Neuronavigated Versus Non-navigated Repetitive Transcranial Magnetic Stimulation for Chronic Tinnitus: A Randomized Study.

Only 40 patients were analysed, so a true difference between the two targeting methods could have been missed. There was no placebo group, so improvement could be due to placebo, natural fluctuation, or time rather than rTMS. The study was single-blind, so patients did not know which targeting method they received; the paper does not say that clinicians or outcome assessors were blinded. Treatment delivery was not identical: two navigated patients had one session with 3,950 or 3,980 pulses, one non-navigated patient had one session with 3,100 pulses, and intensity was lowered for 13 navigated and 11 non-navigated patients because of facial contractions. Two patients in the navigated group and three in the non-navigated group were taking antidepressant medication at baseline, which could have influenced mood, sleep, or tinnitus-related ratings. Patients had chronic tinnitus with intensity of at least 4/10 and excluded pulsatile or objective tinnitus, so results may not apply to every tinnitus patient.

The work was funded by state research funding from the Hospital District of Southwest Finland, Finnish governmental University Hospital grants, and the Finnish Research Foundation of Ear Diseases. The supplied article does not include an author conflict-of-interest declaration.

Do not conclude that rTMS is proven to work for chronic tinnitus. This study had no placebo group, and its main between-group result was that neuronavigation did not improve primary tinnitus handicap, annoyance, or distress scores; the only significant difference favored non-navigated rTMS for intensity.