Transcranial Magnetic Stimulation (TMS) therapy is emerging as an effective and innovative treatment for tinnitus. Living with tinnitus – a constant ringing, buzzing, or hissing sound in the ears – can be an overwhelming experience that disturbs sleep, impacts mental health, and disrupts your daily life. Despite around 21 million adults in the U.S. dealing with this condition, treatment options are relatively limited.
Thankfully, TMS offers hope for managing tinnitus by targeting the neurological mechanisms underlying tinnitus. In this article, we explore TMS for tinnitus, including how it works, its benefits, and what you can expect from treatment.
What is tinnitus?
Tinnitus, sometimes simply referred to as ‘ringing in the ears’, is an auditory condition that involves hearing a noise that doesn’t come from an outside source. Often described as a ringing, whooshing, buzzing, clicking, or screeching sound, tinnitus can affect one or both ears, and sometimes even feel like it’s coming from the center of the head.
Tinnitus can vary in severity. For some people, it’s a mild annoyance that appears from time-to-time, while for others it’s a disruptive condition that interferes with daily activities and sleep. People with severe tinnitus can experience anxiety or depression as a result of the condition.
Types of tinnitus
There are two main types of tinnitus, subjective and objective.
Subjective tinnitus is the most common form of tinnitus. In this type, only the affected individual can actually hear the sound. Causes of subjective tinnitus can include prolonged exposure to loud noise, aging, head injuries, or medical conditions such as Meniere’s disease.
Objective tinnitus is less common. In this type, both the affected individual and another person (like a healthcare professional with a stethoscope) can hear the sound. Objective tinnitus is often linked to vascular disorders or structural abnormalities within the body.
Symptoms of tinnitus
The primary symptom of tinnitus is hearing a ringing, buzzing, whooshing, clicking, or screeching sound that doesn’t come from an external source. In some cases, the disorder can be so severe that it affects a person’s ability to focus, sleep, and talk.
Tinnitus treatment options
Tinnitus is often treated with a combination of therapies aimed at reducing symptoms or improving the affected individual’s quality of life. Below, we explore some conventional and innovative treatments for tinnitus.
Cognitive Behavioral Therapy (CBT)
CBT is a form of psychotherapy that helps people reframe negative thought patterns associated with tinnitus. It aims to reduce the levels of emotional distress, anxiety, and depression caused by the condition and offer helpful coping strategies.
Tinnitus Retraining Therapy (TRT)
TRT combines counseling with sound therapy to help an individual get used to the sounds of tinnitus. Over time, TRT can teach the brain to filter out tinnitus-related noises and make them less noticeable.
Noise suppression devices
Another way to manage tinnitus is with noise suppression devices, like white noise machines and masking devices. These tools emit low-level background sounds that can help reduce the perception of tinnitus, especially in quiet environments.
Medications
While there’s no medication to treat tinnitus, antidepressants and anti-anxiety medications are often prescribed for those who experience secondary mental health conditions as a result of tinnitus.
Transcranial Magnetic Stimulation (TMS)
TMS is an innovative treatment that shows significant promise for managing tinnitus. Originally approved by the FDA for treating depression, TMS uses electromagnetic pulses to stimulate targeted regions of the brain. When using TMS for tinnitus, magnetic pulses target the medial temporal lobe area of the brain – the part of the brain responsible for creating the tinnitus sound. Over time, repetitive TMS sessions can help relieve tinnitus symptoms by altering the tonality of that brain region.
What is TMS?
Transcranial Magnetic Stimulation (TMS) is a non-invasive, non-pharmacological therapy that uses magnetic pulses to stimulate specific regions of the brain. It is FDA-approved for treating depression and obsessive-compulsive disorders, and has been proven effective for other neurological and psychiatric conditions, including Parkinson’s disease, anxiety, and attention-deficit hyperactivity disorder (ADHD). TMS’s benefits are also being explored for other applications, including tinnitus management.
TMS therapy involves placing a specialized electromagnetic coil on the scalp. This coil generates magnetic pulses that reach targeted brain regions, creating small electrical currents that either stimulate or inhibit neuronal activity. Through a series of repetitive treatments, TMS hopes to restore normal brain function and alleviate symptoms of various conditions.
There are different types of TMS therapies:
- Repetitive Transcranial Magnetic Stimulation (rTMS): This is the most common type of TMS, delivering repeated magnetic pulses over 20-30 minute sessions.
- Theta Burst Stimulation (TBS): This is a faster, high-frequency form of TMS that uses bursts of magnetic pulses to reduce session times.
- Deep Transcranial Magnetic Stimulation (Deep TMS): This type of TMS targets deeper brain regions than rTMS.
- Accelerated TMS: Accelerated TMS is a more intensive version of rTMS, delivering multiple sessions per day over a shorter period of time.
See: Who Qualifies for TMS Therapy? (TMS Requirements)
How does TMS for tinnitus work?
TMS therapy manages tinnitus by targeting the brain’s auditory cortex. When people have chronic tinnitus, there’s an imbalance in the auditory cortex that leads to perceiving phantom sounds like ringing, buzzing, or hissing. TMS uses magnetic pulses to gently stimulate the affected brain regions, helping restore balance and reduce the intensity of tinnitus sounds.
Here’s what you can expect from a typical TMS for tinnitus process.
Initial evaluation
Before starting TMS therapy, we ask patients to confirm a diagnosis of subjective tinnitus with a primary care provider or ENT specialist. This ensures that TMS therapy is an appropriate treatment option.
Once diagnosis is confirmed, we start with an initial consultation where we discuss the treatment and confirm that it’s right for you. There are certain cases where TMS may not be a suitable treatment option (see below section: Who Shouldn’t Get TMS Therapy?).
TMS sessions
TMS for tinnitus generally involves 10-20 treatments, each lasting around 20 minutes. At BestMind Behavioral Health, these treatments are conducted at our comfortable clinics in Colorado and Oregon.
The first TMS session involves ‘brain mapping’, where the TMS technician locates the correct region of your brain to target with the therapy. Subsequent sessions involve delivering magnetic pulses to target the auditory cortex and decrease the tinnitus signal.
During each session, you’ll be comfortably seated in one of our reclining chairs. An electromagnetic coil will be placed on your head, delivering magnetic pulses to your brain. The treatment is painless, although some patients report feeling a mild tingling sensation.
Continue Reading: What is Brain Mapping for Transcranial Magnetic Stimulation (TMS)?
Post-session
After your TMS session, you’re free to go home and resume normal activities as usual. Because TMS is non-invasive and doesn’t require sedation, you can even drive yourself to and from appointments.
Can TMS help treat tinnitus?
TMS therapy is a promising treatment that directly addresses the neurological roots of tinnitus. While it often feels like an ear issue, research shows that subjective tinnitus mostly originates in the brain.
There are two key issues thought to contribute to tinnitus:
- Overactivity in the auditory complex (the region of the brain involved in processing sounds). This leads to the ringing, buzzing, or whooshing sound.
- Disruptions in the brain’s ‘noise-canceling’ networks. This part of your brain would normally ignore or tune out unnecessary noise, however with tinnitus it begins to focus even more on the sound.
TMS targets both these issues by delivering magnetic pulses that reduce overactivity in the auditory cortex while stimulating activity in the ‘noise-canceling’ network. This has the dual benefit of decreasing the intensity of tinnitus and improving a person’s ability to ignore the sound.
Is TMS for tinnitus effective?
While TMS for tinnitus is currently considered off-label, plenty of research has demonstrated its effectiveness in relieving tinnitus symptoms.
One study published in the Journal of the American Medical Association found that 56% of participants receiving TMS for tinnitus experienced significant improvements in symptoms, compared with 22% in the placebo controlled study. For some patients, the effects persisted for up to six months post-treatment.
In another study, TMS was found to improve symptoms and improve quality of life in between 20 to 50% of tinnitus patients. Many patients showed reductions in Tinnitus Handicap Inventory (THI) scores, a common measure of tinnitus severity, with results lasting anywhere from weeks to months after treatment.
Another study looked into the implications of TMS as a treatment modality for tinnitus, reviewing research and clinical trials. This study found that after rTMS treatment, patients reported an enhanced quality of life and improvements in tinnitus loudness, annoyance, and distress.
Benefits of TMS therapy for tinnitus
Beyond its effectiveness in treating tinnitus, TMS has other benefits including being non-invasive, having minimal side effects, providing long-term relief, and offering precise treatment.
Non-invasive and painless
TMS therapy is a completely external procedure that doesn’t involve surgery, sedation, or invasive techniques. Patients remain awake throughout the entire treatment and most describe it as being comfortable and pain-free.
Minimal side effects
TMS is also well-tolerated with minimal side effects. Its few side effects include headaches, twitching of facial muscles, scalp or neck discomfort, and drowsiness, all of which tend to be short-lived and resolve on their own after treatment.
Long-lasting relief
Studies exploring the benefits of TMS for tinnitus have shown that its effects can last for up to six months after treatment.
Tailored, precise treatment
TMS is a highly customized procedure that can be tailored to the unique needs of each patient. The initial brain mapping session uses individual parameters to accurately target the correct brain regions and deliver the appropriate intensity of magnetic pulses. Treatment can also be continually adjusted to remain comfortable and effective for the patient.
Non-sedative
TMS therapy doesn’t require sedation, meaning patients can drive themselves home and continue about their day as normal after sessions. This makes the treatment easy to fit into daily life.
Keep Reading: Accelerated TMS vs. Traditional TMS: Which One Makes Sense for You?
Who shouldn’t get TMS therapy?
Although TMS is safe and generally well-tolerated, there are certain situations in which it may not be a suitable treatment option.
TMS therapy isn’t recommended if you:
- Have a history of seizures, epilepsy, or other neurological conditions
- Are pregnant or breastfeeding
- Have experienced a traumatic brain injury, brain tumor, stroke, or other significant brain disorder
- Are currently using stimulant medications.
It should also be avoided if you have non-removable metallic objects in your head, such as:
- Deep brain stimulators
- Cochlear implants
- Aneurysm clips or coils
- Neck, brain, or heart stents
- Implanted electrodes
- Shrapnel or bullet fragments
- Vagus nerve stimulators.
The magnetic pulses used in TMS can heat or move metallic objects, which can be dangerous. It’s OK to do TMS therapy if you have braces or dental fillings, as they won’t interfere with treatments.
If you’re unsure whether TMS is suitable for you, don’t worry. We will discuss the treatment with you in detail during your initial consultation to ensure it’s appropriate and safe for you.
What are the side effects of TMS?
TMS is generally well-tolerated, however a small number of people may experience side effects. These tend to be mild and short-lived, usually resolving on their own within a few hours. With more treatment sessions, side effects tend to completely subside as the body adjusts to the therapy.
Potential side effects of TMS therapy include:
- Mild headaches
- Lightheadedness
- Neck or scalp discomfort
- Tingling sensations
- Twitching of facial muscles
- Sleepiness.
In extremely rare cases, TMS therapy can trigger seizures in some people. This is very uncommon, but if you have any concerns feel free to discuss them with us prior to treatment.
Is TMS therapy for tinnitus covered by insurance?
Since TMS therapy is considered off-label for the treatment of tinnitus, it is not covered by most treatment plans. However, most insurance policies cover TMS treatments for depression. If you have both tinnitus and depression, then your treatment may be covered by insurance.
To learn more about your specific coverage, don’t hesitate to contact our team at BestMind Behavioral Health – we’re more than happy to assist.
TMS therapy for tinnitus
Tinnitus can be an isolating and frustrating experience that affects every aspect of life, from sleep to peace of mind. But you don’t have to face this journey alone – help is available. At BestMind Behavioral Health, we’re here to support you with TMS therapy that targets the regions of the brain involved in tinnitus.
Contact us today to take the first step towards lasting tinnitus relief.
