Search Results (170)

Objectives: Tinnitus, defined as the perception of sound without an external stimulus, is a complex condition with unclear etiology. Emerging evidence suggests a link between vascular dysfunction, particularly arterial stiffness, and tinnitus. This study aimed to evaluate vertebral artery stiffness in patients with idiopathic subjective tinnitus and assess the utility of Doppler ultrasonography as a non-invasive diagnostic tool. Materials and Methods: In this prospective study, 31 patients with idiopathic tinnitus (11 males, 20 females; mean age: 50.42 ± 9.64 years) and 24 healthy controls (12 males, 12 females; mean age: 39.67 ± 10.63 years) underwent comprehensive clinical evaluations, including pure tone audiometry, blood tests, and vertebrobasilar Doppler ultrasonography. Vertebral artery stiffness index (VAS), resistive index (RI), and pulsatility index (PI) were measured bilaterally. Results: A total of 31 patients with idiopathic subjective tinnitus and 24 healthy controls were evaluated. The mean age was significantly higher in the tinnitus group compared to controls (50.42 ± 9.64 vs. 39.67 ± 10.63 years, p < 0.001). Lipid profile analysis revealed significantly higher levels of total cholesterol (193.6 ± 47.28 vs. 167.5 ± 28.99 mg/dL, p = 0.021), LDL (149.4 ± 37.9 vs. 106.1 ± 10.7 mg/dL, p < 0.005), and triglycerides (202.2 ± 83.5 vs. 148.6 ± 26.4 mg/dL, p < 0.005) in tinnitus patients. Doppler ultrasonography demonstrated significantly higher vertebral artery stiffness values in the tinnitus group (left: 2.87 ± 0.72 vs. 2.12 ± 0.22; right: 2.99 ± 0.77 vs. 2.14 ± 0.5; both p < 0.005). Similarly, pulsatility index (PI) was significantly elevated in patients compared to controls (left: 2.45 ± 1.2 vs. 1.2 ± 0.43; right: 2.49 ± 1.02 vs. 1.19 ± 0.42; both p < 0.005). No significant differences were observed in resistive index (RI) or vertebral artery diameters between groups. Among tinnitus patients, PI and VAS were significantly higher on the side corresponding to reported tinnitus symptoms (p < 0.05), suggesting a lateralized vascular contribution. Conclusions: The findings suggested a potential relationship between idiopathic subjective tinnitus and vertebral artery stiffness. We demonstrated the utility of Doppler ultrasonography, a cost-effective and non-invasive imaging modality, for evaluating vascular parameters in tinnitus patients, paving the way for broader clinical applications. By uncovering a significant association between vertebral artery stiffness and tinnitus, our findings suggest that vascular health assessments could enhance diagnostic and therapeutic strategies for tinnitus management. Full article

Background/Objectives: This study aimed to (i) cross-culturally adapt the Inventory of Hyperacusis (IHS) into Danish and (ii) assess its usability, validity, and reliability in Danish adults with hyperacusis. Methods: The translation followed established guidelines for adapting hearing-related questionnaires. A two-phase design ensured linguistic and cultural adaptation and evaluated test–retest reliability and construct validity. The IHS, consisting of 25 items, was translated and tested in seven participants through cognitive debriefing. In phase two, temporal consistency was assessed in 32 patients. Results: Thirty-two participants (twenty-eight female; mean age 49.8 years) completed the study over 2–4 weeks (mean 22 days). Eight used hearing aids, and twenty-four reported tinnitus. The Danish IHS showed good reliability (Cronbach’s alpha = 0.95) and acceptable test–retest reliability, except for the General Loudness factor. While no systematic score changes occurred, significant variability in score changes were noted. Conclusions: The Danish IHS appears to be a reliable and valid tool for assessing hyperacusis. Further research is needed, but the IHS-DK shows potential as an effective clinical and research tool for evaluating hyperacusis impact and treatment outcomes. Full article

Objectives: Muscular dysfunction of the cervical spine is the most likely cause of somatosensory tinnitus and dizziness. Some patients can modulate their tinnitus through movement or palpation. This study aimed to investigate the effect of manual therapy on muscle pressure pain, range of motion in the cervical spine, and tinnitus and dizziness. Methods: A pilot randomized controlled trial with a waiting-group design was conducted in a university hospital setting. Participants in the intervention group received manual therapy to the head and neck region combined with stretching exercises and muscle relaxation techniques such as releasing tense muscles and myofascial trigger point therapy involving muscle and connective tissue techniques. The primary and secondary outcome measures were pressure pain, tinnitus modulation by head and neck muscles, and range of motion of the cervical spine. Tinnitus and dizziness were assessed before and after the intervention using the Tinnitus Handicap Inventory and the Dizziness Handicap Inventory. Results: After the intervention, significant differences were observed in pressure pain, tinnitus modulation, and range of motion as well as the Tinnitus Handicap Inventory (U = 644; p < 0.001) and the Dizziness Handicap Inventory (U = 133.5; p = 0.010), favoring the intervention group. Conclusions: The results demonstrate that manual therapy significantly altered pressure pain in the head and neck muscles as well as symptoms such as tinnitus and dizziness in the intervention group. Manual therapy may be beneficial in treating cervicogenic somatosensory tinnitus, provided that other potential causes such as otorhinolaryngological pathology have been ruled out. Full article

A single intratympanic application of the small-molecule drug AC102 was previously shown to promote significant recovery of hearing thresholds in a noise-induced hearing loss model in guinea pigs. Here, we report the effects of AC102 to revert synaptopathy of inner hair cells (IHCs) and behavioral signs of tinnitus in Mongolian gerbils following mild noise trauma. This experimental protocol led to minor hearing threshold shifts with no loss of auditory hair cells (HCs) but induced synaptopathy and a sustained and significant tinnitus percept. Treatment by intratympanic application of AC102 was evaluated in two protocols: 1. three weekly injections or 2. a single application. We evaluated hearing threshold changes using the auditory brainstem response (ABR) and the development of a tinnitus percept using the gap prepulse inhibition of acoustic startle (GPIAS) behavioral response. The number of IHC ribbon synapses along the cochlear frequency map were counted by immunostaining for the synaptic ribbon protein carboxy-terminal binding protein 2 (CTBP2). AC102 strongly and significantly reduced behavioral signs of tinnitus, as reflected by altered GPIAS. Noise-induced loss of IHC ribbon synapses was significantly reduced by AC102 compared to vehicle-treated ears. These results demonstrate that a single application of AC102 restores ribbon synapses following mild noise trauma thereby promoting recovery from tinnitus-related behavioral responses in vivo. Full article

Cognitive behavioural therapy (CBT) is an evidence-based intervention for managing distress associated with tinnitus, hyperacusis, and misophonia. This paper summarises key points from the 2025 Tonndorf Lecture presented at the third World Tinnitus Congress and the 14th International Tinnitus Seminar in Poland. The lecture addressed (1) the theoretical foundations of CBT for these conditions, (2) clinical evidence on CBT delivered by psychologists, audiologists, and digital self-help, and (3) the proportion of patients who may benefit from CBT. Research demonstrates that CBT can effectively reduce distress related to tinnitus, hyperacusis, and misophonia. Both psychologist- and audiologist-delivered CBT approaches have demonstrated significant improvements in reducing the impact of tinnitus, hyperacusis, and misophonia on patients’ quality of life, while guided internet-based CBT also demonstrates positive outcomes. Unguided internet-based CBT is also effective, though it faces challenges such as higher dropout rates. Despite these promising results, not all patients experience the same level of benefit. Some continue to experience distress even after completing CBT, highlighting the need for alternative or complementary interventions and ongoing support. This paper estimates that approximately 1 in 52 individuals with tinnitus require CBT, indicating that while tinnitus is relatively common, the need for intensive therapy is comparatively small. To enhance treatment outcomes, future research should compare the effectiveness of psychologist- and audiologist-delivered CBT, explore hybrid models that combine face-to-face and digital interventions, and address challenges with internet-based CBT, particularly for hyperacusis and misophonia. Furthermore, incorporating neuroimaging and physiological measures in future randomised controlled trials could provide objective insights into the neural mechanisms underlying symptom improvement, ultimately helping to refine CBT interventions. Identifying characteristics of non-responders to CBT may also guide the development of more tailored therapeutic approaches. Full article

Background: To develop and validate the Tinnitus Qualities and Impact Questionnaire (TQIQ), a new tool for evaluating the perceived qualities of tinnitus sound. Method: The study was part of two clinical trials on internet-based tinnitus interventions, using cross-sectional (n = 380) and pretest–posttest data (n = 280). Participants completed various questionnaires online, including the newly developed TQIQ and measures of tinnitus severity (Tinnitus Functional Index; TFI), anxiety (Generalized Anxiety Disorder 7; GAD-7), depression (Patient Health Questionnaire 9; PHQ-9), insomnia (Insomnia Severity Index; ISI), and health-related quality of life (EQ-5D-5L Visual Analog Scale; VAS). The psychometric properties of the TQIQ were assessed, including construct validity, internal consistency reliability, floor and ceiling effects, interpretability, and responsiveness to treatment. Results: Exploratory factor analysis resulted in two factors that accounted for 57% of the variance—internal and external tinnitus qualities. Overall, 92% convergent validity predictions were confirmed; TQIQ total scores strongly (≥0.6) or moderately (0.30 to 0.59) correlated with the TFI, GAD-7, PHQ-9, and ISI. The known-groups validity prediction was confirmed as individuals with an overall TFI score > 50 (severe) obtained significantly higher TQIQ scores. All internal consistency reliability statistics were within the required range (Cronbach’s α > 0.8). Floor and ceiling effects were negligible. ROC established clinically important cut-off scores, enhancing the interpretability of tinnitus severity classification. Finally, 89% convergent validity predictions were confirmed; TQIQ and TFI change scores were moderately correlated, indicating good responsiveness of the former to treatment. Conclusions: The TQIQ has adequate psychometric properties, providing a standardized measure for the assessment of characteristics of tinnitus sound in clinical practice. Full article

Background: Single-sided deafness (SSD) and asymmetric hearing loss (AHL) impair spatial hearing and speech perception, often reducing quality of life. Cochlear implants (CIs) and bone conduction implants (BCIs) are rehabilitation options used in SSD and AHL to improve auditory perception and support functional integration in daily life. Objective: We aimed to evaluate hearing outcomes after auditory implantation in SSD and AHL patients, focusing on localization accuracy, speech-in-noise understanding, tinnitus relief, and perceived benefit. Methods: In this longitudinal observational study, 37 patients (adults and children) received a CI or a BCI according to clinical indications. Outcomes included localization and spatial speech-in-noise assessment, tinnitus ratings, and SSQ12 scores. Statistical analyses used parametric and non-parametric tests (p < 0.05). Results: In adult CI users, localization error significantly decreased from 81.9° ± 15.8° to 43.7° ± 13.5° (p < 0.001). In children, regardless of the implant type (CI or BCI), localization error improved from 74.3° to 44.8°, indicating a consistent spatial benefit. In adult BCI users, localization error decreased from 74.6° to 69.2°, but the improvement did not reach statistical significance. Tinnitus severity, measured on a 10-point VAS scale, decreased significantly in CI users (mean reduction: 2.8 ± 2.0, p < 0.001), while changes in BCI users were small and of limited clinical relevance. SSQ12B/C scores improved in all adult groups, with the largest gains observed in spatial hearing for CI users (2.1 ± 1.2) and in speech understanding for BCI users (1.6 ± 0.9); children reported high benefits across all domains. Head shadow yielded the most consistent benefit across all groups (up to 4.9 dB in adult CI users, 3.8 dB in adult BCI users, and 4.6 dB in children). Although binaural effects were smaller in BCI users, positive gains were observed, especially in pediatric cases. Correlation analysis showed that daily device use positively predicted SSQ12 improvement (r = 0.57) and tinnitus relief (r = 0.42), while longer deafness duration was associated with poorer localization outcomes (r = –0.48). Conclusions: CIs and BCIs provide measurable benefits in SSD and AHL rehabilitation. Outcomes vary with age, device, and deafness duration, underscoring the need for early intervention and consistent auditory input. Full article

Background: To examine the changes in perceived tinnitus sound qualities following internet-based cognitive behavioral therapy (ICBT) for tinnitus. Method: This study was embedded within several clinical trials evaluating the efficacy of ICBT and used a quasi-experimental design (N = 152). Participants completed a series of online questionnaires, including measures of tinnitus sound qualities (Tinnitus Qualities and Impact Questionnaire; TQIQ), tinnitus severity (Tinnitus Functional Index; TFI), anxiety (Generalized Anxiety Disorder-7; GAD-7), depression (Patient Health Questionnaire-9; PHQ-9), insomnia (Insomnia Severity Index; ISI), and health-related quality of life (EQ-5D-5L Visual Analog Scale; VAS). Data were analyzed using a range of parametric and non-parametric statistics, and Cohen’s d effect sizes were reported. Results: There were no significant differences between the intervention and control groups in sociodemographic and clinical variables at baseline except for anxiety and depression symptoms, which were higher in the intervention group. A statistically significant reduction in tinnitus severity, anxiety, depression, and insomnia was noted post-intervention, with small-to-moderate effect sizes. Statistically significant improvements were also noted for the TQIQ (overall and all subscales) following ICBT compared to the no-intervention group (p ≤ 0.028), all with small-to-large effect sizes, except for the loud sounds subscale and for participants with a TQIQ < 38 at baseline, or “mild” perceived qualities of tinnitus (p ≥ 0.136). A significantly greater proportion of participants in the intervention group had minimum clinically important differences (38%) on the TQIQ compared to the no-intervention group (9%). Conclusions: ICBT can lead to changes in the perceived qualities of tinnitus sound in addition to reducing tinnitus severity and other aspects, such as anxiety, depression, and insomnia. While these findings are preliminary, they highlight that tinnitus distress and perception may be related. However, the study has several limitations including a lack of audiological variables and objective measures. For this reason, the study results must be viewed with caution and must be treated as preliminary. Full article

Background/Objectives: This study evaluated the feasibility and effectiveness of three sound therapies—enriched acoustic environment with random noise (EAERR), enriched acoustic environment with gamma tones (EAEGT), and white noise (WN)—in alleviating tinnitus distress and enhancing emotional well-being. Methods: A total of 125 individuals with tinnitus were recruited, with 92 completing the four-month intervention. Following counseling, participants selected a therapy and listened daily for one hour for four-months at the mixing point intensity. Tinnitus severity and emotional state were assessed at the baseline and post-treatment using the Tinnitus Handicap Inventory (THI), Tinnitus Functional Index (TFI), and Hospital Anxiety and Depression Scale (HADS). Results: All therapies significantly reduced tinnitus distress and improved emotional well-being, with 80.4% of participants reporting benefits. Conclusions: These findings suggest that sound therapies are effective for tinnitus management, though further research with larger and more homogeneous samples is needed to refine their application and optimize treatment for diverse tinnitus profiles. Full article

Background and Objectives: The management of chronic tinnitus in patients with otosclerosis presents a considerable clinical challenge, particularly as to those who are either ineligible for or reluctant to undergo surgical interventions. Surgical interventions improve hearing levels and may provide relief from tinnitus; however, medical research is also focused on alternative non-surgical treatments aimed at symptomatic improvement. This is particularly relevant, considering that otosclerosis currently has no definitive cure, despite the existence of various surgical techniques and oral therapies. This study evaluates the effects of oral calcium and fluoride supplementation on tinnitus severity in otosclerosis patients who opted for non-surgical management. Materials and Methods: A total of 128 otosclerosis patients with tinnitus were included in this study, which was conducted over a five-year period. Patients were categorized into three groups based on the severity of their tinnitus (mild, moderate and severe), as assessed by the Tinnitus Handicap Inventory (THI). Patients in all three groups received Florical (Mericon Industries, Inc., Peoria, IL, USA), a calcium and fluoride supplement, and were monitored over three months. The severity of tinnitus was reassessed following supplementation. Statistical analyses were conducted to further investigate patient scores. Results: Evaluating patients based on the severity of their tinnitus, we consistently observed clinically significant reductions in THI scores, specifically a decrease of 10 points or more, among those with mild tinnitus. The moderate group exhibited a lower degree of reduction in their THI scores, while the severe group appeared to be unaffected. Statistical analyses reveal a significant correlation between the reduction of tinnitus and the supplementation of Florical, as the severity of tinnitus decreases. Conclusions: The present study suggests that oral calcium and fluoride supplementation may serve as a promising non-surgical approach for tinnitus management in otosclerosis (particularly in patients with mild symptoms), in addition to its marketing-indicated role, supporting the preservation of hearing levels in otosclerosis. Its efficacy seems to diminish as tinnitus severity increases, further pointing out a potential preventative role of this supplementation. Full article

Objectives: This study aimed to analyse the potential influence of abnormalities detected through carotid–vertebral ultrasonography and brain MRI on pure-tone averages (PTAs) and the frequency and intensity of tinnitus. Methods: 423 participants with subjective tinnitus were enrolled in this investigation. All patients underwent carotid– vertebral ultrasonography, brain MRI, and pure-tone audiometry, including tinnitus matching. Results: The median values for tinnitus onset indicated chronic tinnitus in most cases. Regarding tinnitus location, left-sided symptoms (32%) and bilateral symptoms (44%) were the most prevalent. In analysing the effects of abnormalities detected by carotid–vertebral ultrasonography on PTAs, a statistically significant difference was found between the groups (p = 0.0037). Specifically, individuals with intimal hyperplasia had significantly higher PTAs (p = 0.02), as did those with carotid artery plaques (p = 0.005). However, no significant differences in PTAs were noted in relation to carotid artery stenosis (p = 0.07). Similar trends emerged regarding tinnitus intensity (p = 0.013), with significantly higher values observed in the presence of any carotid–vertebral ultrasonography abnormalities. In contrast, tinnitus frequencies were not significantly affected (p = 0.401). Regarding brain MRI findings, Fazekas scores of 2 (p = 0.02) and 3 (p = 0.0052) significantly influenced PTAs. For tinnitus intensity, Fazekas scores of 2 (p = 0.0027) and 3 (p = 0.0005), and the presence of acoustic neuromas (p = 0.019), significantly impacted the intensity values. However, tinnitus frequencies were not significantly (p = 0.36) influenced by brain MRI abnormalities. Conclusions: The findings of this study show that carotid–vertebral ultrasonography and brain MRI abnormalities significantly influence PTAs and tinnitus intensities. Full article

Background/Objectives: Persistent and distressing tinnitus and TMDs may significantly impair the quality of patients’ lives. Problems are particularly severe for those who experience both. Although the exact causes of this association are not fully understood, several hypotheses connect TMD conditions with otological symptoms. Methods: The systematic review presented involved records published between 1 January 2004 and 27 November 2024, in the databases PubMed, Scopus, and Web of Science, according to the PRISMA guidelines. The search queries included “temporomandibular disorder” and “tinnitus”. Inclusion and exclusion criteria were predefined according to PECOS. A risk of bias assessment and meta-analyses were performed. The study’s protocol was registered in PROSPERO (CRD42024533293). Results: Eleven studies included in this review fulfilled all the predefined criteria. In a sample of 114,071 tinnitus patients, 50.99% (95% CI: 33.31–68.54) also had coexisting TMDs. Furthermore, tinnitus patients had more than 2.2 times higher odds of having TMDs compared to the control group (p = 0.002 for random effects). The absence of data regarding randomisation, blinding, and sample size justification was the most frequent risk of bias. Conclusions: Tinnitus frequently co-occurs in patients who suffer from TMDs. It is essential to expand the diagnostic evaluation of patients to confirm its presence and assess its impact on their quality of life. Additionally, dental consultation should be considered to evaluate patients about TMD signs and symptoms when suffering from tinnitus. Full article

Background: Meniere’s disease (MD) is a set of rare disorders that affects >4 million people worldwide. Individuals with MD suffer from episodes of vertigo associated with fluctuating sensorineural hearing loss and tinnitus. Hearing loss can involve one or both ears. Over 10% of the reported cases are observed in families, suggesting its significant genetic contribution. The condition is polygenic with >20 genes, and several patterns of inheritance have been reported, including autosomal dominant, autosomal recessive, and digenic inheritance across multiple MD families. Preclinical research using animal models has been an indispensable tool for studying the neurophysiology of the auditory and vestibular systems and to get a better understanding of the functional role of genes that are involved in the hearing and vestibular dysfunction. While mouse models are the most used preclinical model, this review analyzes alternative animal and non-animal models that can be used to study MD genes. Methods: A literature search of the 21 genes reported for familial MD and the preclinical models used to investigate their functional role was performed. Results: Comparing the homology of proteins encoded by these genes to other model organisms revealed Drosophila and zebrafish as cost-effective models to screen multiple genes and study the pathophysiology of MD. Conclusions: Murine models are preferred for a quantitative neurophysiological assessment of hearing and vestibular functions to develop drug or gene therapy. Full article

Background/Objectives: Since high frequencies are susceptible to disruption in various types of hearing loss, a symptom which is common in people with tinnitus, the aim of the study was to investigate EEG cortical auditory evoked and P300 responses to both a high- and low frequency-centered oddball paradigm to begin to establish the most suitable cognitive physiologic testing conditions for those with both unimpaired hearing and those with hearing impairments. Methods: Cortical auditory evoked potential (CAEP) P1, N1, P2 and P300 (subtraction wave) peaks were identified in response to high- (standard: 6000 Hz, deviant: 8000 Hz) and low frequency (Standard: 375 Hz, Deviant: 500 Hz) oddball paradigms. Each paradigm was presented at various intensity levels. Latencies and amplitudes were then computed for each condition to assess the effects of frequency and intensity. Results: Stimulus intensity had no effect on either the high- or low frequency paradigms of P300 characteristics. In contrast, for the low frequency paradigm, intensity influenced the N1 latency and P2 amplitude, while for the high frequency paradigm intensity influenced P1 and P2 latency and P2 amplitude. Conclusions: Obligatory CAEP components responded more readily to stimulus frequency and intensity changes, and one possible consideration is that higher frequencies could play a role in the response characteristics exhibited by N1 (except for N1 amplitude) and P2, given their involvement in attentional processes linked to the detection of warning cues. P300 latency and amplitude were not influenced by such factors. These findings support the hypothesis that disentangling the cognitive from the more sensory-based response is possible, even in those with hearing loss, provided that the patient’s hearing loss is considered when determining the presentation level. While the present study was performed in participants with unimpaired hearing, these data set up future studies investigating the effectiveness of using similar methods in hearing-impaired persons. Full article

Background: Tinnitus can significantly impact a patient’s quality of life. As no evidence-based curative treatments exist, therapies such as cognitive behavioral therapy, tinnitus retraining therapy, acceptance and commitment therapy, and mindfulness-based interventions aim to minimize tinnitus severity and have been shown effective. Since traditional delivery can be costly and time-consuming and often has limited accessibility, therapies might also be provided via eHealth. This study investigates the change in tinnitus severity measured by the Tinnitus Functional Index (TFI) score after participation in an online self-paced tinnitus (“Still Tinnitus”) course. The secondary aim was to identify predictors for the clinically relevant improvement after participation in this course. Methods: This retrospective record study included patients from Still Tinnitus course between March 2023 and July 2024. Patients were recruited via the Still Tinnitus website. Differences in the TFI scores from baseline and after completing the fifth (last) module of the course were calculated to investigate the change in tinnitus over time. Multivariate logistic analyses were performed to identify the possible predictors for the clinically relevant improvement after completion of the Still Tinnitus course. Results: In total, 122 patients were included in the study. The analysis revealed a clinically relevant reduction in the TFI score of 27.2 points. Multiple regression analyses showed that the “duration of the tinnitus” (OR 5.0; 95%CI: 1.537–16.240; p = 0.007) and “female sex” (OR 1.9; 95%CI 0.111–7.637; p = 0.030) are predictors for a clinically relevant improvement. Conclusions: In a convenience sample of tinnitus patients, the Still Tinnitus course may contribute to a clinically relevant reduction in tinnitus severity. A shorter duration of tinnitus and female sex were identified as significant predictors. Full article