Despite being common and clinically burdensome, subjective tinnitus is diagnosed and characterised primarily through subjective reporting. Objective biomarkers could transform tinnitus care by enabling reproducible identification, stratification, and monitoring, but their clinical utility for detecting tinnitus and quantifying its severity remains unclear. We conducted a PRISMA-guided systematic review of tinnitus biomarkers, critically evaluating their clinical and diagnostic relevance, methodological quality, and readiness for clinical translation. PubMed, Scopus, and Web of Science were searched for human studies reporting objective measures linked to tinnitus presence, severity, or diagnostic accuracy. Risk of bias was assessed using Joanna Briggs Institute tools, and results were synthesised narratively due to heterogeneity. We included 69 studies spanning neurophysiological, neuroimaging, cognitive-behavioural, and molecular approaches. Although many studies reported tinnitus-related group differences, convergence across studies was limited. Common limitations included small cohorts, inconsistent phenotyping, heterogenous methodologies, and inadequate adjustment for major confounders, especially hearing loss. Cognitive-behavioural paradigms, particularly attention-modulated cortical responses, showed the strongest and most consistent association with tinnitus burden and the greatest translational potential. Molecular biomarkers, notably metabolomics, showed early promise but currently lack replication and external validation. Neurophysiological and neuroimaging markers provided mechanistic insights but were constrained by reproducibility and feasibility for routine clinical use. In summary, tinnitus biomarkers are advancing, but no single measure currently supports stand-alone clinical diagnosis. Progress will require harmonised methods, large well-characterised samples, severity-stratified designs, and validated multimodal panels aligned to mechanistic models. Systematic review registration: PROSPERO (CRD420261449639).

Background Conductive hearing loss (CHL) is a significant contributor to hearing impairment, especially in low-income settings. Chronic suppurative otitis media (CSOM) is often a dominant cause in developing regions. This study examined the causes and clinical profiles of patients with CHL at Khartoum Ear, Nose and Throat (ENT) Hospital. Methods We conducted a retrospective descriptive cross-sectional study of 106 patients diagnosed with CHL (confirmed by audiometry or tuning-fork testing) who presented between October 2021 and March 2022. Demographic data, etiologies, and associated symptoms were extracted from medical records and analysed descriptively. Results The cohort (mean age 27 years) comprised 61 (57.5%) female patients, predominantly young adults with 54 (51%) patients aged 18-35 years. CSOM was the leading cause of CHL, affecting 50 (47.2%) patients, far exceeding other etiologies. Smaller proportions were due to ear canal foreign bodies in seven (6.6%) participants, external auditory polyps in seven (6.6%), otosclerosis in five (4.7%), and various others (each <4%). The majority of cases were acquired, seen in 99 cases (93.4%) and only four (3.8%) were congenital cases. Most patients had mild-to-moderate hearing loss, with 50 (47.2%) patients reporting progressive loss. Common accompanying symptoms included ear discharge in 70 people (66.0%), tinnitus in 62 (58.9%), ear pain in 61 (57.5%), vertigo in 36 (34.0%), and ear itch in 28 (26.4%) participants. Conclusion CSOM predominated as the etiology of CHL in this Sudanese ENT hospital, reflecting a high burden of preventable ear infection. The findings underscore the need for early detection and management of CSOM and related conditions to reduce CHL. The data from this study highlights the need for public health intervention in tackling preventable infectious diseases in Khartoum.

Digital avatar-based interventions have been proposed as a promising approach for managing phantom sensations such as tinnitus by externalizing the perceived source of sensation and enabling users to interact with it. However, the emotional impact of symptom-representing avatars on users has received limited attention; it remains unclear whether emotional closeness with avatars influences impressions of phantom sensations and subjective symptom experiences. This pilot study aimed to explore the feasibility and emotional impact of an augmented reality (AR)-based avatar therapy for subjective bothersome tinnitus. We developed a mobile AR application that represents tinnitus as interactive avatars, allowing users to engage with them in everyday environments. Participants reported transient alleviation of symptoms immediately following application use, as well as a nominal improvement in tinnitus-related impression after the 1-week intervention period. Exploratory analyses suggested a possible association between depressive/anxiety-related stress responses and short-term changes in tinnitus botheration. This pilot evaluation provides preliminary insights into the feasibility and emotional aspects of AR-based avatar therapy for tinnitus. The findings inform the design of future controlled studies and suggest that emotionally oriented interactions with symptom-representing avatars may represent a promising direction for digital health interventions targeting tinnitus and other phantom sensations.

Hyperacusis describes the condition in which mid-level sounds are perceived as uncomfortably loud. This study assessed 36 listeners (mean age = 25.75 years) with low noise-exposure history (Noise Exposure Structured Interview, NESI) and no tinnitus, to investigate the association between assessed hyperacusis scores (Hyperacusis Questionnaire, HQ), measured uncomfortable loudness levels (ULLs), and speech intelligibility in noise (Matrix Speech test). Thresholds were ≤ 20 dB HL, for the standard audiometric signal frequencies (0.25-8 kHz). ULLs were measured for signal frequencies of 0.5-, 2-, and 4-kHz. Extended high-frequency (EHF) audiometric thresholds were also measured for signal frequencies up to 16 kHz. Cluster analysis identified three groups based on EHF audiometric threshold and slope. The cluster EHF thresholds for the three groups were 5.2 dB HL (LOW-hf), 18.3 dB HL (MED-hf), and 45.7 dB HL (HIGH-hf). Results indicated that the MED-hf group exhibited significantly higher HQ scores compared to the HQ scores associated with LOW-hf and HIGH-hf groups. Also, elevated EHF thresholds were generally unrelated to speech-in-noise intelligibility scores, and there was no significant relationship between HQ and NESI scores. For young listeners with relatively low noise exposure, normal or mildly-elevated EHF thresholds (8-16 kHz) may be associated with mid-range HQ scores.

Vestibulocochlear infarct, most commonly associated with infarction of a terminal branch of the anterior inferior cerebellar artery, presents with acute vertigo and sensorineural hearing loss. It often mimics peripheral vestibular disorders and may show no abnormal findings on neuroimaging, making the diagnosis particularly challenging. Without appropriate treatment, permanent unilateral hearing loss can significantly impair patients' quality of life. This review synthesizes findings from recent studies regarding the clinical characteristics, diagnostic approach, and therapeutic strategies of this condition. Patients typically present with prolonged vertigo (>24 hours), unilateral hearing loss, tinnitus, and imbalance. On examination, peripheral signs such as a positive head impulse test or horizontal-rotatory nystagmus may be observed, while the only indicator of a central origin is the hearing loss, often subtle or unnoticed even by the patient. Vascular comorbidities, including hypertension and diabetes mellitus, constitute key risk factors. Diagnostic difficulties arise from overlap with idiopathic sudden sensorineural hearing loss and vestibular neuritis; a vascular origin may account for up to 15-20% of acute audio-vestibular syndromes in high-risk populations. Early thrombolysis or antiplatelet therapy may improve outcomes, though thrombolysis is rarely administered due to the lack of imaging evidence. For diagnosis, video head impulse testing, audiometry, and MR neuroimaging are essential. Management relies on vestibular and auditory rehabilitation for persistent vertigo and secondary stroke prevention. Our review highlights the underdiagnosis of vestibulocochlear stroke and advocates for an integrated neuro-otological and vascular diagnostic protocol in patients presenting with vertigo and hearing loss to facilitate faster and more effective treatment. Orv Hetil. 2026; 167(33): 1309-1317.