Transcranial Magnetic stimulation (TMS ) for Tinnitus
Timothy C. Hain, MD. Hearing Page Page last modified:
May 6, 2017
Tinnitus sufferers have long tried numerous unlikely treatments for their malady. Because magnets are perceived as being both mysterious and powerful, they have often been advocated as a treatment.
A recent variant involves using powerful magnetic pulses to temporarily inhibit circuits in the brain. This is called "TMS", for transcutaneous magnetic stimulation. TMS has also been explored as treatment for other relatively intractable illnesses, such as severe depression. The target is auditory cortex, and presumably the idea is to shut down central auditory processing for a few hours.
With respect to tinnitus, as of 2015, there were roughly 120 published papers concerning use of TMS for tinnitus. Many of these seem ridiculous, combining rather obvious placebos (such as laser treatment to the skin), with TMS. Nevertheless, in a recent systemic review, Soleimani et al (2015) stated that "These data underscore the clinical effect of rTMS in the treatment of tinnitus".
- Noh et al (2017) reported that the coordinates recommended for targeting TMS differ between Asians and Caucasians, but that it doesn't matter because TMS is spatially imprecise anyway.
- Piccirro (2016) reported that rTMS (1 hz, 2000 pulses, 10 weeks) resulted in a statistically significant greater percentage of responders in the active treatment group than placebo.
- Bilici et al (2015) reported very variable effects using repetitive TMS at 1hz or 10 hz.
- Yilmaz et al (2014) found low-frequency repeating TMS to be very helpful in a blinded study.
- Langguth et al (2014) reported that rTMS's effect in two randomized controlled studies did not prove superior to placebo.
- Kim et al (2014) reported that rTMS was effective in an unblinded study of unilateral tinnitus.
- Vanneste and De Ridder reported improvement from rTMS over prefrontal cortex.
- Theodoroff and Folmer reported that a meta-analysis was not possible of rTMS because of the heterogeneity of studies.
- Piccirillo et al (2013) reported no difference from placebo for 4 weeks of rTMS over the L temporoparietal junction.
- Park et al (2013) reported that rTMS over auditory cortex and prefrontal cortex has more benefit than rTMS over auditory cortex alone for tinnitus control in patients with depression.
rTMS appears to benefit some patients. The mechanism probably includes some elements of placebo effect, some effects of modulating mood, and least likely of all, some effect on central auditory circuits. It does not appear to be harmful. We have no objections to using the placebo effect -- improvement is improvement. Frequent, repetitive TMS that is administered over many weeks is more likely to be superior to placebo than occasional, weak TMS.
Due to the high cost of rTMS, and the relatively low benefit, it does not presently have a solid indication for treatment. Other approachs that might include placebos and standard antidepressants are more rational choices.
- Bilici, S., et al. (2015). "Medium-term results of combined treatment with transcranial magnetic stimulation and antidepressant drug for chronic tinnitus." Eur Arch Otorhinolaryngol 272(2): 337-343.
- Kim, H. J., et al. (2014). "Long-term effects of repetitive transcranial magnetic stimulation in unilateral tinnitus." Laryngoscope 124(9): 2155-2160.
- Langguth, B., et al. (2014). "Efficacy of different protocols of transcranial magnetic stimulation for the treatment of tinnitus: Pooled analysis of two randomized controlled studies." World J Biol Psychiatry 15(4): 276-285.
- Noh TS1, Rah YC2, Kyong JS1,3, Kim JS3,4, Park MK1, Lee JH1, Oh SH1, Chung CK4,5, Suh MW1.Comparison of treatment outcomes between 10 and 20 EEG electrode location system-guided and neuronavigation-guided repetitive transcranial magnetic stimulation in chronic tinnitus patients and target localization in the Asian brain. Acta Otolaryngol. 2017 May 4:1-7. doi: 10.1080/00016489.2017.1316870. [Epub ahead of print]
- Park, S., et al. (2013). "Combined rTMS to the auditory cortex and prefrontal cortex for tinnitus control in patients with depression: a pilot study." Acta Otolaryngol 133(6): 600-606.
- Piccirillo, J. F., et al. (2013). "Low-frequency repetitive transcranial magnetic stimulation to the temporoparietal junction for tinnitus: four-week stimulation trial." JAMA Otolaryngol Head Neck Surg 139(4): 388-395.
- Piccirrilo J. (2016) Transcranial magnetic stimulation for chronic tinnitus. JAMA OHNS 2015: 14(8) 716-722. [10 weeks of daily treatment; 2000 pulses, 1/sec]
- Soleimani, R., et al. (2015). "Therapeutic impact of repetitive transcranial magnetic stimulation (rTMS) on tinnitus: a systematic review and meta-analysis." Eur Arch Otorhinolaryngol.
- Theodoroff, S. M. and R. L. Folmer (2013). "Repetitive transcranial magnetic stimulation as a treatment for chronic tinnitus: a critical review." Otol Neurotol 34(2): 199-208.
- Vanneste, S. and D. De Ridder (2013). "Differences between a single session and repeated sessions of 1 Hz TMS by double-cone coil prefrontal stimulation for the improvement of tinnitus." Brain Stimul 6(2): 155-159.
- Yilmaz, M., et al. (2014). "Effectiveness of transcranial magnetic stimulation application in treatment of tinnitus." J Craniofac Surg 25(4): 1315-1318.
May 6, 2017
, Timothy C. Hain, M.D.
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May 6, 2017