Low-Frequency rTMS for Refractory Tinnitus Treatment

A 30-year-old woman with severe, treatment-resistant chronic tinnitus saw her Tinnitus Handicap Inventory score drop from 98 to 50 after receiving three separate courses of repetitive transcranial magnetic stimulation (rTMS) over one year. A new single-subject case study suggests that repeated application of this non-invasive brain stimulation may be associated with lasting reductions in both tinnitus severity and related psychological distress.

## A Detailed Look at the rTMS Protocol

Researchers Ardıl Bayram Şahin, Melike Kocahasan, and Rışvan Deniz designed a retrospective case study to examine the long-term effects of repeated rTMS. The patient was a 30-year-old female with severe, chronic tinnitus that had not responded to previous treatments. She remained off all tinnitus or psychiatric medications for the study’s duration.

The team administered three identical rTMS courses over one year, with breaks between each series. Each course consisted of 10 daily sessions. The stimulation targeted the left auditory cortex with a low frequency of 1 Hz, set at 110% of the patient’s resting motor threshold. This low-frequency protocol is thought to reduce cortical excitability in hyperactive brain regions often implicated in tinnitus perception. You can read more about the principles behind this approach in our related article on Low-Frequency rTMS for Refractory Tinnitus.

## Progressive Reductions in Tinnitus Severity and Distress

The patient’s progress was tracked using multiple standardized tools. The primary outcome was tinnitus severity, measured by the Tinnitus Handicap Inventory (THI), Tinnitus Severity Index (TSI), and a simple visual analog scale (VAS).

The results showed a clear, cumulative benefit. The THI score fell from a severe 98 at baseline to 50 after the third course. The TSI dropped from 59 to 41, and the VAS rating of tinnitus loudness/annoyance halved from 10 to 5. The researchers calculated standardized effect sizes, which were large, ranging from -2.00 to -2.34. This indicates the changes were substantial relative to typical score variations on these questionnaires.

Concurrently, her psychiatric symptoms improved significantly. Scores on depression (PHQ-9), anxiety (GAD-7), and stress (CSS) scales all dropped, with the most pronounced shift happening after the initial rTMS course. A broad measure of psychological distress, the SCL-90-R, also showed sustainable decline across its subscales. This interplay between tinnitus perception and emotional state is a key focus of therapies like Tinnitus CBT, which aims to manage the distress caused by the condition.

Importantly, repeated audiometric evaluations confirmed the patient’s peripheral hearing thresholds did not change. This finding rules out the possibility that the improvements were due to or caused by changes in basic hearing function.

## Implications for Managing Refractory Tinnitus

This detailed case study offers several practical insights. First, it provides preliminary evidence that the benefits of rTMS for tinnitus may be amplified or extended with repeated application. While short-term studies have shown promise, long-term sustainability has been a major question. Here, the effects not only persisted but appeared to strengthen across three treatment cycles over a year.

Second, the parallel improvement in mood and stress symptoms is notable. The authors hypothesize that rTMS may not “cure” the tinnitus sound but instead reduce the brain’s attentional bias and negative emotional response to it. By modulating network activity in the auditory cortex and connected limbic regions, the treatment may help decouple the sound from the distress it causes. This mechanism shares a conceptual similarity with neuromodulation approaches explored for other sound sensitivity conditions, such as Transcutaneous Vagus Nerve Stimulation for Misophonia.

The connection between affective state and treatment response also mirrors findings in other domains of behavioral health. For instance, research on cognitive behavioral therapy for insomnia has shown that baseline depression can predict long-term outcomes, highlighting the importance of addressing co-occurring psychological factors.

## A Call for Larger, Controlled Investigations

The authors are clear about the limitations of a single-subject case design. Without a control group or blinding, it is impossible to definitively attribute the improvements to the rTMS itself versus placebo or natural fluctuation. The patient’s medication-free status, however, strengthens the observation that the changes coincided with the treatment periods.

This case acts as a strong justification for more rigorous research. Controlled trials with larger groups are needed to confirm whether repeated rTMS courses are a viable strategy for people with chronic, treatment-resistant tinnitus. Future studies should also aim to identify which patients are most likely to respond based on their tinnitus characteristics, brain activity patterns, and psychological profiles.

The full study, “Long-term outcomes of repeated courses of repetitive transcranial magnetic stimulation in treatment-resistant chronic tinnitus: A single-subject case study,” by Şahin, Kocahasan, and Deniz, is available for review (DOI: 10.3389/fpsyt.2026.1870689).