耳鼻咽喉科中的无创迷走神经刺激：范围综述与证据图。

文献信息

中文摘要

背景： 无创迷走神经刺激（nVNS）可能通过迷走传入通路影响脑干核团及上行网络，并已被研究作为耳鼻咽喉科问题的附加治疗。然而，其证据基础较为零散且方法学多样。
目的： 开展一项带有证据图的全面综述，以绘制并综合已报道的nVNS在耳鼻咽喉科中的人体临床证据，并识别未来研究的空白。
方法： 按照PRISMA-ScR指南，在PubMed、Embase、Web of Science和Scopus数据库中进行了从建库至2025年12月20日的范围综述。符合条件的设计包括随机和非随机干预试验、队列和机制分析以及病例系列。数据使用预先定义的耳鼻咽喉科结局域框架进行组织，并以证据图形式呈现。
结果： 在4974条记录中，筛选了2690条唯一记录，并纳入20项研究。共涉及七个适应证类别：咽部感觉异常（n=1）、喉咽反流相关疾病（n=1）、MD（n=2）、嗅觉功能障碍（n=2）、吞咽困难（n=3）、前庭疾病/前庭康复（n=3）以及耳鸣（n=8）。结局主要为患者报告结局，并选择了部分客观功能和机制指标。常见局限性包括样本量小、对照和盲法策略不一、刺激参数和疗程定义不统一、随访时间短以及不良事件报告异质性较大。
结论： 当前关于耳鼻咽喉科nVNS的证据在很大程度上仍属探索性，不应被解释为已确立临床有效性。耳鸣构成最大的证据集群，而前庭康复和吞咽困难研究更常纳入可操作的功能终点。未来的验证性试验应统一刺激和报告标准，加强假刺激对照盲法，预先指定表型和机制锚点，并延长随访以评估持久性和维持效果。

英文摘要

BACKGROUND: Noninvasive vagus nerve stimulation (nVNS) may influence brainstem nuclei and ascending networks via vagal afferent pathways and has been investigated as an additional treatment for otolaryngological problems. Nonetheless, the evidence base is fragmented and methodologically diverse.
OBJECTIVE: To conduct a comprehensive review with evidence mapping to map and synthesize reported human clinical evidence on nVNS in otolaryngology and identify gaps for future studies.
METHODS: A scoping review guided by PRISMA-ScR was conducted in the PubMed, Embase, Web of Science, and Scopus databases from inception to December 20, 2025. Eligible designs included randomized and nonrandomized interventional trials, cohort and mechanistic analyses, and case series. Data were organized using a predefined otolaryngology outcome-domain framework and presented as an evidence map.
RESULTS: Of 4974 records, 2690 unique records were screened, and 20 studies were included. Seven indication categories were represented: pharyngeal dysesthesia (n = 1), laryngopharyngeal reflux-related disorders (n = 1), MD (n = 2), olfactory dysfunction (n = 2), dysphagia (n = 3), vestibular disorders/vestibular rehabilitation (n = 3), and tinnitus (n = 8). Outcomes were primarily patient-reported, with selected objective functional and mechanistic measures. Common limitations included small samples, variable comparators and blinding strategies, non-harmonized stimulation parameters and treatment-course definitions, short follow-up, and heterogeneous reporting of harms.
CONCLUSIONS: Current evidence on otolaryngologic nVNS is largely exploratory and should not be interpreted as establishing clinical effectiveness. Tinnitus constitutes the largest evidence cluster, whereas vestibular rehabilitation and dysphagia studies more often incorporate operationalizable functional endpoints. Future confirmatory trials should harmonize stimulation and reporting, strengthen sham-controlled blinding, prespecify phenotype and mechanistic anchors, and extend follow-up to assess durability and maintenance.