Neuromodulation for Subjective Tinnitus: A Systematic Review and Meta-Analysis of Randomized Trials

Dimitrios Kitsis; Giorgos Sideris; Agapi Skouloudaki; Alexander Delides; Petros Vlastarakos

doi:10.1002/lary.70633

Neuromodulation for Subjective Tinnitus: A Systematic Review and Meta-Analysis of Randomized Trials

Laryngoscope. 2026 May 21. doi: 10.1002/lary.70633. Online ahead of print.

Authors

Dimitrios Kitsis¹, Giorgos Sideris², Agapi Skouloudaki², Alexander Delides², Petros Vlastarakos²

Affiliations

¹ General Hospital of Ioannina "Hatzikosta", Otolaryngology Department, Ioannina, Greece.
² National & Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, 2nd Otolaryngology Department, Athens, Greece.

PMID: 42167925
DOI: 10.1002/lary.70633

Abstract

Objective: To evaluate the effectiveness and safety of neuromodulation and bimodal stimulation for chronic subjective tinnitus in randomized controlled trials (RCTs).

Data sources: PubMed/MEDLINE, Web of Science, and EMBASE (January 2015-December 2025) searched per PRISMA 2020.

Review methods: Adult RCTs (≥ 18 years) with chronic subjective tinnitus (> 3 months) assessing validated outcomes (THI, TFI, TQ) for neuromodulation/bimodal interventions vs. sham/controls. Two-stage screening, Cochrane RoB-2 risk-of-bias assessment. Random-effects meta-analyses (REML) were performed when ≥ 3 comparable trials were available; effects reported as standardized mean differences (SMD) with 95% CIs. Main Outcomes and measures included change in tinnitus severity (THI/TFI/TQ) while secondary outcomes included loudness (VAS/NRS), durability, and adverse events.

Results: Twenty-six RCTs (n = 1576) met criteria: tES (11; n = 372), rTMS (8; n = 432), acoustic coordinated reset (1; n = 100), vagus nerve stimulation (2; n = 90), and bimodal stimulation (4; n = 582). Meta-analysis showed a nonsignificant pooled effect for tDCS (SMD -0.36; 95% CI -0.75 to 0.02; I² = 51%) and rTMS (SMD -0.15; 95% CI -0.37 to 0.07; I² = 0%). Single-trial evidence for coordinated reset showed no advantage over broadband noise. VNS demonstrated modest benefits with safety concerns limited to implanted approaches. Bimodal stimulation yielded consistent, clinically meaningful reductions (often ≥ 10-20 points on THI/TFI), with durability up to 12 months. Adverse events were mild/transient across noninvasive modalities.

Conclusions: Noninvasive neuromodulation appears safe with average benefits; among modalities, bimodal stimulation shows the most consistent and durable clinical improvements. Standardized, adequately powered RCTs with harmonized protocols and long-term follow-up are needed to refine targets and dosing.

Keywords: bimodal stimulation; neuromodulation; tinnitus; transcranial direct current stimulation; transcranial random noise stimulation.

Publication types

Review