Tinnitus and Cochlear Synaptopathy: Exploring Listening Effort, Speech Perception in Noise and Auditory Brainstem Response in Normal Hearing Adults

Tinnitus and Cochlear Synaptopathy: Exploring Listening Effort, Speech Perception in Noise and Auditory Brainstem Response in Normal Hearing Adults | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Tinnitus and Cochlear Synaptopathy: Exploring Listening Effort, Speech Perception in Noise and Auditory Brainstem Response in Normal Hearing Adults Rebecca Stanley, Nikita Nanavati This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6946459/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background : Tinnitus, a common auditory condition, frequently disrupts speech perception in noisy environments and heightens listening effort in individuals with normal hearing, possibly due to hidden hearing loss indicated by diminished auditory brainstem response (ABR) wave I amplitude. The current study aimed to evaluate speech perception in noise, listening effort, and amplitude of ABR wave I in individuals with tinnitus and normal hearing Method : The study included 34 adults with tinnitus and normal hearing sensitivity, and 34 age-matched controls with normal hearing. A speech-in-noise test at +5, 0 and -5 dB signal-to-noise ratios (SNR), subjective listening effort rating, and ABR testing was done for all the participants Results : Individuals with tinnitus exhibited poorer speech perception at 0 dB and -5 dB SNR (p < 0.05) and reported greater listening effort (p < 0.01) compared to controls. Correlation between Speech in noise at 0, -5dB SNR with listening effort was observed in tinnitus group. Reduced ABR wave I amplitude in the tinnitus group (p < 0.05) correlated with lower speech-in-noise scores (r = 0.62, p < 0.01) Conclusions : These findings highlight significant auditory challenges in normal-hearing individuals with tinnitus, including impaired speech perception in noise and heightened listening effort. The association between reduced ABR wave I amplitude and speech-in-noise deficits supports its potential as a biomarker for cochlear synaptopathy. Tinnitus Ringing sensation Cochlear synaptopathy Effortful listening Auditory Brainstem Response Neural degeneration Speech in noise Figures Figure 1 Figure 2 Figure 3 BACKGROUND Tinnitus is defined as the auditory perception of a sound by an individual without an external corresponding sound source, derived from the Latin word "tinnire," meaning "to ring" [1]. This condition can affect individuals across all age groups, from young children to the elderly, and may be associated with varying degrees of hearing loss, or even occur in those with normal hearing sensitivity. The subjective perception of tinnitus ranges from barely noticeable to severe. In the Indian middle-aged population, the prevalence of tinnitus is approximately 6.7% [2]. Globally, the prevalence of tinnitus in individuals with normal audiometric thresholds is estimated to be between 8% and 10% [3]. Individuals experiencing tinnitus often report varying degrees of distress, significantly impacting their quality of life across physical, social, and emotional domains. A notable challenge stemming from tinnitus perception is the difficulty in communication, particularly in the presence of background noise, a problem observed to be exacerbated in individuals with persistent tinnitus [4]. This observed discrepancy between normal hearing sensitivity and subjective communication difficulties is frequently attributed to the increased listening effort required for speech processing amidst concurrent background noise [5,6]. Furthermore, the annoyance caused by tinnitus can disrupt an individual's attention, thereby limiting the effective utilization of cognitive resources crucial for simultaneous speech recognition and recall, consequently increasing listening effort [7]. This effort may be further intensified in conditions like hidden hearing loss, cochlear synaptopathy. This condition involves the deafferentation between cochlear nerve fibers and inner hair cells within the spiral ganglion [8]. If the re-establishment of these deafferented synapses doesn't occur, it can lead to not only the disruption of innervated auditory nerve fibers but also a slower degeneration of spiral ganglion neurons [9]. A prominent consequence of cochlear synaptopathy is the presence of tinnitus. Dysfunction of cochlear synapses can impair the brain's ability to filter background noise, potentially leading to increased central auditory gain. This compensatory mechanism, which amplifies neural activity to offset lost input, may contribute to the perception of tinnitus [10]. This study addresses a lack of comprehensive investigation into the listening effort experienced by individuals with tinnitus during speech perception in noisy environments, particularly relevant to the highly challenging acoustic landscapes of India. Existing research lacks a holistic approach, failing to connect subjective reports of listening effort with objective measures like Speech in noise (SPIN) scores and ABR Wave I amplitude, especially in the context of tinnitus. This research is vital as reduced ABR Wave I amplitude, indicative of cochlear synaptopathy, is increasingly linked to tinnitus pathophysiology. By bridging these significant gaps through a multi-faceted approach, this research seeks to provide a more holistic understanding of the underlying pathophysiology and auditory difficulties experienced by individuals with tinnitus. METHOD In this cross-sectional study, 68 participants aged 18–60 years were recruited using purposive sampling. Two groups of participants were recruited using purposive sampling. Group I (control group) comprised of 34 individuals with normal hearing sensitivity (hearing thresholds of ≤ 25 dBHL at octave frequencies from 250 Hz to 8000 Hz), with no history of tinnitus, and were native Marathi speakers. Group II (Clinical group) comprised of 34 individuals with normal hearing sensitivity (hearing thresholds of ≤ 25dBHL at octave frequencies from 250 Hz to 8000 Hz), who reported continuous tinnitus-either unilateral or bilateral, of at least one month duration, and were native Marathi speakers. In the control group, individuals with otological conditions such as otitis media, otosclerosis, Ménière’s disease, tinnitus, or known neurological, psychological, or cognitive impairments were excluded. Similarly, in the clinical group, participants with otological abnormalities, neurological, psychological, or cognitive deficits, a history of using a tinnitus masker, or prior participation in tinnitus masking therapy or counseling were excluded. The study was approved by the Institutional Ethics Committee (name removed for review) and following the guidelines of the ethical committee. Participants who provided informed consent were included in the study. Equipment and Material A calibrated two-channel diagnostic audiometer (Inventis Piano Plus) with Radio ear IP 30 insert earphones with 2.5mm connectors, were used for obtaining audiometric thresholds and to determine the pitch and loudness of tinnitus. The audiometer was connected to laptop (Lenovo Windows 11), and calibrated speech-in-noise stimuli were presented at 65 dB SPL through insert earphones. For auditory brainstem response (ABR) wave I recordings, the Interacoustics Eclipse EP25 (version 4.4) software module with IP30 insert earphones was utilized. Speech perception in noise was assessed using the the sentence perception in noise test material in marathi (Nayna.,2023)[11]. Listening effort was evaluated using a 5-point rating scale adapted and translated into Marathi (Nayna.,2023))[11]. Procedure All the procedures were carried out in a well-illuminated sound-treated room with ambient noise levels well within the permissible limits (According to ANSI S3.1, 1999). Pure tone audiometry was carried out to obtain air conduction and bone conduction thresholds at octave frequencies from 250 Hz to 8000 Hz using the modified Hughson and Westlake procedure [12]. Sentence perception in noise was assessed at three signal-to-noise ratios (SNRs): +5 dB, 0 dB, and − 5 dB. For each SNR, a unique list of six sentences was presented. Participants were instructed to repeat each sentence they heard. Performance was scored based on the total number of correctly repeated keywords, with each list having a maximum score of 21. After each sentence list was presented at varying signal-to-noise ratios (SNRs), participants rated the listening effort they expended to perceive the sentences. They used a five-point scale, where '1' indicated no effort and '5' indicated a lot of effort. Auditory brainstem response (ABR) wave I was recorded with participants lying supine in a comfortable position. The electrode configuration included an inverting electrode on the upper forehead (Fz), a non-inverting electrode on the mastoid of the test ear (M1 or M2), and a ground electrode on the lower forehead (Fpz). Click stimuli (10 ms duration) were presented at 70 dBnHL with a repetition rate of 21.1 clicks per second through IP-30 insert earphones placed in the ear canal. Responses were filtered between 150 and 3000 Hz, and ipsilateral recordings were analyzed. A total of 2000 sweeps were averaged to enhance the signal-to-noise ratio, with two replicate waveforms collected to verify response consistency. Electrode impedance was kept below 5 kΩ, and testing was conducted in a quiet, electrically shielded environment to minimize interference. Analysis The data obtained from the participants were tabulated and subjected to the statistical analyses. Statistical analyses were carried out using SPSS Version 23 software. The Shapiro–Wilk test revealed a non normal distribution (< 0.05). Hence, non-parametric tests were used to investigate the aims of the study. The Mann-Whitney U test was used for comparison of the test results between the two groups. Spearman's Rank correlation was used to check the relationship between the tests in each group. A value of p < 0.05 was considered as statistically significant. RESULTS A total of 68 individuals were included in the present study, wherein 34 individuals were included in the control group (Group I) and 34 individuals were included in the clinical group (Group I). In the control group the, 20 individuals were female and 14 individuals were male whereas in the clinical group 28 individuals were female and 9 individuals were male. The mean participant age for the control group was 31.58 ± 12.19and the mean pure tone average 11.19 ± 5.11 whereas for the clinical group was the mean participant age was 31.86 ± 12.59 and the mean pure tone average was 12.84 ± 6.1. In the clinical group the ear with tinnitus was observed to be 59% in the left ear and 41% in the right ear. Table 1 presents the descriptive statistics for speech perception in noise and listening effort. A Mann-Whitney U test was conducted to compare differences between groups, revealing statistically significant differences in speech perception scores at 0 dB SNR and − 5 dB SNR, with the clinical group performing poorer than the control group. Additionally, statistically significant differences was observed for listening effort at both 0 dB SNR and − 5 dB SNR, with the clinical group exhibited significantly greater listening effort compared to controls. To examine the relationship between speech perception scores and listening effort in the clinical group, a Spearman’s rank correlation analysis was performed. Results indicated a moderate negative correlation at 0 dB SNR (r = -0.41, p < 0.05) and − 5 dB SNR (r = − 0.38, p < 0.05), as illustrated in Fig. 1, while a weak negative correlation was observed at 5 dB SNR (r = − 0.02, p < 0.05). A Spearman’s rank correlation test was utilized to evaluate the relationship between speech perception in noise scores and wave I of the auditory brainstem response (ABR). The analysis demonstrated a statistically significant moderate positive correlation (r = 0.42, p < 0.05) between speech perception scores and wave I amplitude in individuals with tinnitus at -5 dB SNR, as illustrated in Fig. 2. The characteristic waveforms for the control and clinical groups are illustrated in Fig. 3. Descriptive statistics were conducted to compare wave I parameters, specifically ABR amplitude, between the control and clinical groups. In the clinical group, a majority (n = 26) of individual in tinnitus ear displayed reduced amplitude, while a smaller subset (n = 8) showed amplitudes similar to those of the control group [13]. A statistically significant difference was found when comparing the tinnitus ear to the non-tinnitus ear, both between the clinical and control groups (Z = 45.5, p < 0.05) and within the clinical group itself (Z = 4.88, p < 0.05), as presented in Table 2. DISCUSSION In the current study, it was observed that increasing environmental noise significantly impairs speech perception in individuals with tinnitus compared to those without, aligning with prior research. A study had reported that individuals with tinnitus with normal hearing exhibited significantly lower speech-in-noise perception scores than controls, indicating a reduced ability to recognize speech in noisy conditions [14]. Similarly, in another study it was observed that there was an elevation in the speech recognition thresholds in young individuals with normal hearing and tinnitus compared to their non-tinnitus peers [15]. In a study it was further noted that, in individuals with tinnitus, the ear affected by tinnitus showed poorer speech recognition thresholds in noise compared to the unaffected ear, suggesting that tinnitus may act as a "central masker," disrupting speech perception through central auditory system alterations rather than peripheral damage [16]. Additionally, studies indicate that cochlear damage leads to broader, more linear basilar membrane responses, reducing frequency selectivity and temporal resolution [17,18]. However, it was proposed that impaired speech perception in noise among tinnitus patients may occur independently of outer hair cell damage, likely driven by neuroplastic changes in the central auditory system [15]. These findings underscore the complex interplay between tinnitus and central auditory processing, highlighting the need for further investigation into its impact on speech perception in adverse listening conditions. The current research demonstrated that as listening conditions deteriorate, individuals with tinnitus experience not only reduced speech perception but also a significant increase in listening effort. This aligns with a study in which it was found that distorted speech signals require greater cognitive resources than minimally degraded ones [19]. Similarly it was noted elevated auditory effort among middle-aged adults in unfavorable listening environments [20]. Additionally,it was reported that individuals with tinnitus and hearing loss required substantially higher listening effort at 0 dB SNR compared to favorable conditions, suggesting that cochlear damage results in unclear speech reaching the auditory cortex, demanding increased cognitive effort for processing [7]. These findings emphasize the heightened cognitive load faced by tinnitus patients in challenging auditory settings. This study reported a negative correlation between speech perception scores and listening effort in individuals with tinnitus at 0 dB and − 5 dB SNR, suggesting that increased noise reduces speech clarity and elevates cognitive load, as evidenced by greater listening effort. The presence of tinnitus, combined with external noise, significantly hinders speech perception in noisy settings, demanding increased cognitive and attentional effort. Consistent with these findings, it was reported that continuous noise significantly affects speech recognition thresholds, with steady noise posing the greatest challenge, followed by male and female competing speech [21]. In found that tinnitus impairs speech-from-noise segregation, reflecting central processing difficulties and reduced relief from informational masking [4]. They highlighted that tinnitus depletes cognitive resources, affecting working memory and complicating speech perception in noise, particularly under adverse conditions where cognitive spare capacity for information processing is diminished. In the current study, it was observed that there was a positive correlation between speech in noise scores at -5dB SNR and the amplitude of Wave I of the ABR. Also it was observed that ABR wave I amplitude was reduced in tinnitus ear as compared to non tinnitus ear and control group. Similar to current study findings, previous studies also have reported that reduced ABR wave I amplitude has been associated with tinnitus, potentially due to central auditory system compensatory gain, which may contribute to tinnitus perception [9,22–24]. Previous studies have shown that deafferentation from inner hair cell or spiral ganglion cell degeneration impairs signal detection in noise, reducing peripheral input to the central auditory system [25–28]. Partial spiral ganglion neuron loss has also been linked to increased speech comprehension difficulties in moderate noise [29,30]. One study noted reduced ABR wave I amplitude alongside impaired speech-in-noise perception, attributing this to low-spontaneous-rate (SR) fiber loss [31]. Research indicates that cochlear synaptopathy, characterized by tinnitus and impaired speech perception in noisy environments, is associated with a reduction in auditory brainstem response (ABR) wave I amplitude [29,32]. This electrophysiological marker reflects diminished peripheral auditory nerve activity, potentially due to selective damage to low-spontaneous-rate auditory nerve fibers, despite preserved audiometric thresholds. Acoustic overexposure can cause rapid, irreversible cochlear nerve terminal loss at inner hair cell peripheries, followed by gradual spiral ganglion cell degeneration, despite full audiometric threshold recovery and no hair cell loss. A reduced subset of auditory nerve fibers along the cochlear spiral is critical for detecting stimuli, particularly pure tones in quiet settings [33]. Low-SR auditory nerve fibers potentially due to glutamate excitotoxicity involving Ca + + overload, where mitochondria serve as a key buffering system [34,35]. Limitations and Future direction of the study The present study did not include a high frequency audiometric evaluation which could have helped in attaining a better understanding of whether a high frequency loss is present or not. Additionally, cognitive function such as working memory and attention which could impact the listening effort of an individual was not assessed formally. The future research should aim to adopt a multifaceted approach which incorporates high frequency audiometric thresholds so as to detect the presence of a subclinical hearing loss, as well as include electrocohleography assessment which will help in attaining a better amplitude ratio. The test battery should also include cognitive assessments so as to rule out the effect of cognition/memory on the listening effort that the individual would require. CONCLUSION This study highlights the multifaceted challenges that continuous tinnitus presents for individuals. As the listening environment becomes more adverse, patients exhibited heightened listening effort, accompanied by a decrease in the perception of speech. Additionally, a moderate positive correlation emerged between the speech perception scores in noise at -5dB SNR with the amplitude of wave I of ABR, all these factors could be indicative of an underlying pathology such as cochlear synaptopathy, especially in those individuals with tinnitus. By recognizing the multifaceted nature of these challenges of tinnitus, interventions can be tailored to address not only the physical aspects of tinnitus but also on the and physiological consequences, ultimately fostering a better quality of life for the affected individuals. Abbreviations SNR - Signal to Noise Ratio SPIN - Speech Perception in Noise ABR - Auditory Brainstem Response Declarations Funding The current study did not receive any funding from any agencies Author Contribution Contributor 1 (Stanley Rebecca) collected the data, interpreted and analyzed the data and assisted in writing the manuscript; Contributor 2 (Nanavati Nikita) designed the experiment , interpreted and analyzed the data and was also a major contributor in writing the manuscript. Both the authors have read and approved submission of the manuscript. Acknowledgement We acknowledge all the authorities of Bharati Vidyapeeth (Deemed to be University) for permitting us to carry out this research. . We would also like to thank all the participants who took their time out and participated in this study. Data Availability if data is asked, I have the data to declare References Jastreboff, P. J., Gray, W. C., & Gold, S. L. (1996). Neurophysiological approach to tinnitus patients. Am J Otolaryngol, 17(2), 236–240. Aryal, S., Sharma, Y., & Prabhu, P. (2023). Prevalence of Tinnitus and its Characteristics Among Indian Adult Population. AONO, 5 (1), 15–20. https://doi.org/10.1055/s-0043-1769889 Barnea, G., Attias, J., Gold, S., & Shahar, A. (1990). Tinnitus with normal hearing sensitivity: Extended high-frequency audiometry and auditory-nerve brain-stem-evoked responses. Audiology: Official Organ of the International Society of Audiology, 29 (1), 36–45. Madhukesh, S., Palaniswamy, H. P., Ganapathy, K., Rajashekhar, B., & Nisha, K. V. (2024). The impact of tinnitus on speech perception in noise: A systematic review and meta-analysis. EUFOS, 281 (12), 6211–6228. https://doi.org/10.1007/s00405-024-08844-1 Glyde, H., Hickson, L., Cameron, S., & Dillon, H. (2011). Problems hearing in noise in older adults: a review of spatial processing disorder. Trends in amplification, 15 (3), 116–126. https://doi.org/10.1177/1084713811424885 Keidser, G., & Alamudi, K. (2013). Real-life efficacy and reliability of training a hearing aid. Ear and Hearing, 34(5), 619–629. https://doi.org/10.1097/AUD.0b013e31828d269a Shetty, H. N., & Raju, S. (2023). Objective Measure of Listening Effort in Hearing Impaired Individuals With and Without Tinnitus. J.Int Adv Otol , 19 (4), 295–302. https://doi.org/10.5152/iao.2023.22827 Colla, M. D. F., Lunardelo, P. P., & Dias, F. A. M. (2024). Cochlear synaptopathy and hidden hearing loss: A scoping review. CoDAS , 36 (2), e20230032. https://doi.org/10.1590/2317-1782/20232023032en Shi, L., Chang, Y., Li, X., Aiken, S., Liu, L., & Wang, J. (2016). Cochlear Synaptopathy and Noise-Induced Hidden Hearing Loss. Neural Plasticity, 2016(1), 6143164. https://doi.org/10.1155/2016/6143164 Schaette, R., & McAlpine, D. (2011). Tinnitus with a normal audiogram: Physiological evidence for hidden hearing loss and computational model. JNEUROSCI, 31 (38), 13452–13457. https://doi.org/10.1523/JNEUROSCI.2156-11.2011 Nayna (2023). Self perceived listening effort as a measure of hearing aid outcome. Carhart, R., & Jerger, J. F. (1959). Preferred method for clinical determination of pure-tone thresholds./JSHD, 24 (4), 330–345. https://doi.org/10.1044/jshd.2404.330 Singh, R., & Vates, E. (2023, November 14). Brainstem auditory evoked response test . In StatPearls. Publishing. https://www.ncbi.nlm.nih.gov/books/NBK597358/ Huang, C.-Y., Lee, H.-H., Chung, K.-C., Chen, H.-C., Shen, Y.-J., & Wu, J.-L. (2007). Relationships among speech perception, self-rated tinnitus loudness and disability in tinnitus patients with normal pure-tone thresholds of hearing. ORL; J Otorhinolaryngology Rel Spec, 69 (1), 25–29. https://doi.org/10.1159/000096713 Ryu, I. S., Ahn, J. H., Lim, H. W., Joo, K. Y., & Chung, J. W. (2012). Evaluation of masking effects on speech perception in patients with unilateral chronic tinnitus using the hearing in noise test. Otology & Neurotology: Official Publication of the AOS, ANS [and] EAONO, 33(9), 1472–1476. https://doi.org/10.1097/MAO.0b013e31826dbcc4 Moon, I. J., Won, J. H., Kang, H. W., Kim, D. H., An, Y.-H., & Shim, H. J. (2015). Influence of Tinnitus on Auditory Spectral and Temporal Resolution and Speech Perception in Tinnitus Patients. JNEUROSCI, 35 (42), 14260–14269. https://doi.org/10.1523/JNEUROSCI.5091-14.2015 Oxenham, A. J., & Bacon, S. P. (2003). Cochlear compression: Perceptual measures and implications for normal and impaired hearing. Ear and Hearing, 24(5), 352–366. https://doi.org/10.1097/01.AUD.0000090470.73934.78 Moore, B. C., & Glasberg, B. R. (1988). Gap detection with sinusoids and noise in normal, impaired, and electrically stimulated ears. The Journal of the Acoustical Society of America, 83 (3), 1093–1101. https://doi.org/10.1121/1.396054 Schneider, B. A., Daneman, M., & Pichora-Fuller, M. K. (2002). Listening in aging adults: From discourse comprehension to psychoacoustics. Can. J.Exp Psychol , 56 (3), 139–152. https://doi.org/10.1037/h0087392 Degeest, S., Keppler, H., & Corthals, P. (2015). The Effect of Age on Listening Effort. JSLHR, 58 (5), 1592–1600. https://doi.org/10.1044/2015_JSLHR-H-14-0288 Zhang, W., Yu, Z., Ruan, Q., Zhang, W., Yu, Z., & Ruan, Q. (2020). Presbycusis-Related Tinnitus and Cognitive Impairment: Gender Differences and Common Mechanisms . In An Overview and Management of Multiple Chronic Conditions. IntechOpen. https://doi.org/10.5772/intechopen.90956 Gu, J. W., Herrmann, B. S., Levine, R. A., & Melcher, J. R. (2012). Brainstem Auditory Evoked Potentials Suggest a Role for the Ventral Cochlear Nucleus in Tinnitus. JARO, 13 (6), 819–833. https://doi.org/10.1007/s10162-012-0344-1 Bramhall, N., Beach, E. F., Epp, B., Le Prell, C. G., Lopez-Poveda, E. A., Plack, C. J., Schaette, R., Verhulst, S., & Canlon, B. (2019). The search for noise-induced cochlear synaptopathy in humans: Mission impossible? Hearing Research, 377, 88–103. https://doi.org/10.1016/j.heares.2019.02.016 Bramhall, N. F., McMillan, G. P., Kujawa, S. G., & Konrad-Martin, D. (2018). Use of non-invasive measures to predict cochlear synapse counts. Hearing Research, 370, 113–119. https://doi.org/10.1016/j.heares.2018.10.006 Lobarinas, E., Salvi, R., & Ding, D. (2020). Gap Detection Deficits in Chinchillas with Selective Carboplatin-Induced Inner Hair Cell Loss. JARO, 21 (6), 475–483. https://doi.org/10.1007/s10162-020-00744-5 Lobarinas, E., Spankovich, C., & Le Prell, C. G. (2017). Evidence of “hidden hearing loss” following noise exposures that produce robust TTS and ABR wave-I amplitude reductions. Hearing Research,349,155–163. https://doi.org/10.1016/j.heares.2016.12.009 Monaghan, J. J. M., Garcia-Lazaro, J. A., McAlpine, D., & Schaette, R. (2020). Hidden hearing loss impacts the neural representation of speech in background noise. Current Biology, 30(23), 4710-4721.e4. https://doi.org/10.1016/j.cub.2020.09.046 Resnik, J., & Polley, D. B. (2021). Cochlear neural degeneration disrupts hearing in background noise by increasing auditory cortex internal noise. Neuron, 109(6), 984-996.e4. https://doi.org/10.1016/j.neuron.2021.01.015 Lin, H. W., Furman, A. C., Kujawa, S. G., & Liberman, M. C. (2011). Primary Neural Degeneration in the Guinea Pig Cochlea After Reversible Noise-Induced Threshold Shift. JARO, 12 (5), 605–616. https://doi.org/10.1007/s10162-011-0277-0 Kujawa, S. G., & Liberman, M. C. (2009). Adding Insult to Injury: Cochlear Nerve Degeneration after “Temporary” Noise-Induced Hearing Loss. JNEUROSCI, 29 (45), 14077–14085. https://doi.org/10.1523/jneurosci.2845-09.2009 Bramhall, N., Ong, B., Ko, J., & Parker, M. (2015). Speech Perception Ability in Noise is Correlated with Auditory Brainstem Response Wave I Amplitude. JAAA, 26 (5), 509–517. https://doi.org/10.3766/jaaa.14100 Kujawa, S. G., & Liberman, M. C. (2015). Synaptopathy in the noise-exposed and aging cochlea: Primary neural degeneration in acquired sensorineural hearing loss. Hearing Research, 330(Pt B), 191–199. https://doi.org/10.1016/j.heares.2015.02.009 Liberman, L. D., Suzuki, J., & Liberman, M. C. (2015). Dynamics of cochlear synaptopathy after acoustic overexposure. JARO, 16 (2), 205–219. https://doi.org/10.1007/s10162-015-0510-3 Schmiedt, R. A., Mills, J. H., & Boettcher, F. A. (1996). Age-related loss of activity of auditory-nerve fibers. J.Neurophysiol, 76 (4), 2799–2803. https://doi.org/10.1152/jn.1996.76.4.2799 Furman, A. C., Kujawa, S. G., & Liberman, M. C. (2013). Noise-induced cochlear neuropathy is selective for fibers with low spontaneous rates. J.Neurophysio, 110(3), 577–586. https://doi.org/10.1152/jn.00164.2013 Tables Table 1 Table of descriptive statistics and significance of Mann Whitney U test for comparison of speech perception scores and the listening effort between the groups N Mean SD Median (Q1-Q3) Mann Whitney U test Z p Speech perception scores @ 0 dB SNR Normal 34 20.47 0.78 21 20-21 2.38 0.02 Tinnitus 34 19.79 1.20 20.0 19-21 Speech perception scores @ 5 dB SNR Normal 34 20.76 0.49 21.0 21-21 1.16 0.24 Tinnitus 34 20.35 0.65 21.0 20-21 Speech Perception scores @ -5 dB SNR Normal 34 20.29 0.90 21.0 19.75-21 4.97 < 0.001 Tinnitus 34 18.41 1.51 18.0 17-19.25 Listening Effort @ 0 dB SNR Normal 34 1.35 0.48 1.00 1-2 3.40 <0.001 Tinnitus 34 1.94 0.73 2.00 1-2.25 Listening Effort @ 5 dB SNR Normal 34 1.08 0.28 1.00 1-1 1.63 0.102 Tinnitus 34 1.23 .43 1.00 1-1.25 Listening Effort @ -5 dB SNR Normal 34 1.70 0.71 2.00 1-2 4.50 < 0.001 Tinnitus 34 2.79 0.94 3.00 2-3.25 Table 2 Table of descriptive statistics of Amplitude of Wave I of auditory brainstem response in Control group vs Clinical group N=34 Mean SD Median IQR Individuals without tinnitus 0.31 0.22 0.29 0.21-0.43 Individuals with tinnitus (Tinnitus ear) 0.07 0.08 0.05 0.22-0.10 Individuals with tinnitus (Non-tinnitus ear) 0.22 0.11 0.21 0.16-0.27 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 29 Jul, 2025 Reviews received at journal 28 Jul, 2025 Reviewers agreed at journal 20 Jul, 2025 Reviewers agreed at journal 19 Jul, 2025 Reviewers invited by journal 18 Jul, 2025 Editor assigned by journal 27 Jun, 2025 Submission checks completed at journal 27 Jun, 2025 First submitted to journal 21 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6946459","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":488130190,"identity":"41790a35-aafe-44fc-a8f6-0a7b52c66926","order_by":0,"name":"Rebecca Stanley","email":"","orcid":"","institution":"Bharati Vidyapeeth Deemed University","correspondingAuthor":false,"prefix":"","firstName":"Rebecca","middleName":"","lastName":"Stanley","suffix":""},{"id":488130191,"identity":"7a1edf1d-57e5-499a-a82c-58f39d4fd59c","order_by":1,"name":"Nikita Nanavati","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAklEQVRIiWNgGAWjYBADHgYGxmaGBAYGORDvwAPCOgygWhIYjMFaEojQAiKYGYDWJDaAmPi0mLOfPfiZp+aPDIN0c7PBwx926fPDDj8E2mInp9uAXYtlT16yNM8xoMNkDjYnJCQk5268nWYA1JJsbHYAh4sO5BhIzmADapFIbD6QkMCcu3F2AkjLgcRtuLScf2P8c8Y/uJb6dMPZ6R/wa7mRYybxsQ2iBeiwwwny0jkEbLnxxsziY58xDxtQi0FC2nHDDdI5BQcSDPD45XyO8Y2Eb3L2/BLpjyV/2FTLy89O3/zhQ4WdHC4tcMCGCBAwSUA5CpBvIEX1KBgFo2AUjAQAAEIUXd7H0am4AAAAAElFTkSuQmCC","orcid":"","institution":"Bharati Vidyapeeth Deemed University","correspondingAuthor":true,"prefix":"","firstName":"Nikita","middleName":"","lastName":"Nanavati","suffix":""}],"badges":[],"createdAt":"2025-06-21 18:23:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6946459/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6946459/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87383034,"identity":"0d32e207-8b35-4203-8eb4-2fa934ef11ef","added_by":"auto","created_at":"2025-07-23 08:40:57","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":30742,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eCorrelation between speech perception in noise scores and listening effort at 0dB SNR and -5dB SNR in clinical group\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6946459/v1/79069d9fdcec29abc9a2fbae.jpg"},{"id":87383036,"identity":"425f2b74-e0b5-47b8-8b89-434610a5d424","added_by":"auto","created_at":"2025-07-23 08:40:57","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":21186,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eCorrelation between speech perception in noise scores and amplitude of wave I at-5dB SNR in clinical group\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6946459/v1/6c93a6b6d93455d6681f4597.jpg"},{"id":87384321,"identity":"83173258-58da-410b-a96c-75b9f590215b","added_by":"auto","created_at":"2025-07-23 08:48:57","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":56583,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eCharacteristic waveform of amplitude of wave I of auditory brainstem response in control group vs clinical group.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6946459/v1/c15a980df79f1e3c797c29e0.jpg"},{"id":87467168,"identity":"c628073b-a7bd-498b-9ebc-688be891f197","added_by":"auto","created_at":"2025-07-24 08:01:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":615328,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6946459/v1/669cfe20-017f-4645-a07d-1bfdaea64b66.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Tinnitus and Cochlear Synaptopathy: Exploring Listening Effort, Speech Perception in Noise and Auditory Brainstem Response in Normal Hearing Adults","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eTinnitus is defined as the auditory perception of a sound by an individual without an external corresponding sound source, derived from the Latin word \"tinnire,\" meaning \"to ring\" [1]. This condition can affect individuals across all age groups, from young children to the elderly, and may be associated with varying degrees of hearing loss, or even occur in those with normal hearing sensitivity. The subjective perception of tinnitus ranges from barely noticeable to severe. In the Indian middle-aged population, the prevalence of tinnitus is approximately 6.7% [2]. Globally, the prevalence of tinnitus in individuals with normal audiometric thresholds is estimated to be between 8% and 10% [3]. Individuals experiencing tinnitus often report varying degrees of distress, significantly impacting their quality of life across physical, social, and emotional domains. A notable challenge stemming from tinnitus perception is the difficulty in communication, particularly in the presence of background noise, a problem observed to be exacerbated in individuals with persistent tinnitus [4].\u003c/p\u003e\u003cp\u003eThis observed discrepancy between normal hearing sensitivity and subjective communication difficulties is frequently attributed to the increased listening effort required for speech processing amidst concurrent background noise [5,6]. Furthermore, the annoyance caused by tinnitus can disrupt an individual's attention, thereby limiting the effective utilization of cognitive resources crucial for simultaneous speech recognition and recall, consequently increasing listening effort [7]. This effort may be further intensified in conditions like hidden hearing loss, cochlear synaptopathy. This condition involves the deafferentation between cochlear nerve fibers and inner hair cells within the spiral ganglion [8]. If the re-establishment of these deafferented synapses doesn't occur, it can lead to not only the disruption of innervated auditory nerve fibers but also a slower degeneration of spiral ganglion neurons [9]. A prominent consequence of cochlear synaptopathy is the presence of tinnitus. Dysfunction of cochlear synapses can impair the brain's ability to filter background noise, potentially leading to increased central auditory gain. This compensatory mechanism, which amplifies neural activity to offset lost input, may contribute to the perception of tinnitus [10].\u003c/p\u003e\u003cp\u003eThis study addresses a lack of comprehensive investigation into the listening effort experienced by individuals with tinnitus during speech perception in noisy environments, particularly relevant to the highly challenging acoustic landscapes of India. Existing research lacks a holistic approach, failing to connect subjective reports of listening effort with objective measures like Speech in noise (SPIN) scores and ABR Wave I amplitude, especially in the context of tinnitus. This research is vital as reduced ABR Wave I amplitude, indicative of cochlear synaptopathy, is increasingly linked to tinnitus pathophysiology. By bridging these significant gaps through a multi-faceted approach, this research seeks to provide a more holistic understanding of the underlying pathophysiology and auditory difficulties experienced by individuals with tinnitus.\u003c/p\u003e"},{"header":"METHOD","content":"\u003cp\u003eIn this cross-sectional study, 68 participants aged 18\u0026ndash;60 years were recruited using purposive sampling. Two groups of participants were recruited using purposive sampling. Group I (control group) comprised of 34 individuals with normal hearing sensitivity (hearing thresholds of \u0026le;\u0026thinsp;25 dBHL at octave frequencies from 250 Hz to 8000 Hz), with no history of tinnitus, and were native Marathi speakers. Group II (Clinical group) comprised of 34 individuals with normal hearing sensitivity (hearing thresholds of \u0026le;\u0026thinsp;25dBHL at octave frequencies from 250 Hz to 8000 Hz), who reported continuous tinnitus-either unilateral or bilateral, of at least one month duration, and were native Marathi speakers. In the control group, individuals with otological conditions such as otitis media, otosclerosis, M\u0026eacute;ni\u0026egrave;re\u0026rsquo;s disease, tinnitus, or known neurological, psychological, or cognitive impairments were excluded. Similarly, in the clinical group, participants with otological abnormalities, neurological, psychological, or cognitive deficits, a history of using a tinnitus masker, or prior participation in tinnitus masking therapy or counseling were excluded. The study was approved by the Institutional Ethics Committee (name removed for review) and following the guidelines of the ethical committee. Participants who provided informed consent were included in the study.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eEquipment and Material\u003c/h2\u003e\u003cp\u003eA calibrated two-channel diagnostic audiometer (Inventis Piano Plus) with Radio ear IP 30 insert earphones with 2.5mm connectors, were used for obtaining audiometric thresholds and to determine the pitch and loudness of tinnitus. The audiometer was connected to laptop (Lenovo Windows 11), and calibrated speech-in-noise stimuli were presented at 65 dB SPL through insert earphones. For auditory brainstem response (ABR) wave I recordings, the Interacoustics Eclipse EP25 (version 4.4) software module with IP30 insert earphones was utilized. Speech perception in noise was assessed using the the sentence perception in noise test material in marathi (Nayna.,2023)[11]. Listening effort was evaluated using a 5-point rating scale adapted and translated into Marathi (Nayna.,2023))[11].\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003eAll the procedures were carried out in a well-illuminated sound-treated room with ambient noise levels well within the permissible limits (According to ANSI S3.1, 1999). Pure tone audiometry was carried out to obtain air conduction and bone conduction thresholds at octave frequencies from 250 Hz to 8000 Hz using the modified Hughson and Westlake procedure [12]. Sentence perception in noise was assessed at three signal-to-noise ratios (SNRs): +5 dB, 0 dB, and \u0026minus;\u0026thinsp;5 dB. For each SNR, a unique list of six sentences was presented. Participants were instructed to repeat each sentence they heard. Performance was scored based on the total number of correctly repeated keywords, with each list having a maximum score of 21. After each sentence list was presented at varying signal-to-noise ratios (SNRs), participants rated the listening effort they expended to perceive the sentences. They used a five-point scale, where '1' indicated no effort and '5' indicated a lot of effort.\u003c/p\u003e\u003cp\u003e Auditory brainstem response (ABR) wave I was recorded with participants lying supine in a comfortable position. The electrode configuration included an inverting electrode on the upper forehead (Fz), a non-inverting electrode on the mastoid of the test ear (M1 or M2), and a ground electrode on the lower forehead (Fpz). Click stimuli (10 ms duration) were presented at 70 dBnHL with a repetition rate of 21.1 clicks per second through IP-30 insert earphones placed in the ear canal. Responses were filtered between 150 and 3000 Hz, and ipsilateral recordings were analyzed. A total of 2000 sweeps were averaged to enhance the signal-to-noise ratio, with two replicate waveforms collected to verify response consistency. Electrode impedance was kept below 5 kΩ, and testing was conducted in a quiet, electrically shielded environment to minimize interference.\u003c/p\u003e\n\u003ch3\u003eAnalysis\u003c/h3\u003e\n\u003cp\u003eThe data obtained from the participants were tabulated and subjected to the statistical analyses. Statistical analyses were carried out using SPSS Version 23 software. The Shapiro\u0026ndash;Wilk test revealed a non normal distribution (\u0026lt;\u0026thinsp;0.05). Hence, non-parametric tests were used to investigate the aims of the study. The Mann-Whitney U test was used for comparison of the test results between the two groups. Spearman's Rank correlation was used to check the relationship between the tests in each group. A value of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered as statistically significant.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv\u003e\n \u003cp\u003eA total of 68 individuals were included in the present study, wherein 34 individuals were included in the control group (Group I) and 34 individuals were included in the clinical group (Group I). In the control group the, 20 individuals were female and 14 individuals were male whereas in the clinical group 28 individuals were female and 9 individuals were male. The mean participant age for the control group was 31.58\u0026thinsp;\u0026plusmn;\u0026thinsp;12.19and the mean pure tone average 11.19\u0026thinsp;\u0026plusmn;\u0026thinsp;5.11 whereas for the clinical group was the mean participant age was 31.86\u0026thinsp;\u0026plusmn;\u0026thinsp;12.59 and the mean pure tone average was 12.84\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1. In the clinical group the ear with tinnitus was observed to be 59% in the left ear and 41% in the right ear.\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eTable 1 presents the descriptive statistics for speech perception in noise and listening effort. A Mann-Whitney U test was conducted to compare differences between groups, revealing statistically significant differences in speech perception scores at 0 dB SNR and \u0026minus;\u0026thinsp;5 dB SNR, with the clinical group performing poorer than the control group. Additionally, statistically significant differences was observed for listening effort at both 0 dB SNR and \u0026minus;\u0026thinsp;5 dB SNR, with the clinical group exhibited significantly greater listening effort compared to controls.\u003c/p\u003e\n\u003cp\u003eTo examine the relationship between speech perception scores and listening effort in the clinical group, a Spearman\u0026rsquo;s rank correlation analysis was performed. Results indicated a moderate negative correlation at 0 dB SNR (r = -0.41, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and \u0026minus;\u0026thinsp;5 dB SNR (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.38, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as illustrated in Fig.\u0026nbsp;1, while a weak negative correlation was observed at 5 dB SNR (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.02, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003cp\u003eA Spearman\u0026rsquo;s rank correlation test was utilized to evaluate the relationship between speech perception in noise scores and wave I of the auditory brainstem response (ABR). The analysis demonstrated a statistically significant moderate positive correlation (r\u0026thinsp;=\u0026thinsp;0.42, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) between speech perception scores and wave I amplitude in individuals with tinnitus at -5 dB SNR, as illustrated in Fig.\u0026nbsp;2. The characteristic waveforms for the control and clinical groups are illustrated in Fig.\u0026nbsp;3.\u003c/p\u003e\n\u003cp\u003eDescriptive statistics were conducted to compare wave I parameters, specifically ABR amplitude, between the control and clinical groups. In the clinical group, a majority (n\u0026thinsp;=\u0026thinsp;26) of individual in tinnitus ear displayed reduced amplitude, while a smaller subset (n\u0026thinsp;=\u0026thinsp;8) showed amplitudes similar to those of the control group [13]. A statistically significant difference was found when comparing the tinnitus ear to the non-tinnitus ear, both between the clinical and control groups (Z\u0026thinsp;=\u0026thinsp;45.5, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and within the clinical group itself (Z\u0026thinsp;=\u0026thinsp;4.88, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as presented in Table 2.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\u003c/table\u003e\n\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn the current study, it was observed that increasing environmental noise significantly impairs speech perception in individuals with tinnitus compared to those without, aligning with prior research. A study had reported that individuals with tinnitus with normal hearing exhibited significantly lower speech-in-noise perception scores than controls, indicating a reduced ability to recognize speech in noisy conditions [14]. Similarly, in another study it was observed that there was an elevation in the speech recognition thresholds in young individuals with normal hearing and tinnitus compared to their non-tinnitus peers [15]. In a study it was further noted that, in individuals with tinnitus, the ear affected by tinnitus showed poorer speech recognition thresholds in noise compared to the unaffected ear, suggesting that tinnitus may act as a \u0026quot;central masker,\u0026quot; disrupting speech perception through central auditory system alterations rather than peripheral damage [16].\u003c/p\u003e\n\u003cp\u003eAdditionally, studies indicate that cochlear damage leads to broader, more linear basilar membrane responses, reducing frequency selectivity and temporal resolution [17,18]. However, it was proposed that impaired speech perception in noise among tinnitus patients may occur independently of outer hair cell damage, likely driven by neuroplastic changes in the central auditory system [15]. These findings underscore the complex interplay between tinnitus and central auditory processing, highlighting the need for further investigation into its impact on speech perception in adverse listening conditions.\u003c/p\u003e\n\u003cp\u003eThe current research demonstrated that as listening conditions deteriorate, individuals with tinnitus experience not only reduced speech perception but also a significant increase in listening effort. This aligns with a study in which it was found that distorted speech signals require greater cognitive resources than minimally degraded ones [19]. Similarly it was noted elevated auditory effort among middle-aged adults in unfavorable listening environments [20]. Additionally,it was reported that individuals with tinnitus and hearing loss required substantially higher listening effort at 0 dB SNR compared to favorable conditions, suggesting that cochlear damage results in unclear speech reaching the auditory cortex, demanding increased cognitive effort for processing [7]. These findings emphasize the heightened cognitive load faced by tinnitus patients in challenging auditory settings.\u003c/p\u003e\n\u003cp\u003eThis study reported a negative correlation between speech perception scores and listening effort in individuals with tinnitus at 0 dB and \u0026minus;\u0026thinsp;5 dB SNR, suggesting that increased noise reduces speech clarity and elevates cognitive load, as evidenced by greater listening effort. The presence of tinnitus, combined with external noise, significantly hinders speech perception in noisy settings, demanding increased cognitive and attentional effort. Consistent with these findings, it was reported that continuous noise significantly affects speech recognition thresholds, with steady noise posing the greatest challenge, followed by male and female competing speech [21]. In found that tinnitus impairs speech-from-noise segregation, reflecting central processing difficulties and reduced relief from informational masking [4]. They highlighted that tinnitus depletes cognitive resources, affecting working memory and complicating speech perception in noise, particularly under adverse conditions where cognitive spare capacity for information processing is diminished.\u003c/p\u003e\n\u003cp\u003eIn the current study, it was observed that there was a positive correlation between speech in noise scores at -5dB SNR and the amplitude of Wave I of the ABR. Also it was observed that ABR wave I amplitude was reduced in tinnitus ear as compared to non tinnitus ear and control group. Similar to current study findings, previous studies also have reported that reduced ABR wave I amplitude has been associated with tinnitus, potentially due to central auditory system compensatory gain, which may contribute to tinnitus perception [9,22\u0026ndash;24]. Previous studies have shown that deafferentation from inner hair cell or spiral ganglion cell degeneration impairs signal detection in noise, reducing peripheral input to the central auditory system [25\u0026ndash;28]. Partial spiral ganglion neuron loss has also been linked to increased speech comprehension difficulties in moderate noise [29,30]. One study noted reduced ABR wave I amplitude alongside impaired speech-in-noise perception, attributing this to low-spontaneous-rate (SR) fiber loss [31].\u003c/p\u003e\n\u003cp\u003eResearch indicates that cochlear synaptopathy, characterized by tinnitus and impaired speech perception in noisy environments, is associated with a reduction in auditory brainstem response (ABR) wave I amplitude [29,32]. This electrophysiological marker reflects diminished peripheral auditory nerve activity, potentially due to selective damage to low-spontaneous-rate auditory nerve fibers, despite preserved audiometric thresholds. Acoustic overexposure can cause rapid, irreversible cochlear nerve terminal loss at inner hair cell peripheries, followed by gradual spiral ganglion cell degeneration, despite full audiometric threshold recovery and no hair cell loss. A reduced subset of auditory nerve fibers along the cochlear spiral is critical for detecting stimuli, particularly pure tones in quiet settings [33]. Low-SR auditory nerve fibers potentially due to glutamate excitotoxicity involving Ca\u0026thinsp;+\u0026thinsp;+\u0026thinsp;overload, where mitochondria serve as a key buffering system [34,35].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations and Future direction of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study did not include a high frequency audiometric evaluation which could have helped in attaining a better understanding of whether a high frequency loss is present or not. Additionally, cognitive function such as working memory and attention which could impact the listening effort of an individual was not assessed formally. The future research should aim to adopt a multifaceted approach which incorporates high frequency audiometric thresholds so as to detect the presence of a subclinical hearing loss, as well as include electrocohleography assessment which will help in attaining a better amplitude ratio. The test battery should also include cognitive assessments so as to rule out the effect of cognition/memory on the listening effort that the individual would require.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study highlights the multifaceted challenges that continuous tinnitus presents for individuals. As the listening environment becomes more adverse, patients exhibited heightened listening effort, accompanied by a decrease in the perception of speech. Additionally, a moderate positive correlation emerged between the speech perception scores in noise at -5dB SNR with the amplitude of wave I of ABR, all these factors could be indicative of an underlying pathology such as cochlear synaptopathy, especially in those individuals with tinnitus. By recognizing the multifaceted nature of these challenges of tinnitus, interventions can be tailored to address not only the physical aspects of tinnitus but also on the and physiological consequences, ultimately fostering a better quality of life for the affected individuals.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eSNR - Signal to Noise Ratio\u003c/p\u003e\n\u003cp\u003eSPIN - Speech Perception in Noise\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eABR - Auditory Brainstem Response\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThe current study did not receive any funding from any agencies\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eContributor 1 (Stanley Rebecca) collected the data, interpreted and analyzed the data and assisted in writing the manuscript; Contributor 2 (Nanavati Nikita) designed the experiment , interpreted and analyzed the data and was also a major contributor in writing the manuscript. Both the authors have read and approved submission of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe acknowledge all the authorities of Bharati Vidyapeeth (Deemed to be University) for permitting us to carry out this research. . We would also like to thank all the participants who took their time out and participated in this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eif data is asked, I have the data to declare\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eJastreboff, P. J., Gray, W. C., \u0026amp; Gold, S. L. (1996). Neurophysiological approach to tinnitus patients. Am J Otolaryngol, 17(2), 236\u0026ndash;240.\u003c/li\u003e\n\u003cli\u003eAryal, S., Sharma, Y., \u0026amp; Prabhu, P. (2023). Prevalence of Tinnitus and its Characteristics Among Indian Adult Population. AONO, \u003cem\u003e5\u003c/em\u003e(1), 15\u0026ndash;20. https://doi.org/10.1055/s-0043-1769889\u003c/li\u003e\n\u003cli\u003eBarnea, G., Attias, J., Gold, S., \u0026amp; Shahar, A. (1990). Tinnitus with normal hearing sensitivity: Extended high-frequency audiometry and auditory-nerve brain-stem-evoked responses. Audiology: Official Organ of the International Society of Audiology, \u003cem\u003e29\u003c/em\u003e(1), 36\u0026ndash;45.\u003c/li\u003e\n\u003cli\u003eMadhukesh, S., Palaniswamy, H. P., Ganapathy, K., Rajashekhar, B., \u0026amp; Nisha, K. V. (2024). The impact of tinnitus on speech perception in noise: A systematic review and meta-analysis. EUFOS, \u003cem\u003e281\u003c/em\u003e(12), 6211\u0026ndash;6228. https://doi.org/10.1007/s00405-024-08844-1\u003c/li\u003e\n\u003cli\u003eGlyde, H., Hickson, L., Cameron, S., \u0026amp; Dillon, H. (2011). Problems hearing in noise in older adults: a review of spatial processing disorder. Trends in amplification, \u003cem\u003e15\u003c/em\u003e(3), 116\u0026ndash;126. https://doi.org/10.1177/1084713811424885\u003c/li\u003e\n\u003cli\u003eKeidser, G., \u0026amp; Alamudi, K. (2013). Real-life efficacy and reliability of training a hearing aid. Ear and Hearing, 34(5), 619\u0026ndash;629. https://doi.org/10.1097/AUD.0b013e31828d269a\u003c/li\u003e\n\u003cli\u003eShetty, H. N., \u0026amp; Raju, S. (2023). Objective Measure of Listening Effort in Hearing Impaired Individuals With and Without Tinnitus. J.Int Adv Otol , \u003cem\u003e19\u003c/em\u003e(4), 295\u0026ndash;302. https://doi.org/10.5152/iao.2023.22827\u003c/li\u003e\n\u003cli\u003eColla, M. D. F., Lunardelo, P. P., \u0026amp; Dias, F. A. M. (2024). Cochlear synaptopathy and hidden hearing loss: A scoping review. \u003cem\u003eCoDAS\u003c/em\u003e, \u003cem\u003e36\u003c/em\u003e(2), e20230032. https://doi.org/10.1590/2317-1782/20232023032en\u003c/li\u003e\n\u003cli\u003eShi, L., Chang, Y., Li, X., Aiken, S., Liu, L., \u0026amp; Wang, J. (2016). Cochlear Synaptopathy and Noise-Induced Hidden Hearing Loss. Neural Plasticity, 2016(1), 6143164. https://doi.org/10.1155/2016/6143164\u003c/li\u003e\n\u003cli\u003eSchaette, R., \u0026amp; McAlpine, D. (2011). Tinnitus with a normal audiogram: Physiological evidence for hidden hearing loss and computational model. JNEUROSCI, \u003cem\u003e31\u003c/em\u003e(38), 13452\u0026ndash;13457. https://doi.org/10.1523/JNEUROSCI.2156-11.2011\u003c/li\u003e\n\u003cli\u003eNayna (2023). Self perceived listening effort as a measure of hearing aid outcome. \u003c/li\u003e\n\u003cli\u003eCarhart, R., \u0026amp; Jerger, J. F. (1959). Preferred method for clinical determination of pure-tone thresholds./JSHD, \u003cem\u003e24\u003c/em\u003e(4), 330\u0026ndash;345. https://doi.org/10.1044/jshd.2404.330\u003c/li\u003e\n\u003cli\u003eSingh, R., \u0026amp; Vates, E. (2023, November 14). \u003cem\u003eBrainstem auditory evoked response test\u003c/em\u003e. In StatPearls. Publishing. https://www.ncbi.nlm.nih.gov/books/NBK597358/\u003c/li\u003e\n\u003cli\u003eHuang, C.-Y., Lee, H.-H., Chung, K.-C., Chen, H.-C., Shen, Y.-J., \u0026amp; Wu, J.-L. (2007). Relationships among speech perception, self-rated tinnitus loudness and disability in tinnitus patients with normal pure-tone thresholds of hearing. \u003cem\u003eORL; \u003c/em\u003eJ Otorhinolaryngology Rel Spec, \u003cem\u003e69\u003c/em\u003e(1), 25\u0026ndash;29. https://doi.org/10.1159/000096713\u003c/li\u003e\n\u003cli\u003eRyu, I. S., Ahn, J. H., Lim, H. W., Joo, K. Y., \u0026amp; Chung, J. W. (2012). Evaluation of masking effects on speech perception in patients with unilateral chronic tinnitus using the hearing in noise test. Otology \u0026amp; Neurotology: Official Publication of the\u003cem\u003e \u003c/em\u003eAOS, ANS [and] EAONO, 33(9), 1472\u0026ndash;1476. https://doi.org/10.1097/MAO.0b013e31826dbcc4\u003c/li\u003e\n\u003cli\u003eMoon, I. J., Won, J. H., Kang, H. W., Kim, D. H., An, Y.-H., \u0026amp; Shim, H. J. (2015). Influence of Tinnitus on Auditory Spectral and Temporal Resolution and Speech Perception in Tinnitus Patients. JNEUROSCI, \u003cem\u003e35\u003c/em\u003e(42), 14260\u0026ndash;14269. https://doi.org/10.1523/JNEUROSCI.5091-14.2015\u003c/li\u003e\n\u003cli\u003eOxenham, A. J., \u0026amp; Bacon, S. P. (2003). Cochlear compression: Perceptual measures and implications for normal and impaired hearing. Ear and Hearing, 24(5), 352\u0026ndash;366. https://doi.org/10.1097/01.AUD.0000090470.73934.78\u003c/li\u003e\n\u003cli\u003eMoore, B. C., \u0026amp; Glasberg, B. R. (1988). Gap detection with sinusoids and noise in normal, impaired, and electrically stimulated ears. The Journal of the Acoustical Society of America, \u003cem\u003e83\u003c/em\u003e(3), 1093\u0026ndash;1101. https://doi.org/10.1121/1.396054\u003c/li\u003e\n\u003cli\u003eSchneider, B. A., Daneman, M., \u0026amp; Pichora-Fuller, M. K. (2002). Listening in aging adults: From discourse comprehension to psychoacoustics. \u003cem\u003eCan. J.Exp Psychol\u003c/em\u003e, \u003cem\u003e56\u003c/em\u003e(3), 139\u0026ndash;152. https://doi.org/10.1037/h0087392\u003c/li\u003e\n\u003cli\u003eDegeest, S., Keppler, H., \u0026amp; Corthals, P. (2015). The Effect of Age on Listening Effort. JSLHR, \u003cem\u003e58\u003c/em\u003e(5), 1592\u0026ndash;1600. https://doi.org/10.1044/2015_JSLHR-H-14-0288\u003c/li\u003e\n\u003cli\u003eZhang, W., Yu, Z., Ruan, Q., Zhang, W., Yu, Z., \u0026amp; Ruan, Q. (2020). Presbycusis-Related Tinnitus and Cognitive Impairment: Gender Differences and Common Mechanisms\u003cem\u003e.\u003c/em\u003e In An Overview and Management of Multiple Chronic Conditions. IntechOpen. https://doi.org/10.5772/intechopen.90956\u003c/li\u003e\n\u003cli\u003eGu, J. W., Herrmann, B. S., Levine, R. A., \u0026amp; Melcher, J. R. (2012). Brainstem Auditory Evoked Potentials Suggest a Role for the Ventral Cochlear Nucleus in Tinnitus. JARO, \u003cem\u003e13\u003c/em\u003e(6), 819\u0026ndash;833. https://doi.org/10.1007/s10162-012-0344-1\u003c/li\u003e\n\u003cli\u003eBramhall, N., Beach, E. F., Epp, B., Le Prell, C. G., Lopez-Poveda, E. A., Plack, C. J., Schaette, R., Verhulst, S., \u0026amp; Canlon, B. (2019). The search for noise-induced cochlear synaptopathy in humans: Mission impossible? Hearing Research, 377, 88\u0026ndash;103. https://doi.org/10.1016/j.heares.2019.02.016\u003c/li\u003e\n\u003cli\u003eBramhall, N. F., McMillan, G. P., Kujawa, S. G., \u0026amp; Konrad-Martin, D. (2018). Use of non-invasive measures to predict cochlear synapse counts. Hearing Research, 370, 113\u0026ndash;119. https://doi.org/10.1016/j.heares.2018.10.006\u003c/li\u003e\n\u003cli\u003eLobarinas, E., Salvi, R., \u0026amp; Ding, D. (2020). Gap Detection Deficits in Chinchillas with Selective Carboplatin-Induced Inner Hair Cell Loss. JARO, \u003cem\u003e21\u003c/em\u003e(6), 475\u0026ndash;483. https://doi.org/10.1007/s10162-020-00744-5\u003c/li\u003e\n\u003cli\u003eLobarinas, E., Spankovich, C., \u0026amp; Le Prell, C. G. (2017). Evidence of \u0026ldquo;hidden hearing loss\u0026rdquo; following noise exposures that produce robust TTS and ABR wave-I amplitude reductions. Hearing Research,349,155\u0026ndash;163. https://doi.org/10.1016/j.heares.2016.12.009\u003c/li\u003e\n\u003cli\u003eMonaghan, J. J. M., Garcia-Lazaro, J. A., McAlpine, D., \u0026amp; Schaette, R. (2020). Hidden hearing loss impacts the neural representation of speech in background noise. Current Biology, 30(23), 4710-4721.e4. https://doi.org/10.1016/j.cub.2020.09.046\u003c/li\u003e\n\u003cli\u003eResnik, J., \u0026amp; Polley, D. B. (2021). Cochlear neural degeneration disrupts hearing in background noise by increasing auditory cortex internal noise. Neuron, 109(6), 984-996.e4. https://doi.org/10.1016/j.neuron.2021.01.015\u003c/li\u003e\n\u003cli\u003eLin, H. W., Furman, A. C., Kujawa, S. G., \u0026amp; Liberman, M. C. (2011). Primary Neural Degeneration in the Guinea Pig Cochlea After Reversible Noise-Induced Threshold Shift. JARO, \u003cem\u003e12\u003c/em\u003e(5), 605\u0026ndash;616. https://doi.org/10.1007/s10162-011-0277-0\u003c/li\u003e\n\u003cli\u003eKujawa, S. G., \u0026amp; Liberman, M. C. (2009). Adding Insult to Injury: Cochlear Nerve Degeneration after \u0026ldquo;Temporary\u0026rdquo; Noise-Induced Hearing Loss. JNEUROSCI, \u003cem\u003e29\u003c/em\u003e(45), 14077\u0026ndash;14085. https://doi.org/10.1523/jneurosci.2845-09.2009\u003c/li\u003e\n\u003cli\u003eBramhall, N., Ong, B., Ko, J., \u0026amp; Parker, M. (2015). Speech Perception Ability in Noise is Correlated with Auditory Brainstem Response Wave I Amplitude. JAAA, \u003cem\u003e26\u003c/em\u003e(5), 509\u0026ndash;517. https://doi.org/10.3766/jaaa.14100\u003c/li\u003e\n\u003cli\u003eKujawa, S. G., \u0026amp; Liberman, M. C. (2015). Synaptopathy in the noise-exposed and aging cochlea: Primary neural degeneration in acquired sensorineural hearing loss. Hearing Research, 330(Pt B), 191\u0026ndash;199. https://doi.org/10.1016/j.heares.2015.02.009\u003c/li\u003e\n\u003cli\u003eLiberman, L. D., Suzuki, J., \u0026amp; Liberman, M. C. (2015). Dynamics of cochlear synaptopathy after acoustic overexposure. JARO, \u003cem\u003e16\u003c/em\u003e(2), 205\u0026ndash;219. https://doi.org/10.1007/s10162-015-0510-3\u003c/li\u003e\n\u003cli\u003eSchmiedt, R. A., Mills, J. H., \u0026amp; Boettcher, F. A. (1996). Age-related loss of activity of auditory-nerve fibers. J.Neurophysiol, \u003cem\u003e76\u003c/em\u003e(4), 2799\u0026ndash;2803. https://doi.org/10.1152/jn.1996.76.4.2799\u003c/li\u003e\n\u003cli\u003eFurman, A. C., Kujawa, S. G., \u0026amp; Liberman, M. C. (2013). Noise-induced cochlear neuropathy is selective for fibers with low spontaneous rates. J.Neurophysio, 110(3), 577\u0026ndash;586. https://doi.org/10.1152/jn.00164.2013\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTable of descriptive statistics and significance of Mann Whitney U test for comparison of speech perception scores and the listening effort between the groups\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"576\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(Q1-Q3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMann\u0026nbsp;Whitney\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eU\u0026nbsp;test\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eZ\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003eSpeech\u003c/p\u003e\n \u003cp\u003eperception scores\u003c/p\u003e\n \u003cp\u003e@ 0\u0026nbsp;dB\u0026nbsp;SNR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e20.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e20-21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e2.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eTinnitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e19.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e20.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e19-21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003eSpeech\u003c/p\u003e\n \u003cp\u003eperception scores\u003c/p\u003e\n \u003cp\u003e@ 5\u0026nbsp;dB\u0026nbsp;SNR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e20.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e21.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e21-21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e1.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eTinnitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e20.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e21.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e20-21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003eSpeech\u003c/p\u003e\n \u003cp\u003ePerception scores\u003c/p\u003e\n \u003cp\u003e@ -5\u0026nbsp;dB\u0026nbsp;SNR\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e20.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e21.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e19.75-21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e4.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eTinnitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e18.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e1.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e18.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e17-19.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003eListening\u0026nbsp;Effort\u003c/p\u003e\n \u003cp\u003e@ 0\u0026nbsp;dB\u0026nbsp;SNR\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e1.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e1-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e3.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eTinnitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e1.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e1-2.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003eListening\u0026nbsp;Effort\u003c/p\u003e\n \u003cp\u003e@ 5\u0026nbsp;dB\u0026nbsp;SNR\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e1-1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e1.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eTinnitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e1-1.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003eListening\u0026nbsp;Effort\u003c/p\u003e\n \u003cp\u003e@ -5\u0026nbsp;dB\u0026nbsp;SNR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e1.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e1-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e4.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026nbsp;0.001\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eTinnitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e2.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e3.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e2-3.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTable of descriptive statistics\u0026nbsp;of Amplitude of Wave I of auditory brainstem response in Control group vs Clinical group\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"450\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN=34\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMedian\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eIQR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003eIndividuals without\u0026nbsp;\u003c/p\u003e\n \u003cp\u003etinnitus\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.21-0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003eIndividuals with tinnitus\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(Tinnitus\u0026nbsp;ear)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.22-0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003eIndividuals with tinnitus\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(Non-tinnitus\u0026nbsp;ear)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.16-0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"the-egyptian-journal-of-otolaryngology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [The Egyptian Journal of Otolaryngology](https://ejo.springeropen.com/)","snPcode":"43163","submissionUrl":"https://submission.springernature.com/new-submission/43163/3","title":"The Egyptian Journal of Otolaryngology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Tinnitus, Ringing sensation, Cochlear synaptopathy, Effortful listening, Auditory Brainstem Response, Neural degeneration, Speech in noise","lastPublishedDoi":"10.21203/rs.3.rs-6946459/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6946459/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Tinnitus, a common auditory condition, frequently disrupts speech perception in noisy environments and heightens listening effort in individuals with normal hearing, possibly due to hidden hearing loss indicated by diminished auditory brainstem response (ABR) wave I amplitude. The current study aimed to evaluate speech perception in noise, listening effort, and amplitude of ABR wave I in individuals with tinnitus and normal hearing\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e: The study included 34 adults with tinnitus and normal hearing sensitivity, and 34 age-matched controls with normal hearing. A speech-in-noise test at +5, 0 and -5 dB signal-to-noise ratios (SNR), subjective listening effort rating, and ABR testing was done for all the participants\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Individuals with tinnitus exhibited poorer speech perception at 0 dB and -5 dB SNR (p \u0026lt; 0.05) and reported greater listening effort (p \u0026lt; 0.01) compared to controls. Correlation between Speech in noise at 0, -5dB SNR with listening effort was observed in tinnitus group. Reduced ABR wave I amplitude in the tinnitus group (p \u0026lt; 0.05) correlated with lower speech-in-noise scores (r = 0.62, p \u0026lt; 0.01)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: These findings highlight significant auditory challenges in normal-hearing individuals with tinnitus, including impaired speech perception in noise and heightened listening effort. The association between reduced ABR wave I amplitude and speech-in-noise deficits supports its potential as a biomarker for cochlear synaptopathy.\u003c/p\u003e","manuscriptTitle":"Tinnitus and Cochlear Synaptopathy: Exploring Listening Effort, Speech Perception in Noise and Auditory Brainstem Response in Normal Hearing Adults","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-23 08:40:52","doi":"10.21203/rs.3.rs-6946459/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-07-29T20:31:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-28T16:14:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"305532558683287851401489818127044828135","date":"2025-07-20T18:09:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"246616792520692978344757089770949746551","date":"2025-07-19T13:28:43+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-18T18:05:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-27T12:30:39+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-27T12:30:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"The Egyptian Journal of Otolaryngology","date":"2025-06-21T18:19:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"the-egyptian-journal-of-otolaryngology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [The Egyptian Journal of Otolaryngology](https://ejo.springeropen.com/)","snPcode":"43163","submissionUrl":"https://submission.springernature.com/new-submission/43163/3","title":"The Egyptian Journal of Otolaryngology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9f348940-86fa-41ca-949e-346fac6e79b8","owner":[],"postedDate":"July 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-08-14T14:08:10+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-23 08:40:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6946459","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6946459","identity":"rs-6946459","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}