Repetitive Transcranial Magnetic Stimulation (rTMS) for the treatment of chronic Tinnitus

慢性耳鸣是一种使人虚弱并改变生活的经历，在西方国家影响着数百万人。尽管它造成了巨大的社会和经济负担，但到目前为止，还没有针对这种疾病的成熟的特效治疗方法。虽然传统上慢性耳鸣被认为是纯粹的听觉病因，但越来越多的证据强调了中枢神经系统的异常功能，包括听觉皮质的过度活动和不同皮质网络中的适应性神经可塑性不良。重复经颅磁刺激(RTMS)是一种新的生物物理治疗方法，应用于低频范围内，已被证明可以降低大脑的过度兴奋性，并调节关键皮质回路的神经可塑性。基于这些神经生物学特性，并作为一种因果导向的治疗策略，在几项临床试验中，低频rTMS能够显著改善超过刺激期的耳鸣症状。同时，有益的治疗反应与神经生物学机制的选择性改变有关，表明神经可塑性的改变对于调节治疗效果至关重要。该随机对照多中心试验旨在进行一项基于大样本的系统性研究，旨在研究低频rTMS治疗慢性耳鸣的疗效，并将重点阐明rTMS临床疗效的神经生物学机制。

Chronic tinnitus is a debilitating and life-altering experience affecting millions of people in western countries. Despite its enormous social and ecomic burden, up to now no well-established specific treatment for this disorder is available. While traditionally chronic tinnitus has been viewed as having a purely auditory etiology, growing evidence underscore abnormal functioning of the central nervous system including hyperactivity of the auditory cortex and maladaptive neuroplasticity in distinct cortical networks. Repetitive Transcranial Magnetic Stimulation (rTMS) is a new biophysical treatment method which applied in a low-frequency range has shown to reduce brain hyperexcitability and to modulate neuroplasticity in critical cortical circuits. Based on these neurobiological qualities and used as a causally-orientated treatmant strategy, low-frequency rTMS was able to improve tinnitus complaints significantly beyond the stimulation period in several clinical trials. Simultaneously, beneficial therapeutical response was associated with selective changes in neurobiological mechanisms, pointing to alterations in neuroplasticity as crucial for the mediation of treatment effects. Aiming at a systematic investigation based on a large sample size, the proposed randomized controlled multicenter trial will study the efficacy of low frequency rTMS in the treatment of chronic tinnitus and will focus to elucidate neurobiological mechanisms underlying rTMS induced clinical effects.