Repetitive Transcranial Magnetic Stimulation for Tinnitus: A Case Study

Authors

  • Gresham T. Richter MD,

    1. Department of Otolaryngology–Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, U.S.A.
    Search for more papers by this author
  • Mark Mennemeier PhD,

    1. Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas, U.S.A.,
    Search for more papers by this author
  • Twyla Bartel DO,

    1. Department of Radiology, Division of Nuclear Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, U.S.A.,
    Search for more papers by this author
  • Kenneth C. Chelette MS,

    1. Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas, U.S.A.,
    Search for more papers by this author
  • Timothy Kimbrell MD,

    1. Department of Psychiatry, University of Arkansas for Medical Sciences and Mental Health Service, Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock, Arkansas, U.S.A.
    Search for more papers by this author
  • William Triggs MD,

    1. Department of Neurology, University of Florida, Gainesville, Florida, U.S.A.
    Search for more papers by this author
  • John L. Dornhoffer MD

    Corresponding author
    1. Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas, U.S.A.,
    • Dr. John L. Dornhoffer, Department of Otolaryngology–Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 W. Markham Slot #543, Little Rock, AR 72205.
    Search for more papers by this author

  • This study was presented at the 12th International Symposium and Workshops on Inner Ear Medicine and Surgery, Zell im Zillertal, Austria, March 4–11, 2006.

    This study was performed at the University of Arkansas for Medical Sciences, Little Rock, Arkansas, U.S.A.

    This study was supported by the NIH National Center for Research Resources Centers of Biomedical Research Excellence (COBRE) Grant Number RR020146.

Abstract

Objectives/Hypothesis: Correlate subjective improvements in tinnitus severity with restoration of cortical symmetry and sustained attention after neuronavigated low-frequency, repetitive transcranial magnetic stimulation (rTMS).

Study Design: Case study.

Methods: Positron emission tomography and computed tomography imaging (PET-CT) guided rTMS was performed on a 43-year-old white male with more than a 30 year history of bilateral tinnitus. rTMS was administered to the area of increased cortical activation visualized on PET-CT at a rate of 1 Hz for 30 minutes (1,800 pulses/session) for each of 5 consecutive days, with optimization applied on day 5 using single pulses of TMS to temporarily alter tinnitus perception. Subjective tinnitus severity was rated before and after rTMS using the tinnitus severity index with analogue scale. Attention and vigilance were assessed before and after therapy using the psychomotor vigilance task (PVT), a simple reaction time test that is sensitive to thalamocortical contributions to sustained attention. Posttherapy PET-CT was used to evaluate any change in asymmetric cortical activation.

Results: The most marked reduction in tinnitus severity occurred after rTMS optimization; this persisted up to 4 weeks after rTMS. PVT testing showed the patient exhibited a statistically significant improvement in mean slowest 10% reaction times after rTMS (P = .004). PET-CT imaging 2 days after the cessation of rTMS showed no changes in cortical blood flow or metabolic asymmetries.

Conclusions: Low-frequency rTMS applied to the primary auditory cortex can reduce tinnitus severity, with rTMS optimization yielding the most favorable results. Beneficial changes occurring in the patient's slowest reaction times suggest that attentional deficits associated with tinnitus may also respond to low-frequency rTMS.

Ancillary