Randevu 0216 449 09 41
Prof. Dr. Cengiz BAHADIR

TMS (Tinnutus)

Transcranial Magnetic Stimulation (TMS) Treatment for Tinnutus

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Constant ringing in ears is a common and hard-to-treat disorder which can have an extreme impact on the patients’ lives. The symptoms of tinnutus are a result of a certain neural dysfunction of central nervous system. Electrophysiological studies and functional MRI images showed that tinnutus is caused by an increased neuron (nerve cell) activity in the central hearing path. This increased activity induces the hearing center of the brain to sense a sound that is actually non-existent. The severity of tinnutus may range from mild to extreme cases where the patient finds it unbearable.
Transcranial Magnetic Stimulation (TMS) is a novel treatment that has been heavily studied for the last decade. This treatment is based on the painless external stimulation of related brain nerves via a magnetic coil. It is an FDA (Food and Drug Administration, known by it’s strict regulatory practices) approved treatment choice for drug resistant depression and it has also been scientifically approved for many disorders including paralysis, movement disorders and many neurological diseases. Recent studies have shown that TMS is effective in the treatment of tinnutus with permanent outcomes for some patients.
It is possible to stimulate related brain parts externally and painlessly with TMS treatment. The neurons on the external layer of the brain called cortex with the magnetic field generated by the coil of the device in this treatment. This stimulation creates various impacts based on the frequency of the stimulation when applied successively. The higher frequencies cause an increase on the neuron activity while frequencies of ≤ 1 Hz cause suppression on the neuron activity. In recent years, TMS treatment has been started to be applied for the cases of tinnutus. This treatment includes administration of stimulus to the area on left hemisphere of the brain called temporoparietal cortex which is related to hearing. Usually, stimuli of 1 Hz frequency are administered to the left hemisphere. The treatment also includes high frequency stimulation (10-25 Hz) to the right hemisphere of the brain. High frequency stimulation to the right hemisphere increases the activity of the right hemisphere while suppressing left hemisphere. Alternative treatments are also experienced. Each treatment session includes 1000-2000 stimuli based on the treatment protocol. The severity of the stimulation is established by a simple motor threshold test performed prior to the treatment. This test determines the lowest current that produces movement signal on the hands of the patients upon a small magnetic stimulation applied on the movement center of the cortex. The treatments are carried out with a stimulation severity 10% less than this established threshold value. Usually 10 sessions of treatment at the intervals on the weekend is effective. Some cases respond very well to this treatment and the efficacy of the treatment lasts after the termination of the treatment.

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TMS therapy is not a painful therapy method for the patient. The patient does not feel any pain during the treatment. They only hear a “clicking” voice in each stimuli. In uncommon cases, the patient may experience headache, neck pain and rarely nausea after the treatment. Uncommon cases of temporary epilepsy attacks have been reported for mainly experimental very high frequency stimulation. TMS treatment, which is a very safe method for standard treatments, provides hope for tinnutus patients who have not responded to other methods.