重复经颅磁刺激治疗主观性慢性耳鸣的疗效：一项随机对照试验的荟萃分析。

Efficacy of repetitive transcranial magnetic stimulation for subjective chronic tinnitus: a randomized controlled trial meta-analysis.

作者信息

He Ziyan, Liao Defu, Ji Qipei, Yan Shichang, Ai Shuangchun

机构信息

College of Health and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China.

Department of Rehabilitation Medicine, Mianyang Hospital, Chengdu University of Traditional Chinese Medicine, Mianyang, Sichuan, China.

出版信息

Front Neurosci. 2025 Apr 15;19:1579846. doi: 10.3389/fnins.2025.1579846. eCollection 2025.

DOI:10.3389/fnins.2025.1579846

PMID:40303608

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12037475/

Abstract

OBJECTIVES

Chronic tinnitus affects approximately 10%-15% of the population. The long-term presence of severe tinnitus significantly impacts affected individuals' quality of life and emotional state. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive technique that employs pulsed magnetic fields to modulate neural activity. rTMS is considered a promising treatment strategy for chronic tinnitus. However, the therapeutic effect of rTMS on subjective chronic tinnitus remains inconclusive, and its validity is still a subject of debate among researchers.

METHODS

To identify RCTs investigating rTMS for subjective chronic tinnitus, a comprehensive computerized search was conducted across multiple databases, including PubMed, The Cochrane Library, Embase, Web of Science, China Knowledge, WIPO, Wanfang, and the China Biomedical Literature Database (CBM). The search timeframe spanned from the inception of each database to 2 June 2024. Two independent investigators performed literature screening, data extraction, and quality assessment using the Cochrane Risk of Bias Assessment Tool. Meta-analysis was conducted using RevMan 5.4 software.

RESULTS

Sixteen randomized controlled trials (RCTs) involving 1,105 chronic tinnitus patients were included. RTMS was superior to Sham rTMS in THI and VAS and had a positive effect on the short-term impact of THI (1 month), Still, this meta-analysis did not observe a positive effect of rTMS on the long-term implications of tinnitus (6 months). rTMS had no significant immediate effect on TQ and LM scores on tinnitus questionnaires.

CONCLUSION

This meta-analysis demonstrated that rTMS has some efficacy in chronic tinnitus. However, more RCTs are needed to validate its effectiveness, to support the effectiveness of repetitive transcranial magnetic stimulation for tinnitus with larger sample sizes and more follow-up data, and to explore the potential benefits of rTMS in chronic tinnitus.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024569403.

摘要

目的

慢性耳鸣影响约10%-15%的人群。严重耳鸣的长期存在会显著影响患者的生活质量和情绪状态。重复经颅磁刺激（rTMS）是一种利用脉冲磁场调节神经活动的非侵入性技术。rTMS被认为是治疗慢性耳鸣的一种有前景的策略。然而，rTMS对主观性慢性耳鸣的治疗效果仍不明确，其有效性仍是研究人员争论的话题。

方法

为了识别研究rTMS治疗主观性慢性耳鸣的随机对照试验（RCT），我们在多个数据库中进行了全面的计算机检索，包括PubMed、Cochrane图书馆、Embase、科学网、中国知网、世界知识产权组织数据库、万方数据库和中国生物医学文献数据库（CBM）。检索时间范围从每个数据库创建到2024年6月2日。两名独立研究人员使用Cochrane偏倚风险评估工具进行文献筛选、数据提取和质量评估。使用RevMan 5.4软件进行荟萃分析。

结果

纳入了16项涉及1105名慢性耳鸣患者的随机对照试验。在耳鸣严重程度指数（THI）和视觉模拟量表（VAS）方面，rTMS优于假rTMS，并且对THI的短期影响（1个月）有积极作用。不过，该荟萃分析未观察到rTMS对耳鸣长期影响（6个月）的积极作用。rTMS对耳鸣问卷的耳鸣残疾评定量表（TQ）和生活质量量表（LM）评分没有显著的即时影响。