Effects of Non-Invasive Neuromodulation of the Vagus Nerve for Management of Tinnitus: A Systematic Review with Meta-Analysis

Background: Tinnitus is the perception of sound in the absence of actual external stimuli. Other associated symptoms include frustration, annoyance, anxiety, depression, stress, cognitive dysfunction, insomnia, or emotional exhaustion. Objective: In this study, we aimed to conduct a systematic review and meta-analysis on the effectiveness of the non-invasive neuromodulation of the vagus nerve in patients with tinnitus. Methods: Six databases were searched from their date of inception to 15 June 2022 to identify clinical trials in which at least one group received any form of non-invasive neuromodulation of the vagus nerve for tinnitus management, with outcomes based on annoyance and related disability. Data on participants, interventions, blinding strategies, assessment outcomes, and results were extracted by two reviewers. Results: The search identified 183 articles with five clinical trials eligible for inclusion in the review and four for the meta-analysis. The methodological quality scores ranged from 6 to 8 (mean: 7.3, SD: 0.8) points. The meta-analysis identified a significant positive effect on THI post-treatment for unilateral auricular stimulation (hg = 0.69, 95% CI 0.06, 1.32) or transcutaneous nerve stimulation (hg = 0.51, 95% CI 0.1, 0.9) compared with a comparative group. No effect on loudness intensity was observed. Conclusion: The results of the meta-analysis suggest that the application of the non-invasive neuromodulation of the vagus nerve has a positive effect post-treatment in terms of related disability in patients with tinnitus, although its clinical relevance is low. No firm conclusions about the effect of the non-invasive neuromodulation of the vagus nerve on tinnitus are available based on the current literature.