Abstract
While brain stimulation techniques have been examined as treatment options for chronic tinnitus for many years, they have recently been extended to multimodal treatment approaches. As chronic tinnitus is often accompanied by comorbid muscular tension in the neck and back, we performed a one-arm pilot study to explore the feasibility of a new multimodal treatment approach. In detail, repetitive peripheral magnetic stimulation (rPMS) of the back was performed before and after each session of repetitive transcranial magnetic stimulation (rTMS) of the brain. Data of 41 patients were analyzed, all of which were treated with ten sessions of rTMS of the left prefrontal and left temporoparietal cortex followed by rPMS of the neck and back muscles. Tinnitus severity was measured using the tinnitus questionnaire (TQ). Neck pain was assessed using the neck pain and disability scale (NPAD). The new treatment approach was feasible and well accepted by the majority of patients. However, the overall patient group did not improve significantly in either of the questionnaires. If patients were divided in different subgroups depending on whether they were suffering from neck pain or somatosensory tinnitus, explorative post-hoc tests suggested differential effects: patients with both neck pain and somatosensory tinnitus had better outcomes than patients without those conditions or with neck pain only. This was true for both the TQ and the NPAD. This effect was of transient nature though: the TQ score went back to its baseline level after a follow-up period of 12 weeks. Based on our results we recommend that in studies that investigate tinnitus treatments targeting somatosensory afferents patients should be stratified according to somatic co-morbidities and somatosensory influence on the tinnitus percept.Clinical trial registration: www.clinicaltrials.gov, NCT02306447.
Highlights
Chronic subjective tinnitus is a very heterogeneous condition with respect to its causes, clinical characteristics and the emotional distress perceived by a patient
Integrating the knowledge about the central nervous dysfunction as well as the importance of the somatosensory system for chronic tinnitus, we investigate a new multimodal treatment approach which targets both systems by combining repetitive transcranial magnetic stimulation (rTMS) with repetitive peripheral magnetic stimulation of the neck muscles
This is the first study to report combined rTMS and repetitive peripheral magnetic stimulation (rPMS) for the treatment of patients suffering from chronic subjective tinnitus
Summary
Chronic subjective tinnitus is a very heterogeneous condition with respect to its causes, clinical characteristics and the emotional distress perceived by a patient. Tinnitus has been shown to be accompanied by altered activity of and connectivity between different cortical networks including temporal, parietal and frontal cortices (Schlee et al, 2009; Schmidt et al, 2013; Elgoyhen et al, 2015). As rTMS is considered to be able to interfere with alterations of cortical activity, it has been examined as a treatment option for patients suffering from tinnitus (Theodoroff and Folmer, 2013; Lefaucheur et al, 2014). The stimulation of temporal and frontal cortical areas has been suggested to exert beneficial effects on tinnitus (Kleinjung et al, 2008; Langguth and De Ridder, 2013)
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