Acoustic trauma in extracranial magnetic brain stimulation

The effects of the magnetic coil acoustic artifact (MCAA) associated with extracranial magnetic field stimulation (EMFS) of the brain were studied in normal hearing rabbits. Spectral and intensity analyses showed that the MCAA is a high intensity transient signal with peak energy between 2 and 5 kHz, and peak amplitudes in the first 100-200 mu sec. At EMFS levels of 50-100% of maximum output (2.0 Tesla), the corresponding MCAA levels were 131-142 dB sound pressure level (peak hold) at the outer ear and amplified by the external meatus to reach 145-157 dB sound pressure level (SPL) at the position of the tympanic membrane in rabbits. Measurements of the acoustic middle ear muscle reflex (AMR) in non-anesthetized rabbits indicated that exposure to EMFS levels of 50-100% resulted in correspondingly increasing compound threshold shifts (CTS) and permanent threshold shifts (PTS) in the unprotected ears of the experimental animals. Auditory brain-stem responses (ABR) measures on the same and additional animals corroborated these findings. Morphological studies showed evidence of substantial cochlear trauma at EMFS levels as low as 50%, with increasing severity up to 100% EMFS. Morphological examination of inner ear structures following exposure to the MCAA in the acute preparation (fixed within hours after exposure) showed ruptures between pillar cells and a detached organ of Corti. Preparations examined 3 or more weeks after exposure showed damaged pillar cells, a widespread loss of outer hair cells, fused and fractured inner hair cell stereocilia, and kinocilium outgrowth on inner hair cells. Although this extremely short impulse contains approximately 2 orders of magnitude less acoustic energy than a continuous noise exposure of 131 dB for 15 min, it is substantially more injurious to the cochlea. The present findings suggest that the acoustic artifact produced by the EMFS coil in some clinical instruments may pose a potential risk for temporary and permanent hearing loss in patients and clinicians when held in close proximity to the unprotected ear. Initial studies suggest that the magnetic field alone did not appear to cause permanent hearing impairment. We recommend the use of ear protectors for the patient and clinician during EMFS as a precautionary measure to prevent possible hearing loss from the MCAA.