Neuromodulatory effects of audio-proprio-phonatory reinforcement training on subjective tinnitus, a HD-EEG study protocol

Tinnitus affects 14% of the global population, with 2% experiencing a severe form of the condition. Sound therapy using white noise emitted by hearing aids is a common intervention, supported by the phenomenon of residual inhibition observed during tinnitus assessment. This study aims to investigate whether audio-proprio-phonatory reinforcement training can improve the quality of life of patients with chronic subjective tinnitus by enabling them to listen to their own phonation, which may mask the tinnitus or induce residual inhibition. We will conduct a prospective, controlled, monocentric, 2-arm block-randomized study, stratified by the Tinnitus Handicap Inventory (THI) score, involving two groups for two sequential phases (Phase 1 and Phase 2). Fifty-six patients with tinnitus, recruited from the Ear Nose Throat (ENT) Department of Orléans University Hospital, will undergo a five-week training program, randomized into weekly remote group workshops, and daily individual sessions using specially developed videos. Training efficacy will be assessed through self-report questionnaires. The primary endpoint, the Tinnitus Handicap Inventory, will be assessed at three ENT medical visits: at inclusion, end of phase 1 and end of phase 2. Additionally, patients in both groups will regularly complete Visual Analog Scales for Tinnitus and five related questions (noise, cervical, jaw, sleep, stress-anxiety) via a secure digital platform throughout the study. High-density electroencephalograms (HD-EEG) will be performed in a blinded manner before and after Phase 1 at the Neurology Department of Orléans University Hospital. This pilot study aims to evaluate the clinical efficacy of audio-proprio-phonatory training in patients with chronic subjective tinnitus and to objectively measure its effects using HD-EEG. We will explore potential correlations between changes brain activity (such as functional brain connectivity) and clinical responses to the intervention.