{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T07:17:42Z","timestamp":1787728662164,"version":"build-2784847793"},"reference-count":53,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T00:00:00Z","timestamp":1762387200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Audiology Research"],"abstract":"<jats:p>Background\/Objectives: Tinnitus is a complex auditory phenomenon with multifactorial origins, often involving both peripheral and central auditory pathways. Given the multifactorial nature of tinnitus, this review specifically focuses on the auditory brainstem as it represents the first central relay for auditory input and a key site of abnormal synchrony and central gain, which may generate or modulate tinnitus even when peripheral hearing appears normal. Several studies suggest a potential role of brainstem dysfunction in its pathogenesis, even among patients with normal hearing thresholds. Although the physiopathological data provide evidence for the role of brainstem in the generation and magnification of tinnitus, the diagnostic tools are still unclear. This systematic review aimed to investigate the diagnostic relevance of brainstem-level abnormalities in individuals with tinnitus. Methods: Following PRISMA guidelines, a literature search was conducted using PubMed, Scopus, and Web of Science from January 2000 to June 2025. Studies were included if they addressed the diagnostic relationship between tinnitus and brainstem involvement. Data on auditory brainstem response (ABR), otoacoustic emissions (used to differentiate peripheral from central auditory abnormalities), neuroimaging, and electrophysiological markers were extracted. Results: Twenty studies were included. Most used ABR as a diagnostic tool, revealing significant amplitude and latency alterations in tinnitus patients compared to controls, particularly in wave V and V\/I amplitude ratios. Imaging studies supported altered brainstem\u2013cortical connectivity and localized changes in inferior colliculus (IC) activity. Additional techniques, such as middle-latency evoked potentials and gap-in-noise detection, showed potential but lacked consistent clinical utility. Conclusions: Evidence suggests that brainstem dysfunction may contribute to tinnitus generation or persistence. ABR and advanced imaging represent specific diagnostic tools, though standardization and high-quality studies are still needed to improve clinical applicability.<\/jats:p>","DOI":"10.3390\/audiolres15060149","type":"journal-article","created":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T10:08:51Z","timestamp":1762423731000},"page":"149","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["An Insight into Role of Auditory Brainstem in Tinnitus: A Systematic Review of Diagnostic Assessments"],"prefix":"10.3390","volume":"15","author":[{"given":"Giovanni","family":"Freda","sequence":"first","affiliation":[{"name":"Department of Neuroscience, Reproductive Sciences and Dentistry, Audiology Section University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3455-2295","authenticated-orcid":false,"given":"Andrea","family":"Ciorba","sequence":"additional","affiliation":[{"name":"ENT and Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, 44121 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8086-6362","authenticated-orcid":false,"given":"Nicola","family":"Serra","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Reproductive Sciences and Dentistry, Audiology Section University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2728-339X","authenticated-orcid":false,"given":"Rita","family":"Malesci","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Reproductive Sciences and Dentistry, Audiology Section University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy"},{"name":"Hearing and Balance Unit, Department of Head and Neck, Federico II University Hospital, Via Pansini 5, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Stomeo","sequence":"additional","affiliation":[{"name":"ENT and Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, 44121 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Bianchini","sequence":"additional","affiliation":[{"name":"ENT and Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, 44121 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Pelucchi","sequence":"additional","affiliation":[{"name":"ENT and Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, 44121 Ferrara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1502-6508","authenticated-orcid":false,"given":"Pasqualina Maria","family":"Picciotti","sequence":"additional","affiliation":[{"name":"Complex Operational Unit of Ear Nose and Throat, Department of Neuroscience, Sense Organs and Thorax, Foundation Polyclinic University A. Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Department of Neuroscience, Sense Organs and Thorax, Catholic University of the Sacred Heart, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Maiolino","sequence":"additional","affiliation":[{"name":"Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1890-0384","authenticated-orcid":false,"given":"Giacinto","family":"Asprella Libonati","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology and Cervico-Facial Surgery, Madonna delle Grazie Hospital, 75100 Matera, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Rita","family":"Fetoni","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Reproductive Sciences and Dentistry, Audiology Section University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy"},{"name":"Hearing and Balance Unit, Department of Head and Neck, Federico II University Hospital, Via Pansini 5, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1600","DOI":"10.1016\/S0140-6736(13)60142-7","article-title":"Tinnitus","volume":"382","author":"Baguley","year":"2013","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e02074","DOI":"10.1002\/brb3.2074","article-title":"The evaluation of global cognitive and emotional status of older patients with chronic tinnitus","volume":"11","author":"Fetoni","year":"2021","journal-title":"Brain Behav."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Malesci, R., Brigato, F., Di Cesare, T., Del Vecchio, V., Laria, C., De Corso, E., and Fetoni, A.R. 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