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Neuromodulation for Subjective Tinnitus: A Systematic Review and Meta-Analysis of Randomized Trials
Dimitrios Kitsis1, Giorgos Sideris2, Agapi Skouloudaki2
1General Hospital of Ioannina "Hatzikosta", Otolaryngology Department, Ioannina, Greece.
Bimodal stimulation offers the most effective and durable relief for chronic subjective tinnitus among neuromodulation techniques. Noninvasive options are generally safe, but further research is needed for optimal treatment protocols.
Area of Science:
- Neurology
- Otolaryngology
- Biomedical Engineering
Background:
- Chronic subjective tinnitus significantly impacts quality of life.
- Neuromodulation and bimodal stimulation are emerging treatment options.
Purpose of the Study:
- To evaluate the effectiveness and safety of neuromodulation and bimodal stimulation for chronic subjective tinnitus.
- To synthesize evidence from randomized controlled trials (RCTs).
Main Methods:
- Systematic literature search of PubMed/MEDLINE, Web of Science, and EMBASE (2015-2025).
- Included adult RCTs with chronic subjective tinnitus, assessing validated outcomes.
- Performed random-effects meta-analyses for comparable trials; assessed risk of bias.
Main Results:
- Twenty-six RCTs (n=1576) analyzed, including tES, rTMS, and bimodal stimulation.
- Transcranial electrical stimulation (tES) and repetitive transcranial magnetic stimulation (rTMS) showed nonsignificant pooled effects.
- Bimodal stimulation demonstrated consistent, clinically meaningful tinnitus severity reductions (≥10-20 points on THI/TFI) with up to 12-month durability.
Conclusions:
- Noninvasive neuromodulation is generally safe with modest benefits.
- Bimodal stimulation shows the most consistent and durable clinical improvements for tinnitus.
- Standardized, adequately powered RCTs with long-term follow-up are required.
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