Table 3.

Meta-analyses and systematic reviews: Summary of characteristics, results, and conclusions of 1 systematic review and 3 meta-analyses of RCTs regarding the efficacy of rTMS for the treatment of Tinnitus.

Author	Year	Number of Studies Analyzed and Years of Interest	Location Target(s)	Neuromodulation Frequencies	Main Outcome Assessment	Heterogeneity (I2 Analysis)	Results	Conclusions
Schoisswoh et al. [53]	2019	-55 significant study arms from 2005 to 2017 -18 insignificant study arms from 2007 to 2017 -Randomized controlled trials	-Temporal cortex (n = 32,9) -Temporoparietal cortex (n = 23, 9) -Prefrontal in addition to AC (n = 9,7)	-Inhibitory: 1 Hz, cTBS (n = 49, 18) -Excitatory: 10 Hz, 25 Hz (n = 6, 0)	-Chi-squared analysis of reported significant and not significant results of study arms	-Not applicable, only a systematic review performed	-Higher efficacy in active rTMS compared to sham rTMS -Lower stimulation intensity associated with significance -Lower number of pulses increased significance -Adding prefrontal cortical areas did not contribute to significance	-Meta-analysis would have given less of a dichotomized result -There are many factors that go into rTMS efficacy in treating tinnitus -The prefrontal cortex may not be significant due to the addition of more pulses -rTMS protocols need to be more standardized for a definitive analysis
Lefebvre-Demers et al. [54]	2020	-28 studies from 2004 to 2019 -Randomized controlled trials	-Auditory cortex (n = 16) -Temporoparietal area (n = 17) -DLPFC and left AC (n = 3) - DLPFC and both AC (n = 1) -Frontal cortex (n = 1)	-1 Hz (n =20) -10 Hz (n =1), -50 Hz cTBS (n = 4) -27,12 MHz (n 1⁄4 1) -≥1 frequency (20 Hz and 1 Hz, n = 1; 25 Hz and 1 Hz, n = 1)	-THI (n = 20) -Tinnitus Questionnaire (TQ) (n = 6) -Tinnitus Functional Index (TFI) (n = 1) -Tinnitus Severity Index (TSI) (n = 1)	-moderate total heterogeneity (54.9%)	-Sample size: 34 ± 29 participants -Tinnitus outcomes: Pre- to post-rTMS Hedges g-value of 0.45 (CI = 0.66; 0.24; p < 0.0001), showing a moderate effect -Active rTMS showed a statistically significant mean change in questionnaire scores of 7.60 -Location: rTMS targeting the AC significantly reduced symptoms compared to other sites	-rTMS is an effective treatment option for tinnitus based on the effect on standardized questionnaires
Dong et al. [55]	2020	-10 studies from 2010 to 2019 -Randomized controlled trials	-Temporal cortex/auditory cortex only (n = 7) -Temporoparietal cortex only (n = 2) -Temporal with the frontal regions (n = 1)	-1 Hz with 100% or 110% RMT with varying pulses of 1000, 1020, 1500, 2000, 3000, and 4000)	-THI only (n = 4) -TQ only (n = 1) -VAS only (n = 1) -THI and TQ (n = 1) -THI and VAS (n = 1) -THI, TQ, and VAS (n = 2)	-No heterogeneity	-A pooled analysis showed that active rTMS had no significant effect on THI scores compared with sham in the short term, medium term, or long term -A pooled analysis showed no significant effect of active rTMS on the loudness assessed by VAS in the short term, medium term, or long term -A pooled analysis showed no significant improvement of the severity assessed by TQ in the short term, medium term, or long term	-The review showed no significant improvement of tinnitus symptoms following rTMS treatment compared to sham -Inconsistent with previous studies and may be limited to a small sample size
Liang et al. [56]	2020	-29 studies from 2010 to 2019 -Randomized controlled trials	-Auditory cortex (n = 27) -Motor cortex (n = 1) -Not specified (n = 1)	-1 Hz most frequently used (93.1%)	-THI and TQ scores at 1 week, 2 weeks, 1 month, and 6 months post treatment	-0% at 1 week -0% at 1 month -21% at 6 months	-Significant difference in THI scores at 1 week, 1 month, and 6 months compared to sham -Significant difference in TQ scores 1-week post treatment compared to sham	-Efficacy of active rTMS compared to sham proven in the analysis -More studies needed for further confirmation