Repetitive transcranial magnetic stimulation frequency dependent tinnitus improvement by double cone coil prefrontal stimulation

Background A double cone coil (DCC) with large angled windings has been developed to modulate deeper brain areas such as the dorsal and subcallosal anterior cingulate cortex. Methods Seventy-eight tinnitus patients received transcranial magnetic stimulation (TMS) using a DCC placed over the dorsal frontal cortex. Treatment effects were assessed with visual analogue scale for intensity and distress. Results The results showed that 1 and 3 Hz of DCC frontal TMS can improve both tinnitus intensity and tinnitus distress, 5 Hz is equal to sham and 20 Hz is significantly worse than sham. Of the 78 tinnitus patients, 52 had no control response. Of these 52 placebo negative participants, 21 showed no suppressive response to stimulation and 31 patients were TMS responders. For this latter group, mean transient tinnitus suppression was obtained in 34.38% for tinnitus intensity and in 26% for tinnitus related distress. Conclusion Frontal TMS using a DCC is capable of suppressing tinnitus transiently dependent on the repetitive TMS frequency used. These data further support the idea that non-auditory areas are involved in tinnitus intensity and tinnitus distress modulation.