Chen Jiann-Jy, Chen Yen-Wen, Zeng Bing-Yan, Hung Chao-Ming, Zeng Bing-Syuan, Stubbs Brendon, Carvalho Andre F, Thompson Trevor, Roerecke Michael, Su Kuan-Pin, Tu Yu-Kang, Wu Yi-Cheng, Smith Lee, Chen Tien-Yu, Lin Pao-Yen, Liang Chih-Sung, Hsu Chih-Wei, Hsu Shih-Pin, Kuo Hung-Chang, Wu Ming-Kung, Tseng Ping-Tao
Department of Otorhinolaryngology, E-Da Cancer Hospital, Kaohsiung, Taiwan.
Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung City, Taiwan.
EClinicalMedicine. 2021 Aug 13;39:101080. doi: 10.1016/j.eclinm.2021.101080. eCollection 2021 Sep.
Although tinnitus has a prevalence between 20 and 42.8%, the currently recommended management for tinnitus, such as tinnitus support and psychologic therapies, are relatively time-consuming and expensive. Several new pharmacologic treatments designed for tinnitus patients without specific origin had been developed but their efficacy remains unclear.
The current Network Meta-Analysis (NMA) of randomised controlled trials (RCTs) was conducted to evaluate the efficacy of different pharmacologic treatments for tinnitus management in tinnitus patients without specific or treatable origin (i.e. primary tinnitus). Databases were searched from inception to April 5, 2021. All network meta-analytic procedures were conducted under the frequentist model. We calculated the effect size of outcomes with different rating scales with standardized mean difference. PROSPERO registration: CRD42020177742.
Overall, 36 RCTs were included with 2,761 participants. The main results revealed that pharmacologic interventions with brain-acting effect (for example, amitriptyline, acamprosate, and gabapentin) and those with anti-inflammation/anti-oxidant effect (for example, intra-tympanic dexamethasone injection plus oral melatonin) were associated with superior improvement in tinnitus severity and response rate compared to placebo/control. Oral amitriptyline were associated with the highest improvement in tinnitus severity and the fourth highest response rate. None of the investigated interventions was associated with different changes in quality of life compared to placebo/control. All the investigated treatments were associated with similar drop-out rate to placebo/control.
The current NMA suggests a potential role for treatments with brain-acting effect (for example, amitriptyline, acamprosate, and gabapentin) or anti-inflammation/anti-oxidant effect (for example, intra-tympanic dexamethasone injection plus oral melatonin) as the preferable effective treatments for tinnitus without specific or treatable origin.
none.
尽管耳鸣的患病率在20%至42.8%之间，但目前推荐的耳鸣治疗方法，如耳鸣支持和心理治疗，相对耗时且昂贵。已经开发了几种针对无特定病因的耳鸣患者的新型药物治疗方法，但其疗效仍不明确。
进行了当前的随机对照试验网络荟萃分析（NMA），以评估不同药物治疗对无特定或可治疗病因（即原发性耳鸣）的耳鸣患者耳鸣管理的疗效。从数据库建立至2021年4月5日进行检索。所有网络荟萃分析程序均在频率论模型下进行。我们用标准化均数差计算了不同评定量表结局的效应量。国际前瞻性系统评价注册库注册号：CRD42020177742。
总体而言，纳入了36项随机对照试验，共2761名参与者。主要结果显示，与安慰剂/对照组相比，具有脑作用效应的药物干预（如阿米替林、阿坎酸和加巴喷丁）以及具有抗炎/抗氧化作用的药物干预（如鼓室内注射地塞米松加口服褪黑素）与耳鸣严重程度和缓解率的显著改善相关。口服阿米替林与耳鸣严重程度的最高改善相关，缓解率排名第四。与安慰剂/对照组相比，所研究的干预措施均未与生活质量的不同变化相关。所有研究的治疗方法与安慰剂/对照组的退出率相似。
当前的网络荟萃分析表明，具有脑作用效应（如阿米替林、阿坎酸和加巴喷丁）或抗炎/抗氧化作用（如鼓室内注射地塞米松加口服褪黑素）的治疗方法可能作为无特定或可治疗病因耳鸣的首选有效治疗方法。
无。
