Hyperacusis is associated with smaller gray matter volumes in the supplementary motor area

Cognitive Behavioural Therapy (CBT) for Managing Tinnitus, Hyperacusis, and Misophonia: The 2025 Tonndorf Lecture

Cognitive behavioural therapy (CBT) is an evidence-based intervention for managing distress associated with tinnitus, hyperacusis, and misophonia. This paper summarises key points from the 2025 Tonndorf Lecture presented at the third World Tinnitus Congress and the 14th International Tinnitus Seminar in Poland. The lecture addressed (1) the theoretical foundations of CBT for these conditions, (2) clinical evidence on CBT delivered by psychologists, audiologists, and digital self-help, and (3) the proportion of patients who may benefit from CBT. Research demonstrates that CBT can effectively reduce distress related to tinnitus, hyperacusis, and misophonia. Both psychologist- and audiologist-delivered CBT approaches have demonstrated significant improvements in reducing the impact of tinnitus, hyperacusis, and misophonia on patients' quality of life, while guided internet-based CBT also demonstrates positive outcomes. Unguided internet-based CBT is also effective, though it faces challenges such as higher dropout rates. Despite these promising results, not all patients experience the same level of benefit. Some continue to experience distress even after completing CBT, highlighting the need for alternative or complementary interventions and ongoing support. This paper estimates that approximately 1 in 52 individuals with tinnitus require CBT, indicating that while tinnitus is relatively common, the need for intensive therapy is comparatively small. To enhance treatment outcomes, future research should compare the effectiveness of psychologist- and audiologist-delivered CBT, explore hybrid models that combine face-to-face and digital interventions, and address challenges with internet-based CBT, particularly for hyperacusis and misophonia. Furthermore, incorporating neuroimaging and physiological measures in future randomised controlled trials could provide objective insights into the neural mechanisms underlying symptom improvement, ultimately helping to refine CBT interventions. Identifying characteristics of non-responders to CBT may also guide the development of more tailored therapeutic approaches.

Disrupted Cross-Scale Network Associated With Cognitive-Emotional Disorders in Sudden Sensorineural Hearing Loss

BACKGROUND

Sudden sensorineural hearing loss (SSNHL) is associated with abnormal changes in the brain's central nervous system. Previous studies on the brain networks of SSNHL have primarily focused on functional connectivity within the brain. However, in addition to functional connectivity, structural connectivity also plays a crucial role in brain networks. Moreover, traditional functional connectivity analyses often overlook the spatial and temporal characteristics of connectivity changes and fail to provide directional information and causal relationships.

AIMS

This study utilized Structural Covariance Network (SCN), multilayer network analysis, and Dynamic Causal Modeling (DCM) to investigate the cross-scale changes in neural network structure and function in SSNHL patients with accompanying cognitive and emotional disorders.

MATERIALS & METHODS

We collected 3D-T1 structural magnetic resonance image data and functional magnetic resonance image data from 70 SSNHL patients and 81 healthy controls (HCs). SCN analysis was performed based on gray matter volume, and multilayer network analysis was used to calculate node switching rates. Based on the results of multilayer network analysis, six nodes exhibiting significant inter-group differences in node switching rates were selected as regions of interest (ROIs). DCM was then conducted to explore the causal relationships of functional connectivity between these nodes.

RESULTS

Based on SCN, there were no significant inter-group differences in global network properties between SSNHL and HCs. At the node level, the left precentral gyrus in SSNHL showed a significant decrease in node efficiency. In the multilayer network analysis, SSNHL showed a significantly increased node switching rate at the level of the Left Superior Frontal Gyrus (L.SFG), Left Supplementary Motor Area (L.SMA), Left Superior Parietal Gyrus (L.SPG), Right Superior Parietal Gyrus (R.SPG), Right Inferior Parietal Lobe(R.IPL), and Left Thalamus (L.THA). Furthermore, the node switching rate of L.SFG showed a significant negative correlation with the Self-Rating Anxiety Scale (SAS) scores. DCM analysis of these six nodes revealed differences in the functional effective connectivity between the left superior parietal gyrus (L.SPG) and the left supplementary motor area (L.SMA), which were positively correlated with the AVLT-delay scores.

DISCUSSION

These findings suggest that SSNHL patients experience structural and functional remodeling of the cerebral cortex, with hearing loss leading to the reallocation of cognitive resources.

CONCLUSION

This provides new insights into understanding the potential mechanisms between cross-scale networks and cognitive-emotional disorders in SSNHL.

Hyperacusis in Tinnitus Individuals Is Associated with Smaller Gray Matter Volumes in the Supplementary Motor Area Regardless of Hearing Levels

Recent evidence suggests a connection between hyperacusis and the motor system of the brain. For instance, our recent study reported that hyperacusis in participants with tinnitus and hearing loss is associated with smaller gray matter volumes in the supplementary motor area (SMA). Given that hearing loss can affect gray matter changes in tinnitus, this study aimed to determine if the changes reported in our previous findings of smaller SMA gray matter volumes in hyperacusis persist in the absence of hearing loss. Data for this study were gathered from four prior studies conducted between 2004 and 2019 at the University Medical Centre Groningen (UMCG). A total of 101 participants with tinnitus and either clinically normal hearing (normal hearing with tinnitus or NHT, n = 35) or bilateral sensorineural hearing loss (hearing loss with tinnitus or HLT, n = 66) were included across four studies. Hyperacusis was determined by a score of ≥22 on the Hyperacusis Questionnaire (HQ). In the NHT group, 22 (63%) participants scored ≥22 on the HQ (NHT with hyperacusis: mean age 44.1 years, 12 females), while in the HLT group, 25 (38%) participants scored ≥22 on the HQ (HLT with hyperacusis: mean age 59.5 years, 10 females). The 2 × 2 between-group ANOVAs revealed that hyperacusis is associated with smaller SMA gray matter volumes, regardless of hearing levels. Notably, the smaller SMA gray matter volumes in hyperacusis were primarily influenced by the attentional subscales of the HQ. The association between hyperacusis and the motor system may indicate a constant alertness to sounds and a readiness for motor action.