PTSD and Audio Vestibular Symptoms: A Two-Way Street Driven by the Amygdala? A Speculative Hypothesis

Background/Objective: Auditory and vestibular (AV) symptoms can be considered functional neurological disorders (FND) when they do not arise from structural abnormalities. These symptoms can arise as expressions of underlying neuropsychological or psychiatric conditions, yet they may also play a role in precipitating or maintaining such disorders. This systematic review aimed at exploring the prevalence of AV symptoms in post-traumatic stress disorders (PTSD) as well as to understand if they correlate with each other. Methods: We conducted a systematic review of the literature including PubMed, Scopus and Google Scholar. Articles in English published between 1985 and 2025 were screened using the following keywords: "Tinnitus", "Ghost sound", "Dizziness" "Vertigo", "Persistent Postural Perceptual Dizziness", "PPPD", "Hearing concerns", "Hyperacusis", "Diplacusis", "Auditory hallucination(s)", "Audio and Vestibular symptom" and "Post Traumatic Stress Disorders" or "PTSD". Risk of bias was used to evaluate the quality of the articles. Results: We found 18 studies analysing specifically these symptoms in PTSD, including a total of 598,654 subjects. We identified 123.006 patients with PTSD (20.5% of the entire analysed sample) suffering from AV symptoms, in particular tinnitus (33.8%) and a combination of hearing loss and tinnitus (29%). A very small separate percentage suffered from auditory hallucinations (0.3%) or vertigo/dizziness (0.8%). Magnetic resonance imaging studies have identified hyperactivation in various brain areas both in PTSD and in the presence of AV symptoms, with amygdala hyperactivation emerging as the most common finding. Conclusions: Based on the results of this systematic review, patients with PTSD suffer from AV symptoms in 20.5% of cases. MRI studies conducted separately on patients with PTSD and tinnitus, vertigo or dizziness showed a hyperactivation of the amygdala in all these conditions. We speculate that amygdala hyperactivation might explain the coexistence of and the relationship between PTSD and AV symptoms.