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.