Low-Frequency rTMS for Refractory Tinnitus

A single patient with severe, treatment-resistant chronic tinnitus experienced a substantial and progressive reduction in her symptoms after receiving three repeated courses of repetitive transcranial magnetic stimulation (rTMS) over one year. Her Tinnitus Handicap Inventory (THI) score fell from a severe 98 to a moderate 50, a change quantified as a large clinical effect.

How the Study Evaluated Repeated rTMS

Researchers Ardıl Bayram Şahin, Melike Kocahasan, and Rışvan Deniz conducted a retrospective case study on a 30-year-old female patient with severe chronic tinnitus that had not responded to other treatments. The team administered three identical rTMS courses over a 12-month period. Each course consisted of 10 sessions where 1 Hz stimulation was applied to the left auditory cortex at an intensity of 110% of the resting motor threshold.

The patient used no tinnitus medications during the study, allowing the team to isolate the effects of the brain stimulation. They measured outcomes using standardized tools: the Tinnitus Handicap Inventory (THI), Tinnitus Severity Index (TSI), and a tinnitus visual analog scale (VAS) for symptom severity. To capture the strong psychological component often linked to tinnitus, they also used psychiatric questionnaires for depression (PHQ-9), anxiety (GAD-7), stress (CSS), and overall psychological distress (SCL-90-R). Regular audiometric tests checked for any changes in peripheral hearing.

To gauge the clinical importance of the score changes, the authors calculated standardized mean change (SMC) indices. This method compares the change in a patient’s score to the typical variation seen in the general population, providing an effect size that shows whether a change is small, medium, or large.

Progressive Reduction in Tinnitus and Distress

The patient’s tinnitus severity showed clear, cumulative improvement across the three treatment cycles. The THI score fell from 98 (severe handicap) to 50 (moderate handicap). The TSI dropped from 59 to 41, and the VAS—where 10 represents the worst imaginable tinnitus—was halved from 10 to 5. The calculated effect sizes for these changes were large, ranging from -2.00 to -2.34.

Perhaps just as significant were the changes in psychological health. Scores for depression, anxiety, and chronic stress all decreased markedly. The most pronounced psychological shift happened after the first rTMS course, with scores then stabilizing at improved levels through the subsequent courses. The global measure of psychological distress (SCL-90-R) also showed a sustained decline, indicating broad improvement in mental well-being.

Throughout the follow-up period, the patient’s pure-tone audiometry thresholds remained stable. This finding is important for safety, as it suggests the targeted brain stimulation did not negatively affect her peripheral hearing function.

What These Improvements Might Mean

The authors note that while tinnitus severity decreased, the changes appeared to vary with the patient’s affective and stress states. This pattern leads them to a specific interpretation: the rTMS treatment may not have “erased” the tinnitus signal itself. Instead, it might have reduced the attentional bias and emotional distress associated with the sound.

In this model, the brain’s auditory cortex remains active, but the limbic and prefrontal networks that assign importance and negative emotion to the signal become less reactive. The sound becomes less salient and threatening, thereby reducing its perceived severity and impact on daily life. This mechanism aligns with neurophysiological models of tinnitus that emphasize the role of non-auditory brain networks. For more on the complex factors involved in hearing disorders, our article on stressors and heart rate patterns explores the body’s stress response in this context.

The study provides a real-world look at applying a known intervention—low-frequency rTMS for refractory tinnitus—in a novel, repeated protocol to achieve longer-term benefits. It adds to the growing evidence that managing the emotional reaction to tinnitus is a valid therapeutic target.

Practical Implications and Future Research

This single case study offers a proof of concept that repeated courses of rTMS could be a strategy for sustaining benefits in tough-to-treat tinnitus. The approach may be particularly relevant for patients who experience initial relief from rTMS but later see symptoms return, a common challenge with many neuromodulation therapies.

The concurrent improvement in psychiatric symptoms underscores the deep connection between chronic tinnitus and mental health. Effective treatment likely needs to address both. This connection is also seen in other conditions; for instance, research on CBT-I outcomes shows how baseline depression can influence long-term treatment results for insomnia, another condition closely tied to psychological state.

It is critical to remember this is a report of one individual. The results are promising but not conclusive. The authors explicitly state that the findings “warrant larger controlled studies.” Such future research must determine if these effects are reproducible across a broader population and how factors like treatment timing and individual brain differences influence outcomes. For a broader view of how tinnitus research has evolved, readers can explore the 40-year bibliometric analysis of trends in the field.

The full study, “Long-term outcomes of repeated courses of repetitive transcranial magnetic stimulation in treatment-resistant chronic tinnitus: A retrospective single-subject case study,” was published in Frontiers in Psychiatry and is available via DOI: 10.3389/fpsyt.2026.1870689.