Objective: This literature review aims to investigate the efficacy and safety of deep brain stimulation for primary refractory tinnitus. It seeks to describe the current state of evidence for this new DBS indication by considering neuroanatomical sites, patient characteristics, treatment response, adverse effects, and other considerations. It also discusses the pathophysiology of tinnitus and how DBS might modulate this disease process.

Background: Tinnitus is a common and often debilitating condition with limited evidence-based treatment options. Deep Brain Stimulation (DBS) is an approved treatment modality for certain neurological conditions, but its experimental use as a treatment modality for severe tinnitus is novel and beginning to show promise. This systematic review focuses on the current evidence for the safety and efficacy of DBS for treatment of refractory tinnitus.

Method: A systematic search in PubMed and EMBASE was performed to identify peer-reviewed studies for DBS of non-cortical structures for the primary indication of tinnitus treatment. Three studies were identified meeting these criteria, one of which had two related sub-studies.

Results: Seven patients with available data who underwent DBS for tinnitus were identified. DBS targets included Nucleus Accumbens (NAc),ventral anterior limb of the internal capsule (vALIC), Caudate Nucleus, and the Medial geniculate body (MGB) of the thalamus. All studies used the Tinnitus Functional Index (TFI) as a primary outcome measure. DBS of the caudate was most commonly reported (n=5) with a mean TFI improvement of 23.3 points. Only one subject underwent DBS targeting the NAc/vALIC (extrapolated TFI improvement 46.8) and one subject underwent DBS targeting the MGB (TFI improvement 59 points).

Conclusion: Deep Brain Stimulation is a promising treatment option for refractory subjective tinnitus, with early data from a small patient cohort from multiple studies supporting its efficacy. These outcomes demonstrate that DBS should continue to be considered as a treatment modality for patients with this condition.

PRISMA diagram detailing the review process

Outcomes 1

Adverse effects

Outcomes 2

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MDS Abstracts - https://www.mdsabstracts.org/abstract/deep-brain-stimulation-for-primary-refractory-tinnitus-a-systematic-review/