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In this narrative review, we give an overview on various clinical aspects of tinnitus including its heterogeneity, contributing factors, comorbidities and therapeutic pathways with a specific emphasis on the implications for its pathophysiology and future research directions. Tinnitus exhibits high perceptual variability between affected individuals (heterogeneity) and within affected individuals (temporal variability). Hearing loss emerges as predominant risk factor and the perceived pitch corresponds to areas of hearing loss, supporting the compensatory response theory. Whereas most people who have tinnitus can live a normal life, in 10\u201320% tinnitus interferes severely with quality of life. These patients suffer frequently from comorbidities such as anxiety, depression or insomnia, acting as both risk factors and consequences. Accordingly, neuroimaging studies demonstrate shared brain networks between tinnitus and stress-related disorders shedding light on the intricate interplay of mental health and tinnitus. The challenge lies in deciphering causative relationships and shared pathophysiological mechanisms. Stress, external sounds, time of day, head movements, distraction, and sleep quality can impact tinnitus perception. Understanding these factors provides insights into the interplay with autonomic, sensory, motor, and cognitive processes. Counselling and cognitive-behavioural therapy demonstrate efficacy in reducing suffering, supporting the involvement of stress and anxiety-related networks. Hearing improvement, especially through cochlear implants, reduces tinnitus and thus indirectly validates the compensatory nature of tinnitus. Brain stimulation techniques can modulate the suffering of tinnitus, presumably by alteration of stress-related brain networks. Continued research is crucial for unravelling the complexities of tinnitus. Progress in management hinges on decoding diverse manifestations, identifying treatment-responsive subtypes, and advancing targeted therapeutic approaches.<\/jats:p>","DOI":"10.1007\/s10162-024-00939-0","type":"journal-article","created":{"date-parts":[[2024,3,26]],"date-time":"2024-03-26T13:03:29Z","timestamp":1711458209000},"page":"249-258","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":66,"title":["Tinnitus: Clinical Insights in Its Pathophysiology-A Perspective"],"prefix":"10.1007","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7066-510X","authenticated-orcid":false,"given":"Berthold","family":"Langguth","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"de Ridder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Winfried","family":"Schlee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Kleinjung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,3,26]]},"reference":[{"issue":"11","key":"939_CR1","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1016\/j.tins.2004.08.010","volume":"27","author":"JJ Eggermont","year":"2004","unstructured":"Eggermont JJ, Roberts LE (2004) The neuroscience of tinnitus. 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Front Syst Neurosci 6:1","journal-title":"Front Syst Neurosci"}],"container-title":["Journal of the Association for Research in Otolaryngology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10162-024-00939-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10162-024-00939-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10162-024-00939-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,4]],"date-time":"2024-06-04T11:35:12Z","timestamp":1717500912000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10162-024-00939-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,26]]},"references-count":129,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,6]]}},"alternative-id":["939"],"URL":"https:\/\/doi.org\/10.1007\/s10162-024-00939-0","relation":{},"ISSN":["1438-7573"],"issn-type":[{"value":"1438-7573","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,26]]},"assertion":[{"value":"28 December 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 February 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 March 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"B. Langguth received honoraria for consultancy and speakers\u2019 fees from ANM, AstraZeneca, Autifony Therapeutics, Decibel Therapeutics, Desyncra, Gerson Lehmanns Group, Lundbeck, Merz, MagVenture, Medical Tribune, Neurolite, Neuromod, Novartis, Pfizer, Rovi, Schwabe, Sea Pharma, Servier, Sonova and Sound Therapeutics; research funding from the Tinnitus Research Initiative, Bayhost, the German Research Foundation, the German Bundesministerium f\u00fcr Bildung und Forschung, the American Tinnitus Association, AstraZeneca, cerbomed, Neuromod and the European Union; funding for equipment from MagVenture and Deymed Diagnostic; and travel and accommodation payments from Eli Lilly, Lundbeck, Servier, and Pfizer. He owns shares of Sea Pharma. D. De Ridder received honoraria for consultancy and speakers\u2019 fees from Abbott laboratories and research funding from ATA and TRI. W. Schlee received honoraria for consultancy and speakers\u2019 fess from Schwabe, Pohl-Boskamp, and Pansatori. He received funding from the EU, the Bavarian Research Foundation, the German Research Foundation, Innosuisse, and the Rainwater Charitable Foundation. He is stakeholder of the Lenox uG and the HealthStudyClub GmbH, which aim to translate scientific knowledge into digital health applications. T. Kleinjung received honoraria for consultancy and speaker\u2019s fees form Sonova and Schwabe and travel and accommodation payments from Cochlear. His research was funded from the Tinnitus Research Initiative, the Swiss National Science Foundation, the European Union, the Zurich Hearing Foundation and Cochlear.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}}]}}