title: Long-term effects of repetitive transcranial magnetic stimulation (rTMS) in patients with chronic tinnitus.
abstract: OBJECTIVE
  The pathophysiologic mechanisms of idiopathic tinnitus remain unclear. Recent studies demonstrated focal brain activation in the auditory cortex of patients with chronic tinnitus. Low-frequency repetitive transcranial magnetic stimulation (rTMS) is able to reduce cortical hyperexcitability.
  
  
  METHODS
  Fusing of the individual PET-scan with the structural MRI-scan (T1, MPRAGE) allowed us to identify exactly the area of increased metabolic activity in the auditory cortex of patients with chronic tinnitus. With the use of a neuronavigational system, this target area was exactly stimulated by the figure 8-shaped magnetic coil. In a prospective study, rTMS (110% motor threshold; 1 Hz; 2000 stimuli/day over 5 days) was performed using a placebo controlled cross-over design. Patients were blinded regarding the stimulus condition. For the sham stimulation a specific sham-coil system was used. Fourteen patients were followed for 6 months. Treatment outcome was assessed with a specific tinnitus questionnaire (Goebel and Hiller).
  
  
  METHODS
  Tertiary referral medical center.
  
  
  RESULTS
  Increased metabolic activation in the auditory cortex was verified in all patients. After 5 days of verum rTMS, a highly significant improvement of the tinnitus score was found whereas the sham treatment did not show any significant changes. The treatment outcome after 6 months still demonstrated significant reduction of tinnitus score.
  
  
  CONCLUSIONS
  These preliminary results demonstrate that neuronavigated rTMS offers new possibilities in the understanding and treatment of chronic tinnitus.
authors.affiliation: Department of Otorhinolaryngology, University of Regensburg, Germany. tobias.kleinjung@klinik.uni-regensburg.de
authors.forename: Tobias
authors.initials: T
authors.lastname: Kleinjung
authors.forename: Peter
authors.initials: P
authors.lastname: Eichhammer
authors.forename: Berthold
authors.initials: B
authors.lastname: Langguth
authors.forename: Peter
authors.initials: P
authors.lastname: Jacob
authors.forename: Joerg
authors.initials: J
authors.lastname: Marienhagen
authors.forename: Goeran
authors.initials: G
authors.lastname: Hajak
authors.forename: Stephan R
authors.initials: SR
authors.lastname: Wolf
authors.forename: Juergen
authors.initials: J
authors.lastname: Strutz
mesh_terms: D000328:Adult; D001303:Auditory Cortex / Q000503:physiopathology*; D002908:Chronic Disease; D018592:Cross-Over Studies; D004292:Dominance, Cerebral / Q000502:physiology; D004311:Double-Blind Method; D004734:Energy Metabolism / Q000502:physiology; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000295:instrumentation; D010296:Parietal Lobe / Q000503:physiopathology; D017060:Patient Satisfaction; D049268:Positron-Emission Tomography; D019233:Retreatment; D011795:Surveys and Questionnaires; D013702:Temporal Lobe / Q000503:physiopathology; D014012:Tinnitus / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D050781:Transcranial Magnetic Stimulation / Q000627:therapeutic use*; D016896:Treatment Outcome