How Does Repetitive Transcranial Magnetic Stimulation (rTMS) Affect Tinnitus?
The rTMS method is noninvasive and designed to stimulate auditory cortex. Based on electromagnetic energy, this treatment reduces neural overactivity in cortical regions associated with tinnitus.
Our study demonstrated the efficacy of rTMS therapy in decreasing tinnitus intensity among those suffering from chronic tinnitus. Furthermore, a strong correlation was noted between this intensity reduction and increases of auditory alpha power in non-auditory brain areas.
How It Works
Repetitive transcranial magnetic stimulation (rTMS) involves using a magnet placed near the head to deliver electromagnetic pulses through it, in order to reduce hyperactivity of brain cells that is associated with tinnitus, as well as regulate levels of chemicals responsible for sound perception in the brain.
Scientists generally believe that tinnitus is caused by a disruption in neural pathways in the brain, often as the result of overactive neurons within the hearing center of the brain or due to hearing loss (which can occur at any age), although other health conditions or medications could also play a part.
Medical researchers have demonstrated that transcranial magnetic stimulation (rTMS) can be used to manage tinnitus symptoms by altering how your brain processes sound and managing hyperactive neurons in your hearing center of the brain. By modulating these signals, modulated signals allow your brain to become accustomed to hearing tinnitus more often and its intensity.
The initial study to use transcranial magnetic stimulation as a treatment for tinnitus was published in 2011. The researchers reported that it significantly improved symptoms for 233 chronic sufferers; however, they could not determine whether the results were due to real or placebo effects. Since then, other studies have used TMS treatment but its results remain inconsistent or contradictory.
Recently, scientists from Oregon Health & Science University and Veterans Affairs Portland Medical Center collaborated on a meta-analysis study designed to gain a clearer understanding of rTMS for treating tinnitus. 22 carefully qualified TMS studies for treating tinnitus were evaluated against each other to see which was more successful at suppressing it.
Research demonstrated that repetitive transcranial magnetic stimulation had a beneficial effect on tinnitus when applied to both the left primary auditory cortex and prefrontal cortex of patients regardless of its laterality or handedness. Further investigation demonstrated that suppression was greater when applied directly to auditory cortex vs prefrontal cortex; furthermore tinnitus reduction increased with higher frequency application.
Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive brain stimulation treatment, using rapidly alternating electromagnetic currents to produce electric fields in targeted brain areas. Studies have demonstrated that repetitive transcranial magnetic stimulation significantly reduces both loudness and severity of chronic tinnitus (5, 6). However, several technical factors may impede its effectiveness such as stimulation frequency, number of pulses delivered per session, and coil placement relative to target regions (7, 8).
Recent research showed that patients suffering from more severe tinnitus found greater relief with 1 Hz active rTMS applied over the temporal cortex than low frequency rTMS (9). Its authors believe this might be due to higher intensity rTMS’ direct or indirect activation of corticothalamic system which modulates perceptions of tinnitus perception.
Studies have also demonstrated the varying tinnitus suppressive effects of rTMS depending on its underlying neural mechanism, as evidenced by one case involving a 62-year old with severe tinnitus and depression who saw significant improvements after receiving rTMS treatments to his right dorsolateral prefrontal cortex and left auditory cortex (13).
These findings were confirmed through EEG analysis of resting state oscillatory brain activity. Researchers observed that rTMS decreased gamma activity across both hemispheres while increasing alpha activity – this correlated with a reduction in perceived loudness of tinnitus on numeric rating scales.
Another study (9) performed a meta-analysis on existing transcranial magnetic stimulation trials for treating tinnitus and concluded that most showed statistically significant positive outcomes. However, the authors noted that there was considerable variance among trials and discussed possible reasons for such variations. The authors believe this phenomenon could be explained by the choice of statistical strategy used, which only dichotomizes observation of significant or not significant tinnitus effects between verum arms and sham arms, regardless of available data quantity. Given this information, the authors propose improving both quality and quantity of reporting on rTMS protocols to reveal more clinically-relevant clinical effects.
rTMS treatment has shown great promise in alleviating tinnitus; however, its clinical efficacy relies heavily on limited sample sizes of studies conducted over short time periods and limited follow-up periods. To better evaluate its effects on tinnitus symptoms more precisely. It would be ideal if future research used larger sample sizes and long follow-up periods with more standardized protocols used during research trials to measure efficacy more precisely.
Utilizing a magnetic coil, brain activity can be modulated through intermittent, low-intensity electrical stimulation pulses delivered directly to the scalp and then penetrating into cortical neurons in order to reduce firing rate and therefore decrease tinnitus intensity.
TMS is an easy, noninvasive technique that is well tolerated by patients. The only side effects are temporary discomfort caused by rapid muscle contractions triggered by short bursts of electrical stimulation; this should not be considered serious side effects and can easily be remedied by relaxing muscles.
Recently, in a systematic review of randomized sham-controlled trials, active transcranial magnetic stimulation (rTMS) was shown to be superior to sham rTMS for alleviating tinnitus symptoms. Unfortunately, however, the study was small and did not evaluate Tinnitus Handicap Inventory or Beck Depression Inventory scores to accurately gauge results; although promising, results need to be confirmed through larger samples with extended follow up periods and longer follow up times.
No other reported side effects are observed with rTMS aside from mild discomfort during sessions – which may be alleviated by altering duration or frequency of pulses – although studies have observed an increased sensitivity to light and sound after repeated sessions; however, their occurrence remains low and likely won’t pose significant problems.
Current rTMS treatments for tinnitus typically rely on behavioral responses rather than objective measures of response; to overcome this limitation, the authors of the current study used TMS-EEG in combination to create tailored rTMS protocols based on each patient’s EEG response – specifically those which created stronger alpha increases or gamma decreases.
Repetitive Transcranial Magnetic Stimulation (rTMS) is a noninvasive neuromodulation treatment that utilizes an upper scalp-mounted coil electrode to generate electromagnetic pulses that target specific brain regions, producing electric current that depolarizes cortical neurons and reconfigures neural networks. Used to treat various neuropsychiatric conditions, including Tinnitus (6, 7).
Park and colleagues (13) conducted a pilot study with 11 participants suffering from chronic tinnitus; eight of whom also displayed depressive symptoms. Each of the 11 received the initial cycle of repetitive transcranial magnetic stimulation on primary auditory cortex for five days followed by another cycle encompassing primary auditory cortex and prefrontal cortex for an additional five-day treatment session; after their second rTMS session, participants scored significantly better on Tinnitus Handicap Inventory (THI).
To enhance the effectiveness of repetitive TMS (rTMS), precise stimulation positions should be determined using TMS integrated neuronavigation systems. However, whether local precision has any bearing on how rTMS treats tinnitus remains unknown; furthermore, its neural mechanism of attenuating symptoms remains undefined.
One factor contributing to the variability of rTMS effects is individual differences in brain network activity, which could explain why one treatment might work for one patient while not working at all for another patient. Customized protocols could potentially address this issue.
As it’s essential to understanding your type of tinnitus and its impact on your quality of life, rTMS should not be used if yours is loud enough to disturb others or interfere with daily activities. Also, cardiac pacemakers or devices implanted for other medical conditions (such as pacemakers) cannot receive treatment via this route; any antidepressants taken prior to or during therapy could interfere with its effects as well. Also be sure to inform your healthcare provider if pregnant/breastfeeding or any medical conditions that could arise that need attention or treatment in advance rTMS therapy can cause issues or effects that could alter its effects – beware any attempts with antidepressants/other tinnitus treatments before undertaking TMS therapy to avoid complications associated with receiving it treatment from either therapy side rTMS therapy such as cardiac pacemakers etc rTMS therapy before or rTMS treatments could worsen matters further!
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