Bilateral Low-Frequency Repetitive Transcranial Magnetic Stimulation of the Auditory Cortex in Tinnitus Patients Is Not Effective: A Randomised Controlled Trial

Abstract

Background: Although some therapies may be beneficial for some patients in reducing tinnitus, there is no curative therapy. Repetitive transcranial magnetic stimulation (rTMS) has been applied as a treatment for chronic tinnitus, but the effect remains controversial. Material and Methods: Fifty patients were treated with rTMS or placebo. Treatment consisted of 2,000 TMS pulses on each auditory cortex, at a rate of 1 Hz and an intensity of 110% of the individual motor threshold, on 5 consecutive days. rTMS and placebo effects were evaluated directly after treatment, after 1 week, and after 1, 3 and 6 months. Primary outcome was the Tinnitus Questionnaire (TQ). Secondary outcomes were the Tinnitus Handicap Inventory (THI) and a visual analogue scale. Results: At none of the follow-up evaluation moments a significant difference between rTMS and placebo was observed with respect to changes in TQ or THI scores relative to pretreatment scores. Multilevel modelling (MLM) analyses did not show a global treatment effect either. Patients with a higher degree of burden showed slightly greater improvement after rTMS (only significant on the THI with MLM analyses). Conclusion: Bilateral low-frequency rTMS of the auditory cortex was not effective in treating tinnitus.

Transcranial Direct Current Stimulation for the Treatment of Chronic Tinnitus: A Randomized Controlled Study

“…Thus, many possible stimulation parameters have yet to be explored, and it remains unclear if tDCS can be used as a therapeutic tool for tinnitus. While rTMS studies have determined a level C recommendation for possible efficacy [40], recent randomized, double-blind, placebo controlled trials have also found non-significant changes between placebo and active conditions [36,46].…”

Pairing broadband noise with cortical stimulation induces extensive suppression of ascending sensory activity

“…All of these approaches, as is the case for the treatment of many other neurological or psychiatric disorders, have shown quite variable results across tinnitus patients (Friedland et al , 2007; Vanneste and De Ridder, 2012; De Ridder et al , 2011; Song et al , 2012; Hoekstra et al , 2013; Kim et al , 2014; Langguth and De Ridder, 2013; Piccirillo et al , 2013; Johnson et al , 2013; Engelhardt et al , 2014). Only a small proportion of patients obtain full suppression of their tinnitus, and across patients the tinnitus percept typically returns after the termination of the treatment on different time scales.…”

Evidence and evidence gaps in tinnitus therapy

“…On this topic, a current study from Utrecht was published with the conclusion that rTMS was ineffective for treating chronic tinnitus [95]. The randomized, double-blind, placebo-controlled design of the study enrolled 50 patients treated with rTMS (low frequency, 1 Hz or placebo).…”