Dual-site rTMS is More Effective than Single-site rTMS in Tinnitus Patients: A Blinded Randomized Controlled Trial
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ORIGINAL PAPER
Dual-site rTMS is More Effective than Single-siterTMS in Tinnitus Patients: A Blinded Randomized Controlled Trial Tae‑Soo Noh1 · Jeong‑Sug Kyong2 · Moo Kyun Park1 · Jun Ho Lee1 · Seung Ha Oh1 · Myung‑Whan Suh1 Received: 27 March 2020 / Accepted: 9 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Repetitive transcranial magnetic stimulation (rTMS) has been proposed as an alternative option for treating tinnitus. rTMS is a noninvasive method in which repetitive magnetic stimulation is applied to the cortex; it is considered a therapeutic strategy that modulates the loudness of tinnitus. In this study, we performed a double-blind randomized clinical trial to compare the outcome of tinnitus treatment among (1) dual-site (auditory + prefrontal) rTMS stimulation, (2) auditory cortex only rTMS stimulation (AC), and (3) sham stimulation. The left primary auditory cortex and left dorsolateral prefrontal cortex (DLPFC) were targeted independently of handedness or tinnitus laterality. Dual-site and auditory only groups were treated with a total of 12,000 pulses, 2000 pulses over the AC and 1000 pulses over the DLPFC (group 1), 3000 pulses over the AC only (group 2), and daily for 4 consecutive days. Dual-site group exhibited a significantly better ΔTinnitus Handicap Inventory (ΔTHI) score at 4, 8 weeks and 12 weeks after rTMS treatments compared with pre-treatment. However, there was no effect in the auditory only group. Also, there was no effect in sham group when THI scores were compared with that of the pre-treatment. These results are in line with the former studies that reported a better treatment effect by multiple site rTMS. Keywords Tinnitus · Transcranial magnetic stimulation · Auditory Cortex · Prefrontal cortex
Introduction Chronic tinnitus is characterized by hearing nonexistent noise or perceiving phantom auditory stimuli. Approximately 10–15% of the US population suffers from tinnitus (Henry et al. 2005). Various treatment methods have been proposed, such as medications, tinnitus retraining therapy, and electrical stimulation. However, these methods are not effective in every patient. Repetitive transcranial magnetic Handling Editor: Christoph M. Michel. Tae-Soo Noh and Jeong-Sug Kyong haveequally contributed to this work. * Myung‑Whan Suh [email protected] 1
Department of Otorhinolaryngology‑Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of medicine, Yongon‑Dong, Chongno‑Gu, Seoul 110‑744, Korea
Department of Audiology and Speech‑Language Pathology, Audiology Institute, Hallym University of Graduate Studies, Seoul, Korea
2
stimulation (rTMS) has been proposed as an alternative option for treating tinnitus (Kleinjung et al. 2008; Noh et al. 2019a). rTMS is a noninvasive method in which repetitive magnetic stimulation is applied to the cortex; it is considered a therapeutic strategy that modulates the loudness of tinnitus (Hallett 2000; Tunkel et al. 2014). Studies have demonstrated that it is an
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