Chen, Jiann-Jy, Chen, Yen-Wen, Zeng, Bing-Yan, Hung, Chao-Ming, Zeng, Bing-Syuan, Stubbs, Brendon, Carvalho, Andre F., Thompson, Trevor ORCID: https://orcid.org/0000-0001-9880-782X, Roerecke, Michael, Su, Kuan-Pin, Tu, Yu-Kang, Wu, Yi-Cheng, Smith, Lee, Chen, Tien-Yu, Lin, Pao-Yen, Liang, Chih-Sung, Hsu, Chih-Wei, Hsu, Shih-Pin, Kuo, Hung-Chang, Wu, Ming-Kung and Tseng, Ping-Tao (2021) Efficacy of pharmacologic treatment in tinnitus patients without specific or treatable origin: a network meta-analysis of randomised controlled trials. EClinicalMedicine:101080. ISSN 25895370 (doi:10.1016/j.eclinm.2021.101080)

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Abstract

Background
Although tinnitus has a prevalence between 20 and 42.8%, the currently recommended management for tinnitus, such as tinnitus support and psychologic therapies, are relatively time-consuming and expensive. Several new pharmacologic treatments designed for tinnitus patients without specific origin had been developed but their efficacy remains unclear.
Methods
The current Network Meta-Analysis (NMA) of randomised controlled trials (RCTs) was conducted to evaluate the efficacy of different pharmacologic treatments for tinnitus management in tinnitus patients without specific or treatable origin (i.e. primary tinnitus). Databases were searched from inception to April 5th, 2021. All network meta-analytic procedures were conducted under the frequentist model. We calculated the effect size of outcomes with different rating scales with standardized mean difference. PROSPERO registration: CRD42020177742.
Findings
Overall, 36 RCTs were included with 2,761 participants. The main results revealed that pharmacologic interventions with brain-acting effect (for example, amitriptyline, acamprosate, and gabapentin) and those with anti-inflammation/anti-oxidant effect (for example, intra-tympanic dexamethasone injection plus oral melatonin) were associated with superior improvement in tinnitus severity and response rate compared to placebo/control. Oral amitriptyline were associated with the highest improvement in tinnitus severity and the fourth highest response rate. None of the investigated interventions was associated with different changes in quality of life compared to placebo/control. All the investigated treatments were associated with similar drop-out rate to placebo/control.
Interpretation
The current NMA suggests a potential role for treatments with brain-acting effect (for example, amitriptyline, acamprosate, and gabapentin) or anti-inflammation/anti-oxidant effect (for example, intra-tympanic dexamethasone injection plus oral melatonin) as the preferable effective treatments for tinnitus without specific or treatable origin.

Item Type:	Article
Uncontrolled Keywords:	network meta-analysis; tinnitus; treatment; intervention
Subjects:	R Medicine > RB Pathology R Medicine > RF Otorhinolaryngology
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > School of Human Sciences (HUM) Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development > Centre for Chronic Illness and Ageing
Related URLs:	Publisher Publisher
Last Modified:	23 Sep 2021 09:56
URI:	http://gala.gre.ac.uk/id/eprint/33585

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