Transcranial Magnetic Stimulation (rTMS) for Tinnitus Treatment

Transcranial magnetic stimulation for the treatment of tinnitus has been attempted by many researchers around the world. The idea behind why transcranial magnetic stimulation works for tinnitus is that since there is increased brain activity that causes tinnitus, stimulation of that transcranial magnetic stimulation can reduce that activity and cause relief of tinnitus. Below, we will review some of the medical studies performed on the effectiveness of repetitive transcranial magnetic stimulation for tinnitus treatment.
Low-frequency repetitive transcranial magnetic stimulation (rTMS) has been proposed as a method for treating brain’s excitability disorders by reducing this hyperexcitability. This has been done in depression and other conditions as well. Rossi and colleagues (2007) reported on a group of 14 patients who had low frequency (1Hz [once a second]) transcranial magnetic stimulation for chronic tinnitus. Using the Magstim® Nerve Stimulator transcranial magnetic stimulation was applied to an area of increased activity in the hearing area of the brain (auditory cortex). This area was identified using positron emission tomography (PET-MRI).
After one week of transcranial magnetic stimulation, of the 14 patients who completed the study, eight (57%) were classified as responders (25% improvement in loudness). Two patients (14%) dropped out of the study due to worsening of tinnitus. Limitations of this study include the small sample size, patient dropout rate (12%), and the lack of long-term follow-up.

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This is an image of the Neurostar transcranial magnetic stimulation device used for tinnitus treatment in some studies.
The current published literature shows an increasing interest in the potential treatment of tinnitus with repetitive transcranial magnetic stimulation (rTMS). In a randomized, double-blind, sham-controlled trial with 16 patients, Rossi and colleagues (2007) utilized low frequency repetitive transcranial magnetic stimulation over the part of the brain that does the hearing (and the source of tinnitus). The patients had to meet the following criteria: one sided or both sided tinnitus for more than one year, normal examination (no signs of brain tumors, etc.), and normal brain MRI. Patients were randomly assigned to receive the real or sham repetitive transcranial magnetic stimulation as the first treatment for tinnitus. The patients received one week of repetitive transcranial magnetic stimulation (or sham) for tinnitus. This was followed by 2 weeks of observation. After 2 weeks of observation, the group that received the sham treatment, received the real treatment and vice versa. The sham treatment caused a 10% improvement in tinnitus, while the repetitive transcranial magnetic stimulation caused an improvement of 35%.

TMS image

This is another example of a transcranial magnetic stimulation device used for tinnitus treatment in some studies.

Another small randomized sham controlled study (8 patients) found a temporary (30 minutes or less) duration-dependent reduction in tinnitus in about 50% of subjects following a single 5-, 15- or 30-minute session of repetitive transcranial magnetic stimulation over the brain areas associated with tinnitus-related activity (found on positron-emission tomography [PET] with and without intravenous lidocaine). In this study, the authors concluded that the response to treatment was not as good if the duration of the tinnitus was longer (Plewnia, 2007).
Kleinjung and colleagues (2007) have performed a number of studies on the use of repetitive transcranial magnetic stimulation for tinnitus therapy. They conducted a study of 45 patients with repetitive transcranial magnetic stimulation delivered in ten sessions to the brain’s hearing area on the left side in patients with chronic tinnitus. Treatment outcome was assessed with a tinnitus questionnaire. Forty percent of patients were classified as responders and 60% as nonresponders. Response rate of 40% is no different from sham or sugar pill studies which have found an improvement of 30-40%. The authors found that those with normal hearing and duration of tinnitus of less than three years were more likely to have improvement. The authors concluded that tinnitus-related neuroplastic changes might be less pronounced in patients with normal hearing and a short history of tinnitus.

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In a comparative, pilot study, Kleinjung and colleagues (2008) proposed the use of low-frequency rTMS of the hearing parts of the brain as a new treatment strategy for patients with chronic tinnitus. The authors stated that a functional abnormality in tinnitus patients involves multiple brain structures used for attention and emotional processing (front part of the brain). Therefore, the researchers suggested the use of a new rTMS treatment strategy for tinnitus patients consisting of a combination of high-frequency front al (emotional part) and low-frequency temporal (hearing part) rTMS. A total of 32 patients received either low-frequency temporal rTMS or a combination of high-frequency prefrontal and low-frequency temporal rTMS. Treatment effects were assessed with a standardized tinnitus questionnaire. The authors reported that during and immediately after stimulation, there was a significant reduction of the tinnitus score in both groups (p=0.016), however, no significant difference between the two stimulation protocols (p=0.828) was observed. After three months though, there was no significant difference (p=0.08) between the two treatment conditions. The authors concluded that these results support recent data that suggest that auditory and nonauditory brain areas are involved in tinnitus pathophysiology. However, as these conclusions were drawn from a pilot study without sham control, randomized controlled trials of larger patient populations are necessary to determine the safety and effectoveness of combination therapy consisting of high-frequency prefrontal and low-frequency temporal rTMS for the treatment of tinnitus.
One of the latest studies done on this treatment was performed by Anders and colleagues (2010). This group of researchers used the 1 Hz frequency repetitive transcranial magnetic stimulation over a period of 2 weeks. 52 patients were tested with half receiving the real transcranial magnetic stimulation and half receiving the sham. The results showed that both groups showed improvement of tinnitus in both the sham treatment and the real transcranial magnetic stimulation treatment. The conclusion of this study is that while the real transcranial magnetic stimulation helps tinnitus, the sham transcranial magnetic stimulation does as well. This means that there is conflicting information as to how effective this treatment is.
Despite the suggested benefit of rTMS reported in some of the recent peer-reviewed literature, sufficient evidence is lacking from randomized, controlled clinical trials comparing rTMS with placebo therapies that demonstrates a durable outcome benefit of rTMS therapy for the treatment of tinnitus.

Advantages of transcranial magnetic stimulation for tinnitus

  • Non-invasive
  • May be effective for some

Disadvantages of transcranial magnetic stimulation

  • Requires repeated visits to the center
  • The equipment is very expensive so very few places have it and it may be very far
  • The stimulation is very loud and you have to wear ear plugs
  • The stimulation feels like being hit in the head
  • Considered experimental and not covered by insurance
  • Out of pocket costs are in the $1000s

There is still not enough evidence in the medical journals to support the effectiveness of transcranial magnetic stimulation for tinnitus treatment. The same level of brain stimulation that the transcranial magnetic stimulations is aiming to achieve, can be performed with particular sounds that are customized to the patient. This sound based therapy has been studied via research inspired by technology developed by Dr. Djalilian from University of California Irvine and found to be effective in helping tinnitus patients. For this breakthrough research-based tinnitus therapy click here.

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