Noh Tae-Soo, Kyong Jeong Sug, Chang Mun Young, Park Moo-Kyun, Lee Jun-Ho, Oh Seung-Ha, Kim June Sic, Chung Chun Kee, Suh Myung-Whan
*Department of Otolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital†Medical Research Center, Seoul National University College of Medicine‡Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine§Department of Brain and Cognitive Science, Seoul National University College of Natural Science||Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
Otol Neurotol. 2017 Feb;38(2):296-303. doi: 10.1097/MAO.0000000000001266.
We evaluated treatment outcomes following single-site repetitive transcranial magnetic stimulation (rTMS) in the dorsolateral prefrontal cortex (DLPFC) and dual-site rTMS in the auditory cortex (AC) and DLPFC (AC + FC).
This prospective randomized double-blind trial initially included 19 patients with chronic tinnitus and 17 of these patients received rTMS on the left AC and left DLPFC or only the left DLPFC. The subjects were randomly allocated to either the dual-site rTMS (AC + FC) protocol (Group 1, n = 9) or the singlesite rTMS (DLPFC) protocol (Group 2, n = 8). Group 1 received daily treatments with 2,000 pulses applied to the AC and 1,000 pulses applied to the DLPFC for 4 days (total of 12,000 pulses) and Group 2 received daily treatments with 3,000 pulses applied the DLPFC for 4 days (total of 12,000 pulses).
The severity of tinnitus was assessed before rTMS treatment using the Tinnitus Handicap Inventory (THI) and the self-rated Visual Analog Scale. These measures were used to determine the awareness, loudness, annoyance, and effects of tinnitus on daily life at 1, 2, 4, and 12 weeks after treatment.
The improvement in THI score was significantly better in Group 1 than in Group 2, even after controlling for the between-group differences in pretreatment THI score. In terms of psychological factors, Group 1 exhibited significant improvements in scores on the State-Trait Anxiety Inventory (STAI) for both state anxiety (STAI-X1) and trait anxiety (STAI-X2) at 12 weeks posttreatment and scores on the Pittsburgh Sleep Quality Index at 4 weeks posttreatment. Group 2 showed an improvement in only the STAI-X2 score at 12 weeks posttreatment.
The rTMS protocol effectively suppressed tinnitus in the dual-site rTMS (AC+FC) group but not in the single-site rTMS (DLPFC) group. Although recent evidence has shown that non-auditory cortices in the tinnitus network play an important role in the generation of tinnitus, our findings indicate that rTMS on non-auditory cortical sites alone may not be sufficient for treatment. Thus, dual-site rTMS in the AC and DLPFC may be preferable for controlling this condition.
我们评估了背外侧前额叶皮质（DLPFC）的单部位重复经颅磁刺激（rTMS）以及听觉皮质（AC）和 DLPFC（AC+FC）的双部位 rTMS 后的治疗效果。
这项前瞻性随机双盲试验最初纳入了 19 例慢性耳鸣患者，其中 17 例患者接受了左侧 AC 和左侧 DLPFC 或仅左侧 DLPFC 的 rTMS 治疗。受试者被随机分配到双部位 rTMS（AC+FC）方案组（第 1 组，n=9）或单部位 rTMS（DLPFC）方案组（第 2 组，n=8）。第 1 组每天接受 2000 次脉冲刺激 AC 和 1000 次脉冲刺激 DLPFC，共治疗 4 天（总计 12000 次脉冲），第 2 组每天接受 3000 次脉冲刺激 DLPFC，共治疗 4 天（总计 12000 次脉冲）。
在 rTMS 治疗前，使用耳鸣致残量表（THI）和自评视觉模拟量表评估耳鸣的严重程度。这些指标用于确定治疗后 1、2、4 和 12 周时耳鸣的知晓度、响度、烦恼程度以及对日常生活的影响。
即使在控制了治疗前 THI 评分的组间差异后，第 1 组的 THI 评分改善仍显著优于第 2 组。在心理因素方面，第 1 组在治疗后 12 周时状态-特质焦虑量表（STAI）的状态焦虑（STAI-X1）和特质焦虑（STAI-X2）评分以及治疗后 4 周时匹兹堡睡眠质量指数评分均有显著改善。第 2 组仅在治疗后 12 周时 STAI-X2 评分有所改善。
rTMS 方案在双部位 rTMS（AC+FC）组有效抑制了耳鸣，但在单部位 rTMS（DLPFC）组无效。尽管最近的证据表明耳鸣网络中的非听觉皮质在耳鸣产生中起重要作用，但我们的研究结果表明仅对非听觉皮质部位进行 rTMS 可能不足以治疗。因此，AC 和 DLPFC 的双部位 rTMS 可能更适合控制这种情况。
