Efficacy of Transcutaneous Auricular Vagus Nerve StimulationCombined with Retroauricular Glucocorticoid Injectionin the Treatment of Chronic Tinnitus

Authors

  • Shanwen Chen Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University
  • Yanxun Han Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University
  • Yuchen Liu Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University
  • Jiaxin Li Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University
  • Qiling Shen Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University
  • Yichen Li Head and Neck Tumor Center, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei, Anhui, China
  • Chunhui Tian Department of Otolaryngology Head and neck surgery, Suzhou hospital, Anhui Medical University, Suzhou, China
  • Yehai Liu Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University

DOI:

https://doi.org/10.71321/5nx25d85

Keywords:

tinnitus, auricular vagus nerve stimulation, neuromodulation, glucocorticoid injection

Abstract

Objective: To evaluate the efficacy of transcutaneous auricular vagus nerve stimulation (taVNS) in combination with retroauricular glucocorticoid injection for the treatment of chronic tinnitus.
Methods: This prospective, single-arm study enrolled a total of 34 patients with chronic tinnitus. All participants received combined therapy consisting of taVNS and subcutaneous triamcinolone acetonide injection at the retroauricular mastoid sieve area. The interventions were administered over a one-month period, with taVNS delivered twice daily. Assessments were performed at three time points: baseline (T0), immediately post-treatment (T1), and one month after treatment completion (T2). The primary outcome was tinnitus severity, measured using the Tinnitus Functional Index (TFI). Secondary outcomes included sleep quality (Insomnia Severity Index, ISI), anxiety (Generalized Anxiety Disorder-7, GAD-7), and depression (Patient Health Questionnaire-9, PHQ-9).
Results: Significant improvements in tinnitus severity were observed, as reflected by a reduction in TFI scores from baseline to T1 (P = 0.002), with sustained improvement at T2 (P = 0.054). ISI scores also showed significant improvement from T0 to T1 (P = 0.033), with further improvement at T2 (P = 0.011). Although GAD-7 and PHQ-9 scores did not show immediate improvement post-treatment, both decreased significantly by T2 compared with baseline (GAD-7: P = 0.001; PHQ-9: P = 0.004), indicating delayed but meaningful reductions in anxiety and depressive symptoms.
Conclusion: The combined application of taVNS and retroauricular glucocorticoid injection yielded significant reductions in tinnitus severity. While additional controlled studies are warranted, these results offer preliminary evidence that this non-invasive approach may represent a promising therapeutic strategy for chronic tinnitus.

References

[1] Carlotta M, Jarach, Alessandra, Lugo, Marco, Scala, Piet A, vandenBrandt, Christopher R, Cederroth, Anna, Odone, et al. (2022). Global Prevalence and Incidence of Tinnitus: A Systematic Review and Meta-analysis. JAMA Neurol, 10.1001/jamaneurol.2022.2189. https://doi.org/10.1001/jamaneurol.2022.2189

[2] Jay M, Bhatt, Neil, Bhattacharyya, & Harrison W, Lin. (2016). Relationships between tinnitus and the prevalence of anxiety and depression. LaryngoscoPe, 10.1002/lary.26107. https://doi.org/10.1002/lary.26107

[3] Ilias, Trochidis, Alessandra, Lugo, Elisa, Borroni, Christopher R, Cederroth, Rilana, Cima, Dimitris, Kikidis, et al. (2021). Systematic Review on Healthcare and Societal Costs of Tinnitus. Int J Environ Res Public Health, 10.3390/ijerph18136881. https://doi.org/10.3390/ijerph18136881

[4] Hans-Peter, Zenner, Wolfgang, Delb, Birgit, Kröner-Herwig, Burkhard, Jäger, Ingrid, Peroz, Gerhard, Hesse, et al. (2016). A multidisciplinary systematic review of the treatment for chronic idiopathic tinnitus. Eur Arch Otorhinolaryngol, 10.1007/s00405-016-4401-y. https://doi.org/10.1007/s00405-016-4401-y

[5] Charles B, Nemeroff, Helen S, Mayberg, Scott E, Krahl, James, McNamara, Alan, Frazer, Thomas R, Henry, et al. (2006). VNS therapy in treatment-resistant depression: clinical evidence and putative neurobiological mechanisms. Neuropsychopharmacology, 10.1038/sj.npp.1301082. https://doi.org/10.1038/sj.npp.1301082

[6] Charley A, Merrill, Michael A, Jonsson, Lennart, Minthon, Hasse, Ejnell, Hans, C-sonSilander, Kaj, Blennow, et al. (2006). Vagus nerve stimulation in patients with Alzheimer's disease: Additional follow-up results of a pilot study through 1 year. J Clin Psychiatry, 10.4088/jcp.v67n0801. https://doi.org/10.4088/jcp.v67n0801

[7] Cynthia, Aranow, Yemil, Atish-Fregoso, Martin, Lesser, Meggan, Mackay, Erik, Anderson, Sangeeta, Chavan, et al. (2020). Transcutaneous auricular vagus nerve stimulation reduces pain and fatigue in patients with systemic lupus erythematosus: a randomised, double-blind, sham-controlled pilot trial. Ann Rheum Dis, 10.1136/annrheumdis-2020-217872. https://doi.org/10.1136/annrheumdis-2020-217872

[8] Jesse, Dawson, Charles Y, Liu, Gerard E, Francisco, Steven C, Cramer, Steven L, Wolf, Anand, Dixit, et al. (2021). Vagus nerve stimulation paired with rehabilitation for upper limb motor function after ischaemic stroke (VNS-REHAB): a randomised, blinded, pivotal, device trial. Lancet, 10.1016/s0140-6736(21)00475-x. https://doi.org/10.1016/s0140-6736(21)00475-x

[9] Marios, Lampros, Nikolaos, Vlachos, Andreas, Zigouris, Spyridon, Voulgaris, & George A, Alexiou. (2021). Transcutaneous Vagus Nerve Stimulation (t-VNS) and epilepsy: A systematic review of the literature. Seizure, 10.1016/j.seizure.2021.05.017. https://doi.org/10.1016/j.seizure.2021.05.017

[10] Matthew C, Baker, Sarah, Kavanagh, Stanley, Cohen, Alan K, Matsumoto, Ara, Dikranian, John, Tesser, et al. (2023). A Randomized, Double-Blind, Sham-Controlled, Clinical Trial of Auricular Vagus Nerve Stimulation for the Treatment of Active Rheumatoid Arthritis. Arthritis Rheumatol, 10.1002/art.42637. https://doi.org/10.1002/art.42637

[11] M P, Kilgard, & M M, Merzenich. (1998). Cortical map reorganization enabled by nucleus basalis activity. Science, 10.1126/science.279.5357.1714. https://doi.org/10.1126/science.279.5357.1714

[12] Navzer D, Engineer, Jonathan R, Riley, Jonathan D, Seale, Will A, Vrana, Jai A, Shetake, Sindhu P, Sudanagunta, et al. (2011). Reversing pathological neural activity using targeted plasticity. Nature, 10.1038/nature09656. https://doi.org/10.1038/nature09656

[13] Navzer D, Engineer, Aage R, Møller, & Michael P, Kilgard. (2012). Directing neural plasticity to understand and treat tinnitus. Hear Res, 10.1016/j.heares.2012.10.001. https://doi.org/10.1016/j.heares.2012.10.001

[14] Kwaku K, Ohemeng, & Kourosh, Parham. (2019). Vagal Nerve Stimulation: Indications, Implantation, and Outcomes. Otolaryngol Clin North Am, 10.1016/j.otc.2019.09.008. https://doi.org/10.1016/j.otc.2019.09.008

[15] Mohsin F, Butt, Ahmed, Albusoda, Adam D, Farmer, & Qasim, Aziz. (2019). The anatomical basis for transcutaneous auricular vagus nerve stimulation. J Anat, 10.1111/joa.13122. https://doi.org/10.1111/joa.13122

[16] Natalia, Yakunina, Sam S, Kim, & Eui-Cheol, Nam. (2018). BOLD fMRI effects of transcutaneous vagus nerve stimulation in patients with chronic tinnitus. PLoS One, 10.1371/journal.pone.0207281. https://doi.org/10.1371/journal.pone.0207281

[17] Belgin, Tutar, Sevgi, Atar, Güler, Berkiten, Onur, Üstün, Tolgar L, Kumral, & Yavuz, Uyar. (2019). The effect of transcutaneous electrical nerve stimulation (TENS) on chronic subjective tinnitus. Am J Otolaryngol, 10.1016/j.amjoto.2019.102326. https://doi.org/10.1016/j.amjoto.2019.102326

[18] Hyun J, Shim, Min Y, Kwak, Yong-Hwi, An, Dong H, Kim, Yun J, Kim, & Hyo J, Kim. (2016). Feasibility and Safety of Transcutaneous Vagus Nerve Stimulation Paired with Notched Music Therapy for the Treatment of Chronic Tinnitus. J Audiol Otol, 10.7874/jao.2015.19.3.159. https://doi.org/10.7874/jao.2015.19.3.159

[19] Jarmo, Lehtimäki, Petteri, Hyvärinen, Matti, Ylikoski, Mikael, Bergholm, Jyrki P, Mäkelä, Antti, Aarnisalo, et al. (2012). Transcutaneous vagus nerve stimulation in tinnitus: a pilot study. Acta Otolaryngol, 10.3109/00016489.2012.750736. https://doi.org/10.3109/00016489.2012.750736

[20] Jukka, Ylikoski, Marika, Markkanen, Ulla, Pirvola, Jarmo A, Lehtimäki, Matti, Ylikoski, Zou, Jing, et al. (2020). Stress and Tinnitus; Transcutaneous Auricular Vagal Nerve Stimulation Attenuates Tinnitus-Triggered Stress Reaction. Front Psychol, 10.3389/fpsyg.2020.570196. https://doi.org/10.3389/fpsyg.2020.570196

[21] Peter M, Kreuzer, Michael, Landgrebe, Markus, Resch, Oliver, Husser, Martin, Schecklmann, Florian, Geisreiter, et al. (2014). Feasibility, safety and efficacy of transcutaneous vagus nerve stimulation in chronic tinnitus: an open pilot study. Brain Stimul, 10.1016/j.brs.2014.05.003. https://doi.org/10.1016/j.brs.2014.05.003

[22] Won C Suk, Su J Kim, Dong S Chang, & Ho Y Lee. (2018). Characteristics of Stimulus Intensity in Transcutaneous Vagus Nerve Stimulation for Chronic Tinnitus. J Int Adv Otol, 10.5152/iao.2018.3977. https://doi.org/10.5152/iao.2018.3977.

[23] Mary B Meikle, James A Henry, Susan E Griest, Barbara J Stewart, Harvey B Abrams, Rachel, McArdle, et al. (2011). The tinnitus functional index: development of a new clinical measure for chronic, intrusive tinnitus. Ear Hear, 10.1097/AUD.0b013e31822f67c0. https://doi.org/10.1097/AUD.0b013e31822f67c0

[24] Xianren Wang, Ruyan Zeng, Huiwen Zhuang, Qiyang Sun, Zijun Yang, Cangjian Sun, et al. (2020). Chinese validation and clinical application of the tinnitus functional index. Health Qual Life Outcomes, 10.1186/s12955-020-01514-w. https://doi.org/10.1186/s12955-020-01514-w

[25] C H Bastien, A Vallières, & C M Morin. (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med, 10.1016/s1389-9457(00)00065-4. https://doi.org/10.1016/s1389-9457(00)00065-4

[26] Robert L Spitzer, Kurt Kroenke, Janet B Williams, & Bernd Löwe. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med, 10.1001/archinte.166.10.1092. https://doi.org/10.1001/archinte.166.10.1092

[27] K Kroenke, R L Spitzer, & J B Williams. (2001). The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med, 10.1046/j.1525-1497.2001.016009606.x. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

[28] Berthold Langguth, Peter M Kreuzer, Tobias Kleinjung, & Dirk DeRidder. (2013). Tinnitus: causes and clinical management. Lancet Neurol, 10.1016/s1474-4422(13)70160-1. https://doi.org/10.1016/s1474-4422(13)70160-1

[29] Dirk DeRidder, Sven Vanneste, Jae-Jin Song, & Divya Adhia. (2022). Tinnitus and the Triple Network Model: A Perspective. Clin Exp Otorhinolaryngol, 10.21053/ceo.2022.00815. https://doi.org/10.21053/ceo.2022.00815

[30] Shanwen Chen, Maoshan Du, Yang Wang, Yifan Li, Busheng Tong, Jianxin Qiu, et al. (2023). State of the art: non-invasive electrical stimulation for the treatment of chronic tinnitus. Ther Adv Chronic Dis, 10.1177/20406223221148061. https://doi.org/10.1177/20406223221148061

[31] Scott T Aaronson, Peter Sears, Francis Ruvuna, Mark Bunker, Charles R Conway, Darin D Dougherty, et al. (2017). A 5-Year Observational Study of Patients With Treatment-Resistant Depression Treated With Vagus Nerve Stimulation or Treatment as Usual: Comparison of Response, Remission, and Suicidality. Am J Psychiatry, 10.1176/appi.ajp.2017.16010034. https://doi.org/10.1176/appi.ajp.2017.16010034

[32] Wang Y, Han L, Diao T, Jing Y, Wang L, Zheng H, et al. (2018). A comparison of systemic and local dexamethasone administration: From perilymph/cochlea concentration to cochlear distribution. Hear Res, 370, 1-10. https://doi.org/10.1016/j.heares.2018.09.002

[33] Sean L Thompson, Georgia H O'Leary, Christopher W Austelle, Elise Gruber, Alex T Kahn, Andrew J Manett, et al. (2021). A Review of Parameter Settings for Invasive and Non-invasive Vagus Nerve Stimulation (VNS) Applied in Neurological and Psychiatric Disorders. Front Neurosci, 10.3389/fnins.2021.709436. https://doi.org/10.3389/fnins.2021.709436

[34] Jonathan Y Yap, Charlotte Keatch, Elisabeth Lambert, Will Woods, Paul R Stoddart, & Tatiana Kameneva. (2020). Critical Review of Transcutaneous Vagus Nerve Stimulation: Challenges for Translation to Clinical Practice. Front Neurosci, 10.3389/fnins.2020.00284. https://doi.org/10.3389/fnins.2020.00284

Type

Research Article

Published

2025-12-14

Issue

Section

Otology, Audiology and Neurotology

How to Cite

Chen, S., Han, Y., Liu, Y., Li, J., Shen, Q., Li, Y., Tian, C., & Liu, Y. (2025). Efficacy of Transcutaneous Auricular Vagus Nerve StimulationCombined with Retroauricular Glucocorticoid Injectionin the Treatment of Chronic Tinnitus. Head and Neck Diseases Conflux, 1(2), e286. https://doi.org/10.71321/5nx25d85

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