Electromagnetic pulse treatment lessens tinnitus

Nearly 31% of patients with chronic tinnitus reported reductions in severity after electromagnetic pulse therapy treatment, according to a study published online by JAMA Otolaryngology-Head & Neck Surgery.

Tinnitus is a major health concern that affects up to 15% of the adult population. Approximately 20% of those who experience chronic tinnitus consider it to be a “clinically significant” problem. But finding a safe and effective treatment has remained elusive.

One potential treatment is repetitive transcranial magnetic stimulation (rTMS), a noninvasive method of delivering electromagnetic pulses through a coil to the patient’s scalp. Low-frequency rTMS is known to reduce brain activity in directly stimulated regions and has been proposed as an innovative treatment strategy for medical conditions associated with increased cortical activity, including tinnitus.

In this study, Robert L. Folmer, PhD, and colleagues at the Portland Veterans Affairs Medical Center and Oregon Health & Science University, in Portland, Ore., randomly assigned 70 study participants with chronic tinnitus (mean age of 60) to receive 2,000 pulses per session of active or placebo rTMS on 10 consecutive workdays. Severity of tinnitus was measured with the Tinnitus Functional Index (TFI).

The researchers found that the active rTMS group had an average 31% reduction in TFI scores at the 26-week follow-up compared with baseline, while the placebo rTMS group averaged a 7% reduction. Overall, 18 of 32 participants in the active rTMS group (56%), and 7 of 32 participants in the placebo rTMS group (22%) responded to rTMS treatment.

Response was particularly good in patients with severe tinnitus, as indicated by high baseline TFI scores. “The fact that many participants in this study with high TFIs exhibited significant and sustained reductions in tinnitus severity after undergoing 10 sessions of TMS provides compelling evidence for the efficacy of this treatment,” the authors wrote. “Given these findings, it is likely that baseline TFIs are among the factors that could be used to identify patients with tinnitus who are most likely to respond favorably to TMS treatment.”

The authors noted several limitations in this study, one of which was the small study population.

The researchers also acknowledged that their findings run counter to the American Academy of Otolaryngology’s 2014 clinical practice guidelines, which specifically recommend against using rTMS treatment for tinnitus. The authors defended their findings in this study due to its more rigorous design than previous studies and the use of more appropriate TFI scores as an outcome measure.

“We do not believe that rTMS should be viewed as a replacement for effective tinnitus management strategies that are available now,” the authors wrote. “Instead, rTMS could augment existing tinnitus therapies and provide a viable option for patients who do not respond favorably to other treatments.”

The researchers call for larger research studies to confirm that rTMS is an effective treatment. “If these larger clinical trials replicate efficacy of rTMS that has been demonstrated in the present study, then steps should be taken to implement the procedure as a clinical treatment for chronic tinnitus,” the authors concluded.