Modulation of activity in the left temporoparietal area (LTA) by 10 Hz repetitive transcranial magnetic stimulation (rTMS) results in a transient reduction of tinnitus. We aimed to replicate these results and test whether transcranial direct current stimulation (tDCS) of LTA could yield similar effect. Patients with tinnitus underwent six different types of stimulation in a random order: 10-Hz rTMS of LTA, 10-Hz rTMS of mesial parietal cortex, sham rTMS, anodal tDCS of LTA, cathodal tDCS of LTA and sham tDCS. A non-parametric analysis of variance showed a significant main effect of type of stimulation (P = 0.002) and post hoc tests showed that 10-Hz rTMS and anodal tDCS of LTA resulted in a significant reduction of tinnitus. These effects were short lasting. These results replicate the findings of the previous study and, in addition, show preliminary evidence that anodal tDCS of LTA induces a similar transient tinnitus reduction as high-frequency rTMS.

These results support the potential of rTMS as a new therapeutic tool for the treatment of chronic tinnitus, by demonstrating a significant reduction of tinnitus complaints over a period of at least 6 months and significant reduction of neural activity in the inferior temporal cortex, despite the stimulation applied on the superior temporal cortex.

Even in this early stage of investigation, there is a convincing body of evidence that rTMS represents a promising tool for pathophysiological assessment and therapeutic management of tinnitus. Further development of this technique will depend on a more detailed understanding of the neurobiological effects mediating the benefit of TMS on tinnitus perception. Moreover clinical studies with larger sample sizes and longer follow-up periods are needed.

The mechanisms underlying tinnitus are still not completelyelucidated, but advances inn euroimaging and brain stimulation have provided us with new insights. Evidence sugge sts that tinnitus might actua lly be generated by central rather than periph eral structures. To illustrate the importance of brain activity changes in the pa thology of tinnitus, we report the cases of2 pat ients who expe rienced a recurrence/ worsening of their tinnitus after they had undergone treatment fo r major depression with repetitive transcranial magnetic stimul ation. We suggest that the tinnitus in these 2 pa tients was induced by changes in bra in activity resul ting fro m transcranial magnetic stimulation of the prefrontal cortex. We also review the path ophysiology and other aspects of tinnitus. f ocusing on associa ted brain reorganization.

Stapedotomy is primarily performed to treat hearing loss secondary to otospongiosis, although some patients find that the accompanying tinnitus is more bothersome than the hearing loss. Weprospectively studied 23 consecutive patients with tinnitus secondary to otospongiosis who had undergone s tapedotomy, and we compared their pre-and postoperative medical and audiologic findings. Patients' annoyance with their tinnitus was quantified by means of a visual analog scale, and their air-conduction thresholds were determined by measurements ofa-t-frequency puretone average (0.5, 1,2, and 4 kHz). Statistical analysis was performed using the paired Student s t test and Fisher s exact test. In the group as a whole , the mean tinnitus annoyance visual analog scores were 8.34 preoperatively and 1.56 postoperatively, a highly Significant difference. Clinically, 22 of the 23 patients (95.7%) achieved satisfactory control oftheir tinnitus (improvement or complete resolution)followingstapedotomy. Withrespect to hearing loss, all patients clinically improvedpostoperatively, and audiometry confirmed improvement at all 4 frequencies between 0.5 and 4 kHz. An air-bone gap of less than 10 dB was noted in 17 patients (73.9%). We conclude that in addition to improving hearing, stapedotomy also provides good control oftinnitus.