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Asymmetry of vestibular pathways predicts upper-brainstem auditory imbalance in subjective somatosensory tinnitus: A tract-specific chronological reorganization model.

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Τίτλος: Asymmetry of vestibular pathways predicts upper-brainstem auditory imbalance in subjective somatosensory tinnitus: A tract-specific chronological reorganization model.
Συγγραφείς: Kurt D; Department of Audiology, Hacettepe University Faculty of Health Sciences, 06100 Sıhhiye, Ankara, Turkey., Sendesen E; Department of Audiology, Hacettepe University Faculty of Health Sciences, 06100 Sıhhiye, Ankara, Turkey. Electronic address: esersendesen@hacettepe.edu.tr., Türkyılmaz MD; Department of Audiology, Hacettepe University Faculty of Health Sciences, 06100 Sıhhiye, Ankara, Turkey.
Πηγή: Hearing research [Hear Res] 2026 Oct; Vol. 480, pp. 109774. Date of Electronic Publication: 2026 Aug 10.
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Elsevier/North-Holland Biomedical Press Country of Publication: Netherlands NLM ID: 7900445 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1878-5891 (Electronic) Linking ISSN: 03785955 NLM ISO Abbreviation: Hear Res Subsets: MEDLINE
Imprint Name(s): Original Publication: Amsterdam, Elsevier/North-Holland Biomedical Press.
Ιατρικοί όροι (MeSH): Tinnitus*/physiopathology , Tinnitus*/diagnosis , Tinnitus*/psychology , Auditory Pathways*/physiopathology , Brain Stem*/physiopathology , Vestibular System*/physiopathology , Evoked Potentials, Auditory, Brain Stem*, Humans ; Adult ; Vestibular Evoked Myogenic Potentials ; Female ; Young Adult ; Adolescent ; Male ; Middle Aged ; Acoustic Stimulation ; Time Factors ; Auditory Threshold ; Neuronal Plasticity ; Functional Laterality
Περίληψη: Objective: This study evaluated subcortical auditory and peripheral vestibular pathway alterations in normal-hearing individuals with unilateral subjective somatic tinnitus, isolating cross-modal electrophysiological relationships using an intra-subject, internally controlled paradigm.
Methods: Twenty-four participants (aged 17-61 years) with unilateral subjective somatic tinnitus and symmetric normal hearing thresholds (≤15 dB HL across 0.125-8 kHz) underwent auditory brainstem response (ABR), cervical vestibular evoked myogenic potential (cVEMP), and ocular VEMP (oVEMP) testing. Mathematically normalized Interaural Asymmetry Indices (AI) isolated side-specific neural imbalances.
Results: Conventional audiological profiles, middle ear compliance, and absolute ABR parameters (waves I-V) displayed interaural symmetry (p > .05). Conversely, absolute oVEMP evaluations demonstrated a statistically significant reduction in P1-N1 peak-to-peak amplitudes within the tinnitus-affected ears (M = 4.23 µV, SD = 2.98) relative to the healthy contralateral ears (M = 5.76 µV, SD = 4.72, p = .014), while absolute cVEMP parameters remained balanced (p = .396). Correlation analysis of normalized indices revealed a strong positive relationship between cVEMP AI and ABR wave V AI (r(22) = .555, p = .005). Multiple linear regression modeling showed that combined vestibulocollic (cVEMP) and vestibulo-ocular (oVEMP) neural asymmetries significantly predicted upper-brainstem auditory asymmetry at the level of the inferior colliculus, F(2, 21) = 8.66, p = .002, accounting for 45.2% of the variance in ABR wave V asymmetry (R2 = .452). Tinnitus chronicity showed an exploratory positive correlation with cVEMP AI (r(22) = .456, unadjusted p = .025; did not survive FDR correction).
Conclusion: Unilateral subjective somatic tinnitus appears to involve tract-specific subcortical electrophysiological asymmetries. We discuss these side-specific differences within a chronological reorganization framework. While acute ascending vestibulo-ocular suppression marks the initial gating failure, a progressively deepening descending vestibulocollic imbalance is strongly associated with upper auditory brainstem asymmetry. These outcomes validate combined VEMP indices as objective biomarkers and provide a neurophysiological rationale for future interventional trials to test whether early targeted bimodal neuromodulation can effectively reset subcortical hyperactivity before persistent neuroplastic consolidation.
(Copyright © 2026 Elsevier B.V. All rights reserved.)
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Contributed Indexing: Keywords: Asymmetry index; Auditory brainstem response (ABR); Multisensory integration; Neuroplasticity; Subjective somatic tinnitus; Vestibular evoked myogenic potentials (VEMP)
Entry Date(s): Date Created: 20260814 Date Completed: 20260901 Latest Revision: 20260913
Update Code: 20260914
DOI: 10.1016/j.heares.2026.109774
PMID: 42600509
Βάση Δεδομένων: MEDLINE
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  Data: Asymmetry of vestibular pathways predicts upper-brainstem auditory imbalance in subjective somatosensory tinnitus: A tract-specific chronological reorganization model.
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  Data: <searchLink fieldCode="AU" term="%22Kurt+D%22">Kurt D</searchLink>; Department of Audiology, Hacettepe University Faculty of Health Sciences, 06100 Sıhhiye, Ankara, Turkey.<br /><searchLink fieldCode="AU" term="%22Sendesen+E%22">Sendesen E</searchLink>; Department of Audiology, Hacettepe University Faculty of Health Sciences, 06100 Sıhhiye, Ankara, Turkey. Electronic address: esersendesen@hacettepe.edu.tr.<br /><searchLink fieldCode="AU" term="%22Türkyılmaz+MD%22">Türkyılmaz MD</searchLink>; Department of Audiology, Hacettepe University Faculty of Health Sciences, 06100 Sıhhiye, Ankara, Turkey.
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  Data: <searchLink fieldCode="JN" term="%227900445%22">Hearing research</searchLink> [Hear Res] 2026 Oct; Vol. 480, pp. 109774. <i>Date of Electronic Publication: </i>2026 Aug 10.
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  Data: <i>Publisher: </i><searchLink fieldCode="PB" term="%22Elsevier%2FNorth-Holland+Biomedical+Press%22">Elsevier/North-Holland Biomedical Press </searchLink><i>Country of Publication: </i>Netherlands <i>NLM ID: </i>7900445 <i>Publication Model: </i>Print-Electronic <i>Cited Medium: </i>Internet <i>ISSN: </i>1878-5891 (Electronic) <i>Linking ISSN: </i><searchLink fieldCode="IS" term="%2203785955%22">03785955 </searchLink><i>NLM ISO Abbreviation: </i>Hear Res <i>Subsets: </i>MEDLINE
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  Data: <i>Original Publication</i>: Amsterdam, Elsevier/North-Holland Biomedical Press.
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  Data: <searchLink fieldCode="MM" term="%22Tinnitus%22">Tinnitus*</searchLink>/<searchLink fieldCode="MM" term="%22Tinnitus+physiopathology%22">physiopathology</searchLink> <br /><searchLink fieldCode="MM" term="%22Tinnitus%22">Tinnitus*</searchLink>/<searchLink fieldCode="MM" term="%22Tinnitus+diagnosis%22">diagnosis</searchLink> <br /><searchLink fieldCode="MM" term="%22Tinnitus%22">Tinnitus*</searchLink>/<searchLink fieldCode="MM" term="%22Tinnitus+psychology%22">psychology</searchLink> <br /><searchLink fieldCode="MM" term="%22Auditory+Pathways%22">Auditory Pathways*</searchLink>/<searchLink fieldCode="MM" term="%22Auditory+Pathways+physiopathology%22">physiopathology</searchLink> <br /><searchLink fieldCode="MM" term="%22Brain+Stem%22">Brain Stem*</searchLink>/<searchLink fieldCode="MM" term="%22Brain+Stem+physiopathology%22">physiopathology</searchLink> <br /><searchLink fieldCode="MM" term="%22Vestibular+System%22">Vestibular System*</searchLink>/<searchLink fieldCode="MM" term="%22Vestibular+System+physiopathology%22">physiopathology</searchLink> <br /><searchLink fieldCode="MM" term="%22Evoked+Potentials%2C+Auditory%2C+Brain+Stem%22">Evoked Potentials, Auditory, Brain Stem*</searchLink><br /><searchLink fieldCode="MH" term="%22Humans%22">Humans</searchLink> ; <searchLink fieldCode="MH" term="%22Adult%22">Adult</searchLink> ; <searchLink fieldCode="MH" term="%22Vestibular+Evoked+Myogenic+Potentials%22">Vestibular Evoked Myogenic Potentials</searchLink> ; <searchLink fieldCode="MH" term="%22Female%22">Female</searchLink> ; <searchLink fieldCode="MH" term="%22Young+Adult%22">Young Adult</searchLink> ; <searchLink fieldCode="MH" term="%22Adolescent%22">Adolescent</searchLink> ; <searchLink fieldCode="MH" term="%22Male%22">Male</searchLink> ; <searchLink fieldCode="MH" term="%22Middle+Aged%22">Middle Aged</searchLink> ; <searchLink fieldCode="MH" term="%22Acoustic+Stimulation%22">Acoustic Stimulation</searchLink> ; <searchLink fieldCode="MH" term="%22Time+Factors%22">Time Factors</searchLink> ; <searchLink fieldCode="MH" term="%22Auditory+Threshold%22">Auditory Threshold</searchLink> ; <searchLink fieldCode="MH" term="%22Neuronal+Plasticity%22">Neuronal Plasticity</searchLink> ; <searchLink fieldCode="MH" term="%22Functional+Laterality%22">Functional Laterality</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: This study evaluated subcortical auditory and peripheral vestibular pathway alterations in normal-hearing individuals with unilateral subjective somatic tinnitus, isolating cross-modal electrophysiological relationships using an intra-subject, internally controlled paradigm.<br />Methods: Twenty-four participants (aged 17-61 years) with unilateral subjective somatic tinnitus and symmetric normal hearing thresholds (≤15 dB HL across 0.125-8 kHz) underwent auditory brainstem response (ABR), cervical vestibular evoked myogenic potential (cVEMP), and ocular VEMP (oVEMP) testing. Mathematically normalized Interaural Asymmetry Indices (AI) isolated side-specific neural imbalances.<br />Results: Conventional audiological profiles, middle ear compliance, and absolute ABR parameters (waves I-V) displayed interaural symmetry (p > .05). Conversely, absolute oVEMP evaluations demonstrated a statistically significant reduction in P1-N1 peak-to-peak amplitudes within the tinnitus-affected ears (M = 4.23 µV, SD = 2.98) relative to the healthy contralateral ears (M = 5.76 µV, SD = 4.72, p = .014), while absolute cVEMP parameters remained balanced (p = .396). Correlation analysis of normalized indices revealed a strong positive relationship between cVEMP AI and ABR wave V AI (r(22) = .555, p = .005). Multiple linear regression modeling showed that combined vestibulocollic (cVEMP) and vestibulo-ocular (oVEMP) neural asymmetries significantly predicted upper-brainstem auditory asymmetry at the level of the inferior colliculus, F(2, 21) = 8.66, p = .002, accounting for 45.2% of the variance in ABR wave V asymmetry (R<superscript>2</superscript> = .452). Tinnitus chronicity showed an exploratory positive correlation with cVEMP AI (r(22) = .456, unadjusted p = .025; did not survive FDR correction).<br />Conclusion: Unilateral subjective somatic tinnitus appears to involve tract-specific subcortical electrophysiological asymmetries. We discuss these side-specific differences within a chronological reorganization framework. While acute ascending vestibulo-ocular suppression marks the initial gating failure, a progressively deepening descending vestibulocollic imbalance is strongly associated with upper auditory brainstem asymmetry. These outcomes validate combined VEMP indices as objective biomarkers and provide a neurophysiological rationale for future interventional trials to test whether early targeted bimodal neuromodulation can effectively reset subcortical hyperactivity before persistent neuroplastic consolidation.<br /> (Copyright © 2026 Elsevier B.V. All rights reserved.)
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  Data: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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  Data: <i>Keywords: </i>Asymmetry index; Auditory brainstem response (ABR); Multisensory integration; Neuroplasticity; Subjective somatic tinnitus; Vestibular evoked myogenic potentials (VEMP)
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  Data: <i>Date Created: </i>20260814 <i>Date Completed: </i>20260901 <i>Latest Revision: </i>20260913
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      – TitleFull: Asymmetry of vestibular pathways predicts upper-brainstem auditory imbalance in subjective somatosensory tinnitus: A tract-specific chronological reorganization model.
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