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Therapeutic impact of repetitive transcranial magnetic stimulation (rTMS) on tinnitus: a systematic review and meta-analysis

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Abstract

In this study, we conducted a systematic literature review and meta-analysis on the effect of repetitive transcranial magnetic stimulation (rTMS) compared with sham in chronic tinnitus patients. We searched databases, from their onset up to August 2014, for randomized controlled trials (RCT) in English that assessed the effectiveness of rTMS for chronic tinnitus. RCTs were selected according to inclusion/exclusion criteria before data were extracted. For the meta-analysis weighted mean differences (and standard deviations) of Tinnitus Questionnaire (TQ) and Tinnitus Handicap Inventory (THI) scores were determined. Therapeutic success was defined as difference of at least 7 points in the THI score between baseline and the follow-up assessment after treatment. The odds ratio (OR) for this variable was assessed. Results from 15 RCTs were analyzed. The mean difference for TQ score at 1 week after intervention was 3.42. For THI, the data of mean difference score in two groups, 1 and 6 month after intervention, was 6.71 and 12.89, respectively. The all comparisons indicated a significant medium to large effect size in follow-up which is in favor of the rTMS. The pooled OR of therapeutic success of the studies which used THI at 1 month after intervention was 15.75. These data underscore the clinical effect of rTMS in the treatment of tinnitus. However, there is high variability of studies design and reported outcomes. Replication of data in multicenter trials with a large number of patients and long-term follow-up is needed before further conclusions can be drawn.

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References

  1. Davis A, Rafaie AE (2000) Epidemiology of tinnitus. In: Tyler R (ed) Tinnitus handbook. Thomson Learning, Singular, San Diego, pp 1–23

    Google Scholar 

  2. Henry JA, Zaugg TL, Myers PJ, Kendall CJ, Turbin MB (2009) Principles and application of educational counseling used in progressive audiologic tinnitus management. Noise Health 11(42):33

    Article  PubMed  Google Scholar 

  3. Theodoroff SM, Folmer RL (2013) Repetitive transcranial magnetic stimulation as a treatment for chronic tinnitus: a critical review. Otol Neurotol 34(2):199–208

    Article  PubMed  Google Scholar 

  4. Zacharek M, Kaltenbach JA, Mathog TA, Zhang J (2002) Effects of cochlear ablation on noise induced hyperactivity in the hamster dorsal cochlear nucleus: implications for the origin of noise induced tinnitus. Hear Res 172:137–143

    Article  PubMed  Google Scholar 

  5. Yang G, Lobarinas E, Zhang L, Turner J, Stolzberg D, Salvi R et al (2007) Salicylate induced tinnitus: behavioral measures and neural activity in auditory cortex of awake rats. Hear Res 226(1–2):244–253

    Article  CAS  PubMed  Google Scholar 

  6. Kaltenbach JA (2006) The dorsal cochlear nucleus as a participant in the auditory, attentional and emotional components of tinnitus. Hear Res 216–217:224–234

    Article  PubMed  Google Scholar 

  7. Llinas RR, Ribary U, Jeanmonod D, Kronberg E, Mitra PP (1999) Thalamocortical dysrhythmia: a neurological and neuropsychiatric syndrome characterized by magnetoencephalography. Proc Natl Acad Sci USA 96(26):15222–15227

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Melcher JR, Sigalovsky IS, Guinan JJ Jr, Levine RA (2000) Lateralized tinnitus studied with functional magnetic resonance imaging: abnormal inferior colliculus activation. J Neurophysiol 83(2):1058–1072

    CAS  PubMed  Google Scholar 

  9. Folmer R (2007) Lateralization of neural activity associated with tinnitus. Neuroradiology 49:689–691

    Article  PubMed  Google Scholar 

  10. George MS, Nahas Z, Kozel FA, Li X, Denslow S, Yamanaka K et al (2002) Mechanisms and state of the art of transcranial magnetic stimulation. J ECT 18(4):170–181

    Article  PubMed  Google Scholar 

  11. Chen R, Classen J, Gerloff C, Celnik P, Wassermann EM, Hallett M et al (1997) Depression of motor cortex excitability by low-frequency transcranial magnetic stimulation. Neurology 48(5):1398–1403

    Article  CAS  PubMed  Google Scholar 

  12. Siebner HR, Filipovic SR, Rowe JB, Cordivari C, Gerschlager W, Rothwell JC et al (2003) Patients with focal arm dystonia have increased sensitivity to slow-frequency repetitive TMS of the dorsal premotor cortex. Brain 126(12):2710–2725

    Article  PubMed  Google Scholar 

  13. May A, Hajak G, Gänssbauer S, Steffens T, Langguth B, Kleinjung T et al (2007) Structural brain alterations following 5 days of intervention: dynamic aspects of neuroplasticity. Cereb Cortex 17(1):205–210

    Article  CAS  PubMed  Google Scholar 

  14. Langguth B, de Ridder D, Dornhoffer JL, Eichhammer P, Folmer RL, Frank E et al (2008) Controversy: does repetitive transcranial magnetic stimulation/transcranial direct current stimulation show efficacy in treating tinnitus patients? Brain Stimul 1(3):192–205

    Article  PubMed  Google Scholar 

  15. Meng Z, Liu S, Zheng Y, Phillips JS (2011) Repetitive transcranial magnetic stimulation for tinnitus. Cochrane Database Syst Rev 10:CD007946

    PubMed  Google Scholar 

  16. Anders M, Dvorakova J, Rathova L, Havrankova P, Pelcova P, Vaneckova M et al (2010) Efficacy of repetitive transcranial magnetic stimulation for the treatment of refractory chronic tinnitus: a randomized, placebo controlled study. Neuro Endocrinol Lett 31(2):238–249

    PubMed  Google Scholar 

  17. Ghossaini SN, Spitzer JB, Mackins CC, Zschommler A, Diamond BE, Wazen JJ (2004) High-frequency pulsed electromagnetic energy in tinnitus treatment. Laryngoscope 114(3):495–500

    Article  PubMed  Google Scholar 

  18. Marcondes R, Sanchez T, Kii M, Ono C, Buchpiguel C, Langguth B et al (2010) Repetitive transcranial magnetic stimulation improve tinnitus in normal hearing patients: a double-blind controlled, clinical and neuroimaging outcome study. Eur J Neurol 17(1):38–44

    Article  CAS  PubMed  Google Scholar 

  19. Khedr E, Rothwell J, Ahmed M, 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(2):212–215

    Article  CAS  PubMed  Google Scholar 

  20. Roland N, Hughes J, Daley M, Cook J, Jones A, McCormick M (1993) Electromagnetic stimulation as a treatment of tinnitus: a pilot study. Clin Otolaryngol Allied Sci 18(4):278–281

    Article  CAS  PubMed  Google Scholar 

  21. Schardt C, Adams MB, Owens T, Keitz S, Fontelo P (2007) Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med Inform Decis Mak 7(1):16

    Article  PubMed  PubMed Central  Google Scholar 

  22. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17(1):1–12

    Article  CAS  PubMed  Google Scholar 

  23. Zeman F, Koller M, Figueiredo R, Aazevedo A, Rates M, Coelho C et al (2011) Tinnitus handicap inventory for evaluating treatment effects which changes are clinically relevant? Otolaryngol Head Neck Surg 145(2):282–287

    Article  PubMed  Google Scholar 

  24. Kleinjung T, Steffens T, Sand P, Murthum T, Hajak G, Strutz J et al (2007) Which tinnitus patients benefit from transcranial magnetic stimulation? Otolaryngol Head Neck Surg 137(4):589–595

    Article  PubMed  Google Scholar 

  25. Hoekstra CE, Versnel H, Neggers SF, Niesten ME, van Zanten GA (2013) Bilateral low-frequency repetitive transcranial magnetic stimulation of the auditory cortex in tinnitus patients is not effective: a randomised controlled trial. Audiol Neurotol 18(6):362–373

    Article  Google Scholar 

  26. Lorenz I, Mueller N, Langguth B, Schlee W, Weisz N (2010) Short-term effects of different transcranial magnetic stimulation paradigms on auditory cortical responses: implications for the treatment of chronic tinnitus. In: Conference Abstract: Biomag—17th International Conference on Biomagnetism, Front. Neurosci.

  27. Vanneste S, De Ridder D (2012) The involvement of the left ventrolateral prefrontal cortex in tinnitus: a TMS study. Exp Brain Res 221(3):345–350

    Article  PubMed  Google Scholar 

  28. Rossi S, De Capua A, Ulivelli M, Bartalini S, Falzarano V, Filippone G et al (2007) Effects of repetitive transcranial magnetic stimulation on chronic tinnitus: a randomised, crossover, double blind, placebo controlled study. J Neurol Neurosurg Psychiatry 78(8):857–863

    Article  PubMed  PubMed Central  Google Scholar 

  29. Smith JA, Mennemeier M, Bartel T, Chelette KC, Kimbrell T, Triggs W et al (2007) Repetitive transcranial magnetic stimulation for tinnitus: a pilot study. Laryngoscope 117(3):529–534

    Article  PubMed  Google Scholar 

  30. Plewnia C, Reimold M, Najib A, Brehm B, Reischl G, Plontke SK et al (2007) Dose-dependent attenuation of auditory phantom perception (tinnitus) by PET-guided repetitive transcranial magnetic stimulation. Hum Brain Mapp 28(3):238–246

    Article  PubMed  Google Scholar 

  31. Goebel G, Hiller W (1994) The tinnitus questionnaire. A standard instrument for grading the degree of tinnitus. Results of a multicenter study with the tinnitus questionnaire. Hno 42(3):166–172

    CAS  PubMed  Google Scholar 

  32. Newman CW, Jacobson GP, Spitzer JB (1996) Development of the tinnitus handicap inventory. Arch Otolaryngol Head Neck Surg 122(2):143–148

    Article  CAS  PubMed  Google Scholar 

  33. Higgins J, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560

    Article  PubMed  PubMed Central  Google Scholar 

  34. Lehner A, Schecklmann M, Poeppl TB, Kreuzer PM, Vielsmeier V, Rupprecht R et al (2013) Multisite rTMS for the treatment of chronic tinnitus: stimulation of the cortical tinnitus network—a pilot study. Brain Topogr 26(3):501–510

    Article  PubMed  Google Scholar 

  35. Triggs WJ, Hajioff D (2012) Transcranial magnetic stimulation for tinnitus: no better than sham treatment? Neurology 78(21):1624–1625

    Article  PubMed  Google Scholar 

  36. Arfeller C, Vonthein R, Plontke SK, Plewnia C (2009) Efficacy and safety of bilateral continuous theta burst stimulation (cTBS) for the treatment of chronic tinnitus: design of a three-armed randomized controlled trial. Trials 10:74

    Article  PubMed  PubMed Central  Google Scholar 

  37. Landgrebe M, Binder H, Koller M, Eberl Y, Kleinjung T, Eichhammer P et al (2008) Design of a placebo-controlled, randomized study of the efficacy of repetitive transcranial magnetic stimulation for the treatment of chronic tinnitus. BMC Psychiatry 8:23

    Article  PubMed  PubMed Central  Google Scholar 

  38. Kleinjung T, Vielsmeier V, Landgrebe M, Hajak G, Langguth B (2008) Transcranial magnetic stimulation: a new diagnostic and therapeutic tool for tinnitus patients. Int Tinnitus J 14(2):112–118

    PubMed  Google Scholar 

  39. Langguth B, Kleinjung T, Landgrebe M, de Ridder D, Hajak G (2010) rTMS for the treatment of tinnitus: the role of neuronavigation for coil positioning. Neurophysiol Clin 40(1):45–58

    Article  CAS  PubMed  Google Scholar 

  40. Langguth B, Landgrebe M, Hajak G, Eichhammer P, De Ridder D, Kleinjung T (2008) Tinnitus and transcranial magnetic stimulation. Semin Hear 29(3):288–299

    Article  Google Scholar 

  41. Muller PA, Pascual-Leone A, Rotenberg A (2012) Safety and tolerability of repetitive transcranial magnetic stimulation in patients with pathologic positive sensory phenomena: a review of literature. Brain Stimul 5(3):320–329

    Article  PubMed  Google Scholar 

  42. Peng Z, Chen XQ, Gong SS (2012) Effectiveness of repetitive transcranial magnetic stimulation for chronic tinnitus: a systematic review. Otolaryngol Head Neck Surg 147(5):817–825

    Article  PubMed  Google Scholar 

  43. Marcondes R, Sanchez T, Kii M, Ono C, Buschpiguel C, Marcolin M, et al (2009) Clinical and neuroimaging outcomes of the efficacy of transcranial magnetic stimulation in patients with tinnitus and normal hearing.In: Conference book of 3rd Tinnitus Research Initiative, Meeting From Clinical Practice to Basic Neuroscience and back, Italy, 27–28

  44. Engelhardt J, Dauman R, Arné P, Allard M, Dauman N, Branchard O et al (2014) Effect of chronic cortical stimulation on chronic severe tinnitus: a prospective randomized double-blind cross-over trial and long-term follow up. Brain Stimul 7:694–700

    Article  PubMed  Google Scholar 

  45. Langguth B, Eichhammer P, Zowe M, Marienhagen J, Kleinjung T, Jacob P et al (2004) Low frequency repetitive transcranial magnetic stimulation (rTMS) for the treatment of chronic tinnitus—are there long-term effects? Psychiatr Prax 31(Suppl 1):S52–S54

    Article  PubMed  Google Scholar 

  46. Schraven SP, Plontke SK, Rahne T, Wasserka B, Plewnia C (2013) Hearing safety of long-term treatment with theta burst stimulation. Brain Stimul 6(4):563–568

    Article  PubMed  Google Scholar 

  47. Landgrebe M, Cordes J, Fallgatter A, Höppner J, Padberg F, Schönfeldt-Lecuona C et al (2013) P 111. Repetitive transcranial magnetstimulation (rTMS) for the treatment of chronic tinnitus: results of the german multicenter study. Clin Neurophysiol 124(10):e117–e118

    Article  Google Scholar 

  48. Langguth B, Landgrebe M, Frank E, Schecklmann M, Sand P, Vielsmeier V 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

    Article  CAS  PubMed  Google Scholar 

  49. Barwood CHS, Wilson WJ, Malicka AN, McPherson B, Lloyd D, Munt K et al (2013) The effect of rTMS on auditory processing in adults with chronic, bilateral tinnitus: a placebo-controlled pilot study. Brain Stimul 6(5):752–759

    Article  PubMed  Google Scholar 

  50. Bilici S, Yigit O, Taskin U, Gor AP, Yilmaz ED (2015) Medium-term results of combined treatment with transcranial magnetic stimulation and antidepressant drug for chronic tinnitus. Eur Arch Otorhinolaryngol 272(2):337–343

    Article  PubMed  Google Scholar 

  51. Chung HK, Tsai CH, Lin YC, Chen JM, Tsou YA, Wang CY et al (2012) Effectiveness of theta-burst repetitive transcranial magnetic stimulation for treating chronic tinnitus. Audiol Neurootol 17(2):112–120

    Article  PubMed  Google Scholar 

  52. De Ridder D, Verstraeten E, Van der Kelen K, De Mulder G, Sunaert S, Verlooy J et al (2005) Transcranial magnetic stimulation for tinnitus: influence of tinnitus duration on stimulation parameter choice and maximal tinnitus suppression. Otol Neurotol 26(4):616–619

    Article  PubMed  Google Scholar 

  53. Plewnia C, Vonthein R, Wasserka B, Arfeller C, Naumann A, Schraven SP et al (2012) Treatment of chronic tinnitus with theta burst stimulation: a randomized controlled trial. Neurology 78(21):1628–1634

    Article  CAS  PubMed  Google Scholar 

  54. Khedr E, Rothwell J, El-Atar A (2009) One-year follow up of patients with chronic tinnitus treated with left temporoparietal rTMS. Eur J Neurol 16(3):404–408

    Article  CAS  PubMed  Google Scholar 

  55. Lee HY, Yoo SD, Ryu EW, Byun JY, Yeo SG, Park MS (2013) Short term effects of repetitive transcranial magnetic stimulation in patients with catastrophic intractable tinnitus: preliminary report. Clin Exp Otorhinolaryngol 6(2):63–67

    Article  PubMed  PubMed Central  Google Scholar 

  56. Lee M, Kim SE, Kim WS, Han J, Kim HJ, Kim BS et al (2013) Cortico-cortical modulation induced by 1-Hz repetitive transcranial magnetic stimulation of the temporal cortex. J Clin Neurol 9(2):75–82

    Article  PubMed  PubMed Central  Google Scholar 

  57. Vanneste S, Plazier M, Van de Heyning P, De Ridder D (2011) Repetitive transcranial magnetic stimulation frequency dependent tinnitus improvement by double cone coil prefrontal stimulation. J Neurol Neurosurg Psychiatry 82(10):1160–1164

    Article  PubMed  Google Scholar 

  58. Yilmaz M, Yener MH, Turgut NF, Aydin F, Altug T (2014) Effectiveness of transcranial magnetic stimulation application in treatment of tinnitus. J Craniofac Surg 25(4):1315–1318

    Article  PubMed  Google Scholar 

  59. Goats G (1989) Pulsed electromagnetic (short-wave) energy therapy. Br J Sports Med 23(4):213–216

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Hallett M (2000) Transcranial magnetic stimulation and the human brain. Nature 406(6792):147–150

    Article  CAS  PubMed  Google Scholar 

  61. Lisanby SH, Gutman D, Luber B, Schroeder C, Sackeim HA (2001) Sham TMS: intracerebral measurement of the induced electrical field and the induction of motor-evoked potentials. Biol Psychiatry 49(5):460–463

    Article  CAS  PubMed  Google Scholar 

  62. Fuller M, Dobson J, Gregor Wieser H, Moser S (1995) On the sensitivity of the human brain to magnetic fields: evocation of epileptiform activity. Brain Res Bull 36(2):155–159

    Article  CAS  PubMed  Google Scholar 

  63. Meeus O, Blaivie C, Ost J, De Ridder D, Van de Heyning P (2009) Influence of tonic and burst transcranial magnetic stimulation characteristics on acute inhibition of subjective tinnitus. Otol Neurotol 30(6):697–703

    Article  PubMed  Google Scholar 

  64. Gerwig M, Kastrup O, Meyer BU, Niehaus L (2003) Evaluation of cortical excitability by motor and phosphene thresholds in transcranial magnetic stimulation. J Neurol Sci 215(1–2):75–78

    Article  CAS  PubMed  Google Scholar 

  65. McConnell KA, Nahas Z, Shastri A, Lorberbaum JP, Kozel FA, Bohning DE et al (2001) The transcranial magnetic stimulation motor threshold depends on the distance from coil to underlying cortex: a replication in healthy adults comparing two methods of assessing the distance to cortex. Biol Psychiatry 49(5):454–459

    Article  CAS  PubMed  Google Scholar 

  66. Plewnia C, Bartels M, Gerloff C (2003) Transient suppression of tinnitus by transcranial magnetic stimulation. Ann Neurol 53(2):263–266

    Article  PubMed  Google Scholar 

  67. De Ridder D, van der Loo E, Van der Kelen K, Menovsky T, van de Heyning P, Moller A (2007) Theta, alpha and beta burst transcranial magnetic stimulation: brain modulation in tinnitus. Int J Med Sci 4(5):237–241

    Article  PubMed  PubMed Central  Google Scholar 

  68. Khedr EM, Abo-Elfetoh N, Rothwell JC, El-Atar A, Sayed E, Khalifa H (2010) Contralateral versus ipsilateral rTMS of temporoparietal cortex for the treatment of chronic unilateral tinnitus: comparative study. Eur J Neurol 17(7):976–983

    Article  CAS  PubMed  Google Scholar 

  69. Bohning D (2000) Introduction and overview of TMS physics. In: George M, Belmaker R (eds) Transcranial magnetic stimulation in neuropsychiatry. American Psychiatric Press, Washington, pp 13–44

    Google Scholar 

  70. De Ridder D, De Mulder G, Verstraeten E, Van der Kelen K, Sunaert S, Smits M et al (2006) Primary and secondary auditory cortex stimulation for intractable tinnitus. ORL J Otorhinolaryngol Relat Spec 68(1):48–54 (Discussion 54–55)

    Article  PubMed  Google Scholar 

  71. Rücker G, Schwarzer G, Carpenter JR, Schumacher M (2008) Undue reliance on I2 in assessing heterogeneity may mislead. BMC Med Res Methodol 8(1):79

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Psychiatry Department of Shafa Hospital, Guilan University of Medical Sciences, Rasht, Iran

    Robabeh Soleimani

  2. Sinonasal Disease Research Center, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran

    Mir Mohammad Jalali

  3. Medical Faculty, Guilan University of Medical Sciences, Rasht, Iran

    Tolou Hasandokht

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  1. Robabeh Soleimani
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  2. Mir Mohammad Jalali
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Soleimani, R., Jalali, M. & Hasandokht, T. Therapeutic impact of repetitive transcranial magnetic stimulation (rTMS) on tinnitus: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 273, 1663–1675 (2016). https://doi.org/10.1007/s00405-015-3642-5

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