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Impact of Brainstem Diseases on Hearing, Balance, Speech and Swallowing

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A special issue of Audiology Research (ISSN 2039-4349). This special issue belongs to the section "Hearing".

Deadline for manuscript submissions: closed (15 August 2025) | Viewed by 11185

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Special Issue Editors

Prof. Dr. Giuseppe Chiarella

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Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy
Interests: audiology; dizziness; ear; hearing loss and vertigo
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Prof. Dr. Anna Rita Fetoni

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Department of Neuroscience, Reproductive and Odontostomatological Sciences-Audiology Section, University of Naples Federico II, 80131 Naples, Italy
Interests: audiology; dizziness; ear; hearing loss and vertigo
Special Issues, Collections and Topics in MDPI journals

Dr. Maria Luisa Fiorella

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Guest Editor

Otolaryngology Unit, Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, 70121 Bari, Italy
Interests: phoniatrics; swallowing; dysphagia; rehabilitation; dysphonia; voice; dysarthria

Prof. Dr. Antonio Schindler

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Guest Editor

Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
Interests: phoniatrics; voice; speech; swallowing; rehabilitation; dysphagia; dysarthria; dysphonia

Special Issue Information

Dear Colleagues,

This Special Issue aims to delve into the pivotal role of the brainstem in orchestrating essential sensory and motor functions. It aims to comprehensively explore the neuroanatomical and physiological mechanisms by which the brainstem controls hearing, maintains balance, facilitates speech, and regulates swallowing. It also seeks to illuminate how different brainstem pathologies manifest as impairments in these domains, contributing to a deeper understanding of the clinical spectrum. Furthermore, it aims to discuss advancements in diagnostic techniques and therapeutic interventions designed to address these complex neurological deficits.

The scope includes original research, insightful reviews, and clinical perspectives focusing on the fundamental neural circuits within the brainstem that govern auditory processing, vestibular function, phonation, articulation, and deglutition; the impact of diverse brainstem diseases—such as strokes, demyelinating conditions, tumors, and neurodegenerative disorders—on these specific functions; novel diagnostic methods for the early detection and precise characterization of brainstem-related impairments in hearing, balance, speech, and swallowing; and current and emerging rehabilitation strategies and medical/surgical treatments aiming to improve outcomes for affected individuals.

Ultimately, this Special Issue strives to consolidate knowledge and stimulate further research, bridging the gap between basic neuroscience and clinical applications to enhance the diagnosis and management of brainstem-related disorders impacting hearing, balance, speech, and swallowing.

Prof. Dr. Giuseppe Chiarella
Prof. Dr. Anna Rita Fetoni
Dr. Maria Luisa Fiorella
Prof. Dr. Antonio Schindler
Guest Editors

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This Online Special Issue presents a collection of extended papers from the 40th National Congress of the Italian Society of Audiology and Phoniatrics (SIAF). The Article Processing Costs (APCs) of published manuscripts herein were partially covered by Amplifon Italia S.p.A. The Editorial Office and Editor-in-Chief of Audiology Research have approved this topic, and MDPI’s standard manuscript editorial processing procedure (https://www.mdpi.com/editorial_process) was applied to all submissions. As such, Amplifon Italia S.p.A did not have any input into the research findings of individual publications or into the selection of articles that received this financial support, nor were they involved in any part of the editorial process. As per our standard procedure, Guest Editors were excluded from participating in the editorial process for their own submission and/or for submissions from persons for whom a potential conflict of interest may have existed. More details on MDPI’s Conflict of Interest policy for reviewers and editors can be found here: https://www.mdpi.com/ethics#_bookmark22.

Keywords

hearing
balance
speech
swallowing
hearing loss
tinnitus
vertigo
dysphagia
dysphonia
dysarthria
neurodegenerative diseases
brainstem stroke

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Published Papers (12 papers)

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Research

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8 pages, 513 KB

Open AccessArticle

Mechanisms of VOR Suppression in Brainstem Pathology: Insights from the Absence of Anti-Compensatory Saccades Despite Normal VOR Gain

by Marco Tramontano, Laura Casagrande Conti, Nicola Ferri and Leonardo Manzari

Audiol. Res. 2025, 15(6), 154; https://doi.org/10.3390/audiolres15060154 - 12 Nov 2025

Viewed by 354

Abstract

Background/Objective: The Suppression Head Impulse Paradigm (SHIMP) is a specialized variant of the Head Impulse Test (HIT), designed to evaluate the suppression of the angular Vestibulo-Ocular Reflex (aVOR) by central mechanisms. These mechanisms are primarily mediated by brainstem structures, including the vestibular nuclei, their projections to ocular motor nuclei, and modulatory inputs from the cerebellum. Damage to these areas can impair the generation of anti-compensatory saccades (ACs), even when the peripheral vestibular apparatus remains intact. The present study explores this phenomenon in a cohort of patients with neurological disorders known to potentially involve the brainstem, including multiple sclerosis, severe traumatic brain injury, stroke, and Parkinson’s disease. Methods: This cross-sectional study included 119 patients with multiple sclerosis (PwMS), severe traumatic brain injury (PwTBI), stroke (PwS), and Parkinson’s disease (PwPD). The video Head Impulse Test was performed to assess the aVOR gain across all semicircular canals using both the HIMP and SHIMP. The presence, absence, or delay of ACs was systematically recorded. Results: Among the 119 patients evaluated (238 semicircular canals), 24 (20%) demonstrated normal aVOR gain but failed to generate ACs during SHIMP. The absence of ACs was observed in seven PwMS, five with PwTBI, six with PwS, and six with PwPD. Conclusions: The absence of ACs despite normal aVOR gain suggests a potential impairment in the central pathways controlling saccadic responses, independently of peripheral vestibular function. These findings underscore the clinical relevance of integrating the SHIMP into vestibular assessments to improve the identification of central vestibular dysfunction in neurological disorders. Full article

(This article belongs to the Special Issue Impact of Brainstem Diseases on Hearing, Balance, Speech and Swallowing)

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15 pages, 1057 KB

Open AccessArticle

Acoustic Vowel Metrics as Correlates of Dysphagia and Dysarthria in Brainstem Neurodegenerative Diseases

by Silvia Capobianco, Luca Bastiani, Francesca Forli, Bruno Fattori, Francesco Stomeo, Maria Russo, Maria Rosaria Barillari and Andrea Nacci

Audiol. Res. 2025, 15(6), 152; https://doi.org/10.3390/audiolres15060152 - 8 Nov 2025

Viewed by 615

Abstract

Background/Objectives: Swallowing and speech rely on shared brainstem circuits coordinating oropharyngeal motor functions. In neurodegenerative diseases affecting the brainstem—such as progressive supranuclear palsy (PSP), amyotrophic lateral sclerosis (ALS), and multiple system atrophy (MSA)—bulbar dysfunction often impairs tongue propulsion and motility, affecting both swallowing (dysphagia) and phonation (dysarthria). This study aimed to investigate whether vowel-based acoustic features are associated with swallowing severity in brainstem-related disorders and to explore their potential as surrogate markers of bulbar involvement. Methods: This was a cross-sectional observational study. Thirty-one patients (13 PSP, 12 ALS, 6 MSA) underwent clinical dysarthria assessment, acoustic analysis of the first (F1) and second (F2) formants during sustained phonation of /a/, /i/, /e/, and /u/, and swallowing evaluation using standardized clinical scales (DOSS, FOIS, ASHA-NOMS) and fiberoptic endoscopic evaluation (Pooling Score, Penetration-Aspiration Scale). The vowel space area (tVSA, qVSA) and Formant Centralization Ratio (FCR) were computed. Results: Significant correlations emerged between acoustic vowel metrics and dysphagia severity, especially for liquids. The FCR showed strong correlations with DOSS (ρ = −0.660, p < 0.0001), FOIS (ρ = −0.531, p = 0.002), ASHA-NOMS (ρ = −0.604, p < 0.0001), and instrumental scores for liquids: the Pooling Score (ρ = 0.538, p = 0.002) and PAS (ρ = 0.630, p < 0.0001). VSA measures were also associated significantly with liquid swallowing impairment. F2u correlated with dysarthria severity and all liquid-related dysphagia scores. Conclusions: Vowel-based acoustic parameters, particularly FCR and F2u, reflect the shared neuromotor substrate of articulation and swallowing. Acoustic analysis may support early detection and monitoring of bulbar dysfunction, especially where instrumental assessments are limited. Full article

(This article belongs to the Special Issue Impact of Brainstem Diseases on Hearing, Balance, Speech and Swallowing)

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15 pages, 366 KB

Open AccessArticle

Exploring the Trajectory of Swallowing Within Psychomotor Development in Spinal Muscular Atrophy: Moving Toward Integrated Care

by Sofia Gandolfi, Claudia Dosi, Stefano Parravicini, Maria Teresa Arnoldi, Riccardo Zanin, Sofia Biagi, Livia Rinaldi and Riccardo Masson

Audiol. Res. 2025, 15(5), 131; https://doi.org/10.3390/audiolres15050131 - 7 Oct 2025

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Abstract

Background: Spinal Muscular Atrophy type 1 (SMA type 1) is a genetic neuromuscular disease that typically presents before 6 months of age and is characterized by profound hypotonia, progressive muscle weakness, and early involvement of respiratory and bulbar musculature. Swallowing impairment (dysphagia) is a hallmark of SMA type 1 and significantly contributes to morbidity. Despite the documented benefits of disease-modifying therapies (DMTs) in terms of enhanced survival and motor outcomes, their impact on swallowing remains understudied. Aim: This study aims to longitudinally characterize swallowing function in children with SMA type 1 treated with DMTs, while contextualizing these findings in relation to the patients’ current motor abilities and cognitive performance. Materials and Methods: A single-center, longitudinal, observational study was conducted at IRCCS Besta, Milan, Italy, from 2021 to 2025. Swallowing function was evaluated using four validated scales (MAS, OrSAT, FILS, and p-FOIS), while motor and cognitive functions were assessed using CHOP-INTEND and age-appropriate cognitive tests (DQ/IQ). Patients were stratified by baseline swallowing status, pharmacological therapy, and age at DMT administration. Non-parametric statistical tests were applied. Results: No statistically significant changes in swallowing function were observed over one year in the overall cohort or its subgroups, despite significant improvements in motor function. MAS/e, FILS, and p-FOIS showed moderate associations with CHOP-INTEND and DQ/IQ scores. Conclusions: Swallowing function in children with SMA type 1 remained largely stable, while motor function significantly improved over one year, regardless of baseline swallowing status, DMT type, and age at administration. These findings underscore the need for standardized, longitudinal assessments of swallowing, motor, and cognitive functions in the management of SMA type 1. Full article

(This article belongs to the Special Issue Impact of Brainstem Diseases on Hearing, Balance, Speech and Swallowing)

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Review

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34 pages, 761 KB

Open AccessReview

Retrocochlear Auditory Dysfunctions (RADs) and Their Treatment: A Narrative Review

by Domenico Cuda, Patrizia Mancini, Giuseppe Chiarella and Rosamaria Santarelli

Audiol. Res. 2026, 16(1), 5; https://doi.org/10.3390/audiolres16010005 (registering DOI) - 23 Dec 2025

Abstract

Background/Objectives: Retrocochlear auditory dysfunctions (RADs), including auditory neuropathy (AN) and auditory processing disorders (APD), encompass disorders characterized by impaired auditory processing beyond the cochlea. This narrative review critically examines their distinguishing features, synthesizing recent advances in classification, pathophysiology, clinical presentation, and treatment. Methods: This narrative review involved a comprehensive literature search across major electronic databases (e.g., PubMed, Scopus) to identify and synthesize relevant studies on the classification, diagnosis, and management of AN and APD. The goal was to update the view on etiologies (genetic/non-genetic) and individualized rehabilitative strategies. Diagnosis relies on a comprehensive assessment, including behavioral, electrophysiological, and imaging tests. Rehabilitation is categorized into bottom-up and top-down approaches. Results: ANSD is defined by neural desynchronization with preserved outer hair cell function, resulting in abnormal auditory brainstem responses and poor speech discrimination. The etiologies (distal/proximal) influence the prognosis for interventions, particularly cochlear implants (CI). APD involves central processing deficits, often with normal peripheral hearing and heterogeneous symptoms affecting speech perception and localization. Rehabilitation is multidisciplinary, utilizing bottom-up strategies (e.g., auditory training, CI) and compensatory top-down approaches. Remote microphone systems are highly effective in improving the signal-to-noise ratio. Conclusions: Accurate diagnosis and personalized, multidisciplinary management are crucial for optimizing communication and quality of life. Evidence suggests that combined bottom-up and top-down interventions may yield superior outcomes. However, methodological heterogeneity limits the generalizability of protocols, highlighting the need for further targeted research. Full article

(This article belongs to the Special Issue Impact of Brainstem Diseases on Hearing, Balance, Speech and Swallowing)

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22 pages, 338 KB

Open AccessReview

Multidisciplinary Management of Cerebellopontine Angle Tumors with Brainstem Involvement

by Concheri Stefano, Vito Pontillo, Alberto D’Amico, Stefano Di Girolamo, Francesco Signorelli, Elisabetta Zanoletti and Nicola Antonio Adolfo Quaranta

Audiol. Res. 2025, 15(6), 168; https://doi.org/10.3390/audiolres15060168 - 4 Dec 2025

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Abstract

Background/Objectives: Tumors of the cerebellopontine angle (CPA) encompass a limited range of histologies, predominantly vestibular schwannomas (VSs), meningiomas, and paragangliomas (PGLs). Their growth region threatens the cranial nerves (V–XII), brainstem, and cerebellum, possibly causing functional deficits. This review aims to synthesize clinical features and multidisciplinary treatment strategies for CPA tumors with brainstem involvement, emphasizing functional preservation alongside tumor control. Methods: A systematic PubMed search identified studies on VSs, CPA meningiomas, and intradural PGLs. Eligibility criteria included studies reporting tumor management and cranial nerve outcomes. Data extraction focused on tumor size, neurological presentation, surgical approach, adjunctive therapies, and postoperative cranial nerve function. Multidisciplinary involvement and rehabilitation strategies were noted. Results: Twenty studies (3311 patients) analyzed large VSs, showing facial nerve dysfunction in 8–53%, trigeminal neuropathy in 20–77%, and cerebellar signs in up to 79%. Microsurgery (MS) achieved variable gross total resection, while stereotactic radiosurgery (SRS) preserved facial nerve function but carried trigeminal and hydrocephalus risks. CPA meningiomas demonstrated cranial nerve displacement patterns critical for surgical planning, with transient deficits common and recovery linked to baseline function. In 388 intradural PGL cases, staged surgery combined with preoperative embolization was standard; functional preservation of lower cranial nerves was often limited. Across all histologies, multidisciplinary management and targeted rehabilitation were essential. Conclusions: Optimal CPA tumor management balances tumor control with functional preservation. VSs benefit from individualized MS or SRS based on size and mass effect. Meningioma surgery prioritizes cranial nerve preservation over radical resection. Intradural PGLs require staged vascular-conscious approaches. Multidisciplinary care and structured rehabilitation are pivotal to improving outcomes and quality of life. Full article

(This article belongs to the Special Issue Impact of Brainstem Diseases on Hearing, Balance, Speech and Swallowing)

14 pages, 394 KB

Open AccessReview

Trigeminal Nerve and Vestibular System: Update on Pathophysiological and Clinical Links

by Mario Faralli, Giuseppe Santopietro, Francesco Frati and Luigi Califano

Audiol. Res. 2025, 15(6), 159; https://doi.org/10.3390/audiolres15060159 - 19 Nov 2025

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Abstract

The points of contact between the vestibular system and the trigeminal nerve remain an active area of research. Anatomically, several connections have been clearly identified, and these may play a role in the development of various disorders. Understanding these connections also proves to be extremely valuable from a clinical perspective. It is increasingly evident that the etiopathogenesis of various vestibular disorders is multifactorial. Therefore, knowledge of the points of interaction between the two systems can assist clinicians in patient assessment and, most importantly, in selecting the most appropriate therapeutic approach. This study is presented as a narrative review. A literature search was conducted to identify studies investigating the correlation between the trigeminal system and the vestibular system, as well as their respective characteristics, to provide a comprehensive overview. Since this is a narrative rather than a systematic review, no specific inclusion or exclusion criteria were applied. So, the aim of this study is to analyze these connections through a comprehensive review of the literature, trying to present a multidisciplinary approach to the topic, one that can involve both the neurologist and the otologist, in order to achieve a more refined management of clinical cases. To better understand their anatomical relationships, we begin by examining the embryological development of both the vestibular system and the trigeminal nerve. Finally, we present current knowledge on the trigeminal influence in certain vestibular disorders—particularly vestibular migraine—and, conversely, the vestibular system’s potential impact on trigeminal-related conditions. Full article

(This article belongs to the Special Issue Impact of Brainstem Diseases on Hearing, Balance, Speech and Swallowing)

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23 pages, 502 KB

Open AccessReview

Brainstem Stroke and Dysphagia Treatment: A Narrative Review on the Role of Neuromodulation, Skill-Based Swallowing Training and Transient Receptor Potential Agonists

by Ivy Cheng, Wan-Qi Li, Shaheen Hamdy, Emilia Michou, Maggie-Lee Huckabee, Noemí Tomsen, Pere Clavé and Rainer Dziewas

Audiol. Res. 2025, 15(6), 156; https://doi.org/10.3390/audiolres15060156 - 12 Nov 2025

Viewed by 2052

Abstract

Swallowing is mediated by the central nervous system, including cortical and subcortical structures, the cerebellum, and the brainstem. The brainstem contains the swallowing centre that is crucial for initiating and coordinating swallowing. Consequently, brainstem damage due to stroke often leads to severe and persistent dysphagia. The aim of the present narrative review is to provide an overview of dysphagia following brainstem stroke and its management. It summarizes the physiology and pathophysiology of dysphagia following brainstem stroke and the available therapeutic options, and evaluate their effectiveness for dysphagia following brainstem stroke, which would promote the development of therapeutic protocols. Neuromodulatory techniques, including pharyngeal electrical stimulation (PES), repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS), modulate the excitability of corticobulbar circuits. These techniques promote neuroplasticity through peripheral or cortical electrical or electromagnetic inputs. Skill-based swallowing training emphasizes cortical involvement in enhancing swallowing skill, offering a targeted approach to behavioural rehabilitation. Finally, transient receptor potential (TRP) agonists increase sensory inputs to the swallowing system by stimulating the sensory receptors in the oropharynx, potentially activating the swallowing network. While these options have shown promise in dysphagia rehabilitation following stroke, most the available data comes from patients with mixed stroke lesions, with limited data focused specifically on brainstem lesions. Therefore, the evidence for their efficacy in patients with brainstem stroke remains underexplored. Therefore, treatment decisions should rely on the understanding of swallowing physiology, neuroplasticity, and clinical evidence from related stroke populations. Full article

(This article belongs to the Special Issue Impact of Brainstem Diseases on Hearing, Balance, Speech and Swallowing)

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12 pages, 1113 KB

Open AccessReview

Management of Facial Paralysis Following Skull Base Surgery: A Comprehensive Narrative Review

by Laura Maria De Luca, Sergio Cannova, Sebastiana Lai, Marco Accolla, Alice Barbazza, Lea Calò, Davide Rizzo, Pierangela Tramaloni, Marco Bonali, Ignacio Javier Fernandez and Francesco Bussu

Audiol. Res. 2025, 15(6), 155; https://doi.org/10.3390/audiolres15060155 - 12 Nov 2025

Viewed by 693

Abstract

Objectives: Facial paralysis is a devastating yet frequent complication of skull base surgery, significantly impacting quality of life through functional impairments and psychosocial consequences. Management is complex and requires an individualized approach based on duration of paralysis, etiology and extent of nerve injury, overall prognosis, and rehabilitative goals. This review provides a comprehensive overview of current strategies for managing post-skull base surgery facial paralysis. Methods: A narrative review of the literature was performed, analyzing surgical reanimation techniques (nerve grafting, nerve transfers, regional and free muscle transfers), static procedures for facial symmetry and ocular protection, and non-surgical interventions such as physical therapy, botulinum toxin injections, and psychological support. Key criteria guiding treatment selection, including muscle viability and timing since injury, were examined. Results: Dynamic surgical approaches remain central to restoring movement. Nerve grafting and transfers are effective when viable musculature is present, whereas regional or free muscle transfers are required in long-standing paralysis with irreversible atrophy. Static procedures provide adjunctive improvements in resting symmetry and eye protection. Non-surgical strategies, including rehabilitation therapy and botulinum toxin, enhance functional outcomes and reduce synkinesis. Psychological counseling addresses the profound emotional burden associated with facial disfigurement. Across modalities, individualized treatment planning is crucial. Conclusions: Management of facial paralysis after skull base surgery demands a multidisciplinary, patient-centered approach. Combining surgical and non-surgical interventions optimizes functional and aesthetic outcomes, helping restore both facial movement and psychosocial well-being. Full article

(This article belongs to the Special Issue Impact of Brainstem Diseases on Hearing, Balance, Speech and Swallowing)

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15 pages, 732 KB

Open AccessReview

Pathophysiology and Etiology of Brainstem-Related Dysphagia

by Lucia D’Alatri, Maria Raffaella Marchese, Angelo Tizio and Jacopo Galli

Audiol. Res. 2025, 15(6), 153; https://doi.org/10.3390/audiolres15060153 - 11 Nov 2025

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Abstract

Background: Brainstem-related dysphagia represents a complex and severe form of neurogenic dysphagia (ND) arising from lesions that disrupt the central pattern generator (CPG) for swallowing located in the medulla oblongata. Methods: This paper explores the physiological basis of swallowing and its disruption in various brainstem pathologies. Results: The clinical presentation and electrophysiological evaluation of dysphagia are discussed, with a focus on volitional and spontaneous swallowing (SS) and the use of electromyography (EMG)-based assessment techniques. Conclusions: Finally, therapeutic strategies are reviewed, including conventional rehabilitative methods, neuromuscular electrical stimulation, non-invasive brain stimulation, and invasive procedures such as neurobotulinum toxin-A (BoNT-A) injections, balloon dilation, and CP myotomy. Full article

(This article belongs to the Special Issue Impact of Brainstem Diseases on Hearing, Balance, Speech and Swallowing)

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20 pages, 1714 KB

Open AccessReview

Oculomotor Abnormalities and Nystagmus in Brainstem Disease: A Mini Review

by Augusto Pietro Casani, Mauro Gufoni, Nicola Ducci, Giacinto Asprella Libonati and Giuseppe Chiarella

Audiol. Res. 2025, 15(6), 150; https://doi.org/10.3390/audiolres15060150 - 6 Nov 2025

Viewed by 1686

Abstract

The brainstem plays a pivotal role in the generation and control of eye movements—including saccades, smooth pursuit, the vestibulo-ocular reflex (VOR), vergence, and gaze holding. Beyond its vital physiological functions, it is also essential for the coordination of balance and movement. Consequently, eye movement disorders of brainstem origin are often accompanied by vertigo, imbalance, unsteady gait, and diplopia, particularly during changes in head or body position. A sound understanding of the neural structures involved in oculomotor and vestibular control is therefore crucial for accurately identifying and localizing a wide variety of brainstem syndromes. However, oculomotor abnormalities resulting from brainstem disease represent a major diagnostic challenge for the neurotologist, owing to the wide spectrum of possible etiologies (vascular, traumatic, degenerative, neoplastic), their variable severity and clinical course (acute, fluctuating, or progressive), and the frequent concomitant involvement of other central structures, particularly the cerebellum. This mini review summarizes the pathophysiological mechanisms and clinical features of oculomotor disorders and nystagmus associated with brainstem disease. Full article

(This article belongs to the Special Issue Impact of Brainstem Diseases on Hearing, Balance, Speech and Swallowing)

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10 pages, 353 KB

Open AccessReview

The Presence of Serotonin in the Vestibular System: Supporting the Use of SSRIs/SNRIs in the Treatment of Vestibular Disorders—A Narrative Review

by Roberto Teggi, Daniela Caldirola, Giampiero Neri, Iacopo Cangiano, Pasquale Viola and Giuseppe Chiarella

Audiol. Res. 2025, 15(6), 148; https://doi.org/10.3390/audiolres15060148 - 6 Nov 2025

Viewed by 1513

Abstract

Background: Serotonin (5-HT) is a neurotransmitter and a hormone that regulates various functions. Serotonin receptors have been studied in animal experiments in the vestibular system, beginning from the inner ear and vestibular nuclei. However, the role of serotonin in the vestibular system and disorders remains to be clarified. Methods: A review of the literature was performed on different databases according to the PRISMA guidelines. Only publications published on humans and in English have been included. A total of 41 articles were included in this review. Results: There are many publications regarding the use of SSRI/SNRI in vestibular disorders. Regarding persistent postural perceptual dizziness (PPPD) and chronic subjective dizziness (CSD) the available evidence supports multimodality treatment incorporating vestibular rehabilitation, serotonergic medications, and cognitive behavior therapy, although most studies have not included a placebo control group. As for vestibular migraine (VM), SNRI and SSRIs were proposed as preventive therapy and demonstrated a reduction in vertigo attacks in patients with Menière’s Disease (MD), especially when symptoms of anxiety disorder were present. Conclusions: Although SSRIs/SNRIs are considered an off-label therapy for vertigo, several studies have assessed their efficacy in vestibular disorders, as indicated in the data published on PPPD, MD, and VM above all. As some studies report that serotonin receptors are also present in the inner ear and vestibular nuclei, it can be postulated that in cases where the natural levels of serotonin are altered, such as in depression and anxiety, the change in serotonin levels may affect vestibular function and play a role in vestibular disorders. Full article

(This article belongs to the Special Issue Impact of Brainstem Diseases on Hearing, Balance, Speech and Swallowing)

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Other

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20 pages, 972 KB

Open AccessSystematic Review

An Insight into Role of Auditory Brainstem in Tinnitus: A Systematic Review of Diagnostic Assessments

by Giovanni Freda, Andrea Ciorba, Nicola Serra, Rita Malesci, Francesco Stomeo, Chiara Bianchini, Stefano Pelucchi, Pasqualina Maria Picciotti, Luigi Maiolino, Giacinto Asprella Libonati and Anna Rita Fetoni

Audiol. Res. 2025, 15(6), 149; https://doi.org/10.3390/audiolres15060149 - 6 Nov 2025

Viewed by 982

Abstract

Background/Objectives: Tinnitus is a complex auditory phenomenon with multifactorial origins, often involving both peripheral and central auditory pathways. Given the multifactorial nature of tinnitus, this review specifically focuses on the auditory brainstem as it represents the first central relay for auditory input and a key site of abnormal synchrony and central gain, which may generate or modulate tinnitus even when peripheral hearing appears normal. Several studies suggest a potential role of brainstem dysfunction in its pathogenesis, even among patients with normal hearing thresholds. Although the physiopathological data provide evidence for the role of brainstem in the generation and magnification of tinnitus, the diagnostic tools are still unclear. This systematic review aimed to investigate the diagnostic relevance of brainstem-level abnormalities in individuals with tinnitus. Methods: Following PRISMA guidelines, a literature search was conducted using PubMed, Scopus, and Web of Science from January 2000 to June 2025. Studies were included if they addressed the diagnostic relationship between tinnitus and brainstem involvement. Data on auditory brainstem response (ABR), otoacoustic emissions (used to differentiate peripheral from central auditory abnormalities), neuroimaging, and electrophysiological markers were extracted. Results: Twenty studies were included. Most used ABR as a diagnostic tool, revealing significant amplitude and latency alterations in tinnitus patients compared to controls, particularly in wave V and V/I amplitude ratios. Imaging studies supported altered brainstem–cortical connectivity and localized changes in inferior colliculus (IC) activity. Additional techniques, such as middle-latency evoked potentials and gap-in-noise detection, showed potential but lacked consistent clinical utility. Conclusions: Evidence suggests that brainstem dysfunction may contribute to tinnitus generation or persistence. ABR and advanced imaging represent specific diagnostic tools, though standardization and high-quality studies are still needed to improve clinical applicability. Full article

(This article belongs to the Special Issue Impact of Brainstem Diseases on Hearing, Balance, Speech and Swallowing)

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