The role of the brainstem in generating and modulating tinnitus

Purpose: The purpose of this work is to present a perspective article summarizing ideas pertaining to the brainstem’s role in generating and modulating tinnitus. It is organized in 4 sections: Part 1, the role of the brainstem as a tinnitus generator; Part 2, the role of the brainstem in modulating tinnitus; Part 3, the role of the brainstem in nonauditory comorbid conditions associated with tinnitus; and Part 4, clinical implications. In Part 1, well-established neurophysiological models are discussed providing the framework of evidence that auditory brainstem nuclei play a role in generating tinnitus. In Part 2, ideas are presented explaining modulatory effects on tinnitus related to underlying pathways originating from or projecting to brainstem auditory and nonauditory nuclei. This section addresses multiple phenomena including somatic-related, attention-mediated, and emotion-mediated changes in the tinnitus percept. In Part 3, the role of the brainstem in common nonauditory comorbidities that occur in patients with tinnitus is discussed. Part 4 presents clinical implications of these new ideas related to the brainstem’s involvement in generating and modulating tinnitus. Impact: Knowledge of the brainstem’s involvement in generating and modulating tinnitus provides a context for health care professionals to understand the temporal relationship between tinnitus and common nonauditory comorbid conditions.