Neuronavigated Versus Non-navigated Repetitive Transcranial Magnetic Stimulation for Chronic Tinnitus: A Randomized Study

Abstract

Repetitive transcranial magnetic stimulation (rTMS) has shown variable effect on tinnitus. A prospective, randomized 6-month follow-up study on parallel groups was conducted to compare the effects of neuronavigated rTMS to non-navigated rTMS in chronic tinnitus. Forty patients (20 men, 20 women), mean age of 52.9 years (standard deviation [SD] = 11.7), with a mean tinnitus duration of 5.8 years (SD = 3.2) and a mean tinnitus intensity of 62.2/100 (SD = 12.8) on Visual Analog Scale (VAS 0–100) participated. Patients received 10 sessions of 1-Hz rTMS to the left temporal area overlying auditory cortex with or without neuronavigation. The main outcome measures were VAS scores for tinnitus intensity, annoyance, and distress, and Tinnitus Handicap Inventory (THI) immediately and at 1, 3, and 6 months after treatment. The mean tinnitus intensity (hierarchical linear mixed model: F3 = 7.34, p = .0006), annoyance (F3 = 4.45, p = .0093), distress (F3 = 5.04, p = .0051), and THI scores (F4 = 17.30, p < .0001) decreased in both groups with non-significant differences between the groups, except for tinnitus intensity (F3 = 2.96, p = .0451) favoring the non-navigated rTMS. Reduction in THI scores persisted for up to 6 months in both groups. Cohen’s d for tinnitus intensity ranged between 0.33 and 0.47 in navigated rTMS and between 0.55 and 1.07 in non-navigated rTMS. The responder rates for VAS or THI ranged between 35% and 85% with no differences between groups (p = .054–1.0). In conclusion, rTMS was effective for chronic tinnitus, but the method of coil localization was not a critical factor for the treatment outcome.

Methodological Aspects of Randomized Controlled Trials for Tinnitus: A Systematic Review and How a Decision Support System Could Overcome Barriers

“…Primary objective of the included RCTs is the evaluation of specific therapeutic approaches; seventeen of them focus on transcranial magnetic stimulation (TMS) [ 28 , 33 , 41 , 42 , 44 , 45 , 48 , 54 , 67 , 71 , 72 , 76 , 79 , 82 , 85 , 89 , 90 , 91 ], four on acupuncture as monotherapy [ 25 , 51 , 53 , 66 ], more than ten on cognitive behavioral treatment, relaxation and mindfulness [ 20 , 21 , 23 , 26 , 35 , 40 , 47 , 61 , 65 , 68 , 69 , 70 , 75 , 81 , 92 ], seven on provision of hearing aids [ 38 , 41 , 63 , 84 , 87 , 93 , 94 ], 8 on sound therapy [ 24 , 39 , 55 , 60 , 86 , 95 , 96 , 97 ], two on electrical stimulation [ 29 , …”

The roles of the LpSTS and DLPFC in self‐prioritization: A transcranial magnetic stimulation study

“…Future research could add a fourth group without even sham stimulation, allowing more accurately quantify the practice effect. Second, although locating targeted regions based on international 10-20 system has been extensively utilized and validated (Beam, Borckardt, Reeves, & George, 2009;Koch et al, 2008;Noh et al, 2017;Sahlsten et al, 2019;Veniero et al, 2021;Zhao, Li, Liu, Voon, & Yuan, 2020), future work with neuronavigational-guided TMS based on anatomical brain scans is recommended to validate the results of the present study. Third, in the present study, the target site was a betweensubject factor, such that each participant only received TMS to one of the sites.…”

Repetitive transcranial magnetic stimulation on chronic tinnitus: a systematic review and meta-analysis

“…In recent years, there has been a growing annual prevalence of tinnitus, which might be related to the lack of a cure for most patients and a lack of effective standardized treatments. Several studies have ascertained supportive evidence that rTMS is effective in the treatment of chronic tinnitus [ 5 , 6 ]. rTMS is a non-invasive technique that involves electromagnetic pulses passing through the skull into the brain that can reduce the excitability of relevant neurons and neurotransmitter systems in tinnitus [ 7 ].…”