목적: Tinnitus is linked to various auditory conditions and various psychological issues such as anxiety, depression, and cognitive impairment. Tinnitus Retraining Therapy (TRT) aim to alleviate tinnitus distress through counseling and sound therapy, addressing cognitive and emotional responses. Transcranial direct current stimulation (tDCS), a non-invasive technique, modulates brain activity linked to tinnitus. This study aimed to compare the effectiveness of TRT-based directive counseling, tDCS, and a combination of both in managing chronic tinnitus symptoms. 방법:A retrospective cohort study was conducted on 41 patients with chronic tinnitus treated at a tertiary hospital between November 2021 and December 2023. Patients were assigned to three groups: counseling (n=11), tDCS (n=19), or combined therapy (n=11), based on patient preference. Pre- and post-treatment evaluations included the Tinnitus Handicap Inventory (THI), Numeric Rating Scale (VAS), Beck’s Depression Inventory (BDI), and other psychological assessments. 결과:Significant improvements were observed in all treatment groups across THI, VAS, and BDI scores, with the tDCS and combined groups showing more pronounced changes. The combined therapy group showed a greater reduction in anxiety as seen as HAD-A, compared to the other groups, indicating enhanced anxiety management through combined counseling and tDCS. 결론:tDCS, particularly when combined with counseling, demonstrated significant benefits in reducing tinnitus-related distress and anxiety. These findings suggest that integrating neuromodulatory and psychological approaches could provide a comprehensive treatment strategy for tinnitus. Further research should explore personalized treatment protocols and the long-term efficacy of combined therapies.