engleski

Repetitive Transcranial Magnetic Stimulation in Treatment of Tinnitus: Meta-Analysis of Randomized Sham-Controlled Trials

Background: Tinnitus etiology and clinical presentations are highly variable. There is no stringent and universally accepted definition of the disorder, and objective diagnostic biomarkers are missing. There is no gold treatment standard, and the results of studies on various treatment effects are inconsistent. Clinical practice guidelines from 2014 stated that rTMS may not be recommended for the routine treatment of tinnitus neither, because of methodological heterogeneity/weaknesses, and inconsistencies of results of rTMS randomized controlled trials. Since 2014, more studies of rTMS efficacy on tinnitus have been published, but the results are still highly heterogenous, poorly reported, with low reproducibility, and non-conclusive. To access the efficacy of rTMS on idiopathic, chronic tinnitus disorder.Methods: We conducted a meta- analysis of randomized sham- controlled, double- blind trials. Instead of a systematic search for the primary studies and new risk-of-bias assessment, we used 13 systematic reviews and meta-analyses that were published by February 25, 2022. We used a random-effects model, and analyzed the standardized effect sizes, and instead of only calculating the confidence intervals, as was done in literally all 13 meta-analyzes, we calculated the 95% prediction intervals to respect the uncertainty in estimating between-study variance. Results: Total number of eligible studies was 42, of witch large number did not define the primary outcome. In the final analysis, we included 26 studies with 549 patients in active and 537 in passive sham arms. The overall effect of rTMS on severity of tinnitus was Hedges g= -0.39 (95% CI -0.57 ; -0.21 ; 95% prediction interval -1.00 ; 0.22) (Figure 1). Conclusion: Too many randomized sham-controlled trials on the efficacy of rTMS on tinnitus and reporting of their results are of unsatisfactory quality. The whole body of literature is fragmented into small, too often poorly designed trials with exclusive/new protocols and presumably low reproducibility. The whole field would probably benefit from larger, better theoretically founded studies, replications of the most promising experiments, and the empirically founded patient-oriented approach that will respect the tinnitus phenotype heterogeneity and the existence of distinct patient subpopulations. In this area of research, the race for the ad-hoc discovery of the Holy Grail of rTMS perfect protocol should be stopped, and the traditional scientific paradigm of theoretically grounded gradual improvement on previous studies and theories should be adhered to.

tinnitus ; Repetitive Transcranial Magnetic Stimulation ; Sham-Controlled Trials

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