A mild electrical current applied to a specific part of the brain could quiet the phantom ringing of tinnitus. Tinnitus affects millions of people, yet existing treatments are inconsistent—the same brain stimulation technique that helps one patient often fails another, and researchers do not fully understand why. This trial aims to solve that variability by tailoring the electrical dose to each individual’s brain anatomy and measuring how the stimulation actually changes brain activity, not just asking patients how they feel. If successful, the results would provide a reliable, non-invasive treatment for a condition that currently has no cure and few effective options. The research could also establish a simple brain-wave test—cortical auditory evoked potentials—as an objective way to measure tinnitus severity, replacing today’s reliance on subjective patient reports. That would make future clinical trials faster and more precise, accelerating the development of other therapies. This is a clinical trial with a clear practical goal: to turn a promising but unreliable technique into a dependable treatment.
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Transcranial direct current stimulation (tDCS) has been proposed as a non-invasive brain stimulation technique to alleviate tinnitus. Many trials target the right dorsolateral prefrontal cortex (rDLPFC), with the aim of strengthening deficient top-down mechanisms and interfering with the emotional response to tinnitus. This technique has a high theoretical potential, but the considerable number of trials investigating the effects of tDCS over the DLPFC on tinnitus are characterized by a high level of interindividual variability in treatment response. Furthermore, attempts at replication often fail. A major reason for the variability observed in the literature is the known large interindividual variation in electric field strength and neurophysiological effects of tDCS. Moreover, there is a lack of insight into the underlying effects of the tDCS, as trials often only take clinical outcomes into account and not effects on cortical activity. The proposed research aims to optimise tDCS as a tinnitus treatment by delivering individualised paradigms and assessing its effects on evoked cortical activity alongside subjective tinnitus severity. We hypothesize that an individualised anodal tDCS paradigm, with the current optimum in the rDLPFC, will significantly decrease subjective tinnitus severity compared to a sham stimulation protocol. Moreover, we expect that tDCS effects on tinnitus severity will be mediated by its effects on evoked brain activity as measured via cortical auditory evoked potentials (CAEPs). Preliminary data from our centre have shown that active tDCS may elicit a measurable impact on CAEPs, and that these CAEPs may function as an objective neural marker of subjective tinnitus severity. Combining this prior knowledge in a prospective randomized controlled trial, we will elucidate the effects of optimised tDCS over the rDLPFC on tinnitus by taking the underlying effects on cortical activity into account. If successful, the results of this trial will have a tangible effect on the treatment of tinnitus.
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