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Original Investigation |

Repetitive Transcranial Magnetic Stimulation Treatment for Chronic Tinnitus A Randomized Clinical Trial

Robert L. Folmer, PhD1,2; Sarah M. Theodoroff, PhD1,2; Linda Casiana, MS, CCRP1; Yongbing Shi, MD, PhD1; Susan Griest, MPH1,2; Jay Vachhani, AuD1
[+] Author Affiliations
1National Center for Rehabilitative Auditory Research, Portland Veterans Affairs Medical Center, Portland, Oregon
2Department of Otolaryngology, Oregon Health & Science University, Portland
JAMA Otolaryngol Head Neck Surg. 2015;141(8):716-722. doi:10.1001/jamaoto.2015.1219.
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Importance  Chronic tinnitus negatively affects the quality of life for millions of people. This clinical trial assesses a potential treatment for tinnitus.

Objectives  To determine if repetitive transcranial magnetic stimulation (rTMS) can reduce the perception or severity of tinnitus and to test the hypothesis that rTMS will result in a statistically significantly greater percentage of responders to treatment in an active rTMS group compared with a placebo rTMS group.

Design, Setting, and Participants  A randomized, participant and clinician or observer–blinded, placebo-controlled clinical trial of rTMS involving individuals who experience chronic tinnitus. Follow-up assessments were conducted at 1, 2, 4, 13, and 26 weeks after the last treatment session. The trial was conducted between April 2011 and December 2014 at Portland Veterans Affairs Medical Center among 348 individuals with chronic tinnitus who were initially screened for participation. Of those, 92 provided informed consent and underwent more detailed assessments. Seventy individuals met criteria for inclusion and were randomized to receive active or placebo rTMS. Sixty-four participants (51 men and 13 women, with a mean [SD] age of 60.6 [8.9] years) were included in the data analyses. No participants withdrew because of adverse effects of rTMS.

Interventions  Participants received 2000 pulses per session of active or placebo rTMS at a rate of 1-Hz rTMS daily on 10 consecutive workdays.

Main Outcomes and Measures  The Tinnitus Functional Index (TFI) was the main study outcome. Our hypothesis was tested by comparing baseline and posttreatment TFIs for each participant and group.

Results  Overall, 18 of 32 participants (56%) in the active rTMS group and 7 of 32 participants (22%) in the placebo rTMS group were responders to rTMS treatment. The difference in the percentage of responders to treatment in each group was statistically significant (χ21 = 7.94, P < .005).

Conclusions and Relevance  Application of 1-Hz rTMS daily for 10 consecutive workdays resulted in a statistically significantly greater percentage of responders to treatment in the active rTMS group compared with the placebo rTMS group. Improvements in tinnitus severity experienced by responders were sustained during the 26-week follow-up period. Before this procedure can be implemented clinically, larger studies should be conducted to refine treatment protocols.

Trial Registration  clinicaltrials.gov Identifier: NCT01104207

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Figure 1.
Consolidated Standards of Reporting Trials Participant Flow Diagram

Shown are the numbers of participants screened for eligibility, excluded, and included in the data analyses for this study. rTMS indicates repetitive transcranial magnetic stimulation.

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Figure 2.
Change in Tinnitus Functional Index

Shown is the change from baseline for the repetitive transcranial magnetic stimulation (rTMS) groups at all posttreatment assessment time points among 64 participants (32 in the active rTMS group and 32 in the placebo rTMS group).

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