Evidence map›Paper›PMID 42867641›Full record

ReviewEuropean 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 Surgery2026

Effect of the vagus nerve stimulation combined with sound therapy for tinnitus treatment: a systematic review and meta-analysis.

Mitra Rezapour, Mir Mohammad Jalali, Shadman Nemati, Azadeh Borna

Abstract readReview
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In one paragraph

Review in 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, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Mitra RezapourOtorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran.ORCID http://orcid.org/0000-0001-6825-7468
Mir Mohammad JalaliOtorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran. mmjalali@gmail.com.ORCID http://orcid.org/0000-0002-7030-7070
Shadman NematiOtorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran.ORCID http://orcid.org/0000-0002-5246-1023
Azadeh BornaDepartment of Audiology, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.ORCID http://orcid.org/0000-0001-6832-9978

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTinnitus 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.

methodsSix 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.

resultsEight 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.

conclusionsWithin 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.

Indexed as

Bimodal stimulationMinimal clinically important differenceSound therapyTinnitusTinnitus handicap inventoryVagus nerve stimulationVisual analogue scale

Identifiers

PMID42867641

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.