The International Tinnitus Journal


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The International Tinnitus Journal

Official Journal of the Neurootological and Equilibriometric Society
Official Journal of the Brazil Federal District Otorhinolaryngologist Society

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ISSN: 0946-5448

Volume 25, Issue 1 / June 2021

Research Article Pages:51-58

Repetitive Transcranial Magnetic Stimulation For The Treatment of Chronic Tinnitus: A Preliminary Study of The Influence of Traumatic Brain Injury on Treatment Response

Authors: Garret A. Horton, Omar Ibrahim, Marcus Jansen, Jessica Trier, Roumen Milev, Jason A. Beyea



This study aims to test whether the efficacy of repetitive Transcranial Magnetic Stimulation (rTMS) differs between patients who developed tinnitus following a traumatic brain injury (TBI), and those without a history of TBI. This was a parallel pilot, open-label, non-randomized, clinical trial to compare the efficacy of low frequency rTMS on tinnitus symptoms in patients with and without a TBI history. Patients with moderate to severe tinnitus symptoms based on the Tinnitus Handicap Inventory (THI) and the Tinnitus Functional Index (TFI) were enrolled in the study. Validated questionnaires (THI and TFI) were used to quantify the severity of tinnitus symptoms and hearing impairment (Hearing Handicap Index – HHI) before and after ten sessions of rTMS of the left primary auditory cortex. Hearing threshold levels as well as speech reception and speech discrimination thresholds were also compared. The number of patients who experienced a reduction in their subjective tinnitus symptoms was greater and sustained longer in patients without a history of TBI. The same was seen with subjective symptoms of hearing impairment. In conclusion, our preliminary results suggest tinnitus patients without a history of TBI respond better to low frequency rTMS than those with a history of TBI, suggesting that treatments could be more effective if tailored to tinnitus etiology.

Keywords: Tinnitus, Tinnitus, TBI, rTMS

Repetitive Transcranial Magnetic Stimulation For The Treatment of Chronic Tinnitus: A Preliminary Study of The Influence of Traumatic Brain Injury on Treatment Response



?In spite of being a typical condition that influences almost 15% of the populace, and in spite of much examination progress made in the ongoing years, tinnitus stays a logical and clinical riddle. Abstract tinnitus is characterized as a ghost view of a tone or commotion without any physical source. It is known to be a heterogeneous condition, both in the method of indication and of age. By and large, "heterogeneity" depicts the way that there is a non-uniform appearance of a substance, life form, or illness.



 Hearing impairment is a silent and invisible problem that often goes unnoticed by the individual and the family itself, which is considered a major public health problem since it causes numerous losses to the development of human beings1. Over the years, there has been an increase in the demand for audiologist professionals, since the geriatric population has been growing rapidly and along with it, hearing and balance problems, in addition to speech, language and swallowing disorders also increase. In the last decades has been increasing cases of inner ear disorders and among them is included hearing loss, tinnitus, and vertigo and the demands of that kind of patients are predominantly older, thus, the audiologist has the role of minimizing the deficiency and maximizing the patient’s daily function2-4 . Thus, the demand for new treatments is growing, with Low Level Laser Therapy (LLLT) being a highly targeted treatment due to its non-invasive nature5. The acronym LASER has its origin in the English language, abbreviating “light amplification by stimulated emission of radiation” and is defined as a monochromatic, intense, coherent and collimated light source, whose radiation emission is done by stimulating the external field, with varied applications and are classified as high (applied to the removal, cutting and coagulation of tissues) and low (applied to tissue repair processes, such as muscle, joint, nerve, bone and skin injuries)6. Its anti-inflammatory action is achieved through microcirculation acceleration, which determines the types of changes in the hydrostatic pressure of the capillaries, with absorption of edema and inactivation of the intermediate catabolics7. Low-level laser therapy (LLLT), sometimes known as low-intensity light therapy or photobiomodulation Therapy (PBMT), is a light therapy with a photochemical, non-thermal effect, since light triggers biochemical changes in cells, similar to the process of photosynthesis in plants, where photons are absorbed by cellular photoreceptors and triggers chemical changes8. Researchers believe that mitochondria play an important role in the generation and metabolism of energy and are involved in current research on the mechanism of the effects of photobiomodulation therapy. It is proposed that cytochrome c oxidase (Cco) is the primary photoacceptor for the red and infrared light band in mammalian cells, as these longer wavelengths have more effective tissue penetration compared to the light bands blue or green, being absorbed by hemoglobin more efficiently9,10. Because it is an efficient, non-invasive, low-cost and safe tool, capable of promoting anti-inflammatory effects, epithelial and fibroblast proliferation, healing, collagen synthesis and deposition, revascularization, wound contraction, reducing pain, among others, the low intensity laser that is already used in the routine of medical, dental and physiotherapeutic treatments, has become the target of areas of interest in the sciences of speech, language and hearing11,12. The therapeutic effects of the Low Level Laser (LLL) have already been presented in the audiology area as in sensorineural hearing loss since it has several etiologies in human patients13. Experiments carried out by researchers at the University of Dankook, in South Korea, showed that LLLT can not only prevent cochlear damage caused by exposure to noise, but can also become a treatment for noise-induced hearing loss14. Other researchers also agree with these results, showing that PBMT represents an effective tool to control and limit cochlear oxidative stress and the induction of cochlear inflammation located in the organ of Corti, making it a therapeutic alternative to deal with high levels oxidative stress in hearing cells exposed to ototoxic drugs or resulting from exposure to occupational noise15. In another study, the application of transmeatal photobiomodulation allowed the functional recovery of the vestibular system of rats with bilateral ototoxic vestibulopathy, showing that the treatment, in addition to being non-invasive and with minimal complications, can be promising for vestibular changes16. When applied to tinnitus, it has been showing controversial results. While some researchers conclude that after low-level laser treatment, individuals did not show improvement in tinnitus17-19 (17), (18), (19), others show that tinnitus can improve and even disappear after laser treatment20-24. Since the audiologist is part of the team interested in hearing problems, the interest in joining the group of professionals who use this therapeutic resource has increased over the years25. Therefore, the intention of this article is to search the literature for the findings through the bibliometric analysis of the articles in the Web of Science - Clarivate Analytics database using the association of the words “low Level laser therapy” and “hearing”, being selected the articles that have in the title the descriptor searched or correlated to some area of audiology.


The referring quantitative study of bibliometric character was carried out by searching for scientific articles in the database of Web of Science - Clarivate Analytics. The association of the words “low level laser therapy” and “hearing” was used to construct the sample. As inclusion criteria, we chose to limit the sample to only articles, using the filters: “Document type - article” and English language. As it is a review article, there was no need to submit the study to the Research Ethics Committee. Eight articles from the sample were excluded because they did not fit the theme, did not have the descriptors used, or were not relevant to the research. The total number of articles analyzed in the research was 14 and after selecting the most relevant articles, the sample was considered to be of excellent scientific level. According to Souza and Kerbauy26 the quantitative approach is based on generalizing and objectifying the results, distancing the subject from the object, as well as making the researcher neutral in order to ensure and legitimize the scientific research data. The bibliometric study is composed of techniques that aim to quantify the written communication process. Such studies have become popular and their adherence in the health area is a national and international trend, since a large amount of bibliographic material that is produced and made available today, which facilitates the understanding of researchers, and may even show future paths of research27,28 this study, data were recorded in Microsoft Office Excel, tabulated and described according to the descriptive statistical analysis of the most significant items in relation to the articles read, such as: authors, descriptors, year of publication, journals, objectives, methods, results, conclusions, limitations, suggestions for future studies.



*Corresponding Author: 

Jason A. Beyea Department of Otolaryngology, Otology, Neurotology, and Cranial Base Surgery, Assistant Professor and ICES Adjunct Scientist, Queen’s University School of Medicine, Kingston Health Sciences Centre, Ontario Canada, E-mail: [email protected] Phone: +16135443400

Paper submitted on February 10, 2021; and Accepted on March 01, 2021

Citation: Garret A. Horton,Omar Ibrahim, Marcus Jansen, Jessica Trier, Roumen Milev, Jason A. Beyea. Repetitive Transcranial Magnetic Stimulation For The Treatment of Chronic Tinnitus: A Preliminary Study of The Influence of Traumatic Brain Injury on Treatment Response. Int Tinnitus Journal. 2021;25(1):51-58.

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