We compared the effects of repetitive transcranial magnetic stimulation (rTMS) and paroxetine [a selective serotonin reuptake inhibitor (SSRI)] on tinnitus in terms of effectiveness and medium-term results. This is a randomised, double-blind, placebo-controlled study. Seventy-five patients with moderate tinnitus were divided into five equal groups. Each group was treated for 1 month as follows: group 1 received rTMS alone at 1 Hz frequency; group 2 received rTMS alone at 10 Hz frequency; group 3 received rTMS at 1 Hz frequency combined with paroxetine; group 4 received paroxetine alone; and group 5 received a placebo (sham rTMS). Participants were tested using the Tinnitus Handicap Inventory (THI), Tinnitus Severity Index (TSI), the Beck Anxiety Scoring (BAS), and Psychiatric Sign Screening (PSS) tests. THI, TSI, BAS, and PSS were measured prior to treatment, and at the first and sixth month post-treatment. The THI and TSI scores improved after treatment in all groups, except the placebo group. The THI scores in groups 1 and 2 showed a statistically significant improvement after the first and sixth month compared to pretreatment scores, whereas a significant improvement in THI scores occurred only after the sixth month in groups 3 and 4. The TSI scores in group 3 showed a significant improvement at the first and sixth month marks after treatment. The rTMS and SSRI play potential roles in the reduction of tinnitus severity, but without cumulative or synergistic effects when a combination of treatment regimens is applied. These positive effects might be due to the relationship between the auditory cortex areas related to emotions and tinnitus.

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We found a significant decrease in ADMA, SDMA, and L-arginine as NO inhibitors between the groups, possibly because of an increase in NO. However, the insignificant increase in NO suggests that ADMA, SDMA, and L-arginine play direct and potentially important roles in OCD biology.