Electric field-navigated transcranial magnetic stimulation for chronic tinnitus: a randomized, placebo-controlled study

Sahlsten, Hanna; Virtanen, Juuso; Joutsa, Juho; Niinivirta-Joutsa, Katri; Löyttyniemi, Eliisa; Johansson, Reijo; Paavola, Janika; Taiminen, Tero; Sjösten, Noora; Salonen, Jarno; Holm, Anu; Rauhala, Esa; Jääskeläinen, Satu K.

doi:10.1080/14992027.2017.1313461

Cited by 20 publications

(55 citation statements)

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“…Twenty-six articles remained when we removed the duplicates and screened the titles and abstracts. After screening the full text, we included 10 RCTs [12,[14][15][16][17][18][19][20][21][22] with a total of 567 participants in our meta-analysis ( Figure 1). Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…The risk of bias of the nine included studies is summarized in Figure 2. Seven studies [12,14,[16][17][18][19]21] described the method of random sequence generation in detail, while three studies [15,20,22] did not provide sufficient information about randomized methods. Five studies [12,14,16,17,21] reported adequate allocation concealment.…”

Section: Risk Of Biasmentioning

confidence: 99%

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Low-Frequency Repetitive Transcranial Magnetic Stimulation for the Treatment of Chronic Tinnitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Dong

Chen

Wang

et al. 2020

BioMed Research International

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Background. Chronic tinnitus affects approximately 10-15% of the population. Low-frequency repetitive transcranial magnetic stimulation (rTMS) has been considered as a promising and well-tolerated therapeutic strategy for chronic tinnitus. However, a recent large-scale multicenter clinical trial showed a negative result. Objective. This systematic review is aimed at assessing the efficacy and safety of low-frequency rTMS in chronic tinnitus. Methods. We searched PubMed, Embase, and Cochrane Library for randomized controlled studies of rTMS treatment of chronic tinnitus. A pooled analysis of standardized mean difference (SMD) was performed with 95% confidence intervals (CI). Results. Ten RCTs involving 567 participants were included in this review. Compared with sham stimulation, rTMS showed no significant efficacy in tinnitus severity and disability measured by Tinnitus Handicap Inventory (THI) in short-term (SMD=−0.04, 95% CI -0.23 to 0.16, P=0.72), medium-term (SMD=−0.13, 95% CI -0.43 to 0.17, P=0.41), and long-term (SMD=−0.16, 95% CI -0.38 to 0.05, P=0.14) follow-up. Tinnitus severity and disability measured by Tinnitus Questionnaire (TQ) also showed no significant improvement in short-term (SMD=−0.11, 95% CI -0.31 to 0.10, P=0.30), medium-term (SMD=−0.10, 95% CI -0.37 to 0.16, P=0.44), and long-term (SMD=−0.20, 95% CI -0.40 to 0.01, P=0.06) follow-up. Additionally, no statistically significant difference was shown in the changes of tinnitus loudness assessed by a visual analogue scale (VAS) between rTMS and sham groups in the short-term (SMD=−0.28, 95% CI -0.59 to 0.02, P=0.07), medium-term (SMD=−0.26, 95% CI -0.59 to 0.07, P=0.13), and long-term (SMD=−0.20, 95% CI -0.53 to 0.13, P=0.24) follow-up. Few mild or moderate adverse events were observed in both the rTMS and sham groups. Conclusion. Low-frequency rTMS is well tolerated but not effective in treating chronic tinnitus based on the current analysis of pooled data. Further studies with modified and uniform protocols are required to investigate the potential benefit of rTMS in chronic tinnitus.

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Section: Resultsmentioning

confidence: 99%

Section: Risk Of Biasmentioning

confidence: 99%

Low-Frequency Repetitive Transcranial Magnetic Stimulation for the Treatment of Chronic Tinnitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Dong

Chen

Wang

et al. 2020

BioMed Research International

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“…Six stimulation positions for rTMS were localized in reference to Sahlsten et al (3). Stimulation positions consisted of anterior (aSTG), middle (mSTG), and posterior (pSTG) parts of the left and right STG.…”

Section: Rtms Test Sessionmentioning

confidence: 99%

Short-Term Tinnitus Suppression With Electric-Field Guided rTMS for Individualizing rTMS Treatment: A Technical Feasibility Report

2020

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Background: Past research highlighted the benefits of personalized repetitive transcranial magnetic stimulation (rTMS) for the treatment of chronic subjective tinnitus. Objective/Hypothesis: The objective was to investigate the feasibility of rTMS personalization by identifying individually optimal stimulation parameters in test sessions. Particularly, effectiveness and retest-reliability of different stimulation parameters were examined. Methods: Via electric-field guided rTMS, five patients were stimulated with different frequencies on three positions of the left and right superior temporal gyrus on 2 separate days. After each stimulation, the patients had to evaluate tinnitus loudness and discomfort of the used protocol. Results: Individualization of rTMS was possible in all five patients. Significant lower tinnitus loudness was found for 1 Hz stimulation. Positive correlations between 2 days were observed for hemisphere (left, right), position (mSTG, pSTG), and frequency (1, 10, 20 Hz). High-frequency stimulation produced high discomfort. Conclusion: Personalization of rTMS is considered as feasible. Consistency of parameter-specific tinnitus suppression is demonstrated.

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“…Fifteen studies [5,15,17,19,20,23,27,[27][28][29][30][31]36,39] reporting adverse events after rTMS sessions were meta-analysed using a xed effects model, with nonsigni cant heterogeneity among the studies (I 2 = 37%, P = 0.13). The results showed a nonsigni cant difference in the incidence of adverse events between the rTMS and sham-rTMS groups (12.55% vs. 13.38%; OR: 1.11, 95% CI: 0.51-2.42; P = 0.79) ( Fig.…”

Section: Adverse Eventsmentioning

confidence: 99%

Repetitive Transcranial Magnetic Stimulation on Chronic Tinnitus: A Systematic Review and Meta-Analysis

Liang

Gang

Huang

et al. 2020

Preprint

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Background: Although the clinical efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) in the treatment of chronic tinnitus have been frequently examined, the results remain contradictory. Therefore, we performed a systematic review and meta-analysed clinical trials examining the effects of rTMS to evaluate its clinical efficacy and safety.Methods: Studies of rTMS for chronic tinnitus were retrieved from PubMed, Embase, and Cochrane Library through April 2020. Review Manager 5.3 software was employed for data synthesis, and Stata 13.0 software was used for analyses of publication bias and sensitivity.Results: Twenty-nine randomized studies involving 1,228 chronic tinnitus patients were included. Compared with sham-rTMS, rTMS exhibited significant improvements in the tinnitus handicap inventory (THI) scores at 1 week (mean difference [MD]: -7.92, 95% confidence interval [CI]: -14.18, -1.66), 1 month (MD: -8.52, 95% CI: -12.49, -4.55), and 6 months (MD: -6.53, 95% CI: -11.406, -1.66) post intervention; there were significant mean changes in THI scores at 1 month (MD: -14.86, 95% CI: -21.42, -8.29) and 6 months (MD: -16.37, 95% CI: -20.64, -12.11) post intervention, and the tinnitus questionnaire (TQ) score at 1 week post intervention (MD: -8.54, 95% CI: -15.56, -1.52). Nonsignificant efficacy of rTMS was found regarding the THI score 2 weeks post intervention (MD: -1.51, 95% CI: -13.42, -10.40); the mean change in TQ scores 1 month post intervention (MD: -3.67, 95% CI: -8.56, 1.22); TQ scores 1 (MD: -8.97, 95% CI: -20.41, 2.48) and 6 months (MD: -7.02, 95% CI: -18.18, 4.13) post intervention; and adverse events (odds ratios [OR]: 1.11, 95% CI: 0.51, 2.42). Egger's and Begg's tests indicated no publication bias (P = 0.925).Conclusion: This meta-analysis demonstrated that rTMS is effective for chronic tinnitus; however, its safety needs more validation. Restrained by the insufficient number of included studies and the small sample size, more large randomized double-blind multi-centre trials are needed for further verification.

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Electric field-navigated transcranial magnetic stimulation for chronic tinnitus: a randomized, placebo-controlled study

Abstract: Despite the significant effects of rTMS on tinnitus, differences between active and placebo groups remained non-significant, due to large placebo-effect and wide inter-individual variation.

Cited by 20 publications

References 43 publications

Low-Frequency Repetitive Transcranial Magnetic Stimulation for the Treatment of Chronic Tinnitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Low-Frequency Repetitive Transcranial Magnetic Stimulation for the Treatment of Chronic Tinnitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Short-Term Tinnitus Suppression With Electric-Field Guided rTMS for Individualizing rTMS Treatment: A Technical Feasibility Report

Repetitive Transcranial Magnetic Stimulation on Chronic Tinnitus: A Systematic Review and Meta-Analysis

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