Minami Shujiro B, Shinden Seiichi, Okamoto Yasuhide, Watada Yukiko, Watabe Takahisa, Oishi Naoki, Kanzaki Sho, Saito Hideyuki, Inoue Yasuhiro, Ogawa Kaoru
National Institute of Sensory Organs, National Tokyo Medical Center, 2-5-1 Higashigaoka, Tokyo, Japan.
Auris Nasus Larynx. 2011 Jun;38(3):301-6. doi: 10.1016/j.anl.2010.09.007. Epub 2010 Oct 23.
There is compelling evidence that tinnitus is associated with functional alterations in the central nervous system. Repetitive transcranial magnetic stimulation (rTMS) is a potent tool for modifying neural activity at the stimulated area and at a distance along the functional anatomical connections. Depending on the stimulation parameters, cortical networks can be functionally disturbed or modulated in their activities. Low-frequency rTMS has been shown to result in a decrease in cortical excitability. The technique can alleviate tinnitus by modulating the excitability of neurons in the auditory cortex. We aimed to investigate the effects of low-frequency rTMS in patients and determine the factors that predict a beneficial outcome with rTMS treatment.
Sixteen patients (male 10, female 6) with chronic tinnitus underwent low-frequency (1Hz) rTMS (intensity: 110% motor threshold; number of stimuli: 1200) to the left auditory cortex. The treatment outcome was assessed with a visual analog scale (VAS) of loudness, annoyance and duration, loudness balance test, and tinnitus handicap inventory (THI). Therapeutic success was studied according to the patients' clinical characteristics.
A significant reduction in the VAS (loudness and annoyance) occurred immediately after rTMS, with a gradual return to pretreatment levels after 7 days. The tinnitus patients with sudden deafness were significant resistant to rTMS treatment compared with those diagnosed with age-related hearing loss.
These results support the potential of rTMS as a new therapeutic tool for the treatment of chronic tinnitus. Because this study was performed with a small sample size and showed high interindividual variability in treatment effects, further development of the technique is needed before it can be recommended for clinical applications.
有确凿证据表明耳鸣与中枢神经系统的功能改变有关。重复经颅磁刺激（rTMS）是一种强有力的工具，可用于改变受刺激区域以及沿功能解剖连接远处的神经活动。根据刺激参数，皮层网络的活动可在功能上受到干扰或调节。低频rTMS已被证明会导致皮层兴奋性降低。该技术可通过调节听觉皮层神经元的兴奋性来缓解耳鸣。我们旨在研究低频rTMS对患者的影响，并确定预测rTMS治疗有益结果的因素。
16例慢性耳鸣患者（男10例，女6例）接受了对左侧听觉皮层的低频（1Hz）rTMS治疗（强度：110%运动阈值；刺激次数：1200次）。使用响度、烦恼和持续时间的视觉模拟量表（VAS）、响度平衡测试和耳鸣 handicap 量表（THI）评估治疗结果。根据患者的临床特征研究治疗效果。
rTMS治疗后VAS（响度和烦恼）立即显著降低，7天后逐渐恢复到治疗前水平。与诊断为年龄相关性听力损失的患者相比，突发性耳聋的耳鸣患者对rTMS治疗有明显的抵抗性。
这些结果支持rTMS作为治疗慢性耳鸣的一种新治疗工具的潜力。由于本研究样本量小，且治疗效果个体差异大，在推荐临床应用之前，该技术还需要进一步发展。
