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Current understanding of subjective tinnitus in adults

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Abstract

Purpose

An up-to-date overview of epidemiology, etiology and pathophysiological mechanisms, diagnostic and evaluation methods, current treatment status and future directions of subjective tinnitus in adults.

Methods

Review of current evidence-based literature on subjective tinnitus in adults.

Results

The prevalence of subjective tinnitus in the adult population is estimated to be around 14%, and it tends to increase with age. Subjective tinnitus is a complex condition with multiple factors contributing to its origin. However, the exact causes and underlying mechanisms remain unknown. Potential causes may include hearing loss, dysfunction in the somatosensory system, and auditory cortical dysfunction, although severe underlying pathology is rare. Currently, diagnosis primarily relies on patient self-reported medical history and physician-based clinical assessment due to the lack of objective testing. Various treatment and management options have been proposed, but their effectiveness varies, and there is no universally agreed-upon treatment option.

Conclusions

Tinnitus is a complex and heterogeneous disease with a high incidence rate and a tendency to increase with age. A holistic perspective is needed to understand the generation, perception, and emotional responses to tinnitus. Diagnosis requires a comprehensive assessment based on medical history and relevant examinations, identification of concurrent psychosomatic comorbidities, and active pursuit of objective diagnostic methods. At the same time, on the basis of existing treatment plans and combining emerging technologies, we will develop new personalized, precise, and combined treatment plans.

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References

  1. Grevin P, Ohresser M, Kossowski M et al (2020) First assessment of sophrology for the treatment of subjective tinnitus. Eur Ann Otorhinolaryngol Head Neck Dis 137(3):195–199. https://doi.org/10.1016/j.anorl.2020.03.007

    Article  CAS  PubMed  Google Scholar 

  2. Nicolas-Puel C, Faulconbridge RL, Guitton M et al (2002) Characteristics of tinnitus and etiology of associated hearing loss: a study of 123 patients. Int Tinnitus J 8(1):37. https://doi.org/10.3342/kjorl-hns.2022.00885

    Article  PubMed  Google Scholar 

  3. Mccormack A, Edmondson-Jones M, Somerset S et al (2016) A systematic review of the reporting of tinnitus prevalence and severity. Hearing Res 337:70–79. https://doi.org/10.1016/j.heares.2016.05.009

    Article  Google Scholar 

  4. Trochidis I, Lugo A, Borroni E et al (2021) Systematic review on healthcare and societal costs of tinnitus. Int J Environ Res Public Health 18(13):6881. https://doi.org/10.3390/ijerph18136881

    Article  PubMed  PubMed Central  Google Scholar 

  5. Emilie F, Catarina J, Ellenor MR et al (2012) Sickness absence due to otoaudiological diagnoses and risk of disability pension: a nationwide Swedish prospective cohort study. PLoS ONE 7(1):e29966. https://doi.org/10.1186/1471-2458-14-137

    Article  Google Scholar 

  6. Jarach CM, Lugo A, Scala M et al (2022) Global prevalence and incidence of tinnitus. JAMA Neurol. https://doi.org/10.1001/jamaneurol.2022.2189

    Article  PubMed  PubMed Central  Google Scholar 

  7. Park M, Kang SH, Nari F et al (2021) Association between tinnitus and depressive symptoms in the South Korean population. PLoS ONE 16(12):e0261257. https://doi.org/10.1371/journal.pone.0261257

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Stohler NA, Reinau D, Jick SS et al (2019) A study on the epidemiology of tinnitus in the United Kingdom. Clin Epidemiol. https://doi.org/10.2147/clep.s213136

    Article  PubMed  PubMed Central  Google Scholar 

  9. Hackenberg B, O’brien K, Döge J et al (2023) Tinnitus prevalence in the adult population—results from the Gutenberg Health Study. Medicina. https://doi.org/10.3390/medicina59030620

    Article  PubMed  PubMed Central  Google Scholar 

  10. Lewkowski K, Heyworth J, Ytterstad E et al (2021) The prevalence of tinnitus in the Australian working population. Med J Aust 216(4):189–193. https://doi.org/10.5694/mja2.51354

    Article  PubMed  Google Scholar 

  11. Henry JA, Reavis KM, Griest SE et al (2020) Tinnitus an epidemiologic perspective. Otolaryngol Clin N Am 53(4):481–99

    Article  Google Scholar 

  12. Biswas R, Lugo A, Akeroyd MA et al (2021) Tinnitus prevalence in Europe: a multi-country cross-sectional population study. Lancet Reg Health-Eur. https://doi.org/10.1016/j.lanepe.2021.100250

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kim HJ, Lee HJ et al (2015) Analysis of the prevalence and associated risk factors of tinnitus in adults. PLoS ONE 10(5):e0127578. https://doi.org/10.1371/journal.pone.0127578

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Cresswell M, Casanova F, Beaumont RN et al (2021) Understanding factors that cause tinnitus: a Mendelian randomization study in the UK Biobank. Ear Hearing 43(1):70–80. https://doi.org/10.1097/aud.0000000000001074

    Article  Google Scholar 

  15. Henton A, Tzounopoulos T (2021) What’s the buzz? The neuroscience and the treatment of tinnitus. Physiol Rev 101(4):1609–1632. https://doi.org/10.1152/physrev.00029.2020

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Saeed SK, Han QU (2021) The pathological mechanisms and treatments of tinnitus. Discoveries. https://doi.org/10.15190/d.2021.16

    Article  PubMed  PubMed Central  Google Scholar 

  17. Shore SE, Roberts LE, Langguth B (2016) Maladaptive plasticity in tinnitus-triggers, mechanisms and treatment. Nat Rev Neurol 12(3):150–160. https://doi.org/10.1038/nrneurol.2016.12

    Article  PubMed  PubMed Central  Google Scholar 

  18. Henning T, Andreas W, Hidehiko O et al (2014) Combining transcranial direct current stimulation and tailor-made notched music training to decrease tinnitus-related distress-a pilot study. PLoS ONE 9(2):e89904. https://doi.org/10.1371/journal.pone.0089904

    Article  CAS  Google Scholar 

  19. Richardson BD, Brozoski TJ, Ling LL et al (2012) Targeting inhibitory neurotransmission in tinnitus. Brain Res 1485:77–87. https://doi.org/10.1016/j.brainres.2012.02.014

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Mller AR (2016) Sensorineural tinnitus: its pathology and probable therapies. Int J Otolaryngol 2016(3):1–13. https://doi.org/10.1155/2016/2830157

    Article  Google Scholar 

  21. Bauer CA (2018) Tinnitus. N Engl J Med 378(13):1224–1231. https://doi.org/10.1056/NEJMcp1506631

    Article  PubMed  Google Scholar 

  22. Kalappa BI, Brozoski TJ, Turner JG et al (2015) Single unit hyperactivity and bursting in the auditory thalamus of awake rats directly correlates with behavioural evidence of tinnitus. J Physiol 592(22):5065–5078. https://doi.org/10.1113/jphysiol.2014.278572

    Article  CAS  Google Scholar 

  23. Xia C, Yin M, Wu C et al (2020) Neuroglial activation in the auditory cortex and medial geniculate body of salicylate-induced tinnitus rats. Am J Transl Res 12(10):6043–6059

    CAS  PubMed  PubMed Central  Google Scholar 

  24. EggermontJos J (2015) The auditory cortex and tinnitus – a review of animal and human studies. Eur J Neurosci 41(5):665–676. https://doi.org/10.1111/ejn.12759

    Article  CAS  Google Scholar 

  25. Vanneste S, De Ridder D (2012) The auditory and non-auditory brain areas involved in tinnitus: an emergent property of multiple parallel overlapping subnetworks. Front Syst Neurosci 6:31. https://doi.org/10.3389/fnsys.2012.00031

    Article  PubMed  PubMed Central  Google Scholar 

  26. Al-Rawashdeh BM, Qaswal AB, Suleiman A et al (2022) The quantum tunneling of ions model can explain the pathophysiology of tinnitus. Brain Sci. https://doi.org/10.3390/brainsci12040426

    Article  PubMed  PubMed Central  Google Scholar 

  27. Tunkel DE, Bauer CA et al (2014) Clinical practice guideline: tinnitus. J Otolaryngol Head Neck Surg: Off J Am Acad Otolaryngol Head. https://doi.org/10.1177/0194599814545325

    Article  Google Scholar 

  28. Lee HY, Jung DJ (2023) Recent updates on tinnitus management. J Audiol Otol 27(4):181–192. https://doi.org/10.7874/jao.2023.00416

    Article  PubMed  PubMed Central  Google Scholar 

  29. Cima RFF, Mazurek B, Haider H et al (2019) A multidisciplinary European guideline for tinnitus: diagnostics, assessment, and treatment. HNO 67(4):10–42. https://doi.org/10.1007/s00106-019-0633-7

    Article  CAS  PubMed  Google Scholar 

  30. Chari DA, Limb CJ (2018) Tinnitus. Med Clin N Am 102(6):1081–1093. https://doi.org/10.1016/j.mcna.2018.06.014

    Article  PubMed  Google Scholar 

  31. Dalrymple SN, Lewis SH, Philman S (2021) Tinnitus: diagnosis and management. Am Family Phys 11:103

    Google Scholar 

  32. Mazurek B, Hesse G, Sattel H et al (2022) S3 guideline: chronic tinnitus. HNO 70(11):795–827. https://doi.org/10.1007/s00106-022-01207-4

    Article  PubMed  PubMed Central  Google Scholar 

  33. Simoes J, Daoud E, Shabbir M et al (2021) Corrigendum: multidisciplinary tinnitus research: challenges and future directions from the perspective of early stage researchers. Front Aging Neurosci. https://doi.org/10.3389/fnagi.2021.730758

    Article  PubMed  PubMed Central  Google Scholar 

  34. Hoare DJ, Mark EJ, Gander PE et al (2014) Agreement and reliability of tinnitus loudness matching and pitch likeness rating. PLoS ONE 9(12):e114553. https://doi.org/10.1371/journal.pone.0114553

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Ogawa K, Hiroaki S, Takahashi M, Wada T et al (2020) Clinical practice guidelines for diagnosis and treatment of chronic tinnitus in Japan. Auris Nasus Larynx 47(1):1–6. https://doi.org/10.1016/j.anl.2019.09.007

    Article  PubMed  Google Scholar 

  36. Byun SW, Shin S-H, Kim SJ et al (2022) Measures of subjective tinnitus: what does visual analog scale stand for? J Am Acad Audiol 33(02):092–097. https://doi.org/10.1055/s-0041-1736649

    Article  Google Scholar 

  37. Park Y, Shin S-H, Byun SW et al (2023) Audiological and psychological assessment of tinnitus patients with normal hearing. Front Neurol. https://doi.org/10.3389/fneur.2022.1102294

    Article  PubMed  PubMed Central  Google Scholar 

  38. Shin S-H, Byun SW, Park Y et al (2023) The tinnitus handicap inventory is a better indicator of the overall status of patients with tinnitus than the numerical rating scale. Am J Otolaryngol. https://doi.org/10.1016/j.amjoto.2022.103719

    Article  PubMed  Google Scholar 

  39. Lewis S, Chowdhury E, Stockdale DK et al (2020) Assessment and management of tinnitus: summary of NICE guidance. BMJ 368:m976. https://doi.org/10.1136/bmj.m976

    Article  PubMed  Google Scholar 

  40. Mazurek B, Hesse G, Dobel C et al (2022) Clinical practice guideline: chronic tinnitus—diagnosis and treatment. Deutsch Ärztebl Int 119(13):219–225. https://doi.org/10.3238/arztebl.m2022.0135

    Article  Google Scholar 

  41. Newman CW, Sandridge SA, Jacobson GP (1998) Psychometric adequacy of the tinnitus handicap inventory (THI) for evaluating treatment outcome. J Am Acad Audiol 9(2):153–160

    CAS  PubMed  Google Scholar 

  42. Henry JA, Griest S et al (2016) Tinnitus functional index: development, validation, outcomes research, and clinical application. Hearing Res 334:58–64. https://doi.org/10.1016/j.heares.2015.06.004

    Article  Google Scholar 

  43. Mb M, Ja H, Se G et al (2012) The tinnitus functional index: development of a new clinical measure for chronic, intrusive tinnitus. Ear Hearing 33(2):153–176. https://doi.org/10.1097/AUD.0b013e31822f67c0

    Article  Google Scholar 

  44. Cuesta M (2022) Special issue “New insights into pathophysiology diagnosis and treatment of tinnitus.” Brain Sci. https://doi.org/10.3390/brainsci12101330

    Article  PubMed  PubMed Central  Google Scholar 

  45. Hesse G, Langguth B, Jaeger B et al (2015) On the interdisciplinary S3 guidelines for the treatment of chronic idiopathic tinnitus. HNO 63(6):419–427. https://doi.org/10.1007/s00106-015-0011-z

    Article  PubMed  Google Scholar 

  46. Czornik M, Malekshahi A, Mahmoud W et al (2022) Psychophysiological treatment of chronic tinnitus: a review. Clin Psychol Psychother 29(4):1236–1253. https://doi.org/10.1002/cpp.2708

    Article  PubMed  Google Scholar 

  47. Scott B, Lindberg P, Lyttkens L et al (2009) Psychological treatment of tinnitusan experimental group study. Scand Audiol 14(4):223–230. https://doi.org/10.3109/01050398509045945

    Article  Google Scholar 

  48. Fuller T, Cima R, Langguth B et al (2020) Cognitive behavioural therapy for tinnitus. Cohrane Database Syst Rev 1(1):CD012614. https://doi.org/10.1002/14651858.CD012614.pub2

    Article  Google Scholar 

  49. Landry EC, Sandoval XCR, Simeone CN et al (2020) Systematic review and network meta-analysis of cognitive and/or behavioral therapies (CBT) for tinnitus. Otology 41(2):153–166. https://doi.org/10.1097/MAO.0000000000002472

    Article  Google Scholar 

  50. Park KW, Kullar P, Malhotra CS et al (2023) Current and emerging therapies for chronic subjective tinnitus. J Clin Med. https://doi.org/10.3390/jcm12206555

    Article  PubMed  PubMed Central  Google Scholar 

  51. Wang B, Gould RL, Kumar P et al (2022) A systematic review and meta-analysis exploring effects of third-wave psychological therapies on hearing-related distress, depression, anxiety, and quality of life in people with audiological problems. Am J Audiol 31(2):487–512. https://doi.org/10.1044/2022_AJA-21-00162

    Article  PubMed  Google Scholar 

  52. Pj J (1990) Phantom auditory perception (tinnitus): mechanisms of generation and perception. Neurosci Res 8(4):221–254. https://doi.org/10.1016/0168-0102(90)90031-9

    Article  Google Scholar 

  53. Jastreboff PJ (1993) A neurophysiological approach to tinnitus: clinical implications. Br J Audiol. https://doi.org/10.3109/03005369309077884

    Article  PubMed  Google Scholar 

  54. Baguley D, Andersson G, Mcferran D, Mckenna L (2013) Tinnitus : a multidisciplinary approach. Wiley, Hoboken. https://doi.org/10.1002/9781118783009

    Book  Google Scholar 

  55. Limviriyakul S, Atipas S, Suvarnsit K et al (2021) A randomized, controlled trial of notched music therapy for tinnitus patients. Int Adv Otol 17(3):221–227. https://doi.org/10.5152/iao.2021.9385

    Article  Google Scholar 

  56. Piromchai P, Srisukhumchai C, Kasemsiri P et al (2021) A Three-arm, single-blind, randomized controlled trial examining the effects of notched music therapy, conventional music therapy, and counseling on tinnitus. Otol Neurotol 42(2):335–340. https://doi.org/10.1097/MAO.0000000000002935

    Article  PubMed  Google Scholar 

  57. Yoo S, Yakunina N, Nam EC (2022) Does listening to tinnitus frequency-filtered music relieve tinnitus? J Audiol Otol 26(3):147–152. https://doi.org/10.7874/jao.2022.00010

    Article  PubMed  PubMed Central  Google Scholar 

  58. Tong Z, Deng W, Huang X et al (2023) Efficacy of tailor-made notched music training versus tinnitus retraining therapy in adults with chronic subjective tinnitus: a randomized controlled clinical trial. Ear Hear 44(4):670–681. https://doi.org/10.1097/aud.0000000000001318

    Article  PubMed  Google Scholar 

  59. Aa EJR (2018) A review of tinnitus. Aust J Gen Pract 47(4):205–208. https://doi.org/10.31128/ajgp-12-17-4420

    Article  Google Scholar 

  60. Hesse G (2016) Evidence and evidence gaps in tinnitus therapy. GMS Currt Topics Otorhinolaryngol Head Neck Surg 15:04. https://doi.org/10.3205/cto000131

    Article  Google Scholar 

  61. Hoare DJ, Edmondson-Jones M, Sereda M et al (2014) Amplification with hearing aids for patients with tinnitus and co-existing hearing loss. Cochrane Database Syst Rev 1(1):CD010151. https://doi.org/10.1002/14651858.CD010151.pub2

    Article  Google Scholar 

  62. Alf B, Ples D, Rbs A et al (2021) Cochlear implant and tinnitus-a meta-analysis. Braz J Otorhinolaryngol 87(3):353–365. https://doi.org/10.1016/j.bjorl.2020.11.006

    Article  Google Scholar 

  63. Yuen E, Ma C, Nguyen SA et al (2021) The effect of cochlear implantation on tinnitus and quality of life: a systematic review and meta-analysis. Otol Neurotol: Off Publ Am Otol Soc, Am Neurotol Soc Eur Acad Otol Neurotol 8:42. https://doi.org/10.1097/MAO.0000000000003172

    Article  Google Scholar 

  64. Sj O, Ma M, Cj F et al (2023) Cochlear implantation in adults with single-sided deafness: a systematic review and meta-analysis. Otolaryngol Head Neck Surg: Off J Am Acad Otolaryngol-Head Neck Surg 168(2):131–142. https://doi.org/10.1177/01945998221083283

    Article  Google Scholar 

  65. Yz W, Dm T, Hy M et al (2023) Comparison of guidelines on tinnitus. Chin J Otorhinolaryngol Head 58(8):834–840. https://doi.org/10.3760/cma.j.cn115330-20221023-00626

    Article  Google Scholar 

  66. Talluri S, Palaparthi SM, Michelogiannakis D et al (2021) Efficacy of photobiomodulation in the management of tinnitus: a systematic review of randomized control trials. Eur Ann Otorhinolaryngol Head Neck Dis. https://doi.org/10.1016/j.anorl.2020.10.013

    Article  PubMed  Google Scholar 

  67. Demirkol N, Usumez A, Demirkol M et al (2017) Efficacy of low-level laser therapy in subjective tinnitus patients with temporomandibular disorders. Photomed Laser Surg 2016:4240. https://doi.org/10.1089/pho.2016.4240

    Article  CAS  Google Scholar 

  68. Gd S, Pj S, Z D, et al (2021) A state-of-art review of digital technologies for the next generation of tinnitus therapeutics. Front Digit Health 3:724370. https://doi.org/10.3389/fdgth.2021.724370

    Article  Google Scholar 

  69. Searchfield GD (2021) Sense and sensibility: a review of the behavioral neuroscience of tinnitus sound therapy and a new typology. J Curr Topics Behav Neurosci 51:213–247. https://doi.org/10.1007/7854_2020_183

    Article  CAS  Google Scholar 

  70. Conlon B, Langguth B, Hamilton C et al (2020) Bimodal neuromodulation combining sound and tongue stimulation reduces tinnitus symptoms in a large randomized clinical study. Sci Transl Med. https://doi.org/10.1126/scitranslmed.abb2830

    Article  PubMed  Google Scholar 

  71. Winfried S, Stefan S, Susanne S et al (2021) Towards a unification of treatments and interventions for tinnitus patients: the EU research and innovation action UNITI. Prog Brain Res 260:441–451. https://doi.org/10.1016/bs.pbr.2020.12.005

    Article  Google Scholar 

  72. Tutton R (2012) Personalizing medicine: futures present and past. Soc Sci Med 75(10):1721–1728. https://doi.org/10.1016/j.socscimed.2012.07.031

    Article  PubMed  Google Scholar 

  73. Tzounopoulos T, Balaban C, Zitelli L et al (2019) Towards a mechanistic-driven precision medicine approach for tinnitus. J Assoc Res Otolaryngol 20(2):115–131. https://doi.org/10.1007/s10162-018-00709-9

    Article  PubMed  PubMed Central  Google Scholar 

  74. Grundfast KM, Jamil TL (2023) Evaluation and management of tinnitus: are there opportunities for improvement? J Otolaryngol Head Neck Surg: Off J Am Acad Otolaryngol-Head Neck Surg 168(1):45–58. https://doi.org/10.1177/01945998221088286

    Article  Google Scholar 

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Acknowledgements

This work was supported by a grant from the Clinical Study of Standard Diagnosis and Rehabilitation of Tinnitus Patients and a Grant from the Health and Family Planning Commission of Sichuan Province (No. 150134).

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Authors and Affiliations

  1. Hearing Center, Department of Otolaryngology-Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, China

    Yao-Jie Kang & Yun Zheng

  2. Department of Otolaryngology-Head and Neck Surgery, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi Tujia and Miao Autonomous Prefecture, China

    Yao-Jie Kang

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YJ K and YZ contributed to the conception of the review and interpreted previous findings. The article was drafted by YJ K and critically revised by YZ. Two authors approved the final version for publication. Two authors agreed to be accountable for all aspects of the work. YJ K acts as guarantor of the work.

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Kang, YJ., Zheng, Y. Current understanding of subjective tinnitus in adults. Eur Arch Otorhinolaryngol (2024). https://doi.org/10.1007/s00405-024-08633-w

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