Tinnitus Questionnaire Research Articles

Phase-shift treatment for tinnitus of cochlear origin

Phase-shift treatment is a new tinnitus therapy that aims at sound cancelling. This technique is based on a theory advocating that the induction of a sound wave with a 180 degrees phase-shift compared to the sound experienced by the patient could result in sound cancelling, likely by negation of the cortical perception of tinnitus or residual inhibition, which can be partial or complete. The aim of our study is to compare the effect of phase-shifting generated by the tinnitus phase-out device between pure tone tinnitus patients (PTP) and narrow band noise tinnitus patients (NBNP). In present comparative study, we explore the effects of phase-shifting during 6 weeks of phase-out therapy in PTP and NBNP. Thirty-five tinnitus patients were included in the study. Twenty-one patients had pure tone tinnitus and 14 patients had narrow band noise tinnitus. The effects on tinnitus were assessed using three separate visual analogue scales (VAS), the tinnitus questionnaire, the hyperacusis questionnaire, the Beck depression inventory, a categorical scale and audiometric measurements. While no differences in VAS were seen after therapy in NBNP, tinnitus increase could be demonstrated in PTP. This increase could be demonstrated for tinnitus loudness (p = 0.002) and tinnitus annoyance (p = 0.014). In conclusion, implementation of phase-shifting did not lead to significant sound cancelling. Our results are discussed and compared to previous studies investigating the effects of phase-out in tinnitus patients.

Efficacy and safety of bilateral continuous theta burst stimulation (cTBS) for the treatment of chronic tinnitus: design of a three-armed randomized controlled trial

BackgroundTinnitus, the perception of sound and noise in absence of an auditory stimulus, has been shown to be associated with maladaptive neuronal reorganization and increased activity of the temporoparietal cortex. Transient modulation of tinnitus by repetitive transcranial magnetic stimulation (rTMS) indicated that these areas are critically involved in the pathophysiology of tinnitus and suggested new treatment strategies. However, the therapeutic efficacy of rTMS in tinnitus is still unclear, individual response is variable, and the optimal stimulation area disputable. Recently, continuous theta burst stimulation (cTBS) has been put forward as an effective rTMS protocol for the reduction of pathologically enhanced cortical excitability.Methods48 patients with chronic subjective tinnitus will be included in this randomized, placebo controlled, three-arm trial. The treatment consists of two trains of cTBS applied bilaterally to the secondary auditory cortex, the temporoparietal associaction cortex, or to the lower occiput (sham condition) every working day for four weeks. Primary outcome measure is the change of tinnitus distress as quantified by the Tinnitus Questionnaire (TQ). Secondary outcome measures are tinnitus loudness and annoyance as well as tinnitus change during and after treatment. Audiologic and speech audiometric measurements will be performed to assess potential side effects. The aim of the present trail is to investigate effectiveness and safety of a four weeks cTBS treatment on chronic tinnitus and to compare two areas of stimulation. The results will contribute to clarify the therapeutic capacity of rTMS in tinnitus.Trial registrationThe trial was registered with the clinical trials register of (NCT00518024).

Does a single session of theta-burst transcranial magnetic stimulation of inferior temporal cortex affect tinnitus perception?

BackgroundCortical excitability changes as well as imbalances in excitatory and inhibitory circuits play a distinct pathophysiological role in chronic tinnitus. Repetitive transcranial magnetic stimulation (rTMS) over the temporoparietal cortex was recently introduced to modulate tinnitus perception. In the current study, the effect of theta-burst stimulation (TBS), a novel rTMS paradigm was investigated in chronic tinnitus. Twenty patients with chronic tinnitus completed the study. Tinnitus severity and loudness were monitored using a tinnitus questionnaire (TQ) and a visual analogue scale (VAS) before each session. Patients received 600 pulses of continuous TBS (cTBS), intermittent TBS (iTBS) and intermediate TBS (imTBS) over left inferior temporal cortex with an intensity of 80% of the individual active or resting motor threshold. Changes in subjective tinnitus perception were measured with a numerical rating scale (NRS).ResultsTBS applied to inferior temporal cortex appeared to be safe. Although half of the patients reported a slight attenuation of tinnitus perception, group analysis resulted in no significant difference when comparing the three specific types of TBS. Converting the NRS into the VAS allowed us to compare the time-course of aftereffects. Only cTBS resulted in a significant short-lasting improvement of the symptoms. In addition there was no significant difference when comparing the responder and non-responder groups regarding their anamnestic and audiological data. The TQ score correlated significantly with the VAS, lower loudness indicating less tinnitus distress.ConclusionTBS does not offer a promising outcome for patients with tinnitus in the presented study.

Theta Burst Stimulation in the Treatment of Incapacitating Tinnitus Accompanied by Severe Depression

This case report describes the use of transcranial magnetic theta burst stimulation (TBS) in the treatment of incapacitating tinnitus accompanied by symptoms of severe depression. Tinnitus is known to be associated with hyperactivity and maladaptive cortical reorganization of the central auditory system. Combined with anxiety and depression, it can occasionally constitute a psychiatric emergency. Recently, it has been demonstrated that tinnitus can be temporarily suppressed by non-invasive transcranial magnetic stimulation. TBS is a newly developed technique for rapid and lasting modulation of cortical excitability. Herein, we present a case of a 54-year-old woman with incapacitating tinnitus that has significantly decreased after three cycles of 1-week treatment with continuous TBS to the temporo-parietal auditory association cortex. According to the Tinnitus Questionnaire, tinnitus intensity decreased from 84 points before to 59 points after treatment. Hamilton Rating Scale for Depression score dropped from 44 to 23 points. TBS showed to be efficient, well-tolerated, and practical in the management of distressing tinnitus accompanied by symptoms of severe depression.

Evaluation of vardenafil for the treatment of subjective tinnitus: a controlled pilot study

BackgroundVardenafil (Levitra®) represents a potent and highly selective phosphodiesterase type 5 (PDE5) inhibitor, which is established for treatment of various diseases. There are several unpublished reports from patients stating that vardenafil has a considerable therapeutic effect on their concomitant tinnitus. This pilot study was conducted to specifically assess the effect of vardenafil in patients with chronic tinnitus.MethodsThis trial was based on a prospective, randomized, double-blind, placebo-controlled, parallel group design. Fourty-two consecutive subjects with mon- or binaural chronic tinnitus received 10 mg vardenafil (N = 21) or matching placebo tablets (N = 21) administered orally twice a day over a period of 12 weeks. Clinical examination and data acquisition took place at each visit: at baseline, after 4 weeks, after 12 weeks (end of treatment with study medication), and at non-medicated follow-up after 16 weeks. Assessment of clinical effectiveness was based on a standardized tinnitus questionnaire (TQ), the Short Form 36 health survey (SF-36), audiometric measurements (mode, pitch and loudness of tinnitus; auditory thresholds) and biomarkers of oxidative stress in patients' blood (malondialdehyde, protein carbonyl, homocysteine and total antioxidative status). Therapeutic efficacy was evaluated by comparison of subjective and objective parameters with baseline data between both treatment groups (ANCOVA).ResultsVardenafil had no superior efficacy over placebo in the treatment of chronic tinnitus during this study. The primary efficacy criterion 'TQ total score' failed to demonstrate significant improvement compared to placebo. Subjective reports of TQ subscales and general quality of life areas (SF-36), objective audiometric examinations as well as investigated biomarkers for oxidative stress did not reveal any significant treatment effects. The safety profile was favorable and consistent with that in other vardenafil studies.ConclusionAlthough hypoxia and ischemia play a special role in the pathogenesis of tinnitus, the PDE5-inhibitor-induced increase of nitric oxide-mediated vasodilatation exerted no specific influence on tinnitus symptomatology. Considering the unclear risk of rarely associated hearing impairment, systemic application of vardenafil or other PDE5 inhibitors prove to be not appropriate for therapy of chronic tinnitus.

One‐year follow up of patients with chronic tinnitus treated with left temporoparietal rTMS

Although there are a number of positive reports on the therapeutic effects of repetitive transcranial magnetic stimulation (rTMS) for treatment of tinnitus, there are few details about the duration of treatment effects or the relative efficiency of different rTMS protocols. Sixty six patients with chronic tinnitus were divided into four groups, receiving sham rTMS, 1, 10 and 25 Hz rTMS applied each day for 10 days over left temporoparietal cortex. They were followed up at 4 months and 1 year using the tinnitus questionnaire [Tinnitus Handicap Inventory(THI)] and self ratings of annoyance as well as measures of residual inhibition. A two factor anova revealed a significant 'rTMS' x 'time' interaction indicating that real and sham rTMS had different effects on the THI scale and annoyance of tinnitus (P = 0.026 and 0.046 respectively). After 1 year, the tinnitus was absent in one or both ears of 10 patients who had received real rTMS: one of these was in the 1 Hz group, four patients were in the 10 Hz group and five patients were in the 25 Hz group. Some patients show a lasting benefit at 1 year after 10 days of rTMS treatment. It appears that treatment at 10 or 25 Hz may be more beneficial than at 1 Hz, although more work is necessary to validate this conclusion.

Tinnitus Among Airline Pilots: Prevalence and Effects of Age, Flight Experience, and Other Noise

Frequent or constant tinnitus can be a problem for pilots because it can be distracting and/or interfere with communications in the cockpit. We studied tinnitus in a population of airline pilots to determine its prevalence and identify predictors. A total of 418 male and 42 female pilots on duty in a Swedish airline returned a completed tinnitus questionnaire (response rate 79%). Multiple logistic regression analysis was performed; variables retained in the model included age, smoking, exposure to loud impulse noise during leisure time, previous work as a military pilot, years of employment as a commercial pilot, and type of aircraft. When available, the pilots' most recent routine audiometric test (N = 388) was used to study the association between hearing impairment and tinnitus. A total of 40% of respondents had experienced tinnitus for more than 5 min during the past year, 18% reported constant or severe tinnitus, and 12% had at some time visited a doctor for problems related to tinnitus. There were associations between tinnitus and age, impulse noise, and hearing impairment at 3, 4, and 6 kHz. There was no association with aircraft type or work as a military pilot. Pilots with tinnitus were more likely to report themselves disturbed by noise in the cockpit. These results show that tinnitus is relatively common among pilots and can create problems with sensitivity to noise. The frequency of tinnitus is most closely related to age, gender, exposure to high impulse noise during leisure time, and hearing impairment.

Integrierte Tinnitusintensivbehandlung: Verringerung der tinnitusbedingten Belastung während einer 1-Jahres-Katamnese

The therapy of the chronic tinnitus is aimed at improving the way patients cope with their tinnitus and at reducing the tinnitus-related distress. The present study investigated the changes of psychometric parameters that occurred in patients with chronic tinnitus after 7-days outpatient multidisciplinary therapy. The changes were monitored for up to 1 year in order to evaluate the long-term efficiency. Main emphasis of the intensive tinnitus therapy applied was placed on tinnitus habituation and on teaching the patients how to apply coping strategies. The main elements of the multimodal concept included progressive muscle relaxation according to Jacobson, physiotherapy, educative seminars, training of selective attention and, lastly, the change of judgment, attitude and behaviour towards tinnitus. Psychometric parameters and tinnitus-related distress were assessed prior to and after the therapy (at 3, 6 and 12 months) using the tinnitus questionnaire (TQ) according to Goebel and Hiller. Furthermore, subjects waiting for therapy (waiting list) were recruited to the control group and compared with the therapy group which had received therapy 3 months earlier. The therapy group showed a significant reduction of the TQ total score after 3 months as compared to the control group. Moreover, we observed a long-term, progressive positive outcome during the one-year follow-up. The TQ total score was reduced by 10.9 points. There was an obvious decrease of the emotional and cognitive distress as well as of the intrusiveness of tinnitus, as per evaluation of TQ subscales. The outpatient intensive multidisciplinary tinnitus therapy with long-term aftercare has proved to be an effective method in the treatment of patients with chronic tinnitus. The outpatient setting enables the instant implementation of strategies learned during therapy in the patients' everyday life.

Psychometric properties of a Chinese (Cantonese) version of the Tinnitus Questionnaire

The objective of this study was to determine the psychometric properties of a Chinese (Cantonese) version of the Tinnitus Questionnaire (TQ), which is a psychometric self-report measure of perceived tinnitus-related distress. The subjects were 114 adults who attended audiology clinics with a primary or secondary complaint of tinnitus. They completed the Chinese versions of the TQ (TQ-CH), Short-Form 36 Health Survey (SF-36), and Hospital Anxiety and Depression Scale (HADS). The subjective severity of tinnitus and tinnitus-related problems were scored using rating scales. The TQ-CH and its subscales had good internal consistency reliability estimates (α=0.75–0.94), which were comparable to those of the original version. Significant correlations were observed between the TQ-CH and psychological distress, tinnitus-related problem ratings, and severity ratings. Factor analysis showed the high construct validity of the TQ-CH subscales. High test-retest reliablity (intraclass correlation coefficient=0.96) was observed. The results suggest that the TQ-CH is a reliable and valid measure of general tinnitus-related distress that can be used in clinical settings to quantify the impact of tinnitus on daily living.

Treatment Response of Modified Tinnitus Retraining Therapy with Medical Therapy in the Patients with Tinnitus

Background and ObjectivesZZAccording to the neurophysiologic model of tinnitus, emotion and autonomic nervous systems are closely related to generation of tinnitus. We performed this study to evaluate the treatment response of modified tinnitus retraining therapy (TRT) with medication in the patients with sensorineural tinnitus. Subjects and MethodZZForty-three tinnitus patients who were diagnosed as sensorineural tinnitus through audiologic evaluation and have normal hearing in speech frequency were included in this study. Tinnitus and psychological status were measured by tinnitus questionnaire, Korean version of Brief Encounter Psychosocial Instrument (BEPSI) scale, Beck Depression Inventory (BDI), Spielberger State Trait Anxiety Inventory (STAI). Patients treated with anxiolytics and microcirculation enhancer were Group 1 and those treated with modified TRT and medications were Group 2. Short-term therapeutic response was analyzed and compared between two groups. ResultsZZLoudness, awareness, annoyance and effect on life of tinnitus and tinnitus handicap score were significantly decreased in Group 2. Relief of tinnitus in more than 2 of 4 subjective parameters was achieved in 4 patients (30.7%) in Group 1 and 15 patients (75%) in Group 2. Stress score was also decreased significantly after treatment in Group 2. ConclusionZZTinnitus patients in Group 2 treated with medication and modified TRT showed the higher compliance and the response rate of treatment than the patients in Group 1 treated with medication alone. Modified TRT, in addition to medical therapy, should be considered to increase the therapeutic response in patients with sensorineural tinnitus. Korean J Otorhinolaryngol-Head Neck Surg 2009;52:648-54 Key WordsZZTinnitus·Stress·Depression·Anxiety·Tinnitus retraining therapy.

Levodopa does not enhance the effect of low-frequency repetitive transcranial magnetic stimulation in tinnitus treatment

Low-frequency repetitive transcranial magnetic stimulation (rTMS) has shown promise for the treatment of tinnitus. Experimental data from motor cortex stimulation in healthy subjects indicate that the suppressing effect of low-frequency rTMS can be enhanced by dopaminergic receptor activation. Here we investigated whether administration of the dopamine precursor levodopa before low-frequency rTMS enhances its efficacy in tinnitus treatment. Sixteen patients with chronic tinnitus received 100 mg of levodopa before each session of low-frequency rTMS. Results were compared with a matched control group of 16 patients who received the same treatment, but without levodopa. Treatment outcome was assessed with a standardized tinnitus questionnaire. Both stimulation protocols resulted in a significant reduction of tinnitus scores after 10 days of stimulation; however, there was no significant difference between the two groups. Our data suggest that 100 mg of levodopa does not enhance the effect of rTMS in the treatment of tinnitus.

Incapacitating Unilateral Tinnitus in Single-Sided Deafness Treated by Cochlear Implantation

Tinnitus is a well-known, difficult-to-treat symptom of hearing loss. Users of cochlear implants (CIs) have reported a reduction in tinnitus following implantation for bilateral severe-to-profound deafness. This study assessed the effect of electrical stimulation via a CI on tinnitus in subjects with unilateral deafness and ipsilateral tinnitus who underwent implantation in an attempt to treat tinnitus with the CI. Twenty-one subjects who complained of severe intractable tinnitus that was unresponsive to treatment received a CI. Tinnitus loudness was measured with a Visual Analog Scale; loudness percepts were recorded with the device activated and deactivated. Tinnitus distress was measured with the Tinnitus Questionnaire before and after implantation. Electrical stimulation via a CI resulted in a significant reduction in tinnitus loudness (mean +/- SD; 1 year after implantation, 2.4 +/- 1.8; 2 years after implantation, 2.5 +/- 1.9; before implantation, 8.5 +/- 1.3). With the device deactivated, tinnitus loudness was still reduced to between 6.1 and 7.0 over 24 months. The Tinnitus Questionnaire revealed a significant positive effect of CI stimulation. Unilateral tinnitus resulting from single-sided deafness can be treated with electrical stimulation via a CI. The outcomes of this pilot study demonstrate a new method for treatment of tinnitus in select subjects, perhaps an important new indication for cochlear implantation.

S227 – Investigation of the Prion Protein in Subjects with Tinnitus

Objectives The prion protein (PrP) plays a major role in central nervous excitability, cellular adhesion, and neurite outgrowth. We hypothesized that PrP variants may act as a modulator of chronic tinnitus, a condition frequently associated with states of overexcitability in the auditory pathway. Methods 139 Caucasian patients who presented with tinnitus lasting more than 6 months were recruited from a tinnitus clinic, underwent detailed neuro-otological examinations and donated venous blood for the extraction of genomic DNA from lymphocytes. Subjects with a history of vestibular schwannoma, Meniere's disease, or pathological middle ear conditions were excluded. Tinnitus severity was graded using the Tinnitus Questionnaire (TQ). A polymorphism encoding residue 117 of PrP was genotyped by PCR-based RFLP. Results When carriers of the minor PrP allele were compared to the remaining subjects, we noted only a moderate difference in mean TQ scores (33.4 ± 4.9 vs. 37.4 ± 1.5, p > 0.05). Conclusions The present results thus do not support a significant effect of PrP variant rs8124214 on subjective ratings of tinnitus. However, functional PrP variants may act on additional outcome parameters, e.g., on the response to treatment. Future studies will need to address the interplay of these variants, and their effects on specific subgroups.

TMS in Tinnitus Treatment: Enhancement by Dopamine Agonists?

Objective Repetitive transcranial magnetic stimulation (rTMS) of the temporal cortex revealed positive effects in patients with chronic tinnitus. Recent preclinical data in healthy controls suggest that effects of low frequency rTMS can be enhanced by application of dopamine agonists. Based on these data, we investigated whether application of a dopaminergic drug increases clinical effects of low frequency rTMS over the auditory cortex in tinnitus patients. Methods 18 subjects with chronic tinnitus received sessions of 1Hz rTMS (2000 pulses/d, 110% motor threshold) applied to the left temporal cortex on 10 subsequent working days. Additionally, these subjects received one dosage of Madopar® (100mg Levodopa/ 25 mg Benserazide)1 hour prior to each TMS session. Treatment outcome was assessed over a 3-month period with a tinnitus questionnaire (TQ). Treatment effects were compared to a control group matched for age, gender, tinnitus duration, and hearing loss, which received the same rTMS treatment without prior Levodopa application. Results TMS treatment resulted in a reduction of TQ scores in both groups. Improvement was slightly superior in the Levodopa group, but the difference did not reach statistical significance (p <0.05). Conclusions These results further support that rTMS has beneficial effects in treatment of chronic tinnitus. Levodopa resulted in a slight, but non-significant, tendency towards better outcome. Further studies with larger sample sizes are needed.

Tinnitus Outcomes Assessment

Over the past two decades, recognition has grown that measures for evaluating treatment outcomes must be designed specifically to have high responsiveness. With that in mind, four major types of tinnitus measures are reviewed, including psychoacoustic measures, self-report questionnaires concerning functional effects of tinnitus, various rating scales, and global outcome measures. Nine commonly used tinnitus questionnaires, developed in the period 1980-2000, are reviewed. Because of many similarities between tinnitus and pain, comparisons between pain and tinnitus measures are discussed, and recommendations that have been made for developing a core set of measures to evaluate treatment-related changes in pain are presented as providing a fruitful path for developing a core set of measures for tinnitus. Finally, the importance of having both immediately obtainable outcome measures (psychoacoustic, rating scales, or single global measures) and longer term measures (questionnaires covering the negative effects of tinnitus) is emphasized for further work in tinnitus outcomes assessment.

Design of a placebo-controlled, randomized study of the efficacy of repetitive transcranial magnetic stimulation for the treatment of chronic tinnitus

BackgroundChronic tinnitus is a frequent condition, which can have enormous impact on patient's life and which is very difficult to treat. Accumulating data indicate that chronic tinnitus is related to dysfunctional neuronal activity in the central nervous system. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive method which allows to focally modulate neuronal activity. An increasing amount of studies demonstrate reduction of tinnitus after repeated sessions of low-frequency rTMS and indicate that rTMS might represent a new promising approach for the treatment of tinnitus. However available studies have been mono-centric and are characterized by small sample sizes. Therefore, this multi-center trial will test the efficacy of rTMS treatment in a large sample of chronic tinnitus patients.Methods/DesignThis is a randomized, placebo-controlled, double-blind multi-center trial of two weeks 1 Hz rTMS-treatment in chronic tinnitus patients. Eligible patients will be randomized to either 2 weeks real or sham rTMS treatment. Main eligibility criteria: male or female individuals aged 18–70 years with chronic tinnitus (duration > 6 months), tinnitus-handicap-inventory-score ≥ 38, age-adjusted normal sensorineural hearing (i.e. not more than 5 dB below the 10% percentile of the appropriate age and gender group (DIN EN ISO 7029), conductive hearing loss ≤ 15dB. The primary endpoint is a change of tinnitus severity according to the tinnitus questionnaire of Goebel and Hiller (baseline vs. end of treatment period). A total of 138 patients are needed to detect a clinical relevant change of tinnitus severity (i.e. 5 points on the questionnaire of Goebel and Hiller; alpha = 0.05; 1-beta = 0.80). Assuming a drop-out rate of less than 5% until the primary endpoint, 150 patients have to be randomized to guarantee the target number of 138 evaluable patients. The study will be conducted by otorhinolaryngologists and psychiatrists of 7 university hospitals and 1 municipal hospital in Germany.DiscussionThis study will provide important information about the efficacy of rTMS in the treatment of chronic tinnitus.Trial registrationCurrent Controlled Trials ISRCTN89848288

Combined temporal and prefrontal transcranial magnetic stimulation for tinnitus treatment: A pilot study

Low-frequency repetitive transcranial magnetic stimulation (rTMS) of the temporal cortex has been proposed as a new treatment strategy for patients with chronic tinnitus. However, functional abnormalities in tinnitus patients also involve brain structures used for attentional and emotional processing, such as the dorsolateral prefrontal cortex. Therefore, we have developed a new rTMS treatment strategy for tinnitus patients that consists of a combination of high-frequency prefrontal and low-frequency temporal rTMS. A total of 32 patients received either low-frequency temporal rTMS or a combination of high-frequency prefrontal and low-frequency temporal rTMS. Treatment effects were assessed with a standardized tinnitus questionnaire (TQ). Directly after therapy there was an improvement of the TQ-score for both groups, but no differences between groups. An evaluation after 3 months revealed a remarkable benefit from the use of combined prefrontal and temporal rTMS treatment. These results support recent data that suggest that auditory and nonauditory brain areas are involved in tinnitus pathophysiology.

Pilot study to evaluate psychiatric co-morbidity in tinnitus patients with and without hyperacusis

The relationship between hyperacusis with chronic tinnitus and psychiatric disorders has long been ignored. A prevalence of hyperacusis in 59% of tinnitus patients was found using the Structured Tinnitus Interview (STI). Twenty-four per cent of the subgroup noticed the hyperacusis before the tinnitus had begun. Study participants were 163 consecutive inpatients with chronic tinnitus. A Tinnitus Questionnaire assessed the degree of severity of the tinnitus. Hyperacusis was assessed in a structured interview, with the Hyperacusis Questionnaire and by Uncomfortable Loudness Levels. We conducted a psychiatric interview to check for acute psychiatric disorders, and additional questionnaires assessed different psychosomatic and psychiatric symptoms. In 69% of the patients there was an acute psychiatric diagnosis present. Because precise criteria for sound intolerance have seldom been defined, we computed the cut-off points for the German ‘Questionnaire on Hypersensitivity to Sounds’ (GÜF), Uncomfortable Loudness Levels to tones (ULLt) and to broadband noises (ULLn). Our hypothesis that affective and anxiety disorders correlate more highly with a diagnosis of tinnitus with hyperacusis was confirmed. This was particularly true when we diagnosed hyperacusis using the GÜF or the ULL. It is assumed that, in most cases, the hyperacusis does not contribute to the psychiatric disorder, but that the existing disorders present a risk factor for the development of hyperacusis.

High-frequency priming stimulation does not enhance the effect of low-frequency rTMS in the treatment of tinnitus

Based on its ability to reduce the excitability of the cortex locally, low-frequency repetitive transcranial magnetic stimulation (rTMS) has been investigated for the treatment of hyperexcitability disorders such as auditory hallucinations and tinnitus. Results are promising, but characterized by only moderate improvement and a high inter-individual variability. Experimental data from motor cortex stimulation in healthy subjects indicates that the depressant effect of low-frequency rTMS can be enhanced by high-frequency priming stimulation. Here we will investigate whether high-frequency priming also improves the therapeutic efficacy of low-frequency rTMS in a clinical application. 32 patients with chronic tinnitus were randomly assigned to either a standard protocol of low-frequency rTMS (110% motor threshold, 1 Hz, 2000 stimuli/day) or a stimulation protocol in which priming stimulation with 6 Hz (90% motor threshold, 960 stimuli) preceded low-frequency rTMS (110% motor threshold, 1 Hz, 1040 stimuli/day). Stimulation was applied over the left auditory cortex by using MRI-guided coil positioning. The treatment outcome was assessed with a standardized tinnitus questionnaire. There was no significant difference between the standard protocol and the protocol involving priming stimulation. Both stimulation protocols resulted in significant clinical improvement after 10 days of stimulation, as compared to baseline. Our data does not support an enhancing effect of higher frequency priming on low-frequency rTMS in the treatment of tinnitus.

Feasibility of Auditory Cortical Stimulation for the Treatment of Tinnitus

To investigate the feasibility and safety of an implantable epidural cortical stimulator for the treatment of severe tinnitus. Prospective, controlled, single-blinded study of cortical stimulation for 4 weeks, and then an open-label stimulation period. Tertiary care referral center. Adults (n = 8) with constant tinnitus of at least 1 year with a tinnitus reaction questionnaire score greater than 33. Tinnitus was predominantly unilateral with a frequency less than 8,000 Hz. Surgical implantation of an investigational epidural electrode over the posterior superior temporal gyrus using functional magnetic resonance imaging targeting. A 2-week stimulation period alternated with a 2-week sham period in random order to which subjects were blinded. This was followed by continuous stimulation with parameter adjustments to maximize tinnitus suppression. Subjective rating of tinnitus severity, loudness, and device efficacy. Objective measures of hearing thresholds, tinnitus frequency, loudness, and minimum masking levels. Outcome measures using the Tinnitus Handicap Questionnaire, Tinnitus Reaction Questionnaire, and Beck Depression Inventory. There were no effects of stimulation during the 4-week blinded period. With continuous chronic stimulation, 2 patients had persistent reduction of pure-tone tinnitus, and 6 patients had short periods of total tinnitus suppression. Significant improvements in the Beck Depression Inventory and tinnitus questionnaires were found, although objective measures of tinnitus loudness remained fairly stable. No surgical or stimulation-related complications were noted. Chronic electrical stimulation of the secondary auditory cortex seems safe and warrants further investigation as a potential therapeutic intervention for the suppression of tinnitus.