Background
Tinnitus affects 10% of the population, its pathophysiology remains incompletely understood,
and treatment is elusive. Functional imaging has demonstrated a relationship between
the intensity of tinnitus and the degree of reorganization in the auditory cortex.
Experimental studies have further shown that tinnitus is associated with synchronized
hyperactivity in the auditory cortex. Therefore, targeted modulation of auditory cortex
has been proposed as a new therapeutic approach for chronic tinnitus.
Methods
Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current
stimulation (tDCS) are noninvasive methods that can modulate cortical activity. These
techniques have been applied in different ways in patients with chronic tinnitus.
Single sessions of high-frequency rTMS over the temporal cortex have been successful
in reducing the intensity of tinnitus during the time of stimulation and could be
predictive for treatment outcome of chronic epidural stimulation using implanted electrodes.
Results
Another approach that uses rTMS as a treatment for tinnitus is application of low-frequency
rTMS in repeated sessions, to induce a lasting change of neuronal activity in the
auditory cortex beyond the duration of stimulation. Beneficial effects of this treatment
have been consistently demonstrated in several small controlled studies. However,
results are characterized by high interindividual variability and only a moderate
decrease of the tinnitus. The role of patient-related (for example, hearing loss,
tinnitus duration, age) and stimulation-related (for example, stimulation site, stimulation
protocols) factors still remains to be elucidated.
Conclusions
Even in this early stage of investigation, there is a convincing body of evidence
that rTMS represents a promising tool for pathophysiological assessment and therapeutic
management of tinnitus. Further development of this technique will depend on a more
detailed understanding of the neurobiological effects mediating the benefit of TMS
on tinnitus perception. Moreover clinical studies with larger sample sizes and longer
follow-up periods are needed.
Keywords
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Article info
Publication history
Published online: July 03, 2008
Accepted:
June 6,
2008
Received in revised form:
May 29,
2008
Received:
April 30,
2008
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
