The Effects of Repeated Sessions of Neurofeedback Therapy in Patients with Chronic Tinnitus: A Randomized Controlled Study
Abstract
Background and Aim: Although neurofeedback therapy (NFT) has been proposed as a beneficial method for treating psychological and neurological disorders, no consensus exists regarding the feasibility of NFT in patients with chronic tinnitus. This study aimed to assess the effects of NFT on chronic tinnitus in adults with normal hearing levels During this study, the effect of NFT on tinnitus severity, loudness and distress was explored.
Methods: In a randomized controlled trial, 96 adults with chronic tinnitus were equally assigned to either NFT or control group. The NFT protocol was based on the alpha/delta paradigm, and consisted of 20 therapy sessions over 4 consecutive weeks. The primary outcome of this study was the Tinnitus Handicap Inventory (THI) test, and the secondary outcome measures were Visual Analogue Scale (VAS), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) scales. Participants in the control group performed the pseudo-training and received no actual NFT.
Results: For the tinnitus distress (THI scale), loudness (VAS) and anxiety (BAI), the repeated-measures analysis of variance showed a significant main effect of Time, Group as well as a Group × Time interaction effect. Post-hoc pairwise comparisons indicated a significant reduction in THI, VAS, and BAI scores in the NFT group relative to the control group at each time points. However, we found no significant main effect of Time, Group or Time × Group interaction for the BDI test.
Conclusion: NFT is a promising approach to improve chronic tinnitus in adults; alleviating tinnitus distress, reducing tinnitus related-anxiety and loudness.
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9. YuLeung To E, Abbott K, Foster DS, Helmer D. Working Memory and Neurofeedback. Appl Neuropsychol Child. 2016;5(3):214-22. [DOI:10.1080/21622965.2016.1167500
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14. Parsons B, Faubert J. Enhancing learning in a perceptual‑cognitive training paradigm using EEG‑neurofeedback. Sci Rep 2021; 11(1):4061. [DOI:10.1038/s41598-021-83456-x]
15. Ma X, Wang F, Zhang C, Shen W, Yang S. Self-Directed Neurofeedback Treatment for Subjective Tinnitus Patients Evaluated by Multimodal Functional Imaging. Neural Plast. 2022;2022:5114721. [DOI:10.1155/2022/5114721]
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17. Khoramzadeh S, Saki N, Davoodi I, Nosratabadi M, Yadollahpour A. Investigating the therapeutic Efficacy of neurofeedback treatment on the severity of symptoms and quality of life in patients with tinnitus. Int J Ment Health Addiction. 2016;14:982-92. [DOI:10.1007/s11469-016-9670-6]
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20. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56(6):893-7. [DOI:10.1037//0022-006x.56.6.893]
21. Beck AT, Steer RA, Brown GK. Manual for Beck Depression Inventory II (BDI-2). 2nd ed. 1996. San Antonio, TX: The Psychological Corporation.
22. Bao X, Feng X, Chen D, Huang H, Cai Y, Huang Q, et al. Thalamocortical dysrhythmia-related sleep spindle desynchronization in patients with tinnitus. Neurobiol Dis. 2025;216:107081. [DOI:10.1016/j.nbd.2025.107081]
23. De Ridder D, Vanneste S, Weisz N, Londero A, Schlee W, Elgoyhen AB, et al. An integrative model of auditory phantom perception: tinnitus as a unified percept of interacting separable subnetworks. Neurosci Biobehav Rev. 2014;44:16-32. [DOI:10.1016/j.neubiorev.2013.03.021]
24. Wang Y, Zhang J, Huang X, Huang S, Feng Y, Shi H, et al. Theta-Beta/Gamma Coupling Identifies Bothersome Tinnitus Induced by Thalamocortical Dysrhythmia. Brain Behav. 2025;15(6):e70437. [DOI:10.1002/brb3.70437]
25. Adjamian P, Sereda M, Zobay O, Hall DA, Palmer AR. Neuromagnetic indicators of tinnitus and tinnitus masking in patients with and without hearing loss. J Assoc Res Otolaryngol. 2012;13(5):715–31. [DOI:10.1007/s10162-012-0340-5]
26. Kleinjung T, Meyer M, Neff P. Neurofeedback for tinnitus treatment: an innovative method with promising potential. Brain Commun. 2023;5(4):fcad209. [DOI:10.1093/braincomms/fcad209]
27. Elmer S, Talaska D, Peter N, Giroud N, Neff P, Kleinjung T, et al. EEG-based multifocal tomographic neurofeedback in older individuals with chronic tinnitus does not lead to persistent electrophysiological changes. Brain Behav. 2026;16(4):e71293. [DOI:10.1002/brb3.71293]
28. Weisz N, Müller S, Schlee W, Dohrmann K, Hartmann T, Elbert T. The neural code of auditory phantom perception. J Neurosci. 2007;27(6):1479-84. [DOI:10.1523/JNEUROSCI.3711-06.2007]
29. Gninenko N, Senn P, Haller S, Van De Ville D. Altered parietal multisensory integration in chronic tinnitus during closed-loop real-time fMRI auditory downregulation. Neuroimage Clin. 2026;49:103960. [DOI:10.1016/j.nicl.2026.103960]
30. Jensen M, Hüttenrauch E, Schmidt J, Andersson G, Chavanon ML, Weise C. Neurofeedback for tinnitus: study protocol for a randomised controlled trial assessing the specificity of an alpha/delta neurofeedback training protocol in alleviating both sound perception and psychological distress in a cohort of chronic tinnitus sufferers. Trials. 2020;21(1):382. [DOI:10.1186/s13063-020-04309-y]
31. Schlee W, Hartmann T, Langguth B, Weisz N. Abnormal resting-state cortical coupling in chronic tinnitus. BMC Neurosci. 2009;10:11. [DOI:10.1186/1471-2202-10-11]
32. Jensen M, Alanis JCG, Hüttenrauch E, Winther-Jensen M, Chavanon ML, Andersson G, et al. Does it matter what is trained? A randomized controlled trial evaluating the specificity of alpha/delta ratio neurofeedback in reducing tinnitus symptoms. Brain Commun. 2023;5(4):fcad185. [DOI:10.1093/braincomms/fcad185]
33. Czornik M, Malekshahi A, Mahmoud W, Wolpert S, Birbaumer N. Psychophysiological treatment of chronic tinnitus: A review. Clin Psychol Psychother. 2022;29(4):1236-53. [DOI:10.1002/cpp.2708]
34. Pattyn T, Van Den Eede F, Vanneste S, Cassiers L, Veltman DJ, Van De Heyning P, et al. Tinnitus and anxiety disorders: A review. Hear Res. 2016;333:255-65. [DOI:10.1016/j.heares.2015.08.014]
35. Diotaiuti P, Valente G, Corrado S, Tosti B, Carissimo C, Di Libero T, et al. Enhancing Working Memory and Reducing Anxiety in University Students: A Neurofeedback Approach. Brain Sci. 2024;14(6):578. [DOI:10.3390/brainsci14060578]
36. De Ridder D, Vanneste S, Langguth B, Llinas R. Thalamocortical Dysrhythmia: A Theoretical Update in Tinnitus. Front Neurol. 2015;6:124. [DOI:10.3389/fneur.2015.00124]
2. Eggermont JJ, Roberts LE. The neuroscience of tinnitus. Trends Neurosci. 2004; 27(11):676-82. [DOI:10.1016/j.tins.2004.08.010]
3. Heller AJ. Classification and epidemiology of tinnitus. Otolaryngol Clin North Am. 2003; 36(2):239-48. [DOI:10.1016/s0030-6665(02)00160-3]
4. Sadeghijam M, Rahimi Pour S, Hasanpour Z, Hamraz I. Psychometric Evaluation of the Persian Version of the Tinnitus Cognitions Questionnaire. Aud Vestib Res. 2025;34(1):61-8. [DOI:10.18502/avr.v34i1.17273]
5. Güntensperger D, Thüring C, Kleinjung T, Neff P, Meyer M. Investigating the Efficacy of an Individualized Alpha/Delta Neurofeedback Protocol in the Treatment of Chronic Tinnitus. Neural Plast. 2019;2019:3540898. [DOI:10.1155/2019/3540898]
6. Peter N, Kleinjung T. Neuromodulation for tinnitus treatment: an overview of invasive and non-invasive techniques. J Zhejiang Univ Sci B. 2019;20(2):116-30. [DOI:10.1631/jzus.B1700117]
7. Varela Barrenechea F. Efficacy of neurofeedback as a treatment for people with subjective tinnitus in reducing the symptom and related consequences: a systematic review from 2010 to 2020. Acta Otorrinolaringol Esp (Engl Ed). 2023;74(4):253-62. [DOI:10.1016/j.otoeng.2022.10.003]
8. Güntensperger D, Thüring C, Meyer M, Neff P, Kleinjung T. Neurofeedback for Tinnitus Treatment - Review and Current Concepts. Front Aging Neurosci. 2017;9:386. [DOI:10.3389/fnagi.2017.00386]
9. YuLeung To E, Abbott K, Foster DS, Helmer D. Working Memory and Neurofeedback. Appl Neuropsychol Child. 2016;5(3):214-22. [DOI:10.1080/21622965.2016.1167500
10. 10 Gong A, Gu F, Nan W, Qu Y, Jiang C, Fu Y. A Review of Neurofeedback Training for Improving Sport Performance from the Perspective of User Experience. Front Neurosci. 2021;15:638369. [DOI:10.3389/fnins.2021.638369]
11. Witte M, Kober SE, Ninaus M, Neuper C, Wood G. Control beliefs can predict the ability to up-regulate sensorimotor rhythm during neurofeedback training. Front Hum Neurosci. 2013;7:478. [DOI:10.3389/fnhum.2013.00478]
12. Loriette C, Ziane C, Ben Hamed S. Neurofeedback for cognitive enhancement and intervention and brain plasticity. Rev Neurol (Paris). 2021;177(9):1133-44. [DOI:10.1016/j.neurol.2021.08.004]
13. Lam S-L, Criaud M, Alegria A, Barker GJ, Giampietro V, Rubia K. Neurofunctional and behavioural measures associated with fMRI-neurofeedback learning in adolescents with attention-deficit/hyperactivity disorder. NeuroImage Clin. 2020; 27:102291. [DOI:10.1016/j.nicl.2020.102291]
14. Parsons B, Faubert J. Enhancing learning in a perceptual‑cognitive training paradigm using EEG‑neurofeedback. Sci Rep 2021; 11(1):4061. [DOI:10.1038/s41598-021-83456-x]
15. Ma X, Wang F, Zhang C, Shen W, Yang S. Self-Directed Neurofeedback Treatment for Subjective Tinnitus Patients Evaluated by Multimodal Functional Imaging. Neural Plast. 2022;2022:5114721. [DOI:10.1155/2022/5114721]
16. Crocetti A, Forti S, Del Bo L. Neurofeedback for subjective tinnitus patients. Auris Nasus Larynx. 2011;38(6):735-8. [DOI:10.1016/j.anl.2011.02.003]
17. Khoramzadeh S, Saki N, Davoodi I, Nosratabadi M, Yadollahpour A. Investigating the therapeutic Efficacy of neurofeedback treatment on the severity of symptoms and quality of life in patients with tinnitus. Int J Ment Health Addiction. 2016;14:982-92. [DOI:10.1007/s11469-016-9670-6]
18. Dohrmann K, Elbert T, Schlee W, Weisz N. Tuning the tinnitus percept by modification of synchronous brain activity. Restor Neurol Neurosci. 2007;25(3-4):371-8. [DOI:10.3233/RNN-2007-253418]
19. Newman CW, Jacobson GP, Spitzer JB. Development of the Tinnitus Handicap Inventory. Arch Otolaryngol Head Neck Surg. 1996;122(2):143-8. [DOI:10.1001/archotol.1996.01890140029007]
20. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56(6):893-7. [DOI:10.1037//0022-006x.56.6.893]
21. Beck AT, Steer RA, Brown GK. Manual for Beck Depression Inventory II (BDI-2). 2nd ed. 1996. San Antonio, TX: The Psychological Corporation.
22. Bao X, Feng X, Chen D, Huang H, Cai Y, Huang Q, et al. Thalamocortical dysrhythmia-related sleep spindle desynchronization in patients with tinnitus. Neurobiol Dis. 2025;216:107081. [DOI:10.1016/j.nbd.2025.107081]
23. De Ridder D, Vanneste S, Weisz N, Londero A, Schlee W, Elgoyhen AB, et al. An integrative model of auditory phantom perception: tinnitus as a unified percept of interacting separable subnetworks. Neurosci Biobehav Rev. 2014;44:16-32. [DOI:10.1016/j.neubiorev.2013.03.021]
24. Wang Y, Zhang J, Huang X, Huang S, Feng Y, Shi H, et al. Theta-Beta/Gamma Coupling Identifies Bothersome Tinnitus Induced by Thalamocortical Dysrhythmia. Brain Behav. 2025;15(6):e70437. [DOI:10.1002/brb3.70437]
25. Adjamian P, Sereda M, Zobay O, Hall DA, Palmer AR. Neuromagnetic indicators of tinnitus and tinnitus masking in patients with and without hearing loss. J Assoc Res Otolaryngol. 2012;13(5):715–31. [DOI:10.1007/s10162-012-0340-5]
26. Kleinjung T, Meyer M, Neff P. Neurofeedback for tinnitus treatment: an innovative method with promising potential. Brain Commun. 2023;5(4):fcad209. [DOI:10.1093/braincomms/fcad209]
27. Elmer S, Talaska D, Peter N, Giroud N, Neff P, Kleinjung T, et al. EEG-based multifocal tomographic neurofeedback in older individuals with chronic tinnitus does not lead to persistent electrophysiological changes. Brain Behav. 2026;16(4):e71293. [DOI:10.1002/brb3.71293]
28. Weisz N, Müller S, Schlee W, Dohrmann K, Hartmann T, Elbert T. The neural code of auditory phantom perception. J Neurosci. 2007;27(6):1479-84. [DOI:10.1523/JNEUROSCI.3711-06.2007]
29. Gninenko N, Senn P, Haller S, Van De Ville D. Altered parietal multisensory integration in chronic tinnitus during closed-loop real-time fMRI auditory downregulation. Neuroimage Clin. 2026;49:103960. [DOI:10.1016/j.nicl.2026.103960]
30. Jensen M, Hüttenrauch E, Schmidt J, Andersson G, Chavanon ML, Weise C. Neurofeedback for tinnitus: study protocol for a randomised controlled trial assessing the specificity of an alpha/delta neurofeedback training protocol in alleviating both sound perception and psychological distress in a cohort of chronic tinnitus sufferers. Trials. 2020;21(1):382. [DOI:10.1186/s13063-020-04309-y]
31. Schlee W, Hartmann T, Langguth B, Weisz N. Abnormal resting-state cortical coupling in chronic tinnitus. BMC Neurosci. 2009;10:11. [DOI:10.1186/1471-2202-10-11]
32. Jensen M, Alanis JCG, Hüttenrauch E, Winther-Jensen M, Chavanon ML, Andersson G, et al. Does it matter what is trained? A randomized controlled trial evaluating the specificity of alpha/delta ratio neurofeedback in reducing tinnitus symptoms. Brain Commun. 2023;5(4):fcad185. [DOI:10.1093/braincomms/fcad185]
33. Czornik M, Malekshahi A, Mahmoud W, Wolpert S, Birbaumer N. Psychophysiological treatment of chronic tinnitus: A review. Clin Psychol Psychother. 2022;29(4):1236-53. [DOI:10.1002/cpp.2708]
34. Pattyn T, Van Den Eede F, Vanneste S, Cassiers L, Veltman DJ, Van De Heyning P, et al. Tinnitus and anxiety disorders: A review. Hear Res. 2016;333:255-65. [DOI:10.1016/j.heares.2015.08.014]
35. Diotaiuti P, Valente G, Corrado S, Tosti B, Carissimo C, Di Libero T, et al. Enhancing Working Memory and Reducing Anxiety in University Students: A Neurofeedback Approach. Brain Sci. 2024;14(6):578. [DOI:10.3390/brainsci14060578]
36. De Ridder D, Vanneste S, Langguth B, Llinas R. Thalamocortical Dysrhythmia: A Theoretical Update in Tinnitus. Front Neurol. 2015;6:124. [DOI:10.3389/fneur.2015.00124]
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How to Cite
1.
Mirmomeni G, Saki N, Bayat A. The Effects of Repeated Sessions of Neurofeedback Therapy in Patients with Chronic Tinnitus: A Randomized Controlled Study. Aud Vestib Res. 2026;.
