Soleimani Robabeh, Jalali Mir Mohammad, Hasandokht Tolou
Psychiatry Department of Shafa Hospital, Guilan University of Medical Sciences, Rasht, Iran.
Sinonasal Disease Research Center, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran.
Eur Arch Otorhinolaryngol. 2016 Jul;273(7):1663-75. doi: 10.1007/s00405-015-3642-5. Epub 2015 May 13.
In this study, we conducted a systematic literature review and meta-analysis on the effect of repetitive transcranial magnetic stimulation (rTMS) compared with sham in chronic tinnitus patients. We searched databases, from their onset up to August 2014, for randomized controlled trials (RCT) in English that assessed the effectiveness of rTMS for chronic tinnitus. RCTs were selected according to inclusion/exclusion criteria before data were extracted. For the meta-analysis weighted mean differences (and standard deviations) of Tinnitus Questionnaire (TQ) and Tinnitus Handicap Inventory (THI) scores were determined. Therapeutic success was defined as difference of at least 7 points in the THI score between baseline and the follow-up assessment after treatment. The odds ratio (OR) for this variable was assessed. Results from 15 RCTs were analyzed. The mean difference for TQ score at 1 week after intervention was 3.42. For THI, the data of mean difference score in two groups, 1 and 6 month after intervention, was 6.71 and 12.89, respectively. The all comparisons indicated a significant medium to large effect size in follow-up which is in favor of the rTMS. The pooled OR of therapeutic success of the studies which used THI at 1 month after intervention was 15.75. These data underscore the clinical effect of rTMS in the treatment of tinnitus. However, there is high variability of studies design and reported outcomes. Replication of data in multicenter trials with a large number of patients and long-term follow-up is needed before further conclusions can be drawn.
在本研究中，我们对重复经颅磁刺激（rTMS）与假刺激相比治疗慢性耳鸣患者的效果进行了系统的文献综述和荟萃分析。我们检索了截至2014年8月的数据库，查找评估rTMS治疗慢性耳鸣有效性的英文随机对照试验（RCT）。在提取数据前，根据纳入/排除标准选择RCT。对于荟萃分析，确定了耳鸣问卷（TQ）和耳鸣障碍量表（THI）得分的加权平均差（及标准差）。治疗成功定义为治疗后随访评估时THI得分较基线至少提高7分。评估该变量的比值比（OR）。分析了15项RCT的结果。干预后1周TQ得分的平均差为3.42。对于THI，干预后1个月和6个月两组的平均差得分数据分别为6.71和12.89。所有比较均表明随访中有显著的中到较大效应量，支持rTMS。干预后1个月使用THI的研究中治疗成功的合并OR为15.75。这些数据强调了rTMS治疗耳鸣的临床效果。然而，研究设计和报告结果存在很大差异。在得出进一步结论之前，需要在多中心试验中对大量患者进行数据重复和长期随访。
