Neural Mechanisms and Neuromodulation Therapies for Tinnitus-From Abnormal Auditory Cortex Synchronization to Closed-Loop Acoustic Stimulation

Tinnitus, the perception of sound without an external source, affects 10 to 15 percent of people worldwide, of whom 3 to 5 percent suffer chronic symptoms. Its prevalence varies by age, sex and region and it imposes significant auditory, emotional and cognitive burdens. Current treatments such as drugs, sound therapy and non-invasive brain stimulation provide only partial, transient relief and often carry side effects. Closed-loop acoustic stimulation (CLAS) has emerged as a promising neuromodulation strategy. By leveraging real-time electroencephalography (EEG) signals, CLAS delivers personalized auditory feedback to disrupt aberrant neural oscillations associated with tinnitus perception. This approach offers the potential for greater precision and individualization compared to traditional methods. However, significant challenges remain regarding hardware miniaturization, algorithm optimization, clinical validation, and long-term efficacy assessment. This review summarizes tinnitus pathophysiology and therapies, assesses CLAS promise and limitations, and highlights future priorities such as multimodal integration, biomarker-based stratification, wearable platforms and ethical and regulatory frameworks to advance personalized neuromodulation.