title: Bilateral low-frequency repetitive transcranial magnetic stimulation of the auditory cortex in tinnitus patients is not effective: a randomised controlled trial.
abstract: BACKGROUND
  Although some therapies may be beneficial for some patients in reducing tinnitus, there is no curative therapy. Repetitive transcranial magnetic stimulation (rTMS) has been applied as a treatment for chronic tinnitus, but the effect remains controversial.
  
  
  METHODS
  Fifty patients were treated with rTMS or placebo. Treatment consisted of 2,000 TMS pulses on each auditory cortex, at a rate of 1 Hz and an intensity of 110% of the individual motor threshold, on 5 consecutive days. rTMS and placebo effects were evaluated directly after treatment, after 1 week, and after 1, 3 and 6 months. Primary outcome was the Tinnitus Questionnaire (TQ). Secondary outcomes were the Tinnitus Handicap Inventory (THI) and a visual analogue scale.
  
  
  RESULTS
  At none of the follow-up evaluation moments a significant difference between rTMS and placebo was observed with respect to changes in TQ or THI scores relative to pretreatment scores. Multilevel modelling (MLM) analyses did not show a global treatment effect either. Patients with a higher degree of burden showed slightly greater improvement after rTMS (only significant on the THI with MLM analyses).
  
  
  CONCLUSIONS
  Bilateral low-frequency rTMS of the auditory cortex was not effective in treating tinnitus.
authors.affiliation: Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Carlijn E L
authors.initials: CE
authors.lastname: Hoekstra
authors.forename: Huib
authors.initials: H
authors.lastname: Versnel
authors.forename: Sebastiaan F W
authors.initials: SF
authors.lastname: Neggers
authors.forename: Marlien E F
authors.initials: ME
authors.lastname: Niesten
authors.forename: Gijsbert A
authors.initials: GA
authors.lastname: van Zanten
mesh_terms: D000328:Adult; D000368:Aged; D001303:Auditory Cortex / Q000502:physiology*; D002908:Chronic Disease; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation; D015990:Placebo Effect; D014012:Tinnitus / Q000628:therapy*; D050781:Transcranial Magnetic Stimulation / Q000295:instrumentation / Q000379:methods*; D017211:Treatment Failure