TMS & Other Therapies

The Relationship Between Tinnitus and TMS Therapy + How It Can Deliver Relief For Patients

December 27, 2019

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Tinnitus is very common, yet there has been very little medical treatments that can help with symptoms of tinnitus, and no cure has been found. A new study done by Dr. Robert L. Folmer and a group of colleagues shows some promising results in treating tinnitus with TMS therapy. Find more details below.

Tinnitus can significantly affect quality of life. Photo courtesy of zaneslaw.com.

What Is Tinnitus?

Tinnitus is the perception of noise or ringing in the ears. It is a very common problem and 15% - 20% of people have dealt with it at some time or another. Tinnitus is a really annoying symptom of larger underlying problems. Some of those problems are age-related hearing loss, circulatory system disorders, or any ear injuries. Tinnitus brings great discomfort to those suffering from it, but it is usually not the sign or something medically serious.  Tinnitus usually worsens with age.

Tinnitus involves the sensation of hearing sound when no external sound is present. Tinnitus symptoms may include phantom noises like buzzing, ringing, clicking, hissing, roaring, or humming. The phantom noises can vary in pitch. Sometimes they may be very faint and sometimes they may be overpoweringly loud.  Tinnitus can even get so loud that it can interfere with your ability to concentrate or hear other sounds. Some people suffering from tinnitus hear it all day every day at varying pitches, while other people say the condition comes and goes.

There are two different forms of tinnitus, subjective and objective. Subjective tinnitus is the most common form of the condition. It is when you can hear the buzzing or ringing phantom sound, but no one else can. This type can be caused by ear problems in your outer, middle or inner ear. It can also be caused by problems with the hearing nerves or the part of your brain that interprets nerve signals as sound. On the other hand, Objective tinnitus can actually be heard by doctors during an examination. This super rare form of tinnitus can be caused by a blood vessel problem, a middle ear bone condition or muscle contractions.

Conditions that affect the nerves in your ear or the hearing center in your brain often cause tinnitus. Photo courtesy of pnwaudiology.com

Causes of Tinnitus

There are a number of different things that can cause or worsen tinnitus in patients. However, in most cases, an exact cause is rarely pinpointed. Tinnitus can be caused by some very common conditions or it can be a symptom of other more serious health conditions.

Some of the common causes include:

  • Age-related hearing loss. For many people, hearing worsens with age, usually starting around age 60. Hearing loss can cause tinnitus. The medical term for this type of hearing loss is presbycusis.
  • Ear hair cell damage. Tiny, delicate hairs in your inner ear move in relation to the pressure of sound waves. This triggers cells to release an electrical signal through a nerve from your auditory nerve to your brain. Your brain interprets these signals as sound. If the hairs inside your inner ear are bent or broken, they can "leak" random electrical impulses to your brain, causing tinnitus.
  • Exposure to loud noise. Loud noises, such as those from heavy equipment, chain saws, and firearms, are common sources of noise-related hearing loss. Portable music devices, such as MP3 players or iPods, also can cause noise-related hearing loss if played loudly for long periods. Tinnitus caused by short-term exposure, such as attending a loud concert, usually goes away; both short- and long-term exposure to loud sound can cause permanent damage.
  • Earwax blockage. Earwax protects your ear canal by trapping dirt and slowing the growth of bacteria. When too much earwax accumulates, it becomes too hard to wash away naturally, causing hearing loss or irritation of the eardrum, which can lead to tinnitus.
  • Ear bone changes. Stiffening of the bones in your middle ear (otosclerosis) may affect your hearing and cause tinnitus. This condition, caused by abnormal bone growth, tends to run in families.

Less common causes are:

  • Meniere's disease. Tinnitus can be an early indicator of Meniere's disease, an inner ear disorder that may be caused by abnormal inner ear fluid pressure.
  • TMJ disorders. Problems with the temporomandibular joint, the joint on each side of your head in front of your ears, where your lower jawbone meets your skull, can cause tinnitus.
  • Head injuries or neck injuries. Head or neck trauma can affect the inner ear, hearing nerves or brain function linked to hearing. Such injuries generally cause tinnitus in only one ear.
  • Acoustic neuroma. This noncancerous (benign) tumor develops on the cranial nerve that runs from your brain to your inner ear and controls balance and hearing. Also called vestibular schwannoma, this condition generally causes tinnitus in only one ear.
  • Eustachian tube dysfunction. In this condition, the tube in your ear connecting the middle ear to your upper throat remains expanded all the time, which can make your ear feel full. Loss of a significant amount of weight, pregnancy and radiation therapy can sometimes cause this type of dysfunction.
  • Muscle spasms in the inner ear. Muscles in the inner ear can tense up (spasm), which can result in tinnitus, hearing loss and a feeling of fullness in the ear. This sometimes happens for no explainable reason, but can also be caused by neurologic diseases, including multiple sclerosis.
Tinnitus can be a lifechanging condition. Talk to your doctor to see if you have any options.  

If Tinnitus Effects You

If you have tinnitus that is bothering you, you should definitely see a doctor. Be sure to make an appointment if you develop tinnitus after an upper respiratory infection, such as a cold, and your tinnitus doesn't improve within a week, your tinnitus occurs suddenly or without an apparent cause, or if you experience hearing loss or dizziness with the tinnitus.

Tinnitus can occur in anyone, but there are some factors that may increase your risk of tinnitus. Some of those risks are:

  • Loud noise exposure. Prolonged exposure to loud noise can damage the tiny sensory hair cells in your ear that transmit sound to your brain. People who work in noisy environments — such as factory and construction workers, musicians, and soldiers — are particularly at risk.
  • Age. As you age, the number of functioning nerve fibers in your ears declines, possibly causing hearing problems often associated with tinnitus.
  • Gender. Men are more likely to experience tinnitus.
  • Smoking. Smokers have a higher risk of developing tinnitus.
  • Cardiovascular problems. Conditions that affect your blood flow, such as high blood pressure or narrowed arteries (atherosclerosis), can increase your risk of tinnitus.
Transcranial magnetic stimulation (TMS) is a safe, non-invasive, and FDA-approved treatment for depression and other brain health issues. Photo courtesy of mytransformations.com.

How Is TMS Connected to Tinnitus?

Tinnitus affects nearly 45 million Americans.  Almost 15% of all Americans experience some degree of tinnitus, according to the Centers for Disease Control. There have been no proven treatments available. So, patients are forced to suffer with this symptom and often have to just learn how to cope with the problem. Because of their time at war, military veterans are at a greater risk for developing tinnitus. It is the most common disability caused by service in the VA health system.

For those reasons, this clinical trial used a mix of veterans and non - veterans. The objective of this study was to “determine if repetitive transcranial magnetic stimulation (TMS) can reduce the perception or severity of tinnitus and to test the hypothesis that TMS will result in a statistically significantly greater percentage of responders to treatment in an active TMS group compared with a placebo TMS group.” To test this hypothesis, Robert L. Folmer, PhD, facilitated a randomized placebo-controlled clinical trial of TMS involving individuals who experience chronic tinnitus.

To complete the research, Filmer and his colleagues used a TMS system that generates a cone-shaped magnetic field that penetrates the scalp and skull to interact with brain tissue. The more intense the stimulation, the deeper the magnetic field is allowed to penetrate and affect the brain’s activity. All participants received 2000 pulses per session of active or placebo TMS at a rate of one pulse of TMS per second to their skull just above the ear to target the auditory cortex in the brain. This happened for 10 consecutive workdays.

The trial was conducted between April 2011 and December 2014 at Portland Veterans Affairs Medical Center among 348 individuals. To break it down, 92 of those individuals provided informed consent and were assessed with more detail, 70 were randomized to receive active or placebo TMS, and 64 participants were included in data analysis. This is the largest trial on this subject to date. Of the 32 active TMS recipients, 18 responded to the treatment. That is just 56%. Of the placebo group, only 7 out of 32 responded the same way. Those same 18 people reported that their tinnitus symptoms were alleviated for at least six months. Patients were required to have had tinnitus for at least a year.

A significant number of participants who had tinnitus for more than 20 years were pleased to receive some relief from TMS treatment. Because of these amazing results, Dr.Folmer plans on conducting a larger clinical trial to refine everything. With the results of this new research, TMS therapy seems like it could be a legitimate cure to tinnitus for a lot of people.

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