Long-term effects of repetitive transcranial magnetic stimulation (rTMS) in patients with chronic tinnitus

Otolaryngol Head Neck Surg. 2005 Apr;132(4):566-9. doi: 10.1016/j.otohns.2004.09.134.


Objectives: The pathophysiologic mechanisms of idiopathic tinnitus remain unclear. Recent studies demonstrated focal brain activation in the auditory cortex of patients with chronic tinnitus. Low-frequency repetitive transcranial magnetic stimulation (rTMS) is able to reduce cortical hyperexcitability.

Study design: Fusing of the individual PET-scan with the structural MRI-scan (T1, MPRAGE) allowed us to identify exactly the area of increased metabolic activity in the auditory cortex of patients with chronic tinnitus. With the use of a neuronavigational system, this target area was exactly stimulated by the figure 8-shaped magnetic coil. In a prospective study, rTMS (110% motor threshold; 1 Hz; 2000 stimuli/day over 5 days) was performed using a placebo controlled cross-over design. Patients were blinded regarding the stimulus condition. For the sham stimulation a specific sham-coil system was used. Fourteen patients were followed for 6 months. Treatment outcome was assessed with a specific tinnitus questionnaire (Goebel and Hiller).

Setting: Tertiary referral medical center.

Results: Increased metabolic activation in the auditory cortex was verified in all patients. After 5 days of verum rTMS, a highly significant improvement of the tinnitus score was found whereas the sham treatment did not show any significant changes. The treatment outcome after 6 months still demonstrated significant reduction of tinnitus score.

Conclusion: These preliminary results demonstrate that neuronavigated rTMS offers new possibilities in the understanding and treatment of chronic tinnitus.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Auditory Cortex / physiopathology*
  • Chronic Disease
  • Cross-Over Studies
  • Dominance, Cerebral / physiology
  • Double-Blind Method
  • Energy Metabolism / physiology
  • Female
  • Humans
  • Image Processing, Computer-Assisted
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neuronavigation* / instrumentation
  • Parietal Lobe / physiopathology
  • Patient Satisfaction
  • Positron-Emission Tomography
  • Retreatment
  • Surveys and Questionnaires
  • Temporal Lobe / physiopathology
  • Tinnitus / diagnosis
  • Tinnitus / physiopathology
  • Tinnitus / therapy*
  • Transcranial Magnetic Stimulation / therapeutic use*
  • Treatment Outcome