Repetitive transcranial magnetic stimulation on chronic tinnitus: a systematic review and meta-analysis

Abstract

Background Although the clinical efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) in the treatment of chronic tinnitus have been frequently examined, the results remain contradictory. Therefore, we performed a systematic review and meta-analysed clinical trials examining the effects of rTMS to evaluate its clinical efficacy and safety. Methods Studies of rTMS for chronic tinnitus were retrieved from PubMed, Embase, and Cochrane Library through April 2020. Review Manager 5.3 software was employed for data synthesis, and Stata 13.0 software was used for analyses of publication bias and sensitivity. Results Twenty-nine randomized studies involving 1228 chronic tinnitus patients were included. Compared with sham-rTMS, rTMS exhibited significant improvements in the tinnitus handicap inventory (THI) scores at 1 week (mean difference [MD]: − 7.92, 95% confidence interval [CI]: − 14.18, − 1.66), 1 month (MD: -8.52, 95% CI: − 12.49, − 4.55), and 6 months (MD: -6.53, 95% CI: − 11.406, − 1.66) post intervention; there were significant mean changes in THI scores at 1 month (MD: -14.86, 95% CI: − 21.42, − 8.29) and 6 months (MD: -16.37, 95% CI: − 20.64, − 12.11) post intervention, and the tinnitus questionnaire (TQ) score at 1 week post intervention (MD: -8.54, 95% CI: − 15.56, − 1.52). Nonsignificant efficacy of rTMS was found regarding the THI score 2 weeks post intervention (MD: -1.51, 95% CI: − 13.42, − 10.40); the mean change in TQ scores 1 month post intervention (MD: -3.67, 95% CI: − 8.56, 1.22); TQ scores 1 (MD: -8.97, 95% CI: − 20.41, 2.48) and 6 months (MD: -7.02, 95% CI: − 18.18, 4.13) post intervention; and adverse events (odds ratios [OR]: 1.11, 95% CI: 0.51, 2.42). Egger’s and Begg’s tests indicated no publication bias (P = 0.925). Conclusion This meta-analysis demonstrated that rTMS is effective for chronic tinnitus; however, its safety needs more validation. Restrained by the insufficient number of included studies and the small sample size, more large randomized double-blind multi-centre trials are needed for further verification.

Repetitive Transcranial Magnetic Stimulation for Tinnitus Treatment in Vestibular Schwannoma: A Pilot Study

“…However, the number of patients is too low for more profound statistical evaluation. Finally, although our study indicates an acute rTMS effect on VS-associated TN, there is no evidence for a longterm effect after a period of 4 weeks (21,24,(26)(27)(28)(29). However, independent of the sustained long-term effect, rTMS might be useful for priming the cortex in chronic TN patients in order to increase the susceptibility for further treatment options, e.g., notched-noise therapy, pharmacological intervention, cognitive behavioral therapy, TN masking, or music therapy (10,11).…”

“…Considering the hypothesized pathophysiology of TN driven by a central maladaptation, rTMS has been suggested in TN treatment several years ago. However, the results have been divergent and even contradictory (21,24,(26)(27)(28)(29). rTMS applies a train of repetitive magnetic pulses to alter the excitability of the neurons and modulate cortical activity.…”

“…rTMS is suggested to modify the excitability of relevant neurons and neurotransmitter systems in TN (25). However, the results have been divergent and even contradictory (21,24,(26)(27)(28)(29). First, there are still unsolved methodological issues, e.g., uncertainties concerning appropriate stimulation sites and stimulation intensities (20,23).…”

“…First, there are still unsolved methodological issues, e.g., uncertainties concerning appropriate stimulation sites and stimulation intensities (20,23). Second, there has been a large heterogeneity in the treated patient cohorts (20,26). Most studies have evaluated the rTMS effects in patients with an idiopathic TN which are characterized by a large variability or ambiguity of the underlying cause.…”

“…Most studies have evaluated the rTMS effects in patients with an idiopathic TN which are characterized by a large variability or ambiguity of the underlying cause. Additionally, the amount of hearing loss, tinnitus duration, and quality of the tinnitus seem to play important roles for the treatment outcome (26,30,31). In contrast, patients with anatomical causes of TN, such as VS, are usually excluded from rTMS studies.…”