Tinnitus Perception Research Articles

Tinnitus is associated with increased extracellular matrix density in the auditory cortex of Mongolian gerbils

Most scientists agree that subjective tinnitus is the pathological result of an interaction of damage to the peripheral auditory system and central neuroplastic adaptations. Here we investigate such tinnitus related adaptations in the primary auditory cortex (AC) 7 and 13 days after noise trauma induction of tinnitus by quantifying the density of the extracellular matrix (ECM) in the AC of Mongolian gerbils (Meriones unguiculatus). The ECM density has been shown to be relevant for neuroplastic processes and synaptic stability within the cortex. We utilized a mild monaural acoustic noise trauma in overall 22 gerbils to induce tinnitus and a sham exposure in 16 control (C) animals. Tinnitus was assessed by a behavioral response paradigm. Animals were separated for a presence (T) or absence (NT) of a tinnitus percept by a behavioral task. The ECM density 7 and 13 days after trauma was quantified using immunofluorescence luminance of Wisteria floribunda lectin-fluoresceine-5-isothiocyanate (WFA-FITC) on histological slices of the primary AC, relative to the non-auditory brainstem as a reference area. At both timepoints, we found that the WFA-FITC luminance of the AC of NT animals was not significantly different from that of C animals. However, we found a significant increase of luminance in T animals’ ACs compared to NT or C animals’ cortices. This effect was found exclusively on the AC side contralateral to the trauma ear. These results point to a hemisphere specific process of stabilization of synaptic connections in primary AC, which may be involved in the chronic manifestation of tinnitus.

Involvement of BK Channels and Ryanodine Receptors in Salicylate-induced Tinnitus.

Neural hyperexcitability of the central auditory system is a key pathological characteristic of tinnitus, but its underlying molecular mechanisms remain elusive. The large-conductance Ca2+-activated K+ channel (BK) plays a crucial role in down- or upregulating neuronal activity. This study aims to investigate the role of BK channels in mediating tinnitus-associated neural hyperexcitability and elucidate the mechanisms behind it. Immunofluorescent staining revealed extensive expression of the BK channels on neurons within the central auditory system of rats. After long-term systemic administration of salicylate, a stable tinnitus inducer, we observed a significant change in the expression levels of BKα and β4 subunits in the rat central auditory system. In addition, salicylate was found to enhance the outward potassium currents mediated by the BK channel when exogenously expressed in HEK293 cells. Interestingly, this effect could be blocked by ryanodine, a potent inhibitor of ryanodine receptors (RyRs). Molecular docking identified Gln4020 within the central domain of RyR as a key residue in RyR-salicylate interactions. The results indicated that salicylate might directly activate RyRs leading to Ca2+ release from endoplasmic reticulum, and increased BK currents subsequently. Systemic treatment with paxilline, a potent blocker of BK channel, selectively reversed the increased P4/P1 amplitude ratios in the frequency region of tinnitus perception induced by single-dose salicylate administration. These results suggest that BK channels and ryanodine receptors may play a selective role in salicylate-induced tinnitus.

What is an impact of hearing aids primarily fitted for presbyacusis on quality of life in patients complaining of tinnitus: a pilot study

ObjectiveTo assess the secondary effect of hearing aids primarily fitted for presbyacusis and their impact on the quality of life of patients complaining of tinnitus. DesignPilot case studyStudy sampleAdults with presbyacusis hearing loss were recruited in the Asker ENT clinic in Norway. Twenty consecutive patients were included in the pilot study.MethodsTwenty patients who were diagnosed with presbyacusis and additional tinnitus by the hearing tests (pure tone audiometry and speech audiometry) and medical interviews were recruited for the study. The level of their tinnitus distress was measured by the Tinnitus Handicap Inventory (THI) before and around 2 months after the hearing aid fitting. The results were afterwards statistically analyzed using paired sampled t-tests in Excel.ResultsThe data showed that hearing aids fitted primarily for presbyacusis can improve the quality of life in individuals suffering from tinnitus (p = 0.001504). In our sample, women showed higher levels of complaints about their tinnitus, compared to men. We found that age was an influencing factor on the outcomes of hearing aid usage for both presbyacusis and tinnitus, as people in this study before the age of 75 benefited less than patients above 75 (p = 0.005). All patients with moderate hearing loss in our sample showed significant improvement in their quality of life in regard to their tinnitus complaint, with a statistical value of p = 0.044. Also, patients with the lower levels of THI (slight and mild) were the groups who had the most clinically significant improvements in tinnitus distress. Finally, while analyzing the answers to all the THI questionnaire questions from the patients who did not show improvements in THI scores, a pattern of having trouble sleeping was detected as the most probable factor.ConclusionsThe results showed that hearing aids fitted primarily for presbycusis can have a positive influence on the perception of tinnitus and their quality of life.

Patient-related outcome measures (PROM) in adult cochlear implant patients

Cochlear implants (CI) provide individuals with severe sensorineural hearing loss the opportunity for artificial auditory perception. The standardized documentation of speech intelligibility tests is widespread, while the systematic capture of patient-related outcome measures (PROMs) remains inconsistent. Relevant PROM instruments were evaluated and selected based on the criteria of dissemination, clarity, and relevance, integrated into routine clinical practice, and tested at longitudinal time points. A total of three PROM instruments were selected and successfully integrated into the clinical routine. The comparison of 2measurement points from 25individuals showed improvements in subjective speech comprehension and tinnitus perception. This study demonstrates the clinical implementation and integration of PROMs in adult CI candidates and patients. The PROMs are apromising tool to support various phases of treatment, both as adecision aid for potential CI candidates and for monitoring after implantation.

Cochlear implant induced changes in cortical networks associated with tinnitus severity

We investigated tinnitus-related cortical networks in cochlear implant users who experience tinnitus and whose perception of tinnitus changes with use of their implant. &#xD;&#xD;Tinnitus, the perception of unwanted sounds which are not present externally, can be a debilitating condition. In individuals with cochlear implants, use of the implant is known to modulate tinnitus, often improving symptoms but worsening them in some cases. Little is known about underlying cortical changes with use of the implant, which lead to changes in tinnitus perception. In this study we investigated whether changes in brain networks with the cochlear implant turned on and off, were associated with changes in tinnitus perception, as rated subjectively.&#xD;&#xD;Approach: Using functional near-infrared spectroscopy (fNIRS), we recorded cortical activity at rest, from 14 cochlear implant users who experienced tinnitus. Recordings were performed with the cochlear implant turned off and on. For each condition, participants rated the loudness and annoyance of their tinnitus using a visual rating scale. Changes in neural synchrony have been reported in humans and animal models of tinnitus. To assess neural synchrony, functional connectivity networks with the implant turned on and off, were compared using two network features: node strength and diversity coefficient. &#xD;&#xD;Main results: Changes in subjective ratings of loudness were significantly correlated with changes in node strength, averaged across occipital channels (r=-0.65,p = 0.01). Changes in both loudness and annoyance were significantly correlated with changes in diversity coefficient averaged across all channels (r=-0.79,p<0.001 and r = -0.86,p<0.001). More distributed connectivity with the implant on, compared to implant off, was associated with a reduction in tinnitus loudness and annoyance. &#xD;&#xD;Significance: A better understanding of neural mechanisms underlying tinnitus suppression with cochlear implant use, could lead to their application as a tinnitus treatment and pave the way for effective use of other less invasive stimulation-based treatments. &#xD.

Electrocochleography in Chronic Tinnitus: Correlations with Audiological Profiles and Psychological Distress

ObjectivesThis study aimed to explore the electrophysiological characteristics of patients with chronic tinnitus through electrocochleography (ECochG) findings and determine if these findings correlate with specific audiological patterns that could differentiate tinnitus patients from those without this condition. Materials and methodsA retrospective analysis of medical records from patients who visited a tinnitus clinic at a tertiary university hospital between March 2020 and December 2023 was conducted. Inclusion criteria were non-pulsatile subjective tinnitus lasting over three months, and ECochG performed at initial evaluation. Audiological assessments and ECochG results were analyzed, with the SP/AP ratio being a focal point. ResultsAmong 256 patients, an elevated SP/AP ratio was observed in 37.5 % of patients. No significant difference in ECochG outcomes was noted based on tinnitus laterality. Patients with an elevated SP/AP ratio reported more sleep disturbances, higher depression scores, attention problems, and aural fullness. These patients also exhibited lower loudness discomfort levels and low-frequency hearing losses. Significant correlations were found between elevated SP/AP ratios and DPOAE responses. ConclusionsThe findings highlight the SP/AP ratio in ECochG as a valuable biomarker for assessing clinical and psychological aspects of tinnitus, indicating its potential utility in tailoring treatment strategies. Elevated SP/AP ratios were associated with sleep disturbances, depression, attention problems, aural fullness, hyperacusis, and low-frequency hearing loss, suggesting a complex interplay between cochlear pathology and tinnitus perception. This study underscores the need for a nuanced understanding of ECochG results in the clinical evaluation of tinnitus, potentially guiding more personalized management approaches.

Performance of hybrid gain formula versus traditional fitting formulas in hearing aid fitting in tinnitus patients with hearing loss.

Hearing aid fitting can be challenging when tinnitus accompanies hearing loss, as speech intelligibility and quality of life are affected by both hearing loss and tinnitus perception. However, studies focusing on the optimal hearing aid fitting for this group are scarce. Here, we aim to investigate the performance of alternative hearing aid fitting scenarios in improving hearing aid benefit and managing tinnitus. Sixty-six participants were included in the study and randomly divided into three groups based on the fitting formula: NAL-NL2, DSL pediatric and hybrid gain fitting procedure (covering NAL-NL2 for low frequencies and DSL pediatric formulas for high frequencies). Hearing aid benefit was evaluated using the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire and speech perception in noise (SPIN). To evaluate tinnitus perception, psychoacoustic characteristics of tinnitus were determined, and the Tinnitus Handicap Inventory (THI) was gathered. The NAL-NL2 fitting procedure showed better results in hearing aid benefit and SPIN compared to the DSL pediatric procedure. In the DSL pediatric procedure, better results were obtained in tinnitus management compared to NAL-NL2. There was no difference between the hybrid fitting procedure and DSL pediatric in tinnitus management. The hybrid fitting procedure also did not differ from NAL-NL2 in SPIN and hearing aid benefit. Here, we propose a hybrid gain fitting procedure that can be a better alternative to boost hearing aid performance and tinnitus management in clinical practice.

Neuromodulation Treatments Targeting Pathological Synchrony for Tinnitus in Adults: A Systematic Review.

(1) Background: Tinnitus involves the conscious awareness of a tonal or composite noise for which there is no identifiable corresponding external acoustic source. For many people, tinnitus is a disorder associated with symptoms of emotional distress, cognitive dysfunction, autonomic arousal, behavioural changes, and functional disability. Many symptoms can be addressed effectively using education or cognitive behavioural therapy. However, there is no treatment that effectively reduces or alters tinnitus-related neurophysiological activity and thus the tinnitus percept. In this systematic review, we evaluated the effectiveness of neuromodulation therapies for tinnitus that explicitly target pathological synchronous neural activity. (2) Methods: Multiple databases were searched for randomised controlled trials of neuromodulation interventions for tinnitus in adults, with 24 trials included. The risk of bias was assessed, and where appropriate, meta-analyses were performed. (3) Results: Few trials used acoustic, vagal nerve, or transcranial alternating current stimulation, or bimodal stimulation techniques, with limited evidence of neuromodulation or clinical effectiveness. Multiple trials of transcranial direct current stimulation (tDCS) were identified, and a synthesis demonstrated a significant improvement in tinnitus symptom severity in favour of tDCS versus control, although heterogeneity was high. (4) Discussion: Neuromodulation for tinnitus is an emerging but promising field. Electrical stimulation techniques are particularly interesting, given recent advances in current flow modelling that can be applied to future studies.

Neural markers associated with improved tinnitus perception after tinnitus retraining therapy

Objective Tinnitus retraining therapy (TRT) has been widely used in tinnitus management. However, its efficacy is often assessed through subjective methods. Here, we aimed to assess potential neural changes following TRT using mismatch negativity (MMN). Design Chronic tinnitus (>6 months) patients participated in a six-month TRT program. We collected tinnitus psychoacoustic features and gathered the tinnitus handicap inventory (THI) before and after TRT. We also used a multi-featured paradigm, including frequency, intensity, duration, location and silent gap deviants, to elicit MMN response before and after TRT. Data were analyzed retrospectively. Study sample The study involved 26 chronic tinnitus patients. Results Post-TRT measurements showed that MMN amplitudes significantly increased for all deviant conditions (p ≤ .03). However, we did not find a significant difference in MMN latencies for all deviant conditions (p ≥ .13). The THI scores of the patients significantly decreased following the TRT program (p < 0.001). Our results reveal improved subjective tinnitus perception following the TRT program. Conclusion These findings indicate that TRT might be a viable alternative in tinnitus management. The greater MMN amplitudes and improved subjective tinnitus perception raise the possibility that MMN can be a useful tool in tinnitus research and tinnitus patient follow-up.

Cervicogenic Somatic Tinnitus: A Narrative Review Exploring Non-otologic Causes.

Cervicogenic somatic tinnitus (CST) is a subgroup of somatosensory tinnitus that arises from altered sensory input from the cervical spine due to changes in anatomical and physiological functions. Unlike primary tinnitus, usually caused by auditory system issues, CST is due to somatosensory disruptions from the cervical region. Conditions such as degenerative disc disease, cervical spondylosis, whiplash injuries, and neck muscle stress or spasms are commonly associated with CST. The pathophysiology of CST involves complex interactions between the cervical spine's somatosensory inputs and central auditory pathways, particularly affecting the dorsal cochlear nucleus (DCN) in the brainstem, leading to enhanced excitability and synaptic reorganization, giving rise to tinnitus. Accurate diagnosis and management of CST require a comprehensive approach, including patient history, physical examination, audiological assessments, and imaging studies. Treatment strategies encompass physical therapy, medications, interventional procedures, and complementary therapies, aiming to reduce tinnitus perception, alleviate neck dysfunction, and improve overall quality of life. Emerging therapies, such as neuromodulation and regenerative medicine, show promise in further improving CST management. This multidisciplinary approach highlights the importance of addressing both musculoskeletal and auditory health in the effective treatment of CST.

Customized Music Therapy Combined With the Counseling and Follow-Up System: Stratified Results for Tinnitus Efficacy.

Chronic subjective tinnitus is a worldwide intractable problem. In our previous studies, customized music therapy combined with a follow-up system can reduce tinnitus perception and improve anxiety/depression. This study aims to explore which characteristics of tinnitus patients are more likely to benefit from our therapy. This study included 1031 patients with chronic subjective tinnitus, all of whom completed customized music therapy with the follow-up system. Population demographics, tinnitus characteristics, and tinnitus-related scales at pretherapy and posttherapy were collected. Huadong Hospital affiliated Fudan University, Department of Otorhinolaryngology-Head & Neck Surgery from 2018 to 2022. A paired t test and the one-way analysis of variance were utilized to the overall efficacy and stratified difference based on tinnitus duration/age/tinnitus frequency. There were significant statistical differences in the Tinnitus Handicap Inventory (THI), Tinnitus Loudness Visual Analog Scale (VAS), and Hospital Anxiety and Depression Scale (HADS)-A/D scores between pretherapy and 3 months posttherapy. THI and HADS (A/D) scores decreased the most in the 1-year duration tinnitus group. The most significant decrease in THI and VAS scores was observed in the 31- to 50-year-old tinnitus group. Patients with high-frequency tinnitus and extended high-frequency tinnitus had greater decreases generally than those with low-frequency tinnitus though no significance. Group with severe and prolonged tinnitus, shorter duration of tinnitus onset, and 31 to 50 years old benefit more from our therapy. Therefore, standardized personalized music and consulting and follow-up systems while promoting early treatment can reduce tinnitus and its comorbidities.

The role of hidden hearing loss in tinnitus: Insights from early markers of peripheral hearing damage

Since the presence of tinnitus is not always associated with audiometric hearing loss, it has been hypothesized that hidden hearing loss may act as a potential trigger for increased central gain along the neural pathway leading to tinnitus perception. In recent years, the study of hidden hearing loss has improved with the discovery of cochlear synaptopathy and several objective diagnostic markers. This study investigated three potential markers of peripheral hidden hearing loss in subjects with tinnitus: extended high-frequency audiometric thresholds, the auditory brainstem response, and the envelope following response. In addition, speech intelligibility was measured as a functional outcome measurement of hidden hearing loss. To account for age-related hidden hearing loss, participants were grouped according to age, presence of tinnitus, and audiometric thresholds. Group comparisons were conducted to differentiate between age- and tinnitus-related effects of hidden hearing loss. All three markers revealed age-related differences, whereas no differences were observed between the tinnitus and non-tinnitus groups. However, the older tinnitus group showed improved performance on low-pass filtered speech in noise tests compared to the older non-tinnitus group. These low-pass speech in noise scores were significantly correlated with tinnitus distress, as indicated using questionnaires, and could be related to the presence of hyperacusis. Based on our observations, cochlear synaptopathy does not appear to be the underlying cause of tinnitus. The improvement in low-pass speech-in-noise could be explained by enhanced temporal fine structure encoding or hyperacusis. Therefore, we recommend that future tinnitus research takes into account age-related factors, explores low-frequency encoding, and thoroughly assesses hyperacusis.

Investigation of the effectiveness of sound enrichment in the treatment of tinnitus due to hearing loss.

In previous animal studies, sound enhancement reduced tinnitus perception in cases associated with hearing loss. The aim of this study was to investigate the efficacy of sound enrichment therapy in tinnitus treatment by developing a protocol that includes criteria for psychoacoustic characteristics of tinnitus to determine whether the etiology is related to hearing loss. A total of 96 patients with chronic tinnitus were included in the study. Fifty-two patients in the study group and 44 patients in the placebo group considered residual inhibition (RI) outcomes and tinnitus pitches. Both groups received sound enrichment treatment with different spectrum contents. The tinnitus handicap inventory (THI), visual analog scale (VAS), minimum masking level (MML), and tinnitus loudness level (TLL) results were compared before and at 1, 3, and 6 months after treatment. There was a statistically significant difference between the groups in THI, VAS, MML, and TLL scores from the first month to all months after treatment (p<.01). For the study group, there was a statistically significant decrease in THI, VAS, MML, and TLL scores in the first month (p<.01). This decrease continued at a statistically significant level in the third month of posttreatment for THI (p<.05) and at all months for VAS-1 (tinnitus severity) (p<.05) and VAS-2 (tinnitus discomfort) (p<.05). In clinical practice, after excluding other factors related to the tinnitus etiology, sound enrichment treatment can be effective in tinnitus cases where RI is positive and the tinnitus pitch is matched with a hearing loss between 45 and 55dB HL in a relatively short period of 1 month.

Attention-Modulated Cortical Responses as a Biomarker for Tinnitus.

Attention plays an important role in not only the awareness and perception of tinnitus but also its interactions with external sounds. Recent evidence suggests that attention is heightened in the tinnitus brain, likely as a result of relatively local cortical changes specific to deafferentation sites or global changes that help maintain normal cognitive capabilities in individuals with hearing loss. However, most electrophysiological studies have used passive listening paradigms to probe the tinnitus brain and produced mixed results in terms of finding a distinctive biomarker for tinnitus. Here, we designed a selective attention task, in which human adults attended to one of two interleaved tonal (500 Hz and 5 kHz) sequences. In total, 16 tinnitus (5 females) and 13 age- and hearing-matched control (8 females) subjects participated in the study, with the tinnitus subjects matching the tinnitus pitch to 5.4 kHz (range = 1.9-10.8 kHz). Cortical responses were recorded in both passive and attentive listening conditions, producing no differences in P1, N1, and P2 between the tinnitus and control subjects under any conditions. However, a different pattern of results emerged when the difference was examined between the attended and unattended responses. This attention-modulated cortical response was significantly greater in the tinnitus than control subjects: 3.9-times greater for N1 at 5 kHz (95% CI: 2.9 to 5.0, p = 0.007, ηp2 = 0.24) and 3.0 for P2 at 500 Hz (95% CI: 1.9 to 4.5, p = 0.026, ηp2 = 0.17). We interpreted the greater N1 modulation as local neural changes specific to the tinnitus frequency and the greater P2 as global changes to hearing loss. These two cortical measures were used to differentiate between the tinnitus and control subjects, producing 83.3% sensitivity and 76.9% specificity (AUC = 0.81, p = 0.006). These results suggest that the tinnitus brain is more plastic than that of the matched non-tinnitus controls and that the attention-modulated cortical response can be developed as a clinically meaningful biomarker for tinnitus.

An Exploratory Study of Bimodal Electro-Aural Stimulation Through the Ear Canals for Tinnitus.

The aim of this study was to explore the potential for bimodal auditory and noninvasive electrical stimulation at the ears to alleviate tonal, somatic tinnitus that was investigated in a small preliminary trial (11 participants). Auditory stimulation took the form of short "notched noise" bursts customized to each participant's tinnitus percept. Simultaneous pulsed electrical stimulation, intended to facilitate neuroplasticity, was delivered via hydrogel electrodes placed in opposite ears. After a 6-week intervention period, average Tinnitus Functional Index (TFI) and Tinnitus Primary Function Questionnaire (TPFQ) scores were consistent with clinically meaningful improvements in the study population. Magnitudes and effect sizes of improvements in TFI and TPFQ are comparable to those reported in other recent bimodal therapy studies using different auditory and electrical stimulation parameters. Our results should be considered preliminary given the small sample size, lack of crossover data, and small subject pool. When considered alongside other recent bimodal therapy results, we do believe that there are therapeutic benefits of bimodal stimulation for tinnitus sufferers that have the potential to help some with tinnitus, with a variety of stimulation parameters and electrode placements. https://doi.org/10.23641/asha.25444546.

Survey to Assess the Impact of the COVID-19 Pandemic on Tinnitus Perception

Survey to Assess the Impact of the COVID-19 Pandemic on Tinnitus Perception

Subcortical auditory system in tinnitus with normal hearing: insights from electrophysiological perspective

PurposeThe mechanism of tinnitus remains poorly understood; however, studies have underscored the significance of the subcortical auditory system in tinnitus perception. In this study, our aim was to investigate the subcortical auditory system using electrophysiological measurements in individuals with tinnitus and normal hearing. Additionally, we aimed to assess speech-in-noise (SiN) perception to determine whether individuals with tinnitus exhibit SiN deficits despite having normal-hearing thresholds.MethodsA total 42 normal-hearing participants, including 22 individuals with chronic subjective tinnitus and 20 normal individuals, participated in the study. We recorded auditory brainstem response (ABR) and speech-evoked frequency following response (sFFR) from the participants. SiN perception was also assessed using the Matrix test.ResultsOur results revealed a significant prolongation of the O peak, which encodes sound offset in sFFR, for the tinnitus group (p < 0.01). The greater non-stimulus-evoked activity was also found in individuals with tinnitus (p < 0.01). In ABR, the tinnitus group showed reduced wave I amplitude and prolonged absolute wave I, III, and V latencies (p ≤ 0.02). Our findings suggested that individuals with tinnitus had poorer SiN perception compared to normal participants (p < 0.05).ConclusionThe deficit in encoding sound offset may indicate an impaired inhibitory mechanism in tinnitus. The greater non-stimulus-evoked activity observed in the tinnitus group suggests increased neural noise at the subcortical level. Additionally, individuals with tinnitus may experience speech-in-noise deficits despite having a normal audiogram. Taken together, these findings suggest that the lack of inhibition and increased neural noise may be associated with tinnitus perception.

Development and Validation of Self-Management Manual for Acute Tinnitus.

The aim of the study was to develop a self-management manual for tinnitus. The study was carried out in three phases. In phase-1, an evidence-based approach was considered by reviewing the literature to select intervention strategies that had proven to reduce tinnitus percept. Further, health literacy recommendations were used to convey the information in the manual to the patient. Phase-2 included expert committee scrutiny and assessing the understandability and actionability of the prepared self-management manual using the Patient Education Material Assessment Tool (PEMAT). In Phase-3, the self-management manual was validated from tinnitus patients. The expert committee mainly gave suggestions regarding the content, word choice and grammatical errors. PEMAT scores from patients and the expert committee revealed that activities provided in the manual are understandable and actionable. The THI and TFI scores were reduced after one month of short-term intervention. The self-management manual effectively reduced tinnitus percept and associated problems.

Tinnitus: Clinical Insights in Its Pathophysiology-A Perspective

Tinnitus, the perception of sound without a corresponding external sound source, and tinnitus disorder, which is tinnitus with associated suffering, present a multifaceted clinical challenge due to its heterogeneity and its incompletely understood pathophysiology and especially due to the limited therapeutic options. In this narrative review, we give an overview on various clinical aspects of tinnitus including its heterogeneity, contributing factors, comorbidities and therapeutic pathways with a specific emphasis on the implications for its pathophysiology and future research directions. Tinnitus exhibits high perceptual variability between affected individuals (heterogeneity) and within affected individuals (temporal variability). Hearing loss emerges as predominant risk factor and the perceived pitch corresponds to areas of hearing loss, supporting the compensatory response theory. Whereas most people who have tinnitus can live a normal life, in 10–20% tinnitus interferes severely with quality of life. These patients suffer frequently from comorbidities such as anxiety, depression or insomnia, acting as both risk factors and consequences. Accordingly, neuroimaging studies demonstrate shared brain networks between tinnitus and stress-related disorders shedding light on the intricate interplay of mental health and tinnitus. The challenge lies in deciphering causative relationships and shared pathophysiological mechanisms. Stress, external sounds, time of day, head movements, distraction, and sleep quality can impact tinnitus perception. Understanding these factors provides insights into the interplay with autonomic, sensory, motor, and cognitive processes. Counselling and cognitive-behavioural therapy demonstrate efficacy in reducing suffering, supporting the involvement of stress and anxiety-related networks. Hearing improvement, especially through cochlear implants, reduces tinnitus and thus indirectly validates the compensatory nature of tinnitus. Brain stimulation techniques can modulate the suffering of tinnitus, presumably by alteration of stress-related brain networks. Continued research is crucial for unravelling the complexities of tinnitus. Progress in management hinges on decoding diverse manifestations, identifying treatment-responsive subtypes, and advancing targeted therapeutic approaches.

An Evaluation of the Relationship between Subjective Tinnitus Perception and COVID-19-Related Psychological Factors

Aim: This study aimed to examine the relationship of tinnitus loudness, annoyance and handicap in tinnitus patients with the level of coronavirus-related anxiety, psychological distress, and fear. It was also aimed to evaluate the effects of insomnia severity and social and emotional loneliness perception on tinnitus in the pandemic period.&#x0D; Materials and Methods: A total of 112 patients over the age of 18 who were followed up in two centers with the diagnosis of chronic subjective tinnitus were included in the study. During the pandemic, the data were collected using the following tools via Google Forms: Demographic Information Form, Visual Analogue Scale (VAS) for tinnitus loudness and annoyance, the Tinnitus Handicap Inventory (THI), Coronavirus Anxiety Scale (CAS), Fear of COVID Scale (FCVS-T), COVID-19 related Psychological Distress Scale (CORPD), Insomnia Severity Index (ISI), and Social and Emotional Loneliness Scale (SELSA-S). &#x0D; Results: A weak positive correlation was found between CAS score and VAS for tinnitus loudness and annoyance, FCVS-T, ISI, Selsa-S total scores; between FCVS-T score and VAS for annoyance, CORPD, ISI scores; and, between CORPD and THI, ISI scores (p