Improvement in smell and taste dysfunction after repetitive transcranial magnetic stimulation

The Taste and Smell Clinic, Washington, DC, USA.
American journal of otolaryngology (Impact Factor: 0.98). 12/2009; 32(1):38-46. DOI: 10.1016/j.amjoto.2009.10.001
Source: PubMed


Olfactory and gustatory distortions in the absence of odors or tastants (phantosmia and phantageusia, respectively) with accompanying loss of smell and taste acuity are relatively common symptoms that can occur without other otolaryngologic symptoms. Although treatment of these symptoms has been elusive, repetitive transcranial magnetic stimulation (rTMS) has been suggested as an effective corrective therapy.
The objective of the study was to assess the efficacy of rTMS treatment in patients with phantosmia and phantageusia.
Seventeen patients with symptoms of persistent phantosmia and phantageusia with accompanying loss of smell and taste acuity were studied. Before and after treatment, patients were monitored by subjective responses and with psychophysical tests of smell function (olfactometry) and taste function (gustometry). Each patient was treated with rTMS that consisted of 2 sham procedures followed by a real rTMS procedure.
After sham rTMS, no change in measurements of distortions or acuity occurred in any patient; after initial real rTMS, 2 patients received no benefit; but in the other 15, distortions decreased and acuity increased. Two of these 15 exhibited total inhibition of distortions and return of normal sensory acuity that persisted for over 5 years of follow-up. In the other 13, inhibition of distortions and improvement in sensory acuity gradually decreased; but repeated rTMS again inhibited their distortions and improved their acuity. Eighty-eight percent of patients responded to this therapeutic method, although repeated rTMS was necessary to induce these positive changes.
These results suggest that rTMS is a potential future therapeutic option to treat patients with the relatively common problems of persistent phantosmia and phantageusia with accompanying loss of taste and smell acuity. Additional systematic studies are necessary to confirm these results.

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    • "It is likely that any successful treatment of smell loss would also improve the associated symptoms of distorted olfactory perception. However, some treatments, like the surgical excision of olfactory sensory neurons [3,102,103], bilateral olfactory nerve sections [104], and repetitive transcranial magnetic stimulation [105] have been specifically targeted at smell distortions. "
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    • "Further work should investigate methods of lengthening the active duration of cTBS, such as varying intensity increments and burst delivery patterns. There are 3 mainstream methods of evaluating the outcome of tinnitus therapy: (1) questionnaires, such as TQ and THI, (2) self-rating of tinnitus, for example, 10-grading or 100-grading visual analogue scores (VAS), and (3) audiometric examinations, for instance, tinnitus frequency-and loudness-matching or residual inhibition measures [Kleinjung et al., 2005, 2008; Lee et al., 2008; Mennemeier et al., 2008; Henkin et al., 2011] "
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    ABSTRACT: Repetitive transcranial magnetic stimulation (rTMS), a noninvasive method for altering cortical excitability, is becoming a therapeutic strategy in auditory research institutions worldwide. Application of inhibiting rTMS on these overactive cortical regions can result in effective tinnitus suppression. The aim of this study is to investigate the efficacy of theta-burst rTMS in patients with chronic tinnitus. Parallel randomized control study. Tertiary referral center. We enrolled 2 female and 20 male patients in this study. The evaluative tools included tinnitus frequency- and loudness-matching, tinnitus questionnaires (TQ), and the Tinnitus Handicap Inventory (THI). The orthogonal projection of the auditory cortex on the scalp was focalized. A figure-eight coil was placed on the surface of the skull over the targeted region with the intensity setting at 80% of the resting motor threshold. We delivered 900 pulses of theta-burst rTMS daily for 10 business days. Nine of twelve patients (75%) in the active-stimulation group reported tinnitus suppression following treatment with rTMS. The treatment led to reductions of 8.58 and 8.33 in the mean TQ global and THI scores, respectively. Tinnitus loudness also decreased significantly after delivering rTMS. Descriptive analysis of the TQs revealed that patients experienced significant improvements in emotional distress levels and somatic symptoms. Our preliminary results demonstrate that theta-burst rTMS treatments offer a method of modulating tinnitus. Patients could benefit from emotional improvements, even more than auditory perceptive relief. Further studies are needed to establish a standard protocol and to clarify nervous propagation along the auditory and psychological projection following treatment with rTMS.
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