Rabau Sarah, Shekhawat Giriraj S, Aboseria Mohamed, Griepp Daniel, Van Rompaey Vincent, Bikson Marom, Van de Heyning Paul
University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University HospitalEdegem, Belgium.
Faculty of Medicine, Campus Drie Eiken, University of AntwerpAntwerp, Belgium.
Front Aging Neurosci. 2017 Jul 28;9:217. doi: 10.3389/fnagi.2017.00217. eCollection 2017.
: Transcranial direct current stimulation (tDCS) is one of the methods described in the literature to decrease the perceived loudness and distress caused by tinnitus. However, the main effect is not clear and the number of responders to the treatment is variable. The objective of the present study was to investigate the effect of the placement of the cathode on the outcome measurements. : Patients considered for the trial were chronic non-pulsatile tinnitus patients with complaints for more than 3 months and a Tinnitus Functional Index (TFI) score that exceeded 25. The anode was placed on the right dorsolateral prefrontal cortex (DLPFC). In the first group-"bifrontal"-the cathode was placed on the left DLPFC, while in the second group-"shoulder"-the cathode was placed on the shoulder. Each patient received two sessions of tDCS weekly and eight sessions in total. Evaluations took place on the first visit for an ENT consultation, at the start of therapy, after eight sessions of tDCS and at the follow-up visit, which took place 84 days after the start of the therapy. Subjective outcome measures such as TFI, Visual Analog Scales (VAS) for loudness and percentage of consciousness of tinnitus were administered in every patient. : There was no difference in the results for tinnitus loudness and the distress experienced between the placement of the cathode on the left DLPFC or on the shoulder. In addition, no statistically significant overall effect was found between the four test points. However, up to 39.1% of the patients experienced a decrease in loudness, measured by the VAS for loudness. Moreover, 72% of those in the bifrontal group, but only 46.2% of those in the shoulder group reported some improvement in distress. : While some improvement was noted, this was not statistically significant. Both electrode placements stimulated the right side of the hippocampus, which could be responsible for the effect found in both groups. Further research should rule out the placebo effect and investigate alternative electrode positions.
经颅直流电刺激（tDCS）是文献中描述的用于降低耳鸣引起的主观响度和痛苦的方法之一。然而，其主要效果尚不清楚，且治疗的有效应答者数量存在差异。本研究的目的是探讨阴极放置位置对疗效测量结果的影响。
纳入试验的患者为慢性非搏动性耳鸣患者，耳鸣症状持续超过3个月，耳鸣功能指数（TFI）得分超过25分。阳极置于右侧背外侧前额叶皮质（DLPFC）。在第一组——“双额叶组”中，阴极置于左侧DLPFC；而在第二组——“肩部组”中，阴极置于肩部。每位患者每周接受两次tDCS治疗，共八次。评估在首次耳鼻喉科会诊时、治疗开始时、八次tDCS治疗后以及治疗开始84天后的随访时进行。对每位患者进行主观疗效测量，如TFI、响度视觉模拟量表（VAS）以及耳鸣自觉率。
将阴极置于左侧DLPFC或肩部时，耳鸣响度及所经历的痛苦程度的结果并无差异。此外，在四个测试点之间未发现统计学上的显著总体效应。然而，高达39.1%的患者通过响度VAS测量显示响度有所降低。此外，双额叶组中有72%的患者报告痛苦有所改善，而肩部组中只有46.2%的患者报告有改善。
虽然观察到了一些改善，但这在统计学上并不显著。两种电极放置方式均刺激了海马体右侧，这可能是两组中都出现该效应的原因。进一步的研究应排除安慰剂效应，并研究其他电极位置。
