The AudioNotch Tinnitus Treatment Blog

TMS Tinnitus

TMS, as it is colloquially referred to (or Repetitive Transcranial Magnetic Stimulation, which is the proper term) has recently been investigated as a possible treatment avenue for tinnitus. A lot patients get excited about TMS & tinnitus, but the results have not been good. People are attracted to TMS because it’s noninvasive (basically just a magnet held over your head) and thus doesn’t really appear to have any significant complications with use. It’s been used in depression as well, and the logic is that you could target the affected region of the brain non-invasively. Unfortunately, a new study in 2014 has come out and reaffirmed its lack of efficacy:

An increasing amount of studies apply repetetive transcranial magnetic stimulation (rTMS) to treat chronic tinnitus, yet the neurophysiological impacts have remained largely obscure. Several studies show that endogenous brain rhythms may be enhanced via diverse brain stimulation techniques applying rhythmic stimulation. Here, we investigated in normal hearing participants whether application of rTMS (left auditory cortex) with an individualized alpha frequency was capable of increasing alpha activity in stimulated auditory regions in a sustained manner. Behavioral intensity discrimination performance worsened for the rTMS group as compared to Sham. Electroencephalography (EEG) data, however, clearly show that this functional inhibition is not accompanied by increases of auditory cortical alpha. Even though more pronounced power reductions for the rTMS group were observed at slower frequencies (delta to theta range) at stimulated and other sites of the left hemisphere, they were unrelated to behavioral changes. Our results also strongly suggest that the amount of power modulations at these slower frequencies is strongly dependent on pre-rTMS power, thus supporting current state-dependency notions. Strong relationships to behavioral changes were in particular observed for anterior cingulate cortex (ACC) beta power and posterior cingulate cortex (PCC) beta connectivity. Moreover, these beta band measures were strongly inter-related and when viewed together specifically sensitive to behavioral changes in the rTMS group. We conclude that currently alpha frequency rTMS is not a promising avenue for the treatment of chronic tinnitus and that beneficial effects could be mediated via nonauditory systems. Our study argues for the value of combined EEG-TMS studies when investigating the impacts of rTMS. Hum Brain Mapp 35:14–29, 2014. © 2012 Wiley Periodicals, Inc.

3 Responses to “TMS Tinnitus”

  1. Peter said:

    Mar 29, 14 at 3:57 pm

    Two studies are not enough to declare rTMS ineffective in treating Tinnitus.

    Both of these studies targeted the Auditory Cortex, when in reality rTMS can be used to treat Tinnitus by targeting other areas such as the right DLFPC and left VLPFC.

    A tinnitus patient not responding to Auditory Cortex rTMS does not necessarily mean they would not respond to stimulation of other areas.

    And we also have to define what we mean by “lack of efficacy”. I’m sure the thousands, (or tens of thousands) of tinnitus patients in Europe and Worldwide who have benefited from rTMS do not consider rTMS ineffective.

    http://www.ncbi.nlm.nih.gov/pubmed/22069382

    http://www.ncbi.nlm.nih.gov/pubmed/22853891

    http://www.ncbi.nlm.nih.gov/pubmed/22782483

    http://www.ncbi.nlm.nih.gov/pubmed/24606019

  2. Peter said:

    Apr 01, 14 at 12:41 am

    EXCERPTS FROM PEER-REVIEWED MEDICAL JOURNAL ARTICLES ON RTMS FOR TINNITUS

    “…this study demonstrates… that it is feasible to use maintenance rTMS to manage chronic tinnitus. Maintenance rTMS might impede cortical expansion of the tinnitus frequency into adjacent cortical areas…” (Mennemeier et al., 2008)

    “An evaluation after 3 months revealed a remarkable benefit from the use of combined prefrontal and temporal rTMS treatment. These results support recent data that suggest that auditory and nonauditory brain areas are involved in tinnitus pathophysiology.” (Kleinjung et al., 2008)

    “Prolonged low frequency (1 Hz) stimulation was effective in 62.5% of patients; the effect appeared 48 h after treatment and lasted for approximately 5 days.” (Londero et. al., 2006)

    “The tinnitus score was significantly improved after 5 days of active rTMS, an effect not seen after placebo stimulation.” (Kleinjung et.al., 2006)

    “Following active rTMS there was a moderate improvement of tinnitus perception. Treatment effects lasted up to six months in some patients.” (Langguth et. al., 2006)

  3. Peter said:

    May 07, 14 at 7:24 am

    Hey Peter,

    Meta-analyses have conclusively shown that this doesn’t work. It’s not uncommon for small scale studies to show a benefit to a therapy and have it later be disproved by the overall aggregate of evidence.


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