Tinnitus: ENT assessment, French HAS recommendations and the role of neurofeedback

The essentials in 30 seconds

Common10–19% of adults have tinnitus; 1–4% find it bothersome, according to the French National Authority for Health (HAS).
See an ENT specialist firstThe essential first step is a medical assessment by an ear, nose and throat (ENT) specialist, with an examination, audiometry and imaging if needed.
CBT recommendedThe HAS recommends cognitive behavioural therapy (CBT) in all cases, and hearing aids where there is hearing loss.
Neurofeedback: still being researchedIt is not recommended for tinnitus itself, but it may help with stress, anxiety or sleep, alongside other care.

What is tinnitus?

Tinnitus is the perception of a sound (whistling, buzzing, crackling, etc.) that has no external source. According to the guideline adopted in June 2026 by the French National Authority for Health (HAS), it is described as persistent when it has lasted for at least six months, and disabling when it significantly affects quality of life. Distress is measured with tools such as the THI questionnaire (Tinnitus Handicap Inventory).

Tinnitus becomes more common with age and with hearing loss. A large international meta-analysis (Jarach et al., 2022) estimates that around 14% of adults have tinnitus, and that around 2% have a severe form.

Proportion of adults with tinnitus, by age

Aged 18–44
9,7 %
Aged 45–64
13,7 %
Aged 65 and over
23,6 %

Source: Jarach et al., JAMA Neurology, 2022 (meta-analysis of 113 studies).

Why the brain is involved

Tinnitus is often linked to hearing loss or noise exposure, but it is the brain that perceives it, gives it importance and determines whether or not it becomes a source of distress. The HAS describes a well-known vicious circle: tinnitus causes stress; stress focuses attention on the sound; and this in turn amplifies how the sound is perceived.

TinnitusA perceived sound, sometimes intermittent, sometimes constant.
StressWorry, tension, sometimes emotional distress.
AttentionIt focuses on the sound, which becomes ever-present.
AmplificationThe distress increases; sleep and concentration suffer.

EEG studies have also found altered brain activity in the auditory regions of many people, notably a decrease in alpha rhythms, which are associated with rest, and an increase in slow delta rhythms, although this profile is not found in every study. The idea of neurofeedback training is based on these observations.

Standard care: see an ENT specialist first

The HAS places the GP or ENT specialist at the heart of the care pathway. The assessment includes a detailed history, a clinical examination with otoscopy, audiometry and, depending on the case, imaging (for example, an MRI scan is routinely recommended when tinnitus affects one side only).

Seek medical advice without delay if you have pulsatile tinnitus that has appeared suddenly or is changing quickly, recent tinnitus accompanied by an unusual, sudden headache, neurological signs (weakness, speech or vision problems, etc.), or tinnitus that appeared after an injury. These situations require prompt medical advice, sometimes as an emergency.
Doctor or ENT specialistHistory, examination, checking for warning signs.
Functional assessmentAudiometry and hearing tests, preferably with an ENT specialist.
Imaging if neededDepending on the type of tinnitus and the examination.
Review consultationAn explanation of the findings and a care plan drawn up with you.
Regular follow-upDistress is reassessed at each stage.
Approach HAS position (2026)
Cognitive behavioural therapy Recommended in all cases.
Hearing aids (sound therapy) Offered depending on hearing level and degree of distress, with a hearing aid audiologist.
Cochlear implant In specific cases of severe deafness.
Physical activity Recommended when there are associated anxiety disorders.
Neuromodulation, stimulation Insufficient data to recommend it; repetitive transcranial magnetic stimulation (rTMS) not recommended for chronic refractory tinnitus.
Neurofeedback, sophrology, hypnosis Not recommended as a routine approach for tinnitus itself; may be used alongside other care for associated difficulties.

The HAS also highlights the role of patient associations and peer support in sharing reliable information and guarding against questionable practices.

Neurofeedback and tinnitus: what the research says

Neurofeedback aims to teach the brain to rebalance the activity observed in the auditory regions, for example by strengthening alpha rhythms and reducing delta rhythms. A literature review (Güntensperger et al., 2017) describes the early results as promising, but highlights the lack of standardised protocols, which makes studies hard to compare, and the need for more robust research.

The HAS is clear: the evidence is insufficient to recommend neurofeedback as a routine approach as part of care aimed at the tinnitus itself. However, it acknowledges that these approaches may provide “help for the patient in managing comorbidities”, particularly in cases of anxiety, sleep disorders, stress or concentration difficulties, alongside psychological and audiological care. It also lists cardiac coherence among the complementary interventions for managing stress.

What we can work towardsalongside other care

  • Regulating the stress and anxiety linked to tinnitus more effectively.
  • Getting back to more restorative sleep.
  • Supporting concentration in everyday life.

What we cannot promisebased on current knowledge

  • Making tinnitus disappear.
  • Replacing the ENT assessment or CBT.
  • A quantified or guaranteed result.

What we offer, alongside ENT follow-up

Training room at Centre Élan
The centre’s training room in Brétigny-sur-Orge.

We see people troubled by tinnitus after their ENT assessment. Support focuses on managing stress and sleep: cardiac coherence and breathing biofeedback, learning muscle relaxation and, after a qEEG assessment, neurofeedback focused on self-regulation. With your consent, this work is coordinated with your ENT specialist, your doctor and your psychologist. If anxiety is the main issue, our article on anxiety disorders will give you useful pointers.

Complementary support. Neurofeedback and biofeedback are methods for training self-regulation. They do not replace diagnosis, ENT and medical follow-up, or the recommended therapies. Medication must never be stopped or changed without the advice of the doctor who prescribed it.

Frequently asked questions

Can neurofeedback make my tinnitus disappear?

We cannot promise that. The HAS does not recommend it for tinnitus itself, owing to insufficient evidence. Training may, however, help you better manage the stress, anxiety and sleep problems that often come with tinnitus.

Do I need to see an ENT specialist before coming?

Yes. A medical and ENT assessment is essential to look for a cause, hearing loss or any warning signs. Our support comes afterwards, alongside your medical care.

What do we actually work on in a session?

Depending on the assessment: breathing and cardiac coherence, releasing tension, and neurofeedback training geared towards a calmer state. You will also have simple exercises to practise at home between sessions.

Sources

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