Although the clinical efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) in the treatment of chronic tinnitus have been frequently examined, the results remain contradictory. Therefore, we performed a systematic review and meta-analysed clinical trials examining the effects of rTMS to evaluate its clinical efficacy and safety. Studies of rTMS for chronic tinnitus were retrieved from PubMed, Embase, and Cochrane Library through April 2020. Review Manager 5.3 software was employed for data synthesis, and Stata 13.0 software was used for analyses of publication bias and sensitivity. Twenty-nine randomized studies involving 1228 chronic tinnitus patients were included. Compared with sham-rTMS, rTMS exhibited significant improvements in the tinnitus handicap inventory (THI) scores at 1 week (mean difference [MD]: − 7.92, 95% confidence interval [CI]: − 14.18, − 1.66), 1 month (MD: -8.52, 95% CI: − 12.49, − 4.55), and 6 months (MD: -6.53, 95% CI: − 11.406, − 1.66) post intervention; there were significant mean changes in THI scores at 1 month (MD: -14.86, 95% CI: − 21.42, − 8.29) and 6 months (MD: -16.37, 95% CI: − 20.64, − 12.11) post intervention, and the tinnitus questionnaire (TQ) score at 1 week post intervention (MD: -8.54, 95% CI: − 15.56, − 1.52). Nonsignificant efficacy of rTMS was found regarding the THI score 2 weeks post intervention (MD: -1.51, 95% CI: − 13.42, − 10.40); the mean change in TQ scores 1 month post intervention (MD: -3.67, 95% CI: − 8.56, 1.22); TQ scores 1 (MD: -8.97, 95% CI: − 20.41, 2.48) and 6 months (MD: -7.02, 95% CI: − 18.18, 4.13) post intervention; and adverse events (odds ratios [OR]: 1.11, 95% CI: 0.51, 2.42). Egger’s and Begg’s tests indicated no publication bias (P = 0.925). This meta-analysis demonstrated that rTMS is effective for chronic tinnitus; however, its safety needs more validation. Restrained by the insufficient number of included studies and the small sample size, more large randomized double-blind multi-centre trials are needed for further verification.

中文翻译：

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重复经颅磁刺激治疗慢性耳鸣：系统评价和荟萃分析


尽管重复经颅磁刺激（rTMS）治疗慢性耳鸣的临床疗效和安全性已被频繁检验，但结果仍然相互矛盾。因此，我们对 rTMS 的效果进行了系统评价和荟萃分析临床试验，以评估其临床疗效和安全性。截至 2020 年 4 月，从 PubMed、Embase 和 Cochrane 图书馆检索了 rTMS 治疗慢性耳鸣的研究。采用 Review Manager 5.3 软件进行数据合成，并使用 Stata 13.0 软件进行发表偏倚和敏感性分析。纳入了 29 项随机研究，涉及 1228 名慢性耳鸣患者。与 sham-rTMS 相比，rTMS 在 1 周时表现出耳鸣障碍量表 (THI) 评分的显着改善（平均差 [MD]：− 7.92，95% 置信区间 [CI]：− 14.18，− 1.66），1 个月（ MD：-8.52，95% CI：− 12.49，− 4.55），以及干预后 6 个月（MD：-6.53，95% CI：− 11.406，− 1.66）；干预后 1 个月（MD：-14.86，95% CI：− 21.42，− 8.29）和 6 个月（MD：-16.37，95% CI：− 20.64，− 12.11）时 THI 评分有显着平均变化，并且干预后 1 周的耳鸣问卷 (TQ) 评分（MD：-8.54，95% CI：− 15.56，− 1.52）。干预后 2 周，rTMS 对 THI 评分的疗效不显着（MD：-1.51，95% CI：− 13.42，− 10.40）；干预后 1 个月 TQ 评分的平均变化（MD：-3.67，95% CI：− 8.56，1.22）；干预后 TQ 评分 1（MD：-8.97，95% CI：− 20.41，2.48）和 6 个月（MD：-7.02，95% CI：− 18.18，4.13）；和不良事件（比值比 [OR]：1.11，95% CI：0.51，2.42）。 Egger 和 Begg 的检验表明不存在发表偏倚（P = 0.925）。 这项荟萃分析表明，rTMS 对慢性耳鸣有效；然而，其安全性需要更多验证。受纳入研究数量不足、样本量较小的制约，尚需更大规模的随机双盲多中心试验进一步验证。