The Role of Neurofeedback in Audiology: A Review of Current Evidence and Future Directions

Despite the widespread employment of electroencephalographic (EEG) neurofeedback (NF) in clinical and cognitive enhancement contexts, its impact on selective attention and response inhibition remains poorly understood. The present research investigated the influence of theta frequency suppression and low-beta frequencies enhancement on these cognitive functions. A first study investigated the differential impact of the sensorimotor rhythm (SMR) and beta1 amplitude enhancement NF on event-related potentials (ERP) and behavioral measures indexing selective attention and response inhibition in the three-stimuli oddball and in the cued-Go/Nogo tasks. The learning curves evinced training-specific amplitude increments in the beta1 but not in the SMR frequency. However, SMR NF was associated with increased Go-P3 amplitude, decreased mean RT and RT SD, while control and beta1 NF were associated with increased false alarm rates in the cued-Go/Nogo. A second study attempted to understand whether performance increments in selective attention and response inhibition could be explained by theta suppression NF when compared to beta1 NF in the same task conditions. Within-session theta amplitude was decreased in theta relative to beta1 NF in passive resting state but not during feedback trials. However, for both theta and beta1 NF there was no evidence of training-specific amplitude changes relative to controls. Regarding selective attention, the mean RT was increased following beta1 NF and decreased after theta NF but not in the same task conditions. This study also failed to provide evidence of increased or decreased performance in response inhibition. In conclusion, the present research was not conclusive regarding the NF conditions that might have contributed to improvements in target processing efficiency and cancellation of a previously prepared response in previous studies. Specific proposals to address several methodological limitations that might have hindered the possibility of detecting frequency-specific amplitude changes and cognitive improvements were advanced.

F160. Investigation of the effects of transcranial direct current stimulation and neurofeedback by continuous performance test and beck inventories

Neurofeedback (NFB) is a relatively novel approach to the treatment of tinnitus, and prior studies have demonstrated that the increases in alpha activity rather than reduced delta power seem to drive these NFB-related improvements in tinnitus symptoms. The present study was therefore designed to explore whether the implementation of an alpha training protocol with a portable neurofeedback apparatus would achieve improvements in tinnitus patient symptoms. In this study, 38 tinnitus patients underwent NFB training while 18 were enrolled in a control group. The study was single-blinded such that only participants were not aware of their group assignments. Those in the NFB group underwent 15 NFB training sessions over 5 weeks, in addition to pre- and posttraining tests including the Tinnitus Handicap Inventory (THI), Tinnitus Handicap Questionnaire (THQ), visual analog scales (VAS), electroencephalography (EEG), and functional magnetic resonance imaging (fMRI). Our result find that when the THI, THQ, and VAS scores of patients in the two groups were assessed after a 5-week training period, these scores were unchanged in control patients whereas they had significantly improved in the NFB group patients. EEG analyses revealed that the alpha band was increased in the occipital lobe following NFB treatment, while fMRI indicated an increase in regional homogeneity (ReHo) in the right frontal lobe of patients in the NFB group after treatment that was negatively correlated with THI and VAS scores. The results of this analysis indicate that alpha NFB training can be effectively used to reduce tinnitus-related distress and sound perception in patients.

Neurofeedback (NF) is emerging as a promising adjunctive intervention for substance use disorders (SUDs) and behavioral addictions. By providing real-time feedback on brain activity, NF enables individuals to self-regulate neural circuits implicated in craving, reward processing, and executive control. This mini review synthesizes recent evidence regarding the efficacy, mechanisms, and clinical applications of NF in addiction treatment. Addiction remains a major public health concern characterized by high relapse rates and limited long-term success from pharmacological and psychosocial therapies, underscoring the need for innovative approaches. Studies included in this review were identified through PubMed, Scopus, and Web of Science using the terms “neurofeedback,” “EEG,” “fMRI,” “addiction,” “substance use disorder,” “behavioral addiction,” and “craving,” with priority given to publications from 2019–2025. Two primary NF modalities have been examined: electroencephalography (EEG)-based and functional magnetic resonance imaging (fMRI)-based neurofeedback. EEG-NF, particularly the alpha–theta protocol, has demonstrated reductions in craving, anxiety, and relapse rates among individuals with alcohol and substance dependence. fMRI-NF enables targeted modulation of addiction-related brain regions, such as the insula and dorsolateral prefrontal cortex, with region-specific but variable clinical effects. Systematic reviews indicate that NF, especially EEG-based, reliably reduces craving and improves psychological outcomes, though methodological heterogeneity limits generalizability. Recent advances integrating NF with biofeedback and machine learning approaches suggest potential for personalized and multimodal interventions. Overall, NF represents a promising, neuroscience-informed adjunct in addiction treatment, warranting large-scale controlled trials to establish efficacy and optimize clinical application.

Background : Neurofeedback (NF) is a physiological method that enables a subject to learn how to regulate his or her own brain activity. NF can be used as an alternative treatment for symptoms of attention deficit hyperactivity disorder (ADHD) via improved cortical self-regulation of brain potentials known to be related to ADHD symptoms such as changed attentional control, impulsive behaviours, and hyperactivity. However, no detailed teaching resources or tutorials are available to date, which allow a thorough teaching approach covering the technical aspects of electroencephalography (EEG)-based NF administration. Methods : To allow a flexible and easily accessible online resource for teaching the administration of NF, an online teaching module was developed (NF-eTutorial). Specifically, this online tutorial module was developed for one of the most commonly used NF systems (TheraPrax EEG-neurofeedback device, NeuroConn, Ilmenau, Germany) currently available. The NF-eTutorial was implemented and made available to medical students who were interested in NF administration via the eMedia Skills lab of RWTH Aachen University ( www.emedia-medizin.rwth-aachen.de/ ). Furthermore, this tutorial was also used as a resource to educate clinicians, patients, and carers about NF. This short article aims to present the development and specific features of the newly developed NF-eTutorial resource in a brief and descriptive manner. Results : The NF-eTutorial comprises the following components: 1) Basic introduction (overview and information on using NF in patients with ADHD, outline of the training schedule, and basic scientific information on NF); 2) Correct handling of the electrodes (electrode and skin preparation, positioning of the electrodes, linking the system to the amplifier of the NF system, disconnecting the electrodes, and cleaning and storing of the electrodes); 3) Using the NF device (detailed guide to specific technical settings); 4) Explanation of specific tasks of the patient when engaging in NF training; 5) Aspects of NF training (checklists and training protocols that can assist the use of NF as a therapeutic application); and 6) Aspects of signal quality (step-by-step guide to troubleshooting and artefact correction). Summary : The NF-eTutorial is the first web-based platform that allows access to detailed and practical information on the administration of EEG-based NF. Future research and development should focus on the practical use of such NF-related web-based tutorials with regard to the administration of NF by different groups of trainers, such as professionals, allied health staff and also lay people. This in turn will facilitate high-quality NF training for young patients with ADHD in non-clinical environments such as home and school. Keywords: web-based tutorial; neurofeedback; teaching; ADHD; children and adolescents; attention; slow cortical potentials

Background/Aim. In everyday communication, people are exposed to a myriad of sounds that need to be sorted and relevant information extracted. The ability of a person to concentrate on certain sounds in a noisy background environment, perform selective attention, and focus their auditory attention is crucial for everyday functioning and communication. The aim of this study was to investigate the effect of the sensorimotor rhythm (SMR) (12?15 Hz) neurofeedback (NFB) training to improve auditory cognition measured by the achievements in the Quick speech-in-noise (QuickSIN) test, changes in the amplitudes and latencies of components of auditory evoked potentials (AEP) N100, N200, and P300 in the auditory oddball discrimination task, and changes in the spectral power of the SMR. Methods. The study included 16 healthy participants aged 25?40 years (8 males and 8 females). Each participant had 20 daily sessions of SMR NFB training. Auditory cognitive functions and electrophysiological correlates of cognitive processing were recorded 5 times ? before NFB, after 5, 10, and 20 sessions, and one month after the last session of NFB. Re-sults. The results showed a statistically significant decrease in N200 and P300 latencies at frontal midline (Fz), central midline (Cz), and parietal midline (Pz) regions, an improvement on the QuickSIN test, and an increase in electroencephalogram SMR rhythm spectral power in the Cz region as a result of the NFB SMR training. No significant effect of the NFB training on the N100, N200, and P300 amplitudes on Fz, Cz, and Pz was found. Conclusion. The obtained results suggest that SMR NFB affects auditory perception in terms of shorter latencies of AEP and better performance on the QuickSIN test.

Research on sensorimotor rhythms (SMR) based on neurofeedback (NFb) emphasizes improvements in selective attention associated with SMR amplification. However, the long-term training proposed in most studies posed the question of acceptability, which led to the evaluation of the potential of a single NFb session. Based on cognitive and autonomic controls interfering with attention processes, we hypothesized changes in selective attention after a single SMR-NFb session, along with changes in brain–heart interplay, which are reflected in the multifractality of heartbeat dynamics. Here, young healthy participants (n = 35, 20 females, 21 ± 3 years) were randomly assigned either to a control group (Ctrl) watching a movie or to a neurofeedback (NFb) group performing a single session of SMR-NFb. A headset with EEG electrodes (positioned on C3 and C4) connected to a smartphone app served to guide and to evaluate NFb training efficacy. A Stroop task was performed for 8 min by each group before and after the intervention (movie vs. SMR-NFb) while collecting heart rate variability and C4-EEG for 20 min. When compared to Ctrl, the NFb group exhibited better Stroop performance, especially when facing incongruent trials. The multifractality and NFb training efficacy were identified as strong predictors of the gain in global Stroop performance, while multifractality was the only predictor regarding incongruent trials. We conclude that a single session of SMR-NFb improves selective attention in healthy individuals through the specific reorganization of brain–heart interplay, which is reflected in multifractal heartbeat dynamics.

Postoperative cognitive impairment is common among patients undergoing brain tumor resection. Neurofeedback (NF) represents a promising adjunctive intervention for cognitive rehabilitation, though its clinical application in neuro-oncology remains largely unexplored. This prospective case series enrolled seven inpatients (5 women, 2 men; aged 46-76years) with cognitive deficits following brain tumor surgery. Each underwent 15 sessions of EEG-based NF (35min/session, five times per week for three weeks) in parallel with daily motor rehabilitation. Baseline and post-intervention assessments included quantitative EEG (qEEG), a comprehensive neuropsychological battery, and functional measures. All patients completed the NF protocol without adverse events. qEEG analyses revealed heterogeneous but measurable modulations in absolute power and spectral ratios, with several patients showing normalization of pathological delta/beta activity. Reliable Change Index analyses indicated cognitive improvements in all patients, particularly in domains of memory, executive function, and language. Secondary benefits were also observed in mood, motor performance, and activities of daily living, though these varied across individuals. Intensive NF training combined with motor rehabilitation was feasible and well tolerated in this heterogeneous cohort. Preliminary results suggest that NF may promote postoperative cognitive recovery, with additional gains in functional and affective domains. Larger controlled studies are required to validate these exploratory findings.

Background Cognitive impairment is common in patients with traumatic brain injury (TBI). Studies that have examined the effectiveness of neurofeedback (NFB) on cognitive function following TBI have had poor study designs and small sample sizes. Objectives This randomized controlled trial assessed the effects of low-resolution tomography Z-score NFB (LZNFB) and theta/beta NFB on cognitive impairment, return to productive activity, and quality of life in patients with TBI. Methods We randomly assigned 87 patients with TBI with cognitive impairment to LZNFB, theta/beta NFB, or usual care (UC) groups. Patients in both NFB groups received weekly 60-minute treatment for 10 weeks, and those in the control group received UC and telephone interviews for 10 weeks. The primary outcome was cognitive function as measured by performance on cognitive tasks; the secondary outcomes included productive activity and quality of life based on the Community Integration Questionnaire-revised (CIQ-R) and the Quality of Life after Brain Injury (QOLIBRI), respectively, at baseline and immediately after the last intervention. Results The LZNFB group exhibited significantly greater improvements in immediate recall, delayed recall, recognition memory, and selective attention compared with the UC group; the theta/beta NFB group exhibited improvements in only immediate memory and selective attention (P < .05). The total CIQ-R scores of the LZNFB group after treatment were significantly improved than those of the UC group were. Conclusion Consecutive LZNFB achieved therapeutic effects in memory, attention, and productive activity, whereas theta/beta NFB improved memory and attention in patients with TBI. This trial was prospectively registered at ClinicalTrial.gov (registration number: NCT03515317; https://clinicaltrials.gov/ct2/show/NCT03515317).

Listeners with sensorineural hearing loss often have trouble understanding speech amid other voices. While poor spatial hearing is often implicated, direct evidence is weak; moreover, studies suggest that reduced audibility and degraded spectrotemporal coding may explain such problems. We hypothesized that poor spatial acuity leads to difficulty deploying selective attention, which normally filters out distracting sounds. In listeners with normal hearing, selective attention causes changes in the neural responses evoked by competing sounds, which can be used to quantify the effectiveness of attentional control. Here, we used behavior and electroencephalography to explore whether control of selective auditory attention is degraded in hearing-impaired (HI) listeners. Normal-hearing (NH) and HI listeners identified a simple melody presented simultaneously with two competing melodies, each simulated from different lateral angles. We quantified performance and attentional modulation of cortical responses evoked by these competing streams. Compared with NH listeners, HI listeners had poorer sensitivity to spatial cues, performed more poorly on the selective attention task, and showed less robust attentional modulation of cortical responses. Moreover, across NH and HI individuals, these measures were correlated. While both groups showed cortical suppression of distracting streams, this modulation was weaker in HI listeners, especially when attending to a target at midline, surrounded by competing streams. These findings suggest that hearing loss interferes with the ability to filter out sound sources based on location, contributing to communication difficulties in social situations. These findings also have implications for technologies aiming to use neural signals to guide hearing aid processing.

Application of Latent Growth Curve modeling to predict individual trajectories during neurofeedback treatment for tinnitus.

Coding and Reimbursement for Auditory Rehabilitation

Cognitive regulation is often used to influence behavioral outcomes. However, the computational and neurobiological mechanisms by which it affects behavior remain unknown. We studied this issue using an fMRI task in which human participants used cognitive regulation to upregulate and downregulate their cravings for foods at the time of choice. We found that activity in both ventromedial prefrontal cortex (vmPFC) and dorsolateral prefrontal cortex (dlPFC) correlated with value. We also found evidence that two distinct regulatory mechanisms were at work: value modulation, which operates by changing the values assigned to foods in vmPFC and dlPFC at the time of choice, and behavioral control modulation, which operates by changing the relative influence of the vmPFC and dlPFC value signals on the action selection process used to make choices. In particular, during downregulation, activation decreased in the value-sensitive region of dlPFC (indicating value modulation) but not in vmPFC, and the relative contribution of the two value signals to behavior shifted toward the dlPFC (indicating behavioral control modulation). The opposite pattern was observed during upregulation: activation increased in vmPFC but not dlPFC, and the relative contribution to behavior shifted toward the vmPFC. Finally, ventrolateral PFC and posterior parietal cortex were more active during both upregulation and downregulation, and were functionally connected with vmPFC and dlPFC during cognitive regulation, which suggests that they help to implement the changes to the decision-making circuitry generated by cognitive regulation.

In a binaural selective-listening task, subjects' performance was strongly influenced by the position of their eyes, Subjects remembered fewest words from the relevant message and made the most intrusion errors when looking in the direction of the irrelevant input. Looking away from the relevant message but in a direction from which no auditory input originated was not significantly different from looking toward the relevant input. As the speakers were arrayed along a vertical line, the results cannot be interpreted as reflecting activation of the cerebral hemispheres (unlike earlier related work). The results are discussed in terms of the control of auditory attention.

An effective treatment to completely alleviate chronic tinnitus symptoms has not yet been discovered. However, recent developments suggest that neurofeedback (NFB), a method already popular in the treatment of other psychological and neurological disorders, may provide a suitable alternative. NFB is a non-invasive method generally based on electrophysiological recordings and visualizing of certain aspects of brain activity as positive or negative feedback that enables patients to voluntarily control their brain activity and thus triggers them to unlearn typical neural activity patterns related to tinnitus. The purpose of this review is to summarize and discuss previous findings of neurofeedback treatment studies in the field of chronic tinnitus. In doing so, also an overview about the underlying theories of tinnitus emergence is presented and results of resting-state EEG and MEG studies summarized and critically discussed. To date, neurofeedback as well as electrophysiological tinnitus studies lack general guidelines that are crucial to produce more comparable and consistent results. Even though neurofeedback has already shown promising results for chronic tinnitus treatment, further research is needed in order to develop more sophisticated protocols that are able to tackle the individual needs of tinnitus patients more specifically.