The use of tDCS as a therapeutic option for tinnitus: a systematic review

Santos, Amanda dos Humildes Maia; Santos, Afonso Paranhos Silva; Santos, Henrique Souza; Silva, Adriana Campos da

doi:10.1016/j.bjorl.2018.02.003

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Brazilian Journal of Otorhinolaryngology

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Review articles • Braz. j. otorhinolaryngol. 84 (5) • Sep-Oct 2018 • https://doi.org/10.1016/j.bjorl.2018.02.003 copy

The use of tDCS as a therapeutic option for tinnitus: a systematic review^☆ ☆ Please cite this article as: Santos AH, Santos AP, Santos HS, Silva AC. The use of tDCS as a therapeutic option for tinnitus: a systematic review. Braz J Otorhinolaryngol. 2018;84:653-59.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

Due to the subjectivity of the tinnitus diagnosis and its diverse etiologies, establishing an effective treatment is complex. In this context, transcranial direct current stimulation, a noninvasive option, is available for most patients and has shown good results in the treatment of other symptoms such as chronic pain.

Objective:

To evaluate the therapeutic response of tinnitus to transcranial direct current stimulation.

Methods:

A systematic review of the literature was performed using the following descriptors: tinnitus, transcranial direct current stimulation and randomized clinical trial. The research was carried out in the MEDLINE/PUBMED, Lilacs, and Scielo databases. The inclusion criteria were: patients over 18 years of age with no associated comorbidities, who had a diagnosis established by a specialist or through the application of previously validated scales and criteria applied by a non-specialist physician.

Results:

A total of 4165 studies were found, and a total of six were selected after the inclusion criteria were applied, obtaining a sample of 602 patients. Based on the defined criteria, there was a positive response to transcranial direct current stimulation in 14.86% of the participants.

Conclusion:

Based on literature studied, there is no therapeutic response of tinnitus to transcranial direct current stimulation.

KEYWORDS
Tinnitus; tDCS; Transcranial direct current stimulation

Inclusion criteria	Exclusion criteria
Randomized, quasi-randomized clinical trials and open-label trials.	Case-control, cohort studies, case reports.
Patients older than 18 years.	Patients younger than 18 years.
Tinnitus diagnosed by specialist assessment or through scales validated for the symptom.	Tinnitus-associated comorbidities: history of head trauma, epilepsy, use of ototoxic substances, intracranial tumor, Meniere's disease.
Use of tDCS for at least two sessions and no other associated therapy.	Use of tDCS in only one session.

References	Study type	Sample size	Stimulation site	Type of stimulation	Time of stimulation (minutes)	Intensity (mA)
Vanneste et al.⁶6 Vanneste S, Plazier M, Ost J, Lou EV, Heyning PV, Ridder D. Bilateral dorsolateral prefrontal cortex modulation for tinnitus by transcranial direct current stimulation: a preliminary clinical study. Exp Brain Res. 2010;202:779-85.	OL	478	DLPFC	Anode on the right and cathode on the left/anode on the left and cathode on the right	20	1.5
Garin et al.⁹9 Garin P, Gilain C, Philipe J. Short and long lasting tinnitus relief induced by transcranial current direct stimulation. J Neurol. 2011;:1940-8.	RCT	20	LTPA	Cathode or anode on the left	20	1
Frank et al.¹¹11 Frank E, Schecklman M, Landgrebe M, Burger J, Kreuzer P, Poeppl T, et al. Treatment of chronic tinnitus with repeated sessions of prefrontal transcranial direct current stimulation: outcomes from no open label pilot study. J Neurol. 2012;259:327-33.	OL	32	DLPFC	Anode on the right and cathode on the left	30	1.5
Faber et al.⁸8 Faber M, Vannest S, Fregni F, Ridder D. Top down pre-frontal affective modulation of tinnitus with multiple sessions of TDCS of dorsolateral prefrontal cortex. Brain Stimul. 2012;:492-550.	RCT	15	DLPFC	Anode on the right and cathode on the left/anode on the left and cathode on the right	20	1.5
Forogh et al.¹⁰10 Forogh B, Mirshaki Z, Raisse G, Shirazi A, Mansoori K, Ahadi T. Repeated sessions of transcranial direct current stimulation for treatment of chronic subjective tinnitus: a pilot randomized controlled trial. Neurol Sci. 2016;37:253-9.	RCT	22	LTPA	Anode on the left and cathode in supra orbital area	20	2
Pal et al.⁷7 Pal N, Maire R, Stephan M, Hermnann F. Transcranial direct current stimulation for the treatment of chronic tinnitus: a randomized controlled study. Brain Stimul. 2013;:1101-7.	RCT	42	AC/DLPFC	Cathode on the auditory cortex and anode on the DLPFC	20	2

	Vanneste et al.⁶6 Vanneste S, Plazier M, Ost J, Lou EV, Heyning PV, Ridder D. Bilateral dorsolateral prefrontal cortex modulation for tinnitus by transcranial direct current stimulation: a preliminary clinical study. Exp Brain Res. 2010;202:779-85.	Pal et al.⁷7 Pal N, Maire R, Stephan M, Hermnann F. Transcranial direct current stimulation for the treatment of chronic tinnitus: a randomized controlled study. Brain Stimul. 2013;:1101-7.	Faber et al.⁸8 Faber M, Vannest S, Fregni F, Ridder D. Top down pre-frontal affective modulation of tinnitus with multiple sessions of TDCS of dorsolateral prefrontal cortex. Brain Stimul. 2012;:492-550.	Garin et al.⁹9 Garin P, Gilain C, Philipe J. Short and long lasting tinnitus relief induced by transcranial current direct stimulation. J Neurol. 2011;:1940-8.	Forogh et al.¹⁰10 Forogh B, Mirshaki Z, Raisse G, Shirazi A, Mansoori K, Ahadi T. Repeated sessions of transcranial direct current stimulation for treatment of chronic subjective tinnitus: a pilot randomized controlled trial. Neurol Sci. 2016;37:253-9.	Frank et al.¹¹11 Frank E, Schecklman M, Landgrebe M, Burger J, Kreuzer P, Poeppl T, et al. Treatment of chronic tinnitus with repeated sessions of prefrontal transcranial direct current stimulation: outcomes from no open label pilot study. J Neurol. 2012;259:327-33.
Title and abstract
Identification as a randomized trial

Structured abstract
Methods
Study design is described, with defined methodological changes
Criteria for the participants' inclusion and place where the collection occurred
Detailed intervention for each group
Primary and secondary outcomes are described and changes that occurred after the start
How the sample was determined
Randomization
How the randomization was carried out
Which group was blinded, who generated the randomization sequence
Statistical methods utilized
Results
Table with the groups of each patient, losses and exclusions after randomization
Data defining the time of recruitment and follow-up
Table depicting patient profile
Results of the primary and secondary outcomes for each group
Important damage
Discussion
Study limitations are described
Description of external validity and applicability
Interpretation consistent with results, balancing benefits and losses
Other information
Clinical trial registration number
Where the complete protocol can be accessed
Sponsorship description
	51%	86%	45%	62,10%	48,00%	40%

References	Scale used (primary endpoint)	Therapeutic response based on p value (primary endpoint)
Vanneste et al.⁶6 Vanneste S, Plazier M, Ost J, Lou EV, Heyning PV, Ridder D. Bilateral dorsolateral prefrontal cortex modulation for tinnitus by transcranial direct current stimulation: a preliminary clinical study. Exp Brain Res. 2010;202:779-85.	VAS (intensity and stress)	p < 0.001* (AR/CL)
	VAS (intensity and stress)	p > 0.05 (AL/CR)
Frank et al.¹¹11 Frank E, Schecklman M, Landgrebe M, Burger J, Kreuzer P, Poeppl T, et al. Treatment of chronic tinnitus with repeated sessions of prefrontal transcranial direct current stimulation: outcomes from no open label pilot study. J Neurol. 2012;259:327-33.	THI	p = 0.957
Garin et al.⁹9 Garin P, Gilain C, Philipe J. Short and long lasting tinnitus relief induced by transcranial current direct stimulation. J Neurol. 2011;:1940-8.	VAS (intensity and discomfort)	p = 0.013* (C/I)
Faber et al.⁸8 Faber M, Vannest S, Fregni F, Ridder D. Top down pre-frontal affective modulation of tinnitus with multiple sessions of TDCS of dorsolateral prefrontal cortex. Brain Stimul. 2012;:492-550.	VAS (annoyance)	p = 0.020*(A/I)
		p = 0.108 (D)
		p < 0.05*(AL/AR)
Forogh et al.¹⁰10 Forogh B, Mirshaki Z, Raisse G, Shirazi A, Mansoori K, Ahadi T. Repeated sessions of transcranial direct current stimulation for treatment of chronic subjective tinnitus: a pilot randomized controlled trial. Neurol Sci. 2016;37:253-9.	CGI	p = 0.807
Pal et al.⁷7 Pal N, Maire R, Stephan M, Hermnann F. Transcranial direct current stimulation for the treatment of chronic tinnitus: a randomized controlled study. Brain Stimul. 2013;:1101-7.	THI	p = 0.69

References	Place of stimulation	Correspondence in the international electroencephalogram system
Vanneste et al.⁶6 Vanneste S, Plazier M, Ost J, Lou EV, Heyning PV, Ridder D. Bilateral dorsolateral prefrontal cortex modulation for tinnitus by transcranial direct current stimulation: a preliminary clinical study. Exp Brain Res. 2010;202:779-85.	DLPFC	F3 and F4
Pal et al.⁷7 Pal N, Maire R, Stephan M, Hermnann F. Transcranial direct current stimulation for the treatment of chronic tinnitus: a randomized controlled study. Brain Stimul. 2013;:1101-7.	AC/PFC	T3 and T4/F3 E F4
Faber et al.⁸8 Faber M, Vannest S, Fregni F, Ridder D. Top down pre-frontal affective modulation of tinnitus with multiple sessions of TDCS of dorsolateral prefrontal cortex. Brain Stimul. 2012;:492-550.	DLPFC	F3 and F4
Garin et al.⁹9 Garin P, Gilain C, Philipe J. Short and long lasting tinnitus relief induced by transcranial current direct stimulation. J Neurol. 2011;:1940-8.	LTPA	Between T4 and F8
Forogh et al.¹⁰10 Forogh B, Mirshaki Z, Raisse G, Shirazi A, Mansoori K, Ahadi T. Repeated sessions of transcranial direct current stimulation for treatment of chronic subjective tinnitus: a pilot randomized controlled trial. Neurol Sci. 2016;37:253-9.	LTPA	Between C3 and T5
Frank et al.¹¹11 Frank E, Schecklman M, Landgrebe M, Burger J, Kreuzer P, Poeppl T, et al. Treatment of chronic tinnitus with repeated sessions of prefrontal transcranial direct current stimulation: outcomes from no open label pilot study. J Neurol. 2012;259:327-33.	DLPFC	F3 and F4

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
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[1] * Corresponding author. E-mail:amandamsantos13.2@bahiana.edu.br (A.H. Santos).

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The use of tDCS as a therapeutic option for tinnitus: a systematic review☆ ☆ Please cite this article as: Santos AH, Santos AP, Santos HS, Silva AC. The use of tDCS as a therapeutic option for tinnitus: a systematic review. Braz J Otorhinolaryngol. 2018;84:653-59.

Abstract

Introduction:

Objective:

Methods:

Results:

Conclusion:

The use of tDCS as a therapeutic option for tinnitus: a systematic review^☆ ☆ Please cite this article as: Santos AH, Santos AP, Santos HS, Silva AC. The use of tDCS as a therapeutic option for tinnitus: a systematic review. Braz J Otorhinolaryngol. 2018;84:653-59.