Transcranial direct current stimulation (tDCS), a treatment option for tinnitus in profound hearing loss

A 45-year-old man presented with a history of sudden sensory neural hearing loss and severe tinnitus in his left ear. Audiological investigations revealed a profound hearing loss on his left ear and mild conductive hearing loss on his right. Tinnitus pitch and loudness were matched to a 4 kHz narrow-band noise at 50dBHL and subjective tinnitus questionnaires revealed that he had a catastrophic handicap (grade IV). Traditional audiological treatment approaches (tinnitus maskers, hearing aid and sound therapy) that stimulate the cochlea to induce cortical reorganisation were futile. Hence, a top-down approach (transcranial direct current stimulation (tDCS)) to directly modulate the cortical centres was attempted. tDCS was provided for a sum of 15 sessions across 2 phases. There was a substantial improvement in the tinnitus loudness, distress and depression scores which maintained for 3 months post-treatment. tDCS is a potential treatment for phantom perceptions (tinnitus) in cases of profound sensory neural hearing loss where there is no residual sensory ability. Tailor-made approaches seem to be more appropriate until a standard protocol for tDCS in tinnitus is established.