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.

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.

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.

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 (χ[2] = 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.

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 Clínico 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.

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.

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.

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.

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.

Introduction: Teprotumumab (Tepezza®), 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.