Year: 2026
Type: editorial
Abstract: Tinnitus is a perceptual phenomenon impacting 10% to 15% of the global population. In majority patients, it significantly undermines their quality of life and their emotional stability. In this research topic in Frontiers in Neuroscience, titled "Tinnitus in Relation to Auditory Processing: Unraveling Complex Relationships," we aimed to discuss different aspects of tinnitus from theories, clinical inquiries to advanced diagnostic procedures to address the complex tinnitus dilemma. This topic included six articles highlighting different perspectives of tinnitus from definition, impact on life, diagnosis, and management.In his article titled 'Defining Tinnitus: A Socratic and Epistemological Inquiry" Aazh (2026) tried to find a definition of tinnitus using a Socratic and epistemological inquiry away from the traditional definition of being phantom without an external source (Jastreboff, 1990;1995) or meaning (Norena et al., 2021). The author argues that these formulations are insufficient as they fail to distinguish tinnitus from other internal auditory experiences, such as the sounds heard in dreams, or auditory hallucinations. In his trial to find a definition of tinnitus, the author pursued what is shared by all cases of tinnitus and belongs to nothing else. He was derived by several factors: first, the wide prevalence rates of tinnitus that vary from 5% to 37% indicate an inconsistent definition of tinnitus (Jarach et al., 2022). Second, the frequent confusion between tinnitus descriptions and its definitions. Third, how to distinguish the definition of tinnitus itself from the meanings individuals may attribute to it (Davis & Refaie, 2000). Using the Socratic approach, Aazh (2026) developed a working definition of tinnitus as "the consciously recognized experience of a non-semantic, sound or sound-like event in wakeful consciousness that persists beyond fleeting moments and becomes experientially salient". The main aim of such formulation was to treat tinnitus as a hypothesis and to avoid imposing a conceptual uniformity on a heterogeneous experience.Another article investigated the nature of tinnitus in our issue, provided by Barker et al. (2026), examined the Zwicker tone (ZT) to understand the nature of tinnitus perception. ZT is an auditory illusion tone experienced by about 42% of the normal hearing population after exposure to "notched noise." Interestingly, ZTs can be perceived by about 95% of tinnitus cases (Parra and Pearlmutter, 2007). It is commonly recorded in response to the presentation of notched noise (NN), where a faint, quickly decaying pure tone, the frequency of which falls within the range of the notch, is noticed (Schilling et al., 2023). Both tinnitus and the Zwicker Tone have common features like being illusory sounds associated with a spectral contrast (tinnitus is often linked to hearing loss, while ZT is triggered by a notch in a low-frequency band-pass noise), and both percepts fall within the unstimulated frequency region (hearing loss region for tonal tinnitus) and within the notch for ZTs. Additionally, the exact mechanism that creates ZTs, as in the case of tinnitus, and where in the brain it originates is still a matter of debate. The study highlighted the importance of using ZTs as a controllable laboratory model for tinnitus to understand the underlying neural mechanisms of chronic tinnitus Another study in this issue named "Sex-Specific Alterations of Cerebral Blood Flow in Subjective Tinnitus" where Zhang et al., (2026) examined the sex-specific alterations of cerebral blood flow (CBF) in chronic subjective tinnitus patients using arterial spin labeling (ASL). CBF is considered a direct index of neuronal activity closely related to the metabolic needs of the neural tissue. ASL is a non-invasive, magnetic resonance perfusion imaging technique used for quantification of the whole-brain CBF The complex correlation between STAI scores, questionnaire scores, salivary amylase and cortisol levels, and heart rate (HR) across various experimental phases emphasize the need to shift toward multimodal, personalized, and gender-sensitive approaches in the assessment and management of tinnitus. This research topic addresses the management of tinnitus. In their meta-analysis titled "Efficacy of repetitive transcranial magnetic stimulation or subjective chronic tinnitus: a randomized controlled trial meta-analysis" He et al., (2026) examined the use of rTMS as a non-invasive technique modulating neural activity in tinnitus patients in conjunction with both THI and VAS. The study showed lower tinnitus loudness immediately and for one-month post-treatment. However, this effect diminishes gradually to reach uncertain level at six months indicating that the duration and the frequency of rTMS treatment protocol need to be refined to have more prolonged relief.Another article addressed the efficacy of music therapy in chronic patients using Disappeared Group (0 VAS score), Tinnitus Relieved Group: Noticeable reduction in VAS, but > 0) and Tinnitus Unchanged Group (same VAS score). Through an AI-application "Tinnitus Assistant" all individuals' data of patients, their test results and questionnaire scores were used to create a personalized sound profile (music) that can be used to suppress tinnitus. This music was edited to be 180° out of phase with the frequency of patient's tinnitus for reduce cortical perception of tinnitus. Patients were instructed to listen for more than 2 hours daily (in total) for a least 30 minutes at a time in a quiet environment for 10 months followed by assessment using VAS, THI, HADS-A. The treatment efficacy rate was higher in the tinnitus disappeared group than that of other groups. Findings of this study suggested that CMT can, to some extent, be effective in patients with chronic subjective tinnitus with a promising role as a guide during clinical therapy.This issue highlighted the importance of future direction in customizing tinnitus diagnosis and management. It also highlighted the importance of considering the gender impact on tinnitus pathogenesis. The connection between tinnitus and cognition should be targeted more in future research specially those using advanced imaging techniques and address the co-morbidity between tinnitus and the functional impairment in the central nervous system.This research topic in this issue of Frontiers in Neuroscience emphasizes the complex nature of tinnitus where its profound personal experience requires multimodal approaches. A more comprehensive definition of tinnitus is required with more concentration of the individual factors specially the physiological difference between males and females in brain perfusion and neural network that requires a new direction in the diagnostic tools. By understanding the unique neural signatures and cognitive burdens of each patient-whether influenced by their sex, their stress response, or their physiological reaction to sound-we can move away from standardized solutions. The relationships between tinnitus and auditory processing are indeed complex, but through this integrated research, we are beginning to unravel the threads.
Source: Frontiers in Neuroscience
Authors: Takwa Gabr, Prashanth Prabhu, Haúla Haider
Language: English
Subfield: Sensory Systems
Field: Neuroscience
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7222937034