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Active middle ear implants are an alternative to conventional hearing aids that allow more power delivered to the cochlea, especially at high frequencies, and can also be used when middle ear ossicles are damaged. A study supported by the Tinnitus Research Initiative (TRI) and MED-EL of the effect of a middle ear implant showed that individuals with severe tinnitus and high-frequency hearing loss achieved relief of their tinnitus after implantation. Some patients had complete relief of their tinnitus after activation of the middle ear implant.
Individuals who have significant residual inhibition of their tinnitus and high-frequency hearing loss seem to be the best candidates for implantations. Individuals with tinnitus, who also suffer from hearing loss, often benefit from amplification. It has been reported that up to 67% of individuals who received unilateral hearing aids and 69% of individuals who received bilateral hearing aids report improvement in their tinnitus [1]. Hearing aids often increase the perceived quality (color, crispness, clarity, pureness) of sounds, which could be important in reducing tinnitus annoyance, but unfortunately is not measured in routine clinical practice and is difficult to define. Today’s digital hearing instruments are very advanced, offering maximum performance and reducing many of the difficulties encountered in earlier designs. Traditional hearing aids lack amplification of high frequencies (above 6,000 Hz) and fail to provide sufficient power. Good reproduction of high-frequency sounds is also necessary for directional hearing and hearing when background noise is present. Using a conventional “loudspeaker” at the end of the amplification chain seems to be the limiting factor for a sophisticated development of these devices. Relocating the loudspeaker to the outer ear canal increased the performance of amplification in the high frequency range. Recognizing these problems and the fact that sound quality will always be an issue for those who use traditional hearing instruments and individuals with tinnitus, promoted the development of active middle ear implants.
With customized active middle ear implants, there is no need for a “loudspeaker” (receiver), thus reducing the distortion and reduction in the quality of sounds that occurs in traditional hearing aids. Middle ear implants started in 1935 when Wilska [3] experimented with iron particles placed on the tympanic membrane. Today, three general types of transducers are used in middle ear implants, each with advantages and disadvantages related to power, performance, frequency range, and reliability. Yanagihara and his colleagues [6] described an implantable piezoelectric device attached to the head of the stapes and performed the earliest human trials using these devices [7–12].
A totally implantable piezoelectric device, known as the Esteem Hearing implant [13], was developed by St. Soundbridge is the middle ear implant with the longest clinical experiences, 3,000 patients so far (2009). The semi-implantable device consists of an outward audio processor which is placed over the implanted coil and magnet.
In the last few years, the Vibrant Soundbridge has assumed particular importance through the fact that the FMT can also be implanted in the round window [17] (Picture 4).
A special form of implanting the FMT was achieved by Huttenbrink with “TORP-Y-Vibroplasty” [18]. In the ENT Clinic in Traunstein, 52 patients have been equipped with the implant since 1998 (four of them bilaterally). In 2000, a patient implanted on both sides with middle ear implants reported that this tinnitus disappeared completely after activating the implant.
After the operation, the audio processor was activated, and the reaction of his tinnitus was surprising: the tinnitus shifted from his left side to his right side. Picture 6 shows the result: because of the remaining tinnitus, there was no improvement regarding annoyance after 2 months, and the person did not develop any habituation. Picture 7 shows the functional gain (green line) after the implantation of the Soundbridge in both ears.
The first patient of a new study, sponsored by the company Med-El® with five participants with unilateral tinnitus and reproducible residual inhibition, received a Soundbridge implantation in June 2008. Implantable hearing aids have shown to be effective in reducing tinnitus in individuals with severe hearing loss and tinnitus, where the hearing loss was caused by middle ear or cochlear pathologies.
One reason for the success of implantation might be that it facilitates residual inhibition. 6 Week Pregnancy Weight Loss Program Review – This weight loss program is created by Sara Dean, a weight loss professional in the fitness business, that teaches you to workout after pregnancy to get in shape.
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Even if the pathophysiology of tinnitus remains incompletely understood, there is growing agreement that dysfunctional neuroplastic processes in the brain are involved.
Tinnitus is a very frequent clinical condition, which is often associated with a lesion of the peripheral auditory system, such as presbycusis, Meniere's disease, noise trauma, sudden deafness, or drug-related ototoxicity [9,10]. The notion that rTMS is safe and well tolerated by patients within a range of parameters defined according to a consensus on a safety guideline [33] is proven by an extensive body of data. Several studies with single sessions of rTMS have been performed to transiently disrupt tinnitus perception (Table 1). In recent years, an increasing number of studies on rTMS for the treatment of tinnitus have been published (Table 2). New insights into neurobiology of chronic tinnitus suggested that functional abnormalities are not limited to temporal and temporoparietal cortical areas but can occur in brain areas used for attentional and emotional processing, such as the dorsolateral prefrontal cortex.
Because tinnitus is a subjective phantom perception of sound, it represents a condition that is susceptible for placebo effects. Though some studies demonstrated effects that outlasted the stimulation period by 3, 4, or 6 months [16,52,53], others were not able to observe longer-lasting effects [44,50]. In most studies, validated tinnitus questionnaires and visual analog scales serve as primary outcome measurement, owing to the lack of objective parameters. Just recently, a case report showed that using maintenance rTMS to manage chronic tinnitus is feasible [57].
The high variability of treatment results, which is encountered in all studies, confirms the concept of the biological heterogeneity of tinnitus.
In summary, the results from an increasing number of studies using rTMS show that treatment of tinnitus with this method is promising. Neuromonics Tinnitus Treatment, FDA approved treatment devices, utilizes a customized neural stimulus combined with specific music, delivered according to a coordinated program. The Neuromonics Oasis is customized for each user's audiological profile, engages the auditory pathways to promote neural plastic changes.
The Haven utilizes precisely engineer music to deliver relief to the tinnitus patient while listening to the device.
However, in some individuals with severe high-frequency hearing loss, classical hearing aids are not always able to amplify the high frequencies sufficiently and provide enough power. The use of hearing aids in tinnitus patients may make the patient less aware of the tinnitus as well as improve communication by reducing masking by the tinnitus. The effect of the pinna and the resonance in the external auditory canal contribute to optimize gain at higher frequencies [2]. In past years, improvements in hearing devices have substantially helped control feedback, widening the frequency range, and, to some degree, have improved sound quality.
This is a problem in connection with suppression of tinnitus, which requires that high-frequency sounds are delivered to the ear at sufficient intensity. Wilska generated a magnetic field from an electromagnetic coil inside an earphone, which caused the iron filings to vibrate in synchrony with the magnetic field. The types of transducers used in middle ear implants consist of piezoelectric, electromagnetic, and electromechanical transducers.
The magnet is attached to the ossicular chain, tympanic membrane, or the inner ear (round window or oval window).
It was first marked by Symphonix Devices in San Jose, California, as the Vibrant Soundbridge. The indication here refers to a destroyed middle ear, such as after removal of the petrosal bone, malformations, cholesteatoma, sclerosis of the footplate, etc. All patients were provided with conventional hearing aids before and, for different reasons, were not content with these devices.
His audiogram showed severe hearing loss on the left side and minor hearing loss on the right side (Picture 5).
Facing the fact that this individual now had tinnitus on the right side, we also implanted the right side with the Soundbridge 12 weeks after the original implantation.
The patient describes that his tinnitus decreases already by switching on the device, although he is not able to hear the receiver noise.
The reason the middle ear implantable devices provide relief of tinnitus may be masking, but it seems more likely that the benefit is caused because these devices provide effective activation of the auditory nervous system, and thereby counteract the effect of deprivation of sound input that had activated neural plasticity causing the tinnitus. Moller AR (2006) Hearing: Anatomy, Physiology, and Disorders of the Auditory System, 2nd Ed. Wilska A (1935) Ein Methode zur Bestimmung der horsch wellenamplituden des Trommelfells bei verschieden Frequenzen. Rutschmann J (1959) Magnetic audition: Auditory stimulation by means of alternating magnetic fields acting on a permanent magnet fixed to the eardrum.
Yanagihara N, Suzuki J, Gyo K, Syono H, Ikeda H (1984) Development of an implantable hearing aid using a piezoelectric vibrator of bimorph design: state of the art.


Yanagihara N, Aritomo H, Yamanaka E, Gyo K (1987) Implantable hearing aid: Report of the first human applications Arch.
Yanagihara N, Gyo K, Hinohira Y (1995) Partially implantable hearing aid using piezoelectric ceramic ossicular vibrator. Yanagihara N, Sato H, Hinohira Y, Gyo K, Hori K (2001) Long-term results using a piezoelectric semi-implantable middle ear hearing device: The Rion device E-type. Suzuki J-I, Yanagihara N, Kadera K (1987) The partially implantable middle ear implant, case reports. Suzuki J, Kodera K, Nagai K, Yabe T (1994) Long-term clinical results of the partially implantable piezoelectric middle ear implant.
Gyo K, Yanagihara N, Saiki T, Hinohira Y (1990) Present status and outlook of the implantable hearing aid.
Kroll K, Grant IL, Javel E (2002) The envoy totally implantable hearing system, St Croix Medical. Snik AF, Cremers CW (2001) Vibrant semi-implantable hearing device with digital sound processing: effective gain and speech perception. Snik FM, Cremers WRJ (1999) First audiometric results with the Vibrant Soundbridge, a semi-implantable hearing device for sensorineural hearing loss. Sterkers O, Boucarra D, Labassi S (2003) A middle ear implant, the Symphonix Vibrant Soundbridge. Colletti V, Carner M, Colletti L (2009) TORP vs round window implantat for hearing restoration of patients with extensive ossicular chain defect. Huttenbrink K-B, Zahnert T, Bornitz M, Beutne D (2008) TORP Vibroplasty: a new alternative for the chronically disabled middle ear. Goebel G, Hiller W (1998) Tinnitus-Fragebogen (TF) Ein Instrument zur Erfassung von Belastung und Schweregrad bei Tinnitus. This is a proven and efficient program that you should check it out now if you are suffering from being obese after baby. Using these videos, learners uses their body weight to buid lean body mass, improve their metabolism, burn up bunches of calories from fat, and reduce excess fat.
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After reading my covering 6 Week Pregnancy Weight Loss program, you must have recognized much about the item and found it helpful for you. Transcranial Magnetic Stimulation: A New Diagnostic and Therapeutic Tool for Tinnitus Patients. Repetitive transcranial magnetic stimulation (rTMS) is a potent tool for modifying neural activity at the stimulated area and at a distance along functional anatomical connections. However, there is increasing agreement that deafferentation-induced neuroplastic processes in the brain are also critically involved in the pathophysiology of tinnitus [11,12].
Most rTMS treatment studies applied lowfrequency rTMS in long trains of 1,200-2,000 pulses repeatedly over 5-10 days. They reported moderate-but significant-effects after active stimulation with high interindividual variability.
A recently published study demonstrated a more pronounced long-term effect of a combined treatment protocol of rTMS applied to the temporal and dorsolateral prefrontal cortex as compared to an exclusive stimulation of the temporal cortex [46].
Evaluation of treatment efficacy requires adequate methodology for control of nonspecific treatment effects. The number of daily sessions may be an important issue to achieve sustained results in tinnitus patients [54], as already seen in other TMS applications, such as depression [55] and auditory hallucinations [56]. In a patient in that study, tinnitus could be reduced each time it recurred using one to three maintenance sessions, and finally it remained stable on a low level after the third stimulation series. The treatment is designed to interact, interrupt, and desensitize tinnitus disturbance for long term benefit. Hearing aids may also reduce the tinnitus, because they provide input to the nervous system that may reverse some of the plastic changes from deprivation of sound that has caused tinnitus and may counteract the deprivation of sound that causes some forms of tinnitus.
However, some individuals still experience the stigma and practical problems of using these devices. It was therefore of great advantage in the treatment of some forms of tinnitus, occurring together with hearing loss, when devices that provide sound delivered directly to the middle ear bones or directly into the cochlea were developed. This vibration in turn caused the eardrum to vibrate and allowed sound to be transduced to the cochlea in normal fashion.
The frequency range is 1,000–8,000 Hz, but technically amplification up to 16,000 Hz is possible.
The FMT provides a better way to induce sound energy into the cochlea than using the ossicular chain. All patients continue to use their middle ear implant as of August 2009 without any technical problems. The participants had sensorineural hearing loss at high frequencies and tinnitus and had been given middle ear implants. The combination, with a good dynamic range assessed by the level of discomfort, gave a good indication for implantation. With the activation of both audio processors, the annoyance due to tinnitus diminished, and the quality of life improved.
This indicates that in addition to a masking effect, there might be other effects from the implanted device. Immediately after the fitting process, the patient’s tinnitus disappeared completely after switching on the device. This means that the effect of the implanted hearing aids on tinnitus is similar to that of cochlear implants.
Methoden zur Erfassung tinnitusspezifischer Beeintrachtigungen und Prasentation des Tinnitus- Beeintrachtigungs-Fragebogens (TBF-12). Secondly, the 2nd video is a severe belly burner that just can be done once they possess mastered the first primary video. This tool may let users pre-plan their own workouts for weight loss and all sorts of moms can take a look at some product on the website to know how to avoid stretch marks after dropping baby weight.
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Depending on stimulation parameters, cortical networks can be functionally disturbed or modulated in their activity. This method, called transcranial magnetic stimulation (TMS), was much less painful than transcranial electrical stimulation. Figure eight-shaped coils are more focal, with a maximum current at the intersection of the two round components [2]. In particular, phenomenological analogies with phantom limb pain suggest that chronic tinnitus as an auditory phantom perception might be the correlate of maladaptive attempts at cortical reorganization owing to distorted sensory input from a peripheral lesion [13]. After 2-4 weeks of daily prefrontal rTMS, there was no sign of structural magnetic resonance imaging changes [34], no significant changes in auditory thresholds, and no significant EEG abnormalities [35]. Even if the quantity of improvement varied across studies, a stable statistically significant improvement of tinnitus complaints could be observed. Another combined treatment protocol consisting of a 6-Hz priming stimulation prior to 1-Hz rTMS of the temporal cortex resulted also in a reduction in tinnitus severity.
Most controlled studies published thus far have used placebo treatment in crossover designs.
The positive effect of this maintenance stimulation could also be confirmed by reduced cerebral metabolism in PET imaging after treatment. Several rTMS studies indicate that treatment response depends on tinnitus duration, with better outcome for shorter duration [37,44,52,53].
Depression of motor cortex excitability by low-frequency transcranial magnetic stimulation. Slow transcranial magnetic stimulation, long-term depotentiation, and brain hyperexcitability disorders. Characteristics of tinnitus and etiology of associated hearing loss: A study of 123 patients.
Focal metabolic activation in the predominant left auditory cortex in patients suffering from tinnitus: A PET study with [ 18 F]deoxyglucose. Long-term effects of repetitive transcranial magnetic stimulation (rTMS) in patients with chronic tinnitus. The impact of auditory cortex activity on characterizing and treating patients with chronic tinnitus-first results from a PET study. The functional neuroanatomy of tinnitus: Evidence for limbic system links and neural plasticity.
Dose-dependent attenuation of auditory phantom perception (tinnitus) by PET-guided repetitive transcranial magnetic stimulation. Salicylate and quinine selectively increase spontaneous firing rates in secondary auditory cortex. Transcranial magnetic stimulation of left temporoparietal cortex and medication-resistant auditory hallucinations.
Neuronavigated transcranial magnetic stimulation and auditory hallucinations in a schizophrenic patient: Monitoring of neurobiological effects. Low-frequency repetitive transcranial magnetic stimulation of the motor cortex in writer's cramp. Repetitive transcranial magnetic stimulation (rTMS) in the treatment of obsessive-compulsive disorder (OCD) and Tourette's syndrome (TS). Risk and safety of repetitive transcranial magnetic stimulation: Report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5-7, 1996.
Lack of significant changes on magnetic resonance scans before and after 2 weeks of daily prefrontal transcranial magnetic stimulation for depression.
Effects of a 2- to 4-week course of repetitive transcranial magnetic stimulation (rTMS) on neuropsychological functioning, electroencephalogram and auditory threshold in depressed patients. Transcranial magnetic stimulation for tinnitus: Influence of tinnitus duration on stimulation parameter choice and maximal tinnitus suppression. Transient tinnitus suppression induced by repetitive transcranial magnetic stimulation and transcranial direct current stimulation. Moderate therapeutic efficacy of positron emission tomography-navigated repetitive transcranial magnetic stimulation for chronic tinnitus: A randomised, controlled pilot study.
Transcranial magnetic stimulation for the treatment of tinnitus: A new coil positioning method and first results.


Combined temporal and prefrontal transcranial magnetic stimulation for tinnitus treatment: A pilot study. High-frequency priming stimulation does not enhance the effect of lowfrequency rTMS in the treatment of tinnitus.
Design of a placebo-controlled, randomized study of the efficacy of repetitive transcranial magnetic stimulation for the treatment of chronic tinnitus.
Neuronavigated repetitive transcranial magnetic stimulation in patients with tinnitus: A short case series.
Effect of daily repetitive transcranial magnetic stimulation for treatment of tinnitus: Comparison of different stimulus frequencies. Temporoparietal transcranial magnetic stimulation for auditory hallucinations: Safety, efficacy and moderators in a fifty patient sample. Maintenance repetitive transcranial magnetic stimulation can inhibit the return of tinnitus.
In reference to: Maintenance repetitive transcranial magnetic stimulation can inhibit the return of tinnitus. Repetitive transcranial magnetic stimulation in veterans with debilitating tinnitus: A pilot study.
The amplification and the power that can be delivered to the cochlea using such devices exceed those of conventional hearing aids. Later, Rutschmann (1959) [4] successfully stimulated the ossicles by gluing 10-mg magnets onto the umbo. It was surprising that most patients, who simultaneously suffered from tinnitus, reported that the middle ear implant largely reduced their tinnitus which could not have been achieved by traditional hearing aids.
Although they were once greatly bothered and annoyed by the tinnitus, the activation of the device gave complete relief.
The technique can alleviate tinnitus by modulating the excitability of neurons in the auditory cortex. For TMS, a brief (100-300 µsec), high-current pulse is produced in an insulated coil of wire that is placed above the skull over the region of particular interest. Owing to the strong decline of the magnetic field with increasing distance from the coil, direct stimulation effects are limited to superficial cortical areas.
Support for this model comes from magnetoencephalography studies showing reorganization of the auditory cortex as reflected by a shift in the tonotopic map of the auditory cortex contralateral to the tinnitus [14]. Adverse auditory effects, such as hearing loss or auditory hallucinations, have not been reported to date after temporal rTMS.
Differences in study design, stimulation parameters, and patient population render a further comparison of results difficult. After active treatment, a significant decrease in the tinnitus score [43] could be observed, whereas sham treatment showed no effect. An easier applicable technique is the coil localization according to the 10-20 EEG coordinate system, which was described by Langguth et al. Therefore, carryover effects and missed effects owing to limited observation periods cannot be entirely excluded. Therefore, functional imaging might represent an important objective marker of treatment effects in the future. On the basis of findings, it is tempting to conclude that the degree of maladaptive neuroplastic changes in auditory and nonauditory brain structures may depend on tinnitus duration.
This might be owing to the relatively low number of daily stimuli (600 per day) used in this investigation [59]. Particularly, amplification is achieved in a larger frequency range than what is possible using traditional hearing aids. However, the company went out of business in 2002 only to return in March 2003 as the Med-EL Vibrant Soundbridge. They were studied for 1 year using a visual analogue scale (VAS), Goebel–Hiller score [19], and the Tinnitus Handicap Inventory (the German TBF-12 [20, 21]). It is assumed that TMS decreases the hyperexcitability that is associated with some forms of tinnitus. The strong current in the coil results in a magnetic field (1.5-2 Tesla) with lines of flux passing perpendicularly to the plane of the coil.
Whereas single magnetic pulses do not seem to have longer-lasting effects, the application of multiple pulses in rhythmic sessions, called repetitive TMS (rTMS), can have effects that outlast the stimulation period. Functional imaging studies demonstrated that tinnitus is associated with neuroplastic alterations in the central auditory system and associated areas.
The risk of highintensity and high-frequency rTMS-induced epileptic seizures that had been reported in individual cases has been largely reduced since the introduction of safety guidelines [33]. When stimulation was administered to the left temporoparietal cortex-corresponding to the area of the secondary auditory cortex-a significant transient reduction of tinnitus was observed in 57% of the participants. In the latter study, functional magnetic resonance imaging with an acoustic paradigm was used for target detection within the auditory cortex.
At 6 months after treatment, 57% of patients reported a remarkable, sustained reduction in tinnitus.
However, all results have to be considered as preliminary, owing to the small sample sizes, the methodological heterogeneity, and the high variability of results. A growing number of studies demonstrate reduction of tinnitus after repeated sessions of low-frequency rTMS and indicate that rTMS might represent a new promising approach for the treatment of tinnitus. An electric field is induced perpendicularly to the magnetic field, resulting in neuronal depolarization of the underlying brain area. Positron emission tomography (PET) investigations showed abnormal asymmetry in the auditory cortices of tinnitus patients with higher levels of spontaneous neuronal activity on the left side, irrespective of tinnitus laterality [15-17]. Mild adverse effects, such as physical discomfort on the skull during stimulation or transient headache after stimulation, are reported by approximately 10% of stimulated patients. The clinical validation of this coil-positioning method resulted in a significant reduction of tinnitus severity after 10 sessions of 1-Hz rTMS. Deprivation from auditory input is assumed to result in deafferentation-induced neuroplastic changes in the central auditory system that might represent the crucial step in the development of subjective tinnitus. Replication of data must be performed in multicenter trials with a large number of patients and long-term follow-up before further conclusions can be drawn [48]. Single sessions of high-frequency rTMS over the temporal cortex have been successful in reducing the intensity of tinnitus during the time of stimulation and could be predictive for treatment outcome of chronic epidural stimulation using implanted electrodes. Low-frequency ( 1 Hz) rTMS has been repeatedly shown to result in a decrease in cortical excitability [3,4] and is considered to produce long-term synaptic depression, which diminishes the efficiency of intercellular links. Other studies revealed additional changes in the middle temporal and temporoparietal regions as well as activation in frontal and limbic areas [18-22]. As there is no study so far comparing different coil-positioning strategies with treatment outcome, the optimum coil localization is still a matter of debate. Besides the sham coil system [16,49], which mimics the sound of the active coil without producing a magnetic field, an angulation of an active coil tilted 45 degrees [50] or 90 degrees [51] to the skull surface or stimulation of nonauditory brain areas [22,44] has been described.
For that reason, chronic hearing impairment might attenuate rTMS effects by continuously triggering neuroplastic changes in central auditory structures.
Further research is needed for a clear definition of subgroups of patients who benefit most from rTMS. Because most available studies have been performed with small sample sizes and show only moderate effect sizes and high interindividual variability of treatment effects, further development of the technique is needed before it can be recommended for use in clinical routine.
High-frequency (5-20 Hz) rTMS results in an increase in excitability [5] and therefore might generate long-term potentiationlike effects [6]. Electrophysiological studies in animal models of tinnitus have shown an increase of firing rate and neuronal synchrony in both the lemniscal and extralemniscal systems [23-25]. Only patients in whom tinnitus could be suppressed by an intravenous lidocaine bolus were included. Finding an optimal control condition for treatment studies is also difficult, owing to limitations in blinding of patient and operator to different stimulus conditions and owing to the fact that TMS itself results in auditory and somatosensory stimulation in addition to the actual brain site-specific effect. In this context, short trains of high-frequency rTMS seem to have a promising potential to select patients for surgical implantation of cortical electrodes. Interestingly, these features of rTMS effects are similar to those of direct electrical cortical stimulation in animal studies [4,7]. Electroencephalography (EEG) and magnetoencephalography studies in humans have demonstrated that tinnitus is associated with reduced alpha and increased gamma activity in the contralateral auditory cortex [26,27]. The large sample allowed the establishment of a statistical relationship between optimum tinnitus suppression, optimum stimulation frequency, and tinnitus duration. Still far from being obvious is determining which stimulation parameters, such as frequency, intensity, and coil localization, account for optimum treatment outcome. In addition, for brief periods after stimulation, rTMS can block or inhibit a brain function and create a transient functional lesion in the immediate poststimulation period [8]. As rTMS has the ability to modulate cortical activity focally, there was a rationale to assume that TMS could interfere with cortical hyperexcitability and, therefore, influence the tinnitus sensation. The amount of tinnitus suppression was correlated positively with stimulation frequency and negatively with tinnitus duration, indicating the potential of TMS as a diagnostic tool for differentiating pathophysiologically distinct forms of chronic tinnitus.
Single sessions of low-frequency (1 Hz) rTMS with the coil navigated to these activated areas resulted in tinnitus reduction lasting up to 30 minutes in six of eight patients. The monitoring of rTMS effects with electrophysiological and neuroimaging methods might contribute to a better understanding of neurobiological mechanisms that underlie the clinical effects.
On the basis of these multiple effects, TMS is now widely used as a research tool to study the physiology and pathophysiology of the brain.
Moreover, repeated applications of rTMS might represent a potential treatment by producing longer-lasting modulation of cortical activity. This approach has already been successfully used as a screening method to select patients for surgical implantation of cortical electrodes [38,39]. As these effects can outlast the time of stimulation, the technique was considered to be potentially useful for the therapy of disorders with cortical dysfunction [2].
The rationale was confirmed by promising results obtained by the use of rTMS as a therapeutic tool in various neurological and psychiatric conditions, in which increased cortical activity as underlying pathophysiology is assumed [28-32]. Patients responding to this type of rTMS with a shortlasting suppression of tinnitus perception were considered as good surgical candidates for permanent electrical stimulation of the auditory cortex.



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