Department of Otolaryngology, Shaanxi Provincial People's Hospital, China.
Xi'an Medical University, China.
Medicine (Baltimore). 2021 Oct 15;100(41):e27509. doi: 10.1097/MD.0000000000027509.
Tinnitus is a common otological symptom and can be debilitating. Sound therapy has increased in popularity due to its potential for increased efficacy and fewer and milder side effects, but the available evidence is limited by the lack of randomized controlled trials comparing different sound therapies for tinnitus. Network meta-analysis (NMA) is a useful tool to compare multiple treatments when there is limited or no direct evidence available. The aim of this paper is to evaluate the efficacy and acceptability of different sound therapies for tinnitus.
A literature search was conducted to identify articles in EMBASE, PubMed/MEDLINE, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chinese Biomedical Literature, and Wanfang and Weipu from inception to April 1, 2021. The Tinnitus Handicap Inventory, Tinnitus Questionnaire, and effective rate were used to assess perceived tinnitus suppression after treatment. We used Review Manager 5.4 for the standard meta-analysis; R 4.0.4 and Stata 15.1 were used for the NMA and the publication bias and sensitivity analyses.
The effect estimates of the direct comparisons (when available) were very similar to those of the NMA. Overall, sound stimulation alone performed better than medication alone, educational consultation alone, and no treatment. Combination therapy, such as sound stimulation plus educational consultation and sound stimulation plus drug therapy, yielded significantly better outcomes with regard to the alleviation of tinnitus than individual treatments.
This is the first NMA to evaluate and compare the effectiveness of different sound therapies for the management of tinnitus. It may help inform the selection of sound therapy and the development of guidelines in clinical practice. Future studies of sound therapy with larger sample sizes involving multiple medical centers are needed to improve the current evidence.
耳鸣是一种常见的耳科症状，可能使人虚弱。由于声音疗法具有增加疗效和较少且较轻的副作用的潜力，因此越来越受欢迎，但由于缺乏比较不同耳鸣声音疗法的随机对照试验，现有证据有限。网络荟萃分析（NMA）是在缺乏或没有直接证据时比较多种治疗方法的有用工具。本文旨在评估不同耳鸣声音疗法的疗效和可接受性。
从 2021 年 4 月 1 日起，我们在 EMBASE、PubMed/MEDLINE、Web of Science、Cochrane 图书馆、中国国家知识基础设施、中国生物医学文献和万芳和维普中进行了文献检索，以确定文章。使用耳鸣残疾量表、耳鸣问卷和有效率来评估治疗后感知到的耳鸣抑制情况。我们使用 Review Manager 5.4 进行标准荟萃分析；使用 R 4.0.4 和 Stata 15.1 进行 NMA 以及发表偏倚和敏感性分析。
直接比较（如有）的效应估计与 NMA 非常相似。总体而言，单独的声音刺激优于单独的药物治疗、单独的教育咨询和无治疗。联合治疗，如声音刺激加教育咨询和声音刺激加药物治疗，在缓解耳鸣方面的效果明显优于单一治疗。
这是第一项评估和比较不同声音疗法治疗耳鸣效果的 NMA。它可能有助于为临床实践中的声音疗法选择和指南制定提供信息。需要更多涉及多个医疗中心的更大规模的声音疗法研究来提高现有证据。
