Author(s)
Young Jae Byun, BS
Joshua A. Lee, BA
Shaun A. Nguyen, MD
Habib G. Rizk, MD
Ted A. Meyer, MD, PhD
Paul R. Lambert, MD
Affiliation(s)
Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina;
Abstract:
Objective: To evaluate the treatment efficacy of transcutaneous electrical nerve stimulation (TENS) in patients with
tinnitus.
Data Sources: PubMed, Scopus, Web of Science, and Cochrane Library were searched for the following two concepts:
"transcutaneous electric nerve stimulation" and "tinnitus".
Study Selection: Studies were considered for inclusion if they were: 1) double- or single-blinded randomized controlled
trials, 2) double- or single-blinded randomized comparison trials, 3) prospective or retrospective observational studies,
and 4) case series.
Data Extraction: Tinnitus Handicap Inventory (THI), the Visual Analog Scale (VAS), and perceived tinnitus suppression
after treatment. Additional data collected included tinnitus laterality, duration of symptoms, location of electrode
placement, time to follow-up, etiology of tinnitus, and treatment side effects.
Data Synthesis: The literature search yielded 54 unique articles. After reviewing 27 full-text articles, 16 studies reporting
on 1142 patients were included for final analysis. Four studies provided data available for meta-analysis of pre- and posttreatment
THI and VAS (Cochrane Review Manager). TENS showed significant overall reduction on THI (-7.55 [-10.93
to -4.18], p<0.0001) and VAS (-0.65 [-0.99 to -0.30], p<0.0002). Subjective improvement of tinnitus was pooled across
thirteen studies using meta-analysis of proportions (MedCalc). Tinnitus suppression occurred in 39.0% [27.1% to 51.6%]
patients. Among them, 24.6% [1.4% to 63.3%] experienced persistent improvement at 3 months and 22.2% [12.2% to
29.7%] experienced complete suppression.
Conclusions: TENS represents a safe and feasible treatment option for tinnitus and might be a worthy consideration
among the spectrum of interventions developed for tinnitus.
Define Professional Practice Gap & Educational Need: Tinnitus is an increasingly prevalence disorder that can have a
profound impact on the social functioning and psychological well-being of patients. Although various treatment
modalities have been investigated, no therapy demonstrated compelling benefit in its management. TENS offers an
enticing non-invasive method in tinnitus treatment but its efficacy has only been evaluated in small observational studies
and a few randomized controlled trials.
Learning Objective: To understand current knowledge on TENS as a treatment option for tinnitus and to analyze its
efficacy based on reported outcomes.
Desired Result: Attendees will be aware of TENS as an option for tinnitus management and understand its efficacy in its
management.
Level of Evidence: LEVEL II, small RCTs with unclear results
Indicate IRB or IACUC: Exempt.