Non-invasive treatments improve patient outcomes in chronic tinnitus: a systematic review and network meta-analysis

Abstract

ObjectiveTo investigate the relative effectiveness of various Non-Invasive Treatment Techniques (NITs) in chronic tinnitus management. MethodsWe searched PubMed, Embase and Cochrane Library databases from the time of data construction to December 31, 2022. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, NITs were evaluated, including Aacceptance and commitment therapy (A), Cognitive behavioral therapy (C), Sound therapy (S), Transcranial magnetic stimulation (T), Electrical stimulation therapy (E), Virtual reality therapy (V), tinnitus Retraining therapy (R), general psychotherapy (D), and Placebo (P). The outcome indicators included the Tinnitus Handicap Inventory (THI), Tinnitus Questionnaire (TQ), Hospital Anxiety and Depression Scale-anxiety-Depression (HADS-D), Insomnia Severity Index (ISI), Visual Analogue Scales-Loudness (VAS-L), and Visual Analogue Scales-Distress (VAS-D). Statistical analysis was performed using Stata 14.0 for NMA. ResultsThis systematic review and meta-analysis included 22 randomized controlled trials comprising 2,354 patients. The treatment effects varied on each scale. For THI, S (86.9%) was the most effective, whereas P (6.5%) was the worst. For TQ, C (89.5%) was the most effective, whereas D (25.4%) was the worst. For HADS-D, A (82.4%) was the most effective, whereas D (9.47%) was the worst. For ISI, A (83.2%) was the most effective, whereas R (20.6%) was the worst. For VAS-L, S (73.5%) was the most effective, whereas E (18.9%) was the worst. For VAS-D, C (84.7%) was the most effective, whereas P (18.1%) was the worst. ConclusionsThe combination of acoustics and cognitive behavioral therapy may be an effectively treat patients with chronic tinnitus. Level of EvidenceHow common is the problem? Level 2.Is this diagnostic or monitoring test accurate? (Diagnosis) Level 1.What will happen if we do not add a therapy? (Prognosis) Level 1.Does this intervention help? (Treatment Benefits) Level 1.What are the COMMON harms? (Treatment Harms) Level 1.What are the RARE harms? (Treatment Harms) Level 1.Is this (early detection) test worthwhile? (Screening) Level 1I.