title: Repetitive transcranial magnetic stimulation for tinnitus: a pilot study.
abstract: OBJECTIVE
  Low-frequency repetitive transcranial magnetic stimulation (rTMS) has been shown to alleviate tinnitus perception, presumably by inhibiting cortical activity associated with tinnitus. We conducted a pilot study to assess effectiveness of neuronavigated rTMS and its effects on attentional deficits and cortical asymmetry in four patients with chronic tinnitus using objective and subjective measures and employing an optimization technique refined in our laboratory.
  
  
  METHODS
  Randomized, placebo-controlled (sham stimulation) crossover study.
  
  
  METHODS
  Patients received 5 consecutive days of active, low-frequency rTMS or sham treatment (using a 45-degree coil-tilt method) before crossing over. Subjective tinnitus was assessed at baseline, after each treatment, and 4 weeks later. Positron emission tomography/computed tomography (PET/CT) scans were obtained at baseline and immediately after active treatment to examine change in cortical asymmetry. Attentional vigilance was assessed at baseline and after each treatment using a simple reaction time test.
  
  
  RESULTS
  All patients had a response to active (but not sham) rTMS, as indicated by their best tinnitus ratings; however, tinnitus returned in all patients by 4 weeks after active treatment. All patients had reduced cortical activity visualized on PET immediately after active rTMS. Mean reaction time improved (P < .05) after active but not sham rTMS.
  
  
  CONCLUSIONS
  rTMS is a promising treatment modality that can transiently diminish tinnitus in some individuals, but further trials are needed to determine the optimal techniques required to achieve a lasting response. It is unclear whether the improved reaction times were caused by tinnitus reduction or a general effect of rTMS. PET/CT scans immediately after treatment suggest that improvement may be related to reduction of cortical asymmetry associated with tinnitus.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Smith
authors.forename: Mark
authors.initials: M
authors.lastname: Mennemeier
authors.forename: Twyla
authors.initials: T
authors.lastname: Bartel
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Chelette
authors.forename: Timothy
authors.initials: T
authors.lastname: Kimbrell
authors.forename: William
authors.initials: W
authors.lastname: Triggs
authors.forename: John L
authors.initials: JL
authors.lastname: Dornhoffer
mesh_terms: D000328:Adult; D001143:Arousal / Q000502:physiology; D001288:Attention / Q000502:physiology; D018592:Cross-Over Studies; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D049268:Positron-Emission Tomography; D011597:Psychomotor Performance / Q000502:physiology; D014012:Tinnitus / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome