Brief report| Volume 54, ISSUE 8, P862-865, October 15, 2003

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Neuronavigated repetitive transcranial magnetic stimulation in patients with tinnitus: a short case series



      Clinical as well as neurophysiological and neuroimaging data suggest that chronic tinnitus resembles neuropsychiatric syndromes characterized by focal brain activation. Low-frequency repetitive transcranial magnetic stimulation (rTMS) has been proposed as an efficient method in treating brain hyperexcitability disorders by reducing cortical excitability.


      In three patients suffering from chronic tinnitus, the effect of magnetic resonance imaging and positron emission tomography guided neuronavigated 1 Hz rTMS on auditory cortex activity was evaluated, using a sham controlled double-blind crossover design.


      Two of three patients revealed clearly increased metabolic activity in circumscript areas of the primary auditory cortex (PAC), allowing a selective stimulation of these cortical areas with low-frequency rTMS. Considerable improvement in tinnitus was achieved in these patients.


      Neuronavigated rTMS of increased PAC activity may help to better understand the neuronal basis of chronic tinnitus and might offer a new option for treating auditory phantom perceptions like chronic tinnitus.


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        • Arnold W.
        • Bartenstein P.
        • Oestreicher E.
        • Romer W.
        • Schwaiger M.
        Focal metabolic activation in the predominant left auditory cortex in patients suffering from tinnitus.
        ORL J Otorhinolaryngol Relat Spec. 1996; 58: 195-199
        • Bohning D.E.
        • Shastri A.
        • McConnell K.A.
        • Nahas Z.
        • Lorberbaum J.P.
        • Roberts D.R.
        • et al.
        A combined TMS/fMRI study of intensity-dependent TMS over motor cortex.
        Biol Psychiatry. 1999; 45: 385-394
        • Chen R.
        • Classen J.
        • Gerloff C.
        • Celnik P.
        • Wassermann E.M.
        • Hallett M.
        • et al.
        Depression of motor cortex excitability by low-frequency transcranial magnetic stimulation.
        Neurology. 1997; 48: 1398-1403
        • Dobie R.A.
        A review of randomized clinical trials in tinnitus.
        Laryngoscope. 1999; 109: 1202-1211
        • Folmer R.L.
        • Griest S.E.
        • Martin W.H.
        Chronic tinnitus as phantom auditory pain.
        Otolaryngol Head Neck Surg. 2001; 124: 394-400
        • Goebel G.
        • Hiller W.
        The tinnitus questionnaire. A standard instrument for grading the degree of tinnitus. Results of a multicenter study with the tinnitus questionnaire.
        HNO. 1994; 42: 166-172
        • Gumprecht H.K.
        • Widenka D.C.
        • Lumenta C.B.
        BrainLab VectorVision Neuronavigation System.
        Neurosurgery. 1999; 44: 97-104
        • Hallam R.S.
        • Jakes S.C.
        • Hinchcliffe R.
        Cognitive variables in tinnitus annoyance.
        Br J Clin Psychol. 1988; 27: 213-222
        • Hesse G.
        • Rienhoff N.K.
        • Nelting M.
        • Laubert A.
        Chronic complex tinnitus.
        Laryngorhinootologie. 2001; 80: 503-508
        • Hoffman R.E.
        • Boutros N.N.
        • Berman R.M.
        • Roessler E.
        • Belger A.
        • Krystal J.H.
        • et al.
        Transcranial magnetic stimulation of left temporoparietal cortex in three patients reporting hallucinated “voices”.
        Biol Psychiatry. 1999; 46: 130-132
        • Hoffman R.E.
        • Boutros N.N.
        • Hu S.
        • Berman R.M.
        • Krystal J.H.
        • Charney D.S.
        Transcranial magnetic stimulation and auditory hallucinations in schizophrenia.
        Lancet. 2000; 355: 1073-1075
        • Hoffman R.E.
        • Cavus I.
        Slow transcranial magnetic stimulation, long-term depotentiation, and brain hyperexcitability disorders.
        Am J Psychiatry. 2002; 159: 1093-1102
        • Kaltenbach J.A.
        Neurophysiologic mechanisms of tinnitus.
        J Am Acad Audiol. 2000; 11: 125-137
        • Lockwood A.H.
        • Salvi R.J.
        • Burkard R.F.
        • Galantowicz P.J.
        • Coad M.L.
        • Wack D.S.
        Neuroanatomy of tinnitus.
        Scand Audiol Suppl. 1999; 51: 47-52
        • Mirz F.
        • Gjedde A.
        • Ishizu K.
        • Pedersen C.B.
        Cortical networks subserving the perception of tinnitus—A PET study.
        Acta Otolaryngol Suppl. 2000; 543: 241-243
        • Muhlnickel W.
        • Elbert T.
        • Taub E.
        • Flor H.
        Reorganization of auditory cortex in tinnitus.
        Proc Natl Acad Sci U S A. 1998; 95: 10340-10343
        • Nahas Z.
        • Lomarev M.
        • Roberts D.R.
        • Shastri A.
        • Lorberbaum J.P.
        • Teneback C.
        • et al.
        Unilateral left prefrontal transcranial magnetic stimulation (TMS) produces intensity-dependent bilateral effects as measured by interleaved BOLD fMRI.
        Biol Psychiatry. 2001; 50: 712-720
        • Roland N.J.
        • Hughes J.B.
        • Daley M.B.
        • Cook J.A.
        • Jones A.S.
        • McCormick M.S.
        Electromagnetic stimulation as a treatment of tinnitus.
        Clin Otolaryngol. 1993; 18: 278-281
        • Tergau F.
        • Naumann U.
        • Paulus W.
        • Steinhoff B.J.
        Low-frequency repetitive transcranial magnetic stimulation improves intractable epilepsy.
        Lancet. 1999; 353: 2209
        • Touge T.
        • Gerschlager W.
        • Brown P.
        • Rothwell J.C.
        Are the after-effects of low-frequency rTMS on motor cortex excitability due to changes in the efficacy of cortical synapses?.
        Clin Neurophysiol. 2001; 112: 2138-2145
        • von Wedel H.
        • Strahlmann U.
        • Zorowka P.
        Effectiveness of various non-medicinal therapeutic measures in tinnitus. A long-term study.
        Laryngorhinootologie. 1989; 68: 259-266
        • Wang H.
        • Wang X.
        • Scheich H.
        LTD and LTP induced by transcranial magnetic stimulation in auditory cortex.
        Neuroreport. 1996; 7: 521-525
        • Wassermann E.M.
        Risk and safety of repetitive transcranial magnetic stimulation.
        Electroencephalogr Clin Neurophysiol. 1998; 108: 1-16
        • Wassermann E.M.
        • Lisanby S.H.
        Therapeutic application of repetitive transcranial magnetic stimulation.
        Clin Neurophysiol. 2001; 112: 1367-1377
        • Wise K.
        • Rief W.
        • Goebel G.
        Meeting the expectations of chronic tinnitus patients.
        J Psychosom Res. 1998; 44: 681-685