Efficacy of different protocols of transcranial magnetic stimulation for the treatment of tinnitus: Pooled analysis of two randomized controlled studies

Abstract

This large study demonstrates the safety and tolerability of rTMS treatment in patients with chronic tinnitus. While the overall effect did not prove superior to placebo, secondary outcome parameters argue in favour of the active stimulation groups, and specifically the combined frontal and temporal rTMS protocol.

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

“…All studies show an improvement in the rTMS group, and all studies but one [Marcondes et al, 2010] show an improvement in the placebo group. This positive effect of rTMS is, in agreement with our study, only small in 2 of these studies [Anders et al, 2010;Langguth et al, 2012]. One of these studies shows, in line with our study, no significant difference between rTMS and placebo treatment , the other shows that the improvement for both rTMS and placebo is significant compared with baseline, but it does not compare the groups with each other [Anders et al, 2010].…”

“…In contrast, 1 study correcting for possible confounding effects [Lehner et al, 2012] did not find a relationship. Along that line and opposing a positive effect of normal hearing, the study of Langguth et al [2012] included only patients with near-to-normal hearing (average thresholds: 16 dB hearing level, HL, in placebo patients, and 14 dB HL in rTMS patients), but it did not find an effect of rTMS. It could be postulated that rTMS for tinnitus exerts its effect by a positive effect on depression.…”

“…A second parameter that might influence rTMS effectiveness, but which has not been varied often, is the duration of rTMS. The RCTs performed until now have treated for 1 week [Marcondes et al, 2010; present study] or 2 weeks [Anders et al, 2010;Khedr et al, 2008;Langguth et al, 2012]. For depression it has been stated that results may be better after a longer duration of treatment (>2 weeks) [Loo and Mitchell, 2005].…”

“…Parallel blinded randomised controlled trials (RCT) are preferred. Thus far, 4 parallel RCT on low-frequency rTMS have been performed [Anders et al, 2010;Khedr et al, 2008;Langguth et al, 2012;Marcondes et al, 2010]. Two of these studies reported a significant effect of rTMS compared with placebo [Khedr et al, 2008;Marcondes et al, 2010].…”

A theoretical protocol of all-night EEG in polysomnography (PSG) as a preparation and precaution for repetitive transcranial magnetic stimulation (rTMS) in the elderly subjects aged 65 years and over

“…There has been an article presenting that the elevated AHI was largely due to central apnea, but not obstructive apnea, for the age range from 65 years and over [37], hence, central apnea predicts mortality above age 65 years; others also published similar data [38].…”