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The study provides an in-depth analysis of tinnitus by categorizing it into otologic, non-otologic, and mixed types. It finds that 70.7% of tinnitus cases are otologic, primarily linked to middle and inner ear issues. Non-otologic causes, including central and somatosensory origins, are less common. Tinnitus is more prevalent in older patients and males but with no significant links. Otologic cases were often found to be associated with reduced hearing, central cases with significant giddiness, and somatosensory cases.

References: Wadhwa S, Jain S, Patil N, Dobariya H, Patil V, Kawale M, Deshmukh PT, Gaurkar SS. Exploring the Association Between Clinical Characteristics and Etiopathogenesis of Tinnitus: A Cross-Sectional Study. Cureus. 2024 Sep 27;16(9):e70320. doi: 10.7759/cureus.70320. PMID: 39469400; PMCID: PMC11513205.

Smoking was associated with the occurrence of all three audiovestibular symptoms at once. The risk for hearing loss only was increased by higher levels of glucose and arterial hypertension, while dizziness only was facilitated by dyslipidemia as well as increased levels of HbA1c. These findings contribute to our understanding of the complex interplay between lifestyle and health outcomes.

References: Ihler F, Brzoska T, Altindal R, Dziemba O, Völzke H, Busch CJ, Ittermann T. Prevalence and risk factors of self-reported hearing loss, tinnitus, and dizziness in a population-based sample from rural northeastern Germany. Sci Rep. 2024 Jul 31;14(1):17739. doi: 10.1038/s41598-024-68577-3. PMID: 39085387; PMCID: PMC11291685.

Treatment for hyperacusis can broadly be categorized into those which target the physical symptoms, and those which aim to reduce the psychological burden of the condition. Tinnitus retraining therapy (TRT) involves educating the patient about their condition alongside gradual sound enrichment, and its use in hyperacusis is becoming increasingly popular.[26] Prolonged low-level noise exposure has been shown to have a reversing effect on the enhanced neural gain, which is thought to be the underlying mechanism of hyperacusis.[28]

References: Coey JG, De Jesus O. Hyperacusis. [Updated 2023 Aug 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557713/

MBCT is effective in reducing tinnitus severity in chronic tinnitus patients compared to intensive RT. It also reduces psychological distress and disability. Future studies should explore the generalizability of this approach and how outcome relates to different aspects of the intervention.

References: McKenna L, Marks EM, Hallsworth CA, Schaette R. Mindfulness-Based Cognitive Therapy as a Treatment for Chronic Tinnitus: A Randomized Controlled Trial. Psychother Psychosom. 2017;86(6):351-361. doi: 10.1159/000478267. Epub 2017 Nov 3. PMID: 29131084.

CBT may be effective in reducing the negative impact that tinnitus can have on quality of life. There is, however, an absence of evidence at 6 or 12 months follow-up. There is also some evidence that adverse effects may be rare in adults with tinnitus receiving CBT, but this could be further investigated.

References: Fuller T, Cima R, Langguth B, Mazurek B, Vlaeyen JW, Hoare DJ. Cognitive behavioural therapy for tinnitus. Cochrane Database Syst Rev. 2020 Jan 8;1(1):CD012614. doi: 10.1002/14651858.CD012614.pub2. PMID: 31912887; PMCID: PMC6956618.

Tinnitus retraining therapy (TRT) is a specific clinical method based on the neurophysiological model of tinnitus described by Jastreboff (Jastreboff, P.J. (1990). Neurosci. Res., 8: 221-254). The method is aimed at habituation of reactions evoked by tinnitus, and subsequently habituation of the tinnitus perception. Several other methods have been suggested for habituation of tinnitus, but in TRT two components that strictly follow the principles of the neurophysiological model of tinnitus are implemented and necessary: (1) counseling, aimed at reclassification of tinnitus to a category of a neutral signals and (2) sound therapy, aimed at weakening tinnitus-related neuronal activity as suggested by Jastreboff and Hazell (Jastreboff, P.J. and Hazell, J.W.P. (2004). Cambridge University Press, Cambridge).

References: Jastreboff PJ. Tinnitus retraining therapy. Prog Brain Res. 2007;166:415-23. doi: 10.1016/S0079-6123(07)66040-3. PMID: 17956806.

This systematic review and meta-analysis included 22 randomized controlled trials comprising 2,354 patients. The combination of acoustics and cognitive behavioral therapy may be an effective way to treat patients with chronic tinnitus.

References: Lu T, Wang Q, Gu Z, Li Z, Yan Z. Non-invasive treatments improve patient outcomes in chronic tinnitus: a systematic review and network meta-analysis. Braz J Otorhinolaryngol. 2024 Jul-Aug;90(4):101438. doi: 10.1016/j.bjorl.2024.101438. Epub 2024 May 2. PMID: 38788246; PMCID: PMC11143903.

13 eligible RTs with a total of 1345 patients were included in this meta-analysis. The meta-analysis results showed that the 1-month response rate, 3-month response rate, 6-month response rate, and overall response rate of TRT with drugs for tinnitus were higher than that of drugs only (P < 0.05). The results demonstrated that the THI (Tinnitus Handicap Inventory) scale after the treatment period of TRT with medications for tinnitus was lower than that of drugs only (P < 0.05).

References: Han M, Yang X, Lv J. Efficacy of tinnitus retraining therapy in the treatment of tinnitus: A meta-analysis and systematic review. Am J Otolaryngol. 2021 Nov-Dec;42(6):103151. doi: 10.1016/j.amjoto.2021.103151. Epub 2021 Jun 27. PMID: 34303210.

Studies have provided evidence that Hearing Aid fitting is a valuable treatment strategy for chronic tinnitus relief with associated hearing loss.

References: 1) Simonetti P, Vasconcelos LG, Gândara MR, Lezirovitz K, Medeiros ÍRT, Oiticica J. Hearing aid effectiveness on patients with chronic tinnitus and associated hearing loss. Braz J Otorhinolaryngol. 2022 Nov-Dec;88 Suppl 3(Suppl 3):S164-S170. doi: 10.1016/j.bjorl.2022.03.002. Epub 2022 May 20. PMID: 35729042; PMCID: PMC9761006. 2) Lee HJ, Kang DW, Yeo SG, Kim SH. Hearing Aid Effects and Satisfaction in Patients with Tinnitus. J Clin Med. 2022 Feb 18;11(4):1096. doi: 10.3390/jcm11041096. PMID: 35207368; PMCID: PMC8875221.

Medicines used to treat other diseases, as well as foods and other ingested materials, can result in unwanted tinnitus. These include alcohol, antineoplastic chemotherapeutic agents and heavy metals, antimetabolites, antitumor agents, antibiotics, caffeine, cocaine, marijuana, nonnarcotic analgesics and antipyretics, ototoxic antibiotics and diuretics, oral contraceptives, quinine and chloroquine, and salicylates.

References: Kim SH, Kim D, Lee JM, Lee SK, Kang HJ, Yeo SG. Review of Pharmacotherapy for Tinnitus. Healthcare (Basel). 2021 Jun 21;9(6):779. doi: 10.3390/healthcare9060779. PMID: 34205776; PMCID: PMC8235102.

Patients with impacted ear wax that occludes the external auditory canal can present with tinnitus, conductive hearing loss and aural fullness. Symptoms usually resolve with clearance of the wax.

References: Chan HBY, Low D, Yuen HW, How CH. Tinnitus – ringing in the ears. Singapore Med J. 2020 Sep;61(9):448-452. doi: 10.11622/smedj.2020128. PMID: 33043372; PMCID: PMC7927175.

The hypothalamus pituitary adrenal axis, one of the main neuroendocrine systems involved in stress response, is commonly disturbed in tinnitus patients. Patients with chronic tinnitus have been shown to develop abnormal responses to psycho-social stress, where the hypothalamus pituitary adrenal axis response is weaker and delayed, suggesting chronic stress contributes to the development of chronic tinnitus.

References: Patil JD, Alrashid MA, Eltabbakh A, Fredericks S. The association between stress, emotional states, and tinnitus: a mini-review. Front Aging Neurosci. 2023 May 3;15:1131979. doi: 10.3389/fnagi.2023.1131979. PMID: 37207076; PMCID: PMC10188965.

In this nationally representative sample of US adults, negative sleep characteristics were significantly associated with bothersome tinnitus. Report of bothersome tinnitus was associated with less hours of sleep per night, being diagnosed with sleep disorders, report of trouble with sleeping, and OSA symptoms.

References: Awad M, Abdalla I, Jara SM, Huang TC, Adams ME, Choi JS. Association of Sleep Characteristics with Tinnitus and Hearing Loss. OTO Open. 2024 Feb 28;8(1):e117. doi: 10.1002/oto2.117. PMID: 38420352; PMCID: PMC10900921.

Potential risk factors identified in the literature include pathologies of middle and inner ear structures, bone or nerve malformations, rhino sinusitis, and social factors such as poor diet.

References: Hoare DJ, Smith H, Kennedy V, Fackrell K. Tinnitus in Children. J Assoc Res Otolaryngol. 2024 Jun;25(3):239-247. doi: 10.1007/s10162-024-00944-3. Epub 2024 May 6. PMID: 38709437; PMCID: PMC11150219.

Animal-model studies have demonstrated that after noise exposures that lead to some damage of the cochlea, neurons in both the dorsal and ventral divisions of the first auditory brain station, the cochlear nucleus, show increased Spontaneous firing rate.

References: 1) Bledsoe SC Jr, Koehler S, Tucci DL, Zhou J, Le Prell C, Shore SE. Ventral cochlear nucleus responses to contralateral sound are mediated by commissural and olivocochlear pathways. J Neurophysiol. 2009 Aug;102(2):886-900. doi: 10.1152/jn.91003.2008. Epub 2009 May 20. PMID: 19458143; PMCID: PMC2724362.; 2) Kaltenbach JA, Afman CE. Hyperactivity in the dorsal cochlear nucleus after intense sound exposure and its resemblance to tone-evoked activity: a physiological model for tinnitus. Hear Res. 2000 Feb;140(1-2):165-72. doi: 10.1016/s0378-5955(99)00197-5. PMID: 10675644.

The results show a different average pattern of hearing impairment amongst the tinnitus patients, consistent with the suggestion that inner hair cell dysfunction with subsequent reduced auditory innervation is a possible trigger of tinnitus.

References: Tan CM, Lecluyse W, McFerran D, Meddis R. Tinnitus and patterns of hearing loss. J Assoc Res Otolaryngol. 2013 Apr;14(2):275-82. doi: 10.1007/s10162-013-0371-6. Epub 2013 Jan 18. PMID: 23328862; PMCID: PMC3660910.

Tinnitus does not represent a disease itself, but instead is a symptom of a variety of underlying diseases. Otologic causes include noise-induced hearing loss, presbycusis, otosclerosis, otitis, impacted cerumen, sudden deafness, Meniere’s disease, and other causes of hearing loss. Neurologic causes include head injury, whiplash, multiple sclerosis, vestibular schwannoma (commonly called an acoustic neuroma), and other cerebellopontine-angle tumors. Infectious causes include otitis media and sequelae of Lyme disease, meningitis, syphilis, and other infectious or inflammatory processes that affect hearing. Tinnitus is also a side effect of some oral medications, such as salicylates, nonsteroidal anti-inflammatory drugs, aminoglycoside antibiotics, loop diuretics, and chemotherapy agents (e.g., platins and vincristine). Temporomandibular-joint dysfunction and other dental disorders can also cause tinnitus. However, in many cases no underlying physical cause is identifiable. For many years, hearing loss has been understood to be the most common cause of tinnitus,29 and population-based data indicate that excessive noise exposure represents the second most common cause of tinnitus. However, about 40% of patients cannot identify any cause associated with tinnitus onset.

Any pathologic lesion in the auditory pathway or any reduction in auditory nerve function has the potential to produce tinnitus. The location of the hearing problem (i.e., in the middle ear or in the inner ear) and the otologic disorder causing the hearing loss do not appear to influence the etiologic potential. Interestingly, most patients with tinnitus complain about a sensation of fullness or blockage in the middle ear, suggesting a problem with middle ear pressure or increased impedance of the ossicular chain.

Unilateral high-frequency hearing loss combined with poor speech discrimination suggests the presence of a tumor, usually a vestibular schwannoma/acoustic neuroma or a meningioma. Bilateral subjective tinnitus requires assessment of hearing and can be associated with presbycusis, noise-induced hearing loss, endolymphatic hydrops, and a vascular labyrinthine lesion. However, most cases of unilateral tinnitus are not associated with life-threatening otologic disease.

References: Han BI, Lee HW, Kim TY, Lim JS, Shin KS. Tinnitus: characteristics, causes, mechanisms, and treatments. J Clin Neurol. 2009 Mar;5(1):11-9. doi: 10.3988/jcn.2009.5.1.11. Epub 2009 Mar 31. PMID: 19513328; PMCID: PMC2686891.

Tinnitus is the perception of sound in the absence of a corresponding external acoustic stimulus. With prevalence ranging from 10% to 15%, tinnitus is a common disorder. Many people habituate to the phantom sound, but tinnitus severely impairs quality of life of about 1-2% of all people. Tinnitus has traditionally been regarded as an otological disorder, but advances in neuroimaging methods and development of animal models have increasingly shifted the perspective towards its neuronal correlates. Increased neuronal firing rate, enhanced neuronal synchrony, and changes in the tonotopic organization are recorded in central auditory pathways in reaction to deprived auditory input and represent–together with changes in non-auditory brain areas–the neuronal correlate of tinnitus.

References: Langguth B, Kreuzer PM, Kleinjung T, De Ridder D. Tinnitus: causes and clinical management. Lancet Neurol. 2013 Sep;12(9):920-930. doi: 10.1016/S1474-4422(13)70160-1. PMID: 23948178.

Studies from independent labs demonstrated alterations in CN neural activity that were correlated with tinnitus behavior but not with changes in auditory brain stem response (ABR) thresholds or supra threshold ABR wave-1 amplitude (i.e., ABR responses to increasing levels of intensity) (Li et al., 2015; Wu et al., 2016).

References: 1) Li S, Kalappa BI, Tzounopoulos T. Noise-induced plasticity of KCNQ2/3 and HCN channels underlies vulnerability and resilience to tinnitus. Elife. 2015 Aug 27;4:e07242. doi: 10.7554/eLife.07242. PMID: 26312501; PMCID: PMC4592936. 2) Wu C, Martel DT, Shore SE. Increased Synchrony and Bursting of Dorsal Cochlear Nucleus Fusiform Cells Correlate with Tinnitus. J Neurosci. 2016 Feb 10;36(6):2068-73. doi: 10.1523/JNEUROSCI.3960-15.2016. PMID: 26865628; PMCID: PMC4748084.

Tinnitus results from changes within the auditory system, which may stem from damage to the ear or the neural pathways that carry sound to the brain. The most accepted theory is that tinnitus comes from outer hair cell damage in the cochlea in the ear, leading to changes in the signals sent from the ear to the brain. Some research suggests that when these normal signals are disrupted, the brain compensates by creating its own noise, leading to tinnitus. This phantom sound can also emerge as the brain’s auditory system becomes overly sensitive after hearing loss, detecting internal processes in the ear and interpreting them as sound. Further research indicates that tinnitus is associated with changes in the brain’s activity pattern, suggesting it’s not just a hearing issue but also involves significant neuroplastic changes within the brain’s auditory cortex (“Understanding the Facts,” American Tinnitus Association).

Source: American Tinnitus Association – Understanding the Facts

Tinnitus is the perception of noise or ringing in the ears, a common condition affecting about 15% to 20% of people. It is not a condition itself but rather a symptom of an underlying condition, such as age-related hearing loss, ear injury, or a circulatory system disorder. Tinnitus can vary in pitch from a low roar to a high squeal, and you may hear it in one or both ears. In some cases, the sound can be so loud it can interfere with your ability to concentrate or hear external sound. Tinnitus may be present all the time, or it may come and go. Despite extensive research, tinnitus remains a poorly understood condition with no cure, but there are several treatments available to help manage its symptoms (“Tinnitus,” Mayo Clinic). 

Source: Tinnitus, Mayo Clinic