Kleinjung Tobias, Vielsmeier Veronika, Landgrebe Michael, Hajak Göran, Langguth Berthold
Department of Otorhinolaryngology, University of Regensburg, Regensburg, Germany.
Int Tinnitus J. 2008;14(2):112-8.
Even if the pathophysiology of tinnitus remains incompletely understood, there is growing agreement that dysfunctional neuroplastic processes in the brain are involved. Repetitive transcranial magnetic stimulation (rTMS) is a potent tool for modifying neural activity at the stimulated area and at a distance along functional anatomical connections. Depending on stimulation parameters, cortical networks can be functionally disturbed or modulated in their activity. The technique can alleviate tinnitus by modulating the excitability of neurons in the auditory cortex. It is assumed that TMS decreases the hyperexcitability that is associated with some forms of tinnitus. A growing number 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. Single sessions of high-frequency rTMS over the temporal cortex have been successful in reducing the intensity of tinnitus during the time of stimulation and could be predictive for treatment outcome of chronic epidural stimulation using implanted electrodes. Because most available studies have been performed with small sample sizes and show only moderate effect sizes and high interindividual variability of treatment effects, further development of the technique is needed before it can be recommended for use in clinical routine. Both patient-related (e.g., hearing loss, tinnitus duration, age) and stimulation-related (e.g., stimulation site, stimulation protocols) factors seem to influence treatment outcome; however, their exact impact still remains to be clarified.
即使耳鸣的病理生理学仍未被完全理解，但人们越来越一致地认为，大脑中功能失调的神经可塑性过程与之相关。重复经颅磁刺激（rTMS）是一种强大的工具，可用于改变受刺激区域以及沿功能解剖连接在一定距离处的神经活动。根据刺激参数，皮层网络的活动在功能上可能会受到干扰或调节。该技术可通过调节听觉皮层中神经元的兴奋性来减轻耳鸣。据推测，经颅磁刺激可降低与某些形式耳鸣相关的过度兴奋。越来越多的研究表明，在多次进行低频rTMS治疗后耳鸣减轻，这表明rTMS可能是一种治疗耳鸣的新的有前景的方法。在颞叶皮层单次进行高频rTMS已成功降低了刺激期间耳鸣的强度，并且可能对使用植入电极进行慢性硬膜外刺激的治疗结果具有预测性。由于大多数现有研究的样本量较小，仅显示出中等效应量以及治疗效果的个体间高变异性，因此在该技术可被推荐用于临床常规治疗之前，还需要进一步发展。与患者相关的因素（例如听力损失、耳鸣持续时间、年龄）和与刺激相关的因素（例如刺激部位、刺激方案）似乎都会影响治疗结果；然而，它们的确切影响仍有待阐明。
