RT Journal Article SR Electronic T1 Sound comparison of seven TMS coils at matched stimulation strength JF bioRxiv FD Cold Spring Harbor Laboratory SP 606418 DO 10.1101/606418 A1 Lari M. Koponen A1 Stefan M. Goetz A1 Debara L. Tucci A1 Angel V. Peterchev YR 2019 UL http://biorxiv.org/content/early/2019/05/29/606418.abstract AB Background Accurate data on the sound emitted by transcranial magnetic stimulation (TMS) coils is lacking.Methods We recorded the sound waveforms of seven coils with high bandwidth. We estimated the neural stimulation strength by measuring the induced electric field and applying a strength–duration model to account for different waveforms.Results Across coils, at maximum stimulator output and 25 cm distance, the sound pressure level (SPL) was 98–125 dB(Z) per pulse and 75–97 dB(A) for a 15 Hz pulse train. At 5 cm distance, these values were estimated to increase to 112–139 dB(Z) and 89–111 dB(A), respectively.Conclusions The coils’ sound was below, but near, relevant exposure limits for operators and may exceed some limits for the subject. Exposure standards may inadequately capture some risks to hearing. For persons near operating TMS coils we recommend hearing protection, and we consider it essential for the TMS subject.Highlights Coil click varies by over 20 dB(Z) between TMS coils at matched stimulation strength.Close to TMS coil, sound pressure level may reach nearly 140 dB(Z).For rTMS, the continuous sound level can exceed 110 dB(A).Hearing protection is recommended during TMS, especially for the subject.