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Trends Hear. 2019 Jan-Dec;23:2331216518822198. doi: 10.1177/2331216518822198.

Neuronavigated Versus Non-navigated Repetitive Transcranial Magnetic Stimulation for Chronic Tinnitus: A Randomized Study.

Author information

1 Faculty of Medicine, University of Turku, Finland.
2 Department of Clinical Neurophysiology, SataDiag, Satakunta Hospital District, Pori, Finland.
3 Department of Biostatistics, University of Turku, Finland.
4 Unit of Adolescent Psychiatry, Satakunta Hospital District, Pori, Finland.
5 Department of Psychiatry, University of Turku and Turku University Hospital, Finland.
6 Department of Ear, Nose and Throat, Satakunta Hospital District, Pori, Finland.
7 Department of Medical Physics, Turku University Hospital, Finland.
8 Department of Ear, Nose and Throat, Turku University Hospital, Finland.
9 Department of Psychiatry, Turku University Hospital, Finland.
10 Department of Clinical Neurophysiology, Division of Medical Imaging, Turku University Hospital and University of Turku, Finland.


Repetitive transcranial magnetic stimulation (rTMS) has shown variable effect on tinnitus. A prospective, randomized 6-month follow-up study on parallel groups was conducted to compare the effects of neuronavigated rTMS to non-navigated rTMS in chronic tinnitus. Forty patients (20 men, 20 women), mean age of 52.9 years (standard deviation [ SD] = 11.7), with a mean tinnitus duration of 5.8 years ( SD = 3.2) and a mean tinnitus intensity of 62.2/100 ( SD = 12.8) on Visual Analog Scale (VAS 0-100) participated. Patients received 10 sessions of 1-Hz rTMS to the left temporal area overlying auditory cortex with or without neuronavigation. The main outcome measures were VAS scores for tinnitus intensity, annoyance, and distress, and Tinnitus Handicap Inventory (THI) immediately and at 1, 3, and 6 months after treatment. The mean tinnitus intensity (hierarchical linear mixed model: F3 = 7.34, p = .0006), annoyance ( F3 = 4.45, p = .0093), distress ( F3 = 5.04, p = .0051), and THI scores ( F4 = 17.30, p < .0001) decreased in both groups with non-significant differences between the groups, except for tinnitus intensity ( F3 = 2.96, p = .0451) favoring the non-navigated rTMS. Reduction in THI scores persisted for up to 6 months in both groups. Cohen's d for tinnitus intensity ranged between 0.33 and 0.47 in navigated rTMS and between 0.55 and 1.07 in non-navigated rTMS. The responder rates for VAS or THI ranged between 35% and 85% with no differences between groups ( p = .054-1.0). In conclusion, rTMS was effective for chronic tinnitus, but the method of coil localization was not a critical factor for the treatment outcome.


TMS; neuronavigated; rTMS; tinnitus; transcranial magnetic stimulation

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