Abstract
Recent research indicates that tinnitus is related to alterations of neural networks including temporal, parietal, and prefrontal brain regions. The current study examines a rTMS protocol which targets three central nodes of these networks in a two-arm randomized parallel group trial. Overall, 49 patients with chronic tinnitus were randomized to receive either triple-site stimulation (left dorsolateral prefrontal stimulation, 1000 pulses, 20 Hz plus left and right temporoparietal stimulation, 1000 pulses each, 1 Hz) or single-site stimulation (left temporoparietal stimulation, 3000 pulses, 1 Hz). Both groups were treated in ten sessions. Tinnitus severity as measured by the tinnitus questionnaire was assessed before rTMS (day1), after rTMS (day12) and at two follow-up visits (day 90 and day 180). The triple-site protocol was well tolerated. There was a significant reduction in tinnitus severity for both treatment groups. The triple-site group tended to show a more pronounced treatment effect at day 90. However, the measurement time point x group interaction effect was not significant. The current results confirm former studies that indicated a significant reduction of tinnitus severity after rTMS treatment. No significant superiority of the multisite protocol was observed. Future approaches for the enhancement of treatment effects are discussed.
Highlights
Chronic subjective tinnitus is defined as the perception of sound or noise without presence of a corresponding internal or external sound source
Recent studies have suggested that alterations of the connectivity between and within widespread neural networks including frontal, parietal and temporal areas are associated with chronic tinnitus[6,7,11,28]
The current study aimed to use this knowledge about tinnitus pathophysiology for a new treatment option by stimulating three central hubs of these neural networks involved in tinnitus
Summary
Chronic subjective tinnitus is defined as the perception of sound or noise without presence of a corresponding internal or external sound source. It is a highly prevalent[1] and for many patients very stressful condition which impairs their everyday lives and mental well-being[2]. It has been shown that tinnitus is accompanied by alterations of functional connectivity within and between several neural networks including temporal, parietal and frontal cortices[7,8,9]. It is supposed that the tinnitus reaches awareness only if there is a co-activation between the auditory cortex and a “perception network” including parietal and frontal cortices[6]. The current study seizes the idea of this network perspective with the aim of improving rTMS treatment for chronic subjective tinnitus
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