Listening Effort and Stress in Tinnitus. A Multidimensional Approach

Giovanna Giliberto¹Maria Itatí Palacio¹Giulia Cartocci²Emiliano Fernandez-Villalba¹Dario Rossi²Nieves Minguez¹Maria Botía¹Jose Domingo Cubillana¹Jose Ceron¹Fabio Babiloni²Maria-Trinidad Herrero^3*

• ¹University of Murcia, Murcia, Murcia, Spain
• ²Sapienza University of Rome, Rome, Lazio, Italy
• ³School of Medicine, Murcia BioHealth Research Institute, University of Murcia, Murcia, Murcia, Spain

This study examined the effects of chronic tinnitus on auditory perception, text comprehension, and physiological stress responses, with a focus on sex differences. The main objectives were to assess the influence of sex and stress on tinnitus incidence and severity, examine neurophysiological indices of listening effort in tinnitus patients versus controls, and evaluate how background noise levels affect perceived difficulty and pleasantness. This approach offers a deeper understanding of tinnitus's psychological and cognitive impact. Forty-seven participants (24 with tinnitus, 23 controls) completed a listening task using audiobook passages at different signal-to-noise ratios. Controls outperformed tinnitus participants in comprehension during the initial quiet phase (p = 0.020*); men controls scored significantly higher than tinnitus men (p = 0.008**). Tinnitus participants rated listening as less pleasant in quiet (p = 0.036*) and high-noise conditions (p = 0.012*). Sex-related effects were observed: women participants reported more difficulty under moderate noise (p = 0.030*), while EEG data showed higher enjoyment in men participants (p = 0.005**). Physiologically, salivary amylase increased post-task across groups (p = 0.016*); electrodermal activity varied between the initial and final quiet phases (p < 0.001***), and heart rate changed with noise levels (p = 0.008**). A negative correlation between subjective and EEG-recorded pleasantness in quiet highlighted a divergence between perceived and neural responses. These findings reveal tinnitus-related cognitive and emotional burdens, shaped by sex and stress responses, and emphasize the importance of integrated, multimodal, and gender-sensitive approaches for assessment and personalized treatment.