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 after receiving three separate courses of repetitive transcranial magnetic stimulation over one year. This single-subject case study suggests repeated non-invasive brain stimulation may offer a path to sustained relief for some of the most difficult cases.

A Protocol for Persistent Tinnitus

Researchers Ardıl Bayram Şahin, Melike Kocahasan, and Rışvan Deniz designed this retrospective case study to test if repeated application of rTMS could produce lasting benefits where single courses often fail. The patient was a 30-year-old woman with severe, chronic tinnitus that had not responded to other treatments. She received three identical rTMS courses over 12 months, remaining off all tinnitus medications during the study.

Each course consisted of 10 daily sessions. The team applied low-frequency (1 Hz) magnetic stimulation to the left auditory cortex, set at 110% of the patient’s individual resting motor threshold. This protocol targets brain hyperactivity often associated with tinnitus perception.

Progressive Decline in Tinnitus Severity and Distress

The team measured outcomes using three tinnitus-specific tools and several psychiatric questionnaires. The results showed a clear, progressive improvement.

The Tinnitus Handicap Inventory (THI) score, a measure of tinnitus-related life impact, fell from a severe 98 at baseline to 50 after the third course. The Tinnitus Severity Index (TSI) dropped from 59 to 41, and the patient’s subjective rating on a visual analog scale halved, from 10 to 5. The effect sizes for these changes were large, quantified between -2.00 and -2.34 using standardized mean change indices.

Psychological improvements were equally striking. Scores for depression (PHQ-9), anxiety (GAD-7), and perceived stress all dropped significantly. The most substantial psychological shift happened after the initial rTMS course, with scores then stabilizing. Global psychological distress, measured by the SCL-90-R, also declined and remained lower, indicating a broad and sustained reduction in suffering. This connection between tinnitus relief and improved mental health is well-documented, as seen in resources on the link between PTSD and tinnitus and guides for managing distress with CBT.

Critically, standard audiometric tests confirmed the patient’s peripheral hearing thresholds did not change. This finding rules out the possibility that the improvements came from an alteration in basic hearing function and confirms the treatment’s target was central brain processes.

Implications: Shifting Attention, Not Sound

The authors offer an important interpretation of their results. They noted that the level of tinnitus relief fluctuated somewhat with the patient’s affective and stress states. This observation leads them to suggest that rTMS may not “cure” tinnitus by erasing the phantom sound itself. Instead, its benefit may come from reducing the brain’s attentional bias toward the tinnitus signal. By dampening hyperactivity in relevant cortical networks, the treatment could make the sound less salient and emotionally charged, thereby reducing its perceived severity and impact. This mechanism shares conceptual ground with other neuromodulation approaches, such as self-adjusting neuromodulation devices.

For patients, this distinction is practical. It means a successful treatment outcome might be measured by habituation and decreased reactivity, not necessarily absolute silence. The concurrent improvement in mood and stress scores supports this idea, as lower anxiety can break the cycle of negative attention focused on tinnitus.

Limitations and Future Research Directions

As a single-subject case study, these results cannot be generalized. The dramatic improvements seen here require confirmation in larger, randomized controlled trials. The study design also cannot definitively prove that rTMS caused the improvements, though the temporal association and magnitude of change are compelling.

The research by Şahin, Kocahasan, and Deniz provides a strong rationale for such trials. It demonstrates a protocol for repeated rTMS administration that was associated with cumulative benefit and no adverse effects on hearing. Future studies must determine which patients are most likely to respond and optimize the timing and number of treatment courses. The full details of the study are available in the source paper: Front. Psychiatry, 10.3389/fpsyt.2026.1870689.

For individuals with severe, refractory tinnitus, this case adds to the evidence that neuromodulation is a field worth watching. It also highlights the deep interconnection between auditory perception and emotional state, suggesting that comprehensive care addressing both areas, including strategies for managing sleep hygiene which is often disrupted by tinnitus, may yield the best long-term results.