Treatment effects of combined transcranial direct current stimulation and counseling for the treatment of chronic tinnitus

Aims

We aimed to evaluate the comparative efficacy of three treatment modalities for chronic tinnitus: TRT-based directive counseling, transcranial direct current stimulation (tDCS), and their combination. Primary endpoints were changes in tinnitus severity and psychological distress; secondary endpoints included treatment response rates and anxiety reduction.

Methods

Forty-one patients with chronic tinnitus lasting 3 months or more of duration were enrolled who were treated at a tertiary hospital between November 2021 and December 2023. Patients were allocated to counseling (n = 11), tDCS (n = 19), or combined therapy (n = 11) based on informed preference. Treatment outcomes were assessed using the Tinnitus Handicap Inventory (THI), Visual Analog Scale (VAS), Beck's Depression Inventory (BDI), and Hospital Anxiety-Depression Scale (HADS). Statistical analysis included Wilcoxon Signed-Rank tests for within-group comparisons and Kruskal-Wallis tests for between-group analyses.

Results

Clinically significant improvement (THI reduction ≥7 points) was achieved in 70.7 % of patients overall: 63.6 % in counseling, 73.7 % in tDCS, and 72.7 % in combined therapy groups. Mean THI scores decreased significantly from 54.3 ± 22.8 to 37.7 ± 19.7 (p < 0.01). The combined therapy group showed superior anxiety reduction (HAD-A, p = 0.034) compared to single modalities. Both tDCS and combined therapy demonstrated greater improvements in multiple psychological measures compared to counseling alone.

Conclusion

Combined tDCS and counseling therapy shows enhanced efficacy in managing chronic tinnitus, particularly for patients with concurrent anxiety symptoms. This multimodal approach may provide a more comprehensive treatment strategy than single modalities alone. Future randomized controlled trials are needed to confirm these findings and establish optimal treatment protocols.