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Peer-reviewedCC BYFrontiers in neuroscience

Effects of individualized phase-amplitude-coupled transcranial alternating current stimulation on tinnitus and cognition

  • Youngmin Na1
  • Nour Alsabbagh2
  • Jayce Woojin Baek1
  • Sunmi Ma3
  • Hyo-Jeong Lee1
  • Jung Hye Park3
  • Sung Kwang Hong1
  1. 1The Laboratory of Hearing, Balance, and Integrated Neuroscience, Hallym University College of Medicine, Chuncheon , ,
  2. 2Department of Communication Sciences and Disorders, College of Liberal Arts and Sciences, University of Iowa , , ,
  3. 3Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Anyang , ,
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Abstract

Introduction: Chronic tinnitus is a prevalent and disabling condition that is frequently accompanied by domain-specific cognitive difficulties. Abnormal neural oscillations and disrupted cross-frequency coupling (CFC) have been implicated in its pathophysiology. This study investigated whether individualized phase-amplitude-coupled transcranial alternating current stimulation (tACS), tailored to each participant’s individual alpha frequency (IAF), was associated with changes in tinnitus symptoms, cognition, and neurophysiological measures.

Methods: In this prospective single-arm interventional study, 25 adults with chronic tinnitus (>6 months) were enrolled, and 21 completed the protocol. Participants received five sessions of individualized IAF-based phase-amplitude-coupled tACS at 2 mA for 20 min per session. Tinnitus outcomes included the Tinnitus Handicap Inventory (THI) and visual analog scale ratings of loudness (VAS-L) and annoyance (VAS-A). Cognitive performance was assessed using the Montreal Cognitive Assessment, Trail Making Tests A and B, Digit Span Tests forward and backward (DST-F/B), and Symbol Digit Modalities Test (SDMT). Electroencephalography-based spectral and CFC analyses were conducted in an artifact-free subgroup of 10 participants.

Results: THI scores decreased significantly over the course of the intervention, whereas VAS-L and VAS-A showed no significant group-level changes. Cognitive performance improved across global cognition, processing speed, executive function, and working memory. Repeated-measures analyses demonstrated significant session effects for DST-F, DST-B, and SDMT. DST-B also showed a significant overall pre- to post-stimulation effect, whereas this effect was marginal for DST-F and absent for SDMT; no significant tACS × session interactions were observed. CFC analyses showed no significant pre- to post-stimulation changes after correction for multiple comparisons.

Conclusion: Repeated individualized IAF-based phase-amplitude-coupled tACS was associated with reduced tinnitus-related functional impact and improvements in several cognitive measures, whereas subjective loudness and annoyance did not change significantly at the group level. No robust group-level CFC changes were detected. Given the single-arm design and absence of sham control, these findings are preliminary and do not establish treatment-specific or causal effects. Larger randomized sham-controlled studies are needed to determine efficacy and clarify underlying neurophysiological mechanisms.

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Cite

BibTeXRIS
BibTeX
@article{na2026effects,
  title = {{Effects of individualized phase-amplitude-coupled transcranial alternating current stimulation on tinnitus and cognition}},
  author = {Youngmin Na and Nour Alsabbagh and Jayce Woojin Baek and Sunmi Ma and Hyo-Jeong Lee and Jung Hye Park and Sung Kwang Hong},
  journal = {Frontiers in neuroscience},
  year = {2026},
  month = sep,
  doi = {10.3389/fnins.2026.1905125},
  url = {https://europepmc.org/article/PMC/PMC13662099},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Effects of individualized phase-amplitude-coupled transcranial alternating current stimulation on tinnitus and cognition
AU  - Youngmin Na
AU  - Nour Alsabbagh
AU  - Jayce Woojin Baek
AU  - Sunmi Ma
AU  - Hyo-Jeong Lee
AU  - Jung Hye Park
AU  - Sung Kwang Hong
PY  - 2026
DA  - 2026/09/30
JO  - Frontiers in neuroscience
DO  - 10.3389/fnins.2026.1905125
UR  - https://europepmc.org/article/PMC/PMC13662099
AB  - Introduction: Chronic tinnitus is a prevalent and disabling condition that is frequently accompanied by domain-specific cognitive difficulties. Abnormal neural oscillations and disrupted cross-frequency coupling (CFC) have been implicated in its pathophysiology. This study investigated whether individualized phase-amplitude-coupled transcranial alternating current stimulation (tACS), tailored to each participant’s individual alpha frequency (IAF), was associated with changes in tinnitus symptoms, cognition, and neurophysiological measures.  Methods: In this prospective single-arm interventional study, 25 adults with chronic tinnitus (>6 months) were enrolled, and 21 completed the protocol. Participants received five sessions of individualized IAF-based phase-amplitude-coupled tACS at 2 mA for 20 min per session. Tinnitus outcomes included the Tinnitus Handicap Inventory (THI) and visual analog scale ratings of loudness (VAS-L) and annoyance (VAS-A). Cognitive performance was assessed using the Montreal Cognitive Assessment, Trail Making Tests A and B, Digit Span Tests forward and backward (DST-F/B), and Symbol Digit Modalities Test (SDMT). Electroencephalography-based spectral and CFC analyses were conducted in an artifact-free subgroup of 10 participants.  Results: THI scores decreased significantly over the course of the intervention, whereas VAS-L and VAS-A showed no significant group-level changes. Cognitive performance improved across global cognition, processing speed, executive function, and working memory. Repeated-measures analyses demonstrated significant session effects for DST-F, DST-B, and SDMT. DST-B also showed a significant overall pre- to post-stimulation effect, whereas this effect was marginal for DST-F and absent for SDMT; no significant tACS × session interactions were observed. CFC analyses showed no significant pre- to post-stimulation changes after correction for multiple comparisons.  Conclusion: Repeated individualized IAF-based phase-amplitude-coupled tACS was associated with reduced tinnitus-related functional impact and improvements in several cognitive measures, whereas subjective loudness and annoyance did not change significantly at the group level. No robust group-level CFC changes were detected. Given the single-arm design and absence of sham control, these findings are preliminary and do not establish treatment-specific or causal effects. Larger randomized sham-controlled studies are needed to determine efficacy and clarify underlying neurophysiological mechanisms.
SN  - 1662-4548
SN  - 1662-453X
ER  -