Tinnitus Mechanisms, Comorbidities and Emerging Therapeutic Strategies

Fitria Waffi Nur Aini, Agus Surono, Ashadi Prasetyo

Abstract


Tinnitus is the perception of sound without an external source and affects about one tenth of the population, with a small proportion experiencing severe disability. It arises from cochlear injury, central auditory hyperexcitability, maladaptive neuroplasticity, and involvement of limbic, prefrontal, and somatosensory systems, with additional contributions from inflammation, oxidative stress, and metabolic factors. This narrative review summarizes current concepts of tinnitus mechanisms, frequent psychological, auditory, somatosensory, and systemic comorbidities, and available treatments. The strongest evidence supports psychological and sound based interventions such as cognitive behavioral therapy, counseling, hearing rehabilitation, and tinnitus retraining therapy, which reduce distress and improve daily functioning even when loudness changes little. Pharmacological therapy mainly targets comorbid depression, anxiety, sleep disturbance, inflammation, and oxidative stress. Adequate intake of zinc and iron may help prevent tinnitus. Despite several promising options, clinical evidence remains heterogeneous and no single therapy is universally effective, so individualized multidisciplinary care informed by underlying mechanisms and further supported by advances in basic research, biomarker development, and rigorous clinical trials is required.


Keywords


Tinnitus, Pathophysiology, Comorbidities, Therapy

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References


Mazurek B, Hesse G, Dobel C, Kratzsch V, Lahmann C, Sattel H. Chronischer Tinnitus: Diagnostik und Therapie. Dtsch Arztebl Int. 2022;119(13):219–25.

Bhatt JM, Lin HW, Bhattacharyya N. Tinnitus epidemiology: prevalence, severity, exposures and treatment patterns in the United States. JAMA Otolaryngol Head Neck Surg. 2016;142(10):959–65.

Haider HF, Bojić T, Ribeiro SF, Paço J, Hall DA, Szczepek AJ. Pathophysiology of subjective tinnitus: triggers and maintenance. Front Neurosci. 2018;12:866.

Lee HY, Jung DJ. Recent updates on tinnitus management. J Audiol Otol. 2023;27(4):181–92.

Elgoyhen AB, Langguth B, De Ridder D, Vanneste S. Tinnitus: perspectives from human neuroimaging. Nat Rev Neurosci. 2015;16(10):632–42.

Shore SE, Roberts LE, Langguth B. Maladaptive plasticity in tinnitus: triggers, mechanisms and treatment. Nat Rev Neurol. 2016;12(3):150–60.

Chen X, Ren L, Xue X, et al. The comorbidity of depression and anxiety symptoms in tinnitus sufferers: a network analysis. Brain Sci. 2023;13(4):583.

Mennink LM, Aalbers MW, van Dijk P, van Dijk JMC. The role of inflammation in tinnitus: a systematic review and meta analysis. J Clin Med. 2022;11(4):1000.

Sydorova N, Mosulishvili T. Unexpected possibility to treat tinnitus as an inflammation process: a case report. Current Aspects of Military Medicine. 2021:28–9.

Petridou AI, Zagora ET, Petridis P, et al. The effect of antioxidant supplementation in patients with tinnitus and normal hearing or hearing loss: a randomized, double blind, placebo controlled trial. Nutrients. 2019;11(12):3037.

Canto T. Effects of plant extract and dietary supplements on tinnitus perception in adults: a systematic review and meta analysis. 2025.

Vier C, Almeida MB, Neves ML, Santos ARSD, Bracht MA. The effectiveness of dry needling for patients with orofacial pain associated with temporomandibular dysfunction: a systematic review and meta analysis. Braz J Phys Ther. 2019;23(1):3–11.

Enrico P, Sirca D, Mereu M. Antioxidants, minerals, vitamins, and herbal remedies in tinnitus therapy. Prog Brain Res. 2007;166:323–30.

Tang D, Shekhawat GS, Burlutsky G, Mitchell P, Gopinath B. The association between dietary intakes of vitamins and minerals with tinnitus. Nutrients. 2024;16(15):2535.

Formby C, Yang X, Scherer RW. Contributions of counseling and sound generator use in tinnitus retraining therapy: treatment response dynamics assessed in a secondary analysis of a randomized trial. J Speech Lang Hear Res. 2022;65(2):816–28.

Bauer CA, Berry JL, Brozoski TJ. The effect of tinnitus retraining therapy on chronic tinnitus: a controlled trial. Laryngoscope Investig Otolaryngol. 2017;2(4):166–77.

Palumbo DB, Joos K, De Ridder D, Vanneste S. The management and outcomes of pharmacological treatments for tinnitus. CNS Neurol Disord Drug Targets. 2015;14(5):620–40.

Zheng Y, McPherson K, Reid P, Smith PF. The anti inflammatory selective melanocortin receptor subtype 4 agonist RO27 3225 fails to prevent acoustic trauma–induced tinnitus in rats. Eur J Pharmacol. 2015;761:206–10.

Syahputra F. Antioxidant therapy in the elderly with tinnitus: systematic review. J Adv Res Med Health Sci. 2023;9(5):81–6.

Yu S, Wu J, Sun Y, Lyu J. Advances in acupuncture treatment for tinnitus. Am J Otolaryngol Head Neck Med Surg. 2024;45(3):104215.

Dinarvand G, et al. The effect of zinc therapy on tinnitus symptoms reduction. Jundishapur J Health Sci. 2013;5(4):–.

Ochi K, Ohashi T, Kinoshita H, et al. Zinc deficiency and tinnitus. Otolaryngol Head Neck Surg. 2003;128(1):16–9.

Yeh CW, et al. Effects of oral zinc supplementation on patients with noise induced hearing loss–associated tinnitus: a clinical trial. Biomed J. 2019;42(6):391–9.

Arda HN, Tuncel U, Akdogan O, Ozluoglu LN. The role of zinc in the treatment of tinnitus. Otol Neurotol. 2003;24(1):86–9.

Person OC, et al. Zinc supplementation for tinnitus. Cochrane Database Syst Rev. 2016;11:CD009832.

Liu D, Hu Y, Wang D, et al. Herbal medicines in the treatment of tinnitus: an updated review. Front Pharmacol. 2023;13:1037528.

Mahmoudian Sani MR. A review of medicinal plants for the treatment of earache and tinnitus in Iran. Int Tinnitus J. 2017;21(1):44–9.

Chauhan B, Arya S, Chauhan K. Ginkgo biloba administered singly and combined with antioxidants in tinnitus patients. J Audiol Otol. 2023;27(1):37–44.

Karimi Q, Soltani M, Khazaei A, Malkaneh M, Mofatteh MR. The effect of treatment with an herbal formulation of Salvia hydrangea, Citrus aurantium, Lippia citriodora and elm bark on the intensity of tinnitus: a clinical trial. J Otorhinolaryngol Facial Plast Surg. 2019;5(1):1–6.

Khosravi MH, Atefi A, Mehri A, et al. Therapeutic effects of Rosa canina, Urtica dioica and Tanacetum vulgare herbal combination in treatment of tinnitus symptoms: a double blind randomized clinical trial. 2022.

de Oliveira NKS, Almeida MRS, Pontes FMM, Barcelos MP, de Paulada Silva CHT, Rosa JMC, et al. Antioxidant effect of flavonoids present in Euterpe oleracea Martius and neurodegenerative diseases: a literature review. Cent Nerv Syst Agents Med Chem. 2019;19(2):75–99.

Oppitz SJ, Garcia MV, Bruno RS, Zemolin CM, Baptista BO, Turra BO, et al. Supplementation with açaí (Euterpe oleracea Martius) for the treatment of chronic tinnitus: effects on perception, anxiety levels and oxidative metabolism biomarkers. Codas. 2022;34(4):e20210076.

Zhai S, Fang Y, Yang W, Gu R, Han D, Yang S. Clinical investigation on the beneficial effects of the Chinese medicinal herb Gushen Pian on sensorineural deafness and tinnitus. Cell Biochem Biophys. 2013;67(2):785–93.




DOI: https://doi.org/10.30596/jih.v7i2.26178

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