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A Systematic Review and Meta-

analysis of Randomized Controlled 

Trials on the Effect of Transcranial 

Magnetic Stimulation on Tinnitus 

Management 
 

Salma Galal1*, Naema Ismail2, 

Ghada Niel3 
 
1Community and Industrial Medicine 
Department, Faculty of Medicine;  
2Audiology Department, Faculty of 
Medicine, Al-Azhar University, Cairo, 
Egypt;  
3Audiology Department, Mansoura 
International Hospital, Mansoura, Egypt 
 
*Corresponding Author 

 

Vol. 9, No. 1 (2020)   |   ISSN 2166-7403 (online)  

DOI 10.5195/cajgh.2020.356 |http://cajgh.pitt.edu 

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Abstract 

Introduction: Tinnitus occurs in 10-15% of the world’s population. It may lead to hearing loss, depression, and suicidal tendencies, 

as well as reduced quality of life. The aim of this study was to assess whether Transcranial Magnetic Stimulation (TMS) effectively 

reduces tinnitus handicapping after six months or more of follow-up. 

Methods: A systematic review of randomized controlled trials with follow-up of six months was undertaken. The review took 

place through searching Medline, Science Direct, and Google Scholar databases using the keywords “tinnitus” and “Transcranial 

Magnetic Stimulation” and limiting the search results to randomized controlled trials (RCTs) conducted on adults (19 years and 

older) published between 2005-2015. Meta-analysis was performed on the similarly designed studies. 

Results: Five RCTs with six month follow-up were found conforming to the inclusion criteria. In total, there were 119 patients in 

the TMS arms and 115 in the placebo arms. However, designs were different between the studies and were therefore not all 

comparable. Different parameters were used to measure the severity of tinnitus and depression scores. Tinnitus handicapped 

inventory (THI) was the common measured outcome parameter used in all studies. THI score decreased after the TMS in four 

studies. Meta-analysis was performed on three similarly designed RCTs with the overall effect being insignificant. 

Conclusion: TMS reduced the THI score and decreased the severity of tinnitus in 45% of patients and lead to a complete recovery 

in 32% of cases in one study. However, the meta-analysis demonstrated lack of significant effect of TMS on tinnitus management. 

Keywords:Tinnitus; TMS; Transcranial Magnetic Stimulation; Magnetic Field Therapy 

 

 

A Systematic Review and Meta-

analysis of Randomized Controlled 

Trials on the Effect of Transcranial 

Magnetic Stimulation on Tinnitus 

Management 

 

Salma Galal1, Naema Ismail2, Ghada 

Niel3 

 
 
1Community and Industrial Medicine 
Department, Faculty of Medicine;  
2Audiology Department, Faculty of Medicine, 
Al-Azhar University, Cairo, Egypt;  
3Audiology Department, Mansoura 
International Hospital, Mansoura, Egypt 

Research 

Tinnitus is the perception of sound in the ear or 

in the head without any external acoustic stimulation. 

Numerous hypotheses have been developed for the 

pathophysiology of tinnitus. It has been suggested that 

tinnitus may arise from any abnormality of the neural 

pathway from the cochlear neural axis to the auditory 

cortex.1 The pathophysiological theory implies that the 

central nervous system is the source or “generator” of 

tinnitus.2 Tinnitus is often a feature of ear disease and is 

usually associated with hearing loss, but it may also occur 

in patients with normal hearing.3 Many cases of tinnitus 

have no identifiable cause. Environmental exposure to 

recreational, urban, and occupational noise or ototoxic 

drugs can develop tinnitus.4 Explosion or firing can cause 

damage to the peripheral auditory organs, which in turn 

causes the activation of neural plasticity and leads to 

tinnitus.5  

In 39 studies done in Belgium, Italy, Denmark, 

Finland, Norway, Sweden, UK, Scotland, USA, Japan, 

China, South Korea, Australia, Egypt, Nigeria, and 

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Brazil, the prevalence of tinnitus ranges from 5.1% to 

42.7% and is higher in males than in females.6 The 

National Health Interview Survey found that, within the 

US population, 11.2% of adults and 7.5% of adolescents 

suffer from tinnitus; tinnitus prevalence increases with 

age.7,8 In 1–2% of people who have tinnitus, tinnitus 

symptoms seriously reduce the quality of life, resulting 

in social isolation, depression, and even suicidal 

tendencies.5 

In chronic cases, a variety of treatment 

approaches are available, including pharmacological 

treatment, complementary and alternative medicine 

therapies, sound treatment/associated technologies, 

psychological/behavioral treatment, and cochlear 

implants. There is no pharmacological treatment for 

tinnitus with long-term effect.9 Talk therapy and sound 

therapy with little support of medication are the primary 

treatment in developed countries.10,11 There is little 

evidence on tinnitus management forms using Chinese, 

alternative or complementary medicine. These therapy 

methods include Ginkgo biloba, melatonin, zinc, diet 

modification, hyperbaric oxygen, temporo-mandibular 

joint therapy, and acupuncture, among others.12 

Tinnitus treatment can be reached by 

interrupting the abnormal activity and neuro-

modulation.13  Repetitive magnetic fields generated by 

repetitive Transcranial Magnetic Stimulation (rTMS) can 

reduce neural overactivity in cortical areas and can 

potentially alleviate tinnitus.14 It is a non-invasive 

procedure.15 Meng et al. review on tinnitus management 

with TMS suggests addressing its long-term 

effectiveness.9 Recent and ongoing research studies have 

attempted to assess whether rTMS could be an effective 

tinnitus treatment for a longer duration. Therefore, the 

aim of this study was reviewing RCTs that addressed the 

effect of TMS on tinnitus after at least six months. 

 

Methods 

Search strategy 

Electronic searches on the Medline (PubMed), 

Science Direct, and GoogleScholar databases were 

carried out in February 2016. English language articles 

published between 2005 and 2015 were selected. 

Cochrane Library was searched for systematic reviews 

on the topic. The search keywords used were either 

“unilateral or bilateral tinnitus”, “Trans-cranial Magnetic 

Stimulation”, “TMS”, “TMS treatment”, “repetitive 

TMS” and “rTMS”. Only RCTs with adults at least 19 

years old and at least six months follow-up were 

included. The authors independently searched the sites, 

reviewed the titles, abstracts, and keywords, and agreed 

on the studies included in the review. The decision for a 

final inclusion of the studies was made after reviewing 

the full articles. The authors resolved differences by 

discussing them together. The libraries of the Faculties of 

Medicine in some Egyptian Universities were searched 

on the same topic by another author. No thesis was found 

on the systematic review of rTMS for tinnitus treatment. 

Study inclusion and exclusion criteria 

Any RCT using rTMS treatment (low/high 

frequency) with at least six months of follow-up was 

considered eligible. Studies with children under the age 

of 19 or adults with total hearing loss. Studies with 

combined therapy, where rTMS treatment was used in 

conjunction with pharmacological therapy, diet 

modification, psychotherapy, hearing aids, or any metal 

appliances were also excluded. Different tools are used 

in RCTs to measure the severity of tinnitus. The authors 

tried to find one common primary or secondary tool for 

measuring severity, which was ultimately determined to 

be tinnitus handicapped inventory (THI).  

Data extraction 

General information on publication, authors, 

article title, journal title, and publication year was 

extracted. The design of the trial was assessed in regard 

to trial arms, sample size, randomization process, 

allocation method, blinding of information, and statistical 

methods. The total number of intervention and 

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comparison groups of participants was registered with 

baseline characteristics, age, gender, inclusion and 

exclusion criteria. The intervention with TMS pulse, 

stimulus frequency, and dropouts were reviewed. 

Primary and secondary outcomes such as THI and 

depression or anxiety tests at baseline, at the end of the 

treatment and at follow-up were assessed. The number 

and type of adverse events were also extracted. The 

conclusion was considered. The review authors assessed 

the risk of bias in the included studies. The authors 

collected and extracted data from each RCT study 

included and authors of the primary studies were 

contacted to clarify any questions about the data.  

Data synthesis 

A descriptive data synthesis was done according 

to the reporting of the studies. In addition, meta-analysis 

of three studies with similar design was carried out in 

Review Manager 5. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 1. Flowchart of the review: RCTs on tinnitus management with rTMS 

  

Records identified through database 

searching in English language  

(n=362) 

Abstract records screened  

(n=329) 

Records excluded  

(n =292) 

Full-text primary articles 

assessed for eligibility  

(n=37) 

Full-text articles excluded 

(n=32) 

24 didn’t mention follow-up 

1 author didn’t answer 

7 studies had follow-up at 

less than 6 months 

Studies included in 

systematic review  

(n=5) 

Additional records identified through 

other sources 

(n=0) 

Records after duplicates removed  

(n=330) 

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Results 

The electronic search using the keywords for 

studies from 2005-2015 identified 362 articles: 240 from 

Google Scholar, 46 from Medline, and 76 from Science 

Direct. After removing duplicates, the authors screened 

329 studies— 292 by abstract and 37 by full text— 

according to the criteria of the search; 292 were excluded, 

24 studies did not mention the follow-up, and seven 

studies had follow-ups less than six months. Landgrebe 

et al. study had to be excluded, as the corresponding 

author did not respond to the authors’ questions.21 The 

five studies eligible for inclusion were: Andres et al., 

Hoekstra et al., Khedr et al., Kim et al., and Marcondes 

et al.16-20 

Five included studies 

All five studies included in this review were 

randomized controlled double-blind trials from Czech 

Republic, Netherlands, Egypt, Korea, and Brazil 

investigating the efficacy of rTMS for at least six months 

post treatment. Khedr et al. followed up monthly for 10 

months.18 Studies were published in 2010-2014. All 

studies used low-frequency 1-Hz rTMS in 2-trial arms 

except Khedr et al. who had 4-trial arms assessing 1-Hz 

rTMS versus 25-Hz rTMS and ipsilateral rTMS against 

contralateral.18 Three studies compared rTMS with sham, 

unlike Kim et al. and Khedr et al.18,19 All studies enrolled 

19 to 62 chronic tinnitus patients with different 

conditions. 17They were assigned randomly to the trial 

arms. Diverse primary and secondary tools were used to 

measure the outcomes. The tinnitus handicapped 

inventory (THI) and the visual analogue rating scores 

(VAS) were used to measure outcomes in all studies 

alongside diverse other tools at baseline, during follow-

up, and after six months.  

Analysis of studies 

Random allocation was described in all studies 

except for Marcondes et al. study.20 The blinding process 

was explained in all trials except for in Kim et al.19 All 

studies had 3.8% (low risk) to 19.6% (high risk) dropouts 

except for Khedr et al. with no dropouts.18 Reasons for 

dropping out given by Kim et al. were four patients 

received additional treatment during follow up and one 

patient had severe headaches.19 During the rTMS 

treatment no serious side-effects were reported. Nine 

patients from all studies experienced headache as adverse 

effects and only sporadic dizziness, pain at the site of 

stimulation, and sleep pattern changes.  

Diverse scales were applied to measure the primary and 

secondary outcomes, however, tinnitus handicapped 

inventory (THI) was used in all studies. Only two studies 

had scales for secondary outcome.17,18 The measurements 

were taken at baseline, after rTMS treatment or placebo, 

2-10 times during follow-up and six months after the 

intervention. Only one study measured them after 10 

months. Andres et al. found significant reduction of the 

total score of basic scales that measure tinnitus severity.16 

Hoekstra et al. pointed out that tinnitus was 

unchanged.17Khedr et al. revealed that 32.25% of all 

patients recovered completely from tinnitus and 27.4% 

improved in having tinnitus only at night before 

sleeping.18 Kim et al reported improvement in 46.7% of 

the ipsilateral group and 51.6% of the contralateral 

group.19 For Marcondes et al., 40% had a significant 

reduction of tinnitus severity after five days and for one 

to six months after treatment of active rTMS.20 Overall, 

more than 45% of patients experienced improvement. 

Three of the studies assessing depression and anxiety 

with different scales did not find any differences between 

the groups during follow-up.16-18 Khedr et al. used VAS 

for loudness, awareness, and annoyance level of 

symptoms. After 10 months follow-up, the contralateral 

group showed more improvement regarding the 

annoyance level than the ipsilateral group.18 In the study 

of Kim et al., the annoyance level did not show a 

significant difference.19 

Although the comparison between high and low 

rTMS and ipsilateral and contralateral is of importance, 

the aim of our study implies the comparison of rTMS 

versus ‘sham’ which was applied in three studies.16,17,20  

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Comments 
Time of 

measurement 

Secondary 

Outcome 

Primary 

Outcome 
Site 

Duration of 

intervention 

Inclusion 

criteria 

Patients’ 

Number 

Number of 

trial arms 

Study 

design 

Date 

pub- 

lished 

Authors 

 

significant reduction of the total score 

of basic scales that measure tinnitus 

severity. 

reduction was displayed in figures 

-before start 

-after 2 – 6 – 14- 26 

weeks 

 

 TQ* 

modified 

THI** 

VAS1*** 

VAS2 

Goebel & 

Hiller 

tinnitus 

questionnaire 

Czech Republic 

Psychiatry 

Otorhinolaryng

ology, 

Neurology, 

Radiology 

Charles 

University in 

Prague 

 

2 weeks chronic 

uni- or 

bilateral 

tinnitus 

patients of 

~9 years 

duration 

Normal 

hearing Right 

handed 

 

22 

 

20 

1- Hz  rTMS 

 

Sham 

randomized,

prospective,

placebo-

controlled 

 

 

2010 Andres et 

al.18 

 

Tinnitus unchanged. 

25% improvement on the TQ. 

 

-before start 

-after last session 

-after 1 week 

-after 1-3-6 months 

THI –VAS 

STAI**** 

Beck 

Depression 

Inventory 

TQ Netherlands 

Otorhinolaryng

ology 

University 

Medical Center 

Utrecht 

&Brain Center 

5 consecutive 

days 

 

chronic non-

fluctuating 

tinnitus of 8 

months 

with some 

hearing loss 

 

26 

 

24 

1 -Hz  rTMS 

 

Placebo 

RCT block 

design per 

group of 8, 

double- 

blind 

placebo-

controlled 

 

2013 Hoekstra et 

al.19 

 

32.25% of all patients recovered 

completely from tinnitus. 

27.4% improved to the point where 

they only had tinnitus at night before 

sleeping. 

In the contralateral group 64.5% 

improved in comparison to 29% in the 

ipsilateral group. 

No different effect of 1Hz or 25 Hz 

frequency. 

-before start 

-after last session 

-monthly interval for 

10 months 

RI and 

Hamilton 

ratings of 

depression 

and anxiety 

THI 

VAS 

Egypt 

NeuroPsychiatr

y, Audiology 

Assiut 

University 

Hospital 

2 weeks daily Right or left 

ear tinnitus 

Normal 

hearing & 

some hearing 

loss 

 

 

15 

16 

 

 

15 

16 

 

1- Hz rTMS: 

Ipsilateral 

Contralateral 

 

25 -Hz  rTMS: 

Ipsilateral 

Contralateral 

 

RCT 

randomized 

to four 

groups 

2010 Khedr et 

al.20 

 

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46.7% of patients having ipsilateral 

stimulation and 51.6% of contralateral 

showed improvement 

-before start 

-after last session 

-after 1-3-6 months 

 THI 

VAS:- 

loudness  

awareness 

annoyance 

Korea 

Dept 

Otorhinolaryng

ology, Research 

Institute of 

Rehabilitation 

for 5 days tinnitus 

localized to 

poor ear 

asymmetric 

hearing 

impairment 

at least 

6months & 

treated 

for at least 2 

months 

 

30 

 

31 

1- Hz rTMS : 

Ipsilateral 

 

Contralateral 

RCT patients 

were 

assigned 

randomly to 

the 

ipsilateral 

orcontralater

al 

2014 Kim et al.21 

 

major changes in the physical & 

catastrophic domain 

 

40% had a significant reduction of 

tinnitus severity after 5 days  and 1, 6 

months after treatment of active rTMS 

-before start 

-after 7- 14- 21days 

- monthly interval for 

6 months 

 THI 

VAS 

SPECT****

* 

Brazil 

Dept 

Otolaryngology

, Radiology, 

Psychiatry 

 

 

5 consecutive 

days 

uni- or 

bilateral 

tinnitus of 3 

months 

duration, 

normal 

hearing 

10 

 

9 

1 -Hz  rTMS 

 

Placebo 

RCT 

Randomized 

double-blind 

controlled 

2010 Marcondes 

et al.22 

 

*TQ= tinnitus questionnaire   

**THI= tinnitus handicapped inventory  

 ***VAS= visual analogue rating scores 

****STAI=State-Trait Anxiety Inventory 

*****SPECT= Single photon emission computed tomography 

 

Table 1. Patients with tinnitus with rTMS intervention for randomized controlled studies (RCT) with at least 6 months of follow-up

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THI was the common scale used for the comparison of 

outcomes at baseline, during follow-up, and six months 

after the intervention. There was improvement in the THI 

scores in the rTMS group in the RCTs of Andres et al. 

and Marcondes et al., but not in Hoesksta et al.16,17,20 No 

significant differences were found between rTMS and the 

sham group in all three studies at baseline, during follow-

up, or six months after the intervention, except in the 

study of Marcondes et al. directly after rTMS.20 

Meta-analysis of the three studies with similar 

design was performed. Two separate comparisons 

between the outcomes of the THI scores in rTMS and 

sham group were set using data derived from the three 

studies. The first comparison at 1-4 weeks post-

intervention favored the rTMS intervention over the 

sham but not to a statistically significant level (Test of 

overall effect: Z = 0.29, P = 0.77; Fig. 2). The second 

comparison at six months post-intervention also favored 

the rTMS intervention over the sham but not to a 

statistically significant level (Test of overall effect: Z = 

0.93, P = 0.35; Fig. 3). 

 

After 6 months 
THI 

After rTMS 
Baseline    

Mean THI ± SD 
Mean age 

(years) 

Number of patients 

in trial arm 
Studies 

33.27±21.6 31.82±22.9 (2weeks) 37.09±21.7 48.09 rTMS 22 
Andres et al. (2010) 

27.7±23.2 23.1±19.5 26.5±20.4 50.05 Sham 20 

43 ±18 41 ±16(1week) 45 ±21 50 rTMS 26 
Hoekstra et al. (2013) 

52 ± 22 47 ±23 44± 22 55 Sham 24 

22.8 ± 18.2 19.4 ± 17.6* (1month) 29.8 ± 22.8 -- rTMS 10 
Marcondes et al. (2010) 

29.6 ± 23.5 28.9 ± 25.9 28.9 ± 23.8 -- Sham 9 

-- patients were more than18 years of age 

* p=0.047 one sided (significant) 

Table 2. Mean tinnitus handicapped inventory (THI) in 3 studies with similar design at baseline, directly after rTMS 

and after 6 months 

Figure 2. Forrest-plot showing the mean THI scores in rTMS versus Sham (1-4 weeks post-intervention) in the three 

studies 

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Figure 3. Forrest-plot showing the mean THI scores in rTMS versus Sham (6 months post-intervention) in the three 

studies 

Discussion 

According to this systematic review, rTMS 

reduced the severity of tinnitus in four RCTs in over 45% 

of the patients for a duration of six months following the 

intervention. Around one third of patients in one study 

were completely recovered from tinnitus.18 Only one 

study did not find any changes.17 The outcome 

differences of the THI scores of the trials is due to diverse 

inclusion criteria of patients or technical application of 

rTMS. Two studies measuring depression and anxiety did 

not find any changes after rTMS application despite 

reduction of tinnitus. It is likely that depression and 

anxiety take longer to improve, which explains the 

accompanying use of talk therapy in some regimens.10,11 

As the primary aim of our review was to 

compare rTMS with ‘sham’, only three studies 

matched.16,17,20 Andres et al. reported significant 

reduction of the total score of basic scales that measure 

tinnitus severity, even for patients with a mean duration 

of nine years not responding to pharmacological 

treatment.16  For 40% of patients exposed to rTMS in the 

Marcondes et al. trial, the tinnitus severity decreased as 

measured with the THI.20 In contrast, the study of 

Hoekstra et al. indicated no changes,17 likely due to this 

study including non-fluctuating tinnitus patients while 

the other two trials mentioned just unilateral and bilateral 

tinnitus patients.  

Some other inclusion criteria such as hearing 

loss can have an effect on the outcome. Marcondes et al.20 

reported a positive effect of rTMS on subjects with 

normal hearing. Hearing loss might influence the effect 

of rTMS. The trial of Khedret al.18 reported that hearing 

impairment might exacerbate the plastic changes in 

neural function causing tinnitus, and that decreases the 

effect of rTMS. This is in agreement with the study of 

Kleinjung et al. and Smith et al. reporting on the negative 

influence of hearing loss on the efficacy of rTMS.13,22 In 

contrast, Lehner et al. did not find a relationship between 

hearing loss and rTMS efficacy.23 Andres et al. included 

only normal hearing patients.16 The studies of Hoekstra 

et al. and Kim et al. did not report on this issue in their 

results, although they both included patients with 

impaired hearing.17,19 

In addition, all studies included chronic tinnitus 

patients. Duration of tinnitus is another one of the 

inclusion criteria that can affect the outcome. Tinnitus 

duration should be considered when explaining the 

different outcomes between the five included studies. 

Khedr et al.’s18 trial showed that there was a significant 

correlation between the duration of symptoms and 

change in THI (at baseline and 10 months after). This is 

substantiated through other studies that found patients 

who had the shortest history of tinnitus tended to respond 

the best to rTMS therapy,13,24-26 though other studies did 

not find this effect.22, 23 Andres et al. stated that their trial 

lowered the severity of tinnitus even in chronic patients 

who had it for nine years.16 The other three studies did 

not mention the effect of tinnitus duration on the 

outcome.17,19,20 

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Volume 9, No. 1 (2020) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2020.356 |http://cajgh.pitt.edu 

 

 

Another clinical implication of our review 

suggests that low-frequency rTMS, ipsi- or contralateral 

positioning of the coil on the temporo-parietal cortex or 

auditory cortex reduces the severity of tinnitus. The 

auditory cortex is thought to play an important role in 

tinnitus, but there is strong evidence that the auditory 

cortex together with the limbic system, prefrontal and 

parietal cortex determines tinnitus distress.27-30 The 

parietal cortex and its connections to the auditory cortex 

could be involved in tinnitus through the mediating effect 

that the parietal cortex has on auditory attention.31, 32 

Repetitive TMS of these areas could therefore decrease a 

patient’s reaction to tinnitus, leading to a reduction in the 

perception of tinnitus. Another study reported that a 

combination of temporal and prefrontal stimulation 

showed a significant effect on tinnitus.13 Repetitive TMS 

works by interfering with baseline activity in the cortex 

and decreases tinnitus. This opinion is confirmed by 

Smith et al. who found greater response of the 

contralateral stimulation using low-frequency rTMS.22In 

contrast Kim et al.’s trial found no significant difference 

between ipsilateral and contralateral stimulation, and 

tinnitus was reduced in half of the patients regardless of 

the side of stimulation.19 Hoekstra et al. found no effect 

of bilateral stimulation of the auditory 

cortex.17Marcondes et al. did not mention this point.20 

The use of low-frequency rTMS was applied by the five 

trials, which is contrary to Meng et al. who found “very 

limited support for the use of low-frequency rTMS for 

the treatment of patients with tinnitus” after four months 

of follow-up.9 

The duration of rTMS is another factor that 

might influence its effect. In Andres et al. trial and Khedr 

et al. the patients were treated for two weeks.16,18 In 

Marcondes et al., Hoekstra et al., and Kim et al., the 

patients were treated for one week.17,19,20 It is reported 

that results may be better after a longer duration of 

treatment over two weeks.33 

Meta-analysis was not applied to all the RCT 

studies as they differed in their design (Table 1). Kim et 

al. used ipsilateral versus contralateral.19Khedr et al. had 

four trial arms comparing between high- and low-

frequency and ipsilateral versus contralateral.18 Three 

RCTs abided to the primary aim of our study, using rTMS 

versus sham in the trial arms: Andres et al., Hoekstra et 

al., and Marcondes et al.16,17,20 The tinnitus handicapped 

inventory (THI) was used as the measurement for tinnitus 

severity by all studies. The meta-analysis was performed 

on those RCTs with comparable design.16,17,20 The rTMS 

intervention was favored, but without statistically 

significant effect. More than three identified RCTs for 

the meta-analysis would have given stronger evidence. 

The limitations of this review were lack of funding, 

differences in protocols of the studies, its performance on 

limited database, and using only articles published in 

English.  

Tinnitus handicapped inventory (THI) scores 

indicate that rTMS has a role in decreasing the severity 

of tinnitus. It sustained the improvement and reduced 

handicapping for the duration of six months in three 

RCTs or, as is the case in one trial, even 10 months. Four 

studies reported reduction in tinnitus severity after rTMS 

in over 45% of patients even after six months follow-

up.16,18-20 One of the four studies had one third of patients 

completely recovered from tinnitus.18 Only one study 

found rTMS not effective on any outcome parameter.17 

Although the meta-analysis of the three studies 

with similar design of rTMS and sham favored rTMS 

intervention, the overall statistical effect showed no 

significant difference between the groups, regarding the 

tinnitus handicapped inventory (THI) scores. Given the 

scarce number of RCTs between 2005 and 2015, more 

studies in multi-centers with the same protocol of design, 

inclusion/exclusion criteria, technological procedure, 

and outcome measurements will provide stronger 

evidence. Follow-up in future studies should preferably 

be longer than six months to accrue stronger evidence. 

 

 

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Volume 9, No. 1 (2020) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2020.356 |http://cajgh.pitt.edu 

 

 

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GALAL 

 

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of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 

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Volume 9, No. 1 (2020) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2020.356 |http://cajgh.pitt.edu 

 

 

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