Influence of Tonic and Burst Transcranial Magnetic Stimulation Characteristics on Acute Inhibition of Subjective Tinnitus

Abstract

Several parameters determine the amount of tinnitus reduction after TMS. An increased stimulation intensity relative to the patient's motor threshold only accounts for 10% of this effect. Our data also suggest different pathophysiologic mechanisms for unilateral and bilateral tinnitus.

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

“…After examining the effectiveness of tonic and burst TMS on 46 patients with narrow band or white noise tinnitus, De Ridder et al [2007] found the following: (1) response rate was 30.4%; (2) burst TMS resulted in better tinnitus suppression than tonic TMS; (3) alpha and beta burst, as well as theta burst, can be used to control narrow band noise or white noise tinnitus. Later, the same group suggested that burst TMS can be used to control noise-like tinnitus, while tonic TMS resulted in greater tinnitus reduction on pure tone tinnitus [Meeus et al, 2009]. Our outcomes also indicate that theta-burst rTMS can have a significant effect on pure-tone tinnitus (42% of patients experienced 1 33% reduction in tinnitus).…”

“…dorsolateral prefrontal cortex). One popular paradigm for tinnitus is low-frequency tonic stimulation (mostly at 1 Hz, with an intensity of 110-120% RMT), although time-saving burst stimulation has become increasingly popular in recent years [Richter et al, 2006;Arfeller et al, 2009;Meeus et al, 2009]. The 1-Hz protocol takes 25 min, whereas the TBS (consisting of 900 pulses per session), takes less than 5 min.…”

“…For instance, both Meeus et al [2009] and placed the coil 5 cm above the EAC inlet along a straight line to the vertex, without any other navigational guides. These nonstereotactic positioning strategies seem particularly inaccurate in targeting the auditory cortex, but even methods such as frameless stereotactic localization have limitations, due to cy- toarchitectonic mismatches between external anatomical landmarks and defined boundaries of the auditory cortex [Morosan et al, 2001[Morosan et al, , 2005.…”

Repetitive Transcranial Magnetic Stimulation as a Treatment for Chronic Tinnitus

“…However, Vanneste et al (66) concluded that rMT cannot be assumed to be a guide to auditory cortex excitability because ''excitatory measurements of one specific cortex cannot be generalized to the excitability of the whole cortex.'' Also, in a study that used different TMS stimulus intensities with tinnitus patients, Meeus et al (67) stated, ''Increasing the TMS stimulation intensity [in relation to] the patient's motor threshold only plays a minor role in achieving higher tinnitus reduction.'' In fact, Meeus et al (67) reported that increasing TMS intensity above 50% of their Magstim system's maximum output accounted for only 10% improvement in tinnitus suppression.…”

“…Also, in a study that used different TMS stimulus intensities with tinnitus patients, Meeus et al (67) stated, ''Increasing the TMS stimulation intensity [in relation to] the patient's motor threshold only plays a minor role in achieving higher tinnitus reduction.'' In fact, Meeus et al (67) reported that increasing TMS intensity above 50% of their Magstim system's maximum output accounted for only 10% improvement in tinnitus suppression. Until there is a greater degree of standardization, it is difficult to determine the TMS intensity that is most effective for reducing the perception or severity of tinnitus.…”