Combined central and peripheral stimulation for treatment of chronic tinnitus: a randomized pilot study

Neurorehabil Neural Repair. 2015 Mar-Apr;29(3):224-33. doi: 10.1177/1545968314542616. Epub 2014 Jul 15.


Background: Tinnitus is a common untreatable condition that originates from central maladaptive plasticity initiated by peripheral injury. Repetitive transcranial magnetic stimulation (rTMS), direct cochlear low-level laser therapy (LLLT), and acupuncture were tried for tinnitus treatment, but the results of these methods were clinically unsatisfactory.

Objective: This study aimed to test the combined effect of the 3 methods targeting both peripheral and central auditory areas as a new therapeutic strategy for tinnitus.

Methods: For this, 30 patients were randomized to 3 equal groups receiving 3 different interventions: inhibitory rTMS to the left auditory cortex, LLLT (which includes a combination of direct cochlear LLLT and laser acupuncture) to the affected ear(s), and finally, a combination of rTMS and LLLT. The Tinnitus Handicap Inventory (THI) and Visual Analogue Scale (VAS) were assessed before, immediately after, and at 2 weeks and 4 weeks after 10 consecutive every-other-day sessions for each intervention type.

Results: We found that combined stimulation was effective in tinnitus treatment. This effect remained for 4 weeks after the end of the treatment. However, each of rTMS and LLLT alone had no significant effect. Repeated-measures ANOVA showed a significant effect of Time and Time × Intervention interaction for THI and VAS scores. The post hoc t test for different time points per intervention revealed a significant difference between baseline and all postintervention measurements of both THI and VAS for the combination intervention.

Conclusion: Combined central rTMS and peripheral LLLT is more beneficial as a new method for management of tinnitus rather than these two used separately.

Keywords: acupuncture; low-level laser therapy; rehabilitation; tinnitus; transcranial magnetic stimulation.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Acoustic Stimulation
  • Acupuncture Therapy*
  • Adult
  • Chronic Disease
  • Combined Modality Therapy
  • Female
  • Humans
  • Low-Level Light Therapy*
  • Male
  • Middle Aged
  • Pilot Projects
  • Tinnitus / therapy*
  • Transcranial Magnetic Stimulation*
  • Treatment Outcome