Low-Frequency rTMS for Refractory Tinnitus Study

A 30-year-old patient with severe, treatment-resistant chronic tinnitus saw her Tinnitus Handicap Inventory score drop from 98 to 50 over a year. This change followed three separate courses of repetitive transcranial magnetic stimulation (rTMS). Her psychological distress scores also fell substantially. A new single-subject case study suggests that repeated rTMS courses may offer a path to sustained relief for some people with refractory tinnitus.

A Protocol for Refractory Cases: Three Courses of rTMS

Chronic tinnitus that does not respond to standard treatments poses a significant clinical challenge. While single courses of repetitive transcranial magnetic stimulation have shown short-term promise, their lasting effects are often unclear. Researchers Ardıl Bayram Şahin, Melike Kocahasan, and Rışvan Deniz designed a retrospective case study to examine a more intensive approach. They followed a single patient—a 30-year-old woman with severe, refractory tinnitus—over a year. She received three identical courses of rTMS, each consisting of 10 daily sessions. The stimulation targeted the left auditory cortex with a low-frequency (1 Hz) protocol at 110% of the resting motor threshold. The patient used no tinnitus medications during the study period.

The team measured outcomes using multiple tools. Tinnitus severity was tracked with the Tinnitus Handicap Inventory (THI), Tinnitus Severity Index (TSI), and a visual analog scale (VAS). Psychiatric symptoms were assessed with scales for depression (PHQ-9), anxiety (GAD-7), chronic stress (CSS), and overall psychological distress (SCL-90-R). Standard audiometric evaluations monitored hearing. To quantify changes, the researchers calculated standardized mean change indices, which compare score changes to normative population data.

Progressive Reduction in Tinnitus and Psychological Distress

The results showed a clear trend. From the start of the first course to the end of the third, tinnitus severity scores dropped progressively. The THI score fell from 98 (indicating catastrophic handicap) to 50 (moderate handicap). The TSI score moved from 59 to 41, and the patient’s rating of tinnitus loudness on the VAS halved, from 10 to 5. The calculated effect sizes for these changes were large, ranging from -2.00 to -2.34.

Perhaps as significant were the changes in psychological health. Scores for depression, anxiety, and stress all decreased markedly. The most substantial improvements in these areas occurred after the first rTMS course, with scores then stabilizing at lower levels through the subsequent courses. The global measure of psychological distress (SCL-90-R) also showed a sustained decline, with improvements across multiple symptom domains like somatization and obsessive-compulsive traits. Throughout the entire follow-up period, the patient’s pure-tone hearing thresholds remained stable, confirming the rTMS did not harm peripheral hearing.

This pattern of co-occurring improvement aligns with other research on the mind-body connection in hearing health. For instance, studies on how stressors alter heart rate patterns in people with tinnitus highlight the strong link between auditory perception and emotional state.

Implications: Changing Perception, Not Sound

The authors offer an important interpretation of their findings. They note that the patient’s reported tinnitus severity varied somewhat with her affective and stress states during the study period. This observation leads them to a hypothesis: the benefit of repeated rTMS may not be erasing the tinnitus signal itself, but rather reducing the attentional bias and emotional reaction to it. By modulating cortical activity in the auditory and connected networks, the treatment could help the brain classify the tinnitus sound as less salient and less threatening.

This mechanism is distinct from treatments aimed at the ear or auditory nerve. It focuses on the central processing of sound, an area of growing interest in hearing science. Research into conditions like hidden hearing loss, for example, is also shifting focus toward neural synchrony and central gain in the brainstem and cortex.

The psychological improvements are critical. Chronic tinnitus is often accompanied by mood disorders, and this case suggests rTMS may address both simultaneously. The connection between mental health and symptom burden is not unique to tinnitus; similar relationships are seen in sleep medicine, where baseline depression can predict long-term outcomes of cognitive behavioral therapy for insomnia.

Future Directions and Cautions

This study provides a detailed, longitudinal look at a novel treatment protocol for a difficult condition. It adds to the evidence base for neuromodulation approaches like low-frequency rTMS for refractory tinnitus. However, the authors are explicit about its limitations. As a single-subject case study, the results cannot be generalized. The patient’s improvements, while compelling, may not be replicable in all individuals with treatment-resistant tinnitus.

The clear call is for larger, controlled trials to test the efficacy of repeated rTMS courses. Key questions remain: What is the optimal number of courses and the ideal spacing between them? Which patient profiles are most likely to benefit? How long do the effects truly last after the final course? Answering these will require studies with more participants and longer follow-up periods.

For patients and clinicians, this case offers a note of cautious optimism. It suggests that for some individuals, a longer-term neuromodulation strategy, rather than a single short course, might be necessary to achieve and maintain meaningful relief. It reinforces the idea that effective tinnitus management often requires addressing both the perceptual and the emotional components of the condition.

Source: Şahin, A. B., Kocahasan, M., & Deniz, R. (2026). Long-term outcomes of repeated courses of repetitive transcranial magnetic stimulation in treatment-resistant chronic tinnitus: A single-subject case study. Frontiers in Psychiatry. DOI: 10.3389/fpsyt.2026.1870689.