rTMS over bilateral superior temporal gyri combined with auditory-speech training for post-stroke pure word deafness: a case report

Abstract

Objective To describe the application of high-frequency rTMS over the bilateral superior temporal gyri (STG) combined with auditory-speech training and assess its effects on auditory comprehension. Methods A 54-year-old woman with PWD secondary to bilateral temporal ischemic strokes underwent a 10-day combined intervention. She received 10 Hz rTMS over the left STG, followed by auditory-speech training, and then received rTMS over the right STG with identical parameters. Treatment outcomes were assessed using the Western Aphasia Battery (WAB), the Psycholinguistic Assessment in Chinese Aphasia (PACA), the Boston Naming Test (BNT), and the abbreviated Token Test. Results Audiological evaluation confirmed the patient’s normal peripheral hearing. At baseline, the patient had preserved cognitive function but severe auditory comprehension deficits. On the WAB, the Aphasia Quotient was 40.8 and the Cortical Quotient was 56.47. The abbreviated Token Test score was 3.5/36, and the BNT correct rate was 83.3%. Environmental sound recognition, reading, naming, oral reading, picture-based writing, and direct copying were at or near ceiling levels. Baseline performance on PACA was severely impaired. After the 10-day intervention, the patient’s WAB Aphasia Quotient improved to 65.9, Token Test scored to 16/36, and BNT correct rate remained 83.3%. On PACA, notable improvements were observed in phoneme discrimination (4/30 to 19/30), minimal difference word judgment (5/40 to 32/40), speech input buffer (1/24 to 6/24), speech input lexicon (3/24 to 12/24), auditory word-picture matching (13/40 to 32/40), auditory semantic knowledge (0/36 to 20/36), word repetition (0/30 to 10/30), word repetition with oral-cue prompting (6/30 to 15/30), and dictation (0/40 to 17/40). No adverse events occurred. Conclusion This case provides preliminary evidence that combined bilateral STG rTMS and auditory-speech training may be feasible and may support auditory-verbal rehabilitation in PWD. Controlled studies with longer-term follow-up are needed.