Tinnitus: The Phantom Sound (Part IV) – Does neuromodulation really have a beneficial and scientifically proven role in cases of tinnitus?

2MEDINCUS - DOI: 10.5281/ZENODO.17101649 - VOL.27, NOVEMBER/2025 The topic of tinnitus is common but complex, with three previous bulletins already dealing with this multifactorial symptom. We recommend you read the previous materials and the references consulted at the end of this bulletin. Continuing this topic, the objective of this bulletin is to discuss the role of neuromodulation treatments in cases of patients suffering from Tinnitus Disorder. Milaine Dominici Sanfins, Piotr Henryk Skarzynski and Anna Carolina Marques Perrella de Barros. TINNITUS: THE PHANTOM SOUND (PART IV) – DOES NEUROMODULATION REALLY HAVE A BENEFICIAL AND SCIENTIFICALLY PROVEN ROLE IN CASES OF TINNITUS? 3 MEDINCUS - DOI: 10.5281/ZENODO.17101649 - VOL.27, NOVEMBER/2025 Neuromodulation is related to the alteration of nervous activity through electrical, magnetic, acoustic, or chemical stimuli directed to specific areas of the nervous system. The goal is to adjust, regulate, or normalize neural function that has been impaired due to injury, disease, or dysfunction. Neuromodulation can be invasive (e.g., deep brain stimulation) or non-invasive. WHAT IS NEUROMODULATION? 4MEDINCUS - DOI: 10.5281/ZENODO.17101649 - VOL.27, NOVEMBER/2025 Neuromodulation treatments are based on fundamental principles that aim to alter the activity of the nervous system to restore functions, relieve symptoms, and improve quality of life. The bases of these treatments are as follows. This bulletin aims to address more specifically the structural and functional changes in the brain resulting from neuromodulation by electrical or magnetic stimuli. Before we do so, it is essential to understand brain electrophysiology, specific neural targets, and some important technical terms. 1) NEUROPLASTICITY Neuroplasticity is the brain's natural ability to change and form new neural connections throughout life, in response to environmental modifications, whether internal or external to the subject. Internal modifications can include injury or illness, and external modifications can include experiences such as learning. Neuromodulation takes advantage of this through: • Induction of adaptive changes: Neuromodulation attempts to strengthen or weaken synaptic connections, alter the level of excitation of neurons, and stimulate the growth of new neural pathways through electrical, magnetic, acoustic stimuli, or chemical agents. • Reorganization of brain circuits: Neural circuits may not work properly in people who have suffered some type of brain injury or chronic pain. The goal of neuromodulation is to reestablish or "recalibrate" these circuits so that they work normally again or to compensate for any problems. WHAT IS THE BASIS OF NEUROMODULATION TREATMENTS? 5 MEDINCUS - DOI: 10.5281/ZENODO.17101649 - VOL.27, NOVEMBER/2025 Sanfins, Skarzynski e Hall, 2025 6MEDINCUS - DOI: 10.5281/ZENODO.17101649 - VOL.27, NOVEMBER/2025 2) BRAIN ELECTROPHYSIOLOGY The nervous system acts as a transmitter of electrical and chemical signals. Electrical signals involve action potentials, while chemical signals derive from neurotransmitters. In this sense, neuromodulation has a direct effect on electrophysiological processes, such as: • Modulation of neuronal excitability: Neuromodulation techniques use electric currents or magnetic fields to alter the activity of certain neurons or neural networks, making them more active (excitatory) or less active (inhibitory). • Interference with abnormal activity patterns: People with epilepsy, essential tremor, or Parkinson's disease have abnormal brain activity. Neuromodulation can disrupt or correct these patterns that are not working properly. 7 MEDINCUS - DOI: 10.5281/ZENODO.17101649 - VOL.27, NOVEMBER/2025 3) SPECIFIC NEURAL TARGETS Neuromodulation treatments are targeted to specific parts of the brain, spinal cord, or peripheral nerves that are involved in disease. To do so, they must: 4) THE ABILITY TO CHANGE AND FLIP Many neuromodulation therapies, especially those that use implants, are designed to be reversible and adjustable. By adjusting the parameters, it is possible to minimize possible adverse effects. • Identify dysfunctional circuits: Neurological research and advanced neuroimaging allow us to identify brain regions and neural networks that are compromised in various conditions (e.g., the basal ganglia in Parkinson's disease, the motor cortex in chronic pain). • Selective stimulation and maximization of benefits: Neuromodulation devices and methods are designed to send signals only to these specific targets, which maximizes therapeutic effects and minimizes side effects. • Parameter adjustments: You can change the frequency, intensity, pulse width, and duration of stimulation to get the best therapeutic response and meet the patient's evolving needs over time. • Minimizing adverse effects: The ability to change parameters makes it possible to adjust treatment and decrease the risk of side effects, making therapy safer and more personalized to the individual. 8MEDINCUS - DOI: 10.5281/ZENODO.17101649 - VOL.27, NOVEMBER/2025 5) DIFFERENT STIMULATION MODES There are different modes of stimulation and, depending on the proposed approach model, each has a therapeutic objective. Some modes of stimulation are: • Peripheral Nerve Stimulation: Focuses on specific nerves (e.g., vagus nerve, peripheral nerves) that, when stimulated, indirectly influence brain activity. • Direct Drug Administration: Intrathecal drug administration (as by an infusion pump) is not strictly electrical, but it qualifies as a type of chemical neuromodulation as it alters neural activity in a specific area. • Sensory Substitution/Biofeedback: There are systems that induce plasticity and brain reorganization which act in an indirect way to modulate the system. This is the case of systems such as the Tongue Display Unit (TDU) or even BrainPort that do not apply the stimulus directly to the brain for neuromodulation; instead they provide modulated sensory information which indirectly modulates the system. • Direct Stimulation: Application of electrical current. E.g: Deep Brain Stimulation (DBS), Spinal Cord Stimulation (SCS), Transcranial Direct Current Stimulation (tDCS), or magnetic fields such as Transcranial Magnetic Stimulation (TMS)] to directly modulate neural activity. 9 MEDINCUS - DOI: 10.5281/ZENODO.17101649 - VOL.27, NOVEMBER/2025 For treating tinnitus, neuromodulation presents itself as a new and promising technique. The main objective is to alter brain activity through the stimulation of specific neurobiological substrates. Because tinnitus is multifactorial, it is important to seek treatments that address all aspects of this symptom. The experience of tinnitus can be altered by the use of neuromodulation, which works by directly suppressing or reconstructing abnormal brain activity over time. This approach adds to the current tools for managing tinnitus, and is innovative in that it emphasizes the modification of central neurophysiological substrates, diverging from currently available treatments which focus on patient behavior in response to tinnitus. The objective of neuromodulation is to act directly on neural networks that have been altered and are related to the underlying mechanisms. In this way, it addresses a critical deficiency in currently available therapeutic options and, for this reason, it is the subject of current scientific studies. It is important to note that the mechanisms underlying tinnitus are still under study and, therefore, there are no definitive protocols for the use of electrical or magnetic neuromodulation in tinnitus. NEUROMODULATION AND TINNITUS 16 MEDINCUS - DOI: 10.5281/ZENODO.17101649 - VOL.27, NOVEMBER/2025 3) Vagus Nerve Stimulation (VNS) and Transcutaneous Vagus Nerve Stimulation (tVNS) Vagus Nerve Stimulation (VNS) is a neuromodulation technique that can be performed invasively or non-invasively. Invasive VNS consists of the surgical insertion of a device and an electrode designed to stimulate the cervical vagus nerve. This procedure has FDA approval for the treatment of epilepsy and depression. In contrast, Transcutaneous Vagus Nerve Stimulation (tVNS), also known as Transcutaneous Auricular Vagus Nerve Stimulation (at-VNS), is a non-invasive approach. It stimulates the auricular branch of the vagus nerve (ABVN) located in the outer ear. tVNS is considered safer and more cost-effective than VNS, as it does not require general anesthesia and a surgical implantation procedure. Multiple neuroimaging studies have confirmed that tVNS activates the same brain networks and pathways as direct VNS, making it a viable alternative. The neurophysiological mechanisms of VNS and tVNS in the treatment of tinnitus are closely linked to the promotion of neuroplasticity and the modulation of neurotransmitter release. VNS induces the release of neuromodulators in the brain, including acetylcholine, norepinephrine, serotonin, and brain-derived neurotrophic factor. These substances play crucial roles in promoting plastic changes in the brain (Hoare et al., 2024; Yakunina and Cheol Nam, 2021). 17 MEDINCUS - DOI: 10.5281/ZENODO.17101649 - VOL.27, NOVEMBER/2025 As for studies with tinnitus patients, it was observed that VNS and tVNS seem to perform well in the prevention and reversal of cases; in addition some studies have demonstrated a decrease in the severity of symptoms. However, according to Yakunina and Cheol Nam (2021), existing studies have important flaws, such as the absence of a control group, small sample size, lack of randomization, among others. Similarly, there is no reliable evidence to date showing that tVNS alone, without paired sound stimuli, is effective for the treatment of tinnitus. 18 MEDINCUS - DOI: 10.5281/ZENODO.17101649 - VOL.27, NOVEMBER/2025 FINAL THOUGHTS AND FUTURE DIRECTIONS The study of neuromodulation in tinnitus patients is still under development, and there are many gaps to be filled. Tinnitus is a complex and debilitating condition whose neurophysiological underpinning is still a matter of investigation, meaning that the search for an effective neuromodulatory intervention is challenging. Based on analysis of subjective measures for outcomes, Repetitive Transcranial Magnetic Stimulation (rTMS) has shown potential in reducing tinnitus, especially over the short term, when directed to the auditory cortex. However, there is still a need to prove long-term outcomes. The possible identification of neurophysiological biomarkers, such as increased alpha power in the auditory cortex, presents a promising strategy for personalizing and optimizing rTMS interventions. At the present time, Transcranial Direct Current Stimulation (tDCS), suffers from a lack of standardized protocols, despite its neurophysiological mechanisms being relatively well understood. Studies are needed that analyze the long-term results of robust and consistent clinical outcomes. Vagus Nerve Stimulation (VNS) and its non-invasive form, tVNS, represent an innovative approach, but the results in humans are contradictory, and they require better scientific studies. Thus, neuromodulation offers a therapeutic approach to tinnitus, seeking first to correct neural dysfunctions rather than just managing symptoms. However, we need cutting-edge research that focuses on standardization of protocols, identification of objective biomarkers to guide and personalize treatment, and randomized controlled trials with larger samples and long-term follow-ups. Detailed understanding of neurophysiological mechanisms and optimization of application strategies are essential steps to transform the potential of neuromodulation into effective and long-lasting clinical solutions for tinnitus patients. 19 MEDINCUS - DOI: 10.5281/ZENODO.17101649 - VOL.27, NOVEMBER/2025 QUIZ: NEUROMODULATION AND TINNITUS 1. Which of the following most accurately describes the concept of neuroplasticity in the context of neuromodulation? a) The brain's ability to remain unchanged throughout life, resisting any external stimulus. b) The ability of the nervous system to generate random electrical impulses without a specific purpose. c) The way the brain forms new neural connections and changes its structure in response to experiences, injuries or diseases, being exploited by neuromodulation to induce adaptive changes. d) The process of neuronal degeneration that occurs naturally with aging. e) The ability of certain areas of the brain to function independently of others, without any interconnection. 2. In the context of the pathophysiology of tinnitus, how does auditory deafferentation (loss of nerve connections due to peripheral hearing loss) impact the neuronal activity of the central auditory system? a) Increases lateral inhibition in specific frequency ranges, resulting in less synchronization and neuronal hypoexcitability. b) It causes a significant decrease in neuronal activity, leading to complete inactivity of auditory neurons. c) It strengthens synaptic connections, normalizing the brain's ability to process sound. d) It weakens lateral inhibition in certain frequency ranges, leading to synchronization and hyperexcitability of neurons in the central auditory system. e) It has no impact on the neuronal activity of the central auditory system, it only affects the perception of sound. 20 MEDINCUS - DOI: 10.5281/ZENODO.17101649 - VOL.27, NOVEMBER/2025 3. Which of the following neuronal oscillation bands has been identified as the best objective predictor of changes in tinnitus, according to studies using techniques such as MEG and EEG? a) Beta band (13–30 Hz) b) Theta band (4–7 Hz) c) Delta band (1–3 Hz) d) Alpha band (8–12 Hz) e) Gamma Band (40–90 Hz) 4.Low-frequency Repetitive Transcranial Magnetic Stimulation (rTMS) could be indicated for the treatment of tinnitus due to which of its effects? a) Its ability to induce neuronal excitation and increase brain hyperactivity. b) Its action of directly inducing the growth of new complex neural pathways, without modulation of existing excitability. c) Its inhibitory effects on neuroplasticity and reduction of neuronal hyperactivity implicated in the perception of tinnitus. d) Its extremely high cost, which limits its application to a few research centers. e) Its need for surgical implantation, making it an invasive technique. 5. What is one of the main gaps and challenges in the use of Transcranial Direct Current Stimulation (tDCS) for the treatment of tinnitus, as discussed in the text? a) Its high current intensity, which causes significant pain and severe side effects. b) The lack of studies proving any neurophysiological effect of tDCS on the brain. c) The absence of standardized protocols, long-term studies, and robust and consistent clinical results, hindering effective analysis and application. d) The need for general anesthesia for its application, making it a high-risk procedure. e) The fact that tDCS directly induces neural activity, which is counterproductive in the treatment of tinnitus. 21 MEDINCUS - DOI: 10.5281/ZENODO.17101649 - VOL.27, NOVEMBER/2025 REFERÊNCIAS CONSULTADAS: Garcia MV, Skarzynski PH, Sanfins MD. Tinnitus: The phantom sound (part I). MEDINCUS. 2023 Feb;1. DOI: 10.13140/RG.2.2.14473.52325. Disponível em: https://www.researchgate. net/publication/368812328_Tinnitus_The_ Phantom_Sound_Part_I Sanfins MD, Soares A, Skarzysnki PH. Tinnitus: The phantom sound (part II) – Auditory Evoke Potentials of short latency. MEDINCUS. 2023 Jun;5. DOI: 10.13140/RG.2.2.13437.54243. Disponível em: https://www.researchgate. net/publication/371607598_Tinnitus_The_ phantom_sound_part_II_-_Auditory_Evoke_ Potentials_of_short_latency Skarzynska MB, Skarzynski PH, Sanfins MD. Tinnitus: The phantom sound (part III) – Pharmacological Treatment of Tinnitus. MEDINCUS. 2023 Jul;6. DOI: 10.13140/ RG.2.2.11663.15526. Disponível em: https://www. researchgate.net/publication/372076007_ Tinnitus_The_phantom_sound_part_III_-_ Pharmacological_Treatment_of_Tinnitus Barker AT, Jalinous R, TMS IS. Non-invasive magnetic stimulation of the human brain. Lancet. 1999;353(9164):1597-8. Hallett M, Chokroverty S. Magnetic stimulation of the human nervous system. Oxford University Press; 2010. 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Mares T, Albrecht J, Buday J, Podgorna G, Le TH, Magyarova E, Poshor K, Halik J, Buna J, Capek V, Kostylkova L, Klasova J, Fabian V, Anders M. Long-term effect of transcranial direct current stimulation in the treatment of chronic tinnitus: A randomized, placebo-controlled trial. Front Psychiatry. 2022;13:969800. DOI: 10.3389/ fpsyt.2022.969800. Ylikoski J, Markkanen M, Pirvola U, Lehtimäki JA, Ylikoski M, Jing Z, Sinkkonen ST, Mäkitie A. Stress and Tinnitus; Transcutaneous Auricular Vagal Nerve Stimulation Attenuates Tinnitus-Triggered Stress Reaction. Front Psychol. 2020;11:570196. DOI: 10.3389/ fpsyg.2020.570196. COLOCAR A REFERÊNCA FORTES E SANFINS, 2025 Respostas Corretas do Quiz 1. correct answer: c 2. correct answer: d 3. correct answer: c 4. correct answer: c 5. correct answer: d 23 MEDINCUS - DOI: 10.5281/ZENODO.17101649 - VOL.27, NOVEMBER/2025 1. Garcia MV, Skarzynski PH, Sanfins MD. Tinnitus: The phantom sound (part I). MEDINCUS. 2023 Feb;1. DOI: 10.13140/ RG.2.2.14473.52325. Disponível em: https:// www.researchgate.net/publication/368812328_ Tinnitus_The_Phantom_Sound_Part_I 2. Sanfins MD, Soares A, Skarzysnki PH. Tinnitus: The phantom sound (part II) – Auditory Evoke Potentials of short latency. MEDINCUS. 2023 Jun;5. DOI: 10.13140/ RG.2.2.13437.54243. Disponível em: https:// www.researchgate.net/publication/371607598_ Tinnitus_The_phantom_sound_part_II_-_ Auditory_Evoke_Potentials_of_short_latency 3. Skarzynska MB, Skarzynski PH, Sanfins MD. Tinnitus: The phantom sound (part III) – Pharmacological Treatment of Tinnitus. MEDINCUS. 2023 Jul;6. DOI: 10.13140/ RG.2.2.11663.15526. Disponível em: https://www. researchgate.net/publication/372076007_ Tinnitus_The_phantom_sound_part_III_-_ Pharmacological_Treatment_of_Tinnitus 4. Barker AT, Jalinous R, TMS IS. Noninvasive magnetic stimulation of the human brain. Lancet. 1999;353(9164):1597-8. 5. Hallett M, Chokroverty S. Magnetic stimulation of the human nervous system. Oxford University Press; 2010. 6. George MS, Sackeim HA, Prichard CL. Repetitive transcranial magnetic stimulation (rTMS) of the prefrontal cortex for depression: a review. J Neurother. 2000;4(1):21-39. 7. Post A, Keck ME, Dannon PN. Repetitive transcranial magnetic stimulation in the treatment of obsessive-compulsive disorder. J Clin Psychiatry. 2001;62(7):541-8. 8. Roth Y, Pascual-Leone A, Hallett M. The therapeutic potential of repetitive transcranial magnetic stimulation. Neuroscientist. 2000;6(4):283-93. 9. Jawish R, Smid M, Gordon A, Shangraw K, Mickey BJ. Journal of Medical Case Reports. 2024;18:512. DOI: 10.1186/s13256-024-04855-y. Disponível em: https://jmedicalcasereports. biomedcentral.com/articles/10.1186/s13256-02404855-y 10. La Marra M, Monda A, Monda M, Villano I, Chieffi S, Ricci M, et al. Transcranial Magnetic Stimulation: A New Possibility in Obesity Treatment. Open Neurol J. 2024;18:e1874205X309047. DOI: 10.2174/01187 4205X309047240503104533. Disponível em: https://opennj.com/contents/volumes/V18/ONJ18-e1874205X309047.pdf 11. British Society of Audiology. Practice Guidance: Tinnitus in Adults. 2021. Disponível em: https://www.thebsa.org.uk/guidance-andresources/current-guidance/ 01. 02. 03. 04. 05. 06. 07. 08. 09. 1. Garcia MV, Skarzynski PH, Sanfins MD. Tinnitus: The phantom sound (part I). MEDINCUS. 2023 Feb;1. DOI: 10.13140/ RG.2.2.14473.52325. Disponível em: https:// www.researchgate.net/publication/368812328_ Tinnitus_The_Phantom_Sound_Part_I 2. Sanfins MD, Soares A, Skarzysnki PH. Tinnitus: The phantom sound (part II) – Auditory Evoke Potentials of short latency. MEDINCUS. 2023 Jun;5. DOI: 10.13140/ RG.2.2.13437.54243. Disponível em: https:// www.researchgate.net/publication/371607598_ Tinnitus_The_phantom_sound_part_II_-_ Auditory_Evoke_Potentials_of_short_latency 3. Skarzynska MB, Skarzynski PH, Sanfins MD. Tinnitus: The phantom sound (part III) – Pharmacological Treatment of Tinnitus. MEDINCUS. 2023 Jul;6. DOI: 10.13140/ RG.2.2.11663.15526. Disponível em: https://www. researchgate.net/publication/372076007_ Tinnitus_The_phantom_sound_part_III_-_ Pharmacological_Treatment_of_Tinnitus 4. Barker AT, Jalinous R, TMS IS. Noninvasive magnetic stimulation of the human brain. Lancet. 1999;353(9164):1597-8. 5. Hallett M, Chokroverty S. Magnetic stimulation of the human nervous system. Oxford University Press; 2010. 6. George MS, Sackeim HA, Prichard CL. Repetitive transcranial magnetic stimulation (rTMS) of the prefrontal cortex for depression: a review. J Neurother. 2000;4(1):21-39. 7. Post A, Keck ME, Dannon PN. Repetitive transcranial magnetic stimulation in the treatment of obsessive-compulsive disorder. J Clin Psychiatry. 2001;62(7):541-8. 8. Roth Y, Pascual-Leone A, Hallett M. The therapeutic potential of repetitive transcranial magnetic stimulation. Neuroscientist. 2000;6(4):283-93. 9. Jawish R, Smid M, Gordon A, Shangraw K, Mickey BJ. Journal of Medical Case Reports. 2024;18:512. DOI: 10.1186/s13256-024-04855-y. Disponível em: https://jmedicalcasereports. biomedcentral.com/articles/10.1186/s13256-02404855-y 10. La Marra M, Monda A, Monda M, Villano I, Chieffi S, Ricci M, et al. Transcranial Magnetic Stimulation: A New Possibility in Obesity Treatment. Open Neurol J. 2024;18:e1874205X309047. DOI: 10.2174/01187 4205X309047240503104533. Disponível em: https://opennj.com/contents/volumes/V18/ONJ18-e1874205X309047.pdf 11. British Society of Audiology. Practice Guidance: Tinnitus in Adults. 2021. Disponível em: https://www.thebsa.org.uk/guidance-andresources/current-guidance/ 01. 02. 03. 04. 05. 06. 07. 08. 09. 1. Garcia MV, Skarzynski PH, Sanfins MD. Tinnitus: The phantom sound (part I). MEDINCUS. 2023 Feb;1. DOI: 10.13140/ RG.2.2.14473.52325. Disponível em: https:// www.researchgate.net/publication/368812328_ Tinnitus_The_Phantom_Sound_Part_I 2. Sanfins MD, Soares A, Skarzysnki PH. Tinnitus: The phantom sound (part II) – Auditory Evoke Potentials of short latency. MEDINCUS. 2023 Jun;5. DOI: 10.13140/ RG.2.2.13437.54243. Disponível em: https:// www.researchgate.net/publication/371607598_ Tinnitus_The_phantom_sound_part_II_-_ Auditory_Evoke_Potentials_of_short_latency 3. Skarzynska MB, Skarzynski PH, Sanfins MD. Tinnitus: The phantom sound (part III) – Pharmacological Treatment of Tinnitus. MEDINCUS. 2023 Jul;6. DOI: 10.13140/ RG.2.2.11663.15526. Disponível em: https://www. researchgate.net/publication/372076007_ Tinnitus_The_phantom_sound_part_III_-_ Pharmacological_Treatment_of_Tinnitus 4. Barker AT, Jalinous R, TMS IS. Noninvasive magnetic stimulation of the human brain. Lancet. 1999;353(9164):1597-8. 5. Hallett M, Chokroverty S. Magnetic stimulation of the human nervous system. Oxford University Press; 2010. 6. George MS, Sackeim HA, Prichard CL. Repetitive transcranial magnetic stimulation (rTMS) of the prefrontal cortex for depression: a review. J Neurother. 2000;4(1):21-39. 7. Post A, Keck ME, Dannon PN. 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Disponível em: https://www. researchgate.net/publication/372076007_ Tinnitus_The_phantom_sound_part_III_-_ Pharmacological_Treatment_of_Tinnitus 4. Barker AT, Jalinous R, TMS IS. Noninvasive magnetic stimulation of the human brain. Lancet. 1999;353(9164):1597-8. 5. Hallett M, Chokroverty S. Magnetic stimulation of the human nervous system. Oxford University Press; 2010. 6. George MS, Sackeim HA, Prichard CL. Repetitive transcranial magnetic stimulation (rTMS) of the prefrontal cortex for depression: a review. J Neurother. 2000;4(1):21-39. 7. Post A, Keck ME, Dannon PN. Repetitive transcranial magnetic stimulation in the treatment of obsessive-compulsive disorder. J Clin Psychiatry. 2001;62(7):541-8. 8. Roth Y, Pascual-Leone A, Hallett M. The therapeutic potential of repetitive transcranial magnetic stimulation. Neuroscientist. 2000;6(4):283-93. 9. Jawish R, Smid M, Gordon A, Shangraw K, Mickey BJ. Journal of Medical Case Reports. 2024;18:512. DOI: 10.1186/s13256-024-04855-y. 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Autores - Adjunct Professor of the Discipline of Hearing Disorders of the Speech-Language Pathology and Audiology Course at the Federal University of São Paulo (UNIFESP); - Membro do grupo de pesquisa do Institute of Physiology and Pathology of Hearing and World Hearing Center, Kajetany, Poland. - Professor of the Postgraduate Course in Clinical Audiology at the Israeli Institute of Teaching and Research of the Albert Einstein Hospital. - Postdoctoral fellow at the World Hearing Center, Warsaw, Poland; - Sandwich doctorate from the Faculty of Medical Sciences, State University of Campinas (FCM-UNICAMP) and from the Università degli Studi di Ferrara/Italy; PROF. DRA. MILAINE DOMINICI SANFINS - Specialist in Audiology by the Federal Council of SpeechLanguage Pathology and Audiology; - Bachelor's and Master's degree from the Faculty of Medicine of the University of São Paulo (FMUSP); - Member of the teaching and research committee of the Brazilian Academy of Audiology (2024-2026); - Rapporteur of the Research Ethics Committee of the Federal University of São Paulo; - Reviewer of scientific articles and book chapters in the area of Audiology, Electrophysiology, Neuroaudiology and Neuroscience; - Instagram @misanfins / email: [email protected] e [email protected] - Clinical Speech Therapist; - PhD and Master of Science from the Graduate Program in Human Communication Disorders at the Federal University of São Paulo/ Paulista School of Medicine (UNIFESP/EPM); - Specialist in Clinical Audiology and Otoneurology by the Federal Council of Speech-Language Pathology and Audiology); - Degree in Speech-Language Pathology and Audiology from the Pontifical Catholic University of São Paulo (PUCSP); FGA. DR. ANNA CAROLINA MARQUES PERRELLA DE BARROS - Professor of the Specialization Course in Clinical Audiology (Albert Einstein Israeli Institute of Teaching and Research and CEAFI College) and extension courses (Fonoaudiálogo). - Member of the Study and Research Group on Tinnitus and Sound Sensitivity Prof. Yotaka Fukuda, from the Federal University of São Paulo. 24 MEDINCUS - DOI: 10.5281/ZENODO.17101649 - VOL.27, NOVEMBER/2025 - Professor, ENT, Master and Doctorate by Medical University of Warsaw; - Research, didactic, clinical, and organizational work in World Hearing Center of Institute of Physiology and Pathology of Hearing, Institute of Sensory Organs and Medical University of Warsaw; - Specialist in ENT, pediatric ENT, audiology and phoniatrics, and public health. Participated in the 3rd Stakeholders Consultation meeting during which the World Hearing Forum of WHO was announced; - Member of the Roster of Experts on Digital Health of WHO, Vice-President and Institutional Representative of ISfTeH; - President-elect of International Advisory Board of AAOHNS, member of Congress and Meeting Department of EAONO, Regional Representative of Europe of ISA, VicePresident of HearRing Group, Auditor of EFAS, member of the Facial Nerve Stimulation Steering Committee; PROF. DR. PIOTR HENRYK SKARZYNSKI - Board Secretary of the Polish Society of Otorhinolaryngologists, Phoniatrists and Audiologists. Member of Hearing Committee (2018–19); - Goodwill Ambassador representing Poland at the AAO-HNSF 2021 Annual Meeting & OTO Experience, and since 2021 a member of Implantable Hearing Devices Committee and Otology & Neurotology Education Committee of AAO-HNS; - Consultant Committee of International Experts of CPAM-VBMS (by special invitation), honorary member of ORL Danube Society, and honorary member of Société Française d’Oto-Rhino-Laryngologie; - Member of the Council of National Science Center; - Expert and member of numerous national organizations.