Effect of the vagus nerve stimulation combined with sound therapy for tinnitus treatment: a systematic review and meta-analysis
- Journal
- European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (Q1)
- Published
- 13 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Mitra Rezapour, Mir Mohammad Jalali, Shadman Nemati, Azadeh Borna
- PMID
- 42867641
- DOI
- 10.1007/s00405-026-10713-y
Why clinicians should know about it
- Picked for Otorhinolaryngology (top studies of the week, 18 October 2026): VNS + sound therapy reduces THI scores in tinnitus patients
Abstract
BACKGROUND: Tinnitus is a prevalent hearing problem linked to anxiety and depression. It currently has no cure. This systematic review and meta-analysis aimed to explore the potential association of combining vagus nerve stimulation (VNS) with auditory stimulation in alleviating tinnitus, recognizing the exploratory nature of evidence. METHODS: Six databases were searched from 1990 to 2023 (2025 updated) for randomized clinical trials, observational studies, and case studies with at least one group receiving invasive or non-invasive VNS with sound for tinnitus management. Eligible studies used validated questionnaires to quantify tinnitus distress or severity in patients compared with controls or pre-treatment status. Two reviewers extracted participant, intervention, blinding, assessment, and outcome data. The risk of bias was assessed with ROBINS-I for non-randomized studies and ROB2 for randomized controlled trials. PRISMA guidelines were followed. RESULTS: Eight studies were included in the systematic review and six in the meta-analysis. The Tinnitus Handicap Inventory (THI) and the Visual Analogue Scale (VAS) were suitable for meta-analysis. The analysis was primarily based on within-group pre‑post changes, not between‑group comparisons. For THI, the standardized mean difference (SMD) was 0.53 (95% CI: 0.12-0.94, p = 0.01), while the weighted mean difference (WMD) was 12.52 (95% CI: 4.56-20.48, p < 0.001), surpassing 7 minimal clinically important difference (MCID) threshold. For VAS, SMD was 0.55 (95% CI: 0.14-0.96, p = 0.01), but WMD was 11.21 (95% CI: 4.79-17.63, p < 0.001) and the improvement fell short of the 15 MCID. CONCLUSIONS: Within the limitations of an exploratory within‑group meta‑analysis, statistically and clinically significant reductions in THI were observed when VNS plus sound therapy. However, improvement in VAS was not clinically significant. These exploratory findings suggest a possible synergistic effect, but should not be considered conclusive evidence of comparative efficacy. Further controlled studies are needed.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.