Low-Frequency rTMS for Refractory Tinnitus Treatment

A 30-year-old patient with severe, treatment-resistant chronic tinnitus saw her Tinnitus Handicap Inventory score drop from 98 to 50 after three courses of repetitive transcranial magnetic stimulation (rTMS). This single-subject case study, published by researchers Ardıl Bayram Şahin, Melike Kocahasan, and Rışvan Deniz, suggests repeated rTMS courses may be associated with sustained reductions in both tinnitus severity and related psychological distress.

Studying Repeated rTMS in a Refractory Case

The research was a retrospective case study of a single patient. This individual had severe, chronic tinnitus that had not responded to other treatments. Over one year, she received three identical courses of low-frequency rTMS. Each course consisted of 10 sessions where magnetic pulses were applied to the left auditory cortex at 1 Hz.

The patient used no tinnitus medications during the study period, allowing the researchers to isolate the effects of the brain stimulation. The team measured outcomes using a multi-faceted approach. They tracked tinnitus severity with the Tinnitus Handicap Inventory (THI), Tinnitus Severity Index (TSI), and a visual analog scale (VAS). They also monitored psychiatric symptoms with tools like the PHQ-9 for depression and the GAD-7 for anxiety. Standard audiometric tests checked for any changes in hearing ability.

To quantify the changes, the authors calculated standardized mean change (SMC) indices. This statistical method compares score changes to the typical variation seen in the general population, helping to show whether an observed change is clinically meaningful.

Progressive Reduction in Tinnitus and Distress

The data showed a clear trend. After three rTMS courses, the patient’s THI score fell from a severe 98 to 50. Her TSI score dropped from 59 to 41, and her VAS rating halved from 10 to 5. The calculated effect sizes were large, ranging from -2.00 to -2.34 SMC. While the immediate response after each 10-session course varied, the overall direction was a progressive, stepwise improvement over the full year.

Perhaps just as significant were the changes in psychological well-being. Scores for depression, anxiety, and chronic stress all decreased markedly. The most substantial psychological shift happened after the first rTMS course, with benefits stabilizing afterward. The global measure of psychological distress (SCL-90-R) also declined sustainably, showing improvements across multiple symptom domains. The researchers noted that tinnitus severity scores often fluctuated in relation to the patient’s reported stress and mood, implying a strong link.

Audiometric evaluations confirmed that the patient’s pure-tone hearing thresholds did not change. This indicates the rTMS protocol did not damage peripheral hearing, a important safety consideration. For readers interested in the complex relationship between auditory function and perception, our article on Hidden Hearing Loss: Modern Diagnosis Advances explores related challenges.

Implications: A Shift in Attention, Not Sensation?

The authors propose a compelling interpretation of their findings. The parallel improvement in tinnitus perception and psychological symptoms suggests the treatment’s benefit may not be in “erasing” the tinnitus signal. Instead, repeated rTMS may reduce the brain’s attentional bias toward the sound and its associated emotional distress. By modulating cortical activity, the therapy could help decouple the tinnitus sensation from the negative emotional and stress responses that amplify suffering.

This idea aligns with other neuromodulation approaches. For instance, research on Neurofeedback Reduces Tinnitus by Modifying Brain Connectivity also targets maladaptive brain networks. The observed link between stress and symptom severity further underscores the need to address the emotional component of tinnitus, a connection detailed in our analysis of Stressors & Heart Rate: Tinnitus Study Insights.

Practical Considerations and Future Research

This case study offers cautious optimism. It provides preliminary evidence that repeated courses of low-frequency rTMS could be a viable strategy for managing otherwise refractory chronic tinnitus, particularly when it is accompanied by significant psychological distress. The treatment was associated with sustained benefits over one year without the need for concurrent medication.

However, the study has clear limitations. As a single-subject, retrospective design, it cannot establish cause and effect or predict how other patients will respond. The findings urgently require validation in larger, randomized controlled trials. Future research must determine optimal protocols: how many sessions per course, how many courses, and at what intervals. The role of individual factors like tinnitus characteristics, brain anatomy, and baseline psychological state also needs investigation.

The interplay between sleep, mood, and chronic conditions is well-recognized. The psychological improvements seen in this tinnitus case resonate with findings in sleep medicine, where baseline mental state often predicts outcomes, as discussed in the cross-site article “CBT-I Outcomes: Baseline Depression Predicts Long-Term Results”.

In summary, this detailed case report adds to the evidence base for Low-Frequency rTMS for Refractory Tinnitus. It shifts the conversation from single treatment attempts to the potential of repeated, periodic courses for long-term management. The associated reduction in co-occurring anxiety and depression highlights the importance of treating the whole patient, not just the phantom sound.

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 retrospective single-subject case study. Frontiers in Psychiatry. DOI: 10.3389/fpsyt.2026.1870689.