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

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Summary

Introduction

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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