Evaluation of the Effectiveness of Transcranial Magnetic Stimulation in the Treatment of Subjective Tinnitus with Psychoacoustic Tests and Psychosomatic Tests

Evaluation of the Effectiveness of Transcranial Magnetic Stimulation in the Treatment of Subjective Tinnitus with Psychoacoustic Tests and Psychosomatic Tests | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of the Effectiveness of Transcranial Magnetic Stimulation in the Treatment of Subjective Tinnitus with Psychoacoustic Tests and Psychosomatic Tests Oğuz karakas, Agit ŞİMŞEK, Mehmet TAN This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7231296/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: Tinnitus is a very common symptom in the society and although it can affect all age groups, it is especially common in the elderly. Due to the uncertainty in its etiopathogenesis, there is currently no definitive treatment method with proven efficacy. In this study, we aimed to evaluate the effectiveness of Repetitive Transcranial Magnetic Stimulation (rTMS) for the suppression of increased neuronal activity. In this context, the effect of rTMS on tinnitus was analysed using various tests and scales. Materials and Methods: The study included 38 patients aged 18-70 years with tinnitus and a control group consisting of 38 age- and sex-matched healthy individuals. The frequency and severity of the symptoms of individuals with tinnitus were measured; Tinnitus Disability Questionnaire (TEA), Visual Analogue Scale (VAS) and Beck Depression Scale (BDS) were applied. The study group underwent rTMS treatment, and statistical comparisons were made between the two groups by repeating the measurements compared to pre-treatment values at both 1 and 3 months. Results: There was no statistically significant difference between the rTMS and control groups in tinnitus frequency measurements between pre-treatment and 1 and 3 months post-treatment (p > 0.05). However, a significant difference was found in tinnitus severity measurements (p < 0.05). Statistically significant differences were observed between rTMS and placebo groups in TEA, VAS and BDI scores before and after treatment (p < 0.05). When the groups were evaluated within themselves, significant time-dependent changes were found in tinnitus frequency, severity and questionnaire scores in the rTMS group (p 0.05). Conclusion: In our study, rTMS treatment was shown to have favourable effects on tinnitus symptoms. However, the fact that there is still no consensus on the site, duration and frequency of application and the inconsistent results in the existing literature limit the routine clinical use of rTMS. The use of advanced neuroimaging techniques in combination with rTMS may increase the effectiveness of the treatment and allow the development of a more standardised application protocol. It is likely that rTMS, which attracts attention with its noninvasive nature and minimal side effects, will become an FDA-approved option in the treatment of tinnitus as well as depression in the future. Tinnitus frequency Tinnitus severity Transcranial Magnetic Stimulation Tinnitus Disability Questionnaire Figures Figure 1 Figure 2 INTRODUCTION Tinnitus is a symptom characterised by the perception of sound in the ears or head without an external sound source ( 1 ). Studies have reported that the prevalence of tinnitus in the population varies between 6.6% and 18.6% ( 2 , 3 ). Factors such as hearing loss, long-term noise exposure, depression and stress have been shown to be closely related with tinnitus ( 4 , 5 , 6 ). In addition, cardiovascular risk factors such as high body mass index, hypertension, diabetes, cerebral stroke, angina and myocardial infarction are among the important risk factors for the development of tinnitus ( 7 ). While early studies investigating the physiopathology of tinnitus generally focused on the inner ear, cochlear nerve and auditory system, recent studies have focused on the auditory cortex and neural networks associated with this region ( 8 ). In studies conducted with animal models, increased spontaneous neuronal activity was observed in neurons in the medial geniculate ganglion region in individuals with tinnitus ( 8 ). In Moller's study, it was reported that when damage occurs between neighbouring nerve fibres, abnormal synapse connections are formed between these fibres, resulting in the transmission of non-physiological signals and sound perception without an acoustic stimulus ( 9 ). Similarly, it has been shown in some studies that tinnitus persists despite cutting the cochlear nerve, which suggests that tinnitus may have not only peripheral but also central origin ( 10 ). According to the generally accepted opinion in the literature, increased spontaneous discharge in neurons plays a fundamental role in the formation of tinnitus. Although some patients partially benefit from the current treatment modalities, a significant number of them cannot find an effective treatment option and have to learn to live with this condition. In this context, the search for more effective and permanent treatment methods is of great clinical importance. The aim of this study was to evaluate the efficacy of Transcranial Magnetic Stimulation (TMS) in the treatment of subjective tinnitus using psychoacoustic tests and psychosomatic scales. MATERIAL AND METHOD This study was conducted on 76 patients between the ages of 18–70 years who applied to the outpatient clinics of Inonu University Turgut Özal Medical Centre Department of Otorhinolaryngology between September 2022 and February 2023 with the complaint of tinnitus. Participants were randomly selected and included in the study without gender discrimination. Patient Group Selection Patient selection was made in the same way between the TMS group and the control group. Patient Group Selection Patients were distributed equally to the Repetitive Transcranial Magnetic Stimulation (rTMS) group and the control group according to similar criteria. Inclusion Criteria : To be between the ages of 18–70 Subjective complaint of tinnitus for at least three months Patients Excluded from the Study : Being pregnant or breastfeeding To be using a hearing aid Having a pacemaker Having a history of any diagnosed psychiatric illness History of previous ear surgery Presence of diseases that may cause objective tinnitus History of chronic otitis History of neurotological surgery Detection of haematological/metabolic parameter disorders (e.g. iron, B12, TSH levels) that may cause tinnitus and can be corrected with treatment Patients with anatomical disorders of the ear other than inner ear pathologies Characteristics of Patient Groups The distribution of 38 patients included in the TMS group according to detailed anamnesis and pure tone audiometry results is as follows: 12 patients with presbycusis History of sudden hearing loss in 7 patients 3 patients had a history of Meniere's disease 9 patients with prolonged exposure to loud noise (classified as acoustic trauma) In 7 patients, no specific aetiology was detected and audiometry results were normal The distribution of 38 patients in the control group was as follows: 13 patients with presbycusis History of sudden hearing loss in 6 patients 2 patients with Meniere's disease History of acoustic trauma in 5 patients In 12 patients, there was no specific clinical history and audiometry findings were normal. rTMS Implementation A total of 76 patients included in the study were randomly selected and divided into two equal groups. Real rTMS was applied to 38 patients in the intervention group and placebo rTMS was applied to 38 patients in the control group. participants were not informed which group they were included in; the study was conducted with a double-blind method. Biochemical parameters were evaluated, acoustic tests and psychosomatic scales were applied to both groups before treatment. The applications were performed with a Neuro-MS/D (Neurosoft, Russia) brand device. rTMS application was planned to include 1500 pulses at low frequency (1 Hz), 1 session per day for 10 days. Each session lasted approximately 25 minutes, the patients were kept in a sitting position throughout the application and the figure- eight stimulation coil was fixed to the targeted area. The left auditory cortex was targeted for the first 5 days and the left dorsolateral prefrontal cortex for the next 5 days. In the placebo group, only the coil device was placed in the left temporal region without stimulation and sham application was performed without magnetic wave. All participants were recalled at 1 and 3 months after treatment and evaluated with the same acoustic tests and psychosomatic scales. Evaluation of Tinnitus In order to evaluate the effect of rTMS on tinnitus, the participants were evaluated on a total of five parameters before treatment, at 1 month and 3 months after treatment. Two of these parameters were obtained by acoustic measurements (tinnitus frequency and severity) and three were obtained by psychometric tests (Tinnitus Disability Questionnaire, Visual Analogue Scale, Beck Depression Scale). The findings were statistically compared over time. Tinnitus Disability Questionnaire TEA, which is used to evaluate the effect of tinnitus on the quality of life of the individual, is a psychosomatic assessment tool with high reliability and frequently used. The questionnaire consists of a total of 25 questions and each question is answered as "yes", "sometimes" or "no". The questionnaire was administered before treatment and at the 1st and 3rd months after treatment (74, 122). Visual Analogue Scale The VAS, which was used for the subjective assessment of the participants' discomfort due to tinnitus, is in the form of a visual ruler graded between 0 and 10 and supported by facial expressions. "0" was defined to represent a happy mood and "10" to represent an unhappy mood; patients were asked to mark their current mood on this scale. The reliability of the scale has been reported to be high in the literature (66). Back Depression Scale The BDI, which was used to evaluate the relationship between tinnitus and depression, consists of 21 items. Translated into Turkish in 1997, the validity and reliability of the scale was adapted to the Turkish population by Ulusoy et al. Studies have reported that the BDI has a reliability of over 90% (74, 78, 82, 124). Tinnitus Frequency All audiological evaluations for objective measurement of tinnitus were performed using an Interacoustics AC-40 (Middelfart, Denmark) clinical audiometry device. Threshold measurements in the range of 250 − 16.000 Hz were performed with this device with high frequency module. Measurements were repeated before, 1 month and 3 months after treatment. Tinnitus Severity Tinnitus intensity was measured by presenting sounds of different intensities at the same frequency after the patient's tinnitus frequency was determined. Among the sounds presented in 1 dB increments, the patient was asked to choose the sound that most resembled his/her tinnitus. This measurement was repeated before treatment, at 1 and 3 months and analysed statistically. Statistical Analysis Data analysis was performed with SPSS 25 programme. Normal distribution status was evaluated by Kolmogorov-Smirnov test and parametric tests were performed if p > 0.05. Dependent pairwise group comparisons were analysed by paired t test and repeated measures were analysed by repeated measures ANOVA . Independent sample t test was used for independent two-group comparisons and chi-square analysis was used for categorical data. Friedman test was used for nonparametric dependent measurements and Wilcoxon test was used for intra-group comparisons. Significance level was accepted as p < 0.05 in all tests. Ethics Approval Prior to the study, approval was obtained from the Malatya Clinical Research Ethics Committee of Inonu University (dated 31 August 2022, no. 2022/78). Our research was conducted in accordance with the Helsinki Declaration. No funding support has been received from any organization. An informed consent form was used when the ethics committee was established. All participants signed this form. RESULTS Age, gender, duration of tinnitus and affected side (unilateral/bilateral) were compared between the groups and the results are presented in Table 1 . No statistically significant difference was found between TMS and placebo groups in terms of these variables (p > 0.05). Thus, a homogeneous distribution was achieved between the groups in terms of demographic and clinical characteristics of the participants. Table 1 Distribution of Demographic Variables by Groups Variable Group n / % Group Total ꭓ(2) Value p Value TMS Placebo Womann 7 14 21 % 18,4% 36,8% 27,6% Gender 2,369 0,124 Male n 31 24 55 % 81,6% 63,2% 72,4% Singlen 32 30 62 % 84,2% 78,9% 81,6% Party 0,088 0,767 Bilateral n 6 8 14 % 15,8% 21,1% 18,4% Total n 38 38 76 % 100,0% 100,0% 100,0% Variables Value TMS Placebo t Value p Value Age Mean ± ss 49,76 ± 10,28 49,24 ± 12,96 0,196 0,845 M (Min - Max) 50,5(26–70) 51,5(21–69) Duration(Month) Mean ± ss 50,21 ± 45,06 47,58 ± 50,63 0,239 0,811 M (Min - Max) 42,5(6-240) 36(6-240) Mean; mean, SD; standard deviation, M; median, t value; significance test of the difference between two means (t test), p value, p; statistical significance. Table 1 : Distribution of Demographic Variables by Groups The frequency of tinnitus in the study participants was measured before treatment and at the first and third months, and intra- and inter-group changes were analysed. The results are presented in Table 2 . When the changes in tinnitus frequency between the first and third months before and after treatment were analysed, no statistically significant difference was found between the TMS and placebo groups (p > 0.05). Table 2 Intra-group and Inter-group Comparison of Tinnitus Frequency Measurements Variable TMS Plasebo Intergroup Comparison Intergroup Independent Comparison Gruplar arası Karşılaştırma ± ss Gruplar arası Karşılaştırma ± ss F a p a First Tinnitus Frequency 6830,17 ± 3371,99 6831,22 ± 2462,87 F = 2,773 F = 0,001 p = 0,999 First Month Tinnitus Frequency 5794,03 ± 2467,18 6472 ± 2034,32 p = 0,083 F = 1,708 p = 0,195 Third Month Tinnitus Frequency 4869,43 ± 1914,32 6232,41 ± 1416,88 η = 0,036 F = 12,445 p = 0,002* Intra-group Comparison F b =13,385 p b =0,001* F b =1,119 p b =0,332 Before Treatment - First Month p = 0,103 p = 1,000 Before Treatment - Third Month p = 0,001* p = 0,563 First Month - Third Month p = 0,002* p = 1,000 Mean; standard deviation, ss; standard deviation, F; Two-way mixed ANOVA test value for repeated measurements, η; eta coefficient, Fa; t-test, Fb; Repeated ANOVA, *p < 0.05; there is a difference between measurements. Table 2 : Intra-group and Inter-group Comparison of Tinnitus Frequency Measurements In independent comparisons between groups; There was no statistically significant difference between TMS and placebo groups in terms of tinnitus frequency before treatment (p > 0.05). No significant difference was found between the groups in the tinnitus frequency measurements at the first month of treatment (p > 0.05). However, a significant difference was found between the groups in tinnitus frequency measurements at the third month of treatment (p < 0.05). In intra-group comparisons according to time; In the TMS group, the change in tinnitus during the treatment period was statistically significant (p 0.05). A statistically significant difference was found between the pre-treatment and the third month of treatment (p < 0.05). A statistically significant difference was found between the first month of treatment and the third month of treatment (p 0.05). In addition, the tinnitus severity of the participants was measured before treatment, at the first and third months, and both intra- and inter-group analyses were performed. The results are presented in Table 3 . In terms of tinnitus severity, a statistically significant difference was found between the TMS and placebo groups in the first and third months before and after treatment (p < 0.05). 13.5% (η) of the intergroup variation in the severity measurement is explained by time-dependent variation. Table 3 Intra- and Intergroup Comparison of Tinnitus Severity Measurements Variable TMS Plasebo Intergroup Comparison Intergroup Independent Comparison Average ± ss Average ± ss F a p a Initial Tinnitus Severity 57,43 ± 16,73 64,45 ± 20,72 F = 11,572 F = 2,635 p = 0,109 Tinnitus Severity_1 Month 48,26 ± 15,18 68,82 ± 18,9 p = 0,001* F = 27,317 p = 0,001* Tinnitus Severity_3 Months 48,76 ± 15,6 67,53 ± 17,73 η = 0,135 F = 23,982 p = 0,001* Intra-group Comparison F b =8,305 p b =0,002* F b =1,706 p b =0,189 Before Treatment - First Month p = 0,002* p = 0,201 Before Treatment - Third Month p = 0,001* p = 0,578 First Month - Third Month p = 1,000 p = 1,000 Mean; standard deviation, ss; standard deviation, F; Two-way mixed ANOVA test value for repeated measurements, η; eta coefficient, Fa; t-test, Fb; Repeated ANOVA, *p < 0.05; there is a difference between measurements. Table 3 : Intra- and Intergroup Comparison of Tinnitus Severity Measurements In independent comparisons between groups; There was no statistically significant difference between TMS and placebo groups in tinnitus severity measurements before treatment (p > 0.05). Significant differences were found between the groups in tinnitus severity measurements at the first and third months of treatment (p < 0.05). In intra-group comparisons according to time; Changes in tinnitus severity in the TMS group were statistically significant (p 0.05). The differences between pre-treatment and third month and between first month and third month were significant (p 0.05).In the placebo group, there was no statistically significant difference in tinnitus change during the treatment period (p > 0.05). Tinnitus Handicap Index (THI) scores of the individuals participating in the study were measured before the treatment and at the first and third months, and intra- and inter- group analyses were performed. These results are presented in Table 4 . In terms of THI scores, statistically significant differences were determined between TMS and placebo groups in pre-treatment and post-treatment periods (p < 0.05). In addition, 15.6% (η) of the between- group change in THI scores is explained by time-dependent change. Table 4 Comparison of THI Scores Within and Between Groups Variable TMS Plasebo Intergroup Comparison Intergroup Independent Comparison Average ± ss Average ± ss F a p a Initial THI 51,84 ± 23,59 58,21 ± 22,27 F = 13,727 F = 1,465 p = 0,230 First Month THI 42,42 ± 25,22 60,61 ± 23,15 p = 0,001 F = 10,723 p = 0,002* Third Month THI 38,95 ± 24,95 58,87 ± 25,43 η = 0,156 F = 11,879 p = 0,002* Intragroup Comparison F b =14,562 p b =0,001* F b =1,297 p b =0,280 Pre-treatment - First Month p = 0,001* p = 0,765 Pre-treatment - Third Month p = 0,001* p = 1,000 First Month - Third Month p = 0,041* p = 0,633 Mean; standard deviation, ss; standard deviation, F; Two-way mixed ANOVA test value for repeated measurements, η; eta coefficient, Fa; t-test, Fb; Repeated ANOVA, *p < 0.05; there is a difference between measurements. Table 4 : Comparison of THI Scores Within and Between Groups In independent comparisons between groups; No significant difference was observed between TMS and placebo groups in terms of Tinnitus Handicap Index (THI) scores before treatment (p > 0.05). However, statistically significant differences were found between the groups in THI scores at the first and third months of treatment (p < 0.05). In intra-group comparisons according to time; The change in THI scores in the TMS group was significant (p < 0.05). The differences between pretreatment and first month, pretreatment and third month, and first month and third month were statistically significant (p 0.05). Beck Depression Questionnaire (BDI) scores of the participants were measured before treatment, at the first and third months, and the changes within and between groups were analysed. The results are presented in Table 5 . Table 5 Intragroup and Intergroup Comparison of BDA Scores Variable TMS Plasebo Intergroup Comparison Intergroup Independent Comparison Average ± ss Average ± ss F a p a Pre-treatment BDA 13,76 ± 8,82 15,39 ± 9,38 F = 4,188 F = 0,610 p = 0,437 First Month BDA 12,32 ± 8,89 16,76 ± 11,19 p = 0,026* F = 3,681 p = 0,059 Third Month BDA 10,97 ± 7,85 16,37 ± 11,7 η = 0,054 F = 5,573 p = 0,021* Intragroup Comparison F b =3,620 p b =0,032* F b =0,936 p b =0,397 Pre-treatment - First Month p = 0,488 p = 0,560 Pre-treatment - Third Month p = 0,044* p = 1,000 First Month - Third Month p = 0,144 p = 1,000 Mean; standard deviation, ss; standard deviation, F; Two-way mixed ANOVA test value for repeated measurements, η; eta coefficient, Fa; t-test, Fb; Repeated ANOVA, *p < 0.05; there is a difference between measurements. Table 5 : Intragroup and Intergroup Comparison of BDA Scores The Beck Depression Questionnaire (BDI) scores of the study participants were measured before treatment and at the first and third months after treatment, and intra- and inter-group changes were analysed. The results showed that there were statistically significant differences between the groups (TMS and placebo) (p < 0.05). 5.4% (η) of the between-group change in BDA scores was explained by time-dependent change. In independent comparisons between groups; There was no significant difference between TMS and placebo groups in terms of BDA scores before treatment and at the first month of treatment (p > 0.05). However, a statistically significant difference was found between the groups in BDA scores at the third month of treatment (p < 0.05). In intra-group comparisons according to time; A significant change in BDI scores was observed in the TMS group (p 0,05), there was a significant difference between pre-treatment and third month (p 0.05). In the placebo group, the change in BDA scores was not significant over time (p > 0.05). In addition, Visual Analogue Scale (VAS) scores of the participants were measured before treatment, at the first and third months, and intra- and inter-group analyses were performed. The results are presented in Table 6 . Statistically significant differences were found between TMS and placebo groups in VAS scores before treatment and at the first and third months after treatment (p < 0.05). 13.5% (η) of the intergroup variation in VAS scores is explained by time-dependent variation. Table 6 Intragroup and Intergroup Comparison of VAS Scores Variable TMS Plasebo Intergroup Comparison Intergroup Independent Comparison Average ± ss Average ± ss F a p a Pre-treatment VAS 30,82 ± 10,47 33,08 ± 8,4 F = 11,416 F = 1,064 p = 0,306 First_Month VAS 24,29 ± 10,22 34,54 ± 8,92 p = 0,001* F = 21,384 p = 0,001* Third_Month_VAS 23,39 ± 11,17 34,03 ± 8,22 η = 0,135 F = 21,944 p = 0,001* Intra-group Comparison F = 12,195 p = 0,001* F = 0,529 p = 0,591 Pre-treatment - First Month p = 0,001* p = 0,946 Pre-treatment - Third Month p = 0,001* p = 1,000 First Month - Third Month p = 1,000 p = 1,000 Mean; standard deviation, ss; standard deviation, F; Two-way mixed ANOVA test value for repeated measurements, η; eta coefficient, Fa; t-test, Fb; Repeated ANOVA, *p < 0.05; there is a difference between measurements. Table 6 : Intragroup and Intergroup Comparison of VAS Scores In independent comparisons between groups; There was no statistically significant difference between TMS and placebo groups in pre-treatment Visual Analogue Scale (VAS) scores (p > 0.05). Significant differences were found between the groups in VAS scores at the first and third months of treatment (p < 0.05). In intra-group comparisons according to time; A significant change in VAS scores was observed in the TMS group (p < 0.05). There was a significant difference between pre-treatment and first month and between pre-treatment and third month (p 0.05). The change in VAS scores in the placebo group was not found to be significant in relation to time (p > 0.05). Tinnitus Degrees : The pre-treatment and post-treatment first and third month grades are presented in Table 7 . In the TMS group, a significant decrease in tinnitus degrees was observed in the first and third months after treatment and a more significant improvement was achieved compared to the placebo group. While there was a 26.3% Grade 3 superiority in the TMS group before treatment, this superiority shifted to Grade 2 with a rate of 28.9% at the end of the third month. In the placebo group, while there was a 26.3% Grade 3 superiority before treatment, this superiority was observed to be in the direction of Grade 5 in the third month. Table 7 Distribution of Tinnitus Degree Variable Group n / % Before First Month Third Month TMS Plasebo TMS Plasebo TMS Plasebo Tinnitus Severity Grade 1 n 2 1 8 1 9 1 % 5,3% 2,6% 21,1% 2,6% 23,7% 2,6% Grade 2 n 9 7 9 6 11 9 % 23,7% 18,4% 23,7% 15,8% 28,9% 23,7% Grade 3 n 10 10 12 9 9 7 % 26,3% 26,3% 31,6% 23,7% 23,7% 18,4% Grade 4 n 9 10 5 10 6 10 % 23,7% 26,3% 13,2% 26,3% 15,8% 26,3% Grade 5 n 8 10 4 12 3 11 % 21,1% 26,3% 10,5% 31,6% 7,9% 28,9% Total n 38 38 38 38 38 38 % 100,0% 100,0% 100,0% 100,0% 100,0% 100,0% • n; frequency, %; percentage Table 7 : Distribution of Tinnitus Degree The numerical distribution of tinnitus grades of the TMS and placebo groups before treatment and at the first and third month after treatment are presented in Fig. 1 and Fig. 2 While the most common grade in the TMS group was Grade 3 with 10 patients before treatment, this superiority shifted to Grade 2 with 11 patients in the third month after treatment and the number of patients in Grade 1 increased from 2 to 9. In the placebo group, Grade 3, Grade 4 and Grade 5 had the highest number of patients (10 patients) before the treatment, while this superiority shifted towards Grade 5 with 11 patients at the end of the treatment. In tinnitus grading, Grade 5, which is the highest grade according to the Tinnitus Handicap Index (THI) scores, is considered to be the group most affected by tinnitus. As a result of the evaluation of Fig. 1 and Fig. 2 , it was understood that the response to treatment was significantly better in the TMS group, while in the placebo group, the response to treatment remained poor and even a tendency to worsen in the grading was observed. Figure 1 : TMS Group Tinnitus Degree Distributions Figure 2 : Placebo Group Tinnitus Degree Distributions DISCUSSION In the literature, the relationship between tinnitus and depression is around 30% and it has been reported that 50% of patients receiving psychological treatment have tinnitus ( 11 ). Because of this close relationship, instead of treating tinnitus alone, the psychological status of the patient should be taken into consideration, symptoms should be conveyed through psycho-education, patient fears should be reduced and excessive treatment expectations should be controlled. Acoustic and psychosomatic tests are widely used in the literature to evaluate the effectiveness of tinnitus treatment ( 12 ). In this study, patients with tinnitus were divided into TMS and placebo groups and the efficacy of TMS was evaluated by psychoacoustic and psychosomatic tests and the results were compared with the current literature. When the distribution of tinnitus according to gender is analysed, it has been reported that it is more common in males in some studies, whereas the ratio of males and females is equal in others ( 13 – 15 ). In our study, the rate of male patients was compatible with the literature with 72.4%. According to the age factor, it has been reported in the literature that tinnitus is more common in older ages ( 16 , 17 ), and in our study, the mean age was found to be 49.76 ± 10.28 in the TMS group and 49.24 ± 12.96 in the placebo group. The fact that the majority of the patients were elderly is in parallel with the literature. Although there are different results in the literature about whether tinnitus is unilateral or bilateral ( 18 , 19 ), 81.6% unilateral and 18.4% bilateral tinnitus was observed in our study. In addition, it has been reported in the literature that tinnitus is more common in the left ear ( 20 ), and in our study, 52% of the patients had tinnitus in the left ear. In the literature, psychosomatic tests are generally preferred in the follow-up of rTMS efficacy, but we used both psychoacoustic and psychosomatic tests in our study. Tinnitus frequency, one of the psychoacoustic tests, was measured before treatment and at the first and third months after treatment. In the TMS group, the mean tinnitus frequency before treatment was 6830.17 ± 3371.99 Hz, while it was the same value in the placebo group. These values were 5794.03 ± 2467.18 Hz and 6472 ± 2034.32 Hz in the first month and 4869.43 ± 1914.32 Hz and 6232.41 ± 1416.88 Hz in the third month, respectively. The change in tinnitus frequency between the groups was not statistically significant (p > 0.05). This finding is consistent with the study by Tae Soo et al. who similarly found no significant difference in tinnitus frequency ( 21 ). In 2017, it was reported that measurements made with the tinnitometry device developed in 2017 did not produce a significant difference compared to traditional audiometry ( 22 ). In our study, tinnitus severity, another psychoacoustic test, was also evaluated. There are studies in the literature showing that tinnitus severity decreased in TMS treatment ( 23 , 24 ). Our results showed significant differences in tinnitus severity in both groups in the first and third months before and after treatment (p < 0.05). The mean tinnitus severity before treatment was 57.43 ± 16.73 in the TMS group and 64.45 ± 20.72 in the placebo group; 48.26 ± 15.18 and 68.82 ± 18.9 in the first month and 48.76 ± 15.6 and 67.53 ± 17.73 in the third month, respectively. CONCLUSION In this study, we investigated the efficacy of Repetitive Transcranial Magnetic Stimulation (rTMS) treatment in patients with subjective tinnitus using psychoacoustic and psychosomatic tests. Our findings revealed that although there was no significant change in tinnitus frequency between groups, there were statistically significant improvements in tinnitus severity, Tinnitus Handicap Index (THI), Beck Depression Scale (BDS) and Visual Analogue Scale (VAS) scores in the rTMS group. In the placebo group, no significant change was observed in these parameters, and even a worsening trend was found in tinnitus grading. These results suggest that rTMS treatment has positive effects on the severity and psychological effects of tinnitus symptoms. In our study, the fact that tinnitus is more common in males, its prevalence increases with age, and that there are more complaints in the left ear was confirmed in accordance with the existing literature. In addition, the use of psychoacoustic and psychosomatic measurement tools together in the treatment of tinnitus is important for the multidimensional evaluation of treatment efficacy. In particular, psychological reflection of tinnitus and monitoring of depressive symptoms of patients are necessary for detailed follow-up of treatment success. In parallel with the findings in the literature that rTMS did not cause a significant change in tinnitus frequency, the frequency change did not show statistical significance in our study. However, the reduction in tinnitus severity and related psychosocial effects supports rTMS as a promising noninvasive method in the treatment of tinnitus. However, there is still no consensus on the parameters such as duration, frequency and target area of rTMS treatment. Therefore, further studies are needed to standardise the treatment protocols and increase the efficacy. In conclusion, rTMS can be considered as a treatment option with minimal side effects, high applicability and the potential to improve the quality of life of patients in the treatment of tinnitus. Its use in combination with neuroimaging techniques may increase treatment efficacy and provide a better understanding of the pathophysiology of tinnitus. Future randomized controlled trials will more definitively establish the role of rTMS in the treatment of tinnitus. Declarations Author Contribution Agit ŞİMŞEK design of the work OR interpretation of data OR have drafted the work or substantively revised itOğuz KARAKAŞ design of the work OR the acquisition, analysis OR interpretation of dataMehmet TAN design of the work OR References Jastreboff P, Gray W, Mattox D. Tinnitus and hyperacusis. Otolaryngol Head Neck Surg. 1998;165:3198–222. Chung DY, Gannon RP, Mason K. Factors affecting the prevalence of tinnitus. Audiology 1984, 23(5): 441–452 Sindhusake D, Mitchell P, Newall P, Golding M, Rochtchina E, Rubin G. Prevalence and characteristics of tinnitus in older adults: the Blue Mountains Hearing Study. Int J Audiol 2003, 42(5): 289–294. Kim HJ, Lee HJ, An SY, Sim S, Park B, Kim SW, et al. Analysis of the prevalence and associated risk factors of tinnitus in adults. PLoS One 2015, 10(5) Elliott B. Diagnosing and treating hypothyroidism. Nurse Pract 2000, 25(3): 92–105. Shargorodsky J, Curhan GC, Farwell WR. Prevalence and characteristics of tinnitus among US adults. Am J Med 2010, 123(7): 711–718 Gopinath B, McMahon CM, Rochtchina E, Karpa MJ, Mitchell P. Risk factors and impacts of incident tinnitus in older adults. Ann Epidemiol 2010, 20(2): 129–135. Shore SE, Roberts LE, Langguth B. Maladaptive plasticity in tinnitus-triggers, mechanisms and treatment. Nat Rev Neurol 2016, 12(3): 150–160 Moller AR. Pathophsiology of Tinnitus. Ann Otol Rhinol Laryngol 1984, 93(2): 39–44 Bartnik, G., Baguley, D.M., Kleinjung, T., Savastano, M., & Hough, E.A. Troublesome tinnitus in childhood and adolescence: data from expert centres. International Journal of Pediatric Otorhinolaryngology 2013,77(2): 248–251 Bartels H, Pedersen SS, van der Laan BF, Staal MJ, Albers FW, Middel B. The impact of Type D personality on health-related quality of life in tinnitus patients is mainly mediated by anxiety and depression. Otol Neurotol 2010, 31(2):11–8. Langguth B, Zowe M, Landgrebe M, Sand P, Kleinjung T, Binder H. Transcranial magnetic stimulation for the treatment of tinnitus: a new coil positioning method and first results. Brain Topogr 2006 18(4):241–7 Biswas R, Genitsaridi E, Trpchevska N, Lugo A, Schlee W, Cederroth CR, Gallus S, Hall DA. Low Evidence for Tinnitus Risk Factors: A Systematic Review and Meta-analysis. J Assoc Res Otolaryngol 2023, 24(1):81–94. Stouffer JL, Tyler RS. Characterization of tinnitus by tinnitus patients. J Speech Hear Disord 1990, 55(3):439–53 Krog NH, Engdahl B, Tambs K. The association between tinnitus and mental health in a general population sample: results from the HUNT Study. J Psychosom Res 2010, 69(3):289–98 Tang D, Li H, Chen L. Advances in Understanding, Diagnosis, and Treatment of Tinnitus. Adv Exp Med Biol 2019, 1130:109–128 Akyıldız N. Kulak Hastalıkları ve Mikrocerrahisi ed). Bilimsel Tıp Yayınevi, Ankara 2002,pp 67–81. Wu BP, Searchfield G, Exeter DJ, Lee A. Tinnitus prevalence in New Zealand. N Z Med J 2015, 16;128(1423):24–34 Baguley D, McFerran D, Hall D. Tinnitus. Lancet 2013, 382(9904):1600–1607 Yenigün A, Doğan R, Aksoy F, Akyüz S, Dabak H. Assessment of tinnitus with tinnitus severity index, tinnitus handicap inventory and distortion product otoacoustic emissions in patients with normal hearing and hearing loss. Kulak Burun Bogaz Ihtis Dergisi 2014, 24(1):11–6 Aydın M, Erkan M, Gündoğdu R, Vural A, Kökoğlu K, Şahin Mİ. Assessment of the Effectiveness of Transcranial Magnetic Stimulation in Subjective Tinnitus. Int Arch Otorhinolaryngol. 2021,25(3):453–458 Noh TS, Kyong JS, Park MK, Lee JH, Oh SH, Suh MW. Dual-site rTMS is More Effective than Single-site rTMS in Tinnitus Patients: A Blinded Randomized Controlled Trial. Brain Topogr. 2020;33(6):767–775. Vernon J, Fenwick J. Identification of tinnitus: a plea for standardization. J Laryngol Otol 1984, 98:45–53. Jastreboff P, Gray W, Mattox D. Tinnitus and hyperacusis. Otolaryngol Head Neck Surg 1998, 165:3198–222 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7231296","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":506396510,"identity":"8ad7a72c-a06e-4a02-a473-824c0d0aadf2","order_by":0,"name":"Oğuz karakas","email":"","orcid":"","institution":"Inonu University","correspondingAuthor":false,"prefix":"","firstName":"Oğuz","middleName":"","lastName":"karakas","suffix":""},{"id":506396511,"identity":"ee48d2c5-fbcc-4652-926f-624a89445f60","order_by":1,"name":"Agit ŞİMŞEK","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAklEQVRIiWNgGAWjYFACxgYgIQHEbIwPEqBiEgS0NDZAtTAbIGkxIGgNSAsb3HC8Wvj7F7c/YPhjES3f3pZW8XCHTZ7BAeaDt3kY/uTj0iJx42FjA2ObRO6GM8eO3Ug8k1ZscIAt2ZqHwcCyAZeeGweBWhqAWiTS224kth1O3HCAx0waqAWny+RBWhj+SOTOn/+8rQCihf8bXi0G5xuBWtgkchtusB1jgNrChleL4Q3GxhmJYL+kJUsktqUlzjzMZmw5x8AYpxa588cffPjwpy53fvsxw48/22wS+443P7zxpkIOdyhLJDAwJKCIMIMdjFMDMGIO4JEcBaNgFIyCUQACACBmWwI1C97ZAAAAAElFTkSuQmCC","orcid":"","institution":"Inonu University Faculty of Health Sciences","correspondingAuthor":true,"prefix":"","firstName":"Agit","middleName":"","lastName":"ŞİMŞEK","suffix":""},{"id":506396512,"identity":"20823cac-3273-4a9c-a253-4b457ca379ed","order_by":2,"name":"Mehmet TAN","email":"","orcid":"","institution":"Inonu University","correspondingAuthor":false,"prefix":"","firstName":"Mehmet","middleName":"","lastName":"TAN","suffix":""}],"badges":[],"createdAt":"2025-07-28 08:08:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7231296/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7231296/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90470072,"identity":"92e30317-6606-4c7a-abfe-1e13f38e7249","added_by":"auto","created_at":"2025-09-03 06:12:56","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":17773,"visible":true,"origin":"","legend":"\u003cp\u003eTMS Group Tinnitus DegreeDistributions\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7231296/v1/32a61b67cf867836d71e1933.png"},{"id":90470077,"identity":"d5dcb38a-508b-4875-8162-e1822347c1fd","added_by":"auto","created_at":"2025-09-03 06:12:57","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":17686,"visible":true,"origin":"","legend":"\u003cp\u003ePlacebo Group Tinnitus Degree Distributions\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7231296/v1/797f19e07298dbe77bb37360.png"},{"id":90901601,"identity":"263dbea0-4c17-4a17-bef7-2278cd9eca4d","added_by":"auto","created_at":"2025-09-09 12:23:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1966088,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7231296/v1/dbae32c9-16a3-4d12-9633-4f50d86ab430.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of the Effectiveness of Transcranial Magnetic Stimulation in the Treatment of Subjective Tinnitus with Psychoacoustic Tests and Psychosomatic Tests","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eTinnitus is a symptom characterised by the perception of sound in the ears or head without an external sound source (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Studies have reported that the prevalence of tinnitus in the population varies between 6.6% and 18.6% (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Factors such as hearing loss, long-term noise exposure, depression and stress have been shown to be closely related with tinnitus (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). In addition, cardiovascular risk factors such as high body mass index, hypertension, diabetes, cerebral stroke, angina and myocardial infarction are among the important risk factors for the development of tinnitus (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWhile early studies investigating the physiopathology of tinnitus generally focused on the inner ear, cochlear nerve and auditory system, recent studies have focused on the auditory cortex and neural networks associated with this region (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In studies conducted with animal models, increased spontaneous neuronal activity was observed in neurons in the medial geniculate ganglion region in individuals with tinnitus (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In Moller's study, it was reported that when damage occurs between neighbouring nerve fibres, abnormal synapse connections are formed between these fibres, resulting in the transmission of non-physiological signals and sound perception without an acoustic stimulus (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Similarly, it has been shown in some studies that tinnitus persists despite cutting the cochlear nerve, which suggests that tinnitus may have not only peripheral but also central origin (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e According to the generally accepted opinion in the literature, increased spontaneous discharge in neurons plays a fundamental role in the formation of tinnitus. Although some patients partially benefit from the current treatment modalities, a significant number of them cannot find an effective treatment option and have to learn to live with this condition. In this context, the search for more effective and permanent treatment methods is of great clinical importance.\u003c/p\u003e\u003cp\u003eThe aim of this study was to evaluate the efficacy of Transcranial Magnetic Stimulation (TMS) in the treatment of subjective tinnitus using psychoacoustic tests and psychosomatic scales.\u003c/p\u003e"},{"header":"MATERIAL AND METHOD","content":"\u003cp\u003eThis study was conducted on 76 patients between the ages of 18–70 years who applied to the outpatient clinics of Inonu University Turgut Özal Medical Centre Department of Otorhinolaryngology between September 2022 and February 2023 with the complaint of tinnitus. Participants were randomly selected and included in the study without gender discrimination.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePatient Group Selection\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePatient selection was made in the same way between the TMS group and the control\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003egroup.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePatient Group Selection\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePatients were distributed equally to the Repetitive Transcranial Magnetic Stimulation (rTMS) group and the control group according to similar criteria.\u003c/p\u003e\u003cp\u003e\u003cb\u003eInclusion Criteria\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eTo be between the ages of 18–70\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSubjective complaint of tinnitus for at least three months\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003ePatients Excluded from the Study\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eBeing pregnant or breastfeeding\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eTo be using a hearing aid\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHaving a pacemaker\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHaving a history of any diagnosed psychiatric illness\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHistory of previous ear surgery\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePresence of diseases that may cause objective tinnitus\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHistory of chronic otitis\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHistory of neurotological surgery\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eDetection of haematological/metabolic parameter disorders (e.g. iron, B12, TSH levels) that may cause tinnitus and can be corrected with treatment\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePatients with anatomical disorders of the ear other than inner ear pathologies\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eCharacteristics of Patient Groups\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe distribution of 38 patients included in the TMS group according to detailed anamnesis and pure tone audiometry results is as follows:\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e12 patients with presbycusis\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHistory of sudden hearing loss in 7 patients\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e3 patients had a history of Meniere's disease\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e9 patients with prolonged exposure to loud noise (classified as acoustic trauma)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eIn 7 patients, no specific aetiology was detected and audiometry results were normal\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe distribution of 38 patients in the control group was as follows:\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e13 patients with presbycusis\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHistory of sudden hearing loss in 6 patients\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e2 patients with Meniere's disease\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHistory of acoustic trauma in 5 patients\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eIn 12 patients, there was no specific clinical history and audiometry findings were normal.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003erTMS Implementation\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of 76 patients included in the study were randomly selected and divided into two equal groups. Real rTMS was applied to 38 patients in the intervention group and placebo rTMS was applied to 38 patients in the control group. participants were not informed which group they were included in; the study was conducted with a double-blind method.\u003c/p\u003e\u003cp\u003eBiochemical parameters were evaluated, acoustic tests and psychosomatic scales were applied to both groups before treatment. The applications were performed with a Neuro-MS/D (Neurosoft, Russia) brand device. rTMS application was planned to include 1500 pulses at low frequency (1 Hz), 1 session per day for 10 days. Each session lasted approximately 25 minutes, the patients were kept in a sitting position throughout the application and the figure- eight stimulation coil was fixed to the targeted area.\u003c/p\u003e\u003cp\u003eThe left auditory cortex was targeted for the first 5 days and the left dorsolateral prefrontal cortex for the next 5 days. In the placebo group, only the coil device was placed in the left temporal region without stimulation and sham application was performed without magnetic wave.\u003c/p\u003e\u003cp\u003eAll participants were recalled at 1 and 3 months after treatment and evaluated with the same acoustic tests and psychosomatic scales.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEvaluation of Tinnitus\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn order to evaluate the effect of rTMS on tinnitus, the participants were evaluated on a total of five parameters before treatment, at 1 month and 3 months after treatment. Two of these parameters were obtained by acoustic measurements (tinnitus frequency and severity) and three were obtained by psychometric tests (Tinnitus Disability Questionnaire, Visual Analogue Scale, Beck Depression Scale). The findings were statistically compared over time.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTinnitus Disability Questionnaire\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTEA, which is used to evaluate the effect of tinnitus on the quality of life of the individual, is a psychosomatic assessment tool with high reliability and frequently used. The questionnaire consists of a total of 25 questions and each question is answered as \"yes\", \"sometimes\" or \"no\". The questionnaire was administered before treatment and at the 1st and 3rd months after treatment (74, 122).\u003c/p\u003e\u003cp\u003e\u003cb\u003eVisual Analogue Scale\u003c/b\u003e\u003c/p\u003e\u003cp\u003e The VAS, which was used for the subjective assessment of the participants' discomfort due to tinnitus, is in the form of a visual ruler graded between 0 and 10 and supported by facial expressions. \"0\" was defined to represent a happy mood and \"10\" to represent an unhappy mood; patients were asked to mark their current mood on this scale. The reliability of the scale has been reported to be high in the literature (66).\u003c/p\u003e\u003cp\u003e\u003cb\u003eBack Depression Scale\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe BDI, which was used to evaluate the relationship between tinnitus and depression, consists of 21 items. Translated into Turkish in 1997, the validity and reliability of the scale was adapted to the Turkish population by Ulusoy et al. Studies have reported that the BDI has a reliability of over 90% (74, 78, 82, 124).\u003c/p\u003e\u003cp\u003e\u003cb\u003eTinnitus Frequency\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAll audiological evaluations for objective measurement of tinnitus were performed using an Interacoustics AC-40 (Middelfart, Denmark) clinical audiometry device. Threshold measurements in the range of 250 − 16.000 Hz were performed with this device with high frequency module. Measurements were repeated before, 1 month and 3 months after treatment.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTinnitus Severity\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTinnitus intensity was measured by presenting sounds of different intensities at the same frequency after the patient's tinnitus frequency was determined. Among the sounds presented in 1 dB increments, the patient was asked to choose the sound that most resembled his/her tinnitus. This measurement was repeated before treatment, at 1 and 3 months and analysed statistically.\u003c/p\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eData analysis was performed with SPSS 25 programme. Normal distribution status was evaluated by Kolmogorov-Smirnov test and parametric tests were performed if p \u0026gt; 0.05. Dependent pairwise group comparisons were analysed \u003cb\u003eby paired t test\u003c/b\u003e and repeated measures were analysed \u003cb\u003eby repeated measures ANOVA\u003c/b\u003e. Independent \u003cb\u003esample t test was\u003c/b\u003e used for independent two-group comparisons and \u003cb\u003echi-square analysis was\u003c/b\u003e used for categorical data. \u003cb\u003eFriedman test was\u003c/b\u003e used for nonparametric dependent measurements and \u003cb\u003eWilcoxon test was\u003c/b\u003e used for intra-group comparisons. Significance level was accepted as p \u0026lt; 0.05 in all tests.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthics Approval\u003c/strong\u003e\u003c/p\u003e\u003cp\u003e Prior to the study, approval was obtained from the Malatya Clinical Research Ethics Committee of Inonu University (dated 31 August 2022, no. 2022/78). Our research was conducted in accordance with the Helsinki Declaration.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eNo funding support has been received from any organization.\u003c/p\u003e\u003cp\u003eAn informed consent form was used when the ethics committee was established. All participants signed this form.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eAge, gender, duration of tinnitus and affected side (unilateral/bilateral) were compared between the groups and the results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. No statistically significant difference was found between TMS and placebo groups in terms of these variables (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Thus, a homogeneous distribution was achieved between the groups in terms of demographic and clinical characteristics of the participants.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of Demographic Variables by Groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"13\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c3\" namest=\"c2\" rowspan=\"2\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003en / %\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eGroup\u003c/span\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c9\" namest=\"c8\" rowspan=\"2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c11\" namest=\"c10\" rowspan=\"2\"\u003e\u003cp\u003e\u003csup\u003eꭓ(2)\u003c/sup\u003eValue\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c13\" namest=\"c12\" rowspan=\"2\"\u003e\u003cp\u003ep Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eTMS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePlacebo\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWomann\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e%\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c6\" namest=\"c5\" rowspan=\"2\"\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e18,4%\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e36,8%\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c9\" namest=\"c8\" rowspan=\"2\"\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e27,6%\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c11\" namest=\"c10\" rowspan=\"2\"\u003e\u003cp\u003e2,369\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c13\" namest=\"c12\" rowspan=\"2\"\u003e\u003cp\u003e0,124\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e81,6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e63,2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e72,4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSinglen\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e%\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c6\" namest=\"c5\" rowspan=\"2\"\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e84,2%\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e78,9%\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c9\" namest=\"c8\" rowspan=\"2\"\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e81,6%\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eParty\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c11\" namest=\"c10\" rowspan=\"2\"\u003e\u003cp\u003e0,088\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c13\" namest=\"c12\" rowspan=\"2\"\u003e\u003cp\u003e0,767\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003eBilateral\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e15,8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e21,1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e18,4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" morerows=\"1\" nameend=\"c3\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e\u003cb\u003e38\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e38\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e\u003cb\u003e76\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e\u003cb\u003e100,0%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e100,0%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e\u003cb\u003e100,0%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eVariables\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eValue\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e\u003cb\u003eTMS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u003cp\u003e\u003cb\u003ePlacebo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003e\u003cb\u003et Value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u003cp\u003e\u003cb\u003ep Value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" morerows=\"1\" nameend=\"c3\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;ss\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e49,76\u0026thinsp;\u0026plusmn;\u0026thinsp;10,28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u003cp\u003e49,24\u0026thinsp;\u0026plusmn;\u0026thinsp;12,96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c11\" namest=\"c10\" rowspan=\"2\"\u003e\u003cp\u003e0,196\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c13\" namest=\"c12\" rowspan=\"2\"\u003e\u003cp\u003e0,845\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eM (Min - Max)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e50,5(26\u0026ndash;70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u003cp\u003e51,5(21\u0026ndash;69)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eDuration(Month)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;ss\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e50,21\u0026thinsp;\u0026plusmn;\u0026thinsp;45,06\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e47,58\u0026thinsp;\u0026plusmn;\u0026thinsp;50,63\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c10\" namest=\"c9\" rowspan=\"2\"\u003e\u003cp\u003e0,239\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c12\" namest=\"c11\" rowspan=\"2\"\u003e\u003cp\u003e0,811\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c13\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e\u003cb\u003eM (Min - Max)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e42,5(6-240)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e36(6-240)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c13\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"13\"\u003eMean; mean, SD; standard deviation, M; median, t value; significance test of the difference between two means (t test), p value, p; statistical significance.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e: Distribution of Demographic Variables by Groups\u003c/p\u003e\u003cp\u003e The frequency of tinnitus in the study participants was measured before treatment and at the first and third months, and intra- and inter-group changes were analysed. The results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. When the changes in tinnitus frequency between the first and third months before and after treatment were analysed, no statistically significant difference was found between the TMS and placebo groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eIntra-group and Inter-group Comparison of Tinnitus Frequency Measurements\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eTMS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003ePlasebo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eIntergroup Comparison\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eIntergroup Independent Comparison\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eGruplar arası Karşılaştırma\u0026thinsp;\u0026plusmn;\u0026thinsp;ss\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eGruplar arası Karşılaştırma\u0026thinsp;\u0026plusmn;\u0026thinsp;ss\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eF\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFirst Tinnitus Frequency\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e6830,17\u0026thinsp;\u0026plusmn;\u0026thinsp;3371,99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e6831,22\u0026thinsp;\u0026plusmn;\u0026thinsp;2462,87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;2,773\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;0,001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,999\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFirst Month Tinnitus Frequency\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e5794,03\u0026thinsp;\u0026plusmn;\u0026thinsp;2467,18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e6472\u0026thinsp;\u0026plusmn;\u0026thinsp;2034,32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,083\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;1,708\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,195\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eThird Month Tinnitus Frequency\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e4869,43\u0026thinsp;\u0026plusmn;\u0026thinsp;1914,32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e6232,41\u0026thinsp;\u0026plusmn;\u0026thinsp;1416,88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eη\u0026thinsp;=\u0026thinsp;0,036\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003eF\u0026thinsp;=\u0026thinsp;12,445\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0,002*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIntra-group Comparison\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eF\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e \u003cb\u003e=13,385\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e \u003cb\u003e=0,001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF\u003csup\u003eb\u003c/sup\u003e =1,119\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003csup\u003eb\u003c/sup\u003e =0,332\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBefore Treatment - First Month\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,103\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBefore Treatment - Third Month\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0,001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,563\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFirst Month - Third Month\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0,002*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003eMean; standard deviation, ss; standard deviation, F; Two-way mixed ANOVA test value for repeated measurements, η; eta coefficient, Fa; t-test, Fb; Repeated ANOVA, *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05; there is a difference between measurements.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e: Intra-group and Inter-group Comparison of Tinnitus Frequency Measurements\u003c/p\u003e\u003cp\u003e\u003cb\u003eIn independent comparisons between groups;\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eThere was no statistically significant difference between TMS and placebo groups in terms of tinnitus frequency before treatment (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eNo significant difference was found between the groups in the tinnitus frequency measurements at the first month of treatment (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHowever, a significant difference was found between the groups in tinnitus frequency measurements at the third month of treatment (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eIn intra-group comparisons according to time;\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eIn the TMS group, the change in tinnitus during the treatment period was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThere was no statistically significant difference between pre-treatment and first month of treatment (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eA statistically significant difference was found between the pre-treatment and the third month of treatment (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eA statistically significant difference was found between the first month of treatment and the third month of treatment (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eIn the placebo group, no statistically significant difference was found in the change in tinnitus during the treatment period (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eIn addition, the tinnitus severity of the participants was measured before treatment, at the first and third months, and both intra- and inter-group analyses were performed. The results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. In terms of tinnitus severity, a statistically significant difference was found between the TMS and placebo groups in the first and third months before and after treatment (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). 13.5% (η) of the intergroup variation in the severity measurement is explained by time-dependent variation.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eIntra- and Intergroup Comparison of Tinnitus Severity Measurements\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eTMS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003ePlasebo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eIntergroup Comparison\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eIntergroup Independent Comparison\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eAverage\u0026thinsp;\u0026plusmn;\u0026thinsp;ss\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eAverage\u0026thinsp;\u0026plusmn;\u0026thinsp;ss\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eF\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eInitial Tinnitus Severity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e57,43\u0026thinsp;\u0026plusmn;\u0026thinsp;16,73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e64,45\u0026thinsp;\u0026plusmn;\u0026thinsp;20,72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003eF\u0026thinsp;=\u0026thinsp;11,572\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;2,635\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,109\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTinnitus Severity_1 Month\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e48,26\u0026thinsp;\u0026plusmn;\u0026thinsp;15,18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e68,82\u0026thinsp;\u0026plusmn;\u0026thinsp;18,9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0,001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003eF\u0026thinsp;=\u0026thinsp;27,317\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0,001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTinnitus Severity_3 Months\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e48,76\u0026thinsp;\u0026plusmn;\u0026thinsp;15,6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e67,53\u0026thinsp;\u0026plusmn;\u0026thinsp;17,73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003eη\u0026thinsp;=\u0026thinsp;0,135\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003eF\u0026thinsp;=\u0026thinsp;23,982\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0,001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIntra-group Comparison\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eF\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e \u003cb\u003e=8,305\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e \u003cb\u003e=0,002*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF\u003csup\u003eb\u003c/sup\u003e =1,706\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003csup\u003eb\u003c/sup\u003e =0,189\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBefore Treatment - First Month\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0,002*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,201\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBefore Treatment - Third Month\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0,001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,578\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFirst Month - Third Month\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003eMean; standard deviation, ss; standard deviation, F; Two-way mixed ANOVA test value for repeated measurements, η; eta coefficient, Fa; t-test, Fb; Repeated ANOVA, *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05; there is a difference between measurements.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e: Intra- and Intergroup Comparison of Tinnitus Severity Measurements\u003c/p\u003e\u003cp\u003e\u003cb\u003eIn independent comparisons between groups;\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eThere was no statistically significant difference between TMS and placebo groups in tinnitus severity measurements before treatment (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSignificant differences were found between the groups in tinnitus severity measurements at the first and third months of treatment (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eIn intra-group comparisons according to time;\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eChanges in tinnitus severity in the TMS group were statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eNo significant difference was observed between pretreatment and first month (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThe differences between pre-treatment and third month and between first month and third month were significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eIn the placebo group, there was no significant change in tinnitus severity over time (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).In the placebo group, there was no statistically significant difference in tinnitus change during the treatment period (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eTinnitus Handicap Index (THI) scores of the individuals participating in the study were measured before the treatment and at the first and third months, and intra- and inter- group analyses were performed. These results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. In terms of THI scores, statistically significant differences were determined between TMS and placebo groups in pre-treatment and post-treatment periods (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In addition, 15.6% (η) of the between- group change in THI scores is explained by time-dependent change.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of THI Scores Within and Between Groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eTMS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003ePlasebo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eIntergroup Comparison\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eIntergroup Independent Comparison\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eAverage\u0026thinsp;\u0026plusmn;\u0026thinsp;ss\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eAverage\u0026thinsp;\u0026plusmn;\u0026thinsp;ss\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eF\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eInitial THI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e51,84\u0026thinsp;\u0026plusmn;\u0026thinsp;23,59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e58,21\u0026thinsp;\u0026plusmn;\u0026thinsp;22,27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003eF\u0026thinsp;=\u0026thinsp;13,727\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;1,465\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,230\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFirst Month THI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e42,42\u0026thinsp;\u0026plusmn;\u0026thinsp;25,22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e60,61\u0026thinsp;\u0026plusmn;\u0026thinsp;23,15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0,001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003eF\u0026thinsp;=\u0026thinsp;10,723\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0,002*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eThird Month THI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e38,95\u0026thinsp;\u0026plusmn;\u0026thinsp;24,95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e58,87\u0026thinsp;\u0026plusmn;\u0026thinsp;25,43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003eη\u0026thinsp;=\u0026thinsp;0,156\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003eF\u0026thinsp;=\u0026thinsp;11,879\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0,002*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIntragroup Comparison\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eF\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e \u003cb\u003e=14,562\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e \u003cb\u003e=0,001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF\u003csup\u003eb\u003c/sup\u003e =1,297\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003csup\u003eb\u003c/sup\u003e =0,280\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePre-treatment - First Month\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0,001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,765\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePre-treatment - Third Month\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0,001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFirst Month - Third Month\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0,041*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,633\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003eMean; standard deviation, ss; standard deviation, F; Two-way mixed ANOVA test value for repeated measurements, η; eta coefficient, Fa; t-test, Fb; Repeated ANOVA, *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05; there is a difference between measurements.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e: Comparison of THI Scores Within and Between Groups\u003c/p\u003e\u003cp\u003e\u003cb\u003eIn independent comparisons between groups;\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eNo significant difference was observed between TMS and placebo groups in terms of Tinnitus Handicap Index (THI) scores before treatment (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHowever, statistically significant differences were found between the groups in THI scores at the first and third months of treatment (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eIn intra-group comparisons according to time;\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eThe change in THI scores in the TMS group was significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThe differences between pretreatment and first month, pretreatment and third month, and first month and third month were statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eIn the placebo group, the change in THI scores was not significant over time (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eBeck Depression Questionnaire (BDI) scores of the participants were measured before treatment, at the first and third months, and the changes within and between groups were analysed. The results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eIntragroup and Intergroup Comparison of BDA Scores\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eTMS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003ePlasebo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eIntergroup Comparison\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eIntergroup Independent Comparison\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eAverage\u0026thinsp;\u0026plusmn;\u0026thinsp;ss\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eAverage\u0026thinsp;\u0026plusmn;\u0026thinsp;ss\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eF\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePre-treatment BDA\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e13,76\u0026thinsp;\u0026plusmn;\u0026thinsp;8,82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e15,39\u0026thinsp;\u0026plusmn;\u0026thinsp;9,38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003eF\u0026thinsp;=\u0026thinsp;4,188\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;0,610\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,437\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFirst Month BDA\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e12,32\u0026thinsp;\u0026plusmn;\u0026thinsp;8,89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e16,76\u0026thinsp;\u0026plusmn;\u0026thinsp;11,19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0,026*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;3,681\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,059\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eThird Month BDA\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e10,97\u0026thinsp;\u0026plusmn;\u0026thinsp;7,85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e16,37\u0026thinsp;\u0026plusmn;\u0026thinsp;11,7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003eη\u0026thinsp;=\u0026thinsp;0,054\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003eF\u0026thinsp;=\u0026thinsp;5,573\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0,021*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIntragroup Comparison\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eF\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e \u003cb\u003e=3,620\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e \u003cb\u003e=0,032*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF\u003csup\u003eb\u003c/sup\u003e =0,936\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003csup\u003eb\u003c/sup\u003e =0,397\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePre-treatment - First Month\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,488\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,560\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePre-treatment - Third Month\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0,044*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFirst Month - Third Month\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,144\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003eMean; standard deviation, ss; standard deviation, F; Two-way mixed ANOVA test value for repeated measurements, η; eta coefficient, Fa; t-test, Fb; Repeated ANOVA, *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05; there is a difference between measurements.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e: Intragroup and Intergroup Comparison of BDA Scores\u003c/p\u003e\u003cp\u003eThe Beck Depression Questionnaire (BDI) scores of the study participants were measured before treatment and at the first and third months after treatment, and intra- and inter-group changes were analysed. The results showed that there were statistically significant differences between the groups (TMS and placebo) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). 5.4% (η) of the between-group change in BDA scores was explained by time-dependent change.\u003c/p\u003e\u003cp\u003e\u003cb\u003eIn independent comparisons between groups;\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eThere was no significant difference between TMS and placebo groups in terms of BDA scores before treatment and at the first month of treatment (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHowever, a statistically significant difference was found between the groups in BDA scores at the third month of treatment (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eIn intra-group comparisons according to time;\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eA significant change in BDI scores was observed in the TMS group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eWhile there was no significant difference between pre-treatment and first month (p\u0026thinsp;\u0026gt;\u0026thinsp;0,05), there was a significant difference between pre-treatment and third month (p\u0026thinsp;\u0026lt;\u0026thinsp;0,05).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThe difference between the first month and the third month was not significant (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eIn the placebo group, the change in BDA scores was not significant over time (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eIn addition, Visual Analogue Scale (VAS) scores of the participants were measured before treatment, at the first and third months, and intra- and inter-group analyses were performed. The results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e. Statistically significant differences were found between TMS and placebo groups in VAS scores before treatment and at the first and third months after treatment (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). 13.5% (η) of the intergroup variation in VAS scores is explained by time-dependent variation.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eIntragroup and Intergroup Comparison of VAS Scores\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eTMS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003ePlasebo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eIntergroup Comparison\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003eIntergroup Independent Comparison\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eAverage\u0026thinsp;\u0026plusmn;\u0026thinsp;ss\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eAverage\u0026thinsp;\u0026plusmn;\u0026thinsp;ss\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eF\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePre-treatment VAS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e30,82\u0026thinsp;\u0026plusmn;\u0026thinsp;10,47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e33,08\u0026thinsp;\u0026plusmn;\u0026thinsp;8,4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003eF\u0026thinsp;=\u0026thinsp;11,416\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;1,064\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,306\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFirst_Month VAS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e24,29\u0026thinsp;\u0026plusmn;\u0026thinsp;10,22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e34,54\u0026thinsp;\u0026plusmn;\u0026thinsp;8,92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0,001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003eF\u0026thinsp;=\u0026thinsp;21,384\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0,001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eThird_Month_VAS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e23,39\u0026thinsp;\u0026plusmn;\u0026thinsp;11,17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e34,03\u0026thinsp;\u0026plusmn;\u0026thinsp;8,22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003eη\u0026thinsp;=\u0026thinsp;0,135\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003eF\u0026thinsp;=\u0026thinsp;21,944\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0,001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIntra-group Comparison\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eF\u0026thinsp;=\u0026thinsp;12,195\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0,001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF\u0026thinsp;=\u0026thinsp;0,529\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,591\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePre-treatment - First Month\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0,001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,946\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePre-treatment - Third Month\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0,001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFirst Month - Third Month\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1,000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003eMean; standard deviation, ss; standard deviation, F; Two-way mixed ANOVA test value for repeated measurements, η; eta coefficient, Fa; t-test, Fb; Repeated ANOVA, *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05; there is a difference between measurements.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e: Intragroup and Intergroup Comparison of VAS Scores\u003c/p\u003e\u003cp\u003e\u003cb\u003eIn independent comparisons between groups;\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eThere was no statistically significant difference between TMS and placebo groups in pre-treatment Visual Analogue Scale (VAS) scores (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSignificant differences were found between the groups in VAS scores at the first and third months of treatment (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eIn intra-group comparisons according to time;\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eA significant change in VAS scores was observed in the TMS group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThere was a significant difference between pre-treatment and first month and between pre-treatment and third month (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), while the difference between first month and third month was not significant (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThe change in VAS scores in the placebo group was not found to be significant in relation to time (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eTinnitus Degrees\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eThe pre-treatment and post-treatment first and third month grades are presented in Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e. In the TMS group, a significant decrease in tinnitus degrees was observed in the first and third months after treatment and a more significant improvement was achieved compared to the placebo group. While there was a 26.3% Grade 3 superiority in the TMS group before treatment, this superiority shifted to Grade 2 with a rate of 28.9% at the end of the third month. In the placebo group, while there was a 26.3% Grade 3 superiority before treatment, this superiority was observed to be in the direction of Grade 5 in the third month.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of Tinnitus Degree\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003en / %\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eBefore\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eFirst Month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003eThird Month\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTMS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePlasebo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTMS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePlasebo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eTMS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ePlasebo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e\u003cp\u003e\u003cb\u003eTinnitus Severity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eGrade 1\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5,3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2,6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e21,1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2,6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e23,7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2,6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eGrade 2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23,7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e18,4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e23,7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15,8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e28,9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e23,7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eGrade 3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26,3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26,3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e31,6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e23,7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e23,7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e18,4%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eGrade 4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23,7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26,3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e13,2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e26,3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e15,8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e26,3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eGrade 5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21,1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26,3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10,5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e31,6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7,9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e28,9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e38\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e38\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e38\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e38\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e38\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e38\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e100,0%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e100,0%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e100,0%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e100,0%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e100,0%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e100,0%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u0026bull; n; frequency, %; percentage\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e: Distribution of Tinnitus Degree\u003c/p\u003e\u003cp\u003eThe numerical distribution of tinnitus grades of the TMS and placebo groups before treatment and at the first and third month after treatment are presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e While the most common grade in the TMS group was Grade 3 with 10 patients before treatment, this superiority shifted to Grade 2 with 11 patients in the third month after treatment and the number of patients in Grade 1 increased from 2 to 9. In the placebo group, Grade 3, Grade 4 and Grade 5 had the highest number of patients (10 patients) before the treatment, while this superiority shifted towards Grade 5 with 11 patients at the end of the treatment.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eIn tinnitus grading, Grade 5, which is the highest grade according to the Tinnitus Handicap Index (THI) scores, is considered to be the group most affected by tinnitus. As a result of the evaluation of Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, it was understood that the response to treatment was significantly better in the TMS group, while in the placebo group, the response to treatment remained poor and even a tendency to worsen in the grading was observed.\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e: TMS Group Tinnitus Degree Distributions\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e: Placebo Group Tinnitus Degree Distributions\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn the literature, the relationship between tinnitus and depression is around 30% and it has been reported that 50% of patients receiving psychological treatment have tinnitus (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Because of this close relationship, instead of treating tinnitus alone, the psychological status of the patient should be taken into consideration, symptoms should be conveyed through psycho-education, patient fears should be reduced and excessive treatment expectations should be controlled. Acoustic and psychosomatic tests are widely used in the literature to evaluate the effectiveness of tinnitus treatment (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). In this study, patients with tinnitus were divided into TMS and placebo groups and the efficacy of TMS was evaluated by psychoacoustic and psychosomatic tests and the results were compared with the current literature.\u003c/p\u003e\u003cp\u003eWhen the distribution of tinnitus according to gender is analysed, it has been reported that it is more common in males in some studies, whereas the ratio of males and females is equal in others (\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In our study, the rate of male patients was compatible with the literature with 72.4%. According to the age factor, it has been reported in the literature that tinnitus is more common in older ages (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), and in our study, the mean age was found to be 49.76\u0026thinsp;\u0026plusmn;\u0026thinsp;10.28 in the TMS group and 49.24\u0026thinsp;\u0026plusmn;\u0026thinsp;12.96 in the placebo group. The fact that the majority of the patients were elderly is in parallel with the literature. Although there are different results in the literature about whether tinnitus is unilateral or bilateral (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), 81.6% unilateral and 18.4% bilateral tinnitus was observed in our study. In addition, it has been reported in the literature that tinnitus is more common in the left ear (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), and in our study, 52% of the patients had tinnitus in the left ear.\u003c/p\u003e\u003cp\u003eIn the literature, psychosomatic tests are generally preferred in the follow-up of rTMS efficacy, but we used both psychoacoustic and psychosomatic tests in our study. Tinnitus frequency, one of the psychoacoustic tests, was measured before treatment and at the first and third months after treatment. In the TMS group, the mean tinnitus frequency before treatment was 6830.17\u0026thinsp;\u0026plusmn;\u0026thinsp;3371.99 Hz, while it was the same value in the placebo group. These values were 5794.03\u0026thinsp;\u0026plusmn;\u0026thinsp;2467.18 Hz and 6472\u0026thinsp;\u0026plusmn;\u0026thinsp;2034.32 Hz in the first month and 4869.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1914.32 Hz and 6232.41\u0026thinsp;\u0026plusmn;\u0026thinsp;1416.88 Hz in the third month, respectively. The change in tinnitus frequency between the groups was not statistically significant (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). This finding is consistent with the study by Tae Soo et al. who similarly found no significant difference in tinnitus frequency (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). In 2017, it was reported that measurements made with the tinnitometry device developed in 2017 did not produce a significant difference compared to traditional audiometry (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn our study, tinnitus severity, another psychoacoustic test, was also evaluated. There are studies in the literature showing that tinnitus severity decreased in TMS treatment (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Our results showed significant differences in tinnitus severity in both groups in the first and third months before and after treatment (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The mean tinnitus severity before treatment was 57.43\u0026thinsp;\u0026plusmn;\u0026thinsp;16.73 in the TMS group and 64.45\u0026thinsp;\u0026plusmn;\u0026thinsp;20.72 in the placebo group; 48.26\u0026thinsp;\u0026plusmn;\u0026thinsp;15.18 and 68.82\u0026thinsp;\u0026plusmn;\u0026thinsp;18.9 in the first month and 48.76\u0026thinsp;\u0026plusmn;\u0026thinsp;15.6 and 67.53\u0026thinsp;\u0026plusmn;\u0026thinsp;17.73 in the third month, respectively.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn this study, we investigated the efficacy of Repetitive Transcranial Magnetic Stimulation (rTMS) treatment in patients with subjective tinnitus using psychoacoustic and psychosomatic tests. Our findings revealed that although there was no significant change in tinnitus frequency between groups, there were statistically significant improvements in tinnitus severity, Tinnitus Handicap Index (THI), Beck Depression Scale (BDS) and Visual Analogue Scale (VAS) scores in the rTMS group. In the placebo group, no significant change was observed in these parameters, and even a worsening trend was found in tinnitus grading.\u003c/p\u003e\u003cp\u003eThese results suggest that rTMS treatment has positive effects on the severity and psychological effects of tinnitus symptoms.\u003c/p\u003e\u003cp\u003eIn our study, the fact that tinnitus is more common in males, its prevalence increases with age, and that there are more complaints in the left ear was confirmed in accordance with the existing literature. In addition, the use of psychoacoustic and psychosomatic measurement tools together in the treatment of tinnitus is important for the multidimensional evaluation of treatment efficacy. In particular, psychological reflection of tinnitus and monitoring of depressive symptoms of patients are necessary for detailed follow-up of treatment success.\u003c/p\u003e\u003cp\u003eIn parallel with the findings in the literature that rTMS did not cause a significant change in tinnitus frequency, the frequency change did not show statistical significance in our study. However, the reduction in tinnitus severity and related psychosocial effects supports rTMS as a promising noninvasive method in the treatment of tinnitus. However, there is still no consensus on the parameters such as duration, frequency and target area of rTMS treatment. Therefore, further studies are needed to standardise the treatment protocols and increase the efficacy.\u003c/p\u003e\u003cp\u003eIn conclusion, rTMS can be considered as a treatment option with minimal side effects, high applicability and the potential to improve the quality of life of patients in the treatment of tinnitus. Its use in combination with neuroimaging techniques may increase treatment efficacy and provide a better understanding of the pathophysiology of tinnitus. Future randomized controlled trials will more definitively establish the role of rTMS in the treatment of tinnitus.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAgit ŞİMŞEK design of the work OR interpretation of data OR have drafted the work or substantively revised itOğuz KARAKAŞ design of the work OR the acquisition, analysis OR interpretation of dataMehmet TAN design of the work OR\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJastreboff P, Gray W, Mattox D. Tinnitus and hyperacusis. Otolaryngol Head Neck Surg. 1998;165:3198\u0026ndash;222.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChung DY, Gannon RP, Mason K. Factors affecting the prevalence of tinnitus. \u003cem\u003eAudiology\u003c/em\u003e 1984, 23(5): 441\u0026ndash;452\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSindhusake D, Mitchell P, Newall P, Golding M, Rochtchina E, Rubin G. Prevalence and characteristics of tinnitus in older adults: the Blue Mountains Hearing Study. \u003cem\u003eInt J Audiol\u003c/em\u003e 2003, 42(5): 289\u0026ndash;294.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKim HJ, Lee HJ, An SY, Sim S, Park B, Kim SW, et al. Analysis of the prevalence and associated risk factors of tinnitus in adults. \u003cem\u003ePLoS One\u003c/em\u003e 2015, 10(5)\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eElliott B. Diagnosing and treating hypothyroidism. \u003cem\u003eNurse Pract\u003c/em\u003e 2000, 25(3): 92\u0026ndash;105.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShargorodsky J, Curhan GC, Farwell WR. Prevalence and characteristics of tinnitus among US adults. \u003cem\u003eAm J Med\u003c/em\u003e 2010, 123(7): 711\u0026ndash;718\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGopinath B, McMahon CM, Rochtchina E, Karpa MJ, Mitchell P. Risk factors and impacts of incident tinnitus in older adults. \u003cem\u003eAnn Epidemiol\u003c/em\u003e 2010, 20(2): 129\u0026ndash;135.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShore SE, Roberts LE, Langguth B. Maladaptive plasticity in tinnitus-triggers, mechanisms and treatment. \u003cem\u003eNat Rev Neurol\u003c/em\u003e 2016, 12(3): 150\u0026ndash;160\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoller AR. Pathophsiology of Tinnitus. \u003cem\u003eAnn Otol Rhinol Laryngol\u003c/em\u003e 1984, 93(2): 39\u0026ndash;44\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBartnik, G., Baguley, D.M., Kleinjung, T., Savastano, M., \u0026amp; Hough, E.A. Troublesome tinnitus in childhood and adolescence: data from expert centres. \u003cem\u003eInternational Journal of Pediatric Otorhinolaryngology\u003c/em\u003e 2013,77(2): 248\u0026ndash;251\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBartels H, Pedersen SS, van der Laan BF, Staal MJ, Albers FW, Middel B. The impact of Type D personality on health-related quality of life in tinnitus patients is mainly mediated by anxiety and depression. \u003cem\u003eOtol Neurotol\u003c/em\u003e 2010, 31(2):11\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLangguth B, Zowe M, Landgrebe M, Sand P, Kleinjung T, Binder H. Transcranial magnetic stimulation for the treatment of tinnitus: a new coil positioning method and first results. Brain Topogr 2006 18(4):241\u0026ndash;7\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBiswas R, Genitsaridi E, Trpchevska N, Lugo A, Schlee W, Cederroth CR, Gallus S, Hall DA. Low Evidence for Tinnitus Risk Factors: A Systematic Review and Meta-analysis. J Assoc Res Otolaryngol 2023, 24(1):81\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStouffer JL, Tyler RS. Characterization of tinnitus by tinnitus patients. J Speech Hear Disord 1990, 55(3):439\u0026ndash;53\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKrog NH, Engdahl B, Tambs K. The association between tinnitus and mental health in a general population sample: results from the HUNT Study. J Psychosom Res 2010, 69(3):289\u0026ndash;98\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTang D, Li H, Chen L. Advances in Understanding, Diagnosis, and Treatment of Tinnitus. Adv Exp Med Biol 2019, 1130:109\u0026ndash;128\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAkyıldız N. Kulak Hastalıkları ve Mikrocerrahisi ed). Bilimsel Tıp Yayınevi, Ankara 2002,pp 67\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWu BP, Searchfield G, Exeter DJ, Lee A. Tinnitus prevalence in New Zealand. N Z Med J 2015, 16;128(1423):24\u0026ndash;34\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBaguley D, McFerran D, Hall D. Tinnitus. Lancet 2013, 382(9904):1600\u0026ndash;1607\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYenig\u0026uuml;n A, Doğan R, Aksoy F, Aky\u0026uuml;z S, Dabak H. Assessment of tinnitus with tinnitus severity index, tinnitus handicap inventory and distortion product otoacoustic emissions in patients with normal hearing and hearing loss. Kulak Burun Bogaz Ihtis Dergisi 2014, 24(1):11\u0026ndash;6\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAydın M, Erkan M, G\u0026uuml;ndoğdu R, Vural A, K\u0026ouml;koğlu K, Şahin Mİ. Assessment of the Effectiveness of Transcranial Magnetic Stimulation in Subjective Tinnitus. Int Arch Otorhinolaryngol. 2021,25(3):453\u0026ndash;458\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNoh TS, Kyong JS, Park MK, Lee JH, Oh SH, Suh MW. Dual-site rTMS is More Effective than Single-site rTMS in Tinnitus Patients: A Blinded Randomized Controlled Trial. Brain Topogr. 2020;33(6):767\u0026ndash;775.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVernon J, Fenwick J. Identification of tinnitus: a plea for standardization. J Laryngol Otol 1984, 98:45\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJastreboff P, Gray W, Mattox D. Tinnitus and hyperacusis. Otolaryngol Head Neck Surg 1998, 165:3198\u0026ndash;222\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Tinnitus frequency, Tinnitus severity, Transcranial Magnetic Stimulation, Tinnitus Disability Questionnaire","lastPublishedDoi":"10.21203/rs.3.rs-7231296/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7231296/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTinnitus is a very common symptom in the society and although it can affect all age groups, it is especially common in the elderly. Due to the uncertainty in its etiopathogenesis, there is currently no definitive treatment method with proven efficacy. In this study, we aimed to evaluate the effectiveness of Repetitive Transcranial Magnetic Stimulation (rTMS) for the suppression of increased neuronal activity. In this context, the effect of rTMS on tinnitus was analysed using various tests and scales.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study included 38 patients aged 18-70 years with tinnitus and a control group consisting of 38 age- and sex-matched healthy individuals. The frequency and severity of the symptoms of individuals with tinnitus were measured; Tinnitus Disability Questionnaire (TEA), Visual Analogue Scale (VAS) and Beck Depression Scale (BDS) were applied. The study group underwent rTMS treatment, and statistical comparisons were made between the two groups by repeating the measurements compared to pre-treatment values at both 1 and 3 months.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was no statistically significant difference between the rTMS and control groups in tinnitus frequency measurements between pre-treatment and 1 and 3 months post-treatment (p \u0026gt; 0.05). However, a significant difference was found in tinnitus severity measurements (p \u0026lt; 0.05). Statistically significant differences were observed between rTMS and placebo groups in TEA, VAS and BDI scores before and after treatment (p \u0026lt; 0.05). When the groups were evaluated within themselves, significant time-dependent changes were found in tinnitus frequency, severity and questionnaire scores in the rTMS group (p \u0026lt; 0.05), while no significant change was found in these parameters in the placebo group (p \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn our study, rTMS treatment was shown to have favourable effects on tinnitus symptoms. However, the fact that there is still no consensus on the site, duration and frequency of application and the inconsistent results in the existing literature limit the routine clinical use of rTMS. The use of advanced neuroimaging techniques in combination with rTMS may increase the effectiveness of the treatment and allow the development of a more standardised application protocol. It is likely that rTMS, which attracts attention with its noninvasive nature and minimal side effects, will become an FDA-approved option in the treatment of tinnitus as well as depression in the future.\u003c/p\u003e","manuscriptTitle":"Evaluation of the Effectiveness of Transcranial Magnetic Stimulation in the Treatment of Subjective Tinnitus with Psychoacoustic Tests and Psychosomatic Tests","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-03 06:12:52","doi":"10.21203/rs.3.rs-7231296/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"02a7bc54-80eb-4505-826a-17067b0e4418","owner":[],"postedDate":"September 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-09T12:23:21+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-03 06:12:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7231296","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7231296","identity":"rs-7231296","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}