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Repetitive Transcranial Magnetic Stimulation for Tinnitus: A Pilot Study. Laryngoscope. 2007 Mar;117(3):529-534. Smith JA1, Mennemeier M2, Bartel T3, Chelette KC2, Kimbrell T4, Triggs W5, Dornhoffer JL1, 2 1From the Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, U.S.A.;2the Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas, U.S.A.; 3the Department of Radi- ology, Division of Nuclear Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkan- sas, U.S.A.; 4the Department of Psychiatry, University of Arkansas for Medical Sciences and Mental Health Service, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, Arkansas, U.S.A.;5The Department of Neurology, University of Florida, Gainesville, Florida, U.S.A.

Objectives/Hypotheses: 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 attenti- onal deficits and cortical asymmetry in four patients with chronic tinnitus using objective and subjective measures and employing an optimization technique refined in our laboratory. Study design: 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 reac- tion 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 redu- ced 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 indi- viduals, but further trials are needed to determine the optimal techniques required to achieve a lasting re- sponse. 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.

Transcranial magnetic stimulation for the treatment of auditory phantom perceptions (tin- nitus) – a randomized placebo controlled study. (Abstract of ARO Meeting Denver, Colorado) Tobias Kleinjung1, Berthold Langguth2, Peter Eichhammer2, Michael Landgrebe2, Philipp Sand2, Juergen Strutz1, Goeran Hajak2 1University of Regensburg, Department of Otorhinolaryngology, 2University of Regensburg, Department of Psychiatry

Introduction: Repetitive transcranial magnetic stimulation (rTMS) represents a minimal invasive tool for focal brain stimulation. Patients suffering from auditory phantom perceptions (tinnitus) demonstrated focal brain activation within the auditory cortex. Neuronavigated low frequency transcranial magnetic stimulation of the area of increased activity cortex was able to reduce tinnitus perception in first studies. Methods: Patients suffering from chronic tinnitus underwent a FDG- PET study (positron emission tomo- graphy with [18F]deoxyglucose) to detect areas of increased metabolic activity in the cortex. Fusioning of the individual PET scans with structural MRI-scans (T1, MPRAGE) revealed an increased metabolic ac- tivation in the primary auditory cortex as target point for rTMS. The exact position of the figure 8-shaped magnetic coil in relation to the target was monitored with a neuronavigational system. The rTMS (110% motor threshold; 1 Hz; 2000 stimuli/ day over 10 days) was performed in a placebo controlled design.

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