经皮神经电刺激治疗慢性主观性耳鸣：临床疗效与神经可塑性机制

Transcutaneous Electrical Nerve Stimulation for Chronic Subjective Tinnitus: Clinical Efficacy and Neuroplasticity Mechanisms

摘要: 目的：系统评价经皮神经电刺激(transcutaneous electrical nerve stimulation, TENS)治疗慢性主观性耳鸣的临床疗效，并探讨其潜在神经可塑性机制。方法：检索PubMed、Web of Science、Cochrane Library、CNKI及万方数据库建库至2025年12月关于TENS及其变体(经皮耳迷走神经刺激taVNS、经皮三叉神经刺激)治疗慢性主观性耳鸣的临床研究，系统归纳TENS对耳鸣主观感知(耳鸣致残量表THI、耳鸣功能指数TFI、视觉模拟量表VAS)、共病情绪(GAD-7、PHQ-9、HADS、BAI)及睡眠质量(PSQI)的改善作用，并整合听性脑干反应(ABR)与静息态脑电图(EEG)证据，分析其对听觉通路及大脑网络可塑性的调节作用。结果：现有证据表明，TENS可显著降低THI评分(平均降低约7.6~16.2分)，约35%~45%患者报告主观症状改善，疗效主要表现为减轻耳鸣相关主观困扰与致残性而非消除耳鸣感知本身。由于多数研究存在盲法实施的固有困难，上述效应量可能部分受到安慰剂效应的影响。客观电生理研究显示，TENS可抑制听觉脑干过度兴奋(ABR I波波幅降低、波间期缩短)，并在皮层水平增强额叶α功率、抑制听觉及相关皮层γ振荡，削弱听觉皮层与默认网络(DMN)、边缘系统间的病理功能连接。结论：TENS作为安全、无创辅助疗法，可通过调节听觉–体感整合通路与大脑网络振荡短期内有效减轻耳鸣相关困扰与共病情绪。未来需通过改进研究设计(尤其是采用令人信服的假刺激对照)来更精确地评估其真实效应，并基于耳鸣亚型开展精准分层研究，结合声治疗优化个体化方案以提升长期疗效。

Abstract: Objective: This systematic review aims to comprehensively evaluate the clinical efficacy of TENS in chronic subjective tinnitus and to explore its underlying neuroplasticity mechanisms. Methods: A systematic literature search was performed in PubMed, Web of Science, Cochrane Library, CNKI and Wanfang databases up to December 2025 for clinical studies on TENS, taVNS and trigeminal branch stimulation in chronic subjective tinnitus. The review focused on subjective tinnitus perception (THI; TFI; VAS), comorbid emotional symptoms (GAD-7, PHQ-9, HADS, BAI) and sleep quality (PSQI), together with objective electrophysiological evidence from ABR and resting-state EEG. Results: Current evidence demonstrates that TENS produces a mild-to-moderate but clinically meaningful reduction in tinnitus-related distress: meta-analyses show that electrical stimulation including TENS can reduce THI scores by approximately 7.6~16.2 points, with about 35%~45% of patients reporting subjective symptom relief. The improvement is more pronounced in reducing functional disability and emotional burden than in decreasing perceived loudness. Due to inherent challenges in blinding, effect sizes may be partially influenced by placebo responses. Objective electrophysiology provides convergent support: at the brainstem level, ABR studies report reductions in Wave I amplitude and shortened inter-peak latencies (I~III, III~V); at the cortical level, EEG studies demonstrate enhanced frontal alpha power and suppressed excessive gamma oscillations in auditory-related regions, with decoupling of hyperconnectivity between auditory cortex, the DMN and the limbic system. Conclusion: As a safe, non-invasive adjunctive therapy, TENS can alleviate tinnitus-related distress and comorbid emotional symptoms in the short term by modulating the auditory-somatosensory integration pathway and rebalancing aberrant brain network oscillations. Future studies should employ improved methodology—particularly convincing sham controls—and adopt precision-medicine approaches based on tinnitus subtypes, combined with sound therapy (bimodal neuromodulation), to achieve sustained benefits.