Cochlear Synaptopathy: Translational Evidence from Animal Models to Human Electrophysiological Correlates
Main Article Content
Abstract
Background: Cochlear synaptopathy is defined as the loss of synapses between inner hair cells and auditory nerve fibers. It is well established in animal models following noise exposure and aging. In humans, direct histopathologic confirmation is not feasible; therefore, synaptopathy must be inferred from electrophysiologic and behavioral proxies, contributing to variability in findings across populations.
Objective: To synthesize translational evidence for cochlear synaptopathy and to evaluate the validity of electrophysiologic markers, including auditory brainstem responses, electrocochleography, envelope following responses, and middle‑ear muscle reflex measures.
Methods: A PRISMA‑informed narrative review of peer‑reviewed studies indexed in MEDLINE, Scopus, and Embase was conducted. Animal, human temporal bone, and human in vivo investigations were organized thematically and tabulated to compare exposure categories, electrophysiologic measures, and clinical outcomes.
Results: Animal and temporal bone studies consistently demonstrate synaptic loss accompanied by reduced suprathreshold neural output despite preserved thresholds. Human findings are more heterogeneous. High‑risk groups, including individuals with military or occupational noise exposure and older adults, frequently show reduced neural responses as signs of cochlear synaptopathy, whereas younger normal‑hearing cohorts often show null results unless stress‑test paradigms or complex electrophysiologic batteries are employed.
Conclusion: Cochlear synaptopathy is a biologically established neural lesion in animals but remains a probabilistic diagnosis in humans. Convergent abnormalities across multiple electrophysiologic measures enhance detection relative to single metrics and may inform future clinical trials targeting synaptic repair.
Keywords:
Cochlear synaptopathy, Hidden hearing loss, Noise exposure, Aging, Suprathreshold auditory dysfunction, Auditory brainstem response, Electrocochleography, Envelope following response, Middle ear reflex
Article Details
How to Cite
KAF, Wafaa A..
Cochlear Synaptopathy: Translational Evidence from Animal Models to Human Electrophysiological Correlates.
Medical Research Archives, [S.l.], v. 14, n. 4, may 2026.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/7342>. Date accessed: 08 may 2026.
doi: https://doi.org/10.18103/mra.v14i4.7342.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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2. Sergeyenko Y, Lall K, Liberman MC, Kujawa SG. Age-related cochlear synaptopathy: an early-onset contributor to auditory functional decline. J Neurosci. 2013;33(34):13686-13694.
3. Fernandez KA, Jeffers PW, Lall K, Liberman MC, Kujawa SG. Aging after noise exposure: acceleration of cochlear synaptopathy in "recovered" ears. J Neurosci. 2015;35(19):7509-7520.
4. Furman AC, Kujawa SG, Liberman MC. Noise-induced cochlear neuropathy is selective for fibers with low spontaneous rates. J Neurophysiol. 2013;110(3):577-586.
5. Liberman MC, Kujawa SG. Cochlear synaptopathy in acquired sensorineural hearing loss: Manifestations and mechanisms. Hear Res. 2017;349:138-147.
6. Schaette R, McAlpine D. Tinnitus with a normal audiogram: physiological evidence for hidden hearing loss and computational model. J Neurosci. 2011;31(38):13452-13457.
7. Bharadwaj HM, Mai AR, Simpson JM, Choi I, Heinz MG, Shinn-Cunningham BG. Non-Invasive Assays of Cochlear Synaptopathy - Candidates and Considerations. Neuroscience. 2019;407:53-66.
8. Plack CJ, Barker D, Prendergast G. Perceptual consequences of "hidden" hearing loss. Trends Hear. 2014;18:1-11.
9. Wan G, Gomez-Casati ME, Gigliello AR, Liberman MC, Corfas G. Neurotrophin-3 regulates ribbon synapse density in the cochlea and induces synapse regeneration after acoustic trauma. Elife. 2014;3(e03564).
10. Valero MD, Burton JA, Hauser SN, Hackett TA, Ramachandran R, Liberman MC. Noise-induced cochlear synaptopathy in rhesus monkeys (Macaca mulatta). Hear Res. 2017;353:213-223.
11. Wu PZ, Liberman LD, Bennett K, de Gruttola V, O'Malley JT, Liberman MC. Primary Neural Degeneration in the Human Cochlea: Evidence for Hidden Hearing Loss in the Aging Ear. Neuroscience. 2019;407:8-20.
12. Liberman MC, Epstein MJ, Cleveland SS, Wang H, Maison SF. Toward a Differential Diagnosis of Hidden Hearing Loss in Humans. PLoS One. 2016;11(9):e0162726.
13. Mehraei G, Hickox AE, Bharadwaj HM, et al. Auditory Brainstem Response Latency in Noise as a Marker of Cochlear Synaptopathy. J Neurosci. 2016;36(13):3755-3764.
14. Guest H, Munro KJ, Prendergast G, Plack CJ. Reliability and interrelations of seven proxy measures of cochlear synaptopathy. Hear Res. 2019;375:34-43.
15. Parthasarathy A, Kujawa SG. Synaptopathy in the Aging Cochlea: Characterizing Early-Neural Deficits in Auditory Temporal Envelope Processing. J Neurosci. 2018;38(32):7108-7119.
16. Bramhall NF, McMillan GP, Kampel SD. Envelope following response measurements in young veterans are consistent with noise-induced cochlear synaptopathy. Hear Res. 2021;408:108310.
17. Grose JH, Buss E, Hall JW, 3rd. Loud Music Exposure and Cochlear Synaptopathy in Young Adults: Isolated Auditory Brainstem Response Effects but No Perceptual Consequences. Trends Hear. 2017;21:2331216517737417.
18. Guest H, Munro KJ, Prendergast G, Millman RE, Plack CJ. Impaired speech perception in noise with a normal audiogram: No evidence for cochlear synaptopathy and no relation to lifetime noise exposure. Hear Res. 2018;364:142-151.
19. Johannesen PT, Buzo BC, Lopez-Poveda EA. Evidence for age-related cochlear synaptopathy in humans unconnected to speech-in-noise intelligibility deficits. Hear Res. 2019;374:35-48.
20. Valero MD, Hancock KE, Maison SF, Liberman MC. Effects of cochlear synaptopathy on middle-ear muscle reflexes in unanesthetized mice. Hear Res. 2018;363:109-118.
21. Wojtczak M, Beim JA, Oxenham AJ. Weak Middle-Ear-Muscle Reflex in Humans with Noise-Induced Tinnitus and Normal Hearing May Reflect Cochlear Synaptopathy. eNeuro. 2017;4(6).
22. Kaf WA, Turntine M, Jamos A, Smurzynski J. Examining the Profile of Noise-Induced Cochlear Synaptopathy Using iPhone Health App Data and Cochlear and Brainstem Electrophysiological Responses to Fast Clicks Rates. Semin Hear. 2022;43(3):197-222.
23. Guest H, Munro KJ, Prendergast G, Howe S, Plack CJ. Tinnitus with a normal audiogram: Relation to noise exposure but no evidence for cochlear synaptopathy. Hear Res. 2017;344:265-274.
24. Mepani AM, Kirk SA, Hancock KE, et al. Middle Ear Muscle Reflex and Word Recognition in "Normal-Hearing" Adults: Evidence for Cochlear Synaptopathy? Ear Hear. 2020;41(1):25-38.
25. Valero MD, Hancock KE, Liberman MC. The middle ear muscle reflex in the diagnosis of cochlear neuropathy. Hear Res. 2016;332:29-38.
26. Bovee S, Klump GM, Pyott SJ, Sielaff C, Koppl C. Cochlear Ribbon Synapses in Aged Gerbils. Int J Mol Sci. 2024;25(5).
27. Kurioka T, Mizutari K. Gap detection ability declines with central auditory neurodegeneration following age-related cochlear synaptopathy. Eur J Neurosci. 2024;60(8):5861-5875.
28. Mohrle D, Ni K, Varakina K, et al. Loss of auditory sensitivity from inner hair cell synaptopathy can be centrally compensated in the young but not old brain. Neurobiol Aging. 2016;44:173-184.
29. Kujawa SG, Liberman MC. Acceleration of age-related hearing loss by early noise exposure: evidence of a misspent youth. J Neurosci. 2006;26(7):2115-2123.
30. Viana LM, O'Malley JT, Burgess BJ, et al. Cochlear neuropathy in human presbycusis: Confocal analysis of hidden hearing loss in post-mortem tissue. Hear Res. 2015;327:78-88.
31. Bakay WMH, Anderson LA, Garcia-Lazaro JA, McAlpine D, Schaette R. Hidden hearing loss selectively impairs neural adaptation to loud sound environments. Nat Commun. 2018;9(1):4298.
32. Hickox AE, Liberman MC. Is noise-induced cochlear neuropathy key to the generation of hyperacusis or tinnitus? J Neurophysiol. 2014;111(3):552-564.
33. Maison SF, Usubuchi H, Liberman MC. Efferent feedback minimizes cochlear neuropathy from moderate noise exposure. J Neurosci. 2013;33(13):5542-5552.
34. Benson MA, Peacock J, Greene NT, DJ. T. Can you hear me now? Binaural brainstem and spatial hearing deficits in a Guinea pig model of noise-induced cochlear synaptopathy. AIP Conf Proc. 2024;3062(1):1-6.
35. Xia L, Ripley S, Jiang Z, et al. Synaptopathy in Guinea Pigs Induced by Noise Mimicking Human Experience and Associated Changes in Auditory Signal Processing. Front Neurosci. 2022;16:935371.
36. Haggerty RA, Hutson KA, Riggs WJ, et al. Assessment of cochlear synaptopathy by electrocochleography to low frequencies in a preclinical model and human subjects. Front Neurol. 2023;14:1104574.
37. Dorje NM, Shvachiy L, Kuck F, et al. Age-related alterations in efferent medial olivocochlear-outer hair cell and primary auditory ribbon synapses in CBA/J mice. Front Cell Neurosci. 2024;18:1412450.
38. Lin YC, Shih CP, Lin YY, et al. C-Phycocyanin Attenuates Noise-Induced Cochlear Synaptopathy via the Inhibition of Oxidative Stress and Intercellular Adhesion Molecule-1 in the Cochlea. Int J Mol Sci. 2024;25(10):5154.
39. Suzuki J, Corfas G, Liberman MC. Round-window delivery of neurotrophin 3 regenerates cochlear synapses after acoustic overexposure. Sci Rep. 2016;6:24907.
40. Wu PZ, O'Malley JT, de Gruttola V, Liberman MC. Primary Neural Degeneration in Noise-Exposed Human Cochleas: Correlations with Outer Hair Cell Loss and Word-Discrimination Scores. J Neurosci. 2021;41(20):4439-4447.
41. Bal N, Derinsu U. The possibility of cochlear synaptopathy in young people using a personal listening device. Auris Nasus Larynx. 2021;48(6):1092-1098.
42. Suresh CH, Krishnan A. Search for Electrophysiological Indices of Hidden Hearing Loss in Humans: Click Auditory Brainstem Response Across Sound Levels and in Background Noise. Ear Hear. 2021;42(1):53-67.
43. Stamper GC, Johnson TA. Auditory Function in Normal-Hearing, Noise-Exposed Human Ears. Ear Hear. 2015;36(2):172-184.
44. Cildir B, Tokgoz-Yilmaz S, Turkyilmaz MD. Cochlear synaptopathy causes loudness perception impairment without hearing loss. Noise Health. 2022;24(113):49-60.
45. Pinsonnault-Skvarenina A, Moin-Darbari K, Zhao W, Zhang M, Qiu W, Fuente A. No effect of occupational noise exposure on auditory brainstem response and speech perception in noise. Front Neurosci. 2022;16:915211.
46. Encina-Llamas G, Harte JM, Dau T, Shinn-Cunningham B, Epp B. Investigating the Effect of Cochlear Synaptopathy on Envelope Following Responses Using a Model of the Auditory Nerve. J Assoc Res Otolaryngol. 2019;20(4):363-382.
47. Bramhall NF, Konrad-Martin D, McMillan GP, Griest SE. Auditory Brainstem Response Altered in Humans With Noise Exposure Despite Normal Outer Hair Cell Function. Ear Hear. 2017;38(1):e1-e12.
48. Singer W, Zuccotti A, Jaumann M, et al. Noise-induced inner hair cell ribbon loss disturbs central arc mobilization: a novel molecular paradigm for understanding tinnitus. Mol Neurobiol. 2013;47(1):261-279.
49. Paul BT, Bruce IC, Roberts LE. Evidence that hidden hearing loss underlies amplitude modulation encoding deficits in individuals with and without tinnitus. Hear Res. 2017;344:170-182.
50. Fujihira H, Yamagishi S, Furukawa S, Kashino M. Auditory brainstem response to paired clicks as a candidate marker of cochlear synaptopathy in humans. Clin Neurophysiol. 2024;165:44-54.
51. Schmidt FH, Dormann A, Ehrt K, Grossmann W, Mlynski R, Zhang L. The curvature quantification of wave I in auditory brainstem responses detects cochlear synaptopathy in human beings. Eur Arch Otorhinolaryngol. 2024;281(9):4735-4746.
52. Seo HW, Lee SY, Byun H, Lee SH, Chung JH. Possible Existence of Cochlear Synaptopathy in Patients Completely Recovered from Idiopathic Sudden Sensorineural Hearing Loss. J Clin Med. 2022;11(3):875.
53. Carcagno S, Plack CJ. Effects of age on electrophysiological measures of cochlear synaptopathy in humans. Hear Res. 2020;396:108068.
54. Garrett M, Verhulst S. Applicability of subcortical EEG metrics of synaptopathy to older listeners with impaired audiograms. Hear Res. 2019;380:150-165.
55. Hasanpour Z, Mazaheryazdi M, Haddadzade Niri H, Maarefvand M, Mehdizadeh H. Cochlear Synaptopathy in Full-Term Neonates: A Case-Control Study of NICU Hospitalization Impact. Indian J Otolar yngol Head Neck Surg. 2025;77(4):1842-1848.
56. Mehraei G, Gallardo AP, Shinn-Cunningham BG, Dau T. Auditory brainstem response latency in forward masking, a marker of sensory deficits in listeners with normal hearing thresholds. Hear Res. 2017;346:34-44.
57. Peacock J, Mackey CA, Benson MA, et al. The Binaural Interaction Component in Rhesus Macaques (Macaca mulatta). eNeuro. 2021;8(6).
58. Mackey CA, Mondul JA, Conner AN, et al. Persistent impairment of spatial hearing and neural binaural interaction after "temporary" noise-induced hearing loss. bioRxiv. 2026.
59. Bramhall NF, McMillan GP. Perceptual Consequences of Cochlear Deafferentation in Humans. Trends Hear. 2024;28:23312165241239541.
60. Kaf WA. Moving from Bedside to Clinic: Electrocochleography Applications. Canadian Audiologist. 2018;5(5).
61. Hashimoto K, Hickman TT, Suzuki J, et al. Protection from noise-induced cochlear synaptopathy by virally mediated overexpression of NT3. Sci Rep. 2019;9(1):15362.
2. Sergeyenko Y, Lall K, Liberman MC, Kujawa SG. Age-related cochlear synaptopathy: an early-onset contributor to auditory functional decline. J Neurosci. 2013;33(34):13686-13694.
3. Fernandez KA, Jeffers PW, Lall K, Liberman MC, Kujawa SG. Aging after noise exposure: acceleration of cochlear synaptopathy in "recovered" ears. J Neurosci. 2015;35(19):7509-7520.
4. Furman AC, Kujawa SG, Liberman MC. Noise-induced cochlear neuropathy is selective for fibers with low spontaneous rates. J Neurophysiol. 2013;110(3):577-586.
5. Liberman MC, Kujawa SG. Cochlear synaptopathy in acquired sensorineural hearing loss: Manifestations and mechanisms. Hear Res. 2017;349:138-147.
6. Schaette R, McAlpine D. Tinnitus with a normal audiogram: physiological evidence for hidden hearing loss and computational model. J Neurosci. 2011;31(38):13452-13457.
7. Bharadwaj HM, Mai AR, Simpson JM, Choi I, Heinz MG, Shinn-Cunningham BG. Non-Invasive Assays of Cochlear Synaptopathy - Candidates and Considerations. Neuroscience. 2019;407:53-66.
8. Plack CJ, Barker D, Prendergast G. Perceptual consequences of "hidden" hearing loss. Trends Hear. 2014;18:1-11.
9. Wan G, Gomez-Casati ME, Gigliello AR, Liberman MC, Corfas G. Neurotrophin-3 regulates ribbon synapse density in the cochlea and induces synapse regeneration after acoustic trauma. Elife. 2014;3(e03564).
10. Valero MD, Burton JA, Hauser SN, Hackett TA, Ramachandran R, Liberman MC. Noise-induced cochlear synaptopathy in rhesus monkeys (Macaca mulatta). Hear Res. 2017;353:213-223.
11. Wu PZ, Liberman LD, Bennett K, de Gruttola V, O'Malley JT, Liberman MC. Primary Neural Degeneration in the Human Cochlea: Evidence for Hidden Hearing Loss in the Aging Ear. Neuroscience. 2019;407:8-20.
12. Liberman MC, Epstein MJ, Cleveland SS, Wang H, Maison SF. Toward a Differential Diagnosis of Hidden Hearing Loss in Humans. PLoS One. 2016;11(9):e0162726.
13. Mehraei G, Hickox AE, Bharadwaj HM, et al. Auditory Brainstem Response Latency in Noise as a Marker of Cochlear Synaptopathy. J Neurosci. 2016;36(13):3755-3764.
14. Guest H, Munro KJ, Prendergast G, Plack CJ. Reliability and interrelations of seven proxy measures of cochlear synaptopathy. Hear Res. 2019;375:34-43.
15. Parthasarathy A, Kujawa SG. Synaptopathy in the Aging Cochlea: Characterizing Early-Neural Deficits in Auditory Temporal Envelope Processing. J Neurosci. 2018;38(32):7108-7119.
16. Bramhall NF, McMillan GP, Kampel SD. Envelope following response measurements in young veterans are consistent with noise-induced cochlear synaptopathy. Hear Res. 2021;408:108310.
17. Grose JH, Buss E, Hall JW, 3rd. Loud Music Exposure and Cochlear Synaptopathy in Young Adults: Isolated Auditory Brainstem Response Effects but No Perceptual Consequences. Trends Hear. 2017;21:2331216517737417.
18. Guest H, Munro KJ, Prendergast G, Millman RE, Plack CJ. Impaired speech perception in noise with a normal audiogram: No evidence for cochlear synaptopathy and no relation to lifetime noise exposure. Hear Res. 2018;364:142-151.
19. Johannesen PT, Buzo BC, Lopez-Poveda EA. Evidence for age-related cochlear synaptopathy in humans unconnected to speech-in-noise intelligibility deficits. Hear Res. 2019;374:35-48.
20. Valero MD, Hancock KE, Maison SF, Liberman MC. Effects of cochlear synaptopathy on middle-ear muscle reflexes in unanesthetized mice. Hear Res. 2018;363:109-118.
21. Wojtczak M, Beim JA, Oxenham AJ. Weak Middle-Ear-Muscle Reflex in Humans with Noise-Induced Tinnitus and Normal Hearing May Reflect Cochlear Synaptopathy. eNeuro. 2017;4(6).
22. Kaf WA, Turntine M, Jamos A, Smurzynski J. Examining the Profile of Noise-Induced Cochlear Synaptopathy Using iPhone Health App Data and Cochlear and Brainstem Electrophysiological Responses to Fast Clicks Rates. Semin Hear. 2022;43(3):197-222.
23. Guest H, Munro KJ, Prendergast G, Howe S, Plack CJ. Tinnitus with a normal audiogram: Relation to noise exposure but no evidence for cochlear synaptopathy. Hear Res. 2017;344:265-274.
24. Mepani AM, Kirk SA, Hancock KE, et al. Middle Ear Muscle Reflex and Word Recognition in "Normal-Hearing" Adults: Evidence for Cochlear Synaptopathy? Ear Hear. 2020;41(1):25-38.
25. Valero MD, Hancock KE, Liberman MC. The middle ear muscle reflex in the diagnosis of cochlear neuropathy. Hear Res. 2016;332:29-38.
26. Bovee S, Klump GM, Pyott SJ, Sielaff C, Koppl C. Cochlear Ribbon Synapses in Aged Gerbils. Int J Mol Sci. 2024;25(5).
27. Kurioka T, Mizutari K. Gap detection ability declines with central auditory neurodegeneration following age-related cochlear synaptopathy. Eur J Neurosci. 2024;60(8):5861-5875.
28. Mohrle D, Ni K, Varakina K, et al. Loss of auditory sensitivity from inner hair cell synaptopathy can be centrally compensated in the young but not old brain. Neurobiol Aging. 2016;44:173-184.
29. Kujawa SG, Liberman MC. Acceleration of age-related hearing loss by early noise exposure: evidence of a misspent youth. J Neurosci. 2006;26(7):2115-2123.
30. Viana LM, O'Malley JT, Burgess BJ, et al. Cochlear neuropathy in human presbycusis: Confocal analysis of hidden hearing loss in post-mortem tissue. Hear Res. 2015;327:78-88.
31. Bakay WMH, Anderson LA, Garcia-Lazaro JA, McAlpine D, Schaette R. Hidden hearing loss selectively impairs neural adaptation to loud sound environments. Nat Commun. 2018;9(1):4298.
32. Hickox AE, Liberman MC. Is noise-induced cochlear neuropathy key to the generation of hyperacusis or tinnitus? J Neurophysiol. 2014;111(3):552-564.
33. Maison SF, Usubuchi H, Liberman MC. Efferent feedback minimizes cochlear neuropathy from moderate noise exposure. J Neurosci. 2013;33(13):5542-5552.
34. Benson MA, Peacock J, Greene NT, DJ. T. Can you hear me now? Binaural brainstem and spatial hearing deficits in a Guinea pig model of noise-induced cochlear synaptopathy. AIP Conf Proc. 2024;3062(1):1-6.
35. Xia L, Ripley S, Jiang Z, et al. Synaptopathy in Guinea Pigs Induced by Noise Mimicking Human Experience and Associated Changes in Auditory Signal Processing. Front Neurosci. 2022;16:935371.
36. Haggerty RA, Hutson KA, Riggs WJ, et al. Assessment of cochlear synaptopathy by electrocochleography to low frequencies in a preclinical model and human subjects. Front Neurol. 2023;14:1104574.
37. Dorje NM, Shvachiy L, Kuck F, et al. Age-related alterations in efferent medial olivocochlear-outer hair cell and primary auditory ribbon synapses in CBA/J mice. Front Cell Neurosci. 2024;18:1412450.
38. Lin YC, Shih CP, Lin YY, et al. C-Phycocyanin Attenuates Noise-Induced Cochlear Synaptopathy via the Inhibition of Oxidative Stress and Intercellular Adhesion Molecule-1 in the Cochlea. Int J Mol Sci. 2024;25(10):5154.
39. Suzuki J, Corfas G, Liberman MC. Round-window delivery of neurotrophin 3 regenerates cochlear synapses after acoustic overexposure. Sci Rep. 2016;6:24907.
40. Wu PZ, O'Malley JT, de Gruttola V, Liberman MC. Primary Neural Degeneration in Noise-Exposed Human Cochleas: Correlations with Outer Hair Cell Loss and Word-Discrimination Scores. J Neurosci. 2021;41(20):4439-4447.
41. Bal N, Derinsu U. The possibility of cochlear synaptopathy in young people using a personal listening device. Auris Nasus Larynx. 2021;48(6):1092-1098.
42. Suresh CH, Krishnan A. Search for Electrophysiological Indices of Hidden Hearing Loss in Humans: Click Auditory Brainstem Response Across Sound Levels and in Background Noise. Ear Hear. 2021;42(1):53-67.
43. Stamper GC, Johnson TA. Auditory Function in Normal-Hearing, Noise-Exposed Human Ears. Ear Hear. 2015;36(2):172-184.
44. Cildir B, Tokgoz-Yilmaz S, Turkyilmaz MD. Cochlear synaptopathy causes loudness perception impairment without hearing loss. Noise Health. 2022;24(113):49-60.
45. Pinsonnault-Skvarenina A, Moin-Darbari K, Zhao W, Zhang M, Qiu W, Fuente A. No effect of occupational noise exposure on auditory brainstem response and speech perception in noise. Front Neurosci. 2022;16:915211.
46. Encina-Llamas G, Harte JM, Dau T, Shinn-Cunningham B, Epp B. Investigating the Effect of Cochlear Synaptopathy on Envelope Following Responses Using a Model of the Auditory Nerve. J Assoc Res Otolaryngol. 2019;20(4):363-382.
47. Bramhall NF, Konrad-Martin D, McMillan GP, Griest SE. Auditory Brainstem Response Altered in Humans With Noise Exposure Despite Normal Outer Hair Cell Function. Ear Hear. 2017;38(1):e1-e12.
48. Singer W, Zuccotti A, Jaumann M, et al. Noise-induced inner hair cell ribbon loss disturbs central arc mobilization: a novel molecular paradigm for understanding tinnitus. Mol Neurobiol. 2013;47(1):261-279.
49. Paul BT, Bruce IC, Roberts LE. Evidence that hidden hearing loss underlies amplitude modulation encoding deficits in individuals with and without tinnitus. Hear Res. 2017;344:170-182.
50. Fujihira H, Yamagishi S, Furukawa S, Kashino M. Auditory brainstem response to paired clicks as a candidate marker of cochlear synaptopathy in humans. Clin Neurophysiol. 2024;165:44-54.
51. Schmidt FH, Dormann A, Ehrt K, Grossmann W, Mlynski R, Zhang L. The curvature quantification of wave I in auditory brainstem responses detects cochlear synaptopathy in human beings. Eur Arch Otorhinolaryngol. 2024;281(9):4735-4746.
52. Seo HW, Lee SY, Byun H, Lee SH, Chung JH. Possible Existence of Cochlear Synaptopathy in Patients Completely Recovered from Idiopathic Sudden Sensorineural Hearing Loss. J Clin Med. 2022;11(3):875.
53. Carcagno S, Plack CJ. Effects of age on electrophysiological measures of cochlear synaptopathy in humans. Hear Res. 2020;396:108068.
54. Garrett M, Verhulst S. Applicability of subcortical EEG metrics of synaptopathy to older listeners with impaired audiograms. Hear Res. 2019;380:150-165.
55. Hasanpour Z, Mazaheryazdi M, Haddadzade Niri H, Maarefvand M, Mehdizadeh H. Cochlear Synaptopathy in Full-Term Neonates: A Case-Control Study of NICU Hospitalization Impact. Indian J Otolar yngol Head Neck Surg. 2025;77(4):1842-1848.
56. Mehraei G, Gallardo AP, Shinn-Cunningham BG, Dau T. Auditory brainstem response latency in forward masking, a marker of sensory deficits in listeners with normal hearing thresholds. Hear Res. 2017;346:34-44.
57. Peacock J, Mackey CA, Benson MA, et al. The Binaural Interaction Component in Rhesus Macaques (Macaca mulatta). eNeuro. 2021;8(6).
58. Mackey CA, Mondul JA, Conner AN, et al. Persistent impairment of spatial hearing and neural binaural interaction after "temporary" noise-induced hearing loss. bioRxiv. 2026.
59. Bramhall NF, McMillan GP. Perceptual Consequences of Cochlear Deafferentation in Humans. Trends Hear. 2024;28:23312165241239541.
60. Kaf WA. Moving from Bedside to Clinic: Electrocochleography Applications. Canadian Audiologist. 2018;5(5).
61. Hashimoto K, Hickman TT, Suzuki J, et al. Protection from noise-induced cochlear synaptopathy by virally mediated overexpression of NT3. Sci Rep. 2019;9(1):15362.