Difference in Tinnitus Treatment Outcome According to the Pulse Number of Repetitive Transcranial Magnetic Stimulation.

OBJECTIVE: We aimed to compare the treatment result between 6,000 and 12,000 pulses of low-frequency repetitive transcranial magnetic stimulation (rTMS) and to evaluate the correct location of rTMS in Korean brains compared with that of Caucasians.

STUDY DESIGN: Controlled trial.

SETTING: Tertiary referral center.

PATIENTS: Fourteen patients with chronic essential tinnitus were treated with rTMS on the left auditory cortex (AC) and prefrontal cortex (FC). AC targets were determined using the 10-20 electroencephalographic (EEG) method proposed by Langguth in 2006. Six patients received a total of 6,000 pulses rTMS (AC, 1,000; FC, 1,000; 3-d course; Group 1), and eight patients were given 12,000 pulses (AC, 2,000; FC, 1,000; 4-d course; Group 2).

MAIN OUTCOME MEASURES: Treatment results were assessed with pretreatment and posttreatment Tinnitus Handicap Inventory (THI) and self-rating Visual Analog Scale (VAS) of awareness, loudness, annoyance, and effect on daily life of tinnitus at 1, 2, 4, 8, and 12 weeks after treatment. Using the individual subject's magnetic resonance image and Neuronavigation System, the location of primary AC was determined and compared with that of the 10-20 method in four patients.

RESULTS: There was no improvement of THI and VAS in Group 1. On the contrary, a substantial decrease of THI scores and VAS scores for awareness, loudness, and effect on daily life was observed in Group 2.

CONCLUSION: Despite the small number of patients, a beneficial effect of rTMS on tinnitus suppression was found in the 12,000-pulse treatment group, whereas no effect was found in the 6,000-pulse treatment group. rTMS localization based on the 10-20 EEG method seems to be valid even in Koreans with a shorter anteroposterior skull diameter.