Doctoral dissertation (article) (G5)

Tinnitus – psychiatric comorbidity and treatment using transcranial magnetic stimulation (TMS)




List of AuthorsSahlsten Hanna

PublisherUniversity of Turku

PlaceTurku

Publication year2019

ISBN978-951-29-7531-0

eISBN978-951-29-7532-7

URLhttp://urn.fi/URN:ISBN:978-951-29-7532-7

Self-archived copy’s web addresshttp://urn.fi/URN:ISBN:978-951-29-7532-7


Abstract

Tinnitus is the perception of sound in the absence of any external noise. It severely impairs the quality of life in 1-2% of people. Tinnitus is frequently associated with depression, anxiety, and insomnia. The exact pathophysiology of tinnitus is still unclear. No curative therapy exists for chronic tinnitus, and treatment focuses on symptomatic relief. 

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation technique that is used for treating depression and neuropathic pain. The evidence of its efficacy for chronic tinnitus is still inconclusive, and the optimal treatment protocols are thus still obscure. 

This thesis aimed to further evaluate the use of rTMS for chronic tinnitus and investigate the psychiatric comorbidity of tinnitus patients. The first (open pilot) study utilized electric field (E-field) navigated rTMS for very severe chronic tinnitus with promising results. In the second (randomized placebo-controlled) study, the effects of 1-Hz E-field rTMS targeted according to the tinnitus pitch to the left auditory cortex were analyzed. Despite the significant improvements in tinnitus, active rTMS was not superior to the placebo, possibly due to large placebo-effect and wide inter-individual variation in treatment efficacy. The third study on parallel groups compared the effects of neuronavigated rTMS to nonnavigated rTMS (based on the 10-20 EEG localization system). Both groups benefitted from the treatment, but the method of coil localization was not a critical factor for treatment outcome. In the fourth study, current and lifetime DSM-IV diagnoses of Axis I (psychiatric disorders) and Axis II (personality disorders) were assessed in tinnitus patients using structured clinical interviews (SCID-I and -II). Tinnitus patients were prone to episodes of major depression, and they often had obsessive-compulsive personality features. Psychiatric disorders in this study seemed to be comorbid or predisposing conditions rather than the consequences of tinnitus.


Last updated on 2021-24-06 at 09:26