Effect of Cognitive Rehabilitation by Auditory Stroop Training on Quality of Life of Individuals with Tinnitus.

Background: Studies have shown that tinnitus patients have difficulties in cognitive function such as memory and attention. The Stroop task engages the attention network where one aspect of the stimulus is noticed while the other one is ignored. Thus, Stroop training can improve the patient's cognitive control and ability to ignore the tinnitus signal. Method: Thirty chronic tinnitus (> 6 months) patients were included in this study. They were distributed into two 15-member groups: intervention and control. Common audiometric, psychometric, and psychoacoustic evaluations of tinnitus were performed for two groups before intervention and after auditory Stroop training of group 1. Results: There was significant difference in the quality of life and THI scores, VAS of annoyance, and reaction time of Stroop task before and after intervention in group1. The decreased reaction time was positively correlated with improved quality of life, THI score, and VAS of annoyance. Conclusion: Cognitive rehabilitation using tasks such as auditory Stroop can be effective in controlling tinnitus by improving cognitive control. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-04011-w.

Combined Bifrontal Transcranial Direct Current Stimulation and Auditory Stroop Training in Chronic Tinnitus.

Patients with tinnitus experience difficulties in cognitive control and executive functions. Many of which are regarded as the cause of tinnitus rather than its complications. Methods for the improvement of inhibitory and cognitive control seem to be effective in the control of tinnitus. In this study, transcranial direct current stimulation and auditory Stroop exercise were have been to improve inhibitory control and the ability to ignore tinnitus in patients suffering from chronic tinnitus. 34 patients with chronic tinnitus (> 6 months) were randomly divided into two groups. The first group consist of 17 patients who received 6 sessions of tDCS followed by 6 sessions of auditory Stroop training. The second group received 6 sessions of sham tDCS followed by 6 sessions of auditory Stroop training. The initial evaluations including pure tone audiometry, psychoacoustic measurements, tinnitus handicap inventory (THI) survey and visual analog scale (VAS) of annoyance and loudness were performed before, immediately after, and one month after the tDCS, sham, and Stroop training. The results of this study revealed a significant reduction in THI score, VAS of loudness, and annoyance of tinnitus. A significant correlation was detected between the reaction time of incongruent words in the Stroop task and improvement of THI score and VAS of annoyance. Combined tDCS and Stroop training efficiently improve chronic tinnitus.

Effect of an Auditory Temporal Training Program on Speech Fluency of Children with Developmental Stuttering.

Objectives: The present study aims to investigate the effect of a temporal processing-based auditory training program on alleviating stuttering severity in children diagnosed with auditory temporal processing disorders. Materials & Methods: Thirty-one children with stuttering diagnosed with auditory temporal processing disorders participated in this study (intervention group: 17 participants between seven to 12 years old; control group: 14 participants between eight to 12 years old). The auditory temporal processing test and Stuttering Severity Instrument-3 (SSI-3) were examined before/after 12 sessions (nearly 540 minutes) of training and three months following the conclusion of the intervention. Results: According to the results, auditory temporal processing improved significantly in the intervention group after temporal processing-based auditory training. Besides, the differences between the intervention and control groups were significant (P<0.05). The improvement of auditory temporal processing skills remained stable in the post-training evaluation after three months (P>0.05). Although the SSI-3 score was somewhat improved in the intervention group, no significant difference was found between the two groups (P=0.984). Conclusion: The findings revealed that auditory temporal processing training acted as a complementary therapy alleviating the stuttering severity of children who stutter with auditory temporal processing disorders to some extent.

Can Galvanic Vestibular Stimulation Be an Effective Management for Bilateral Vestibulopathy?

Background: Vestibulo-ocular and vestibulospinal reflexes contribute to postural stability and gaze stabilization during head and body movements. Thus, chronic disequilibrium, postural imbalance, and oscillopsia occur after bilateral vestibulopathy (BVP). This disorder reduces the daily physical activity and seriously affects the quality of life. Because of its limiting and hazardous consequences, it is necessary to plan an effective therapeutic and rehabilitative strategy for BVP. Recent attempts have used the beneficial effects of stochastic resonance through noisy galvanic vestibular stimulation (nGVS) for this purpose. The present paper aimed to review the effects of nGVS on balance functions in patients with BVP. Methods: This review article investigated research papers in the field of usefulness of nGVS in the treatment of BVP. In the initial search, a total of 134 articles were found with keywords of this manuscript in the SID, Google Scholar, Science Direct, and PubMed databases, of which 7 articles were considered relevant to our subject. Results: The results of these articles suggest that nGVS can have ameliorating effects on the static and dynamic balance as well as on the vestibular performance in BVP patients. Conclusion: In BVP, nGVS may be useful in designing prosthetics for permanent use by the patient, and/or as a method for enhancing the neuroplasticity in combination with other therapies, such as vestibular rehabilitation.

Long latency auditory evoked potentials and object-related negativity based on harmonicity in hearing-impaired children.

Hearing-impaired children (HIC) have difficulty understanding speech in noise, which may be due to difficulty parsing concurrent sound object based on harmonicity cues. Using long latency auditory evoked potentials (LLAEPs) and object-related negativity (ORN), a neural metric of concurrent sound segregation, this study investigated the sensitivity of HIC in processing harmonic relation. The participants were 14 normal-hearing children (NHC) with an average age of 7.82 ± 1.31 years and 17 HIC with an average age of 7.98 ± 1.25 years. They were presented with a sequence of 200 Hz harmonic complex tones that had either all harmonic in tune or the third harmonic mistuned by 2%, 4%, 8%, and 16% of its original value while neuroelectric brain activity was recorded. The analysis of scalp-recorded LLAEPs revealed lower N2 amplitudes elicited by the tuned stimuli in HIC than control. The ORN, isolated in difference wave between LLAEP elicited by tuned and mistuned stimuli, was delayed and smaller in HIC than NHC. This study showed that deficits in processing harmonic relation in HIC, which may contribute to their difficulty in understanding speech in noise. As a result, top-down and bottom-up rehabilitations aiming to improve processing of basic acoustic characteristics, including harmonics are recommended for children with hearing loss.

Effect of tinnitus distress on auditory steady-state response amplitudes in chronic tinnitus sufferers.

Tinnitus is a bothersome disorder of primarily unknown etiology that affects a large number of people worldwide. Tinnitus distress is the most common clinical complaint by tinnitus sufferers because it strongly affects their personal and social life. Many studies have been carried out to determine the relation between tinnitus pathophysiology and electrophysiological findings such as the auditory steady-state response (ASSR). The results of such studies have been contradictory. The current study aimed to detect a possible relation between tinnitus distress and ASSR amplitudes. The tinnitus participants were divided into high and low distress subgroups according to their tinnitus handicap inventory (THI) scores. The ASSR stimuli were carrier frequencies with low (500 Hz), mid (2000 Hz), and high (4000 Hz) amplitude-modulated tones. ASSR amplitudes were calculated in anterio-frontal (F3, Fz, F4), centro-frontal (FC3, FCz, FC4), left auditory (T3, C5, C3) and right auditory (C4, T4, C6) regions of interest (ROI). Twenty-four right-handed subjects with non-pulsatile chronic tinnitus and 23 normal matched participants participated in this study. For recording ASSR amplitudes were used from 32-electrode EEG recording. Two-way repeated-measurement ANOVA was used to compare the ASSR amplitudes. The findings showed that the ASSR amplitudes in the tinnitus group with low distress were higher (better) than in the group with high distress (p < 0.001). This finding was seen in anterio-frontal and right auditory regions and at all carrier frequencies. The results indicated that there is a relation between the ASSR amplitude and the degree of tinnitus distress as measured by the THI questionnaire.

The effectiveness of the combined transcranial direct current stimulation (tDCS) and tailor-made notched music training (TMNMT) on psychoacoustic, psychometric, and cognitive indices of tinnitus patients.

PURPOSE: Tinnitus network(s) consists of pathways in the auditory cortex, frontal cortex, and the limbic system. The cortical hyperactivity caused by tinnitus may be suppressed by neuromodulation techniques. Due to the lack of definitive treatment for tinnitus and limited usefulness of the individual methods, in this study, a combination of transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) and tailor-made notched music training (TMNMT) was used. MATERIAL AND METHODS: In this descriptive-analytic study, 26 patients with chronic unilateral tinnitus of the right ear were randomly divided into the clinical trial group (CTG) and the control group (CG). In both groups, six sessions of tDCS with 2 mA intensity for 20 min, with anode on F4 and cathode on F3, were conducted. Simultaneous with tDCS sessions, and based on TMNMT, the participant was asked to listen passively for 120 min/day, to a CD containing her/his favorite music with a proper notch applied in its spectrum according to the individual's tinnitus The treatment outcome was measured by, psychoacoustic (loudness-matching), psychometric (awareness, loudness and annoyance Visual Analogue Scale (VAS) scores, and Tinnitus Handicap Inventory (THI)) scores, and cognitive assessments (randomized dichotic digits test (RDDT) and dichotic auditory-verbal memory test (DAVMT)). Repeated measurement test was used for statistical analyses. RESULTS: In the CTG, the tinnitus loudness and annoyance VAS scores, and THI were reduced significantly (p = 0.001). In addition, the DAVMT and RDDT scores were enhanced (p = 0.001). Such changes were not observed in the CG (p > 0.05). CONCLUSION: The combination of tDCS and TMNMT led to a reduction in the loudness, awareness, annoyance, and also disability induced by tinnitus in CTG. Furthermore, this method showed an improvement of cognitive functions (auditory divided attention, selective attention and working memory) in the CTG.

Testing A Hypothesis: Tinnitus Control by Enhancing Physiological Inhibition.

Background: Deficit in cognitive functions and central executive function is one of the popular hypotheses on the underlying cause of tinnitus. Some studies expressed the effect of tinnitus on the inhibitory cognitive tasks, referring to the slower inhibitory results such as in the Stroop task in the people suffering from tinnitus as compared to normal subjects. Since Stroop engages the network overlapping the attention and tinnitus distress networks, it seems likely that Stroop exercises can effectively contribute to controlling the tinnitus and its consequent distress through improvement of the cognitive function and increasing the physiological inhibition. Method: A total of 25 patients with chronic tinnitus (> 6 months) were randomly divided into two groups: an intervention group of 15 patients and a control group of 10 patients. Both groups were subjected to initial evaluations including pure tone audiometry, psychoacoustic measurements, tinnitus handicap inventory (THI) survey, and visual analogue scale (VAS) of annoyance and loudness. The intervention group underwent a rehabilitation program consisting of 6 Stroop training sessions. The control group didn't receive any training. Afterwards, both groups were reevaluated and the results were compared to those of initial evaluations. Results: Results of this study indicated significant differences in THI scores and VAS of annoyance, before and after Stroop training in the intervention group, although no significant difference was observed when it came to VAS of loudness. Conclusion: Successive sessions of conflict processing training can improve the annoyance of tinnitus by enhancing the patient's inhibition control, making this task a safe practice for tinnitus treatment.

The effect of harmonic training on speech perception in noise in hearing-impaired children.

OBJECTIVE: Speech perception in noise is a highly challenging situation experienced by hearing-impaired children (HIC). Despite advances in hearing aid technologies, speech perception in noise still poses challenges. Pitch-based training improves pitch discrimination and speech perception and may facilitate concurrent sound segregation. Considering the role of harmonics in the analysis of concurrent sounds, we performed a harmonic assessment, examined the role of harmonic training in the rehabilitation of moderate-to-severe HIC, and investigated its effect on their speech perception in noise. METHODS: The participants were 57 normally hearing children (NHC) with a mean age of 7.73 ± 1.57 years and 18 HIC with a mean age of 7.94 ± 1.47 years. The two groups were compared in terms of harmonic assessment, the Pitch Pattern Sequence Test (PPST), the Consonant-Vowel in Noise (CV in noise) test, and the Bamford-Kowal Bench (BKB) test. Subsequently, the HIC underwent harmonic training, and the results of the pre- and post-harmonic training assessments were compared. RESULTS: HIC displayed poorer harmonic discrimination than NHC at all harmonics (P < 0.05). They also showed lower scores in PPST, CV in noise, and BKB tests compared to NHC (P < 0.05). Harmonic training led to HIC's better performance in harmonic assessment, PPST, and CV in noise test (P < 0.05). However, the BKB test results pre- and post-training did not significantly differ (P > 0.05). CONCLUSION: Harmonic training plays a significant role in improving the HIC's temporal processing of the PPST and CV in noise test; therefore, it can serve as a rehabilitation method to enhance temporal processing and auditory scene analysis.

Comparison of efficacy of vestibular rehabilitation and noisy galvanic vestibular stimulation to improve dizziness and balance in patients with multiple sclerosis.

BACKGROUND: Dizziness and imbalance are common symptoms in patients with multiple sclerosis (PwMS), and rehabilitation interventions varying greatly in effectiveness. OBJECTIVE: To compare the effectiveness of vestibular rehabilitation therapy (VRT) and noisy galvanic vestibular stimulation (nGVS) on dizziness and balance in PwMS. METHODS: This was a single-blind, randomized controlled trial. Twenty-four PwMS were randomly divided into groups of VRT, nGVS, and Control. The VRT and the nGVS groups underwent the intervention program. The patients were assessed with the composite score in anteroposterior and lateral directions (CS AP and LAT) obtained by sensory organization test (SOT), Dizziness Handicap Inventory (DHI), and Activities-Specific Balance Confidence Scale (ABC). RESULTS: The VRT group showed greater improvements in CS AP and LAT, DHI total score, and ABC total score compared with the nGVS group and the control group. No significant difference was found between the nGVS group and the control group. These results were approximately stable at the 4-week follow-up. CONCLUSIONS: These findings provided evidence for effectiveness of the VRT in improvement of dizziness and balance in PwMS. These improvements were not associated with the nGVS. Further studies are needed to assess the effectiveness of the nGVS on dizziness and balance in PwMS.

Effects of auditory processing training on speech perception and brainstem plastisity in adolescents with autism spectrum disorders.

OBJECTIVE: Autism spectrum disorder (ASD) is a neurodevelopmental disorder. A major problem of ASD is speech perception impairment in the presence of background noise. Additionally, researchers have reported temporal auditory processing impairment in patients with ASD. In the present study, we evaluated the effects of a temporal-based training program on improvement of speech perception in the presence of noise using the speech auditory brainstem response (sABR). MATERIALS & METHODS: Twenty-eight adolescents with high functional ASD with the mean age of 14.35±1.86 years were randomly selected and divided into an ASD group (11 males and three females) and a control group (13 males and one female). All the subjects had a normal hearing and intelligence threshold and had no history of neurological disorder.A speech perception test was performed in signal-to-noise ratios of 0 and +10. The intervention group received a temporal processingbased auditory training program, and the control group received a conventional training program. A P-value of <0.05 was considered significant. RESULTS: After training, speech perception in the presence of noise was significantly higher (P <0.001) and the latency of all sABR waves was lower in the intervention group compared to the control group. CONCLUSION: Improvement of speech perception in noisy environments and the reduced latency of sABR waves following a temporal processingbased training program highlight the role of brainstem neural plasticity in speech processing.

Effect of Vowel Auditory Training on the Speech-In-Noise Perception among Older Adults with Normal Hearing.

INTRODUCTION: Aging reduces the ability to understand speech in noise. Hearing rehabilitation is one of the ways to help older people communicate effectively. This study aimed to investigate the effect of vowel auditory training on the improvement of speech-in-noise (SIN) perception among elderly listeners. MATERIALS AND METHODS: This study was conducted on 36 elderly listeners (17 males and 15 females) with the mean±SD of 67.6±6.33. They had the normal peripheral auditory ability but had difficulties in SIN perception. The samples were randomly divided into two groups of intervention and control. The intervention group underwent vowel auditory training; however, the control group received no training. RESULTS: After vowel auditory training, the intervention group showed significant changes in the results of the SIN test at two signal-to-noise ratios of 0 and -10 and the Iranian version of the Speech, Spatial, and Qualities of Hearing Scale, compared to the control group (P<0.001). Regarding the Speech Auditory Brainstem Response test, the F0 magnitude was higher in the intervention group (8.42±2.26), compared to the control group (6.68±1.87) (P<0.011). CONCLUSION: This study investigated the effect of vowel auditory training on the improvement of SIN perception which could be probably due to better F0 encoding and receiving. This ability enhancement resulted in the easier perception of speech and its more proper separation from background noise which in turn enhanced the ability of the old people to follow the speech of a specific person and track the discussion.

Auditory temporal processing assessment in children with developmental stuttering.

OBJECTIVE: Stuttering is a developmental disorder of speech production with a dynamic and multifactorial nature. Scientific theories mentioned the role of auditory processing disorder in stuttering. Investigating the auditory processing in stuttering would provide insights into the mechanisms of stuttering. The details of basic auditory processing in children with stuttering (CWS) continue to remain uncertain. This study aimed to investigate the auditory temporal processing (ATP) in CWS and also its relationship with the stuttering severity. METHODS: The participants of this comparative cross-sectional study were 54 CWS and 63 children without stuttering (CWOS). All children were between 7 and 12 years old. ATP ability of the participants was measured using the Backward Masking (BM), Duration Pattern (DP), and Gap in Noise (GIN) tests. Then, the groups were compared in terms of ATP results. The correlation between the scores of these tests and stuttering severity was assessed. RESULTS: According to the results, CWS showed poorer performance on DP, BM and GIN tests when compared with CWOS. Moreover, the stuttering severity had a significant negative correlation with the DP scores and percentage of correct identification scores in GIN; whereas it had a significant positive correlation with the BM thresholds. CONCLUSIONS: The results showed that some CWS have ATP disorder, which could exacerbate their stuttering. These findings highlighted the role of ATP disorder in stuttering.

Spectro-temporal modulation detection and its relation to speech perception in children with auditory processing disorder.

OBJECTIVES: Poor speech perception in noise is one of the most common complaints reported for children with auditory processing disorder (APD). APD is defined as a deficit in perceptual processing of acoustic information in the auditory system in which decreased spectro-temporal resolution may also contribute. Since the recognition of spoken message in the context of other sounds, is based on the processing of auditory spectro-temporal modulations, the assessment of spectro-temporal modulations sensitivity can evaluate the listener's ability to retrieve and integrate speech segments covered by noise. Therefore, the purpose of this study was to examine spectro-temporal modulation (STM) detection and its relation to speech perception in children with APD and to compare the results with aged-matched normally developed children. METHODS: 35 children with APD and 32 normal hearing children (8-12 years old) were enrolled. In order to examine STM detection performance, six different STM stimulus conditions were employed using three different temporal modulation rates (4, 12 and 32 Hz) and two different spectral modulation densities (0.5 and 2.0 cycles/octave). Initially, the STM detection thresholds at these six STM stimulus conditions were measured in both groups and the results were compared. Thereafter, the relation between STM detection thresholds and speech perception tests, including consonant-vowel in noise and word in noise tests were assessed. RESULTS: The STM sensitivity was poorer than normal for APD children at all STM stimulus conditions. Children with APD displayed significantly poorer STM detection thresholds than those of normally developed children (p < 0.05). Significant correlations were found between STM detection thresholds and speech perception in noise in both groups (p < 0.05). CONCLUSION: The results suggest that the altered encoding of spectro-temporal acoustic cues in the auditory nervous system may be one of the underlying factors of reduced STM detection performance in children with APD. The present study may suggest that poor ability to extract STM cues in children with APD, can be an underlying factor for their listening problems in noise and poor speech perception in challenging situations.

Speech-evoked auditory brainstem response; electrophysiological evidence of upper brainstem facilitative role on sound lateralization in noise.

BACKGROUND AND AIM: Sound lateralization/localization is one of the most important auditory processing abilities, which plays approved role in auditory streaming and speech perception in challenging situations like noisy places. In addition to the main role of lower brainstem centers like superior olivary complex in sound lateralization, efferent auditory system effects on improving auditory skills in everyday auditory challenging positions were revealed. This study evaluated noise effects on lateralization scores in correlation with an objective electrophysiologic test (Speech-ABR in noise), which objectively shows cumulative effects of the afferent and efferent auditory systems at the inferior colliculus and upper brainstem pathway. METHOD: Fourteen normal-hearing subjects in the age range of 18 to 25 participated in this study. Lateralization scores in the quiet and noisy modes were evaluated. Speech-ABR in both ears for quiet mode and three different contralateral noise levels (SNR = + 5, 0, - 5) were recorded, too. Correlation of lateralization scores and Speech-ABR changes in noise was studied. RESULTS: Significant decrease of lateralization scores with latency increase and amplitude decrease of Speech-ABR transient peaks (V, A, O) was seen with noise presentation. A high positive correlation between lateralization decrease with latency increase of onset peaks (V, A) and amplitude decrease of transient peaks (V, A, O) was found in low signal-to-noise ratios. CONCLUSION: The study revealed that in high challenging auditory situations like auditory lateralization in noise, upper brainstem centers and pathways play a facilitative role for main auditory lateralization centers in lower levels.

Correlation between Auditory Spectral Resolution and Speech Perception in Children with Cochlear Implants.

BACKGROUND: Variability in speech performance is a major concern for children with cochlear implants (CIs). Spectral resolution is an important acoustic component in speech perception. Considerable variability and limitations of spectral resolution in children with CIs may lead to individual differences in speech performance. The aim of this study was to assess the correlation between auditory spectral resolution and speech perception in pediatric CI users. METHODS: This cross-sectional study was conducted in Shiraz, Iran, in 2017. The frequency discrimination threshold (FDT) and the spectral-temporal modulated ripple discrimination threshold (SMRT) were measured for 75 pre-lingual hearing-impaired children with CIs (age=8-12 y). Word recognition and sentence perception tests were completed to assess speech perception. The Pearson correlation analysis and multiple linear regression analysis were used to determine the correlation between the variables and to determine the predictive variables of speech perception, respectively. RESULTS: There was a significant correlation between the SMRT and word recognition (r=0.573 and P<0.001). The FDT was significantly correlated with word recognition (r=0.487 and P<0.001). Sentence perception had a significant correlation with the SMRT and the FDT. There was a significant correlation between chronological age and age at implantation with SMRT but not the FDT. CONCLUSION: Auditory spectral resolution correlated well with speech perception among our children with CIs. Spectral resolution ability accounted for approximately 40% of the variance in speech perception among the children with CIs.

Speech-ABR in contralateral noise: A potential tool to evaluate rostral part of the auditory efferent system.

In parallel with the auditory afferent system, the auditory efferent system is active in all parts of the auditory pathways from auditory cortex to the cochlea. The auditory efferent system has two main segments: the rostral and the caudal parts. The rostral part, which starts from the cortical centers to thalamic nuclei and continues into collicular pathways in rostral brainstem, which sends its neural fibers to the main collicular nuclei especially inferior colliculus. The caudal part includes the olivocochlear bundle, which originates from the superior olivary complex and terminates on the cochlear hair cells. Most studies about the auditory efferent system have focused only on the caudal part using otoacoustic emission suppression test. Speech-evoked auditory brainstem response (S-ABR) as an electrophysiologic test that uses speech stimuli to simulate real-life auditory conditions, reflects the performance of rostral brainstem centers, so structurally seems to be an appropriate candidate to examine the rostral part of the auditory efferent system. Our hypothesis is that S-ABR in noisy condition, a typical condition for stimulating the auditory efferent system, has the potential to be used as an objective noninvasive electrophysiologic test for studying the rostral auditory efferent system in diagnosis and treatment/rehabilitation follow-ups. In addition, S-ABR can potentially reflect higher-order auditory functions and the effects of their dysfunctions on the lower brainstem. This characteristic makes S-ABR even more suitable tool for evaluation of the efferent system. To evaluate our hypothesis, Eighteen normal hearing subjects in the age range of 18-25 were tested in a pilot study for S-ABR in quiet mode and three signal to noise ratios of +10,0 and -10 for both ears. Then we checked the correlation between the results of S-ABR in different conditions and scores of auditory behavioral tests that auditory efferent system is involved in them: Consonant-Vowel perception in noise, dichotic Consonant-Vowel-Consonant and sound lateralization in noise. The results of our pilot study showed a significant correlation between S-ABR changes in noise with the scores of the behavioral tests in noisy or dichotic situations. Findings of the current study suggest that S-ABR with specific contralateral noise can be an appropriate option for evaluating the performance of rostral part of the auditory efferent system and may be suitable for top-down auditory training follow-ups, although the generalization of these results needs further studies in different groups with different auditory processing abnormalities or skills.

The hypothetical relation between the degree of stress and auditory cortical evoked potentials in tinnitus sufferers.

Tinnitus, known as" the ringing in the ears," is a heterogeneous auditory disorder. Many studies have shown that tinnitus perception and its correlations are not limited to the activity of a single brain area, but there are several networks involved in tinnitus generation, perception, and interpretation. One of the most important complications and comorbidity of tinnitus is tinnitus distress. Various studies have revealed that tinnitus distress is the product of multiple networks activity, namely the tinnitus distress network; some of them overlap with the perception and cognitive networks. Such an overlapping between the tinnitus perception network and the distress network brings to mind the role of stress on tinnitus perception. Moreover, tinnitus perception networks overlap the auditory perception network leading to the hypothesis that tinnitus distress might affect the functional status of the auditory cortex indexed by the auditory evoked potentials (AEPs), and consequently, the diversity in findings of studies concerning the AEPs in tinnitus sufferers could be interpreted by the amount of stress they have.