A proof-of-concept study on the combination of repetitive transcranial magnetic stimulation and relaxation techniques in chronic tinnitus.
Interference of ongoing neuronal activity and brain stimulation motivated this study to combine repetitive transcranial magnetic stimulation (rTMS) and relaxation techniques in tinnitus patients. Forty-two patients were enrolled in this one-arm proof-of-concept study to receive ten sessions of rTMS applied to the left dorsolateral prefrontal cortex and temporo-parietal cortex. During stimulation, patients listened to five different kinds of relaxation audios. Variables of interest were tinnitus questionnaires, tinnitus numeric rating scales, depressivity, and quality of life. Results were compared to results of historical control groups having received the same rTMS protocol (active control) and sham treatment (placebo) without relaxation techniques. Thirty-eight patients completed the treatment, drop-out rates and adverse events were low. Responder rates (reduction in tinnitus questionnaire (TQ) score ≥5 points 10 weeks after treatment) were 44.7 % in the study, 27.8 % in the active control group, and 21.7 % in the placebo group, differing between groups on a near significant level. For the tinnitus handicap inventory (THI), the main effect of group was not significant. However, linear mixed model analyses showed that the relaxation/rTMS group differed significantly from the active control group showing steeper negative THI trend for the relaxation/rTMS group indicating better amelioration over the course of the trial. Deepness of relaxation during rTMS and selection of active relaxation vs. passive listening to music predicted larger TQ. All remaining secondary outcomes turned out non-significant. This combined treatment proved to be a safe, feasible and promising approach to enhance rTMS treatment effects in chronic tinnitus.
Department of Psychiatry and Psychotherapy, University of Regensburg, Universitätsstrasse 84, 93053, Regensburg, Germany. peter.kreuzer@medbo.de.|Interdisciplinary Tinnitus Centre of the University of Regensburg, Regensburg, Germany. peter.kreuzer@medbo.de.
Peter M
PM
Kreuzer
Department of Psychiatry and Psychotherapy, University of Regensburg, Universitätsstrasse 84, 93053, Regensburg, Germany.|Interdisciplinary Tinnitus Centre of the University of Regensburg, Regensburg, Germany.
Timm B
TB
Poeppl
Department of Mathematics, University of Bergen, P.O. Box 7800, 5020, Bergen, Norway.
Jan
J
Bulla
Department of Psychiatry and Psychotherapy, University of Regensburg, Universitätsstrasse 84, 93053, Regensburg, Germany.|Interdisciplinary Tinnitus Centre of the University of Regensburg, Regensburg, Germany.
Winfried
W
Schlee
Department of Psychiatry and Psychotherapy, University of Regensburg, Universitätsstrasse 84, 93053, Regensburg, Germany.|Interdisciplinary Tinnitus Centre of the University of Regensburg, Regensburg, Germany.
Astrid
A
Lehner
Department of Psychiatry and Psychotherapy, University of Regensburg, Universitätsstrasse 84, 93053, Regensburg, Germany.|Interdisciplinary Tinnitus Centre of the University of Regensburg, Regensburg, Germany.
Berthold
B
Langguth
Department of Psychiatry and Psychotherapy, University of Regensburg, Universitätsstrasse 84, 93053, Regensburg, Germany.|Interdisciplinary Tinnitus Centre of the University of Regensburg, Regensburg, Germany.
Martin
M
Schecklmann
D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000628:therapy; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D004569:Electroencephalography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017397:Prefrontal Cortex / Q000502:physiology*; D011788:Quality of Life; D012064:Relaxation Therapy / Q000379:methods*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014012:Tinnitus / Q000628:therapy*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
Chronic tinnitus; Hypnosis; Muscle relaxation; Relaxation; Repetitive transcranial magnetic stimulation