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Tinnitus

Nature Reviews Disease Primers volume 12, Article number: 29 (2026) Cite this article

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Abstract

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 ear regeneration, closed-loop neuromodulation and digital therapeutics.

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Fig. 1: Pathway-based contributors to tinnitus.
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Fig. 2: The human auditory pathway.
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Fig. 3: Pathway- and network-level mechanisms of tinnitus.
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Fig. 4: Brain regions and resting-state networks.
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Fig. 5: Diagnostic and therapeutic management of tinnitus.
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Authors and Affiliations

  1. School of Psychology, Trinity College Dublin, Dublin, Ireland

    Sven Vanneste & Dirk De Ridder

  2. Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland

    Sven Vanneste & Anusha Yasoda-Mohan

  3. Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland

    Sven Vanneste & Anusha Yasoda-Mohan

  4. Section of Neurosurgery, Department of Surgical Sciences, University of Otago, Dunedin, New Zealand

    Dirk De Ridder

  5. Brai3n research, Brai3n, Ghent, Belgium

    Dirk De Ridder

  6. Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy

    Silvano Gallus

  7. Department of Speech and Hearing Science, The Neuroscience Program, University of Illinois Urbana-Champaign, Champaign, IL, USA

    Fatima T. Husain

  8. The Beckmann Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Champaign, IL, USA

    Fatima T. Husain

  9. Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland

    Tobias Kleinjung

  10. Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany

    Berthold Langguth & Winfried Schlee

  11. Otology & Neurotology Group CTS495, Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain

    Jose Antonio Lopez-Escamez

  12. Division of Otolaryngology, Department of Surgery, Universidad de Granada, Granada, Spain

    Jose Antonio Lopez-Escamez

  13. Sensorineural Pathology Programme, Centro de Investigación Biomédica en Red en Enfermedades Raras, CIBERER, Madrid, Spain

    Jose Antonio Lopez-Escamez

  14. Meniere Disease Neuroscience Research Program, Faculty of Medicine & Health, School of Medical Sciences, The Kolling Institute, University of Sydney, Sydney, New South Wales, Australia

    Jose Antonio Lopez-Escamez

  15. Ear Science Institute Australia, Nedlands, Western Australia, Australia

    Jose Antonio Lopez-Escamez

  16. Institute of Information and Process Management, Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland

    Winfried Schlee

  17. Chennai Institute of Technology, Chennai, India

    Anusha Yasoda-Mohan

  18. Instituto de Investigaciones en Ingeniería Genética y Biología Molecular, Dr. Héctor N. Torres, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina

    Ana Belén Elgoyhen

  19. Brai3n research, Brai3n, Ghent, Belgium

    Sven Vanneste

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Contributions

Introduction (S.V., J.A.L.-E. and A.B.E.); Epidemiology (S.V., S.G., W.S. and A.B.E.); Mechanisms/pathophysiology (S.V., D.D.R., B.L., J.A.L.-E., A.B.E. and A.Y.-M.); Diagnosis, screening and prevention (S.V., B.L., T.K., J.A.L.-E., A.B.E. and F.T.H.); Management (S.V., T.K., W.S. and A.B.E.); Quality of life (S.V., B.L., S.G., W.S., A.B.E. and F.T.H.); Outlook (S.V., S.G., T.K., J.A.L.-E., W.S. and A.B.E.); overview of Primer (S.V.).

Corresponding author

Correspondence to Sven Vanneste.

Ethics declarations

Competing interests

S.V. declares research support from the European Union, the Rainwater Foundation, Neuromod and Royal National Institute for Deaf People, and Nederlands Fond voor Wetenschappelijk onderzoek. S.V. has carried out paid consultancy for Neuromod and is an executive member of the Tinnitus Research Initiative (NGO, unpaid). D.D.R. declares research support from the Rainwater Foundation and is chairman of the board of directors of TRI. F.T.H. declares research support from the Rainwater Foundation, Department of Defense, USA, and Royal National Institute of Deafness. F.T.H. is a Scientific Advisor for Hyperacusis (NGO, unpaid), Tinnitus Learning and Health Network (NGO, unpaid) and SoQuiet Misophonia Advocacy (NGO, unpaid). B.L. declares research support from the European Union, the Rainwater Foundation, Neuromod and Sonova. B.L. has carried out paid consultancy for Neuromod, Sea Pharma and Sonova, holds shares of the company Sea Pharma, and has served as a scientific Advisor for consumer protection organizations (paid) and as a court-appointed expert (paid). B.L. is also Chair of the Tinnitus Research Initiative (NGO, unpaid), a scientific Advisor for the Royal National Institute of Deafness (NGO, unpaid) and a scientific Advisor for Tinnitus Quest (NGO, unpaid). T.K. received honoraria for consulting and lecturing activities from Sonova and Schwabe Pharma CH, as well as travel and accommodation expenses from Cochlear. His research was funded by the Tinnitus Research Initiative, the Swiss National Science Foundation, the European Union, the Zurich Hearing Foundation, and Cochlear. J.A.L.-E. received funds from the American Tinnitus Association (grant no. 1329287) and the University of Sydney (Meniere Disease Neuroscience Program). W.S. declares research support from the Rainwater Foundation and is an executive member of the Tinnitus Research Initiative (NGO, unpaid). A.Y.-M. serves as the Director of TRI Academy, the dissemination and communication wing of Tinnitus Research Initiative, is a member of the Tinnitus Detect (TIDE) consortium, and the Founder and Community Lead of Tinnitus Éire, an online community in Ireland for people living with tinnitus. A.Y.-M. is also the co-principal investigator for a grant received from the Royal National Institute for Deaf People. A.B.E. is a member of the Tinnitus Research Initiative (NGO, unpaid). S.G. declares no competing interests.

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Vanneste, S., De Ridder, D., Gallus, S. et al. Tinnitus. Nat Rev Dis Primers 12, 29 (2026). https://doi.org/10.1038/s41572-026-00702-0

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