Low-Frequency rTMS for Refractory Tinnitus

A 30-year-old patient with severe, treatment-resistant chronic tinnitus saw her Tinnitus Handicap Inventory score drop from 98 to 50 over one year, following three separate courses of repetitive transcranial magnetic stimulation (rTMS). A new single-subject case study suggests that repeated, low-frequency rTMS may be associated with progressive, long-term reductions in both tinnitus severity and related psychological distress without the use of medication.

Method: Evaluating Repeated rTMS Courses Over One Year

Researchers Ardıl Bayram Şahin, Melike Kocahasan, and Rışvan Deniz conducted a retrospective case study on a single patient with severe, chronic tinnitus that had not responded to previous treatments. The patient, a 30-year-old woman, remained off all tinnitus or psychiatric medications for the study’s duration.

She received three identical courses of rTMS over 12 months. Each course consisted of 10 sessions where a low-frequency (1 Hz) magnetic pulse was applied to the left auditory cortex. The stimulation intensity was set to 110% of her resting motor threshold. To track changes, the team used a multi-dimensional assessment approach.

Tinnitus severity was measured using three tools: the Tinnitus Handicap Inventory (THI), the Tinnitus Severity Index (TSI), and a visual analog scale (VAS) where the patient rated her tinnitus from 0 to 10. Psychiatric symptoms were tracked with validated questionnaires for depression (PHQ-9), anxiety (GAD-7), chronic stress (CSS), and overall psychological distress (SCL-90-R). Standard audiometric evaluations were performed to monitor hearing. The team used standardized mean change indices to quantify the effect size of any improvements.

Findings: Progressive Decline in Severity and Distress

The data showed a clear, progressive decline in tinnitus severity measures across the three treatment courses. The THI score fell from 98 (indicating catastrophic handicap) to 50 (moderate handicap). The TSI dropped from 59 to 41, and the patient’s personal VAS rating halved from 10 to 5. While short-term responses after each course varied, the overall effect sizes were large, ranging from -2.00 to -2.34.

Perhaps just as significant were the changes in psychological health. Scores for depression, anxiety, and stress all decreased substantially. The most pronounced psychological improvements occurred after the first rTMS course, with later courses helping to stabilize these gains. The global measure of psychological distress (SCL-90-R) also showed a sustained decline, indicating broad-based mental health benefits. Audiometric tests confirmed that the rTMS treatment did not negatively affect the patient’s peripheral hearing.

Implications: A Path for Refractory Cases and a Proposed Mechanism

This case offers a potential roadmap for managing refractory chronic tinnitus. The progressive improvement across multiple courses suggests that, for some patients, rTMS may not be a one-time intervention but part of an ongoing management strategy. The study provides preliminary evidence that repeated applications can be safe from an auditory perspective, a necessary consideration for any tinnitus therapy.

The pattern of improvement—linked strongly with reductions in affective and stress symptoms—led the authors to a specific interpretation. They propose that the rTMS may not have “silenced” the tinnitus percept itself. Instead, it may have reduced the brain’s attentional bias and emotional reaction to the sound, making it less intrusive and disabling. This aligns with neurological models of tinnitus that emphasize the role of non-auditory brain networks. For readers interested in other brain-based approaches, our site explores how neurofeedback reduces tinnitus by modifying brain connectivity.

Connections to Broader Hearing Health and Management

This research sits within a wider context of advancing neuromodulation for hearing disorders. The targeted, non-invasive nature of rTMS shares conceptual ground with other emerging technologies. For instance, self-adjusting neuromodulation for tinnitus relief also aims to give patients control over their therapy. Furthermore, the study’s focus on a patient with normal peripheral hearing highlights that the root of chronic tinnitus often lies in the brain. This underscores the importance of the diagnostic workup discussed in articles like Hidden Hearing Loss: Diagnosis & Tinnitus, which explores subtler auditory pathway dysfunctions.

The significant reduction in comorbid anxiety and depression also highlights the tight link between mental health and tinnitus perception. This supports the use of integrated therapeutic approaches. Cognitive Behavioral Therapy (CBT), for example, is a well-established psychological method for managing the distress of tinnitus, as detailed in our guide to Tinnitus CBT. The psychological improvements seen in this rTMS case mirror desired outcomes of such behavioral therapies.

Conclusion and Call for Further Research

The case study by Şahin, Kocahasan, and Deniz provides a detailed, long-term look at repeated rTMS for a tough-to-treat condition. Their work, available in the source paper (DOI: 10.3389/fpsyt.2026.1870689), documents a promising association between multiple treatment courses and sustained reductions in both tinnitus severity and psychological burden.

Crucially, the authors note that the observed changes varied with the patient’s affective state, supporting a model where treatment alters the brain’s reaction to tinnitus rather than the phantom sound itself. They conclude that these findings warrant larger, controlled studies to definitively test the efficacy of repeated rTMS courses. For patients and clinicians, this adds another data point suggesting that for chronic, refractory tinnitus, effective management may require sustained, multi-modal intervention targeting both auditory and emotional processing pathways.