Abstract
A 28-year-old deaf female patient underwent 10 sessions of repetitive Transcranial Magnetic Stimulation (rTMS) as a participant in a placebo-controlled clinical trial for treatment of tinnitus. Trial participants received 2000 pulses of rTMS per session at a stimulation rate of 1 Hz. The neural target for rTMS was auditory cortex within Heschl’s gyrus. The primary outcome measure was the Tinnitus Functional Index (TFI); secondary outcome measures included a Visual Numeric Scale (VNS) for selfrated tinnitus loudness, Beck Depression Inventory II (BDI-II) and State Anxiety Inventory (SAI). Assessments were conducted at baseline, immediately after the last (10 th ) rTMS session, and 1, 2, 4, 13 and 26 weeks after the last rTMS session. At baseline, the patient’s TFI score was 27.6, which indicates that tinnitus was not a severe problem for her. After 10 rTMS sessions, her scores on the TFI, BDI and SAI increased (worsened), while the VNS score for tinnitus loudness decreased from 5.1 at baseline to 3.5. Her TFI score remained elevated at all follow-up assessments until week 26 when this score returned to its baseline level. Approximately half of the tinnitus patients in the clinical trial who received active rTMS (18 of 35) exhibited significant reductions in TFI scores that were sustained throughout the follow-up period. The fact that this patient did not benefit from rTMS might be attributed to the following factors: Low TFI baseline score; sub-optimal TMS stimulus intensity; suboptimal neural target for TMS. Although this patient did not benefit from rTMS, additional participants with profound hearing loss + bothersome tinnitus should be tested to determine if some of them do benefit from the procedure. Because many forms of sound therapy for tinnitus management are not practical for patients with profound hearing loss, rTMS might be a potential treatment option for this population.
Highlights
Chronic tinnitus, the perception of sound in the absence of external acoustic stimuli, affects 10-15% of the adult population [1] and is a major clinical problem that negatively affects quality of life [2,3,4,5]
74% of respondents experienced tinnitus, only 17% of them were severely distressed by their tinnitus; this percentage increased only to 25% when individuals with moderate tinnitus-related distress were included in the calculation
Data presented in this case study indicate that the subject’s baseline self-reported tinnitus severity (TFI score) was low, consistent with the findings of Andersson et al [31] that many individuals with profound hearing loss experience tinnitus, but are not distressed by it
Summary
The perception of sound in the absence of external acoustic stimuli, affects 10-15% of the adult population [1] and is a major clinical problem that negatively affects quality of life [2,3,4,5]. A treatment capable of reducing the perceived loudness of tinnitus would be invaluable. Different clinical management strategies are available, but there are no procedures that consistently offer relief for all individuals with tinnitus. Tinnitus rehabilitation encompasses a wide variety of methods, many of which show little evidence-based support of effectiveness [7]. There is a lack of understanding as to why some tinnitus patients report benefit from one treatment over another. Perhaps certain populations or certain forms of tinnitus respond better to specific interventions
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