The repetitive transcranial magnetic stimulation (rTMS) is now considered an effective treatment to reduce the loudness of the subjective tinnitus. We can provide this treatment in our center.
Subjective tinnitus is a frequent symptom, affecting 5–15% of the general population and, not rarely, disabling, especially in those subjects who often focus their attention to the noise.
Such a symptom could negatively affect the quality of life and be the cause of major anxiety and depression. The etiology of tinnitus is still uncertain. Neurological and ORL assessments are needed to exclude treatable but generally rare causes.
However, the most probable mechanism for the common subjective tinnitus is an abnormal neural activity of the brain network which includes the auditory areas. This network incorporates the frontal cortex and the limbic system which are also important for developing depression.
Actually, the tinnitus arises in the inner ear, triggered by acute (trauma, drug toxicity) or chronic diseases (presbycusis, chronic otitis, neurinoma) and sustained by partial hearing loss. The brain circuits trying to cope with this peripheral auditory dysfunction originate some abnormal reorganization, which, finally, constitutes the tinnitus’ neural substrate. In this context. it appears understandable that there are not yet specific drug treatments which are able to suppress it completely and durably. Acoustic treatments (improving hearing loss or contrasting with other sounds the tinnitus), and cognitive or behavioral therapies are essentially palliative and have the effects of masking the tinnitus or diverting attention.
New treatments are needed, in order to modify directly the abnormal brain activation which produces the tinnitus and its behavioral consequences.
The repetitive transcranial magnetic stimulation (rTMS) is a non-invasive technique modulating neuronal activity by delivering brief and repeated intense magnetic bursts though the scalp and skull. Low frequency rTMS should have an inhibitory effect on the brain cortex and on the other connected areas of the brain. rTMS is considered safe and without substantial side effects. It can be effectuated in a medical cabinet and does not need any previous treatment.
In particular, rTMS protocols with a repetition rate less than 1 Hz inhibit the neural activity of the auditory cortex (AC), and reduce neural excitability in the connected brain areas (such as the left frontodorsal region). A significant reduction in tinnitus loudness has been demonstrated in patients undergoing rTMS through the analysis of several randomized controlled trials comparing the effect of rTMS versus sham rTMS.
Some debate remain on the number of session and rTMS stimuli and stimulation sites and side, however, as the theoretical premises are understandable, results of the metanalyses and randomized studies are more than encouraging, and rTMS is a safe procedure, we invite you to try this treatment for tinnitus in our center.
References
Londero et al. Transcranial magnetic stimulation and subjective tinnitus. A review of the literature, 2014-2016. Eur Ann Stor. Head and Neck diseases (2017).
Cacace AT et al. Glutamate is down regulated and tinnitus loudness-levels decreased following rTMS over auditory cortex of the left hemisphere: a prospective randomized single-blinded sham-controlled cross-over study. Hear Res 2017.
Park et al. Otol Neurotol 36:1450-1456, 2015.
DeMoraes LT et al. Determining an effective rTMS protocol fro treating chronic tinnitus: focus on inhbiting the left temporoparietal cortex. Eur Arch Otorhinolaryngol. 2017;2359-2360.
Schecklmann M. et al. Repetitive transcranial magnetic stimulation induces oscillatory power changes in chronic tinnitus. Front Cell Neurosci. 2015; 9:421.