[Multiple associations between tinnitus and cognition]

Tinnitus can impair cognitive functions, such as attention, working memory and executive control. Pathophysiologically, this is explained by maladaptive neural plasticity, in which central auditory and nonauditory networks (e.g., prefrontal and limbic structures) become overactive or dysfunctional. Altered activity patterns in the frontoparietal control network and the default mode network (DMN) are associated with increased attention to the ear noise and reduced cognitive capacity in tinnitus patients. In addition, dysfunctional cortico-subcortical interactions (including with the limbic system) exacerbate emotional stress, which further impairs cognitive resources. These mechanisms are used to explain why tinnitus is often associated with reduced cognitive performance, increased distractibility and increased mental fatigue. In some studies, the negative impact of tinnitus is stronger than that of the accompanying reduced hearing ability or psychological comorbidities such as stress or depression/anxiety. The pathophysiological links between tinnitus and cognitive impairment require multidimensional therapeutic approaches. Treatment should aim to reduce maladaptive plasticity and optimize cognitive control. An interdisciplinary approach that combines neurological, psychological and audiological interventions therefore appears necessary in order to sustainably reduce both tinnitus perception and the associated cognitive impairments.