Electroencephalographic Biomarkers in Tinnitus: A Narrative Review of Current Approaches and Clinical Perspectives

<b>Background/Objectives</b>: Tinnitus causes significant cognitive and emotional distress; however, its clinical assessment mostly relies on subjective measures without evaluation of objective indices. In this narrative review, we examined the potential of electroencephalography (EEG)-based neurophysiological markers as objective biomarkers in tinnitus assessment. <b>Methods</b>: The Web of Science, PubMed, EMBASE, and MEDLINE databases were searched to identify research articles on EEG-based analysis of individuals with tinnitus. Studies in which treatment and control groups were compared across four analytical domains (spectral power analysis, functional connectivity, microstate analysis, and entropy measures) were included. Qualitative synthesis was conducted to elucidate neurophysiological mechanisms, methodological characteristics, and clinical implications. <b>Results</b>: Analysis of 18 studies (n = 1188 participants) revealed that tinnitus is characterized by distributed neural dysfunction that extends beyond the auditory system. Spectral power analyses revealed sex-dependent, frequency-specific abnormalities across distributed brain regions. Connectivity analyses demonstrated elevated long-range coupling in high-frequency bands concurrent with diminished low-frequency synchronization. Microstate analyses revealed alterations in spatial configuration and transition probabilities. Entropy quantification indicated elevated complexity, particularly in the frontal and auditory cortices. <b>Conclusions</b>: EEG-derived neurophysiological markers demonstrate associations with tinnitus in group analyses and show potential for elucidating pathophysiological mechanisms. However, significant limitations, including low spatial resolution, small sample sizes, methodological heterogeneity, and lack of validation for individual-level diagnosis or treatment prediction, highlight the need for cautious interpretation. Standardized analytical protocols, larger validation studies, multimodal neuroimaging integration, and demonstration of clinical utility in prospective trials are required before EEG markers can be established as biomarkers for tinnitus diagnosis and management.