title: A Pilot Study of EEG Source Analysis Based Repetitive Transcranial Magnetic Stimulation for the Treatment of Tinnitus.
abstract: OBJECTIVE
  Repetitive Transcranial Magnetic Stimulation (rTMS) is a novel therapeutic tool to induce a suppression of tinnitus. However, the optimal target sites are unknown. We aimed to determine whether low-frequency rTMS induced lasting suppression of tinnitus by decreasing neural activity in the cortex, navigated by high-density electroencephalogram (EEG) source analysis, and the utility of EEG for targeting treatment.
  
  
  METHODS
  In this controlled three-armed trial, seven normal hearing patients with tonal tinnitus received a 10-day course of 1-Hz rTMS to the cortex, navigated by high-density EEG source analysis, to the left temporoparietal cortex region, and to the left temporoparietal with sham stimulation. The Tinnitus handicap inventory (THI) and a visual analog scale (VAS) were used to assess tinnitus severity and loudness. Measurements were taken before, and immediately, 2 weeks, and 4 weeks after the end of the interventions.
  
  
  RESULTS
  Low-frequency rTMS decreased tinnitus significantly after active, but not sham, treatment. Responders in the EEG source analysis-based rTMS group, 71.4% (5/7) patients, experienced a significant reduction in tinnitus loudness, as evidenced by VAS scores. The target site of neuronal generators most consistently associated with a positive response was the frontal lobe in the right hemisphere, sourced using high-density EEG equipment, in the tinnitus patients. After left temporoparietal rTMS stimulation, 42.8% (3/7) patients experienced a decrease in tinnitus loudness.
  
  
  CONCLUSIONS
  Active EEG source analysis based rTMS resulted in significant suppression in tinnitus loudness, showing the superiority of neuronavigation-guided coil positioning in dealing with tinnitus. Non-auditory areas should be considered in the pathophysiology of tinnitus. This knowledge in turn can contribute to investigate the pathophysiology of tinnitus.
authors.affiliation: Department of Otolaryngology head and neck surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China, 200233.
authors.forename: Hui
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Otolaryngology head and neck surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China, 200233.
authors.forename: Bei
authors.initials: B
authors.lastname: Li
authors.affiliation: Department of Otolaryngology head and neck surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China, 200233.
authors.forename: Yanmei
authors.initials: Y
authors.lastname: Feng
authors.affiliation: Department of Otolaryngology head and neck surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China, 200233.
authors.forename: Biao
authors.initials: B
authors.lastname: Cui
authors.affiliation: Department of Otolaryngology head and neck surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China, 200233.
authors.forename: Hongmin
authors.initials: H
authors.lastname: Wu
authors.affiliation: Department of Otolaryngology head and neck surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China, 200233.
authors.forename: Haibo
authors.initials: H
authors.lastname: Shi
authors.affiliation: Department of Otolaryngology head and neck surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China, 200233.
authors.forename: Shankai
authors.initials: S
authors.lastname: Yin
mesh_terms: D000328:Adult; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D014012:Tinnitus / Q000628:therapy*; D050781:Transcranial Magnetic Stimulation