# Using sympathetic nervous system responses to evaluate distressing tinnitus: a pupillometry and skin conductance feasibility study.

> **NIH VA I21** · JAMES H QUILLEN VA MEDICAL CENTER · 2024 · —

## Abstract

Objective. There is no universal measure of tinnitus apart from subjective reports. Therefore, to
improve Veteran health and wellbeing, it is crucial that objective tools be developed that distinguish
between the presence of tinnitus and tinnitus distress. Tinnitus distress is a high impact area of study in
Veterans because tinnitus is consistently the most-common service-connected disability. The Cognitive
Behavioral Model of Tinnitus Distress predicts that one of the proposed mechanisms behind tinnitus
distress is that it increases the cognitive demands on the listener, which interfere with their ability to
concentrate. The application of cognitive resources towards a listening task is commonly referred to as
listening effort. Increased listening effort increases sympathetic nervous system activity, and
pupillometry can reliably capture these changes. The Cognitive Behavioral Model of Tinnitus Distress
asserts that bothersome tinnitus increases arousal and distress, which also increase sympathetic
nervous system activity. Skin conductance measurements reliably increase when participants view or
listen to arousing images and sounds; they also covary with pupil responses. Therefore, this proposal
will use pupillometry and skin conductance to explore how distressing tinnitus alters listening effort and
affective processing.
Design. The proposed study will employ a cross-sectional design and quantify sympathetic nervous
system activity that has been associated with listening effort and affective processing. Adult Veterans
and non-Veterans will be recruited and grouped into one of three categories: 1) adult controls without
hearing loss or distressing tinnitus, 2) adults with hearing loss but not distressing tinnitus, 3) adults with
hearing loss and distressing tinnitus.
Methods. Participants will listen to sentences, view affective images, and listen to affective sounds.
Pupillometry and skin conductance responses will be simultaneously recorded for all stimuli. These
methods will be used to address the following aims:
Aim 1: Quantify the “selective monitoring and attention” component of the Cognitive-Behavioral
Model of Tinnitus Distress by assessing listening effort in Veterans with and without distressing
tinnitus. The working hypothesis is that distressing tinnitus is associated with increased listening effort.
Participants with tinnitus distress will exhibit larger pupil dilations while listening to sentences,
particularly in quiet, compared to adults without tinnitus distress. Skin conductance responses are not
anticipated to be sensitive to listening effort.
Aim 2: Quantify the “arousal and distress” component of the Cognitive-Behavioral Model of
Tinnitus Distress by assessing physiological responses to affective visual and auditory stimuli
in Veterans with and without distressing tinnitus. The working hypothesis is that distressing tinnitus
is associated with amplified physiological responses to affective auditory and visual stimuli. Partic...

## Key facts

- **NIH application ID:** 10928371
- **Project number:** 1I21RX005157-01
- **Recipient organization:** JAMES H QUILLEN VA MEDICAL CENTER
- **Principal Investigator:** Nicholas Giuliani
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2024-07-01 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10928371

## Citation

> US National Institutes of Health, RePORTER application 10928371, Using sympathetic nervous system responses to evaluate distressing tinnitus: a pupillometry and skin conductance feasibility study. (1I21RX005157-01). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10928371. Licensed CC0.

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