Hidden auditory dysfunction in tinnitus with normal audiograms: selective and chronicity-dependent ABR changes in middle-aged adults

Tinnitus can occur in adults with normal audiograms, suggesting subtle auditory dysfunction beyond conventional threshold measures. This study investigated whether middle-aged adults with tinnitus and clinically normal hearing show evidence of peripheral neural dysfunction and duration-related brainstem changes....

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Middle-aged tinnitus patients with normal audiograms may have subclinical auditory nerve damage detectable by ABR; clinicians should consider extended diagnostics (ABR, extended high-frequency audiometry) rather than assuming normal hearing in this group, especially when tinnitus is chronic.

This study strengthens the case that 'hidden hearing loss' (cochlear synaptopathy — damage to the connections between hair cells and hearing nerves) is a real, measurable phenomenon in tinnitus patients who appear audiometrically normal, challenging routine clinical dismissal of their symptoms.

1. 01ABR changes were found in middle-aged tinnitus patients with clinically normal audiograms.
2. 02ABR abnormalities were selective (affecting specific wave components) and more pronounced with longer tinnitus duration.
3. 03Findings support the concept of 'hidden hearing loss' or cochlear synaptopathy as a tinnitus mechanism.
4. 04Standard pure-tone audiometry may miss underlying auditory dysfunction in this population.
5. 05Chronicity of tinnitus appears to be a key moderating factor in the degree of subclinical dysfunction.

PMID

42673781

DOI

10.1016/j.heares.2026.109786.

Journal

Hearing Research

Publication type

research_article

Evidence level

3

Population

Middle-aged adults with tinnitus and normal pure-tone audiograms

Intervention

Auditory brainstem response (ABR) assessment in tinnitus patients with normal audiograms

Comparator

Adults without tinnitus and normal audiograms