[Treatment of chronic tinnitus with neuronavigated repetitive Transcranial Magnetic Stimulation (rTMS)].
OBJECTIVE
Idiopathic tinnitus is a frequent and debilitating disorder of largely unknown pathophysiology. Focal brain activation in the auditory cortex has recently been demonstrated in chronic tinnitus. Low-frequency rTMS can reduce cortical hyperexcitability.


METHODS
In 12 patients with chronic tinnitus, fusion of [18F]deoxyglucose-PET and structural MRI (T1, MPRAGE) scans allowed the area of increased metabolic activity in the auditory cortex to be exactly identified; this area was selected as the target for rTMS. A neuronavigational system adapted for TMS positioning enabled the relative positions of the figure-8 coil and the target area to be monitored. Repetitive TMS (110% motor threshold; 1 Hz; 2000 stimuli per day over 5 days) was performed using a placebo-controlled crossover design. A sham coil system was used for the placebo stimulation. Treatment outcome was assessed with a specific tinnitus questionnaire (Goebel and Hiller).


RESULTS
In all 12 patients an asymmetrically increased metabolic activation of the gyrus of Heschl was detected. The tinnitus score was significantly improved after 5 days of active rTMS, an effect not seen after placebo stimulation.


CONCLUSIONS
These preliminary results show that neuronavigated rTMS may improve our understanding and treatment of chronic tinnitus.
Kleinjung
T
T
Klinik für HNO-Heilkunde der Universität Regensburg, Regensburg. tobias.kleinjung@klinik.uni-regensburg.de
Steffens
T
T
Langguth
B
B
Eichhammer
P
P
Marienhagen
J
J
Hajak
G
G
Strutz
J
J
D000328:Adult; D001303:Auditory Cortex / Q000000981:diagnostic imaging* / Q000473:pathology*; D001931:Brain Mapping / Q000379:methods; D002908:Chronic Disease; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D038361:Neuronavigation / Q000379:methods*; D049268:Positron-Emission Tomography / Q000379:methods*; D014012:Tinnitus / Q000628:therapy*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome