Efficacy of Repetitive Transcranial Magnetic Stimulation (rTMS) for Tinnitus: A Retrospective Study

Abstract

Objective: Current studies still find insufficient evidence to support the routine use of repetitive transcranial magnetic stimulation (rTMS) in tinnitus. This study aimed to assess response of tinnitus to treatment with rTMS and identify factors influencing the overall response. Methods: Between January 2016 and May 2017, 199 tinnitus patients were identified from a retrospective review of the electronic patient record at the Sun Yat-sen Memorial Hospital. All patients received rTMS treatment. Their clinicodemographic profile and outcomes, including the tinnitus handicap inventory (THI) and visual analog scale (VAS) scores, were extracted for analysis. Results: Regarding the THI results, 62.3% of all patients responded to rTMS. The analysis of the VAS score revealed an overall response rate of 66.3%. Both percentages were close to the patient’s subjective assessment result, of 63.8%. Patients with tinnitus of less than 1-week duration had the highest response rate to rTMS in terms of either THI/VAS scores or the patient’s subjective assessment of symptoms. Tinnitus duration was recognized as a factor influencing the overall response to the treatment. Conclusions: Repetitive transcranial magnetic stimulation treatment is effective for patients with tinnitus, but its efficacy is affected by tinnitus duration. Tinnitus patients are advised to attend for rTMS as soon as possible since therapy was more effective in those with a shorter duration of disease of less than 1 week.

Implications of Transcranial Magnetic Stimulation as a Treatment Modality for Tinnitus

“…All four of the studies in Table 1 utilized 1 Hz of frequency for a treatment length of 10 days; however, the total amount of pulses per session varied between 1000 and 2000, with varying results in their respective questionnaires used to evaluate patients posttreatment [13,34,41,42]. Wang et al [41], the largest experimental study in this group, found that rTMS was successful in nearly half of the patients when treated with 1 Hz directed over the left temporoparietal cortex for 10 days, as evident by a statistically significant improvement in the VAS-L scores in participants used to characterize tinnitus loudness in participants.…”

“…Negative predictors of treatment success were identified, such as the length of symptoms, presence of hearing loss, and presence of sleep disturbance [41]. In a retrospective study of 199 patients, Yang et al [13] noted significant results in a total of 62.3% of patients following treatment with 2000 pulses at 1 Hz. They noted the most pronounced improvement, of 82.8%, in the group that only had symptoms for 1 week, compared to 67.2% of patients who had symptoms longer than a year [13].…”

“…In a retrospective study of 199 patients, Yang et al [13] noted significant results in a total of 62.3% of patients following treatment with 2000 pulses at 1 Hz. They noted the most pronounced improvement, of 82.8%, in the group that only had symptoms for 1 week, compared to 67.2% of patients who had symptoms longer than a year [13]. Kan et al [42] followed the above-mentioned protocol at the temporoparietal junction (TPJ), noting no significant difference in their patients' symptoms based on the THI and VAS scores.…”

“…Since its development as a therapeutic tool in 1985 [5], rTMS has been shown to provide various degrees of symptomatic relief for conditions such as depressive disorders, pain, aphasia, movement disorders, motor stroke, multiple sclerosis, epilepsy, disorders of consciousness, Alzheimer's disease, schizophrenia, substance abuse, and addiction [6][7][8][9]. Considering the beneficial effects, there has been an emerging interest in utilizing rTMS for auditory disorders such as tinnitus [10][11][12][13].…”

“…Among the most recent treatment methods is the utilization of non-invasive techniques that focus on the electrical or magnetic stimulation of specific brain regions that are known to be associated with tinnitus [14]. Though a newer therapy, many studies have examined the utilization of rTMS as a novel therapeutic tool for tinnitus [10][11][12][13].…”