Londero A, Bonfils P, Lefaucheur J P
Service ORL et CCF, hôpital Européen G.-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France.
Service ORL et CCF, hôpital Européen G.-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France.
Eur Ann Otorhinolaryngol Head Neck Dis. 2018 Feb;135(1):51-58. doi: 10.1016/j.anorl.2017.12.001. Epub 2017 Dec 26.
Subjective tinnitus is a symptom in many ENT pathologies, for which there is no curative treatment. It may be poorly tolerated by some patients, who develop attention or sleep disorder or even major anxiety and depression, severely impairing quality of life. Pathophysiological models of the genesis and maintenance of tinnitus symptomatology highlight maladaptive cerebral plasticity induced by peripheral hearing loss. Although not fully elucidated, these changes in neuronal activity are the target of various attempts at neuromodulation, particularly using repetitive transcranial magnetic stimulation (rTMS), which has been the focus of various clinical studies and meta-analyses. A recent consensus statement (Lefaucheur, 2014) reported level-C evidence (possible efficacy) for rTMS using low frequency (1Hz) tonic stimulation targeting the left cerebral cortex. However, many questions remain concerning the use of this technique in everyday practice. The present article reports a recent literature review using the search-terms "tinnitus" and "rTMS" in the PubMed and Cochrane databases for April 2014 to December 2016.
主观性耳鸣是许多耳鼻喉科疾病的一种症状,目前尚无治愈性治疗方法。一些患者可能难以耐受耳鸣,进而出现注意力不集中、睡眠障碍,甚至严重的焦虑和抑郁,严重影响生活质量。耳鸣症状发生和维持的病理生理模型强调了外周听力损失引起的适应性不良的大脑可塑性。尽管尚未完全阐明,但这些神经元活动的变化是各种神经调节尝试的目标,特别是使用重复经颅磁刺激(rTMS),这一直是各种临床研究和荟萃分析的重点。最近的一项共识声明(Lefaucheur,2014年)报告了针对左脑皮层使用低频(1Hz)强直刺激的rTMS的C级证据(可能有效)。然而,关于该技术在日常实践中的应用仍有许多问题。本文报告了一项最近的文献综述,该综述在2014年4月至2016年12月期间使用关键词“耳鸣”和“rTMS”在PubMed和Cochrane数据库中进行检索。