Listening effort and stress in tinnitus: a multidimensional approach

Abstract

Introduction: This study investigated the impact of chronic tinnitus on auditory perception, text comprehension, and physiological stress responses, with a focus on sex-related differences. The main objectives were to assess the influence of sex and stress on tinnitus severity, examine neurophysiological indicators of listening effort, and evaluate the effects of background noise on perceived difficulty and listening pleasantness.

Materials and methods: Forty-seven participants (24 with tinnitus, 23 controls) performed a listening task involving audiobook excerpts presented at different signal-to-noise ratios. Subjective ratings, comprehension scores, and physiological data were collected, including salivary alpha-amylase, electrodermal activity, heart rate, and EEG-based measures of listening pleasantness.

Results: Control participants outperformed tinnitus participants during the initial quiet condition (p = 0.020), with male controls scoring significantly higher than males with tinnitus (p = 0.008). Tinnitus participants rated listening as less pleasant in both quiet (p = 0.036) and high-noise conditions (p = 0.012). Female participants reported greater difficulty under moderate noise (p = 0.030), while EEG data showed higher enjoyment in males (p = 0.005). Salivary amylase increased post-task (p = 0.016), electrodermal activity differed between the initial and final quiet phases (p < 0.001), and heart rate varied according to noise levels (p = 0.008). Negative correlation emerged between subjective and EEG-based pleasantness in the quiet condition.

Discussion: These findings suggest that tinnitus imposes a measurable cognitive and emotional burden, influenced by both sex and stress responses. They emphasize the need for multimodal, personalized, and gender-sensitive approaches in the assessment and management of tinnitus.

Keywords: EEG analysis; auditory perception; gender differences; stress biomarkers; tinnitus.

Figure 1

Graphical representation of the experimental protocol adopted in the present study. Auditory conditions during audiobook listening were assigned to participants in a pseudorandomized manner, following the sequence Quiet–signal-to-noise ratio (SNR)–Quiet–SNR–Quiet–SNR–Quiet, for a total of seven conditions. Every 90 s, participants completed two visual analog scales (VAS): one for perceived pleasantness and the other for perceived difficulty. Additionally, at the end of the audiobook, questions were administered to assess text comprehension.

Figure 2

Average pleasantness ratings across experimental conditions. Bar graph shows mean pleasantness scores (± SEM) for man (M) and woman (H) TIN and CTRL participants.

Figure 3

Bar graph referring to pre and post hearing amylases.

Figure 4

Bar graph comparing EDA values of the quiet at start and end of listening.

Figure 5

Bar graph comparing EDA values during different noise phases (SNR0, SNR5, SRN10).

Figure 6

Bar graphs comparing HR values during the different noise phases (A) (SNR0, SNR5, SRN10) as well as during the quiet phases (B).