sufficient scientific evidence for the clinical application of acupuncture in treating SD.