Direct and Transcutaneous Vagus Nerve Stimulation for Treatment of Tinnitus: A Scoping Review

Natalia Yakunina, Eui-Cheol Nam, Natalia Yakunina, Eui-Cheol Nam

Abstract

Recent animal research has shown that vagus nerve stimulation (VNS) paired with sound stimuli can induce neural plasticity in the auditory cortex in a controlled manner. VNS paired with tones excluding the tinnitus frequency eliminated physiological and behavioral characteristics of tinnitus in noise-exposed rats. Several clinical trials followed and explored the effectiveness of VNS paired with sound stimuli for alleviating tinnitus in human subjects. Transcutaneous VNS (tVNS) has received increasing attention as a non-invasive alternative approach to tinnitus treatment. Several studies have also explored tVNS alone (not paired with sound stimuli) as a potential therapy for tinnitus. In this review, we discuss existing knowledge about direct and tVNS in terms of applicability, safety, and effectiveness in diminishing tinnitus symptoms in human subjects. This review includes all existing clinical and neuroimaging studies of tVNS alone or paired with acoustic stimulation in tinnitus patients and outlines the present limitations that must be overcome to maximize the potential of (t)VNS as a therapy for tinnitus.

Keywords: auricular branch of vagus nerve; neuromodulation; tinnitus; transcutaneous vagus nerve stimulation; vagus nerve stimulation.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Yakunina and Nam.

Figures

FIGURE 1
FIGURE 1
(A) Acustom-built MRI-compatible tVNS stimulator used in the tVNS fMRI studies by Yakunina et al., 2017, (B) Six silver electrodes (four active, two reference electrodes). (C) tVNS stimulation locations: inner surface of the tragus (A), inferoposterior wall of the external acoustic meatus (B), cymba conchae (C), and earlobe (sham; D).
FIGURE 2
FIGURE 2
Activation maps induced by tVNS in the tragus (A), inferoposterior wall of the external acoustic meatus (B), concha (C), and earlobe (D). tVNS at the tragus and concha activated the locus coeruleus (LC) and nucleus of the solitary tract (NTS), while tVNS at the ear canal and earlobe did not activate either brain center.
FIGURE 3
FIGURE 3
Activations (red) and deactivations (blue) induced by tVNS at the tragus and cymba conchae in tinnitus patients. tVNS resulted in deactivation of the auditory and limbic systems, as well as a number of other cortical areas. ACC/MCC/PCC, anterior/middle/posterior cingulate cortex; Amyg, amygdala; AnG, angular gyrus; CC, corpus callosum; CBLL, cerebellum; FuG, fusiform gyrus; Hip, hippocampus; LiG, lingual gyrus; MOG, middle orbital gyrus; MTG/STG, middle/superior temporal gyrus; PCu, precuneus; PoG/PrG, postcentral/precentral gyrus; SFG, superior frontal gyrus; TMP, temporal pole.

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