{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T02:00:01Z","timestamp":1781143201453,"version":"3.54.1"},"reference-count":58,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82271165"],"award-info":[{"award-number":["82271165"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82471956"],"award-info":[{"award-number":["82471956"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2023YFC2508400"],"award-info":[{"award-number":["2023YFC2508400"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004608","name":"Natural Science Foundation of Jiangsu Province","doi-asserted-by":"publisher","award":["BK20211008"],"award-info":[{"award-number":["BK20211008"]}],"id":[{"id":"10.13039\/501100004608","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To determine if tinnitus is associated with glymphatic system dysfunction and cognitive decline and whether repetitive transcranial magnetic stimulation (rTMS) treatment associates with an improvement in glymphatic function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We compared glymphatic function in tinnitus patients and healthy controls (HCs) using multimodal MRI indices. Multimodal MRI analyses of choroid plexus volume (CPV), enlarged perivascular space (EPVS), diffusion tensor image analysis along the perivascular space (DTI\u2010ALPS) index, and free water (FW). Tinnitus patients received repetitive transcranial magnetic stimulation (rTMS) and the changes in their tinnitus handicap questionnaire (THQ) scores were then correlated with changes in glymphatic function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Tinnitus patients exhibited reduced DTI\u2010ALPS indices (median, 1.51 vs. 1.55,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008, effect size\u2009=\u20090.242) and increased CPV (median, 2.39 vs. 2.10,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.026, effect size\u2009=\u2009\u22120.203) compared to HCs. Elevated CPV was correlated with impaired executive function (TMT\u2010B:\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.197,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.033), while the reduction of the ALPS index was correlated with increased tinnitus severity (THQ:\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u22120.340,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.010). ROC analysis showed DTI\u2010ALPS\u2010mean optimally discriminated tinnitus patients from HCs (AUC\u2009=\u20090.896). Treatment of tinnitus patients with rTMS showed a significant decrease in FW values (median, 0.30 vs. 0.29,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007, effect size\u2009=\u20090.631) and a significant increase in the ALPS\u2010index (mean, 1.35 vs. 1.37,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.013, effect size\u2009=\u20090.653).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings suggest that glymphatic dysfunction is associated with tinnitus, highlighting a potential link that requires confirmation in longitudinal and mechanistic studies. rTMS treatment is related to reduced tinnitus severity and enhanced glymphatic function, suggesting its therapeutic potential.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>3.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.70384","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T10:48:41Z","timestamp":1769165321000},"page":"3165-3175","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Altered Glymphatic Function in Tinnitus: Associations With Cognition and Effects of\n                    <scp>rTMS<\/scp>"],"prefix":"10.1002","volume":"136","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-8437-5531","authenticated-orcid":false,"given":"Weijie","family":"Ye","sequence":"first","affiliation":[{"name":"Department of Otolaryngology Sun Yat\u2010Sen Memorial Hospital, Sun Yat\u2010Sen University  Guangzhou China"},{"name":"Institute of Hearing and Speech\u2010Language Science Sun Yat\u2010Sen University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinjuan","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Zhongda Hospital, Southeast University  Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuo","family":"Li","sequence":"additional","affiliation":[{"name":"Medical Imaging Research Institute, Department of Radiology, Nanjing First Hospital Nanjing Medical University  Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qianhui","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Sun Yat\u2010Sen Memorial Hospital, Sun Yat\u2010Sen University  Guangzhou China"},{"name":"Institute of Hearing and Speech\u2010Language Science Sun Yat\u2010Sen University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zihuai","family":"Fang","sequence":"additional","affiliation":[{"name":"Medical Imaging Research Institute, Department of Radiology, Nanjing First Hospital Nanjing Medical University  Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin\u2010Jing","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Nanjing Pukou People's Hospital Liangjiang Hospital, Southeast University  Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Radiology Affiliated Jiangning Hospital of Nanjing Medical University  Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Salvi","sequence":"additional","affiliation":[{"name":"Center for Hearing and Deafness University at Buffalo, The State University of New York  Buffalo New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu\u2010Chen","family":"Chen","sequence":"additional","affiliation":[{"name":"Medical Imaging Research Institute, Department of Radiology, Nanjing First Hospital Nanjing Medical University  Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2434-9747","authenticated-orcid":false,"given":"Yuexin","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Sun Yat\u2010Sen Memorial Hospital, Sun Yat\u2010Sen University  Guangzhou China"},{"name":"Institute of Hearing and Speech\u2010Language Science Sun Yat\u2010Sen University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.0697"},{"key":"e_1_2_12_3_1","first-page":"888","article-title":"Global Prevalence and Incidence of Tinnitus: A Systematic Review and Meta\u2010Analysis","volume":"79","author":"Jarach C. 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