The International Tinnitus Journal

Multimodal integration in tinnitus. Exploratory factor analysis of the relationships between the latent variable tinnitus and the observed clinical variables or indicators

Henk M. Koning,Wim E. Tuinebreijer

Background: In the auditory system, the integration of information from the cochlea with other sensory modalities begins in the cochlear nucleus. Proper interpretation of this information in patients with tinnitus can enhance our understanding of how auditory signals combine with somatosensory and proprioceptive signals that convey different types of information. Objectives: The objective of this study is to examine the fundamental mechanisms of multimodal integration by evaluating the intermodal effects of hearing, proprioception, cervical pain, cervical degeneration, and pupillometry on tinnitus using factor analysis. Methods: A retrospective study of all patients who visited our clinic from February 2010 to September 2025 for tinnitus lasting at least 1 month. Results: Exploratory factor analysis shows the relationships between the latent variable tinnitus and the observed variables (indicators), such as dizziness, postural instability, cervical pain, hearing loss at 0.125 kHz, hearing loss due to environmental noise (hidden hearing loss), size of anterior osteophyte at the 4th cervical vertebra, and Farfan’s measure between the 6th and 7th cervical vertebrae for measuring disc height and baseline pupil diameter (mm), pupillary constriction rate (%) measured by pupillometry. Conclusion: Tinnitus is a multifactorial condition which is associated with a disinhibition of neurons in the dorsal cochlear nucleus, due to less excitation of the inhibitory part of the cochlear nucleus leading to increasing spontaneous activity in the central auditory system. Loss of inhibition at the fusiform cell in the dorsal cochlear nucleus are especially induced by hidden hearing loss and postural instability.