Tinnitus is commonly associated with hearing loss, yet it can also occur in individuals with clinically normal audiometric thresholds. This dissociation has led to the hypothesis that hidden sensorineural hearing loss underlies tinnitus in audiometrically normal-hearing individuals. However, identifying such subclinical deficits non-invasively is challenging because audiometric measures are influenced by age-related changes and interactions among sensorineural processes. In this study, we disentangled the contributions of tinnitus, age, and hearing status to sensorineural encoding and speech perception. We included 113 participants, divided into age- and hearing-status-matched groups with and without tinnitus, and assessed them using otoacoustic emissions, auditory evoked potentials, auditory reflex measurements, and behavioral tasks of speech perception. This design enabled a rigorous evaluation of whether hidden sensorineural deficits underlie tinnitus. Age and hearing status had substantial effects on objective measures of sensorineural function, whereas tinnitus-related effects were subtle and age specific. Young adults with tinnitus and normal audiometric thresholds exhibited enhanced auditory brainstem responses, elevated envelope following responses, and better vowel discrimination. In contrast, middle-aged adults with tinnitus showed no such enhancements and demonstrated poorer speech-in-noise performance. Correlation analyses revealed a tinnitus-related shift toward greater reliance on central auditory processing, compared with the predominantly peripheral associations observed in controls. The middle ear muscle reflex was unaffected by tinnitus but was correlated with hyperacusis-related parameters. Together, these findings suggest distinct tinnitus-related auditory profiles across the lifespan: neural enhancement and improved vowel discrimination in young adults, versus degraded sensorineural encoding and reduced speech intelligibility in middle-aged adults.
Devolder, P., Keppler, H., Dhooge, I., Verhulst, S.
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