Neuromodulation for Treatment of Tinnitus: A Systematic Review and Meta‐Analysis

Abstract

ObjectiveTo evaluate the treatment efficacy of neuromodulation versus sham for the treatment of tinnitus.Data SourcesCochrane Library, CINAHL, PubMed, Scopus.Review MethodsThe Cochrane Library, CINAHL, PubMed, and Scopus were searched from inception through May 2023 for English language articles documenting “neuromodulation” and “tinnitus” stratified by sham‐controlled randomized control trials with 40 or more patients. Data collected included Beck Anxiety Inventory, Beck Depression Inventory (BDI), Tinnitus Handicap Inventory (THI), Tinnitus Questionnaire, and Visual Analog Scale. A Meta‐analysis of continuous measures (mean) and proportions (%) were conducted.ResultsA total of 19 randomized control trials (N = 1186) were included. The mean age was 48.4 ± 5.3 (range: 19‐74), mean duration of tinnitus was 3.8 ± 3.4 years, 61% [56.2‐65.7] male, and 55.7% [46‐65] with unilateral tinnitus. The short‐term effect of transcutaneous electrical nerve stimulation and transcranial direct current stimulation on THI score is −16.2 [−23.1 to −9.3] and −19 [−30.1 to −7.8], respectively. The long‐term effect of repetitive transcranial magnetic stimulation on THI score is −8.6 [−11.5 to −5.7]. Transcranial direct current stimulation decreases BDI score by −11.8 [−13.3 to −10.3].ConclusionAs measured by the Tinnitus Handicap Index, our findings suggest the effects of transcutaneous electrical nerve stimulation and transcranial direct current stimulation reach significant benefit in the short term, whereas repetitive transcranial magnetic stimulation reaches significant benefit in the long term. Based on the BDI, transcranial direct current stimulation significantly reduces comorbid depression in patients with tinnitus.

Consecutive Dual-Session Transcranial Direct Current Stimulation in Chronic Subjective Severe to Catastrophic Tinnitus with Normal Hearing

“…There was no significant difference in the age, sex, threshold of PTA, initial THI, VAS score, and BDI among the three groups. Twenty-one patients were considered to have borderline clinical depression (score of [17][18][19][20] or moderate depression (score of 21-30) based on their BDI score.…”

“…The targets to be stimulated through tDCS in tinnitus are mainly the auditory cortex [ 14 , 15 ], dorsolateral prefrontal cortex (DLPFC) [ 16 , 17 ], and left temporoparietal area (LTPA) [ 18 ], which are different for each study. Most studies reported significant improvement in patients who have tinnitus with tDCS treatment, but the duration of tinnitus suppression varies from minutes to several days [ 19 , 20 , 21 ]. Additionally, studies to date have conducted tDCS on chronic subjective tinnitus, but the subjects’ loudness, distress of tinnitus, level of hearing threshold, and psychiatric comorbidity have varied, and there is no report on whether there is an effect of suppressing tinnitus through stimulation several times a day.…”