To cite this article: Neuroendocrinol Lett 2010; 31(2):238–249 ORIGINAL ARTICLE Neuroendocrinology Letters Volume 31 No. 2 2010 Efficacy of repetitive transcranial magnetic stimulation for the treatment of refractory chronic tinnitus: A randomized, placebo controlled study Martin Anders 1 , Jana Dvorakova 1 , Lucie Rathova 2 , Petra Havrankova 3 , Petra Pelcova 1 , Manuela Vaneckova 4 , Robert Jech 2 , Martin Holcat 2 , Zdenek Seidl 4 , Jiri Raboch 1 1 Charles University in Prague, First Faculty of Medicine, Department of Psychiatry of the First Faculty of Medicine and General Teaching Hospital, Prague, Czech Republic 2 Charles University in Prague, First Faculty of Medicine, Department of Otorhinolaryngology, Head and Neck Surgery of the First Faculty of Medicine and Motol Teaching Hospital, Prague, Czech Republic 3 Charles University in Prague, First Faculty of Medicine, Department of Neurology of the First Faculty of Medicine and General Teaching Hospital, Prague, Czech Republic 4 Charles University in Prague, First Faculty of Medicine, Department of Radiology of the First Faculty of Medicine and General Teaching Hospital, Prague, Czech Republic Correspondence to: Martin Anders, MD., PhD. Charles University in Prague, First Faculty of Medicine, Department of Psychiatry of the First Faculty of Medicine and General Teaching Hospital Ke Karlovu 11, Prague 2, 120 00, Czech Republic. tel: +420-2-24965220; fax: +420-2-24923077; e-mail: martin.anders@vfn.cz Submitted: 2009-11-15 Accepted: 2009-12-17 Published online: 2010-04-28 Key words: rTMS; transcranial magnetic stimulation; neuronavigation; chronic refractory tinnitus Neuroendocrinol Lett 2010; 31(2):238–249 PMID: 20424590 NEL310210A01 © 2010 Neuroendocrinology Letters • www.nel.edu Abstract OBJECTIVE: The pathophysiologic mechanisms of idiopathic tinnitus remain unclear. Low frequency rTMS applied over the auditory cortex has been proposed as a new and causally oriented treatment approach for pathological conditions with abnormal, increased cortical activity including tinnitus with increased activ- ity in the auditory cortex. However available studies are characterized by a positive reports on the therapeutic effects of repetitive transcranial magnetic stimulation (rTMS) for treatment of tinnitus, there are few details about the duration of spe- cific treatment effects. DESIGN: The design of the study was randomized, prospective, placebo-controlled. Right-handed patients were treated with either real or sham 1 Hz frequency rTMS over a period of two weeks. Fifty-two patients with chronic, treatment resistant tinnitus and stable medication were enrolled in the study after giving written informed consent and forty-two patients completed the study and were included in data analysis. RESULTS: The ability to reduce the symptoms of tinnitus appeared in both ran- domized groups immediately after the 1 Hz rTMS and sham stimulation phase. There was a significant reduction in both groups of the tinnitus total score on the Tinnitus Handicap Inventory (THI) (real rTMS p=0.005; sham rTMS p=0.049) and Tinnitus Questionnaire (TQ) total score (real rTMS p=0.003; sham rTMS p=0.049). On the THI evaluation scale, in the real rTMS a mild worsening was noted during week 6 in comparison with the state attained in week 2. During the subsequent course of the study a significant reduction of the total score persisted in the case of THI (real rTMS week 14 p=0.033 and borderline week 26 p=0.058).