A Systematic Review and Meta-analysis of Randomized Controlled Trials on the Effect of Transcranial Magnetic Stimulation on Tinnitus Management
Abstract
Introduction: Tinnitus occurs in 10-15% of the world’s population. It may lead to hearing loss, depression, and suicidal tendencies, as well as reduced quality of life. The aim of this study was to assess whether Transcranial Magnetic Stimulation (TMS) effectively reduces tinnitus handicapping after six months or more of follow-up.
Methods: A systematic review of randomized controlled trials with follow-up of six months was undertaken. The review took place through searching Medline, Science Direct, and Google Scholar databases using the keywords “tinnitus” and “Transcranial Magnetic Stimulation” and limiting the search results to randomized controlled trials (RCTs) conducted on adults (19 years and older) published between 2005-2015. Meta-analysis was performed on the similarly designed studies.
Results: Five RCTs with six month follow-up were found conforming to the inclusion criteria. In total, there were 119 patients in the TMS arms and 115 in the placebo arms. However, designs were different between the studies and were therefore not all comparable. Different parameters were used to measure the severity of tinnitus and depression scores. Tinnitus handicapped inventory (THI) was the common measured outcome parameter used in all studies. THI score decreased after the TMS in four studies. Meta-analysis was performed on three similarly designed RCTs with the overall effect being insignificant.
Conclusion: TMS reduced the THI score and decreased the severity of tinnitus in 45% of patients and lead to a complete recovery in 32% of cases in one study. However, the meta-analysis demonstrated lack of significant effect of TMS on tinnitus management.
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Crummer R, Hassan G. Diagnostic approach to tinnitus. American Family Physician. 2004;
(1),120-6.
Atik A, Pathophysiology and Treatment of Tinnitus: An Elusive Disease. Indian J
Otolaryngol Head Neck Surg. 2014 Jan; 66(Suppl 1): 1–5.
Kehrle H, Granjeiro R, Sampaio A, Bezerra R, Almeida V, Oliveira C. Comparison of
auditory brainstem response results in normal-hearing patients with and without tinnitus.
Arch Otolaryngol Head Neck Surg, 2008;134 (6), 647–651.
Mazurek B, Stöver T, Haupt H, Gross J, Szczepek A. The role of cochlear
neurotransmitters in tinnitus. HNO 2007; 55(12):964–71.
Moller A. Pathophysiology of tinnitus. Otolaryngol Clin North Am. 2003; 36, 249–266,
v–vi.
McCormack A, Edmondson-Jones M , Somerset S , Hall D. A systematic review of the
reporting of tinnitus prevalence and Severity. Hearing Research 337 (2016) 70e79
Zelaya CE, Lucas JW, Hoffman HJ, MMWR QuickStats: Percentage of adults with
selected hearing problems, by type of problem and age group—National Health Interview
Survey, United States, 2014. MMWR. 2015;64(37):1058. Available from
https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6437a8.htm.
Mahboubi H, Oliaei S, Kiumehr S, Dwabe S, Djalilian HR. The prevalence and
characteristics of tinnitus in the youth population of the United States. Laryngoscope.
;123(8):2001–8.13
Meng Z, Liu S, Zheng Y, Phillips JS. Repetitive transcranial magnetic stimulation for
tinnitus (Review). The Cochrane Collaboration. 2011. JohnWiley & Sons, Ltd.
Langguth B, Kreuzer PM, Kleinjung T, De Ridder D. Tinnitus: causes and clinical
management. Lancet Neurol. 2013 Sep;12(9):920-930. doi:
1016/S1474-4422(13)70160-1
Baguley D, McFerran D, Hall D. Tinnitus. The Lancet. 2013; 382, (9904),1600–1607.
Li Y, Zeng RF, Zheng D. Acupuncture for tinnitus.Cochrane Database of Systematic
Reviews2009, Issue 4. Art. No.:CD008149. DOI:
1002/14651858.CD008149
Kobayashi M and Pascual-Leone A. Transcranial magnetic stimulation in neurology. THE
LANCET Neurology Vol 2 March 2003
Kleinjung T, Eichhammer P, Landgrebe M, Sand P, Hajak G, Steffens T. Combined
temporal and prefrontal transcranial magnetic stimulation for tinnitus treatment: a pilot study.
Otolaryngology - Head and Neck Surgery. 2008; 138(4), 497–501.
Eichhammer P, Hajak G, Kleinjung T, Landgrebe M, Langguth B. Functional imaging of
chronic tinnitus: the use of positron emission tomography. Prog Brain Res. 2007; 166, 83–88.
Miller, M. Magnetic stimulation: a new approach to treating depression? Harvard Health
Publications. 2012.
Rossi S, Hallett M, Rossini PM, Pascual-Leone A, The Safety of TMS Consensus Group.
Safety, ethical considerations, and application guidelines for the use of transcranial magnetic
stimulation in clinical practice and research, Clin Neurophysiol. 2009 Dec; 120(12):
–2039.
Andres M, Dvorakova J, Rathova L, Havrankova P, Pelcova P, Vaneckova M. Efficacy of
repetitive transcranial magnetic stimulation for the treatment of refractory chronic tinnitus: a
randomized, placebo controlled study. Neuro Endocrinol Lett. 2010; 31,238–249.
Hoekstra C, Versnel H, Neggers S, Niesten M, Van Zanten G. Bilateral Low-Frequency
Repetitive Transcranial Magnetic Stimulation of the Auditory Cortex in Tinnitus Patients Is
Not Effective: A Randomised Controlled Trial. Audiol Neurotol. 2013; 18,362–373.
Khedr E, AboElfetoh N, Rothwell J, El-Atar A, Sayed E, Khalifa H. Contralateral versus
ipsilateral TMS of temporoparietal cortex for the treatment of chronic unilateral tinnitus: a
comparative study. European Journal of Neurology. 2010; 17, 976–983.
Kim HJ, Kim DY, Kim HI, Hee S, Sim NS, Moon IS. Long-Term Effects of Repetitive
Transcranial Magnetic Stimulation in Unilateral Tinnitus. The Laryngoscope. 2014; 124,
-2160.
Marcondes R, Sanchez T, Ono C, Buchpiguel C, Langguth B. (). Repetitive transcranial
magnetic stimulation improve tinnitus in normal hearing patients: a double-blind controlled,
clinical and neuroimaging outcome study. European Journal of Neurology. 2010; 17, 38–44.
Landgrebe M, Binder H, Koller M, Eberl Y, Kleinjung T, Eichhammer P. Design of a
placebo-controlled, randomized study of the efficacy of repetitive transcranial magnetic
stimulation for the treatment of chronic tinnitus. BMC Psychiatry. 2008; 8, 23–31.
Krieg SM, Shiban E, Buchmann N, Gempt J, Foerschler A, Meyer B, Ringel F. Utility
of presurgical navigated transcranial magnetic brain stimulation for the resection of tumors in
eloquent motor areas. J Neurosurg 116:994–1001, 2012
Smith J, Mennemeier M, Bartel T, Chelette K, Kimbrell T, Triggs W, et al. Repetitive
transcranial magnetic stimulation for tinnitus: a pilot study. Laryngoscope. 2007; 117(3),
– 534.
Lehner A, Schecklmann M, Landgrebe M, Kreuzer P, Poeppl T, Frank E, et al. Predictors
for rTMS response in chronic tinnitus. Front Syst Neurosci. 2012; 6, 11.
De Ridder D, Vertraeten E, Der Kelen V. Transcranial magnetic stimulation for tinnitus:
influences of tinnitus duration on stimulation parameter choice and maximal tinnitus
suppression. Otol Neurol, 2005; (26), 616–619.
Plewnia C, Reimold M, Najib A, Reischl G, Plontke S, Gerloff C. Moderate therapeutic
efficacy of positron emission tomographynavigated repetitive transcranial magnetic
stimulation for chronic tinnitus: a randomised, controlled pilot study. J NeurolNeurosurg
Psychiatry. 2007; 78, 152–156.
Khedr E, Rothwell J, Ahmed M, El-Atar A. Effect of daily repetitive transcranial
magnetic stimulation for treatment of tinnitus: comparison of different stimulus frequencies. J
Neurol Neurosurg Psychiatry. 2008; 79, 212–215.
Schlee W, Hartmann T, Langguth B, Weisz N. Abnormal resting-state cortical coupling
in chronic tinnitus. BMC Neurosci. 2009; Feb 19,10,11. doi: 10.1186/1471-2202-10-11.
Roberts L, Eggermont J, Caspary D, Shore S, Melcher J, Kaltenbach J. Ringing ears: the
neuroscience of tinnitus. J Neurosci. 2010; 30, 14972–14979.
De Ridder D, Elgoyhen A, Romo R, Langguth B. Phantom percepts: tinnitus and pain as
persisting aversive memory networks. Proc Natl Acad Sci USA. 2011; 108, 8075–8080.
Leaver A, Renier L, Chevillet M, Morgan S, Kim H, Rauschecker J. Dysregulation of
limbic and auditory networks in tinnitus. Neuron. 2011; 69, 33–43.
Cuny C, Norena A, El Massioui F, Chéry-Croze S. Reduced attention shift in response to
auditory changes in subjects with tinnitus. Audiol Neurotol. 2004; 9, 294–302.
Searchfield G, Morrison-Low J, Wise K. Object identification and attention training for
treating tinnitus. Prog Brain Res. 2007; 166, 441–460.
Loo C, Mitchell P. A review of the efficacy of transcranial magnetic stimulation (TMS)
treatment for depression, and current and future strategies to optimize efficacy. J Affect
Disord, 2005; 88, 255–267.
DOI: https://doi.org/10.5195/cajgh.2020.356
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