title: Combined central and peripheral stimulation for treatment of chronic tinnitus: a randomized pilot study.
abstract: BACKGROUND
  Tinnitus is a common untreatable condition that originates from central maladaptive plasticity initiated by peripheral injury. Repetitive transcranial magnetic stimulation (rTMS), direct cochlear low-level laser therapy (LLLT), and acupuncture were tried for tinnitus treatment, but the results of these methods were clinically unsatisfactory.
  
  
  OBJECTIVE
  This study aimed to test the combined effect of the 3 methods targeting both peripheral and central auditory areas as a new therapeutic strategy for tinnitus.
  
  
  METHODS
  For this, 30 patients were randomized to 3 equal groups receiving 3 different interventions: inhibitory rTMS to the left auditory cortex, LLLT (which includes a combination of direct cochlear LLLT and laser acupuncture) to the affected ear(s), and finally, a combination of rTMS and LLLT. The Tinnitus Handicap Inventory (THI) and Visual Analogue Scale (VAS) were assessed before, immediately after, and at 2 weeks and 4 weeks after 10 consecutive every-other-day sessions for each intervention type.
  
  
  RESULTS
  We found that combined stimulation was effective in tinnitus treatment. This effect remained for 4 weeks after the end of the treatment. However, each of rTMS and LLLT alone had no significant effect. Repeated-measures ANOVA showed a significant effect of Time and Time × Intervention interaction for THI and VAS scores. The post hoc t test for different time points per intervention revealed a significant difference between baseline and all postintervention measurements of both THI and VAS for the combination intervention.
  
  
  CONCLUSIONS
  Combined central rTMS and peripheral LLLT is more beneficial as a new method for management of tinnitus rather than these two used separately.
authors.affiliation: Sohag University Hospital, Sohag, Egypt Mohamed_hamdon@med.sohag.edu.eg.
authors.forename: Mohamed N
authors.initials: MN
authors.lastname: Thabit
authors.affiliation: Sohag General Hospital, Sohag, Egypt.
authors.forename: Naglaa
authors.initials: N
authors.lastname: Fouad
authors.affiliation: Sohag University Hospital, Sohag, Egypt.
authors.forename: Badawy
authors.initials: B
authors.lastname: Shahat
authors.affiliation: Sohag University Hospital, Sohag, Egypt.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Youssif
mesh_terms: D000161:Acoustic Stimulation; D015670:Acupuncture Therapy; D000328:Adult; D002908:Chronic Disease; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D028022:Low-Level Light Therapy; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D014012:Tinnitus / Q000628:therapy*; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome
keywords: acupuncture; low-level laser therapy; rehabilitation; tinnitus; transcranial magnetic stimulation