Improvement of Chronic Tinnitus Following Personalized, Parcel-guided Accelerated rTMS: Feasibility in a Retrospective Case Series.

Increasing evidence suggests that brain areas outside of the auditory pathway may be involved in the development and maintenance of tinnitus. We hypothesized that repetitive transcranial magnetic stimulation (rTMS) to those areas in patients with comorbid psychiatric and neurocognitive disorder may reduce tinnitus distress. This is a case series of patients treated with off-label accelerated continuous or intermittent theta burst rTMS for medically refractory tinnitus. Target selections for each patient were performed using a personalized brain atlas based on resting state functional MRI (rsMRI) that identified regions of anomalous connectivity by comparing resting state functional connectivity to a normal cohort. Nine patients were treated with personalized, parcel-guided rTMS (Sydney, Australia) from 2018 to 2023, inclusive. Four patients had Major Depressive Disorder (MDD) of which three had comorbid anxiety, three patients had traumatic brain injury, and one patient had migraines. All patients had targets identified outside of the auditory network, including central executive network (CEN), default mode network (DMN), and salience network (SN). Clinically significant improvements in tinnitus symptoms were reported in 75% and 100% of patients based on TRQ and THI, respectively. No major adverse safety events occurred. rTMS with target selection using a personalized, agile approach is safe and may provide durable symptomatic relief rTMS with target selection using a personalized, agile approach is safe and may provide durable symptomatic relief for patients with chronic tinnitus, including those with comorbid psychiatric and neurocognitive conditions.