PAPER

Effects of repetitive transcranial magnetic stimulation on chronic tinnitus: a randomised, crossover, double blind, placebo controlled study

Simone Rossi¹, Alberto De Capua², Monica Ulivelli¹, Sabina Bartalini¹, Vincenzo Falzarano², Giovanni Filippone², Stefano Passero¹

¹ Dipartimento di Neuroscienze, Sezione Neurologia, Università di Siena, Italy
² Dipartimento di Neuroscienze, Sezione Psichiatria, Università di Siena, Italy

Correspondence to:
Dr Simone Rossi
Dipartimento di Neuroscienze, Sezione Neurologia, Brain Stimulation and Evoked Potentials Lab, Università di Siena, Policlinico Le Scotte, Viale Bracci, I-53100, Siena, Italy; Rossisimo{at}unisi.it

Background: Chronic tinnitus is a disabling, almost untreatable, condition, usually accompanied by psychiatric distress. In patients with complex neuropsychiatric diseases, such as chronic pain, with which tinnitus shares pathophysiological similarities, placebo effects may be pronounced. Moreover, it may be difficult to distinguish actual repetitive transcranial magnetic stimulation (rTMS) induced clinical benefits beyond placebo effects in neuropsychiatric patients.

Methods: 16 patients with chronic tinnitus underwent a randomised, double blind, crossover, placebo controlled trial of 1 Hz rTMS (120% of motor threshold; 1200 stimuli/day for 5 days) of the left temporoparietal region. Patients were screened for psychiatric comorbidity; additionally, anxiety and depression were monitored throughout the study. Moreover, an original placebo rTMS procedure produced the same activation of ipsilateral face muscles (a condition which may per se change the subjective rating of tinnitus) as the real rTMS.

Results: There were 8 out of 14 responders. Two patients dropped out for transient worsening of tinnitus. Active rTMS induced an overall significant, but transient, improvement (35% of the basal score) of subjective tinnitus perception that was independent of either tinnitus laterality or mood or anxiety changes. No correlations were found between response to rTMS and tinnitus duration, initial subjective score or patient age. When asked after the study was over, 71.4% of patients failed to identify the temporal sequence of the real or sham rTMS interventions.

Conclusion: The beneficial effects of rTMS on tinnitus are independent of mood changes. Moreover, they appear in the context of an original placebo stimulation designed to more closely replicate the somatic sensation of active stimulation. Because of the limited temporal duration of the clinical benefit, these neuromodulatory effects could be mediated by transient functional changes taking place in the neural circuits underlying tinnitus processing.

Abbreviations: AC, auditory cortex; HAM-A, Hamilton Anxiety Scale; HAM-D, Hamilton Depression Scale; PET, positron emission tomography; rTMS, repetitive transcranial magnetic stimulation; VAS, Visual Analogue Scale

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This article has been cited by other articles:

• Khedr, E M, Rothwell, J C, Ahmed, M A, El-Atar, A (2008). Effect of daily repetitive transcranial magnetic stimulation for treatment of tinnitus: comparison of different stimulus frequencies. J. Neurol. Neurosurg. Psychiatry 79: 212-215 [Abstract] [Full Text]