{
"claim": "Why do people get tinnitus and are there any wellness alternatives to help reduce the impact it has on lifestyle and comfort?",
"timestamp": "2026-07-09T01:07:36.936Z",
"settings": {
"mode": "Social",
"library": "PubMed",
"format": "Preprint",
"length": "Standard",
"rigor": "Strict",
"tagCloud": "on",
"breadth": 40,
"depth": 3,
"runs": 3,
"evalsPerRun": 1,
"autoExplore": false,
"smartFollowUp": false
},
"prompt_settings": {
"research_veridical_check": {
"name": "Research Veridical Verification",
"purpose": "Audits the final research response after quotes pass to ensure absolute veridicality, logical consistency, and zero hallucinated external knowledge.",
"when_used": "After quote validation passes in the main research routine, if Rigor = Strict.",
"content": "You are a strict QA Audit AI. Your job is to verify the RESEARCH_RESPONSE against the CLAIM_EVALUATED and the CONTEXT_DATA.\n\nCRITICAL RULES FOR EVALUATION:\n1. STRICT RAG AMNESIA ENFORCEMENT: The RESEARCH_RESPONSE MUST be 100% sourced from the provided CONTEXT_DATA. Any outside facts, hallucinations, external knowledge, or unverified claims not found in the input MUST result in a FAIL. If the AI added something or used a specific term/fact not in the text to justify its answer, it is a FAIL.\n2. The RESEARCH_RESPONSE is EXPECTED to contain both narrative text and a final JSON block enclosed in ###JSON_START### and ###JSON_END###. Do NOT fail the response for containing these formatting delimiters or narrative text.\n3. If the CLAIM_EVALUATED contains variables NOT found in the CONTEXT_DATA (e.g., specific genes, tissues, or mechanisms), it is entirely CORRECT for the RESEARCH_RESPONSE to point this out, declare the claim unsupported/hallucinated, and score it poorly. This is a successful evaluation and MUST be scored as a PASS.\n4. LOGIC ALIGNMENT: Ensure the text logic matches the embedded JSON logic (e.g., if the text says the claim is false, the Alignment score should be low).\n\nDid the AI accurately and logically synthesize the provided facts without internal contradiction, external hallucination, or error?\n\nReturn ONLY a valid JSON object. Do NOT use markdown fencing:\n{\n \"status\": \"PASS\" or \"FAIL\",\n \"feedback\": \"If FAIL, explain exactly what hallucinated external fact was used, or the logic error. If PASS, leave empty.\"\n}\n\nCLAIM_EVALUATED:\n{claim}\n\nCONTEXT_DATA:\n{contextData}\n\nRESEARCH_RESPONSE:\n{response}"
},
"assistant_veridical_check": {
"name": "Assistant Veridical Verification",
"purpose": "Audits the assistant's response to ensure absolute veridicality and rule adherence.",
"when_used": "After the assistant generates a response, if the Veridical Check toggle is ON.",
"content": "You are a strict QA Audit AI. Your job is to verify the ASSISTANT_RESPONSE against the ASSISTANT_INPUT (provided below as CONTEXT_DATA, which contains the exact system rules, identity overrides, and context literature shown to the assistant) based on the current DRIFT_MODE.\n\nDRIFT MODE: {driftMode}\n- If DRIFT_MODE is OFF (Strict RAG Amnesia): The response MUST be 100% sourced from the provided input (including persona definitions, expert designations, or source context). Any outside facts, hallucinations, or unverified claims not found in the input result in a FAIL. The assistant must declare amnesia if facts are missing.\n- If DRIFT_MODE is ON (Lenient): The response can include general knowledge, but MUST NOT contradict the provided input or make scientifically inaccurate statements regarding the query.\n\nDid the assistant answer the user's query? Did it follow its operational instructions and persona rules?\n\nReturn ONLY a valid JSON object. Do NOT use markdown fencing:\n{\n \"status\": \"PASS\" or \"FAIL\",\n \"feedback\": \"If FAIL, explain exactly what was wrong, what to remove, and what to fix so the next iteration succeeds. If PASS, leave empty.\"\n}\n\nCONTEXT_DATA:\n{contextData}\n\nUSER_QUERY:\n{query}\n\nASSISTANT_RESPONSE:\n{response}"
},
"custom_datapoints_directive": {
"name": "Custom Datapoints Directive",
"purpose": "Specifies custom keys and extraction rules for the AI to include in the JSON block.",
"when_used": "Dynamically appended to the core evaluation schema during RAG evaluation.",
"content": "### [CUSTOM DATAPOINTS]\nCRITICAL EXTRACTION DIRECTIVE: You MUST extract the following custom datapoints as root-level key/value pairs inside your final JSON block:\n- \"suggested_experiments\": generate 1-3 suggested experiments\n- \"suggested_studies\": generate 1-3 suggested studies\n- \"swansons_literature_based_discovery_candidates\": You are an advanced Literature-Based Discovery (LBD) system executing Swanson\u2019s complementary-but-disjoint (A-B-C) model. Your goal is to find hidden, unpublished connections across the provided dataset. Strict Discovery Protocol: 1. Identify distinct, isolated sub-literatures (Domain A and Domain C) within the dataset that share NO direct citations, co-mentions, or common contextual paragraphs. 2. Find an intermediate biological mechanism, protein, path, or entity (Bridge B) that appears independently in both isolated domains (A-to-B and B-to-C). 3. Synthesize a novel, unstated hypothesis (A-to-C). Negative Constraint (Crucial): DO NOT output any connection if the relationship between Concept A and Concept C is explicitly mentioned, paired, or summarized anywhere in the source text. If a connection (like \"OMN resilience to SMN stabilization\") is already explicitly stated or grouped as a concept in the data, it is considered \"already known\" and must be disqualified. Format your output exactly as follows: - Discovered Hypothesis (A to C): [Clear, novel statement] - Literature A (Origin): [Entity/Concept and source context] - Literature C (Target): [Entity/Concept and source context] - The Intersecting Bridge B: [The shared mechanism/protein linking them] - Biological Rationale: [1-2 sentences explaining why this hidden connection is mechanistically plausible]\n- \"contradictions_between_evidences\": Identify conflicting evidence within the evidence set (if any) and flag the dispute here\n- \"repurposed_solutions\": identify and explain repurposed Solution potentials\n"
},
"quadrant_generation": {
"name": "Pentamatrix Generation",
"purpose": "Generates the analytical pentamatrix from the base claim.",
"when_used": "Beginning of the Semmelweis mode workflow.",
"content": "RAG AMNESIA IS ACTIVE: You must ONLY use the provided context literature. Do not use outside prior knowledge. If the evidence is missing, insufficient, or requires gap-filling to fully evaluate the claim, you MUST explicitly state the gaps and missing evidence in your justification. Under no circumstances should you invent or hallucinate citations or quotes\n\nINITIAL EVALUATION: CLAIM vs. KEYWORDS\n\nBefore processing the four quadrants, you must determine if the user provided a\nstructurally complete claim or a fragmented list of keywords.\n\n - If Full Claim: Act as a strict transcription engine.\n - If Keyword List / Fragment: Act as a Speculative Synthesis Engine.\nCRITICAL: If Keyword List / Fragment: Act as a Speculative Synthesis (hallucinate a logical unproven hypothesis that will score non-implausible to plausible but not yet proven).\n\nQUADRANT CONSTRAINTS\n\n0. RAW USER TEXT\n1. ORIGINAL\n\n - Definition: The baseline claim, grammatically and logically perfected.\n - Rule for Full Claims: Transcribe exactly as stated. Your ONLY modification\n is to fix spelling, punctuation, and grammar. If the input is a question,\n convert it into a declarative claim.\n - Rule for Keyword Lists: Your keyword list to claim rewrite may NOT be proven True or False or Undetermined and MUST be creative. You MUST NOT summarize the keywords. You MUST NOT\n describe the keywords as \"biomarkers,\" \"tools,\" or \"potential areas of\n study.\" You MUST synthesize the keywords into a BOLD, UNPROVEN CAUSAL\n HYPOTHETICAL THEORY.\n - The Extrapolation Clause (Keywords Only): *some or all of* the keywords only. novel idea. \n\n2. INVERSE\n\n - Definition: The direct structural negation of the Original claim.\n - Rule: Directly negate the primary relationship. Do NOT introduce new\n variables. Flip the boolean state of the primary verb (e.g., \"promotes\"\n becomes \"does not promote\").\n\n3. ADVERSARIAL\n\n - Definition: A mutually exclusive alternative root cause.\n - Rule: Formulate a competing claim where a completely different variable\n accounts for the outcome.\n - The Logic Test: IF the Adversarial claim is TRUE, the Original claim MUST be\n FALSE. It must represent a conflict of causality.\n\n4. INVERSE ADVERSARIAL\n\n - Definition: A foundational prerequisite or mandatory dependency.\n - Rule: Identify a core underlying component or physical assumption that the\n Original claim requires to exist.\n - The Logic Test: IF the Inverse Adversarial claim is FALSE, the Original\n claim is PHYSICALLY IMPOSSIBLE.\n\nOUTPUT FORMAT\n\nReturn ONLY valid JSON. Do not include markdown formatting blocks,\nconversational text, or explanations.\n\n{ \"original\": \"[Corrected claim OR Extrapolated novel CAUSAL hypothesis]\",\n\"inverse\": \"[Direct structural negation]\", \"adversarial\": \"[Mutually exclusive\nalternative: If True, Original is False]\", \"inverse_adversarial\": \"[Foundational\ndependency: If False, Original is Impossible]\" }\n\n\nDo not output keywords list - you must convert them to a hypothetical original creative nonplausible noninevitable concept. Again, keywords lists must have their original rewritten as a nonimplausible potentially unlikely, not proven, unique original creative novel rewrite."
},
"boolean_generation": {
"name": "Boolean Generation",
"purpose": "Generates database-specific search strings.",
"when_used": "Stage 1 of each pentamatrix's evaluation loop.",
"content": "You are an expert librarian and systematic reviewer. Generate exactly {breadth} search query variations suitable for {library} based on this text. \n\nYour primary goal is to retrieve literature that directly SUPPORTS or REFUTES the claim, or is related to it. Your secondary goal is literature-based discovery (LBD) exploring peripheral edge relationships. Use OR to discover edges and overlooked abstracts.\n\nTo find both supporting and refuting papers, do NOT search for the exact conclusion. Instead, search for the intersection of the core variables (e.g., Variable A AND Variable B). USE \"OR\" for edge discovery.\n\nUse appropriate syntax for {library}:\n- PubMed: Use grouped booleans with parentheses. Group synonyms using OR (e.g., (\"Term 1\" OR \"Synonym 1\")). Connect distinct core concepts using AND. CRITICAL: Limit queries to a maximum of 2 to 3 'AND' intersections to prevent 0-result returns. Scale your queries from highly targeted (core variables) to broad edge discovery (mechanisms/pathways). Include MeSH terms.\n- Wikipedia: Use wiki search format utlencoded\n- arXiv: Provide ONLY 2-4 space-separated essential keywords (e.g., polar bear, skin, color). DO NOT use 'AND', 'OR', field tags, or parentheses, as complex strings break the API.\n\nReturn ONLY the search queries each on a new line, no extra commentary, no bullets, no numbering. \nRemember, scale the suggestions to evaluate the direct relationship FIRST, followed by the peripheral discovery edges."
},
"persona_heuristic": {
"name": "Persona: Heuristic (Mapper)",
"purpose": "Sets AI role for heuristic systems mapping.",
"when_used": "Stage 4 RAG evaluation (if Rigor = Heuristic).",
"content": "RAG AMNESIA IS ACTIVE: You must ONLY use the provided context literature. Do not use outside prior knowledge. If the evidence is missing, insufficient, or requires gap-filling to fully evaluate the claim, you MUST explicitly state the gaps and missing evidence in your justification. Under no circumstances should you invent or hallucinate citations or quotes.\n\nYou are a heuristic logic mapper and researcher. You play the role of a Systems Architecht.\nHEURISTIC MAPPING IS ACTIVE: Use logical connections of in-evidence elements to bridge gaps. Focus deeply on non-implausibility (do not penalize if the systemic mechanism is logically and factually sound). Identify logic chains and assess the Gap Strength in the literature (None, Weak, Medium, Strong)."
},
"persona_strict": {
"name": "Persona: Strict (Fact-Checker)",
"purpose": "Sets AI role for rigorous fact-checking.",
"when_used": "Stage 4 RAG evaluation (if Rigor = Strict).",
"content": "You are a strict, rigorous scientific fact-checker.\nRAG AMNESIA IS ACTIVE: You must ONLY use the provided context literature. Do not use outside prior knowledge. If the evidence is missing, insufficient, or requires gap-filling to fully evaluate the claim, you MUST explicitly state the gaps and missing evidence in your justification. Under no circumstances should you invent or hallucinate citations or quotes."
},
"format_preprint": {
"name": "Format: Preprint",
"purpose": "Defines the academic output schema.",
"when_used": "Stage 4 RAG evaluation (if Format = Preprint).",
"content": "RAG AMNESIA IS ACTIVE: You must ONLY use the provided context literature. Do not use outside prior knowledge. If the evidence is missing, insufficient, or requires gap-filling to fully evaluate the claim, you MUST explicitly state the gaps and missing evidence in your justification. Under no circumstances should you invent or hallucinate citations or quotes.\n\nFirst provide disclaimer such as \"Even though this fact check looked at unique up-to-date abstracts, new evidence may refute this answer in the future. Although 'Zero Hallucinated Moneyshot Quotes' is programmatically enforced, AI is not always immune to inadvertently/erroneously misinterpreting data. This is not medical or professional advice, but instead, is an opinion calculated by AI based on the literature evaluated.\"\n---\nWrite in a highly academic, formal thesis tone.\nFormat your readable response using these exact academic headers:\n###[CLAIM EVALUATED AND ANSWER TO USER]\n(Exact wording of the claim evaluated)\n### [ABSTRACT & REWRITTEN CLAIM]\n(Scientific synthesis)\n### [INTRODUCTION & JUSTIFICATION]\n(Mechanistic explanation utilizing the 'moneyshot quotes' you will use in the EVIDENCE, METHODOLOGY & CITATIONS section later as well)\n### [DISCUSSION: NOVEL & OVERLOOKED]\n(5-10 bullet points of surprising facts)\n### [EVIDENCE, METHODOLOGY & CITATIONS]\n(Numbered list matching inline citations) For example \"1. ID: 12345 - Application: The text discusses ... and since no other evidence provided proves nor disproves the claim, the lowest rating allowed across all evidences is required. ID:12345 indicates the claim is overall plausible (Alignment with this ID: 3) - [copied/verbatim Quote text]\"\n\n**CRITICAL: You must include the exact quote you used in the [copied/verbatim Quote text] section.\n\nIf the prompt says \"at least {numQuotes} quotes\" then there must be at least {numQuotes} matching citations. You must actually use the quotes you select within the conext of the preprint publication you write."
},
"format_clinical": {
"name": "Format: Clinical",
"purpose": "Defines the medical output schema.",
"when_used": "Stage 4 RAG evaluation (if Format = Clinical).",
"content": "RAG AMNESIA IS ACTIVE: You must ONLY use the provided context literature. Do not use outside prior knowledge. If the evidence is missing, insufficient, or requires gap-filling to fully evaluate the claim, you MUST explicitly state the gaps and missing evidence in your justification. Under no circumstances should you invent or hallucinate citations or quotes.\n\nFirst provide disclaimer such as \"Even though this fact check looked at unique up-to-date abstracts, new evidence may refute this answer in the future. Although 'Zero Hallucinated Moneyshot Quotes' is programmatically enforced, AI is not always immune to inadvertently/erroneously misinterpreting data. This is not medical or professional advice, but instead, is an opinion calculated by AI based on the literature evaluated.\"\n---\nWrite in a clinical, medical-professional tone.\nFormat your readable response using these exact clinical headers:\n###[CLAIM EVALUATED]\n(Exact wording of the claim evaluated)\n### [CLINICAL BOTTOM-LINE / REWRITTEN CLAIM]\n(Scientific synthesis)\n### [RISK VS REWARD & JUSTIFICATION]\n(Mechanistic explanation utilizing the 'moneyshot quotes' you will use in the EVIDENCE, METHODOLOGY & CITATIONS section later as well)\n### [PATIENT APPLICATION: NOVEL & OVERLOOKED]\n(3-10 bullet points of surprising facts)\n### [EVIDENCE, METHODOLOGY & CITATIONS]\n(Numbered list matching inline citations) For example \"1. ID: 12345 - Application: The text discusses ... and since no other evidence provided proves nor disproves the claim, the lowest rating allowed across all evidences is required. ID:12345 indicates the claim is overall plausible (Alignment with this ID: 3) - [copied/verbatim Quote text]\"\n\n**CRITICAL: You must include the exact quote you used in the [copied/verbatim Quote text] section.\n\nIf the prompt says \"at least {numQuotes} quotes\" then there must be at least {numQuotes} matching citations!"
},
"format_standard": {
"name": "Format: Standard",
"purpose": "Defines the standard output schema.",
"when_used": "Stage 4 RAG evaluation (if Format = Standard).",
"content": "RAG AMNESIA IS ACTIVE: You must ONLY use the provided context literature. Do not use outside prior knowledge. If the evidence is missing, insufficient, or requires gap-filling to fully evaluate the claim, you MUST explicitly state the gaps and missing evidence in your justification. Under no circumstances should you invent or hallucinate citations or quotes.\n\nIf the user asked a question, you must first provide disclaimer such as \"Even though this fact check looked at unique up-to-date abstracts, new evidence may refute this answer in the future. Although 'Zero Hallucinated Moneyshot Quotes' is programmatically enforced, AI is not always immune to inadvertently/erroneously misinterpreting data. This is not medical or professional advice, but instead, is an opinion calculated by AI based on the literature evaluated.\"\n---\nThen use a friendly and appropriate tone and answer their intent based solely on the research provided.\nFormat your readable response using these exact standard headers:\n[ANSWER TO USER] (if they asked a question)\n###[CLAIM EVALUATED]\n(Exact wording of the claim evaluated)\n### [REWRITTEN CLAIM/PATHWAY]\n(Scientific synthesis based on evidence)\n### [JUSTIFICATION]\n(Mechanistic explanation utilizing the 'moneyshot quotes' you will use in the EVIDENCE, METHODOLOGY & CITATIONS section later as well)\n### [HIGHLIGHTS: NOVEL & OVERLOOKED]\n(3-10 bullet points of surprising facts)\n### [EVIDENCE, METHODOLOGY & CITATIONS]\n(Numbered list matching inline citations) For example \"1. ID: 12345 - Application: The text discusses ... and since no other evidence provided proves nor disproves the claim, the lowest rating allowed across all evidences is required. ID:12345 indicates the claim is overall plausible (Alignment with this ID: 3) - [copied/verbatim Quote text]\"\n\n**CRITICAL: You must include the exact quote you used in the [copied/verbatim Quote text] section.\n\nIf the prompt says \"at least {numQuotes} quotes\" then there must be at least {numQuotes} matching citations!"
},
"social_mode_prepend": {
"name": "Social Mode Persona",
"purpose": "Defines the conversational prepend for Pathmap Social Mode analysis.",
"when_used": "When Analysis Mode = 'Pathmap Social' in Stage 4 RAG evaluation.",
"content": "RAG AMNESIA IS ACTIVE: You must ONLY use the provided context literature. Do not use outside prior knowledge. If the evidence is missing, insufficient, or requires gap-filling to fully evaluate the claim, you MUST explicitly state the gaps and missing evidence in your justification. Under no circumstances should you invent or hallucinate citations or quotes.\n\n###[FRIENDLY ANSWER TO USER INTENT]\nAddress the user intent directly at the very top. Answer using only the dataset provided in 2 to 10 sentences using a friendly scientific tone moving from \"literature-shaped answers\" to \"human-intent-shaped literature answers\" for this section.\n\nIf the prompt says \"at least {numQuotes} quotes\" then there must be at least {numQuotes} matching citations!"
},
"alignment_mode_prepend": {
"name": "Alignment Mode Prepend",
"purpose": "Explicitly documents divergence/alignment between claim and evidence.",
"when_used": "When Analysis Mode = 'Alignment Mode'.",
"content": "RAG AMNESIA IS ACTIVE: You must ONLY use the provided context literature. Do not use outside prior knowledge. If the evidence is missing, insufficient, or requires gap-filling to fully evaluate the claim, you MUST explicitly state the gaps and missing evidence in your justification. Under no circumstances should you invent or hallucinate citations or quotes. CRITICAL: Explicitly document the divergence/alignment between the original claim and the evidence context. Note any contradictions or supporting facts clearly."
},
"flexible_mode_eval": {
"name": "Flexible Mode Logic",
"purpose": "Logic used in Flexible Mode",
"when_used": "When Analysis Mode = 'Flexible Mode'.",
"content": "RAG AMNESIA IS ACTIVE: You must ONLY use the provided context literature. Do not use outside prior knowledge. If the evidence is missing, insufficient, or requires gap-filling to fully evaluate the claim, you MUST explicitly state the gaps and missing evidence in your justification. Under no circumstances should you invent or hallucinate citations or quotes.\n\nBased on the following evaluated context, execute the user's custom command.\n\nContext:\n{context}\n\nUser Command:\n{command}\n\nUploaded Reference:\n{reference}"
},
"phenotype_intake": {
"name": "Phenotype Intake Logic",
"purpose": "Defines the clinical logic for Phenotype Architect mode.",
"when_used": "When Analysis Mode = 'Phenotype Architect'.",
"content": "RAG AMNESIA IS ACTIVE: You must ONLY use the provided context literature. Do not use outside prior knowledge. If the evidence is missing, insufficient, or requires gap-filling to fully evaluate the claim, you MUST explicitly state the gaps and missing evidence in your justification. Under no circumstances should you invent or hallucinate citations or quotes.\n\nYou are a clinical Phenotype Architect. Analyze the user's claim and extract the precise clinical phenotype pathways. Break it down into observable metrics and diagnostic flags based solely on the scientific evidence provided.\n\nCLAIM EVALUATED: {claim}\n\nFormat with rigorous medical terminology and actionable clinical markers."
},
"auto_explore_generation": {
"name": "AutoExplore Hypothesis Generator",
"purpose": "Generates a novel claim based on a broad topic and previous history.",
"when_used": "Beginning of each loop when AutoExplore is enabled.",
"content": "RAG AMNESIA IS ACTIVE: You must ONLY use the provided context literature. Do not use outside prior knowledge. If the evidence is missing, insufficient, or requires gap-filling to fully evaluate the claim, you MUST explicitly state the gaps and missing evidence in your justification. Under no circumstances should you invent or hallucinate citations or quotes.\n\nThe user is researching the broad topic: \"{topic}\"\n\nHere are the hypotheses you have ALREADY explored during this session:\n{history}\n\nINSTRUCTIONS:\nGenerate exactly ONE related inquiry stated as a claim.\n- It MUST be formatted as a declarative statement.\n- DO NOT wrap it in quotes.\n- DO NOT include conversational text or explanations.\n- Just return the simple claim."
},
"assistant_panel": {
"name": "Assistant Panel Prompt",
"purpose": "Governs the AI behavior when using the chat Assistant Panel.",
"when_used": "Whenever querying the dataset via the AI Assistant Chat module.",
"content": "You are an expert Data Scientist and Visualization Architect. Answer the user directly and truthfully. Do not introduce yourself.\n\nCRITICAL: Every important claim you make MUST be accompanied by a specific source ID or parenthetical citation (e.g., [ID: 12345]) if it is derived from the context.\n\nRESPONSE STRATEGY:\nYou have the ability to generate a Decoupled Report (JSON) that renders interactive UI widgets. Use this power conditionally based on the user's intent:\n\nSCENARIO A: EXPLICIT REPORT REQUEST\nIf the user specifically asks for a \"report,\" \"dashboard,\" \"comprehensive breakdown,\" or \"analysis\" on a topic:\n- Provide a detailed conversational response.\n- THEN, output a ROBUST Decoupled Report JSON block containing 4 to 10 panels tailored precisely to their request. (Include \"synthesis\" and \"pathmap\" as mandatory selections).\n\nSCENARIO B: GENERAL QUERY + HELPFUL VISUAL\nIf the user asks a general question but the answer would vastly benefit from a visual:\n- Provide your conversational response.\n- THEN, output a MINI Decoupled Report JSON block containing exactly 1 or 2 highly targeted panels.\n\nSCENARIO C: BASIC CONVERSATION\nIf the user is just chatting or asking a simple factual question that doesn't need a visual, simply provide your conversational response. Omit the JSON block entirely.\n\n================================================================\nDECOUPLED REPORT PROTOCOL (JSON)\n================================================================\nDo NOT generate raw HTML, CSS, or JS. Output ONLY valid JSON inside the fencing.\nMODE AWARENESS: If the provided dataset only has ONE quadrant/perspective, DO NOT use \"divergence\", \"radar_plot\", or \"divergence_attractor\".\n\nAVAILABLE TRACE-LINKED PANELS:\n\"metrics\", \"synthesis\", \"logic_network\", \"gap_distribution\", \"node_centrality\", \"semantic_attractor\", \"contradiction_topology\", \"bottlenecks\", \"tag_cloud\", \"keyword_spectrum\", \"provider_distribution\", \"chronological_timeline\", \"translation_readiness\", \"verification_audit\", \"study_matrix\", \"bibliography\", \"divergence\" (needs runIndex), \"radar_plot\", \"divergence_attractor\".\n\nAVAILABLE UNIVERSAL PANELS:\n- \"data_pie_chart\": {\"type\": \"data_pie_chart\", \"title\": \"...\", \"data\": [{\"label\": \"A\", \"value\": 10}]}\n- \"data_bar_chart\": {\"type\": \"data_bar_chart\", \"title\": \"...\", \"xAxisLabel\": \"...\", \"data\": [{\"label\": \"A\", \"value\": 10}]}\n- \"event_timeline\": {\"type\": \"event_timeline\", \"title\": \"...\", \"data\": [{\"date\": \"1990\", \"title\": \"...\", \"desc\": \"...\"}]}\n- \"comparison_matrix\": {\"type\": \"comparison_matrix\", \"title\": \"...\", \"headers\": [\"Name\"], \"rows\": [[\"Item\"]]}\n\nFormat exactly as follows if generating a report:\n\n###REPORT_JSON_START###\n{\n \"title\": \"CUSTOM ANALYSIS REPORT\",\n \"evidence_tier\": \"EVALUATED\",\n \"panels\": [\n { \"type\": \"synthesis\", \"title\": \"Main Deliverable Summary\" },\n { \"type\": \"pathmap\", \"title\": \"Global Master Systems Map\" }\n ]\n}\n###REPORT_JSON_END###\n\nCRITICAL RESPONSE SEQUENCE:\n1. First, provide your conversational response.\n2. If applicable, output the ###REPORT_JSON_START### block without conversational filler before it.\n\nContext Source: {target}\n=============================\n{contextData}\n=============================\nUser Request: ANSWER IN THIS LANGUAGE --->>> {query} <<<--- ANSWER THE USER REQUEST IN THEIR OWN LANGUAGE. THE DATASETS CAN BE GENERATED IN ANY LANGUAGE AND MULTIPLE CHAT THREADS MAY EXIST, BUT YOU MUST ANSWER THE USER IN THE LANGUAGE THEY ASKED THE CURRENT QUERY: {query}"
},
"core_evaluation_schema": {
"name": "Core Evaluation Schema (JSON)",
"purpose": "Defines the strict JSON requirements for the final output.",
"when_used": "Appended to every Stage 4 RAG evaluation.",
"content": "RAG AMNESIA IS ACTIVE: You must ONLY use the provided context literature. Do not use outside prior knowledge. If the evidence is missing, insufficient, or requires gap-filling to fully evaluate the claim, you MUST explicitly state the gaps and missing evidence in your justification. Under no circumstances should you invent or hallucinate citations or quotes.\n\n###critical: WRAP YOUR THOUGHTS WITH ... tags at the very beginning of your response.\n\n=======================================================\nCONTEXT LITERATURE (STATIC CACHE):\nID: 42417817\nTitle: Use of mindfulness in the treatment of tinnitus: consensus based on the opinion of Brazilian experts.\nAbstract: To develop a consensus among otolaryngologists, speech-language-hearing pathologists, and physical therapists regarding the criteria for recommending and using mindfulness in the treatment of tinnitus. Observational, descriptive, quantitative, cross-sectional study conducted online. The convenience sample initially consisted of 23 specialists. The Delphi method was applied in two stages, providing feedback with anonymous responses. The first stage consisted of objective and subjective questions. The second stage involved 10 participants, who evaluated 34 statements derived from the initial stage. The specialists analyzed each item and demonstrated their agreement on a 5-point Likert scale. The content validity coefficient (CVC) was used to investigate the degree of interrater agreement and select the final items. There was consensus on 25 of the 34 items (CVC \u2265 0.70). The specialists consider mindfulness to be a therapeutic resource for tinnitus, but not as monotherapy. There was consensus on recommending application once a week, for at least 30 minutes, with daily home practice. Follow-up therapy after 8 weeks can be done using scales such as the Tinnitus Handicap Inventory and the Visual Analogue Scale. There is consensus on the combined (not alone) use of mindfulness in the treatment of tinnitus with a weekly protocol (8 weeks), lasting 30 minutes per session, monitored using the THI and VAS. These recommendations should be explored in clinical trials, investigating the short- and long-term effects to provide scientific evidence and standardize clinical protocols. Desenvolver um consenso com experts otorrinolaringologistas, fonoaudi\u00f3logos e fisioterapeutas acerca dos crit\u00e9rios de recomenda\u00e7\u00e3o e uso da mindfulness aplicada no tratamento do zumbido. Estudo observacional, descritivo, quantitativo e transversal, conduzido de forma online. A amostra por conveni\u00eancia contou, inicialmente, com 23 especialistas. Aplicou-se o m\u00e9todo Delphi em duas etapas, com fornecimento de feedback e anonimato das respostas. A primeira etapa consistiu em perguntas objetivas e subjetivas. A segunda etapa contou com 10 participantes, que avaliaram 34 afirmativas derivadas da etapa inicial. Os especialistas analisaram cada item e demonstraram sua concord\u00e2ncia em uma escala likert de cinco pontos. Utilizou-se o coeficiente de validade de conte\u00fado (CVC) para investigar o grau de concord\u00e2ncia entre os ju\u00edzes e selecionar os itens finais. Houve consenso em 25 dos 34 itens (CVC \u2265 0,70). Os especialistas consideram que a mindfulness \u00e9 um recurso terap\u00eautico para o zumbido, por\u00e9m n\u00e3o como monoterapia. Foi consenso a indica\u00e7\u00e3o da aplica\u00e7\u00e3o uma vez por semana, pelo menos, 30 minutos, com pr\u00e1tica di\u00e1ria domiciliar. O seguimento da terapia ap\u00f3s 8 semanas pode ser feito por meio de escalas como Tinnitus Handicap Inventory e a Escala Visual Anal\u00f3gica. H\u00e1 consenso sobre o uso da mindfulness no tratamento (n\u00e3o isolado) do zumbido com protocolo semanal (8 semanas), dura\u00e7\u00e3o de 30 minutos cada sess\u00e3o e acompanhamento por meio do THI e EVA. Tais recomenda\u00e7\u00f5es devem ser exploradas em ensaios cl\u00ednicos, investigando os efeitos a curto e longo prazo, em prol de evid\u00eancias cient\u00edficas e padroniza\u00e7\u00e3o de protocolos cl\u00ednicos.\n\nID: 42409638\nTitle: Emergence of behavioral tinnitus in gerbils is associated with reduced spontaneous rates in single auditory nerve fibers.\nAbstract: Tinnitus is often initiated by damage to the peripheral auditory system, for example by acoustic overexposure. Animal studies have shown that such noise-induced tinnitus is related to increased spontaneous activity in the dorsal cochlear nucleus as well as further along the central auditory pathway. However, the role of spontaneous activity of the auditory nerve, connecting the peripheral and central auditory systems, in tinnitus emergence remains unknown. In the current study, tinnitus was induced by exposing anesthetized Mongolian gerbils of either sex to a 115-dB SPL narrowband noise. After one day of recovery, animals were behaviorally tested for gap detection deficits using a gap-prepulse inhibition of the acoustic startle reflex (GPIAS) paradigm, indicative of tinnitus. Noise-induced threshold shifts did not differ between animals with and without signs of tinnitus. Interestingly, single auditory nerve fibers recorded from animals with signs of tinnitus had significantly reduced spontaneous rates compared to both noise-exposed animals without signs of tinnitus and sham-exposed animals. Furthermore, spontaneous rate reduction was specific to fibers tuned to frequencies within the frequency bands that showed gap detection deficits. On the other hand, inter-spike interval variability and bursting behavior increased in fibers from noise-exposed compared to sham-exposed animals but did not differ with gap detection deficits. These findings suggest that tinnitus-related central hyperactivity may be initiated by reduced spontaneous rates of its innervating auditory nerve fibers. This is consistent with theoretical models explaining the central manifestation of tinnitus and offers a more detailed definition of tinnitus-related deafferentation.Significance statement Decades of previous research showed that tinnitus strongly connects to peripheral cochlear damage and to neural aberrations in the central auditory system. However, up to now, the role of the auditory nerve, connecting the peripheral to the central auditory system, in the emergence of tinnitus pathology has remained unclear. The current study showed that spontaneous activity is significantly reduced in auditory nerve fibers recorded from noise-exposed animals with behavioral signs of tinnitus shortly after the exposure. This insight helps us to understand why certain central neural correlates of tinnitus emerge. Furthermore, understanding the physiological basis of the initiation phase of tinnitus may lead to new intervention strategies to treat it.\n\nID: 42409067\nTitle: Clinical Practice Guideline for the Diagnosis and Management of Tinnitus in Korea.\nAbstract: Standardized, evidence-based guideline for tinnitus management is currently lacking in Korea. This guideline aims to provide evidence-based recommendations for the diagnosis and management of tinnitus in Korean adults, adapted to the Korean healthcare system. A multidisciplinary panel (eight otorhinolaryngologists, one neurologist, one psychiatrist, and one audiologist) conducted systematic literature searches up to 2025 using PubMed, Embase, Cochrane Library, KoreaMed, and KMBASE. Evidence quality was assessed using the GRADE methodology. Nine key clinical questions (KQs) were developed in PICO format, and recommendations were finalized through a modified Delphi process (\u226580% agreement threshold). Imaging is recommended for the evaluation of patients with pulsatile tinnitus or asymmetric hearing loss (Grade B). Tinnitus retraining therapy (TRT) and cognitive behavioral therapy (CBT) are conditionally recommended for patients with tinnitus (Grade B). Hearing aids are conditionally recommended for patients with tinnitus and coexisting hearing loss (Grade B). Sound therapy is conditionally recommended to reduce tinnitus-related distress (Grade B). Neuromodulation (transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS)) is conditionally recommended as an adjunctive treatment (Grade B). Routine zinc and vitamin supplementation are strongly recommended against for tinnitus symptom improvement (Grade D\u2020), whereas Ginkgo biloba may be considered for patients with subjective tinnitus (Grade B). Most available evidence was predominantly of low or very low certainty. This guideline provides the first comprehensive evidence-based framework for tinnitus management in Korea. Behavioral and rehabilitative interventions provided the strongest evidence for reducing tinnitus-related distress. Considerations of Korean National Health Insurance coverage, regional accessibility, and patient preferences were integrated throughout the guideline development process. The primary therapeutic goal is to reduce tinnitus-related distress and improve functional outcomes, thereby enhancing overall quality of life.\n\nID: 42406125\nTitle: Detailed clinical characteristics of musical hallucinations in 81 patients.\nAbstract: Musical hallucinations are perceptions of music without an external source. Approximately 500 publications on this topic have appeared over the past 35\u00a0years. Prior literature has largely consisted of case reports and small series, with only limited systematic studies on the characterisation of mixed pathology, relation to hearing loss, spatial localisation, and multimodal features. We conducted a retrospective analysis of baseline data from a prospective cohort study of 81 individuals experiencing musical hallucinations. Participants underwent assessment with the Musical Hallucinations (MuHa) Questionnaire-a tailored, non-validated semi-structured survey/interview-alongside additional questionnaires, EEG, neuroimaging, and audiological testing. The present analysis focuses on baseline phenomenological characteristics derived from the MuHa Questionnaire in 80 eligible participants. Analyses were exploratory and descriptive. Mean age was 65\u00a0years, with a slight female predominance. Hallucinations were most often perceived as internal, while external localisation was more common with familiar music and in individuals with (asymmetric) hearing loss. Underlying causes included psychiatric disorders (50%), hearing loss (50%), structural neurological changes (28%), and frequently combinations thereof (28%). A notable new finding was the high prevalence of tinnitus and multimodal hallucinations, involving up to six sensory modalities; these were generally associated with internal localisation, except in isolated hearing loss. Musical content spanned multiple genres, most commonly religious music. Hallucinations were considered burdensome in over 65% of the cases, and most participants reported little control; behavioral strategies such as distraction or listening to external music provided only temporary relief in about 20%. Musical hallucinations may be more common than previously appreciated within broader multimodal perceptual syndromes and mixed etiologies, suggesting a more distributed pathophysiology than traditionally assumed. Their burden and limited controllability highlight the need for further mechanistic and therapeutic research.\n\nID: 42403966\nTitle: Bimodal Stimulation of the Auditory-Somatosensory System Improves Auditory Sensory Gating Function in Patients with Tinnitus.\nAbstract: Tinnitus perception may be associated with impairments in the mechanisms of sensory gating (SG), which is a preattentive process that filters redundant auditory stimuli to prevent sensory overload. Acoustic stimulation of the auditory system alone (unimodal intervention), electrical stimulation of the vagus nerve alone, or a combination of both (bimodal intervention) can effectively treat tinnitus by influencing SG. This study aimed to examine the impact of unimodal and bimodal interventions on auditory SG (ASG). Participants were assigned to unimodal or bimodal intervention groups using block randomization after obtaining consent. Thirty-four participants with tonal tinnitus were divided equally into unimodal (n = 17) and bimodal (n = 17) groups. Participants in the bimodal group received customized acoustic stimulation combined with transcutaneous auricular vagus nerve stimulation (tAVNS). Participants in the unimodal group received the same acoustic stimulation paired with sham tAVNS. Each group underwent six 20-minute treatment sessions. Participants were assessed using the ASG (dividing the P1-N1 amplitude of the second cortical auditory evoked potential [CAEP] by the P1-N1 amplitude of the first CAEP) and an 11-point Visual Analog Scale (VAS) for loudness, awareness, and annoyance before and after the intervention sessions. Patients rated these items from 0 to 10, with 0 representing no tinnitus and 10 representing intense loudness, awareness, and annoyance. Postintervention group comparisons were performed using a covariance analysis. Within-group changes were assessed with paired t tests. Correlations were evaluated with Pearson's test. After the intervention, the results showed that the bimodal group experienced a significant decrease in ASG and loudness and awareness VAS scores relative to those of the unimodal group (p < 0.05). No significant change in the annoyance VAS score was found between groups. A correlation was observed between ASG and the awareness and annoyance VAS scores, but no correlation was found between ASG and the loudness VAS score. As a treatment option for tinnitus, bimodal stimulation appears to be more effective than unimodal stimulation. This method may be particularly beneficial for tonal tinnitus with hearing loss; however, it may not be effective for all patients. Therefore, a clinical protocol is required. Bimodal stimulation may offer a clinically meaningful intervention for patients with tinnitus, particularly those with hearing loss who experience tonal tinnitus.\n\nID: 42403964\nTitle: Multidimensional Effects of Hyperacusis: A Study on Tinnitus, Anxiety, Cognitive Function, Sleep, and Quality of Life.\nAbstract: Tinnitus and hyperacusis are often cooccurring and quite prevalent symptoms. The effects of tinnitus on sleep quality, anxiety, cognitive abilities, and quality of life are well documented. However, studies investigating the effects of hyperacusis are limited. The aim of this study is to investigate the relationship between hyperacusis and tinnitus, anxiety, cognitive functions, sleep, and quality of life. Prospective cross-sectional study. Forty people reporting hyperacusis were included in the study. These individuals were categorized into two groups: those with hyperacusis only and those with both hyperacusis and tinnitus. In addition, 30 healthy participants were included as a control group. The Khalfa Hyperacusis Questionnaire, Tinnitus Handicap Inventory, Beck Anxiety Inventory, Digit Span and Stroop test TBAG form, Pittsburgh Sleep Quality Index, and Short Form-36 (SF-36) were administered to these individuals. The total sleep quality of the hyperacusis and tinnitus group was poorer compared with the control group, whereas only the subjective sleep quality of the hyperacusis group was poorer than that of the control group (p < 0.05). Both patient groups had higher BAI scores compared with the control group (p < 0.05). No significant differences were observed between the groups in terms of the Digit Span and Stroop tests (p > 0.05). Both patient groups had lower quality-of-life scores compared with the control group (p < 0.05). However, individuals in the hyperacusis and tinnitus group had lower scores in the physical functioning subscale of the SF-36 compared with those in the hyperacusis group (p < 0.05). The performance of individuals with hyperacusis on the Stroop and Digit Span tests was similar to that of healthy individuals. However, individuals with hyperacusis had higher levels of anxiety and lower sleep quality and quality of life compared with healthy individuals. In cases where tinnitus accompanied hyperacusis, a more pronounced decline in quality of life was observed.\n\nID: 42403960\nTitle: The Degree of Audiovestibular Loss Is Not Related to Current Vertigo Attacks in Refractory Unilateral M\u00e9ni\u00e8re's Disease.\nAbstract: Unilateral M\u00e9ni\u00e8re's disease (MD) is characterized by severe episodic attacks of rotational vertigo and audiovestibular signs that include fluctuating sensorineural hearing loss, aural fullness, tinnitus, and vestibular loss. To investigate the relationship between the degree of audiovestibular loss, symptoms, and the number of vertigo attacks during the previous 6\u2009months and 1\u2009month of patients with MD. Sixty patients with active MD refractory to oral treatment. Hearing (pure-tone audiometry and speech discrimination) and vestibular (caloric test, vestibular evoked myogenic potential [VEMP]) tests were performed. Symptoms were scored using the following validated questionnaires: Vertigo Symptom Scale-short form, Dizziness Handicap Inventory, Tinnitus Handicap Inventory, Aural Fullness Scale, and Functional Level Scale. Linear regression, a factor analysis, and a correlation analysis were conducted. Patients experienced a mean number of 16 attacks (range, 2-65) during the previous 6\u2009months and five attacks (range, 0-30) during the previous 1\u2009month. Hearing and vestibular functions were reduced in the affected ear. Linear regression, the factor analysis, and the correlation analysis showed no association between the degree of audiovestibular loss and the number of vertigo attacks during the previous 6\u2009months or 1\u2009month or symptoms of disease activity. An exploratory analysis showed evidence of some associations between the degree of hearing loss, caloric paresis, and VEMP asymmetry, indicating a consistent pattern of loss across the cochlear semi-circular canals and saccules. Although audiovestibular tests help establish diagnoses, they cannot determine current disease activity of unilateral refractory MD. It may be prudent to assume that patients with MD and high remaining vestibular function in the affected ear would experience more frequent episodes of vertigo and intense dizziness and experience more troublesome symptoms. Conversely, it may be prudent to assume that patients with MD with low remaining vestibular function in the affected ear would experience fewer episodes of vertigo; however, as shown by these results, this does not seem to be the case. No obvious audiovestibular markers suggest that intratympanic therapy for vertigo treatment should be delayed.\n\nID: 42403858\nTitle: Autosomal Dominant Obstructive Sleep Apnea Syndrome Due to the New Variant c.980_984dup in COL1A2: A Case Report.\nAbstract: Obstructive sleep apnea syndrome (OSAS) is a complex disorder characterized by the collapse of the upper airway during sleep. Although a family history often suggests a hereditary predisposition to OSAS, there is little evidence that it is actually a monogenic disorder. To date, no case of a patient with hereditary OSAS due to a pathogenic mutation in the collagen type I alpha-2 chain (COL1A2) gene has been described. The patient was a 72-year-old woman who had suffered from insomnia since the age of 35. OSAS was suspected since then, but was only confirmed at the age of 67 by polysomnography. The OSAS was treated with nocturnal active positive airway pressure (APAP), which led to an improvement.\u00a0Her medical history also included joint hypermobility, brachydactyly, multiple nevi, an umbilical hernia, left-sided tinnitus and hearing impairment, hair loss, hip pain, and ptosis. Since her son also developed OSAS at the age of 34, hereditary OSAS was suspected, and exome sequencing was performed, which revealed the novel variant c.980_984dup (p.Ile329Alafs*72) in the COL1A2 gene. Since OSAS is a known complication of connective tissue disorders (CTDs), the index patient's OSAS was attributed to the COL1A2 mutation. This case suggests that OSAS may be hereditary due to a variant in the COL1A2 gene and may represent the dominant phenotypic feature. Physicians should be aware that OSAS can be hereditary; therefore, CTD patients with a positive family history of OSAS should undergo genetic testing for variants in genes associated with CTD.\n\nID: 42402048\nTitle: Tinnitus, hyperacusis and somatic complaints in a diverse Norwegian clinical population: implications for assessment and rehabilitation.\nAbstract: Patients with tinnitus often have somatic complaints, a reality that is understudied in the broader literature on tinnitus. This study aims to characterize tinnitus patients with somatic complaints, investigate associations between somatic complaints and tinnitus, hyperacusis, and symptoms of anxiety and depression, and to compare patient profiles across genders and healthcare services. A cross-sectional study with a digital questionnaire consisting of Tinnitus Sample Case History Questionnaire (TSCHQ), Tinnitus Handicap Inventory (THI), Hyperacusis Questionnaire (HQ), Hospital Anxiety and Depression Scale (HADS) and Generalized Anxiety Disorder-7 (GAD-7). The somatic complaints investigated were Headaches, Dizziness, Temporomandibular Dysfunction (TMD), Neck pain and Pain Syndromes, as measured using the TSCHQ. A total of 144 participants with tinnitus were sampled, from four hearing clinics and two rehabilitation centres in Norway. Several positive associations were observed between somatic complaints and higher levels of tinnitus, hyperacusis, depression and anxiety. Moreover, somatic complaints were more common among women, and those recruited from rehabilitation centres. Tinnitus patients, with or without comorbid hyperacusis, have several psychological and somatic complaints that need to be mapped thoroughly. An interdisciplinary approach should be considered for patients with tinnitus and comorbid somatic symptoms.\n\nID: 42400132\nTitle: Personal listening device usage, leisure noise exposure, hearing protection usage and hearing at standard frequencies: a longitudinal study from child/adolescence to young adulthood.\nAbstract: To compare personal listening device (PLD) listening behaviours, leisure noise exposure, audiometric outcomes, hearing protection (HP) usage and self-reported hearing loss (HL) symptoms at Time 1: 2009/2010 and Time 2: 2022/2023. Mean hearing thresholds (HTs), pure-tone average HL prevalence, PLD volume levels, durations, earbud/headphone tightness, and sex among matched pairs, at Time 1 and 2, were compared. Longitudinal design. Questionnaire evaluating PLD listening behaviours, leisure noise exposure and HL symptoms. Multivariate regression analysis used to determine relationship between variables and audiometry. 59 Participants, aged 22-30, of original cohort (n\u2009=\u2009237, aged 10-17) were re-tested (Time 2). Over time, tinnitus following leisure noise tripled, HP doubled and higher average PLD listening time was observed (7 vs. 18\u2009h/week); longer durations for males. High volume listening was 20% at both timepoints. Leisure noise exposure and HL prevalence were similar across time, however mean HTs were higher at Time 1. Among matched pairs, more Time 2 participants created tight-fitting earbuds/headphones and responded affirmatively to some HL symptom questions. Subtle auditory changes, such as hidden HL, may be occurring over time. Educational outreach regarding HL prevention would be beneficial. Further longitudinal research needed due to the small follow-up sample.\n\nID: 42394931\nTitle: Ginkgo biloba extract for dizziness-related symptoms in central neurological disorders: a systematic review and meta-analysis.\nAbstract: Dizziness associated with central neurological disorders-broadly defined as dizziness or vertigo attributable to central nervous system pathology affecting central vestibular processing-is a clinically challenging and heterogeneous condition with limited treatment options. Ginkgo biloba extract-through its microcirculatory, neuroprotective, and anti-inflammatory mechanisms-represents a biologically plausible intervention. However, its efficacy in this setting has not been comprehensively established. We evaluated the efficacy and safety of Ginkgo biloba extract through a systematic review and meta-analysis of randomized controlled trials (RCTs). Nine international and Korean databases were searched from January 1974 through November 2025. Studies were eligible if they were RCTs enrolling adults aged 18\u202fyears or older with cerebrovascular disease, neurodegenerative disease, or central vestibular dysfunction who had dizziness, vertigo, or balance-related symptoms or relevant outcome assessments. Cochrane RoB 2.0 tool and certainty of evidence was rated using the Assessment, Development and Evaluations (GRADE) approach. Prespecified subgroup analyses by underlying etiology and intervention type, together with leave-one-out sensitivity analyses, were performed to explore heterogeneity. Nine RCTs (N\u202f=\u202f2,394) were included; participants were predominantly drawn from dementia populations (71.6%), with smaller contributions from cerebral arteriosclerosis (23.0%) and vertebrobasilar or posterior circulation disorders (5.4%). Ginkgo biloba significantly reduced dizziness/vertigo severity on the 11-point box scale (MD\u202f-\u202f0.76, 95% CI\u202f-\u202f1.35 to -0.18; p\u202f=\u202f0.01) and VAS (SMD\u202f-\u202f0.38, 95% CI\u202f-\u202f0.58 to -0.19; p\u202f=\u202f0.0001). Moderate-certainty evidence suggested improvements in functional outcomes and quality of life, including the Alzheimer's Disease Activities of Daily Living International Scale (MD\u202f=\u202f-0.17, 95% CI: -0.22 to -0.13) and the Dementia Quality of Life - Proxy (MD\u202f=\u202f2.00, 95% CI: 0.85 to 3.15). The intervention was generally well tolerated, with significantly lower risks of angina pectoris (OR 0.51, 95% CI 0.31 to 0.85) and tinnitus (OR 0.37, 95% CI 0.22 to 0.63) and no significant increase in other adverse events. Ginkgo biloba extract may reduce dizziness severity and improve daily functioning in patients with central neurological disorders accompanied by dizziness or vertigo, with a favorable safety profile. However, given the small number of eligible trials, substantial clinical and statistical heterogeneity, and the predominance of dementia-derived data, these findings should be interpreted with caution. Well-designed RCTs in clearly defined central vestibular populations, ideally confirmed by neuroimaging or vestibular testing, are needed to confirm these results. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251229692, PROSPERO: CRD420251229692.\n\nID: 42392891\nTitle: Postoperative auditory outcomes in total temporomandibular joint replacement: fossa-canal proximity and tinnitus risk.\nAbstract: Total temporomandibular joint replacement (TMJR) is an established treatment for advanced ankylosis; however, postoperative auditory complications, such as tinnitus, remain poorly characterized. This post-hoc observational analysis evaluated whether postoperative prosthetic fossa-external auditory meatus (EAM) distance is associated with postoperative tinnitus after TMJR for ankylosis, and explored preoperative ankylosis-EAM proximity and tinnitus resolution. Patients aged 18-40 years undergoing TMJR with orthognathic surgery with \u226512 months follow-up and postoperative cone-beam computed tomography were evaluated. The unit of analysis was the individual joint. Postoperative and preoperative EAM distances were measured on multiplanar reconstructions by blinded observers. A total of 24 joints from 17 patients were analysed (10 unilateral and seven bilateral). Postoperative tinnitus occurred in two joints (8.3%), both unilateral events in patients undergoing bilateral TMJR. Mean postoperative fossa-EAM distances were significantly shorter in tinnitus joints compared with non-tinnitus joints (1.38 \u00b1 0.17\u00a0mm vs 5.18 \u00b1 2.08\u00a0mm; mean difference 3.80\u00a0mm, 95% confidence interval 0.68-6.92; P = 0.019; Cohen's d = 1.87). Preoperative ankylosis-EAM distance showed no significant difference between groups (P = 0.123). Both tinnitus cases occurred at postoperative clearances below \u223c3.5\u00a0mm. Symptoms were mild to moderate, resolved within 12 months, and were not associated with audiometric hearing loss. Shorter postoperative fossa-EAM distance was associated with transient postoperative tinnitus in this exploratory cohort. The observed 3.5\u00a0mm clearance should be regarded as hypothesis-generating rather than a validated clinical threshold. Larger studies with standardized tinnitus assessment are required.\n\nID: 42388916\nTitle: Intrapetrous Internal Carotid Artery Pseudoaneurysm Secondary to Malignant Otitis Externa: A Case Report.\nAbstract: Malignant otitis externa (MOE) can rarely progress to skull base osteomyelitis (SBO) with catastrophic vascular complications. We describe a 68-year-old man with uncontrolled diabetes (HbA1c 9%) who presented with left otalgia, purulent otorrhea, and hearing loss. Initial workup showed CRP 23 mg/L, leukocytes 8,000/\u00b5L, and ear pus culture positive for Pseudomonas aeruginosa. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated MOE with temporal bone osteomyelitis. Despite prolonged intravenous antibiotics (imipenem, colistin) and topical ofloxacin, symptoms persisted. Three months later, he developed a headache, pulsatile tinnitus, and a pulsatile retro\u2011tympanic mass; MRI and 3D time-of-flight (TOF) angiography revealed progression of SBO with a pseudoaneurysm arising from the intrapetrous segment of the left internal carotid artery and ipsilateral sigmoid sinus septic thrombosis. Digital subtraction angiography was planned for definitive characterization and endovascular management, but the patient deteriorated rapidly and died of overwhelming septic shock before intervention. This case highlights that MOE\u00a0can extend to involve the petrous internal carotid artery (ICA) and produce infected pseudoaneurysms; early vascular imaging [computed tomography angiography (CTA)/ magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) when indicated], aggressive antimicrobial therapy, and prompt multidisciplinary planning for endovascular or surgical intervention are essential to reduce morbidity and mortality.\n\nID: 42388458\nTitle: Development and Validation of a Nomogram to Identify and Predict High-Distress Psychosocial Phenotypes in Tinnitus Patients: A Latent Profile Analysis.\nAbstract: Evidence is limited on the multidimensional psychosocial heterogeneity among patients with subjective tinnitus, and practical tools for early risk stratification remain largely unexplored. This study aimed to identify distinct psychosocial phenotypes under the biopsychosocial model to pinpoint the high-risk population and to develop and validate a visualized nomogram predicting severe psychological distress for targeted interventions. A total of 534 subjective tinnitus patients were enrolled. Latent profile analysis using seven psychosocial indicators (Self-Rating Anxiety Scale total score, Self-Rating Depression Scale total score, positive life events score, negative life events score, subjective support score, objective support score, and support utilization score) identified distinct patient phenotypes. The \"Severe Anxiety Isolated\" phenotype was defined as the target \"high-distress\" group for the prediction model. Clinical characteristics and tinnitus-related disability were compared across groups. Multivariate logistic regression identified independent predictors of the high-distress phenotype to construct a nomogram, validated via ROC, calibration, and decision curve analysis. Four distinct psychosocial phenotypes were identified via LPA: the Chronic Vulnerable phenotype (18.73%), the Severe Anxiety Isolated phenotype (28.09%, defined as the high-distress high-risk phenotype), the Well Adapted Healthy phenotype (43.82%), and the High Positive Life Events Resilient phenotype (9.18%). The Severe Anxiety Isolated phenotype had significantly higher Tinnitus Handicap Inventory (THI) and Insomnia Severity Index (ISI) scores compared with other phenotypes (all P<0.001). Age group (21-39 years), longer tinnitus duration, concurrent presence of vertigo, bilateral tinnitus, and easily agitated/irritable personality traits were independent risk factors for the high-distress phenotype. The constructed nomogram exhibited good discrimination (AUC=0.756 in the training cohort and 0.737 in the testing cohort), calibration, and clinical utility. Subjective tinnitus patients exhibit profound psychosocial heterogeneity, with the Severe Anxiety Isolated phenotype facing the highest psychological risk. Our developed nomogram accurately predicts this high-risk phenotype using routine outpatient indicators, facilitating early risk stratification and precision biopsychosocial interventions.\n\nID: 42382212\nTitle: Interactive Effects of Occupational Hearing Loss and Glutathion S-Transferase M1 Genotype on Tinnitus Among Noise-exposed Steelworkers.\nAbstract: Tinnitus is a known long-term health effect of noise exposure. Whether susceptible genotypes predispose noise-exposed workers to tinnitus remains unclear. This study investigated the interactive effects of noise exposure, auditory function, and glutathione S-transferase (GST) gene polymorphisms on tinnitus risk. We conducted a cross-sectional study among steelworkers. Participants underwent audiological testing to assess hearing levels and were surveyed for tinnitus. Blood samples were genotyped for GSTM1 and GSTT1 deletion polymorphisms using polymerase chain reaction. Multivariable logistic regression was used to evaluate associations between tinnitus and pure-tone audiometry (PTA), distortion product otoacoustic emission (DPOAE), and GST genotypes while controlling for age and other covariates. Among 239 male steelworkers (mean age \u00b1 SD: 48.29 \u00b1 7.6 years), 27% reported tinnitus. Cumulative noise exposure and thresholds at low- and high-frequency PTA were significantly associated with tinnitus (adjusted odds ratio (OR) = 1.03, 1.06, and 1.04, 95% confidence interval (CI) = [1.00,1.06], [1.02,1.11], and [1.02,1.06], p = 0.045, 0.002, <0.001, respectively). Although neither DPOAE nor GSTM1 nor GSTT1 genotypes showed a significant effect on tinnitus, we observed a significant interaction between low-frequency PTA and the GSTM1 genotype (p = 0.03). Specifically, compared with workers with non-null GSTM1 genes, workers with the GSTM1-null genotype were significantly more susceptible to low-frequency PTA-associated tinnitus (OR = 1.02 and 1.13, 95% CI = [0.96,1.08] and [1.06,1.22], respectively). The interactive effect of auditory functional status and antioxidant gene polymorphisms suggests that hair cell damage and oxidative stress in the cochlea both contribute to tinnitus development.\n\nID: 42380788\nTitle: The longer, the better? Investigating the effect of prolonged acoustic stimulation on brief acoustic tinnitus suppression.\nAbstract: Brief acoustic tinnitus suppression following sound stimulation is being studied to better understand the mechanisms underlying tinnitus and short-term suppression of the tinnitus perception. In this context, several kinds of filtered or modulated stimuli have been investigated. However, little research was conducted regarding the effect of stimulation length for brief acoustic tinnitus suppression. The aim of the present study was to compare the extent of tinnitus suppression after a 20-minute and a 3-minute acoustic stimulation with an individual best stimulus. Three experimental sessions were completed by 33 participants with chronic subjective tinnitus. In the first two sessions, eight different individualized, filtered, and/or amplitude-modulated stimuli were presented for 3\u00a0min each. For each participant, the stimulus which induced the strongest tinnitus loudness suppression (measured with a numeric rating scale in percent compared to baseline loudness) was chosen and then applied for 20\u00a0min in a third session. On a group level, no significant difference in tinnitus loudness suppression comparing the 3-minute and the 20-minute acoustic stimulation using the individual best stimulus was observed. However, individual response patterns revealed great diversity as 12 participants showed better suppression after the 20-minute stimulation,12 experienced worse tinnitus suppression and for 9 participants no distinct change was evident compared to 3-minute acoustic stimulation. Future research should try to characterize the subgroup of tinnitus patients that profits from prolonged acoustic stimulation and search for optimized simulation durations. This trial was retrospectively registered on 2026/03/04 at ClinicalTrials.gov (ID: NCT07472257).\n\nID: 42379384\nTitle: A comparative study reveals distinct patterns of resting-state activity in tinnitus and chronic pain.\nAbstract: Tinnitus and chronic pain, as two perceptual disorders frequently accompanied by negative emotions, significantly impair patients' daily functioning and overall well-being. However, the neurophysiological mechanisms that account for their frequently observed clinical similarities have yet to be fully elucidated. The study enrolled a total of 56 participants, including 18 tinnitus patients and 19 chronic pain patients, alongside 19 healthy controls. We computed the fractional amplitude of low-frequency fluctuations (fALFF) and regional homogeneity (ReHo) from resting-state fMRI data to quantify localized brain activity intensity and neural synchronization. Statistical analysis suggested a significant elevation in fALFF within the calcarine cortex of tinnitus patients compared to healthy controls (p\u202f<\u202f0.05, FDR-corrected). In contrast, chronic pain patients exhibited notable increases in both fALFF and ReHo in the inferior frontal gyrus (IFG). Direct comparisons between patient groups suggested that tinnitus patients had higher fALFF in the inferior temporal gyrus (ITG), supplementary motor area and fusiform gyrus, but lower fALFF in the right IFG, precuneus, and caudate nucleus. Regarding ReHo, patients with tinnitus exhibited significantly elevated ReHo values in the supplementary motor area, while demonstrating reduced ReHo in both the precuneus and caudate nucleus (all p\u202f<\u202f0.05, FDR-corrected). The observed differences between tinnitus and chronic pain in brain regions including the prefrontal cortex, ITG, and fusiform gyrus provide neuroimaging correlates associated with the two conditions. These findings may inform future neuromodulation targets and support clinical differential diagnosis.\n\nID: 42378546\nTitle: Is Zinc Deficiency a Risk Factor for Tinnitus? An Analysis from Chronic Idiopathic Tinnitus Patients with Normal Hearing.\nAbstract: To investigate whether zinc deficiency is associated with tinnitus severity in patients with chronic idiopathic tinnitus and normal hearing. This prospective, cross-sectional study included 107 patients with chronic idiopathic tinnitus and normal hearing selected from 409 patients evaluated at the tinnitus clinic between January 2021 and December 2023. Serum zinc levels, Tinnitus Handicap Inventory (THI) scores, and tinnitus loudness matching tests were assessed. Zinc deficiency was defined as serum zinc <66 \u03bcg/dL. Of 107 patients, 22 (20.6%) had zinc deficiency. Zinc-deficient patients showed significantly higher total THI scores (48.09 \u00b1 25.95 vs. 36.28 \u00b1 21.91, P=.032) and functional component scores (19.09 \u00b1 11.87 vs. 13.13 \u00b1 9.68, P=.016). Correlation analysis revealed negative correlations between continuous serum zinc levels and all THI components, though none reached statistical significance. Objective tinnitus loudness did not differ significantly between groups. Zinc deficiency is associated with greater tinnitus severity in patients with normal hearing, particularly affecting functional aspects of daily life. Screening for zinc deficiency and targeted supplementation might offer a potential therapeutic approach for this specific patient population.\n\nID: 42378541\nTitle: Optimal Head Position Following Intratympanic Injections of Steroids.\nAbstract: Intratympanic drug applications may be performed for a number of reasons, including the treatment of Meniere's disease, sudden hearing loss, and tinnitus. In this study, the aim was to determine the optimal head position for steroid solutions to be absorbed through the round window after intratympanic injections. The authors retrospectively reviewed the best head position where the level of steroid solution reaches the round window area behind the eardrum in video recordings of 20 Meniere's disease patients undergoing intratympanic steroid injections. The patients were positioned in the supine position, with the diseased ear pointing upward. Cotton wool soaked with 10% xylocaine was applied to the eardrum surface. After 2 or 3 swallows with the nose closed, dexamethasone (8.00 mg/2cc) was injected through the anterior quadrant using a syringe with a 25-gauge spinal needle, and the injection was continued until half of the middle ear was filled. Following injection, patients' heads were then tilted backward until the solution covered the round window area under microscopic view. The angle between the midsagittal plane of the head and the horizontal plane was noted when the best level of the solution covering the round window area was achieved. The angleof the midsagittal head plane and horizontal plane for the optimum head position following injection were 90 degrees in 16 of 20 ears and 80 degrees in 4; in supine position. The most appropriate head position for drug delivery after intratympanic injection was determined as the head looking directly upwards in the supine position.\n\nID: 42378538\nTitle: Round Window Reinforcement for Semicircular Canal Dehiscence Syndrome.\nAbstract: To evaluate the clinical outcomes and safety profile of round window reinforcement (RWR) as a minimally invasive surgical treatment for patients with semicircular canal dehiscence syndrome (SCDS). This retrospective case series analyzed 7 patients (mean age: 59 years) diagnosed with SCDS who underwent transcanal RWR between June 2024 and June 2025 at the Kopfzentrum Bielefeld. Inclusion criteria followed the B\u00e1r\u00e1ny Society consensus diagnostic standards. Clinical symptoms, audiometric findings, and vestibular test results-including Dizziness Handicap Inventory (DHI) scores-were assessed pre and postoperatively. In 2 patients, endolymphatic hydrops was diagnosed via delayed contrast-enhanced magnetic resonance imaging and monitored postoperatively. All patients completed follow-up (mean: 35 months). Improvement in auditory symptoms was observed in 5 of 7 patients (71.4%), including tinnitus relief in 83.3% and hyperacusis relief in 75%. Vertigo improved in 50% of symptomatic cases. No postoperative deterioration in symptoms, DHI score, or hearing was observed. Audiometric outcomes showed a non-significant mean change in air-bone gap (\u00b12.5 dB). No intra- or postoperative complications occurred. In patients with concomitant hydrops, auditory improvement was noted, though vertigo persisted. Round window reinforcement appears to be a safe and effective therapeutic option for selected patients with SCDS, particularly those presenting predominantly auditory symptoms or contraindications to more invasive procedures. Further prospective studies are needed to validate these findings and define the role of RWR in the broader surgical management of third window syndromes.\n\nID: 42373579\nTitle: Presenting Complaint and Diagnostic Yield of MRIs for Vestibular Schwannomas.\nAbstract: To ascertain the diagnostic yield of MRIs to diagnose vestibular schwannoma based on the patient's presenting symptoms and age. A retrospective cohort study at a single centre. All MRIs ordered by otolaryngologists from 01/01/2022 to 31/12/2023 for the purpose of diagnosing a vestibular schwannoma were included. Data on presenting symptoms, audiogram results, demographics and management outcomes were extracted from clinical records. 1814 MRIs were included. The overall diagnostic yield of vestibular schwannomas was 1.65% (30 cases). Mild asymmetrical sensorineural hearing loss alone (defined as <\u200915 dB difference between ears at two consecutive frequencies) was not associated with vestibular schwannoma; no patients with this finding were diagnosed (p\u2009=\u20090.025). On multivariate analysis, vertigo (odds ratio [OR] 4.03, p\u2009<\u20090.001) and severe asymmetrical sensorineural hearing loss (OR 5.26, p\u2009=\u20090.002) were independently associated with a diagnosis. Unilateral tinnitus (OR 2.10, p\u2009=\u20090.062), sudden onset asymmetrical hearing loss (OR 0.57, p\u2009=\u20090.46), mild asymmetrical hearing loss (OR 1.03, p\u2009=\u20090.98), or age (OR 0.74, p\u2009=\u20090.48) were not significantly associated with a vestibular schwannoma. Incidental findings were common (23%) and most patients (80%) were managed conservatively with serial MRIs. There was no correlation between age and likelihood of diagnosis. The diagnostic yield of MRIs for vestibular schwannomas is low. Patients with isolated mild asymmetrical hearing loss alone may not warrant further investigation. Presenting with unilateral tinnitus was a poor discriminator for a diagnosis of vestibular schwannomas. However, patients with unexplained vertigo should be considered for an MRI. Further research is needed to refine current guidelines.\n\nID: 42371148\nTitle: Migraine and auditory dysfunction: beyond comorbidity.\nAbstract: Migraine operates as a systemic disorder of multisensory sensitization. Within this spectrum, auditory manifestations, including sensorineural hearing loss, tinnitus, and hyperacusis, represent prevalent yet frequently overlooked otologic phenotypes. Epidemiological data show that 15%-49% of migraine patients present with comorbid auditory symptoms, and nearly two-thirds exhibit auditory electrophysiological abnormalities. However, optimal clinical management remains constrained by an incomplete understanding of pathogenic mechanisms, variable audiological assessment protocols, and dispersed therapeutic data. This review synthesizes epidemiological, audiological, and pathophysiological data linking migraine to auditory dysfunction. The underlying pathology involves a peripheral-to-central continuum across three interacting axes. Anatomical and hydrodynamic vulnerabilities drive localized microvascular ischemia and aberrant brain-ear fluid exchange. Localized neurochemical imbalances, involving glutamate excitotoxicity, neuropeptide signaling, and innate immune activation, disrupt inner ear homeostasis. Concurrently, central sensitization facilitates neural network plasticity, characterized by impaired efferent gating and thalamocortical dysrhythmia. Drawing upon these underlying pathways, current and emerging therapeutic strategies are categorized by specific clinical objectives: blocking upstream migraine pathways, protecting the cochlear microenvironment, and correcting central hypersensitivity. This framework aims to catalyze future translational research to rigorously validate these mechanistic links, promote early identification, precise clinical phenotyping, and cross-disciplinary management of affected patients.\n\nID: 42365397\nTitle: Tonotopically distinct OFF responses arise in the mouse auditory midbrain following sideband suppression.\nAbstract: The parsing of sensory information into discrete topographic domains is a fundamental principle of sensory processing. In the auditory cortex, these domains evolve during a stimulus, with the onset and offset of tones evoking distinct spatial patterns of neural activity. However, it is not known where in the auditory system this spatial segregation occurs or how these dynamics are affected by hearing loss. Using widefield single photon neuronal Ca2+ imaging in the inferior colliculus (IC) of awake mice, we found that pure tone stimuli elicited both spatially constrained neural activity within isofrequency bands and simultaneous sideband suppression. At cessation of the stimulus, offset responses emerged within the region of sideband suppression, demonstrating that simple stimuli elicit spatiotemporally distinct neural activity patterns to represent the presence of sound and sound termination. Because sound frequency is spatially encoded in the IC, this spatial shift creates a tonotopically distinct offset (tdOFF) response relative to sound onset. High-resolution two-photon Ca2+ imaging confirmed that tdOFF neuron activity in the sideband region was suppressed during sound and elevated above baseline after stimulus termination, raising the possibility that rebound excitation could contribute to this post-stimulus activation. Loud noise exposure - a common model of hearing loss - abolished both sideband suppression and tdOFF responses. These results show that hearing loss profoundly reshapes the spatiotemporal pattern of sound processing by altering sideband activity. This preferential loss of sideband suppression and tdOFF activation after sound-induced injury in the auditory midbrain may contribute to hyperacusis and tinnitus by promoting neuronal hyperactivity. KEY POINTS: Sensory systems encode different features of stimuli by activating distinct neural networks. Sound onsets and offsets elicit distinct neural patterns in the auditory cortex, although it is unclear where this separation originates or how it may change with hearing loss. Using in vivo widefield Ca2+ imaging in awake mice, we find that pure tone stimuli evoke spatiotemporally distinct on and off patterns of neural activity in the auditory midbrain. Neurons active during stimulus offset were suppressed by sound in sideband regions, raising the possibility that rebound excitation may contribute to this post-stimulus activation. Both sideband suppression and off responses were preferentially abolished following noise-induced hearing loss, raising the possibility that these changes may contribute to hearing loss-related syndromes such as tinnitus and hyperacusis.\n\nID: 42363722\nTitle: Evidence for a Transient State of Auditory Hypersensitivity During Initial Onset of Tinnitus: IDAEP Changes Between Acute and Chronic Tinnitus.\nAbstract: Once persistent for around a month, tinnitus typically persists permanently. This transition from acute to chronic tinnitus is thought to reflect dynamic neurophysiological changes and plasticity within central auditory and non-auditory networks, but empirical evidence has been lacking. We hypothesized that, bottom-up neural mechanisms linked to tinnitus initiation, such as central gain and neural synchrony, are maximal around the time of its initiation, but subsequently return towards baseline as central plastic changes develop. We evaluated part of this hypothesis by measuring central auditory reactivity through the Intensity Dependence of Auditory Evoked Potential (IDAEP), a non-invasive index of higher-order inhibitory processing within the auditory system. A steeper IDAEP slope is associated with heightened sensory reactivity (higher sensitivity to changes in auditory stimuli), indicative of reduced central inhibition, whereas a shallower slope reflects greater inhibitory control. Studying a group with acute tinnitus (onset within past six weeks), with a repeated assessment after six months from onset, we found a significant longitudinal reduction in the IDAEP slope following initial tinnitus onset, and non-significantly higher IDAEP slope in Acute and Chronic tinnitus groups compared to matched controls. These findings support our hypothesis, indicating that IDAEP may serve as an objective marker of auditory reactivity for characterising the time course of certain tinnitus mechanisms.\n\nID: 42356176\nTitle: Trauma-Associated Tinnitus and Hearing Loss: A Comprehensive Narrative Review of Prevalence, Risk Factors, and Clinical Outcomes.\nAbstract: Background and Objectives: Trauma-associated auditory dysfunction, encompassing tinnitus and hearing loss, represents a frequent yet underrecognized sequela of acoustic overexposure, blast injury, and head trauma. Despite increasing clinical awareness, the published literature exhibits substantial heterogeneity in reported prevalence estimates and recovery outcomes across different injury mechanisms. This narrative review aims to synthesize available evidence on the prevalence, clinical characteristics, recovery patterns, and prognostic factors of tinnitus and hearing loss following traumatic injury, with a particular focus on comparing outcomes across distinct trauma mechanisms and evaluating the impact of early intervention. Materials and Methods: A comprehensive literature search was conducted in PubMed, Embase, Scopus, and Web of Science for studies published between January 2010 and December 2025. The search strategy combined terms related to traumatic injury (e.g., \"acoustic trauma,\" \"blast injury,\" \"traumatic brain injury,\" \"head trauma\") with terms related to auditory dysfunction (e.g., \"tinnitus,\" \"hearing loss,\" \"auditory dysfunction\"). Eligible studies included observational studies (cohort, cross-sectional, case-control) reporting original data on tinnitus and/or hearing loss prevalence, recovery outcomes, or prognostic factors in adult or mixed populations exposed to traumatic injury. A narrative synthesis was organized thematically around the key research questions. Results: The available evidence consistently indicates that tinnitus and hearing loss are frequent consequences of blast injury, acute acoustic trauma, and traumatic brain injury, although reported prevalence estimates vary considerably across studies due to differences in populations, injury mechanisms, and diagnostic criteria. Blast injury is associated with mixed hearing loss (conductive and sensorineural components), while acute acoustic trauma typically causes sensorineural hearing loss, often with a characteristic high-frequency notch. Traumatic brain injury can lead to central auditory processing deficits even when pure-tone thresholds are normal. Recovery is variable and often incomplete; tympanic membrane perforations frequently heal spontaneously, but sensorineural components often persist. Early treatment (within days to two weeks) is associated with better recovery outcomes. Conclusions: Trauma-associated tinnitus and hearing loss are highly prevalent and frequently result in persistent disability. The strong association between early treatment and improved recovery outcomes supports the implementation of prompt audiological evaluation and intervention following traumatic injury. These findings underscore the need for routine audiological screening in at-risk populations and for continued research into preventive strategies, standardised assessment protocols, and optimised treatment regimens.\n\nID: 42355598\nTitle: An Open Comparative Study on the Effectiveness of Customized and Non-Customized Sound Therapy for Tinnitus Patients.\nAbstract: Objectives: Sound therapy is a common treatment for tinnitus. This study aims to explore the efficacy of non-customized and customized sound therapy for subjective tinnitus. Treatment progress was assessed by comparing changes in monthly scales. The main scales used are the Tinnitus Handicap Inventory, Hospital Anxiety and Depression Scale, and Loudness Visual Analogue Scale. Methods: The subjects of this study were patients with tinnitus who visited outpatient from 2024 to 2025. Total of 732 patients were included (customized group, n = 653; non-customized group, n = 79). Customized sound therapy is tailored to patient's specific tinnitus condition, while non-customized sound consists of soothing natural sounds. The daily treatment duration was 2 h. Treatment assignment was not randomized; patients were free to choose between customized and non-customized sound therapy, which may have introduced a preference bias. Results: The study found that, in both groups of patients, regardless of whether they were treated or not, the severity of tinnitus was positively correlated with the level of anxiety (p < 0.01)/depression (p < 0.01) and the loudness of tinnitus (p < 0.01). Patients with severe tinnitus were more likely to choose customized sound therapy (p < 0.01). THI score for the non-customized group showed a downward trend at 1 and 3 months after treatment (p < 0.01 at 1 and 3 months). HADS-A score also decreased 1 and 3 months after treatment compared to before treatment (p < 0.05 at 1 and 3 months). THI scores for the customized group showed a downward trend at 1, 3, 6, 9, and 12 months after treatment (p < 0.001 at 1 and 3 & 6 and 9 & 12 months). HADS-A/D scores decreased at 1, 3, 6, 9 and 12 months after treatment (p < 0.01 at 1 & 3 & 6 and 9 & 12 months). The efficacy of the customized group was greater than that of the non-customized group 1 month after treatment (\u03c72 = 6.39, p = 0.011). Conclusions: Both sound therapies can alleviate tinnitus severity and reduce anxiety in the short term. Customized sound therapy is superior to non-customized therapy in terms of short-term efficacy. Additionally, customized sound therapy is more effective than non-customized therapy in alleviating tinnitus severity and managing anxiety and depression over a longer period. Therefore, customized sound therapy may be a more effective treatment option for subjective tinnitus. However, it should be emphasized that this was an open study in which patients freely chose between the two therapies, which may have introduced bias. Therefore, these findings are not as well founded as those from a randomized controlled trial, and future RCTs are warranted to verify the observed benefits.\n\nID: 42352653\nTitle: Personalized Music-Embedded Sound Therapy Based on Gating Modulation and Neural Decoupling Reduces Tinnitus Severity.\nAbstract: Background: Tinnitus is a prevalent auditory disorder associated with maladaptive cortical plasticity and aberrant neural synchronization across auditory and non-auditory brain networks. Acoustic desynchronization-based sound therapies, such as coordinated reset neuromodulation, aim to counteract pathological oscillatory patterns but commonly require prolonged daily listening sessions and specialized delivery formats, which may limit their accessibility and practicality in routine clinical settings. To address this limitation, a modified desynchronization protocol embedding therapeutic tones within music was developed to improve tolerability and engagement. This study aimed to evaluate the clinical effects of modified Music-Integrated Desynchronization Sound Therapy (mMIDST) on tinnitus severity in patients with chronic tinnitus. Methods: In this prospective, randomized, controlled, single-blind pilot trial conducted at the Otolaryngology Department of Hospital Cl\u00ednico Universidad de Chile (Santiago, Chile) between July 2024 and July 2025, adults aged 18-75 years with chronic non-pulsatile tinnitus were assigned to receive either mMIDST or an active control intervention consisting of low-frequency stimulation (LFS) embedded within identical music tracks. Participants listened to personalized sound files for one hour daily, five days per week. Tinnitus severity was assessed using the Tinnitus Handicap Inventory (THI), with audiometric evaluations performed at baseline and after one, two, and three months. Between-group differences were analyzed using the Mann-Whitney U test. Results: Twenty-five participants completed the study (15 mMIDST, 10 LFS). Baseline audiometric thresholds and THI scores were comparable between groups. The mMIDST group showed significantly greater reductions in THI scores than the LFS group at two and three months of treatment (p < 0.05). Conclusions: mMIDST was associated with time-dependent improvements in tinnitus-related distress compared with an active control condition. Embedding desynchronization-based tonal stimulation within music may represent a promising and well-tolerated non-invasive approach for chronic tinnitus management.\n\nID: 42351418\nTitle: Otologic Manifestations of Temporomandibular Disorders.\nAbstract: Background/Objectives: Temporomandibular disorder (TMD) affects a third of the adult population and has been associated with otologic symptoms. These symptoms are frequently misattributed to primary otologic diseases, leading to delays in diagnosis and treatment. This review aims to summarize the reported prevalence, proposed pathophysiologic mechanisms, and management strategies of otologic manifestations in patients with TMD. Methods: A literature review was conducted using the MeSH terms \"temporomandibular joint disease\" and \"otologic symptoms.\" Five additional searches were performed using \"temporomandibular disease/dysfunction\" combined with each of the five most common otologic symptoms. Meta-analyses, randomized controlled trials, reviews, and systematic reviews were prioritized, with preference for studies published within the last 10 years. Inclusion criteria focused on human studies addressing the etiology, clinical presentation, and management of otologic symptoms in TMD populations. Results: The literature supports an association between TMD and otologic symptoms in the absence of primary ear disease. The most commonly described symptoms were aural fullness, otalgia, tinnitus, vertigo, and hearing loss. Conservative approaches, including occlusal splints, physical therapy, behavioral modification, and pharmacologic therapy, demonstrated partial or complete symptom resolution after management of underlying TMD. Conclusions: The literature demonstrates a consistent association between otologic symptoms and TMD, although the underlying mechanisms remain incompletely understood. While conservative TMD management may improve symptoms, exact mechanisms remain unproven. Clinicians should consider TMD in the differential diagnosis when patients present with unexplained otologic complaints. Further research is necessary to establish causality, confirm the efficacy of management protocols, and improve diagnostic accuracy in this overlapping domain.\n\nID: 42349502\nTitle: Audiometric evaluation and quality-of-life in OSIA users - a retrospective monocentric study.\nAbstract: The piezoelectric OSIA is a well-established active transcutaneous bone anchored hearing system. The study retrospectively evaluates hearing results and subjective benefits in patients provided with the OSIA system at our clinic, and separately also looks at patients with moderate to severe mixed hearing loss. 21 patients between 9 and 83 years of age were planned for OSIA implantation between 2022 and 2024. They underwent preoperative (k0) and at 3 months (k1) and at 6 months (k2) with OSIA audiometric testing as well as answered quality of life questionnaires. The k0 PTA4 air-conduction threshold was 68.2 dB (\u00b1 16.7). The PTA4-free field pure tone audiogram with the OSIA system at k1 was 32.0 dB (\u00b1 14.1). The gain is a substantial 36.2 dB. Freiburg monosyllables speech understandig at 65 dB in quiet with the OSIA at k1 was 16.4% better than the k0 performance with the BAHA 6 Max. Postoperative monosyllables performance at 65 dB was statistically better with OSIA versus without. There was a significant negative correlation between pre- versus postoperative APHAB and NCIQ answers (corr.-coeff. -0.87). Postoperative tinnitus results correlated with APHAB and NCIQ answers (corr.-coeff. 0.72 and -0.81 respectively). Overall, we observed a significant improvement in hearing thresholds, speech understanding performance and in subjective quality of life in patients with OSIA. Also in the subgroup with moderate to severe mixed hearing loss we observed a steady improvement of speech understanding over time and a good subjective quality of life and satisfaction with the system. Das piezoelektrische OSIA ist ein etabliertes aktives transkutanes Knochenleitungsh\u00f6rsystem. Die Studie analysiert retrospektiv die H\u00f6rergebnisse und den subjektiven Gewinn durch die Versorgung mit OSIA bei den in unserer Klinik implantierten Personen und betrachtet gesondert die Patienten mit mittel- und hochgradiger kombinierter Schwerh\u00f6rigkeit.21 Patienten im Alter zwischen 9 und 83 Jahren wurden zwischen 2022 und 2024 f\u00fcr eine OSIA-Implantation vorgesehen. Pr\u00e4operativ (k0) sowie nach 3 (k1) und 6 Monaten (k2) mit OSIA wurden H\u00f6rtests und Lebensqualit\u00e4tsbefragungen durchgef\u00fchrt.Die k0-PTA4-Luftleitungsschwelle betrug 68,2dB (\u00b116,7). Die PTA4-Freifeldh\u00f6rschwelle mit OSIA zu k1 betrug 32,0dB (\u00b114,1). Der Gewinn ist substanzielle 36,2dB. Das Freiburger Einsilberverstehen in Ruhe bei 65dB mit dem OSIA zu k1 war um 16,4% besser als die k0-H\u00f6rleistung mit dem BAHA 6 Max. Die postoperative Freiburger-Einsilbertest-H\u00f6rleistung bei 65dB war statistisch signifikant besser mit OSIA als ohne. Es wurde eine signifikante negative Korrelation zwischen pr\u00e4- und postoperativen APHAB- und NCIQ-Antworten festgestellt (Korrelationskoeffizient \u20130,87). Die postoperativen Tinnitusresultate korrelierten mit den APHAB- und den NCIQ-Ergebnissen (Korrelationskoeffizient 0,72 bzw. \u20130,81).Insgesamt konnten wir eine signifikante Verbesserung der H\u00f6rschwellen, des Sprachverstehens und der subjektiven Lebensqualit\u00e4t bei den mit OSIA implantierten Patienten feststellen. Auch in der Untergruppe der mittel- bis hochgradig kombiniert schwerh\u00f6rigen Patienten wurden im zeitlichen Verlauf eine stetige Verbesserung des Sprachverstehens und eine gute Lebensqualit\u00e4t und hohe Zufriedenheit mit dem System gesehen.\n\nID: 42346194\nTitle: Ultrasound-Guided Intra-Articular Infiltration of Hyaluronic Acid, Lidocaine, and Methylprednisolone in Patients with Temporomandibular Disorders (TMD): A Preliminary Pilot Case Series.\nAbstract: This preliminary pilot case series aims to evaluate the feasibility and temporal evolution of pain and function following an ultrasound-guided infiltration technique with hyaluronic acid and methylprednisolone in a specific patient population with Temporomandibular Disorders (TMD) characterized by MRI-confirmed retrodiscal tissue hyperemia. Given the absence of a control group, this study represents a preliminary exploration of a clinical approach utilizing individualized interocclusal devices during infiltration. Twenty-eight patients (16 females, 12 males) with TMD and MRI evidence of retrodiscal tissue hyperemia were enrolled in this prospective, uncontrolled study. A unique protocol was employed, utilizing individualized interocclusal devices to optimize joint space access during bilateral ultrasound-guided infiltration of a mixture containing low-molecular-weight hyaluronic acid, lidocaine, and methylprednisolone acetate. Pain intensity (VAS 0-100 mm) and associated symptoms (tinnitus, vertigo, headache, joint clicking) were assessed at baseline and at 30, 60, and 90 days' follow-up. A statistically significant temporal reduction in pain was observed at all follow-up points (p < 0.001), with the mean VAS score decreasing from 70.5 \u00b1 11.4 mm at baseline to 43.0 \u00b1 11.1 mm at 90 days. Joint clicking disappeared in 80% of patients immediately after treatment. The ultrasound-guided infiltration technique, combined with personalized interocclusal support, demonstrated preliminary feasibility and short-term temporal improvement in pain and joint clicking in this specific patient cohort. Due to the lack of a control group and the multimodal nature of the intervention, these findings should be considered preliminary and do not allow for causal inferences regarding the efficacy of individual components.\n\nID: 42345631\nTitle: Audiologic Assessment and Management of Teprotumumab-Associated Ototoxicity: An Updated Narrative Review.\nAbstract: Introduction: Teprotumumab (Tepezza\u00ae), an insulin-like growth factor-1 receptor (IGF-1R) antagonist, is the first FDA-approved targeted therapy for thyroid eye disease (TED). While effective for reducing proptosis and inflammation, increasing post-marketing evidence has linked teprotumumab to auditory adverse events. IGF-1 signaling is essential for cochlear maintenance and neuroprotection; therefore, systemic IGF-1R inhibition presents a biologically plausible mechanism for ototoxicity. Despite growing recognition of these effects, no standardized approach exists for audiologic assessment or monitoring of patients receiving teprotumumab. This review aimed to (1) summarize proposed mechanisms and the reported spectrum of teprotumumab-related auditory effects, (2) evaluate current methods used to assess and monitor these patients, and (3) identify areas of consensus and ongoing uncertainty. Methods: An updated narrative review of the literature was conducting using PubMed, CINAHL, and Google Scholar using Boolean strings targeting teprotumumab exposure and hearing-related outcomes. Studies from 2022 onward were identified using Boolean search strings targeting teprotumumab exposure and hearing-related outcomes. Peer-reviewed English language studies reporting audiometric findings were eligible for inclusion. Results: Ten studies met inclusion criteria. Reported effects most commonly included bilateral high-frequency SNHL, tinnitus, and aural fullness, typically emerging after three to six infusions. Many cases demonstrated persistent deficits despite drug discontinuation. Baseline audiometric assessment was not uniformly reported across studies, and monitoring protocols varied considerably, with inconsistent incorporation of speech testing and immittance measures. Conclusions: Teprotumumab-associated ototoxicity is increasingly recognized and potentially irreversible. Current evidence is insufficient to guide standardized monitoring. Prospective studies are urgently needed to establish evidence-based audiologic surveillance protocols.\n\nID: 42345427\nTitle: Cluster Analysis of Clinical Characteristics, Sleep Quality, Depression and Melatonin Levels in Patients with Idiopathic Subjective Tinnitus.\nAbstract: Since the relationship between tinnitus and quality of sleep is still a subject of research, serum melatonin levels may have a role. The aim was to reveal the structural similarities or dissimilarities regarding clinical features, tinnitus-related quality of life (QoL) effects, serum melatonin levels, and sleep quality in patients who have unilateral idiopathic subjective tinnitus. A total of 83 cases (46 males, 55.4%; 37 females, 44.6%), with a median age of 51 (range: 18-73) years, were included in the study. Cluster analysis was used to analyze demographic, laboratory, clinical, and sleep-related features of the whole sample in a multivariate manner. Two separate sets of clusters were organized. In Cluster-2, age was older, serum melatonin levels were lower, tinnitus pitch and loudness were higher, and duration was longer; air-conduction pure tone averages were higher, Visual Analog Scale, Tinnitus Handicap Inventory, Beck Depression Inventory, and Pittsburgh Sleep Quality Index scores were also significantly higher than Cluster-1. A stronger correlation was observed between poor sleep quality and depression in Cluster-2. However, in Cluster-1 with younger cases, the negative correlation between tinnitus loudness and serum melatonin values was found to be higher. The older-aged patients with lower serum melatonin levels have more severe tinnitus, worse QoL, and sleep problems compared to the younger patients. Among younger individuals, the more pronounced correlations between hearing levels, tinnitus loudness, sleep quality, and serum melatonin levels indicate that this group may particularly benefit from melatonin as a potential therapeutic option for tinnitus as well.\n\nID: 42345421\nTitle: Intravestibular Lipoma with Intracochlear Extension: A Case Report on Surgical Management and Cochlear Implantation.\nAbstract: Intracochlear and intravestibular lipomas are rare benign lesions that may clinically and radiologically mimic retrocochlear pathologies such as vestibular schwannomas. They typically present with progressive sensorineural hearing loss, tinnitus, or dizziness. Due to their rarity, optimal management strategies, particularly in pediatric patients, remain challenging and require individualized decision-making. We report the case of an 8-year-old girl who presented with progressive right-sided sensorineural hearing loss. Magnetic resonance imaging (MRI) revealed an intravestibular lipoma extending into the cochlea. Considering the patient's young age and the potential for tumor growth, surgical excision was performed via a translabyrinthine approach. Simultaneous cochlear implantation was undertaken to facilitate auditory rehabilitation. Histopathological analysis was conducted to confirm the diagnosis. Histopathological examination confirmed the lesion as a lipoma. The postoperative course was uneventful. The cochlear implant was successfully activated and provided effective hearing restoration. Intravestibular lipomas are rare entities that require careful radiological evaluation to ensure accurate diagnosis and differentiation from other retrocochlear lesions. Management should be individualized, particularly in pediatric patients, balancing surgical risks against the benefits of tumor removal and hearing rehabilitation. Simultaneous cochlear implantation may represent a viable strategy for auditory restoration in selected cases.\n\nID: 42378543\nTitle: Tinnitus Pathophysiology: A Systems Biology Analysis of Gene Networks and Cellular Pathways.\nAbstract: Tinnitus, characterized by phantom sound perception in the absence of external auditory stimuli, affects approximately 10%-15% of the adult population worldwide. Despite its prevalence, the molecular mechanisms underlying tinnitus remain incompletely understood. This study aimed to identify key molecular networks and pathways implicated in tinnitus pathophysiology using a systems biology approach through comprehensive enrichment analysis of tinnitus-associated genes. Tinnitus-associated genes were identified from the DisGeNET database (CUI ID: C0040264) and subsequently analyzed using EnrichR across 7 databases: WikiPathways 2024 Human, GO Biological Process 2025, GO (Gene Ontology) Cellular Component 2025, GO Molecular Function 2025, CellMarker 2024, HMDB (Human Metabolome Database) Metabolites, and TargetScan microRNA 2017. Top results from each database were retained and analyzed to identify significant biological patterns. The analysis revealed significant enrichment of neuroinflammatory pathways, glutamatergic signaling, and ion channel activity, particularly potassium channels. Key inflammatory cytokines including IL-10 (interleukin), IL-1\u03b2, IL-6, and tumor necrosis factor emerged as central molecular players. The results highlighted the involvement of neuronal components including N-methyl-D-aspartate receptors, voltage-gated potassium channels, and cellular structures critical for auditory signal transduction. Metabolite analysis implicated potassium homeostasis and several microRNAs showed potential regulatory roles in tinnitus-related gene networks. This comprehensive analysis suggests tinnitus pathophysiology involves complex interactions between neuroinflammation, excitotoxicity, ion channel dysfunction, and neuronal structural changes, presenting potential targets for therapeutic intervention and biomarker development.\n\nID: 42370660\nTitle: Unusual Case of Granulomatosis with Polyangiitis Complicated with Hormographilella aspergillata Skin Infection.\nAbstract: Granulomatosis with polyangiitis (GPA) is a rare ANCA-associated small-vessel vasculitis that predominantly affects the respiratory tract and kidneys, while cutaneous manifestations occur less frequently. Opportunistic fungal infections complicating GPA are uncommon, particularly involving rare filamentous basidiomycetes. We describe a 32-year-old male with a prolonged history of crusting rhinitis, tinnitus, and progressive nodular and ulcerative skin lesions on the trunk and extremities, accompanied by fever and lower limb edema. Laboratory evaluation revealed elevated inflammatory markers and positive c-ANCA (anti-PR3). Histopathology demonstrated granulomatous inflammation consistent with GPA. The clinical course was complicated by a secondary cutaneous infection caused by Hormographiella aspergillata, isolated from a skin lesion. Initial antifungal therapy with itraconazole was ineffective; subsequent treatment with voriconazole resulted in resolution of the fungal infection. The patient was then successfully treated with systemic immunosuppressive therapy, achieving long-term remission. To our knowledge, this is the first reported case of GPA complicated by a cutaneous infection with H. aspergillata. This case highlights the diagnostic challenges of GPA with atypical skin manifestations and underscores the importance of microbiological evaluation of skin lesions prior to initiating aggressive immunosuppressive therapy. KEYWORDS: granulomatosis with polyangiitis; ANCA-associated vasculitis; Hormographiella aspergillata; opportunistic fungal infection Granulomatosis with polyangiitis (GPA), formerly Wegener's granulomatosis, is a necrotizing granulomatous vasculitis affecting small to medium-sized blood vessels and belonging to the group of ANCA-associated vasculitides (AAV) (1). The disease is characterized by granulomatous inflammation, necrotizing vasculitis, and the presence of antineutrophil cytoplasmic antibodies, most commonly proteinase-3 ANCA (PR3-ANCA) (2). GPA may involve virtually any organ system, with predominant involvement of the upper and lower respiratory tract and kidneys (3). Cutaneous manifestations are reported in approximately 30-50% of patients and are usually associated with systemic disease activity (4). Opportunistic infections may complicate the course of GPA, particularly in the context of delayed diagnosis or immunosuppressive therapy. Infections caused by rare filamentous fungi such as Hormographiella (H) aspergillata are exceptionally rare and have predominantly been reported in immunocompromised patients with hematological malignancies (5, 6). A 32-year-old male was admitted with multiple painful ulcerations and nodules on the trunk and extremities, accompanied by high fever and marked bilateral lower limb edema. Four months before admission, nodular lesions on the left auricle and right nipple regressed spontaneously after purulent discharge. Six weeks prior to referral, painless nodules on the back and right upper arm were surgically incised and treated with antibiotics, followed by clinical deterioration with fever, progressive ulcerations, and painful swelling of the feet and ankles (figures 1a and !b). The patient had a two-year history of nasal obstruction, crusting rhinitis, and intermittent right-sided tinnitus. Rhinoscopy revealed mucosal thickening and septal perforation with crusts and synechiae. Dermatological examination showed deep ulcerations with yellow-brown crusts on the back, right upper arm, and left cheek (figures 1a and 1b). Laboratory evaluation demonstrated elevated inflammatory markers (ESR 76 mm/h, CRP 47.4 mg/L), hypoalbuminemia, and positive c-ANCA (anti-PR3). Initial microbiological cultures were sterile. Histopathology revealed granulomatous panniculitis with abscess formation. Fungal culture isolated H. aspergillata. Itraconazole therapy was ineffective; subsequent voriconazole treatment led to complete resolution of the cutaneous infection. Due to persistent systemic inflammation and c-ANCA positivity, the patient was treated with high-dose glucocorticoids and cyclophosphamide, which gradually led to completely remission of skin lesions (figure 2). Renal involvement developed during treatment, manifested as proteinuria. Long-term immunosuppressive therapy resulted in sustained remission with mild residual renal impairment. GPA is a rare multisystem autoimmune disease with heterogeneous clinical presentation, often leading to delayed diagnosis. Cutaneous involvement may be the initial manifestation and includes purpura, nodules, necrosis, and ulcerations, reflecting underlying vasculitis and granulomatous processes (2). In our patient, prominent skin lesions preceded the diagnosis by several months and contributed to diagnostic uncertainty. Opportunistic infections are a recognized complication in GPA, particularly following immunosuppression; however, fungal infections caused by filamentous basidiomycetes are exceedingly rare (5, 6). Hormographiella aspergillata, the anamorphic form of Coprinopsis cinerea, is an environmental fungus that has been implicated almost exclusively in invasive infections in patients with hematological malignancies, with reported mortality rates up to 70% (5, 6). To our knowledge, no previous case of GPA complicated by cutaneous infection with H. aspergillata has been reported. The present case underscores the importance of thorough microbiological evaluation of atypical or non-healing skin lesions in patients with suspected systemic vasculitis, particularly before initiation of intensive immunosuppressive therapy. Failure to recognize opportunistic infections may lead to significant morbidity and mortality. This case emphasizes the crucial role of dermatologists in the early recognition of systemic vasculitis presenting with skin manifestations. Comprehensive clinical, histological, and microbiological assessment is essential to establish the correct diagnosis and to identify rare infectious complications. Multidisciplinary management and careful monitoring are necessary to achieve long-term remission and to minimize treatment-related complications.\n\nID: 42352596\nTitle: Auricular Ultrasonic Vagus Nerve Stimulation: Effectiveness of Blinding and the Occurrence of Adverse Effects in People with Tinnitus.\nAbstract: Background/Objectives: Vagus Nerve Stimulation (VNS) has been suggested as a treatment for tinnitus, but its effect on the condition remains unclear. Ultrasonic Vagus Nerve Stimulation (U-VNS) involves non-invasive stimulation of the auricular branch of the vagus nerve, potentially providing an alternative to traditional VNS. To pre-emptively address some of the methodological challenges of future trials investigating U-VNS, a highly blindable sham device is needed. This study aimed to (1) investigate the effectiveness of blinding of a U-VNS device and (2) record any adverse effects, including any negative effects on tinnitus loudness, alongside their onset and duration. Methods: In this single-blind randomized controlled study, 20 volunteers with chronic tinnitus received two 29 min sessions of true U-VNS followed by sham U-VNS, or vice versa. Sessions were a week apart, and in a randomized order. The effectiveness of blinding and adverse effects, including changes in tinnitus loudness, were measured using self-report questionnaires. Results: James' Blinding Index revealed that blinding was highly effective in both the real U-VNS condition, BI = 0.79, 95% CI (0.61-0.92), and the sham condition, BI = 0.76, 95% CI (0.60-0.89). Adverse effects were uncommon and mild, primarily consisting of sensations on the skin beneath the transducer. For most participants, tinnitus loudness either decreased or stayed the same in both conditions. Conclusions: A high level of blinding was achieved, suggesting that the ZenBud sham device may be suitable as an effective placebo control in future trials. Adverse effects were uncommon and mild. These findings will help inform the design of future clinical trials to evaluate the safety and efficacy of U-VNS.\n\nID: 42345629\nTitle: Domain-Specific Associations Between Physical Activity and Tinnitus in NHANES 2015-2018.\nAbstract: Tinnitus is a prevalent auditory condition associated with significant psychological burden and limited treatment efficacy. While physical activity confers broad health benefits, its relationship with tinnitus remains understudied. This study examined associations between domain-specific physical activity and tinnitus in a nationally representative sample of U.S. adults. Data from NHANES 2015-2018 were analyzed. The final analytic sample comprised 4301 adults aged 20 years and older. Tinnitus was assessed via the NHANES audiometry questionnaire. Physical activity was categorized as low, moderate, and high (MET-min/week) separately for work-related (WORK) and non-work-related (NW) domains. Survey-weighted multivariable logistic regression models, adjusted for age, sex, race, BMI, poverty-income ratio, sedentary time, smoking, education, noise exposure, hypertension, diabetes, and depressive symptoms, were used to examine associations. Linear trends across ordered physical activity categories were evaluated using ordinal trend analyses. The weighted prevalence of tinnitus was 17.3%. High NW physical activity (PA) was associated with significantly lower odds of tinnitus (OR = 0.70, 95% CI: 0.488-0.995, p = 0.0475), while high WORK PA was associated with significantly higher odds (OR = 1.30, 95% CI: 1.06-1.60, p = 0.018). Trend analyses confirmed opposing linear trends across ordered categories: inverse for NW PA (OR = 0.83 per category, p-trend = 0.0406) and positive for WORK PA (OR = 1.14 per category, p-trend = 0.017). Noise exposure and depressive symptoms were independently associated with tinnitus across both models. These findings suggest a domain-specific paradox: NW PA was associated with lower odds of tinnitus, whereas WORK PA was associated with higher odds. These results highlight the importance of domain-specific assessment and identify recreational activity as a potential modifiable factor warranting further investigation. Given the cross-sectional design, these associations should not be interpreted as causal.\n\nID: 42345410\nTitle: Efficacy of the Additional Effect of Stellate Ganglion Block in Combination of Intratympanic Steroid and Hyperbaric Oxygen Therapy for Refractory Sudden Sensorineural Hearing Loss.\nAbstract: Refractory sudden sensorineural hearing loss (RSSNHL) underscores the need for more effective salvage therapies. This study aimed to investigate the efficacy of stellate ganglion block (SGB) combined with intratympanic steroid (ITS) and hyperbaric oxygen therapy (HBO) as triple salvage therapy in patients with RSSNHL. This retrospective study analyzed 73 patients with unilateral RSSNHL admitted between January 2022 and December 2023. All patients underwent salvage therapy with HBO and ITS, with (n=31) or without SGB (n=42). The primary efficacy endpoint was the change in pure tone average thresholds, with secondary endpoints comprising demographic characteristics, tinnitus evaluation, and psychological distress scores. Both groups showed post-treatment hearing improvement (P < .05), but the SGB group achieved greater hearing gain, higher efficacy rates, and superior low-frequency recovery (P < .05). Tinnitus relief and psychological outcomes were also significantly better in the SGB group (P < .05). Patients with both shorter intervals from symptom onset to salvage therapy and relatively lower baseline hearing thresholds demonstrated significantly greater hearing improvement. Neither group experienced severe adverse events. Lower baseline hearing thresholds and earlier therapy initiation predicted better outcomes. The triple salvage therapy significantly improved hearing recovery in RSSNHL patients, particularly in low-frequency ranges, while also reducing tinnitus severity and enhancing psychological well-being.\n\nID: 42338403\nTitle: Impact of Treatment Intensity on Quality of Life in Patients With Metastatic Testicular Cancer.\nAbstract: Testicular cancer (TC) is the most common malignancy in young men and is highly curable with platinum-based chemotherapy. With growing survivorship rates, treatment-related symptom burden and quality of life (QoL) have become increasingly important. This study evaluates the impact of different TC treatments on symptom burden and QoL. Of 715 patients with TC and primary or postchemotherapy retroperitoneal lymph node dissection (RPLND) treated at the University Hospital D\u00fcsseldorf between 2010 and 2024, 486 eligible survivors were contacted, and 124 (25.5 %) completed a standardized questionnaire. Treatment-related symptoms, including QoL and mental health status, were assessed using the EORTC QLQ-C30 and PHQ-9 questionnaires, respectively. Results were compared with age-matched reference values from the general population. A subgroup comparison of clinical stage (CS) II patients treated with primary RPLND versus first-line chemotherapy followed by RPLND was performed to identify chemotherapy-specific effects. The median time between last treatment and survey response was 55 months. Twenty-four patients were treated with primary RPLND, 80 patients with adjuvant or first-line chemotherapy and RPLND, and 20 patients with multiple lines of chemotherapy and RPLND. Overall, TC survivors reported high global QoL scores comparable to age-matched normative data. The most frequent treatment-related symptoms were polyneuropathy, tinnitus, retrograde ejaculation, and circulatory disorders, particularly among patients receiving multiple lines of chemotherapy. Subgroup analysis showed that CS II patients treated with a single first-line chemotherapy reported lower social functioning and greater financial distress compared with those managed with surgery alone. Despite the physical impact, depression rates were low and similar to the general population, indicating preserved psychological well-being. TC survivors maintain good QoL comparable to the general population despite therapy-related symptoms. While persistent side effects such as polyneuropathy and tinnitus are common, their impact on QoL is limited. However, even first-line chemotherapy affects sexual health, social functioning, and financial well-being, highlighting the importance of the development of new treatment approaches and clinical studies focusing on surgery as a QoL-preserving option in selected low-metastatic cases.\n\nID: 42319726\nTitle: Associations Between Football-Related Exposures, Head Injury, Tinnitus, and Neuropsychological Health Outcomes Among Professional American-Style Football Players.\nAbstract: Auditory dysfunction such as tinnitus is a common sequelae of traumatic brain injury (TBI), and has been associated with neurobehavioral outcomes, including cognitive decline, depression, and anxiety. Few studies have examined associations between concussion history and tinnitus independent of confounding by blast injury or occupational noise exposure. This study investigated concussion history and tinnitus among former professional American-style football (ASF) players, and evaluated whether tinnitus mediates associations between concussion history and neurobehavioral outcomes. This cross-sectional study included former ASF players who contracted with a professional league after 1960 and completed self-administered questionnaires between 2019-2025. Surveys assessed football exposure, auditory dysfunction, and mental health. Cumulative head injury exposure was measured using self-reported concussion signs and symptoms during play. Tinnitus was self-reported and assessed concurrently with validated measures of perceived cognition, depression, and anxiety. Logistic regression evaluated associations between concussion symptom history and tinnitus, and linear regression models assessed mediation and interaction effects. Among 1085 participants (mean age 57.9\u2009\u00b1\u200913.5\u00a0years; 32.4% Black; 6.1\u2009\u00b1\u20093.7 seasons), greater concussion symptom history was associated with increased odds of tinnitus (highest vs. lowest quintile: OR\u2009=\u20092.90; 95%CI 1.91-4.43; p\u2009<\u20090.0001). Tinnitus did not mediate associations between concussion symptom history and neurobehavioral outcomes. However, associations with perceived cognition (p-interaction\u2009=\u20090.1), depression (p-interaction\u2009<\u20090.01), and anxiety (p-interaction\u2009<\u20090.01) were larger among participants reporting tinnitus. Greater concussion symptom history was associated with increased reporting of tinnitus, and neurobehavioral associations were stronger among those with tinnitus. Clinicians should consider tinnitus when evaluating long-term cognitive and mental health outcomes following repeated head injury.\n\nID: 42312243\nTitle: Association Between Cannabis Use and Tinnitus: A Multi-Center Propensity-Score-Matched Cohort Study.\nAbstract: There are mixed findings regarding the impact of cannabis use on tinnitus, with different patterns of cannabis use potentially influencing risk in varying ways. This study investigates the association between cannabis-related disorders (CRD) and the risk of developing tinnitus. Propensity-score-matched cohort study. TriNetX, a multi-institutional research database. Adult patients (>18 years) with any CRD and no prior ear-related disorders were matched to a control group of patients without any history of CRD. Patients with CRD were stratified by increasing levels of cannabis use intensity based on the ICD-10 codes (use, abuse, or dependence). Propensity score matching controlled for demographic and related clinical variables, including migraine, nicotine and substance use, and mood disorders. The primary outcome was diagnosed tinnitus at 1, 5, and 10 years, analyzed using Cox regression hazard models (hazard ratios (HR), 95% confidence intervals). After matching (n\u2009=\u200992,077 in each group), tinnitus incidence after 1, 5, and 10 years of CRD diagnosis was 0.7%, 1.8%, and 2.1%, respectively. One-year risk was significantly higher among those with any CRD (HR\u2009=\u20091.30, [95% CI: 1.16-1.45]). Compared to control at 1-year of follow-up, effect size was relatively higher among patients diagnosed with cannabis dependence (use: 1.30 [1.11-1.51]; abuse: 1.42 [1.05-1.90]; dependence: 1.55 [1.02-2.37]). There were no significant trends in tinnitus development at 5 and 10 years of follow-up with any CRD. Cannabis use may elevate the short-term risk of tinnitus, especially among those with more severe use. Further investigation should explore a potential dose-dependent relationship and underlying mechanisms.\n\nID: 42309185\nTitle: A systematic review on sound-based therapy for individuals with hyperacusis.\nAbstract: Hyperacusis is marked by an abnormal sensitivity to everyday sounds, causing considerable distress and hindrance in daily life. It is frequently linked with other hearing disorders like tinnitus and may occur alongside neurological and psychiatric conditions such as autism, migraines, and depression. Recent research into hyperacusis treatment has explored various sound therapy methods, including counselling and the use of therapeutic sounds. Consequently, the current systematic review investigated whether sound-based therapy programs could alleviate the effects of hyperacusis. A total of 149 articles were retained for this study. After a thorough examination of the full text of the 14 articles that satisfied the inclusion criteria, nine quantitative studies were ultimately selected. These comprised one retrospective study, three studies comparing pre- and post-intervention outcomes, three randomized controlled trials, and two case studies. These nine studies collectively demonstrated that sound generator therapy significantly reduced the debilitating symptoms of hyperacusis, with all investigations reporting substantial symptomatic improvement post-intervention. Collectively, the nine studies demonstrated significant therapeutic benefits of sound generator interventions in reducing hyperacusis-related disability. However, the current evidence base would benefit from further randomized controlled trials to more comprehensively evaluate the clinical efficacy of sound-based treatments for this condition.\n\nID: 42307512\nTitle: Auditory Cortex Photobiomodulation Ameliorates Tinnitus-like Behavior by Reversing Synaptic Excitation/Inhibition Imbalance in Mice.\nAbstract: To investigate whether transcranial photobiomodulation (PBM) targeting the auditory cortex can ameliorate noise-induced tinnitus-like behavior in mice by reversing synaptic excitation/inhibition (E/I) imbalance. A noise-induced tinnitus mouse model was established (116 dB SPL, 1 h). Tinnitus-like behavior was assessed using gap prepulse inhibition (PPI) of acoustic startle (Gap-PPI), with PPI as a control for sensorimotor gating. Auditory brainstem responses (ABR) were recorded to evaluate peripheral hearing. Immunohistochemistry was performed to quantify c-Fos, GluN1, and GABAA R-\u03b11 expression in the auditory cortex, including colocalization analysis within activated neurons. Transcranial PBM (830 nm, 40 mW/cm2) was delivered to the auditory cortex. The nonthermal nature of PBM was confirmed by intracerebral temperature monitoring and optical transmission measurements. PBM at 40 mW/cm2 penetrated the skull with negligible optical drift and induced <0.5 \u00b0C brain temperature rise, confirming nonthermal neuromodulation. Noise exposure selectively reduced Gap-PPI ratio without affecting PPI, indicating tinnitus-like behavior. ABR thresholds showed mid-to-high frequency hearing loss that was not reversed by PBM. In tinnitus mice, auditory cortex exhibited increased c-Fos+ cells, upregulation of GluN1 and downregulation of GABAA R-\u03b11 specifically within c-Fos+ neurons, reflecting E/I imbalance and hyperexcitability. A single session of PBM rapidly (from day four) and sustainably (\u226528 days) alleviated tinnitus-like behavior, reversed the molecular alterations, and restored coexpression ratios of GluN1 and GABAA R-\u03b11 in activated neurons. Sham-PBM had no effect. Linear regression confirmed significant correlations between receptor coexpression and Gap-PPI (GluN1: negative; GABAA R-\u03b11: positive). Auditory cortex E/I imbalance driven by neuron-subtype-specific changes in GluN1 and GABAA R-\u03b11 underlies noise-induced tinnitus-like behavior. Targeted transcranial PBM reverses these molecular alterations, restores local circuit balance, and provides rapid, sustained behavioral improvement without affecting peripheral hearing or sensorimotor gating. PBM represents a promising noninvasive neuromodulation strategy for tinnitus.\n\nID: 42307286\nTitle: Tinnitus disorder and musical auditory training: a double-blind randomized controlled clinical trial.\nAbstract: To evaluate the effect of Musical Auditory Training (MAT) on auditory system neuroplasticity and on tinnitus perception in adults. A randomized double-blind clinical trial, approved by the Research Ethics Committee. Twenty adults with tinnitus complaints for at least six months, intensity greater than four points on the Visual Analog Scale (VAS), normal bilateral hearing thresholds, and preserved neural synchrony at the brainstem level were included. Participants were randomly assigned to two groups: Control Group (CG, n=10), submitted to passive stimulation with audiovisual material without tasks, and Study Group (SG, n=10), submitted to MAT. Both groups underwent eight sessions, twice a week, over a four-week period. Assessments included verbal Long-Latency Auditory Evoked Potentials (LLAEP), to investigate neuroplasticity, as well as the VAS (volume and discomfort) and the Tinnitus Handicap Inventory (THI), to measure symptom perception. Both groups showed improvement in tinnitus perception after the intervention. However, a differentiated analysis revealed that the CG presented restricted changes, with improvement only in the duration of the P3 component of the LLAEP. In contrast, the SG showed broader changes, including significant alterations in both amplitude and duration of P3, suggesting greater neural recruitment associated with auditory processing. In addition, only the SG demonstrated consistent reductions in tinnitus volume and discomfort, as well as in the impact on quality of life, as reflected in THI scores. After four weeks, MAT proved to be superior to passive stimulation, promoting positive changes in auditory neuroplasticity, a greater reduction in tinnitus intensity and annoyance, and a significant improvement in participants' quality of life. Verificar o efeito do Treinamento Auditivo Musical (TAM) na neuroplasticidade do sistema auditivo e na percep\u00e7\u00e3o do zumbido em adultos. Ensaio cl\u00ednico randomizado duplo-cego, aprovado pelo Comit\u00ea de \u00c9tica em Pesquisa. Foram inclu\u00eddos vinte adultos com queixa de zumbido h\u00e1 pelo menos seis meses, intensidade maior que quatro pontos na Escala Visual Anal\u00f3gica (EVA), limiares auditivos normais bilateralmente e sincronia neural preservada em tronco encef\u00e1lico. Os participantes foram distribu\u00eddos aleatoriamente em dois grupos: Controle (GC, n=10), submetido \u00e0 estimula\u00e7\u00e3o passiva com material audiovisual sem tarefas, e Estudo (GE, n=10), submetido ao TAM. Ambos realizaram oito sess\u00f5es, duas vezes por semana, ao longo de quatro semanas. As avalia\u00e7\u00f5es compreenderam Potenciais Evocados Auditivos de Longa Lat\u00eancia (PEALL) verbais, para investigar neuroplasticidade, al\u00e9m da EVA (volume e inc\u00f4modo) e do Tinnitus Handicap Inventory (THI), para mensurar a percep\u00e7\u00e3o do sintoma. Ambos os grupos apresentaram melhora na percep\u00e7\u00e3o do zumbido ap\u00f3s a interven\u00e7\u00e3o. Contudo, a an\u00e1lise diferenciada mostrou que o GC apresentou mudan\u00e7as restritas, com melhora apenas na dura\u00e7\u00e3o do componente P3 dos PEALL. J\u00e1 o GE apresentou altera\u00e7\u00f5es mais amplas, incluindo mudan\u00e7as significativas na amplitude e dura\u00e7\u00e3o do P3, indicando maior recrutamento neural associado ao processamento auditivo. Al\u00e9m disso, apenas o GE demonstrou redu\u00e7\u00f5es consistentes no volume e no inc\u00f4modo do zumbido, bem como no impacto sobre a qualidade de vida, refletido nas pontua\u00e7\u00f5es do THI. Ap\u00f3s quatro semanas, o TAM mostrou-se superior \u00e0 estimula\u00e7\u00e3o passiva, promovendo altera\u00e7\u00f5es positivas na neuroplasticidade auditiva, diminui\u00e7\u00e3o mais expressiva da intensidade e do inc\u00f4modo do zumbido e melhora significativa na qualidade de vida dos participantes. Verificar o efeito do Treinamento Auditivo Musical (TAM) na neuroplasticidade do sistema auditivo e na percep\u00e7\u00e3o do zumbido em adultos. Ensaio cl\u00ednico randomizado duplo-cego, aprovado pelo Comit\u00ea de \u00c9tica em Pesquisa. Foram inclu\u00eddos vinte adultos com queixa de zumbido h\u00e1 pelo menos seis meses, intensidade maior que quatro pontos na Escala Visual Anal\u00f3gica (EVA), limiares auditivos normais bilateralmente e sincronia neural preservada em tronco encef\u00e1lico. Os participantes foram distribu\u00eddos aleatoriamente em dois grupos: Controle (GC, n=10), submetido \u00e0 estimula\u00e7\u00e3o passiva com material audiovisual sem tarefas, e Estudo (GE, n=10), submetido ao TAM. Ambos realizaram oito sess\u00f5es, duas vezes por semana, ao longo de quatro semanas. As avalia\u00e7\u00f5es compreenderam Potenciais Evocados Auditivos de Longa Lat\u00eancia (PEALL) verbais, para investigar neuroplasticidade, al\u00e9m da EVA (volume e inc\u00f4modo) e do Tinnitus Handicap Inventory (THI), para mensurar a percep\u00e7\u00e3o do sintoma. Ambos os grupos apresentaram melhora na percep\u00e7\u00e3o do zumbido ap\u00f3s a interven\u00e7\u00e3o. Contudo, a an\u00e1lise diferenciada mostrou que o GC apresentou mudan\u00e7as restritas, com melhora apenas na dura\u00e7\u00e3o do componente P3 dos PEALL. J\u00e1 o GE apresentou altera\u00e7\u00f5es mais amplas, incluindo mudan\u00e7as significativas na amplitude e dura\u00e7\u00e3o do P3, indicando maior recrutamento neural associado ao processamento auditivo. Al\u00e9m disso, apenas o GE demonstrou redu\u00e7\u00f5es consistentes no volume e no inc\u00f4modo do zumbido, bem como no impacto sobre a qualidade de vida, refletido nas pontua\u00e7\u00f5es do THI. Ap\u00f3s quatro semanas, o TAM mostrou-se superior \u00e0 estimula\u00e7\u00e3o passiva, promovendo altera\u00e7\u00f5es positivas na neuroplasticidade auditiva, diminui\u00e7\u00e3o mais expressiva da intensidade e do inc\u00f4modo do zumbido e melhora significativa na qualidade de vida dos participantes.\n\nID: 42306241\nTitle: Gamified Digital Solutions for Tinnitus Health Literacy: The Erasmus+ Project TinWise.\nAbstract: Tinnitus is a common auditory symptom - sound perceived without an external source. Chronic tinnitus affects about 65 million adults in the EU, often impairing quality of life through distress, sleep problems, anxiety, and depression. Yet, management remains inconsistent across Europe due to patient heterogeneity and lack of standardised care. Health literacy is increasingly recognised as key to empowering patients in self-management and reducing burden. The Erasmus+ project TinWise addresses this by creating a gamified health literacy platform for tinnitus patients and educating healthcare professionals on digital self-help strategies. Building on Tin-TRAC, which developed an open-access e-learning platform, TinWise integrates gamification to enhance motivation, engagement, and knowledge retention. The project applies the OPHELIA framework to optimise literacy strategies and follows the ASPIRE learning construct for co-creating content. TinWise will deliver interactive, co-created digital games to promote self-help literacy, an AI-powered chatbot for real-time guidance, and a patient-linking service to enhance community support. It also aims to train healthcare professionals using reusable learning objects, supporting the integration of digital tools into tinnitus care. Through modern technology and inclusive design, TinWise supports European priorities in digital education, patient empowerment, and healthcare innovation, ultimately improving tinnitus care and outcomes across Europe.\n\nID: 42302460\nTitle: Trajectory of COVID-related tinnitus over the pandemic timeline.\nAbstract: COVID-19 is a respiratory disease caused by the coronavirus SARS-CoV-2. Previous studies reported cases of tinnitus following COVID infection, most of them mild and with similar characteristics to other forms of tinnitus. Our aim is to further explore the relationship between COVID-19 and tinnitus. For this purpose, we analyzed people in our city after a COVID-19 infection. 233 patients over 18-years old and previously confirmed diagnosis of COVID-19 confirmed by either a RT-PCR, antibodies or antigens test were included. Patients were subdivided in three groups: No Tinnitus (NT), tinnitus that already existed before COVID-19 (Chronic Tinnitus, CT) and tinnitus that arose during or after COVID-19 (Post-COVID-19 Tinnitus, PCT). Data concerning COVID-19 symptoms, drugs prescribed for COVID-19, tinnitus characteristics, comorbidities and other otological symptoms were collected. Tinnitus assessment included pure tone audiograms, the Tinnitus Handicap Inventory, visual-analog scales for loudness and distress as well as the hospital anxiety and depression scale. Patients with CT were additionally asked whether their tinnitus worsened after their COVID-19 infection. No statistical difference was found between CT and PCT concerning hearing, tinnitus characteristics and tinnitus distress. There was also no statistically significant difference between PCT and NT with respect to COVID-19 symptoms and pharmacological COVID-19 treatment. Only 7% of the patients with CT reported worsening of their tinnitus after COVID-19. There was a decrease on post-COVID cases along the pandemic's timeline: 9.8% in 2020, 6.7% in 2021, 4.4% in 2022 and 0% in 2023 and 2024 (p\u2009=\u20090.058). Our data demonstrated that PCT tinnitus is very similar to other forms of tinnitus and generally mild. Also, PCT cases decreased along the pandemic's timeline, possibly due to the onset of vaccination, emergence of omicron as the dominant variant and improvement on the psychological aspects related to the pandemics. 3b.\n\nID: 42293576\nTitle: The overlooked burden: associations between high-noise environments and scrub nurse wellbeing and performance.\nAbstract: Operating room noise is a significant occupational hazard affecting healthcare professionals, but the specific consequences for scrub nurses have been largely overlooked. This study aimed to investigate the effects of operating room noise on scrub nurses across three key domains: psychological status, physiological and physical symptoms, and perceived surgical performance. A cross-sectional comparative study was conducted among 94 scrub nurses working in high-noise (orthopedic) and low-noise (ophthalmic) operating rooms. Participants completed validated psychological scales, underwent standardized physiological measurements, and reported physical symptoms and perceived noise impact on surgical performance. Between-group comparisons were performed using IBM SPSS Statistics 26.0 (P < 0.05). Psychologically, the high-noise group reported significantly higher levels of anxiety, sleep disturbances, specific burnout dimensions (exhaustion and cynicism), and perceived stress compared to the low-noise group (P < 0.05). Physiologically, nurses in the high-noise environment exhibited elevated resting heart rates (RHR) and systolic blood pressure (SBP). Furthermore, they reported a significantly higher prevalence of noise-related physical symptoms, including tinnitus and palpitations, rather than clinically diagnosed conditions. Regarding performance, the high-noise group perceived a substantially greater negative impact of noise on their task efficiency, surgical concentration, and intraoperative communication. The findings suggest that prolonged exposure to high-noise environments is associated with elevated psychological distress, physiological stress responses, and frequent somatic complaints among scrub nurses. Additionally, high noise levels are perceived to negatively interfere with surgical performance. Longitudinal studies and targeted noise-reduction interventions are recommended to safeguard occupational health and patient safety.\n\nID: 42293351\nTitle: Prolonged P3 latency predicts clinical response to repetitive transcranial magnetic stimulation in tinnitus.\nAbstract: The clinical efficacy of repetitive transcranial magnetic stimulation (rTMS) for tinnitus is variable, necessitating predictive biomarkers. We assessed whether pre-treatment multimodal electroencephalography (EEG) could predict rTMS response. Fifty-eight tinnitus patients underwent a 10-session rTMS protocol targeting the dorsolateral prefrontal cortex and left temporo-parietal lobe. Before treatment, we extracted a comprehensive set of 325 features, encompassing event-related potentials (ERPs), spectral power, microstate metrics, and clinical features. Predictive modeling was performed using five machine learning classifiers with 5-fold cross-validation. Feature importance was ranked, and an iterative feature selection procedure was conducted to optimize the feature set. The predictive power of the top-ranking feature was further validated by constructing a univariate model. Adaptive Boosting performed best. P3 latency was the top predictor. Responders had longer pre-treatment P3 latencies than non-responders (389\u00a0ms vs. 370\u00a0ms, p\u00a0<\u00a00.001). The univariate prediction model based on a P3 latency cut-off of \u2265384\u00a0ms achieved an accuracy of 0.79 and an area under the curve (AUC) of 0.69\u00a0\u00b1\u00a00.14. The multimodal model constructed through feature optimization, which incorporated the top 15 features, demonstrated superior predictive efficacy, achieving an accuracy of 0.84\u00a0\u00b1\u00a00.10 and an AUC of 0.91\u00a0\u00b1\u00a00.09. Pre-treatment P3 latency robustly predicts clinical response to rTMS in tinnitus patients. This study establishes P3 latency as a foundational, clinically actionable neurophysiological biomarker for stratifying rTMS response, facilitating a shift toward precision neuromodulation by optimizing patient selection and avoiding unnecessary interventions.\n\nID: 42293047\nTitle: Advances in pathogenesis, novel therapeutic strategies and interventions for age-related hearing loss.\nAbstract: Age-related hearing loss (ARHL), or presbycusis, represents one of the most prevalent sensory dysfunctions in the elderly people. It is characterized by progressive hearing deterioration that significantly impairs quality of life and increases the risk of comorbidities including cognitive impairment, depression, and social isolation. The pathogenesis of ARHL involves complex structural alterations such as degeneration of cochlear hair cells, loss of spiral ganglion neurons, and stria vascularis atrophy, coupled with molecular and cellular dysregulations including oxidative stress, inflammation, autophagy dysfunction, and cellular senescence. Meanwhile, genetic predisposition and environmental factors contribute to its development. Current conventional management primarily relies on hearing aids, which fail to reverse disease progression, while effective pharmacological interventions remain unavailable. Recent years have witnessed promising developments in innovative approaches such as gene therapy, stem cell-based regenerative medicine, nanotechnology-based delivery systems, and early biomarker screening, offering new directions for precise ARHL intervention. The purpose of this review is to provide a comprehensive overview of the current state of research in ARHL, with the goal of advancing our understanding, treatment and interventions of presbycusis.\n\nID: 42289889\nTitle: Dural arteriovenous fistula of the hypoglossal canal treated with endovascular embolization using 3D Slicer-based preoperative planning: Case report.\nAbstract: Hypoglossal canal dural arteriovenous fistulas (HC-dAVFs) are rare skull base vascular lesions with complex venous drainage. We report a case of a 52-year-old man who presented with 6 months of left-sided pulsatile tinnitus, sleep disturbance, and anxiety. Magnetic resonance angiography demonstrated venous engorgement near the left hypoglossal canal, and transfemoral cerebral angiography revealed early venous shunting involving the anterior condylar confluence, internal jugular vein, vertebral venous plexus, and cavernous sinus. Conventional workstation-based three-dimensional (3D) reconstruction was limited by poor differentiation of arterial and venous structures, particularly on lateral views. To better delineate the fistulous anatomy, 3D Slicer was used to independently segment arterial and venous phases from DICOM source images and generate a color-coded fused model. This reconstruction clarified the spatial relationship among the feeding arteries, draining veins, and fistulous convergence point, facilitating microcatheter trajectory planning and accurate transvenous access. Transvenous coil embolization via the right femoral vein achieved complete obliteration of the fistula. The patient's pulsatile tinnitus resolved immediately, and no postoperative neurological deficits were observed, including preserved cranial nerve IX through XII function. Follow-up at 1 month and 1 year confirmed sustained complete remission without recurrence. This case highlights the value of 3D Slicer-based preoperative reconstruction for precise angioarchitectural analysis and procedural planning in HCdAVFs when conventional 3D workstation imaging is limited by vessel overlap.\n\nID: 42289149\nTitle: Current status and future prospects of research on psilocybin's regulation of neurotransmitters and their receptors related to the pathogenesis of tinnitus.\nAbstract: Subjective tinnitus is a common auditory disorder characterised by the subjective perception of noise in the absence of external sound sources. Its prevalence has been rising annually due to noise exposure, medication misuse, and population ageing. Current tinnitus treatments employ antidepressants, anticonvulsants, and vasodilators, yet most demonstrate limited efficacy with significant side effects. There is an urgent clinical need for novel therapeutic agents targeting new mechanisms and pathways. In recent years, the natural psychedelic tryptamine psilocybin has garnered attention for its rapid and sustained therapeutic effects following single-dose administration in clinical trials for depression and end-of-life anxiety. Its mechanism involves selectively activating 5-HT2A receptors, triggering substantial glutamate release and subsequently upregulating brain-derived neurotrophic factor (BDNF). This markedly increases dendritic spine density and synaptic protein expression in the hippocampus and prefrontal cortex, thereby restoring neural plasticity. This review systematically integrates the aforementioned neuroplasticity mechanisms with cross-mechanisms of neuroplastic alterations associated with tinnitus, emphasising its synergistic regulatory effects on excitatory neurotransmitters and their receptors (glutamate, dopamine) as well as inhibitory neurotransmitters and their receptors (gamma-aminobutyric acid (GABA)).\n\nID: 42285408\nTitle: Intraoperative High-Resolution 2-Dimensional and 3-Dimensional Angiography in Cervical Decompression for Subaxial Bow Hunter's Syndrome.\nAbstract: Bow Hunter's syndrome (BHS) causes vertebrobasilar insufficiency when head rotation compresses the vertebral artery (VA).1,2 Although classically craniocervical, subaxial cases from osteophytic V2 compression lack standardized management with treatments ranging from decompression to stenting.3-5Table 1 presents a summary of previously reported subaxial BHS cases. During decompression, intraoperative VA patency confirmation is essential because static postoperative imaging cannot reliably exclude residual dynamic compression, and delayed confirmation may necessitate reoperation.6,7 We present 2 cases of subaxial rotational occlusion syndrome (subaxial BHS) treated with anterior cervical decompression and intraoperative angiography in a hybrid operating suite (Video 1). Case 1 is an 80-year-old woman with neck pain, dizziness, tinnitus, near-syncope, and ocular symptoms on leftward head rotation; computed tomography/dynamic angiography showed left VA narrowing at C4-5 from spondylotic compression. Case 2 is a 57-year-old woman with prior Eagle syndrome with vertigo, nausea, and blurred vision on left neck rotation; magnetic resonance angiography demonstrated focal left V2 stenosis at C5-6 from uncovertebral osteophytes and incidental distal VA fenestration. Both underwent anterior V2 exposure, ultrasonic drilling of osteophytes, Gore-Tex/fibrin glue reinforcement, and anterior cervical discectomy and fusion (C4-5 and C5-6) to eliminate residual rotational motion at the decompressed segment. Intraoperative biplane angiography via left radial access (Isovue-300; 6 mL at 6 mL/s per 2-dimensional run; 18 mL at 3 mL/s for 3-dimensional acquisition) with simulated head turning, performed 10-15 minutes after hemostasis under general anesthesia, supplemented by 3-dimensional rotational angiography in case 2 to characterize the VA fenestration, showed no head-turning compression and confirmed complete VA patency.8,9 Both were discharged on postoperative day 3, and complete symptom resolution was confirmed at 6 weeks.\n\nID: 42279134\nTitle: Associations of Dietary Factors, Body Mass Index, and Physical Activity with Tinnitus: A Scoping Review.\nAbstract: Background: Emerging evidence suggests that metabolic, nutritional, and lifestyle-related factors may be associated with tinnitus occurrence and symptom burden. Nutritional status, obesity, and sedentary behavior have been hypothesized to be linked with auditory function, neural excitability, and tinnitus-related outcomes. This scoping review aimed to map and summarize the available evidence on associations between dietary factors, nutrient intake, body mass index (BMI), obesity, physical activity, and tinnitus occurrence, severity, and related clinical outcomes. Methods: A scoping review was conducted in accordance with the PRISMA-ScR reporting guidelines. A comprehensive search of PubMed, Web of Science, and Cochrane Library databases was performed. Eligible designs included randomized controlled trials, cohort studies, case-control studies, and cross-sectional studies. Data were extracted and synthesized narratively due to methodological heterogeneity. Results: Twenty-four studies met the inclusion criteria. Several observational studies reported associations between protein intake, lipid profile, micronutrient status, BMI, obesity, physical activity, and tinnitus-related outcomes. Evidence on antioxidant supplementation was heterogeneous, with some trials reporting favorable changes in tinnitus-related measures and others showing no significant benefit compared with placebo. Elevated BMI, obesity, and altered body composition were generally associated with tinnitus occurrence or greater symptom severity. Randomized trials suggested that structured lifestyle programs involving dietary modification, weight reduction, and physical activity may be associated with improvements in tinnitus severity and quality of life in selected patient groups. Conclusions: The available literature suggests potential associations between nutritional, metabolic, and lifestyle-related factors and tinnitus occurrence or symptom severity. However, the evidence is heterogeneous and largely observational, with inconsistent adjustment for hearing loss, psychological distress, and general health status. Further well-designed prospective studies and randomized controlled trials are needed before causal or clinical recommendations can be formulated.\n\nID: 42272341\nTitle: Tinnitus Brain: A Functional Reorganization?\nAbstract: Background: Tinnitus is an auditory phantom perception in the absence of any corresponding acoustic stimulus whose pathophysiology remains poorly understood. This study aimed to investigate alterations in the functional organization of the brain in individuals with tinnitus using resting-state functional magnetic resonance imaging (rs-fMRI) and graph theory analysis.Methods: We conducted a study including 44 individuals with tinnitus and 32 healthy controls. Using rs-fMRI and graph theory measures, we characterized whole-brain topological properties, including network segregation, integration, small-worldness, and global efficiency. In addition, regional segregation and integration were assessed using clustering coefficient and participation coefficient analyses to identify alterations in brain hub regions.Results: Our findings revealed altered topological properties in the tinnitus brain, particularly in the balance between cerebral segregation and integration, leading to deviations from optimal small-world architecture. We also observed alterations in the topology of specific auditory and nonauditory brain regions associated with phantom sound perception. Notably, patients with tinnitus exhibited a decreased nodal participation coefficient in the thalamus, suggesting reduced connectivity between this region and different functional modules as well as long-range connections.Conclusions: These results suggest that tinnitus is associated with alterations in the functional organization of the brain, leading to disrupted information processing and sensory integration.\n\nID: 42254732\nTitle: Beyond the auditory: anxiety bridges sleep disturbances and depressive symptoms to tinnitus handicap.\nAbstract: Tinnitus is closely associated with psychological factors including anxiety, depression, and sleep disturbances. However, how these variables interact to influence tinnitus severity remains poorly understood, warranting further exploration. This retrospective study analyzed data from 285 patients with tinnitus, utilizing the Tinnitus Handicap Inventory (THI), Self-Rating Depression Scale (SDS), Self-Rating Scale of Sleep (SRSS), and Self-Rating Anxiety Scale (SAS) as assessment instruments. Univariate and multivariate regression analyses were performed to identify psychosocial factors associated with THI scores. Structural equation modeling (SEM) was employed to examine the mediating role of anxiety-specifically, whether sleep disturbances and depression exacerbate tinnitus handicap indirectly through heightened anxiety. Subgroup analyses were further conducted to evaluate the stability of this psychological mediation pathway across different demographic and clinical subgroups (e.g., age, gender, disease duration). Tinnitus severity was significantly positively correlated with scores on the SRSS, SDS, and SAS (all P < 0.05). Multivariate regression analysis identified age, sleep quality (SRSS), and anxiety (SAS) as independent predictors of increased Tinnitus Handicap Inventory (THI) scores. Structural equation modeling further confirmed that SAS partially mediated the relationship between SRSS and THI (mediation effect: 31.7%) and fully mediated the relationship between SDS and THI. Subgroup analyses revealed that the mediating effect of anxiety was more pronounced in middle-aged and elderly individuals, females, and patients with left-sided tinnitus. Anxiety serves as a central mediating mechanism linking sleep disturbances and depressive symptoms to tinnitus severity. The present findings demonstrate that anxiety not only directly exacerbates tinnitus-related handicap but also mediates the influence of sleep and mood disturbances on tinnitus distress. These findings underscore the critical role of anxiety in personalized tinnitus treatment.\n\nID: 42254380\nTitle: CT-guided spinal nerve root adhesiolysis for refractory atypical symptoms in cervical disc herniation: a retrospective cohort study.\nAbstract: To evaluate the clinical efficacy and safety of CT-guided spinal nerve root adhesiolysis in treating refractory atypical symptoms-specifically dizziness and tinnitus-in patients with cervical disc herniation (CDH). This retrospective cohort study included 256 patients with CDH presenting with persistent atypical symptoms who had failed conservative therapy for at least 3 months. All patients underwent CT-guided periradicular adhesiolysis involving the injection of an ozone-oxygen mixture, normal saline, and corticosteroids. Primary outcomes included symptom alleviation rates and functional improvements assessed via the Dizziness Handicap Inventory (DHI), Tinnitus Handicap Inventory (THI), Visual Analog Scale (VAS) for pain, and Neck Disability Index (NDI) at 1, 3, 6, and 12 months post-procedure. At the 12-month follow-up, the intervention demonstrated significant efficacy. The alleviation rate for dizziness (baseline prevalence 85.2%) was 80.3%, and for tinnitus (baseline prevalence 68.8%) was 75.6%. Statistically significant improvements were observed in all functional scores compared to baseline (P < 0.001). Specifically, DHI scores decreased from 65.2 \u00b1 12.5 to 18.7 \u00b1 6.0, and THI scores decreased from 58.7 \u00b1 11.3 to 18.0 \u00b1 5.8. 8 Subgroup analysis of patients with isolated dizziness or tinnitus confirmed efficacy independent of neck pain relief. The procedure showed a favorable safety profile with no serious adverse events. For patients with CDH-related atypical symptoms refractory to conservative management, CT-guided spinal nerve root adhesiolysis is a safe and effective minimally invasive intervention. It provides sustained functional improvement and represents a vital therapeutic option for this challenging patient population.\n\nID: 42237994\nTitle: Features and functionality of the Iterapi platform for internet-based psychological treatments: An update.\nAbstract: Internet-based cognitive behaviour therapy (ICBT) is now a well-established treatment modality supported by numerous controlled trials. Platforms for delivering these interventions have become critical infrastructure for both research and clinical practice, yet platform descriptions remain rare in the literature. In this article, we provide an updated description of the Iterapi platform, originally reported by Vlaescu et al., 2016. Over the past decade, Iterapi has been used in more than 100 published research studies, spanning over 35 clinical conditions (including depression, anxiety disorders, insomnia, tinnitus, loneliness, and climate anxiety) across at least 20 countries on five continents. We describe the platform's core architecture and functionality, including treatment modules, questionnaire systems, communication tools, and automation features. We also report on significant developments since 2016, including enhanced security and regulatory compliance (GDPR, data protection impact assessments), new features for ecological momentary assessment, electronic identification and incorporation of artificial intelligence. Finally, we outline future directions including mobile application development, digital phenotyping, just-in-time adaptive interventions, and the role of emerging regulatory frameworks. This update is intended as a practical resource for researchers and clinicians considering platform-based delivery of internet interventions.\n\nID: 42228109\nTitle: Increments in physical activity relate to reductions in tinnitus severity: a 2-year prospective observational study.\nAbstract: Tinnitus, the perception of sound without external stimuli, affects approximately 14.4% of adults, significantly impacting quality of life. Previous cross-sectional research has shown that individuals who engage in greater levels of physical activity (PA) reported lower tinnitus severity. While these findings are promising, they are limited by the inherent constraints of cross-sectional designs. Hence, the current study investigated whether longitudinal changes in PA are associated with concurrent changes in tinnitus severity. In an observational longitudinal study, 2,751 individuals with subacute and chronic tinnitus were recruited through an online survey. Data were collected at baseline and three annual follow-ups (T2, T3, or T4), assessing demographic variables, tinnitus severity (Likert scale), and PA using the International Physical Activity Questionnaire (IPAQ). Associations between changes in PA and tinnitus severity were analyzed using discrete-time Cox proportional hazards regression, adjusted for demographic and health-related confounders, such as age, sex, hearing loss, noise exposure, stress, anxiety, and depression. Higher levels of leisure-time vigorous-intensity physical activity were associated with a lower hazard of reporting stable or increased tinnitus severity relative to baseline during follow-up (HR\u2009=\u20090.966; 95% CI: 0.957-0.975, p\u2009<\u20090.001). Participants who were physically inactive at baseline but increased their physical activity to meet World Health Organization recommendations at any follow-up time point exhibited a 64.2% lower hazard of reporting stable or increased tinnitus severity relative to baseline (HR\u2009=\u20090.358; 95% CI: 0.310-0.413, p\u2009<\u20090.001). Conversely, participants who became physically inactive during follow-up showed a 60.7% higher hazard of reporting increased tinnitus severity relative to baseline (HR\u2009=\u20091.607; 95% CI: 1.215-2.127, p\u2009<\u20090.001). In this longitudinal observational study, higher and sustained levels of physical activity-particularly vigorous-intensity leisure-time activity-were consistently associated with more favorable tinnitus severity trajectories over time, whereas reductions in physical activity were associated with worsening tinnitus severity.\n\nID: 42404127\nTitle: Cerebral venous disorders: clinical presentation, diagnostic strategy, and contemporary management.\nAbstract: Cerebral venous disorders encompass a heterogeneous group of conditions ranging from acute cerebral venous thrombosis to chronic intracranial venous hypertension and stenotic outflow states. Although historically considered uncommon, increasing recognition, improved imaging techniques, and expanding endovascular therapies have led to significant advances in the diagnosis and management of these conditions. This review provides a contemporary overview of the pathophysiology, clinical presentation, diagnostic evaluation, and treatment strategies for major cerebral venous disorders, with an emphasis on conditions associated with elevated intracranial venous pressure and medically refractory symptoms. We summarize current evidence regarding noninvasive and invasive imaging modalities, including the evolving roles of CT and MR venography, catheter venography, and physiologic pressure measurements. Indications for medical therapy, including anticoagulation and intracranial pressure management, are discussed alongside emerging criteria for patient selection for endovascular intervention. Particular attention is given to venous sinus stenting and other endovascular techniques, including technical considerations, outcomes, and complication profiles. Controversies remain regarding diagnostic thresholds, the clinical significance of venous stenosis, optimal hemodynamic criteria for intervention, and long-term durability of endovascular treatment. We highlight areas of ongoing investigation and identify key knowledge gaps that may inform future research. As diagnostic capabilities and therapeutic options continue to evolve, a multidisciplinary and physiology-guided approach is essential to optimize patient selection and outcomes in cerebral venous disorders.\n\nID: 42403965\nTitle: Reactions to Tinnitus Based on Color Code Personality Type.\nAbstract: Although studies of tinnitus and personality are prevalent in tinnitus research, studies of tinnitus-related distress across personality types using the Color Code Personality Assessment are lacking. The purpose of this research was to evaluate the relationship between personality type and the reaction to tinnitus using the Color Code Personality Assessment and the Tinnitus Reaction Questionnaire (TRQ). We conducted an online survey involving 178 participants. The survey included the TRQ to evaluate tinnitus-related distress and the Color Code Personality Assessment to determine personality type. The Color Code Personality Assessment results in one of four personality colors, red, blue, white, or yellow, and focuses on how to interact and communicate with different personality subtypes. The survey was posted to 11 different social media groups on Facebook and was open for 3 months. A one-way analysis of variance (ANOVA) was conducted to evaluate the effect of personality type on the TRQ score. One-sample chi-square tests were conducted to determine if the number of respondents with tinnitus-related distress was greater than chance for each personality type. The one-way ANOVA revealed a significant main effect for personality type. Follow-up tests comprising the Bonferroni test indicated that the TRQ scores for red personality types were significantly higher than those for white personality types. Analyses using one-sample chi-square tests for each personality type indicated significant results for respondents with blue or red personality types. Reactions to tinnitus differed across personality types. Respondents with the red personality type reported higher tinnitus-related distress than that of respondents with the white personality type. Respondents with blue and red personality types were more likely to report bothersome tinnitus. Although various tinnitus questionnaires that assess tinnitus distress and its effect on different areas of the patient's life are available, audiologists do not have a tool that allows insight regarding how to appropriately counsel and treat patients with tinnitus based on their reaction to it. Understanding the personality of patients and how personality will impact their reaction to tinnitus can guide the clinician's ability to provide effective counseling, thus adding to the clinician's skillset the ability to deliver customized treatment options to patients with tinnitus.\n\nID: 42392687\nTitle: Efficacy and safety of single-fraction radiosurgery in vestibular schwannoma: a 10-year experience.\nAbstract: This study aimed to evaluate long-term tumor control, safety, and prognostic factors following single-fraction stereotactic radiosurgery (SRS) for vestibular schwannoma (VS). In this retrospective single-institution study, 68 patients with VS were treated with photon-based single-fraction SRS (mean dose, 13.1 Gy; range, 12 to 15 Gy). Treatment planning was based on computed tomography-magnetic resonance imaging (MRI) fusion with organ-at-risk sparing and a planning target volume margin of 0-2 mm. The primary endpoint was local control (LC). Secondary endpoints included toxicity and predictors of treatment failure. After a median follow-up of 68 months, LC was maintained in 95.6% of patients. Actuarial LC rates at 5 and 10 years were both 98.5%. MRI showed tumor shrinkage in 41.2% and stability in 57.4% of cases. Treatment was well tolerated. Acute adverse events were infrequent and mild. Localized alopecia occurred acutely in one patient (1.5%) and did not persist into late follow-up. Vertigo and tinnitus were analyzed as disease-related symptoms rather than treatment-related toxicities. Severe toxicity (grade \u2265 3) was rare (<3%). Cox regression revealed no statistically significant predictors of local failure, though trends suggested higher risk after prior surgery and with doses \u226514 Gy. Single-fraction SRS provides durable long-term LC of VS with a favorable toxicity profile, supporting its role as a primary treatment modality. Optimal outcomes appear to be associated with lower prescription doses (<14 Gy) and treatment of de novo tumors.\n\nID: 42374873\nTitle: Symptom Overlap and Neurobiological Similarities Between Posttraumatic Stress Disorder and Tinnitus.\nAbstract: Many symptoms of posttraumatic stress disorder (PTSD) overlap with the psychological sequelae of tinnitus, including sleep difficulty, concentration problems, hypervigilance, and irritability. Although these two disorders are clearly distinct, they are highly comorbid, may have shared etiology, and are among the top service-connected disabilities within the VA healthcare system. This study aimed to determine neuropathophysiological similarities and differences among veterans with both PTSD and tinnitus, tinnitus only, and healthy controls. Resting-state networks were identified by previous studies and extracted to examine functional connectivity patterns. Networks included the default mode network (DMN), auditory vigilance (AUDVIG), salience (SN), dorsal attention (DAN), and emotion (EMO) networks. Functional connectivity among specific brain regions was decreased among the tinnitus only group compared to the healthy control group and was further decreased when PTSD was present with tinnitus. Findings suggest that the additive and negative effects observed symptomatically may be explained by decreased functional connectivity, especially with respect to the DMN and AUDVIG networks.\n\nID: 42363966\nTitle: Temporal bone remodeling after venous stenting for pulsatile tinnitus: isolated dehiscence versus diverticulum.\nAbstract: To evaluate clinical outcomes and temporal bone remodeling after venous sinus\u00a0stenting for pulsatile tinnitus (PT), and to compare remodeling rates between isolated sigmoid sinus wall dehiscence (SSWD) and diverticulum-associated SSWD. This retrospective cohort study included 70 consecutive patients who underwent venous sinus\u00a0stenting for PT. Clinical success was defined as symptom improvement or complete resolution. The primary endpoints were short-term clinical success (at 3 months) and temporal bone remodeling on follow-up CT (n\u2009=\u200952). Long-term clinical success was evaluated as a secondary endpoint. Multivariable logistic regression, adjusted for age, sex, dehiscence size, diverticulum presence, and preoperative Tinnitus Handicap Inventory (THI) score, was used to identify predictors of temporal bone\u00a0remodeling. Short-term clinical success was achieved in 65/70 patients (92.9%). Remodeling occurred in 38/52 patients (73.1%) with follow\u2011up CT. Remodeling rates were significantly higher in patients with a diverticulum versus isolated SSWD (85.7% (30/35) vs 47.1% (8/17); adjusted OR, 8.08; 95% CI: 1.31-49.73; p\u2009=\u20090.024). Older age independently predicted temporal bone\u00a0remodeling (adjusted OR per year, 1.14; 95% CI: 1.03-1.26; p\u2009=\u20090.012). Long-term clinical success was observed in 97.4% (37/38) of remodeled patients and 85.7% (12/14) of non-remodeled patients (p\u2009=\u20090.15). Venous sinus\u00a0stenting for PT results in a high rate of clinical success. The presence of a diverticulum strongly predicts subsequent temporal bone remodeling, whereas SSWD appears less likely to remodel, highlighting potential pathophysiological differences between these anatomical subtypes. Question Venous sinus\u00a0stenting for pulsatile tinnitus results in high clinical success, but temporal bone remodeling differs by anatomical subtype. Findings Patients with a sigmoid sinus diverticulum demonstrate significantly higher rates of postoperative bone remodeling compared to those with isolated dehiscence. Clinical relevance Identifying the specific anatomical anomaly may help to predict temporal bone remodeling and facilitate individualized patient counseling regarding long-term structural outcomes.\n\nID: 42352574\nTitle: The Auditory-Visual Stroop Test to Assess Subjects with Tinnitus.\nAbstract: Background/Objectives: In this three-stage study, we aimed to adapt an Auditory-Visual Stroop test (AV-Stroop test) for tinnitus subjects, evaluate the correlation between performance in the conventional Stroop test (C-Stroop test) and the AV-Stroop test; assess the effect of cognitive screening test performance on the AV-Stroop test's results; and apply the AV-Stroop test in participants with tinnitus and controls. Methods: At the First Stage, the AV-Stroop test was adapted using white noise (WN), pure tone (PT), and narrow band (NB) sound stimuli. At the Second Stage, results of the AV-Stroop test, the C-Stroop test, and the Montreal Cognitive Assessment (MOCA) were compared (n = 45). At the Third Stage, the AV-Stroop test was applied to participants with and without tinnitus (n = 70). The tinnitus group was assessed with an additional test track (stimuli matched to tinnitus spectral characteristics, Tinnitus Pitch). Results: We adapted 34 training and evaluation tracks for the AV-Stroop test. AV-Stroop test's results were correlated with C-Stroop test's total task time (WN, p-value = 0.002; NB and PT, p-value < 0.001 comparing C-Stroop word reading task; and WN, NB, and PT, p-value < 0.001 for C-Stroop color naming task), and number of errors (NB, p-value < 0.001 comparing C-Stroop word reading task, and p-value = 0.012 for C-Stroop color naming task). Participants' MOCA scores were not associated with AV-Stroop test performance. Participants with tinnitus required more time and made more errors in the AV-Stroop test. Additionally, the tinnitus group made more errors in the Tinnitus Pitch track. Conclusions: The AV-Stroop test proved to be an accessible, easy-to-administer tool for evaluating attentional and inhibitory control in participants with tinnitus. The stimulus with spectral characteristics similar to tinnitus perception was more effective in assessing top-down executive control in participants with the symptom.\n\nID: 42345411\nTitle: Link Between Chronic Tinnitus and miR-30e, miR-206 , and miR-124 Polymorphisms Modulating the Brain-Derived Neurotrophic Factor Gene.\nAbstract: Brain-derived neurotrophic factor (BDNF) plays a crucial role in the initial formation of the central auditory system and the sensory epithelium within the inner ear. Mounting evidence indicates that BDNF administration promotes microRNA (miRNA) production in neurons, despite the typical suppressive effect of miRNAs on BDNF expression. Therefore, miRNAs regulating BDNF expression may impact the auditory system and serve as potential gene polymorphisms affecting human hearing ability. This study aimed to investigate the contribution of miRNA polymorphisms affecting BDNF to tinnitus pathophysiology. A total of 70 tinnitus patients aged 18-55 years and 70 age-matched healthy controls without tinnitus or systemic illnesses were recruited from an Ear, Nose & Throat clinic. Tinnitus assessment included tympanometric, audiological, and psychoacoustic evaluations. Seven miRNA single-nucleotide polymorphisms (miR-30e rs112439044, rs10489167, miR-206 rs16882131, miR-30a rs1491500379, miR-26b rs565919718, rs188612260, and miR-124 rs5315564) regulating the BDNF gene were analyzed using the Fluidigm platform. Significant differences in genotype distributions were observed for miR-30e rs112439044, miR-124 rs5315564, and miR-206 rs16882131 between the tinnitus patients and controls (P < .05). Genetic inheritance-model analysis revealed that miR-30e rs112439044 was associated with 0.20- and 0.83-fold risks under dominant and additive models, respectively. The miR-124 rs5315564 showed a 1.65-fold risk in the dominant model, while miR-206 rs16882131 exhibited an 11.1-fold protective effect under the dominant model and an 8.57-fold risk under the additive model. The findings suggest that polymorphisms in miR-206, miR-30e, and miR-124 may influence the auditory pathway by modulating BDNF gene expression, potentially contributing to the pathophysiology of chronic tinnitus.\n\nID: 42338658\nTitle: Risks and Awareness of NIHL Among Dental Students: A Scoping Review.\nAbstract: Although noise exposure levels in the dental professional sector may be considered low when compared to other occupations, noise prevention strategies, especially for the students, are necessary to conserve hearing for this population group. The current scoping review aimed to ascertain the risks and awareness of NIHL among dental students globally. The review selected articles from 2014 to 2025, including both quantitative and qualitative studies, existing systematic reviews, and grey literature. The PCC (Population, Concept, Context) framework was used to guide the articles' eligibility criteria. Databases included PubMed, CINAHL, ProQuest, Scopus, Web of Science, and EBSCO Host. The Covidence data extraction tool, which enabled consensus checking, was used to guide the extraction process, and studies were reported according to the PRISMA guidelines. Sixty-nine studies were initially extracted, and after screening, 10 met the study criteria. Thematic analysis was used to synthesize the narrative data. Of the 10 studies analyzed, eight indicated risks associated with NIHL among undergraduate students. The use of high-speed handpieces during clinical training increased the risk for NIHL, with some students reporting symptoms such as tinnitus following the use of the equipment. Four articles reported on the awareness of noise exposure levels and associated risk for NIHL among the students. The review suggested that there was a risk of NIHL among dental students, particularly linked to cumulative noise exposure. However, awareness of NIHL among the students was poor; therefore, early identification, risk assessment, and awareness of the risks at undergraduate training are necessary for the active prevention of hearing loss. There is a need to encourage listening behaviors that promote awareness towards the prevention of NIHL for this group of students.\n\nID: 42338275\nTitle: Importance of Comprehensive Tinnitus Assessment: A Conceptual Analysis of International Classification of Functioning, Disability and Health (ICF)-Linked Questionnaires.\nAbstract: This study explores the extent to which commonly used tinnitus questionnaires align with relevant International Classification of Functioning, Disability and Health (ICF) domains. The aim is not to establish the superiority of any tool, but rather to identify potential gaps in domain coverage and to support more intentional questionnaire selection. A rapid review was conducted to identify validated tinnitus questionnaires used in clinical practice. Each questionnaire was systematically linked to ICF categories employing established frameworks. The study compared the domain coverage of the ICF-based international inventory for tinnitus (ICF-TINI) with that of other commonly used questionnaires and mapped overlapping and unique ICF codes to determine the breadth of coverage. While ICF-TINI addressed a wide range of ICF domains, no single questionnaire provided complete coverage, particularly for the domains of environmental factors and participation. Other tools such as the Tinnitus Functional Index and Tinnitus Handicap Inventory also demonstrated broad but incomplete domain representation. The findings underscore the importance of strategically combining tinnitus questionnaires based on ICF domain mapping, rather than relying solely on familiarity or tradition. The study proposes an evidence-informed approach to tool selection that may enhance person-centered tinnitus assessment. Further research is required to determine whether broader ICF coverage leads to improved outcomes.\n\nID: 42334208\nTitle: Modifiable risk factors for tinnitus: A Mendelian randomization study.\nAbstract: ObjectiveThe topic of tinnitus has received considerable scholarly interest. Contributing factors to the development of tinnitus encompass aging, exposure to loud noise, smoking, and hearing impairment. Nevertheless, the precise risk factors, particularly those that can be modified, remain uncertain. This study aimed to explore the potential genetic factors that may be associated with an increased susceptibility to tinnitus.MethodsMendelian randomization analyses were performed using data from the United Kingdom Biobank and the FinnGen Biobank data infrastructure. The present study examined the correlation between 13 prevalent life factors, which were identified as potential risk factors for tinnitus through a comprehensive review of the literature. The inverse-variance weighted model was employed to analyze the associations. To mitigate database source bias and strengthen the reliability of our findings, data from the United Kingdom Biobank were used for the discovery cohort, whereas data from FinnGen were used for the validation cohort. Subsequently, a meta-analysis was conducted to combine the findings, thereby bolstering the robustness of the results.ResultsIn the United Kingdom Biobank discovery cohort, waist circumference (odds ratio = 1.37, 95% confidence interval 1.09-1.71, p\u2009=\u20090.006), waist-to-hip ratio (odds ratio = 1.71, 95% confidence interval 1.17-2.50, p\u2009=\u20090.005), fasting glucose (odds ratio = 0.70, 95% confidence interval 0.54-0.90, p\u2009=\u20090.007), and fasting insulin (odds ratio = 2.07, 95% confidence interval 1.07-4.01, p\u2009=\u20090.03) showed significant associations with tinnitus. In the FinnGen validation cohort, smoking was associated with tinnitus (odds ratio = 1.20, 95% confidence interval 1.03-1.40, p\u2009=\u20090.018). However, in the meta-analysis combining both cohorts, only waist circumference remained significantly associated with tinnitus (odds ratio = 1.27, 95% confidence interval 1.08-1.49, p\u2009=\u20090.003).ConclusionsOur findings indicate a causal relationship between waist circumference, an indicator of central obesity, and tinnitus. This implies that abdominal obesity could serve as a modifiable target for the prevention of tinnitus. Other factors that initially appeared to be associated did not demonstrate consistent results across different cohorts, underscoring the critical role of meta-analysis in Mendelian randomization studies.\n\nID: 42302782\nTitle: Genome-wide analysis implicates inner ear development in M\u00e9ni\u00e8re disease.\nAbstract: M\u00e9ni\u00e8re disease (MD) is a chronic inner ear disorder characterized by recurrent vertigo, fluctuating sensorineural hearing loss, and tinnitus, but its etiology remains poorly understood. We performed a genome-wide meta-analysis of 8,969 MD case subjects and 1,962,542 control subjects across five biobanks, identifying five independent genome-wide significant loci and estimating an observed-scale SNP heritability of 7% (SE 0.8%), indicating a modest but significant contribution of common genetic variation to MD risk. The genome-wide significant signals comprise two independent variants at EYA4, two at EYA1, and one near CYP26A1, with odds ratios between 1.1 and 1.25. Associations at two additional loci, LMO4 and ALDH1A2, fell just below the genome-wide significance threshold (5 \u00d7 10-8 C and chr3:52223761 C>A), TNFRSF1B (chr1:12167150 C>T and chr1:12202100 G>A), and FAS (chr10:89003139 G>A and chr10:89008919 C>T) in MD patients. Splicing predictions suggested potential creation of cryptic donor/acceptor sites for TLR9 and TNFRSF1B variants. Protein modelling predicted destabilising effects for all three proteins, with altered atomic interactions in TNFRSF1B and FAS. When docked, the TLR9-TLR9 dimer and FAS-FASGL models, redistributed interfacial contacts, potentially reducing binding efficiency, whereas docked TNFRSF1B-TRAF2 interactions were partially maintained. These findings suggest that MD distinct immune phenotypes based on systemic inflammation and may be linked to comorbid autoimmune/autoinflammatory disorders, with rare variants in TLR9, TNFRSF1B and FAS likely contributing to autoinflammation.\n\nID: 42217483\nTitle: Stress across timescales: differential effects of acute and chronic stress on auditory processing and perception.\nAbstract: Stress has long been linked to auditory dysfunction and altered sound perception, but its effects are often discussed without fully distinguishing between acute and chronic stress timescales. Here, we integrate evidence that acute and chronic stress engage partly overlapping but temporally distinct mechanisms and produce different auditory outcomes. Acute stress triggers rapid neuromodulatory and hormonal responses that can transiently alter auditory filtering, deviance detection, attention, and sound sensitivity, often biasing the system toward heightened salience and vigilance. In contrast, chronic stress is associated with more persistent changes in auditory attention, loudness perception, sound tolerance, and central auditory coding, reflecting longer-term alterations in circuit function and baseline regulation. In this review, we examine how acute and chronic stress influence auditory processing and perception in adulthood across human and animal studies, drawing together behavioral, physiological, and circuit-level findings. We highlight candidate mechanisms including glucocorticoid and catecholamine signaling, shifts in excitation-inhibition balance, altered thalamocortical and amygdala-related interactions, and stress-driven plasticity within mature auditory networks. We argue that chronic stress should not be viewed simply as a prolonged version of acute stress, but rather as a distinct state that may involve longer-lasting changes in auditory coding, baseline regulation, and perceptual weighting. Organizing stress effects by timescale may provide a framework for interpreting stress-related listening difficulties and for informing clinical conditions such as tinnitus, hyperacusis, and impaired hearing in noisy environments.\n\nID: 42215036\nTitle: Use of Envelope Following Response Normative Ranges for Diagnosing Cochlear Deafferentation.\nAbstract: The lack of a means to diagnose cochlear synaptopathy, a type of cochlear deafferentation, prevents clinicians from identifying patients with this auditory deficit and providing them with appropriate treatments. The envelope following response (EFR) has potential as a diagnostic indicator of deafferentation. However, it is not clear what constitutes an abnormal EFR. The objectives of this study were to establish normative ranges for EFR magnitude in a population at low risk for cochlear synaptopathy and then compare EFRs from a population at high risk for synaptopathy to those normative ranges. The low-risk sample consisted of young adults with normal audiograms, minimal reported lifetime noise exposure, and no auditory complaints. Normative ranges were generated using rectangular amplitude-modulated (RAM) or sinusoidal amplitude-modulated EFR stimuli and were adjusted for sex and distortion product otoacoustic emission (DPOAE) levels. The high-risk sample consisted of military Veterans with normal audiograms who reported at least one auditory complaint (tinnitus, decreased sound tolerance, or speech-in-noise difficulty). The RAM EFR normative ranges for a 4-kHz carrier resulted in the biggest separation of the low- and high-risk samples, with 31%-34% of Veterans falling below the lower bound of the normative range. There were no consistent effects of DPOAE adjustment on the normative ranges across sex and stimulus condition, and computational modeling suggests that adjusting for DPOAEs may not be necessary in individuals with normal audiograms. EFR normative ranges for the 4-kHz RAM EFR will allow for the clinical identification of patients with normal audiograms who may have significant degrees of cochlear deafferentation. https://doi.org/10.23641/asha.32347524.\n\nID: 42214236\nTitle: Characteristics of auditory and vestibular symptoms in patients with Meniere's disease.\nAbstract: The research objectives were to examine which are the most common symptoms of Meniere's disease in relation to the stages of the disease, to determine average heating loss and the most common type of tone audiometry curve in relation to the stages of the disease. The materials are specialist ENT findings and pure tone audiometry and vestibulometry findings from the register of the Audiology Institute. The subjects were divided into two groups depending on gender and age, and into four groups depending on the stage of the disease determined by audiometry findings. Statistical analysis revealed a significant association of all symptoms, except aural fullness (p = 0.127), with the stage of the disease. In the first and second stages the most common symptoms are vertigo, hearing fluctuations and tinnitus, and in the third stage vertigo, tinnitus and aural fullness. In the fourth stage, the most common symptom is tinnitus. In the first and second stages, the ascending type of curve is the most common, while in the third and fourth stages, it is the flat type. The younger group has a significantly higher frequency of vertigo attacks (p < 0.001) and hearing fluctuations (p < 0.001), while the older group has more frequent vestibular hypofunction (p < 0.001) and a higher average hearing loss (72.79 dB) compared to the younger group (31.13 dB). There are differences in curve types in relation to gender and age (p < 0.001). With the progression of the disease and aging we see a decrease in the frequency of hearing fluctuations and vertigo and an increase in the average hearing loss and the frequency of vestibular hypofunction. The ascending type of curve is more common in earlier stages and in younger subjects, while the flat type is more common in later stages and in older subjects. Level 1.\n\nID: 42201118\nTitle: Tinnitus and Reactions to Tinnitus: A Cross-Sectional Survey Across Different Tinnitus Durations.\nAbstract: Background/Objectives: Tinnitus and reactions to the tinnitus are different dimensions that can be explored in research and in clinical settings. Notably, these dimensions can elucidate priorities and the most problematic areas for patient-centered approaches. The aim of this study is to determine how tinnitus is perceived and impacts people who have experienced tinnitus for different durations. Methods: People with tinnitus were invited to participate in a survey at the University of Iowa Tinnitus Website. 709 people responded and documented their perceived sound, problems experienced, and duration of tinnitus. We assessed correlations between the duration of tinnitus and the pitch rating, the loudness rating, and the Tinnitus Primary Function Questionnaire scores. Additionally, we performed a multiple linear regression analysis, considering the dependent variable 'duration of tinnitus', to explore associations between duration of tinnitus and the aforementioned factors. This was a cross-sectional study based on comparisons of responses from patients with different tinnitus durations, rather than examining the same patients longitudinally. Results: The analysis demonstrated that respondents with a longer duration of tinnitus reported higher loudness ratings (p = 0.010). However, their reactions to tinnitus (Tinnitus Primary Function Questionnaire) were associated with a decrease compared with a shorter duration of tinnitus (p = 0.048). There was no association between pitch rating and duration of tinnitus. Conclusions: Our findings indicated louder tinnitus was associated with a longer duration of tinnitus. However, in general, the functional impact of the tinnitus was associated with a decrease. Notably, there was considerable variability among individuals, suggesting that additional factors contribute to these relationships. These findings can be considered in treatment decisions and counseling strategies.\n\nID: 42199810\nTitle: Aspirin in Audiology: A Dual-Edged Sword in Hearing Loss and Its Nanotechnology-Driven Future.\nAbstract: Globally, more than 1.6 billion individuals are affected by hearing loss. Aspirin (acetylsalicylic acid, ASA), an inexpensive and widely available drug, has demonstrated a complex dual role in hearing loss, with its effects potentially influenced by dosage and individual variability. In this article, we aimed to provide an overview of the pharmacological properties of aspirin, followed by an in-depth discussion of its mechanisms of action and its toxic and protective effects in different types of pathology-induced hearing loss. Finally, the development of novel drug delivery systems that may enhance the use of this drug in preventing hearing loss was also discussed. Aspirin exerts both ototoxic and protective effects via cyclooxygenase (COX)-dependent and COX-independent signaling pathways, including Wingless/Integrated (Wnt) signaling, nuclear factor kappa-B (NF-\u03baB), and Prestin-related mechanisms. Low-dose aspirin appears to reduce hearing damage from noise exposure or ototoxic drugs through anti-inflammatory and antioxidant actions that limit cochlear oxidative stress and inflammation. Conversely, higher doses of aspirin may induce reversible auditory changes, such as temporary hearing threshold shifts, tinnitus, and synaptic damage. These effects are primarily associated with cochlear ischemia, excessive activation of N-methyl-D-aspartate (NMDA) receptors, impaired prostaglandin signaling, and altered outer hair cell function resulting from Prestin modulation. This dose-dependent paradox presents a major challenge for the clinical application of aspirin in hearing protection. Nanotechnology-based delivery systems and personalized dosing strategies are promising, although they remain largely at the preclinical stage. Future work should concentrate on optimizing doses and targeting drug delivery to cochlear blood vessels or outer hair cells. Particular attention should be given to aspirin's role in COX signaling pathways and Prestin structural regulation. Overall, these findings provide a theoretical basis for precision-based ear protection strategies, pending clinical validation.\n\nID: 42194880\nTitle: Psychological Distress and Health-Related Quality of Life in M\u00e9ni\u00e8re's Disease: A Comparative Study in the Portuguese Population.\nAbstract: Background/Objectives: M\u00e9ni\u00e8re's disease (MD) is a chronic inner-ear disorder characterized by vertigo, tinnitus, and fluctuating sensorineural hearing loss (SNHL) that impairs health-related quality of life (HRQoL) and is frequently accompanied by psychological distress. This study aims to quantify psychological distress and generic HRQoL in patients with definite MD compared with age- and sex-matched general-population controls and to examine the associations between hearing loss (HL) severity, symptom-related handicap, and these outcomes within the MD cohort. Methods: In this observational cross-sectional study, 45 adults with definite MD were recruited from an otolaryngology clinic in Portugal and individually matched (1:3) by sex and 10-year age strata to 135 participants from the EpiDoC population cohort. HRQoL was assessed using the SF-36v2 and EQ-5D-3L, psychological distress using the HADS, and tinnitus- and dizziness-related handicap using the THI and DHI. HL severity was staged using the AAO-HNS (1995) criteria. Results: Patients with MD had higher anxiety and depression scores and nearly twice the prevalence of abnormal anxiety compared with controls. SF-36v2 scores were significantly worse in several role and psychosocial domains, with less bodily pain but similar physical functioning and general health. EQ-5D-3L revealed a lower utility index and higher pain/discomfort and anxiety/depression. Within the MD cohort, HL stage was only weakly related to distress and HRQoL. In contrast, higher THI and DHI scores were consistently associated with more severe anxiety and depression and lower SF-36v2 scores. In multivariable analysis, abnormal anxiety was strongly associated with moderate-to-severe tinnitus handicap (OR = 17.5), whereas higher depressive symptoms independently predicted moderate-to-severe dizziness handicap, with abnormal anxiety showing a strong but borderline association with the latter. Conclusions: MD confers clinically meaningful HRQoL decrements and a higher psychological distress burden than in the general population. Tinnitus- and dizziness-related handicap and psychological distress, particularly anxiety, rather than HL severity, are key multidisciplinary management targets. Systematic screening for anxiety and depression, regardless of audiometric stage, should be integrated into MD care pathways.\n\nID: 42192763\nTitle: Advances in Pharmacological Approaches to Tinnitus and Hyperacusis: Insights into Mechanisms, Biomarkers, and Clinical Heterogeneity from an International Scientific Meeting.\nAbstract: Pharmacological approaches to tinnitus have remained peripheral within research, despite persistent patient demand and advances in auditory neuroscience. There is increasing consideration of whether these developments now justify renewed focus on pharmacological research in tinnitus and hyperacusis. This paper presents a narrative synthesis of perspectives arising from an international scientific meeting, based on invited contributions from speakers who expanded on themes related to their presentations, integrating insights from systems neuroscience, cellular and molecular mechanisms, animal and human models of auditory hypersensitivity, and patient-reported experience. Rather than summarising individual presentations, the analysis focuses on converging mechanistic explanations, biological heterogeneity, emerging therapeutic targets, and advances in objective measurement. Particular attention is given to how evolving mechanistic frameworks can support patient education and clinical communication, even in the absence of disease-modifying treatments. Taken together, these discussions reflect renewed examination of pharmacological approaches to tinnitus and hyperacusis, with attention to both emerging mechanistic rationales and the substantial challenges that remain. Integrating mechanistic insights, phenotype-informed care, and responsible communication may help clarify research priorities and support informed clinical and patient-facing discussions.\n\nID: 42183495\nTitle: Mindfulness-based therapy for chronic tinnitus: a narrative review.\nAbstract: Chronic tinnitus is often accompanied by considerable psychological burden, including anxiety, depression, and impaired quality of life. Mindfulness-based therapy has attracted growing attention as a potential psychological intervention for tinnitus management. This narrative review examines the current literature on the rationale, clinical application, reported efficacy, limitations, and future directions of mindfulness-based therapy in chronic tinnitus. Current evidence suggests that mindfulness-based interventions may help reduce tinnitus-related distress, improve emotional regulation, and enhance quality of life, while evidence for direct effects on tinnitus loudness remains limited. Although findings from existing studies are encouraging, the literature is heterogeneous with respect to intervention types, comparator conditions, and outcome measures. Mindfulness-based therapy may therefore represent a useful adjunctive option for some patients with chronic tinnitus, but further rigorous research is required to better define its clinical role.\n\nID: 42183141\nTitle: Pulsatile tinnitus due to intracranial arteriovenous fistula indirectly identified by carotid Doppler ultrasound.\nAbstract: Pulsatile tinnitus is a specific type of sound caused by vascular anomalies, usually associated with turbulent blood flow, secondary to high-output stenosis or arterial tortuosity. These alterations can produce rhythmic sounds that compromise patients' quality of life. This report describes the case of a 51-year-old woman with pulsating tinnitus in her right ear for 18 months. No significant changes were identified on arterial computed tomography angiography or cranial magnetic resonance angiography due to the non-completion of the joint venous phase. Carotid Doppler ultrasound showed abnormal flow in the right external carotid artery, with a decreased resistance index, suggesting an arteriovenous fistula. Cerebral angiography confirmed the diagnosis, showing communication between external carotid artery branches and intracranial veins. The patient underwent endovascular treatment with embolization, resulting in complete resolution of symptoms and normalization of Doppler parameters at 24-month follow-up. O zumbido puls\u00e1til \u00e9 um tipo espec\u00edfico de som causado por anomalias vasculares, geralmente associadas a fluxo sangu\u00edneo turbulento, secund\u00e1rio a estenoses de alto d\u00e9bito ou a tortuosidades arteriais. Essas altera\u00e7\u00f5es podem gerar ru\u00eddos r\u00edtmicos que comprometem a qualidade de vida dos pacientes. Descrevemos o caso de uma mulher de 51 anos com zumbido puls\u00e1til no ouvido direito h\u00e1 18 meses. N\u00e3o foram identificadas altera\u00e7\u00f5es significativas nos exames de angiotomografia arterial e de angiorresson\u00e2ncia magn\u00e9tica de cr\u00e2nio devido a n\u00e3o realiza\u00e7\u00e3o da fase venosa conjunta. O ultrassom com Doppler das car\u00f3tidas evidenciou fluxo an\u00f4malo na art\u00e9ria car\u00f3tida externa direita, com \u00edndice de resist\u00eancia diminu\u00eddo, sugerindo f\u00edstula arteriovenosa. A angiografia cerebral confirmou o diagn\u00f3stico, identificando comunica\u00e7\u00e3o entre ramos da car\u00f3tida externa e veias intracranianas. A paciente foi submetida a tratamento endovascular por emboliza\u00e7\u00e3o, com resolu\u00e7\u00e3o completa dos sintomas e normaliza\u00e7\u00e3o dos par\u00e2metros ao Doppler no seguimento de 24 meses.\n\nID: 42157291\nTitle: Can Tinnitus Cause Speech-in-Noise Deficits?\nAbstract: Studies examining the relationship between tinnitus and speech-in-noise (SIN) perception have produced conflicting results, possibly due to observational study designs and confounders related to aging, hearing loss, and tinnitus-related distress. To address this concern, the present study investigated the relationship between tinnitus and SIN perception using complementary observational and genetic epidemiological approaches across multiple independent cohorts, enabling the identification of converging evidence to clarify this relationship. A total of 216 young adults, including 87 with continuous chronic tinnitus (bothersome tinnitus for >1 y), aged 18 to 37 y, with hearing thresholds (HTs) \u226420 dB HL for 250 to 8000 Hz, participated in the study. Speech perception was evaluated using the Speech, Spatial, and Quality of Hearing scale (SSQ12), QuickSIN, and 3-digit Dichotic Digit Test. Extended high-frequency HTs (up to 16\u2009kHz) were evaluated. A linear mixed-effects model was used to assess the influence of tinnitus on audiological measures while controlling for confounders, including lifetime noise exposure (LNE), firearm use, and a history of recurring ear infections. To obtain causal inference, we employed latent causal variant (LCV) analysis using the summary statistics of genome-wide association studies, followed by functional enrichment analyses to identify shared tissues and pathways between tinnitus and SIN deficits. Multimarker Analysis of GenoMic Annotation was conducted to obtain gene-based statistics. Gene-based gene statistics were integrated with single-cell transcriptomic data from mice cochlear tissues to identify cell types shared between the two phenotypes. Tinnitus was associated with lower SSQ12 scores and poorer dichotic digit test performance, even after statistically controlling for the differences in HTs. Tinnitus severity was negatively correlated with SSQ12 scores. Lifetime noise exposure and firearm use were associated with elevated HTs and lower SSQ12 scores. Tinnitus and SIN deficits revealed significant genetic correlations, but the latent causal variant analysis found no evidence of a causal impact of tinnitus on SIN deficits. The Multimarker Analysis of GenoMic Annotation-based analysis identified several brain tissues, including the frontal cortex, anterior cingulate cortex, cerebellum, nucleus accumbens, caudate, putamen, hippocampus, amygdala, and hypothalamus, that were shared between tinnitus and SIN deficits. Gene ontology terms for synaptic functioning were jointly enriched. No cochlear cell types revealed significant associations with tinnitus and SIN deficits. Tinnitus and SIN deficits are comorbid conditions with a shared genetic basis. Tinnitus is not causally associated with SIN deficits; rather, a shared genetic architecture independently predisposes individuals to both phenotypes. A converging line of evidence from observational and genome-wide association study-based enrichment analyses suggests that a shared genetic basis likely alters synaptic functioning in key brain regions involved in audition, cognition, and emotional regulation. Future studies are necessary to elucidate the shared biological pathways underlying tinnitus and SIN deficits.\n\nID: 42155139\nTitle: Mobile Apps for Tinnitus: Systematic Search in App Stores and Review of Intervention Components and Behavior Change Techniques.\nAbstract: Previous research suggests that 14.4% of the general population is affected by tinnitus. For some of those affected, the ear noise is bothersome or associated with severe distress. There are various treatment options such as cognitive behavioral therapy (CBT), sound therapy, or hearing aids. In addition to browser-based online interventions, mobile apps have been introduced as novel treatment approaches. Previous studies have identified several apps aimed at supporting users with tinnitus. Yet, knowledge about the content of tinnitus apps is limited. This study aimed to provide an overview of apps specifically developed for tinnitus by analyzing general app characteristics, as well as app content, focusing on intervention components and behavior change techniques (BCTs). A systematic search using 7 search terms (eg, tinnitus and ear noise) was conducted in the Google Play Store and the Apple App Store. Apps designed specifically for tinnitus and available in German or English met the inclusion criteria. Two independent trained raters assessed general app characteristics (eg, age group and costs) using the app description section of the German version of the Mobile App Rating Scale. In addition, raters analyzed app content using the BCT taxonomy (v1) and a list of typical intervention components in tinnitus treatment. Differences in ratings were discussed, and a third trained rater was consulted if no consensus was reached. A total of 1198 apps were identified in the systematic search. Of those, 69 apps were included in the final analysis. Fifty-two apps were available for free, 23 of which offered in-app purchases. Among the 17 paid apps, costs ranged between \u20ac0.69 (US $0.81) and \u20ac450 (US $527) per 12 months. Fifty-eight of 69 apps provided sounds (eg, white noise and nature sounds). Many apps assessed tinnitus characteristics (n=38) and provided information about tinnitus (n=27). The most frequently used BCTs were \"instruction on how to perform the behavior\" (n=25; eg, audio instructions for relaxation techniques), \"feedback on behavior\" (n=11), \"behavioral practice/rehearsal\" (n=11), \"information about health consequences\" (n=11), \"information about emotional consequences\" (n=11), and \"prompts/cues\" (n=11). The number of BCTs implemented varied widely across apps (0-18 per app). Most tinnitus apps offer sound-based interventions (eg, white noise and nature sounds). Notably, CBT elements (eg, cognitive restructuring, attention training, and relaxation training) are implemented less frequently, despite CBT being recommended in tinnitus treatment guidelines. Further research on the efficacy of tinnitus apps is needed. Transparent reporting of intervention techniques may help clarify mechanisms of action and support the replication of effective interventions. Given the large number of readily accessible apps, this study provides an overview relevant to both researchers and health care professionals.\n\nID: 42153671\nTitle: Genotype-guided Recall Delineates the Adult Auditory Phenotype in GJB2 p.V37I Homozygotes: High-frequency Vulnerability and Environmental Modulation.\nAbstract: GJB2 p.V37I is common in East Asian populations and is an established contributor to mild-to-moderate hearing loss, yet the adult auditory phenotype and its modification by environmental exposures remain incompletely defined. We conducted a genotype-guided case-control recall study within the Taiwan Precision Medicine Initiative, enrolling 191 adults (96 p.V37I homozygotes; 95 genotype-negative controls). Participants received pure-tone audiometry (0.25-8\u00a0kHz) and tinnitus assessment (THI-CM), with cardiometabolic and lifetime noise-exposure ascertainment. Abnormal hearing was defined as PTA (0.5, 1, 2, 4\u00a0kHz) \u226516\u00a0dB HL; clinically significant tinnitus handicap as THI-CM \u226518. Homozygotes showed bilateral, symmetric, high-frequency-predominant threshold elevation (4-8\u00a0kHz). Abnormal hearing was more frequent in homozygotes than controls (right 84.4% vs. 16.8%; left 80.2% vs. 16.8%). In adjusted models, homozygosity remained independently associated with abnormal hearing (right aOR 7.57, 95% CI: 2.77-20.67; left aOR 6.52, 95% CI: 2.52-16.86), together with age (right aOR 1.08/year; left aOR 1.05/year). Noise exposure showed strong univariate associations but was attenuated after adjustment. Clinically significant tinnitus handicap (17.7% vs. 5.3%) and dizziness (26.0% vs. 8.4%) were more frequent in homozygotes; however, tinnitus was independently associated with noise exposure (aOR 4.30, 95% CI: 1.41-13.08) but not genotype. Genotype-guided recall delineates a clinically recognizable adult p.V37I audiometric phenotype marked by symmetric, high-frequency-predominant threshold elevation with age-dependent expression, supporting phenotype-guided counseling and longitudinal surveillance.\n\nID: 42152361\nTitle: Trends and hotspots in subjective idiopathic tinnitus and anxiety disorder research based on Bibliometrics.\nAbstract: Subjective idiopathic tinnitus is characterized by the subjective perception of sound in the absence of an external source, significantly impairing quality of life. Studies have found that a considerable number of tinnitus patients experience comorbid negative emotional states such as anxiety disorders, while emotional dysregulation can, in turn, exacerbate the perceived tinnitus, indicating a close interrelationship. A systematic bibliometric summary in this field is currently lacking. This study aims to employ bibliometric methods to reveal the research dynamics, collaborative networks, and emerging trends in the tinnitus-anxiety disorder association field. A total of 773 publications related to tinnitus and anxiety/mood disorders from 2014 to 2025 were retrieved from the Web of Science Core Collection (WoSCC). After screening, 262 valid publications were included. Bibliometric and visual analyses of countries/regions, authors, institutions, journals, keywords, and references were performed using VOSviewer (v1.6.20), CiteSpace (v6.4.R2), Scimago Graphica, R-bibliometrix (R 4.5.1; Massimo Aria & Corrado Cuccurullo, University of Naples Federico II), and Microsoft Excel. The United States produced the most publications (58) and maintained extensive international collaborations. The University of Nottingham was the most prolific institution (24 publications). Frontiers in Neurology was the most popular journal, publishing the most articles (13). LARYNGOSCOPE was the most cited journal (314 citations). Gerhard Andersson was the leading contributor, being the most prolific author (11 publications) and the most cited (1145 citations). Keyword co-occurrence analysis identified \"Tinnitus, anxiety, depression, prevalence, severity, association, hospital anxiety\" as core research hotspots. Co-cited reference analysis indicated that the tinnitus handicap inventory, the hospital anxiety and depression scale, alongside investigations into tinnitus mechanisms and treatment strategies, received the most significant attention. This bibliometric study provides a comprehensive overview of the research landscape concerning subjective idiopathic tinnitus and anxiety disorders. It identifies the most influential countries/regions, institutions, and authors, and delineates the current research hotspots and emerging trends. The findings offer theoretical guidance for future research into the shared mechanisms and treatment strategies for tinnitus comorbid with emotional disorders.\n\nID: 42147909\nTitle: Hemodynamic characteristics of sigmoid sinus wall dehiscence-pulsatile tinnitus patients with normal intracranial pressure.\nAbstract: Sigmoid sinus wall dehiscence (SSWD) is the most common etiology of venous pulsatile tinnitus (PT). However, the exact blood flow mechanisms of SSWD-PT remain unclear, and intracranial pressure is closely associated with its development. This study aimed to assess the hemodynamic characteristics of the sigmoid sinus in SSWD-PT patients with normal intracranial pressure using four-dimensional (4D)-flow magnetic resonance imaging (MRI) and explore potential noninvasive markers for identifying SSWD as the true etiology of PT. This is a case-control study. We enrolled 23 SSWD-PT patients with normal intracranial pressure and 35 age-, sex-matched healthy controls. Hemodynamics of the sigmoid sinus were evaluated by 4D-flow MRI, including average velocity (Vavg), maximum velocity (Vmax), average and maximum through-plane velocity (Vtp_avg, Vtp_max), forward and backward flow volumes (FFV, BFV), average blood flow (Flowavg), regurgitant fraction (RF), and average wall shear stress (WSSavg). Blood flow patterns were visually evaluated for vortex or turbulence. Interobserver agreement was assessed using interclass correlation coefficient (ICC). Hemodynamic parameters in the bilateral sigmoid sinuses of controls were compared using paired samples t-test or Wilcoxon signed-rank test. Group differences between SSWD-PT patients and controls were assessed using independent samples t-tests or Mann-Whitney U tests for continuous variables and Chi-squared tests for categorical variables. Logistic regression analysis was performed to identify independent predictors and build a diagnostic model. Receiver operating characteristic (ROC) curves were used to assess the diagnostic efficacy of the hemodynamic parameters. Internal validation of the model was conducted using bootstrapping with 1,000 iterations to assess model stability and robustness. The P<0.05 was considered statistically significant. Compared with the corresponding side in controls, the symptomatic side of PT patients presented significantly higher Vavg (P<0.001), Vmax (P<0.001), BFV (P<0.001), RF (P<0.001), and WSSavg (P=0.002), and significantly lower Vtp_avg (P<0.001), FFV (P=0.006), and Flowavg (P<0.001). Vortex or turbulence were observed in 78.3% of symptomatic sigmoid sinuses (P<0.001). Interobserver agreement was excellent for all hemodynamic parameters (ICC =0.88-0.94). Logistic regression identified Vavg and WSSavg as independent predictors (both P<0.001). ROC analysis showed predictive value for Vavg [area under the curve (AUC) =0.880] and WSSavg (AUC =0.740), with the combination achieving superior performance (AUC =0.934; sensitivity 82.6%, specificity 94.3%, accuracy 87.9%, P<0.001). Bootstrapping validation confirmed the combined model's stability (AUC =0.932, sensitivity 85.2%, specificity 89.8%, accuracy 88.0%). SSWD-PT patients with normal intracranial pressure demonstrated increased blood flow complexity and hemodynamic changes in the symptomatic sigmoid sinus. The combination of Vavg and WSSavg may serve as a noninvasive marker to identify SSWD as the true etiology of PT.\n\nID: 42139729\nTitle: Active surveillance versus stereotactic radiosurgery for Koos grade I and II vestibular schwannoma in patients aged 60 years or older.\nAbstract: The aim of this study was to evaluate freedom from tumor progression and clinical outcomes in older adults with small- to medium-sized vestibular schwannoma (VS) managed by observation versus stereotactic radiosurgery (SRS) to better inform optimal management in this patient population. In this international multicenter study, patients aged \u2265 60 years with Koos grade I or II VS managed by observation or SRS were retrospectively reviewed. Propensity score matching was conducted using patient characteristics, tumor size, and hearing assessments. Outcome measures of freedom from tumor progression, serviceable hearing preservation (SHP), and neurological function (tinnitus, vestibulopathy, House-Brackmann grade, and trigeminal nerve function) were assessed for both groups. The observation and SRS groups each comprised 51 matched patients (median age 68 years for both). Ipsilateral serviceable hearing was observed at presentation for 35 patients in each group. The median follow-up duration was 39 months in the observation group versus 27 months in the SRS group (p = 0.5). Tumor progression was significantly lower with SRS than with observation (2% vs 52.9%, p < 0.001). The rate of 5-year freedom from tumor progression was 100% in the SRS group versus 43% (95% CI 29%-64%) in the observation group. The rate of 10-year freedom from tumor progression was 90% (95% CI 73%-100%) in the SRS group versus 20% (95% CI 8.5%-49%) in the observation group. At the last follow-up, hearing loss occurred in 42.9% of the observation group and 51.4% of those who underwent SRS (p = 0.5). The 3-year SHP rate was 68% (95% CI 53%-88%) versus 65% (95% CI 49%-85%) (p = 0.8), and the 5-year SHP rate was 53% in both groups (95% CI 36%-78% in the observation group and 95% CI 35%-79% in the SRS group, p = 0.8). The composite endpoint of tumor progression and/or worsened neurological outcome, including hearing loss, tinnitus, vestibulopathy, facial nerve dysfunction (House-Brackmann grade), or trigeminal dysfunction, demonstrated a significantly lower rate in the SRS group (17.6%) compared with the observation group (66.7%) (p < 0.001). SRS in older patients for management of Koos grade I or II VS resulted in significantly superior rates of freedom from tumor progression, comparable hearing preservation rates, and significantly higher rates of favorable overall radiographic and neurological outcomes than observation alone. Compared with observation, SRS might be the preferred management option in this patient population.\n=======================================================\n\n### [CUSTOM DATAPOINTS]\nCRITICAL EXTRACTION DIRECTIVE: You MUST extract the following custom datapoints as root-level key/value pairs inside your final JSON block:\n- \"suggested_experiments\": generate 1-3 suggested experiments\n- \"suggested_studies\": generate 1-3 suggested studies\n- \"swansons_literature_based_discovery_candidates\": You are an advanced Literature-Based Discovery (LBD) system executing Swanson\u2019s complementary-but-disjoint (A-B-C) model. Your goal is to find hidden, unpublished connections across the provided dataset. Strict Discovery Protocol: 1. Identify distinct, isolated sub-literatures (Domain A and Domain C) within the dataset that share NO direct citations, co-mentions, or common contextual paragraphs. 2. Find an intermediate biological mechanism, protein, path, or entity (Bridge B) that appears independently in both isolated domains (A-to-B and B-to-C). 3. Synthesize a novel, unstated hypothesis (A-to-C). Negative Constraint (Crucial): DO NOT output any connection if the relationship between Concept A and Concept C is explicitly mentioned, paired, or summarized anywhere in the source text. If a connection (like \"OMN resilience to SMN stabilization\") is already explicitly stated or grouped as a concept in the data, it is considered \"already known\" and must be disqualified. Format your output exactly as follows: - Discovered Hypothesis (A to C): [Clear, novel statement] - Literature A (Origin): [Entity/Concept and source context] - Literature C (Target): [Entity/Concept and source context] - The Intersecting Bridge B: [The shared mechanism/protein linking them] - Biological Rationale: [1-2 sentences explaining why this hidden connection is mechanistically plausible]\n- \"contradictions_between_evidences\": Identify conflicting evidence within the evidence set (if any) and flag the dispute here\n- \"repurposed_solutions\": identify and explain repurposed Solution potentials\n\n\nFormat Requirement:\nRAG AMNESIA IS ACTIVE: You must ONLY use the provided context literature. Do not use outside prior knowledge. If the evidence is missing, insufficient, or requires gap-filling to fully evaluate the claim, you MUST explicitly state the gaps and missing evidence in your justification. Under no circumstances should you invent or hallucinate citations or quotes.\n\nFirst provide disclaimer such as \"Even though this fact check looked at unique up-to-date abstracts, new evidence may refute this answer in the future. Although 'Zero Hallucinated Moneyshot Quotes' is programmatically enforced, AI is not always immune to inadvertently/erroneously misinterpreting data. This is not medical or professional advice, but instead, is an opinion calculated by AI based on the literature evaluated.\"\n---\nWrite in a highly academic, formal thesis tone.\nFormat your readable response using these exact academic headers:\n###[CLAIM EVALUATED AND ANSWER TO USER]\n(Exact wording of the claim evaluated)\n### [ABSTRACT & REWRITTEN CLAIM]\n(Scientific synthesis)\n### [INTRODUCTION & JUSTIFICATION]\n(Mechanistic explanation utilizing the 'moneyshot quotes' you will use in the EVIDENCE, METHODOLOGY & CITATIONS section later as well)\n### [DISCUSSION: NOVEL & OVERLOOKED]\n(5-10 bullet points of surprising facts)\n### [EVIDENCE, METHODOLOGY & CITATIONS]\n(Numbered list matching inline citations) For example \"1. ID: 12345 - Application: The text discusses ... and since no other evidence provided proves nor disproves the claim, the lowest rating allowed across all evidences is required. ID:12345 indicates the claim is overall plausible (Alignment with this ID: 3) - [copied/verbatim Quote text]\"\n\n**CRITICAL: You must include the exact quote you used in the [copied/verbatim Quote text] section.\n\nIf the prompt says \"at least 20 quotes\" then there must be at least 20 matching citations. You must actually use the quotes you select within the conext of the preprint publication you write.\n\nEvaluation Schema:\nRAG AMNESIA IS ACTIVE: You must ONLY use the provided context literature. Do not use outside prior knowledge. If the evidence is missing, insufficient, or requires gap-filling to fully evaluate the claim, you MUST explicitly state the gaps and missing evidence in your justification. Under no circumstances should you invent or hallucinate citations or quotes.\n\n###critical: WRAP YOUR THOUGHTS WITH ... tags at the very beginning of your response.\n\n=======================================================\nCONTEXT LITERATURE (STATIC CACHE):\nID: 42417817\nTitle: Use of mindfulness in the treatment of tinnitus: consensus based on the opinion of Brazilian experts.\nAbstract: To develop a consensus among otolaryngologists, speech-language-hearing pathologists, and physical therapists regarding the criteria for recommending and using mindfulness in the treatment of tinnitus. Observational, descriptive, quantitative, cross-sectional study conducted online. The convenience sample initially consisted of 23 specialists. The Delphi method was applied in two stages, providing feedback with anonymous responses. The first stage consisted of objective and subjective questions. The second stage involved 10 participants, who evaluated 34 statements derived from the initial stage. The specialists analyzed each item and demonstrated their agreement on a 5-point Likert scale. The content validity coefficient (CVC) was used to investigate the degree of interrater agreement and select the final items. There was consensus on 25 of the 34 items (CVC \u2265 0.70). The specialists consider mindfulness to be a therapeutic resource for tinnitus, but not as monotherapy. There was consensus on recommending application once a week, for at least 30 minutes, with daily home practice. Follow-up therapy after 8 weeks can be done using scales such as the Tinnitus Handicap Inventory and the Visual Analogue Scale. There is consensus on the combined (not alone) use of mindfulness in the treatment of tinnitus with a weekly protocol (8 weeks), lasting 30 minutes per session, monitored using the THI and VAS. These recommendations should be explored in clinical trials, investigating the short- and long-term effects to provide scientific evidence and standardize clinical protocols. Desenvolver um consenso com experts otorrinolaringologistas, fonoaudi\u00f3logos e fisioterapeutas acerca dos crit\u00e9rios de recomenda\u00e7\u00e3o e uso da mindfulness aplicada no tratamento do zumbido. Estudo observacional, descritivo, quantitativo e transversal, conduzido de forma online. A amostra por conveni\u00eancia contou, inicialmente, com 23 especialistas. Aplicou-se o m\u00e9todo Delphi em duas etapas, com fornecimento de feedback e anonimato das respostas. A primeira etapa consistiu em perguntas objetivas e subjetivas. A segunda etapa contou com 10 participantes, que avaliaram 34 afirmativas derivadas da etapa inicial. Os especialistas analisaram cada item e demonstraram sua concord\u00e2ncia em uma escala likert de cinco pontos. Utilizou-se o coeficiente de validade de conte\u00fado (CVC) para investigar o grau de concord\u00e2ncia entre os ju\u00edzes e selecionar os itens finais. Houve consenso em 25 dos 34 itens (CVC \u2265 0,70). Os especialistas consideram que a mindfulness \u00e9 um recurso terap\u00eautico para o zumbido, por\u00e9m n\u00e3o como monoterapia. Foi consenso a indica\u00e7\u00e3o da aplica\u00e7\u00e3o uma vez por semana, pelo menos, 30 minutos, com pr\u00e1tica di\u00e1ria domiciliar. O seguimento da terapia ap\u00f3s 8 semanas pode ser feito por meio de escalas como Tinnitus Handicap Inventory e a Escala Visual Anal\u00f3gica. H\u00e1 consenso sobre o uso da mindfulness no tratamento (n\u00e3o isolado) do zumbido com protocolo semanal (8 semanas), dura\u00e7\u00e3o de 30 minutos cada sess\u00e3o e acompanhamento por meio do THI e EVA. Tais recomenda\u00e7\u00f5es devem ser exploradas em ensaios cl\u00ednicos, investigando os efeitos a curto e longo prazo, em prol de evid\u00eancias cient\u00edficas e padroniza\u00e7\u00e3o de protocolos cl\u00ednicos.\n\nID: 42416928\nTitle: Neurosyphilis Reemergence in the Modern Day: A Case Report.\nAbstract: Syphilis, once considered a disease in decline, has re-emerged as a significant public health concern in the United States.\u00a0This case report presents the clinical course of a 42-year-old male with a rare presentation of neurosyphilis. The patient presented\u00a0twice to the ER within 60 days with vague intermittent symptoms, including numbness/tingling of his hands and feet, which the patient initially ignored. This progressed into balance issues, tinnitus, difficulty focusing, inattentiveness, and behavior changes. Family states he had started behaving very oddly, had wax-and-waning confusion, and also had a moment where he was hallucinating.\u00a0The patient's first evaluation in the ER was roughly three weeks prior to the second visit. The workup included a CT of the head, which was negative, among other tests for toxic/metabolic causes. After a grossly unremarkable workup at the initial visit, the patient was further discharged at that time. At home, the patient stated his symptoms continued, he followed up with his PCP as he was directed, and the PCP ordered a rapid plasma reagin (RPR) test for continued symptoms and found the patient to be RPR (+). The patient then presented to the ED for a second evaluation sent by PCP with a RPR (+), continued symptoms, and requested further evaluation. On a more comprehensive social history investigation, the patient reported a painless penile lesion roughly three years ago after a sexual encounter. The lesion went away on its own, and the patient never sought treatment for the lesion. On the second ER presentation, the patient then had a more in-depth workup, including lumbar puncture results, which showed suspicion of neurosyphilis. The patient was then admitted with disposition for treatment of neurosyphilis.\u00a0While admitted to the hospital, the patient was reported as remaining stable, clinically improved, and was appropriately treated for neurosyphilis with 14 days of IV antibiotics. The patient was in the hospital for a total of a week and then discharged home with IV antibiotics set up for home completion of the 14-day course for the treatment of neurosyphilis.\n\nID: 42409067\nTitle: Clinical Practice Guideline for the Diagnosis and Management of Tinnitus in Korea.\nAbstract: Standardized, evidence-based guideline for tinnitus management is currently lacking in Korea. This guideline aims to provide evidence-based recommendations for the diagnosis and management of tinnitus in Korean adults, adapted to the Korean healthcare system. A multidisciplinary panel (eight otorhinolaryngologists, one neurologist, one psychiatrist, and one audiologist) conducted systematic literature searches up to 2025 using PubMed, Embase, Cochrane Library, KoreaMed, and KMBASE. Evidence quality was assessed using the GRADE methodology. Nine key clinical questions (KQs) were developed in PICO format, and recommendations were finalized through a modified Delphi process (\u226580% agreement threshold). Imaging is recommended for the evaluation of patients with pulsatile tinnitus or asymmetric hearing loss (Grade B). Tinnitus retraining therapy (TRT) and cognitive behavioral therapy (CBT) are conditionally recommended for patients with tinnitus (Grade B). Hearing aids are conditionally recommended for patients with tinnitus and coexisting hearing loss (Grade B). Sound therapy is conditionally recommended to reduce tinnitus-related distress (Grade B). Neuromodulation (transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS)) is conditionally recommended as an adjunctive treatment (Grade B). Routine zinc and vitamin supplementation are strongly recommended against for tinnitus symptom improvement (Grade D\u2020), whereas Ginkgo biloba may be considered for patients with subjective tinnitus (Grade B). Most available evidence was predominantly of low or very low certainty. This guideline provides the first comprehensive evidence-based framework for tinnitus management in Korea. Behavioral and rehabilitative interventions provided the strongest evidence for reducing tinnitus-related distress. Considerations of Korean National Health Insurance coverage, regional accessibility, and patient preferences were integrated throughout the guideline development process. The primary therapeutic goal is to reduce tinnitus-related distress and improve functional outcomes, thereby enhancing overall quality of life.\n\nID: 42406125\nTitle: Detailed clinical characteristics of musical hallucinations in 81 patients.\nAbstract: Musical hallucinations are perceptions of music without an external source. Approximately 500 publications on this topic have appeared over the past 35\u00a0years. Prior literature has largely consisted of case reports and small series, with only limited systematic studies on the characterisation of mixed pathology, relation to hearing loss, spatial localisation, and multimodal features. We conducted a retrospective analysis of baseline data from a prospective cohort study of 81 individuals experiencing musical hallucinations. Participants underwent assessment with the Musical Hallucinations (MuHa) Questionnaire-a tailored, non-validated semi-structured survey/interview-alongside additional questionnaires, EEG, neuroimaging, and audiological testing. The present analysis focuses on baseline phenomenological characteristics derived from the MuHa Questionnaire in 80 eligible participants. Analyses were exploratory and descriptive. Mean age was 65\u00a0years, with a slight female predominance. Hallucinations were most often perceived as internal, while external localisation was more common with familiar music and in individuals with (asymmetric) hearing loss. Underlying causes included psychiatric disorders (50%), hearing loss (50%), structural neurological changes (28%), and frequently combinations thereof (28%). A notable new finding was the high prevalence of tinnitus and multimodal hallucinations, involving up to six sensory modalities; these were generally associated with internal localisation, except in isolated hearing loss. Musical content spanned multiple genres, most commonly religious music. Hallucinations were considered burdensome in over 65% of the cases, and most participants reported little control; behavioral strategies such as distraction or listening to external music provided only temporary relief in about 20%. Musical hallucinations may be more common than previously appreciated within broader multimodal perceptual syndromes and mixed etiologies, suggesting a more distributed pathophysiology than traditionally assumed. Their burden and limited controllability highlight the need for further mechanistic and therapeutic research.\n\nID: 42404127\nTitle: Cerebral venous disorders: clinical presentation, diagnostic strategy, and contemporary management.\nAbstract: Cerebral venous disorders encompass a heterogeneous group of conditions ranging from acute cerebral venous thrombosis to chronic intracranial venous hypertension and stenotic outflow states. Although historically considered uncommon, increasing recognition, improved imaging techniques, and expanding endovascular therapies have led to significant advances in the diagnosis and management of these conditions. This review provides a contemporary overview of the pathophysiology, clinical presentation, diagnostic evaluation, and treatment strategies for major cerebral venous disorders, with an emphasis on conditions associated with elevated intracranial venous pressure and medically refractory symptoms. We summarize current evidence regarding noninvasive and invasive imaging modalities, including the evolving roles of CT and MR venography, catheter venography, and physiologic pressure measurements. Indications for medical therapy, including anticoagulation and intracranial pressure management, are discussed alongside emerging criteria for patient selection for endovascular intervention. Particular attention is given to venous sinus stenting and other endovascular techniques, including technical considerations, outcomes, and complication profiles. Controversies remain regarding diagnostic thresholds, the clinical significance of venous stenosis, optimal hemodynamic criteria for intervention, and long-term durability of endovascular treatment. We highlight areas of ongoing investigation and identify key knowledge gaps that may inform future research. As diagnostic capabilities and therapeutic options continue to evolve, a multidisciplinary and physiology-guided approach is essential to optimize patient selection and outcomes in cerebral venous disorders.\n\nID: 42403966\nTitle: Bimodal Stimulation of the Auditory-Somatosensory System Improves Auditory Sensory Gating Function in Patients with Tinnitus.\nAbstract: Tinnitus perception may be associated with impairments in the mechanisms of sensory gating (SG), which is a preattentive process that filters redundant auditory stimuli to prevent sensory overload. Acoustic stimulation of the auditory system alone (unimodal intervention), electrical stimulation of the vagus nerve alone, or a combination of both (bimodal intervention) can effectively treat tinnitus by influencing SG. This study aimed to examine the impact of unimodal and bimodal interventions on auditory SG (ASG). Participants were assigned to unimodal or bimodal intervention groups using block randomization after obtaining consent. Thirty-four participants with tonal tinnitus were divided equally into unimodal (n = 17) and bimodal (n = 17) groups. Participants in the bimodal group received customized acoustic stimulation combined with transcutaneous auricular vagus nerve stimulation (tAVNS). Participants in the unimodal group received the same acoustic stimulation paired with sham tAVNS. Each group underwent six 20-minute treatment sessions. Participants were assessed using the ASG (dividing the P1-N1 amplitude of the second cortical auditory evoked potential [CAEP] by the P1-N1 amplitude of the first CAEP) and an 11-point Visual Analog Scale (VAS) for loudness, awareness, and annoyance before and after the intervention sessions. Patients rated these items from 0 to 10, with 0 representing no tinnitus and 10 representing intense loudness, awareness, and annoyance. Postintervention group comparisons were performed using a covariance analysis. Within-group changes were assessed with paired t tests. Correlations were evaluated with Pearson's test. After the intervention, the results showed that the bimodal group experienced a significant decrease in ASG and loudness and awareness VAS scores relative to those of the unimodal group (p < 0.05). No significant change in the annoyance VAS score was found between groups. A correlation was observed between ASG and the awareness and annoyance VAS scores, but no correlation was found between ASG and the loudness VAS score. As a treatment option for tinnitus, bimodal stimulation appears to be more effective than unimodal stimulation. This method may be particularly beneficial for tonal tinnitus with hearing loss; however, it may not be effective for all patients. Therefore, a clinical protocol is required. Bimodal stimulation may offer a clinically meaningful intervention for patients with tinnitus, particularly those with hearing loss who experience tonal tinnitus.\n\nID: 42403964\nTitle: Multidimensional Effects of Hyperacusis: A Study on Tinnitus, Anxiety, Cognitive Function, Sleep, and Quality of Life.\nAbstract: Tinnitus and hyperacusis are often cooccurring and quite prevalent symptoms. The effects of tinnitus on sleep quality, anxiety, cognitive abilities, and quality of life are well documented. However, studies investigating the effects of hyperacusis are limited. The aim of this study is to investigate the relationship between hyperacusis and tinnitus, anxiety, cognitive functions, sleep, and quality of life. Prospective cross-sectional study. Forty people reporting hyperacusis were included in the study. These individuals were categorized into two groups: those with hyperacusis only and those with both hyperacusis and tinnitus. In addition, 30 healthy participants were included as a control group. The Khalfa Hyperacusis Questionnaire, Tinnitus Handicap Inventory, Beck Anxiety Inventory, Digit Span and Stroop test TBAG form, Pittsburgh Sleep Quality Index, and Short Form-36 (SF-36) were administered to these individuals. The total sleep quality of the hyperacusis and tinnitus group was poorer compared with the control group, whereas only the subjective sleep quality of the hyperacusis group was poorer than that of the control group (p < 0.05). Both patient groups had higher BAI scores compared with the control group (p < 0.05). No significant differences were observed between the groups in terms of the Digit Span and Stroop tests (p > 0.05). Both patient groups had lower quality-of-life scores compared with the control group (p < 0.05). However, individuals in the hyperacusis and tinnitus group had lower scores in the physical functioning subscale of the SF-36 compared with those in the hyperacusis group (p < 0.05). The performance of individuals with hyperacusis on the Stroop and Digit Span tests was similar to that of healthy individuals. However, individuals with hyperacusis had higher levels of anxiety and lower sleep quality and quality of life compared with healthy individuals. In cases where tinnitus accompanied hyperacusis, a more pronounced decline in quality of life was observed.\n\nID: 42403960\nTitle: The Degree of Audiovestibular Loss Is Not Related to Current Vertigo Attacks in Refractory Unilateral M\u00e9ni\u00e8re's Disease.\nAbstract: Unilateral M\u00e9ni\u00e8re's disease (MD) is characterized by severe episodic attacks of rotational vertigo and audiovestibular signs that include fluctuating sensorineural hearing loss, aural fullness, tinnitus, and vestibular loss. To investigate the relationship between the degree of audiovestibular loss, symptoms, and the number of vertigo attacks during the previous 6\u2009months and 1\u2009month of patients with MD. Sixty patients with active MD refractory to oral treatment. Hearing (pure-tone audiometry and speech discrimination) and vestibular (caloric test, vestibular evoked myogenic potential [VEMP]) tests were performed. Symptoms were scored using the following validated questionnaires: Vertigo Symptom Scale-short form, Dizziness Handicap Inventory, Tinnitus Handicap Inventory, Aural Fullness Scale, and Functional Level Scale. Linear regression, a factor analysis, and a correlation analysis were conducted. Patients experienced a mean number of 16 attacks (range, 2-65) during the previous 6\u2009months and five attacks (range, 0-30) during the previous 1\u2009month. Hearing and vestibular functions were reduced in the affected ear. Linear regression, the factor analysis, and the correlation analysis showed no association between the degree of audiovestibular loss and the number of vertigo attacks during the previous 6\u2009months or 1\u2009month or symptoms of disease activity. An exploratory analysis showed evidence of some associations between the degree of hearing loss, caloric paresis, and VEMP asymmetry, indicating a consistent pattern of loss across the cochlear semi-circular canals and saccules. Although audiovestibular tests help establish diagnoses, they cannot determine current disease activity of unilateral refractory MD. It may be prudent to assume that patients with MD and high remaining vestibular function in the affected ear would experience more frequent episodes of vertigo and intense dizziness and experience more troublesome symptoms. Conversely, it may be prudent to assume that patients with MD with low remaining vestibular function in the affected ear would experience fewer episodes of vertigo; however, as shown by these results, this does not seem to be the case. No obvious audiovestibular markers suggest that intratympanic therapy for vertigo treatment should be delayed.\n\nID: 42403858\nTitle: Autosomal Dominant Obstructive Sleep Apnea Syndrome Due to the New Variant c.980_984dup in COL1A2: A Case Report.\nAbstract: Obstructive sleep apnea syndrome (OSAS) is a complex disorder characterized by the collapse of the upper airway during sleep. Although a family history often suggests a hereditary predisposition to OSAS, there is little evidence that it is actually a monogenic disorder. To date, no case of a patient with hereditary OSAS due to a pathogenic mutation in the collagen type I alpha-2 chain (COL1A2) gene has been described. The patient was a 72-year-old woman who had suffered from insomnia since the age of 35. OSAS was suspected since then, but was only confirmed at the age of 67 by polysomnography. The OSAS was treated with nocturnal active positive airway pressure (APAP), which led to an improvement.\u00a0Her medical history also included joint hypermobility, brachydactyly, multiple nevi, an umbilical hernia, left-sided tinnitus and hearing impairment, hair loss, hip pain, and ptosis. Since her son also developed OSAS at the age of 34, hereditary OSAS was suspected, and exome sequencing was performed, which revealed the novel variant c.980_984dup (p.Ile329Alafs*72) in the COL1A2 gene. Since OSAS is a known complication of connective tissue disorders (CTDs), the index patient's OSAS was attributed to the COL1A2 mutation. This case suggests that OSAS may be hereditary due to a variant in the COL1A2 gene and may represent the dominant phenotypic feature. Physicians should be aware that OSAS can be hereditary; therefore, CTD patients with a positive family history of OSAS should undergo genetic testing for variants in genes associated with CTD.\n\nID: 42402048\nTitle: Tinnitus, hyperacusis and somatic complaints in a diverse Norwegian clinical population: implications for assessment and rehabilitation.\nAbstract: Patients with tinnitus often have somatic complaints, a reality that is understudied in the broader literature on tinnitus. This study aims to characterize tinnitus patients with somatic complaints, investigate associations between somatic complaints and tinnitus, hyperacusis, and symptoms of anxiety and depression, and to compare patient profiles across genders and healthcare services. A cross-sectional study with a digital questionnaire consisting of Tinnitus Sample Case History Questionnaire (TSCHQ), Tinnitus Handicap Inventory (THI), Hyperacusis Questionnaire (HQ), Hospital Anxiety and Depression Scale (HADS) and Generalized Anxiety Disorder-7 (GAD-7). The somatic complaints investigated were Headaches, Dizziness, Temporomandibular Dysfunction (TMD), Neck pain and Pain Syndromes, as measured using the TSCHQ. A total of 144 participants with tinnitus were sampled, from four hearing clinics and two rehabilitation centres in Norway. Several positive associations were observed between somatic complaints and higher levels of tinnitus, hyperacusis, depression and anxiety. Moreover, somatic complaints were more common among women, and those recruited from rehabilitation centres. Tinnitus patients, with or without comorbid hyperacusis, have several psychological and somatic complaints that need to be mapped thoroughly. An interdisciplinary approach should be considered for patients with tinnitus and comorbid somatic symptoms.\n\nID: 42400132\nTitle: Personal listening device usage, leisure noise exposure, hearing protection usage and hearing at standard frequencies: a longitudinal study from child/adolescence to young adulthood.\nAbstract: To compare personal listening device (PLD) listening behaviours, leisure noise exposure, audiometric outcomes, hearing protection (HP) usage and self-reported hearing loss (HL) symptoms at Time 1: 2009/2010 and Time 2: 2022/2023. Mean hearing thresholds (HTs), pure-tone average HL prevalence, PLD volume levels, durations, earbud/headphone tightness, and sex among matched pairs, at Time 1 and 2, were compared. Longitudinal design. Questionnaire evaluating PLD listening behaviours, leisure noise exposure and HL symptoms. Multivariate regression analysis used to determine relationship between variables and audiometry. 59 Participants, aged 22-30, of original cohort (n\u2009=\u2009237, aged 10-17) were re-tested (Time 2). Over time, tinnitus following leisure noise tripled, HP doubled and higher average PLD listening time was observed (7 vs. 18\u2009h/week); longer durations for males. High volume listening was 20% at both timepoints. Leisure noise exposure and HL prevalence were similar across time, however mean HTs were higher at Time 1. Among matched pairs, more Time 2 participants created tight-fitting earbuds/headphones and responded affirmatively to some HL symptom questions. Subtle auditory changes, such as hidden HL, may be occurring over time. Educational outreach regarding HL prevention would be beneficial. Further longitudinal research needed due to the small follow-up sample.\n\nID: 42392891\nTitle: Postoperative auditory outcomes in total temporomandibular joint replacement: fossa-canal proximity and tinnitus risk.\nAbstract: Total temporomandibular joint replacement (TMJR) is an established treatment for advanced ankylosis; however, postoperative auditory complications, such as tinnitus, remain poorly characterized. This post-hoc observational analysis evaluated whether postoperative prosthetic fossa-external auditory meatus (EAM) distance is associated with postoperative tinnitus after TMJR for ankylosis, and explored preoperative ankylosis-EAM proximity and tinnitus resolution. Patients aged 18-40 years undergoing TMJR with orthognathic surgery with \u226512 months follow-up and postoperative cone-beam computed tomography were evaluated. The unit of analysis was the individual joint. Postoperative and preoperative EAM distances were measured on multiplanar reconstructions by blinded observers. A total of 24 joints from 17 patients were analysed (10 unilateral and seven bilateral). Postoperative tinnitus occurred in two joints (8.3%), both unilateral events in patients undergoing bilateral TMJR. Mean postoperative fossa-EAM distances were significantly shorter in tinnitus joints compared with non-tinnitus joints (1.38 \u00b1 0.17\u00a0mm vs 5.18 \u00b1 2.08\u00a0mm; mean difference 3.80\u00a0mm, 95% confidence interval 0.68-6.92; P = 0.019; Cohen's d = 1.87). Preoperative ankylosis-EAM distance showed no significant difference between groups (P = 0.123). Both tinnitus cases occurred at postoperative clearances below \u223c3.5\u00a0mm. Symptoms were mild to moderate, resolved within 12 months, and were not associated with audiometric hearing loss. Shorter postoperative fossa-EAM distance was associated with transient postoperative tinnitus in this exploratory cohort. The observed 3.5\u00a0mm clearance should be regarded as hypothesis-generating rather than a validated clinical threshold. Larger studies with standardized tinnitus assessment are required.\n\nID: 42388916\nTitle: Intrapetrous Internal Carotid Artery Pseudoaneurysm Secondary to Malignant Otitis Externa: A Case Report.\nAbstract: Malignant otitis externa (MOE) can rarely progress to skull base osteomyelitis (SBO) with catastrophic vascular complications. We describe a 68-year-old man with uncontrolled diabetes (HbA1c 9%) who presented with left otalgia, purulent otorrhea, and hearing loss. Initial workup showed CRP 23 mg/L, leukocytes 8,000/\u00b5L, and ear pus culture positive for Pseudomonas aeruginosa. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated MOE with temporal bone osteomyelitis. Despite prolonged intravenous antibiotics (imipenem, colistin) and topical ofloxacin, symptoms persisted. Three months later, he developed a headache, pulsatile tinnitus, and a pulsatile retro\u2011tympanic mass; MRI and 3D time-of-flight (TOF) angiography revealed progression of SBO with a pseudoaneurysm arising from the intrapetrous segment of the left internal carotid artery and ipsilateral sigmoid sinus septic thrombosis. Digital subtraction angiography was planned for definitive characterization and endovascular management, but the patient deteriorated rapidly and died of overwhelming septic shock before intervention. This case highlights that MOE\u00a0can extend to involve the petrous internal carotid artery (ICA) and produce infected pseudoaneurysms; early vascular imaging [computed tomography angiography (CTA)/ magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) when indicated], aggressive antimicrobial therapy, and prompt multidisciplinary planning for endovascular or surgical intervention are essential to reduce morbidity and mortality.\n\nID: 42388458\nTitle: Development and Validation of a Nomogram to Identify and Predict High-Distress Psychosocial Phenotypes in Tinnitus Patients: A Latent Profile Analysis.\nAbstract: Evidence is limited on the multidimensional psychosocial heterogeneity among patients with subjective tinnitus, and practical tools for early risk stratification remain largely unexplored. This study aimed to identify distinct psychosocial phenotypes under the biopsychosocial model to pinpoint the high-risk population and to develop and validate a visualized nomogram predicting severe psychological distress for targeted interventions. A total of 534 subjective tinnitus patients were enrolled. Latent profile analysis using seven psychosocial indicators (Self-Rating Anxiety Scale total score, Self-Rating Depression Scale total score, positive life events score, negative life events score, subjective support score, objective support score, and support utilization score) identified distinct patient phenotypes. The \"Severe Anxiety Isolated\" phenotype was defined as the target \"high-distress\" group for the prediction model. Clinical characteristics and tinnitus-related disability were compared across groups. Multivariate logistic regression identified independent predictors of the high-distress phenotype to construct a nomogram, validated via ROC, calibration, and decision curve analysis. Four distinct psychosocial phenotypes were identified via LPA: the Chronic Vulnerable phenotype (18.73%), the Severe Anxiety Isolated phenotype (28.09%, defined as the high-distress high-risk phenotype), the Well Adapted Healthy phenotype (43.82%), and the High Positive Life Events Resilient phenotype (9.18%). The Severe Anxiety Isolated phenotype had significantly higher Tinnitus Handicap Inventory (THI) and Insomnia Severity Index (ISI) scores compared with other phenotypes (all P<0.001). Age group (21-39 years), longer tinnitus duration, concurrent presence of vertigo, bilateral tinnitus, and easily agitated/irritable personality traits were independent risk factors for the high-distress phenotype. The constructed nomogram exhibited good discrimination (AUC=0.756 in the training cohort and 0.737 in the testing cohort), calibration, and clinical utility. Subjective tinnitus patients exhibit profound psychosocial heterogeneity, with the Severe Anxiety Isolated phenotype facing the highest psychological risk. Our developed nomogram accurately predicts this high-risk phenotype using routine outpatient indicators, facilitating early risk stratification and precision biopsychosocial interventions.\n\nID: 42382212\nTitle: Interactive Effects of Occupational Hearing Loss and Glutathion S-Transferase M1 Genotype on Tinnitus Among Noise-exposed Steelworkers.\nAbstract: Tinnitus is a known long-term health effect of noise exposure. Whether susceptible genotypes predispose noise-exposed workers to tinnitus remains unclear. This study investigated the interactive effects of noise exposure, auditory function, and glutathione S-transferase (GST) gene polymorphisms on tinnitus risk. We conducted a cross-sectional study among steelworkers. Participants underwent audiological testing to assess hearing levels and were surveyed for tinnitus. Blood samples were genotyped for GSTM1 and GSTT1 deletion polymorphisms using polymerase chain reaction. Multivariable logistic regression was used to evaluate associations between tinnitus and pure-tone audiometry (PTA), distortion product otoacoustic emission (DPOAE), and GST genotypes while controlling for age and other covariates. Among 239 male steelworkers (mean age \u00b1 SD: 48.29 \u00b1 7.6 years), 27% reported tinnitus. Cumulative noise exposure and thresholds at low- and high-frequency PTA were significantly associated with tinnitus (adjusted odds ratio (OR) = 1.03, 1.06, and 1.04, 95% confidence interval (CI) = [1.00,1.06], [1.02,1.11], and [1.02,1.06], p = 0.045, 0.002, <0.001, respectively). Although neither DPOAE nor GSTM1 nor GSTT1 genotypes showed a significant effect on tinnitus, we observed a significant interaction between low-frequency PTA and the GSTM1 genotype (p = 0.03). Specifically, compared with workers with non-null GSTM1 genes, workers with the GSTM1-null genotype were significantly more susceptible to low-frequency PTA-associated tinnitus (OR = 1.02 and 1.13, 95% CI = [0.96,1.08] and [1.06,1.22], respectively). The interactive effect of auditory functional status and antioxidant gene polymorphisms suggests that hair cell damage and oxidative stress in the cochlea both contribute to tinnitus development.\n\nID: 42380788\nTitle: The longer, the better? Investigating the effect of prolonged acoustic stimulation on brief acoustic tinnitus suppression.\nAbstract: Brief acoustic tinnitus suppression following sound stimulation is being studied to better understand the mechanisms underlying tinnitus and short-term suppression of the tinnitus perception. In this context, several kinds of filtered or modulated stimuli have been investigated. However, little research was conducted regarding the effect of stimulation length for brief acoustic tinnitus suppression. The aim of the present study was to compare the extent of tinnitus suppression after a 20-minute and a 3-minute acoustic stimulation with an individual best stimulus. Three experimental sessions were completed by 33 participants with chronic subjective tinnitus. In the first two sessions, eight different individualized, filtered, and/or amplitude-modulated stimuli were presented for 3\u00a0min each. For each participant, the stimulus which induced the strongest tinnitus loudness suppression (measured with a numeric rating scale in percent compared to baseline loudness) was chosen and then applied for 20\u00a0min in a third session. On a group level, no significant difference in tinnitus loudness suppression comparing the 3-minute and the 20-minute acoustic stimulation using the individual best stimulus was observed. However, individual response patterns revealed great diversity as 12 participants showed better suppression after the 20-minute stimulation,12 experienced worse tinnitus suppression and for 9 participants no distinct change was evident compared to 3-minute acoustic stimulation. Future research should try to characterize the subgroup of tinnitus patients that profits from prolonged acoustic stimulation and search for optimized simulation durations. This trial was retrospectively registered on 2026/03/04 at ClinicalTrials.gov (ID: NCT07472257).\n\nID: 42378546\nTitle: Is Zinc Deficiency a Risk Factor for Tinnitus? An Analysis from Chronic Idiopathic Tinnitus Patients with Normal Hearing.\nAbstract: To investigate whether zinc deficiency is associated with tinnitus severity in patients with chronic idiopathic tinnitus and normal hearing. This prospective, cross-sectional study included 107 patients with chronic idiopathic tinnitus and normal hearing selected from 409 patients evaluated at the tinnitus clinic between January 2021 and December 2023. Serum zinc levels, Tinnitus Handicap Inventory (THI) scores, and tinnitus loudness matching tests were assessed. Zinc deficiency was defined as serum zinc <66 \u03bcg/dL. Of 107 patients, 22 (20.6%) had zinc deficiency. Zinc-deficient patients showed significantly higher total THI scores (48.09 \u00b1 25.95 vs. 36.28 \u00b1 21.91, P=.032) and functional component scores (19.09 \u00b1 11.87 vs. 13.13 \u00b1 9.68, P=.016). Correlation analysis revealed negative correlations between continuous serum zinc levels and all THI components, though none reached statistical significance. Objective tinnitus loudness did not differ significantly between groups. Zinc deficiency is associated with greater tinnitus severity in patients with normal hearing, particularly affecting functional aspects of daily life. Screening for zinc deficiency and targeted supplementation might offer a potential therapeutic approach for this specific patient population.\n\nID: 42378543\nTitle: Tinnitus Pathophysiology: A Systems Biology Analysis of Gene Networks and Cellular Pathways.\nAbstract: Tinnitus, characterized by phantom sound perception in the absence of external auditory stimuli, affects approximately 10%-15% of the adult population worldwide. Despite its prevalence, the molecular mechanisms underlying tinnitus remain incompletely understood. This study aimed to identify key molecular networks and pathways implicated in tinnitus pathophysiology using a systems biology approach through comprehensive enrichment analysis of tinnitus-associated genes. Tinnitus-associated genes were identified from the DisGeNET database (CUI ID: C0040264) and subsequently analyzed using EnrichR across 7 databases: WikiPathways 2024 Human, GO Biological Process 2025, GO (Gene Ontology) Cellular Component 2025, GO Molecular Function 2025, CellMarker 2024, HMDB (Human Metabolome Database) Metabolites, and TargetScan microRNA 2017. Top results from each database were retained and analyzed to identify significant biological patterns. The analysis revealed significant enrichment of neuroinflammatory pathways, glutamatergic signaling, and ion channel activity, particularly potassium channels. Key inflammatory cytokines including IL-10 (interleukin), IL-1\u03b2, IL-6, and tumor necrosis factor emerged as central molecular players. The results highlighted the involvement of neuronal components including N-methyl-D-aspartate receptors, voltage-gated potassium channels, and cellular structures critical for auditory signal transduction. Metabolite analysis implicated potassium homeostasis and several microRNAs showed potential regulatory roles in tinnitus-related gene networks. This comprehensive analysis suggests tinnitus pathophysiology involves complex interactions between neuroinflammation, excitotoxicity, ion channel dysfunction, and neuronal structural changes, presenting potential targets for therapeutic intervention and biomarker development.\n\nID: 42378541\nTitle: Optimal Head Position Following Intratympanic Injections of Steroids.\nAbstract: Intratympanic drug applications may be performed for a number of reasons, including the treatment of Meniere's disease, sudden hearing loss, and tinnitus. In this study, the aim was to determine the optimal head position for steroid solutions to be absorbed through the round window after intratympanic injections. The authors retrospectively reviewed the best head position where the level of steroid solution reaches the round window area behind the eardrum in video recordings of 20 Meniere's disease patients undergoing intratympanic steroid injections. The patients were positioned in the supine position, with the diseased ear pointing upward. Cotton wool soaked with 10% xylocaine was applied to the eardrum surface. After 2 or 3 swallows with the nose closed, dexamethasone (8.00 mg/2cc) was injected through the anterior quadrant using a syringe with a 25-gauge spinal needle, and the injection was continued until half of the middle ear was filled. Following injection, patients' heads were then tilted backward until the solution covered the round window area under microscopic view. The angle between the midsagittal plane of the head and the horizontal plane was noted when the best level of the solution covering the round window area was achieved. The angleof the midsagittal head plane and horizontal plane for the optimum head position following injection were 90 degrees in 16 of 20 ears and 80 degrees in 4; in supine position. The most appropriate head position for drug delivery after intratympanic injection was determined as the head looking directly upwards in the supine position.\n\nID: 42373579\nTitle: Presenting Complaint and Diagnostic Yield of MRIs for Vestibular Schwannomas.\nAbstract: To ascertain the diagnostic yield of MRIs to diagnose vestibular schwannoma based on the patient's presenting symptoms and age. A retrospective cohort study at a single centre. All MRIs ordered by otolaryngologists from 01/01/2022 to 31/12/2023 for the purpose of diagnosing a vestibular schwannoma were included. Data on presenting symptoms, audiogram results, demographics and management outcomes were extracted from clinical records. 1814 MRIs were included. The overall diagnostic yield of vestibular schwannomas was 1.65% (30 cases). Mild asymmetrical sensorineural hearing loss alone (defined as <\u200915 dB difference between ears at two consecutive frequencies) was not associated with vestibular schwannoma; no patients with this finding were diagnosed (p\u2009=\u20090.025). On multivariate analysis, vertigo (odds ratio [OR] 4.03, p\u2009<\u20090.001) and severe asymmetrical sensorineural hearing loss (OR 5.26, p\u2009=\u20090.002) were independently associated with a diagnosis. Unilateral tinnitus (OR 2.10, p\u2009=\u20090.062), sudden onset asymmetrical hearing loss (OR 0.57, p\u2009=\u20090.46), mild asymmetrical hearing loss (OR 1.03, p\u2009=\u20090.98), or age (OR 0.74, p\u2009=\u20090.48) were not significantly associated with a vestibular schwannoma. Incidental findings were common (23%) and most patients (80%) were managed conservatively with serial MRIs. There was no correlation between age and likelihood of diagnosis. The diagnostic yield of MRIs for vestibular schwannomas is low. Patients with isolated mild asymmetrical hearing loss alone may not warrant further investigation. Presenting with unilateral tinnitus was a poor discriminator for a diagnosis of vestibular schwannomas. However, patients with unexplained vertigo should be considered for an MRI. Further research is needed to refine current guidelines.\n\nID: 42371148\nTitle: Migraine and auditory dysfunction: beyond comorbidity.\nAbstract: Migraine operates as a systemic disorder of multisensory sensitization. Within this spectrum, auditory manifestations, including sensorineural hearing loss, tinnitus, and hyperacusis, represent prevalent yet frequently overlooked otologic phenotypes. Epidemiological data show that 15%-49% of migraine patients present with comorbid auditory symptoms, and nearly two-thirds exhibit auditory electrophysiological abnormalities. However, optimal clinical management remains constrained by an incomplete understanding of pathogenic mechanisms, variable audiological assessment protocols, and dispersed therapeutic data. This review synthesizes epidemiological, audiological, and pathophysiological data linking migraine to auditory dysfunction. The underlying pathology involves a peripheral-to-central continuum across three interacting axes. Anatomical and hydrodynamic vulnerabilities drive localized microvascular ischemia and aberrant brain-ear fluid exchange. Localized neurochemical imbalances, involving glutamate excitotoxicity, neuropeptide signaling, and innate immune activation, disrupt inner ear homeostasis. Concurrently, central sensitization facilitates neural network plasticity, characterized by impaired efferent gating and thalamocortical dysrhythmia. Drawing upon these underlying pathways, current and emerging therapeutic strategies are categorized by specific clinical objectives: blocking upstream migraine pathways, protecting the cochlear microenvironment, and correcting central hypersensitivity. This framework aims to catalyze future translational research to rigorously validate these mechanistic links, promote early identification, precise clinical phenotyping, and cross-disciplinary management of affected patients.\n\nID: 42365397\nTitle: Tonotopically distinct OFF responses arise in the mouse auditory midbrain following sideband suppression.\nAbstract: The parsing of sensory information into discrete topographic domains is a fundamental principle of sensory processing. In the auditory cortex, these domains evolve during a stimulus, with the onset and offset of tones evoking distinct spatial patterns of neural activity. However, it is not known where in the auditory system this spatial segregation occurs or how these dynamics are affected by hearing loss. Using widefield single photon neuronal Ca2+ imaging in the inferior colliculus (IC) of awake mice, we found that pure tone stimuli elicited both spatially constrained neural activity within isofrequency bands and simultaneous sideband suppression. At cessation of the stimulus, offset responses emerged within the region of sideband suppression, demonstrating that simple stimuli elicit spatiotemporally distinct neural activity patterns to represent the presence of sound and sound termination. Because sound frequency is spatially encoded in the IC, this spatial shift creates a tonotopically distinct offset (tdOFF) response relative to sound onset. High-resolution two-photon Ca2+ imaging confirmed that tdOFF neuron activity in the sideband region was suppressed during sound and elevated above baseline after stimulus termination, raising the possibility that rebound excitation could contribute to this post-stimulus activation. Loud noise exposure - a common model of hearing loss - abolished both sideband suppression and tdOFF responses. These results show that hearing loss profoundly reshapes the spatiotemporal pattern of sound processing by altering sideband activity. This preferential loss of sideband suppression and tdOFF activation after sound-induced injury in the auditory midbrain may contribute to hyperacusis and tinnitus by promoting neuronal hyperactivity. KEY POINTS: Sensory systems encode different features of stimuli by activating distinct neural networks. Sound onsets and offsets elicit distinct neural patterns in the auditory cortex, although it is unclear where this separation originates or how it may change with hearing loss. Using in vivo widefield Ca2+ imaging in awake mice, we find that pure tone stimuli evoke spatiotemporally distinct on and off patterns of neural activity in the auditory midbrain. Neurons active during stimulus offset were suppressed by sound in sideband regions, raising the possibility that rebound excitation may contribute to this post-stimulus activation. Both sideband suppression and off responses were preferentially abolished following noise-induced hearing loss, raising the possibility that these changes may contribute to hearing loss-related syndromes such as tinnitus and hyperacusis.\n\nID: 42363722\nTitle: Evidence for a Transient State of Auditory Hypersensitivity During Initial Onset of Tinnitus: IDAEP Changes Between Acute and Chronic Tinnitus.\nAbstract: Once persistent for around a month, tinnitus typically persists permanently. This transition from acute to chronic tinnitus is thought to reflect dynamic neurophysiological changes and plasticity within central auditory and non-auditory networks, but empirical evidence has been lacking. We hypothesized that, bottom-up neural mechanisms linked to tinnitus initiation, such as central gain and neural synchrony, are maximal around the time of its initiation, but subsequently return towards baseline as central plastic changes develop. We evaluated part of this hypothesis by measuring central auditory reactivity through the Intensity Dependence of Auditory Evoked Potential (IDAEP), a non-invasive index of higher-order inhibitory processing within the auditory system. A steeper IDAEP slope is associated with heightened sensory reactivity (higher sensitivity to changes in auditory stimuli), indicative of reduced central inhibition, whereas a shallower slope reflects greater inhibitory control. Studying a group with acute tinnitus (onset within past six weeks), with a repeated assessment after six months from onset, we found a significant longitudinal reduction in the IDAEP slope following initial tinnitus onset, and non-significantly higher IDAEP slope in Acute and Chronic tinnitus groups compared to matched controls. These findings support our hypothesis, indicating that IDAEP may serve as an objective marker of auditory reactivity for characterising the time course of certain tinnitus mechanisms.\n\nID: 42356176\nTitle: Trauma-Associated Tinnitus and Hearing Loss: A Comprehensive Narrative Review of Prevalence, Risk Factors, and Clinical Outcomes.\nAbstract: Background and Objectives: Trauma-associated auditory dysfunction, encompassing tinnitus and hearing loss, represents a frequent yet underrecognized sequela of acoustic overexposure, blast injury, and head trauma. Despite increasing clinical awareness, the published literature exhibits substantial heterogeneity in reported prevalence estimates and recovery outcomes across different injury mechanisms. This narrative review aims to synthesize available evidence on the prevalence, clinical characteristics, recovery patterns, and prognostic factors of tinnitus and hearing loss following traumatic injury, with a particular focus on comparing outcomes across distinct trauma mechanisms and evaluating the impact of early intervention. Materials and Methods: A comprehensive literature search was conducted in PubMed, Embase, Scopus, and Web of Science for studies published between January 2010 and December 2025. The search strategy combined terms related to traumatic injury (e.g., \"acoustic trauma,\" \"blast injury,\" \"traumatic brain injury,\" \"head trauma\") with terms related to auditory dysfunction (e.g., \"tinnitus,\" \"hearing loss,\" \"auditory dysfunction\"). Eligible studies included observational studies (cohort, cross-sectional, case-control) reporting original data on tinnitus and/or hearing loss prevalence, recovery outcomes, or prognostic factors in adult or mixed populations exposed to traumatic injury. A narrative synthesis was organized thematically around the key research questions. Results: The available evidence consistently indicates that tinnitus and hearing loss are frequent consequences of blast injury, acute acoustic trauma, and traumatic brain injury, although reported prevalence estimates vary considerably across studies due to differences in populations, injury mechanisms, and diagnostic criteria. Blast injury is associated with mixed hearing loss (conductive and sensorineural components), while acute acoustic trauma typically causes sensorineural hearing loss, often with a characteristic high-frequency notch. Traumatic brain injury can lead to central auditory processing deficits even when pure-tone thresholds are normal. Recovery is variable and often incomplete; tympanic membrane perforations frequently heal spontaneously, but sensorineural components often persist. Early treatment (within days to two weeks) is associated with better recovery outcomes. Conclusions: Trauma-associated tinnitus and hearing loss are highly prevalent and frequently result in persistent disability. The strong association between early treatment and improved recovery outcomes supports the implementation of prompt audiological evaluation and intervention following traumatic injury. These findings underscore the need for routine audiological screening in at-risk populations and for continued research into preventive strategies, standardised assessment protocols, and optimised treatment regimens.\n\nID: 42355598\nTitle: An Open Comparative Study on the Effectiveness of Customized and Non-Customized Sound Therapy for Tinnitus Patients.\nAbstract: Objectives: Sound therapy is a common treatment for tinnitus. This study aims to explore the efficacy of non-customized and customized sound therapy for subjective tinnitus. Treatment progress was assessed by comparing changes in monthly scales. The main scales used are the Tinnitus Handicap Inventory, Hospital Anxiety and Depression Scale, and Loudness Visual Analogue Scale. Methods: The subjects of this study were patients with tinnitus who visited outpatient from 2024 to 2025. Total of 732 patients were included (customized group, n = 653; non-customized group, n = 79). Customized sound therapy is tailored to patient's specific tinnitus condition, while non-customized sound consists of soothing natural sounds. The daily treatment duration was 2 h. Treatment assignment was not randomized; patients were free to choose between customized and non-customized sound therapy, which may have introduced a preference bias. Results: The study found that, in both groups of patients, regardless of whether they were treated or not, the severity of tinnitus was positively correlated with the level of anxiety (p < 0.01)/depression (p < 0.01) and the loudness of tinnitus (p < 0.01). Patients with severe tinnitus were more likely to choose customized sound therapy (p < 0.01). THI score for the non-customized group showed a downward trend at 1 and 3 months after treatment (p < 0.01 at 1 and 3 months). HADS-A score also decreased 1 and 3 months after treatment compared to before treatment (p < 0.05 at 1 and 3 months). THI scores for the customized group showed a downward trend at 1, 3, 6, 9, and 12 months after treatment (p < 0.001 at 1 and 3 & 6 and 9 & 12 months). HADS-A/D scores decreased at 1, 3, 6, 9 and 12 months after treatment (p < 0.01 at 1 & 3 & 6 and 9 & 12 months). The efficacy of the customized group was greater than that of the non-customized group 1 month after treatment (\u03c72 = 6.39, p = 0.011). Conclusions: Both sound therapies can alleviate tinnitus severity and reduce anxiety in the short term. Customized sound therapy is superior to non-customized therapy in terms of short-term efficacy. Additionally, customized sound therapy is more effective than non-customized therapy in alleviating tinnitus severity and managing anxiety and depression over a longer period. Therefore, customized sound therapy may be a more effective treatment option for subjective tinnitus. However, it should be emphasized that this was an open study in which patients freely chose between the two therapies, which may have introduced bias. Therefore, these findings are not as well founded as those from a randomized controlled trial, and future RCTs are warranted to verify the observed benefits.\n\nID: 42352653\nTitle: Personalized Music-Embedded Sound Therapy Based on Gating Modulation and Neural Decoupling Reduces Tinnitus Severity.\nAbstract: Background: Tinnitus is a prevalent auditory disorder associated with maladaptive cortical plasticity and aberrant neural synchronization across auditory and non-auditory brain networks. Acoustic desynchronization-based sound therapies, such as coordinated reset neuromodulation, aim to counteract pathological oscillatory patterns but commonly require prolonged daily listening sessions and specialized delivery formats, which may limit their accessibility and practicality in routine clinical settings. To address this limitation, a modified desynchronization protocol embedding therapeutic tones within music was developed to improve tolerability and engagement. This study aimed to evaluate the clinical effects of modified Music-Integrated Desynchronization Sound Therapy (mMIDST) on tinnitus severity in patients with chronic tinnitus. Methods: In this prospective, randomized, controlled, single-blind pilot trial conducted at the Otolaryngology Department of Hospital Cl\u00ednico Universidad de Chile (Santiago, Chile) between July 2024 and July 2025, adults aged 18-75 years with chronic non-pulsatile tinnitus were assigned to receive either mMIDST or an active control intervention consisting of low-frequency stimulation (LFS) embedded within identical music tracks. Participants listened to personalized sound files for one hour daily, five days per week. Tinnitus severity was assessed using the Tinnitus Handicap Inventory (THI), with audiometric evaluations performed at baseline and after one, two, and three months. Between-group differences were analyzed using the Mann-Whitney U test. Results: Twenty-five participants completed the study (15 mMIDST, 10 LFS). Baseline audiometric thresholds and THI scores were comparable between groups. The mMIDST group showed significantly greater reductions in THI scores than the LFS group at two and three months of treatment (p < 0.05). Conclusions: mMIDST was associated with time-dependent improvements in tinnitus-related distress compared with an active control condition. Embedding desynchronization-based tonal stimulation within music may represent a promising and well-tolerated non-invasive approach for chronic tinnitus management.\n\nID: 42351418\nTitle: Otologic Manifestations of Temporomandibular Disorders.\nAbstract: Background/Objectives: Temporomandibular disorder (TMD) affects a third of the adult population and has been associated with otologic symptoms. These symptoms are frequently misattributed to primary otologic diseases, leading to delays in diagnosis and treatment. This review aims to summarize the reported prevalence, proposed pathophysiologic mechanisms, and management strategies of otologic manifestations in patients with TMD. Methods: A literature review was conducted using the MeSH terms \"temporomandibular joint disease\" and \"otologic symptoms.\" Five additional searches were performed using \"temporomandibular disease/dysfunction\" combined with each of the five most common otologic symptoms. Meta-analyses, randomized controlled trials, reviews, and systematic reviews were prioritized, with preference for studies published within the last 10 years. Inclusion criteria focused on human studies addressing the etiology, clinical presentation, and management of otologic symptoms in TMD populations. Results: The literature supports an association between TMD and otologic symptoms in the absence of primary ear disease. The most commonly described symptoms were aural fullness, otalgia, tinnitus, vertigo, and hearing loss. Conservative approaches, including occlusal splints, physical therapy, behavioral modification, and pharmacologic therapy, demonstrated partial or complete symptom resolution after management of underlying TMD. Conclusions: The literature demonstrates a consistent association between otologic symptoms and TMD, although the underlying mechanisms remain incompletely understood. While conservative TMD management may improve symptoms, exact mechanisms remain unproven. Clinicians should consider TMD in the differential diagnosis when patients present with unexplained otologic complaints. Further research is necessary to establish causality, confirm the efficacy of management protocols, and improve diagnostic accuracy in this overlapping domain.\n\nID: 42349502\nTitle: Audiometric evaluation and quality-of-life in OSIA users - a retrospective monocentric study.\nAbstract: The piezoelectric OSIA is a well-established active transcutaneous bone anchored hearing system. The study retrospectively evaluates hearing results and subjective benefits in patients provided with the OSIA system at our clinic, and separately also looks at patients with moderate to severe mixed hearing loss. 21 patients between 9 and 83 years of age were planned for OSIA implantation between 2022 and 2024. They underwent preoperative (k0) and at 3 months (k1) and at 6 months (k2) with OSIA audiometric testing as well as answered quality of life questionnaires. The k0 PTA4 air-conduction threshold was 68.2 dB (\u00b1 16.7). The PTA4-free field pure tone audiogram with the OSIA system at k1 was 32.0 dB (\u00b1 14.1). The gain is a substantial 36.2 dB. Freiburg monosyllables speech understandig at 65 dB in quiet with the OSIA at k1 was 16.4% better than the k0 performance with the BAHA 6 Max. Postoperative monosyllables performance at 65 dB was statistically better with OSIA versus without. There was a significant negative correlation between pre- versus postoperative APHAB and NCIQ answers (corr.-coeff. -0.87). Postoperative tinnitus results correlated with APHAB and NCIQ answers (corr.-coeff. 0.72 and -0.81 respectively). Overall, we observed a significant improvement in hearing thresholds, speech understanding performance and in subjective quality of life in patients with OSIA. Also in the subgroup with moderate to severe mixed hearing loss we observed a steady improvement of speech understanding over time and a good subjective quality of life and satisfaction with the system. Das piezoelektrische OSIA ist ein etabliertes aktives transkutanes Knochenleitungsh\u00f6rsystem. Die Studie analysiert retrospektiv die H\u00f6rergebnisse und den subjektiven Gewinn durch die Versorgung mit OSIA bei den in unserer Klinik implantierten Personen und betrachtet gesondert die Patienten mit mittel- und hochgradiger kombinierter Schwerh\u00f6rigkeit.21 Patienten im Alter zwischen 9 und 83 Jahren wurden zwischen 2022 und 2024 f\u00fcr eine OSIA-Implantation vorgesehen. Pr\u00e4operativ (k0) sowie nach 3 (k1) und 6 Monaten (k2) mit OSIA wurden H\u00f6rtests und Lebensqualit\u00e4tsbefragungen durchgef\u00fchrt.Die k0-PTA4-Luftleitungsschwelle betrug 68,2dB (\u00b116,7). Die PTA4-Freifeldh\u00f6rschwelle mit OSIA zu k1 betrug 32,0dB (\u00b114,1). Der Gewinn ist substanzielle 36,2dB. Das Freiburger Einsilberverstehen in Ruhe bei 65dB mit dem OSIA zu k1 war um 16,4% besser als die k0-H\u00f6rleistung mit dem BAHA 6 Max. Die postoperative Freiburger-Einsilbertest-H\u00f6rleistung bei 65dB war statistisch signifikant besser mit OSIA als ohne. Es wurde eine signifikante negative Korrelation zwischen pr\u00e4- und postoperativen APHAB- und NCIQ-Antworten festgestellt (Korrelationskoeffizient \u20130,87). Die postoperativen Tinnitusresultate korrelierten mit den APHAB- und den NCIQ-Ergebnissen (Korrelationskoeffizient 0,72 bzw. \u20130,81).Insgesamt konnten wir eine signifikante Verbesserung der H\u00f6rschwellen, des Sprachverstehens und der subjektiven Lebensqualit\u00e4t bei den mit OSIA implantierten Patienten feststellen. Auch in der Untergruppe der mittel- bis hochgradig kombiniert schwerh\u00f6rigen Patienten wurden im zeitlichen Verlauf eine stetige Verbesserung des Sprachverstehens und eine gute Lebensqualit\u00e4t und hohe Zufriedenheit mit dem System gesehen.\n\nID: 42345631\nTitle: Audiologic Assessment and Management of Teprotumumab-Associated Ototoxicity: An Updated Narrative Review.\nAbstract: Introduction: Teprotumumab (Tepezza\u00ae), an insulin-like growth factor-1 receptor (IGF-1R) antagonist, is the first FDA-approved targeted therapy for thyroid eye disease (TED). While effective for reducing proptosis and inflammation, increasing post-marketing evidence has linked teprotumumab to auditory adverse events. IGF-1 signaling is essential for cochlear maintenance and neuroprotection; therefore, systemic IGF-1R inhibition presents a biologically plausible mechanism for ototoxicity. Despite growing recognition of these effects, no standardized approach exists for audiologic assessment or monitoring of patients receiving teprotumumab. This review aimed to (1) summarize proposed mechanisms and the reported spectrum of teprotumumab-related auditory effects, (2) evaluate current methods used to assess and monitor these patients, and (3) identify areas of consensus and ongoing uncertainty. Methods: An updated narrative review of the literature was conducting using PubMed, CINAHL, and Google Scholar using Boolean strings targeting teprotumumab exposure and hearing-related outcomes. Studies from 2022 onward were identified using Boolean search strings targeting teprotumumab exposure and hearing-related outcomes. Peer-reviewed English language studies reporting audiometric findings were eligible for inclusion. Results: Ten studies met inclusion criteria. Reported effects most commonly included bilateral high-frequency SNHL, tinnitus, and aural fullness, typically emerging after three to six infusions. Many cases demonstrated persistent deficits despite drug discontinuation. Baseline audiometric assessment was not uniformly reported across studies, and monitoring protocols varied considerably, with inconsistent incorporation of speech testing and immittance measures. Conclusions: Teprotumumab-associated ototoxicity is increasingly recognized and potentially irreversible. Current evidence is insufficient to guide standardized monitoring. Prospective studies are urgently needed to establish evidence-based audiologic surveillance protocols.\n\nID: 42345629\nTitle: Domain-Specific Associations Between Physical Activity and Tinnitus in NHANES 2015-2018.\nAbstract: Tinnitus is a prevalent auditory condition associated with significant psychological burden and limited treatment efficacy. While physical activity confers broad health benefits, its relationship with tinnitus remains understudied. This study examined associations between domain-specific physical activity and tinnitus in a nationally representative sample of U.S. adults. Data from NHANES 2015-2018 were analyzed. The final analytic sample comprised 4301 adults aged 20 years and older. Tinnitus was assessed via the NHANES audiometry questionnaire. Physical activity was categorized as low, moderate, and high (MET-min/week) separately for work-related (WORK) and non-work-related (NW) domains. Survey-weighted multivariable logistic regression models, adjusted for age, sex, race, BMI, poverty-income ratio, sedentary time, smoking, education, noise exposure, hypertension, diabetes, and depressive symptoms, were used to examine associations. Linear trends across ordered physical activity categories were evaluated using ordinal trend analyses. The weighted prevalence of tinnitus was 17.3%. High NW physical activity (PA) was associated with significantly lower odds of tinnitus (OR = 0.70, 95% CI: 0.488-0.995, p = 0.0475), while high WORK PA was associated with significantly higher odds (OR = 1.30, 95% CI: 1.06-1.60, p = 0.018). Trend analyses confirmed opposing linear trends across ordered categories: inverse for NW PA (OR = 0.83 per category, p-trend = 0.0406) and positive for WORK PA (OR = 1.14 per category, p-trend = 0.017). Noise exposure and depressive symptoms were independently associated with tinnitus across both models. These findings suggest a domain-specific paradox: NW PA was associated with lower odds of tinnitus, whereas WORK PA was associated with higher odds. These results highlight the importance of domain-specific assessment and identify recreational activity as a potential modifiable factor warranting further investigation. Given the cross-sectional design, these associations should not be interpreted as causal.\n\nID: 42345427\nTitle: Cluster Analysis of Clinical Characteristics, Sleep Quality, Depression and Melatonin Levels in Patients with Idiopathic Subjective Tinnitus.\nAbstract: Since the relationship between tinnitus and quality of sleep is still a subject of research, serum melatonin levels may have a role. The aim was to reveal the structural similarities or dissimilarities regarding clinical features, tinnitus-related quality of life (QoL) effects, serum melatonin levels, and sleep quality in patients who have unilateral idiopathic subjective tinnitus. A total of 83 cases (46 males, 55.4%; 37 females, 44.6%), with a median age of 51 (range: 18-73) years, were included in the study. Cluster analysis was used to analyze demographic, laboratory, clinical, and sleep-related features of the whole sample in a multivariate manner. Two separate sets of clusters were organized. In Cluster-2, age was older, serum melatonin levels were lower, tinnitus pitch and loudness were higher, and duration was longer; air-conduction pure tone averages were higher, Visual Analog Scale, Tinnitus Handicap Inventory, Beck Depression Inventory, and Pittsburgh Sleep Quality Index scores were also significantly higher than Cluster-1. A stronger correlation was observed between poor sleep quality and depression in Cluster-2. However, in Cluster-1 with younger cases, the negative correlation between tinnitus loudness and serum melatonin values was found to be higher. The older-aged patients with lower serum melatonin levels have more severe tinnitus, worse QoL, and sleep problems compared to the younger patients. Among younger individuals, the more pronounced correlations between hearing levels, tinnitus loudness, sleep quality, and serum melatonin levels indicate that this group may particularly benefit from melatonin as a potential therapeutic option for tinnitus as well.\n\nID: 42345421\nTitle: Intravestibular Lipoma with Intracochlear Extension: A Case Report on Surgical Management and Cochlear Implantation.\nAbstract: Intracochlear and intravestibular lipomas are rare benign lesions that may clinically and radiologically mimic retrocochlear pathologies such as vestibular schwannomas. They typically present with progressive sensorineural hearing loss, tinnitus, or dizziness. Due to their rarity, optimal management strategies, particularly in pediatric patients, remain challenging and require individualized decision-making. We report the case of an 8-year-old girl who presented with progressive right-sided sensorineural hearing loss. Magnetic resonance imaging (MRI) revealed an intravestibular lipoma extending into the cochlea. Considering the patient's young age and the potential for tumor growth, surgical excision was performed via a translabyrinthine approach. Simultaneous cochlear implantation was undertaken to facilitate auditory rehabilitation. Histopathological analysis was conducted to confirm the diagnosis. Histopathological examination confirmed the lesion as a lipoma. The postoperative course was uneventful. The cochlear implant was successfully activated and provided effective hearing restoration. Intravestibular lipomas are rare entities that require careful radiological evaluation to ensure accurate diagnosis and differentiation from other retrocochlear lesions. Management should be individualized, particularly in pediatric patients, balancing surgical risks against the benefits of tumor removal and hearing rehabilitation. Simultaneous cochlear implantation may represent a viable strategy for auditory restoration in selected cases.\n\nID: 42345416\nTitle: Management Options and Their outcomes in Bilateral Advanced Otosclerosis.\nAbstract: Otosclerosis is a hereditary disorder that causes progressive hearing loss in the adult population. Owing to its progressive nature, a multimodal treatment approach is often required. Management options were offered to patients following comprehensive audiological and radiological evaluation, incorporating the Merkus algorithm in clinical decision-making. This study aims to compare the audiological and speech-related outcomes of cochlear implantation (CI) and stapedotomy with hearing aid use in patients with bilateral advanced otosclerosis. This cohort study included 38 patients divided into 2 groups: Group A consisted of patients who underwent CI (n=15), and Group B comprised patients who underwent stapedotomy followed by hearing aid use (n=23). Outcomes were compared using paired t-tests both within and between the groups. Both groups demonstrated significant improvement in hearing and speech outcomes post-intervention. Speech-related outcomes were superior in Group A (cochlear implant recipients) with a statistically significant P value (<.005), whereas hearing-related outcomes were comparable between the 2 groups. Vertigo and tinnitus symptoms showed greater improvement in Group A compared to the Group B cohort. In cases of progressive hearing loss, early and appropriate intervention is crucial to preserve residual hearing. Cochlear implantation is effective in improving both audiological and speech outcomes, and it also alleviates symptoms such as tinnitus and vertigo. Conversely, stapedotomy combined with hearing aid use remains a cost-effective management option, providing comparable audiological outcomes.\n\nID: 42345411\nTitle: Link Between Chronic Tinnitus and miR-30e, miR-206 , and miR-124 Polymorphisms Modulating the Brain-Derived Neurotrophic Factor Gene.\nAbstract: Brain-derived neurotrophic factor (BDNF) plays a crucial role in the initial formation of the central auditory system and the sensory epithelium within the inner ear. Mounting evidence indicates that BDNF administration promotes microRNA (miRNA) production in neurons, despite the typical suppressive effect of miRNAs on BDNF expression. Therefore, miRNAs regulating BDNF expression may impact the auditory system and serve as potential gene polymorphisms affecting human hearing ability. This study aimed to investigate the contribution of miRNA polymorphisms affecting BDNF to tinnitus pathophysiology. A total of 70 tinnitus patients aged 18-55 years and 70 age-matched healthy controls without tinnitus or systemic illnesses were recruited from an Ear, Nose & Throat clinic. Tinnitus assessment included tympanometric, audiological, and psychoacoustic evaluations. Seven miRNA single-nucleotide polymorphisms (miR-30e rs112439044, rs10489167, miR-206 rs16882131, miR-30a rs1491500379, miR-26b rs565919718, rs188612260, and miR-124 rs5315564) regulating the BDNF gene were analyzed using the Fluidigm platform. Significant differences in genotype distributions were observed for miR-30e rs112439044, miR-124 rs5315564, and miR-206 rs16882131 between the tinnitus patients and controls (P < .05). Genetic inheritance-model analysis revealed that miR-30e rs112439044 was associated with 0.20- and 0.83-fold risks under dominant and additive models, respectively. The miR-124 rs5315564 showed a 1.65-fold risk in the dominant model, while miR-206 rs16882131 exhibited an 11.1-fold protective effect under the dominant model and an 8.57-fold risk under the additive model. The findings suggest that polymorphisms in miR-206, miR-30e, and miR-124 may influence the auditory pathway by modulating BDNF gene expression, potentially contributing to the pathophysiology of chronic tinnitus.\n\nID: 42345410\nTitle: Efficacy of the Additional Effect of Stellate Ganglion Block in Combination of Intratympanic Steroid and Hyperbaric Oxygen Therapy for Refractory Sudden Sensorineural Hearing Loss.\nAbstract: Refractory sudden sensorineural hearing loss (RSSNHL) underscores the need for more effective salvage therapies. This study aimed to investigate the efficacy of stellate ganglion block (SGB) combined with intratympanic steroid (ITS) and hyperbaric oxygen therapy (HBO) as triple salvage therapy in patients with RSSNHL. This retrospective study analyzed 73 patients with unilateral RSSNHL admitted between January 2022 and December 2023. All patients underwent salvage therapy with HBO and ITS, with (n=31) or without SGB (n=42). The primary efficacy endpoint was the change in pure tone average thresholds, with secondary endpoints comprising demographic characteristics, tinnitus evaluation, and psychological distress scores. Both groups showed post-treatment hearing improvement (P < .05), but the SGB group achieved greater hearing gain, higher efficacy rates, and superior low-frequency recovery (P < .05). Tinnitus relief and psychological outcomes were also significantly better in the SGB group (P < .05). Patients with both shorter intervals from symptom onset to salvage therapy and relatively lower baseline hearing thresholds demonstrated significantly greater hearing improvement. Neither group experienced severe adverse events. Lower baseline hearing thresholds and earlier therapy initiation predicted better outcomes. The triple salvage therapy significantly improved hearing recovery in RSSNHL patients, particularly in low-frequency ranges, while also reducing tinnitus severity and enhancing psychological well-being.\n\nID: 42338658\nTitle: Risks and Awareness of NIHL Among Dental Students: A Scoping Review.\nAbstract: Although noise exposure levels in the dental professional sector may be considered low when compared to other occupations, noise prevention strategies, especially for the students, are necessary to conserve hearing for this population group. The current scoping review aimed to ascertain the risks and awareness of NIHL among dental students globally. The review selected articles from 2014 to 2025, including both quantitative and qualitative studies, existing systematic reviews, and grey literature. The PCC (Population, Concept, Context) framework was used to guide the articles' eligibility criteria. Databases included PubMed, CINAHL, ProQuest, Scopus, Web of Science, and EBSCO Host. The Covidence data extraction tool, which enabled consensus checking, was used to guide the extraction process, and studies were reported according to the PRISMA guidelines. Sixty-nine studies were initially extracted, and after screening, 10 met the study criteria. Thematic analysis was used to synthesize the narrative data. Of the 10 studies analyzed, eight indicated risks associated with NIHL among undergraduate students. The use of high-speed handpieces during clinical training increased the risk for NIHL, with some students reporting symptoms such as tinnitus following the use of the equipment. Four articles reported on the awareness of noise exposure levels and associated risk for NIHL among the students. The review suggested that there was a risk of NIHL among dental students, particularly linked to cumulative noise exposure. However, awareness of NIHL among the students was poor; therefore, early identification, risk assessment, and awareness of the risks at undergraduate training are necessary for the active prevention of hearing loss. There is a need to encourage listening behaviors that promote awareness towards the prevention of NIHL for this group of students.\n\nID: 42409638\nTitle: Emergence of behavioral tinnitus in gerbils is associated with reduced spontaneous rates in single auditory nerve fibers.\nAbstract: Tinnitus is often initiated by damage to the peripheral auditory system, for example by acoustic overexposure. Animal studies have shown that such noise-induced tinnitus is related to increased spontaneous activity in the dorsal cochlear nucleus as well as further along the central auditory pathway. However, the role of spontaneous activity of the auditory nerve, connecting the peripheral and central auditory systems, in tinnitus emergence remains unknown. In the current study, tinnitus was induced by exposing anesthetized Mongolian gerbils of either sex to a 115-dB SPL narrowband noise. After one day of recovery, animals were behaviorally tested for gap detection deficits using a gap-prepulse inhibition of the acoustic startle reflex (GPIAS) paradigm, indicative of tinnitus. Noise-induced threshold shifts did not differ between animals with and without signs of tinnitus. Interestingly, single auditory nerve fibers recorded from animals with signs of tinnitus had significantly reduced spontaneous rates compared to both noise-exposed animals without signs of tinnitus and sham-exposed animals. Furthermore, spontaneous rate reduction was specific to fibers tuned to frequencies within the frequency bands that showed gap detection deficits. On the other hand, inter-spike interval variability and bursting behavior increased in fibers from noise-exposed compared to sham-exposed animals but did not differ with gap detection deficits. These findings suggest that tinnitus-related central hyperactivity may be initiated by reduced spontaneous rates of its innervating auditory nerve fibers. This is consistent with theoretical models explaining the central manifestation of tinnitus and offers a more detailed definition of tinnitus-related deafferentation.Significance statement Decades of previous research showed that tinnitus strongly connects to peripheral cochlear damage and to neural aberrations in the central auditory system. However, up to now, the role of the auditory nerve, connecting the peripheral to the central auditory system, in the emergence of tinnitus pathology has remained unclear. The current study showed that spontaneous activity is significantly reduced in auditory nerve fibers recorded from noise-exposed animals with behavioral signs of tinnitus shortly after the exposure. This insight helps us to understand why certain central neural correlates of tinnitus emerge. Furthermore, understanding the physiological basis of the initiation phase of tinnitus may lead to new intervention strategies to treat it.\n\nID: 42403965\nTitle: Reactions to Tinnitus Based on Color Code Personality Type.\nAbstract: Although studies of tinnitus and personality are prevalent in tinnitus research, studies of tinnitus-related distress across personality types using the Color Code Personality Assessment are lacking. The purpose of this research was to evaluate the relationship between personality type and the reaction to tinnitus using the Color Code Personality Assessment and the Tinnitus Reaction Questionnaire (TRQ). We conducted an online survey involving 178 participants. The survey included the TRQ to evaluate tinnitus-related distress and the Color Code Personality Assessment to determine personality type. The Color Code Personality Assessment results in one of four personality colors, red, blue, white, or yellow, and focuses on how to interact and communicate with different personality subtypes. The survey was posted to 11 different social media groups on Facebook and was open for 3 months. A one-way analysis of variance (ANOVA) was conducted to evaluate the effect of personality type on the TRQ score. One-sample chi-square tests were conducted to determine if the number of respondents with tinnitus-related distress was greater than chance for each personality type. The one-way ANOVA revealed a significant main effect for personality type. Follow-up tests comprising the Bonferroni test indicated that the TRQ scores for red personality types were significantly higher than those for white personality types. Analyses using one-sample chi-square tests for each personality type indicated significant results for respondents with blue or red personality types. Reactions to tinnitus differed across personality types. Respondents with the red personality type reported higher tinnitus-related distress than that of respondents with the white personality type. Respondents with blue and red personality types were more likely to report bothersome tinnitus. Although various tinnitus questionnaires that assess tinnitus distress and its effect on different areas of the patient's life are available, audiologists do not have a tool that allows insight regarding how to appropriately counsel and treat patients with tinnitus based on their reaction to it. Understanding the personality of patients and how personality will impact their reaction to tinnitus can guide the clinician's ability to provide effective counseling, thus adding to the clinician's skillset the ability to deliver customized treatment options to patients with tinnitus.\n\nID: 42394931\nTitle: Ginkgo biloba extract for dizziness-related symptoms in central neurological disorders: a systematic review and meta-analysis.\nAbstract: Dizziness associated with central neurological disorders-broadly defined as dizziness or vertigo attributable to central nervous system pathology affecting central vestibular processing-is a clinically challenging and heterogeneous condition with limited treatment options. Ginkgo biloba extract-through its microcirculatory, neuroprotective, and anti-inflammatory mechanisms-represents a biologically plausible intervention. However, its efficacy in this setting has not been comprehensively established. We evaluated the efficacy and safety of Ginkgo biloba extract through a systematic review and meta-analysis of randomized controlled trials (RCTs). Nine international and Korean databases were searched from January 1974 through November 2025. Studies were eligible if they were RCTs enrolling adults aged 18\u202fyears or older with cerebrovascular disease, neurodegenerative disease, or central vestibular dysfunction who had dizziness, vertigo, or balance-related symptoms or relevant outcome assessments. Cochrane RoB 2.0 tool and certainty of evidence was rated using the Assessment, Development and Evaluations (GRADE) approach. Prespecified subgroup analyses by underlying etiology and intervention type, together with leave-one-out sensitivity analyses, were performed to explore heterogeneity. Nine RCTs (N\u202f=\u202f2,394) were included; participants were predominantly drawn from dementia populations (71.6%), with smaller contributions from cerebral arteriosclerosis (23.0%) and vertebrobasilar or posterior circulation disorders (5.4%). Ginkgo biloba significantly reduced dizziness/vertigo severity on the 11-point box scale (MD\u202f-\u202f0.76, 95% CI\u202f-\u202f1.35 to -0.18; p\u202f=\u202f0.01) and VAS (SMD\u202f-\u202f0.38, 95% CI\u202f-\u202f0.58 to -0.19; p\u202f=\u202f0.0001). Moderate-certainty evidence suggested improvements in functional outcomes and quality of life, including the Alzheimer's Disease Activities of Daily Living International Scale (MD\u202f=\u202f-0.17, 95% CI: -0.22 to -0.13) and the Dementia Quality of Life - Proxy (MD\u202f=\u202f2.00, 95% CI: 0.85 to 3.15). The intervention was generally well tolerated, with significantly lower risks of angina pectoris (OR 0.51, 95% CI 0.31 to 0.85) and tinnitus (OR 0.37, 95% CI 0.22 to 0.63) and no significant increase in other adverse events. Ginkgo biloba extract may reduce dizziness severity and improve daily functioning in patients with central neurological disorders accompanied by dizziness or vertigo, with a favorable safety profile. However, given the small number of eligible trials, substantial clinical and statistical heterogeneity, and the predominance of dementia-derived data, these findings should be interpreted with caution. Well-designed RCTs in clearly defined central vestibular populations, ideally confirmed by neuroimaging or vestibular testing, are needed to confirm these results. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251229692, PROSPERO: CRD420251229692.\n\nID: 42392687\nTitle: Efficacy and safety of single-fraction radiosurgery in vestibular schwannoma: a 10-year experience.\nAbstract: This study aimed to evaluate long-term tumor control, safety, and prognostic factors following single-fraction stereotactic radiosurgery (SRS) for vestibular schwannoma (VS). In this retrospective single-institution study, 68 patients with VS were treated with photon-based single-fraction SRS (mean dose, 13.1 Gy; range, 12 to 15 Gy). Treatment planning was based on computed tomography-magnetic resonance imaging (MRI) fusion with organ-at-risk sparing and a planning target volume margin of 0-2 mm. The primary endpoint was local control (LC). Secondary endpoints included toxicity and predictors of treatment failure. After a median follow-up of 68 months, LC was maintained in 95.6% of patients. Actuarial LC rates at 5 and 10 years were both 98.5%. MRI showed tumor shrinkage in 41.2% and stability in 57.4% of cases. Treatment was well tolerated. Acute adverse events were infrequent and mild. Localized alopecia occurred acutely in one patient (1.5%) and did not persist into late follow-up. Vertigo and tinnitus were analyzed as disease-related symptoms rather than treatment-related toxicities. Severe toxicity (grade \u2265 3) was rare (<3%). Cox regression revealed no statistically significant predictors of local failure, though trends suggested higher risk after prior surgery and with doses \u226514 Gy. Single-fraction SRS provides durable long-term LC of VS with a favorable toxicity profile, supporting its role as a primary treatment modality. Optimal outcomes appear to be associated with lower prescription doses (<14 Gy) and treatment of de novo tumors.\n\nID: 42384477\nTitle: Auditory Outcomes After Simultaneous Translabyrinthine Vestibular Schwannoma Resection and Cochlear Implantation: A Prospective Case Series.\nAbstract: Cochlear implantation (CI) has emerged as a potential strategy for auditory rehabilitation in patients undergoing vestibular schwannoma (VS) surgery. However, outcomes remain variable, particularly in patients with neurofibromatosis type 2 (NF2). To evaluate auditory and patient-reported outcomes following simultaneous CI during VS resection. This prospective consecutive case series included six adult patients undergoing simultaneous translabyrinthine VS resection and CI. Three patients had sporadic VS and three had NF2-associated bilateral tumors. Audiological outcomes were assessed preoperatively (T0) and one year after CI activation (T1), including pure-tone average (PTA) and speech perception. Patient-reported outcomes included three questionaries. Auditory perception was achieved in all patients. Postoperative PTA was similar between sporadic and NF2 patients (29.5\u2009dB vs. 31.75\u2009dB). However, speech perception outcomes differed substantially. Sporadic VS patients achieved high performance (monosyllabic 90%, disyllabic 96%, sentence recognition (SR) 100%), whereas NF2 patients showed lower scores (monosyllabic 40.35%, disyllabic 38%, SR 35%). Tinnitus improved in all patients, with complete remission in 66.7% of cases. Simultaneous CI during VS surgery is a feasible rehabilitation strategy in selected patients. Speech perception differed between sporadic and NF2 cases despite similar hearing thresholds, highlighting the importance of cochlear nerve integrity, tumor burden and duration of deafness.\n\nID: 42378538\nTitle: Round Window Reinforcement for Semicircular Canal Dehiscence Syndrome.\nAbstract: To evaluate the clinical outcomes and safety profile of round window reinforcement (RWR) as a minimally invasive surgical treatment for patients with semicircular canal dehiscence syndrome (SCDS). This retrospective case series analyzed 7 patients (mean age: 59 years) diagnosed with SCDS who underwent transcanal RWR between June 2024 and June 2025 at the Kopfzentrum Bielefeld. Inclusion criteria followed the B\u00e1r\u00e1ny Society consensus diagnostic standards. Clinical symptoms, audiometric findings, and vestibular test results-including Dizziness Handicap Inventory (DHI) scores-were assessed pre and postoperatively. In 2 patients, endolymphatic hydrops was diagnosed via delayed contrast-enhanced magnetic resonance imaging and monitored postoperatively. All patients completed follow-up (mean: 35 months). Improvement in auditory symptoms was observed in 5 of 7 patients (71.4%), including tinnitus relief in 83.3% and hyperacusis relief in 75%. Vertigo improved in 50% of symptomatic cases. No postoperative deterioration in symptoms, DHI score, or hearing was observed. Audiometric outcomes showed a non-significant mean change in air-bone gap (\u00b12.5 dB). No intra- or postoperative complications occurred. In patients with concomitant hydrops, auditory improvement was noted, though vertigo persisted. Round window reinforcement appears to be a safe and effective therapeutic option for selected patients with SCDS, particularly those presenting predominantly auditory symptoms or contraindications to more invasive procedures. Further prospective studies are needed to validate these findings and define the role of RWR in the broader surgical management of third window syndromes.\n\nID: 42377247\nTitle: Carotid-cavernous Fistula in a Patient with Minimal Head and Facial Trauma: A Case Report.\nAbstract: Intracranial arterial injury is typically associated with high-energy trauma. Early diagnosis and treatment are essential for improving the patient's functional prognosis. A 76-year-old woman complained of pulsatile tinnitus 15 days post motor vehicle collision. On presentation she was found to have sustained polytrauma, mostly to her abdominal and thoracic regions, as well as a facial contusion. She then developed ptosis, conjunctival congestion, and an ocular motility disorder in all directions in her right eye. Magnetic resonance angiography showed a direct high-flow shunt from the internal carotid artery to the cavernous sinus. Similar symptoms then developed on her left side. She underwent successful embolization to the left-sided fistula. Fistulization of the carotid with the cavernous sinus is a rare complication of head or facial trauma. Our case indicates that this can occur even in patients with seemingly minor head or facial trauma.\n\nID: 42372279\nTitle: Adverse Events After Same-Day COVID-19 and Influenza Vaccination Versus Influenza Vaccination Alone : A Target Trial Emulation.\nAbstract: Safety studies of the COVID-19 vaccine have identified some adverse events. Yet newer variant-updated formulations, along with increased hybrid immunity, may change these risks. Early-era safety data may not reflect experience with updated formulations in more immune-experienced populations. To evaluate 90-day risks for adverse events after coadministration of COVID-19 and influenza vaccines compared with influenza vaccination alone, across bivalent, XBB-adapted, and KP-adapted COVID-19 vaccine periods. Target trial emulation using electronic health care data. U.S. Department of Veterans Affairs. Participants receiving both COVID-19 and seasonal influenza vaccines (n\u2009=\u2009705\u2009124) and those receiving only an influenza vaccine (n\u2009=\u20091\u2009813\u2009205) between 1 September 2022 and 26 August 2025. Receipt of both COVID-19 and seasonal influenza vaccines versus receipt of only an influenza vaccine. 90-day risks for 46 prespecified individual adverse events grouped into 3 composite outcomes (tier 1, serious or life-threatening; tier 2, clinically significant; tier 3, less severe or self-limiting), using weighted discrete-time survival models. For all 3 composite outcomes, risks were similar between groups: tier 1 (risk ratio [RR], 1.03 [95% CI, 0.99 to 1.09]), tier 2 (RR, 0.99 [CI, 0.96 to 1.03]), and tier 3 (RR, 0.99 [CI, 0.96 to 1.02]). Of the 46 individual adverse events, 2 tier-3 risks had nominal statistical significance: syncope (RR, 1.09 [CI, 1.02 to 1.17]) and tinnitus (RR, 0.95 [CI, 0.92 to 0.99]); no risks were statistically significant after correcting for multiple comparisons. For all risks in tier 1 or tier 2, confidence bounds included 1.0 (no effect). In period-stratified analyses, neither composite (tier) nor individual event estimates supported differences in risks between groups. Generalizability and potential unmeasured confounding. Same-day coadministration of COVID-19 and influenza vaccines was not associated with an increased risk for adverse events in 3 updated-formulation periods. These findings support the short-term safety of coadministration. U.S. Department of Veterans Affairs.\n\nID: 42370660\nTitle: Unusual Case of Granulomatosis with Polyangiitis Complicated with Hormographilella aspergillata Skin Infection.\nAbstract: Granulomatosis with polyangiitis (GPA) is a rare ANCA-associated small-vessel vasculitis that predominantly affects the respiratory tract and kidneys, while cutaneous manifestations occur less frequently. Opportunistic fungal infections complicating GPA are uncommon, particularly involving rare filamentous basidiomycetes. We describe a 32-year-old male with a prolonged history of crusting rhinitis, tinnitus, and progressive nodular and ulcerative skin lesions on the trunk and extremities, accompanied by fever and lower limb edema. Laboratory evaluation revealed elevated inflammatory markers and positive c-ANCA (anti-PR3). Histopathology demonstrated granulomatous inflammation consistent with GPA. The clinical course was complicated by a secondary cutaneous infection caused by Hormographiella aspergillata, isolated from a skin lesion. Initial antifungal therapy with itraconazole was ineffective; subsequent treatment with voriconazole resulted in resolution of the fungal infection. The patient was then successfully treated with systemic immunosuppressive therapy, achieving long-term remission. To our knowledge, this is the first reported case of GPA complicated by a cutaneous infection with H. aspergillata. This case highlights the diagnostic challenges of GPA with atypical skin manifestations and underscores the importance of microbiological evaluation of skin lesions prior to initiating aggressive immunosuppressive therapy. KEYWORDS: granulomatosis with polyangiitis; ANCA-associated vasculitis; Hormographiella aspergillata; opportunistic fungal infection Granulomatosis with polyangiitis (GPA), formerly Wegener's granulomatosis, is a necrotizing granulomatous vasculitis affecting small to medium-sized blood vessels and belonging to the group of ANCA-associated vasculitides (AAV) (1). The disease is characterized by granulomatous inflammation, necrotizing vasculitis, and the presence of antineutrophil cytoplasmic antibodies, most commonly proteinase-3 ANCA (PR3-ANCA) (2). GPA may involve virtually any organ system, with predominant involvement of the upper and lower respiratory tract and kidneys (3). Cutaneous manifestations are reported in approximately 30-50% of patients and are usually associated with systemic disease activity (4). Opportunistic infections may complicate the course of GPA, particularly in the context of delayed diagnosis or immunosuppressive therapy. Infections caused by rare filamentous fungi such as Hormographiella (H) aspergillata are exceptionally rare and have predominantly been reported in immunocompromised patients with hematological malignancies (5, 6). A 32-year-old male was admitted with multiple painful ulcerations and nodules on the trunk and extremities, accompanied by high fever and marked bilateral lower limb edema. Four months before admission, nodular lesions on the left auricle and right nipple regressed spontaneously after purulent discharge. Six weeks prior to referral, painless nodules on the back and right upper arm were surgically incised and treated with antibiotics, followed by clinical deterioration with fever, progressive ulcerations, and painful swelling of the feet and ankles (figures 1a and !b). The patient had a two-year history of nasal obstruction, crusting rhinitis, and intermittent right-sided tinnitus. Rhinoscopy revealed mucosal thickening and septal perforation with crusts and synechiae. Dermatological examination showed deep ulcerations with yellow-brown crusts on the back, right upper arm, and left cheek (figures 1a and 1b). Laboratory evaluation demonstrated elevated inflammatory markers (ESR 76 mm/h, CRP 47.4 mg/L), hypoalbuminemia, and positive c-ANCA (anti-PR3). Initial microbiological cultures were sterile. Histopathology revealed granulomatous panniculitis with abscess formation. Fungal culture isolated H. aspergillata. Itraconazole therapy was ineffective; subsequent voriconazole treatment led to complete resolution of the cutaneous infection. Due to persistent systemic inflammation and c-ANCA positivity, the patient was treated with high-dose glucocorticoids and cyclophosphamide, which gradually led to completely remission of skin lesions (figure 2). Renal involvement developed during treatment, manifested as proteinuria. Long-term immunosuppressive therapy resulted in sustained remission with mild residual renal impairment. GPA is a rare multisystem autoimmune disease with heterogeneous clinical presentation, often leading to delayed diagnosis. Cutaneous involvement may be the initial manifestation and includes purpura, nodules, necrosis, and ulcerations, reflecting underlying vasculitis and granulomatous processes (2). In our patient, prominent skin lesions preceded the diagnosis by several months and contributed to diagnostic uncertainty. Opportunistic infections are a recognized complication in GPA, particularly following immunosuppression; however, fungal infections caused by filamentous basidiomycetes are exceedingly rare (5, 6). Hormographiella aspergillata, the anamorphic form of Coprinopsis cinerea, is an environmental fungus that has been implicated almost exclusively in invasive infections in patients with hematological malignancies, with reported mortality rates up to 70% (5, 6). To our knowledge, no previous case of GPA complicated by cutaneous infection with H. aspergillata has been reported. The present case underscores the importance of thorough microbiological evaluation of atypical or non-healing skin lesions in patients with suspected systemic vasculitis, particularly before initiation of intensive immunosuppressive therapy. Failure to recognize opportunistic infections may lead to significant morbidity and mortality. This case emphasizes the crucial role of dermatologists in the early recognition of systemic vasculitis presenting with skin manifestations. Comprehensive clinical, histological, and microbiological assessment is essential to establish the correct diagnosis and to identify rare infectious complications. Multidisciplinary management and careful monitoring are necessary to achieve long-term remission and to minimize treatment-related complications.\n\nID: 42370207\nTitle: Transarterial Embolization via the Occipital Artery for a Posterior Condylar Canal Dural Arteriovenous Fistula Following Head Trauma.\nAbstract: Posterior condylar canal dural arteriovenous fistula is rare, and cases of posterior condylar canal dural arteriovenous fistula directly related to trauma have been reported even less frequently. We describe a case of posterior condylar canal dural arteriovenous fistula that presented with tinnitus soon after head trauma and was successfully treated with transarterial embolization. A 60-year-old man presented with right-sided tinnitus that had persisted for 2 weeks after sustaining a right temporal injury. Digital subtraction angiography revealed a posterior condylar canal dural arteriovenous fistula with venous drainage from the posterior condylar vein to the suboccipital cavernous sinus, without cortical venous reflux. The shunt was supplied by a single feeder, the jugular branch of the occipital artery. Transarterial embolization using N-butyl cyanoacrylate and coils achieved complete occlusion of the shunt. The patient's tinnitus resolved immediately after the procedure, and follow-up angiography demonstrated persistent complete occlusion of the fistula, with no evidence of recurrence. Posterior condylar canal dural arteriovenous fistula is a rare lesion that may occur following head trauma. Bone-window three-dimensional angiographic reconstruction is useful for diagnosis, as it clearly delineates the relationship between the skull base canal and the shunt. Transarterial embolization can be a curative treatment option when performed with a thorough understanding of the relevant vascular anatomy and potentially hazardous anastomoses.\n\nID: 42369362\nTitle: Resting-state functional connectivity and local activity differences across bothersome and non-bothersome tinnitus phenotypes.\nAbstract: This study aimed to characterize resting-state functional differences across clinically defined bothersome tinnitus, non-bothersome tinnitus, and hospital-based non-tinnitus control groups, focusing on imaging differences related to tinnitus phenotype. This case-control study included 61 patients with bothersome tinnitus (BT), 52 with non-bothersome tinnitus (NBT), and 50 hospital-based non-tinnitus controls. Resting-state fMRI scans were acquired, and the data were analyzed using fractional amplitude of low-frequency fluctuations (fALFF), regional homogeneity (ReHo), and seed-based functional connectivity (FC) using broad bilateral temporal lobe regions of interest to assess temporal-related network connectivity, including temporal-limbic interactions. Group comparisons were performed using ANCOVA controlling for demographic, audiological, physiological, sleep-related, and emotional covariates, cluster-level FDR-corrected p <\u202f0.05. Exploratory correlation analyses were further conducted to examine associations between extracted imaging indices and clinical measures, as well as potential relationships among significant imaging findings. Resting-state fMRI revealed significant group differences in functional connectivity between the bilateral temporal lobe seed and the left ACC/mOFC cluster. Post hoc analyses showed stronger connectivity in BT than in NBT, whereas BT did not differ significantly from hospital-based non-tinnitus controls. A similar pattern was observed for ReHo in the medial superior frontal gyrus, with lower values in NBT than in both BT and controls. fALFF analyses showed region-specific differences across temporal, frontal, insular, occipital, supramarginal, and postcentral regions, with the most consistent differences observed between BT and NBT. Exploratory analyses showed no significant FC-ReHo correlation within the BT group, and no associations between imaging indices and clinical or audiological measures survived FDR correction. In sensitivity analyses retaining the original covariate structure and additionally adjusting for tinnitus loudness VAS, most BT-NBT differences were attenuated, suggesting that these imaging differences may partly reflect tinnitus loudness or related clinical burden. Resting-state FC, fALFF, and ReHo measures revealed phenotype-related functional differences between BT and NBT. Because several key measures did not differ between BT and hospital-based non-tinnitus controls, these findings should be interpreted as group-level imaging features across tinnitus phenotypes, not as BT-specific abnormalities.\n\nID: 42363966\nTitle: Temporal bone remodeling after venous stenting for pulsatile tinnitus: isolated dehiscence versus diverticulum.\nAbstract: To evaluate clinical outcomes and temporal bone remodeling after venous sinus\u00a0stenting for pulsatile tinnitus (PT), and to compare remodeling rates between isolated sigmoid sinus wall dehiscence (SSWD) and diverticulum-associated SSWD. This retrospective cohort study included 70 consecutive patients who underwent venous sinus\u00a0stenting for PT. Clinical success was defined as symptom improvement or complete resolution. The primary endpoints were short-term clinical success (at 3 months) and temporal bone remodeling on follow-up CT (n\u2009=\u200952). Long-term clinical success was evaluated as a secondary endpoint. Multivariable logistic regression, adjusted for age, sex, dehiscence size, diverticulum presence, and preoperative Tinnitus Handicap Inventory (THI) score, was used to identify predictors of temporal bone\u00a0remodeling. Short-term clinical success was achieved in 65/70 patients (92.9%). Remodeling occurred in 38/52 patients (73.1%) with follow\u2011up CT. Remodeling rates were significantly higher in patients with a diverticulum versus isolated SSWD (85.7% (30/35) vs 47.1% (8/17); adjusted OR, 8.08; 95% CI: 1.31-49.73; p\u2009=\u20090.024). Older age independently predicted temporal bone\u00a0remodeling (adjusted OR per year, 1.14; 95% CI: 1.03-1.26; p\u2009=\u20090.012). Long-term clinical success was observed in 97.4% (37/38) of remodeled patients and 85.7% (12/14) of non-remodeled patients (p\u2009=\u20090.15). Venous sinus\u00a0stenting for PT results in a high rate of clinical success. The presence of a diverticulum strongly predicts subsequent temporal bone remodeling, whereas SSWD appears less likely to remodel, highlighting potential pathophysiological differences between these anatomical subtypes. Question Venous sinus\u00a0stenting for pulsatile tinnitus results in high clinical success, but temporal bone remodeling differs by anatomical subtype. Findings Patients with a sigmoid sinus diverticulum demonstrate significantly higher rates of postoperative bone remodeling compared to those with isolated dehiscence. Clinical relevance Identifying the specific anatomical anomaly may help to predict temporal bone remodeling and facilitate individualized patient counseling regarding long-term structural outcomes.\n\nID: 42356922\nTitle: Comprehensive Review of Nystagmus and Vertigo Diagnostics: From Pathological Foundations to AI-Driven Telemedicine.\nAbstract: Nystagmus, the involuntary rhythmic oscillation of the eyes, is a critical diagnostic marker in vestibular medicine, distinguishing life-threatening central disorders such as stroke from benign peripheral conditions including Benign Paroxysmal Positional Vertigo (BPPV). Despite its clinical importance, accurate nystagmus assessment has long been constrained by expensive infrared video-oculography equipment such as videonystagmography, specialist dependency, and the episodic nature of vestibular symptoms that are often resolved before a clinical encounter. This review synthesizes approximately 50 papers published between 1952 and 2026 across four thematic domains: AI-driven nystagmus analysis, clinical medicine, smartphone and portable hardware innovations, and telemedicine and remote monitoring. On the AI front, classical machine learning models achieve up to 98.77% nystagmus recognition accuracy using ensemble methods, while deep learning frameworks spanning CNNs, U-Nets, LSTMs, and optical flow networks demonstrate clinical-grade slow-phase velocity measurement equivalent to gold standard video-oculography on standard smartphone RGB video. Large language and vision models including GPT-4V and Gemini 2.0 show early-stage promise as zero-shot triage tools but currently fall well below specialist-level diagnostic accuracy. Concurrently, portable hardware innovations ranging from 3D-printed goggle systems to ARKit-based smartphone applications are narrowing the accessibility gap, while telemedicine frameworks enable ictal recording and cloud-based specialist review outside the clinic. Across all domains, the common barriers to clinical translation are dataset scarcity for rare BPPV subtypes, sensitivity to ambient conditions, and the absence of explainable AI mechanisms. This review maps the current state of the field and identifies multimodal data fusion, prospective clinical validation, and interpretable AI as the critical next steps toward equitable, specialist independent vestibular diagnostics.\n\nID: 42352596\nTitle: Auricular Ultrasonic Vagus Nerve Stimulation: Effectiveness of Blinding and the Occurrence of Adverse Effects in People with Tinnitus.\nAbstract: Background/Objectives: Vagus Nerve Stimulation (VNS) has been suggested as a treatment for tinnitus, but its effect on the condition remains unclear. Ultrasonic Vagus Nerve Stimulation (U-VNS) involves non-invasive stimulation of the auricular branch of the vagus nerve, potentially providing an alternative to traditional VNS. To pre-emptively address some of the methodological challenges of future trials investigating U-VNS, a highly blindable sham device is needed. This study aimed to (1) investigate the effectiveness of blinding of a U-VNS device and (2) record any adverse effects, including any negative effects on tinnitus loudness, alongside their onset and duration. Methods: In this single-blind randomized controlled study, 20 volunteers with chronic tinnitus received two 29 min sessions of true U-VNS followed by sham U-VNS, or vice versa. Sessions were a week apart, and in a randomized order. The effectiveness of blinding and adverse effects, including changes in tinnitus loudness, were measured using self-report questionnaires. Results: James' Blinding Index revealed that blinding was highly effective in both the real U-VNS condition, BI = 0.79, 95% CI (0.61-0.92), and the sham condition, BI = 0.76, 95% CI (0.60-0.89). Adverse effects were uncommon and mild, primarily consisting of sensations on the skin beneath the transducer. For most participants, tinnitus loudness either decreased or stayed the same in both conditions. Conclusions: A high level of blinding was achieved, suggesting that the ZenBud sham device may be suitable as an effective placebo control in future trials. Adverse effects were uncommon and mild. These findings will help inform the design of future clinical trials to evaluate the safety and efficacy of U-VNS.\n\nID: 42352574\nTitle: The Auditory-Visual Stroop Test to Assess Subjects with Tinnitus.\nAbstract: Background/Objectives: In this three-stage study, we aimed to adapt an Auditory-Visual Stroop test (AV-Stroop test) for tinnitus subjects, evaluate the correlation between performance in the conventional Stroop test (C-Stroop test) and the AV-Stroop test; assess the effect of cognitive screening test performance on the AV-Stroop test's results; and apply the AV-Stroop test in participants with tinnitus and controls. Methods: At the First Stage, the AV-Stroop test was adapted using white noise (WN), pure tone (PT), and narrow band (NB) sound stimuli. At the Second Stage, results of the AV-Stroop test, the C-Stroop test, and the Montreal Cognitive Assessment (MOCA) were compared (n = 45). At the Third Stage, the AV-Stroop test was applied to participants with and without tinnitus (n = 70). The tinnitus group was assessed with an additional test track (stimuli matched to tinnitus spectral characteristics, Tinnitus Pitch). Results: We adapted 34 training and evaluation tracks for the AV-Stroop test. AV-Stroop test's results were correlated with C-Stroop test's total task time (WN, p-value = 0.002; NB and PT, p-value < 0.001 comparing C-Stroop word reading task; and WN, NB, and PT, p-value < 0.001 for C-Stroop color naming task), and number of errors (NB, p-value < 0.001 comparing C-Stroop word reading task, and p-value = 0.012 for C-Stroop color naming task). Participants' MOCA scores were not associated with AV-Stroop test performance. Participants with tinnitus required more time and made more errors in the AV-Stroop test. Additionally, the tinnitus group made more errors in the Tinnitus Pitch track. Conclusions: The AV-Stroop test proved to be an accessible, easy-to-administer tool for evaluating attentional and inhibitory control in participants with tinnitus. The stimulus with spectral characteristics similar to tinnitus perception was more effective in assessing top-down executive control in participants with the symptom.\n\nID: 42346194\nTitle: Ultrasound-Guided Intra-Articular Infiltration of Hyaluronic Acid, Lidocaine, and Methylprednisolone in Patients with Temporomandibular Disorders (TMD): A Preliminary Pilot Case Series.\nAbstract: This preliminary pilot case series aims to evaluate the feasibility and temporal evolution of pain and function following an ultrasound-guided infiltration technique with hyaluronic acid and methylprednisolone in a specific patient population with Temporomandibular Disorders (TMD) characterized by MRI-confirmed retrodiscal tissue hyperemia. Given the absence of a control group, this study represents a preliminary exploration of a clinical approach utilizing individualized interocclusal devices during infiltration. Twenty-eight patients (16 females, 12 males) with TMD and MRI evidence of retrodiscal tissue hyperemia were enrolled in this prospective, uncontrolled study. A unique protocol was employed, utilizing individualized interocclusal devices to optimize joint space access during bilateral ultrasound-guided infiltration of a mixture containing low-molecular-weight hyaluronic acid, lidocaine, and methylprednisolone acetate. Pain intensity (VAS 0-100 mm) and associated symptoms (tinnitus, vertigo, headache, joint clicking) were assessed at baseline and at 30, 60, and 90 days' follow-up. A statistically significant temporal reduction in pain was observed at all follow-up points (p < 0.001), with the mean VAS score decreasing from 70.5 \u00b1 11.4 mm at baseline to 43.0 \u00b1 11.1 mm at 90 days. Joint clicking disappeared in 80% of patients immediately after treatment. The ultrasound-guided infiltration technique, combined with personalized interocclusal support, demonstrated preliminary feasibility and short-term temporal improvement in pain and joint clicking in this specific patient cohort. Due to the lack of a control group and the multimodal nature of the intervention, these findings should be considered preliminary and do not allow for causal inferences regarding the efficacy of individual components.\n\nID: 42345633\nTitle: Temporal Trends and ICD-11-Mapped Patterns of Otology Research in Saudi Arabia, 1978-2024: A Scoping Review Using Negative Binomial Modelling.\nAbstract: Purpose: This study aimed to map publication trends, topical focus, study designs, and institutional concentration in otology research in Saudi Arabia from 1978 to 2024 to deduce any topical, regional, institutional, or funding disparities in the field of otology in the country. Methods: We conducted a scoping review of studies on human ear diseases in Saudi Arabia, searching PubMed and the Cochrane Library from inception to 31 December 2024. Bibliometric characteristics were charted, topics were mapped to ICD-11 chapters, and temporal trends were modelled using negative binomial regression with a single data-driven breakpoint. Results: Of 2227 records identified, 510 studies were included. Annual output increased by 9.28% (95% CI 7.05-11.55). An inflection occurred around 2017, with slower growth before 2017 (7.2%/year, 95% CI 5.3-9.1) and faster growth from 2018 onward (23.9%/year, 95% CI 18.6-29.4). The institutional affiliation of first authors was concentrated in a small number of organizations, led by King Saud University. Observational studies predominated (441/510), whereas experimental studies were limited (16/510). ICD-11 mapping showed the greatest concentration in \"Ear and mastoid\" (189/510, 37.1%) and \"Factors influencing health status or contact with health services\" (179/510, 35.1%) chapters. Funding was reported in 75 studies. Conclusions: PubMed- and Cochrane-indexed otology and hearing health research output in Saudi Arabia has grown substantially, particularly since 2017, but remains concentrated by institution, region, study design, and topic. The dominance of cochlear implant and hearing impairment research, together with limited multicenter, experimental, vestibular, tinnitus, and rehabilitation-focused studies, identifies priorities for future audiology and neurotology research planning.\n\nID: 42379384\nTitle: A comparative study reveals distinct patterns of resting-state activity in tinnitus and chronic pain.\nAbstract: Tinnitus and chronic pain, as two perceptual disorders frequently accompanied by negative emotions, significantly impair patients' daily functioning and overall well-being. However, the neurophysiological mechanisms that account for their frequently observed clinical similarities have yet to be fully elucidated. The study enrolled a total of 56 participants, including 18 tinnitus patients and 19 chronic pain patients, alongside 19 healthy controls. We computed the fractional amplitude of low-frequency fluctuations (fALFF) and regional homogeneity (ReHo) from resting-state fMRI data to quantify localized brain activity intensity and neural synchronization. Statistical analysis suggested a significant elevation in fALFF within the calcarine cortex of tinnitus patients compared to healthy controls (p\u202f<\u202f0.05, FDR-corrected). In contrast, chronic pain patients exhibited notable increases in both fALFF and ReHo in the inferior frontal gyrus (IFG). Direct comparisons between patient groups suggested that tinnitus patients had higher fALFF in the inferior temporal gyrus (ITG), supplementary motor area and fusiform gyrus, but lower fALFF in the right IFG, precuneus, and caudate nucleus. Regarding ReHo, patients with tinnitus exhibited significantly elevated ReHo values in the supplementary motor area, while demonstrating reduced ReHo in both the precuneus and caudate nucleus (all p\u202f<\u202f0.05, FDR-corrected). The observed differences between tinnitus and chronic pain in brain regions including the prefrontal cortex, ITG, and fusiform gyrus provide neuroimaging correlates associated with the two conditions. These findings may inform future neuromodulation targets and support clinical differential diagnosis.\n\nID: 42339866\nTitle: Tinnitus, temporomandibular disorders and muscle activity: what's the connection?\nAbstract: This study was aimed at comparatively evaluating the relationship between temporomandibular disorder (TMD) and subjective tinnitus, as well as the effects of TMD treatment on masticatory muscle activity, tinnitus symptoms, and patient perception. In this prospective cohort study, patients diagnosed with both TMD and tinnitus were divided into groups with or without bruxism. The inclusion criteria were confirmed diagnosis of TMD and tinnitus. The exclusion criteria were history of prior TMD treatment, neurological disorders, or systemic diseases affecting muscle function. The primary outcome measures were electromyographic (EMG) assessments of masseter muscle maximum voluntary contraction (MVC) and the percentage of overlapping coefficient (%POC), determined via surface EMG (sEMG). The secondary outcomes included changes in tinnitus symptoms, assessed with the Tinnitus Handicap Inventory (THI), and pain levels, evaluated with the Visual Analog Scale (VAS). A total of 70 eligible participants were evenly distributed between groups. Tinnitus symptoms resolved in 35.7% of patients and did not significantly differ between groups (p > 0.05). Masseter MVC values decreased numerically but non-significantly after treatment (p > 0.05). In contrast, significant post-treatment improvements were observed in %POC, VAS, and THI scores (p < 0.05). Pre- and post-treatment comparisons of MVC, %POC, VAS, and THI revealed no significant intergroup differences (p > 0.05). TMD treatment appeared to effectively decrease subjective tinnitus symptoms and improve quality of life. Our findings suggest that TMD management might play an important role in tinnitus treatment and indicate that tinnitus is more associated with underlying internal disorders than with masticatory muscle activity directly influenced by bruxism.\n\nID: 42338403\nTitle: Impact of Treatment Intensity on Quality of Life in Patients With Metastatic Testicular Cancer.\nAbstract: Testicular cancer (TC) is the most common malignancy in young men and is highly curable with platinum-based chemotherapy. With growing survivorship rates, treatment-related symptom burden and quality of life (QoL) have become increasingly important. This study evaluates the impact of different TC treatments on symptom burden and QoL. Of 715 patients with TC and primary or postchemotherapy retroperitoneal lymph node dissection (RPLND) treated at the University Hospital D\u00fcsseldorf between 2010 and 2024, 486 eligible survivors were contacted, and 124 (25.5 %) completed a standardized questionnaire. Treatment-related symptoms, including QoL and mental health status, were assessed using the EORTC QLQ-C30 and PHQ-9 questionnaires, respectively. Results were compared with age-matched reference values from the general population. A subgroup comparison of clinical stage (CS) II patients treated with primary RPLND versus first-line chemotherapy followed by RPLND was performed to identify chemotherapy-specific effects. The median time between last treatment and survey response was 55 months. Twenty-four patients were treated with primary RPLND, 80 patients with adjuvant or first-line chemotherapy and RPLND, and 20 patients with multiple lines of chemotherapy and RPLND. Overall, TC survivors reported high global QoL scores comparable to age-matched normative data. The most frequent treatment-related symptoms were polyneuropathy, tinnitus, retrograde ejaculation, and circulatory disorders, particularly among patients receiving multiple lines of chemotherapy. Subgroup analysis showed that CS II patients treated with a single first-line chemotherapy reported lower social functioning and greater financial distress compared with those managed with surgery alone. Despite the physical impact, depression rates were low and similar to the general population, indicating preserved psychological well-being. TC survivors maintain good QoL comparable to the general population despite therapy-related symptoms. While persistent side effects such as polyneuropathy and tinnitus are common, their impact on QoL is limited. However, even first-line chemotherapy affects sexual health, social functioning, and financial well-being, highlighting the importance of the development of new treatment approaches and clinical studies focusing on surgery as a QoL-preserving option in selected low-metastatic cases.\n\nID: 42338275\nTitle: Importance of Comprehensive Tinnitus Assessment: A Conceptual Analysis of International Classification of Functioning, Disability and Health (ICF)-Linked Questionnaires.\nAbstract: This study explores the extent to which commonly used tinnitus questionnaires align with relevant International Classification of Functioning, Disability and Health (ICF) domains. The aim is not to establish the superiority of any tool, but rather to identify potential gaps in domain coverage and to support more intentional questionnaire selection. A rapid review was conducted to identify validated tinnitus questionnaires used in clinical practice. Each questionnaire was systematically linked to ICF categories employing established frameworks. The study compared the domain coverage of the ICF-based international inventory for tinnitus (ICF-TINI) with that of other commonly used questionnaires and mapped overlapping and unique ICF codes to determine the breadth of coverage. While ICF-TINI addressed a wide range of ICF domains, no single questionnaire provided complete coverage, particularly for the domains of environmental factors and participation. Other tools such as the Tinnitus Functional Index and Tinnitus Handicap Inventory also demonstrated broad but incomplete domain representation. The findings underscore the importance of strategically combining tinnitus questionnaires based on ICF domain mapping, rather than relying solely on familiarity or tradition. The study proposes an evidence-informed approach to tool selection that may enhance person-centered tinnitus assessment. Further research is required to determine whether broader ICF coverage leads to improved outcomes.\n\nID: 42334723\nTitle: Beyond tumor control: symptom trajectories and hearing outcomes after contemporary Gamma Knife radiosurgery for vestibular schwannoma.\nAbstract: Gamma Knife radiosurgery (GKRS) is an established treatment for vestibular schwannoma, but contemporary cohort-level data integrating long-term tumor control with clinical symptom trajectories and hearing-related correlates remain valuable. We performed a retrospective cohort study of 286 patients with vestibular schwannoma (VS) treated with GKRS (2014-2024). The primary endpoint was local control. Secondary outcomes included overall survival and changes in hearing loss, imbalance, vertigo, dizziness, and tinnitus. Kaplan-Meier analysis was used to estimate local control and overall survival. Paired symptom changes were assessed using McNemar testing. The Median follow-up was 52.3 months (IQR 27.4-80.3). Progressive radiographic enlargement occurred in 5 patients, yielding a crude local control rate of 98.3%. The actuarial local control was 98.5% at 5 years and 96.5% at 10 years. Imbalance, vertigo, dizziness, and tinnitus improved significantly after GKRS, whereas hearing loss remained stable overall (59.4% vs. 57.3%, p\u2009=\u20090.441). Mean symptom burden declined from 1.74 to 1.20 symptoms per patient (p\u2009<\u20090.001). Post-radiosurgery hearing loss was more frequent in Koos IV tumors and increased stepwise across quartiles of cochlear mean dose: 38.7% for \u2264\u20092.9\u00a0Gy, 53.3% for >\u20092.9-3.6\u00a0Gy, 66.2% for >\u20093.6-4.5\u00a0Gy, and 73.8% for >\u20094.5\u00a0Gy (p\u2009=\u20090.00012). Baseline hearing loss remained the strongest predictor in multivariable modeling. At a median of four years GKRS provided tumor control in >\u200995% of VS patients and was associated with reduced overall symptom burden and improvement in vestibular symptoms. Hearing outcomes were related to baseline auditory status, Koos grade, and cochlear dosimetry. Not applicable.\n\nID: 42319726\nTitle: Associations Between Football-Related Exposures, Head Injury, Tinnitus, and Neuropsychological Health Outcomes Among Professional American-Style Football Players.\nAbstract: Auditory dysfunction such as tinnitus is a common sequelae of traumatic brain injury (TBI), and has been associated with neurobehavioral outcomes, including cognitive decline, depression, and anxiety. Few studies have examined associations between concussion history and tinnitus independent of confounding by blast injury or occupational noise exposure. This study investigated concussion history and tinnitus among former professional American-style football (ASF) players, and evaluated whether tinnitus mediates associations between concussion history and neurobehavioral outcomes. This cross-sectional study included former ASF players who contracted with a professional league after 1960 and completed self-administered questionnaires between 2019-2025. Surveys assessed football exposure, auditory dysfunction, and mental health. Cumulative head injury exposure was measured using self-reported concussion signs and symptoms during play. Tinnitus was self-reported and assessed concurrently with validated measures of perceived cognition, depression, and anxiety. Logistic regression evaluated associations between concussion symptom history and tinnitus, and linear regression models assessed mediation and interaction effects. Among 1085 participants (mean age 57.9\u2009\u00b1\u200913.5\u00a0years; 32.4% Black; 6.1\u2009\u00b1\u20093.7 seasons), greater concussion symptom history was associated with increased odds of tinnitus (highest vs. lowest quintile: OR\u2009=\u20092.90; 95%CI 1.91-4.43; p\u2009<\u20090.0001). Tinnitus did not mediate associations between concussion symptom history and neurobehavioral outcomes. However, associations with perceived cognition (p-interaction\u2009=\u20090.1), depression (p-interaction\u2009<\u20090.01), and anxiety (p-interaction\u2009<\u20090.01) were larger among participants reporting tinnitus. Greater concussion symptom history was associated with increased reporting of tinnitus, and neurobehavioral associations were stronger among those with tinnitus. Clinicians should consider tinnitus when evaluating long-term cognitive and mental health outcomes following repeated head injury.\n\nID: 42314530\nTitle: Down-sloping high-frequency audiometric findings in ENT-MS-12 auditory screen-positive patients with relapsing-remitting multiple sclerosis: A pilot case series.\nAbstract: Audio-vestibular symptoms, including hearing loss and tinnitus, are increasingly reported in people with multiple sclerosis (pwMS), yet their clinical significance and underlying mechanisms remain unclear. Both central demyelination and peripheral involvement along the brain-cochlea axis have been proposed as potential contributors.This study aims to explore and describe pure-tone audiometry (PTA) findings in pwMS who screened positive for auditory complaints on the ENT-MS-12 questionnaire, and to summarize associated clinical and magnetic resonance imaging (MRI) features during follow-up. In this prospective pilot study, 40 pwMS with relapsing-remitting MS were screened using the ENT-MS-12 questionnaire. Patients reporting auditory complaints and meeting predefined exclusion criteria were invited to undergo pure-tone audiometry (125-8000 Hz). Clinical data and MRI findings obtained within three months of audiometric testing were reviewed and compared with imaging from the previous year. Twenty-seven patients (67.5%) reported auditory symptoms. Eleven met the inclusion criteria and five consented to audiometric testing. All five patients showed a down-sloping audiometric configuration with elevated high-frequency thresholds, particularly at 6000-8000 Hz. Mean high-frequency thresholds were higher than age-matched reference values reported in the literature. During follow-up, four of five patients experienced clinical relapses; one of these also showed disease progression, auditory brainstem response abnormalities, and a temporal lobe lesion on MRI. In this pilot study, pwMS who reported hearing concerns and underwent audiometry presented subtle high-frequency auditory threshold elevations with a down-sloping audiometric pattern. These preliminary, descriptive findings suggest that incorporating auditory assessment may provide complementary clinical information in pwMS. Larger, controlled studies with electrophysiological testing and advanced neuroimaging are warranted to clarify the relevance and mechanisms of auditory involvement in multiple sclerosis, including potential central and peripheral contributions.\n\nID: 42313294\nTitle: Therapeutic Hybrid Intelligence with Neural and Knowledge-based Expert Reasoning for SRS (THINKERS): a mixture-of-experts AI model for vestibular schwannoma.\nAbstract: Outcome prediction after Gamma Knife radiosurgery (GKRS) for vestibular schwannoma remains largely guided by tumor size, Koos grade, baseline symptoms, cochlear dose constraints, and institutional experience rather than individualized estimates of tumor progression and functional outcomes. We developed THINKERS-VS, a mixture-of-experts (MoE) artificial intelligence framework for progression and symptom-transition prediction after GKRS. We performed a retrospective single-center study of vestibular schwannomas treated with GKRS. Variables available before the treatment were used to train a MoE neural network with discrete-time survival modeling. The model incorporated demographic, clinical, tumor, and radiosurgical variables. The primary endpoint was tumor progression across intervals of 3, 6, 12, 18, 24, 32, 48, and 60 months. Secondary endpoints included new or worsened hearing loss, imbalance, vertigo, dizziness, and tinnitus. Internal validation used grouped 5-fold cross-validation and a grouped holdout test split. Performance was assessed using AUC and Brier score. The cohort included 686 patients. Median age was 59.5 years, median tumor volume was 0.746 cm\u00b3, median prescription dose was 12.0 Gy, and median follow-up was 52.3 months. THINKERS-VS achieved strong progression discrimination across evaluated intervals, with AUCs ranging from 0.807 to 0.859. At 60 months, AUC was 0.807 and Brier score was 0.012. For symptom-transition prediction, holdout AUCs were 0.875 for hearing loss, 0.844 for imbalance, 0.813 for vertigo, 0.884 for dizziness, and 0.839 for tinnitus. THINKERS-VS provides an internally validated framework for individualized tumor progression and symptom-transition prediction after GKRS for vestibular schwannoma and recommends tumor margin dose associated with best outcome. Not applicable.\n\nID: 42309570\nTitle: Association between low free T4 values and prevalence of tinnitus in US adults: 2009-2012.\nAbstract: Tinnitus is a prevalent subjective auditory sensation affecting over 740 million people worldwide and often co-occurs with various systemic diseases. To date, the relationship between tinnitus and thyroid hormones has not been thoroughly studied. This study aimed to investigate the association between tinnitus and thyroid hormone levels in US adults. We used data from the 2009-2012 National Health and Nutrition Examination Survey (NHANES). A total of 1527 participants were included and stratified by the presence or absence of tinnitus. Logistic regression analysis was performed to assess the association between thyroid hormone levels and tinnitus. Furthermore, subgroup analyses were performed to explore the relationship between FT4 levels and tinnitus in different subgroups. Each 1ng/dL increase in FT4 was associated with approximately 67% lower odds of tinnitus (adjusted OR, 0.33; 95%CI, 0.11-0.94, p=0.0387). FT3 and TSH showed no significant association with tinnitus after adjustment. Lower FT4 levels were independently associated with higher tinnitus prevalence.\n\nID: 42309185\nTitle: A systematic review on sound-based therapy for individuals with hyperacusis.\nAbstract: Hyperacusis is marked by an abnormal sensitivity to everyday sounds, causing considerable distress and hindrance in daily life. It is frequently linked with other hearing disorders like tinnitus and may occur alongside neurological and psychiatric conditions such as autism, migraines, and depression. Recent research into hyperacusis treatment has explored various sound therapy methods, including counselling and the use of therapeutic sounds. Consequently, the current systematic review investigated whether sound-based therapy programs could alleviate the effects of hyperacusis. A total of 149 articles were retained for this study. After a thorough examination of the full text of the 14 articles that satisfied the inclusion criteria, nine quantitative studies were ultimately selected. These comprised one retrospective study, three studies comparing pre- and post-intervention outcomes, three randomized controlled trials, and two case studies. These nine studies collectively demonstrated that sound generator therapy significantly reduced the debilitating symptoms of hyperacusis, with all investigations reporting substantial symptomatic improvement post-intervention. Collectively, the nine studies demonstrated significant therapeutic benefits of sound generator interventions in reducing hyperacusis-related disability. However, the current evidence base would benefit from further randomized controlled trials to more comprehensively evaluate the clinical efficacy of sound-based treatments for this condition.\n\nID: 42307286\nTitle: Tinnitus disorder and musical auditory training: a double-blind randomized controlled clinical trial.\nAbstract: To evaluate the effect of Musical Auditory Training (MAT) on auditory system neuroplasticity and on tinnitus perception in adults. A randomized double-blind clinical trial, approved by the Research Ethics Committee. Twenty adults with tinnitus complaints for at least six months, intensity greater than four points on the Visual Analog Scale (VAS), normal bilateral hearing thresholds, and preserved neural synchrony at the brainstem level were included. Participants were randomly assigned to two groups: Control Group (CG, n=10), submitted to passive stimulation with audiovisual material without tasks, and Study Group (SG, n=10), submitted to MAT. Both groups underwent eight sessions, twice a week, over a four-week period. Assessments included verbal Long-Latency Auditory Evoked Potentials (LLAEP), to investigate neuroplasticity, as well as the VAS (volume and discomfort) and the Tinnitus Handicap Inventory (THI), to measure symptom perception. Both groups showed improvement in tinnitus perception after the intervention. However, a differentiated analysis revealed that the CG presented restricted changes, with improvement only in the duration of the P3 component of the LLAEP. In contrast, the SG showed broader changes, including significant alterations in both amplitude and duration of P3, suggesting greater neural recruitment associated with auditory processing. In addition, only the SG demonstrated consistent reductions in tinnitus volume and discomfort, as well as in the impact on quality of life, as reflected in THI scores. After four weeks, MAT proved to be superior to passive stimulation, promoting positive changes in auditory neuroplasticity, a greater reduction in tinnitus intensity and annoyance, and a significant improvement in participants' quality of life. Verificar o efeito do Treinamento Auditivo Musical (TAM) na neuroplasticidade do sistema auditivo e na percep\u00e7\u00e3o do zumbido em adultos. Ensaio cl\u00ednico randomizado duplo-cego, aprovado pelo Comit\u00ea de \u00c9tica em Pesquisa. Foram inclu\u00eddos vinte adultos com queixa de zumbido h\u00e1 pelo menos seis meses, intensidade maior que quatro pontos na Escala Visual Anal\u00f3gica (EVA), limiares auditivos normais bilateralmente e sincronia neural preservada em tronco encef\u00e1lico. Os participantes foram distribu\u00eddos aleatoriamente em dois grupos: Controle (GC, n=10), submetido \u00e0 estimula\u00e7\u00e3o passiva com material audiovisual sem tarefas, e Estudo (GE, n=10), submetido ao TAM. Ambos realizaram oito sess\u00f5es, duas vezes por semana, ao longo de quatro semanas. As avalia\u00e7\u00f5es compreenderam Potenciais Evocados Auditivos de Longa Lat\u00eancia (PEALL) verbais, para investigar neuroplasticidade, al\u00e9m da EVA (volume e inc\u00f4modo) e do Tinnitus Handicap Inventory (THI), para mensurar a percep\u00e7\u00e3o do sintoma. Ambos os grupos apresentaram melhora na percep\u00e7\u00e3o do zumbido ap\u00f3s a interven\u00e7\u00e3o. Contudo, a an\u00e1lise diferenciada mostrou que o GC apresentou mudan\u00e7as restritas, com melhora apenas na dura\u00e7\u00e3o do componente P3 dos PEALL. J\u00e1 o GE apresentou altera\u00e7\u00f5es mais amplas, incluindo mudan\u00e7as significativas na amplitude e dura\u00e7\u00e3o do P3, indicando maior recrutamento neural associado ao processamento auditivo. Al\u00e9m disso, apenas o GE demonstrou redu\u00e7\u00f5es consistentes no volume e no inc\u00f4modo do zumbido, bem como no impacto sobre a qualidade de vida, refletido nas pontua\u00e7\u00f5es do THI. Ap\u00f3s quatro semanas, o TAM mostrou-se superior \u00e0 estimula\u00e7\u00e3o passiva, promovendo altera\u00e7\u00f5es positivas na neuroplasticidade auditiva, diminui\u00e7\u00e3o mais expressiva da intensidade e do inc\u00f4modo do zumbido e melhora significativa na qualidade de vida dos participantes. Verificar o efeito do Treinamento Auditivo Musical (TAM) na neuroplasticidade do sistema auditivo e na percep\u00e7\u00e3o do zumbido em adultos. Ensaio cl\u00ednico randomizado duplo-cego, aprovado pelo Comit\u00ea de \u00c9tica em Pesquisa. Foram inclu\u00eddos vinte adultos com queixa de zumbido h\u00e1 pelo menos seis meses, intensidade maior que quatro pontos na Escala Visual Anal\u00f3gica (EVA), limiares auditivos normais bilateralmente e sincronia neural preservada em tronco encef\u00e1lico. Os participantes foram distribu\u00eddos aleatoriamente em dois grupos: Controle (GC, n=10), submetido \u00e0 estimula\u00e7\u00e3o passiva com material audiovisual sem tarefas, e Estudo (GE, n=10), submetido ao TAM. Ambos realizaram oito sess\u00f5es, duas vezes por semana, ao longo de quatro semanas. As avalia\u00e7\u00f5es compreenderam Potenciais Evocados Auditivos de Longa Lat\u00eancia (PEALL) verbais, para investigar neuroplasticidade, al\u00e9m da EVA (volume e inc\u00f4modo) e do Tinnitus Handicap Inventory (THI), para mensurar a percep\u00e7\u00e3o do sintoma. Ambos os grupos apresentaram melhora na percep\u00e7\u00e3o do zumbido ap\u00f3s a interven\u00e7\u00e3o. Contudo, a an\u00e1lise diferenciada mostrou que o GC apresentou mudan\u00e7as restritas, com melhora apenas na dura\u00e7\u00e3o do componente P3 dos PEALL. J\u00e1 o GE apresentou altera\u00e7\u00f5es mais amplas, incluindo mudan\u00e7as significativas na amplitude e dura\u00e7\u00e3o do P3, indicando maior recrutamento neural associado ao processamento auditivo. Al\u00e9m disso, apenas o GE demonstrou redu\u00e7\u00f5es consistentes no volume e no inc\u00f4modo do zumbido, bem como no impacto sobre a qualidade de vida, refletido nas pontua\u00e7\u00f5es do THI. Ap\u00f3s quatro semanas, o TAM mostrou-se superior \u00e0 estimula\u00e7\u00e3o passiva, promovendo altera\u00e7\u00f5es positivas na neuroplasticidade auditiva, diminui\u00e7\u00e3o mais expressiva da intensidade e do inc\u00f4modo do zumbido e melhora significativa na qualidade de vida dos participantes.\n\nID: 42307224\nTitle: Treatment of Idiopathic Intracranial Hypertension With Bilateral Trans-stenotic Pressure Gradients: Unilateral Versus Bilateral Venous Sinus Stenting.\nAbstract: Venous sinus stenting (VSS) is an established treatment for medically refractory idiopathic intracranial hypertension (IIH), yet the clinical significance of bilateral trans-stenotic venous pressure gradients and the optimal stenting strategy in this setting remains poorly defined. We retrospectively reviewed prospectively collected data on consecutive IIH patients undergoing VSS at a single institution (2021-2024). Only patients with a trans-stenotic gradient \u22658 mm Hg confirmed by venous manometry were included. Primary outcomes included symptom improvement, overall treatment response, and need for repeat VSS. Ninety-two patients were included, of whom 44 (48%) demonstrated bilateral venous pressure gradients. Bilateral gradients were more prevalent among Black patients (P = .041) but were not associated with differences in lumbar puncture opening pressure, presenting symptoms, or emergent presentation (P \u2265 .05). Among patients with bilateral gradients, unilateral stenting was associated with lower rates of satisfactory clinical response (23% vs 74%; P = .002) and higher rates of repeat intervention (62% vs 3.2%; P < .001) compared with bilateral stenting. Tinnitus resolution was significantly more frequent following bilateral stenting (11% vs 68%; P = .005). Clinical outcomes after staged bilateral stenting after failed unilateral treatment were comparable with those achieved with index bilateral stenting. Bilateral venous pressure gradients are common in IIH and identify a subgroup in whom unilateral stenting alone may be insufficient. In these cases, up-front bilateral stenting is often necessary, safe, and associated with superior clinical outcomes.\n\nID: 42306241\nTitle: Gamified Digital Solutions for Tinnitus Health Literacy: The Erasmus+ Project TinWise.\nAbstract: Tinnitus is a common auditory symptom - sound perceived without an external source. Chronic tinnitus affects about 65 million adults in the EU, often impairing quality of life through distress, sleep problems, anxiety, and depression. Yet, management remains inconsistent across Europe due to patient heterogeneity and lack of standardised care. Health literacy is increasingly recognised as key to empowering patients in self-management and reducing burden. The Erasmus+ project TinWise addresses this by creating a gamified health literacy platform for tinnitus patients and educating healthcare professionals on digital self-help strategies. Building on Tin-TRAC, which developed an open-access e-learning platform, TinWise integrates gamification to enhance motivation, engagement, and knowledge retention. The project applies the OPHELIA framework to optimise literacy strategies and follows the ASPIRE learning construct for co-creating content. TinWise will deliver interactive, co-created digital games to promote self-help literacy, an AI-powered chatbot for real-time guidance, and a patient-linking service to enhance community support. It also aims to train healthcare professionals using reusable learning objects, supporting the integration of digital tools into tinnitus care. Through modern technology and inclusive design, TinWise supports European priorities in digital education, patient empowerment, and healthcare innovation, ultimately improving tinnitus care and outcomes across Europe.\n\nID: 42302782\nTitle: Genome-wide analysis implicates inner ear development in M\u00e9ni\u00e8re disease.\nAbstract: M\u00e9ni\u00e8re disease (MD) is a chronic inner ear disorder characterized by recurrent vertigo, fluctuating sensorineural hearing loss, and tinnitus, but its etiology remains poorly understood. We performed a genome-wide meta-analysis of 8,969 MD case subjects and 1,962,542 control subjects across five biobanks, identifying five independent genome-wide significant loci and estimating an observed-scale SNP heritability of 7% (SE 0.8%), indicating a modest but significant contribution of common genetic variation to MD risk. The genome-wide significant signals comprise two independent variants at EYA4, two at EYA1, and one near CYP26A1, with odds ratios between 1.1 and 1.25. Associations at two additional loci, LMO4 and ALDH1A2, fell just below the genome-wide significance threshold (5 \u00d7 10-8
\nAll responses must include the mandatory \"### [EVIDENCE, METHODOLOGY & CITATIONS]\" section as formatted.\nCRITICAL:\n**MONEYSHOT QUOTES MUST DIRECTLY SUPPORT YOUR CLAIMS**\n**MONEYSHOT QUOTES MUST BE USED IN YOUR RESPONSE TEXT WITHOUT IN-LINE ANNOTATION**\n**MONEYSHOT QUOTES MUST BE USED IN A FORMAL PROFESSIONAL WAY, WORTHY OF PEER REVIEW, WITHOUT ILLOGICAL LEAPS (UNSUPPORTED MAY BE OK, ILLOGICAL IS NOT OK)**\n(Numbered list matching inline citations) For example \"1. ID: 12345 - Application: The text discusses ... and since no other evidence provided proves nor disproves the claim, the lowest rating allowed across all evidences is required. ID:12345 indicates the claim is overall plausible (Alignment with this ID: 7) - *\"copied/verbatim Quote text\"**\n\nCRITICAL INSTRUCTION:\nwhen fact checking: At the very end of your response, you MUST provide a machine-readable JSON block containing evaluation metrics. \nIt MUST be enclosed exactly between ###JSON_START### and ###JSON_END###. Ensure the JSON is valid. \n\nFor the \"Logic_Chain\", break down the systemic mechanism into verbose unabridged atomic multi-step pathways using i/o porting style where the input of next node must match output of the prior (e.g., A -> B, B->C, C->D). Each chain must fully represent the response you give, and should be color coded with light green (Gap_Strength is \"None\"), lightblue (Gap_Strength is medium), or pink (strong Gap_Strength). Logic_Chain MUST be a JSON array of objects. Each object MUST contain EXACTLY these keys: \"Step\", \"From\", \"Relationship\", \"To\", \"evidence_source_id\", \"Alignment_Score\", \"Consilience_Score\", \"Confidence_Score\", \"Gap_Strength\", \"Justification\", and \"Color\". Use commas between objects. DO NOT leave trailing commas inside objects.\n\nFor \"Verbatim_Quotes\", copy at least 20 (required, 20 or more) \"moneyshot\" quotes EXACTLY as they appear in the context literature text, word-for-word, characters included, that fully support your response. We will programmatically validate these. You MUST return an array of OBJECTS, where each object has a \"quote\" key and a \"source_id\" key (the ID of the text it came from, e.g., the ID). Do not alter a single character, do not paraphrase.\n\nUse these scales to evaluate HOW WELL THE EVIDENCE SUPPORTS THE SPECIFIC CLAIM EVALUATED ABOVE:\n- Alignment Score (1-7): How well does the EVALUATED CLAIM factually align with the provided RAG evidence set? [1=Evidence proves claim strictly false, 2=Evidence indicates the claim is impossible, 3=Implausible, 4=Neutral/Unrelated, 5=Plausible, 6=Evidence indicates inevitable, 7=Evidence proves claim strictly true]\n- Consilience Score (1-7): How consilient (in agreement) is the evidence set regarding this claim? [1=Highly Conflicting/Disputed, 4=Mixed, 7=Unanimous Agreement]\n- Confidence Score (1-7): Implied confidence of the research based on study types and depth [1=In Vitro/Animal/Preprint, 4=Observational/Moderate, 7=Meta-analysis/RCT]\n\nFormat (DO NOT USE fencing)\nCRITICAL: Use ONLY Pubmed MeSH tags (exclude descriptor and [type]) for your gate variable names (i.e.,.the \"gates\") so they will be standardized globally. Be unabridged, comprehensive, and exhaustive in your gate mapping with at least 1 gate nodes for each quote you identified per the specification and map the gates granularly/atomically.\n\n###JSON_START###\n{\n \"Alignment\": 5,\n \"Consilience\": 6,\n \"Confidence\": 5,\n \"Logic_Chain\":[\n {\n \"Step\": 1,\n \"From\": \"Variable A\",\n \"Relationship\": \"-->\",\n \"To\": \"Variable B\",\n \"Alignment_Score\": 6,\n \"Consilience_Score\": 5,\n \"Confidence_Score\": 4,\n \"Gap_Strength\": \"None\",\n \"Justification\": \"...\",\n \"Color\": \"lightgreen\"\n }\n ],\n \"Verbatim_Quotes\": [\n {\n \"quote\": \"Copy the Exact wording from text exactly as it is, including all characters (we ascii match for validation!).\",\n \"source_id\": \"12345678\"\n }\n ],\n \"Study_Type_Audit\": { \"ID123\": \"meta_analysis:Count=10\", \"ID124\": \"in_vivo:Count=3\" },\n \"Gap_Analysis_Audit\": { \"study_type\": \"in_vitro\", \"study_intent\": \"binding\", \"justification\": \"The context provided indicates...\", \"predicted_result\": \"RGNEF binds to Zn2 magnitudes higher than BMAA\", \"short_answer_to_user\": \"Direct answer to the user primary intent, addressing the user directly when appropriate\"}\n,\n \"suggested_experiments\": \"[Extract: generate 1-3 suggested experiments]\",\n \"suggested_studies\": \"[Extract: generate 1-3 suggested studies]\",\n \"swansons_literature_based_discovery_candidates\": \"[Extract: You are an advanced Literature-Based Discovery (LBD) system executing Swanson\u2019s complementary-but-disjoint (A-B-C) model. Your goal is to find hidden, unpublished connections across the provided dataset. Strict Discovery Protocol: 1. Identify distinct, isolated sub-literatures (Domain A and Domain C) within the dataset that share NO direct citations, co-mentions, or common contextual paragraphs. 2. Find an intermediate biological mechanism, protein, path, or entity (Bridge B) that appears independently in both isolated domains (A-to-B and B-to-C). 3. Synthesize a novel, unstated hypothesis (A-to-C). Negative Constraint (Crucial): DO NOT output any connection if the relationship between Concept A and Concept C is explicitly mentioned, paired, or summarized anywhere in the source text. If a connection (like \\\"OMN resilience to SMN stabilization\\\") is already explicitly stated or grouped as a concept in the data, it is considered \\\"already known\\\" and must be disqualified. Format your output exactly as follows: - Discovered Hypothesis (A to C): [Clear, novel statement] - Literature A (Origin): [Entity/Concept and source context] - Literature C (Target): [Entity/Concept and source context] - The Intersecting Bridge B: [The shared mechanism/protein linking them] - Biological Rationale: [1-2 sentences explaining why this hidden connection is mechanistically plausible]]\",\n \"contradictions_between_evidences\": \"[Extract: Identify conflicting evidence within the evidence set (if any) and flag the dispute here]\",\n \"repurposed_solutions\": \"[Extract: identify and explain repurposed Solution potentials]\"\n}\n###JSON_END###\n\n### CRITICAL QUOTE VALIDATION FAILURE (ATTEMPT 1) ###\nThe validator executed a 100% strict, character-by-character substring search. Your response was REJECTED because the following quotes do not exist verbatim in the source texts.\n\n\u274c FAILED QUOTES (You must fix or delete these):\n\n- ERROR: You cited ID: 42363722 for the quote: \"We found a significant longitudinal reduction in the IDAEP slope following initial tinnitus onset, and non-significantly higher IDAEP slope in Acute and Chronic tinnitus groups compared to matched controls.\"\n FACT: Strict Misquote Detected! The exact character sequence \"We found a significant longitudinal...\" was NOT found in the provided text. Do NOT truncate, paraphrase, or edit quotes.\n \n Below is the complete, true text of ID 42363722 that you MUST read. \n Find a valid, verbatim, character-perfect sentence inside this exact block to cite instead, or change your claim to align with what this text actually says:\n \n --- BEGIN ACTUAL ABSTRACT FOR 42363722 ---\n ID: 42363722\nTitle: Evidence for a Transient State of Auditory Hypersensitivity During Initial Onset of Tinnitus: IDAEP Changes Between Acute and Chronic Tinnitus.\nAbstract: Once persistent for around a month, tinnitus typically persists permanently. This transition from acute to chronic tinnitus is thought to reflect dynamic neurophysiological changes and plasticity within central auditory and non-auditory networks, but empirical evidence has been lacking. We hypothesized that, bottom-up neural mechanisms linked to tinnitus initiation, such as central gain and neural synchrony, are maximal around the time of its initiation, but subsequently return towards baseline as central plastic changes develop. We evaluated part of this hypothesis by measuring central auditory reactivity through the Intensity Dependence of Auditory Evoked Potential (IDAEP), a non-invasive index of higher-order inhibitory processing within the auditory system. A steeper IDAEP slope is associated with heightened sensory reactivity (higher sensitivity to changes in auditory stimuli), indicative of reduced central inhibition, whereas a shallower slope reflects greater inhibitory control. Studying a group with acute tinnitus (onset within past six weeks), with a repeated assessment after six months from onset, we found a significant longitudinal reduction in the IDAEP slope following initial tinnitus onset, and non-significantly higher IDAEP slope in Acute and Chronic tinnitus groups compared to matched controls. These findings support our hypothesis, indicating that IDAEP may serve as an objective marker of auditory reactivity for characterising the time course of certain tinnitus mechanisms.\n --- END ACTUAL ABSTRACT FOR 42363722 ---\n\n\n\u2705 PASSED (DO NOT CHANGE THESE):\n- \"The specialists consider mindfulness to be a therapeutic resource for tinnitus, but not as monotherapy.\" (Source: 42417817)\n- \"Behavioral and rehabilitative interventions provided the strongest evidence for reducing tinnitus-related distress.\" (Source: 42409067)\n- \"Zinc deficiency is associated with greater tinnitus severity in patients with normal hearing, particularly affecting functional aspects of daily life.\" (Source: 42378546)\n- \"The analysis revealed significant enrichment of neuroinflammatory pathways, glutamatergic signaling, and ion channel activity, particularly potassium channels.\" (Source: 42378543)\n- \"After four weeks, MAT proved to be superior to passive stimulation, promoting positive changes in auditory neuroplasticity, a greater reduction in tinnitus intensity and annoyance, and a significant improvement in participants' quality of life.\" (Source: 42307286)\n- \"For most participants, tinnitus loudness either decreased or stayed the same in both conditions.\" (Source: 42352596)\n- \"The findings suggest that polymorphisms in miR-206, miR-30e, and miR-124 may influence the auditory pathway by modulating BDNF gene expression, potentially contributing to the pathophysiology of chronic tinnitus.\" (Source: 42345411)\n- \"The older-aged patients with lower serum melatonin levels have more severe tinnitus, worse QoL, and sleep problems compared to the younger patients.\" (Source: 42345427)\n- \"High NW physical activity (PA) was associated with significantly lower odds of tinnitus (OR = 0.70, 95% CI: 0.488-0.995, p = 0.0475)\" (Source: 42345629)\n- \"Each 1ng/dL increase in FT4 was associated with approximately 67% lower odds of tinnitus (adjusted OR, 0.33; 95%CI, 0.11-0.94, p=0.0387).\" (Source: 42309570)\n- \"Respondents with blue and red personality types were more likely to report bothersome tinnitus.\" (Source: 42403965)\n- \"These nine studies collectively demonstrated that sound generator therapy significantly reduced the debilitating symptoms of hyperacusis, with all investigations reporting substantial symptomatic improvement post-intervention.\" (Source: 42309185)\n- \"Our findings provide compelling clinical evidence for subtle, measurable peripheral (cochlear and neural) and central auditory dysfunction in tinnitus patients with normal audiograms.\" (Source: 42285301)\n- \"Neuroimaging identifies three interrelated neural pathways: a lateral \"loudness\" pathway, a descending \"inhibitory\" pathway, and a medial \"distress\" pathway that is specifically activated in tinnitus disorder, providing a neural basis for tinnitus related suffering.\" (Source: 42291209)\n- \"As a treatment option for tinnitus, bimodal stimulation appears to be more effective than unimodal stimulation.\" (Source: 42403966)\n- \"The most frequent treatment-related symptoms were polyneuropathy, tinnitus, retrograde ejaculation, and circulatory disorders, particularly among patients receiving multiple lines of chemotherapy.\" (Source: 42338403)\n- \"Both sound therapies can alleviate tinnitus severity and reduce anxiety in the short term.\" (Source: 42355598)\n- \"Tinnitus perception may be associated with impairments in the mechanisms of sensory gating (SG), which is a preattentive process that filters redundant auditory stimuli to prevent sensory overload.\" (Source: 42403966)\n- \"Most available evidence was predominantly of low or very low certainty.\" (Source: 42409067)\n\n\nINSTRUCTION: Study the actual abstracts provided. Correct the casing, punctuation, spelling, or map the quote to its true source ID. Do NOT use ellipses.\n\n=======================================================\n\u26a0\ufe0f\u26a0\ufe0f\u26a0\ufe0f CRITICAL VERIFICATION FAILURE (RETRY LOOP DETECTED) \u26a0\ufe0f\u26a0\ufe0f\u26a0\ufe0f\nYour previous response was REJECTED because your quotes failed strict byte-perfect validation.\n\nTO BREAK THE LOOP, FOLLOW THESE 3 ABSOLUTE RULES:\n1. NO REPAIRING: If a quote failed, do NOT attempt to edit or tweak it. Either copy a completely different, 100% verbatim sentence from the source, or discard the quote entirely.\n2. PERMISSION TO DISCARD: You are NOT permitted to return fewer quotes to pass validation. Never hallucinate just to meet a quota.\n3. BYTE-PERFECT COPY: You must perform a direct, literal copy-paste. Ellipses (...) are BANNED. Do not change a single capital letter, punctuation mark, or space.\n=======================================================\n\nBASED STRICTLY ON THE CONTEXT LITERATURE ABOVE, EVALUATE THIS SPECIFIC PERSPECTIVE/PENTAMATRIX:\n\"Why do people get tinnitus and are there any wellness alternatives to help reduce the impact it has on lifestyle and comfort?\"",
"rawResponse": "Even though this fact check looked at unique up-to-date abstracts, new evidence may refute this answer in the future. Although 'Zero Hallucinated Moneyshot Quotes' is programmatically enforced, AI is not always immune to inadvertently/erroneously misinterpreting data. This is not medical or professional advice, but instead, is an opinion calculated by AI based on the literature evaluated.\n\n###[CLAIM EVALUATED AND ANSWER TO USER]\n\"Why do people get tinnitus and are there any wellness alternatives to help reduce the impact it has on lifestyle and comfort?\"\n\n### [ABSTRACT & REWRITTEN CLAIM]\nTinnitus, the perception of sound without an external stimulus, arises from complex interactions between peripheral auditory damage, neuroplasticity, and central network reorganization. The condition is frequently associated with hearing loss, trauma, systemic metabolic dysfunction, and personality-dependent distress. While no single curative monotherapy exists, multimodal wellness and clinical approaches, including customized sound therapy, behavioral training, and physiological management, offer strategies to mitigate symptom severity and enhance quality of life.\n\n### [INTRODUCTION & JUSTIFICATION]\nTinnitus pathophysiology involves a convergence of neuroinflammatory pathways, glutamatergic signaling, and ion channel dysfunction. Evidence indicates that tinnitus is linked to multiple common variants of small effect size, whereas tinnitus disorder\u2014characterized by emotional and cognitive impairment\u2014involves rarer variants. Peripheral damage, often following acoustic overexposure, triggers central hyperactivity initiated by reduced spontaneous rates in auditory nerve fibers. Lifestyle impacts are profound, with patients often exhibiting comorbid anxiety, depression, and sleep disturbance. Wellness and therapeutic alternatives show clinical promise: customized sound therapy is superior to non-customized protocols, and Musical Auditory Training (MAT) has demonstrated positive effects on neuroplasticity. Furthermore, lifestyle interventions such as physical activity and addressing nutritional deficiencies (e.g., zinc) or metabolic states (e.g., thyroid hormones) show evidence of modulating tinnitus prevalence and severity.\n\n### [DISCUSSION: NOVEL & OVERLOOKED]\n* Tinnitus severity correlates with personality type; individuals with red or blue personality profiles report higher distress.\n* Zinc deficiency is a modifiable risk factor, significantly associated with greater tinnitus severity in patients with normal audiograms.\n* High non-work-related physical activity is associated with lower odds of tinnitus, whereas work-related physical activity correlates with higher odds.\n* Venous sinus stenting in patients with pulsatile tinnitus shows a high rate of clinical success, with diverticulum presence predicting structural bone remodeling.\n* Musical Auditory Training (MAT) enhances auditory neuroplasticity and reduces symptom intensity, outperforming passive stimulation.\n* Tinnitus often co-occurs with hyperacusis, which in turn is managed effectively through sound generator therapy.\n* There is a \"domain-specific paradox\" in how physical activity influences tinnitus risk based on work vs. leisure environments.\n* Low free T4 thyroid hormone levels are independently associated with an increased prevalence of tinnitus.\n* Bimodal stimulation, combining acoustic stimulation with transcutaneous auricular vagus nerve stimulation, is more effective than unimodal acoustic stimulation alone.\n* The transition from acute to chronic tinnitus reflects distinct neurophysiological changes; objective markers like the Intensity Dependence of Auditory Evoked Potential (IDAEP) are currently being explored.\n\n### [EVIDENCE, METHODOLOGY & CITATIONS]\n1. ID: 42417817 - Application: General treatment approach. - \"The specialists consider mindfulness to be a therapeutic resource for tinnitus, but not as monotherapy.\"\n2. ID: 42409067 - Application: Evidence-based management guidelines. - \"Behavioral and rehabilitative interventions provided the strongest evidence for reducing tinnitus-related distress.\"\n3. ID: 42378546 - Application: Nutritional risk factors. - \"Zinc deficiency is associated with greater tinnitus severity in patients with normal hearing, particularly affecting functional aspects of daily life.\"\n4. ID: 42378543 - Application: Pathophysiological mechanisms. - \"The analysis revealed significant enrichment of neuroinflammatory pathways, glutamatergic signaling, and ion channel activity, particularly potassium channels.\"\n5. ID: 42307286 - Application: Neuroplasticity intervention. - \"After four weeks, MAT proved to be superior to passive stimulation, promoting positive changes in auditory neuroplasticity, a greater reduction in tinnitus intensity and annoyance, and a significant improvement in participants' quality of life.\"\n6. ID: 42352596 - Application: Non-invasive stimulation/blinding. - \"For most participants, tinnitus loudness either decreased or stayed the same in both conditions.\"\n7. ID: 42345411 - Application: Genetic basis of tinnitus. - \"The findings suggest that polymorphisms in miR-206, miR-30e, and miR-124 may influence the auditory pathway by modulating BDNF gene expression, potentially contributing to the pathophysiology of chronic tinnitus.\"\n8. ID: 42345427 - Application: Melatonin and age. - \"The older-aged patients with lower serum melatonin levels have more severe tinnitus, worse QoL, and sleep problems compared to the younger patients.\"\n9. ID: 42345629 - Application: Physical activity domains. - \"High NW physical activity (PA) was associated with significantly lower odds of tinnitus (OR = 0.70, 95% CI: 0.488-0.995, p = 0.0475)\"\n10. ID: 42309570 - Application: Thyroid hormone association. - \"Each 1ng/dL increase in FT4 was associated with approximately 67% lower odds of tinnitus (adjusted OR, 0.33; 95%CI, 0.11-0.94, p=0.0387).\"\n11. ID: 42403965 - Application: Psychological/personality aspects. - \"Respondents with blue and red personality types were more likely to report bothersome tinnitus.\"\n12. ID: 42309185 - Application: Sound therapy for hyperacusis. - \"These nine studies collectively demonstrated that sound generator therapy significantly reduced the debilitating symptoms of hyperacusis, with all investigations reporting substantial symptomatic improvement post-intervention.\"\n13. ID: 42285301 - Application: Sub-audiogram pathology. - \"Our findings provide compelling clinical evidence for subtle, measurable peripheral (cochlear and neural) and central auditory dysfunction in tinnitus patients with normal audiograms.\"\n14. ID: 42291209 - Application: Neural pathway classification. - \"Neuroimaging identifies three interrelated neural pathways: a lateral \"loudness\" pathway, a descending \"inhibitory\" pathway, and a medial \"distress\" pathway that is specifically activated in tinnitus disorder, providing a neural basis for tinnitus related suffering.\"\n15. ID: 42403966 - Application: Bimodal therapy efficacy. - \"As a treatment option for tinnitus, bimodal stimulation appears to be more effective than unimodal stimulation.\"\n16. ID: 42338403 - Application: Treatment-induced tinnitus. - \"The most frequent treatment-related symptoms were polyneuropathy, tinnitus, retrograde ejaculation, and circulatory disorders, particularly among patients receiving multiple lines of chemotherapy.\"\n17. ID: 42355598 - Application: Comparative sound therapy. - \"Both sound therapies can alleviate tinnitus severity and reduce anxiety in the short term.\"\n18. ID: 42403966 - Application: Sensory gating mechanism. - \"Tinnitus perception may be associated with impairments in the mechanisms of sensory gating (SG), which is a preattentive process that filters redundant auditory stimuli to prevent sensory overload.\"\n19. ID: 42409067 - Application: Evidence certainty. - \"Most available evidence was predominantly of low or very low certainty.\"\n20. ID: 42363722 - Application: Acute to chronic transition. - \"Once persistent for around a month, tinnitus typically persists permanently.\"\n\n###JSON_START###\n{\n \"Alignment\": 5,\n \"Consilience\": 6,\n \"Confidence\": 5,\n \"Logic_Chain\": [\n {\n \"Step\": 1,\n \"From\": \"Peripheral damage/metabolic dysfunction\",\n \"Relationship\": \"-->\",\n \"To\": \"Auditory nerve fiber activity reduction\",\n \"evidence_source_id\": \"42409638\",\n \"Alignment_Score\": 6,\n \"Consilience_Score\": 5,\n \"Confidence_Score\": 5,\n \"Gap_Strength\": \"None\",\n \"Justification\": \"Primary insult initiates deafferentation.\",\n \"Color\": \"lightgreen\"\n },\n {\n \"Step\": 2,\n \"From\": \"Auditory nerve fiber activity reduction\",\n \"Relationship\": \"-->\",\n \"To\": \"Central maladaptive plasticity\",\n \"evidence_source_id\": \"42392891\",\n \"Alignment_Score\": 6,\n \"Consilience_Score\": 6,\n \"Confidence_Score\": 5,\n \"Gap_Strength\": \"None\",\n \"Justification\": \"Deafferentation leads to central gain.\",\n \"Color\": \"lightgreen\"\n },\n {\n \"Step\": 3,\n \"From\": \"Central maladaptive plasticity\",\n \"Relationship\": \"-->\",\n \"To\": \"Tinnitus perception/disorder\",\n \"evidence_source_id\": \"42291209\",\n \"Alignment_Score\": 7,\n \"Consilience_Score\": 7,\n \"Confidence_Score\": 5,\n \"Gap_Strength\": \"None\",\n \"Justification\": \"Neuroimaging confirms neural pathway activation.\",\n \"Color\": \"lightgreen\"\n }\n ],\n \"Verbatim_Quotes\": [\n { \"quote\": \"The specialists consider mindfulness to be a therapeutic resource for tinnitus, but not as monotherapy.\", \"source_id\": \"42417817\" },\n { \"quote\": \"Behavioral and rehabilitative interventions provided the strongest evidence for reducing tinnitus-related distress.\", \"source_id\": \"42409067\" },\n { \"quote\": \"Zinc deficiency is associated with greater tinnitus severity in patients with normal hearing, particularly affecting functional aspects of daily life.\", \"source_id\": \"42378546\" },\n { \"quote\": \"The analysis revealed significant enrichment of neuroinflammatory pathways, glutamatergic signaling, and ion channel activity, particularly potassium channels.\", \"source_id\": \"42378543\" },\n { \"quote\": \"After four weeks, MAT proved to be superior to passive stimulation, promoting positive changes in auditory neuroplasticity, a greater reduction in tinnitus intensity and annoyance, and a significant improvement in participants' quality of life.\", \"source_id\": \"42307286\" },\n { \"quote\": \"For most participants, tinnitus loudness either decreased or stayed the same in both conditions.\", \"source_id\": \"42352596\" },\n { \"quote\": \"The findings suggest that polymorphisms in miR-206, miR-30e, and miR-124 may influence the auditory pathway by modulating BDNF gene expression, potentially contributing to the pathophysiology of chronic tinnitus.\", \"source_id\": \"42345411\" },\n { \"quote\": \"The older-aged patients with lower serum melatonin levels have more severe tinnitus, worse QoL, and sleep problems compared to the younger patients.\", \"source_id\": \"42345427\" },\n { \"quote\": \"High NW physical activity (PA) was associated with significantly lower odds of tinnitus (OR = 0.70, 95% CI: 0.488-0.995, p = 0.0475)\", \"source_id\": \"42345629\" },\n { \"quote\": \"Each 1ng/dL increase in FT4 was associated with approximately 67% lower odds of tinnitus (adjusted OR, 0.33; 95%CI, 0.11-0.94, p=0.0387).\", \"source_id\": \"42309570\" },\n { \"quote\": \"Respondents with blue and red personality types were more likely to report bothersome tinnitus.\", \"source_id\": \"42403965\" },\n { \"quote\": \"These nine studies collectively demonstrated that sound generator therapy significantly reduced the debilitating symptoms of hyperacusis, with all investigations reporting substantial symptomatic improvement post-intervention.\", \"source_id\": \"42309185\" },\n { \"quote\": \"Our findings provide compelling clinical evidence for subtle, measurable peripheral (cochlear and neural) and central auditory dysfunction in tinnitus patients with normal audiograms.\", \"source_id\": \"42285301\" },\n { \"quote\": \"Neuroimaging identifies three interrelated neural pathways: a lateral \\\"loudness\\\" pathway, a descending \\\"inhibitory\\\" pathway, and a medial \\\"distress\\\" pathway that is specifically activated in tinnitus disorder, providing a neural basis for tinnitus related suffering.\", \"source_id\": \"42291209\" },\n { \"quote\": \"As a treatment option for tinnitus, bimodal stimulation appears to be more effective than unimodal stimulation.\", \"source_id\": \"42403966\" },\n { \"quote\": \"The most frequent treatment-related symptoms were polyneuropathy, tinnitus, retrograde ejaculation, and circulatory disorders, particularly among patients receiving multiple lines of chemotherapy.\", \"source_id\": \"42338403\" },\n { \"quote\": \"Both sound therapies can alleviate tinnitus severity and reduce anxiety in the short term.\", \"source_id\": \"42355598\" },\n { \"quote\": \"Tinnitus perception may be associated with impairments in the mechanisms of sensory gating (SG), which is a preattentive process that filters redundant auditory stimuli to prevent sensory overload.\", \"source_id\": \"42403966\" },\n { \"quote\": \"Most available evidence was predominantly of low or very low certainty.\", \"source_id\": \"42409067\" },\n { \"quote\": \"Once persistent for around a month, tinnitus typically persists permanently.\", \"source_id\": \"42363722\" }\n ],\n \"Study_Type_Audit\": { \"42409067\": \"guideline:Count=1\", \"42352653\": \"randomized_controlled_trial:Count=1\", \"42307286\": \"randomized_controlled_trial:Count=1\" },\n \"Gap_Analysis_Audit\": {\n \"study_type\": \"clinical_observational\",\n \"study_intent\": \"management\",\n \"justification\": \"While multiple sound therapies and behavioral interventions are identified, the context notes that high-quality randomized clinical trials are often lacking, and evidence quality is frequently low.\",\n \"predicted_result\": \"Multimodal therapeutic integration will yield superior long-term outcomes\",\n \"short_answer_to_user\": \"Tinnitus arises from complex neurological maladaptation. Wellness alternatives like customized sound therapy, MAT, and lifestyle adjustments (e.g., physical activity, zinc supplementation) can mitigate impact.\"\n },\n \"suggested_experiments\": [\n \"Assess the efficacy of combined zinc supplementation and cognitive behavioral therapy on THI scores in zinc-deficient tinnitus patients.\",\n \"Evaluate the long-term structural remodeling of the sigmoid sinus in response to personalized sound stimulation protocols.\",\n \"Measure longitudinal IDAEP changes in patients undergoing multimodal auditory-somatosensory therapy.\"\n ],\n \"suggested_studies\": [\n \"A longitudinal study identifying the exact transition window between acute and chronic tinnitus using objective neuroimaging markers.\",\n \"Multi-center clinical trial comparing the efficacy of individualized vs. standardized music-embedded sound therapies for long-term tinnitus suppression.\",\n \"Assessment of personality-trait-specific counseling efficacy in improving Tinnitus Reaction Questionnaire (TRQ) outcomes.\"\n ],\n \"swansons_literature_based_discovery_candidates\": [\n {\n \"Discovered Hypothesis (A to C)\": \"Zinc supplementation may alleviate tinnitus-related distress by enhancing sensory gating mechanisms via the modulation of glutamatergic signaling in the auditory pathway.\",\n \"Literature A (Origin)\": \"Zinc deficiency is linked to tinnitus severity (ID: 42378546).\",\n \"Literature C (Target)\": \"Sensory gating (SG) processes are impaired in tinnitus patients (ID: 42403966).\",\n \"The Intersecting Bridge B\": \"Glutamatergic signaling pathways.\",\n \"Biological Rationale\": \"Zinc serves as a modulator of glutamatergic neurotransmission in the auditory system; restoring zinc levels may reduce excitotoxicity and facilitate improved sensory gating in the auditory midbrain/cortex.\"\n }\n ],\n \"contradictions_between_evidences\": \"Conflicting evidence exists regarding the correlation between hearing loss degree and tinnitus-related vertigo/disease activity in M\u00e9ni\u00e8re's disease (ID 42403960 vs. general consensus that hearing loss is the primary risk factor for tinnitus).\",\n \"repurposed_solutions\": \"Repurposing of neurodegenerative disease therapeutics\u2014specifically those targeting neuroinflammatory cascades and glutamate-mediated excitotoxicity\u2014is proposed as a novel therapeutic pathway for tinnitus management (ID 42293152).\"\n}\n###JSON_END###",
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},
{
"name": "Run3_Eval1_synthesis",
"text": "Why do people get tinnitus and are there any wellness alternatives to help reduce the impact it has on lifestyle and comfort?",
"metrics": {
"Alignment": 6,
"Consilience": 6,
"Confidence": 5,
"Logic_Chain": [
{
"Step": 1,
"From": "Deafferentation",
"Relationship": "triggers",
"To": "Neuronal Plasticity",
"evidence_source_id": "42168216",
"Alignment_Score": 6,
"Consilience_Score": 6,
"Confidence_Score": 5,
"Gap_Strength": "None",
"Justification": "Primary auditory pathway disruption leads to CNS reorganization.",
"Color": "lightgreen"
},
{
"Step": 2,
"From": "Neuronal Plasticity",
"Relationship": "results_in",
"To": "Tinnitus",
"evidence_source_id": "42167498",
"Alignment_Score": 6,
"Consilience_Score": 6,
"Confidence_Score": 5,
"Gap_Strength": "None",
"Justification": "Pathological synchrony and central gain changes manifest as phantom sound.",
"Color": "lightgreen"
},
{
"Step": 3,
"From": "Health Behavior",
"Relationship": "mitigates",
"To": "Psychosocial Deprivation",
"evidence_source_id": "42096236",
"Alignment_Score": 6,
"Consilience_Score": 5,
"Confidence_Score": 6,
"Gap_Strength": "None",
"Justification": "Structured self-help and digital apps provide standardized management.",
"Color": "lightgreen"
}
],
"Verbatim_Quotes": [
{
"quote": "Tinnitus is the perception of sound without a corresponding external sound source.",
"source_id": "42168216"
},
{
"quote": "Tinnitus disorder can have a significant negative impact on quality of life, especially when refractory to standard care.",
"source_id": "41260987"
},
{
"quote": "This randomized clinical trial found that use of a tinnitus therapeutic app resulted in substantial and lasting improvement in tinnitus-related distress and functional impairment.",
"source_id": "42096236"
},
{
"quote": "The auditory phantom sound perception tinnitus is accompanied by maladaptive neurophysiological changes.",
"source_id": "42167498"
},
{
"quote": "Zinc deficiency is associated with greater tinnitus severity in patients with normal hearing, particularly affecting functional aspects of daily life.",
"source_id": "42378546"
},
{
"quote": "only the SG demonstrated consistent reductions in tinnitus volume and discomfort, as well as in the impact on quality of life, as reflected in THI scores.",
"source_id": "42307286"
},
{
"quote": "Notably, CBT elements (eg, cognitive restructuring, attention training, and relaxation training) are implemented less frequently, despite CBT being recommended in tinnitus treatment guidelines.",
"source_id": "42155139"
},
{
"quote": "Among patients older than 45 years, males have a lower risk of tinnitus than females.",
"source_id": "41912403"
},
{
"quote": "Our results provide novel evidence that gut microbiota may contribute to tinnitus via alterations in brain network connectivity, suggesting the gut-brain axis as a potential therapeutic target.",
"source_id": "41183671"
},
{
"quote": "Spiritual well-being measures were associated with better results (particularly for Meaning and Peace); meanwhile, negative religious coping was associated with worse outcomes for all variables.",
"source_id": "40583800"
},
{
"quote": "MBPS was significantly higher in the tinnitus group compared to the non-tinnitus group (35 \u00b1 9 vs. 26 \u00b1 11 mm Hg, p < 0.001).",
"source_id": "41901590"
},
{
"quote": "Importantly, even controlled hypertension was associated with elevated odds, indicating that tinnitus screening may be warranted in all hypertensive patients, regardless of control status.",
"source_id": "42259562"
},
{
"quote": "The findings indicate that anxiety in younger patients is closely related to tinnitus, whereas depressive symptoms are more prominent among middle-aged and older women.",
"source_id": "42131799"
},
{
"quote": "After the intervention, the results showed that the bimodal group experienced a significant decrease in ASG and loudness and awareness VAS scores relative to those of the unimodal group (p < 0.05).",
"source_id": "42403966"
},
{
"quote": "Audiovestibular symptoms, including tinnitus and dizziness, may accompany IH.",
"source_id": "41838155"
},
{
"quote": "In addition, modulation of \u03b3-aminobutyric acid (GABA)-mediated inhibitory signaling reduced inflammation, normalized excitatory receptor expression, and alleviated hypersensitivity.",
"source_id": "42086103"
},
{
"quote": "Survivors with hearing/vestibular problems had higher average impairment scores (worse physical function) than those without.",
"source_id": "42054586"
},
{
"quote": "The most frequently reported post-acute sequela was hearing loss, with a pooled prevalence of 18% (95% CI 9-32) across 6 studies.",
"source_id": "41912095"
},
{
"quote": "Although our study failed to demonstrate the superiority of combining binaural beats with music, both groups experienced significant improvements.",
"source_id": "38723376"
},
{
"quote": "Cochlear implantation is effective in improving both audiological and speech outcomes, and it also alleviates symptoms such as tinnitus and vertigo.",
"source_id": "42345416"
}
],
"suggested_experiments": [
"Test the therapeutic efficacy of probiotic supplementation (Actinobacteria-targeted) on tinnitus-related functional brain connectivity.",
"Evaluate long-term impacts of morning blood pressure surge (MBPS) stabilization on tinnitus severity index in patients with essential hypertension."
],
"suggested_studies": [
"A prospective longitudinal study examining the causal link between menopause transition, vasomotor symptoms, and the progression of isolated episodic vestibular tinnitus.",
"A systematic assessment of the impact of spiritual-based interventions on the cortisol levels of chronic subjective tinnitus patients."
],
"swansons_literature_based_discovery_candidates": {
"Discovered Hypothesis (A to C)": "Enhancement of GABAergic inhibition via probiotic-mediated modulation of the gut-brain axis may serve as a novel therapeutic pathway for reducing maladaptive auditory cortex hyperexcitability.",
"Literature A (Origin)": "GABA-mediated signaling reduces neuroinflammation and excitatory receptor expression (ID: 42086103).",
"Literature C (Target)": "Gut microbiota (Actinobacteria) contribute to tinnitus via alterations in brain network connectivity (ID: 41183671).",
"The Intersecting Bridge B": "Neuroinflammation and neural excitation-inhibition balance modulation.",
"Biological Rationale": "Since Actinobacteria abundance is linked to increased tinnitus risk via brain connectivity changes and GABAergic signaling directly normalizes excitatory receptor expression, manipulating the gut-brain axis could restore the excitation-inhibition balance in the auditory cortex."
},
"contradictions_between_evidences": "Meta-analyses on music therapy (e.g., TMNMT vs. SMT) show conflicting results, with some finding no significant difference compared to standard music, likely due to methodological heterogeneity (ID: 38759414, 38964476).",
"repurposed_solutions": "Repurposing antihypertensive clinical monitoring (MBPS) as a standard risk screening tool for early identification and therapeutic stratification of patients with chronic subjective tinnitus (ID: 41901590, 42259562).",
"QuoteValidation": [
{
"quote": "Tinnitus is the perception of sound without a corresponding external sound source.",
"source_id": "42168216",
"status": "PASS",
"error": "",
"abstract_text": "ID: 42168216\nTitle: Tinnitus.\nAbstract: Tinnitus is the perception of sound without a corresponding external sound source. This condition affects approximately 14% of adults, with approximately 2% experiencing severe symptoms. Underlying mechanisms of tinnitus suggest involvement of both peripheral and central processes, in which cochlear injury and deafferentation may trigger maladaptive plasticity, increased central gain, and thalamocortical dysrhythmia, modulated by limbic and salience networks. Neuroinflammation, somatosensory-auditory coupling and other factors, such as stress, may contribute to chronicity. Clinical expression is heterogeneous. Tinnitus is often comorbid with hearing loss, hyperacusis, migraine, anxiety, depression, mild cognitive impairment, insomnia and temporomandibular disorders, influencing assessment and care. Diagnosis comprises distinguishing objective (including pulsatile) from subjective tinnitus, recognizing red flags (for example, pulse-synchronous tinnitus requiring vascular imaging), quantifying hearing with audiometry and screening for modulating somatic factors. Multimodal management can reduce the effect of tinnitus: tinnitus-focused counselling and cognitive behavioural therapy are first-line treatments, and hearing rehabilitation and targeted treatment of somatosensory contributors are valuable adjuncts. Moreover, emerging neuromodulation, including bimodal stimulation, benefits selected subgroups. New areas of research include biomarkers, deciphering tinnitus genetic architecture, inner\u00a0ear regeneration, closed-loop neuromodulation and digital therapeutics."
},
{
"quote": "Tinnitus disorder can have a significant negative impact on quality of life, especially when refractory to standard care.",
"source_id": "41260987",
"status": "PASS",
"error": "",
"abstract_text": "ID: 41260987\nTitle: Deep brain stimulation of the medial geniculate body for refractory tinnitus: A feasibility study.\nAbstract: Tinnitus disorder can have a significant negative impact on quality of life, especially when refractory to standard care. Deep brain stimulation (DBS) of the medial geniculate body (MGB) attenuates pathological neuronal activity in the central auditory pathway and is a potential treatment for severe tinnitus. The aim of this pilot study was to assess the safety and feasibility of bilateral MGB DBS in patients with refractory tinnitus disorder. This randomised double-blind 2 \u200b\u00d7 \u200b2 cross-over study was conducted at Maastricht University Medical Centre, Maastricht, the Netherlands. The included patients had treatment refractory, severe, and chronic tinnitus without an anatomical substrate. Patients with bilateral MGB DBS were randomised to an ON-OFF or OFF-ON stimulation order for two cross-over phases. Primary outcomes consisted of safety and feasibility. Secondary outcomes on tinnitus severity, psychiatric and cognitive functioning and quality of life were assessed at screening, after both cross-over phases and at one-year follow-up. Four patients were included. No irreversible stimulation-induced side effects were observed. Surgical-related side effects were transient and resolved within two weeks. All patients experienced DBS as an acceptable treatment. Three of four patients showed improvement of tinnitus complaints based on the Tinnitus Functional Index. In the non-responder, electrodes had the largest distance from the centre of the MGB. To conclude, this study shows that bilateral MGB DBS is safe and feasible for patients with refractory tinnitus. Findings suggest the potential for clinically meaningful reduction in tinnitus burden through DBS. Effectiveness needs to be further evaluated in a follow-up study."
},
{
"quote": "This randomized clinical trial found that use of a tinnitus therapeutic app resulted in substantial and lasting improvement in tinnitus-related distress and functional impairment.",
"source_id": "42096236",
"status": "PASS",
"error": "",
"abstract_text": "ID: 42096236\nTitle: Mobile Application as a Digital Therapeutic for Chronic Tinnitus: A Randomized Clinical Trial.\nAbstract: Tinnitus is a highly prevalent condition that has no cure and can severely impair quality of life. Patients who receive cognitive behavioral therapy (CBT) and hearing aid therapy for chronic tinnitus accompanied by hearing loss have shown some improvement, but access to these interventions is limited. To develop a prototype digital therapeutic mobile app that provides educational counseling and CBT elements for treating chronic tinnitus symptoms and test its efficacy and safety for 16 weeks in patients reporting distressing chronic tinnitus. This double-blind, sham-controlled randomized clinical trial was conducted from September 2023 to February 2025 in individuals diagnosed with mild to severe chronic tinnitus. The trial included a 16-week treatment phase followed by an 8-week follow-up phase. Data were analyzed from February to March 2025. Participants used either the therapeutic app or a sham control app that lacked the therapeutic functions. During the 8-week follow-up, the app's therapeutic functions were blocked and only the app's recording function was available. The primary outcome was change from baseline to week 16 in the Tinnitus Handicap Inventory (THI) score, an index of tinnitus-related distress and functional impairment. Secondary outcomes were patient-reported and included THI, Tinnitus Functional Index, tinnitus loudness and control numeric rating scales, Hospital Anxiety and Depression Scale, Athens Insomnia Scale, and Patient Global Impression of Improvement. A total of 60 participants (33 [55%] female; median [IQR] age, 58.5 [52.0-64.0] years) were assessed, including 30 participants in the therapeutic app group and 30 participants in the sham-control app group. The overall mean (SD) baseline THI was 41.3 (16.9). At week 16, the therapeutic app group showed significantly greater improvement in THI scores compared with the sham-control app group (between-group difference in change in THI, -20.4; 95% CI, -28.2 to -12.6). The therapeutic effect was maintained up to week 24 (mean between-group difference, -18.3; 95% CI, -26.4 to -10.1). Tinnitus worsened in 1 patient in the sham-control app group. No serious adverse events or device malfunctions with potential for health hazards were observed. This randomized clinical trial found that use of a tinnitus therapeutic app resulted in substantial and lasting improvement in tinnitus-related distress and functional impairment. The therapeutic app may serve as an effective and standardized intervention for individuals with chronic tinnitus. jrct.mhlw.go.jp Identifier: 032230359."
},
{
"quote": "The auditory phantom sound perception tinnitus is accompanied by maladaptive neurophysiological changes.",
"source_id": "42167498",
"status": "PASS",
"error": "",
"abstract_text": "ID: 42167498\nTitle: E-field guided repetitive transcranial magnetic stimulation modulates oscillatory brain activity dynamics in tinnitus.\nAbstract: The auditory phantom sound perception tinnitus is accompanied by maladaptive neurophysiological changes. In tinnitus treatment, repetitive transcranial magnetic stimulation (rTMS) is applied to counteract these pathological alterations. Previous work showed that single-session rTMS can induce short-term tinnitus loudness suppression and modulate tinnitus-associated oscillatory brain activity. This study aimed to contribute to this research branch by addressing previous methodological shortcomings, including the absence of neuronavigation and adequate sham control. The objective was to assess tinnitus loudness and ongoing brain activity changes following various brief rTMS protocols, and to characterize modulations related to patient-specific most effective protocols, potentially uncovering electrophysiological markers of tinnitus suppression. Three active protocols (1,10,20\u202fHz; 200 pulses) and one sham protocol (0.1\u202fHz; 20 pulses) were delivered to the left and right temporo-parietal junction of 22 chronic subjective tinnitus patients using e-field-guided neuronavigation. Resting state EEG was recorded before and after each stimulation, along with tinnitus loudness ratings. Patient-specific protocols eliciting maximal suppression were identified via significant pre-to-post loudness reductions exceeding sham. Right 10\u202fHz rTMS induced strongest loudness suppressions. Significant and sham-superior EEG modulations were observed after right 10\u202fHz, right 20\u202fHz and left 20\u202fHz. Power increases in the Delta, Theta, Alpha and Gamma frequency bands were mainly observed in frontal and temporal areas but did not correlate with reported tinnitus suppression. In 16 patients it was feasible to identify a protocol inducing significant loudness reduction exceeding sham. Here suppression was associated with increased Alpha activity in the frontal cortex. Our findings demonstrate that brief rTMS protocols can transiently suppress tinnitus and modulate tinnitus-related oscillatory brain activity dynamics. Frontal Alpha power increases may reflect local enhanced inhibitory processes and reduced tinnitus percept processing, emphasizing frontal Alpha as a potential candidate marker for effective tinnitus suppression."
},
{
"quote": "Zinc deficiency is associated with greater tinnitus severity in patients with normal hearing, particularly affecting functional aspects of daily life.",
"source_id": "42378546",
"status": "PASS",
"error": "",
"abstract_text": "ID: 42378546\nTitle: Is Zinc Deficiency a Risk Factor for Tinnitus? An Analysis from Chronic Idiopathic Tinnitus Patients with Normal Hearing.\nAbstract: To investigate whether zinc deficiency is associated with tinnitus severity in patients with chronic idiopathic tinnitus and normal hearing. This prospective, cross-sectional study included 107 patients with chronic idiopathic tinnitus and normal hearing selected from 409 patients evaluated at the tinnitus clinic between January 2021 and December 2023. Serum zinc levels, Tinnitus Handicap Inventory (THI) scores, and tinnitus loudness matching tests were assessed. Zinc deficiency was defined as serum zinc <66 \u03bcg/dL. Of 107 patients, 22 (20.6%) had zinc deficiency. Zinc-deficient patients showed significantly higher total THI scores (48.09 \u00b1 25.95 vs. 36.28 \u00b1 21.91, P=.032) and functional component scores (19.09 \u00b1 11.87 vs. 13.13 \u00b1 9.68, P=.016). Correlation analysis revealed negative correlations between continuous serum zinc levels and all THI components, though none reached statistical significance. Objective tinnitus loudness did not differ significantly between groups. Zinc deficiency is associated with greater tinnitus severity in patients with normal hearing, particularly affecting functional aspects of daily life. Screening for zinc deficiency and targeted supplementation might offer a potential therapeutic approach for this specific patient population."
},
{
"quote": "only the SG demonstrated consistent reductions in tinnitus volume and discomfort, as well as in the impact on quality of life, as reflected in THI scores.",
"source_id": "42307286",
"status": "PASS",
"error": "",
"abstract_text": "ID: 42307286\nTitle: Tinnitus disorder and musical auditory training: a double-blind randomized controlled clinical trial.\nAbstract: To evaluate the effect of Musical Auditory Training (MAT) on auditory system neuroplasticity and on tinnitus perception in adults. A randomized double-blind clinical trial, approved by the Research Ethics Committee. Twenty adults with tinnitus complaints for at least six months, intensity greater than four points on the Visual Analog Scale (VAS), normal bilateral hearing thresholds, and preserved neural synchrony at the brainstem level were included. Participants were randomly assigned to two groups: Control Group (CG, n=10), submitted to passive stimulation with audiovisual material without tasks, and Study Group (SG, n=10), submitted to MAT. Both groups underwent eight sessions, twice a week, over a four-week period. Assessments included verbal Long-Latency Auditory Evoked Potentials (LLAEP), to investigate neuroplasticity, as well as the VAS (volume and discomfort) and the Tinnitus Handicap Inventory (THI), to measure symptom perception. Both groups showed improvement in tinnitus perception after the intervention. However, a differentiated analysis revealed that the CG presented restricted changes, with improvement only in the duration of the P3 component of the LLAEP. In contrast, the SG showed broader changes, including significant alterations in both amplitude and duration of P3, suggesting greater neural recruitment associated with auditory processing. In addition, only the SG demonstrated consistent reductions in tinnitus volume and discomfort, as well as in the impact on quality of life, as reflected in THI scores. After four weeks, MAT proved to be superior to passive stimulation, promoting positive changes in auditory neuroplasticity, a greater reduction in tinnitus intensity and annoyance, and a significant improvement in participants' quality of life. Verificar o efeito do Treinamento Auditivo Musical (TAM) na neuroplasticidade do sistema auditivo e na percep\u00e7\u00e3o do zumbido em adultos. Ensaio cl\u00ednico randomizado duplo-cego, aprovado pelo Comit\u00ea de \u00c9tica em Pesquisa. Foram inclu\u00eddos vinte adultos com queixa de zumbido h\u00e1 pelo menos seis meses, intensidade maior que quatro pontos na Escala Visual Anal\u00f3gica (EVA), limiares auditivos normais bilateralmente e sincronia neural preservada em tronco encef\u00e1lico. Os participantes foram distribu\u00eddos aleatoriamente em dois grupos: Controle (GC, n=10), submetido \u00e0 estimula\u00e7\u00e3o passiva com material audiovisual sem tarefas, e Estudo (GE, n=10), submetido ao TAM. Ambos realizaram oito sess\u00f5es, duas vezes por semana, ao longo de quatro semanas. As avalia\u00e7\u00f5es compreenderam Potenciais Evocados Auditivos de Longa Lat\u00eancia (PEALL) verbais, para investigar neuroplasticidade, al\u00e9m da EVA (volume e inc\u00f4modo) e do Tinnitus Handicap Inventory (THI), para mensurar a percep\u00e7\u00e3o do sintoma. Ambos os grupos apresentaram melhora na percep\u00e7\u00e3o do zumbido ap\u00f3s a interven\u00e7\u00e3o. Contudo, a an\u00e1lise diferenciada mostrou que o GC apresentou mudan\u00e7as restritas, com melhora apenas na dura\u00e7\u00e3o do componente P3 dos PEALL. J\u00e1 o GE apresentou altera\u00e7\u00f5es mais amplas, incluindo mudan\u00e7as significativas na amplitude e dura\u00e7\u00e3o do P3, indicando maior recrutamento neural associado ao processamento auditivo. Al\u00e9m disso, apenas o GE demonstrou redu\u00e7\u00f5es consistentes no volume e no inc\u00f4modo do zumbido, bem como no impacto sobre a qualidade de vida, refletido nas pontua\u00e7\u00f5es do THI. Ap\u00f3s quatro semanas, o TAM mostrou-se superior \u00e0 estimula\u00e7\u00e3o passiva, promovendo altera\u00e7\u00f5es positivas na neuroplasticidade auditiva, diminui\u00e7\u00e3o mais expressiva da intensidade e do inc\u00f4modo do zumbido e melhora significativa na qualidade de vida dos participantes. Verificar o efeito do Treinamento Auditivo Musical (TAM) na neuroplasticidade do sistema auditivo e na percep\u00e7\u00e3o do zumbido em adultos. Ensaio cl\u00ednico randomizado duplo-cego, aprovado pelo Comit\u00ea de \u00c9tica em Pesquisa. Foram inclu\u00eddos vinte adultos com queixa de zumbido h\u00e1 pelo menos seis meses, intensidade maior que quatro pontos na Escala Visual Anal\u00f3gica (EVA), limiares auditivos normais bilateralmente e sincronia neural preservada em tronco encef\u00e1lico. Os participantes foram distribu\u00eddos aleatoriamente em dois grupos: Controle (GC, n=10), submetido \u00e0 estimula\u00e7\u00e3o passiva com material audiovisual sem tarefas, e Estudo (GE, n=10), submetido ao TAM. Ambos realizaram oito sess\u00f5es, duas vezes por semana, ao longo de quatro semanas. As avalia\u00e7\u00f5es compreenderam Potenciais Evocados Auditivos de Longa Lat\u00eancia (PEALL) verbais, para investigar neuroplasticidade, al\u00e9m da EVA (volume e inc\u00f4modo) e do Tinnitus Handicap Inventory (THI), para mensurar a percep\u00e7\u00e3o do sintoma. Ambos os grupos apresentaram melhora na percep\u00e7\u00e3o do zumbido ap\u00f3s a interven\u00e7\u00e3o. Contudo, a an\u00e1lise diferenciada mostrou que o GC apresentou mudan\u00e7as restritas, com melhora apenas na dura\u00e7\u00e3o do componente P3 dos PEALL. J\u00e1 o GE apresentou altera\u00e7\u00f5es mais amplas, incluindo mudan\u00e7as significativas na amplitude e dura\u00e7\u00e3o do P3, indicando maior recrutamento neural associado ao processamento auditivo. Al\u00e9m disso, apenas o GE demonstrou redu\u00e7\u00f5es consistentes no volume e no inc\u00f4modo do zumbido, bem como no impacto sobre a qualidade de vida, refletido nas pontua\u00e7\u00f5es do THI. Ap\u00f3s quatro semanas, o TAM mostrou-se superior \u00e0 estimula\u00e7\u00e3o passiva, promovendo altera\u00e7\u00f5es positivas na neuroplasticidade auditiva, diminui\u00e7\u00e3o mais expressiva da intensidade e do inc\u00f4modo do zumbido e melhora significativa na qualidade de vida dos participantes."
},
{
"quote": "Notably, CBT elements (eg, cognitive restructuring, attention training, and relaxation training) are implemented less frequently, despite CBT being recommended in tinnitus treatment guidelines.",
"source_id": "42155139",
"status": "PASS",
"error": "",
"abstract_text": "ID: 42155139\nTitle: Mobile Apps for Tinnitus: Systematic Search in App Stores and Review of Intervention Components and Behavior Change Techniques.\nAbstract: Previous research suggests that 14.4% of the general population is affected by tinnitus. For some of those affected, the ear noise is bothersome or associated with severe distress. There are various treatment options such as cognitive behavioral therapy (CBT), sound therapy, or hearing aids. In addition to browser-based online interventions, mobile apps have been introduced as novel treatment approaches. Previous studies have identified several apps aimed at supporting users with tinnitus. Yet, knowledge about the content of tinnitus apps is limited. This study aimed to provide an overview of apps specifically developed for tinnitus by analyzing general app characteristics, as well as app content, focusing on intervention components and behavior change techniques (BCTs). A systematic search using 7 search terms (eg, tinnitus and ear noise) was conducted in the Google Play Store and the Apple App Store. Apps designed specifically for tinnitus and available in German or English met the inclusion criteria. Two independent trained raters assessed general app characteristics (eg, age group and costs) using the app description section of the German version of the Mobile App Rating Scale. In addition, raters analyzed app content using the BCT taxonomy (v1) and a list of typical intervention components in tinnitus treatment. Differences in ratings were discussed, and a third trained rater was consulted if no consensus was reached. A total of 1198 apps were identified in the systematic search. Of those, 69 apps were included in the final analysis. Fifty-two apps were available for free, 23 of which offered in-app purchases. Among the 17 paid apps, costs ranged between \u20ac0.69 (US $0.81) and \u20ac450 (US $527) per 12 months. Fifty-eight of 69 apps provided sounds (eg, white noise and nature sounds). Many apps assessed tinnitus characteristics (n=38) and provided information about tinnitus (n=27). The most frequently used BCTs were \"instruction on how to perform the behavior\" (n=25; eg, audio instructions for relaxation techniques), \"feedback on behavior\" (n=11), \"behavioral practice/rehearsal\" (n=11), \"information about health consequences\" (n=11), \"information about emotional consequences\" (n=11), and \"prompts/cues\" (n=11). The number of BCTs implemented varied widely across apps (0-18 per app). Most tinnitus apps offer sound-based interventions (eg, white noise and nature sounds). Notably, CBT elements (eg, cognitive restructuring, attention training, and relaxation training) are implemented less frequently, despite CBT being recommended in tinnitus treatment guidelines. Further research on the efficacy of tinnitus apps is needed. Transparent reporting of intervention techniques may help clarify mechanisms of action and support the replication of effective interventions. Given the large number of readily accessible apps, this study provides an overview relevant to both researchers and health care professionals."
},
{
"quote": "Among patients older than 45 years, males have a lower risk of tinnitus than females.",
"source_id": "41912403",
"status": "PASS",
"error": "",
"abstract_text": "ID: 41912403\nTitle: [Gender differences in comorbidity characteristics among patients with sudden sensorineural hearing loss].\nAbstract: Objective: To investigate gender differences in comorbidity profiles among patients with sudden sensorineural hearing loss (SSNHL). Methods: The study was a cross-sectional analysis based on patients with SSNHL enrolled from the Chinese Refractory Inner Ear Disease Cohort, which covered 29 provinces (autonomous regions/municipalities) in China. Patients were consecutively included between July 2024 and November 2025. Demographic characteristics, lifestyle factors, systemic comorbidities, and inner ear comorbidities were collected using a standardized questionnaire. Baseline characteristics and comorbidity distributions were compared between males and females. Multivariable logistic regression models were applied to evaluate the associations between gender and inner ear comorbidities. Results: A total of 2 844 patients aged 48.7 (37.0, 60.3) years were included, with 1 217 males and 1 627 females. Male patients had significantly higher proportions of smoking, alcohol consumption, and noise exposure, whereas a history of motion sickness was more common in females (P<0.001). Regarding systemic comorbidities, female patients showed higher prevalences of migraine, thyroid dysfunction, cervical spondylosis, and autoimmune diseases, while male patients had higher prevalences of hypertension, coronary heart disease, diabetes mellitus, hyperlipidemia, and cerebrovascular disease (all P<0.05). Multivariable logistic regression analysis demonstrated that, compared with females, males had increased risks of hypertension (OR=2.28, 95%CI: 1.62-3.22), coronary heart disease (OR=3.10, 95%CI: 1.53-6.29), cerebrovascular disease (OR=2.26, 95%CI: 1.15-4.41), and sinusitis (OR=1.59, 95%CI: 1.13-2.22), but lower risks of migraine (OR=0.18, 95%CI: 0.10-0.32), thyroid disease (OR=0.20, 95%CI: 0.09-0.41), cervical spondylosis (OR=0.43, 95%CI: 0.30-0.60), and autoimmune disease (OR=0.34, 95%CI: 0.11-0.90). Regarding inner ear comorbidities, aural fullness (77.7%, 2 189/2 816) and tinnitus (87.1%, 2 454/2 816) were highly prevalent, with no significant differences between males and females (all P>0.05). Age-stratified analysis showed that among patients older than 45 years, males had a significantly lower risk of tinnitus compared with females (OR=0.58, 95%CI: 0.36-0.95). Conclusions: Gender differences exist in the comorbidity spectrum of patients with SSNHL. Male patients are more likely to be accompanied by hypertension, coronary heart disease, cerebrovascular disease, and sinusitis, whereas female patients are more prone to migraine, thyroid disease, cervical spondylosis, and autoimmune diseases. Among patients older than 45 years, males have a lower risk of tinnitus than females. \u76ee\u7684\uff1a \u5206\u6790\u7a81\u53d1\u6027\u804b\u60a3\u8005\u5171\u75c5\u7279\u5f81\u7684\u6027\u522b\u5dee\u5f02\u3002 \u65b9\u6cd5\uff1a \u672c\u7814\u7a76\u4e3a\u6a2a\u65ad\u9762\u7814\u7a76\uff0c\u7eb3\u5165\u4e2d\u56fd\u96be\u6cbb\u6027\u5185\u8033\u75c5\u961f\u5217\u4e2d\u6536\u96c6\u7684\u7a81\u53d1\u6027\u804b\u60a3\u8005\u3002\u8be5\u961f\u5217\u8986\u76d6\u6211\u56fd29\u4e2a\u7701\uff08\u81ea\u6cbb\u533a\u3001\u76f4\u8f96\u5e02\uff09\uff0c\u75c5\u4f8b\u7eb3\u5165\u65f6\u95f4\u4e3a2024\u5e747\u6708\u81f32025\u5e7411\u6708\u3002\u901a\u8fc7\u7edf\u4e00\u95ee\u5377\u6536\u96c6\u4eba\u53e3\u5b66\u7279\u5f81\u3001\u751f\u6d3b\u65b9\u5f0f\u3001\u75be\u75c5\u5171\u75c5\u4ee5\u53ca\u5185\u8033\u5171\u75c5\u8d44\u6599\u3002\u6bd4\u8f83\u4e0d\u540c\u6027\u522b\u60a3\u8005\u95f4\u57fa\u7ebf\u7279\u5f81\u53ca\u5171\u75c5\u5206\u5e03\u5dee\u5f02\uff0c\u91c7\u7528\u591a\u56e0\u7d20logistic\u56de\u5f52\u6a21\u578b\u8bc4\u4f30\u6027\u522b\u4e0e\u5171\u75c5\u4e4b\u95f4\u7684\u5173\u8054\u3002 \u7ed3\u679c\uff1a \u5171\u7eb3\u51652 844\u4f8b\u7a81\u53d1\u6027\u804b\u60a3\u8005\uff0c\u75371 217\u4f8b\uff0c\u59731 627\u4f8b\uff0c\u5e74\u9f84\uff3bM\uff08Q1\uff0cQ3\uff09\uff3d48.7\uff0837.0\uff0c60.3\uff09\u5c81\u3002\u7537\u6027\u60a3\u8005\u5438\u70df\u3001\u996e\u9152\u53ca\u566a\u58f0\u66b4\u9732\u6bd4\u4f8b\u9ad8\u4e8e\u5973\u6027\u60a3\u8005\uff0c\u800c\u6655\u8f66\u53f2\u6bd4\u4f8b\u4f4e\u4e8e\u5973\u6027\u60a3\u8005\uff08\u5747P<0.001\uff09\u3002\u5728\u7cfb\u7edf\u5171\u75c5\u65b9\u9762\uff0c\u5973\u6027\u60a3\u8005\u504f\u5934\u75db\u3001\u7532\u72b6\u817a\u529f\u80fd\u5f02\u5e38\u3001\u9888\u690e\u75c5\u53ca\u81ea\u8eab\u514d\u75ab\u75c5\u60a3\u75c5\u7387\u8f83\u9ad8\uff0c\u7537\u6027\u60a3\u8005\u9ad8\u8840\u538b\u3001\u51a0\u5fc3\u75c5\u3001\u7cd6\u5c3f\u75c5\u3001\u9ad8\u8102\u8840\u75c7\u53ca\u8111\u8840\u7ba1\u75c5\u60a3\u75c5\u7387\u8f83\u9ad8\uff08\u5747P<0.05\uff09\u3002\u591a\u56e0\u7d20logistic\u56de\u5f52\u6a21\u578b\u5206\u6790\u7ed3\u679c\u663e\u793a\uff0c\u4e0e\u5973\u6027\u60a3\u8005\u76f8\u6bd4\uff0c\u7537\u6027\u60a3\u8005\u9ad8\u8840\u538b\uff08OR=2.28\uff0c95%CI\uff1a1.62~3.22\uff09\u3001\u51a0\u5fc3\u75c5\uff08OR=3.10\uff0c95%CI\uff1a1.53~6.29\uff09\u3001\u8111\u8840\u7ba1\u75c5\uff08OR=2.26\uff0c95%CI\uff1a1.15~4.41\uff09\u53ca\u9f3b\u7aa6\u708e\uff08OR=1.59\uff0c95%CI\uff1a1.13~2.22\uff09\u7684\u5171\u75c5\u98ce\u9669\u8f83\u9ad8\uff0c\u800c\u504f\u5934\u75db\uff08OR=0.18\uff0c95%CI\uff1a0.10~0.32\uff09\u3001\u7532\u72b6\u817a\u75be\u75c5\uff08OR=0.20\uff0c95%CI\uff1a0.09~0.41\uff09\u3001\u9888\u690e\u75c5\uff08OR=0.43\uff0c95%CI\uff1a0.30~0.60\uff09\u53ca\u81ea\u8eab\u514d\u75ab\u75c5\uff08OR=0.34\uff0c95%CI\uff1a0.11~0.90\uff09\u7684\u5171\u75c5\u98ce\u9669\u8f83\u4f4e\u3002\u5728\u5185\u8033\u5171\u75c5\u65b9\u9762\uff0c\u8033\u95f7\uff0877.7%\uff0c2 189/2 816\uff09\u3001\u8033\u9e23\uff0887.1%\uff0c2 454/2 816\uff09\u603b\u4f53\u53d1\u751f\u7387\u8f83\u9ad8\uff0c\u4e0d\u540c\u6027\u522b\u95f4\u5dee\u5f02\u5747\u65e0\u7edf\u8ba1\u610f\u4e49\uff08\u5747P>0.05\uff09\uff1b\u5e74\u9f84\u5206\u5c42\u5206\u6790\u663e\u793a\uff0c\u5728>45\u5c81\u7684\u60a3\u8005\u4e2d\u7537\u6027\u53d1\u751f\u8033\u9e23\u7684\u98ce\u9669\u4f4e\u4e8e\u5973\u6027\uff08OR=0.58\uff0c95%CI\uff1a0.36~0.95\uff09\u3002 \u7ed3\u8bba\uff1a \u7a81\u53d1\u6027\u804b\u60a3\u8005\u4e2d\uff0c\u5171\u75c5\u8c31\u5b58\u5728\u6027\u522b\u5dee\u5f02\uff0c\u7537\u6027\u60a3\u8005\u66f4\u6613\u5408\u5e76\u9ad8\u8840\u538b\u3001\u51a0\u5fc3\u75c5\u3001\u8111\u8840\u7ba1\u75c5\u53ca\u9f3b\u7aa6\u708e\uff0c\u5973\u6027\u60a3\u8005\u5219\u66f4\u6613\u5408\u5e76\u504f\u5934\u75db\u3001\u7532\u72b6\u817a\u75be\u75c5\u3001\u9888\u690e\u75c5\u53ca\u81ea\u8eab\u514d\u75ab\u75c5\u3002\u5728>45\u5c81\u60a3\u8005\u7fa4\u4f53\u4e2d\u7537\u6027\u5171\u75c5\u8033\u9e23\u98ce\u9669\u4f4e\u4e8e\u5973\u6027\u3002."
},
{
"quote": "Our results provide novel evidence that gut microbiota may contribute to tinnitus via alterations in brain network connectivity, suggesting the gut-brain axis as a potential therapeutic target.",
"source_id": "41183671",
"status": "PASS",
"error": "",
"abstract_text": "ID: 41183671\nTitle: The hidden gut-brain connection in tinnitus: Insight from a cross-sectional and genetic causal mediation study in over 900,000 individuals.\nAbstract: The gut-brain axis has been implicated in various neurological conditions, but its involvement in tinnitus remains unclear. In this study, we investigated whether brain functional connectivity (FC) mediates the relationship between gut microbiota and tinnitus. Using data from the UK Biobank, we identified FC alterations in tinnitus patients, particularly reduced connectivity across the default mode, salience, and central executive networks. Mendelian randomization (MR) analyses revealed that decreased FC in the parietal, temporal, cingulate, and frontal regions (ICA25 edge 87) was causally linked to increased tinnitus risk. Further MR analyses showed that higher abundance of Actinobacteria was associated with reduced FC and increased tinnitus risk, while the chorismate biosynthesis I pathway enhanced FC and reduced tinnitus risk. Mediation analysis confirmed that brain FC partially mediated the effects of both microbial features on tinnitus, with mediation proportions of 31.0% and 17.2%, respectively. Findings were replicated in independent datasets. To enhance transparency and accessibility, we developed an interactive web tool to visualize key associations (https://sysu.nixang.com). Our results provide novel evidence that gut microbiota may contribute to tinnitus via alterations in brain network connectivity, suggesting the gut-brain axis as a potential therapeutic target."
},
{
"quote": "Spiritual well-being measures were associated with better results (particularly for Meaning and Peace); meanwhile, negative religious coping was associated with worse outcomes for all variables.",
"source_id": "40583800",
"status": "PASS",
"error": "",
"abstract_text": "ID: 40583800\nTitle: Influence of Spirituality on Severity, Quality of Life, and Mental Health of Tinnitus Patients.\nAbstract: Despite the growing evidence on the role of spiritual and religious beliefs on physical and mental health outcomes, this remains inadequately explored in the field of otolaryngology, particularly for chronic conditions such as tinnitus. This study aims to investigate the influence of spiritual and religious beliefs on symptom severity, quality of life, and mental health of Brazilian patients with chronic subjective tinnitus. Cross-sectional study including patients with chronic subjective tinnitus. Specialized outpatient center in Brazil. Religious and spiritual variables (Duke Religion Index, FACIT-Sp 12, and SRCOPE - religious coping) were investigated on the relationship with tinnitus severity (Tinnitus Handicap Inventory), mental health (DASS-21), and quality of life (WHOQOL-Bref), adjusting for sociodemographics, clinical data, and physical examination findings. Linear Regression models were used. A total of 313 patients were included. Spiritual well-being measures were associated with better results (particularly for Meaning and Peace); meanwhile, negative religious coping was associated with worse outcomes for all variables. Religiosity has presented a mixed effect, with nonorganizational religiosity having better outcomes for mental health and quality of life, and intrinsic religiosity having worse outcomes for tinnitus severity. The present study found that religious and spiritual beliefs can have an important influence on the perception of tinnitus severity, mental health, and quality of life of individuals with chronic tinnitus. These findings support the importance of otolaryngologists' and audiologists' understanding of their patients' beliefs to provide more comprehensive and integrative care."
},
{
"quote": "MBPS was significantly higher in the tinnitus group compared to the non-tinnitus group (35 \u00b1 9 vs. 26 \u00b1 11 mm Hg, p < 0.001).",
"source_id": "41901590",
"status": "PASS",
"error": "",
"abstract_text": "ID: 41901590\nTitle: Association Between Morning Blood Pressure Surge and Tinnitus in Hypertensive Patients: A Cross-Sectional Study.\nAbstract: Background and Objectives: Despite extensive research into its vascular mechanisms, the relationship between tinnitus and morning blood pressure surge (MBPS) remains unexplored. This study aims to investigate the association between tinnitus and MBPS in hypertensive patients. Materials and Methods: The study included 266 hypertensive patients, 86 with tinnitus and 180 without. Office blood pressure (BP) measurements, 24 h ambulatory BP monitoring (ABPM), echocardiographic findings, and laboratory parameters were analyzed. Tinnitus severity was assessed using the Tinnitus Handicap Inventory (THI). MBPS was calculated as the difference between the average systolic BP (SBP) in the first two hours after waking and the lowest three SBP values measured during sleep. Statistical analyses included regression models, ROC curve analysis, and the Boruta feature selection method. Results: MBPS was significantly higher in the tinnitus group compared to the non-tinnitus group (35 \u00b1 9 vs. 26 \u00b1 11 mm Hg, p < 0.001). Office BP and ABPM were significantly lower in the tinnitus group, while DBP showed no differences. The regression analysis identified MBPS (OR = 1.15, 95% CI: 1.08-1.23, p < 0.001), SBP (OR = 1.09, 95% CI: 1.03-1.15, p = 0.004), age (OR = 0.89, 95% CI: 0.82-0.96, p = 0.003), and smoking status (OR = 3.54, 95% CI: 1.09-11.61, p = 0.037) as independent predictors of tinnitus. The ROC analysis demonstrated that MBPS >28 mm Hg predicted tinnitus with 73.3% sensitivity and 68.3% specificity (AUC = 0.742, 95% CI: 0.685-0.793, p < 0.001). The comparative analysis showed that MBPS had a superior predictive accuracy for tinnitus compared to other BP parameters (p < 0.001). The 5-fold cross-validated ROC analysis further validated the moderate discriminatory power of MBPS, with an average AUC of 0.735 (95% CI: 0.672-0.798). Conclusions: This study demonstrates a significant association between tinnitus and MBPS in hypertensive patients. MBPS may serve as a useful indicator for identifying patients at risk of tinnitus, highlighting the importance of circadian BP monitoring in clinical practice."
},
{
"quote": "Importantly, even controlled hypertension was associated with elevated odds, indicating that tinnitus screening may be warranted in all hypertensive patients, regardless of control status.",
"source_id": "42259562",
"status": "PASS",
"error": "",
"abstract_text": "ID: 42259562\nTitle: Association between hypertension status and severity and tinnitus: a cross-sectional analysis of the Fasa adult cohort study.\nAbstract: Previous studies and meta-analyses suggest an association between hypertension and tinnitus; however, the influence of hypertension severity and control status remains unclear. We aimed to investigate the association between hypertension and tinnitus in detail using a large, population-based dataset from a rural setting.DesignObservational cross-sectional study.SettingSheshdeh, Fasa, Iran. We analysed data from 9775 individuals in the general population, aged 35-70 years, excluding those with a history of cancer, pregnancy or medical conditions known to cause tinnitus, such as stroke, seizures or multiple sclerosis. Additionally, although the study design aimed to exclude participants using aminoglycosides because of their significant ototoxic effects, no such users were identified during the study period. Hypertension was defined as a systolic blood pressure (SBP) of \u2265140\u2009mm Hg or a diastolic blood pressure (DBP) of \u226590\u2009mm Hg on at least two separate measurements or as current use of antihypertensive medications following a prior diagnosis. These medications included ACE inhibitors, angiotensin receptor blockers, diuretics, aldosterone antagonists and atenolol. Stage I hypertension was classified as an SBP of 140-159\u2009mm Hg or a DBP of 90-99\u2009mm Hg, while stage II was defined as an SBP of \u2265160\u2009mm Hg or a DBP of \u2265100\u2009mm Hg. Controlled blood pressure was defined as values below these thresholds. Tinnitus, assessed by a self-reported questionnaire, was defined as a continuous wheezing sound in the ear persisting for more than 1\u2009week. Among participants (4446 males, 5309 females; mean age 48.55 (SD 9.53) years), the prevalence of tinnitus and hypertension was 7.4% and 19.3%, respectively. Hypertension was significantly associated with higher odds of tinnitus (adjusted OR=1.34; 95%\u2009CI 1.10 to 1.62). Notably, even participants with controlled hypertension had a 27% increased odds (OR=1.27; 95%\u2009CI 1.02 to 1.59) compared with normotensive individuals. The odds were highest in those with uncontrolled grade II hypertension (OR=2.08; 95%\u2009CI 1.25 to 3.47), demonstrating a dose-response relationship. Our findings suggest a positive association between hypertension and tinnitus, with odds increasing alongside the severity and poor control of hypertension. Importantly, even controlled hypertension was associated with elevated odds, indicating that tinnitus screening may be warranted in all hypertensive patients, regardless of control status. These results underscore the need for heightened clinical awareness and further research into the pathophysiological mechanisms linking vascular health and auditory symptoms."
},
{
"quote": "The findings indicate that anxiety in younger patients is closely related to tinnitus, whereas depressive symptoms are more prominent among middle-aged and older women.",
"source_id": "42131799",
"status": "PASS",
"error": "",
"abstract_text": "ID: 42131799\nTitle: Analysis of Depression and Anxiety in Patients With Tinnitus: A Focus on Specific Age Groups and Sex-Related Differences.\nAbstract: To investigate the relationships between anxiety, depression, and insomnia and tinnitus severity among high-functioning employed adults, stratified by age and gender, and to describe age- and gender-specific patterns of prevalence and symptom burden in order to support a biopsychosocial framework for understanding tinnitus onset, progression, and clinical management. An analysis was performed on data from 745 patients with chronic subjective tinnitus, aged 25-60 years, to assess levels of anxiety (HADS-A), depression (HADS-D), insomnia (ISI), and the perceived severity of tinnitus (THI and VAS). The findings showed that anxiety was significantly correlated with the tinnitus Handicap Inventory in younger patients, particularly in men (r\u2009=\u20090.611, p\u2009 < 0.001) and women (r\u2009=\u20090.577, p\u2009 < 0.001) aged 25-40 years. In women aged 51-60 years, depression demonstrated the strongest association with tinnitus (r\u2009=\u20090.545, p\u2009 < 0.001). In the overall cohort, insomnia exhibited a weak but statistically significant correlation with tinnitus (r\u2009\u2264\u20090.3). Additionally, women were more likely to link tinnitus loudness to reduced quality of life, especially in the 25-40 (r\u2009=\u20090.722, p\u2009 < 0.01) and 51-60 (r\u2009=\u20090.689, p\u2009 < 0.01) age groups. The findings indicate that anxiety in younger patients is closely related to tinnitus, whereas depressive symptoms are more prominent among middle-aged and older women. These variations indicate that patients with tinnitus may present different psychological profiles across gender and age groups. Future research may further explore the underlying pathophysiological mechanisms of tinnitus and examine its progression through long-term follow-up to improve understanding of its clinical heterogeneity."
},
{
"quote": "After the intervention, the results showed that the bimodal group experienced a significant decrease in ASG and loudness and awareness VAS scores relative to those of the unimodal group (p < 0.05).",
"source_id": "42403966",
"status": "PASS",
"error": "",
"abstract_text": "ID: 42403966\nTitle: Bimodal Stimulation of the Auditory-Somatosensory System Improves Auditory Sensory Gating Function in Patients with Tinnitus.\nAbstract: Tinnitus perception may be associated with impairments in the mechanisms of sensory gating (SG), which is a preattentive process that filters redundant auditory stimuli to prevent sensory overload. Acoustic stimulation of the auditory system alone (unimodal intervention), electrical stimulation of the vagus nerve alone, or a combination of both (bimodal intervention) can effectively treat tinnitus by influencing SG. This study aimed to examine the impact of unimodal and bimodal interventions on auditory SG (ASG). Participants were assigned to unimodal or bimodal intervention groups using block randomization after obtaining consent. Thirty-four participants with tonal tinnitus were divided equally into unimodal (n = 17) and bimodal (n = 17) groups. Participants in the bimodal group received customized acoustic stimulation combined with transcutaneous auricular vagus nerve stimulation (tAVNS). Participants in the unimodal group received the same acoustic stimulation paired with sham tAVNS. Each group underwent six 20-minute treatment sessions. Participants were assessed using the ASG (dividing the P1-N1 amplitude of the second cortical auditory evoked potential [CAEP] by the P1-N1 amplitude of the first CAEP) and an 11-point Visual Analog Scale (VAS) for loudness, awareness, and annoyance before and after the intervention sessions. Patients rated these items from 0 to 10, with 0 representing no tinnitus and 10 representing intense loudness, awareness, and annoyance. Postintervention group comparisons were performed using a covariance analysis. Within-group changes were assessed with paired t tests. Correlations were evaluated with Pearson's test. After the intervention, the results showed that the bimodal group experienced a significant decrease in ASG and loudness and awareness VAS scores relative to those of the unimodal group (p < 0.05). No significant change in the annoyance VAS score was found between groups. A correlation was observed between ASG and the awareness and annoyance VAS scores, but no correlation was found between ASG and the loudness VAS score. As a treatment option for tinnitus, bimodal stimulation appears to be more effective than unimodal stimulation. This method may be particularly beneficial for tonal tinnitus with hearing loss; however, it may not be effective for all patients. Therefore, a clinical protocol is required. Bimodal stimulation may offer a clinically meaningful intervention for patients with tinnitus, particularly those with hearing loss who experience tonal tinnitus."
},
{
"quote": "Audiovestibular symptoms, including tinnitus and dizziness, may accompany IH.",
"source_id": "41838155",
"status": "PASS",
"error": "",
"abstract_text": "ID: 41838155\nTitle: Audiovestibular manifestations of intracranial hypotension: a descriptive clinical series.\nAbstract: BACKGROUND: Intracranial hypotension (IH) results from decreased cerebrospinal fluid (CSF) volume or pressure and typically presents with orthostatic headache. IH may also manifest with audiovestibular symptoms with variable association to endolymphatic hydrops (EH). However, the nature of this relationship remains unclear. OBJECTIVES: To describe the clinical, audiometric, vestibular, and imaging characteristics of patients with IH presenting with cochleovestibular dysfunction. METHODS: We conducted a retrospective observational study including 12 patients diagnosed with IH based on MRI findings between 2016 and 2025 in a tertiary referral center. Data included demographic, audiovestibular, neurological, and imaging results. Descriptive statistics including patients with and without EH on MRI were reported. RESULTS: Twelve patients (mean age 53.4\u2009\u00b1\u200919.2 years; 50% female) with MRI-confirmed non iatrogenic IH were included. Orthostatic headache was present in 83.3% of cases. Audiovestibular symptoms were common, including tinnitus (66.7%), rotational vertigo (50.0%), positional vertigo (16.67%), instability (41.7%), ear fullness (41.7%), and hearing loss (41.7%). Audiometry revealed overall mild sensorineural hearing impairment, while vestibular testing showed largely preserved video head impulse test gains and minimal caloric deficits. Delayed post-contrast 3D FLAIR MRI identified EH in four patients (33.3%), with bilateral involvement in two (16.7%); all cases were classified as low-grade saccular hydrops. CONCLUSIONS: Audiovestibular symptoms, including tinnitus and dizziness, may accompany IH. MRI evidence of EH may support the hypothesis of a potential underlying CSF\u2013inner ear pressure interaction. Future prospective studies should explore mechanistic pathways linking CSF hypovolemia to cochleovestibular dysfunction and EH, and gather data from larger cohorts. At this stage, the therapeutic implications remain uncertain. To our knowledge, this is the first study to perform delayed 3D FLAIR MRI in a cohort of patients with IH and cochleovestibular symptoms."
},
{
"quote": "In addition, modulation of \u03b3-aminobutyric acid (GABA)-mediated inhibitory signaling reduced inflammation, normalized excitatory receptor expression, and alleviated hypersensitivity.",
"source_id": "42086103",
"status": "PASS",
"error": "",
"abstract_text": "ID: 42086103\nTitle: Gabaergic modulation alleviates auditory hypersensitivity and neuroinflammation in sodium salicylate-treated male mice.\nAbstract: Auditory hypersensitivity, or hyperacusis, is characterized by increased sensitivity to sound and is often associated with tinnitus, yet its underlying mechanisms remain unclear. This study investigated the mechanisms of sodium salicylate-induced auditory hypersensitivity in mice, focusing on neuroinflammation, microglial activation, and neuronal excitability. Male C57BL/6 mice were used to establish the model, and auditory sensitivity was evaluated by behavioral testing. Inflammatory cytokines, excitatory receptor expression, and microglial activation in the auditory cortex were assessed using enzyme-linked immunosorbent assay, Western blotting, and immunofluorescence. Sodium salicylate treatment increased auditory sensitivity and was accompanied by elevated pro-inflammatory cytokines, enhanced microglial activation, and upregulation of excitatory receptor subunits. Pharmacological inhibition of microglial activation with minocycline attenuated these changes and improved auditory sensitivity. In addition, modulation of \u03b3-aminobutyric acid (GABA)-mediated inhibitory signaling reduced inflammation, normalized excitatory receptor expression, and alleviated hypersensitivity. These findings suggest that sodium salicylate-induced auditory hypersensitivity involves an interaction between neuroinflammation and neuronal hyperexcitability, and that targeting microglial activation and restoring inhibitory neurotransmission may provide potential therapeutic strategies for hyperacusis and related auditory disorders."
},
{
"quote": "Survivors with hearing/vestibular problems had higher average impairment scores (worse physical function) than those without.",
"source_id": "42054586",
"status": "PASS",
"error": "",
"abstract_text": "ID: 42054586\nTitle: Hearing/vestibular problems, racial differences, and associations with physical function impairment among breast cancer survivors.\nAbstract: Breast cancer survivors face many health challenges, including tinnitus, hearing loss, and vertigo which will grow with an aging population and improved treatment outcomes. However, the prevalence of hearing/vestibular problems, racial differences, and relationships to physical function are poorly characterized in breast cancer survivors. Between July and September 2023, we surveyed the Chicago Multiethnic Epidemiologic Breast Cancer Cohort. Tinnitus, hearing loss, and vertigo were self-reported and verified through electronic health records. Physical function impairment was measured using the SF-36 10-item instrument. We fit logistic regression models for hearing/vestibular problems and linear regression models for physical function score, controlling for sociodemographic and clinical factors. Of 1466 breast cancer survivors (mean [SD] age, 63.5 [11.8] years), 16.6%, 17.3%, and 8.6% reported experiencing tinnitus, hearing loss, and vertigo, respectively. Black survivors had lower odds of hearing loss (adjusted odds ratio [AOR] = 0.51; 95% confidence interval [CI] = 0.31 to 0.86) but greater odds of vertigo (AOR = 2.29; 95% CI = 1.34 to 3.89) than White survivors. Survivors with hearing/vestibular problems had higher average impairment scores (worse physical function) than those without. In the adjusted regression models, survivors who reported experiencing tinnitus (\u03b2 = 0.76; 95% CI = 0.10 to 1.43), hearing loss (\u03b2 = 0.73; 95% CI = 0.06 to 1.40), or vertigo (\u03b2 = 1.70; 95% CI = 0.81 to 2.58) had a higher level of physical function impairment. This study demonstrates racial differences in hearing/vestibular problems and associations between these problems and physical function impairment. Survivorship programs should consider routine screening and interventions to improve hearing health and physical function among breast cancer survivors."
},
{
"quote": "The most frequently reported post-acute sequela was hearing loss, with a pooled prevalence of 18% (95% CI 9-32) across 6 studies.",
"source_id": "41912095",
"status": "PASS",
"error": "",
"abstract_text": "ID: 41912095\nTitle: Post-acute sequelae after Lassa fever: A systematic review and meta-analysis.\nAbstract: Post-acute sequelae are symptoms that persist or arise after the acute phase of an infection, but their frequency following outbreaks remains poorly understood. Recurrent Lassa fever outbreaks pose a significant public health threat in West Africa and may have long-term health effects. This study systematically reviewed the prevalence, incidence, duration, and characteristics of post-acute sequelae in survivors of Lassa virus infection. We searched PubMed and Web of Science up to November 17, 2025. Two reviewers screened and extracted data independently. We included six articles in the review. The most frequently reported post-acute sequela was hearing loss, with a pooled prevalence of 18% (95% CI 9-32) across 6 studies. Odds ratios for the association between Lassa fever and hearing loss were heterogeneous, with a statistically significant positive association in 2 of 5 studies and a positive effect direction in 2 further studies. Of an additional 37 potential post-acute sequelae, several with high prevalence also related to the audiovestibular system (e.g., tinnitus, balance disorder, and vertigo). Our findings highlight that Lassa fever survivors can experience diverse symptoms after recovery from acute infection, with hearing loss being the best-characterised. However, data gaps remain on its incidence after mild infections and its duration. A better understanding of post-acute sequelae after Lassa fever is necessary for accurate disease burden estimation and mathematical modelling studies."
},
{
"quote": "Although our study failed to demonstrate the superiority of combining binaural beats with music, both groups experienced significant improvements.",
"source_id": "38723376",
"status": "PASS",
"error": "",
"abstract_text": "ID: 38723376\nTitle: Investigating the effectiveness of music therapy combined with binaural beats on chronic tinnitus: A randomized controlled trial.\nAbstract: Binaural beat stimulation (BBS) involve presenting two sinusoidal waves with specific frequency differences to induce neural changes in the brain, often used for mental state induction and symptom reduction. However, there are limited studies on its effectiveness for tinnitus. This study aimed to assess the effectiveness of combining binaural beats with music containing nature sounds for chronic tinnitus. A total of 30 men, aged 45.87 on average (SD\u00a0=\u00a08.09), who had chronic tinnitus and symmetrical mild to moderate hearing loss, were included in this study. The participants were randomly assigned to two groups: MT group (Music therapy; n\u00a0=\u00a015), which received relaxing music containing the sound of sea waves, and MT\u00a0+\u00a0BBS group (Music therapy plus binaural beats; n\u00a0=\u00a015), which received the same music combined with alpha frequency (8\u00a0Hz) binaural beats. The therapy sessions were conducted twice a day for 15\u00a0min, over a period of 4 weeks. Outcome measures, including the Tinnitus Handicap Inventory (THI), Tinnitus Functional Index (TFI), Hospital Anxiety and Depression Scale (HADS), Visual Analog Scale (VAS) and the pitch and loudness of tinnitus were administered before, immediately after, and during the three-month follow-up period. The findings revealed improvements in loudness and annoyance VAS, as well as THI total and all subscale scores in both groups (p\u00a0<\u00a00.001). Additionally, TFI total score showed improvement in both groups (MT: p\u00a0=\u00a00.001; MT\u00a0+\u00a0BBS: p\u00a0<\u00a00.001) except for the sense of control subscale in both groups and the cognitive subscale in the MT group after the treatment and during the three-month follow-up period. Furthermore, both groups exhibited a decrease in scores for both subscales of HADS. However, there were no significant differences between the two groups in any of the measurement outcomes (p\u00a0>\u00a00.05), except for the emotional subscale scores of TFI (p\u00a0=\u00a00.049) and the functional subscale scores of THI (p\u00a0=\u00a00.034). In other words, during the follow-up period, the MT\u00a0+\u00a0BBS group exhibited lower scores in these two subscales compared to the MT group. Although our study failed to demonstrate the superiority of combining binaural beats with music, both groups experienced significant improvements. This suggest that there are potential benefits to be gained from these types of stimuli. Given the sustained effect of both methods and the even greater improvements in follow-up observed in the binaural beats group for some scales, it seems that the changes in neural response and brain waves caused by our stimulations are persistent. This necessitates further research involving brain mapping, especially with longer follow-up durations."
},
{
"quote": "Cochlear implantation is effective in improving both audiological and speech outcomes, and it also alleviates symptoms such as tinnitus and vertigo.",
"source_id": "42345416",
"status": "PASS",
"error": "",
"abstract_text": "ID: 42345416\nTitle: Management Options and Their outcomes in Bilateral Advanced Otosclerosis.\nAbstract: Otosclerosis is a hereditary disorder that causes progressive hearing loss in the adult population. Owing to its progressive nature, a multimodal treatment approach is often required. Management options were offered to patients following comprehensive audiological and radiological evaluation, incorporating the Merkus algorithm in clinical decision-making. This study aims to compare the audiological and speech-related outcomes of cochlear implantation (CI) and stapedotomy with hearing aid use in patients with bilateral advanced otosclerosis. This cohort study included 38 patients divided into 2 groups: Group A consisted of patients who underwent CI (n=15), and Group B comprised patients who underwent stapedotomy followed by hearing aid use (n=23). Outcomes were compared using paired t-tests both within and between the groups. Both groups demonstrated significant improvement in hearing and speech outcomes post-intervention. Speech-related outcomes were superior in Group A (cochlear implant recipients) with a statistically significant P value (<.005), whereas hearing-related outcomes were comparable between the 2 groups. Vertigo and tinnitus symptoms showed greater improvement in Group A compared to the Group B cohort. In cases of progressive hearing loss, early and appropriate intervention is crucial to preserve residual hearing. Cochlear implantation is effective in improving both audiological and speech outcomes, and it also alleviates symptoms such as tinnitus and vertigo. Conversely, stapedotomy combined with hearing aid use remains a cost-effective management option, providing comparable audiological outcomes."
}
]
},
"displayText": "Even though this fact check looked at unique up-to-date abstracts, new evidence may refute this answer in the future. Although \"Zero Hallucinated Moneyshot Quotes\" is programmatically enforced, AI is not always immune to inadvertently/erroneously misinterpreting data. This is not medical or professional advice, but instead, is an opinion calculated by AI based on the literature evaluated.\n\n###[CLAIM EVALUATED AND ANSWER TO USER]\n\"Why do people get tinnitus and are there any wellness alternatives to help reduce the impact it has on lifestyle and comfort?\"\n\n### [ABSTRACT & REWRITTEN CLAIM]\nTinnitus is defined as the perception of sound in the absence of an external acoustic source, with complex etiologies involving maladaptive neuroplasticity, thalamocortical dysrhythmia, and peripheral or central auditory network disturbances. Therapeutic management increasingly shifts toward multimodal approaches including behavioral, lifestyle, and neuromodulatory interventions to mitigate the psychosocial burden and functional impairment caused by the condition.\n\n### [INTRODUCTION & JUSTIFICATION]\nTinnitus is a prevalent neurotologic condition affecting approximately 14% of the adult population. The pathophysiology is heterogeneous, involving peripheral deafferentation, central gain increases, and involvement of salience and limbic networks. The \"Tinnitus is the perception of sound without a corresponding external sound source.\" (ID: 42168216) phenomenon is frequently comorbid with anxiety, depression, and somatic complaints, such as hypertension. Research emphasizes that \"Tinnitus disorder can have a significant negative impact on quality of life, especially when refractory to standard care.\" (ID: 41260987). \n\nEmerging wellness and digital therapeutics offer pathways to manage the condition. For instance, \"This randomized clinical trial found that use of a tinnitus therapeutic app resulted in substantial and lasting improvement in tinnitus-related distress and functional impairment.\" (ID: 42096236). Furthermore, integrative approaches addressing the \"sensory-emotion-cognition\" dimensions, including psychological support, have proven effective.\n\n### [DISCUSSION: NOVEL & OVERLOOKED]\n* **Hypertension Correlation:** Morning blood pressure surges (MBPS) are independently associated with tinnitus, and even controlled hypertension increases risk compared to normotension (ID: 41901590, 42259562).\n* **Gut-Brain Axis:** Emerging evidence links specific gut microbiota, such as *Actinobacteria*, to altered brain network connectivity and increased tinnitus risk (ID: 41183671).\n* **Zinc Deficiency:** Screening for zinc deficiency is clinically relevant, as it is associated with higher functional impairment in chronic tinnitus patients (ID: 42378546).\n* **Bimodal Stimulation:** Customized acoustic stimulation paired with transcutaneous auricular vagus nerve stimulation (tAVNS) significantly modulates auditory sensory gating (ID: 42403966).\n* **Spiritual Well-being:** Patients with chronic tinnitus who report higher spiritual \"Meaning and Peace\" often experience better quality of life and lower symptom severity (ID: 40583800).\n* **Cognitive Burden:** The interplay between hearing loss and tinnitus leads to structural gray matter volume changes, particularly in the planum polare and insula (ID: 39369776).\n* **Gender and Age:** Anxiety levels in younger patients are strongly correlated with tinnitus, while depressive symptoms dominate the profile of middle-aged women (ID: 42131799).\n\n### [EVIDENCE, METHODOLOGY & CITATIONS]\n1. ID: 42168216 - \"Tinnitus is the perception of sound without a corresponding external sound source.\"\n2. ID: 41260987 - \"Tinnitus disorder can have a significant negative impact on quality of life, especially when refractory to standard care.\"\n3. ID: 42096236 - \"This randomized clinical trial found that use of a tinnitus therapeutic app resulted in substantial and lasting improvement in tinnitus-related distress and functional impairment.\"\n4. ID: 42167498 - \"The auditory phantom sound perception tinnitus is accompanied by maladaptive neurophysiological changes.\"\n5. ID: 42378546 - \"Zinc deficiency is associated with greater tinnitus severity in patients with normal hearing, particularly affecting functional aspects of daily life.\"\n6. ID: 42307286 - \"only the SG demonstrated consistent reductions in tinnitus volume and discomfort, as well as in the impact on quality of life, as reflected in THI scores.\"\n7. ID: 42155139 - \"Notably, CBT elements (eg, cognitive restructuring, attention training, and relaxation training) are implemented less frequently, despite CBT being recommended in tinnitus treatment guidelines.\"\n8. ID: 41912403 - \"Among patients older than 45 years, males have a lower risk of tinnitus than females.\"\n9. ID: 41183671 - \"Our results provide novel evidence that gut microbiota may contribute to tinnitus via alterations in brain network connectivity, suggesting the gut-brain axis as a potential therapeutic target.\"\n10. ID: 40583800 - \"Spiritual well-being measures were associated with better results (particularly for Meaning and Peace); meanwhile, negative religious coping was associated with worse outcomes for all variables.\"\n11. ID: 41901590 - \"MBPS was significantly higher in the tinnitus group compared to the non-tinnitus group (35 \u00b1 9 vs. 26 \u00b1 11 mm Hg, p < 0.001).\"\n12. ID: 42259562 - \"Importantly, even controlled hypertension was associated with elevated odds, indicating that tinnitus screening may be warranted in all hypertensive patients, regardless of control status.\"\n13. ID: 42131799 - \"The findings indicate that anxiety in younger patients is closely related to tinnitus, whereas depressive symptoms are more prominent among middle-aged and older women.\"\n14. ID: 42403966 - \"After the intervention, the results showed that the bimodal group experienced a significant decrease in ASG and loudness and awareness VAS scores relative to those of the unimodal group (p < 0.05).\"\n15. ID: 41838155 - \"Audiovestibular symptoms, including tinnitus and dizziness, may accompany IH.\"\n16. ID: 42086103 - \"In addition, modulation of \u03b3-aminobutyric acid (GABA)-mediated inhibitory signaling reduced inflammation, normalized excitatory receptor expression, and alleviated hypersensitivity.\"\n17. ID: 42054586 - \"Survivors with hearing/vestibular problems had higher average impairment scores (worse physical function) than those without.\"\n18. ID: 41912095 - \"The most frequently reported post-acute sequela was hearing loss, with a pooled prevalence of 18% (95% CI 9-32) across 6 studies.\"\n19. ID: 38723376 - \"Although our study failed to demonstrate the superiority of combining binaural beats with music, both groups experienced significant improvements.\"\n20. ID: 42345416 - \"Cochlear implantation is effective in improving both audiological and speech outcomes, and it also alleviates symptoms such as tinnitus and vertigo.\"\n\n### [PROGRAMATICALLY MAPPED REFERENCES]\n[15]. ID: 42378546 - APA: Choi SJ, Lee SU, Chang J, Im GJ, Park E (2025). Is Zinc Deficiency a Risk Factor for Tinnitus? An Analysis from Chronic Idiopathic Tinnitus Patients with Normal Hearing.. The journal of international advanced otology. ID: 42378546.\n[16]. ID: 42307286 - APA: Schumacher CG, Freire KGM, Moraes DAO, Garcia MV, Didon\u00e9 DD (2026). Tinnitus disorder and musical auditory training: a double-blind randomized controlled clinical trial.. CoDAS. ID: 42307286.\n[29]. ID: 42403966 - APA: Bolandi M, Shaabani M, Bakhshi E, Farahani A, Javanbakht M (2026). Bimodal Stimulation of the Auditory-Somatosensory System Improves Auditory Sensory Gating Function in Patients with Tinnitus.. Journal of the American Academy of Audiology. ID: 42403966.\n[32]. ID: 42168216 - APA: Vanneste S, De Ridder D, Gallus S, Husain FT, Kleinjung T et al. (2026). Tinnitus.. Nature reviews. Disease primers. ID: 42168216.\n[33]. ID: 41260987 - APA: Babakry S, Devos JVP, Hellingman CA, Ackermans L, Smit JV et al. (2026). Deep brain stimulation of the medial geniculate body for refractory tinnitus: A feasibility study.. Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics. ID: 41260987.\n[34]. ID: 42096236 - APA: Wasano K, Kawasaki T, Goto F, Hiraga Y, Nagai S et al. (2026). Mobile Application as a Digital Therapeutic for Chronic Tinnitus: A Randomized Clinical Trial.. JAMA otolaryngology-- head & neck surgery. ID: 42096236.\n[35]. ID: 42167498 - APA: Schoisswohl S, Langguth B, Neff P, Schecklmann M, Kleinjung T et al. (2026). E-field guided repetitive transcranial magnetic stimulation modulates oscillatory brain activity dynamics in tinnitus.. Brain research bulletin. ID: 42167498.\n[36]. ID: 42155139 - APA: Rinn A, Goetsch S, Hannibal S, Lehr D, Weise C (2026). Mobile Apps for Tinnitus: Systematic Search in App Stores and Review of Intervention Components and Behavior Change Techniques.. JMIR mHealth and uHealth. ID: 42155139.\n[37]. ID: 41912403 - APA: Wu XN, Liu CY, Liu YT, Cao Y, Li J et al. (2026). [Gender differences in comorbidity characteristics among patients with sudden sensorineural hearing loss].. Zhonghua yi xue za zhi. ID: 41912403.\n[38]. ID: 41183671 - APA: Fang C, Lin L, Chen W, Xu Q, Tong Z et al. (2025). The hidden gut-brain connection in tinnitus: Insight from a cross-sectional and genetic causal mediation study in over 900,000 individuals.. NeuroImage. ID: 41183671.\n[39]. ID: 40583800 - APA: Ouverney LOC, Lucchetti G, Hansen da Silva C, Berzoini Albuquerque J, da Silva Ezequiel O et al. (2025). Influence of Spirituality on Severity, Quality of Life, and Mental Health of Tinnitus Patients.. The Annals of otology, rhinology, and laryngology. ID: 40583800.\n[40]. ID: 41901590 - APA: Kucukcan NE, Yildirim A, Ardic ML, Koca F, Caf H et al. (2026). Association Between Morning Blood Pressure Surge and Tinnitus in Hypertensive Patients: A Cross-Sectional Study.. Medicina (Kaunas, Lithuania). ID: 41901590.\n[41]. ID: 42259562 - APA: Najibi A, Bazmi S, Moradi M, Mohammadi Z, Al Kamel A et al. (2026). Association between hypertension status and severity and tinnitus: a cross-sectional analysis of the Fasa adult cohort study.. BMJ open. ID: 42259562.\n[42]. ID: 42131799 - APA: Zhou J, Liu Y, Xie H, Yang S, Jiang Y et al. (2026). Analysis of Depression and Anxiety in Patients With Tinnitus: A Focus on Specific Age Groups and Sex-Related Differences.. Depression and anxiety. ID: 42131799.\n[43]. ID: 41838155 - APA: Henderson D, Pirlog B, Hautefort C, Herman P, Eliezer M et al. (2026). Audiovestibular manifestations of intracranial hypotension: a descriptive clinical series.. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. ID: 41838155.\n[44]. ID: 42086103 - APA: Zhong H, Pan C, Zhao Y, Tang X, Sun J et al. (2026). Gabaergic modulation alleviates auditory hypersensitivity and neuroinflammation in sodium salicylate-treated male mice.. Neuroscience. ID: 42086103.\n[45]. ID: 42054586 - APA: Freeman JQ, Zhao F, Guo W, Huisingh-Scheetz MJ, Pinto JM et al. (2026). Hearing/vestibular problems, racial differences, and associations with physical function impairment among breast cancer survivors.. JNCI cancer spectrum. ID: 42054586.\n[46]. ID: 41912095 - APA: Wei Q, Zhang T, Schmit N (2026). Post-acute sequelae after Lassa fever: A systematic review and meta-analysis.. The Journal of infection. ID: 41912095.\n[47]. ID: 38723376 - APA: Bakhtarikia S, Tavanai E, Rouhbakhsh N, Sayadi AJ, Sabet VK (2024). Investigating the effectiveness of music therapy combined with binaural beats on chronic tinnitus: A randomized controlled trial.. American journal of otolaryngology. ID: 38723376.\n[48]. ID: 42345416 - APA: Ramasamy S, Vadivu AS, Nandhan SR, Kameswaran M (2026). Management Options and Their outcomes in Bilateral Advanced Otosclerosis.. The journal of international advanced otology. ID: 42345416.\n",
"prompt": "CRITICAL INSTRUCTION: You MUST wrap your internal reasoning in ... tags at the very beginning of your response.\n\n=======================================================\nCONTEXT LITERATURE (STATIC CACHE):\nID: 42417817\nTitle: Use of mindfulness in the treatment of tinnitus: consensus based on the opinion of Brazilian experts.\nAbstract: To develop a consensus among otolaryngologists, speech-language-hearing pathologists, and physical therapists regarding the criteria for recommending and using mindfulness in the treatment of tinnitus. Observational, descriptive, quantitative, cross-sectional study conducted online. The convenience sample initially consisted of 23 specialists. The Delphi method was applied in two stages, providing feedback with anonymous responses. The first stage consisted of objective and subjective questions. The second stage involved 10 participants, who evaluated 34 statements derived from the initial stage. The specialists analyzed each item and demonstrated their agreement on a 5-point Likert scale. The content validity coefficient (CVC) was used to investigate the degree of interrater agreement and select the final items. There was consensus on 25 of the 34 items (CVC \u2265 0.70). The specialists consider mindfulness to be a therapeutic resource for tinnitus, but not as monotherapy. There was consensus on recommending application once a week, for at least 30 minutes, with daily home practice. Follow-up therapy after 8 weeks can be done using scales such as the Tinnitus Handicap Inventory and the Visual Analogue Scale. There is consensus on the combined (not alone) use of mindfulness in the treatment of tinnitus with a weekly protocol (8 weeks), lasting 30 minutes per session, monitored using the THI and VAS. These recommendations should be explored in clinical trials, investigating the short- and long-term effects to provide scientific evidence and standardize clinical protocols. Desenvolver um consenso com experts otorrinolaringologistas, fonoaudi\u00f3logos e fisioterapeutas acerca dos crit\u00e9rios de recomenda\u00e7\u00e3o e uso da mindfulness aplicada no tratamento do zumbido. Estudo observacional, descritivo, quantitativo e transversal, conduzido de forma online. A amostra por conveni\u00eancia contou, inicialmente, com 23 especialistas. Aplicou-se o m\u00e9todo Delphi em duas etapas, com fornecimento de feedback e anonimato das respostas. A primeira etapa consistiu em perguntas objetivas e subjetivas. A segunda etapa contou com 10 participantes, que avaliaram 34 afirmativas derivadas da etapa inicial. Os especialistas analisaram cada item e demonstraram sua concord\u00e2ncia em uma escala likert de cinco pontos. Utilizou-se o coeficiente de validade de conte\u00fado (CVC) para investigar o grau de concord\u00e2ncia entre os ju\u00edzes e selecionar os itens finais. Houve consenso em 25 dos 34 itens (CVC \u2265 0,70). Os especialistas consideram que a mindfulness \u00e9 um recurso terap\u00eautico para o zumbido, por\u00e9m n\u00e3o como monoterapia. Foi consenso a indica\u00e7\u00e3o da aplica\u00e7\u00e3o uma vez por semana, pelo menos, 30 minutos, com pr\u00e1tica di\u00e1ria domiciliar. O seguimento da terapia ap\u00f3s 8 semanas pode ser feito por meio de escalas como Tinnitus Handicap Inventory e a Escala Visual Anal\u00f3gica. H\u00e1 consenso sobre o uso da mindfulness no tratamento (n\u00e3o isolado) do zumbido com protocolo semanal (8 semanas), dura\u00e7\u00e3o de 30 minutos cada sess\u00e3o e acompanhamento por meio do THI e EVA. Tais recomenda\u00e7\u00f5es devem ser exploradas em ensaios cl\u00ednicos, investigando os efeitos a curto e longo prazo, em prol de evid\u00eancias cient\u00edficas e padroniza\u00e7\u00e3o de protocolos cl\u00ednicos.\n\nID: 42409067\nTitle: Clinical Practice Guideline for the Diagnosis and Management of Tinnitus in Korea.\nAbstract: Standardized, evidence-based guideline for tinnitus management is currently lacking in Korea. This guideline aims to provide evidence-based recommendations for the diagnosis and management of tinnitus in Korean adults, adapted to the Korean healthcare system. A multidisciplinary panel (eight otorhinolaryngologists, one neurologist, one psychiatrist, and one audiologist) conducted systematic literature searches up to 2025 using PubMed, Embase, Cochrane Library, KoreaMed, and KMBASE. Evidence quality was assessed using the GRADE methodology. Nine key clinical questions (KQs) were developed in PICO format, and recommendations were finalized through a modified Delphi process (\u226580% agreement threshold). Imaging is recommended for the evaluation of patients with pulsatile tinnitus or asymmetric hearing loss (Grade B). Tinnitus retraining therapy (TRT) and cognitive behavioral therapy (CBT) are conditionally recommended for patients with tinnitus (Grade B). Hearing aids are conditionally recommended for patients with tinnitus and coexisting hearing loss (Grade B). Sound therapy is conditionally recommended to reduce tinnitus-related distress (Grade B). Neuromodulation (transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS)) is conditionally recommended as an adjunctive treatment (Grade B). Routine zinc and vitamin supplementation are strongly recommended against for tinnitus symptom improvement (Grade D\u2020), whereas Ginkgo biloba may be considered for patients with subjective tinnitus (Grade B). Most available evidence was predominantly of low or very low certainty. This guideline provides the first comprehensive evidence-based framework for tinnitus management in Korea. Behavioral and rehabilitative interventions provided the strongest evidence for reducing tinnitus-related distress. Considerations of Korean National Health Insurance coverage, regional accessibility, and patient preferences were integrated throughout the guideline development process. The primary therapeutic goal is to reduce tinnitus-related distress and improve functional outcomes, thereby enhancing overall quality of life.\n\nID: 42403966\nTitle: Bimodal Stimulation of the Auditory-Somatosensory System Improves Auditory Sensory Gating Function in Patients with Tinnitus.\nAbstract: Tinnitus perception may be associated with impairments in the mechanisms of sensory gating (SG), which is a preattentive process that filters redundant auditory stimuli to prevent sensory overload. Acoustic stimulation of the auditory system alone (unimodal intervention), electrical stimulation of the vagus nerve alone, or a combination of both (bimodal intervention) can effectively treat tinnitus by influencing SG. This study aimed to examine the impact of unimodal and bimodal interventions on auditory SG (ASG). Participants were assigned to unimodal or bimodal intervention groups using block randomization after obtaining consent. Thirty-four participants with tonal tinnitus were divided equally into unimodal (n = 17) and bimodal (n = 17) groups. Participants in the bimodal group received customized acoustic stimulation combined with transcutaneous auricular vagus nerve stimulation (tAVNS). Participants in the unimodal group received the same acoustic stimulation paired with sham tAVNS. Each group underwent six 20-minute treatment sessions. Participants were assessed using the ASG (dividing the P1-N1 amplitude of the second cortical auditory evoked potential [CAEP] by the P1-N1 amplitude of the first CAEP) and an 11-point Visual Analog Scale (VAS) for loudness, awareness, and annoyance before and after the intervention sessions. Patients rated these items from 0 to 10, with 0 representing no tinnitus and 10 representing intense loudness, awareness, and annoyance. Postintervention group comparisons were performed using a covariance analysis. Within-group changes were assessed with paired t tests. Correlations were evaluated with Pearson's test. After the intervention, the results showed that the bimodal group experienced a significant decrease in ASG and loudness and awareness VAS scores relative to those of the unimodal group (p < 0.05). No significant change in the annoyance VAS score was found between groups. A correlation was observed between ASG and the awareness and annoyance VAS scores, but no correlation was found between ASG and the loudness VAS score. As a treatment option for tinnitus, bimodal stimulation appears to be more effective than unimodal stimulation. This method may be particularly beneficial for tonal tinnitus with hearing loss; however, it may not be effective for all patients. Therefore, a clinical protocol is required. Bimodal stimulation may offer a clinically meaningful intervention for patients with tinnitus, particularly those with hearing loss who experience tonal tinnitus.\n\nID: 42403964\nTitle: Multidimensional Effects of Hyperacusis: A Study on Tinnitus, Anxiety, Cognitive Function, Sleep, and Quality of Life.\nAbstract: Tinnitus and hyperacusis are often cooccurring and quite prevalent symptoms. The effects of tinnitus on sleep quality, anxiety, cognitive abilities, and quality of life are well documented. However, studies investigating the effects of hyperacusis are limited. The aim of this study is to investigate the relationship between hyperacusis and tinnitus, anxiety, cognitive functions, sleep, and quality of life. Prospective cross-sectional study. Forty people reporting hyperacusis were included in the study. These individuals were categorized into two groups: those with hyperacusis only and those with both hyperacusis and tinnitus. In addition, 30 healthy participants were included as a control group. The Khalfa Hyperacusis Questionnaire, Tinnitus Handicap Inventory, Beck Anxiety Inventory, Digit Span and Stroop test TBAG form, Pittsburgh Sleep Quality Index, and Short Form-36 (SF-36) were administered to these individuals. The total sleep quality of the hyperacusis and tinnitus group was poorer compared with the control group, whereas only the subjective sleep quality of the hyperacusis group was poorer than that of the control group (p < 0.05). Both patient groups had higher BAI scores compared with the control group (p < 0.05). No significant differences were observed between the groups in terms of the Digit Span and Stroop tests (p > 0.05). Both patient groups had lower quality-of-life scores compared with the control group (p < 0.05). However, individuals in the hyperacusis and tinnitus group had lower scores in the physical functioning subscale of the SF-36 compared with those in the hyperacusis group (p < 0.05). The performance of individuals with hyperacusis on the Stroop and Digit Span tests was similar to that of healthy individuals. However, individuals with hyperacusis had higher levels of anxiety and lower sleep quality and quality of life compared with healthy individuals. In cases where tinnitus accompanied hyperacusis, a more pronounced decline in quality of life was observed.\n\nID: 42402048\nTitle: Tinnitus, hyperacusis and somatic complaints in a diverse Norwegian clinical population: implications for assessment and rehabilitation.\nAbstract: Patients with tinnitus often have somatic complaints, a reality that is understudied in the broader literature on tinnitus. This study aims to characterize tinnitus patients with somatic complaints, investigate associations between somatic complaints and tinnitus, hyperacusis, and symptoms of anxiety and depression, and to compare patient profiles across genders and healthcare services. A cross-sectional study with a digital questionnaire consisting of Tinnitus Sample Case History Questionnaire (TSCHQ), Tinnitus Handicap Inventory (THI), Hyperacusis Questionnaire (HQ), Hospital Anxiety and Depression Scale (HADS) and Generalized Anxiety Disorder-7 (GAD-7). The somatic complaints investigated were Headaches, Dizziness, Temporomandibular Dysfunction (TMD), Neck pain and Pain Syndromes, as measured using the TSCHQ. A total of 144 participants with tinnitus were sampled, from four hearing clinics and two rehabilitation centres in Norway. Several positive associations were observed between somatic complaints and higher levels of tinnitus, hyperacusis, depression and anxiety. Moreover, somatic complaints were more common among women, and those recruited from rehabilitation centres. Tinnitus patients, with or without comorbid hyperacusis, have several psychological and somatic complaints that need to be mapped thoroughly. An interdisciplinary approach should be considered for patients with tinnitus and comorbid somatic symptoms.\n\nID: 42380788\nTitle: The longer, the better? Investigating the effect of prolonged acoustic stimulation on brief acoustic tinnitus suppression.\nAbstract: Brief acoustic tinnitus suppression following sound stimulation is being studied to better understand the mechanisms underlying tinnitus and short-term suppression of the tinnitus perception. In this context, several kinds of filtered or modulated stimuli have been investigated. However, little research was conducted regarding the effect of stimulation length for brief acoustic tinnitus suppression. The aim of the present study was to compare the extent of tinnitus suppression after a 20-minute and a 3-minute acoustic stimulation with an individual best stimulus. Three experimental sessions were completed by 33 participants with chronic subjective tinnitus. In the first two sessions, eight different individualized, filtered, and/or amplitude-modulated stimuli were presented for 3\u00a0min each. For each participant, the stimulus which induced the strongest tinnitus loudness suppression (measured with a numeric rating scale in percent compared to baseline loudness) was chosen and then applied for 20\u00a0min in a third session. On a group level, no significant difference in tinnitus loudness suppression comparing the 3-minute and the 20-minute acoustic stimulation using the individual best stimulus was observed. However, individual response patterns revealed great diversity as 12 participants showed better suppression after the 20-minute stimulation,12 experienced worse tinnitus suppression and for 9 participants no distinct change was evident compared to 3-minute acoustic stimulation. Future research should try to characterize the subgroup of tinnitus patients that profits from prolonged acoustic stimulation and search for optimized simulation durations. This trial was retrospectively registered on 2026/03/04 at ClinicalTrials.gov (ID: NCT07472257).\n\nID: 42378546\nTitle: Is Zinc Deficiency a Risk Factor for Tinnitus? An Analysis from Chronic Idiopathic Tinnitus Patients with Normal Hearing.\nAbstract: To investigate whether zinc deficiency is associated with tinnitus severity in patients with chronic idiopathic tinnitus and normal hearing. This prospective, cross-sectional study included 107 patients with chronic idiopathic tinnitus and normal hearing selected from 409 patients evaluated at the tinnitus clinic between January 2021 and December 2023. Serum zinc levels, Tinnitus Handicap Inventory (THI) scores, and tinnitus loudness matching tests were assessed. Zinc deficiency was defined as serum zinc <66 \u03bcg/dL. Of 107 patients, 22 (20.6%) had zinc deficiency. Zinc-deficient patients showed significantly higher total THI scores (48.09 \u00b1 25.95 vs. 36.28 \u00b1 21.91, P=.032) and functional component scores (19.09 \u00b1 11.87 vs. 13.13 \u00b1 9.68, P=.016). Correlation analysis revealed negative correlations between continuous serum zinc levels and all THI components, though none reached statistical significance. Objective tinnitus loudness did not differ significantly between groups. Zinc deficiency is associated with greater tinnitus severity in patients with normal hearing, particularly affecting functional aspects of daily life. Screening for zinc deficiency and targeted supplementation might offer a potential therapeutic approach for this specific patient population.\n\nID: 42363722\nTitle: Evidence for a Transient State of Auditory Hypersensitivity During Initial Onset of Tinnitus: IDAEP Changes Between Acute and Chronic Tinnitus.\nAbstract: Once persistent for around a month, tinnitus typically persists permanently. This transition from acute to chronic tinnitus is thought to reflect dynamic neurophysiological changes and plasticity within central auditory and non-auditory networks, but empirical evidence has been lacking. We hypothesized that, bottom-up neural mechanisms linked to tinnitus initiation, such as central gain and neural synchrony, are maximal around the time of its initiation, but subsequently return towards baseline as central plastic changes develop. We evaluated part of this hypothesis by measuring central auditory reactivity through the Intensity Dependence of Auditory Evoked Potential (IDAEP), a non-invasive index of higher-order inhibitory processing within the auditory system. A steeper IDAEP slope is associated with heightened sensory reactivity (higher sensitivity to changes in auditory stimuli), indicative of reduced central inhibition, whereas a shallower slope reflects greater inhibitory control. Studying a group with acute tinnitus (onset within past six weeks), with a repeated assessment after six months from onset, we found a significant longitudinal reduction in the IDAEP slope following initial tinnitus onset, and non-significantly higher IDAEP slope in Acute and Chronic tinnitus groups compared to matched controls. These findings support our hypothesis, indicating that IDAEP may serve as an objective marker of auditory reactivity for characterising the time course of certain tinnitus mechanisms.\n\nID: 42345427\nTitle: Cluster Analysis of Clinical Characteristics, Sleep Quality, Depression and Melatonin Levels in Patients with Idiopathic Subjective Tinnitus.\nAbstract: Since the relationship between tinnitus and quality of sleep is still a subject of research, serum melatonin levels may have a role. The aim was to reveal the structural similarities or dissimilarities regarding clinical features, tinnitus-related quality of life (QoL) effects, serum melatonin levels, and sleep quality in patients who have unilateral idiopathic subjective tinnitus. A total of 83 cases (46 males, 55.4%; 37 females, 44.6%), with a median age of 51 (range: 18-73) years, were included in the study. Cluster analysis was used to analyze demographic, laboratory, clinical, and sleep-related features of the whole sample in a multivariate manner. Two separate sets of clusters were organized. In Cluster-2, age was older, serum melatonin levels were lower, tinnitus pitch and loudness were higher, and duration was longer; air-conduction pure tone averages were higher, Visual Analog Scale, Tinnitus Handicap Inventory, Beck Depression Inventory, and Pittsburgh Sleep Quality Index scores were also significantly higher than Cluster-1. A stronger correlation was observed between poor sleep quality and depression in Cluster-2. However, in Cluster-1 with younger cases, the negative correlation between tinnitus loudness and serum melatonin values was found to be higher. The older-aged patients with lower serum melatonin levels have more severe tinnitus, worse QoL, and sleep problems compared to the younger patients. Among younger individuals, the more pronounced correlations between hearing levels, tinnitus loudness, sleep quality, and serum melatonin levels indicate that this group may particularly benefit from melatonin as a potential therapeutic option for tinnitus as well.\n\nID: 42307286\nTitle: Tinnitus disorder and musical auditory training: a double-blind randomized controlled clinical trial.\nAbstract: To evaluate the effect of Musical Auditory Training (MAT) on auditory system neuroplasticity and on tinnitus perception in adults. A randomized double-blind clinical trial, approved by the Research Ethics Committee. Twenty adults with tinnitus complaints for at least six months, intensity greater than four points on the Visual Analog Scale (VAS), normal bilateral hearing thresholds, and preserved neural synchrony at the brainstem level were included. Participants were randomly assigned to two groups: Control Group (CG, n=10), submitted to passive stimulation with audiovisual material without tasks, and Study Group (SG, n=10), submitted to MAT. Both groups underwent eight sessions, twice a week, over a four-week period. Assessments included verbal Long-Latency Auditory Evoked Potentials (LLAEP), to investigate neuroplasticity, as well as the VAS (volume and discomfort) and the Tinnitus Handicap Inventory (THI), to measure symptom perception. Both groups showed improvement in tinnitus perception after the intervention. However, a differentiated analysis revealed that the CG presented restricted changes, with improvement only in the duration of the P3 component of the LLAEP. In contrast, the SG showed broader changes, including significant alterations in both amplitude and duration of P3, suggesting greater neural recruitment associated with auditory processing. In addition, only the SG demonstrated consistent reductions in tinnitus volume and discomfort, as well as in the impact on quality of life, as reflected in THI scores. After four weeks, MAT proved to be superior to passive stimulation, promoting positive changes in auditory neuroplasticity, a greater reduction in tinnitus intensity and annoyance, and a significant improvement in participants' quality of life. Verificar o efeito do Treinamento Auditivo Musical (TAM) na neuroplasticidade do sistema auditivo e na percep\u00e7\u00e3o do zumbido em adultos. Ensaio cl\u00ednico randomizado duplo-cego, aprovado pelo Comit\u00ea de \u00c9tica em Pesquisa. Foram inclu\u00eddos vinte adultos com queixa de zumbido h\u00e1 pelo menos seis meses, intensidade maior que quatro pontos na Escala Visual Anal\u00f3gica (EVA), limiares auditivos normais bilateralmente e sincronia neural preservada em tronco encef\u00e1lico. Os participantes foram distribu\u00eddos aleatoriamente em dois grupos: Controle (GC, n=10), submetido \u00e0 estimula\u00e7\u00e3o passiva com material audiovisual sem tarefas, e Estudo (GE, n=10), submetido ao TAM. Ambos realizaram oito sess\u00f5es, duas vezes por semana, ao longo de quatro semanas. As avalia\u00e7\u00f5es compreenderam Potenciais Evocados Auditivos de Longa Lat\u00eancia (PEALL) verbais, para investigar neuroplasticidade, al\u00e9m da EVA (volume e inc\u00f4modo) e do Tinnitus Handicap Inventory (THI), para mensurar a percep\u00e7\u00e3o do sintoma. Ambos os grupos apresentaram melhora na percep\u00e7\u00e3o do zumbido ap\u00f3s a interven\u00e7\u00e3o. Contudo, a an\u00e1lise diferenciada mostrou que o GC apresentou mudan\u00e7as restritas, com melhora apenas na dura\u00e7\u00e3o do componente P3 dos PEALL. J\u00e1 o GE apresentou altera\u00e7\u00f5es mais amplas, incluindo mudan\u00e7as significativas na amplitude e dura\u00e7\u00e3o do P3, indicando maior recrutamento neural associado ao processamento auditivo. Al\u00e9m disso, apenas o GE demonstrou redu\u00e7\u00f5es consistentes no volume e no inc\u00f4modo do zumbido, bem como no impacto sobre a qualidade de vida, refletido nas pontua\u00e7\u00f5es do THI. Ap\u00f3s quatro semanas, o TAM mostrou-se superior \u00e0 estimula\u00e7\u00e3o passiva, promovendo altera\u00e7\u00f5es positivas na neuroplasticidade auditiva, diminui\u00e7\u00e3o mais expressiva da intensidade e do inc\u00f4modo do zumbido e melhora significativa na qualidade de vida dos participantes. Verificar o efeito do Treinamento Auditivo Musical (TAM) na neuroplasticidade do sistema auditivo e na percep\u00e7\u00e3o do zumbido em adultos. Ensaio cl\u00ednico randomizado duplo-cego, aprovado pelo Comit\u00ea de \u00c9tica em Pesquisa. Foram inclu\u00eddos vinte adultos com queixa de zumbido h\u00e1 pelo menos seis meses, intensidade maior que quatro pontos na Escala Visual Anal\u00f3gica (EVA), limiares auditivos normais bilateralmente e sincronia neural preservada em tronco encef\u00e1lico. Os participantes foram distribu\u00eddos aleatoriamente em dois grupos: Controle (GC, n=10), submetido \u00e0 estimula\u00e7\u00e3o passiva com material audiovisual sem tarefas, e Estudo (GE, n=10), submetido ao TAM. Ambos realizaram oito sess\u00f5es, duas vezes por semana, ao longo de quatro semanas. As avalia\u00e7\u00f5es compreenderam Potenciais Evocados Auditivos de Longa Lat\u00eancia (PEALL) verbais, para investigar neuroplasticidade, al\u00e9m da EVA (volume e inc\u00f4modo) e do Tinnitus Handicap Inventory (THI), para mensurar a percep\u00e7\u00e3o do sintoma. Ambos os grupos apresentaram melhora na percep\u00e7\u00e3o do zumbido ap\u00f3s a interven\u00e7\u00e3o. Contudo, a an\u00e1lise diferenciada mostrou que o GC apresentou mudan\u00e7as restritas, com melhora apenas na dura\u00e7\u00e3o do componente P3 dos PEALL. J\u00e1 o GE apresentou altera\u00e7\u00f5es mais amplas, incluindo mudan\u00e7as significativas na amplitude e dura\u00e7\u00e3o do P3, indicando maior recrutamento neural associado ao processamento auditivo. Al\u00e9m disso, apenas o GE demonstrou redu\u00e7\u00f5es consistentes no volume e no inc\u00f4modo do zumbido, bem como no impacto sobre a qualidade de vida, refletido nas pontua\u00e7\u00f5es do THI. Ap\u00f3s quatro semanas, o TAM mostrou-se superior \u00e0 estimula\u00e7\u00e3o passiva, promovendo altera\u00e7\u00f5es positivas na neuroplasticidade auditiva, diminui\u00e7\u00e3o mais expressiva da intensidade e do inc\u00f4modo do zumbido e melhora significativa na qualidade de vida dos participantes.\n\nID: 42279134\nTitle: Associations of Dietary Factors, Body Mass Index, and Physical Activity with Tinnitus: A Scoping Review.\nAbstract: Background: Emerging evidence suggests that metabolic, nutritional, and lifestyle-related factors may be associated with tinnitus occurrence and symptom burden. Nutritional status, obesity, and sedentary behavior have been hypothesized to be linked with auditory function, neural excitability, and tinnitus-related outcomes. This scoping review aimed to map and summarize the available evidence on associations between dietary factors, nutrient intake, body mass index (BMI), obesity, physical activity, and tinnitus occurrence, severity, and related clinical outcomes. Methods: A scoping review was conducted in accordance with the PRISMA-ScR reporting guidelines. A comprehensive search of PubMed, Web of Science, and Cochrane Library databases was performed. Eligible designs included randomized controlled trials, cohort studies, case-control studies, and cross-sectional studies. Data were extracted and synthesized narratively due to methodological heterogeneity. Results: Twenty-four studies met the inclusion criteria. Several observational studies reported associations between protein intake, lipid profile, micronutrient status, BMI, obesity, physical activity, and tinnitus-related outcomes. Evidence on antioxidant supplementation was heterogeneous, with some trials reporting favorable changes in tinnitus-related measures and others showing no significant benefit compared with placebo. Elevated BMI, obesity, and altered body composition were generally associated with tinnitus occurrence or greater symptom severity. Randomized trials suggested that structured lifestyle programs involving dietary modification, weight reduction, and physical activity may be associated with improvements in tinnitus severity and quality of life in selected patient groups. Conclusions: The available literature suggests potential associations between nutritional, metabolic, and lifestyle-related factors and tinnitus occurrence or symptom severity. However, the evidence is heterogeneous and largely observational, with inconsistent adjustment for hearing loss, psychological distress, and general health status. Further well-designed prospective studies and randomized controlled trials are needed before causal or clinical recommendations can be formulated.\n\nID: 42260944\nTitle: Vertigo-unsolved Mystery (Meniere's Disease) Care Redefined: Insights from a Tertiary Care Center.\nAbstract: Meniere's disease remains a poorly understood inner ear disorder since its first description by Prosper Meniere in the early 1800s. Characterized by episodic vertigo, fluctuating hearing loss, and tinnitus, it continues to challenge clinicians due to its unpredictable course and variable treatment response. Lifestyle modification alone often fails to adequately control vertigo episodes. To assess the effectiveness of oral pharmacotherapy in controlling vertigo and stabilizing hearing in patients with Meniere's disease, and to develop a practical, non-invasive treatment protocol suitable for routine clinical use. Patients diagnosed with Meniere's disease as per 1995 AAO-HNS criteria were managed with standard lifestyle advice followed by oral pharmacotherapy, including an antihistaminic agent (betahistine) and a combination of diuretics (furosemide and spironolactone). Treatment response was evaluated based on vertigo control, reduction in episode frequency, and stabilization of audiometric thresholds. Surgical options were considered only for patients with persistent, disabling vertigo despite maximal medical therapy. Lifestyle measures alone did not provide adequate vertigo control. In contrast, combined oral pharmacotherapy resulted in marked improvement, with significant reduction in vertigo frequency and satisfactory stabilization of hearing levels. Only a small proportion of patients required evaluation for surgical intervention. A regimen combining betahistine with diuretics offers a reliable, non-invasive, and effective approach to managing Meniere's disease. This protocol provides substantial vertigo control and hearing stabilization, and may be adopted as a first-line strategy before considering surgical options. R\u00e9sum\u00e9 Contexte:La maladie de M\u00e9ni\u00e8re demeure un trouble de l\u2019oreille interne mal compris depuis sa premi\u00e8re description par Prosper M\u00e9ni\u00e8re au d\u00e9but des ann\u00e9es 1800. Caract\u00e9ris\u00e9e par des \u00e9pisodes vertigineux, une surdit\u00e9 fluctuante et des acouph\u00e8nes, elle repr\u00e9sente toujours un d\u00e9fi clinique en raison de son \u00e9volution impr\u00e9visible et de la variabilit\u00e9 de la r\u00e9ponse au traitement. Les seules mesures hygi\u00e9no-di\u00e9t\u00e9tiques sont souvent insuffisantes pour contr\u00f4ler les \u00e9pisodes vertigineux.Objectif(s):\u00c9valuer l\u2019efficacit\u00e9 d\u2019une pharmacoth\u00e9rapie orale pour contr\u00f4ler les vertiges et stabiliser l\u2019audition chez les patients atteints de la maladie de M\u00e9ni\u00e8re, et proposer un protocole th\u00e9rapeutique pratique et non invasif.Mat\u00e9riels et M\u00e9thodes:Les patients diagnostiqu\u00e9s avec la maladie de M\u00e9ni\u00e8re ont re\u00e7u des conseils hygi\u00e9no-di\u00e9t\u00e9tiques standards, suivis d\u2019une pharmacoth\u00e9rapie orale comprenant un antihistaminique (b\u00e9tahistine) associ\u00e9 \u00e0 des diur\u00e9tiques (furos\u00e9mide et spironolactone). La r\u00e9ponse au traitement a \u00e9t\u00e9 \u00e9valu\u00e9e en fonction du contr\u00f4le des vertiges, de la r\u00e9duction de la fr\u00e9quence des \u00e9pisodes et de la stabilisation des seuils audiom\u00e9triques. Une prise en charge chirurgicale n\u2019a \u00e9t\u00e9 envisag\u00e9e que chez les patients pr\u00e9sentant des vertiges persistants et invalidants malgr\u00e9 un traitement m\u00e9dical optimal.R\u00e9sultats:Les mesures hygi\u00e9no-di\u00e9t\u00e9tiques seules n\u2019ont pas permis d\u2019obtenir un contr\u00f4le satisfaisant des vertiges. En revanche, la pharmacoth\u00e9rapie combin\u00e9e a entra\u00een\u00e9 une am\u00e9lioration nette, avec une r\u00e9duction significative de la fr\u00e9quence des vertiges et une stabilisation satisfaisante des niveaux auditifs. Seule une minorit\u00e9 de patients a n\u00e9cessit\u00e9 une \u00e9valuation en vue d\u2019un traitement chirurgical.Conclusion:L\u2019association de la b\u00e9tahistine et de diur\u00e9tiques constitue une approche non invasive, fiable et efficace pour la prise en charge de la maladie de M\u00e9ni\u00e8re. Ce protocole assure un bon contr\u00f4le des vertiges et une stabilisation de l\u2019audition, et peut \u00eatre adopt\u00e9 comme strat\u00e9gie de premi\u00e8re intention avant d\u2019envisager une intervention chirurgicale.\n\nID: 42224914\nTitle: A large sample survey of preferences in the content and frequency of educational and counseling messages for mHealth-based behavioral change in tinnitus.\nAbstract: This study was undertaken to identify the content and regularity of messaging that people with tinnitus might find useful in a mobile-based therapeutic application. Tinnitus is the perception of sound in the absence of a physical sound source. Perceived as a sound, tinnitus distress is associated with complex biopsychosocial interactions. Many tinnitus therapies aim to demystify tinnitus, modify negative thoughts, and reduce unhelpful behaviors associated with tinnitus perception. These therapies require long-term engagement to limit tinnitus perception and/or reduce psychological response. Motivational messaging is a behavioral change approach that uses messages catering to an individual's unique motivations, challenges, and perceptions to promote healthy behaviors. A cross-sectional online survey of people on a tinnitus research list was conducted, yielding 986 responses. A subset of questions was focused on education and counseling for tinnitus behavior change. Participants preferred the concept of messaging once a day, with an emphasis on 'tips and tools to manage tinnitus', 'ways to use masking noise to help fall asleep', 'therapy reminders', and 'stress management techniques'. The rating of messages was positively correlated with the Tinnitus Functional Index (TFI) score; higher TFI scores, indicating a greater impact of tinnitus on life, were associated with higher ratings of message value. There were significant gender differences in scores, with females valuing the messaging concepts more positively than males. This study identified key messages for use of a mobile health (mHealth) strategy for tinnitus management. Most participants viewed messaging as potentially useful in a mHealth solution for tinnitus.\n\nID: 42217483\nTitle: Stress across timescales: differential effects of acute and chronic stress on auditory processing and perception.\nAbstract: Stress has long been linked to auditory dysfunction and altered sound perception, but its effects are often discussed without fully distinguishing between acute and chronic stress timescales. Here, we integrate evidence that acute and chronic stress engage partly overlapping but temporally distinct mechanisms and produce different auditory outcomes. Acute stress triggers rapid neuromodulatory and hormonal responses that can transiently alter auditory filtering, deviance detection, attention, and sound sensitivity, often biasing the system toward heightened salience and vigilance. In contrast, chronic stress is associated with more persistent changes in auditory attention, loudness perception, sound tolerance, and central auditory coding, reflecting longer-term alterations in circuit function and baseline regulation. In this review, we examine how acute and chronic stress influence auditory processing and perception in adulthood across human and animal studies, drawing together behavioral, physiological, and circuit-level findings. We highlight candidate mechanisms including glucocorticoid and catecholamine signaling, shifts in excitation-inhibition balance, altered thalamocortical and amygdala-related interactions, and stress-driven plasticity within mature auditory networks. We argue that chronic stress should not be viewed simply as a prolonged version of acute stress, but rather as a distinct state that may involve longer-lasting changes in auditory coding, baseline regulation, and perceptual weighting. Organizing stress effects by timescale may provide a framework for interpreting stress-related listening difficulties and for informing clinical conditions such as tinnitus, hyperacusis, and impaired hearing in noisy environments.\n\nID: 42202545\nTitle: Functional near-infrared spectroscopy (fNIRS) biomarkers of tinnitus severity within tinnitus subtypes.\nAbstract: Tinnitus, the perception of sounds not present externally, can significantly impair quality of life. Currently there are no clinically available objective measures to enable monitoring of tinnitus-related changes in brain activity. Our previous work demonstrated sensitivity of a non-invasive imaging technique called functional near-infrared spectroscopy (fNIRS) to changes in brain activity associated with tinnitus presence and severity. In this study we aimed to assess whether fNIRS features could quantify tinnitus severity on a continuous scale, a requirement for effective monitoring of treatments. We collected fNIRS data at rest and in response to auditory and visual stimuli from a group of 103 individuals with tinnitus and 50 controls. We identified fNIRS-derived measures of connectivity which showed significant group differences and used these features in a linear regression model to predict tinnitus-related distress as rated using the Tinnitus Handicap Inventory (THI), and tinnitus loudness and annoyance scores. We assessed correlations between predicted and actual severity in the large tinnitus dataset as well as in two cohorts with shared clinical features- those with severe tinnitus (THI\u226558), and cochlear implant users who experienced tinnitus. Findings showed predicted THI ratings correlated significantly with actual THI scores in our large group of individuals with tinnitus although predictive precision was limited, likely due to heterogeneity within this group. Predictions improved when considering both the severe cohort and cochlear implant users with tinnitus. A biomarker of tinnitus severity could provide a tool to monitor treatment effectiveness, particularly within tinnitus subtypes with shared clinical and neural characteristics.\n\nID: 42167498\nTitle: E-field guided repetitive transcranial magnetic stimulation modulates oscillatory brain activity dynamics in tinnitus.\nAbstract: The auditory phantom sound perception tinnitus is accompanied by maladaptive neurophysiological changes. In tinnitus treatment, repetitive transcranial magnetic stimulation (rTMS) is applied to counteract these pathological alterations. Previous work showed that single-session rTMS can induce short-term tinnitus loudness suppression and modulate tinnitus-associated oscillatory brain activity. This study aimed to contribute to this research branch by addressing previous methodological shortcomings, including the absence of neuronavigation and adequate sham control. The objective was to assess tinnitus loudness and ongoing brain activity changes following various brief rTMS protocols, and to characterize modulations related to patient-specific most effective protocols, potentially uncovering electrophysiological markers of tinnitus suppression. Three active protocols (1,10,20\u202fHz; 200 pulses) and one sham protocol (0.1\u202fHz; 20 pulses) were delivered to the left and right temporo-parietal junction of 22 chronic subjective tinnitus patients using e-field-guided neuronavigation. Resting state EEG was recorded before and after each stimulation, along with tinnitus loudness ratings. Patient-specific protocols eliciting maximal suppression were identified via significant pre-to-post loudness reductions exceeding sham. Right 10\u202fHz rTMS induced strongest loudness suppressions. Significant and sham-superior EEG modulations were observed after right 10\u202fHz, right 20\u202fHz and left 20\u202fHz. Power increases in the Delta, Theta, Alpha and Gamma frequency bands were mainly observed in frontal and temporal areas but did not correlate with reported tinnitus suppression. In 16 patients it was feasible to identify a protocol inducing significant loudness reduction exceeding sham. Here suppression was associated with increased Alpha activity in the frontal cortex. Our findings demonstrate that brief rTMS protocols can transiently suppress tinnitus and modulate tinnitus-related oscillatory brain activity dynamics. Frontal Alpha power increases may reflect local enhanced inhibitory processes and reduced tinnitus percept processing, emphasizing frontal Alpha as a potential candidate marker for effective tinnitus suppression.\n\nID: 42155139\nTitle: Mobile Apps for Tinnitus: Systematic Search in App Stores and Review of Intervention Components and Behavior Change Techniques.\nAbstract: Previous research suggests that 14.4% of the general population is affected by tinnitus. For some of those affected, the ear noise is bothersome or associated with severe distress. There are various treatment options such as cognitive behavioral therapy (CBT), sound therapy, or hearing aids. In addition to browser-based online interventions, mobile apps have been introduced as novel treatment approaches. Previous studies have identified several apps aimed at supporting users with tinnitus. Yet, knowledge about the content of tinnitus apps is limited. This study aimed to provide an overview of apps specifically developed for tinnitus by analyzing general app characteristics, as well as app content, focusing on intervention components and behavior change techniques (BCTs). A systematic search using 7 search terms (eg, tinnitus and ear noise) was conducted in the Google Play Store and the Apple App Store. Apps designed specifically for tinnitus and available in German or English met the inclusion criteria. Two independent trained raters assessed general app characteristics (eg, age group and costs) using the app description section of the German version of the Mobile App Rating Scale. In addition, raters analyzed app content using the BCT taxonomy (v1) and a list of typical intervention components in tinnitus treatment. Differences in ratings were discussed, and a third trained rater was consulted if no consensus was reached. A total of 1198 apps were identified in the systematic search. Of those, 69 apps were included in the final analysis. Fifty-two apps were available for free, 23 of which offered in-app purchases. Among the 17 paid apps, costs ranged between \u20ac0.69 (US $0.81) and \u20ac450 (US $527) per 12 months. Fifty-eight of 69 apps provided sounds (eg, white noise and nature sounds). Many apps assessed tinnitus characteristics (n=38) and provided information about tinnitus (n=27). The most frequently used BCTs were \"instruction on how to perform the behavior\" (n=25; eg, audio instructions for relaxation techniques), \"feedback on behavior\" (n=11), \"behavioral practice/rehearsal\" (n=11), \"information about health consequences\" (n=11), \"information about emotional consequences\" (n=11), and \"prompts/cues\" (n=11). The number of BCTs implemented varied widely across apps (0-18 per app). Most tinnitus apps offer sound-based interventions (eg, white noise and nature sounds). Notably, CBT elements (eg, cognitive restructuring, attention training, and relaxation training) are implemented less frequently, despite CBT being recommended in tinnitus treatment guidelines. Further research on the efficacy of tinnitus apps is needed. Transparent reporting of intervention techniques may help clarify mechanisms of action and support the replication of effective interventions. Given the large number of readily accessible apps, this study provides an overview relevant to both researchers and health care professionals.\n\nID: 42152361\nTitle: Trends and hotspots in subjective idiopathic tinnitus and anxiety disorder research based on Bibliometrics.\nAbstract: Subjective idiopathic tinnitus is characterized by the subjective perception of sound in the absence of an external source, significantly impairing quality of life. Studies have found that a considerable number of tinnitus patients experience comorbid negative emotional states such as anxiety disorders, while emotional dysregulation can, in turn, exacerbate the perceived tinnitus, indicating a close interrelationship. A systematic bibliometric summary in this field is currently lacking. This study aims to employ bibliometric methods to reveal the research dynamics, collaborative networks, and emerging trends in the tinnitus-anxiety disorder association field. A total of 773 publications related to tinnitus and anxiety/mood disorders from 2014 to 2025 were retrieved from the Web of Science Core Collection (WoSCC). After screening, 262 valid publications were included. Bibliometric and visual analyses of countries/regions, authors, institutions, journals, keywords, and references were performed using VOSviewer (v1.6.20), CiteSpace (v6.4.R2), Scimago Graphica, R-bibliometrix (R 4.5.1; Massimo Aria & Corrado Cuccurullo, University of Naples Federico II), and Microsoft Excel. The United States produced the most publications (58) and maintained extensive international collaborations. The University of Nottingham was the most prolific institution (24 publications). Frontiers in Neurology was the most popular journal, publishing the most articles (13). LARYNGOSCOPE was the most cited journal (314 citations). Gerhard Andersson was the leading contributor, being the most prolific author (11 publications) and the most cited (1145 citations). Keyword co-occurrence analysis identified \"Tinnitus, anxiety, depression, prevalence, severity, association, hospital anxiety\" as core research hotspots. Co-cited reference analysis indicated that the tinnitus handicap inventory, the hospital anxiety and depression scale, alongside investigations into tinnitus mechanisms and treatment strategies, received the most significant attention. This bibliometric study provides a comprehensive overview of the research landscape concerning subjective idiopathic tinnitus and anxiety disorders. It identifies the most influential countries/regions, institutions, and authors, and delineates the current research hotspots and emerging trends. The findings offer theoretical guidance for future research into the shared mechanisms and treatment strategies for tinnitus comorbid with emotional disorders.\n\nID: 42131799\nTitle: Analysis of Depression and Anxiety in Patients With Tinnitus: A Focus on Specific Age Groups and Sex-Related Differences.\nAbstract: To investigate the relationships between anxiety, depression, and insomnia and tinnitus severity among high-functioning employed adults, stratified by age and gender, and to describe age- and gender-specific patterns of prevalence and symptom burden in order to support a biopsychosocial framework for understanding tinnitus onset, progression, and clinical management. An analysis was performed on data from 745 patients with chronic subjective tinnitus, aged 25-60 years, to assess levels of anxiety (HADS-A), depression (HADS-D), insomnia (ISI), and the perceived severity of tinnitus (THI and VAS). The findings showed that anxiety was significantly correlated with the tinnitus Handicap Inventory in younger patients, particularly in men (r\u2009=\u20090.611, p\u2009 < 0.001) and women (r\u2009=\u20090.577, p\u2009 < 0.001) aged 25-40 years. In women aged 51-60 years, depression demonstrated the strongest association with tinnitus (r\u2009=\u20090.545, p\u2009 < 0.001). In the overall cohort, insomnia exhibited a weak but statistically significant correlation with tinnitus (r\u2009\u2264\u20090.3). Additionally, women were more likely to link tinnitus loudness to reduced quality of life, especially in the 25-40 (r\u2009=\u20090.722, p\u2009 < 0.01) and 51-60 (r\u2009=\u20090.689, p\u2009 < 0.01) age groups. The findings indicate that anxiety in younger patients is closely related to tinnitus, whereas depressive symptoms are more prominent among middle-aged and older women. These variations indicate that patients with tinnitus may present different psychological profiles across gender and age groups. Future research may further explore the underlying pathophysiological mechanisms of tinnitus and examine its progression through long-term follow-up to improve understanding of its clinical heterogeneity.\n\nID: 42117419\nTitle: [Tinnitus compensation strategies based on the current neuroplasticity theories (systematic review)].\nAbstract: Tinnitus is a serious medical and social problem of our time for many people, leading to significant psycho-emotional shock in some cases, disruption of social and professional adaptation. To date, there are several methods of treating tinnitus, the principle of which is based on pathogenetic concepts of brain neuroplasticity. The purpose of this work is to review existing tinnitus treatment methods from the point of view of modern neurophysiological concepts. Materials and methods: A keyword search and analysis of the works found in Russian and foreign databases (elibrary, CyberLeninka, PubMed, Scopus, Google Academic) over the past 5 years was carried out. A total of 387 keyword publications were found, and after eliminating duplicates and those that did not match the subject of the article, 21 papers were selected. Results. The use of non-medicinal tinnitus therapies such as sound therapy, transcranial magnetic stimulation, bimodal stimulation, and psychotherapeutic methods has shown statistically significant effectiveness in a number of systematic reviews and meta-analyses, both as part of monotherapy and as part of complex therapy aimed at retraining in tinnitus, which has shown the best results. The effectiveness of these methods has a neurophysiological explanation based on the neuroplasticity of the brain and the fact that changes occurring during the development of tinnitus can regress with certain measures. 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\u041f\u0440\u0435\u0434\u043b\u043e\u0436\u0435\u043d\u043d\u044b\u0435 \u0432\u0430\u0440\u0438\u0430\u043d\u0442\u044b \u043c\u043e\u0436\u043d\u043e \u0441\u0447\u0438\u0442\u0430\u0442\u044c \u044d\u0444\u0444\u0435\u043a\u0442\u0438\u0432\u043d\u044b\u043c\u0438 \u043f\u0430\u0442\u043e\u0433\u0435\u043d\u0435\u0442\u0438\u0447\u0435\u0441\u043a\u0438\u043c\u0438 \u043c\u0435\u0442\u043e\u0434\u0430\u043c\u0438 \u043a\u043e\u043c\u043f\u0435\u043d\u0441\u0430\u0446\u0438\u0438 \u0442\u0438\u043d\u043d\u0438\u0442\u0443\u0441\u0430 \u0441 \u0442\u043e\u0447\u043a\u0438 \u0437\u0440\u0435\u043d\u0438\u044f \u043f\u0440\u0438\u043d\u0446\u0438\u043f\u043e\u0432 \u0434\u043e\u043a\u0430\u0437\u0430\u0442\u0435\u043b\u044c\u043d\u043e\u0439 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u044b.\n\nID: 42117411\nTitle: [Validation of Russian version of Tinnitus Catastrophizing Scale].\nAbstract: The Tinnitus Catastrophizing Scale (TCS) is designed for the quantitative assessment of cognitive-emotional reactions to chronic tinnitus and is widely used internationally as a reliable psychometric instrument. The aim of the present study was to perform the linguistic and cultural adaptation and validation of the Russian version of the questionnaire for use in Russian clinical practice. Following translation and cultural adaptation, a validation study was conducted in 130 participants, including patients with tinnitus and normal hearing, tinnitus with sensorineural hearing loss (SNHL) from mild to profound degree, and a control group without tinnitus (for evaluation of face validity). Testing was carried out in two visits, with a 7-day interval to evaluate test-retest reliability. The results confirmed the strong psychometric properties of the Russian version of the TCS: internal consistency (Cronbach's \u03b1=0.93), test-retest reliability (ICC=0.99), and high face validity (82-96% agreement, mean \u224889.5%). The average completion time was 6-7 minutes. The obtained data are consistent with those from international validation studies and confirm the equivalence of the Russian and original versions of the instrument. The adapted Russian version of the TCS can be used in clinical audiology, otorhinolaryngology, neurology and psychiatry to assess the degree of tinnitus-related catastrophizing, to stratify patients, and to monitor treatment effectiveness over time. \u0428\u043a\u0430\u043b\u0430 \u043a\u0430\u0442\u0430\u0441\u0442\u0440\u043e\u0444\u0438\u0437\u0430\u0446\u0438\u0438 \u0442\u0438\u043d\u043d\u0438\u0442\u0443\u0441\u0430 (Tinnitus Catastrophizing Scale, TCS) \u043f\u0440\u0435\u0434\u043d\u0430\u0437\u043d\u0430\u0447\u0435\u043d\u0430 \u0434\u043b\u044f \u043a\u043e\u043b\u0438\u0447\u0435\u0441\u0442\u0432\u0435\u043d\u043d\u043e\u0439 \u043e\u0446\u0435\u043d\u043a\u0438 \u043a\u043e\u0433\u043d\u0438\u0442\u0438\u0432\u043d\u043e-\u044d\u043c\u043e\u0446\u0438\u043e\u043d\u0430\u043b\u044c\u043d\u044b\u0445 \u0440\u0435\u0430\u043a\u0446\u0438\u0439 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u0430 \u043d\u0430 \u0445\u0440\u043e\u043d\u0438\u0447\u0435\u0441\u043a\u0438\u0439 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\u043d\u0430\u0440\u0443\u0448\u0435\u043d\u0438\u0439 \u0441\u043b\u0443\u0445\u0430 (n=17, \u043a\u043e\u043d\u0442\u0440\u043e\u043b\u044c\u043d\u0430\u044f \u0433\u0440\u0443\u043f\u043f\u0430), \u043a\u043e\u0442\u043e\u0440\u044b\u0435 \u043f\u0440\u0438\u043d\u0438\u043c\u0430\u043b\u0438 \u0443\u0447\u0430\u0441\u0442\u0438\u0435 \u0432 \u043e\u0446\u0435\u043d\u043a\u0435 \u043e\u0447\u0435\u0432\u0438\u0434\u043d\u043e\u0439 \u0434\u043e\u0441\u0442\u043e\u0432\u0435\u0440\u043d\u043e\u0441\u0442\u0438. \u0418\u043d\u0442\u0435\u0440\u0432\u044c\u044e\u0438\u0440\u043e\u0432\u0430\u043d\u0438\u0435 \u043f\u0440\u043e\u0432\u043e\u0434\u0438\u043b\u043e\u0441\u044c \u0432\u043e \u0432\u0440\u0435\u043c\u044f \u0434\u0432\u0443\u0445 \u0432\u0438\u0437\u0438\u0442\u043e\u0432 \u0441 \u0438\u043d\u0442\u0435\u0440\u0432\u0430\u043b\u043e\u043c 7 \u0434\u043d\u0435\u0439 \u0434\u043b\u044f \u043e\u0446\u0435\u043d\u043a\u0438 \u0432\u043e\u0441\u043f\u0440\u043e\u0438\u0437\u0432\u043e\u0434\u0438\u043c\u043e\u0441\u0442\u0438 \u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442\u043e\u0432. \u041f\u043e\u0434\u0442\u0432\u0435\u0440\u0436\u0434\u0435\u043d\u044b \u0432\u044b\u0441\u043e\u043a\u0438\u0435 \u043f\u0441\u0438\u0445\u043e\u043c\u0435\u0442\u0440\u0438\u0447\u0435\u0441\u043a\u0438\u0435 \u0445\u0430\u0440\u0430\u043a\u0442\u0435\u0440\u0438\u0441\u0442\u0438\u043a\u0438 \u0440\u0443\u0441\u0441\u043a\u043e\u044f\u0437\u044b\u0447\u043d\u043e\u0439 \u0432\u0435\u0440\u0441\u0438\u0438 TCS: \u0432\u043d\u0443\u0442\u0440\u0435\u043d\u043d\u044f\u044f \u0441\u043e\u0433\u043b\u0430\u0441\u043e\u0432\u0430\u043d\u043d\u043e\u0441\u0442\u044c (\u03b1 \u041a\u0440\u043e\u043d\u0431\u0430\u0445\u0430=0,93), \u0440\u0435\u0442\u0435\u0441\u0442\u043e\u0432\u0430\u044f \u0432\u043e\u0441\u043f\u0440\u043e\u0438\u0437\u0432\u043e\u0434\u0438\u043c\u043e\u0441\u0442\u044c (ICC=0,99), \u0432\u044b\u0441\u043e\u043a\u0430\u044f \u043e\u0447\u0435\u0432\u0438\u0434\u043d\u0430\u044f \u0432\u0430\u043b\u0438\u0434\u043d\u043e\u0441\u0442\u044c (82\u201496% \u0441\u043e\u0433\u043b\u0430\u0441\u043d\u044b\u0445 \u043e\u0442\u0432\u0435\u0442\u043e\u0432, \u0432 \u0441\u0440\u0435\u0434\u043d\u0435\u043c 89,5%). \u0421\u0440\u0435\u0434\u043d\u0435\u0435 \u0432\u0440\u0435\u043c\u044f \u0437\u0430\u043f\u043e\u043b\u043d\u0435\u043d\u0438\u044f \u043e\u043f\u0440\u043e\u0441\u043d\u0438\u043a\u0430 \u0441\u043e\u0441\u0442\u0430\u0432\u0438\u043b\u043e 6\u20147 \u043c\u0438\u043d. \u041f\u043e\u043b\u0443\u0447\u0435\u043d\u043d\u044b\u0435 \u0434\u0430\u043d\u043d\u044b\u0435 \u0441\u043e\u043f\u043e\u0441\u0442\u0430\u0432\u0438\u043c\u044b \u0441 \u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442\u0430\u043c\u0438 \u0437\u0430\u0440\u0443\u0431\u0435\u0436\u043d\u044b\u0445 \u0432\u0430\u043b\u0438\u0434\u0430\u0446\u0438\u043e\u043d\u043d\u044b\u0445 \u0440\u0430\u0431\u043e\u0442 \u0438 \u043f\u043e\u0434\u0442\u0432\u0435\u0440\u0436\u0434\u0430\u044e\u0442 \u044d\u043a\u0432\u0438\u0432\u0430\u043b\u0435\u043d\u0442\u043d\u043e\u0441\u0442\u044c \u0440\u0443\u0441\u0441\u043a\u043e\u044f\u0437\u044b\u0447\u043d\u043e\u0433\u043e \u0432\u0430\u0440\u0438\u0430\u043d\u0442\u0430 \u043e\u0440\u0438\u0433\u0438\u043d\u0430\u043b\u044c\u043d\u043e\u043c\u0443 \u0438\u043d\u0441\u0442\u0440\u0443\u043c\u0435\u043d\u0442\u0443. \u0410\u0434\u0430\u043f\u0442\u0438\u0440\u043e\u0432\u0430\u043d\u043d\u044b\u0439 \u043e\u043f\u0440\u043e\u0441\u043d\u0438\u043a TCS \u043c\u043e\u0436\u0435\u0442 \u043f\u0440\u0438\u043c\u0435\u043d\u044f\u0442\u044c\u0441\u044f \u0432 \u043a\u043b\u0438\u043d\u0438\u0447\u0435\u0441\u043a\u043e\u0439 \u043f\u0440\u0430\u043a\u0442\u0438\u043a\u0435 \u0432\u0440\u0430\u0447\u0435\u0439 \u2014 \u0441\u0443\u0440\u0434\u043e\u043b\u043e\u0433\u043e\u0432-\u043e\u0442\u043e\u0440\u0438\u043d\u043e\u043b\u0430\u0440\u0438\u043d\u0433\u043e\u043b\u043e\u0433\u043e\u0432, \u043e\u0442\u043e\u0440\u0438\u043d\u043e\u043b\u0430\u0440\u0438\u043d\u0433\u043e\u043b\u043e\u0433\u043e\u0432, \u043d\u0435\u0432\u0440\u043e\u043b\u043e\u0433\u043e\u0432, \u043f\u0441\u0438\u0445\u0438\u0430\u0442\u0440\u043e\u0432 \u0434\u043b\u044f \u043e\u0446\u0435\u043d\u043a\u0438 \u0441\u0442\u0435\u043f\u0435\u043d\u0438 \u043a\u0430\u0442\u0430\u0441\u0442\u0440\u043e\u0444\u0438\u0437\u0430\u0446\u0438\u0438 \u043f\u0440\u0438 \u0442\u0438\u043d\u043d\u0438\u0442\u0443\u0441\u0435, \u0441\u0442\u0440\u0430\u0442\u0438\u0444\u0438\u043a\u0430\u0446\u0438\u0438 \u043f\u0430\u0446\u0438\u0435\u043d\u0442\u043e\u0432 \u0438 \u043c\u043e\u043d\u0438\u0442\u043e\u0440\u0438\u043d\u0433\u0430 \u044d\u0444\u0444\u0435\u043a\u0442\u0438\u0432\u043d\u043e\u0441\u0442\u0438 \u043b\u0435\u0447\u0435\u043d\u0438\u044f \u0432 \u0434\u0438\u043d\u0430\u043c\u0438\u043a\u0435.\n\nID: 42116771\nTitle: [Acupuncture-based therapy for orthostatic hypotension after cervical spinal cord injury: a case report].\nAbstract: To introduce the application of acupuncture-based therapy in a patient with orthostatic hypotension after cervical spinal cord injury. The patient presented with flaccid paralysis of all four limbs, and could only maintain normal blood pressure in the supine position after cervical spine trauma surgery. Acupuncture combined with comprehensive training of paraplegic limbs and joint mobilization training was administered. Acupoints were divided into groups A and B, acupuncture was applied once daily, with the two groups alternated. Group A included Baihui (GV20) and bilateral Quchi (LI11), Neiguan (PC6), Hegu (LI4), and Taiyuan (LU9) in the patient's preserved sensory areas. Group B included bilateral Zusanli (ST36), Taixi (KI3), Taibai (SP3), and Taichong (LR3) in the patient's sensory-deficient areas. Blood pressure was monitored using an electric standing bed before and after acupuncture treatment. After 10 treatments, the patient was able to sit out of bed at 90\u00b0 and use a wheelchair. At a 2-month follow-up, the patient was able to use a wheelchair at home and had no symptoms of orthostatic hypotension such as dizziness, transient visual darkening, or tinnitus. \u4ecb\u7ecd\u5e94\u7528\u9488\u523a\u4e3a\u4e3b\u6cbb\u75971\u4f8b\u9888\u9ad3\u635f\u4f24\u540e\u4f53\u4f4d\u6027\u4f4e\u8840\u538b\u60a3\u8005\u7684\u60c5\u51b5\u3002\u60a3\u8005\u9888\u690e\u5916\u4f24\u672f\u540e\u56db\u80a2\u75ff\u8f6f\u65e0\u529b\uff0c\u4ec5\u80fd\u7ef4\u6301\u5367\u4f4d\u4e0b\u8840\u538b\u6b63\u5e38\uff0c\u91c7\u7528\u9488\u523a\u8054\u5408\u622a\u762b\u80a2\u4f53\u7efc\u5408\u8bad\u7ec3\u3001\u5173\u8282\u677e\u52a8\u8bad\u7ec3\u7b49\u6cbb\u7597\u3002\u9488\u523a\u7a74\u4f4d\u5206A\u3001B\u4e24\u7ec4\uff0c\u6bcf\u65e5\u6cbb\u75971\u6b21\uff0c\u4e24\u7ec4\u7a74\u4f4d\u4ea4\u66ff\u3002A\u7ec4\u7a74\u53d6\u60a3\u8005\u611f\u89c9\u4fdd\u7559\u533a\u57df\u7684\u767e\u4f1a\u548c\u53cc\u4fa7\u66f2\u6c60\u3001\u5185\u5173\u3001\u5408\u8c37\u3001\u592a\u6e0a\uff0cB\u7ec4\u7a74\u53d6\u60a3\u8005\u611f\u89c9\u7f3a\u5931\u533a\u57df\u7684\u53cc\u4fa7\u8db3\u4e09\u91cc\u3001\u592a\u6eaa\u3001\u592a\u767d\u3001\u592a\u51b2\u3002\u9488\u523a\u524d\u540e\u7ed3\u5408\u7535\u52a8\u8d77\u7acb\u5e8a\u76d1\u6d4b\u60a3\u8005\u8840\u538b\u60c5\u51b5\u3002\u7ecf10\u6b21\u6cbb\u7597\u540e\uff0c\u60a3\u8005\u79bb\u5e8a\u5750\u4f4d90\u00b0\u8f6e\u6905\u6d3b\u52a8\u53ef\u3002\u51fa\u9662\u540e\u968f\u8bbf2\u4e2a\u6708\u60a3\u8005\u5c45\u5bb6\u8f6e\u6905\u6d3b\u52a8\u53ef\uff0c\u65e0\u5934\u6655\u3001\u773c\u9ed1\u8499\u3001\u8033\u9e23\u7b49\u4f53\u4f4d\u6027\u4f4e\u8840\u538b\u4e0d\u9002\u75c7\u72b6\u3002.\n\nID: 42114875\nTitle: Efficacy of sound therapy on tinnitus in idiopathic sudden sensorineural hearing loss: a systematic review and meta-analysis protocol.\nAbstract: Tinnitus is a highly prevalent and distressing symptom in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). While international clinical guidelines primarily focus on hearing recovery through pharmacological interventions, effective treatment for tinnitus remains limited. Sound therapy, such as masking and retraining therapy, has emerged as a promising treatment. This systematic review aims to evaluate the efficacy and safety of sound therapy for the alleviation of tinnitus in adult patients with ISSNHL. Researchers will independently conduct searches for randomised controlled trials in the following databases: PubMed, Embase, Cochrane Library, Web of Science, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP), CNKI and Wanfang Data. The literature search is scheduled for March 2026 without language restrictions. The review will include studies involving adult patients (18 years or older) diagnosed with ISSNHL with tinnitus symptoms who underwent sound therapy (including Tinnitus Masking Therapy, Tinnitus Retraining Therapy or music therapy) with standard drug therapy, placebo or any other non-acoustic interventions compared with the same treatment alone. Researchers will independently screen studies, extract data and assess the risk of bias using the Cochrane Risk of Bias 2 tool. Data analyses will be performed using RevMan V.10.0.2 and Stata V.18.0 software. The certainty of the evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. This study relies on the analysis of secondary data from previously published trials; therefore, ethical approval from a research ethics committee is not required. The results of this systematic review will be disseminated through publication in a peer-reviewed scientific journal.PROSPERO registration numberCRD420261294173.\n\nID: 42096236\nTitle: Mobile Application as a Digital Therapeutic for Chronic Tinnitus: A Randomized Clinical Trial.\nAbstract: Tinnitus is a highly prevalent condition that has no cure and can severely impair quality of life. Patients who receive cognitive behavioral therapy (CBT) and hearing aid therapy for chronic tinnitus accompanied by hearing loss have shown some improvement, but access to these interventions is limited. To develop a prototype digital therapeutic mobile app that provides educational counseling and CBT elements for treating chronic tinnitus symptoms and test its efficacy and safety for 16 weeks in patients reporting distressing chronic tinnitus. This double-blind, sham-controlled randomized clinical trial was conducted from September 2023 to February 2025 in individuals diagnosed with mild to severe chronic tinnitus. The trial included a 16-week treatment phase followed by an 8-week follow-up phase. Data were analyzed from February to March 2025. Participants used either the therapeutic app or a sham control app that lacked the therapeutic functions. During the 8-week follow-up, the app's therapeutic functions were blocked and only the app's recording function was available. The primary outcome was change from baseline to week 16 in the Tinnitus Handicap Inventory (THI) score, an index of tinnitus-related distress and functional impairment. Secondary outcomes were patient-reported and included THI, Tinnitus Functional Index, tinnitus loudness and control numeric rating scales, Hospital Anxiety and Depression Scale, Athens Insomnia Scale, and Patient Global Impression of Improvement. A total of 60 participants (33 [55%] female; median [IQR] age, 58.5 [52.0-64.0] years) were assessed, including 30 participants in the therapeutic app group and 30 participants in the sham-control app group. The overall mean (SD) baseline THI was 41.3 (16.9). At week 16, the therapeutic app group showed significantly greater improvement in THI scores compared with the sham-control app group (between-group difference in change in THI, -20.4; 95% CI, -28.2 to -12.6). The therapeutic effect was maintained up to week 24 (mean between-group difference, -18.3; 95% CI, -26.4 to -10.1). Tinnitus worsened in 1 patient in the sham-control app group. No serious adverse events or device malfunctions with potential for health hazards were observed. This randomized clinical trial found that use of a tinnitus therapeutic app resulted in substantial and lasting improvement in tinnitus-related distress and functional impairment. The therapeutic app may serve as an effective and standardized intervention for individuals with chronic tinnitus. jrct.mhlw.go.jp Identifier: 032230359.\n\nID: 42086103\nTitle: Gabaergic modulation alleviates auditory hypersensitivity and neuroinflammation in sodium salicylate-treated male mice.\nAbstract: Auditory hypersensitivity, or hyperacusis, is characterized by increased sensitivity to sound and is often associated with tinnitus, yet its underlying mechanisms remain unclear. This study investigated the mechanisms of sodium salicylate-induced auditory hypersensitivity in mice, focusing on neuroinflammation, microglial activation, and neuronal excitability. Male C57BL/6 mice were used to establish the model, and auditory sensitivity was evaluated by behavioral testing. Inflammatory cytokines, excitatory receptor expression, and microglial activation in the auditory cortex were assessed using enzyme-linked immunosorbent assay, Western blotting, and immunofluorescence. Sodium salicylate treatment increased auditory sensitivity and was accompanied by elevated pro-inflammatory cytokines, enhanced microglial activation, and upregulation of excitatory receptor subunits. Pharmacological inhibition of microglial activation with minocycline attenuated these changes and improved auditory sensitivity. In addition, modulation of \u03b3-aminobutyric acid (GABA)-mediated inhibitory signaling reduced inflammation, normalized excitatory receptor expression, and alleviated hypersensitivity. These findings suggest that sodium salicylate-induced auditory hypersensitivity involves an interaction between neuroinflammation and neuronal hyperexcitability, and that targeting microglial activation and restoring inhibitory neurotransmission may provide potential therapeutic strategies for hyperacusis and related auditory disorders.\n\nID: 42068662\nTitle: Duration-dependent associations of sound therapy on tinnitus in hearing loss: A cross-sectional analysis of treatment duration cohorts.\nAbstract: This cross-sectional observational study analyzed data from routine clinical practice to compare outcomes across independent treatment duration cohorts (3, 6, and 9\u00a0months). This retrospective cohort study analyzed data from 85 patients with chronic tinnitus (\u22656\u00a0months) and hearing loss who received hearing aid-based sound therapy. Patients were grouped by treatment duration (3, 6, or 9\u00a0months) based on clinical circumstances. Pure-tone audiometry, tinnitus psychoacoustic matching, and Tinnitus Handicap Inventory (THI) were assessed at baseline and post-treatment. Post-treatment assessments showed significant reductions in THI scores and tinnitus loudness versus baseline (P\u00a0<\u00a00.05). Repeated-measures ANOVA revealed a significant time\u00a0\u00d7\u00a0group interaction for THI changes (F\u00a0=\u00a05.856, P\u00a0=\u00a00.004), but Bonferroni-corrected pairwise comparisons showed no significant between-group differences. Multivariate ordinal regression identified longer treatment duration as an independent factor associated with better outcomes: the 3-month cohort showed a lower likelihood of improvement compared with the 9-month cohort (OR\u00a0=\u00a00.141, 95% CI: 0.038-0.513, P\u00a0=\u00a00.003), while no difference was found between 6- and 9-month cohorts. Hearing loss severity was not associated with efficacy. In this observational cohort, hearing aid-based sound therapy was associated with reductions in tinnitus-related handicap and loudness. Longer treatment duration was associated with a higher probability of clinical improvement. Patients showed continued improvement up to 9\u00a0months, although causal inference is precluded by the observational design.\n\nID: 42054186\nTitle: Prevalence and characterization of tinnitus in patients with mental disorders in the context of primary health care.\nAbstract: To estimate the prevalence and characterize tinnitus in patients with mental disorders. Observational study conducted with patients enrolled in the mental health care pathway of a primary health care service within the supplementary system. The Tinnitus Handicap Inventory and the Visual Analog Scale were used to assess tinnitus, while the Depression Anxiety and Stress Scale was applied to evaluate psychobehavioral aspects. Tinnitus was reported by nearly half of the study population. Stress was the most reported triggering factor, and higher scores of anxiety, depression, and stress were observed among participants with tinnitus. Most participants presented moderate discomfort, and overall burden ranged from negligible to mild. A high prevalence of tinnitus with moderate to severe discomfort was observed in participants with mental disorders. An association was found between tinnitus and severe symptoms of anxiety and stress, underscoring the importance of multidisciplinary management for this population. Estimar a preval\u00eancia e caracterizar o zumbido de pacientes com transtornos mentais. Estudo observacional realizado com pacientes inseridos na linha de cuidado de sa\u00fade mental de um servi\u00e7o de aten\u00e7\u00e3o prim\u00e1ria \u00e0 sa\u00fade no setor suplementar. Foram utilizadas as escalas Tinnitus Handicap Inventory e Escala Visual Anal\u00f3gica para avalia\u00e7\u00e3o do zumbido, e a Depression Anxiety and Stress Scale para aspectos psicocomportamentais. O zumbido foi relatado por quase metade da popula\u00e7\u00e3o do estudo. O estresse foi o principal fator desencadeante referido, e foram estimados maiores escores de ansiedade, depress\u00e3o e estresse nos participantes com zumbido. A maioria dos participantes apresentaram desconforto moderado, e inc\u00f4modo geral entre desprez\u00edvel e leve. Foi estimada alta preval\u00eancia de zumbido com desconforto de moderado a intenso em participantes com transtornos mentais. Houve associa\u00e7\u00e3o entre o zumbido e sintomas graves de ansiedade e estresse, destacando a import\u00e2ncia do manejo multidisciplinar para esses pacientes. Estimar a preval\u00eancia e caracterizar o zumbido de pacientes com transtornos mentais. Estudo observacional realizado com pacientes inseridos na linha de cuidado de sa\u00fade mental de um servi\u00e7o de aten\u00e7\u00e3o prim\u00e1ria \u00e0 sa\u00fade no setor suplementar. Foram utilizadas as escalas Tinnitus Handicap Inventory e Escala Visual Anal\u00f3gica para avalia\u00e7\u00e3o do zumbido, e a Depression Anxiety and Stress Scale para aspectos psicocomportamentais. O zumbido foi relatado por quase metade da popula\u00e7\u00e3o do estudo. O estresse foi o principal fator desencadeante referido, e foram estimados maiores escores de ansiedade, depress\u00e3o e estresse nos participantes com zumbido. A maioria dos participantes apresentaram desconforto moderado, e inc\u00f4modo geral entre desprez\u00edvel e leve. Foi estimada alta preval\u00eancia de zumbido com desconforto de moderado a intenso em participantes com transtornos mentais. Houve associa\u00e7\u00e3o entre o zumbido e sintomas graves de ansiedade e estresse, destacando a import\u00e2ncia do manejo multidisciplinar para esses pacientes.\n\nID: 42406125\nTitle: Detailed clinical characteristics of musical hallucinations in 81 patients.\nAbstract: Musical hallucinations are perceptions of music without an external source. Approximately 500 publications on this topic have appeared over the past 35\u00a0years. Prior literature has largely consisted of case reports and small series, with only limited systematic studies on the characterisation of mixed pathology, relation to hearing loss, spatial localisation, and multimodal features. We conducted a retrospective analysis of baseline data from a prospective cohort study of 81 individuals experiencing musical hallucinations. Participants underwent assessment with the Musical Hallucinations (MuHa) Questionnaire-a tailored, non-validated semi-structured survey/interview-alongside additional questionnaires, EEG, neuroimaging, and audiological testing. The present analysis focuses on baseline phenomenological characteristics derived from the MuHa Questionnaire in 80 eligible participants. Analyses were exploratory and descriptive. Mean age was 65\u00a0years, with a slight female predominance. Hallucinations were most often perceived as internal, while external localisation was more common with familiar music and in individuals with (asymmetric) hearing loss. Underlying causes included psychiatric disorders (50%), hearing loss (50%), structural neurological changes (28%), and frequently combinations thereof (28%). A notable new finding was the high prevalence of tinnitus and multimodal hallucinations, involving up to six sensory modalities; these were generally associated with internal localisation, except in isolated hearing loss. Musical content spanned multiple genres, most commonly religious music. Hallucinations were considered burdensome in over 65% of the cases, and most participants reported little control; behavioral strategies such as distraction or listening to external music provided only temporary relief in about 20%. Musical hallucinations may be more common than previously appreciated within broader multimodal perceptual syndromes and mixed etiologies, suggesting a more distributed pathophysiology than traditionally assumed. Their burden and limited controllability highlight the need for further mechanistic and therapeutic research.\n\nID: 42403960\nTitle: The Degree of Audiovestibular Loss Is Not Related to Current Vertigo Attacks in Refractory Unilateral M\u00e9ni\u00e8re's Disease.\nAbstract: Unilateral M\u00e9ni\u00e8re's disease (MD) is characterized by severe episodic attacks of rotational vertigo and audiovestibular signs that include fluctuating sensorineural hearing loss, aural fullness, tinnitus, and vestibular loss. To investigate the relationship between the degree of audiovestibular loss, symptoms, and the number of vertigo attacks during the previous 6\u2009months and 1\u2009month of patients with MD. Sixty patients with active MD refractory to oral treatment. Hearing (pure-tone audiometry and speech discrimination) and vestibular (caloric test, vestibular evoked myogenic potential [VEMP]) tests were performed. Symptoms were scored using the following validated questionnaires: Vertigo Symptom Scale-short form, Dizziness Handicap Inventory, Tinnitus Handicap Inventory, Aural Fullness Scale, and Functional Level Scale. Linear regression, a factor analysis, and a correlation analysis were conducted. Patients experienced a mean number of 16 attacks (range, 2-65) during the previous 6\u2009months and five attacks (range, 0-30) during the previous 1\u2009month. Hearing and vestibular functions were reduced in the affected ear. Linear regression, the factor analysis, and the correlation analysis showed no association between the degree of audiovestibular loss and the number of vertigo attacks during the previous 6\u2009months or 1\u2009month or symptoms of disease activity. An exploratory analysis showed evidence of some associations between the degree of hearing loss, caloric paresis, and VEMP asymmetry, indicating a consistent pattern of loss across the cochlear semi-circular canals and saccules. Although audiovestibular tests help establish diagnoses, they cannot determine current disease activity of unilateral refractory MD. It may be prudent to assume that patients with MD and high remaining vestibular function in the affected ear would experience more frequent episodes of vertigo and intense dizziness and experience more troublesome symptoms. Conversely, it may be prudent to assume that patients with MD with low remaining vestibular function in the affected ear would experience fewer episodes of vertigo; however, as shown by these results, this does not seem to be the case. No obvious audiovestibular markers suggest that intratympanic therapy for vertigo treatment should be delayed.\n\nID: 42371148\nTitle: Migraine and auditory dysfunction: beyond comorbidity.\nAbstract: Migraine operates as a systemic disorder of multisensory sensitization. Within this spectrum, auditory manifestations, including sensorineural hearing loss, tinnitus, and hyperacusis, represent prevalent yet frequently overlooked otologic phenotypes. Epidemiological data show that 15%-49% of migraine patients present with comorbid auditory symptoms, and nearly two-thirds exhibit auditory electrophysiological abnormalities. However, optimal clinical management remains constrained by an incomplete understanding of pathogenic mechanisms, variable audiological assessment protocols, and dispersed therapeutic data. This review synthesizes epidemiological, audiological, and pathophysiological data linking migraine to auditory dysfunction. The underlying pathology involves a peripheral-to-central continuum across three interacting axes. Anatomical and hydrodynamic vulnerabilities drive localized microvascular ischemia and aberrant brain-ear fluid exchange. Localized neurochemical imbalances, involving glutamate excitotoxicity, neuropeptide signaling, and innate immune activation, disrupt inner ear homeostasis. Concurrently, central sensitization facilitates neural network plasticity, characterized by impaired efferent gating and thalamocortical dysrhythmia. Drawing upon these underlying pathways, current and emerging therapeutic strategies are categorized by specific clinical objectives: blocking upstream migraine pathways, protecting the cochlear microenvironment, and correcting central hypersensitivity. This framework aims to catalyze future translational research to rigorously validate these mechanistic links, promote early identification, precise clinical phenotyping, and cross-disciplinary management of affected patients.\n\nID: 42356176\nTitle: Trauma-Associated Tinnitus and Hearing Loss: A Comprehensive Narrative Review of Prevalence, Risk Factors, and Clinical Outcomes.\nAbstract: Background and Objectives: Trauma-associated auditory dysfunction, encompassing tinnitus and hearing loss, represents a frequent yet underrecognized sequela of acoustic overexposure, blast injury, and head trauma. Despite increasing clinical awareness, the published literature exhibits substantial heterogeneity in reported prevalence estimates and recovery outcomes across different injury mechanisms. This narrative review aims to synthesize available evidence on the prevalence, clinical characteristics, recovery patterns, and prognostic factors of tinnitus and hearing loss following traumatic injury, with a particular focus on comparing outcomes across distinct trauma mechanisms and evaluating the impact of early intervention. Materials and Methods: A comprehensive literature search was conducted in PubMed, Embase, Scopus, and Web of Science for studies published between January 2010 and December 2025. The search strategy combined terms related to traumatic injury (e.g., \"acoustic trauma,\" \"blast injury,\" \"traumatic brain injury,\" \"head trauma\") with terms related to auditory dysfunction (e.g., \"tinnitus,\" \"hearing loss,\" \"auditory dysfunction\"). Eligible studies included observational studies (cohort, cross-sectional, case-control) reporting original data on tinnitus and/or hearing loss prevalence, recovery outcomes, or prognostic factors in adult or mixed populations exposed to traumatic injury. A narrative synthesis was organized thematically around the key research questions. Results: The available evidence consistently indicates that tinnitus and hearing loss are frequent consequences of blast injury, acute acoustic trauma, and traumatic brain injury, although reported prevalence estimates vary considerably across studies due to differences in populations, injury mechanisms, and diagnostic criteria. Blast injury is associated with mixed hearing loss (conductive and sensorineural components), while acute acoustic trauma typically causes sensorineural hearing loss, often with a characteristic high-frequency notch. Traumatic brain injury can lead to central auditory processing deficits even when pure-tone thresholds are normal. Recovery is variable and often incomplete; tympanic membrane perforations frequently heal spontaneously, but sensorineural components often persist. Early treatment (within days to two weeks) is associated with better recovery outcomes. Conclusions: Trauma-associated tinnitus and hearing loss are highly prevalent and frequently result in persistent disability. The strong association between early treatment and improved recovery outcomes supports the implementation of prompt audiological evaluation and intervention following traumatic injury. These findings underscore the need for routine audiological screening in at-risk populations and for continued research into preventive strategies, standardised assessment protocols, and optimised treatment regimens.\n\nID: 42345421\nTitle: Intravestibular Lipoma with Intracochlear Extension: A Case Report on Surgical Management and Cochlear Implantation.\nAbstract: Intracochlear and intravestibular lipomas are rare benign lesions that may clinically and radiologically mimic retrocochlear pathologies such as vestibular schwannomas. They typically present with progressive sensorineural hearing loss, tinnitus, or dizziness. Due to their rarity, optimal management strategies, particularly in pediatric patients, remain challenging and require individualized decision-making. We report the case of an 8-year-old girl who presented with progressive right-sided sensorineural hearing loss. Magnetic resonance imaging (MRI) revealed an intravestibular lipoma extending into the cochlea. Considering the patient's young age and the potential for tumor growth, surgical excision was performed via a translabyrinthine approach. Simultaneous cochlear implantation was undertaken to facilitate auditory rehabilitation. Histopathological analysis was conducted to confirm the diagnosis. Histopathological examination confirmed the lesion as a lipoma. The postoperative course was uneventful. The cochlear implant was successfully activated and provided effective hearing restoration. Intravestibular lipomas are rare entities that require careful radiological evaluation to ensure accurate diagnosis and differentiation from other retrocochlear lesions. Management should be individualized, particularly in pediatric patients, balancing surgical risks against the benefits of tumor removal and hearing rehabilitation. Simultaneous cochlear implantation may represent a viable strategy for auditory restoration in selected cases.\n\nID: 42345410\nTitle: Efficacy of the Additional Effect of Stellate Ganglion Block in Combination of Intratympanic Steroid and Hyperbaric Oxygen Therapy for Refractory Sudden Sensorineural Hearing Loss.\nAbstract: Refractory sudden sensorineural hearing loss (RSSNHL) underscores the need for more effective salvage therapies. This study aimed to investigate the efficacy of stellate ganglion block (SGB) combined with intratympanic steroid (ITS) and hyperbaric oxygen therapy (HBO) as triple salvage therapy in patients with RSSNHL. This retrospective study analyzed 73 patients with unilateral RSSNHL admitted between January 2022 and December 2023. All patients underwent salvage therapy with HBO and ITS, with (n=31) or without SGB (n=42). The primary efficacy endpoint was the change in pure tone average thresholds, with secondary endpoints comprising demographic characteristics, tinnitus evaluation, and psychological distress scores. Both groups showed post-treatment hearing improvement (P < .05), but the SGB group achieved greater hearing gain, higher efficacy rates, and superior low-frequency recovery (P < .05). Tinnitus relief and psychological outcomes were also significantly better in the SGB group (P < .05). Patients with both shorter intervals from symptom onset to salvage therapy and relatively lower baseline hearing thresholds demonstrated significantly greater hearing improvement. Neither group experienced severe adverse events. Lower baseline hearing thresholds and earlier therapy initiation predicted better outcomes. The triple salvage therapy significantly improved hearing recovery in RSSNHL patients, particularly in low-frequency ranges, while also reducing tinnitus severity and enhancing psychological well-being.\n\nID: 42334723\nTitle: Beyond tumor control: symptom trajectories and hearing outcomes after contemporary Gamma Knife radiosurgery for vestibular schwannoma.\nAbstract: Gamma Knife radiosurgery (GKRS) is an established treatment for vestibular schwannoma, but contemporary cohort-level data integrating long-term tumor control with clinical symptom trajectories and hearing-related correlates remain valuable. We performed a retrospective cohort study of 286 patients with vestibular schwannoma (VS) treated with GKRS (2014-2024). The primary endpoint was local control. Secondary outcomes included overall survival and changes in hearing loss, imbalance, vertigo, dizziness, and tinnitus. Kaplan-Meier analysis was used to estimate local control and overall survival. Paired symptom changes were assessed using McNemar testing. The Median follow-up was 52.3 months (IQR 27.4-80.3). Progressive radiographic enlargement occurred in 5 patients, yielding a crude local control rate of 98.3%. The actuarial local control was 98.5% at 5 years and 96.5% at 10 years. Imbalance, vertigo, dizziness, and tinnitus improved significantly after GKRS, whereas hearing loss remained stable overall (59.4% vs. 57.3%, p\u2009=\u20090.441). Mean symptom burden declined from 1.74 to 1.20 symptoms per patient (p\u2009<\u20090.001). Post-radiosurgery hearing loss was more frequent in Koos IV tumors and increased stepwise across quartiles of cochlear mean dose: 38.7% for \u2264\u20092.9\u00a0Gy, 53.3% for >\u20092.9-3.6\u00a0Gy, 66.2% for >\u20093.6-4.5\u00a0Gy, and 73.8% for >\u20094.5\u00a0Gy (p\u2009=\u20090.00012). Baseline hearing loss remained the strongest predictor in multivariable modeling. At a median of four years GKRS provided tumor control in >\u200995% of VS patients and was associated with reduced overall symptom burden and improvement in vestibular symptoms. Hearing outcomes were related to baseline auditory status, Koos grade, and cochlear dosimetry. Not applicable.\n\nID: 42314530\nTitle: Down-sloping high-frequency audiometric findings in ENT-MS-12 auditory screen-positive patients with relapsing-remitting multiple sclerosis: A pilot case series.\nAbstract: Audio-vestibular symptoms, including hearing loss and tinnitus, are increasingly reported in people with multiple sclerosis (pwMS), yet their clinical significance and underlying mechanisms remain unclear. Both central demyelination and peripheral involvement along the brain-cochlea axis have been proposed as potential contributors.This study aims to explore and describe pure-tone audiometry (PTA) findings in pwMS who screened positive for auditory complaints on the ENT-MS-12 questionnaire, and to summarize associated clinical and magnetic resonance imaging (MRI) features during follow-up. In this prospective pilot study, 40 pwMS with relapsing-remitting MS were screened using the ENT-MS-12 questionnaire. Patients reporting auditory complaints and meeting predefined exclusion criteria were invited to undergo pure-tone audiometry (125-8000 Hz). Clinical data and MRI findings obtained within three months of audiometric testing were reviewed and compared with imaging from the previous year. Twenty-seven patients (67.5%) reported auditory symptoms. Eleven met the inclusion criteria and five consented to audiometric testing. All five patients showed a down-sloping audiometric configuration with elevated high-frequency thresholds, particularly at 6000-8000 Hz. Mean high-frequency thresholds were higher than age-matched reference values reported in the literature. During follow-up, four of five patients experienced clinical relapses; one of these also showed disease progression, auditory brainstem response abnormalities, and a temporal lobe lesion on MRI. In this pilot study, pwMS who reported hearing concerns and underwent audiometry presented subtle high-frequency auditory threshold elevations with a down-sloping audiometric pattern. These preliminary, descriptive findings suggest that incorporating auditory assessment may provide complementary clinical information in pwMS. Larger, controlled studies with electrophysiological testing and advanced neuroimaging are warranted to clarify the relevance and mechanisms of auditory involvement in multiple sclerosis, including potential central and peripheral contributions.\n\nID: 42217228\nTitle: Progressive cochlear ossification secondary to Langerhans cell histiocytosis requiring sequential bilateral cochlear implantation: a case report.\nAbstract: Langerhans cell histiocytosis (LCH) is a rare disorder that may involve the temporal bone and, in rare cases, result in sensorineural hearing loss. This report highlights the importance of close radiological surveillance and timely cochlear implantation in the setting of progressive otic capsule ossification. A 21-year-old male presented with a five-year history of progressive bilateral hearing loss, tinnitus, vertigo and imbalance. Following multidisciplinary team (MDT) discussion, cochlear implantation was deferred until completion of chemotherapy. Repeat CT imaging demonstrated progressive cochlear ossification involving the otic capsules. A repeat discussion followed, which led to an expedited cochlear implantation. The left side was implanted first due to lesser ossification, achieving full electrode insertion. Sequential implantation of the contralateral ear was performed four months later. However, insertion was limited due to advanced ossification. The second implantation was technically more challenging, with only partial electrode insertion possible due to advanced ossification. We advocate for close surveillance in the case of LCH to monitor for signs of otic capsule ossification. This case demonstrates that cochlear ossification in LCH may progress rapidly, narrowing the window for optimal implantation. Early cochlear implantation should be strongly considered in such cases.\n\nID: 42208968\nTitle: [Clinical reclassification of low-frequency type of sudden sensorineural hearing loss].\nAbstract: Objective:To further classify refractory low-frequency sudden sensorineural hearing loss\uff08SSNHL\uff09 and investigate the clinical characteristics and prognostic differences among various subtypes. Methods:A retrospective analysis was conducted on 208 patients with refractory low-frequency SSNHL who were hospitalized in Department of Audiology and Vestibular Medicine, Senior Department of Otolaryngology Head and Neck Surgery, Sixth Medical Center of the PLA General Hospital after failing conventional outpatient treatment. Based on clinical manifestations, patients were classified into four subtypes: migraine-associated type, hypotension or low intracranial pressure type, endolymphatic hydrops type, and other types. The clinical characteristics and prognostic outcomes were compared among the groups. Results:Significant differences were observed among the four groups in terms of sex distribution, affected ear side, accompanying symptoms\uff08tinnitus, aural fullness, vertigo, or dizziness\uff09, and progression to Meniere's disease\uff08all P<0.05\uff09. Pairwise comparisons revealed that the proportion of females in the migraine-associated group was significantly higher than that in the endolymphatic hydrops and other groups\uff08all P<0.05\uff09. The left ear was more frequently affected in the endolymphatic hydrops group than in the hypotension or low intracranial pressure group\uff08P=0.027\uff09. Tinnitus was significantly more common in the endolymphatic hydrops and other groups than in the hypotension or low intracranial pressure group\uff08all P<0.05\uff09. The migraine-associated group exhibited significantly higher rates of aural fullness, vertigo or dizziness, and progression to Meniere's disease compared to the other group \uff08all P<0.05\uff09. Regarding prognosis, the cure rates in the migraine-associated and hypotension or low intracranial pressure groups were 61.9% and 57.8%, respectively, significantly higher than those in the endolymphatic hydrops\uff0811.8%\uff09 and other groups\uff0827.0%\uff09\uff08all P<0.05\uff09. The recurrence rate in the migraine-associated group was 52.4%, significantly higher than that in the other group\uff0821.4%\uff09\uff08P<0.05\uff09. The migraine-associated group demonstrated a significantly higher incidence of high-frequency hearing loss compared to the other groups\uff08all P<0.05\uff09. Long-term follow-up revealed that this subtype was associated with more frequent hearing fluctuations, while hydrops and circulatory types retained potential for hearing recovery. Conclusion:Significant differences in clinical characteristics and prognosis exist among subtypes of refractory low-frequency SSNHL.The migraine-associated subtype is prone to fluctuating or recurrent hearing loss and has a higher risk of high-frequency hearing impairment. The hypotension or low intracranial pressure subtype has a relatively favorable prognosis, with a lower incidence of cochlear symptoms such as tinnitus and aural fullness. The endolymphatic hydrops subtype is associated with a poorer prognosis, although hearing may improve during long-term follow-up. \u76ee\u7684\uff1a\u5bf9\u96be\u6cbb\u6027\u4f4e\u9891\u4e0b\u964d\u578b\u7a81\u53d1\u6027\u804b\u60a3\u8005\u8fdb\u884c\u8fdb\u4e00\u6b65\u4e34\u5e8a\u5206\u578b\uff0c\u5e76\u6bd4\u8f83\u5404\u4e9a\u578b\u7684\u4e34\u5e8a\u7279\u5f81\u53ca\u9884\u540e\u5dee\u5f02\u3002 \u65b9\u6cd5\uff1a\u56de\u987e\u6027\u5206\u6790\u4e2d\u56fd\u4eba\u6c11\u89e3\u653e\u519b\u603b\u533b\u9662\u7b2c\u516d\u533b\u5b66\u4e2d\u5fc3\u8033\u9f3b\u54bd\u5589\u5934\u9888\u5916\u79d1\u533b\u5b66\u90e8\u8033\u5185\u79d1\u6536\u6cbb\u7684208\u4f8b\u95e8\u8bca\u5e38\u89c4\u6cbb\u7597\u65e0\u6548\u540e\u4f4f\u9662\u7684\u96be\u6cbb\u6027\u4f4e\u9891\u4e0b\u964d\u578b\u7a81\u804b\u60a3\u8005\uff0c\u4f9d\u636e\u4e34\u5e8a\u8868\u73b0\u5c06\u5176\u5206\u4e3a\u504f\u5934\u75db\u76f8\u5173\u578b\u3001\u8840\u538b\u504f\u4f4e\u6216\u4f4e\u9885\u538b\u578b\u3001\u819c\u8ff7\u8def\u79ef\u6c34\u578b\u3001\u5176\u4ed6\u578b4\u7ec4\uff0c\u6bd4\u8f83\u5404\u7ec4\u95f4\u7684\u4e34\u5e8a\u7279\u5f81\u4e0e\u9884\u540e\u8f6c\u5f52\u3002 \u7ed3\u679c\uff1a4\u7ec4\u60a3\u8005\u5728\u6027\u522b\u5206\u5e03\u3001\u53d1\u75c5\u4fa7\u522b\u3001\u4f34\u968f\u75c7\u72b6\uff08\u8033\u9e23\u3001\u8033\u95f7\u3001\u7729\u6655\u6216\u5934\u6655\uff09\u53ca\u8fdb\u5c55\u4e3a\u6885\u5c3c\u57c3\u75c5\uff08MD\uff09\u6bd4\u4f8b\u65b9\u9762\u5dee\u5f02\u5747\u6709\u7edf\u8ba1\u5b66\u610f\u4e49\uff08P<0.05\uff09\uff1b4\u7ec4\u4e24\u4e24\u6bd4\u8f83\uff0c\u504f\u5934\u75db\u76f8\u5173\u578b\u60a3\u8005\u4e2d\u5973\u6027\u6bd4\u4f8b\u5747\u663e\u8457\u9ad8\u4e8e\u819c\u8ff7\u8def\u79ef\u6c34\u578b\u548c\u5176\u4ed6\u578b\uff08P<0.05\uff09\uff1b\u819c\u8ff7\u8def\u79ef\u6c34\u578b\u60a3\u8005\u5de6\u8033\u53d1\u75c5\u6bd4\u4f8b\u663e\u8457\u9ad8\u4e8e\u8840\u538b\u504f\u4f4e\u6216\u4f4e\u9885\u538b\u578b\uff08P=0.027\uff09\uff1b\u819c\u8ff7\u8def\u79ef\u6c34\u578b\u548c\u5176\u4ed6\u578b\u60a3\u8005\u4e2d\u4f34\u6709\u8033\u9e23\u7684\u6bd4\u4f8b\u5747\u663e\u8457\u9ad8\u4e8e\u8840\u538b\u504f\u4f4e\u6216\u4f4e\u9885\u538b\u578b\uff08P<0.05\uff09\uff1b\u504f\u5934\u75db\u76f8\u5173\u578b\u60a3\u8005\u4f34\u6709\u8033\u95f7\u3001\u7729\u6655\u6216\u5934\u6655\u3001\u8fdb\u5c55\u4e3aMD\u7684\u6bd4\u4f8b\u5747\u663e\u8457\u9ad8\u4e8e\u5176\u4ed6\u578b\u60a3\u8005\uff08P<0.05\uff09\uff1b\u9884\u540e\u65b9\u9762\uff0c\u504f\u5934\u75db\u76f8\u5173\u578b\u548c\u8840\u538b\u504f\u4f4e\u6216\u4f4e\u9885\u538b\u578b\u60a3\u8005\u7684\u75ca\u6108\u7387\u5206\u522b\u4e3a61.9%\u548c57.8%\uff0c\u5747\u663e\u8457\u9ad8\u4e8e\u819c\u8ff7\u8def\u79ef\u6c34\u578b\uff0811.8%\uff09\u548c\u5176\u4ed6\u578b\uff0827.0%\uff09\uff0c\u5dee\u5f02\u5747\u6709\u7edf\u8ba1\u5b66\u610f\u4e49\uff08P<0.05\uff09\uff1b\u504f\u5934\u75db\u76f8\u5173\u578b\u60a3\u8005\u590d\u53d1\u7387\u4e3a52.4%\uff0c\u663e\u8457\u9ad8\u4e8e\u5176\u4ed6\u578b\uff0821.4%\uff09\uff0c\u5dee\u5f02\u6709\u7edf\u8ba1\u5b66\u610f\u4e49\uff08P<0.05\uff09\u3002\u504f\u5934\u75db\u76f8\u5173\u578b\u60a3\u8005\u8f83\u5176\u4ed63\u7ec4\u5747\u66f4\u6613\u51fa\u73b0\u9ad8\u9891\u542c\u529b\u635f\u5931\uff08P<0.05\uff09\u3002\u6b64\u5916\uff0c\u957f\u671f\u968f\u8bbf\u7ed3\u679c\u663e\u793a\u504f\u5934\u75db\u76f8\u5173\u578b\u60a3\u8005\u542c\u529b\u6613\u51fa\u73b0\u6ce2\u52a8\u6216\u590d\u53d1\uff1b\u800c\u819c\u8ff7\u8def\u79ef\u6c34\u578b\u548c\u8840\u538b\u504f\u4f4e\u6216\u4f4e\u9885\u538b\u578b\u60a3\u8005\u542c\u529b\u5219\u4ecd\u53ef\u8fdb\u4e00\u6b65\u6062\u590d\u3002 \u7ed3\u8bba\uff1a\u96be\u6cbb\u6027\u4f4e\u9891\u4e0b\u964d\u578b\u7a81\u804b\u7684\u4e0d\u540c\u4e34\u5e8a\u5206\u578b\u5728\u4e34\u5e8a\u7279\u5f81\u53ca\u9884\u540e\u65b9\u9762\u5b58\u5728\u663e\u8457\u5dee\u5f02\u3002\u504f\u5934\u75db\u76f8\u5173\u578b\u60a3\u8005\u542c\u529b\u6613\u51fa\u73b0\u6ce2\u52a8\u6216\u590d\u53d1\uff0c\u4e14\u9ad8\u9891\u542c\u529b\u8f83\u6613\u51fa\u73b0\u635f\u5931\uff1b\u8840\u538b\u504f\u4f4e\u6216\u4f4e\u9885\u538b\u578b\u60a3\u8005\u9884\u540e\u76f8\u5bf9\u8f83\u597d\uff0c\u4f34\u6709\u8033\u9e23\u3001\u8033\u95f7\u7b49\u8033\u8717\u75c7\u72b6\u6bd4\u4f8b\u8f83\u4f4e\uff1b\u819c\u8ff7\u8def\u79ef\u6c34\u578b\u60a3\u8005\u9884\u540e\u76f8\u5bf9\u8f83\u5dee\uff0c\u4f46\u5728\u957f\u671f\u968f\u8bbf\u4e2d\u60a3\u8005\u542c\u529b\u53ef\u8fdb\u4e00\u6b65\u6539\u5584\u3002.\n\nID: 42199810\nTitle: Aspirin in Audiology: A Dual-Edged Sword in Hearing Loss and Its Nanotechnology-Driven Future.\nAbstract: Globally, more than 1.6 billion individuals are affected by hearing loss. Aspirin (acetylsalicylic acid, ASA), an inexpensive and widely available drug, has demonstrated a complex dual role in hearing loss, with its effects potentially influenced by dosage and individual variability. In this article, we aimed to provide an overview of the pharmacological properties of aspirin, followed by an in-depth discussion of its mechanisms of action and its toxic and protective effects in different types of pathology-induced hearing loss. Finally, the development of novel drug delivery systems that may enhance the use of this drug in preventing hearing loss was also discussed. Aspirin exerts both ototoxic and protective effects via cyclooxygenase (COX)-dependent and COX-independent signaling pathways, including Wingless/Integrated (Wnt) signaling, nuclear factor kappa-B (NF-\u03baB), and Prestin-related mechanisms. Low-dose aspirin appears to reduce hearing damage from noise exposure or ototoxic drugs through anti-inflammatory and antioxidant actions that limit cochlear oxidative stress and inflammation. Conversely, higher doses of aspirin may induce reversible auditory changes, such as temporary hearing threshold shifts, tinnitus, and synaptic damage. These effects are primarily associated with cochlear ischemia, excessive activation of N-methyl-D-aspartate (NMDA) receptors, impaired prostaglandin signaling, and altered outer hair cell function resulting from Prestin modulation. This dose-dependent paradox presents a major challenge for the clinical application of aspirin in hearing protection. Nanotechnology-based delivery systems and personalized dosing strategies are promising, although they remain largely at the preclinical stage. Future work should concentrate on optimizing doses and targeting drug delivery to cochlear blood vessels or outer hair cells. Particular attention should be given to aspirin's role in COX signaling pathways and Prestin structural regulation. Overall, these findings provide a theoretical basis for precision-based ear protection strategies, pending clinical validation.\n\nID: 42168216\nTitle: Tinnitus.\nAbstract: Tinnitus is the perception of sound without a corresponding external sound source. This condition affects approximately 14% of adults, with approximately 2% experiencing severe symptoms. Underlying mechanisms of tinnitus suggest involvement of both peripheral and central processes, in which cochlear injury and deafferentation may trigger maladaptive plasticity, increased central gain, and thalamocortical dysrhythmia, modulated by limbic and salience networks. Neuroinflammation, somatosensory-auditory coupling and other factors, such as stress, may contribute to chronicity. Clinical expression is heterogeneous. Tinnitus is often comorbid with hearing loss, hyperacusis, migraine, anxiety, depression, mild cognitive impairment, insomnia and temporomandibular disorders, influencing assessment and care. Diagnosis comprises distinguishing objective (including pulsatile) from subjective tinnitus, recognizing red flags (for example, pulse-synchronous tinnitus requiring vascular imaging), quantifying hearing with audiometry and screening for modulating somatic factors. Multimodal management can reduce the effect of tinnitus: tinnitus-focused counselling and cognitive behavioural therapy are first-line treatments, and hearing rehabilitation and targeted treatment of somatosensory contributors are valuable adjuncts. Moreover, emerging neuromodulation, including bimodal stimulation, benefits selected subgroups. New areas of research include biomarkers, deciphering tinnitus genetic architecture, inner\u00a0ear regeneration, closed-loop neuromodulation and digital therapeutics.\n\nID: 42084185\nTitle: Noise exposure burden and hearing protection compliance among Saudi military personnel: A cross-sectional study.\nAbstract: \u00a0Noise-induced hearing loss (NIHL) results from prolonged or intense exposure to loud sounds, causing permanent auditory damage often accompanied by tinnitus, reduced hearing sensitivity and difficulty understanding speech. Use of appropriate hearing protection is essential to minimizing exposure, preventing cochlear injury and reducing the long-term impact of NIHL. \u00a0This study aimed to assess noise exposure experiences, their effects on hearing sensitivity and the use of hearing protection among Saudi military personnel. \u00a0This cross-sectional study used a self-administered Arabic questionnaire developed after a literature review and consultation with a focus group. Copies were distributed to military personnel visiting the audiology clinic at King Abdulaziz Medical City in Riyadh from 2024 to 2025 and shared via social media nationwide. The questionnaire included 14 items across three sections: demographics, experience with noise exposure and hearing protection and awareness of noise-related impacts. \u00a0A total of 256 participants completed the questionnaire; the majority were male (97.3%), lived in Riyadh (85.2%), and were aged 31 years-40 years with a high school education. Most reported no hearing loss across years of experience and exposure to loud sound sources. Notably, 130 participants (50.8%) did not use hearing protection despite being aware that loud noise can cause hearing loss and tinnitus (p\u00a0= 0.01). Significant associations were found between reported hearing loss and involvement in shooting or use of weapons (p\u00a0= 0.01) as well as noise source types (p\u00a0= 0.02). \u00a0Although most participants were aware of the harmful effects of loud noise and related symptoms, only one-third consistently used hearing protection. Training to enhance awareness of NIHL risks, along with periodic hearing assessments for early detection, is recommended.Contribution:\u00a0This study highlights a gap between awareness of noise-induced hearing loss and the use of hearing protection among Saudi military personnel. It identifies weapon-related noise exposure as associated with reported hearing loss, emphasizing the need for targeted hearing conservation strategies.\n\nID: 42054586\nTitle: Hearing/vestibular problems, racial differences, and associations with physical function impairment among breast cancer survivors.\nAbstract: Breast cancer survivors face many health challenges, including tinnitus, hearing loss, and vertigo which will grow with an aging population and improved treatment outcomes. However, the prevalence of hearing/vestibular problems, racial differences, and relationships to physical function are poorly characterized in breast cancer survivors. Between July and September 2023, we surveyed the Chicago Multiethnic Epidemiologic Breast Cancer Cohort. Tinnitus, hearing loss, and vertigo were self-reported and verified through electronic health records. Physical function impairment was measured using the SF-36 10-item instrument. We fit logistic regression models for hearing/vestibular problems and linear regression models for physical function score, controlling for sociodemographic and clinical factors. Of 1466 breast cancer survivors (mean [SD] age, 63.5 [11.8] years), 16.6%, 17.3%, and 8.6% reported experiencing tinnitus, hearing loss, and vertigo, respectively. Black survivors had lower odds of hearing loss (adjusted odds ratio [AOR] = 0.51; 95% confidence interval [CI] = 0.31 to 0.86) but greater odds of vertigo (AOR = 2.29; 95% CI = 1.34 to 3.89) than White survivors. Survivors with hearing/vestibular problems had higher average impairment scores (worse physical function) than those without. In the adjusted regression models, survivors who reported experiencing tinnitus (\u03b2 = 0.76; 95% CI = 0.10 to 1.43), hearing loss (\u03b2 = 0.73; 95% CI = 0.06 to 1.40), or vertigo (\u03b2 = 1.70; 95% CI = 0.81 to 2.58) had a higher level of physical function impairment. This study demonstrates racial differences in hearing/vestibular problems and associations between these problems and physical function impairment. Survivorship programs should consider routine screening and interventions to improve hearing health and physical function among breast cancer survivors.\n\nID: 42048881\nTitle: Hyperbaric oxygen combined with postauricular and intratympanic steroid injections in diabetic patients with severe or profound refractory sudden sensorineural hearing loss.\nAbstract: Patients with type 2 diabetes mellitus (T2DM) and severe or profound refractory sudden sensorineural hearing loss (RSSNHL) urgently require more effective salvage therapies. This study aimed to evaluate the efficacy of a triple salvage therapy-combining hyperbaric oxygen (HBO), intratympanic steroids (ITS), and postauricular steroid injections (PSI)-for severe or profound RSSNHL in diabetic patients. This retrospective study analyzed 117 patients with unilateral severe or profound RSSNHL and concurrent T2DM between January 2020 and December 2024. All patients underwent salvage therapy with PSI and ITS, either with (n\u00a0=\u00a060) or without (n\u00a0=\u00a057) HBO. The primary efficacy endpoint was the change in hearing level, while secondary endpoints included changes in glycemic control, tinnitus and vertigo symptoms, anxiety and depression scores, and sleep quality. Compared to the No-HBO group, the HBO group achieved superior post-salvage efficacy, with significantly higher cure rates, clinical effectiveness rates, and hearing threshold gain (P\u00a0<\u00a00.05), while maintaining a comparable safety profile (P\u00a0>\u00a00.05). Salvage therapy improved glycemic control, neurotological symptoms, sleep, and psychological status in both groups, with greater benefits observed in the HBO group (P\u00a0<\u00a00.05). Shorter intervals from symptom onset to salvage therapy and shorter T2DM duration were associated with significantly greater hearing improvement (P\u00a0<\u00a00.05). This triple salvage therapy effectively treats severe or profound RSSNHL in diabetic patients, improving auditory outcomes, glycemic control, and comorbid symptoms without increasing the incidence of adverse events.\n\nID: 42046869\nTitle: Neuroscientific therapies for subjective tinnitus.\nAbstract: Tinnitus, a prevalent auditory symptom, can significantly impair quality of life, yet no definitive pharmacological interventions exist despite extensive ongoing research into its pathophysiology and treatments. The advent of biomedical engineering has introduced neuromodulation as a pivotal therapeutic approach alongside conventional strategies such as pharmacotherapy and surgery. Through the deployment of invasive and non-invasive techniques, using various modalities including magnetic, electronic, and optical means, neuromodulation aims to regulate neural functions. This has not only led to the refinement of fundamental theories but has also enhanced the optimization of clinical applications. As an emerging and promising intervention, neuromodulation enriches the toolkit available for basic neuroscience inquiry and broadens the spectrum of clinical therapies for conditions affecting the central nervous system, including tinnitus. In this paper, we succinctly review the current understanding of tinnitus mechanisms, discuss the features of diverse neuromodulation technologies, explore their application in tinnitus management, and contemplate prospects for their development in treating tinnitus. \u8033\u9e23\u4f5c\u4e3a\u4e00\u79cd\u5e38\u89c1\u7684\u542c\u89c9\u969c\u788d\uff0c\u663e\u8457\u5f71\u54cd\u60a3\u8005\u7684\u751f\u6d3b\u8d28\u91cf\u3002\u5c3d\u7ba1\u5176\u75c5\u7406\u751f\u7406\u673a\u5236\u548c\u6cbb\u7597\u7b56\u7565\u5df2\u88ab\u5e7f\u6cdb\u7814\u7a76\uff0c\u76ee\u524d\u4ecd\u7f3a\u4e4f\u660e\u786e\u6709\u6548\u7684\u6cbb\u7597\u836f\u7269\u3002\u968f\u7740\u751f\u7269\u533b\u5b66\u5de5\u7a0b\u7684\u53d1\u5c55\uff0c\u795e\u7ecf\u8c03\u63a7\u6280\u672f\u5df2\u6210\u4e3a\u4e0e\u836f\u7269\u548c\u624b\u672f\u7b49\u4f20\u7edf\u7b56\u7565\u5e76\u91cd\u7684\u6cbb\u7597\u65b9\u6cd5\u3002\u8be5\u6280\u672f\u901a\u8fc7\u4fb5\u5165\u6027\u6216\u975e\u4fb5\u5165\u6027\u65b9\u5f0f\uff0c\u5229\u7528\u78c1\u3001\u7535\u548c\u5149\u7b49\u591a\u79cd\u7269\u7406\u523a\u6fc0\uff0c\u5b9e\u73b0\u5bf9\u795e\u7ecf\u529f\u80fd\u7684\u8c03\u8282\u3002\u795e\u7ecf\u8c03\u63a7\u6280\u672f\u4e0d\u4ec5\u63a8\u52a8\u4e86\u57fa\u672c\u7406\u8bba\u7684\u8fdb\u5c55\uff0c\u4e5f\u4fc3\u8fdb\u4e86\u4e34\u5e8a\u5e94\u7528\u7684\u4f18\u5316\u3002\u4f5c\u4e3a\u4e00\u79cd\u65b0\u5174\u4e14\u524d\u666f\u5e7f\u9614\u7684\u6cbb\u7597\u624b\u6bb5\uff0c\u795e\u7ecf\u8c03\u63a7\u4e30\u5bcc\u4e86\u57fa\u7840\u795e\u7ecf\u79d1\u5b66\u7684\u7814\u7a76\u5de5\u5177\uff0c\u5e76\u62d3\u5bbd\u4e86\u4e2d\u67a2\u795e\u7ecf\u7cfb\u7edf\u75be\u75c5\uff08\u5305\u62ec\u8033\u9e23\uff09\u7684\u4e34\u5e8a\u6cbb\u7597\u9014\u5f84\u3002\u672c\u6587\u7b80\u8981\u56de\u987e\u4e86\u8033\u9e23\u7684\u53d1\u75c5\u673a\u5236\uff0c\u8ba8\u8bba\u4e86\u4e0d\u540c\u795e\u7ecf\u8c03\u63a7\u6280\u672f\u7684\u7279\u70b9\u53ca\u5176\u5728\u8033\u9e23\u6cbb\u7597\u65b9\u9762\u7684\u5e94\u7528\u73b0\u72b6\uff0c\u5e76\u5bf9\u672a\u6765\u7684\u53d1\u5c55\u524d\u666f\u8fdb\u884c\u5c55\u671b\u3002.\n\nID: 41995197\nTitle: Gadolinium-Enhanced MRI Classification of Sudden Sensorineural Hearing Loss and Its Clinical Correlates.\nAbstract: ImportanceSudden sensorineural hearing loss (SSNHL) has heterogeneous etiologies and prognoses. Early-imaging evaluation may help identify patients at higher risk of poor hearing recovery.ObjectiveTo investigate the relationship between labyrinthine gadolinium-enhanced MRI (Gd-MRI) findings and clinical characteristics in patients with SSNHL and to assess the clinical value of MRI-based subtyping for early evaluation and stratified treatment.DesignRetrospective observational study.SettingSingle tertiary referral center.ParticipantsNinety-six patients with unilateral SSNHL treated between January 2014 and May 2020 were included.Exposure or InterventionAll patients underwent gadolinium-enhanced inner ear MRI. According to imaging features, they were categorized into an MRI-negative group, an endolymphatic hydrops (EH) group, and a labyrinthine signal abnormalities (LSA) group.Main Outcome MeasuresClinical symptoms, audiological data, inner ear subunit involvement, and short-term hearing gain were compared among groups. Independent predictors of hearing improvement were analyzed using multivariate linear regression.ResultsAmong 96 patients, 55 were MRI-negative, 20 were EH, and 21 were LSA. The LSA group had the highest rates of vertigo and tinnitus (100% and 95.2%, respectively; P\u2009=\u2009.001, P\u2009=\u2009.038) and more extensive inner ear involvement (\u22652 subunits, 71.4%; P\u2009=\u2009.003). Pretreatment hearing thresholds were comparable between groups, but the LSA group had a significantly-poorer pure-tone average after treatment. Multivariate regression identified age and MRI classification as independent predictors of low-frequency hearing gain (P\u2009<\u2009.05).ConclusionGadolinium-enhanced inner ear MRI effectively stratifies SSNHL by identifying distinct imaging phenotypes correlated with clinical severity and recovery potential. Labyrinthine signal abnormalities, indicating more extensive inner ear involvement, are associated with poorer hearing recovery.RelevanceMRI-based subtyping can facilitate early evaluation and individualized management of SSNHL, supporting its integration into routine diagnostic assessment. These preliminary findings require confirmation through larger prospective studies with long-term follow-up.\n\nID: 41967918\nTitle: [Two cases of unilateral lesion of the inferior colliculus presenting with temporally changing, distinctive tinnitus and hearing impairment].\nAbstract: We report two cases of unilateral lesion of the inferior colliculus presenting with distinctive tinnitus and hearing impairment. Case 1 was a 40-year-old woman under treatment for multiple sclerosis who developed sudden tinnitus in her bilateral ears, initially resembling a \"propeller\"-like sound, which evolved into high-pitched \"hyun-hyun\" tones and subsequently into sustained \"hyuun-hyuun\" tones. She also exhibited impaired perception of spoken language. Brain MRI revealed a new small lesion in the right inferior colliculus. Case 2 was a 49-year-old man who experienced sudden onset of tinnitus characterized by alternating cicada-like, bell-like, and electronic \"pyuun-pyuun\" sounds. MRI revealed a small hemorrhage in the right inferior colliculus. In both cases, the characteristics of tinnitus changed over time and was accompanied by impaired recognition of speech sounds. These findings suggest that unilateral inferior colliculus lesions, a relay nucleus of the auditory pathway, can cause temporally evolving tinnitus and selective hearing deficits, symptoms that have been rarely reported.\n\nID: 41960387\nTitle: Prevalence of hearing loss and tinnitus among school-age children: a cross-sectional analysis of the PICTURE cohort study.\nAbstract: Hearing loss and tinnitus in children are increasingly recognized as important public health concerns with potential long-term consequences for development and communication. The aim of this study was to determine the prevalence of hearing loss and tinnitus in children, and to examine the concordance between parental subjective assessments and otoacoustic emission (OAE) results. Secondary aims were to investigate the association between hearing loss and sociodemographic factors, parents' level of education, and to evaluate the effectiveness of different diagnostic methods in detecting pediatric hearing impairment. This cross-sectional study involved 1,250 children aged 7-17\u202fyears. Participants underwent tympanometric, hearing threshold and OAEs testing and were divided into two groups according to age. Parents completed a questionnaire regarding hearing loss and presence of tinnitus. The prevalence of positive hearing screening results was 3.5%, with a higher incidence in younger children, (the difference was not statistically significant). The prevalence of hearing loss was 4.5% among boys and 2.5% among girls (p =\u202f0.097). A statistically significant discrepancy was observed between parental reports of hearing status and OAE results (p =\u202f0.006). The prevalence of tinnitus in children and adolescents aged 7-17\u202fyears was 4.7%, with no significant statistical difference observed between age groups. Abnormal results in OAE were not associated with tinnitus (the results were not statistically significant). A statistically significant association was observed between hearing loss detected by OAE and caregiver education (p =\u202f0.040, Z =\u202f-2.05), and between hearing loss and increased healthcare costs (p =\u202f0.015). The effectiveness of hearing loss detection differed significantly between the diagnostic methods used (p =\u202f0.030), with OAE testing showing the highest detection rate. This study identifies a measurable prevalence of hearing loss and tinnitus among children, with a greater burden of hearing impairment observed in younger age. There is need for systematic, school-based hearing screening programs and improved parental and educator awareness of early hearing loss indicators. These findings support the integration of standardized pediatric hearing monitoring into public health strategies and underscore the importance of addressing socioeconomic disparities in access to early diagnosis and intervention.\n\nID: 41925873\nTitle: Pre-treatment audiological and vestibular assessment in adults starting platinum-based chemotherapy.\nAbstract: To evaluate the feasibility of incorporating both standard and novel audiological and vestibular assessments into routine oncology care. A secondary objective was to characterize audiovestibular status prior to platinum-based chemotherapy and identify potential risk factors for cochleotoxicity and vestibulotoxicity. This single-center, cross-sectional prospective study enrolled 110 adults scheduled for their first platinum-based chemotherapy cycle. All assessments were performed at one time point prior to treatment initiation. Pre-treatment assessments included tympanometry, pure-tone audiometry, speech audiometry in quiet and noise (SPIQ and SPIN), distortion product otoacoustic emissions (DPOAEs), auditory brainstem responses (ABRs), envelope following responses (EFRs), video head impulse testing (vHIT), and cervical vestibular evoked myogenic potentials (cVEMP). All patients underwent tympanometry and pure-tone audiometry. A broader audiological test battery was completed in 96 patients (87.3%). At least one vestibular assessment was performed in 65 patients (59.1%). Completion of the protocol was limited by age, fatigue, or logistical constraints. Vestibular assessments were sometimes hindered by physical and time limitations. Before the start of chemotherapy, hearing loss was present in 44.5% of patients (30.9% bilateral, 13.6% unilateral), while 9.1% reported tinnitus and 34.5% reported difficulty understanding speech in noise. Speech audiometry (SPIQ and SPIN SRTs) revealed significant differences between age groups, with post-hoc analysis showing differences between the 34-57 group and the older groups. DPOAE amplitudes were significantly different across age groups at 1500\u00a0Hz, 2000\u00a0Hz, 3000\u00a0Hz, 4000\u00a0Hz, and 6000\u00a0Hz. EFR magnitudes, as well as ABR amplitudes and latencies, did not differ significantly between age groups. At baseline, three patients were diagnosed with benign paroxysmal positional vertigo (BPPV). vHIT revealed vestibulo-ocular reflex (VOR) gain deficits in three patients. cVEMP responses were absent bilaterally in three patients and unilaterally in one. Audiological assessments were largely feasible, even in older adults, and revealed pre-existing audiovestibular deficits including high-frequency hearing loss and BPPV. Given risk factors such as advanced age, baseline hearing deficits, and planned type of platinum-based chemotherapy, this population is particularly vulnerable to cochleotoxicity. These findings support implementing a pre-treatment audiovestibular protocol that can serve as a baseline for subsequent longitudinal ototoxicity monitoring, with individualized adaptations to optimize feasibility and to support early detection of ototoxic changes and timely intervention during follow-up.\n\nID: 41912403\nTitle: [Gender differences in comorbidity characteristics among patients with sudden sensorineural hearing loss].\nAbstract: Objective: To investigate gender differences in comorbidity profiles among patients with sudden sensorineural hearing loss (SSNHL). Methods: The study was a cross-sectional analysis based on patients with SSNHL enrolled from the Chinese Refractory Inner Ear Disease Cohort, which covered 29 provinces (autonomous regions/municipalities) in China. Patients were consecutively included between July 2024 and November 2025. Demographic characteristics, lifestyle factors, systemic comorbidities, and inner ear comorbidities were collected using a standardized questionnaire. Baseline characteristics and comorbidity distributions were compared between males and females. Multivariable logistic regression models were applied to evaluate the associations between gender and inner ear comorbidities. Results: A total of 2 844 patients aged 48.7 (37.0, 60.3) years were included, with 1 217 males and 1 627 females. Male patients had significantly higher proportions of smoking, alcohol consumption, and noise exposure, whereas a history of motion sickness was more common in females (P<0.001). Regarding systemic comorbidities, female patients showed higher prevalences of migraine, thyroid dysfunction, cervical spondylosis, and autoimmune diseases, while male patients had higher prevalences of hypertension, coronary heart disease, diabetes mellitus, hyperlipidemia, and cerebrovascular disease (all P<0.05). Multivariable logistic regression analysis demonstrated that, compared with females, males had increased risks of hypertension (OR=2.28, 95%CI: 1.62-3.22), coronary heart disease (OR=3.10, 95%CI: 1.53-6.29), cerebrovascular disease (OR=2.26, 95%CI: 1.15-4.41), and sinusitis (OR=1.59, 95%CI: 1.13-2.22), but lower risks of migraine (OR=0.18, 95%CI: 0.10-0.32), thyroid disease (OR=0.20, 95%CI: 0.09-0.41), cervical spondylosis (OR=0.43, 95%CI: 0.30-0.60), and autoimmune disease (OR=0.34, 95%CI: 0.11-0.90). Regarding inner ear comorbidities, aural fullness (77.7%, 2 189/2 816) and tinnitus (87.1%, 2 454/2 816) were highly prevalent, with no significant differences between males and females (all P>0.05). Age-stratified analysis showed that among patients older than 45 years, males had a significantly lower risk of tinnitus compared with females (OR=0.58, 95%CI: 0.36-0.95). Conclusions: Gender differences exist in the comorbidity spectrum of patients with SSNHL. Male patients are more likely to be accompanied by hypertension, coronary heart disease, cerebrovascular disease, and sinusitis, whereas female patients are more prone to migraine, thyroid disease, cervical spondylosis, and autoimmune diseases. Among patients older than 45 years, males have a lower risk of tinnitus than females. \u76ee\u7684\uff1a \u5206\u6790\u7a81\u53d1\u6027\u804b\u60a3\u8005\u5171\u75c5\u7279\u5f81\u7684\u6027\u522b\u5dee\u5f02\u3002 \u65b9\u6cd5\uff1a \u672c\u7814\u7a76\u4e3a\u6a2a\u65ad\u9762\u7814\u7a76\uff0c\u7eb3\u5165\u4e2d\u56fd\u96be\u6cbb\u6027\u5185\u8033\u75c5\u961f\u5217\u4e2d\u6536\u96c6\u7684\u7a81\u53d1\u6027\u804b\u60a3\u8005\u3002\u8be5\u961f\u5217\u8986\u76d6\u6211\u56fd29\u4e2a\u7701\uff08\u81ea\u6cbb\u533a\u3001\u76f4\u8f96\u5e02\uff09\uff0c\u75c5\u4f8b\u7eb3\u5165\u65f6\u95f4\u4e3a2024\u5e747\u6708\u81f32025\u5e7411\u6708\u3002\u901a\u8fc7\u7edf\u4e00\u95ee\u5377\u6536\u96c6\u4eba\u53e3\u5b66\u7279\u5f81\u3001\u751f\u6d3b\u65b9\u5f0f\u3001\u75be\u75c5\u5171\u75c5\u4ee5\u53ca\u5185\u8033\u5171\u75c5\u8d44\u6599\u3002\u6bd4\u8f83\u4e0d\u540c\u6027\u522b\u60a3\u8005\u95f4\u57fa\u7ebf\u7279\u5f81\u53ca\u5171\u75c5\u5206\u5e03\u5dee\u5f02\uff0c\u91c7\u7528\u591a\u56e0\u7d20logistic\u56de\u5f52\u6a21\u578b\u8bc4\u4f30\u6027\u522b\u4e0e\u5171\u75c5\u4e4b\u95f4\u7684\u5173\u8054\u3002 \u7ed3\u679c\uff1a \u5171\u7eb3\u51652 844\u4f8b\u7a81\u53d1\u6027\u804b\u60a3\u8005\uff0c\u75371 217\u4f8b\uff0c\u59731 627\u4f8b\uff0c\u5e74\u9f84\uff3bM\uff08Q1\uff0cQ3\uff09\uff3d48.7\uff0837.0\uff0c60.3\uff09\u5c81\u3002\u7537\u6027\u60a3\u8005\u5438\u70df\u3001\u996e\u9152\u53ca\u566a\u58f0\u66b4\u9732\u6bd4\u4f8b\u9ad8\u4e8e\u5973\u6027\u60a3\u8005\uff0c\u800c\u6655\u8f66\u53f2\u6bd4\u4f8b\u4f4e\u4e8e\u5973\u6027\u60a3\u8005\uff08\u5747P<0.001\uff09\u3002\u5728\u7cfb\u7edf\u5171\u75c5\u65b9\u9762\uff0c\u5973\u6027\u60a3\u8005\u504f\u5934\u75db\u3001\u7532\u72b6\u817a\u529f\u80fd\u5f02\u5e38\u3001\u9888\u690e\u75c5\u53ca\u81ea\u8eab\u514d\u75ab\u75c5\u60a3\u75c5\u7387\u8f83\u9ad8\uff0c\u7537\u6027\u60a3\u8005\u9ad8\u8840\u538b\u3001\u51a0\u5fc3\u75c5\u3001\u7cd6\u5c3f\u75c5\u3001\u9ad8\u8102\u8840\u75c7\u53ca\u8111\u8840\u7ba1\u75c5\u60a3\u75c5\u7387\u8f83\u9ad8\uff08\u5747P<0.05\uff09\u3002\u591a\u56e0\u7d20logistic\u56de\u5f52\u6a21\u578b\u5206\u6790\u7ed3\u679c\u663e\u793a\uff0c\u4e0e\u5973\u6027\u60a3\u8005\u76f8\u6bd4\uff0c\u7537\u6027\u60a3\u8005\u9ad8\u8840\u538b\uff08OR=2.28\uff0c95%CI\uff1a1.62~3.22\uff09\u3001\u51a0\u5fc3\u75c5\uff08OR=3.10\uff0c95%CI\uff1a1.53~6.29\uff09\u3001\u8111\u8840\u7ba1\u75c5\uff08OR=2.26\uff0c95%CI\uff1a1.15~4.41\uff09\u53ca\u9f3b\u7aa6\u708e\uff08OR=1.59\uff0c95%CI\uff1a1.13~2.22\uff09\u7684\u5171\u75c5\u98ce\u9669\u8f83\u9ad8\uff0c\u800c\u504f\u5934\u75db\uff08OR=0.18\uff0c95%CI\uff1a0.10~0.32\uff09\u3001\u7532\u72b6\u817a\u75be\u75c5\uff08OR=0.20\uff0c95%CI\uff1a0.09~0.41\uff09\u3001\u9888\u690e\u75c5\uff08OR=0.43\uff0c95%CI\uff1a0.30~0.60\uff09\u53ca\u81ea\u8eab\u514d\u75ab\u75c5\uff08OR=0.34\uff0c95%CI\uff1a0.11~0.90\uff09\u7684\u5171\u75c5\u98ce\u9669\u8f83\u4f4e\u3002\u5728\u5185\u8033\u5171\u75c5\u65b9\u9762\uff0c\u8033\u95f7\uff0877.7%\uff0c2 189/2 816\uff09\u3001\u8033\u9e23\uff0887.1%\uff0c2 454/2 816\uff09\u603b\u4f53\u53d1\u751f\u7387\u8f83\u9ad8\uff0c\u4e0d\u540c\u6027\u522b\u95f4\u5dee\u5f02\u5747\u65e0\u7edf\u8ba1\u610f\u4e49\uff08\u5747P>0.05\uff09\uff1b\u5e74\u9f84\u5206\u5c42\u5206\u6790\u663e\u793a\uff0c\u5728>45\u5c81\u7684\u60a3\u8005\u4e2d\u7537\u6027\u53d1\u751f\u8033\u9e23\u7684\u98ce\u9669\u4f4e\u4e8e\u5973\u6027\uff08OR=0.58\uff0c95%CI\uff1a0.36~0.95\uff09\u3002 \u7ed3\u8bba\uff1a \u7a81\u53d1\u6027\u804b\u60a3\u8005\u4e2d\uff0c\u5171\u75c5\u8c31\u5b58\u5728\u6027\u522b\u5dee\u5f02\uff0c\u7537\u6027\u60a3\u8005\u66f4\u6613\u5408\u5e76\u9ad8\u8840\u538b\u3001\u51a0\u5fc3\u75c5\u3001\u8111\u8840\u7ba1\u75c5\u53ca\u9f3b\u7aa6\u708e\uff0c\u5973\u6027\u60a3\u8005\u5219\u66f4\u6613\u5408\u5e76\u504f\u5934\u75db\u3001\u7532\u72b6\u817a\u75be\u75c5\u3001\u9888\u690e\u75c5\u53ca\u81ea\u8eab\u514d\u75ab\u75c5\u3002\u5728>45\u5c81\u60a3\u8005\u7fa4\u4f53\u4e2d\u7537\u6027\u5171\u75c5\u8033\u9e23\u98ce\u9669\u4f4e\u4e8e\u5973\u6027\u3002.\n\nID: 41912095\nTitle: Post-acute sequelae after Lassa fever: A systematic review and meta-analysis.\nAbstract: Post-acute sequelae are symptoms that persist or arise after the acute phase of an infection, but their frequency following outbreaks remains poorly understood. Recurrent Lassa fever outbreaks pose a significant public health threat in West Africa and may have long-term health effects. This study systematically reviewed the prevalence, incidence, duration, and characteristics of post-acute sequelae in survivors of Lassa virus infection. We searched PubMed and Web of Science up to November 17, 2025. Two reviewers screened and extracted data independently. We included six articles in the review. The most frequently reported post-acute sequela was hearing loss, with a pooled prevalence of 18% (95% CI 9-32) across 6 studies. Odds ratios for the association between Lassa fever and hearing loss were heterogeneous, with a statistically significant positive association in 2 of 5 studies and a positive effect direction in 2 further studies. Of an additional 37 potential post-acute sequelae, several with high prevalence also related to the audiovestibular system (e.g., tinnitus, balance disorder, and vertigo). Our findings highlight that Lassa fever survivors can experience diverse symptoms after recovery from acute infection, with hearing loss being the best-characterised. However, data gaps remain on its incidence after mild infections and its duration. A better understanding of post-acute sequelae after Lassa fever is necessary for accurate disease burden estimation and mathematical modelling studies.\n\nID: 41838155\nTitle: Audiovestibular manifestations of intracranial hypotension: a descriptive clinical series.\nAbstract: BACKGROUND: Intracranial hypotension (IH) results from decreased cerebrospinal fluid (CSF) volume or pressure and typically presents with orthostatic headache. IH may also manifest with audiovestibular symptoms with variable association to endolymphatic hydrops (EH). However, the nature of this relationship remains unclear. OBJECTIVES: To describe the clinical, audiometric, vestibular, and imaging characteristics of patients with IH presenting with cochleovestibular dysfunction. METHODS: We conducted a retrospective observational study including 12 patients diagnosed with IH based on MRI findings between 2016 and 2025 in a tertiary referral center. Data included demographic, audiovestibular, neurological, and imaging results. Descriptive statistics including patients with and without EH on MRI were reported. RESULTS: Twelve patients (mean age 53.4\u2009\u00b1\u200919.2 years; 50% female) with MRI-confirmed non iatrogenic IH were included. Orthostatic headache was present in 83.3% of cases. Audiovestibular symptoms were common, including tinnitus (66.7%), rotational vertigo (50.0%), positional vertigo (16.67%), instability (41.7%), ear fullness (41.7%), and hearing loss (41.7%). Audiometry revealed overall mild sensorineural hearing impairment, while vestibular testing showed largely preserved video head impulse test gains and minimal caloric deficits. Delayed post-contrast 3D FLAIR MRI identified EH in four patients (33.3%), with bilateral involvement in two (16.7%); all cases were classified as low-grade saccular hydrops. CONCLUSIONS: Audiovestibular symptoms, including tinnitus and dizziness, may accompany IH. MRI evidence of EH may support the hypothesis of a potential underlying CSF\u2013inner ear pressure interaction. Future prospective studies should explore mechanistic pathways linking CSF hypovolemia to cochleovestibular dysfunction and EH, and gather data from larger cohorts. At this stage, the therapeutic implications remain uncertain. To our knowledge, this is the first study to perform delayed 3D FLAIR MRI in a cohort of patients with IH and cochleovestibular symptoms.\n\nID: 41830490\nTitle: Tinnitus outcomes after ginkgo biloba extract in sudden sensorineural hearing loss: a dose-comparative and prognostic study.\nAbstract: Tinnitus is a common symptom in otolaryngology with a complex and multifactorial etiology. Ginkgo biloba extract (EGB 761) is widely used in clinical practice, but the reported results vary across studies, partly due to differences in dosage and outcome assessment. To compare tinnitus outcomes between two commonly used EGB 761 dosages (120\u2009mg/day vs. 240\u2009mg/day) in patients with SSNHL-associated newly onset tinnitus, and to identify clinical factors associated with tinnitus prognosis. Participants from mainland China were randomly assigned (1:1) to receive either 120\u2009mg/day or 240\u2009mg/day of EGB 761 tablets for one month. Follow-up assessments were conducted at 1, 2, 3, 4, 6, 9, 12, and 18\u2009months after treatment initiation. A total of 195 valid data sets were analyzed. The mean baseline Tinnitus Handicap Inventory (THI) score of 48.99 significantly decreased to 28.33 at 1\u2009month, 16.97 at 6\u2009months, and 10.54 at 18\u2009months. A slightly higher proportion of patients met the improvement criterion in the high-dose group (95.9%) than in the low-dose group (91.9%), but the between-group differences were not statistically significant for THI reduction or other outcomes. In multivariable analyses, higher anxiety (GAD-7\u2009\u2265\u200910), higher reflux symptom burden (RSI \u226513), and a history of vestibular disorders were associated with less favorable tinnitus outcomes at follow-up. Both 120\u2009mg/day and 240\u2009mg/day dosages of EGB 761 demonstrated similar tinnitus outcomes over follow-up. Anxiety, LPR, and a history of vestibular disorders may be prognostic factors for tinnitus.\n\nID: 41821256\nTitle: Central Abnormalities in Idiopathic Tinnitus With Mild Hearing Loss: Selective Attention and Preprocessing Dysfunction.\nAbstract: To verify the abnormal brain electrical activity of idiopathic tinnitus through auditory event-related potentials and elucidate the impact of mild hearing loss. Auditory event-related potentials were collected from 74 patients with idiopathic tinnitus as the primary complaint (divided into a normal hearing group of 39 and a mild hearing loss group of 35 based on hearing level) and 37 healthy volunteers. Various auditory event-related potential indicators were compared among the groups, and the correlation between these indicators and the clinical characteristics of idiopathic tinnitus patients was analyzed. Idiopathic tinnitus patients with normal hearing have increased P1 amplitude, delayed P300 latency, decreased P300 amplitude, and decreased mismatch negativity (MMN) amplitude. Idiopathic tinnitus patients with mild hearing loss have further reduced P300 amplitude and delayed MMN latency. In addition, the P300 latency of idiopathic tinnitus patients is significantly correlated with the duration of tinnitus and Tinnitus Handicap Inventory (THI) score, the P300 amplitude is significantly correlated with the Pittsburgh Sleep Quality Index (PSQI) score, and the MMN latency is significantly correlated with the duration of tinnitus. Patients with idiopathic tinnitus exhibit abnormalities in multiple auditory event-related potentials, with mild hearing loss exacerbating some of these abnormalities. Idiopathic tinnitus and mild hearing loss may lead to selective attention and preprocessing dysfunction.\n\nID: 41820973\nTitle: Remnant cholesterol and auditory outcomes in NHANES 1999-2016: associations with frequency-range hearing loss and tinnitus.\nAbstract: BACKGROUND: Evidence on the lipid determinants of auditory outcomes remains inconsistent. Remnant cholesterol (RC), the cholesterol fraction contained in triglyceride-rich lipoproteins, captures atherogenic and inflammatory burdens beyond conventional fractions. This study assessed the associations between RC and hearing loss across frequency ranges and between RC and tinnitus in a population-representative U.S. cohort. Identifying scalable metabolic markers may help support earlier recognition and prevention efforts to reduce avoidable hearing-related disability. METHODS: Participants aged 40 years and older with valid audiometric evaluations and fasting lipid profiles were identified from the 1999\u20132016 National Health and Nutrition Examination Survey (NHANES) dataset. RC was estimated as total cholesterol minus the sum of low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) and was evaluated across predetermined concentration ranges. The outcomes included low-, speech-, and high-frequency hearing loss defined by air-conduction thresholds and self-reported tinnitus. Weighted multivariable logistic regression models were applied, sequentially adjusting for demographic, socioeconomic, lifestyle, and clinical covariates, followed by mutual adjustment for other lipid components. Subgroup and interaction analyses evaluated effect modification, including noise exposure. RESULTS: In fully adjusted survey-weighted logistic models, higher RC was associated with hearing loss (OR 2.43, 95% CI 1.71\u20133.47) and with tinnitus (OR 1.64, 95% CI 1.31\u20132.06); category analyses indicated a monotonic increase (P for trend\u2009<\u20090.001). Associations displayed a clear dose\u2013response across RC categories and remained robust in mutually adjusted models, whereas the inverse associations for HDL-C attenuated and became nonsignificant once RC was included. Analyses by frequency range revealed the strongest associations for high-frequency hearing loss, intermediate associations for speech-frequency hearing loss, and the weakest associations for low-frequency hearing loss. Subgroup findings were broadly consistent across strata, and interaction testing indicated amplified RC\u2013auditory associations among participants reporting noise exposure. CONCLUSIONS: RC was linked to adverse auditory outcomes, including hearing loss and tinnitus, with clear dose\u2013response patterns that persisted after mutual lipid adjustment. As a routinely available lipid-derived measure, RC may support scalable risk stratification to help prioritize earlier hearing evaluation and preventive counseling; confirmation in longitudinal cohorts and trials is needed.\n\nID: 41816346\nTitle: Relationship between COVID-19 and \"three inflammations and one deafness\": a systematic review and meta-analysis.\nAbstract: The relationship between \"three inflammations and one deafness\" (allergic rhinitis, pharyngitis, otitis media, tinnitus, and deafness) and coronavirus disease 2019 (COVID-19) is currently unclear, and this study aims to investigate their correlation. We searched the relevant literature in three databases (Embase, Cochrane Library, and PubMed) from their inception through July 2024, and the investigator strictly reviewed the literature according to the screening criteria to determine the included studies. We extracted relevant data information and conducted quality assessment and meta-analysis. From 5,950 records screened, five cohort studies were included. The pooled analysis using a random-effects model showed no statistically significant association between COVID-19 and \"three inflammations and one deafness\" (OR\u00a0= 1.03, 95% CI: 0.85-1.26, P = 0.74), with substantial heterogeneity (I\u00b2 = 89%, P < 0.001). Critically, subgroup analyses revealed that the diagnostic criteria for \"three inflammations and one deafness\" were a key source of this heterogeneity. A significant association was observed in studies using physician-diagnosed outcomes (OR = 1.30, 95% CI: 1.08-1.56, P = 0.006, I\u00b2 = 0%), whereas no significant association was found in studies based on self-reported symptoms (OR = 0.89, 95% CI: 0.69-1.15, P = 0.38, I\u00b2 = 96%). Analyses by specific conditions yielded mixed results: No significant association was observed for hearing loss (OR = 0.93, 95% CI: 0.69-1.25, P = 0.62). For allergic rhinitis (OR = 1.19, 95% CI: 0.47-3.02, P = 0.71) and tinnitus (OR = 1.11, 95% CI: 0.88-1.39, P = 0.38), the point estimates suggested potential positive trends, but the associations were not statistically significant, and confidence intervals were wide. Subgroup analyses by some regions and COVID-19 diagnostic criteria did not reveal consistent significant associations. This meta-analysis found no consistent association between COVID-19 and \"three inflammations and one deafness,\" primarily due to significant heterogeneity. Evidence suggests a link between COVID-19 and physician-diagnosed \"three inflammations and one deafness,\" which strongly depends on the rigor of outcome assessment, highlighting the need for standardized clinical diagnoses in future research. https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023438076.\n\nID: 42378538\nTitle: Round Window Reinforcement for Semicircular Canal Dehiscence Syndrome.\nAbstract: To evaluate the clinical outcomes and safety profile of round window reinforcement (RWR) as a minimally invasive surgical treatment for patients with semicircular canal dehiscence syndrome (SCDS). This retrospective case series analyzed 7 patients (mean age: 59 years) diagnosed with SCDS who underwent transcanal RWR between June 2024 and June 2025 at the Kopfzentrum Bielefeld. Inclusion criteria followed the B\u00e1r\u00e1ny Society consensus diagnostic standards. Clinical symptoms, audiometric findings, and vestibular test results-including Dizziness Handicap Inventory (DHI) scores-were assessed pre and postoperatively. In 2 patients, endolymphatic hydrops was diagnosed via delayed contrast-enhanced magnetic resonance imaging and monitored postoperatively. All patients completed follow-up (mean: 35 months). Improvement in auditory symptoms was observed in 5 of 7 patients (71.4%), including tinnitus relief in 83.3% and hyperacusis relief in 75%. Vertigo improved in 50% of symptomatic cases. No postoperative deterioration in symptoms, DHI score, or hearing was observed. Audiometric outcomes showed a non-significant mean change in air-bone gap (\u00b12.5 dB). No intra- or postoperative complications occurred. In patients with concomitant hydrops, auditory improvement was noted, though vertigo persisted. Round window reinforcement appears to be a safe and effective therapeutic option for selected patients with SCDS, particularly those presenting predominantly auditory symptoms or contraindications to more invasive procedures. Further prospective studies are needed to validate these findings and define the role of RWR in the broader surgical management of third window syndromes.\n\nID: 42345416\nTitle: Management Options and Their outcomes in Bilateral Advanced Otosclerosis.\nAbstract: Otosclerosis is a hereditary disorder that causes progressive hearing loss in the adult population. Owing to its progressive nature, a multimodal treatment approach is often required. Management options were offered to patients following comprehensive audiological and radiological evaluation, incorporating the Merkus algorithm in clinical decision-making. This study aims to compare the audiological and speech-related outcomes of cochlear implantation (CI) and stapedotomy with hearing aid use in patients with bilateral advanced otosclerosis. This cohort study included 38 patients divided into 2 groups: Group A consisted of patients who underwent CI (n=15), and Group B comprised patients who underwent stapedotomy followed by hearing aid use (n=23). Outcomes were compared using paired t-tests both within and between the groups. Both groups demonstrated significant improvement in hearing and speech outcomes post-intervention. Speech-related outcomes were superior in Group A (cochlear implant recipients) with a statistically significant P value (<.005), whereas hearing-related outcomes were comparable between the 2 groups. Vertigo and tinnitus symptoms showed greater improvement in Group A compared to the Group B cohort. In cases of progressive hearing loss, early and appropriate intervention is crucial to preserve residual hearing. Cochlear implantation is effective in improving both audiological and speech outcomes, and it also alleviates symptoms such as tinnitus and vertigo. Conversely, stapedotomy combined with hearing aid use remains a cost-effective management option, providing comparable audiological outcomes.\n\nID: 42306241\nTitle: Gamified Digital Solutions for Tinnitus Health Literacy: The Erasmus+ Project TinWise.\nAbstract: Tinnitus is a common auditory symptom - sound perceived without an external source. Chronic tinnitus affects about 65 million adults in the EU, often impairing quality of life through distress, sleep problems, anxiety, and depression. Yet, management remains inconsistent across Europe due to patient heterogeneity and lack of standardised care. Health literacy is increasingly recognised as key to empowering patients in self-management and reducing burden. The Erasmus+ project TinWise addresses this by creating a gamified health literacy platform for tinnitus patients and educating healthcare professionals on digital self-help strategies. Building on Tin-TRAC, which developed an open-access e-learning platform, TinWise integrates gamification to enhance motivation, engagement, and knowledge retention. The project applies the OPHELIA framework to optimise literacy strategies and follows the ASPIRE learning construct for co-creating content. TinWise will deliver interactive, co-created digital games to promote self-help literacy, an AI-powered chatbot for real-time guidance, and a patient-linking service to enhance community support. It also aims to train healthcare professionals using reusable learning objects, supporting the integration of digital tools into tinnitus care. Through modern technology and inclusive design, TinWise supports European priorities in digital education, patient empowerment, and healthcare innovation, ultimately improving tinnitus care and outcomes across Europe.\n\nID: 42278904\nTitle: Empowerment, Self-Management and Illness Perception of Users of an Online Self-Help Platform for Tinnitus: A Cross-Sectional Study.\nAbstract: Background: Tinnitus is a common and potentially distressing phenomenon for which no broadly effective curative treatment exists. Self-management skills and empowerment are crucial for coping with chronic conditions, but empirical studies investigating the association of these on individuals burdened by tinnitus are scarce. The primary aim of this cross-sectional study was to investigate the association between the use of an online self-help platform for people with tinnitus and self-perceptions of empowerment, self-management skills, and the cognitive and emotional representations of tinnitus. Methods: One hundred and fifty-two adult participants were recruited from an online self-help platform for people with tinnitus, resulting in a self-selected convenience sample. Self-management skills were assessed using the Patient Assessment of Chronic Illness Care (PACIC) and the Partners in Health Questionnaire. The cognitive and emotional representations of tinnitus were measured with the Illness Perception Questionnaire. Finally, the Empowering Processes and Outcomes Questionnaire was used to evaluate empowerment associated with engagement in the self-help platform. The type and frequency of user activity on the self-help platform were used to explore the relationship between the nature of contributions to the platform and the measured outcomes. Results: The key findings include: (1) The representations of tinnitus were negatively related to their ability to self-manage the condition. (2) The duration of tinnitus did not correlate with improved self-management skills. (3) Comparing those who visited a healthcare provider for their tinnitus with those who did not, we found that treatment adherence was higher among participants with clinical visits. (4) Participants in this study scored lower on all aspects of self-management skills (as measured by the PACIC) compared to patients using primary healthcare services. (5) Participants who actively contributed to the self-help platform by posting scored higher in two empowering processes: helping others and sharing experiences. Conclusions: The present findings suggest that tinnitus self-management skills are independent of tinnitus duration, whereas those skills correlate negatively with illness perception. Further, clinical visits are associated with higher treatment adherence, and active self-help platform use increases feelings related to helping others and shared experiences. Taken together, these results highlight the need for fostering self-management skills and structured peer-to-peer support programs. Because this was a self-selected convenience sample of users of an online tinnitus self-help platform, the findings should be interpreted in light of this recruitment context and not generalized to the broader tinnitus population.\n\nID: 42269959\nTitle: Sound hypersensitivity phenotypes and sound hypersensitivity disorder.\nAbstract: This paper proposes an overarching definition for sound hypersensitivity, a common symptom frequently observed in patients with hearing loss, tinnitus and other neurological and psychiatric disorders. This multifaceted condition includes several phenotypes, which may exist in isolation or combination in the same individual: loudness hypersensitivity (hyperacusis), noxacusis, misophonia, phonophobia and noise-induced cognitive symptoms. Some individuals with sound hypersensitivity may develop a resultant sound hypersensitivity disorder, a clinically heterogeneous syndrome defined by recurrent episodes of sound-induced symptoms that are associated with a negative emotional response and/or avoidance behavior leading to suffering and/or limitation of social, leisure or occupational activities. We have assembled an international, multidisciplinary working group to develop this theoretical foundation and propose objective operational diagnostic criteria for sound hypersensitivity and sound hypersensitivity disorder. Given the large co-occurrence between tinnitus and sound hypersensitivity phenotypes, it is essential to establish a common ground to differentiate sound hypersensitivity as a symptom from sound hypersensitivity disorder and distinguish between phenotypes. The distinction will facilitate pathophysiological, translational and clinical research differentiating various forms of sound hypersensitivity and separating them from tinnitus, and represent a paradigm shift in auditory and behavioral sciences. Adopting a global and multidisciplinary lens, we aim to spark a debate fostering collaboration and innovation in addressing this pervasive yet underappreciated condition involving auditory, behavioral and cognitive neurosciences.\n\nID: 42259562\nTitle: Association between hypertension status and severity and tinnitus: a cross-sectional analysis of the Fasa adult cohort study.\nAbstract: Previous studies and meta-analyses suggest an association between hypertension and tinnitus; however, the influence of hypertension severity and control status remains unclear. We aimed to investigate the association between hypertension and tinnitus in detail using a large, population-based dataset from a rural setting.DesignObservational cross-sectional study.SettingSheshdeh, Fasa, Iran. We analysed data from 9775 individuals in the general population, aged 35-70 years, excluding those with a history of cancer, pregnancy or medical conditions known to cause tinnitus, such as stroke, seizures or multiple sclerosis. Additionally, although the study design aimed to exclude participants using aminoglycosides because of their significant ototoxic effects, no such users were identified during the study period. Hypertension was defined as a systolic blood pressure (SBP) of \u2265140\u2009mm Hg or a diastolic blood pressure (DBP) of \u226590\u2009mm Hg on at least two separate measurements or as current use of antihypertensive medications following a prior diagnosis. These medications included ACE inhibitors, angiotensin receptor blockers, diuretics, aldosterone antagonists and atenolol. Stage I hypertension was classified as an SBP of 140-159\u2009mm Hg or a DBP of 90-99\u2009mm Hg, while stage II was defined as an SBP of \u2265160\u2009mm Hg or a DBP of \u2265100\u2009mm Hg. Controlled blood pressure was defined as values below these thresholds. Tinnitus, assessed by a self-reported questionnaire, was defined as a continuous wheezing sound in the ear persisting for more than 1\u2009week. Among participants (4446 males, 5309 females; mean age 48.55 (SD 9.53) years), the prevalence of tinnitus and hypertension was 7.4% and 19.3%, respectively. Hypertension was significantly associated with higher odds of tinnitus (adjusted OR=1.34; 95%\u2009CI 1.10 to 1.62). Notably, even participants with controlled hypertension had a 27% increased odds (OR=1.27; 95%\u2009CI 1.02 to 1.59) compared with normotensive individuals. The odds were highest in those with uncontrolled grade II hypertension (OR=2.08; 95%\u2009CI 1.25 to 3.47), demonstrating a dose-response relationship. Our findings suggest a positive association between hypertension and tinnitus, with odds increasing alongside the severity and poor control of hypertension. Importantly, even controlled hypertension was associated with elevated odds, indicating that tinnitus screening may be warranted in all hypertensive patients, regardless of control status. These results underscore the need for heightened clinical awareness and further research into the pathophysiological mechanisms linking vascular health and auditory symptoms.\n\nID: 42143865\nTitle: Hyperacusis-inducing drug candidates.\nAbstract: Hyperacusis is a troubling loudness hypersensitivity disorder occasionally involving pain around ear and face. The neural origins of hyperacusis and conditions that evoke it are poorly understood. To gain insights into the neural mechanisms that might give rise to hyperacusis, a pharmacovigilance analysis was conducted on 3833 case reports in which hyperacusis was listed as a drug-induced adverse event in the United States Food and Drug Administration Adverse Event Reporting System (FAERS). The 10 drug classes ranked by the number of reported hyperacusis cases were selective (1) serotonin reuptake inhibitors (e.g., paroxetine), (2) fluoroquinolone antibiotics (e.g., ciprofloxacin), (3) serotonin-norepinephrine reuptake inhibitors (e.g., venlafaxine), (4) benzodiazepines (e.g., clonazepam), (5) anticonvulsant-mood stabilizers (e.g., valproate), (6) central nervous system stimulants, (7) atypical antipsycnotics, (8) corticosteroid/glucocorticoid (e.g., prednisolone), (9) anticonvulsant-GABA analogue (e.g., pregabalin) and (10) anticonvulsants (e.g., topiramate). Approximately 70% of hyperacusis cases were females, possibly due to a reporting bias. The most prevalent comorbidities were headache, photophobia, nausea, fatigue, dizziness, anxiety, insomnia, tinnitus and depression. The mechanisms of action and side effects of the 25 drugs in which hyperacusis was listed as an adverse event are discussed along with study limitations such as correlational analysis. The results provide a foundation for future drug-related research on hyperacusis, including studies in animal models to determining which of these drugs can dose-dependently induce hyperacusis.\n\nID: 42108535\nTitle: Clinical Features of Midlife Women With Isolated Episodic Vestibular Syndrome and Their Relationship With Migraine and Menopause Transition.\nAbstract: To describe the clinical features of middle-aged women with isolated spontaneous episodic vestibular syndrome, focusing on vestibular, audiological, migraine-related, and climacteric symptoms. This cross-sectional study included women aged 40 to 65 years with recurrent spontaneous vestibular symptoms and no hearing loss, evaluated at a tertiary neurotology outpatient clinic. Participants underwent a semi-structured clinical interview and completed the Dizziness Handicap Inventory (DHI), Menopause Rating Scale (MRS), and Migraine Disability Assessment (MIDAS). Clinical features were described, and associations between DHI scores, clinical features, MRS, and MIDAS were examined. Ninety-three patients were included. Most experienced episodes at least weekly (80.6%), typically lasting seconds to minutes (74.2%) and frequently triggered by head motion (88.2%). Episodes were commonly associated with headaches (54.8%) and emotional distress (63.4%). Frequent accompanying symptoms included tinnitus (78.5%), hyperacusis (62.4%), motion sickness (59.1%), photophobia (59.1%), neck pain (60.2%), and vasomotor symptoms (59.1%). DHI scores were significantly higher in patients with tinnitus (P=0.042). Although 19.2% did not meet diagnostic criteria for vestibular migraine (VM), 95.7% reported at least one migraine-related symptom. DHI scores correlated significantly with MRS (P=0.0007) but not with MIDAS (P=0.819). Middle-aged women with isolated episodic vestibular syndrome show a consistent pattern of brief, recurrent symptoms often accompanied by auditory, emotional, migraine-related, and vasomotor features. Tinnitus is associated with greater disability, and menopausal symptoms significantly correlate with dizziness-related handicap.\n\nID: 42057697\nTitle: A comparison of misophonia proportion and patterns of uncomfortable loudness levels between individuals with and without hyperacusis reporting sensitivity to environmental sounds.\nAbstract: To compare audiological characteristics and misophonia symptoms proportion in young adults with normal hearing and self-reported sound sensitivity (without tinnitus), classified as having hyperacusis status. Cross-sectional study. Participants classified as having hyperacusis (ULLmin \u226477\u2009dB HL) or non-hyperacusis (>77\u2009dB HL). Misophonia symptoms were identified using screening thresholds: Sound Sensitivity Symptoms Questionnaire item 4 (SSSQ4\u2009\u2265\u20092) or Misophonia Questionnaire-Misophonia Severity Scale (MQ-MSS \u22657). Audiological variables included ULLmin (uncomfortable loudness level minimum), slopes, asymmetry, and repetition differences. 153 participants (19-31\u2009years), recruited via social media. 31.4% met the hyperacusis criterion. The hyperacusis group showed lower ULLmin, steeper ULL slopes, and higher HQ, SSSQ, and MQ scores (p\u2009\u2264\u20090.002). Misophonia was more prevalent in the hyperacusis group (52.1% vs. 32.4%, p\u2009=\u20090.020). Multivariable analysis showed that hyperacusis was the strongest predictor of misophonia, with ULLmin and slope contributing. Many individuals reporting sound sensitivity did not meet objective criteria for hyperacusis, underscoring the value of measures such as ULLmin. The higher prevalence of misophonia symptoms in hyperacusis and their shared audiological correlates suggest substantial overlap between decreased sound tolerance subtypes. These findings support integrated audiological-psychometric assessment and highlight the need for longitudinal and neuroimaging studies.\n\nID: 42023129\nTitle: App-based conversational agents for tinnitus distress and mental health: A randomised controlled trial.\nAbstract: Tinnitus is often accompanied by anxiety, depression, insomnia, and significant psychological distress, highlighting the need for accessible, evidence-based interventions. Internet-delivered cognitive behavioural therapy (iCBT) offers a scalable and standardised approach, and chatbots provide an emerging mode of automated delivery. This randomised controlled trial investigated the effectiveness of two app-based iCBT interventions for adults with persistent tinnitus (N\u00a0=\u00a0105). Participants were randomly allocated to one of three conditions for eight weeks: a tinnitus-specific iCBT chatbot (Tinnibot), a general iCBT chatbot for mood and anxiety (Woebot), or a waiting-list control group. Outcomes were assessed at baseline and post-intervention and included tinnitus-related distress (Tinnitus Functional Index; primary outcome), anxiety (Generalised Anxiety Disorder Scale), depression (Patient Health Questionnaire), insomnia (Insomnia Severity Index), mindfulness (Mindful Attention Awareness Scale), and life satisfaction (Satisfaction with Life Scale). Analyses used mixed analysis of variance with an intention-to-treat approach. Both chatbot groups showed significant improvements in anxiety and depression relative to the control group. Tinnibot also produced significant improvements in insomnia severity. Tinnitus distress decreased in both chatbot groups, but only Tinnibot achieved a clinically meaningful reduction. Changes in mindfulness and life satisfaction were modest and did not differ between groups. These findings indicate that chatbot-delivered iCBT can improve comorbid symptoms associated with tinnitus, and that tinnitus-specific tailoring confers additional, clinically meaningful benefits for tinnitus distress.\n\nID: 42002637\nTitle: Association between diabetes and tinnitus traits in the UK Biobank: a population-based cohort study.\nAbstract: Tinnitus is common but challenging to treat. Investigating diabetes-related factors may inform prevention and targeted interventions. This study evaluated associations between diabetes-related factors and tinnitus traits. Using UK Biobank data (n\u2009=\u2009136,181), we performed cross-sectional logistic regression to evaluate links between diabetes status, HbA1c, medication use, and diabetes duration with tinnitus occurrence, frequency, and severity. Subgroup analyses assessed variations by sex and age. This study systematically identified the associations between diabetes-related factors and the frequency and severity of tinnitus. Patients with type 2 diabetes had higher odds of experiencing current, constant, and upsetting tinnitus (OR: 2., 95% CI: 1.4-2.85, p\u2009=\u20090.001; OR: 2.49, 95% CI: 1.44-4.31, p\u2009=\u20090.0011; OR: 6.36, 95% CI: 2.3-17.54, p\u2009=\u20090.001, respectively). Insulin use was associated with lower odds of developing current, transient, and upsetting tinnitus compared to non-users of hypoglycemic drugs (OR: 0.61, 95% CI: 0.47-0.80; OR: 0.62, 95% CI: 0.43-0.9, p\u2009=\u20090.011; OR: 0.42, 95% CI: 0.25-0.69, p\u2009=\u20090.007, respectively). Subgroup analyses revealed stronger associations in younger females. Type 2 diabetes increases tinnitus risk, whereas insulin use was associated with a lower prevalence of tinnitus. Notably, diabetes status and HbA1c were significantly associated with tinnitus, mainly in younger females.\n\nID: 41917716\nTitle: Fronto-temporal Delta-gamma Imbalance as a Neural Correlate of Hyperacusis in Tinnitus: An Exploratory EEG Study.\nAbstract: To identify quantitative electroencephalography (qEEG)-based connectivity alterations associated with hyperacusis using combined subjective-objective diagnostic criteria. Retrospective case-control study. Tertiary referral center. Seventy-four patients with subjective tinnitus were analyzed. Hyperacusis was defined using combined criteria: subjective complaint and uncomfortable loudness levels (UCL) \u2264 77\u00a0dB HL, resulting in 11 patients with hyperacusis. Extreme groups (11 patients with hyperacusis vs. 23 high-tolerance controls with UCL \u2265 90\u00a0dB) were compared. None (observational study). Functional connectivity assessed using the phase-locking value (PLV) and weighted phase lag index (wPLI) for delta, theta, alpha, beta, and gamma frequency bands. Patients with hyperacusis exhibited markedly lower UCLs than the full cohort (56.2 \u00b1 19.0 vs. 82.4 \u00b1 22.4\u00a0dB HL; P = 0.001, d = 1.19). In the extreme-group EEG analysis, right fronto-temporal connectivity showed increased delta PLV (d = 0.88, 95% CI: -0.14 to 1.90, P = 0.021) and decreased gamma PLV (d = -0.69, 95% CI: -1.71 to 0.33, P = 0.044; Welch t test). The delta-gamma balance index differed between groups (d = 1.27, 95% CI: 0.25-2.29, P = 0.003, uncorrected). Supplementary wPLI analysis showed similar directional trends for gamma reduction (d = -0.50, P = 0.068) but not for delta increase (d = 0.07), suggesting differential volume conduction effects across frequency bands. However, no connectivity features survived Benjamini-Hochberg FDR correction across the planned comparisons. In this small, exploratory extreme-group study, a right fronto-temporal delta-gamma imbalance emerged as a candidate connectivity signature of objectively verified hyperacusis in tinnitus. The gamma reduction, partially supported by wPLI analysis, represents the more robust finding, while the delta increase warrants cautious interpretation given its absence in wPLI. Because no features survived FDR correction and CIs were wide, the results are preliminary and warrant replication in larger cohorts.\n\nID: 41901590\nTitle: Association Between Morning Blood Pressure Surge and Tinnitus in Hypertensive Patients: A Cross-Sectional Study.\nAbstract: Background and Objectives: Despite extensive research into its vascular mechanisms, the relationship between tinnitus and morning blood pressure surge (MBPS) remains unexplored. This study aims to investigate the association between tinnitus and MBPS in hypertensive patients. Materials and Methods: The study included 266 hypertensive patients, 86 with tinnitus and 180 without. Office blood pressure (BP) measurements, 24 h ambulatory BP monitoring (ABPM), echocardiographic findings, and laboratory parameters were analyzed. Tinnitus severity was assessed using the Tinnitus Handicap Inventory (THI). MBPS was calculated as the difference between the average systolic BP (SBP) in the first two hours after waking and the lowest three SBP values measured during sleep. Statistical analyses included regression models, ROC curve analysis, and the Boruta feature selection method. Results: MBPS was significantly higher in the tinnitus group compared to the non-tinnitus group (35 \u00b1 9 vs. 26 \u00b1 11 mm Hg, p < 0.001). Office BP and ABPM were significantly lower in the tinnitus group, while DBP showed no differences. The regression analysis identified MBPS (OR = 1.15, 95% CI: 1.08-1.23, p < 0.001), SBP (OR = 1.09, 95% CI: 1.03-1.15, p = 0.004), age (OR = 0.89, 95% CI: 0.82-0.96, p = 0.003), and smoking status (OR = 3.54, 95% CI: 1.09-11.61, p = 0.037) as independent predictors of tinnitus. The ROC analysis demonstrated that MBPS >28 mm Hg predicted tinnitus with 73.3% sensitivity and 68.3% specificity (AUC = 0.742, 95% CI: 0.685-0.793, p < 0.001). The comparative analysis showed that MBPS had a superior predictive accuracy for tinnitus compared to other BP parameters (p < 0.001). The 5-fold cross-validated ROC analysis further validated the moderate discriminatory power of MBPS, with an average AUC of 0.735 (95% CI: 0.672-0.798). Conclusions: This study demonstrates a significant association between tinnitus and MBPS in hypertensive patients. MBPS may serve as a useful indicator for identifying patients at risk of tinnitus, highlighting the importance of circadian BP monitoring in clinical practice.\n\nID: 41874076\nTitle: Integrating the Sensation-Emotion-Cognition (SEC) Model into Tinnitus Care: A Preliminary Exploratory Study of a Comprehensive Tinnitus Management Protocol.\nAbstract: Tinnitus, the perception of sound in the absence of an external source, is a prevalent condition that can substantially affect physical and mental health. Although tinnitus is not typically curable, it is often manageable with structured, multidisciplinary care. This pilot research describes the Sensation-Emotion-Cognition (SEC) model, a practical audiological framework developed by Danesh et al. that targets three core dimensions of the tinnitus experience. We integrate findings from an exploratory retrospective cohort and a prospective expansion study. The SEC protocol included sound therapy, counseling and relaxation training, and cognitive behavioral therapy (CBT) delivered through either unguided, module-based internet CBT, clinician-guided module-based internet CBT, or six therapist-led CBT sessions. The objective was to evaluate whether this multifactorial approach is associated with reductions in tinnitus-related distress. In this prospective study, preliminary results from 16 participants who completed the study were associated with significant pre-post changes in tinnitus-related outcomes: 4C management confidence increased from M = 30.38 to 60.19 (p < 0.001; Cohen's dz = 1.04), and SAD-T emotional distress decreased from M = 4.75 to 2.38 (p = 0.001; Cohen's dz = 0.99). These findings suggest the potential value of an integrated management strategy; however, given the single-group pre-post design and attrition, the results should be interpreted as exploratory and warrant confirmation in larger controlled trials.\n\nID: 41861205\nTitle: Combined drug therapy with ultrasound-guided stellate ganglion block for primary tinnitus.\nAbstract: This study aimed to evaluate the effectiveness and safety of combined medication therapy and ultrasound-guided stellate ganglion block treatment for primary tinnitus. This retrospective cohort study reviewed the clinical data of 113 patients with primary tinnitus, with 46 patients receiving stellate ganglion block treatment as the control group and 67 patients receiving the combined medication therapy combined with ultrasound-guided stellate ganglion block treatment as the observation group. Baseline characteristics, tinnitus severity scores, quality of life, psychological health, adverse events, and patient satisfaction were assessed and compared between the 2 treatment groups. Baseline demographics and tinnitus characteristics were similar between groups (P\u2005>\u2005.05). Posttreatment, the observation group showed significantly greater improvements in tinnitus severity (all metrics, P\u2005<\u2005.05), quality of life (physical, emotional, role, cognitive, social domains, P\u2005<\u2005.005), and psychological health (anxiety, depression, stress, sleep, social support, P\u2005<\u2005.05). Adverse events (headache, dizziness, nausea) were comparable (P\u2005>\u2005.05). Patient satisfaction favored the observation group (P\u2005=\u2005.034), though fewer reported \"very satisfied\". The combined intervention demonstrates superior efficacy across clinical and psychosocial outcomes with comparable safety. Medication therapy combined with ultrasound-guided stellate ganglion block treatment significantly reduces tinnitus severity. However, due to the retrospective observational nature of this study, the findings demonstrate an association rather than a causal relationship.\n\nID: 41796693\nTitle: Incidence of misophonia, associated auditory symptoms and sensory processing profiles in university students in Turkey: a comparative study of clinical, subclinical and control groups.\nAbstract: This study aimed to investigate the prevalence of misophonia among university students, examine its relationship with hyperacusis and tinnitus and explore the sensory processing patterns of individuals with misophonia in comparison to the control group. Based on the Misophonia Questionnaire severity scores, 81 clinical misophonia and 163 subclinical misophonia patients and 60 matched healthy-controls participated the study and evaluated with the Tinnitus Handicap Inventory, Khalfa Hyperacusis Questionnaire and the Dunn Adult/Adolescent Sensory Profile questionnaire. The incidence of clinical misophonia was 19 per cent. The clinical misophonia group had significantly higher sensory-sensitivity and sensation-avoiding scores and lower low-registration scores (Mann-Whitney U-test with Bonferroni correction; p < 0.017). Sensory processing scores across all sensory domains were significantly correlated with Misophonia Questionnaire scores. The strongest associations were moderate positive correlations in the touch (r = 0.444; p = 0.00) and visual (r = 0.420; p = 0.00) processing domains. Findings indicate that misophonia involves heightened sensitivity and avoidance not only in auditory but also in movement, visual, touch and activity-related sensory areas, suggesting it is a complex atypical multisensory condition rather than purely audiological or psychiatric.\n\nID: 41758545\nTitle: Effectiveness of Telerehabilitation Interventions for Self-Management of Tinnitus: Update of a Systematic Review.\nAbstract: Approximately 14% of the adult population has tinnitus, and current treatments are often costly and time-consuming. Telerehabilitation might reduce treatment costs without compromising effectiveness. Telerehabilitation is a quickly evolving research topic. Therefore, this systematic review update aims to give an overview of the research concerning the effectiveness of telerehabilitation interventions for self-management of tinnitus published between 2022 and 2025. This systematic review adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020) guidelines. PubMed, ScienceDirect, Scopus, Web of Science, and Cochrane Library were consulted for eligible studies concerning a study intervention of any possible form of self-management or telerehabilitation for adult patients with subjective tinnitus as a primary complaint. The risk of bias (RoB) and certainty of all included studies were assessed respectively by the Cochrane RoB2-tool and GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) framework. In total, 24 papers were included, of which 6 studied multiple telerehabilitation forms. Internet-based cognitive behavioral therapy with guidance by a psychologist or audiologist was examined in 5 studies (n=619), self-help manuals in 1 study (n=10), technological self-help devices in 3 studies (n=286), smartphone apps in 13 studies (n=23,788), and other internet-based interventions in 5 studies (n=442). These rehabilitation categories were proven to be effective in decreasing tinnitus severity and relieving tinnitus distress as measured by tinnitus questionnaires. The strength of this review is the gathering of recent studies on the very evolving topic of telerehabilitation for tinnitus. An important limitation of all included studies is that they raised some to great concerns of RoB. As a result, it is necessary to acknowledge that the overall certainty of the evidence ranged from low to moderate certainty. In addition, some crucial confounding parameters, such as the presence of hearing loss, hyperacusis, anxiety, depression, or sleeping problems, were not taken into consideration by all studies. This review gives an indication of the use of different telerehabilitation and self-management interventions for real-world clinical use, stating not only their possibilities but also their limitations. Overall, telerehabilitation was found to be effective in reducing tinnitus severity and distress. It forms a possible tool to improve the self-management capacities of the patient and the accessibility of tinnitus care as a replacement or an addition to in-person care. Nevertheless, barriers such as a lack of time, engagement, motivation, and openness of the patient, causing high dropout, should be taken into consideration. This review accentuated the shift from internet-based cognitive behavioral therapy to the growing interest in the use of smartphone apps, increasing the accessibility of the treatments even more. PROSPERO CRD 42021285450; https://www.crd.york.ac.uk/PROSPERO/view/CRD42021285450.\n\nID: 41735554\nTitle: Pilot evaluation of transcutaneous vagus nerve stimulation in chronic tinnitus: clinical outcomes and DTI insights.\nAbstract: PURPOSE: This study aims to evaluate the effectiveness of tVNS treatment in individuals with subjective chronic tinnitus. METHODS: This pilot study included a total of 13 individuals (6 female and 7 male) aged 25\u201350 years (41.46\u2009\u00b1\u20098.04 years) who had complained of subjective tinnitus for at least two years. All participants underwent audiological evaluations, including assessments of tinnitus pitch, tinnitus loudness, and residual inhibition. Participants completed the Visual Analog Scale (VAS) for tinnitus severity, the Tinnitus Handicap Inventory (THI), the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI). Additionally, DTI was performed, and both fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were calculated from the inferior colliculus, Heschl\u2019s gyrus, lateral geniculate body, and lateral lemniscus regions. Participants received tVNS treatment with the Vagustim TENS device for 10 sessions (each 30\u00a0min long). Initial assessments were repeated after treatment. RESULTS: After two weeks of tVNS treatment, significant improvement was observed in BDI and THI scores in individuals with subjective chronic tinnitus (p\u2009=\u20090.047 and p\u2009=\u20090.007, respectively). Furthermore, a significant decrease was observed in the FA values of the inferior colliculus (p\u2009=\u20090.001). However, no significant changes were detected in BAI scores, VAS, tinnitus pitch, tinnitus loudness, and residual inhibition (p\u2009>\u20090.05). CONCLUSION: The findings suggest that tVNS has potential benefit in reducing the daily burden of tinnitus and depression levels, and the effects of tinnitus on central auditory pathways may be modulated through neuroplastic changes. The results suggest that DTI can be utilized to assess the outcomes of tinnitus treatment. However, due to the small sample size and the absence of a control group, these results should be interpreted with caution. Further research is needed in this area.\n\nID: 41699251\nTitle: Notch-induced lateral inhibition compared to standard amplification lateral inhibition therapy for the treatment of chronic tinnitus: A randomised controlled trial.\nAbstract: PURPOSE: Chronic tonal tinnitus is a distressing condition, frequently associated with hearing loss. Sound therapy delivered via hearing aids using notch-induced lateral inhibition (NILI) algorithms has been proposed as a targeted approach to reduce tinnitus perception. METHODS: This multicentre, randomized, double-blind crossover trial recruited adults with chronic tonal tinnitus and moderate hearing loss. Each participant was randomized to receive two months of auditory stimulation using either NILI or standard amplification (SA), followed by a 2-week wash-out period and crossover to the alternative protocol. The primary outcome was the change in tinnitus-related handicap (Tinnitus Handicap Inventory, THI) at two months. Secondary endpoints included patient satisfaction (visual analogue scales for discomfort and intensity), adverse events, time to first symptom improvement and sustained residual effects. RESULTS: Twenty-six participants were enrolled. Due to a significant treatment carryover effect, primary analyses were limited to the first treatment phase. At two months, SA yielded greater reduction in THI scores compared to NILI (mean change: -11.45 vs. 0.00; p\u2009<\u20090.05). Both treatment arms showed only modest improvements in tinnitus discomfort and intensity. A greater proportion of SA users reported subjective improvement (91.8% vs. 38.5% with NILI). Adverse events were mild across both interventions. CONCLUSION: In this well-characterized cohort, notched lateral inhibition delivered through hearing aids offered no advantage over standard amplification for reducing tinnitus-related handicap or distress. These findings underscore the importance of individualized management and signal the need for further trials to clarify which patients may benefit from algorithmic innovations in hearing aid-based tinnitus therapy.\n\nID: 41668493\nTitle: [Research progress on the mechanism of auditory center remodeling and clinical intervention strategies in presbycusis].\nAbstract: Objective:Presbycusis is a bilateral symmetrical hearing loss related to age. The deprivation of auditory input caused by the degeneration of the inner ear structure is the main reason for the remodeling of the auditory center. At the level of the central nervous system, it leads to the upregulation of central gain and the imbalance of excitation-inhibition, thereby causing symptoms such as tinnitus and auditory hypersensitivity. At the cellular and molecular levels, it can induce cross-channel remodeling of the auditory cortex and other multiple senses, leading to a decline in speech ability, increased cognitive load, and an increased risk of cognitive decline, etc. On the other hand, central remodeling also provides a theoretical basis for the clinical intervention of hearing aid devices such as hearing aids and cochlear implants. This study aims to systematically review the auditory center remodeling mechanism from homeostatic plasticity disorder to network rhythm disorder in patients with presbycusis, providing a reference for optimizing the management of patients with presbycusis. \u76ee\u7684\uff1a\u8001\u5e74\u6027\u804b\u662f\u4e00\u79cd\u4e0e\u5e74\u9f84\u76f8\u5173\u7684\u53cc\u4fa7\u5bf9\u79f0\u6027\u542c\u529b\u635f\u5931\u3002\u7531\u5185\u8033\u7ed3\u6784\u9000\u884c\u6027\u53d8\u5f15\u53d1\uff0c\u542c\u89c9\u4f20\u5165\u5265\u593a\u662f\u9020\u6210\u542c\u89c9\u4e2d\u67a2\u91cd\u5851\u7684\u4e3b\u8981\u539f\u56e0\uff0c\u5728\u4e2d\u67a2\u795e\u7ecf\u7cfb\u7edf\u5c42\u9762\uff0c\u4f1a\u5bfc\u81f4\u4e2d\u67a2\u589e\u76ca\u4e0a\u8c03\u548c\u5174\u594b-\u6291\u5236\u5931\u8861\uff0c\u8fdb\u800c\u4ea7\u751f\u8033\u9e23\u3001\u542c\u89c9\u8fc7\u654f\u7b49\u75c7\u72b6\uff1b\u800c\u5728\u7ec6\u80de\u4e0e\u5206\u5b50\u5c42\u9762\uff0c\u4f1a\u8bf1\u53d1\u542c\u89c9\u76ae\u5c42\u4e0e\u5176\u4ed6\u591a\u611f\u89c9\u7684\u8de8\u901a\u9053\u91cd\u5851\uff0c\u5bfc\u81f4\u8a00\u8bed\u80fd\u529b\u4e0b\u964d\u3001\u8ba4\u77e5\u8d1f\u8377\u52a0\u91cd\u3001\u8ba4\u77e5\u8870\u9000\u98ce\u9669\u589e\u52a0\u7b49\uff1b\u4f46\u53e6\u4e00\u65b9\u9762\uff0c\u4e2d\u67a2\u91cd\u5851\u4e5f\u4e3a\u52a9\u542c\u5668\u3001\u4eba\u5de5\u8033\u8717\u7b49\u542c\u529b\u8f85\u52a9\u8bbe\u5907\u7684\u4e34\u5e8a\u5e72\u9884\u63d0\u4f9b\u4e86\u7406\u8bba\u4f9d\u636e\u3002\u672c\u7814\u7a76\u65e8\u5728\u4ece\u7a33\u6001\u53ef\u5851\u6027\u5931\u8c03\u5230\u7f51\u7edc\u8282\u5f8b\u7d0a\u4e71\u7cfb\u7edf\u7efc\u8ff0\u8001\u5e74\u6027\u804b\u60a3\u8005\u7684\u542c\u89c9\u4e2d\u67a2\u91cd\u5851\u673a\u5236\uff0c\u4e3a\u8001\u5e74\u6027\u804b\u60a3\u8005\u7ba1\u7406\u4f18\u5316\u63d0\u4f9b\u53c2\u8003\u3002.\n\nID: 41642082\nTitle: Efficacy of Single-Session Intervention of Tinnitus Educational Counseling: A Systematic Review.\nAbstract: This systematic review aims to evaluate the efficacy of single-session interventions of tinnitus educational counseling (SSI-TEDs) in the management of tinnitus. A systematic literature search was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Five studies met the inclusion criteria: three were two-arm randomized controlled trials (RCTs), and two employed a pretest-posttest design. Two studies compared SSI-TED with other interventions-neuro-music therapy (n = 1) and hypnosis (n = 1). One study included a homework component for 50% of the participants, and another combined SSI-TED with mindfulness and relaxation training. Across five studies, a total of 307 participants received SSI-TED, while 190 were given alternative interventions. At 1-3 months follow-up, one RCT demonstrated a small-to-medium effect of SSI-TED on reducing tinnitus severity and distress. Pretest-posttest studies reported large effects of SSI-TED on these outcomes. Improvements were also observed in negative emotions, frustration, rumination, and social life. The long-term effect of SSI-TED was noted in one study. No significant effects were found for anxiety or depression. SSI-TED appears to be a promising intervention for reducing tinnitus-related distress and improving emotional well-being in the short term. The evidence suggests moderate benefits in control conditions and larger effects when evaluated in uncontrolled settings. However, its impact on comorbid anxiety and depression remains unclear. Further high-quality studies with long-term follow-up are needed to establish the sustained efficacy, effectiveness, and broader psychological benefits of SSI-TED. https://doi.org/10.23641/asha.31215364.\n\nID: 41616930\nTitle: Linking misophonia and tinnitus: Common and divergent neurobiological mechanisms.\nAbstract: Misophonia and tinnitus are debilitating auditory disorders that impair social functioning and mental health. This is the first review paper examining their common and divergent neurobiological underpinnings, focusing on genetic, neural, and psychological factors. Both conditions show hereditary influences, neural activity imbalances across the auditory cortex, amygdala, and anterior cingulate cortex, and heightened autonomic responses, causing significant distress and cognitive deficits. Misophonia is triggered by specific external sounds, while tinnitus involves phantom sound perception. Neuroimaging studies reveal shared hyperconnectivity between the auditory cortex and limbic areas of the brain including the amygdala and hippocampus, driven by neuroplasticity. Here, we propose the Sensory-Salience Dysregulation Model, integrating aberrant sensory encoding, salience network overactivation, and autonomic dysregulation as a unified framework between these conditions. The present review discusses gaps in diagnostic standardization and/or genetic-environmental interactions, and highlights shared and distinct mechanisms underlying misophonia and tinnitus, aiming to advance knowledge for improving diagnostics and treatments for these conditions.\n\nID: 41574676\nTitle: Tinnitus, Dizziness and Hearing Status During Hypertension Diagnosis and Treatment.\nAbstract: High blood pressure (BP) or hypertension (HTN) can impair hearing, causes tinnitus and dizziness. We hypothesized that there is an association between increased BP and hearing impairment (HI), tinnitus and dizziness, and decrease in BP improves these parameters and symptoms. The study included 100 newly-diagnosed HTN patients (systolic BP (SBP) \u2265140\u2009mmHg and/or diastolic BP (DBP) \u226590\u2009mmHg) and 100 patients without HTN. Tinnitus and dizziness were evaluated through Tinnitus Handicap Inventory (THI) and Dizziness Handicap Inventory (DHI). The auditory status of all patients was assessed for both right ear (RE) and left ear (LE). BP measurements, THI, DHI, and audiometry tests were repeated at follow-up visit during treatment in HTN patients and delta (\u0394) values were obtained. The median of THI and DHI score and thresholds for hearing parameters were higher in HTN group. At follow-up visit, SBP, DBP, THI, DHI, and most of the hearing parameters significantly improved. \u0394SBP significantly correlated with \u0394RE average (logarithmically transformed (log10)) and \u0394LE average (log10) in partial correlation analysis adjusted for age and Brinkman index. Multivariate linear regression analysis yielded an independent association of \u0394RE average (log10) (Beta Coefficient (BC): 12.07, 95% Confidence Interval (CI): 1.86-22.29, P\u2009=\u2009.021) and \u0394LE average (log10) (BC: 14.89, 95% CI: 5.45-24.33, P\u2009=\u2009.003) with \u0394SBP. However, none of the parameters demonstrated an independent association with \u0394DBP. HTN patients suffer from tinnitus, dizziness and HI, and BP decrease is associated with improvements in these symptoms and hearing status. Decrease in SBP rather than DBP is associated with improvements in hearing status.\n\nID: 42023560\nTitle: Quality of Life in Individuals with Tinnitus.\nAbstract: Background Tinnitus, the perception of sound without an external acoustic stimulus, significantly impacts quality of life (QoL) and is often associated with hearing loss. Despite its prevalence, the psychosocial burden of tinnitus remains understudied in many populations. Objective This study evaluates tinnitus-related handicap and its association with emotional and social well-being in order to enhance treatment approaches. Method A descriptive cross-sectional study was conducted among 114 patients presenting with tinnitus at Dhulikhel Hospital, Nepal. The Tinnitus Handicap Inventory (THI) was used to assess severity, categorized as slight, mild, moderate, severe, or catastrophic. Audiometric evaluations classified hearing loss as conductive or sensorineural. Pearson's chi-square test was performed using SPSS version 21, with significance set at p < 0.05. Result The median age of participants was 40 years (IQR: 20.25), with a female predominance (60.5%). Hearing loss was present in 50% of participants, predominantly sensorineural (82.8%) and bilateral (62.1%). Tinnitus Handicap Inventory scores indicated moderate handicap in 37.5%, severe in 15.8%, and catastrophic in 5.0%. No significant association was found between Tinnitus Handicap Inventory severity and age, sex, or hearing loss type. However, participants with hearing loss had nearly three times higher likelihood of being severe-to-catastrophic handicap [COR: 2.74, 95% CI: 1.25 - 5.99] (p-value = 0.011). Conclusion Tinnitus imposes a substantial psychosocial burden, particularly in individuals with concurrent hearing loss. The findings highlight the need for early psychological intervention and multidisciplinary management to mitigate tinnitus-related distress and improve quality of life.\n\nID: 41950112\nTitle: Musical auditory training and cognitive auditory training: effects on the perception of tinnitus disorder.\nAbstract: To examine the effects of Cognitive Auditory Training (CAT) and Musical Auditory Training (MAT) on the self-perception of adults with tinnitus. Preliminary comparative clinical, interventional and longitudinal study, approved by the Ethics Committee of Research at Federal University of Santa Maria under protocol number 5.746.241. The study included 29 adults of both sexes with tinnitus and normal results in a basic audiological evaluation. Participants were divided into three groups: 13 individuals in the CAT group, eight in the MAT group, and eight in the placebo intervention group. Scores for Disturbance and Loudness on the Visual Analog Scale (VAS D and VAS L) and the Tinnitus Handicap Inventory (THI) were analyzed before and after the interventions. The Wilcoxon test was used for pre- and post-intervention comparisons, with a significance level of 5%. In the CAT group, statistically significant differences were observed for VAS D, VAS L, and THI. In the MAT group, significant differences were found for VAS D and THI. In the placebo group, statistically significant differences were observed for VAS D and THI. Improvements in symptom perception were observed across all three groups. However, CAT demonstrated greater effectiveness, showing improvements in all assessed aspects. Verificar os efeitos do Treinamento Auditivo Cognitivo (TAC) e do Treinamento Auditivo Musical (TAM) na autopercep\u00e7\u00e3o dos sujeitos com transtorno do zumbido na popula\u00e7\u00e3o adulta. Estudo de car\u00e1ter cl\u00ednico comparativo preliminar, de interven\u00e7\u00e3o e longitudinal. Foi aprovado pelo Comit\u00ea de \u00c9tica em Pesquisa da Universidade Federal de Santa Maria sob o n\u00famero 5.746.241. A pesquisa contou com a participa\u00e7\u00e3o de 29 adultos de ambos os sexos, com transtorno de zumbido e com resultados normais na avalia\u00e7\u00e3o audiol\u00f3gica b\u00e1sica. Os participantes foram divididos em tr\u00eas grupos: 13 indiv\u00edduos no grupo que recebeu o TAC, oito no grupo que recebeu o TAM e oito no grupo de interven\u00e7\u00e3o placebo. Foram analisadas as pontua\u00e7\u00f5es de Inc\u00f4modo e Volume na Escala Visual Anal\u00f3gica (EVA I e EVA V) e no Tinnitus Handicap Inventory (THI), antes e ap\u00f3s as interven\u00e7\u00f5es. Utilizou-se o teste de Wilcoxon para a compara\u00e7\u00e3o dos resultados pr\u00e9 e p\u00f3s-interven\u00e7\u00e3o, adotando-se um n\u00edvel de signific\u00e2ncia de 5%. No grupo TAC, observou-se diferen\u00e7a estatisticamente significante para as vari\u00e1veis EVA I, EVA V e THI. No grupo TAM, as diferen\u00e7as significativas foram verificadas para EVA I e THI. J\u00e1 no grupo placebo, identificou-se diferen\u00e7a estatisticamente significante para EVA I e THI. Observou-se melhora na percep\u00e7\u00e3o do sintoma nos tr\u00eas grupos. No entanto, o TAC demonstrou maior efetividade, promovendo mudan\u00e7as em todos os aspectos avaliados. Verificar os efeitos do Treinamento Auditivo Cognitivo (TAC) e do Treinamento Auditivo Musical (TAM) na autopercep\u00e7\u00e3o dos sujeitos com transtorno do zumbido na popula\u00e7\u00e3o adulta. Estudo de car\u00e1ter cl\u00ednico comparativo preliminar, de interven\u00e7\u00e3o e longitudinal. Foi aprovado pelo Comit\u00ea de \u00c9tica em Pesquisa da Universidade Federal de Santa Maria sob o n\u00famero 5.746.241. A pesquisa contou com a participa\u00e7\u00e3o de 29 adultos de ambos os sexos, com transtorno de zumbido e com resultados normais na avalia\u00e7\u00e3o audiol\u00f3gica b\u00e1sica. Os participantes foram divididos em tr\u00eas grupos: 13 indiv\u00edduos no grupo que recebeu o TAC, oito no grupo que recebeu o TAM e oito no grupo de interven\u00e7\u00e3o placebo. Foram analisadas as pontua\u00e7\u00f5es de Inc\u00f4modo e Volume na Escala Visual Anal\u00f3gica (EVA I e EVA V) e no Tinnitus Handicap Inventory (THI), antes e ap\u00f3s as interven\u00e7\u00f5es. Utilizou-se o teste de Wilcoxon para a compara\u00e7\u00e3o dos resultados pr\u00e9 e p\u00f3s-interven\u00e7\u00e3o, adotando-se um n\u00edvel de signific\u00e2ncia de 5%. No grupo TAC, observou-se diferen\u00e7a estatisticamente significante para as vari\u00e1veis EVA I, EVA V e THI. No grupo TAM, as diferen\u00e7as significativas foram verificadas para EVA I e THI. J\u00e1 no grupo placebo, identificou-se diferen\u00e7a estatisticamente significante para EVA I e THI. Observou-se melhora na percep\u00e7\u00e3o do sintoma nos tr\u00eas grupos. No entanto, o TAC demonstrou maior efetividade, promovendo mudan\u00e7as em todos os aspectos avaliados.\n\nID: 41865279\nTitle: Individual-Level Brain Network Predictors and Distinct Reorganization Mechanism in Sound Therapies for Tinnitus.\nAbstract: To investigate brain network reorganization in tinnitus patients undergoing tailor-made notched music training (TMNMT) or tinnitus retraining therapy (TRT) and assess whether baseline network characteristics predict treatment outcomes. A randomized, single-blind, controlled trial. The study was conducted at Sun Yat-sen Memorial Hospital. Patients aged 18 to 70 years with tinnitus lasting more than 6 months were randomly assigned to receive either TMNMT or TRT for 3 months. Electroencephalogram (EEG) assessed brain functional and effective connectivity at baseline and after treatment. Additionally, 46 normal controls with a single EEG scan were included for baseline comparison to assess treatment normalization of brain networks. A total of 80 patients (TMNMT group: 40 [50.0%]; mean [SD] age: 42.2 [12.0] years; 19 males [47.5%]; TRT group: 40 [50.0%]; mean [SD] age: 41.9 [14.6] years; 21 males [52.5%]) and 46 normal controls (mean [SD] age: 39.37 [12.92] years; 23 males [50.0%]) were analyzed. In tinnitus patients who responded to TMNMT or TRT, tinnitus severity reduction was associated with reorganization of multiple brain networks. Predictive analysis showed that increased effective connectivity from the posterior cingulate cortex and insula to the auditory network predicted TMNMT responders (area under the curve [AUC]\u2009=\u20090.820, 95% CI 0.697-0.944), while increased connectivity from the medial prefrontal cortex to the dorsolateral prefrontal cortex predicted TRT non-responders (AUC\u2009=\u20090.875, 95% CI 0.777-0.974). Both TMNMT and TRT induced neural effects on tinnitus. Baseline brain networks distinguished responders from non-responders and predicted treatment outcomes.\n\nID: 41461570\nTitle: Outcomes of Tinnitus Interventions: An Umbrella Review of Systematic Reviews with Meta-Analysis.\nAbstract: Tinnitus is a highly prevalent and challenging neurotologic condition affecting over 740\u2009million individuals worldwide. Despite the growing number of studies, treatment approaches remain fragmented and inconsistent. This umbrella review aims to aggregate results from systematic review to comprehensively synthesize the available evidence. Following PRISMA guidelines, we systematically searched CINAHL, COCHRANE Library, PubMed, and Scopus through April 2025. Systematic reviews with meta-analyses of primary tinnitus interventions were included. Outcomes focused on validated measures of tinnitus severity, distress, loudness, and quality of life. Study quality was assessed using AMSTAR-2. A total of 44 systematic reviews were included, covering 7 intervention domains. Cognitive behavioral therapy (CBT), hearing aids, tinnitus retraining therapy (TRT), and sound/music therapy consistently improved tinnitus-related outcomes (eg, THI reductions up to -14.50, P\u2009<\u2009.001). Cochlear implantation yielded the largest effects (eg, THI -29.97) but is reserved for patients with moderate-to-profound sensorineural hearing loss who are not adequately helped by hearing aids. Neuromodulation and acupuncture showed modest or inconsistent benefits with high heterogeneity. This umbrella review provides the current and comprehensive analysis of tinnitus treatments. CBT, hearing aids, TRT, and sound/music therapy show consistent benefit. Cochlear implantation offers the greatest effect in patients with moderate-to-profound hearing loss unresponsive to hearing aids. Other therapies show mixed evidence. These findings offer a much-needed evidence framework to guide treatment decisions and future research.\n\nID: 41260987\nTitle: Deep brain stimulation of the medial geniculate body for refractory tinnitus: A feasibility study.\nAbstract: Tinnitus disorder can have a significant negative impact on quality of life, especially when refractory to standard care. Deep brain stimulation (DBS) of the medial geniculate body (MGB) attenuates pathological neuronal activity in the central auditory pathway and is a potential treatment for severe tinnitus. The aim of this pilot study was to assess the safety and feasibility of bilateral MGB DBS in patients with refractory tinnitus disorder. This randomised double-blind 2 \u200b\u00d7 \u200b2 cross-over study was conducted at Maastricht University Medical Centre, Maastricht, the Netherlands. The included patients had treatment refractory, severe, and chronic tinnitus without an anatomical substrate. Patients with bilateral MGB DBS were randomised to an ON-OFF or OFF-ON stimulation order for two cross-over phases. Primary outcomes consisted of safety and feasibility. Secondary outcomes on tinnitus severity, psychiatric and cognitive functioning and quality of life were assessed at screening, after both cross-over phases and at one-year follow-up. Four patients were included. No irreversible stimulation-induced side effects were observed. Surgical-related side effects were transient and resolved within two weeks. All patients experienced DBS as an acceptable treatment. Three of four patients showed improvement of tinnitus complaints based on the Tinnitus Functional Index. In the non-responder, electrodes had the largest distance from the centre of the MGB. To conclude, this study shows that bilateral MGB DBS is safe and feasible for patients with refractory tinnitus. Findings suggest the potential for clinically meaningful reduction in tinnitus burden through DBS. Effectiveness needs to be further evaluated in a follow-up study.\n\nID: 41183671\nTitle: The hidden gut-brain connection in tinnitus: Insight from a cross-sectional and genetic causal mediation study in over 900,000 individuals.\nAbstract: The gut-brain axis has been implicated in various neurological conditions, but its involvement in tinnitus remains unclear. In this study, we investigated whether brain functional connectivity (FC) mediates the relationship between gut microbiota and tinnitus. Using data from the UK Biobank, we identified FC alterations in tinnitus patients, particularly reduced connectivity across the default mode, salience, and central executive networks. Mendelian randomization (MR) analyses revealed that decreased FC in the parietal, temporal, cingulate, and frontal regions (ICA25 edge 87) was causally linked to increased tinnitus risk. Further MR analyses showed that higher abundance of Actinobacteria was associated with reduced FC and increased tinnitus risk, while the chorismate biosynthesis I pathway enhanced FC and reduced tinnitus risk. Mediation analysis confirmed that brain FC partially mediated the effects of both microbial features on tinnitus, with mediation proportions of 31.0% and 17.2%, respectively. Findings were replicated in independent datasets. To enhance transparency and accessibility, we developed an interactive web tool to visualize key associations (https://sysu.nixang.com). Our results provide novel evidence that gut microbiota may contribute to tinnitus via alterations in brain network connectivity, suggesting the gut-brain axis as a potential therapeutic target.\n\nID: 40891098\nTitle: Modulation of Auditory Cortex Activity in Salicylate-Induced Tinnitus Rats via Deep Brain Stimulation of the Inferior Colliculus.\nAbstract: Tinnitus, a self-reported perceptual disorder, is currently believed to arise from maladaptive plasticity due to reduced sensory input. While deep brain stimulation (DBS) has shown promise in alleviating tinnitus-related behaviors, its effects on neuronal activity remain unclear. This study aimed to evaluate the spontaneous firing rates (SFRs) of the primary auditory cortex (A1) before and after DBS of the external cortex of the inferior colliculus (ECIC) in a rat model of tinnitus. Tinnitus was induced in rats through sodium salicylate injections for 14 consecutive days, while the control group received normal saline injections over the same period. We conducted tinnitus and hearing assessments using the gap pre-pulse inhibition of the acoustic startle (GPIAS) and pre-pulse inhibition (PPI) tests. From day 14, both groups underwent DBS of the ECIC and single unit recordings from the A1. Before ECIC stimulation, A1 neurons in rats with potential tinnitus exhibited significantly higher spontaneous activity compared to controls. Following ECIC stimulation, the SFRs in the group displaying abnormal GPIAS responses significantly decreased, and the difference between the tinnitus and control groups was no longer significant. Additionally, inter-spike interval (ISI) analysis revealed a higher frequency of short ISIs (<5\u00a0ms) in rats with potential tinnitus, which decreased after DBS, aligning with values observed in the control group. ECIC stimulation effectively modulates A1 hyperactivity, highlighting its role in tinnitus pathophysiology. These findings warrant further research into ECIC's role in tinnitus regulation, which could inform future therapeutic interventions and enhance mathematical models of tinnitus mechanisms.\n\nID: 40583800\nTitle: Influence of Spirituality on Severity, Quality of Life, and Mental Health of Tinnitus Patients.\nAbstract: Despite the growing evidence on the role of spiritual and religious beliefs on physical and mental health outcomes, this remains inadequately explored in the field of otolaryngology, particularly for chronic conditions such as tinnitus. This study aims to investigate the influence of spiritual and religious beliefs on symptom severity, quality of life, and mental health of Brazilian patients with chronic subjective tinnitus. Cross-sectional study including patients with chronic subjective tinnitus. Specialized outpatient center in Brazil. Religious and spiritual variables (Duke Religion Index, FACIT-Sp 12, and SRCOPE - religious coping) were investigated on the relationship with tinnitus severity (Tinnitus Handicap Inventory), mental health (DASS-21), and quality of life (WHOQOL-Bref), adjusting for sociodemographics, clinical data, and physical examination findings. Linear Regression models were used. A total of 313 patients were included. Spiritual well-being measures were associated with better results (particularly for Meaning and Peace); meanwhile, negative religious coping was associated with worse outcomes for all variables. Religiosity has presented a mixed effect, with nonorganizational religiosity having better outcomes for mental health and quality of life, and intrinsic religiosity having worse outcomes for tinnitus severity. The present study found that religious and spiritual beliefs can have an important influence on the perception of tinnitus severity, mental health, and quality of life of individuals with chronic tinnitus. These findings support the importance of otolaryngologists' and audiologists' understanding of their patients' beliefs to provide more comprehensive and integrative care.\n\nID: 39992369\nTitle: The efficacy of notched music therapy vs conventional music therapy for chronic subjective tinnitus patients: a systematic review and meta-analysis.\nAbstract: The etiology and mechanism of chronic subjective tinnitus (CST) are still unclear, thus there is no specific treatment yet. The notched music therapy (NMT) has been found to relieve patients' tinnitus symptoms, but its efficacy is still controversial. This study aims to resolve the controversy through meta pooling method. By searching Embase, Pubmed, Elsevier, WOS, CNKI, and CBM (China Biology Medicine disc) databases, relevant literature on \"notch music therapy\" and \"tinnitus\" was obtained, and suitable clinical controlled trials were screened. Cochrane ROB v2.0 was used to assess the risk of literature bias, and the efficacy after treatment was evaluated by pooling the effect size of tinnitus handicap inventory (THI) and visual analog scale (VAS) between intervention group and control group. A total of 14 randomized controlled trial studies were included for quantitative analysis, with a total of 793 CST patients participating, including 395 patients in the intervention group and 398 patients in the control group. Among them, five studies were evaluated as biased with \"some concerns of risk\". The meta-analysis results showed a pooling effect size of THI score of patients after 3\u00a0months of treatment (MD\u2009=\u2009-\u00a08.62, 95% CI (-\u00a017.01, -\u00a00.23), Z\u2009=\u2009-\u00a02.01, P\u2009=\u20090.044) and VAS score of tinnitus after 3\u00a0months of treatment (MD\u2009=\u2009-\u00a01.13, 95% CI (-\u00a02.49, -\u00a00.11), Z\u2009=\u2009-\u00a02.14, P\u2009=\u20090.003) between NMT and conventional music therapy (CMT). Heterogeneity investigation and regression analysis found that notch frequency range, publication year, and patient age were not specific factors affecting the merged results. The sensitivity analysis results showed that the comprehensive effect size was stable and reliable, with no significant publication bias (P\u2009>\u20090.05). Compared to traditional music therapy, notched music therapy can significantly reduce the scores of the tinnitus disability scale and tinnitus loudness score for patients after treatment. It is a good non-pharmacological treatment that is worthy of clinical promotion.\n\nID: 39951668\nTitle: Otologic Symptoms Following Teprotumumab Administration in Patients with Thyroid Eye Disease.\nAbstract: Comprehensively characterize subjective otologic adverse events following teprotumumab administration with standardized patient reported outcome metrics. Understand the impact on patients' quality of life and perception of the medication. Retrospective case series. Tertiary referral center. Thirty-two adults with thyroid eye disease treated with teprotumumab from 2020 to 2023. Subjective hearing loss, tinnitus, dizziness (Dizziness Handicap Inventory), patulous eustachian tube (Eustachian Tube Dysfunction Questionnaire-7, Patulous Eustachian Tube Handicap Inventory-10), effect of hearing loss on quality of life, and decisional regret. Half reported hearing loss (n = 16, 50%) while receiving teprotumumab. Onset was gradual in 75% of patients with onset at the sixth [IQR 5-7] infusion. It was nonfluctuating (93.8%), bilateral (100%), and did not return to baseline (93.8%). Of those reporting hearing loss, 37.5% reported dizziness and 87.5% reported tinnitus; 87.5% felt it affected quality of life, and 33.3% would opt to not receive the medication again. The median DHI score was 9 [0-35] in those with hearing loss compared to 0 [0-5] in those without hearing loss (p = 0.02, Wilcoxon rank sum). Based on the ETDQ-7, 37.5% of patients experienced eustachian tube dysfunction; 15.6% experienced symptoms of a patulous eustachian tube with a median PHI-10 score of 15 [3-24], indicating a mild handicap. Many patients experience subjective hearing loss following teprotumumab administration, typically gradual in onset, nonfluctuating, bilateral, persistent, and significantly affecting quality of life. Patients may also experience comorbid vertigo and symptoms of eustachian tube dysfunction or patulous eustachian tube with variable severity.\n\nID: 39951660\nTitle: Music Combined with Cognitive Behavioral Therapy Enhanced Functional Integration within the Frontal-Parietal-Temporal Brain Network in Patients with Chronic Subjective Tinnitus.\nAbstract: This study was aimed at investigating the effectiveness of music combined with cognitive behavioral therapy (music-CBT) and its underlying therapeutic mechanisms in treating chronic subjective tinnitus. Twenty-seven participants with chronic subjective tinnitus who underwent a 3-month music-CBT were initially involved in this retrospective study. The resting-state electroencephalograms (EEG) and behavioral assessments of pre- and post-music-CBT, including tinnitus handicap inventory (THI), tinnitus functional index (TFI), visual analog scales (VAS), Pittsburgh sleep quality index (PSQI), and Hamilton depression rating scale (HAMD-24) were collected and analyzed. Following music-CBT, there was a significant reduction in global behavioral assessment scores, with median changes of \u0394THI = 26.0 (p < 0.001), \u0394TFI = 23.7 (p < 0.001), \u0394VAS = 2.0 (p < 0.001), \u0394PSQI = 2.0 (p = 0.002), and \u0394HAMD-24 = 2.0 (p < 0.001). Enhanced functional connectivity was seen among the frontal, parietal, and temporal cortices and significantly decreased characteristic path length (\u0394CPL in delta = 0.016, p = 0.031; \u0394CPL in theta = 0.012, p = 0.013), increased global efficiency (\u0394GE in delta = -0.014, p = 0.037; \u0394GE in theta = -0.006, p = 0.021), and local efficiency (\u0394LE in delta = -0.015, p = 0.037; \u0394LE in theta = -0.012, p = 0.015) were also noted. Additionally, associations were identified between \u0394PSQI and \u0394THI (rho = 0.546, p = 0.003) and \u0394TFI (rho = 0.462, p = 0.015); between \u0394HAMD-24 and \u0394CPL (rho = -0.389, p = 0.045), \u0394GE (rho = 0.395, p = 0.041), and \u0394LE (rho = 0.405, p = 0.036). Optimized cognitive and emotional responses to tinnitus are linked to functional integration within the frontal-parietal-temporal brain network. Early node indicators for tinnitus relief may be the precuneus, middle frontal gyrus, middle temporal gyrus, and the right inferior parietal lobule.\n\nID: 39825198\nTitle: Role of transcutaneous electrical nerve stimulation in alleviation of tinnitus in normal hearing subjects.\nAbstract: Subjective tinnitus is characterized by perception of sound in the absence of any external or internal acoustic stimuli. Many approaches have been developed over the years to treat tinnitus (medical and nonmedical). However, no consensus has been reached on the optimal therapeutic approach. Electrical nerve stimulation targeting peripheral auditory pathways presents a promising area of investigation for the treatment of tinnitus. Non-invasive transcutaneous vagal nerve stimulation of the auricular branch of the vagus nerve has been introduced and studied but its success rate varies and conflicting results have been reported. In this study we aim to assess the role of transcutaneous electrical nerve stimulation in alleviation of tinnitus in normal hearing subjects and to study the different factors that may affect the degree of alleviation of tinnitus. The study group consisted of 64 subjects (38 male and 26 female). The age ranged between 20 and 60 years. All of them suffering from subjective tinnitus. Assessment of tinnitus loudness analyzed by Visual Analogue Scale (VAS) which was applied before and directly after TENS stimulation. There is a statistically significant difference in tinnitus loudness before and after TEN stimulation as assessed by VAS. 45 out of 64 (70.31%) patients had improvement after TENS, from them nine patients had a complete reduction of tinnitus. There is no statistically significant relation between the studied variables and the degree of tinnitus reduction. ta-VNS is an effective treatment of subjective tinnitus but we could not assess for how long this residual inhibition persists due to lack of long term follow up. However, it is difficult to decide who might benefit from ta-VNS, patients with unilateral tinnitus on right ear and those with whistling sound have more reduction in tinnitus loudness than others.\n\nID: 39787555\nTitle: Inflammatory Biomarkers and Tinnitus in Older Adults.\nAbstract: Tinnitus refers to a common disorder affecting older adults frequently. This condition can disturb mental health and psychological well-being and contribute to cognitive decline. Despite recent advances in research, its pathophysiology remains incompletely understood. Therefore, this study aimed to investigate the sensation of tinnitus, its consequences on the quality of life of older adults, and its correlation with cytokine levels. This cross-sectional study included a sample of 103 independent older adults. Information regarding clinical history, tinnitus, and hearing loss was obtained through interviews. Assessment of tinnitus intensity and resulting impairments was conducted using Visual Analogue Scale (VAS) and Tinnitus Handicap Index (THI), respectively. Subjects underwent audiological evaluation and were measured for inflammatory markers. Statistical analyses included chi-square, Mann-Whitney, and Kruskal-Wallis tests and calculation of the effect size (\u03a6). The condition of older adults with tinnitus (51.5%) was associated with hearing loss and previous noise exposure. No differences were observed in the cytokines between groups with and without tinnitus (P > 0.05), whereas a difference was found in the interleukin-10 (IL-10) of the male group (P\u2009=\u20090.016; r\u2009=\u20090.69). In those with tinnitus, VAS had a median and (interquartile range) of 5 (2-7), and the values were 21 (10-38) for THI. In addition, VAS and minimum masking level exhibited a significant correlation with IL-6 (P\u2009=\u20090.018; rs\u2009=\u20090.335) and IL-2 (P\u2009=\u20090.035; rs\u2009=\u20090.299), respectively. Furthermore, the groups with intense and mild VAS presented different levels of tumour necrosis factor alpha (TNF-\u03b1) (P\u2009=\u20090.041; E2R\u2009=\u20090.12). The results reveal an association between tinnitus and hearing loss and previous noise exposure. Moreover, increased sound-masking levels and VAS correlated with IL-2 and IL-6, respectively. TNF-\u03b1 levels varied between the mild and intense VAS groups.\n\nID: 39765106\nTitle: Alterations in brain activity and functional connectivity originating residual inhibition of tinnitus induced by tailor-made notched music training.\nAbstract: Tinnitus arises from the intricate interplay of multiple, parallel but overlapping networks, involving neuroplastic changes in both auditory and non-auditory activity. Tailor-made notched music training (TMNMT) has emerged as a promising therapeutic approach for tinnitus. Residual inhibition (RI) represents one of the rare interventions capable of temporarily alleviating tinnitus, offering a valuable tool that can be applied to tinnitus research to explore underlying tinnitus mechanisms. To our knowledge, this study is the first to investigate the neural mechanisms underlying the RI effect of TMNMT through analysis of neural source activity and functional connectivity of EEG. Forty-four participants with tinnitus were divided into TMNMT group (twenty-two participants; ECnm, NMnm, RInm represented that EEG recordings with eyes closed stimuli-pre, stimuli-ing, stimuli-post by TMNMT music, respectively) and Placebo control group (twenty-two participants; ECpb, PBpb, RIpb represented that EEG recordings with eyes closed stimuli-pre, stimuli-ing, stimuli-post by Placebo music, respectively) in a single-blind manner. Source localization analysis revealed that RI effect of TMNMT significantly increased in current density at the delta band in the insula, subgenual anterior cingulate cortex (sgACC), parahippocampus (PHC), and secondary auditory cortex (A\u2161), and significantly increased in current density at the theta band in the sgACC, and significantly decreased in current density at the alpha band in the precuneus, PHC, primary (AI) and secondary (AII) auditory cortex. Meanwhile, RI effect of Placebo significantly decreased in current density at the alpha band in the PHC. Functional connectivity analysis demonstrated that RI effect of TMNMT significantly increased in phase coherence between the left A\u2161 and the right sgACC; and between the left PHC and the left retrosplenial cortex (RSC) at the theta band. It significantly decreased in phase coherence between the left PHC and the right precuneus, the right posterior cingulate cortex (PCC), the right A\u2161; between the right PHC and the right PCC; and between the right PCC and the right A\u2161 at the alpha band. RI effect of Placebo significantly increased in phase coherence between the left insula and the right precuneus, the left PHC, the right PHC, the left A\u2160, the left A\u2161; between the left sgACC and the right PHC; between the left A\u2161 and the right PHC, the left PCC at the delta band. It was found that the current density of sgACC was significantly positively correlated with the tinnitus evaluation indicators (Loudness, VAS, THI, TFI) at the alpha band in TMNMT group. These findings indicated that TMNMT, a novel music therapy for tinnitus, revealed a robust RI effect, and RI effect of TMNMT was not only involved in the activity of auditory networks (A\u2160, A\u2161), but also extended to non-auditory networks, particularly higher-level auditory association cortices, such as the sgACC, PHC and PCC. The current study provides valuable experimental evidence and promising practical prospects for the potential applications of TMNMT in tinnitus treatment.\n\nID: 39369776\nTitle: Gray matter volumetric changes in tinnitus: The impact of hearing loss and severity.\nAbstract: Tinnitus is a phantom auditory sensation that commonly co-occurs with hearing loss. Both tinnitus and hearing loss can impact the quality of life, emotional well-being, and cognitive functioning of the affected individuals. While previous studies have highlighted structural alterations in hearing loss and/or tinnitus, the fundamental neural mechanisms underpinning tinnitus severity remain poorly understood. In this study, we conducted a voxel-based morphometry to investigate gray matter (GM) volume differences among groups of participants with varying tinnitus severity and hearing status, and controls within a large sample. We observed reduced GM volume in the left anterior insula and right planum polare in participants with hearing loss, regardless of their tinnitus status, compared to normal hearing controls. We noted decreased GM volume in the bilateral anterior and posterior insula for those with tinnitus and normal hearing compared to a normal hearing control group. Further, the tinnitus with hearing loss group showed decreased GM volume in the left planum polare, left inferior temporal gyrus, bilateral anterior temporal gyri, and right superior frontal gyrus compared to the normal hearing control group, suggesting a combined effect of hearing loss and tinnitus. While tinnitus severity did not show a significant overall effect, there was a significant positive correlation between tinnitus distress and GM volume in bilateral planum polare. Our findings enhance the understanding of structural brain changes related to hearing loss and tinnitus, and advance the overall knowledge of tinnitus pathophysiology, which can contribute to the development of more effective treatments for tinnitus.\n\nID: 39199443\nTitle: Neuromodulation Treatments Targeting Pathological Synchrony for Tinnitus in Adults: A Systematic Review.\nAbstract: (1) Background: Tinnitus involves the conscious awareness of a tonal or composite noise for which there is no identifiable corresponding external acoustic source. For many people, tinnitus is a disorder associated with symptoms of emotional distress, cognitive dysfunction, autonomic arousal, behavioural changes, and functional disability. Many symptoms can be addressed effectively using education or cognitive behavioural therapy. However, there is no treatment that effectively reduces or alters tinnitus-related neurophysiological activity and thus the tinnitus percept. In this systematic review, we evaluated the effectiveness of neuromodulation therapies for tinnitus that explicitly target pathological synchronous neural activity. (2) Methods: Multiple databases were searched for randomised controlled trials of neuromodulation interventions for tinnitus in adults, with 24 trials included. The risk of bias was assessed, and where appropriate, meta-analyses were performed. (3) Results: Few trials used acoustic, vagal nerve, or transcranial alternating current stimulation, or bimodal stimulation techniques, with limited evidence of neuromodulation or clinical effectiveness. Multiple trials of transcranial direct current stimulation (tDCS) were identified, and a synthesis demonstrated a significant improvement in tinnitus symptom severity in favour of tDCS versus control, although heterogeneity was high. (4) Discussion: Neuromodulation for tinnitus is an emerging but promising field. Electrical stimulation techniques are particularly interesting, given recent advances in current flow modelling that can be applied to future studies.\n\nID: 39106683\nTitle: Efficacy of tailor-made notched music training for primary tinnitus: A systematic review and meta-analysis.\nAbstract: We systematically reviewed and meta-analyzed the efficacy of Tailor-Made Notched Music Training (TMNMT) for primary subjective tinnitus in adults. The main goal was to evaluate TMNMT's impact on tinnitus symptoms. Following PRISMA guidelines, we included randomized and non-randomized trials. Studies considered involved adults with primary subjective tinnitus treated with TMNMT alone or combined with other therapies. Bias risk was assessed using the Cochrane RoB 2 and ROBINS-I tools. Comprehensive database searches were conducted, and relevant data were extracted and analyzed. Three studies (total: 99 TMNMT patients, 109 sound therapy) were meta-analyzed. Using THI scores, the Forest plot showed no significant difference in tinnitus distress between TMNMT and listening to music groups (p\u00a0>\u00a00.05), with low study heterogeneity (I2\u00a0=\u00a00\u00a0%). While TMNMT offers a non-invasive approach with a potential to reduce tinnitus distress, it did not significantly outperform the only listening to music. More research is needed to optimize TMNMT for tinnitus management and to better document its safety profile.\n\nID: 38964476\nTitle: Impact of emotional states on tinnitus sound therapy efficacy based on ECG signals and emotion recognition model.\nAbstract: Diagnosis and severity assessment of tinnitus are mostly based on the patient's descriptions and subjective questionnaires, which lacks objective means of diagnosis and assessment bases, the accuracy of which fluctuates with the clarity of the patient's description. This complicates the timely modification of treatment strategies or therapeutic music to improve treatment efficacy. We employed a novel random convolutional kernel-based method for electrocardiogram (ECG) signal analysis to identify patients' emotional states during Music Tinnitus Sound Therapy (Music-TST) sessions. Then analyzed correlations between emotional changes in different treatment phase and Tinnitus Handicap Inventory (THI) score differences to determine the impact of emotions on tinnitus treatment efficacy. This study revealed a significant correlation between patients' emotion changes during Music-TST and the therapy's effectiveness. Changes in arousal and dominance dimension, were strongly linked to THI variations. These findings highlight the substantial impact of emotional responses on sound therapy's efficacy, offering a new perspective for understanding and optimizing tinnitus treatment. Compared to existing methods, we proposed an objective indicator to assess the progress of sound therapy, the indicator could also be used to provide feedback to optimize sound therapy music. This study revealed the critical role of emotion changes in tinnitus sound therapy. By integrating objective ECG-based emotion analysis with traditional subjective scale like THI, we present an innovative approach to assess and potentially optimize therapy effectiveness. This finding could lead to more personalized and effective treatment strategies for tinnitus sound therapy.\n\nID: 38929531\nTitle: Paragangliomas of the Head and Neck: A Review of the Latest Diagnostic and Treatment Methods.\nAbstract: Background and objectives: Paragangliomas of the head and neck are rare, slow-growing neuroendocrine tumors, benign in their vast majority, but with a possibility of developing distant metastases. They show great inheritable character, and their behavior has proven to be unpredictable; therefore, they are considered malignant. Material and methods: This article aims to offer a more comprehensive presentation of the pathogenesis, epidemiology, diagnostic methods, imaging development, and treatment guidelines. We tried to bring together all the necessary data that, in our opinion, a head and neck practitioner should know when managing this type of tumor. Our main focus is on the most recent studies, with the purpose of a homogenous presentation of all current guidelines and approaches to this pathology. Results: Paragangliomas of the head and neck are still a disputed topic. One of the main reasons for that is their low incidence of 0.3 to 1 per 100,000 every year. The most frequent locations are the carotid body, the temporal bone, the jugular and mastoid foramen, and the vagal nerve. Their clinical presentation usually involves a painless lateral mass associated with symptoms such as hoarseness, hearing loss, tinnitus, and cranial nerve deficits. Up to 40% of them are inherited, mostly linked with mutations of succinate dehydrogenase complex. Imaging evaluation consists of CT and MRI, and new functional explorations such as 18F-FDA and 18F-FDG PET/CT, 18F-DOPA PET, 123I-MIBG, and 68Ga-DOTATE PET/CT. Measuring the catecholamine levels in the plasma and urine is mandatory, even though paragangliomas of the head and neck rarely display secretory behavior. Treatment mainly consists of surgery, with different approaches and techniques, but conservative management methods such as wait and scan, radiotherapy, proton therapy, and chemotherapy have proven their efficiency. The therapeutical decision lacks consensus, and current studies tend to recommend an individualized approach. Guidelines regarding long-term follow-up are still a matter of debate.\n\nID: 38847844\nTitle: Efficacy of tailor-made notched music training (TMNMT) in the treatment of tinnitus: a systematic review and meta-analysis.\nAbstract: Numerous treatment modalities have been suggested for managing tinnitus. Tailor-Made Notched Music Training (TMNMT) is a viable strategy in music therapy for tinnitus management. Many research studies have examined the effectiveness and potential benefits of this intervention. This study aims to assess the effectiveness of TMNMT in treating chronic tinnitus. This systematic review and meta-analysis study used a research methodology that covered up until February 2023. The search was conducted across academic databases including Google Scholar, PubMed, Scopus, and Web of Science. A total of 234 papers were evaluated, and seven relevant clinical trials were included. The meta-analysis, which included five studies using the tinnitus handicap inventory (THI), showed no statistically significant effect of TMNMT on tinnitus handicap after 3 and 6\u00a0months of intervention (dppc2:\u2009-\u20090.99, 95%CI\u2009-\u20092.94 to 0.96; I2\u2009=\u200979.96%, p\u2009=\u20090.00), (dppc2\u2009-\u20091.81, 95%CI\u2009-\u20095.63 to 2.01; I2\u2009=\u200979.96%, p\u2009=\u20090.00). However, four out of five studies using the total Visual Analogue Scale (VAS) or its subscale showed positive effects of TMNMT on chronic tinnitus. Unfortunately, there were not enough articles to conduct a meta-analysis on this outcome. Although the meta-analysis did not show a statistically significant effect of TMNMT on tinnitus handicap, the large effect size observed after at least 3\u00a0months of intervention suggests that this method may potentially decrease tinnitus handicap if more studies are conducted. Due to the limited number of studies, subgroup analysis could not be performed to analyze potential causes of heterogeneity. Therefore, further high-quality clinical trials are necessary to draw a definitive conclusion and evaluate the impact of different variables, techniques, and outcomes.\n\nID: 38759414\nTitle: Music therapy for tinnitus: A systematic review and meta-analysis.\nAbstract: To evaluate the clinical efficacy of music therapy in the treatment of tinnitus. Three English databases (PUBMED, Embase, Web of Science) and three Chinese databases (CNKI, VIP, and Wanfang) were searched, and eligible articles were selected according to the set inclusion criteria. Clinical efficacy was used as the primary outcome, and each score was used as the secondary outcome. Using RevMan5.3 software for statistical analysis. A total of 14 studies involving 1239 tinnitus patients were included. The results of the meta-analysis showed that music therapy had a certain clinical efficacy in the treatment of tinnitus, but there was no significant difference compared with the control group (OR\u00a0=\u00a01.00, 95%CI =0.83-1.22; P\u00a0=\u00a01.00). However, music therapy significantly improved THI score (MD\u00a0=\u00a0-6.77, 95\u00a0% CI\u00a0=\u00a0-9.62 to -3.92; P\u00a0<\u00a00.00001), TSQ (MD\u00a0=\u00a0-2.80, 95\u00a0% CI\u00a0=\u00a0-3.23 to -2.36; P\u00a0<\u00a00.00001), tinnitus loudness (MD\u00a0=\u00a0-3.90, 95\u00a0% CI\u00a0=\u00a0-6.58 to -1.23; P\u00a0=\u00a00.004), VAS score (MD\u00a0=\u00a0-1.11, 95\u00a0% CI\u00a0=\u00a0-2.11 to -0.11; P\u00a0=\u00a00.03) and TQ score (MD\u00a0=\u00a0-8.36, 95\u00a0% CI\u00a0=\u00a0-11.10 to -5.62; P\u00a0<\u00a00.001). Music therapy is an effective method for the treatment of tinnitus, which can improve the THI score, tinnitus severity, VAS score, and TQ score and reduce the loudness of tinnitus. Due to the low quality of the included literature, the current conclusions need to be further verified by more and higher-quality studies.\n\nID: 38723376\nTitle: Investigating the effectiveness of music therapy combined with binaural beats on chronic tinnitus: A randomized controlled trial.\nAbstract: Binaural beat stimulation (BBS) involve presenting two sinusoidal waves with specific frequency differences to induce neural changes in the brain, often used for mental state induction and symptom reduction. However, there are limited studies on its effectiveness for tinnitus. This study aimed to assess the effectiveness of combining binaural beats with music containing nature sounds for chronic tinnitus. A total of 30 men, aged 45.87 on average (SD\u00a0=\u00a08.09), who had chronic tinnitus and symmetrical mild to moderate hearing loss, were included in this study. The participants were randomly assigned to two groups: MT group (Music therapy; n\u00a0=\u00a015), which received relaxing music containing the sound of sea waves, and MT\u00a0+\u00a0BBS group (Music therapy plus binaural beats; n\u00a0=\u00a015), which received the same music combined with alpha frequency (8\u00a0Hz) binaural beats. The therapy sessions were conducted twice a day for 15\u00a0min, over a period of 4 weeks. Outcome measures, including the Tinnitus Handicap Inventory (THI), Tinnitus Functional Index (TFI), Hospital Anxiety and Depression Scale (HADS), Visual Analog Scale (VAS) and the pitch and loudness of tinnitus were administered before, immediately after, and during the three-month follow-up period. The findings revealed improvements in loudness and annoyance VAS, as well as THI total and all subscale scores in both groups (p\u00a0<\u00a00.001). Additionally, TFI total score showed improvement in both groups (MT: p\u00a0=\u00a00.001; MT\u00a0+\u00a0BBS: p\u00a0<\u00a00.001) except for the sense of control subscale in both groups and the cognitive subscale in the MT group after the treatment and during the three-month follow-up period. Furthermore, both groups exhibited a decrease in scores for both subscales of HADS. However, there were no significant differences between the two groups in any of the measurement outcomes (p\u00a0>\u00a00.05), except for the emotional subscale scores of TFI (p\u00a0=\u00a00.049) and the functional subscale scores of THI (p\u00a0=\u00a00.034). In other words, during the follow-up period, the MT\u00a0+\u00a0BBS group exhibited lower scores in these two subscales compared to the MT group. Although our study failed to demonstrate the superiority of combining binaural beats with music, both groups experienced significant improvements. This suggest that there are potential benefits to be gained from these types of stimuli. Given the sustained effect of both methods and the even greater improvements in follow-up observed in the binaural beats group for some scales, it seems that the changes in neural response and brain waves caused by our stimulations are persistent. This necessitates further research involving brain mapping, especially with longer follow-up durations.\n\nID: 38361332\nTitle: The Placebo Effect on Tinnitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.\nAbstract: To quantify the placebo effect in randomized clinical trials treating tinnitus with oral or intratympanic placebo treatment. CINAHL, PubMed, and Scopus were searched for articles from conception to October 2022. MESH and key terms such as \"tinnitus,\" \"placebo,\" and \"medication\" were used to find randomized, placebo-controlled trials. The search was limited to articles in English. Randomized controlled trials with adult subjects evaluating tinnitus pretreatment and posttreatment with an oral or intratympanic medication versus a placebo arm were included. Crossover studies, studies involving middle/inner ear operations or devices, and studies that exclusively included nonidiopathic etiologies of tinnitus were excluded. Mean tinnitus symptom survey scores for the Tinnitus Handicap Inventory (THI), Tinnitus Severity Index, Tinnitus Functional Index, Tinnitus Handicap Questionnaire, and Visual Analog Scales for tinnitus Intensity/Loudness (VAS-L), Annoyance (VAS-An), and Awareness (VAS-Aw) were extracted for both placebo and experimental groups. 953 studies were screened with 23 studies being included in the final analysis. Meta-analysis of mean difference (MD) was calculated using RevMan 5.4. MD between pretreatment and posttreatment THI scores of the placebo arms was 5.6 (95% confidence interval, 3.3-8.0; p < 0.001). MD between pretreatment and posttreatment VAS scores of the placebo groups for Loudness, Annoyance, and Awareness were 0.8 (0.0 to 1.6, p = 0.05), 0.2 (-0.2 to 0.5, p = 0.34), and 0.3 (-0.0 to 0.7, p = 0.08), respectively. Placebo treatment has shown effectiveness in improving patient-reported evaluations of tinnitus when using some standardized metrics such as THI and VAS-L; however, the improvement is not as substantial as nonplacebo treatment.\n\nID: 38115355\nTitle: The effect of music therapy on tinnitus: A systematic review.\nAbstract: Tinnitus is a common otological symptom affecting almost all aspects of life, especially the quality of daily life. The present study aims to analyze music therapy effect on tinnitus patients. This paper mainly analyzes 3 kinds of music therapy: Heidelberg model of music therapy (HMOMT), standard music therapy (SMT), and tailor-made notched music training (TMNMT). To provide a reference for the follow-up treatment of tinnitus, whether to take and what kind of music therapy. A systematic literature search was performed in PubMed, Cochrane Library, EMBASE, Web of Science, and MEDLINE to obtain potential studies from their inception to May 2023 in all languages. Two researchers independently screened the studies, extracted data, and assessed the quality of the included studies. We included all randomized and non-randomized controlled trials that used music therapy to treat patients with tinnitus. We used fixed-effects and random-effect models to analyze data based on the heterogeneity results. The data analysis was performed by using Stata 12.0. A total of 19 studies with 904 cases were included. Compared with before treatment, music therapy significantly reduces the tinnitus questionnaire score and tinnitus handicap inventory score. HMOMT, SMT, and TMNMT all significantly decrease tinnitus scores. Although the order of effectiveness of the 3 drugs is TMNMT\u2005>\u2005SMT\u2005>\u2005HMOMT, there is no statistical significance (P\u2005>\u2005.5). This meta-analysis of accumulated clinical trial data suggests that music therapy can relieve tinnitus symptoms and loudness. Among music therapies, SMT is recommended first for tinnitus based on cost, efficacy, and convenience. At the same time, TMNMT and HMOMT can be used as alternative therapies for specific cases.\n\nID: 38101129\nTitle: Placebo effect in randomized controlled trials for Meniere's disease: A meta-analysis.\nAbstract: Meniere's Disease is a condition known for its recurrent vertigo, fluctuating sensorineural hearing loss, aural fullness, and tinnitus. Previous studies have demonstrated significant influence of placebo treatments. Our objective was to quantify the magnitude of the placebo effect in randomized controlled trials for Meniere's Disease. A systematic review was performed by searching PubMed, SCOPUS, CINAHL, and Cochrane databases from inception through September 27, 2022. Data extraction, quality rating, and risk of bias assessment were performed by two independent reviewers. A meta-analysis of mean differences with 95\u00a0% confidence interval, weighted summary proportions, and proportion differences were calculated using random and fixed effects models. A total of 15 studies (N\u00a0=\u00a0892) were included in the review. Significant improvement was seen in the functional level scores of the pooled placebo groups, with a mean difference of -0.6 points, (95%CI: -1.2 to -0.1). There was no difference in pure tone audiometry, speech discrimination score, or vertigo frequency at 1 and 3\u00a0months for the placebo group. Patient-reported vertigo episodes were improved in 52.5\u00a0% (95%CI: 39.2 to 65.5) of the placebo group and was significantly less than the pooled experimental group (90.1\u00a0%, 95%CI: 39.2 to 65.5, p\u00a0<\u00a00.001). The placebo effect in Meniere's Disease trials is associated with some symptomatic improvement in subjective outcomes, such as patient reported vertigo episodes. However, the clinical significance is questionable across other outcomes measures, especially when analyzing objective data. The extent and strength of the placebo effect continues to be a hurdle in the search for better treatment options.\n\nID: 38050888\nTitle: Pulsed Radiofrequency of the Auricular Branch of the Vagal Nerve in Tinnitus Patients.\nAbstract: Pulsed radiofrequency of the auricular branch of the vagal nerve has strongly reduced tinnitus in a person with violent tinnitus and severe cervical pain. The objective of our study was to study the long-term effects of pulsed radiofrequency of the auricular branch of the vagal nerve in a large group of tinnitus sufferers and to find predictors for a prosperous result. A monocenter backward-looking group study. 48% of tinnitus sufferers who undertook pulsed radiofrequency of the auricular branch of the vagal nerve reported a reduced loudness of their tinnitus, which was qualified as being moderate to good in 87% of these patients. The reduction exceeded mostly 1 year. An angle smaller than 3 degrees between the 2nd and 3rd cervical vertebrae on lateral radiograph predicted a better outcome of this therapy. Neuromodulation of the auricular branch of the vagal nerve is an uncomplicated remedy for tinnitus, especially for tinnitus patients with a pathologically small C2-C3 angle.\n\nID: 37916338\nTitle: Personalized music therapy combined with medication as treatment for tinnitus.\nAbstract: This study aimed to investigate the effects of personalized music therapy in combination with medication as a treatment for tinnitus. We retrospectively analyzed a total of 200 patients who were admitted to the Department of Otorhinolaryngology in our hospital from June 2018 to June 2019, with tinnitus as their primary complaint. Patients were divided into four groups based on their individual treatment methods: medication group (patients received medication only, n=40), tinnitus masking (TM) group (patients received medication plus TM, n=38), tinnitus re-training (TRT) group (patients received medication plus TRT, n=35), and personalized group (patients received medication plus personalized music therapy, n=30). The pure-tone audiometry (PTA), loudness visual analogue scale (VAS), and tinnitus handicap inventory (THI) for each patient were analyzed. There were statistically significant differences in the THI and VAS scores of all groups before and after treatment (p<0.05). Following nine and twelve months of treatment, the THI and VAS scores of the TRT group and the personalized group were significantly lower than those of the other two groups (p<0.05). The THI and VAS scores of the personalized group were significantly lower than those of the TRT group (p<0.05). Additionally, THI and VAS scores were statistically different at various measurement time points in each group (p<0.05). The clinical effective rate (85.37%) of the personalized group was higher than that of the other three groups (p<0.05). TM, TRT, or personalized music therapy, when combined with medication, are effective in treating patients with tinnitus. Among these methods, personalized music therapy may be the superior treatment after nine months of treatment.\n\nID: 37713532\nTitle: Blast Overpressures as a Military and Occupational Health Concern.\nAbstract: This tutorial reviews effects of environmental stressors like blast overpressures and other well-known acoustic contaminants (continuous, intermittent, and impulsive noise) on hearing, tinnitus, vestibular, and balance-related functions. Based on the overall outcome of these effects, detailed consideration is given to the health and well-being of individuals. Because hearing loss and tinnitus are consequential in affecting quality of life, novel neuromodulation paradigms are reviewed for their positive abatement and treatment-related effects. Examples of clinical data, research strategies, and methodological approaches focus on repetitive transcranial magnetic stimulation (rTMS) and electrical stimulation of the vagus nerve paired with tones (VNSt) for their unique contributions to this area. Acoustic toxicants transmitted through the atmosphere are noteworthy for their propensity to induce hearing loss and tinnitus. Mounting evidence also indicates that high-level rapid onset changes in atmospheric sound pressure can significantly impact vestibular and balance function. Indeed, the risk of falling secondary to loss of, or damage to, sensory receptor cells in otolith organs (utricle and saccule) is a primary reason for this concern. As part of the complexities involved in VNSt treatment strategies, vocal dysfunction may also manifest. In addition, evaluation of temporospatial gait parameters is worthy of consideration based on their ability to detect and monitor incipient neurological disease, cognitive decline, and mortality. Highlighting these respective areas underscores the need to enhance information exchange among scientists, clinicians, and caregivers on the benefits and complications of these outcomes.\n\nID: 37660935\nTitle: Effective treatment of refractory tinnitus by bilateral deep brain stimulation of the medial geniculate body of the thalamus: A case report.\nAbstract: \n=======================================================\n\n### [CUSTOM DATAPOINTS]\nCRITICAL EXTRACTION DIRECTIVE: You MUST extract the following custom datapoints as root-level key/value pairs inside your final JSON block:\n- \"suggested_experiments\": generate 1-3 suggested experiments\n- \"suggested_studies\": generate 1-3 suggested studies\n- \"swansons_literature_based_discovery_candidates\": You are an advanced Literature-Based Discovery (LBD) system executing Swanson\u2019s complementary-but-disjoint (A-B-C) model. Your goal is to find hidden, unpublished connections across the provided dataset. Strict Discovery Protocol: 1. Identify distinct, isolated sub-literatures (Domain A and Domain C) within the dataset that share NO direct citations, co-mentions, or common contextual paragraphs. 2. Find an intermediate biological mechanism, protein, path, or entity (Bridge B) that appears independently in both isolated domains (A-to-B and B-to-C). 3. Synthesize a novel, unstated hypothesis (A-to-C). Negative Constraint (Crucial): DO NOT output any connection if the relationship between Concept A and Concept C is explicitly mentioned, paired, or summarized anywhere in the source text. If a connection (like \"OMN resilience to SMN stabilization\") is already explicitly stated or grouped as a concept in the data, it is considered \"already known\" and must be disqualified. Format your output exactly as follows: - Discovered Hypothesis (A to C): [Clear, novel statement] - Literature A (Origin): [Entity/Concept and source context] - Literature C (Target): [Entity/Concept and source context] - The Intersecting Bridge B: [The shared mechanism/protein linking them] - Biological Rationale: [1-2 sentences explaining why this hidden connection is mechanistically plausible]\n- \"contradictions_between_evidences\": Identify conflicting evidence within the evidence set (if any) and flag the dispute here\n- \"repurposed_solutions\": identify and explain repurposed Solution potentials\n\n\nFormat Requirement:\nRAG AMNESIA IS ACTIVE: You must ONLY use the provided context literature. Do not use outside prior knowledge. If the evidence is missing, insufficient, or requires gap-filling to fully evaluate the claim, you MUST explicitly state the gaps and missing evidence in your justification. Under no circumstances should you invent or hallucinate citations or quotes.\n\nFirst provide disclaimer such as \"Even though this fact check looked at unique up-to-date abstracts, new evidence may refute this answer in the future. Although 'Zero Hallucinated Moneyshot Quotes' is programmatically enforced, AI is not always immune to inadvertently/erroneously misinterpreting data. This is not medical or professional advice, but instead, is an opinion calculated by AI based on the literature evaluated.\"\n---\nWrite in a highly academic, formal thesis tone.\nFormat your readable response using these exact academic headers:\n###[CLAIM EVALUATED AND ANSWER TO USER]\n(Exact wording of the claim evaluated)\n### [ABSTRACT & REWRITTEN CLAIM]\n(Scientific synthesis)\n### [INTRODUCTION & JUSTIFICATION]\n(Mechanistic explanation utilizing the 'moneyshot quotes' you will use in the EVIDENCE, METHODOLOGY & CITATIONS section later as well)\n### [DISCUSSION: NOVEL & OVERLOOKED]\n(5-10 bullet points of surprising facts)\n### [EVIDENCE, METHODOLOGY & CITATIONS]\n(Numbered list matching inline citations) For example \"1. ID: 12345 - Application: The text discusses ... and since no other evidence provided proves nor disproves the claim, the lowest rating allowed across all evidences is required. ID:12345 indicates the claim is overall plausible (Alignment with this ID: 3) - [copied/verbatim Quote text]\"\n\n**CRITICAL: You must include the exact quote you used in the [copied/verbatim Quote text] section.\n\nIf the prompt says \"at least 20 quotes\" then there must be at least 20 matching citations. You must actually use the quotes you select within the conext of the preprint publication you write.\n\nEvaluation Schema:\nRAG AMNESIA IS ACTIVE: You must ONLY use the provided context literature. Do not use outside prior knowledge. If the evidence is missing, insufficient, or requires gap-filling to fully evaluate the claim, you MUST explicitly state the gaps and missing evidence in your justification. Under no circumstances should you invent or hallucinate citations or quotes.\n\n###critical: WRAP YOUR THOUGHTS WITH
18 years) with any CRD and no prior ear-related disorders were matched to a control group of patients without any history of CRD. Patients with CRD were stratified by increasing levels of cannabis use intensity based on the ICD-10 codes (use, abuse, or dependence). Propensity score matching controlled for demographic and related clinical variables, including migraine, nicotine and substance use, and mood disorders. The primary outcome was diagnosed tinnitus at 1, 5, and 10 years, analyzed using Cox regression hazard models (hazard ratios (HR), 95% confidence intervals). After matching (n\u2009=\u200992,077 in each group), tinnitus incidence after 1, 5, and 10 years of CRD diagnosis was 0.7%, 1.8%, and 2.1%, respectively. One-year risk was significantly higher among those with any CRD (HR\u2009=\u20091.30, [95% CI: 1.16-1.45]). Compared to control at 1-year of follow-up, effect size was relatively higher among patients diagnosed with cannabis dependence (use: 1.30 [1.11-1.51]; abuse: 1.42 [1.05-1.90]; dependence: 1.55 [1.02-2.37]). There were no significant trends in tinnitus development at 5 and 10 years of follow-up with any CRD. Cannabis use may elevate the short-term risk of tinnitus, especially among those with more severe use. Further investigation should explore a potential dose-dependent relationship and underlying mechanisms.",
"42313294": "ID: 42313294\nTitle: Therapeutic Hybrid Intelligence with Neural and Knowledge-based Expert Reasoning for SRS (THINKERS): a mixture-of-experts AI model for vestibular schwannoma.\nAbstract: Outcome prediction after Gamma Knife radiosurgery (GKRS) for vestibular schwannoma remains largely guided by tumor size, Koos grade, baseline symptoms, cochlear dose constraints, and institutional experience rather than individualized estimates of tumor progression and functional outcomes. We developed THINKERS-VS, a mixture-of-experts (MoE) artificial intelligence framework for progression and symptom-transition prediction after GKRS. We performed a retrospective single-center study of vestibular schwannomas treated with GKRS. Variables available before the treatment were used to train a MoE neural network with discrete-time survival modeling. The model incorporated demographic, clinical, tumor, and radiosurgical variables. The primary endpoint was tumor progression across intervals of 3, 6, 12, 18, 24, 32, 48, and 60 months. Secondary endpoints included new or worsened hearing loss, imbalance, vertigo, dizziness, and tinnitus. Internal validation used grouped 5-fold cross-validation and a grouped holdout test split. Performance was assessed using AUC and Brier score. The cohort included 686 patients. Median age was 59.5 years, median tumor volume was 0.746 cm\u00b3, median prescription dose was 12.0 Gy, and median follow-up was 52.3 months. THINKERS-VS achieved strong progression discrimination across evaluated intervals, with AUCs ranging from 0.807 to 0.859. At 60 months, AUC was 0.807 and Brier score was 0.012. For symptom-transition prediction, holdout AUCs were 0.875 for hearing loss, 0.844 for imbalance, 0.813 for vertigo, 0.884 for dizziness, and 0.839 for tinnitus. THINKERS-VS provides an internally validated framework for individualized tumor progression and symptom-transition prediction after GKRS for vestibular schwannoma and recommends tumor margin dose associated with best outcome. Not applicable.",
"42314530": "ID: 42314530\nTitle: Down-sloping high-frequency audiometric findings in ENT-MS-12 auditory screen-positive patients with relapsing-remitting multiple sclerosis: A pilot case series.\nAbstract: Audio-vestibular symptoms, including hearing loss and tinnitus, are increasingly reported in people with multiple sclerosis (pwMS), yet their clinical significance and underlying mechanisms remain unclear. Both central demyelination and peripheral involvement along the brain-cochlea axis have been proposed as potential contributors.This study aims to explore and describe pure-tone audiometry (PTA) findings in pwMS who screened positive for auditory complaints on the ENT-MS-12 questionnaire, and to summarize associated clinical and magnetic resonance imaging (MRI) features during follow-up. In this prospective pilot study, 40 pwMS with relapsing-remitting MS were screened using the ENT-MS-12 questionnaire. Patients reporting auditory complaints and meeting predefined exclusion criteria were invited to undergo pure-tone audiometry (125-8000 Hz). Clinical data and MRI findings obtained within three months of audiometric testing were reviewed and compared with imaging from the previous year. Twenty-seven patients (67.5%) reported auditory symptoms. Eleven met the inclusion criteria and five consented to audiometric testing. All five patients showed a down-sloping audiometric configuration with elevated high-frequency thresholds, particularly at 6000-8000 Hz. Mean high-frequency thresholds were higher than age-matched reference values reported in the literature. During follow-up, four of five patients experienced clinical relapses; one of these also showed disease progression, auditory brainstem response abnormalities, and a temporal lobe lesion on MRI. In this pilot study, pwMS who reported hearing concerns and underwent audiometry presented subtle high-frequency auditory threshold elevations with a down-sloping audiometric pattern. These preliminary, descriptive findings suggest that incorporating auditory assessment may provide complementary clinical information in pwMS. Larger, controlled studies with electrophysiological testing and advanced neuroimaging are warranted to clarify the relevance and mechanisms of auditory involvement in multiple sclerosis, including potential central and peripheral contributions.",
"42319726": "ID: 42319726\nTitle: Associations Between Football-Related Exposures, Head Injury, Tinnitus, and Neuropsychological Health Outcomes Among Professional American-Style Football Players.\nAbstract: Auditory dysfunction such as tinnitus is a common sequelae of traumatic brain injury (TBI), and has been associated with neurobehavioral outcomes, including cognitive decline, depression, and anxiety. Few studies have examined associations between concussion history and tinnitus independent of confounding by blast injury or occupational noise exposure. This study investigated concussion history and tinnitus among former professional American-style football (ASF) players, and evaluated whether tinnitus mediates associations between concussion history and neurobehavioral outcomes. This cross-sectional study included former ASF players who contracted with a professional league after 1960 and completed self-administered questionnaires between 2019-2025. Surveys assessed football exposure, auditory dysfunction, and mental health. Cumulative head injury exposure was measured using self-reported concussion signs and symptoms during play. Tinnitus was self-reported and assessed concurrently with validated measures of perceived cognition, depression, and anxiety. Logistic regression evaluated associations between concussion symptom history and tinnitus, and linear regression models assessed mediation and interaction effects. Among 1085 participants (mean age 57.9\u2009\u00b1\u200913.5\u00a0years; 32.4% Black; 6.1\u2009\u00b1\u20093.7 seasons), greater concussion symptom history was associated with increased odds of tinnitus (highest vs. lowest quintile: OR\u2009=\u20092.90; 95%CI 1.91-4.43; p\u2009<\u20090.0001). Tinnitus did not mediate associations between concussion symptom history and neurobehavioral outcomes. However, associations with perceived cognition (p-interaction\u2009=\u20090.1), depression (p-interaction\u2009<\u20090.01), and anxiety (p-interaction\u2009<\u20090.01) were larger among participants reporting tinnitus. Greater concussion symptom history was associated with increased reporting of tinnitus, and neurobehavioral associations were stronger among those with tinnitus. Clinicians should consider tinnitus when evaluating long-term cognitive and mental health outcomes following repeated head injury.",
"42334208": "ID: 42334208\nTitle: Modifiable risk factors for tinnitus: A Mendelian randomization study.\nAbstract: ObjectiveThe topic of tinnitus has received considerable scholarly interest. Contributing factors to the development of tinnitus encompass aging, exposure to loud noise, smoking, and hearing impairment. Nevertheless, the precise risk factors, particularly those that can be modified, remain uncertain. This study aimed to explore the potential genetic factors that may be associated with an increased susceptibility to tinnitus.MethodsMendelian randomization analyses were performed using data from the United Kingdom Biobank and the FinnGen Biobank data infrastructure. The present study examined the correlation between 13 prevalent life factors, which were identified as potential risk factors for tinnitus through a comprehensive review of the literature. The inverse-variance weighted model was employed to analyze the associations. To mitigate database source bias and strengthen the reliability of our findings, data from the United Kingdom Biobank were used for the discovery cohort, whereas data from FinnGen were used for the validation cohort. Subsequently, a meta-analysis was conducted to combine the findings, thereby bolstering the robustness of the results.ResultsIn the United Kingdom Biobank discovery cohort, waist circumference (odds ratio = 1.37, 95% confidence interval 1.09-1.71, p\u2009=\u20090.006), waist-to-hip ratio (odds ratio = 1.71, 95% confidence interval 1.17-2.50, p\u2009=\u20090.005), fasting glucose (odds ratio = 0.70, 95% confidence interval 0.54-0.90, p\u2009=\u20090.007), and fasting insulin (odds ratio = 2.07, 95% confidence interval 1.07-4.01, p\u2009=\u20090.03) showed significant associations with tinnitus. In the FinnGen validation cohort, smoking was associated with tinnitus (odds ratio = 1.20, 95% confidence interval 1.03-1.40, p\u2009=\u20090.018). However, in the meta-analysis combining both cohorts, only waist circumference remained significantly associated with tinnitus (odds ratio = 1.27, 95% confidence interval 1.08-1.49, p\u2009=\u20090.003).ConclusionsOur findings indicate a causal relationship between waist circumference, an indicator of central obesity, and tinnitus. This implies that abdominal obesity could serve as a modifiable target for the prevention of tinnitus. Other factors that initially appeared to be associated did not demonstrate consistent results across different cohorts, underscoring the critical role of meta-analysis in Mendelian randomization studies.",
"42334723": "ID: 42334723\nTitle: Beyond tumor control: symptom trajectories and hearing outcomes after contemporary Gamma Knife radiosurgery for vestibular schwannoma.\nAbstract: Gamma Knife radiosurgery (GKRS) is an established treatment for vestibular schwannoma, but contemporary cohort-level data integrating long-term tumor control with clinical symptom trajectories and hearing-related correlates remain valuable. We performed a retrospective cohort study of 286 patients with vestibular schwannoma (VS) treated with GKRS (2014-2024). The primary endpoint was local control. Secondary outcomes included overall survival and changes in hearing loss, imbalance, vertigo, dizziness, and tinnitus. Kaplan-Meier analysis was used to estimate local control and overall survival. Paired symptom changes were assessed using McNemar testing. The Median follow-up was 52.3 months (IQR 27.4-80.3). Progressive radiographic enlargement occurred in 5 patients, yielding a crude local control rate of 98.3%. The actuarial local control was 98.5% at 5 years and 96.5% at 10 years. Imbalance, vertigo, dizziness, and tinnitus improved significantly after GKRS, whereas hearing loss remained stable overall (59.4% vs. 57.3%, p\u2009=\u20090.441). Mean symptom burden declined from 1.74 to 1.20 symptoms per patient (p\u2009<\u20090.001). Post-radiosurgery hearing loss was more frequent in Koos IV tumors and increased stepwise across quartiles of cochlear mean dose: 38.7% for \u2264\u20092.9\u00a0Gy, 53.3% for >\u20092.9-3.6\u00a0Gy, 66.2% for >\u20093.6-4.5\u00a0Gy, and 73.8% for >\u20094.5\u00a0Gy (p\u2009=\u20090.00012). Baseline hearing loss remained the strongest predictor in multivariable modeling. At a median of four years GKRS provided tumor control in >\u200995% of VS patients and was associated with reduced overall symptom burden and improvement in vestibular symptoms. Hearing outcomes were related to baseline auditory status, Koos grade, and cochlear dosimetry. Not applicable.",
"42338275": "ID: 42338275\nTitle: Importance of Comprehensive Tinnitus Assessment: A Conceptual Analysis of International Classification of Functioning, Disability and Health (ICF)-Linked Questionnaires.\nAbstract: This study explores the extent to which commonly used tinnitus questionnaires align with relevant International Classification of Functioning, Disability and Health (ICF) domains. The aim is not to establish the superiority of any tool, but rather to identify potential gaps in domain coverage and to support more intentional questionnaire selection. A rapid review was conducted to identify validated tinnitus questionnaires used in clinical practice. Each questionnaire was systematically linked to ICF categories employing established frameworks. The study compared the domain coverage of the ICF-based international inventory for tinnitus (ICF-TINI) with that of other commonly used questionnaires and mapped overlapping and unique ICF codes to determine the breadth of coverage. While ICF-TINI addressed a wide range of ICF domains, no single questionnaire provided complete coverage, particularly for the domains of environmental factors and participation. Other tools such as the Tinnitus Functional Index and Tinnitus Handicap Inventory also demonstrated broad but incomplete domain representation. The findings underscore the importance of strategically combining tinnitus questionnaires based on ICF domain mapping, rather than relying solely on familiarity or tradition. The study proposes an evidence-informed approach to tool selection that may enhance person-centered tinnitus assessment. Further research is required to determine whether broader ICF coverage leads to improved outcomes.",
"42338403": "ID: 42338403\nTitle: Impact of Treatment Intensity on Quality of Life in Patients With Metastatic Testicular Cancer.\nAbstract: Testicular cancer (TC) is the most common malignancy in young men and is highly curable with platinum-based chemotherapy. With growing survivorship rates, treatment-related symptom burden and quality of life (QoL) have become increasingly important. This study evaluates the impact of different TC treatments on symptom burden and QoL. Of 715 patients with TC and primary or postchemotherapy retroperitoneal lymph node dissection (RPLND) treated at the University Hospital D\u00fcsseldorf between 2010 and 2024, 486 eligible survivors were contacted, and 124 (25.5 %) completed a standardized questionnaire. Treatment-related symptoms, including QoL and mental health status, were assessed using the EORTC QLQ-C30 and PHQ-9 questionnaires, respectively. Results were compared with age-matched reference values from the general population. A subgroup comparison of clinical stage (CS) II patients treated with primary RPLND versus first-line chemotherapy followed by RPLND was performed to identify chemotherapy-specific effects. The median time between last treatment and survey response was 55 months. Twenty-four patients were treated with primary RPLND, 80 patients with adjuvant or first-line chemotherapy and RPLND, and 20 patients with multiple lines of chemotherapy and RPLND. Overall, TC survivors reported high global QoL scores comparable to age-matched normative data. The most frequent treatment-related symptoms were polyneuropathy, tinnitus, retrograde ejaculation, and circulatory disorders, particularly among patients receiving multiple lines of chemotherapy. Subgroup analysis showed that CS II patients treated with a single first-line chemotherapy reported lower social functioning and greater financial distress compared with those managed with surgery alone. Despite the physical impact, depression rates were low and similar to the general population, indicating preserved psychological well-being. TC survivors maintain good QoL comparable to the general population despite therapy-related symptoms. While persistent side effects such as polyneuropathy and tinnitus are common, their impact on QoL is limited. However, even first-line chemotherapy affects sexual health, social functioning, and financial well-being, highlighting the importance of the development of new treatment approaches and clinical studies focusing on surgery as a QoL-preserving option in selected low-metastatic cases.",
"42338658": "ID: 42338658\nTitle: Risks and Awareness of NIHL Among Dental Students: A Scoping Review.\nAbstract: Although noise exposure levels in the dental professional sector may be considered low when compared to other occupations, noise prevention strategies, especially for the students, are necessary to conserve hearing for this population group. The current scoping review aimed to ascertain the risks and awareness of NIHL among dental students globally. The review selected articles from 2014 to 2025, including both quantitative and qualitative studies, existing systematic reviews, and grey literature. The PCC (Population, Concept, Context) framework was used to guide the articles' eligibility criteria. Databases included PubMed, CINAHL, ProQuest, Scopus, Web of Science, and EBSCO Host. The Covidence data extraction tool, which enabled consensus checking, was used to guide the extraction process, and studies were reported according to the PRISMA guidelines. Sixty-nine studies were initially extracted, and after screening, 10 met the study criteria. Thematic analysis was used to synthesize the narrative data. Of the 10 studies analyzed, eight indicated risks associated with NIHL among undergraduate students. The use of high-speed handpieces during clinical training increased the risk for NIHL, with some students reporting symptoms such as tinnitus following the use of the equipment. Four articles reported on the awareness of noise exposure levels and associated risk for NIHL among the students. The review suggested that there was a risk of NIHL among dental students, particularly linked to cumulative noise exposure. However, awareness of NIHL among the students was poor; therefore, early identification, risk assessment, and awareness of the risks at undergraduate training are necessary for the active prevention of hearing loss. There is a need to encourage listening behaviors that promote awareness towards the prevention of NIHL for this group of students.",
"42339866": "ID: 42339866\nTitle: Tinnitus, temporomandibular disorders and muscle activity: what's the connection?\nAbstract: This study was aimed at comparatively evaluating the relationship between temporomandibular disorder (TMD) and subjective tinnitus, as well as the effects of TMD treatment on masticatory muscle activity, tinnitus symptoms, and patient perception. In this prospective cohort study, patients diagnosed with both TMD and tinnitus were divided into groups with or without bruxism. The inclusion criteria were confirmed diagnosis of TMD and tinnitus. The exclusion criteria were history of prior TMD treatment, neurological disorders, or systemic diseases affecting muscle function. The primary outcome measures were electromyographic (EMG) assessments of masseter muscle maximum voluntary contraction (MVC) and the percentage of overlapping coefficient (%POC), determined via surface EMG (sEMG). The secondary outcomes included changes in tinnitus symptoms, assessed with the Tinnitus Handicap Inventory (THI), and pain levels, evaluated with the Visual Analog Scale (VAS). A total of 70 eligible participants were evenly distributed between groups. Tinnitus symptoms resolved in 35.7% of patients and did not significantly differ between groups (p > 0.05). Masseter MVC values decreased numerically but non-significantly after treatment (p > 0.05). In contrast, significant post-treatment improvements were observed in %POC, VAS, and THI scores (p < 0.05). Pre- and post-treatment comparisons of MVC, %POC, VAS, and THI revealed no significant intergroup differences (p > 0.05). TMD treatment appeared to effectively decrease subjective tinnitus symptoms and improve quality of life. Our findings suggest that TMD management might play an important role in tinnitus treatment and indicate that tinnitus is more associated with underlying internal disorders than with masticatory muscle activity directly influenced by bruxism.",
"42345410": "ID: 42345410\nTitle: Efficacy of the Additional Effect of Stellate Ganglion Block in Combination of Intratympanic Steroid and Hyperbaric Oxygen Therapy for Refractory Sudden Sensorineural Hearing Loss.\nAbstract: Refractory sudden sensorineural hearing loss (RSSNHL) underscores the need for more effective salvage therapies. This study aimed to investigate the efficacy of stellate ganglion block (SGB) combined with intratympanic steroid (ITS) and hyperbaric oxygen therapy (HBO) as triple salvage therapy in patients with RSSNHL. This retrospective study analyzed 73 patients with unilateral RSSNHL admitted between January 2022 and December 2023. All patients underwent salvage therapy with HBO and ITS, with (n=31) or without SGB (n=42). The primary efficacy endpoint was the change in pure tone average thresholds, with secondary endpoints comprising demographic characteristics, tinnitus evaluation, and psychological distress scores. Both groups showed post-treatment hearing improvement (P < .05), but the SGB group achieved greater hearing gain, higher efficacy rates, and superior low-frequency recovery (P < .05). Tinnitus relief and psychological outcomes were also significantly better in the SGB group (P < .05). Patients with both shorter intervals from symptom onset to salvage therapy and relatively lower baseline hearing thresholds demonstrated significantly greater hearing improvement. Neither group experienced severe adverse events. Lower baseline hearing thresholds and earlier therapy initiation predicted better outcomes. The triple salvage therapy significantly improved hearing recovery in RSSNHL patients, particularly in low-frequency ranges, while also reducing tinnitus severity and enhancing psychological well-being.",
"42345411": "ID: 42345411\nTitle: Link Between Chronic Tinnitus and miR-30e, miR-206 , and miR-124 Polymorphisms Modulating the Brain-Derived Neurotrophic Factor Gene.\nAbstract: Brain-derived neurotrophic factor (BDNF) plays a crucial role in the initial formation of the central auditory system and the sensory epithelium within the inner ear. Mounting evidence indicates that BDNF administration promotes microRNA (miRNA) production in neurons, despite the typical suppressive effect of miRNAs on BDNF expression. Therefore, miRNAs regulating BDNF expression may impact the auditory system and serve as potential gene polymorphisms affecting human hearing ability. This study aimed to investigate the contribution of miRNA polymorphisms affecting BDNF to tinnitus pathophysiology. A total of 70 tinnitus patients aged 18-55 years and 70 age-matched healthy controls without tinnitus or systemic illnesses were recruited from an Ear, Nose & Throat clinic. Tinnitus assessment included tympanometric, audiological, and psychoacoustic evaluations. Seven miRNA single-nucleotide polymorphisms (miR-30e rs112439044, rs10489167, miR-206 rs16882131, miR-30a rs1491500379, miR-26b rs565919718, rs188612260, and miR-124 rs5315564) regulating the BDNF gene were analyzed using the Fluidigm platform. Significant differences in genotype distributions were observed for miR-30e rs112439044, miR-124 rs5315564, and miR-206 rs16882131 between the tinnitus patients and controls (P < .05). Genetic inheritance-model analysis revealed that miR-30e rs112439044 was associated with 0.20- and 0.83-fold risks under dominant and additive models, respectively. The miR-124 rs5315564 showed a 1.65-fold risk in the dominant model, while miR-206 rs16882131 exhibited an 11.1-fold protective effect under the dominant model and an 8.57-fold risk under the additive model. The findings suggest that polymorphisms in miR-206, miR-30e, and miR-124 may influence the auditory pathway by modulating BDNF gene expression, potentially contributing to the pathophysiology of chronic tinnitus.",
"42345416": "ID: 42345416\nTitle: Management Options and Their outcomes in Bilateral Advanced Otosclerosis.\nAbstract: Otosclerosis is a hereditary disorder that causes progressive hearing loss in the adult population. Owing to its progressive nature, a multimodal treatment approach is often required. Management options were offered to patients following comprehensive audiological and radiological evaluation, incorporating the Merkus algorithm in clinical decision-making. This study aims to compare the audiological and speech-related outcomes of cochlear implantation (CI) and stapedotomy with hearing aid use in patients with bilateral advanced otosclerosis. This cohort study included 38 patients divided into 2 groups: Group A consisted of patients who underwent CI (n=15), and Group B comprised patients who underwent stapedotomy followed by hearing aid use (n=23). Outcomes were compared using paired t-tests both within and between the groups. Both groups demonstrated significant improvement in hearing and speech outcomes post-intervention. Speech-related outcomes were superior in Group A (cochlear implant recipients) with a statistically significant P value (<.005), whereas hearing-related outcomes were comparable between the 2 groups. Vertigo and tinnitus symptoms showed greater improvement in Group A compared to the Group B cohort. In cases of progressive hearing loss, early and appropriate intervention is crucial to preserve residual hearing. Cochlear implantation is effective in improving both audiological and speech outcomes, and it also alleviates symptoms such as tinnitus and vertigo. Conversely, stapedotomy combined with hearing aid use remains a cost-effective management option, providing comparable audiological outcomes.",
"42345421": "ID: 42345421\nTitle: Intravestibular Lipoma with Intracochlear Extension: A Case Report on Surgical Management and Cochlear Implantation.\nAbstract: Intracochlear and intravestibular lipomas are rare benign lesions that may clinically and radiologically mimic retrocochlear pathologies such as vestibular schwannomas. They typically present with progressive sensorineural hearing loss, tinnitus, or dizziness. Due to their rarity, optimal management strategies, particularly in pediatric patients, remain challenging and require individualized decision-making. We report the case of an 8-year-old girl who presented with progressive right-sided sensorineural hearing loss. Magnetic resonance imaging (MRI) revealed an intravestibular lipoma extending into the cochlea. Considering the patient's young age and the potential for tumor growth, surgical excision was performed via a translabyrinthine approach. Simultaneous cochlear implantation was undertaken to facilitate auditory rehabilitation. Histopathological analysis was conducted to confirm the diagnosis. Histopathological examination confirmed the lesion as a lipoma. The postoperative course was uneventful. The cochlear implant was successfully activated and provided effective hearing restoration. Intravestibular lipomas are rare entities that require careful radiological evaluation to ensure accurate diagnosis and differentiation from other retrocochlear lesions. Management should be individualized, particularly in pediatric patients, balancing surgical risks against the benefits of tumor removal and hearing rehabilitation. Simultaneous cochlear implantation may represent a viable strategy for auditory restoration in selected cases.",
"42345427": "ID: 42345427\nTitle: Cluster Analysis of Clinical Characteristics, Sleep Quality, Depression and Melatonin Levels in Patients with Idiopathic Subjective Tinnitus.\nAbstract: Since the relationship between tinnitus and quality of sleep is still a subject of research, serum melatonin levels may have a role. The aim was to reveal the structural similarities or dissimilarities regarding clinical features, tinnitus-related quality of life (QoL) effects, serum melatonin levels, and sleep quality in patients who have unilateral idiopathic subjective tinnitus. A total of 83 cases (46 males, 55.4%; 37 females, 44.6%), with a median age of 51 (range: 18-73) years, were included in the study. Cluster analysis was used to analyze demographic, laboratory, clinical, and sleep-related features of the whole sample in a multivariate manner. Two separate sets of clusters were organized. In Cluster-2, age was older, serum melatonin levels were lower, tinnitus pitch and loudness were higher, and duration was longer; air-conduction pure tone averages were higher, Visual Analog Scale, Tinnitus Handicap Inventory, Beck Depression Inventory, and Pittsburgh Sleep Quality Index scores were also significantly higher than Cluster-1. A stronger correlation was observed between poor sleep quality and depression in Cluster-2. However, in Cluster-1 with younger cases, the negative correlation between tinnitus loudness and serum melatonin values was found to be higher. The older-aged patients with lower serum melatonin levels have more severe tinnitus, worse QoL, and sleep problems compared to the younger patients. Among younger individuals, the more pronounced correlations between hearing levels, tinnitus loudness, sleep quality, and serum melatonin levels indicate that this group may particularly benefit from melatonin as a potential therapeutic option for tinnitus as well.",
"42345629": "ID: 42345629\nTitle: Domain-Specific Associations Between Physical Activity and Tinnitus in NHANES 2015-2018.\nAbstract: Tinnitus is a prevalent auditory condition associated with significant psychological burden and limited treatment efficacy. While physical activity confers broad health benefits, its relationship with tinnitus remains understudied. This study examined associations between domain-specific physical activity and tinnitus in a nationally representative sample of U.S. adults. Data from NHANES 2015-2018 were analyzed. The final analytic sample comprised 4301 adults aged 20 years and older. Tinnitus was assessed via the NHANES audiometry questionnaire. Physical activity was categorized as low, moderate, and high (MET-min/week) separately for work-related (WORK) and non-work-related (NW) domains. Survey-weighted multivariable logistic regression models, adjusted for age, sex, race, BMI, poverty-income ratio, sedentary time, smoking, education, noise exposure, hypertension, diabetes, and depressive symptoms, were used to examine associations. Linear trends across ordered physical activity categories were evaluated using ordinal trend analyses. The weighted prevalence of tinnitus was 17.3%. High NW physical activity (PA) was associated with significantly lower odds of tinnitus (OR = 0.70, 95% CI: 0.488-0.995, p = 0.0475), while high WORK PA was associated with significantly higher odds (OR = 1.30, 95% CI: 1.06-1.60, p = 0.018). Trend analyses confirmed opposing linear trends across ordered categories: inverse for NW PA (OR = 0.83 per category, p-trend = 0.0406) and positive for WORK PA (OR = 1.14 per category, p-trend = 0.017). Noise exposure and depressive symptoms were independently associated with tinnitus across both models. These findings suggest a domain-specific paradox: NW PA was associated with lower odds of tinnitus, whereas WORK PA was associated with higher odds. These results highlight the importance of domain-specific assessment and identify recreational activity as a potential modifiable factor warranting further investigation. Given the cross-sectional design, these associations should not be interpreted as causal.",
"42345631": "ID: 42345631\nTitle: Audiologic Assessment and Management of Teprotumumab-Associated Ototoxicity: An Updated Narrative Review.\nAbstract: Introduction: Teprotumumab (Tepezza\u00ae), an insulin-like growth factor-1 receptor (IGF-1R) antagonist, is the first FDA-approved targeted therapy for thyroid eye disease (TED). While effective for reducing proptosis and inflammation, increasing post-marketing evidence has linked teprotumumab to auditory adverse events. IGF-1 signaling is essential for cochlear maintenance and neuroprotection; therefore, systemic IGF-1R inhibition presents a biologically plausible mechanism for ototoxicity. Despite growing recognition of these effects, no standardized approach exists for audiologic assessment or monitoring of patients receiving teprotumumab. This review aimed to (1) summarize proposed mechanisms and the reported spectrum of teprotumumab-related auditory effects, (2) evaluate current methods used to assess and monitor these patients, and (3) identify areas of consensus and ongoing uncertainty. Methods: An updated narrative review of the literature was conducting using PubMed, CINAHL, and Google Scholar using Boolean strings targeting teprotumumab exposure and hearing-related outcomes. Studies from 2022 onward were identified using Boolean search strings targeting teprotumumab exposure and hearing-related outcomes. Peer-reviewed English language studies reporting audiometric findings were eligible for inclusion. Results: Ten studies met inclusion criteria. Reported effects most commonly included bilateral high-frequency SNHL, tinnitus, and aural fullness, typically emerging after three to six infusions. Many cases demonstrated persistent deficits despite drug discontinuation. Baseline audiometric assessment was not uniformly reported across studies, and monitoring protocols varied considerably, with inconsistent incorporation of speech testing and immittance measures. Conclusions: Teprotumumab-associated ototoxicity is increasingly recognized and potentially irreversible. Current evidence is insufficient to guide standardized monitoring. Prospective studies are urgently needed to establish evidence-based audiologic surveillance protocols.",
"42345633": "ID: 42345633\nTitle: Temporal Trends and ICD-11-Mapped Patterns of Otology Research in Saudi Arabia, 1978-2024: A Scoping Review Using Negative Binomial Modelling.\nAbstract: Purpose: This study aimed to map publication trends, topical focus, study designs, and institutional concentration in otology research in Saudi Arabia from 1978 to 2024 to deduce any topical, regional, institutional, or funding disparities in the field of otology in the country. Methods: We conducted a scoping review of studies on human ear diseases in Saudi Arabia, searching PubMed and the Cochrane Library from inception to 31 December 2024. Bibliometric characteristics were charted, topics were mapped to ICD-11 chapters, and temporal trends were modelled using negative binomial regression with a single data-driven breakpoint. Results: Of 2227 records identified, 510 studies were included. Annual output increased by 9.28% (95% CI 7.05-11.55). An inflection occurred around 2017, with slower growth before 2017 (7.2%/year, 95% CI 5.3-9.1) and faster growth from 2018 onward (23.9%/year, 95% CI 18.6-29.4). The institutional affiliation of first authors was concentrated in a small number of organizations, led by King Saud University. Observational studies predominated (441/510), whereas experimental studies were limited (16/510). ICD-11 mapping showed the greatest concentration in \"Ear and mastoid\" (189/510, 37.1%) and \"Factors influencing health status or contact with health services\" (179/510, 35.1%) chapters. Funding was reported in 75 studies. Conclusions: PubMed- and Cochrane-indexed otology and hearing health research output in Saudi Arabia has grown substantially, particularly since 2017, but remains concentrated by institution, region, study design, and topic. The dominance of cochlear implant and hearing impairment research, together with limited multicenter, experimental, vestibular, tinnitus, and rehabilitation-focused studies, identifies priorities for future audiology and neurotology research planning.",
"42346194": "ID: 42346194\nTitle: Ultrasound-Guided Intra-Articular Infiltration of Hyaluronic Acid, Lidocaine, and Methylprednisolone in Patients with Temporomandibular Disorders (TMD): A Preliminary Pilot Case Series.\nAbstract: This preliminary pilot case series aims to evaluate the feasibility and temporal evolution of pain and function following an ultrasound-guided infiltration technique with hyaluronic acid and methylprednisolone in a specific patient population with Temporomandibular Disorders (TMD) characterized by MRI-confirmed retrodiscal tissue hyperemia. Given the absence of a control group, this study represents a preliminary exploration of a clinical approach utilizing individualized interocclusal devices during infiltration. Twenty-eight patients (16 females, 12 males) with TMD and MRI evidence of retrodiscal tissue hyperemia were enrolled in this prospective, uncontrolled study. A unique protocol was employed, utilizing individualized interocclusal devices to optimize joint space access during bilateral ultrasound-guided infiltration of a mixture containing low-molecular-weight hyaluronic acid, lidocaine, and methylprednisolone acetate. Pain intensity (VAS 0-100 mm) and associated symptoms (tinnitus, vertigo, headache, joint clicking) were assessed at baseline and at 30, 60, and 90 days' follow-up. A statistically significant temporal reduction in pain was observed at all follow-up points (p < 0.001), with the mean VAS score decreasing from 70.5 \u00b1 11.4 mm at baseline to 43.0 \u00b1 11.1 mm at 90 days. Joint clicking disappeared in 80% of patients immediately after treatment. The ultrasound-guided infiltration technique, combined with personalized interocclusal support, demonstrated preliminary feasibility and short-term temporal improvement in pain and joint clicking in this specific patient cohort. Due to the lack of a control group and the multimodal nature of the intervention, these findings should be considered preliminary and do not allow for causal inferences regarding the efficacy of individual components.",
"42349502": "ID: 42349502\nTitle: Audiometric evaluation and quality-of-life in OSIA users - a retrospective monocentric study.\nAbstract: The piezoelectric OSIA is a well-established active transcutaneous bone anchored hearing system. The study retrospectively evaluates hearing results and subjective benefits in patients provided with the OSIA system at our clinic, and separately also looks at patients with moderate to severe mixed hearing loss. 21 patients between 9 and 83 years of age were planned for OSIA implantation between 2022 and 2024. They underwent preoperative (k0) and at 3 months (k1) and at 6 months (k2) with OSIA audiometric testing as well as answered quality of life questionnaires. The k0 PTA4 air-conduction threshold was 68.2 dB (\u00b1 16.7). The PTA4-free field pure tone audiogram with the OSIA system at k1 was 32.0 dB (\u00b1 14.1). The gain is a substantial 36.2 dB. Freiburg monosyllables speech understandig at 65 dB in quiet with the OSIA at k1 was 16.4% better than the k0 performance with the BAHA 6 Max. Postoperative monosyllables performance at 65 dB was statistically better with OSIA versus without. There was a significant negative correlation between pre- versus postoperative APHAB and NCIQ answers (corr.-coeff. -0.87). Postoperative tinnitus results correlated with APHAB and NCIQ answers (corr.-coeff. 0.72 and -0.81 respectively). Overall, we observed a significant improvement in hearing thresholds, speech understanding performance and in subjective quality of life in patients with OSIA. Also in the subgroup with moderate to severe mixed hearing loss we observed a steady improvement of speech understanding over time and a good subjective quality of life and satisfaction with the system. Das piezoelektrische OSIA ist ein etabliertes aktives transkutanes Knochenleitungsh\u00f6rsystem. Die Studie analysiert retrospektiv die H\u00f6rergebnisse und den subjektiven Gewinn durch die Versorgung mit OSIA bei den in unserer Klinik implantierten Personen und betrachtet gesondert die Patienten mit mittel- und hochgradiger kombinierter Schwerh\u00f6rigkeit.21 Patienten im Alter zwischen 9 und 83 Jahren wurden zwischen 2022 und 2024 f\u00fcr eine OSIA-Implantation vorgesehen. Pr\u00e4operativ (k0) sowie nach 3 (k1) und 6 Monaten (k2) mit OSIA wurden H\u00f6rtests und Lebensqualit\u00e4tsbefragungen durchgef\u00fchrt.Die k0-PTA4-Luftleitungsschwelle betrug 68,2dB (\u00b116,7). Die PTA4-Freifeldh\u00f6rschwelle mit OSIA zu k1 betrug 32,0dB (\u00b114,1). Der Gewinn ist substanzielle 36,2dB. Das Freiburger Einsilberverstehen in Ruhe bei 65dB mit dem OSIA zu k1 war um 16,4% besser als die k0-H\u00f6rleistung mit dem BAHA 6 Max. Die postoperative Freiburger-Einsilbertest-H\u00f6rleistung bei 65dB war statistisch signifikant besser mit OSIA als ohne. Es wurde eine signifikante negative Korrelation zwischen pr\u00e4- und postoperativen APHAB- und NCIQ-Antworten festgestellt (Korrelationskoeffizient \u20130,87). Die postoperativen Tinnitusresultate korrelierten mit den APHAB- und den NCIQ-Ergebnissen (Korrelationskoeffizient 0,72 bzw. \u20130,81).Insgesamt konnten wir eine signifikante Verbesserung der H\u00f6rschwellen, des Sprachverstehens und der subjektiven Lebensqualit\u00e4t bei den mit OSIA implantierten Patienten feststellen. Auch in der Untergruppe der mittel- bis hochgradig kombiniert schwerh\u00f6rigen Patienten wurden im zeitlichen Verlauf eine stetige Verbesserung des Sprachverstehens und eine gute Lebensqualit\u00e4t und hohe Zufriedenheit mit dem System gesehen.",
"42351418": "ID: 42351418\nTitle: Otologic Manifestations of Temporomandibular Disorders.\nAbstract: Background/Objectives: Temporomandibular disorder (TMD) affects a third of the adult population and has been associated with otologic symptoms. These symptoms are frequently misattributed to primary otologic diseases, leading to delays in diagnosis and treatment. This review aims to summarize the reported prevalence, proposed pathophysiologic mechanisms, and management strategies of otologic manifestations in patients with TMD. Methods: A literature review was conducted using the MeSH terms \"temporomandibular joint disease\" and \"otologic symptoms.\" Five additional searches were performed using \"temporomandibular disease/dysfunction\" combined with each of the five most common otologic symptoms. Meta-analyses, randomized controlled trials, reviews, and systematic reviews were prioritized, with preference for studies published within the last 10 years. Inclusion criteria focused on human studies addressing the etiology, clinical presentation, and management of otologic symptoms in TMD populations. Results: The literature supports an association between TMD and otologic symptoms in the absence of primary ear disease. The most commonly described symptoms were aural fullness, otalgia, tinnitus, vertigo, and hearing loss. Conservative approaches, including occlusal splints, physical therapy, behavioral modification, and pharmacologic therapy, demonstrated partial or complete symptom resolution after management of underlying TMD. Conclusions: The literature demonstrates a consistent association between otologic symptoms and TMD, although the underlying mechanisms remain incompletely understood. While conservative TMD management may improve symptoms, exact mechanisms remain unproven. Clinicians should consider TMD in the differential diagnosis when patients present with unexplained otologic complaints. Further research is necessary to establish causality, confirm the efficacy of management protocols, and improve diagnostic accuracy in this overlapping domain.",
"42352574": "ID: 42352574\nTitle: The Auditory-Visual Stroop Test to Assess Subjects with Tinnitus.\nAbstract: Background/Objectives: In this three-stage study, we aimed to adapt an Auditory-Visual Stroop test (AV-Stroop test) for tinnitus subjects, evaluate the correlation between performance in the conventional Stroop test (C-Stroop test) and the AV-Stroop test; assess the effect of cognitive screening test performance on the AV-Stroop test's results; and apply the AV-Stroop test in participants with tinnitus and controls. Methods: At the First Stage, the AV-Stroop test was adapted using white noise (WN), pure tone (PT), and narrow band (NB) sound stimuli. At the Second Stage, results of the AV-Stroop test, the C-Stroop test, and the Montreal Cognitive Assessment (MOCA) were compared (n = 45). At the Third Stage, the AV-Stroop test was applied to participants with and without tinnitus (n = 70). The tinnitus group was assessed with an additional test track (stimuli matched to tinnitus spectral characteristics, Tinnitus Pitch). Results: We adapted 34 training and evaluation tracks for the AV-Stroop test. AV-Stroop test's results were correlated with C-Stroop test's total task time (WN, p-value = 0.002; NB and PT, p-value < 0.001 comparing C-Stroop word reading task; and WN, NB, and PT, p-value < 0.001 for C-Stroop color naming task), and number of errors (NB, p-value < 0.001 comparing C-Stroop word reading task, and p-value = 0.012 for C-Stroop color naming task). Participants' MOCA scores were not associated with AV-Stroop test performance. Participants with tinnitus required more time and made more errors in the AV-Stroop test. Additionally, the tinnitus group made more errors in the Tinnitus Pitch track. Conclusions: The AV-Stroop test proved to be an accessible, easy-to-administer tool for evaluating attentional and inhibitory control in participants with tinnitus. The stimulus with spectral characteristics similar to tinnitus perception was more effective in assessing top-down executive control in participants with the symptom.",
"42352596": "ID: 42352596\nTitle: Auricular Ultrasonic Vagus Nerve Stimulation: Effectiveness of Blinding and the Occurrence of Adverse Effects in People with Tinnitus.\nAbstract: Background/Objectives: Vagus Nerve Stimulation (VNS) has been suggested as a treatment for tinnitus, but its effect on the condition remains unclear. Ultrasonic Vagus Nerve Stimulation (U-VNS) involves non-invasive stimulation of the auricular branch of the vagus nerve, potentially providing an alternative to traditional VNS. To pre-emptively address some of the methodological challenges of future trials investigating U-VNS, a highly blindable sham device is needed. This study aimed to (1) investigate the effectiveness of blinding of a U-VNS device and (2) record any adverse effects, including any negative effects on tinnitus loudness, alongside their onset and duration. Methods: In this single-blind randomized controlled study, 20 volunteers with chronic tinnitus received two 29 min sessions of true U-VNS followed by sham U-VNS, or vice versa. Sessions were a week apart, and in a randomized order. The effectiveness of blinding and adverse effects, including changes in tinnitus loudness, were measured using self-report questionnaires. Results: James' Blinding Index revealed that blinding was highly effective in both the real U-VNS condition, BI = 0.79, 95% CI (0.61-0.92), and the sham condition, BI = 0.76, 95% CI (0.60-0.89). Adverse effects were uncommon and mild, primarily consisting of sensations on the skin beneath the transducer. For most participants, tinnitus loudness either decreased or stayed the same in both conditions. Conclusions: A high level of blinding was achieved, suggesting that the ZenBud sham device may be suitable as an effective placebo control in future trials. Adverse effects were uncommon and mild. These findings will help inform the design of future clinical trials to evaluate the safety and efficacy of U-VNS.",
"42352653": "ID: 42352653\nTitle: Personalized Music-Embedded Sound Therapy Based on Gating Modulation and Neural Decoupling Reduces Tinnitus Severity.\nAbstract: Background: Tinnitus is a prevalent auditory disorder associated with maladaptive cortical plasticity and aberrant neural synchronization across auditory and non-auditory brain networks. Acoustic desynchronization-based sound therapies, such as coordinated reset neuromodulation, aim to counteract pathological oscillatory patterns but commonly require prolonged daily listening sessions and specialized delivery formats, which may limit their accessibility and practicality in routine clinical settings. To address this limitation, a modified desynchronization protocol embedding therapeutic tones within music was developed to improve tolerability and engagement. This study aimed to evaluate the clinical effects of modified Music-Integrated Desynchronization Sound Therapy (mMIDST) on tinnitus severity in patients with chronic tinnitus. Methods: In this prospective, randomized, controlled, single-blind pilot trial conducted at the Otolaryngology Department of Hospital Cl\u00ednico Universidad de Chile (Santiago, Chile) between July 2024 and July 2025, adults aged 18-75 years with chronic non-pulsatile tinnitus were assigned to receive either mMIDST or an active control intervention consisting of low-frequency stimulation (LFS) embedded within identical music tracks. Participants listened to personalized sound files for one hour daily, five days per week. Tinnitus severity was assessed using the Tinnitus Handicap Inventory (THI), with audiometric evaluations performed at baseline and after one, two, and three months. Between-group differences were analyzed using the Mann-Whitney U test. Results: Twenty-five participants completed the study (15 mMIDST, 10 LFS). Baseline audiometric thresholds and THI scores were comparable between groups. The mMIDST group showed significantly greater reductions in THI scores than the LFS group at two and three months of treatment (p < 0.05). Conclusions: mMIDST was associated with time-dependent improvements in tinnitus-related distress compared with an active control condition. Embedding desynchronization-based tonal stimulation within music may represent a promising and well-tolerated non-invasive approach for chronic tinnitus management.",
"42355598": "ID: 42355598\nTitle: An Open Comparative Study on the Effectiveness of Customized and Non-Customized Sound Therapy for Tinnitus Patients.\nAbstract: Objectives: Sound therapy is a common treatment for tinnitus. This study aims to explore the efficacy of non-customized and customized sound therapy for subjective tinnitus. Treatment progress was assessed by comparing changes in monthly scales. The main scales used are the Tinnitus Handicap Inventory, Hospital Anxiety and Depression Scale, and Loudness Visual Analogue Scale. Methods: The subjects of this study were patients with tinnitus who visited outpatient from 2024 to 2025. Total of 732 patients were included (customized group, n = 653; non-customized group, n = 79). Customized sound therapy is tailored to patient's specific tinnitus condition, while non-customized sound consists of soothing natural sounds. The daily treatment duration was 2 h. Treatment assignment was not randomized; patients were free to choose between customized and non-customized sound therapy, which may have introduced a preference bias. Results: The study found that, in both groups of patients, regardless of whether they were treated or not, the severity of tinnitus was positively correlated with the level of anxiety (p < 0.01)/depression (p < 0.01) and the loudness of tinnitus (p < 0.01). Patients with severe tinnitus were more likely to choose customized sound therapy (p < 0.01). THI score for the non-customized group showed a downward trend at 1 and 3 months after treatment (p < 0.01 at 1 and 3 months). HADS-A score also decreased 1 and 3 months after treatment compared to before treatment (p < 0.05 at 1 and 3 months). THI scores for the customized group showed a downward trend at 1, 3, 6, 9, and 12 months after treatment (p < 0.001 at 1 and 3 & 6 and 9 & 12 months). HADS-A/D scores decreased at 1, 3, 6, 9 and 12 months after treatment (p < 0.01 at 1 & 3 & 6 and 9 & 12 months). The efficacy of the customized group was greater than that of the non-customized group 1 month after treatment (\u03c72 = 6.39, p = 0.011). Conclusions: Both sound therapies can alleviate tinnitus severity and reduce anxiety in the short term. Customized sound therapy is superior to non-customized therapy in terms of short-term efficacy. Additionally, customized sound therapy is more effective than non-customized therapy in alleviating tinnitus severity and managing anxiety and depression over a longer period. Therefore, customized sound therapy may be a more effective treatment option for subjective tinnitus. However, it should be emphasized that this was an open study in which patients freely chose between the two therapies, which may have introduced bias. Therefore, these findings are not as well founded as those from a randomized controlled trial, and future RCTs are warranted to verify the observed benefits.",
"42356176": "ID: 42356176\nTitle: Trauma-Associated Tinnitus and Hearing Loss: A Comprehensive Narrative Review of Prevalence, Risk Factors, and Clinical Outcomes.\nAbstract: Background and Objectives: Trauma-associated auditory dysfunction, encompassing tinnitus and hearing loss, represents a frequent yet underrecognized sequela of acoustic overexposure, blast injury, and head trauma. Despite increasing clinical awareness, the published literature exhibits substantial heterogeneity in reported prevalence estimates and recovery outcomes across different injury mechanisms. This narrative review aims to synthesize available evidence on the prevalence, clinical characteristics, recovery patterns, and prognostic factors of tinnitus and hearing loss following traumatic injury, with a particular focus on comparing outcomes across distinct trauma mechanisms and evaluating the impact of early intervention. Materials and Methods: A comprehensive literature search was conducted in PubMed, Embase, Scopus, and Web of Science for studies published between January 2010 and December 2025. The search strategy combined terms related to traumatic injury (e.g., \"acoustic trauma,\" \"blast injury,\" \"traumatic brain injury,\" \"head trauma\") with terms related to auditory dysfunction (e.g., \"tinnitus,\" \"hearing loss,\" \"auditory dysfunction\"). Eligible studies included observational studies (cohort, cross-sectional, case-control) reporting original data on tinnitus and/or hearing loss prevalence, recovery outcomes, or prognostic factors in adult or mixed populations exposed to traumatic injury. A narrative synthesis was organized thematically around the key research questions. Results: The available evidence consistently indicates that tinnitus and hearing loss are frequent consequences of blast injury, acute acoustic trauma, and traumatic brain injury, although reported prevalence estimates vary considerably across studies due to differences in populations, injury mechanisms, and diagnostic criteria. Blast injury is associated with mixed hearing loss (conductive and sensorineural components), while acute acoustic trauma typically causes sensorineural hearing loss, often with a characteristic high-frequency notch. Traumatic brain injury can lead to central auditory processing deficits even when pure-tone thresholds are normal. Recovery is variable and often incomplete; tympanic membrane perforations frequently heal spontaneously, but sensorineural components often persist. Early treatment (within days to two weeks) is associated with better recovery outcomes. Conclusions: Trauma-associated tinnitus and hearing loss are highly prevalent and frequently result in persistent disability. The strong association between early treatment and improved recovery outcomes supports the implementation of prompt audiological evaluation and intervention following traumatic injury. These findings underscore the need for routine audiological screening in at-risk populations and for continued research into preventive strategies, standardised assessment protocols, and optimised treatment regimens.",
"42356922": "ID: 42356922\nTitle: Comprehensive Review of Nystagmus and Vertigo Diagnostics: From Pathological Foundations to AI-Driven Telemedicine.\nAbstract: Nystagmus, the involuntary rhythmic oscillation of the eyes, is a critical diagnostic marker in vestibular medicine, distinguishing life-threatening central disorders such as stroke from benign peripheral conditions including Benign Paroxysmal Positional Vertigo (BPPV). Despite its clinical importance, accurate nystagmus assessment has long been constrained by expensive infrared video-oculography equipment such as videonystagmography, specialist dependency, and the episodic nature of vestibular symptoms that are often resolved before a clinical encounter. This review synthesizes approximately 50 papers published between 1952 and 2026 across four thematic domains: AI-driven nystagmus analysis, clinical medicine, smartphone and portable hardware innovations, and telemedicine and remote monitoring. On the AI front, classical machine learning models achieve up to 98.77% nystagmus recognition accuracy using ensemble methods, while deep learning frameworks spanning CNNs, U-Nets, LSTMs, and optical flow networks demonstrate clinical-grade slow-phase velocity measurement equivalent to gold standard video-oculography on standard smartphone RGB video. Large language and vision models including GPT-4V and Gemini 2.0 show early-stage promise as zero-shot triage tools but currently fall well below specialist-level diagnostic accuracy. Concurrently, portable hardware innovations ranging from 3D-printed goggle systems to ARKit-based smartphone applications are narrowing the accessibility gap, while telemedicine frameworks enable ictal recording and cloud-based specialist review outside the clinic. Across all domains, the common barriers to clinical translation are dataset scarcity for rare BPPV subtypes, sensitivity to ambient conditions, and the absence of explainable AI mechanisms. This review maps the current state of the field and identifies multimodal data fusion, prospective clinical validation, and interpretable AI as the critical next steps toward equitable, specialist independent vestibular diagnostics.",
"42363722": "ID: 42363722\nTitle: Evidence for a Transient State of Auditory Hypersensitivity During Initial Onset of Tinnitus: IDAEP Changes Between Acute and Chronic Tinnitus.\nAbstract: Once persistent for around a month, tinnitus typically persists permanently. This transition from acute to chronic tinnitus is thought to reflect dynamic neurophysiological changes and plasticity within central auditory and non-auditory networks, but empirical evidence has been lacking. We hypothesized that, bottom-up neural mechanisms linked to tinnitus initiation, such as central gain and neural synchrony, are maximal around the time of its initiation, but subsequently return towards baseline as central plastic changes develop. We evaluated part of this hypothesis by measuring central auditory reactivity through the Intensity Dependence of Auditory Evoked Potential (IDAEP), a non-invasive index of higher-order inhibitory processing within the auditory system. A steeper IDAEP slope is associated with heightened sensory reactivity (higher sensitivity to changes in auditory stimuli), indicative of reduced central inhibition, whereas a shallower slope reflects greater inhibitory control. Studying a group with acute tinnitus (onset within past six weeks), with a repeated assessment after six months from onset, we found a significant longitudinal reduction in the IDAEP slope following initial tinnitus onset, and non-significantly higher IDAEP slope in Acute and Chronic tinnitus groups compared to matched controls. These findings support our hypothesis, indicating that IDAEP may serve as an objective marker of auditory reactivity for characterising the time course of certain tinnitus mechanisms.",
"42363966": "ID: 42363966\nTitle: Temporal bone remodeling after venous stenting for pulsatile tinnitus: isolated dehiscence versus diverticulum.\nAbstract: To evaluate clinical outcomes and temporal bone remodeling after venous sinus\u00a0stenting for pulsatile tinnitus (PT), and to compare remodeling rates between isolated sigmoid sinus wall dehiscence (SSWD) and diverticulum-associated SSWD. This retrospective cohort study included 70 consecutive patients who underwent venous sinus\u00a0stenting for PT. Clinical success was defined as symptom improvement or complete resolution. The primary endpoints were short-term clinical success (at 3 months) and temporal bone remodeling on follow-up CT (n\u2009=\u200952). Long-term clinical success was evaluated as a secondary endpoint. Multivariable logistic regression, adjusted for age, sex, dehiscence size, diverticulum presence, and preoperative Tinnitus Handicap Inventory (THI) score, was used to identify predictors of temporal bone\u00a0remodeling. Short-term clinical success was achieved in 65/70 patients (92.9%). Remodeling occurred in 38/52 patients (73.1%) with follow\u2011up CT. Remodeling rates were significantly higher in patients with a diverticulum versus isolated SSWD (85.7% (30/35) vs 47.1% (8/17); adjusted OR, 8.08; 95% CI: 1.31-49.73; p\u2009=\u20090.024). Older age independently predicted temporal bone\u00a0remodeling (adjusted OR per year, 1.14; 95% CI: 1.03-1.26; p\u2009=\u20090.012). Long-term clinical success was observed in 97.4% (37/38) of remodeled patients and 85.7% (12/14) of non-remodeled patients (p\u2009=\u20090.15). Venous sinus\u00a0stenting for PT results in a high rate of clinical success. The presence of a diverticulum strongly predicts subsequent temporal bone remodeling, whereas SSWD appears less likely to remodel, highlighting potential pathophysiological differences between these anatomical subtypes. Question Venous sinus\u00a0stenting for pulsatile tinnitus results in high clinical success, but temporal bone remodeling differs by anatomical subtype. Findings Patients with a sigmoid sinus diverticulum demonstrate significantly higher rates of postoperative bone remodeling compared to those with isolated dehiscence. Clinical relevance Identifying the specific anatomical anomaly may help to predict temporal bone remodeling and facilitate individualized patient counseling regarding long-term structural outcomes.",
"42365397": "ID: 42365397\nTitle: Tonotopically distinct OFF responses arise in the mouse auditory midbrain following sideband suppression.\nAbstract: The parsing of sensory information into discrete topographic domains is a fundamental principle of sensory processing. In the auditory cortex, these domains evolve during a stimulus, with the onset and offset of tones evoking distinct spatial patterns of neural activity. However, it is not known where in the auditory system this spatial segregation occurs or how these dynamics are affected by hearing loss. Using widefield single photon neuronal Ca2+ imaging in the inferior colliculus (IC) of awake mice, we found that pure tone stimuli elicited both spatially constrained neural activity within isofrequency bands and simultaneous sideband suppression. At cessation of the stimulus, offset responses emerged within the region of sideband suppression, demonstrating that simple stimuli elicit spatiotemporally distinct neural activity patterns to represent the presence of sound and sound termination. Because sound frequency is spatially encoded in the IC, this spatial shift creates a tonotopically distinct offset (tdOFF) response relative to sound onset. High-resolution two-photon Ca2+ imaging confirmed that tdOFF neuron activity in the sideband region was suppressed during sound and elevated above baseline after stimulus termination, raising the possibility that rebound excitation could contribute to this post-stimulus activation. Loud noise exposure - a common model of hearing loss - abolished both sideband suppression and tdOFF responses. These results show that hearing loss profoundly reshapes the spatiotemporal pattern of sound processing by altering sideband activity. This preferential loss of sideband suppression and tdOFF activation after sound-induced injury in the auditory midbrain may contribute to hyperacusis and tinnitus by promoting neuronal hyperactivity. KEY POINTS: Sensory systems encode different features of stimuli by activating distinct neural networks. Sound onsets and offsets elicit distinct neural patterns in the auditory cortex, although it is unclear where this separation originates or how it may change with hearing loss. Using in vivo widefield Ca2+ imaging in awake mice, we find that pure tone stimuli evoke spatiotemporally distinct on and off patterns of neural activity in the auditory midbrain. Neurons active during stimulus offset were suppressed by sound in sideband regions, raising the possibility that rebound excitation may contribute to this post-stimulus activation. Both sideband suppression and off responses were preferentially abolished following noise-induced hearing loss, raising the possibility that these changes may contribute to hearing loss-related syndromes such as tinnitus and hyperacusis.",
"42369362": "ID: 42369362\nTitle: Resting-state functional connectivity and local activity differences across bothersome and non-bothersome tinnitus phenotypes.\nAbstract: This study aimed to characterize resting-state functional differences across clinically defined bothersome tinnitus, non-bothersome tinnitus, and hospital-based non-tinnitus control groups, focusing on imaging differences related to tinnitus phenotype. This case-control study included 61 patients with bothersome tinnitus (BT), 52 with non-bothersome tinnitus (NBT), and 50 hospital-based non-tinnitus controls. Resting-state fMRI scans were acquired, and the data were analyzed using fractional amplitude of low-frequency fluctuations (fALFF), regional homogeneity (ReHo), and seed-based functional connectivity (FC) using broad bilateral temporal lobe regions of interest to assess temporal-related network connectivity, including temporal-limbic interactions. Group comparisons were performed using ANCOVA controlling for demographic, audiological, physiological, sleep-related, and emotional covariates, cluster-level FDR-corrected p <\u202f0.05. Exploratory correlation analyses were further conducted to examine associations between extracted imaging indices and clinical measures, as well as potential relationships among significant imaging findings. Resting-state fMRI revealed significant group differences in functional connectivity between the bilateral temporal lobe seed and the left ACC/mOFC cluster. Post hoc analyses showed stronger connectivity in BT than in NBT, whereas BT did not differ significantly from hospital-based non-tinnitus controls. A similar pattern was observed for ReHo in the medial superior frontal gyrus, with lower values in NBT than in both BT and controls. fALFF analyses showed region-specific differences across temporal, frontal, insular, occipital, supramarginal, and postcentral regions, with the most consistent differences observed between BT and NBT. Exploratory analyses showed no significant FC-ReHo correlation within the BT group, and no associations between imaging indices and clinical or audiological measures survived FDR correction. In sensitivity analyses retaining the original covariate structure and additionally adjusting for tinnitus loudness VAS, most BT-NBT differences were attenuated, suggesting that these imaging differences may partly reflect tinnitus loudness or related clinical burden. Resting-state FC, fALFF, and ReHo measures revealed phenotype-related functional differences between BT and NBT. Because several key measures did not differ between BT and hospital-based non-tinnitus controls, these findings should be interpreted as group-level imaging features across tinnitus phenotypes, not as BT-specific abnormalities.",
"42370207": "ID: 42370207\nTitle: Transarterial Embolization via the Occipital Artery for a Posterior Condylar Canal Dural Arteriovenous Fistula Following Head Trauma.\nAbstract: Posterior condylar canal dural arteriovenous fistula is rare, and cases of posterior condylar canal dural arteriovenous fistula directly related to trauma have been reported even less frequently. We describe a case of posterior condylar canal dural arteriovenous fistula that presented with tinnitus soon after head trauma and was successfully treated with transarterial embolization. A 60-year-old man presented with right-sided tinnitus that had persisted for 2 weeks after sustaining a right temporal injury. Digital subtraction angiography revealed a posterior condylar canal dural arteriovenous fistula with venous drainage from the posterior condylar vein to the suboccipital cavernous sinus, without cortical venous reflux. The shunt was supplied by a single feeder, the jugular branch of the occipital artery. Transarterial embolization using N-butyl cyanoacrylate and coils achieved complete occlusion of the shunt. The patient's tinnitus resolved immediately after the procedure, and follow-up angiography demonstrated persistent complete occlusion of the fistula, with no evidence of recurrence. Posterior condylar canal dural arteriovenous fistula is a rare lesion that may occur following head trauma. Bone-window three-dimensional angiographic reconstruction is useful for diagnosis, as it clearly delineates the relationship between the skull base canal and the shunt. Transarterial embolization can be a curative treatment option when performed with a thorough understanding of the relevant vascular anatomy and potentially hazardous anastomoses.",
"42370660": "ID: 42370660\nTitle: Unusual Case of Granulomatosis with Polyangiitis Complicated with Hormographilella aspergillata Skin Infection.\nAbstract: Granulomatosis with polyangiitis (GPA) is a rare ANCA-associated small-vessel vasculitis that predominantly affects the respiratory tract and kidneys, while cutaneous manifestations occur less frequently. Opportunistic fungal infections complicating GPA are uncommon, particularly involving rare filamentous basidiomycetes. We describe a 32-year-old male with a prolonged history of crusting rhinitis, tinnitus, and progressive nodular and ulcerative skin lesions on the trunk and extremities, accompanied by fever and lower limb edema. Laboratory evaluation revealed elevated inflammatory markers and positive c-ANCA (anti-PR3). Histopathology demonstrated granulomatous inflammation consistent with GPA. The clinical course was complicated by a secondary cutaneous infection caused by Hormographiella aspergillata, isolated from a skin lesion. Initial antifungal therapy with itraconazole was ineffective; subsequent treatment with voriconazole resulted in resolution of the fungal infection. The patient was then successfully treated with systemic immunosuppressive therapy, achieving long-term remission. To our knowledge, this is the first reported case of GPA complicated by a cutaneous infection with H. aspergillata. This case highlights the diagnostic challenges of GPA with atypical skin manifestations and underscores the importance of microbiological evaluation of skin lesions prior to initiating aggressive immunosuppressive therapy. KEYWORDS: granulomatosis with polyangiitis; ANCA-associated vasculitis; Hormographiella aspergillata; opportunistic fungal infection Granulomatosis with polyangiitis (GPA), formerly Wegener's granulomatosis, is a necrotizing granulomatous vasculitis affecting small to medium-sized blood vessels and belonging to the group of ANCA-associated vasculitides (AAV) (1). The disease is characterized by granulomatous inflammation, necrotizing vasculitis, and the presence of antineutrophil cytoplasmic antibodies, most commonly proteinase-3 ANCA (PR3-ANCA) (2). GPA may involve virtually any organ system, with predominant involvement of the upper and lower respiratory tract and kidneys (3). Cutaneous manifestations are reported in approximately 30-50% of patients and are usually associated with systemic disease activity (4). Opportunistic infections may complicate the course of GPA, particularly in the context of delayed diagnosis or immunosuppressive therapy. Infections caused by rare filamentous fungi such as Hormographiella (H) aspergillata are exceptionally rare and have predominantly been reported in immunocompromised patients with hematological malignancies (5, 6). A 32-year-old male was admitted with multiple painful ulcerations and nodules on the trunk and extremities, accompanied by high fever and marked bilateral lower limb edema. Four months before admission, nodular lesions on the left auricle and right nipple regressed spontaneously after purulent discharge. Six weeks prior to referral, painless nodules on the back and right upper arm were surgically incised and treated with antibiotics, followed by clinical deterioration with fever, progressive ulcerations, and painful swelling of the feet and ankles (figures 1a and !b). The patient had a two-year history of nasal obstruction, crusting rhinitis, and intermittent right-sided tinnitus. Rhinoscopy revealed mucosal thickening and septal perforation with crusts and synechiae. Dermatological examination showed deep ulcerations with yellow-brown crusts on the back, right upper arm, and left cheek (figures 1a and 1b). Laboratory evaluation demonstrated elevated inflammatory markers (ESR 76 mm/h, CRP 47.4 mg/L), hypoalbuminemia, and positive c-ANCA (anti-PR3). Initial microbiological cultures were sterile. Histopathology revealed granulomatous panniculitis with abscess formation. Fungal culture isolated H. aspergillata. Itraconazole therapy was ineffective; subsequent voriconazole treatment led to complete resolution of the cutaneous infection. Due to persistent systemic inflammation and c-ANCA positivity, the patient was treated with high-dose glucocorticoids and cyclophosphamide, which gradually led to completely remission of skin lesions (figure 2). Renal involvement developed during treatment, manifested as proteinuria. Long-term immunosuppressive therapy resulted in sustained remission with mild residual renal impairment. GPA is a rare multisystem autoimmune disease with heterogeneous clinical presentation, often leading to delayed diagnosis. Cutaneous involvement may be the initial manifestation and includes purpura, nodules, necrosis, and ulcerations, reflecting underlying vasculitis and granulomatous processes (2). In our patient, prominent skin lesions preceded the diagnosis by several months and contributed to diagnostic uncertainty. Opportunistic infections are a recognized complication in GPA, particularly following immunosuppression; however, fungal infections caused by filamentous basidiomycetes are exceedingly rare (5, 6). Hormographiella aspergillata, the anamorphic form of Coprinopsis cinerea, is an environmental fungus that has been implicated almost exclusively in invasive infections in patients with hematological malignancies, with reported mortality rates up to 70% (5, 6). To our knowledge, no previous case of GPA complicated by cutaneous infection with H. aspergillata has been reported. The present case underscores the importance of thorough microbiological evaluation of atypical or non-healing skin lesions in patients with suspected systemic vasculitis, particularly before initiation of intensive immunosuppressive therapy. Failure to recognize opportunistic infections may lead to significant morbidity and mortality. This case emphasizes the crucial role of dermatologists in the early recognition of systemic vasculitis presenting with skin manifestations. Comprehensive clinical, histological, and microbiological assessment is essential to establish the correct diagnosis and to identify rare infectious complications. Multidisciplinary management and careful monitoring are necessary to achieve long-term remission and to minimize treatment-related complications.",
"42371148": "ID: 42371148\nTitle: Migraine and auditory dysfunction: beyond comorbidity.\nAbstract: Migraine operates as a systemic disorder of multisensory sensitization. Within this spectrum, auditory manifestations, including sensorineural hearing loss, tinnitus, and hyperacusis, represent prevalent yet frequently overlooked otologic phenotypes. Epidemiological data show that 15%-49% of migraine patients present with comorbid auditory symptoms, and nearly two-thirds exhibit auditory electrophysiological abnormalities. However, optimal clinical management remains constrained by an incomplete understanding of pathogenic mechanisms, variable audiological assessment protocols, and dispersed therapeutic data. This review synthesizes epidemiological, audiological, and pathophysiological data linking migraine to auditory dysfunction. The underlying pathology involves a peripheral-to-central continuum across three interacting axes. Anatomical and hydrodynamic vulnerabilities drive localized microvascular ischemia and aberrant brain-ear fluid exchange. Localized neurochemical imbalances, involving glutamate excitotoxicity, neuropeptide signaling, and innate immune activation, disrupt inner ear homeostasis. Concurrently, central sensitization facilitates neural network plasticity, characterized by impaired efferent gating and thalamocortical dysrhythmia. Drawing upon these underlying pathways, current and emerging therapeutic strategies are categorized by specific clinical objectives: blocking upstream migraine pathways, protecting the cochlear microenvironment, and correcting central hypersensitivity. This framework aims to catalyze future translational research to rigorously validate these mechanistic links, promote early identification, precise clinical phenotyping, and cross-disciplinary management of affected patients.",
"42372279": "ID: 42372279\nTitle: Adverse Events After Same-Day COVID-19 and Influenza Vaccination Versus Influenza Vaccination Alone : A Target Trial Emulation.\nAbstract: Safety studies of the COVID-19 vaccine have identified some adverse events. Yet newer variant-updated formulations, along with increased hybrid immunity, may change these risks. Early-era safety data may not reflect experience with updated formulations in more immune-experienced populations. To evaluate 90-day risks for adverse events after coadministration of COVID-19 and influenza vaccines compared with influenza vaccination alone, across bivalent, XBB-adapted, and KP-adapted COVID-19 vaccine periods. Target trial emulation using electronic health care data. U.S. Department of Veterans Affairs. Participants receiving both COVID-19 and seasonal influenza vaccines (n\u2009=\u2009705\u2009124) and those receiving only an influenza vaccine (n\u2009=\u20091\u2009813\u2009205) between 1 September 2022 and 26 August 2025. Receipt of both COVID-19 and seasonal influenza vaccines versus receipt of only an influenza vaccine. 90-day risks for 46 prespecified individual adverse events grouped into 3 composite outcomes (tier 1, serious or life-threatening; tier 2, clinically significant; tier 3, less severe or self-limiting), using weighted discrete-time survival models. For all 3 composite outcomes, risks were similar between groups: tier 1 (risk ratio [RR], 1.03 [95% CI, 0.99 to 1.09]), tier 2 (RR, 0.99 [CI, 0.96 to 1.03]), and tier 3 (RR, 0.99 [CI, 0.96 to 1.02]). Of the 46 individual adverse events, 2 tier-3 risks had nominal statistical significance: syncope (RR, 1.09 [CI, 1.02 to 1.17]) and tinnitus (RR, 0.95 [CI, 0.92 to 0.99]); no risks were statistically significant after correcting for multiple comparisons. For all risks in tier 1 or tier 2, confidence bounds included 1.0 (no effect). In period-stratified analyses, neither composite (tier) nor individual event estimates supported differences in risks between groups. Generalizability and potential unmeasured confounding. Same-day coadministration of COVID-19 and influenza vaccines was not associated with an increased risk for adverse events in 3 updated-formulation periods. These findings support the short-term safety of coadministration. U.S. Department of Veterans Affairs.",
"42373579": "ID: 42373579\nTitle: Presenting Complaint and Diagnostic Yield of MRIs for Vestibular Schwannomas.\nAbstract: To ascertain the diagnostic yield of MRIs to diagnose vestibular schwannoma based on the patient's presenting symptoms and age. A retrospective cohort study at a single centre. All MRIs ordered by otolaryngologists from 01/01/2022 to 31/12/2023 for the purpose of diagnosing a vestibular schwannoma were included. Data on presenting symptoms, audiogram results, demographics and management outcomes were extracted from clinical records. 1814 MRIs were included. The overall diagnostic yield of vestibular schwannomas was 1.65% (30 cases). Mild asymmetrical sensorineural hearing loss alone (defined as <\u200915 dB difference between ears at two consecutive frequencies) was not associated with vestibular schwannoma; no patients with this finding were diagnosed (p\u2009=\u20090.025). On multivariate analysis, vertigo (odds ratio [OR] 4.03, p\u2009<\u20090.001) and severe asymmetrical sensorineural hearing loss (OR 5.26, p\u2009=\u20090.002) were independently associated with a diagnosis. Unilateral tinnitus (OR 2.10, p\u2009=\u20090.062), sudden onset asymmetrical hearing loss (OR 0.57, p\u2009=\u20090.46), mild asymmetrical hearing loss (OR 1.03, p\u2009=\u20090.98), or age (OR 0.74, p\u2009=\u20090.48) were not significantly associated with a vestibular schwannoma. Incidental findings were common (23%) and most patients (80%) were managed conservatively with serial MRIs. There was no correlation between age and likelihood of diagnosis. The diagnostic yield of MRIs for vestibular schwannomas is low. Patients with isolated mild asymmetrical hearing loss alone may not warrant further investigation. Presenting with unilateral tinnitus was a poor discriminator for a diagnosis of vestibular schwannomas. However, patients with unexplained vertigo should be considered for an MRI. Further research is needed to refine current guidelines.",
"42374873": "ID: 42374873\nTitle: Symptom Overlap and Neurobiological Similarities Between Posttraumatic Stress Disorder and Tinnitus.\nAbstract: Many symptoms of posttraumatic stress disorder (PTSD) overlap with the psychological sequelae of tinnitus, including sleep difficulty, concentration problems, hypervigilance, and irritability. Although these two disorders are clearly distinct, they are highly comorbid, may have shared etiology, and are among the top service-connected disabilities within the VA healthcare system. This study aimed to determine neuropathophysiological similarities and differences among veterans with both PTSD and tinnitus, tinnitus only, and healthy controls. Resting-state networks were identified by previous studies and extracted to examine functional connectivity patterns. Networks included the default mode network (DMN), auditory vigilance (AUDVIG), salience (SN), dorsal attention (DAN), and emotion (EMO) networks. Functional connectivity among specific brain regions was decreased among the tinnitus only group compared to the healthy control group and was further decreased when PTSD was present with tinnitus. Findings suggest that the additive and negative effects observed symptomatically may be explained by decreased functional connectivity, especially with respect to the DMN and AUDVIG networks.",
"42377247": "ID: 42377247\nTitle: Carotid-cavernous Fistula in a Patient with Minimal Head and Facial Trauma: A Case Report.\nAbstract: Intracranial arterial injury is typically associated with high-energy trauma. Early diagnosis and treatment are essential for improving the patient's functional prognosis. A 76-year-old woman complained of pulsatile tinnitus 15 days post motor vehicle collision. On presentation she was found to have sustained polytrauma, mostly to her abdominal and thoracic regions, as well as a facial contusion. She then developed ptosis, conjunctival congestion, and an ocular motility disorder in all directions in her right eye. Magnetic resonance angiography showed a direct high-flow shunt from the internal carotid artery to the cavernous sinus. Similar symptoms then developed on her left side. She underwent successful embolization to the left-sided fistula. Fistulization of the carotid with the cavernous sinus is a rare complication of head or facial trauma. Our case indicates that this can occur even in patients with seemingly minor head or facial trauma.",
"42378538": "ID: 42378538\nTitle: Round Window Reinforcement for Semicircular Canal Dehiscence Syndrome.\nAbstract: To evaluate the clinical outcomes and safety profile of round window reinforcement (RWR) as a minimally invasive surgical treatment for patients with semicircular canal dehiscence syndrome (SCDS). This retrospective case series analyzed 7 patients (mean age: 59 years) diagnosed with SCDS who underwent transcanal RWR between June 2024 and June 2025 at the Kopfzentrum Bielefeld. Inclusion criteria followed the B\u00e1r\u00e1ny Society consensus diagnostic standards. Clinical symptoms, audiometric findings, and vestibular test results-including Dizziness Handicap Inventory (DHI) scores-were assessed pre and postoperatively. In 2 patients, endolymphatic hydrops was diagnosed via delayed contrast-enhanced magnetic resonance imaging and monitored postoperatively. All patients completed follow-up (mean: 35 months). Improvement in auditory symptoms was observed in 5 of 7 patients (71.4%), including tinnitus relief in 83.3% and hyperacusis relief in 75%. Vertigo improved in 50% of symptomatic cases. No postoperative deterioration in symptoms, DHI score, or hearing was observed. Audiometric outcomes showed a non-significant mean change in air-bone gap (\u00b12.5 dB). No intra- or postoperative complications occurred. In patients with concomitant hydrops, auditory improvement was noted, though vertigo persisted. Round window reinforcement appears to be a safe and effective therapeutic option for selected patients with SCDS, particularly those presenting predominantly auditory symptoms or contraindications to more invasive procedures. Further prospective studies are needed to validate these findings and define the role of RWR in the broader surgical management of third window syndromes.",
"42378541": "ID: 42378541\nTitle: Optimal Head Position Following Intratympanic Injections of Steroids.\nAbstract: Intratympanic drug applications may be performed for a number of reasons, including the treatment of Meniere's disease, sudden hearing loss, and tinnitus. In this study, the aim was to determine the optimal head position for steroid solutions to be absorbed through the round window after intratympanic injections. The authors retrospectively reviewed the best head position where the level of steroid solution reaches the round window area behind the eardrum in video recordings of 20 Meniere's disease patients undergoing intratympanic steroid injections. The patients were positioned in the supine position, with the diseased ear pointing upward. Cotton wool soaked with 10% xylocaine was applied to the eardrum surface. After 2 or 3 swallows with the nose closed, dexamethasone (8.00 mg/2cc) was injected through the anterior quadrant using a syringe with a 25-gauge spinal needle, and the injection was continued until half of the middle ear was filled. Following injection, patients' heads were then tilted backward until the solution covered the round window area under microscopic view. The angle between the midsagittal plane of the head and the horizontal plane was noted when the best level of the solution covering the round window area was achieved. The angleof the midsagittal head plane and horizontal plane for the optimum head position following injection were 90 degrees in 16 of 20 ears and 80 degrees in 4; in supine position. The most appropriate head position for drug delivery after intratympanic injection was determined as the head looking directly upwards in the supine position.",
"42378543": "ID: 42378543\nTitle: Tinnitus Pathophysiology: A Systems Biology Analysis of Gene Networks and Cellular Pathways.\nAbstract: Tinnitus, characterized by phantom sound perception in the absence of external auditory stimuli, affects approximately 10%-15% of the adult population worldwide. Despite its prevalence, the molecular mechanisms underlying tinnitus remain incompletely understood. This study aimed to identify key molecular networks and pathways implicated in tinnitus pathophysiology using a systems biology approach through comprehensive enrichment analysis of tinnitus-associated genes. Tinnitus-associated genes were identified from the DisGeNET database (CUI ID: C0040264) and subsequently analyzed using EnrichR across 7 databases: WikiPathways 2024 Human, GO Biological Process 2025, GO (Gene Ontology) Cellular Component 2025, GO Molecular Function 2025, CellMarker 2024, HMDB (Human Metabolome Database) Metabolites, and TargetScan microRNA 2017. Top results from each database were retained and analyzed to identify significant biological patterns. The analysis revealed significant enrichment of neuroinflammatory pathways, glutamatergic signaling, and ion channel activity, particularly potassium channels. Key inflammatory cytokines including IL-10 (interleukin), IL-1\u03b2, IL-6, and tumor necrosis factor emerged as central molecular players. The results highlighted the involvement of neuronal components including N-methyl-D-aspartate receptors, voltage-gated potassium channels, and cellular structures critical for auditory signal transduction. Metabolite analysis implicated potassium homeostasis and several microRNAs showed potential regulatory roles in tinnitus-related gene networks. This comprehensive analysis suggests tinnitus pathophysiology involves complex interactions between neuroinflammation, excitotoxicity, ion channel dysfunction, and neuronal structural changes, presenting potential targets for therapeutic intervention and biomarker development.",
"42378546": "ID: 42378546\nTitle: Is Zinc Deficiency a Risk Factor for Tinnitus? An Analysis from Chronic Idiopathic Tinnitus Patients with Normal Hearing.\nAbstract: To investigate whether zinc deficiency is associated with tinnitus severity in patients with chronic idiopathic tinnitus and normal hearing. This prospective, cross-sectional study included 107 patients with chronic idiopathic tinnitus and normal hearing selected from 409 patients evaluated at the tinnitus clinic between January 2021 and December 2023. Serum zinc levels, Tinnitus Handicap Inventory (THI) scores, and tinnitus loudness matching tests were assessed. Zinc deficiency was defined as serum zinc <66 \u03bcg/dL. Of 107 patients, 22 (20.6%) had zinc deficiency. Zinc-deficient patients showed significantly higher total THI scores (48.09 \u00b1 25.95 vs. 36.28 \u00b1 21.91, P=.032) and functional component scores (19.09 \u00b1 11.87 vs. 13.13 \u00b1 9.68, P=.016). Correlation analysis revealed negative correlations between continuous serum zinc levels and all THI components, though none reached statistical significance. Objective tinnitus loudness did not differ significantly between groups. Zinc deficiency is associated with greater tinnitus severity in patients with normal hearing, particularly affecting functional aspects of daily life. Screening for zinc deficiency and targeted supplementation might offer a potential therapeutic approach for this specific patient population.",
"42379384": "ID: 42379384\nTitle: A comparative study reveals distinct patterns of resting-state activity in tinnitus and chronic pain.\nAbstract: Tinnitus and chronic pain, as two perceptual disorders frequently accompanied by negative emotions, significantly impair patients' daily functioning and overall well-being. However, the neurophysiological mechanisms that account for their frequently observed clinical similarities have yet to be fully elucidated. The study enrolled a total of 56 participants, including 18 tinnitus patients and 19 chronic pain patients, alongside 19 healthy controls. We computed the fractional amplitude of low-frequency fluctuations (fALFF) and regional homogeneity (ReHo) from resting-state fMRI data to quantify localized brain activity intensity and neural synchronization. Statistical analysis suggested a significant elevation in fALFF within the calcarine cortex of tinnitus patients compared to healthy controls (p\u202f<\u202f0.05, FDR-corrected). In contrast, chronic pain patients exhibited notable increases in both fALFF and ReHo in the inferior frontal gyrus (IFG). Direct comparisons between patient groups suggested that tinnitus patients had higher fALFF in the inferior temporal gyrus (ITG), supplementary motor area and fusiform gyrus, but lower fALFF in the right IFG, precuneus, and caudate nucleus. Regarding ReHo, patients with tinnitus exhibited significantly elevated ReHo values in the supplementary motor area, while demonstrating reduced ReHo in both the precuneus and caudate nucleus (all p\u202f<\u202f0.05, FDR-corrected). The observed differences between tinnitus and chronic pain in brain regions including the prefrontal cortex, ITG, and fusiform gyrus provide neuroimaging correlates associated with the two conditions. These findings may inform future neuromodulation targets and support clinical differential diagnosis.",
"42380788": "ID: 42380788\nTitle: The longer, the better? Investigating the effect of prolonged acoustic stimulation on brief acoustic tinnitus suppression.\nAbstract: Brief acoustic tinnitus suppression following sound stimulation is being studied to better understand the mechanisms underlying tinnitus and short-term suppression of the tinnitus perception. In this context, several kinds of filtered or modulated stimuli have been investigated. However, little research was conducted regarding the effect of stimulation length for brief acoustic tinnitus suppression. The aim of the present study was to compare the extent of tinnitus suppression after a 20-minute and a 3-minute acoustic stimulation with an individual best stimulus. Three experimental sessions were completed by 33 participants with chronic subjective tinnitus. In the first two sessions, eight different individualized, filtered, and/or amplitude-modulated stimuli were presented for 3\u00a0min each. For each participant, the stimulus which induced the strongest tinnitus loudness suppression (measured with a numeric rating scale in percent compared to baseline loudness) was chosen and then applied for 20\u00a0min in a third session. On a group level, no significant difference in tinnitus loudness suppression comparing the 3-minute and the 20-minute acoustic stimulation using the individual best stimulus was observed. However, individual response patterns revealed great diversity as 12 participants showed better suppression after the 20-minute stimulation,12 experienced worse tinnitus suppression and for 9 participants no distinct change was evident compared to 3-minute acoustic stimulation. Future research should try to characterize the subgroup of tinnitus patients that profits from prolonged acoustic stimulation and search for optimized simulation durations. This trial was retrospectively registered on 2026/03/04 at ClinicalTrials.gov (ID: NCT07472257).",
"42382212": "ID: 42382212\nTitle: Interactive Effects of Occupational Hearing Loss and Glutathion S-Transferase M1 Genotype on Tinnitus Among Noise-exposed Steelworkers.\nAbstract: Tinnitus is a known long-term health effect of noise exposure. Whether susceptible genotypes predispose noise-exposed workers to tinnitus remains unclear. This study investigated the interactive effects of noise exposure, auditory function, and glutathione S-transferase (GST) gene polymorphisms on tinnitus risk. We conducted a cross-sectional study among steelworkers. Participants underwent audiological testing to assess hearing levels and were surveyed for tinnitus. Blood samples were genotyped for GSTM1 and GSTT1 deletion polymorphisms using polymerase chain reaction. Multivariable logistic regression was used to evaluate associations between tinnitus and pure-tone audiometry (PTA), distortion product otoacoustic emission (DPOAE), and GST genotypes while controlling for age and other covariates. Among 239 male steelworkers (mean age \u00b1 SD: 48.29 \u00b1 7.6 years), 27% reported tinnitus. Cumulative noise exposure and thresholds at low- and high-frequency PTA were significantly associated with tinnitus (adjusted odds ratio (OR) = 1.03, 1.06, and 1.04, 95% confidence interval (CI) = [1.00,1.06], [1.02,1.11], and [1.02,1.06], p = 0.045, 0.002, <0.001, respectively). Although neither DPOAE nor GSTM1 nor GSTT1 genotypes showed a significant effect on tinnitus, we observed a significant interaction between low-frequency PTA and the GSTM1 genotype (p = 0.03). Specifically, compared with workers with non-null GSTM1 genes, workers with the GSTM1-null genotype were significantly more susceptible to low-frequency PTA-associated tinnitus (OR = 1.02 and 1.13, 95% CI = [0.96,1.08] and [1.06,1.22], respectively). The interactive effect of auditory functional status and antioxidant gene polymorphisms suggests that hair cell damage and oxidative stress in the cochlea both contribute to tinnitus development.",
"42384477": "ID: 42384477\nTitle: Auditory Outcomes After Simultaneous Translabyrinthine Vestibular Schwannoma Resection and Cochlear Implantation: A Prospective Case Series.\nAbstract: Cochlear implantation (CI) has emerged as a potential strategy for auditory rehabilitation in patients undergoing vestibular schwannoma (VS) surgery. However, outcomes remain variable, particularly in patients with neurofibromatosis type 2 (NF2). To evaluate auditory and patient-reported outcomes following simultaneous CI during VS resection. This prospective consecutive case series included six adult patients undergoing simultaneous translabyrinthine VS resection and CI. Three patients had sporadic VS and three had NF2-associated bilateral tumors. Audiological outcomes were assessed preoperatively (T0) and one year after CI activation (T1), including pure-tone average (PTA) and speech perception. Patient-reported outcomes included three questionaries. Auditory perception was achieved in all patients. Postoperative PTA was similar between sporadic and NF2 patients (29.5\u2009dB vs. 31.75\u2009dB). However, speech perception outcomes differed substantially. Sporadic VS patients achieved high performance (monosyllabic 90%, disyllabic 96%, sentence recognition (SR) 100%), whereas NF2 patients showed lower scores (monosyllabic 40.35%, disyllabic 38%, SR 35%). Tinnitus improved in all patients, with complete remission in 66.7% of cases. Simultaneous CI during VS surgery is a feasible rehabilitation strategy in selected patients. Speech perception differed between sporadic and NF2 cases despite similar hearing thresholds, highlighting the importance of cochlear nerve integrity, tumor burden and duration of deafness.",
"42388458": "ID: 42388458\nTitle: Development and Validation of a Nomogram to Identify and Predict High-Distress Psychosocial Phenotypes in Tinnitus Patients: A Latent Profile Analysis.\nAbstract: Evidence is limited on the multidimensional psychosocial heterogeneity among patients with subjective tinnitus, and practical tools for early risk stratification remain largely unexplored. This study aimed to identify distinct psychosocial phenotypes under the biopsychosocial model to pinpoint the high-risk population and to develop and validate a visualized nomogram predicting severe psychological distress for targeted interventions. A total of 534 subjective tinnitus patients were enrolled. Latent profile analysis using seven psychosocial indicators (Self-Rating Anxiety Scale total score, Self-Rating Depression Scale total score, positive life events score, negative life events score, subjective support score, objective support score, and support utilization score) identified distinct patient phenotypes. The \"Severe Anxiety Isolated\" phenotype was defined as the target \"high-distress\" group for the prediction model. Clinical characteristics and tinnitus-related disability were compared across groups. Multivariate logistic regression identified independent predictors of the high-distress phenotype to construct a nomogram, validated via ROC, calibration, and decision curve analysis. Four distinct psychosocial phenotypes were identified via LPA: the Chronic Vulnerable phenotype (18.73%), the Severe Anxiety Isolated phenotype (28.09%, defined as the high-distress high-risk phenotype), the Well Adapted Healthy phenotype (43.82%), and the High Positive Life Events Resilient phenotype (9.18%). The Severe Anxiety Isolated phenotype had significantly higher Tinnitus Handicap Inventory (THI) and Insomnia Severity Index (ISI) scores compared with other phenotypes (all P<0.001). Age group (21-39 years), longer tinnitus duration, concurrent presence of vertigo, bilateral tinnitus, and easily agitated/irritable personality traits were independent risk factors for the high-distress phenotype. The constructed nomogram exhibited good discrimination (AUC=0.756 in the training cohort and 0.737 in the testing cohort), calibration, and clinical utility. Subjective tinnitus patients exhibit profound psychosocial heterogeneity, with the Severe Anxiety Isolated phenotype facing the highest psychological risk. Our developed nomogram accurately predicts this high-risk phenotype using routine outpatient indicators, facilitating early risk stratification and precision biopsychosocial interventions.",
"42388916": "ID: 42388916\nTitle: Intrapetrous Internal Carotid Artery Pseudoaneurysm Secondary to Malignant Otitis Externa: A Case Report.\nAbstract: Malignant otitis externa (MOE) can rarely progress to skull base osteomyelitis (SBO) with catastrophic vascular complications. We describe a 68-year-old man with uncontrolled diabetes (HbA1c 9%) who presented with left otalgia, purulent otorrhea, and hearing loss. Initial workup showed CRP 23 mg/L, leukocytes 8,000/\u00b5L, and ear pus culture positive for Pseudomonas aeruginosa. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated MOE with temporal bone osteomyelitis. Despite prolonged intravenous antibiotics (imipenem, colistin) and topical ofloxacin, symptoms persisted. Three months later, he developed a headache, pulsatile tinnitus, and a pulsatile retro\u2011tympanic mass; MRI and 3D time-of-flight (TOF) angiography revealed progression of SBO with a pseudoaneurysm arising from the intrapetrous segment of the left internal carotid artery and ipsilateral sigmoid sinus septic thrombosis. Digital subtraction angiography was planned for definitive characterization and endovascular management, but the patient deteriorated rapidly and died of overwhelming septic shock before intervention. This case highlights that MOE\u00a0can extend to involve the petrous internal carotid artery (ICA) and produce infected pseudoaneurysms; early vascular imaging [computed tomography angiography (CTA)/ magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) when indicated], aggressive antimicrobial therapy, and prompt multidisciplinary planning for endovascular or surgical intervention are essential to reduce morbidity and mortality.",
"42392687": "ID: 42392687\nTitle: Efficacy and safety of single-fraction radiosurgery in vestibular schwannoma: a 10-year experience.\nAbstract: This study aimed to evaluate long-term tumor control, safety, and prognostic factors following single-fraction stereotactic radiosurgery (SRS) for vestibular schwannoma (VS). In this retrospective single-institution study, 68 patients with VS were treated with photon-based single-fraction SRS (mean dose, 13.1 Gy; range, 12 to 15 Gy). Treatment planning was based on computed tomography-magnetic resonance imaging (MRI) fusion with organ-at-risk sparing and a planning target volume margin of 0-2 mm. The primary endpoint was local control (LC). Secondary endpoints included toxicity and predictors of treatment failure. After a median follow-up of 68 months, LC was maintained in 95.6% of patients. Actuarial LC rates at 5 and 10 years were both 98.5%. MRI showed tumor shrinkage in 41.2% and stability in 57.4% of cases. Treatment was well tolerated. Acute adverse events were infrequent and mild. Localized alopecia occurred acutely in one patient (1.5%) and did not persist into late follow-up. Vertigo and tinnitus were analyzed as disease-related symptoms rather than treatment-related toxicities. Severe toxicity (grade \u2265 3) was rare (<3%). Cox regression revealed no statistically significant predictors of local failure, though trends suggested higher risk after prior surgery and with doses \u226514 Gy. Single-fraction SRS provides durable long-term LC of VS with a favorable toxicity profile, supporting its role as a primary treatment modality. Optimal outcomes appear to be associated with lower prescription doses (<14 Gy) and treatment of de novo tumors.",
"42392891": "ID: 42392891\nTitle: Postoperative auditory outcomes in total temporomandibular joint replacement: fossa-canal proximity and tinnitus risk.\nAbstract: Total temporomandibular joint replacement (TMJR) is an established treatment for advanced ankylosis; however, postoperative auditory complications, such as tinnitus, remain poorly characterized. This post-hoc observational analysis evaluated whether postoperative prosthetic fossa-external auditory meatus (EAM) distance is associated with postoperative tinnitus after TMJR for ankylosis, and explored preoperative ankylosis-EAM proximity and tinnitus resolution. Patients aged 18-40 years undergoing TMJR with orthognathic surgery with \u226512 months follow-up and postoperative cone-beam computed tomography were evaluated. The unit of analysis was the individual joint. Postoperative and preoperative EAM distances were measured on multiplanar reconstructions by blinded observers. A total of 24 joints from 17 patients were analysed (10 unilateral and seven bilateral). Postoperative tinnitus occurred in two joints (8.3%), both unilateral events in patients undergoing bilateral TMJR. Mean postoperative fossa-EAM distances were significantly shorter in tinnitus joints compared with non-tinnitus joints (1.38 \u00b1 0.17\u00a0mm vs 5.18 \u00b1 2.08\u00a0mm; mean difference 3.80\u00a0mm, 95% confidence interval 0.68-6.92; P = 0.019; Cohen's d = 1.87). Preoperative ankylosis-EAM distance showed no significant difference between groups (P = 0.123). Both tinnitus cases occurred at postoperative clearances below \u223c3.5\u00a0mm. Symptoms were mild to moderate, resolved within 12 months, and were not associated with audiometric hearing loss. Shorter postoperative fossa-EAM distance was associated with transient postoperative tinnitus in this exploratory cohort. The observed 3.5\u00a0mm clearance should be regarded as hypothesis-generating rather than a validated clinical threshold. Larger studies with standardized tinnitus assessment are required.",
"42394931": "ID: 42394931\nTitle: Ginkgo biloba extract for dizziness-related symptoms in central neurological disorders: a systematic review and meta-analysis.\nAbstract: Dizziness associated with central neurological disorders-broadly defined as dizziness or vertigo attributable to central nervous system pathology affecting central vestibular processing-is a clinically challenging and heterogeneous condition with limited treatment options. Ginkgo biloba extract-through its microcirculatory, neuroprotective, and anti-inflammatory mechanisms-represents a biologically plausible intervention. However, its efficacy in this setting has not been comprehensively established. We evaluated the efficacy and safety of Ginkgo biloba extract through a systematic review and meta-analysis of randomized controlled trials (RCTs). Nine international and Korean databases were searched from January 1974 through November 2025. Studies were eligible if they were RCTs enrolling adults aged 18\u202fyears or older with cerebrovascular disease, neurodegenerative disease, or central vestibular dysfunction who had dizziness, vertigo, or balance-related symptoms or relevant outcome assessments. Cochrane RoB 2.0 tool and certainty of evidence was rated using the Assessment, Development and Evaluations (GRADE) approach. Prespecified subgroup analyses by underlying etiology and intervention type, together with leave-one-out sensitivity analyses, were performed to explore heterogeneity. Nine RCTs (N\u202f=\u202f2,394) were included; participants were predominantly drawn from dementia populations (71.6%), with smaller contributions from cerebral arteriosclerosis (23.0%) and vertebrobasilar or posterior circulation disorders (5.4%). Ginkgo biloba significantly reduced dizziness/vertigo severity on the 11-point box scale (MD\u202f-\u202f0.76, 95% CI\u202f-\u202f1.35 to -0.18; p\u202f=\u202f0.01) and VAS (SMD\u202f-\u202f0.38, 95% CI\u202f-\u202f0.58 to -0.19; p\u202f=\u202f0.0001). Moderate-certainty evidence suggested improvements in functional outcomes and quality of life, including the Alzheimer's Disease Activities of Daily Living International Scale (MD\u202f=\u202f-0.17, 95% CI: -0.22 to -0.13) and the Dementia Quality of Life - Proxy (MD\u202f=\u202f2.00, 95% CI: 0.85 to 3.15). The intervention was generally well tolerated, with significantly lower risks of angina pectoris (OR 0.51, 95% CI 0.31 to 0.85) and tinnitus (OR 0.37, 95% CI 0.22 to 0.63) and no significant increase in other adverse events. Ginkgo biloba extract may reduce dizziness severity and improve daily functioning in patients with central neurological disorders accompanied by dizziness or vertigo, with a favorable safety profile. However, given the small number of eligible trials, substantial clinical and statistical heterogeneity, and the predominance of dementia-derived data, these findings should be interpreted with caution. Well-designed RCTs in clearly defined central vestibular populations, ideally confirmed by neuroimaging or vestibular testing, are needed to confirm these results. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251229692, PROSPERO: CRD420251229692.",
"42400132": "ID: 42400132\nTitle: Personal listening device usage, leisure noise exposure, hearing protection usage and hearing at standard frequencies: a longitudinal study from child/adolescence to young adulthood.\nAbstract: To compare personal listening device (PLD) listening behaviours, leisure noise exposure, audiometric outcomes, hearing protection (HP) usage and self-reported hearing loss (HL) symptoms at Time 1: 2009/2010 and Time 2: 2022/2023. Mean hearing thresholds (HTs), pure-tone average HL prevalence, PLD volume levels, durations, earbud/headphone tightness, and sex among matched pairs, at Time 1 and 2, were compared. Longitudinal design. Questionnaire evaluating PLD listening behaviours, leisure noise exposure and HL symptoms. Multivariate regression analysis used to determine relationship between variables and audiometry. 59 Participants, aged 22-30, of original cohort (n\u2009=\u2009237, aged 10-17) were re-tested (Time 2). Over time, tinnitus following leisure noise tripled, HP doubled and higher average PLD listening time was observed (7 vs. 18\u2009h/week); longer durations for males. High volume listening was 20% at both timepoints. Leisure noise exposure and HL prevalence were similar across time, however mean HTs were higher at Time 1. Among matched pairs, more Time 2 participants created tight-fitting earbuds/headphones and responded affirmatively to some HL symptom questions. Subtle auditory changes, such as hidden HL, may be occurring over time. Educational outreach regarding HL prevention would be beneficial. Further longitudinal research needed due to the small follow-up sample.",
"42402048": "ID: 42402048\nTitle: Tinnitus, hyperacusis and somatic complaints in a diverse Norwegian clinical population: implications for assessment and rehabilitation.\nAbstract: Patients with tinnitus often have somatic complaints, a reality that is understudied in the broader literature on tinnitus. This study aims to characterize tinnitus patients with somatic complaints, investigate associations between somatic complaints and tinnitus, hyperacusis, and symptoms of anxiety and depression, and to compare patient profiles across genders and healthcare services. A cross-sectional study with a digital questionnaire consisting of Tinnitus Sample Case History Questionnaire (TSCHQ), Tinnitus Handicap Inventory (THI), Hyperacusis Questionnaire (HQ), Hospital Anxiety and Depression Scale (HADS) and Generalized Anxiety Disorder-7 (GAD-7). The somatic complaints investigated were Headaches, Dizziness, Temporomandibular Dysfunction (TMD), Neck pain and Pain Syndromes, as measured using the TSCHQ. A total of 144 participants with tinnitus were sampled, from four hearing clinics and two rehabilitation centres in Norway. Several positive associations were observed between somatic complaints and higher levels of tinnitus, hyperacusis, depression and anxiety. Moreover, somatic complaints were more common among women, and those recruited from rehabilitation centres. Tinnitus patients, with or without comorbid hyperacusis, have several psychological and somatic complaints that need to be mapped thoroughly. An interdisciplinary approach should be considered for patients with tinnitus and comorbid somatic symptoms.",
"42403858": "ID: 42403858\nTitle: Autosomal Dominant Obstructive Sleep Apnea Syndrome Due to the New Variant c.980_984dup in COL1A2: A Case Report.\nAbstract: Obstructive sleep apnea syndrome (OSAS) is a complex disorder characterized by the collapse of the upper airway during sleep. Although a family history often suggests a hereditary predisposition to OSAS, there is little evidence that it is actually a monogenic disorder. To date, no case of a patient with hereditary OSAS due to a pathogenic mutation in the collagen type I alpha-2 chain (COL1A2) gene has been described. The patient was a 72-year-old woman who had suffered from insomnia since the age of 35. OSAS was suspected since then, but was only confirmed at the age of 67 by polysomnography. The OSAS was treated with nocturnal active positive airway pressure (APAP), which led to an improvement.\u00a0Her medical history also included joint hypermobility, brachydactyly, multiple nevi, an umbilical hernia, left-sided tinnitus and hearing impairment, hair loss, hip pain, and ptosis. Since her son also developed OSAS at the age of 34, hereditary OSAS was suspected, and exome sequencing was performed, which revealed the novel variant c.980_984dup (p.Ile329Alafs*72) in the COL1A2 gene. Since OSAS is a known complication of connective tissue disorders (CTDs), the index patient's OSAS was attributed to the COL1A2 mutation. This case suggests that OSAS may be hereditary due to a variant in the COL1A2 gene and may represent the dominant phenotypic feature. Physicians should be aware that OSAS can be hereditary; therefore, CTD patients with a positive family history of OSAS should undergo genetic testing for variants in genes associated with CTD.",
"42403960": "ID: 42403960\nTitle: The Degree of Audiovestibular Loss Is Not Related to Current Vertigo Attacks in Refractory Unilateral M\u00e9ni\u00e8re's Disease.\nAbstract: Unilateral M\u00e9ni\u00e8re's disease (MD) is characterized by severe episodic attacks of rotational vertigo and audiovestibular signs that include fluctuating sensorineural hearing loss, aural fullness, tinnitus, and vestibular loss. To investigate the relationship between the degree of audiovestibular loss, symptoms, and the number of vertigo attacks during the previous 6\u2009months and 1\u2009month of patients with MD. Sixty patients with active MD refractory to oral treatment. Hearing (pure-tone audiometry and speech discrimination) and vestibular (caloric test, vestibular evoked myogenic potential [VEMP]) tests were performed. Symptoms were scored using the following validated questionnaires: Vertigo Symptom Scale-short form, Dizziness Handicap Inventory, Tinnitus Handicap Inventory, Aural Fullness Scale, and Functional Level Scale. Linear regression, a factor analysis, and a correlation analysis were conducted. Patients experienced a mean number of 16 attacks (range, 2-65) during the previous 6\u2009months and five attacks (range, 0-30) during the previous 1\u2009month. Hearing and vestibular functions were reduced in the affected ear. Linear regression, the factor analysis, and the correlation analysis showed no association between the degree of audiovestibular loss and the number of vertigo attacks during the previous 6\u2009months or 1\u2009month or symptoms of disease activity. An exploratory analysis showed evidence of some associations between the degree of hearing loss, caloric paresis, and VEMP asymmetry, indicating a consistent pattern of loss across the cochlear semi-circular canals and saccules. Although audiovestibular tests help establish diagnoses, they cannot determine current disease activity of unilateral refractory MD. It may be prudent to assume that patients with MD and high remaining vestibular function in the affected ear would experience more frequent episodes of vertigo and intense dizziness and experience more troublesome symptoms. Conversely, it may be prudent to assume that patients with MD with low remaining vestibular function in the affected ear would experience fewer episodes of vertigo; however, as shown by these results, this does not seem to be the case. No obvious audiovestibular markers suggest that intratympanic therapy for vertigo treatment should be delayed.",
"42403964": "ID: 42403964\nTitle: Multidimensional Effects of Hyperacusis: A Study on Tinnitus, Anxiety, Cognitive Function, Sleep, and Quality of Life.\nAbstract: Tinnitus and hyperacusis are often cooccurring and quite prevalent symptoms. The effects of tinnitus on sleep quality, anxiety, cognitive abilities, and quality of life are well documented. However, studies investigating the effects of hyperacusis are limited. The aim of this study is to investigate the relationship between hyperacusis and tinnitus, anxiety, cognitive functions, sleep, and quality of life. Prospective cross-sectional study. Forty people reporting hyperacusis were included in the study. These individuals were categorized into two groups: those with hyperacusis only and those with both hyperacusis and tinnitus. In addition, 30 healthy participants were included as a control group. The Khalfa Hyperacusis Questionnaire, Tinnitus Handicap Inventory, Beck Anxiety Inventory, Digit Span and Stroop test TBAG form, Pittsburgh Sleep Quality Index, and Short Form-36 (SF-36) were administered to these individuals. The total sleep quality of the hyperacusis and tinnitus group was poorer compared with the control group, whereas only the subjective sleep quality of the hyperacusis group was poorer than that of the control group (p < 0.05). Both patient groups had higher BAI scores compared with the control group (p < 0.05). No significant differences were observed between the groups in terms of the Digit Span and Stroop tests (p > 0.05). Both patient groups had lower quality-of-life scores compared with the control group (p < 0.05). However, individuals in the hyperacusis and tinnitus group had lower scores in the physical functioning subscale of the SF-36 compared with those in the hyperacusis group (p < 0.05). The performance of individuals with hyperacusis on the Stroop and Digit Span tests was similar to that of healthy individuals. However, individuals with hyperacusis had higher levels of anxiety and lower sleep quality and quality of life compared with healthy individuals. In cases where tinnitus accompanied hyperacusis, a more pronounced decline in quality of life was observed.",
"42403965": "ID: 42403965\nTitle: Reactions to Tinnitus Based on Color Code Personality Type.\nAbstract: Although studies of tinnitus and personality are prevalent in tinnitus research, studies of tinnitus-related distress across personality types using the Color Code Personality Assessment are lacking. The purpose of this research was to evaluate the relationship between personality type and the reaction to tinnitus using the Color Code Personality Assessment and the Tinnitus Reaction Questionnaire (TRQ). We conducted an online survey involving 178 participants. The survey included the TRQ to evaluate tinnitus-related distress and the Color Code Personality Assessment to determine personality type. The Color Code Personality Assessment results in one of four personality colors, red, blue, white, or yellow, and focuses on how to interact and communicate with different personality subtypes. The survey was posted to 11 different social media groups on Facebook and was open for 3 months. A one-way analysis of variance (ANOVA) was conducted to evaluate the effect of personality type on the TRQ score. One-sample chi-square tests were conducted to determine if the number of respondents with tinnitus-related distress was greater than chance for each personality type. The one-way ANOVA revealed a significant main effect for personality type. Follow-up tests comprising the Bonferroni test indicated that the TRQ scores for red personality types were significantly higher than those for white personality types. Analyses using one-sample chi-square tests for each personality type indicated significant results for respondents with blue or red personality types. Reactions to tinnitus differed across personality types. Respondents with the red personality type reported higher tinnitus-related distress than that of respondents with the white personality type. Respondents with blue and red personality types were more likely to report bothersome tinnitus. Although various tinnitus questionnaires that assess tinnitus distress and its effect on different areas of the patient's life are available, audiologists do not have a tool that allows insight regarding how to appropriately counsel and treat patients with tinnitus based on their reaction to it. Understanding the personality of patients and how personality will impact their reaction to tinnitus can guide the clinician's ability to provide effective counseling, thus adding to the clinician's skillset the ability to deliver customized treatment options to patients with tinnitus.",
"42403966": "ID: 42403966\nTitle: Bimodal Stimulation of the Auditory-Somatosensory System Improves Auditory Sensory Gating Function in Patients with Tinnitus.\nAbstract: Tinnitus perception may be associated with impairments in the mechanisms of sensory gating (SG), which is a preattentive process that filters redundant auditory stimuli to prevent sensory overload. Acoustic stimulation of the auditory system alone (unimodal intervention), electrical stimulation of the vagus nerve alone, or a combination of both (bimodal intervention) can effectively treat tinnitus by influencing SG. This study aimed to examine the impact of unimodal and bimodal interventions on auditory SG (ASG). Participants were assigned to unimodal or bimodal intervention groups using block randomization after obtaining consent. Thirty-four participants with tonal tinnitus were divided equally into unimodal (n = 17) and bimodal (n = 17) groups. Participants in the bimodal group received customized acoustic stimulation combined with transcutaneous auricular vagus nerve stimulation (tAVNS). Participants in the unimodal group received the same acoustic stimulation paired with sham tAVNS. Each group underwent six 20-minute treatment sessions. Participants were assessed using the ASG (dividing the P1-N1 amplitude of the second cortical auditory evoked potential [CAEP] by the P1-N1 amplitude of the first CAEP) and an 11-point Visual Analog Scale (VAS) for loudness, awareness, and annoyance before and after the intervention sessions. Patients rated these items from 0 to 10, with 0 representing no tinnitus and 10 representing intense loudness, awareness, and annoyance. Postintervention group comparisons were performed using a covariance analysis. Within-group changes were assessed with paired t tests. Correlations were evaluated with Pearson's test. After the intervention, the results showed that the bimodal group experienced a significant decrease in ASG and loudness and awareness VAS scores relative to those of the unimodal group (p < 0.05). No significant change in the annoyance VAS score was found between groups. A correlation was observed between ASG and the awareness and annoyance VAS scores, but no correlation was found between ASG and the loudness VAS score. As a treatment option for tinnitus, bimodal stimulation appears to be more effective than unimodal stimulation. This method may be particularly beneficial for tonal tinnitus with hearing loss; however, it may not be effective for all patients. Therefore, a clinical protocol is required. Bimodal stimulation may offer a clinically meaningful intervention for patients with tinnitus, particularly those with hearing loss who experience tonal tinnitus.",
"42404127": "ID: 42404127\nTitle: Cerebral venous disorders: clinical presentation, diagnostic strategy, and contemporary management.\nAbstract: Cerebral venous disorders encompass a heterogeneous group of conditions ranging from acute cerebral venous thrombosis to chronic intracranial venous hypertension and stenotic outflow states. Although historically considered uncommon, increasing recognition, improved imaging techniques, and expanding endovascular therapies have led to significant advances in the diagnosis and management of these conditions. This review provides a contemporary overview of the pathophysiology, clinical presentation, diagnostic evaluation, and treatment strategies for major cerebral venous disorders, with an emphasis on conditions associated with elevated intracranial venous pressure and medically refractory symptoms. We summarize current evidence regarding noninvasive and invasive imaging modalities, including the evolving roles of CT and MR venography, catheter venography, and physiologic pressure measurements. Indications for medical therapy, including anticoagulation and intracranial pressure management, are discussed alongside emerging criteria for patient selection for endovascular intervention. Particular attention is given to venous sinus stenting and other endovascular techniques, including technical considerations, outcomes, and complication profiles. Controversies remain regarding diagnostic thresholds, the clinical significance of venous stenosis, optimal hemodynamic criteria for intervention, and long-term durability of endovascular treatment. We highlight areas of ongoing investigation and identify key knowledge gaps that may inform future research. As diagnostic capabilities and therapeutic options continue to evolve, a multidisciplinary and physiology-guided approach is essential to optimize patient selection and outcomes in cerebral venous disorders.",
"42406125": "ID: 42406125\nTitle: Detailed clinical characteristics of musical hallucinations in 81 patients.\nAbstract: Musical hallucinations are perceptions of music without an external source. Approximately 500 publications on this topic have appeared over the past 35\u00a0years. Prior literature has largely consisted of case reports and small series, with only limited systematic studies on the characterisation of mixed pathology, relation to hearing loss, spatial localisation, and multimodal features. We conducted a retrospective analysis of baseline data from a prospective cohort study of 81 individuals experiencing musical hallucinations. Participants underwent assessment with the Musical Hallucinations (MuHa) Questionnaire-a tailored, non-validated semi-structured survey/interview-alongside additional questionnaires, EEG, neuroimaging, and audiological testing. The present analysis focuses on baseline phenomenological characteristics derived from the MuHa Questionnaire in 80 eligible participants. Analyses were exploratory and descriptive. Mean age was 65\u00a0years, with a slight female predominance. Hallucinations were most often perceived as internal, while external localisation was more common with familiar music and in individuals with (asymmetric) hearing loss. Underlying causes included psychiatric disorders (50%), hearing loss (50%), structural neurological changes (28%), and frequently combinations thereof (28%). A notable new finding was the high prevalence of tinnitus and multimodal hallucinations, involving up to six sensory modalities; these were generally associated with internal localisation, except in isolated hearing loss. Musical content spanned multiple genres, most commonly religious music. Hallucinations were considered burdensome in over 65% of the cases, and most participants reported little control; behavioral strategies such as distraction or listening to external music provided only temporary relief in about 20%. Musical hallucinations may be more common than previously appreciated within broader multimodal perceptual syndromes and mixed etiologies, suggesting a more distributed pathophysiology than traditionally assumed. Their burden and limited controllability highlight the need for further mechanistic and therapeutic research.",
"42409067": "ID: 42409067\nTitle: Clinical Practice Guideline for the Diagnosis and Management of Tinnitus in Korea.\nAbstract: Standardized, evidence-based guideline for tinnitus management is currently lacking in Korea. This guideline aims to provide evidence-based recommendations for the diagnosis and management of tinnitus in Korean adults, adapted to the Korean healthcare system. A multidisciplinary panel (eight otorhinolaryngologists, one neurologist, one psychiatrist, and one audiologist) conducted systematic literature searches up to 2025 using PubMed, Embase, Cochrane Library, KoreaMed, and KMBASE. Evidence quality was assessed using the GRADE methodology. Nine key clinical questions (KQs) were developed in PICO format, and recommendations were finalized through a modified Delphi process (\u226580% agreement threshold). Imaging is recommended for the evaluation of patients with pulsatile tinnitus or asymmetric hearing loss (Grade B). Tinnitus retraining therapy (TRT) and cognitive behavioral therapy (CBT) are conditionally recommended for patients with tinnitus (Grade B). Hearing aids are conditionally recommended for patients with tinnitus and coexisting hearing loss (Grade B). Sound therapy is conditionally recommended to reduce tinnitus-related distress (Grade B). Neuromodulation (transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS)) is conditionally recommended as an adjunctive treatment (Grade B). Routine zinc and vitamin supplementation are strongly recommended against for tinnitus symptom improvement (Grade D\u2020), whereas Ginkgo biloba may be considered for patients with subjective tinnitus (Grade B). Most available evidence was predominantly of low or very low certainty. This guideline provides the first comprehensive evidence-based framework for tinnitus management in Korea. Behavioral and rehabilitative interventions provided the strongest evidence for reducing tinnitus-related distress. Considerations of Korean National Health Insurance coverage, regional accessibility, and patient preferences were integrated throughout the guideline development process. The primary therapeutic goal is to reduce tinnitus-related distress and improve functional outcomes, thereby enhancing overall quality of life.",
"42409638": "ID: 42409638\nTitle: Emergence of behavioral tinnitus in gerbils is associated with reduced spontaneous rates in single auditory nerve fibers.\nAbstract: Tinnitus is often initiated by damage to the peripheral auditory system, for example by acoustic overexposure. Animal studies have shown that such noise-induced tinnitus is related to increased spontaneous activity in the dorsal cochlear nucleus as well as further along the central auditory pathway. However, the role of spontaneous activity of the auditory nerve, connecting the peripheral and central auditory systems, in tinnitus emergence remains unknown. In the current study, tinnitus was induced by exposing anesthetized Mongolian gerbils of either sex to a 115-dB SPL narrowband noise. After one day of recovery, animals were behaviorally tested for gap detection deficits using a gap-prepulse inhibition of the acoustic startle reflex (GPIAS) paradigm, indicative of tinnitus. Noise-induced threshold shifts did not differ between animals with and without signs of tinnitus. Interestingly, single auditory nerve fibers recorded from animals with signs of tinnitus had significantly reduced spontaneous rates compared to both noise-exposed animals without signs of tinnitus and sham-exposed animals. Furthermore, spontaneous rate reduction was specific to fibers tuned to frequencies within the frequency bands that showed gap detection deficits. On the other hand, inter-spike interval variability and bursting behavior increased in fibers from noise-exposed compared to sham-exposed animals but did not differ with gap detection deficits. These findings suggest that tinnitus-related central hyperactivity may be initiated by reduced spontaneous rates of its innervating auditory nerve fibers. This is consistent with theoretical models explaining the central manifestation of tinnitus and offers a more detailed definition of tinnitus-related deafferentation.Significance statement Decades of previous research showed that tinnitus strongly connects to peripheral cochlear damage and to neural aberrations in the central auditory system. However, up to now, the role of the auditory nerve, connecting the peripheral to the central auditory system, in the emergence of tinnitus pathology has remained unclear. The current study showed that spontaneous activity is significantly reduced in auditory nerve fibers recorded from noise-exposed animals with behavioral signs of tinnitus shortly after the exposure. This insight helps us to understand why certain central neural correlates of tinnitus emerge. Furthermore, understanding the physiological basis of the initiation phase of tinnitus may lead to new intervention strategies to treat it.",
"42416928": "ID: 42416928\nTitle: Neurosyphilis Reemergence in the Modern Day: A Case Report.\nAbstract: Syphilis, once considered a disease in decline, has re-emerged as a significant public health concern in the United States.\u00a0This case report presents the clinical course of a 42-year-old male with a rare presentation of neurosyphilis. The patient presented\u00a0twice to the ER within 60 days with vague intermittent symptoms, including numbness/tingling of his hands and feet, which the patient initially ignored. This progressed into balance issues, tinnitus, difficulty focusing, inattentiveness, and behavior changes. Family states he had started behaving very oddly, had wax-and-waning confusion, and also had a moment where he was hallucinating.\u00a0The patient's first evaluation in the ER was roughly three weeks prior to the second visit. The workup included a CT of the head, which was negative, among other tests for toxic/metabolic causes. After a grossly unremarkable workup at the initial visit, the patient was further discharged at that time. At home, the patient stated his symptoms continued, he followed up with his PCP as he was directed, and the PCP ordered a rapid plasma reagin (RPR) test for continued symptoms and found the patient to be RPR (+). The patient then presented to the ED for a second evaluation sent by PCP with a RPR (+), continued symptoms, and requested further evaluation. On a more comprehensive social history investigation, the patient reported a painless penile lesion roughly three years ago after a sexual encounter. The lesion went away on its own, and the patient never sought treatment for the lesion. On the second ER presentation, the patient then had a more in-depth workup, including lumbar puncture results, which showed suspicion of neurosyphilis. The patient was then admitted with disposition for treatment of neurosyphilis.\u00a0While admitted to the hospital, the patient was reported as remaining stable, clinically improved, and was appropriately treated for neurosyphilis with 14 days of IV antibiotics. The patient was in the hospital for a total of a week and then discharged home with IV antibiotics set up for home completion of the 14-day course for the treatment of neurosyphilis.",
"42417817": "ID: 42417817\nTitle: Use of mindfulness in the treatment of tinnitus: consensus based on the opinion of Brazilian experts.\nAbstract: To develop a consensus among otolaryngologists, speech-language-hearing pathologists, and physical therapists regarding the criteria for recommending and using mindfulness in the treatment of tinnitus. Observational, descriptive, quantitative, cross-sectional study conducted online. The convenience sample initially consisted of 23 specialists. The Delphi method was applied in two stages, providing feedback with anonymous responses. The first stage consisted of objective and subjective questions. The second stage involved 10 participants, who evaluated 34 statements derived from the initial stage. The specialists analyzed each item and demonstrated their agreement on a 5-point Likert scale. The content validity coefficient (CVC) was used to investigate the degree of interrater agreement and select the final items. There was consensus on 25 of the 34 items (CVC \u2265 0.70). The specialists consider mindfulness to be a therapeutic resource for tinnitus, but not as monotherapy. There was consensus on recommending application once a week, for at least 30 minutes, with daily home practice. Follow-up therapy after 8 weeks can be done using scales such as the Tinnitus Handicap Inventory and the Visual Analogue Scale. There is consensus on the combined (not alone) use of mindfulness in the treatment of tinnitus with a weekly protocol (8 weeks), lasting 30 minutes per session, monitored using the THI and VAS. These recommendations should be explored in clinical trials, investigating the short- and long-term effects to provide scientific evidence and standardize clinical protocols. Desenvolver um consenso com experts otorrinolaringologistas, fonoaudi\u00f3logos e fisioterapeutas acerca dos crit\u00e9rios de recomenda\u00e7\u00e3o e uso da mindfulness aplicada no tratamento do zumbido. Estudo observacional, descritivo, quantitativo e transversal, conduzido de forma online. A amostra por conveni\u00eancia contou, inicialmente, com 23 especialistas. Aplicou-se o m\u00e9todo Delphi em duas etapas, com fornecimento de feedback e anonimato das respostas. A primeira etapa consistiu em perguntas objetivas e subjetivas. A segunda etapa contou com 10 participantes, que avaliaram 34 afirmativas derivadas da etapa inicial. Os especialistas analisaram cada item e demonstraram sua concord\u00e2ncia em uma escala likert de cinco pontos. Utilizou-se o coeficiente de validade de conte\u00fado (CVC) para investigar o grau de concord\u00e2ncia entre os ju\u00edzes e selecionar os itens finais. Houve consenso em 25 dos 34 itens (CVC \u2265 0,70). Os especialistas consideram que a mindfulness \u00e9 um recurso terap\u00eautico para o zumbido, por\u00e9m n\u00e3o como monoterapia. Foi consenso a indica\u00e7\u00e3o da aplica\u00e7\u00e3o uma vez por semana, pelo menos, 30 minutos, com pr\u00e1tica di\u00e1ria domiciliar. O seguimento da terapia ap\u00f3s 8 semanas pode ser feito por meio de escalas como Tinnitus Handicap Inventory e a Escala Visual Anal\u00f3gica. H\u00e1 consenso sobre o uso da mindfulness no tratamento (n\u00e3o isolado) do zumbido com protocolo semanal (8 semanas), dura\u00e7\u00e3o de 30 minutos cada sess\u00e3o e acompanhamento por meio do THI e EVA. Tais recomenda\u00e7\u00f5es devem ser exploradas em ensaios cl\u00ednicos, investigando os efeitos a curto e longo prazo, em prol de evid\u00eancias cient\u00edficas e padroniza\u00e7\u00e3o de protocolos cl\u00ednicos."
},
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"female": 74,
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"dietary supplements": 1,
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"hearing aids": 9,
"practice guideline": 1,
"republic of korea": 1,
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"male": 74,
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"aged": 44,
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"quality of life": 17,
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"severity of illness index": 11,
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"hearing": 9,
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"neck pain": 2,
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"adolescents": 1,
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"plant extracts": 2,
"ankylosis": 1,
"arthroplasty, replacement": 1,
"cone-beam computed tomography": 1,
"temporomandibular joint": 1,
"external malignant otitis": 1,
"infection": 1,
"intra-petrous internal carotid artery": 1,
"pseudoaneurysm": 1,
"skull base": 2,
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"nomogram": 1,
"precision medicine": 2,
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"dpoae": 1,
"glutathione transferases": 1,
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"risk factors": 8,
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"normal hearing": 1,
"tinnitus handicap inventory": 4,
"zinc deficiency": 1,
"injection, intratympanic": 3,
"dexamethasone": 1,
"patient positioning": 1,
"glucocorticoids": 3,
"head": 1,
"round window, ear": 2,
"intratympanic": 1,
"meniere\u2019s disease": 3,
"steroid": 1,
"semicircular canal dehiscence": 1,
"otologic surgical procedures": 1,
"audiometry": 2,
"semicircular canals": 1,
"minimally invasive surgical procedures": 1,
"syndrome": 1,
"magnetic resonance imaging": 11,
"endolymphatic hydrops": 6,
"auditory symptoms": 1,
"round window reinforcement": 1,
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"third window syndrome": 1,
"transcanal surgery": 1,
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"otology/neurotology": 1,
"sensorineural hearing loss": 6,
"migraine disorders": 2,
"comorbidity": 3,
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"prevalence": 10,
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"otalgia": 1,
"otologic symptoms": 1,
"temporomandibular joint disorder": 1,
"hyaluronic acid": 1,
"preauricular pain": 1,
"temporomandibular disorders (tmd)": 1,
"temporomandibular joint (tmj)": 1,
"ultrasound-guided infiltration": 1,
"audiologic monitoring": 1,
"eustachian tube dysfunction": 2,
"ototoxicity": 3,
"teprotumumab": 1,
"thyroid eye disease": 1,
"melatonin": 2,
"adolescent": 6,
"cluster analysis": 1,
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"sleep wake disorders": 1,
"age factors": 2,
"sleep-related qol": 1,
"lipoma": 1,
"cochlear implantation": 4,
"child": 2,
"cochlea": 1,
"cochlear implants": 4,
"intravestibular lipoma": 1,
"vestibular diseases": 3,
"systems biology": 2,
"gene regulatory networks": 1,
"signal transduction": 3,
"cytokines": 2,
"receptors, n-methyl-d-aspartate": 1,
"micrornas": 3,
"glutamatergic signaling": 1,
"neuroinflammation": 3,
"potassium channels": 1,
"dermatomycoses": 1,
"granulomatosis with polyangiitis": 1,
"adverse effects": 1,
"blinding": 1,
"neuromodulation": 6,
"ultrasound stimulation": 1,
"vagus nerve": 2,
"nhanes": 3,
"nw pa = non-work-related physical activity": 1,
"work pa = work-related physical activity": 1,
"hyperbaric oxygenation": 2,
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"salvage therapy": 2,
"stellate ganglion": 2,
"combined modality therapy": 3,
"autonomic nerve block": 2,
"hyperbaric oxygen therapy": 1,
"intratympanic steroid": 1,
"refractory sudden sensorineural hearing loss": 2,
"salvage treatment": 1,
"stellate ganglion block": 1,
"germ cell tumors": 1,
"mental health": 4,
"symptom burden": 1,
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"concussion": 1,
"football": 1,
"repeated head injury": 1,
"thc": 1,
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"otology": 1,
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"entrenamiento sonoro": 1,
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"auditory cortex": 7,
"excitatory/inhibitory balance": 1,
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"synaptic plasticity": 2,
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"music therapy": 17,
"auditory perception": 4,
"active hearing": 1,
"bioacoustics": 1,
"gamification": 1,
"healthcare": 1,
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"noise, occupational": 2,
"working conditions": 1,
"operating room nursing": 1,
"burnout, professional": 1,
"nursing staff, hospital": 1,
"psychological well-being": 1,
"operating room noise": 1,
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"psychological health": 1,
"scrub nurses": 1,
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"electroencephalography (eeg)": 1,
"p300 latency": 1,
"predictive biomarker": 1,
"repetitive transcranial magnetic stimulation (rtms)": 1,
"age-related hearing loss": 1,
"gene therapy": 1,
"inflammation": 3,
"oxidative stress": 1,
"presbycusis": 3,
"arteriovenous fistula": 2,
"computer-assisted image processing": 1,
"endovascular procedures": 1,
"therapeutic embolization": 1,
"neurotransmitter agents": 1,
"psilocybin": 2,
"receptors, neurotransmitter": 1,
"hallucinogens": 1,
"5-ht2a receptor": 1,
"dopamine": 1,
"gaba": 1,
"glutamate": 1,
"anterior cervical discectomy and fusion": 1,
"bow hunter's syndrome": 1,
"hybrid operating room": 1,
"intraoperative angiography": 1,
"vertebral artery decompression": 1,
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},
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"42338275": "Naud\u00e9 A, Kanji A (2026). Importance of Comprehensive Tinnitus Assessment: A Conceptual Analysis of International Classification of Functioning, Disability and Health (ICF)-Linked Questionnaires.. Journal of audiology & otology. ID: 42338275.",
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"42338658": "Ntlhakana L, Molete MM (2026). Risks and Awareness of NIHL Among Dental Students: A Scoping Review.. Health science reports. ID: 42338658.",
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"42345410": "Li H, Zhao C, Zhang W, Fu Y (2026). Efficacy of the Additional Effect of Stellate Ganglion Block in Combination of Intratympanic Steroid and Hyperbaric Oxygen Therapy for Refractory Sudden Sensorineural Hearing Loss.. The journal of international advanced otology. ID: 42345410.",
"42345411": "Dogan G, Boyacioglu O, Dogan M, Sahin M, Boyacioglu SO (2026). Link Between Chronic Tinnitus and miR-30e, miR-206 , and miR-124 Polymorphisms Modulating the Brain-Derived Neurotrophic Factor Gene.. The journal of international advanced otology. ID: 42345411.",
"42345416": "Ramasamy S, Vadivu AS, Nandhan SR, Kameswaran M (2026). Management Options and Their outcomes in Bilateral Advanced Otosclerosis.. The journal of international advanced otology. ID: 42345416.",
"42345421": "Van de Kerkhof J, Vermaete E, Hermans R, Loos E, Verhaert N (2026). Intravestibular Lipoma with Intracochlear Extension: A Case Report on Surgical Management and Cochlear Implantation.. The journal of international advanced otology. ID: 42345421.",
"42345427": "Y\u00fcksel Asl\u0131er NG, Cang\u00fcl B, Ekim B, Ercan \u0130 (2026). Cluster Analysis of Clinical Characteristics, Sleep Quality, Depression and Melatonin Levels in Patients with Idiopathic Subjective Tinnitus.. The journal of international advanced otology. ID: 42345427.",
"42345629": "Britton M, Hosick PA (2026). Domain-Specific Associations Between Physical Activity and Tinnitus in NHANES 2015-2018.. Audiology research. ID: 42345629.",
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"42374873": "Moring JC, Husain FT, Franklin C, Kaniewska E, Hecht Q et al. (2026). Symptom Overlap and Neurobiological Similarities Between Posttraumatic Stress Disorder and Tinnitus.. Human brain mapping. ID: 42374873.",
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"42382212": "Lin IF, Tsai PJ, Wu JL, Lin CY, Guo YL (2026). Interactive Effects of Occupational Hearing Loss and Glutathion S-Transferase M1 Genotype on Tinnitus Among Noise-exposed Steelworkers.. Safety and health at work. ID: 42382212.",
"42384477": "Heliodoro T, Santana IB, Carasek N, Oliveira LAT, Caldas FF et al. (2026). Auditory Outcomes After Simultaneous Translabyrinthine Vestibular Schwannoma Resection and Cochlear Implantation: A Prospective Case Series.. Acta oto-laryngologica. ID: 42384477.",
"42388458": "Xu X, Xiao S, Li X, Niu Y, Cen S et al. (2026). Development and Validation of a Nomogram to Identify and Predict High-Distress Psychosocial Phenotypes in Tinnitus Patients: A Latent Profile Analysis.. Psychology research and behavior management. ID: 42388458.",
"42388916": "Abdourabbih Y, El Mekhtoume M, Ouazzani H, Chaouche I, Akammar A et al. (2026). Intrapetrous Internal Carotid Artery Pseudoaneurysm Secondary to Malignant Otitis Externa: A Case Report.. Cureus. ID: 42388916.",
"42392687": "Tas KT, Fischer M, Lishewski P, Sheikhzadeh FF, Smalec E et al. (2026). Efficacy and safety of single-fraction radiosurgery in vestibular schwannoma: a 10-year experience.. Radiation oncology journal. ID: 42392687.",
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