Effectiveness of Theta-Burst Repetitive Transcranial Magnetic Stimulation for Treating Chronic Tinnitus

Abstract

Objectives: Repetitive transcranial magnetic stimulation (rTMS), a noninvasive method for altering cortical excitability, is becoming a therapeutic strategy in auditory research institutions worldwide. Application of inhibiting rTMS on these overactive cortical regions can result in effective tinnitus suppression. The aim of this study is to investigate the efficacy of theta-burst rTMS in patients with chronic tinnitus. Study Design: Parallel randomized control study. Setting: Tertiary referral center. Patients: We enrolled 2 female and 20 male patients in this study. The evaluative tools included tinnitus frequency- and loudness-matching, tinnitus questionnaires (TQ), and the Tinnitus Handicap Inventory (THI). Methods: The orthogonal projection of the auditory cortex on the scalp was focalized. A figure-eight coil was placed on the surface of the skull over the targeted region with the intensity setting at 80% of the resting motor threshold. We delivered 900 pulses of theta-burst rTMS daily for 10 business days. Main Outcome Measures: Nine of twelve patients (75%) in the active-stimulation group reported tinnitus suppression following treatment with rTMS. The treatment led to reductions of 8.58 and 8.33 in the mean TQ global and THI scores, respectively. Tinnitus loudness also decreased significantly after delivering rTMS. Results: Descriptive analysis of the TQs revealed that patients experienced significant improvements in emotional distress levels and somatic symptoms. Conclusions: Our preliminary results demonstrate that theta-burst rTMS treatments offer a method of modulating tinnitus. Patients could benefit from emotional improvements, even more than auditory perceptive relief. Further studies are needed to establish a standard protocol and to clarify nervous propagation along the auditory and psychological projection following treatment with rTMS.

Tinnitus does not require macroscopic tonotopic map reorganization

“…Our finding may therefore help explain the reported success of some recently developed transcranial magnetic stimulation (TMS) therapies that target left auditory cortex (Burger et al, 2011; Chung et al, 2012). …”

Neuroimaging and Neuromodulation: Complementary Approaches for Identifying the Neuronal Correlates of Tinnitus

“…Placing the coil over the left temporal area according to the 10–20 EEG coordinate systems (Langguth et al, 2006b) also resulted in a significant reduction of tinnitus severity after 10 sessions of 1 Hz rTMS. Beneficial effects of low-frequency rTMS have been confirmed by many (Rossi et al, 2007; Smith et al, 2007; Khedr et al, 2008, 2010; Anders et al, 2010; Marcondes et al, 2010; Chung et al, 2011; Mennemeier et al, 2011) but not by all controlled studies (Piccirillo et al, 2011). Unspecific effects can largely be excluded since all mentioned studies controlled for the acoustic artifact by using a sham condition and in two recent studies the control condition even involved additional electrical superficial nerve stimulation (Rossi et al, 2007; Mennemeier et al, 2011).…”

Bilateral Low-Frequency Repetitive Transcranial Magnetic Stimulation of the Auditory Cortex in Tinnitus Patients Is Not Effective: A Randomised Controlled Trial

“…In addition to the abovementioned RCTs on low-frequency rTMS, 2 RCT on theta-burst rTMS have been performed and 2 RCT on high-frequency rTMS. One study finds a significant improvement for theta-burst rTMS compared with placebo [Chung et al, 2012], the other did not find a difference between theta-burst rTMS and placebo [Plewnia et al, 2012]. The 2 RCTs on high-frequency rTMS both found a significant effect [Fregni et al, 2006;Khedr et al, 2008].…”